Healthcare costs are out-of-control and many patients can no longer afford medical treatment. The system is broken but no real fixes are visible on the horizon. Sure, politicians debate the road healthcare should take and act like they are very concerned about the health of Americans. Truthfully, however, they are driven by political agendas corporate influence. Little discussion is given to what it would take to fix the system. Rather, fingers at pointed and legislation touted as failures.
America leads the world in medical innovation and technology. Scientists in our country make the world’s medical discoveries. It is an atrocity that many Americans are being priced out of the system. The fact that the US is the only country on the globe that allows its citizens to go bankrupt because of medical expenses is an outrage. And it is the middle class that is being squeezed the hardest.
When I discussed this in the past, I was criticized as not recognizing the fact that “someone has to pay for it”. Yes, this is true and the fact that it is unaffordable doesn’t mean it should be free. It is not an either or situation. What we need to do is make healthcare affordable for everyone. Now many will say that single payer government-run systems are the solution. Do we really want the government in charge if the entire system when we see how the ACA (Affordable Care Act) failed?
What needs to be done to fix the broken system?
- Medication costs are spiralling up so that any are now just as much available as distant galaxies. The pharmaceutical companies will claim that most of the high costs go into research and development but this is simply not true: they spend more on marketing. We all watched how the executives of pharmaceutical companies tried to jack up prices, such as the epipen, for their own profits with little regard for patient safety. We need drug pricing transparency. Bringing these costs as well as executive salaries brought to the light of day will rein in costs as we saw what happened when public outcry called out unfair pricing schemes.
- Commercial insurance companies have a free reign with no oversight. Tests and medications are being denied based on company guidelines with just the aim of controlling costs. Doctors who see the patients no longer can decide the best medical treatment for their patients. Patients can no longer ask for the care that they need. We are all held hostage by these third parties. Some will say that the cost to cover lives is expensive. But, surely when the CEOs are making tens of millions of dollars annually by denying services, something is wrong. We need to call these executives on the carpet. Unnecessary testing should be avoided but we are now in a system where needed care is inaccessible. Insurance companies need to be liable for these decisions that they make. And they need to bring their financials to the light of day as well. It would be interesting to know how much is spend on employees and red tape in denying needed medical services.
- Patients should not be excluded from the system because of pre-existing conditions. No matter how vocal I have been against the ACA, this is one condition that should be kept. Excluding people with medical diseases from having healthcare insurance is just cruel.
- Another term in the ACA that needs to be kept is that college students can remain under their parents plans until the age of 26. Education is what keeps the US at the top of science and technology.
- People should not be unfairly taxed if they cannot afford insurance premiums. Didn’t we learn from the Revolutionary War and the Boston Tea Party?
- More physicians should be encouraged to go into the fields of primary care. Patients who cannot find a primary care doctor often end up in the ER, which drives up costs. We are facing a very significant shortage if we do not find more doctors in this field.
- Patients should be allowed to chose their own doctor. No more arbitrary tiers based on whatever criteria. Patients will have better outcomes when they have a doctor they can trust.
- Kill the prior authorization. These days, most tests need the dreaded PA as well as many medications. My staff spends so much time on this task when they could be doing something that more directly impacts good clinical outcomes, such as calling patients to come in for their flu shots. If the costs of PAs were to be calculated, I am sure it would be a big money drain as well as a time waste.
- Reform malpractice. Real cases of harm should be compensated but much money is wasted on ones that have no basis by someone waiting to hit the lottery. Attorneys who try these cases should pay the costs if they lose. Most malpractice cases are decided in favor of the physician, yet the lawyer still makes much money when they lose.
The politicians will always be there with their political agendas and lack of real world knowledge. Legislation will be proposed to fit their fancy of the day, or to fulfil their lackey role. We, the American people, deserve better than unaffordable, sub par healthcare. The politicians are not incentivized to fix it for the sake of patients. We need to make our voices clear and let them know we have better ideas. Real world knowledge reaps real world consequences. Are you ready to speak out?
Copyright secured by Digiprove © 2017 Linda Girgis, MD, FAAFP
Plaintiff’s med mal lawyers do not make money when they lose cases. They work on a contingency and only make money when they win. Also, when they lose, they are out the costs of bringing the case to trial including expert witness fees (for their doctors) and other expenses. Medical malpractice cases are among the most costly to bring to trial. Which is not to say that they are all meritorious. Too often too many doctors are named at the beginning of a suit and most are dismissed. Certainly being sued takes a psychological toll on defendants. But it is unfair to claim that all cases are frivolous. Furthermore the actual cost to the healthcare system from medical malpractice cases is rather small. That so many cases are settled is some evidence that mistakes are made, patients are injured, often badly, and the legal system compensates them (or their survivors. I feel badly for doctors named in suits unnecessarily, but medical malpractice “reform” even if it discourages cases won’t begin to solve our healthcare cost conundrum.
Dr Linda, I agree with your assessment of what needs to be fixed but I think you are missing the obvious solution.
1. medication costs are controlled when there is a single evidence based formulary and the payor has the heft to negotiate with the pharmaceutical industry. (Like the VA)
2. Commercial insurance not only has no oversight but they are directly interfering in the doctor patient relationship, eroding physician autonomy and diverting 15% of the health care dollar into things that are not healthcare and of NO benefit
3-4. If we give everyone a Medicare card when they are born we do not have to worry about pre-existing conditions or whether they are 27.
5. Medicare for all is a fair tax based on income just like we pay for other civic goods in our country.
6-7. In all international systems that provide universal coverage to their population primary care doctors are 50% of the healthcare system and patients do not have problems finding a medical home.
8-9 No need for prior authorizations and malpractice reform when we create an evidence based system that covers all, gives doctors time to SEE patients instead of their paperwork and that is based on the principles of fair adjudication for medical errors.
Dr Susan FAAFP and proud member of PNHP