The Future
of Healthcare Observations from a
Physician/Legislator Senator Josh Green,
M.D.
The American
healthcare system is broken. Americans pay more for
their healthcare than any other industrialized country
in the world. But even as costs spiral upward and the
ranks of the uninsured swell, for the first time in
decades American's life spans are declining. The old
approach of delays and compromises no longer seems able
to control the problems. The old paradigm no longer
addresses our new reality.
The healthcare system
has become a financial trap in which we buy very
expensive insurance that entitles us to extraordinarily
expensive care, which does not adequately improve our
health outcomes. Meanwhile, the middle class gets
crushed under the weight of premiums that increase
10-15% per year and cost the average family up to 20% of
their income. The indigent and working poor were
abandoned long ago. We now have more than 46 million
uninsured Americans who face bankruptcy when they get
their first hospital bill.
In the past,
healthcare meant time spent between a physician and his
or her patient. Now, healthcare means buying insurance,
searching for a doctor who will accept it, and praying
that your coverage is comprehensive enough should you
get sick. The insurance industry, healthcare’s
gatekeeper, prioritizes costs and profits over patient
outcomes, and reserves the right to deny care to anyone
at all, for any reason they can find.
Americans
are overwhelmed that their family’s plan costs $8,000
annually but still demands co-pays. Health insurers
still often refuse common prescriptions and treatments.
Physicians hire legions of employees just to fill out
the voluminous paperwork and navigate health insurance
rules, even for the simplest of office visits. And when
reimbursements do arrive, they are often shockingly
low.
Insurance executives often laugh that the
system would work perfectly if they could only get rid
of the physicians. Though this sentiment is intended as
a joke, jokes betray the truth. One can’t help but
wonder: if they ever succeeded in dispensing with
doctors, would they then turn their attention to ridding
the system of that last annoying financial liability,
the patients?
If both doctors and patients in the
United States find the current healthcare system
intolerable, and 46 million citizens are completely
abandoned, why don’t things ever change?
The
answer is money.
For the past three decades,
healthcare reform has run into a brick wall in
Washington, D.C. and State Capitols around the country.
Health insurers are able to manipulate a few well-placed
legislators to prevent any reform that would affect
their bottom line. A tiny portion of the massive profits
these ‘friendly’, ‘reasonable’, and ‘cooperative’
politicians protect are used to influence decision
makers on both sides of the aisle every political cycle,
so no one ever loses an election and the status quo is
maintained. Meanwhile, year after year, more people find
themselves unable to afford insurance as the cost of
healthcare spirals out of control.
Fundamental
changes are necessary to make the healthcare system work
in America. So how do we change the system? And what
should it look like?
First, we must enact
campaign finance reform which will at least in part
publicly finance political campaigns, greatly
diminishing the effect of special interest influence and
money on our policy making process. When the voices of
voters influence elected officials as much as health
insurance lobbyists do, reform can begin. When the
playing field has been leveled for the healthcare
consumer, change will come.
We must embrace a
uniquely American single payer system, financially not
unlike the system developed in Canada or England, as
simple and straightforward as possible, which covers
everyone. Clinically however, the American single payer
model will be different. It must be run and operated by
physicians and healthcare policy experts who place
medical outcomes above costs.
To accomplish our
goals a universal electronic health record system must
be established to reduce waste and human errors. This
system will allow us to provide outcome based care
worthy of its high cost. We must also limit the
skyrocketing cost of medical malpractice insurance for
many physicians. Turning the page on this issue will
both encourage doctors to work in rural and under-served
areas, and stop the practice of wasteful defensive
medicine.
Will it be expensive? Yes. Healthcare
is expensive. Period. But at least the vast majority of
our healthcare dollars will be spent on care, not
middlemen who contribute nothing to patient
care.
Will healthcare cost consumers more than it
does today? Not if you are like 95% of American families
who make less than $150,000 per year. The wealthiest 5%
of our people, the entrepreneurs and investors, will
also benefit from reform: their businesses and
industries will be relieved of the crushing costs of
providing healthcare to their employees. American
companies will be able to compete again in global
markets without being forced to outsource jobs because
of the prohibitive costs of healthcare.
Will
hospitals and physicians accept such changes to the
system? They should. In the new system they will again
be able to focus on what they do best, taking care of
patients. By cutting down on the massive overhead
associated with the health insurance model we have
today, there will be more money for doctors and
hospitals to care for patients.
If we take
advantage of the crisis in care to shift the entire
paradigm of healthcare policy, we as healthcare
providers must be committed to make the new system work.
As this transition takes place, the medical community
must commit itself to a new era of care for the American
people. If we as healthcare providers manage the
healthcare system, then we are responsible to make it
work. Physicians must be prepared to care for the most
vulnerable among us.
I propose that all
healthcare providers should designate 10% of their time
to a national initiative that guarantees healthcare for
everyone. 10% of our time must be spent on caring for
those who cannot access care during the transition. This
commitment is what it will take to make the system
work.
And what will it take to achieve the change
we need in America?
It will take the political
courage to reform the way we finance campaigns. It will
take the will to establish a public health system that
cuts out unnecessary middlemen, waste and errors, and
finally it will require the commitment on the part of
American physicians and hospitals to care for our most
vulnerable patients, leaving none behind. If we can
make these changes, we will create the future of
healthcare that Americans deserve.
