The health care system has never been so complex as it is today. As doctors, we’ve seen the struggles that happen just trying to help patients get the medical care they need. Patients are now ladened with high deductibles and often are the victims of baseless denied coverage for diagnostic tests and medication.

Insurance companies insist that they are not practicing medicine, merely making coverage determinations and that the patient is free to follow their doctor’s advice, paying out-of-pocket, of course. Realistically, if all patients have thousands of dollars to pay for their medical care, would we even need health care insurance? The answer is clear and that is medical care is becoming unaffordable, even for patients who are covered by insurance.

While the Affordable Care Act (ACA) did a good job at getting more American lives covered by medical insurance, it did nothing to address the escalating costs. Yes, uninsured patients was a huge money drain on the system. But, patients now are forced to pay premiums for insurance plans that don’t cover much of their medical needs. Now, many insurance companies are pulling out of the ACA insurance exchanges offering discounted plans. Patients are given the choice of going uninsured (and being hit with tax penalties) or paying premiums they cannot afford.

How is our current system adversely affecting patients?

Patients are paying much more on their own. The middle class is being especially squeezed. Many patients are living paycheck to paycheck and simply don’t have the money to pay more. Medical care is not cheap.

Patients are self-rationing care. Many patients decide not to take certain medications because of the cost, despite the advice of their doctor. They are choosing which medications to take and which to stop. This is obviously a very dangerous situation that can have lethal consequences.

Patients delay coming for care. If a patient has a serious disease, delaying care may lead to fewer treatment options or even any. The earlier a disease is diagnosed, the better the chances for a cure or keeping it under control.

Trust is lost. When patients are used for profits by insurance companies and others, they lose trust in the whole system. They stop trusting their doctors. To be effective, the doctor-patient relationship needs to be based on mutual trust. I have had patients get upset with me based on insurance company decisions so I know their frustration is often misplaced. But, it does put a strain in the therapeutic relationship, at least for a time.

Patients give up. What good is it knowing what they need to do to get better, yet not being able to do it because the insurance company will not approve it? Tell me again how insurance companies don’t make medical decisions. If a patient and I decide on a treatment plan and then their insurance company does not authorize it because it is “not medically necessary” that is a medical decision. Not only is that a medical decision, but it is over-turning a doctor’s medical decision who actually examined the patient and not the just his/her cost to the system. Insurance companies are not held accountable for these decisions. In fact, they are immune from accountability by the contracts they sign with clinicians and patients.

Hospitals are no longer patient-friendly. They are for-profit (mostly) business that run like other big businesses. They do not care that their business is to supply care to patients who may feel sick, stressed, confused, overwhelmed, dying or just plain frustrated. Sure, they have all those surveys and hospital volunteers that seek your opinion to bolster their ratings. But, their goal at the end of the day is increasing their profits. If they have to cut nursing staff to dangerously low levels to achieve that goal, they will. If they have to discharge you a day early because they don’t think they will get paid for that day, they will. Whether or not you are ready to go home.

The people who do care have no voice in how the system operates: doctors and patients. How many proposed health care initiatives did we witness last year that failed? Did any of them have support from physician or patient groups? Did any of them seek the opinions of doctors or patients? I would venture a guess no mainly, because I tried very hard to voice my opinion to key lawmakers and mostly was ignored or shot down. No one wanted to hear my real experiences with real patients in the real world of medicine. They were much more interested in protecting their vested interests: the big health insurance and pharmaceutical companies. How can people compete with that power?

Not only is the health care system in the U.S. not working, it is actually traumatizing patients. Patients should feel comfortable to seek help for their health when they need it. Instead, they are often trivialized and used for others’ gain. The health sector is the biggest portion of the U.S. economy and businesses are harvesting huge profits. But, we need to be the patients’ biggest advocates. Medicine is about healing. In the words of Hippocrates and to the oath doctors swear: ” I will follow that system of  regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is  deleterious and mischievous.” The time is here that all who provide medical services to patients (insurance companies, pharmaceutical companies, hospitals, etc.) be bound to the same oath.

Linda Girgis is a family physician who blogs at Dr. Linda.

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