I am a surgeon from a family of surgeons, all based in Massachusetts. Throughout my career, I have faced many challenges, both in and outside of the operating room. Like most doctors, I am saddened by the current collapse of our system in general and my own hospital in particular, which is facing closure due to mounting debt owed to private equity. For the record, I have been warning my colleagues for years, speaking out as an independent physician in my community, writing angry letters to news sources, and finally building a platform where physicians can remain accessible to their patients outside the inevitable insurance company chokehold. I was told recently that I have been like a prophet, but I think of myself more like Cassandra, warning the Trojans not to bring the horse inside the gates of the city. Either way, the die is cast, the city lies in ruins, and it’s time to think about building something new.
The first step is to improve access by putting a ban on all network restrictions. This would immediately allow patients to seek care from any qualified physician who takes their insurance, not just those selected by their employer or government-based health plan. This would free both patients and doctors to focus on care rather than coverage. Network restrictions result in unnecessary delays and denials of care and, to date, have not reduced the cost of care by a single dollar. I can recall when these policies began. I was a surgery resident at Tufts-New England Medical Center. Harvard Pilgrim had decided to restrict their members to only Harvard-affiliated hospitals, which included patients in the middle of cancer treatments and protocols. My chairman, Dr. Thomas O’Donnell, who was also CEO of the hospital at the time, fought the insurers and won, because it wasn’t just unfair; it would be bad for patients. He could see it clearly because he was seeing patients every day. This could never happen today because our hospital boardrooms are filled with MBAs, franchise owners, and marketing executives who prioritize margins and revenue. It’s time to put an end to networks once and for all, and since all insurers are tax subsidized, our elected officials have the authority to make it happen.
Next, along with requirements for more financial transparency, hospitals need to restore physician authority. Hospital administrators often make decisions or implement policies that adversely affect patient outcomes and increase the cost of care. Doctors can no longer take a patient to the OR, order a transfusion, or even admit a patient without stopping to ask permission. Every aspect of patient care is dictated by a corporate model that requires the collection of extraneous data, turning the patient record into an invoice. When doctors cannot comply with the administrative burdens and do what is best for the patient, they face moral injury and burnout. It is no wonder resident physicians and academic physicians are forming unions. To address this issue, it is imperative for public health officials to mandate that hospital boardrooms primarily consist of actively practicing physicians who hold valid licenses. This measure will ensure that decisions are guided by patient well-being rather than financial considerations.
Finally, the citizens of our state should have the right to decide how their health care dollar is spent. Do we want our premiums going toward paying doctors, nurses, and medical technology, or do we want to pay administrators, marketing executives, and business consultants? It’s really that simple. People have a right to ask why an insurer denies coverage of a prescription but rewards a broker for raising premiums. Our system was predicated on a top-down, paternalistic model of care centered in the hospital, but that truth no longer applies. Patients, by necessity, have had to learn more about their health risks, treatment options, and recovery, including the cost, which has created the marketplace for direct-to-consumer medicine. More physicians need to be free to put patients first again, rather than comply with corporate policy. This will take more than just transparency, but a better understanding of the true costs of care, including independent practice. It will take a major shift in how we approach health care in the future, but the city walls have already been breached, and we have no choice.
Elected officials and those running for office consider health care too complicated to fix. Faced with the collapse of a major network in our state, there is no alternative but to act. Eliminate networks, restore physician leadership and autonomy, and require transparency; these are the first steps. Let us have a crack at rebuilding the city we unfortunately helped take down. When the walls of Troy were breached and the city burned, the Trojans who escaped went on to found another great civilization. Rome wasn’t built in a day, and neither will our new version of health care, but the time is now to begin the journey.
Paula Muto is a vascular surgeon.
