So the American Health Care Act was rejected. And I want to scream! Not because it failed, but instead because of the way the whole thing was handled. While both parties will argue that they were trying to do what is best for the American public, I disagree. As a physician, what I see are two forces who are more intent on winning a battle than in helping the public. Both the ACA and the AHCA help some people and hurt others. Young and old, healthy and sick, rich and poor all have competing needs and desires.
It is absolutely incumbent upon our legislators to work together to find common ground. I am offended when Paul Ryan talks about “our” plan where the word “our” refers to Republicans rather than all of Congress. The Democrats are no better, pointing out only the flaws in the AHCA without considering potential benefits. This we vs. they mentality must stop.
The current system is untenable. The core of medicine is the patient-physician relationship. This is being destroyed by government mandates, electronic health records, coding requirements, insurance “guidelines” etc. Third parties are determining health care rather than patients and physicians.
According to the Bureau of Labor Statistics, the number of physicians increased by about 100 percent from 1970 to 2009. During the same time frame, the number of administrators increased by about 3,200 percent. That is an incredible statistic! These administrators stand between patients and doctors. Typically, a third party who is not even in the room is dictating what medicine or tests a patient can have. Physicians now spend more time documenting care to satisfy third party bureaucrats than actually providing care. Something is clearly wrong.
Insurance needs to be a relationship between patient and insurer not between physician and insurer. I believe that patients should pay directly for routine care such as office visits, labs, vaccinations, etc. and then be reimbursed by insurers. This would not apply to catastrophic care. Auto insurance does not cover gas or oil changes. Why is health care expected to cover everything? These basic costs could be funded by tax credits and health savings accounts. Furthermore, direct patient care, a health care model which removes the middleman, is a viable option to provide care at reduced costs.
Incumbent upon this is that costs must come down so that lower income people can have access to care. More importantly, costs must be transparent. Health care is the only entity where services are purchased without knowledge of cost. You would not go into a restaurant and order an item labeled “market price” without asking the price. Why is it different in health care?
We also need to reduce sticker shock in high deductible plans. One idea is to have a limited deductible per event, much like how car insurance works. For example, if a patient has a $10,000 deductible, perhaps the deductible could be $500 per event. If an MRI costs $2000, the patient would be responsible for the first $500. They would continue to pay up to $500 per “event” until they have met their total deductible.
Pharmaceutical costs must be reduced. Competitive negotiating by Medicare, removal of pharmacy benefit managers, and elimination of direct to consumer advertising would be a start. However, the pharmaceutical lobby is a big one and would certainly object.
These are just some of the things we can do. The only way there is change is if there is a public outcry. Physician organizations such as Practicing Physicians of America are leading the charge, but without patient input, change is not likely. I urge each of you to contact your legislator, write an op-ed piece, or post on social media, that it is simply unacceptable for someone other than the patient and physician working together to be dictating patient care. We must demand bipartisan politics. Why not take the best of the AHCA and the best of the ACA to create a new plan with legitimate physician and patient input. We must insist that Democrats and Republicans work together. If not, it is not clear who will win, but it is predetermined who will lose, and that is the American public.
Mark Lopatin is a rheumatologist.
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