Medicare is a massive government program set up to provide health care to virtually all older Americans, but finding health care as a Medicare beneficiary could become increasingly difficult in the coming decades.

According to the U.S. Centers for Medicare & Medicaid Services, Medicare spending reached nearly $830 billion in 2020. Several major strains on the United States health care system could soon collide to create a difficult situation for a program already spending massive sums of money to keep up with its beneficiaries’ needs.

America is aging, and quickly. The New York Times recently reported that 10,000 Americans will turn 65 every day until 2030. Younger adults have historically heavily outweighed the older population, allowing for systems like Medicare and Social Security to function. But, as the baby boomer generation fully enters retirement, the tables are quickly turning.

On top of those concerns, the U.S. is continuously experiencing a shortage of doctors. These issues are poised to collide over the coming years to create a reality in which there are more aging Americans in need of health care than ever before — and fewer doctors to take care of them.

The Doctor Shortage

One of the main problems facing the U.S. health care system is an issue decades in the making: a lack of doctors. The simple reason behind the issue is the difficult road toward becoming a physician in America.

According to The Atlantic, the U.S. has the longest and most expensive educational path to becoming a doctor out of all developed nations. Doctors spend years longer training — and spend much more money along the way — to become qualified than their counterparts across the globe, creating several key ripple effects.

The first is that fewer people make it all the way through the process and actually become medical doctors. The U.S. population has grown rapidly over the years, but the number of doctors has stayed stable. This has led to a situation where there is increasing strain on existing doctors to carry the population burden.

The second effect stems from the cost of becoming a doctor, with many Americans putting themselves in debt to achieve the feat. This also pushes new doctors towards specializing to maximize their earnings, creating a dearth of primary care physicians.

Even outside of Medicare, the doctor shortage has created problems for all Americans. And it will only be exacerbated by the country’s rapidly aging population.

The Effects on Medicare

The U.S. is quickly moving towards becoming an older nation. According to the U.S. Census Bureau, there will be more adults 65 and older than children by 2034.

By 2030, projections show older Americans making up a fifth of the total population. By 2060, close to one in four Americans will be 65 or older. This could easily strain an already struggling system. More adults reaching Medicare eligibility age than ever before will make it more difficult to fund the program, especially with a smaller ratio of younger adults paying into it.

The doctor shortage could exacerbate this by giving Medicare beneficiaries fewer options for their care. The lack of primary care physicians, in particular, could be troublesome.

To add to the concerns, fewer doctors may opt to enroll in Medicare at all as the number of beneficiaries grows. Doctors do not have to accept Medicare, even though historically many of them do.

According to the Kaiser Family Foundation, 1% of non-pediatric primary care physicians opted out of Medicare in 2020. Meanwhile, over 20% of physicians that do accept Medicare are not accepting new Medicare patients.

Another growing issue is mental health care available to Medicare beneficiaries. While seeking mental health treatment has become less stigmatized in recent years, over 7% of psychiatrists do not accept Medicare — a higher rate than any other specialty.

Part of the reason doctors are becoming more hesitant to accept Medicare, especially with the number of beneficiaries growing, is the cost associated with doing so.

According to the Bulletin of the American College of Surgeons, Medicare reimbursement rates have remained relatively steady for over 20 years. But health care costs and inflation have risen dramatically over the same period, making it more costly than ever to treat Medicare patients.

In the coming decades, on top of the U.S. doctor shortage that is already straining the health care system, there will be dramatically more Medicare beneficiaries than ever before as it continuously becomes more expensive for doctors to treat them.