Forget congressional quibbling in Washington. One of the most telling fights over the future of U.S. health care is actually taking place right now in Louisiana.
Last week, the Louisiana House Committee on Health and Welfare advanced HB 527 to consideration by the full House. If passed, the controversial and heavily-lobbied legislation would redefine “optometrists” — who are primary care eye doctors — as “optometric physicians,” giving them expanded authority to prescribe medications and perform minor eye surgeries that they wouldn’t have been allowed to conduct before. Unlikely though it may sound, the future of American health care largely depends on whether or not bills like this can expand access to quality care while lowering costs — or whether they will instead make common medical procedures more dangerous, and ultimately more costly.
HB 527’s most ardent opponents are a different group of eye doctors — ophthalmologists — who are specialists in eye-related surgeries. Ophthalmologists wearing lab coats branded with “Oppose 527” testified against the bill, asserting that its passage would open up Louisiana residents to a “blatant expansion of [optometrists’] services without training.” “The problem is, the optometrists want … this designation as a physician and yet, when it comes to oversight they want to be designated as an optometrists. Well, you cannot have it both ways,” said former Louisiana congressman and ophthalmologist John Cooksey.
Optometrists disagree. “In the end, this bill is about access, access to quality eye care for all the people of Louisiana,” said James Sandefur, executive director of the Optometry Association of Louisiana. “Our patients, and especially those in the rural areas, do not have access to these procedures. This bill would give them the access they deserve.” What Sandefur doesn’t mention is that having certain surgical procedures provided by optometrists would actually also lower health care spending, since optometrists wouldn’t be billing as much for their services. And the combination of these two factors — increased access to medical care for vulnerable populations and lowering costs — are really the cornerstones of health care reform.
As more and more people gain access to insurance under Obamacare, the assumption is that they will begin to consume more health care services. That means that more medical workers will be needed to provide care for these newly-insured populations — many of which will be poor, rural, or some other combination of vulnerable and secluded. The vast majority of care consumption isn’t the expensive kind; it’s the preventative and primary care kind, like doctor’s check ups and minor outpatient procedures. That has led some to worry that there won’t be enough primary care doctors to meet the increased demand once Obamacare is in full effect, and that the U.S. health care sector will be overwhelmed.
Luckily, there likely won’t actually be a doctor shortage. But that will only be averted if more states, and particularly poor and rural states, follow in Louisiana’s footsteps and push measures that make it easier for primary care doctors to provide an expanded list of services. Systemic changes within the health care industry — such as increasing consolidation of doctors’ offices, allowing more skilled practitioners to do work, coordinating between various health care and social workers, etc. — are absolutely critical to providing Americans with affordable, accessible care. Many of these innovations are already taking place. For instance, some companies like Walgreens are looking to the future and becoming direct primary and chronic care providers. In fact, Walgreens’ recent announcement in this area elicited the same critique from physicians that ophthalmologists are making in Louisiana — namely, that medical workers shouldn’t be servicing patients without the appropriate medical schooling.
That’s a valid concern. As HB 527’s opponents have pointed out, ophthalmologists go through medical school and residency, whereas optometrists only go through a four year training program and approval by a certification board. But when it comes to a relatively small list of simple medical procedures, that might be a risk that Americans will just have to take if they want both access and affordability — and primary care providers’ ability to absorb these added responsibilities will dictate how successful reform actually is. If it turns out that they can’t handle it, and the number of medical complications from simple procedures rises, then the quality of American medical care will go down and its costs will go up. On the other hand, if they’re successful, then more states may follow Louisiana’s example and move to allow technicians and primary care providers to perform simple medical procedures.