Two of the top three Democratic candidates for president have proposed abolishing private health insurance in favor of universal coverage, what's being branded as "Medicare for All." Aside from the cost of such a program, there are questions about whether we have enough doctors, nurses and other health professionals, as well as the infrastructure needed, to provide universal coverage. If not, what would it take to get there?
John McDonough is a professor of public health at Harvard University. He spoke with WGBH All Things Considered host Arun Rath about the country's current healthcare landscape. This transcript has been edited for clarity.
Arun Rath: Before we get into the details of what these ambitious plans might entail, just looking at our existing system, you pointed out there are already many ways that supply isn't keeping up with demand. Could you sort of sketch that out broadly for us, what the gaps are and where they are?
John McDonough: So without any changes to the system, aside from what's happening now, there are many ways that our health workforce is affected by significant shortages. Rural America has significant workforce challenges across the board with just about any category of health care professional you can name. Some lower-income, urban areas around the country experience that as well, particularly with behavioral health. Mental health services, for example — there are significant shortages across the country. Even, say, Massachusetts, which by far has the largest population-based supply of mental health professionals to service the population. But recent data shows that about half of all of those professionals in Massachusetts don't take private health insurance or Medicaid or, in many cases, even Medicare. We also have big shortages in terms of long-term care, long-term services and support, especially for a rapidly growing aging population. And we also have shortages of primary care services around the country as well. We also have an aging workforce. Our nurses, our physicians are getting older, are approaching retirement. About a third of physicians in the United States right now are over age 55.
Rath: Is the government or any other institution tracking the data on this so that we have a handle on what would be necessary to turn on a dime if we had to?
McDonough: So there is an agency in the U.S. Department of Health and Human Services called the Health Resources and Services Administration, and they are the part of the government that does a lot of tracking and monitoring, and they implement various initiatives to try to influence the health care workforce. One of the bigger promising developments of the past decade is kind of a tragic story that didn't happen. In the Affordable Care Act, in Title V of that law, one of the crown jewels of that title, which was all about the health care workforce, was the establishment of a national health workforce commission. In 2011, Republicans took the majority in the U.S. House of Representatives, and their message to the folks trying to get this commission up and running was, 'Sorry, this is part of Obamacare. We might like the idea, but we just can't do anything to support it because it's part of this law.' And the commission just faded away. Nobody talks about it anymore.
Rath: So right now in 2019, there's nothing in terms of a national body that looks at the health needs of our population?
McDonough: That is correct.
Rath: This was a key part of the Affordable Care Act. It was never implemented. Do any of the new plans from Democratic candidates take this on to create something like this?
McDonough: I think if there is an effort in 2021 to go back and fix and improve the Affordable Care Act, it is highly possible that this will re-emerge and get back on the agenda. And I think if it were done again, it would probably be done with guaranteed funding. It does seem to be probably the only secure, guaranteed way to prevent this from becoming another political football.
Rath: Whether we have universal coverage or whatever the health care system is in the country, isn't a health care task force like this kind of a good idea anyway?
McDonough: We have urgent health care workforce needs across the span of America, with or without "Medicare for All" or any other kind of health reform that might happen in the next few years. And we need urgent national attention paid to this need across the board. We need something that has the prominence to put out reports that will get national attention to say, listen, here's where this trend is ending. We've got to address and get ahead of this trend now.
