Too Many People Chasing Too Few Healthcare Providers: How Population Growth Can Make You Sick

• Nathanial Gronewold
• October 29, 2024
• Forum Papers
• Forum Paper
• 0 Comments

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An NPG Forum Paper
by Nathanial Gronewold
October 2024

ABSTRACT

The topic of immigration is in the national spotlight as the US presidential election cycle rages on, which is why we’re hearing so much about Springfield, Ohio lately. As nearly everyone knows by now, Springfield has been hit by a sudden rapid increase in its population. The city is buckling under the pressure, and the long-time residents there have legitimate concerns. But the debate over what happened in Springfield masks a larger issue. Immigration is generally not a problem if it’s kept at reasonable levels with the aim of allowing population decline. And we need to see population decline, not rapid population increase. Understanding that nearly all future population growth in the US will be driven by immigration, NPG recommends a cap of no more than 200,000 legal immigrants per year. Federal immigration policy is pushing the nation’s population higher and higher. It has caused Springfield’s population to explode in three years and as a consequence housing costs have soared, and the city’s healthcare infrastructure is under immense strain. These concerns match complaints about stressed healthcare systems heard from Canada and the United Kingdom. The US federal government is now doing this to the entire nation. American healthcare is already a mess, and as I’ve argued before, no problem is ever solved by increasing the number of people suffering under it. As America’s population swells and swells US healthcare outcomes will deteriorate further. It’s time to discuss how population growth is making America’s healthcare system worse, not better, pushing potential solutions farther and farther away.

SICK OF WAITING

A few years back, my wife had something of a minor yet potentially serious health scare. We knew her issue didn’t constitute an emergency requiring an ambulance, but we needed a doctor to look at her sooner rather than later because it was the kind of health concern that could quickly worsen and lead to lifelong complications. So, I called a doctor to see if we could make an appointment to get her checked out. Yes, the doctor would be pleased to check her out, we were told – in three months.

I balked. They told me to take her to the emergency room. But it wasn’t an emergency, I protested. The emergency room was also a very expensive response to something that could easily be handled by a family physician. That didn’t matter, we were advised. I eventually relented and took her to an emergency room that was in-network as far as our insurance was concerned. Naturally and in true American fashion, the hospital may have been an innetwork one but it turned out the doctor they assigned to us was not. They of course didn’t bother to tell us this in advance. We fought the outrageous bill for over a year and eventually had to get a specialized state office involved on our behalf. The wait for her original “emergency” to get attended to was three hours – the ER was packed and we were not exactly a priority.

It’s for this and many other reasons that I am deeply distrustful of the US healthcare system, but I have been for a long time.

America’s healthcare system is the developed world’s most expensive and least efficient, and it produces the worst outcomes. I knew all of this going in. But I was anyway determined to figure out this one thing: Why were we told that it would take us three months to see a non-emergency family doctor? Eventually, it was explained to me that the doctors I could make appointments with had seen their patient rolls explode in recent years. That’s because we were living in one of the fastest-growing cities in the United States. The doctors and hospitals weren’t keeping up with the increase in demand driven by the population influx. Wait times exploded as a consequence; appointments had to be booked months in advance when it used to take mere days to book a visit. And more and more residents were relying on a strained, overworked, and understaffed network of emergency rooms as a result.

At that time, the population explosion happening in the city I was living in was caused by people coming from other parts of the US, not from overseas, but the effect was the same: too many people rushing in too quickly, spiking housing costs and extending the time it takes to see a doctor and get some health issues looked at.

Immigration usually isn’t a problem if the levels are reasonable and sustainable. Rapid population increase is. Economists may love it, but it causes the people experiencing it enormous stress and strain. Any jurisdiction can expand its population faster than it can expand its housing stock. Canada is now learning this the hard way. So is America, perhaps.

Another lesson Canadians are taking from rapid population growth is that it tends to greatly strain a nation’s healthcare infrastructure, as well. Since it takes several years and hundreds of thousands of dollars to train a new doctor, it’s more than safe to also point out that a country’s population can aggressively expand faster than any healthcare system in the world can be scaled up to meet the additional demand.

Healthcare in America is awful, partly because care providers are allowed to charge whatever they want. The International Monetary Fund (IMF) confirmed this in a detailed report on American healthcare spending published a few years back.¹ The IMF says US hospitals and doctors have been able to double their prices unchallenged since the 1980s, resulting in the highest healthcare costs of any place in the world. Meanwhile, government efforts to increase access to care like the Affordable Care Act (otherwise known as Obamacare) and Medicaid expansions have increased healthcare demand but exacerbated cost increases by doing nothing on the supply side.

In other words, the IMF concludes that Americans’ healthcare costs have skyrocketed because demand has exploded while supply has been artificially constrained. “Policies which increase insurance coverage and boost demand for healthcare – and do not go hand-in-hand with supply-side measures that lessen barriers to entry and make supply more elastic – could make resources scarcer, potentially increasing the market power of providers,” the IMF says. “In addition to the direct costs of increasing coverage, resulting increases in demand may also lead to some price increases.”

This means the US government has been encouraging an ever-rising demand for healthcare while keeping certain rules in place that more or less put a cap on the number of doctors, hospitals, and other health practitioners America can or will have. What the IMF is too shy to say is that one of the policies pursued by the federal government that has led to an explosion in healthcare demand and skyrocketing healthcare costs is the rapid expansion of the US population.

America was home to about 226 million people in 1980. About 337 million people live here today. That means almost 111 million more people have been added via natural increase and immigration since 1980. Over that time, it has not become easier to become a doctor or a nurse in the US. On the contrary, one could argue that it’s become substantially more difficult than ever given the huge volumes of debt that must be accrued to clear medical school these days. We should also make note of the rise in Caribbean medical schools. They sprang up in such far-flung places as Grenada, Saba, and Bonaire because the United States mainland has put an artificial cap on the number of medical students our medical schools will accept in any given year.

A massive increase in demand coupled with constraints on supply, and it’s no wonder hospitals have been able to gouge American patients and insurers with abandon, especially as the US has no federal policies to keep prices under control. Our government only very recently granted itself the ability to negotiate drug prices for Medicare patients (and Medicare exists, of course, because private insurers would absolutely let our elderly population suffer with no coverage whatsoever in its absence)…Continue reading the full Forum paper by clicking here.

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