Can doctors lead the fix?

America’s health care systemmuch like Congress, it is broken and doctors must be part of the solution.I don’t know a single doctor who doesn’t want to improve our ability to increase access anddelivery of health services for our patients. Saveand/or improving the health of patients is our goal. This should be the goal of anyone associated withhealth care system, but it is not. Currently, our system is infiltrated and plagued by profit. There is no quick fix or cure. I have ideas for how to make improvementsbut let me point out what I see asthe biggestproblems.

Economic structure

America’s capitalist economy works well for many industries, but not all, and health care is not one of them. Health care is often not subject to the same standards of supply and demand and, therefore, cannot be considered a standard market. Insurance companies limit your choices when they force you to see someone “in network,” so your ability to choose the doctor you want is already limited, if not eliminated. When your family member is sick, the typical response is to do everything you can to make him or her better. When this is an emergency situation, you don’t stop and shop around for the best provider or the cheapest deal. And despite what most people think, it’s actually against the law to turn away an emergency patient for lack of insurance. itISpartly, why community hospitals can’t stay open anymore.Such hospitals must compete with the sometimes for-profit facilities next door – which usurp all the well-insured patients. Because they are obligated to care for uninsured emergency patientsWHOoften make up orbiggerpart of their population they are bound to break.It is already happening in community and rural hospitalsare forcedto close their doors.

hospitalI DO the budget for the care of the poor, which is reimbursed by the government (you and me). Similarly, all those patients who cannot afford treatment for their chronic medical conditions, who present in crisis in the ER with severe consequences of this neglect, will receive the services they need that they cannot. afford them. So again, the government (you and me) is left to pay for that acute care, which is almost always much more than helping to subsidize the cost of keeping their underlying illnesses in the outpatient setting. Sowhenyou think about it, providingthatCoRethe levelhealth care to such patients isActuallyeconomicallysmarter option.And clearlyISmorehumane and ethically appropriateSOMETHING to help prevent such morbidity where possible.There will always be inconsistenciessurebut most patientsActuallyI DO want to get their medication if they don’t have to choose between it and paying for a roof over their head or putting food on the table.It’s a win-win, so why aren’t we doing it? It’s complicated, but I think the contributing factors are: corporations health caregreed running amok from capitalism, big players paying off politicians, and polarized politics with taboo labels like Obamacare and socialism.

The great players

I would like to think that doctors are one of the biggest players.But as doctors, we know better. Doctors were considered the pillars of society. And sometimes, they still are. Butoften,health careproviders areFREQUENTLY mistreated and blamed for our current situation.Patients are attacking doctors’ offices and hospitals. Society has demonized doctors and in a handful of cases, rightfully so. There are some bad doctors out there who got into medicine for the money. Or others who are now disillusioned with the practice and offer reimbursement-based careas opposed to standard of care. Those bad apples are tarnishing the entire profession. But this is itonly they are bad apples among the bunch.Please know that most doctorsreallyI want to help get you and keep you healthy.

Suffice it to say that doctors’ salaries make up a minimal component of the totalhealth care spending at only 8.6% in 2011. And this was the second lowest among Western countries with a “modern” health care system. More than a decade later, doctors’ salaries remain stagnant IN 8.6% of health care expenditures.What mostpeople don’t know himIS that for the last 20 years, we have been paid a little less every year for the same services.What other industry is paying the least?every year for providing the same services? And it’s just the doctorsothershealth careplayers have been more and more for the sameTime period. itexplains why doctors now have to see more patients than beforeonly to earn the same amount and cover expenses, while the latter increase every year.And you can’t pay your staff less every yeargrowth ofoverhead and personnelcomes out of the doctor’s salary.The medical assistant (MA) can now make more at Buc-ee’s or Costco than we can afford to pay them to work in our office. Therefore, the pendulum of the physician practice model has shifted away from private practice and toward employment, being acquired by hospitals orworse, private equity firms. The sole practitioner in private practice is a dying breed; IS onlynot sustainable in our current system.

If doctors’ salaries aren’t the problem, what is? Let’s start with the biggest player: insurance companies. It is in the interest of insurance companies to deny coverage and care as often as possible. It is expensive to keep you healthy. But it is even more dearto try to treat you when you are sick. When we make being healthy a priority (preventive care), in the long run, we all do better. But health carecompanies are in it for the bottom linethat is here and now. Denying coverage for things that practicing doctors have ordered is the norm. Prior authorizations have become such a nuisance that we are making state laws to help deal with this. Texas led the way with the golden card bill, which sought to exempt physicians with prior authorization approval rates of more than 90% from having to obtain prior authorizations. Unfortunately, it is rare for a doctor to even know about their gold card status, and there is no punitive component when an insurance company does not comply.

Similarly, the Affordable Health Care Act (ACA), otherwise known as “Obamacare,” implemented the 80/20 rule, which stated that 80% of the premiums collected had to to be spent on medical claims.itwas to reduce insurance company profits and hopefully lower premiums.My family and I received a check from my insurance companythat next year for more than $500. But no wonder, we never got another check because the insurance companies implemented the right solutions, driving up the costs of medical claims.SoTHESElawend up havingbig goals but withabsolutelyno practical impact.

While insurance companies blamed the ACA rate hikes (which is technically correct since it was theirOWN reaction to the 80/20 rule), they were still able to raise their CEOs’ pay. The combined CEO pay of the eight largest publicly traded insurance companies, including CVS Pharmacy, which bought insurer Aetnawas $143.5 million in 2017, up 14.4% from a year earlier. As of 2023, the highest paid insurance CEO earned over $22 million. Meanwhile, premiums are risingat a much faster pacethan overall wages that leave the average American disabledto afford health insurance as well.

The other big player is drug companies. While drug companies are paying tens of millions of their CEOs, most Americans can’t afford their prescriptions. In 2022, the top 10 CEOs of pharmaceutical companies earned $28 million a year or more, with the highest paid receiving more than $124.9 million a year. Thank God for Mark Cuban, Alexander Oshmyansky and Cost Plus Drugs. Even though they are a profit seeking companyso thatstay in business, that isCLEAR not their motivation.MISSIONit is clearly statedon their website: “We will provide the consumer with low-cost, high-quality pharmaceuticals by any means possible.” As Mark Cuban says, “I could make a fortune out of this, but I won’t. I have enough money. I would prefer to freeze the drug industry in any way possible. Why can’t the government do this? Because the politicians are in the pockets of the big players.

The last big player is the health care administration. From 1990 to 2012, US health careful the labor force increased by 75 percent. All but five percent of that job growth was in administrative staff, not doctors. There were 16 for each doctor health careworkers, andonly six of them were involved in actual patient care (nurses/assistants). The other 10 represented purely administrative roles. And isnot from increased utilization as the number of days Americans spent in the hospital decreased by 12 percent, whileHospital staff increased by 11 percentout of 2002-2012. Why were all these people added? What are they doing? in I DOyou need someone to run a hospital and its staff, but what are all those extra people doing? Some even design this area willincrease by 32%from 2019 to 2029! I can’t understand howexcessive75% of the layers we have now arereallyneeded, not even themresults in improvement inpatient care.

The economic structure that allows anyone and everyone to reap profits from the health care system, the dominance of the market and politicians by insurance and drug companies, and the huge balloon of health care administration are the biggest insults to the American health care system as this practicing physician . you see it. The goal of our system should be the health and well-being of patientswhich is almost uniformly the goal of all medical practitioners.Doctors should not only be at the table of health care discussions, butDIRECTORSthe initiation and implementation ofTHE The solutions.Why aren’t we? partially BECAUSEwe are too busy caring for our patients to spend time and money educating and influencing politicians. But the politicians have to step back and get over itActually practicing medicine for solutions. As doctors, we also fight for the politics of medicine, but ultimately patient careis what unites us not to be re-elected. I’m ready to start tackling these problems and come up with some practical solutions. Let’s let the doctors lead the way.

Alice Bergeris a urologist.


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