The New Health Dialogue

Remember that Frank Luntz memo about how opponents of health reform should fuel worry about waiting "weeks for tests and months for treatments." We wondered at the time when the last time Luntz had tried to schedule a doctor's appointment and how long it took. We weren't being facetious. We do plenty of waiting right now in our broken and beleaguered health care system.

We're not talking about Canada or Britain. We're talking about the good old USA.

Health care consultants Merritt Hawkins and Associates (we had their study printed out on our desk, but USA Today reported on it this week, prodding us to to finish going through all those charts ) looked at waiting times in 15 American cities for nonemergency care.

Overall, the average wait was three weeks—up from 8.6 days since the last survey of this type in 2004 -for a routine heart checkup from a cardiologist, a checkup for skin cancer from a dermatologist, a painful or injured knee from an orthopedic surgeon, a "well woman" exam from an OB/GYN and a routine physical from a family practitioner. But there was a huge variety in wait times, anything from one day to an entire year.

Lest you jump up and down and worry that if we cover more people the waits will get longer—not necessarily. Yes there might be some initial pentup-demand as the uninsured get coverage, and yes we have work to do to beef up primary care. But in Boston, average wait times have been mixed. Cardiology waits, for instance, have dropped since Massachusetts expanded coverage. And we know that better utilization, better incentives and better efficiency, particularly in the context of comprehensive national reform, can help physicians streamline their practices and get patients in more quickly. (IHI has done a ton of work on this and we have personally spoken to and written about doctors who have been through the process and made it work. This is real, not a pipedream).

Nor do "average" wait times really mean much. In Miami, for instance, you can wait four days to see a cardiologist. Or you can wait 200 days. In Philadelphia, you can wait three days for a dermatologist. Or 365 days. In Seattle, an OB/GYN will see you in one day. Or 200. Similar spreads exist for orthopedic surgery and for family medicine.

It doesn't do you much good if the doctor seeing patients in a day isn't in your health plan—and the doctor with the year long wait is. Nor does it help you in one city, if there's a short wait across the country in another city. The system is a mess. But we can fix it.