Several debates down and I am still waiting to see where the Presidential candidates stand on healthcare. For me, this would be a deciding factor in my vote and support. Many American patients and doctors are suffering in our current healthcare system. A few of the candidates issued statements that they plan to repeal the ACA (the Affordable Care Act), also known as Obamacare. But no in-depth or real discussion has taken place on what needs to be done to fix the system. Healthcare and the Presidential election seem to want nothing to do with each other.
The ACA is harmful to patients in many ways. First, it places the burden of funding rising healthcare costs onto patients, who may or may not be able to afford it. Yet, when patients pay premiums out-of-pocket, it does not guarantee payment or even services. Most plans rolled out under the health insurance exchange program carry large deductibles, some even over $12,000 per year. Patients are avoiding medical care because they do not own the money to pay these deductibles. Medical conditions are worsening because of this rationed care.
Also, many insurance plans narrowed down their doctor panels under the new health insurance exchange plans. No, if you had wanted to keep your doctor, it did not happen in many cases. Not only is medical care becoming unaffordable, it is becoming inaccessible. There already exists a primary care shortage in the US. And with narrowed plans, it is becoming harder to find an appointment with a primary care physician.
The idea to repeal Obamacare may be a start. But, anyone who watched politics play out before knows this is an unlikely event. Once a law is passed, unpassing it is much more difficult. While we may be stuck with Obamacare, we can still reform it and not staying tied to the problems inherent in it.
Medical care needs to be more affordable. Often, insurance companies drive healthcare costs. There is no one over-seeing what they are doing. Their CEOs earn huge compensation packages every year. Surely some of this is “earned” by denying expensive medical care. While the media and public clamored for transparency is earnings of doctors and hospitals, insurance companies were free from that scrutiny. Perhaps it is time for them to open their books like the rest of us in the medical field. Wouldn’t it be beneficial to see where our premium dollars are actually being spent?
Another big consumer of healthcare dollars are pharmaceutical companies. They too, are free from cost scrutiny. They can price a medication wherever they like. The fact that a sick patient may need a specific drug to save their lives plays no role in the cost setting, In this way, pharmaceutical companies who hold the patents on their medications are allowed to act like monopolies. Either the patient pay the price or they may lose their lives. These companies should be called on the carpet as well. We saw recently in the news how Turing Pharmaceutical company tried to ratchet up the price of a drug to treat toxoplasmosis purely for profit. We need to see how these companies set costs and where their profits come and go. Unless we grab the reins on the bludgeoning medication costs, many will simply become out of cost range for many patients.
The Presidential election is approaching. Debates continue and the field gets narrowed. But, we need a champion of healthcare. Someone who is going to make a plan to carry out real fixes in our system that can save real lives. Until one steps up, I will continue to watch from the sidelines.
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
Dr Girgis,
I appreciate your comments re the lack of debate on Obamacare and possible alternatives. Listening to candidates, both Democrat and Republican, gives one the impression that both sides are running away from the subject. Democrats know the ACA remains very unpopular, so they either propose a Medicare-for-all single-payer system (Sanders), or promise to fix the broken parts of Obamacare (Clinton). The GOP front runners seems happy to watch Democrats squirm, and avoid discussing just what the healthcare/health insurance system would look like after repeal, since Republicans have no clue what to do.
Watching this political kabuke dance reinforces my thought that market forces should drive reform. A reading of the Patient Protection and Affordable Care Act reads like a laundry list of carve outs, exceptions and trade-offs bartered to gain support for the law. From longshoremen to cosmetic surgeons, there’s a plum for everyone, excepting maybe tanning salons.
The health insurance market has been distorted because the law blocks adjusting for risk, and a substantial number of healthy young people are foregoing insurance, overloading risk pools with older, sicker patients. This same phenomenon is responsible for the collapse of several of the newly-created, non-profit CO-OPs, as ACA prohibitions on advertising left them unable to effectively market themselves to a more balanced pool of members.
Third-party payer arrangements for prescription meds are so byzantine, few know the true cost of medicine. Rebates, discounts, and bundling mean that pharmacy benefit managers (PBMs) don’t pay the sometimes ballyhooed prices reported in the news. Because few, if any, patients have direct contact with the pharma companies manufacturing their meds, they are usually unaware of the co-pay support/rebates/discounts/free supplies available to patients. Yes, there have been some abuses, but it’s important to keep in mind that prescription drugs account for only 10% of healthcare costs.
Fortunately, we do have some proposals for a market-driven system, including a very detailed plan by John C Goodman, often called the father of Health Savings Accounts. He is also the author of “Priceless, Curing the Healthcare Crisis”. The book was released during the fight to pass the ACA, and presents a prescient analysis of the perverse incentives driving healthcare costs up, and quality down. He also provides a outline of a freer, more competitive marketplace.
Dr. Kyle, I lost my perspective when the President told us we could all keep our doctor. My patience with second and third party payment systems grows increasingly thin. These layers foster graft and redundancy within and throughout our healthcare system. Denmark seems to be able to identify long term morbidities in frequent users of antibiotics with a one EMR, one payer system. Before we toss the baby of the ACA out let us further examine this ugly little beast. Given a haircut and a shoeshine it might once again become the potential of a one payer system in a great democracy
Ma’am I am delighted to read your views and I find them a breath of fresh air. I am incredibly disappointed with the implementation of Obamacare. I realize you are probably a busy FP but I believe you need to find your way to the legislature. I’m a 57 y/o mainstream catholic WM 3rd generation from Poland Veteran. I don’t know much about Coptics but have been fascinated by what I’ve read. I see mostly old folks and practice more IM than I do Cardiology.
In all confidentiality I once hoped that Obamacare would work and we’d get a reasonable assimilation of a one party payer and a universal EMR, something like the Danish system. I now hear the most conservative of the Republicans vowing to repeal it and replace it. With what? I hear no substance here at all but think you have an inkling of an idea. If I can ratchet up your voice please let me know. We need more changes, plural.
Leslie A. Beben, PA-C, SC #415