One of the more potent arguments against universal health insurance is that the medical system simply cannot handle an influx of tens of millions of newly-insured people. The market will be overwhelmed with people seeking care for the first time. Wait times will skyrocket.
And we did see something like that in Massachusetts after their universal system was implemented. Via The Healthcare Economist, this report surveyed new patient wait times in 15 major metro areas. These are the average wait times for primary care and four specialties: 
- Boston: 49.6 days
- Philadelphia: 27
- Los Angeles: 24.2
- Houston: 23.4
- Washington, D.C.: 22.6
- San Diego 20.2
- Minneapolis: 19.8
- Dallas: 19.2
- New York: 19.2
- Denver: 15.4
- Miami: 15.4
Sure enough, Boston leads by a mile. But the breakdown is interesting. Waits for specialists were mixed: Between 2004 and 2009, wait times in Boston spiked for ob/gyn visits and orthopedic surgery visits, yet they decreased dramatically for cardiologists.
But specialists in other cities often faired just as poorly since 2004. Wait time to see a dermatologist in Denver has doubled. Ditto for an ob-gyn in Miami or Houston. Wait time for a cardiologist in Minneapolis has more than tripled. And none of those cities have universal coverage schemes. The real culprit seems to be routine primary care, where the wait for a new appointment in Boston is a whopping 63 days. New York is 24 days. Philly is 9 days. The Healthcare Economist notes that this could be mitigated by allowing nurse practitioners and physician assistants to handle more primary care duties.
Though the data is a little murky, none of this can be seen as an argument against covering more people. After all, the point of providing better access to quality medical care is that people use it and get healthier. And how do we know that wait times in 2004, before the Mass. reform, were the “right” wait times? For instance maybe you thought having to wait 50 days for a dermatologist in Boston in 2004 was an outrage. Is 20 days right? or 10 days? To get to those numbers you would have to dramatically restrict access to dermatologists. You would have to advocate dermatologists tripling their prices, or insurance companies rescinding the coverage of anyone who may want to see a dermatologist. To carry this to its logical conclusion, you could have wait times of zero days in every doctor’s office in the country if no one could afford it and no one was covered. Obviously we don’t want that.
Well, there’s another way to fix things: more doctors. You would think that free-marketers who are worried about increased wait times would also have faith in the free market to deal with the problem.
Well, the free market is on the case. The NYT reports today that two dozen new medical schools have either recently opened or are planning to open. To show how major this expansion is: “During the 1980s and ’90s only one new medical school was established.” Wow, that’s unbelievable.
Because of the interminable training period for new doctors, this transition is something of a generational one. But the potential supply is already there. One of the new medical schools highlighted in the article got 1300 applicants for 60 spots in its inaugural year. Expressing concern that the medical system cannot accommodate all of its country’s citizens is not an argument for accommodating fewer citizens, but an argument for dramatically reforming the system.
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