SAN DIEGO, March 18, 2012 – They say that an ounce of prevention is worth a pound of cure and most doctors would probably agree with this assessment. For the physician the real challenge lies within the initial patient diagnosis.
If you do not understand what you’re dealing with, you certainly cannot prevent or treat it.
Designing proper healthcare reform for over three hundred million Americans is clearly not a simple task. Nevertheless, it is a problem that can be tackled effectively by first taking a thorough history and physical of the ‘patient’, in this case, our nation, and making the correct diagnosis.
If three years ago the President took steps to properly diagnose the deficiencies in our country’s health system, we would have moved toward a different and more effective step-by-step treatment program for improved national health.
Instead in 2012, America is far sicker than it was in 2010, the year the ‘Affordable Care Act’ passed. Instead of fixing the weak spots of the healthcare delivery system, we became sidetracked by a cancer in the body politic. Instead of exercising leadership, and appointing medical professional, doctors, nurses, and administrators, to ferret out weaknesses and wasteful practices, Mr. Obama turned his back on the medical professionals in favor of those vying for political gain.
While America lays waiting on the examination table, the President has stuck with the script of his political base which is a losing prescription for our national health.
What are the core, indisputable root problems of our ailing medical system? There are many, but let’s examine three primary diagnostic elements:
- The ‘uninsured’ and ‘under-insured’. These are Americans who may get spotty care in emergency rooms or clinics, but who are fundamentally health-challenged because there is no consistency or completeness to their medical lives. Some diseases are never picked up; others are detected at a dangerously late phase of progression. Proper medication regimens for this population of patients is often missed, compliance and follow-up are often deficient.
Clearly there is a shortage of physicians and nurses in some regions of the country, and taxpayer money must be directed at better serving these millions of Americans, but is the best answer a government take-over of all of medicine?
Let us not be naïve: Obamacare will not lead to greater innovation and efficiency or the necessary components any plan that aims to improve quality and cut costs requires.
From the onerous Independent Payment Advisory Board, i.e., rationing of services, to the low-balled ‘reform’ price tag, this new healthcare law has been disingenuous, misdirected, and, frankly, dishonest with the American people.
The President has designed a pathway for American healthcare that is headed toward nationalized, socialized medicine. This is a cop-out. All the energy that was put into this flawed law could have been used to improve, not denigrate, divide, and diminish the way medicine is practiced and delivered in the United States.
Why not treat this disease, this national challenge, with creativity instead?
Who says healthcare professionals can not be resourceful and charitable? Already, groups of doctors and nurses travel to third world countries on various ‘missions’ to deliver American-grade care on a regular basis—and they do so with the utmost of efficiency and without malpractice insurance.
Where’s the outrage that our healthcare providers and practicing substandard care to the poor and helpless in the Dominican Republic? Find a way to remove unnecessary burdens (e.g., regulations) and threats (e.g., frivolous lawsuits) to doctors and nurses, and there are many who believe you will find thousands of professionals willing to lend more of their medical expertise for ‘free.’
- Waste and abuse. This applies not only to those individuals and entities who seek to defraud the taxpayers through unscrupulous billing practices and unethical treatments, but also to the way healthcare treatments have been analyzed, categorized, and prioritized. Insurance, in many settings, is a necessary reality to our medical system, but federal insurance programs should not be allowed to distract from the doctor-patient relationship.
The American Medical Association’s federally-sanctioned billing code revenue stream ($72 million alone in 2010) has not helped patients get better; rather it has solidified resources and power in a de facto arm of the U.S. government, deterring innovation and competition and forcing medical specialist societies to cater to the AMA to insure their fair share of the reimbursement pie.
The Congressional Budget Office estimates that unnecessary defensive medical practices (due to lack of tort reform and fear of lawsuits) costs the U.S. medical system upwards of $5 billion dollars each year. The problem of defensive medicine is not addressed in Obamacare. In fact, the law only further alienates those with a medical degree.
Obamacare directly strengthens the hand of trial lawyers, the only group in American society that actually benefits from the new legislation. Onerous new layers of rules and regulations take more time away from direct patient care, intrude further into private doctor-patient relationship, and allow a multitude of new avenues to find fault or deviation from government-created mandates.
The Justice Department figures for fraud and abuse of billing practices have been estimated to be anywhere from $10-20 billion dollars annually, but some fear this number may actually be closer to five or ten times the amount. Many believe insurance companies serve an indispensable role in the healthcare equation, but why restrict competition only to the intra-state arena? Many believe that more competition between insurance companies would force a simplification of billing practices, thus closing loopholes for fraud.
Is it possible that competition across state lines would force a major trimming-down of insurance company overhead (in many cases at 20-35% of their total operating budget)?
And what about the waste of physician resources and time with electronic medical record mandates that have unproven efficacy? Or the lack of support for better bartering between patient and physician? Or simply supporting a better developed market for the concierge-model of medical care? Who says that patients who negotiate directly with doctors for their care pay more?
Many doctors who run these types of cash-pay practices say their utilization of services and patient expenses are actually a fraction of what would otherwise have been paid to the third-party insurance company? Many believe that we should direct our national resources toward the development of an expanded ‘Medicare-plus’ system for catastrophic care only, and let free market competition and tax-excluded health savings accounts take care of the rest.
The list of examples of waste and abuse today in the American healthcare system is long, but clearly the 2,700 pages of Obamacare serve mostly to stack the deck in favor of new, wasteful layers of government ‘abuse’, not streamlined treatment solutions.
- Leadership deficit. The President’s first instincts in confronting a massive overhaul of our nation’s medical system were to bring big unions, big ‘industry’, leaders of his own party, and paid lackeys in the medical field to the Oval Office to strike deals. What this achieved, other than a false perception of conformity to his feigned ‘reform’ plan, is uncertain. Only the President knows the answer to this question. What we do know is that the big unions received waivers to the very plan they purportedly endorsed, and then complained that they really didn’t like where the new legislation was headed in the end.
What a slap in the face to the American people who were not in this exclusive, ‘waived’ group. Other groups have since sought and received similar waivers.
We also know that Big Pharmaceuticals has taken a major step backwards, after initially endorsing Obamacare—they now see that the push toward shortened drug patents and increased utilization of generic drugs may become so extreme as to shut down research, development and growth in their industry that is vital not only to their own corporate survival but also to the very heart of future national medical breakthroughs.
We know that leaders of the President’s own party have backed away from the IPAB rationing boards, and that most Americans and medical professionals have never been in support of the law anyway.
This is not a demonstration of leadership, but rather the most extreme portrayal of self-aggrandizement in an American leader. Yes, it would have been harder to build a broad support of politicians and doctors and nurses to create effective healthcare reform in the United States, but the end result would have actually made the American patient better.
Reaching out to the 85% of practicing physicians who are not AMA members would have required a bit more time, but it would have yielded amazing results from an amazingly resourceful body of experts.
Today, America’s health is on the decline, and we are trillions of dollars the poorer because of three years of wasted time propping up, litigating, and selling a failed healthcare reform law. It is not too late for the President of the United States to reverse course and start anew, but that would require a temperament which was lacking from the start.
Adam F. Dorin, M.D., MBA
Medicine and Politics in America
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