How Changes in Healthcare Will Affect You

There has been a tectonic change in the way medicine is being practiced in our country. It began in the early 1960’s, when the government and private insurance became the major payers for physician services, and accelerated in the early 1980’s as those same payers began to increasingly dictate the manner in which medicine should be practiced. Today, it has reached the stage that your doctor is more likely to be an employee of a large bureaucratic structure, be it an insurance company, a large hospital system, or in the case of the VA, the government. Contrary to popular opinion, the vast majority of health care dollars you spend do not end up in the pockets of those who provide your care. Rather, they fund the grand structures of both non-profit and for profit enterprises, whose course is being steered by executives whose monthly paychecks are anywhere from 10 to 100 times larger than those of the physicians they now control. Of note is the fact that these executives almost uniformly have never cared for a patient, or know much about medicine besides its business aspects. Despite a number of states still having laws on the books prohibiting the corporate practice of medicine, these laws have been either removed by the lobbying efforts of the American Hospital Association and the large insurance companies, or subverted to the point that they no longer matter.  Today, less than half of physicians are in any control of their practice, down from 95% just twenty years ago. And even the ones who are have to deal with a federally mandated morass of electronic health records (which do not communicate with one another), growing mountain of prior approvals, after the fact denial of payments, onerous regulations, and rising malpractice costs, forcing many to either retire or join the ranks of the employees.

Why should any of this matter to you, the patients? The answer is twofold. Most importantly, because it affects the kind of care you receive. When the bean counters decide that my productivity and their income will increase if they limit the time I have to interact with you to 5-10 minutes, my ability to decide and explain what is the best course of treatment for you problem becomes impaired. When your care gets shifted numerous times because of a change in the insurance plan you are offered, you no longer have a personal relationship or a level of trust you need to follow my recommendations. When the services I would provide to you are now being given by other “health care providers” who are not doctors, more subtle or unusual problems are more likely to be missed or ignored. And when you are unable to navigate the phone and bureaucratic triage system that has been erected to limit your access to my care, you suffer even more. Secondly, you should care because you are paying for all the layers of middlemen who are making an expensive system even more expensive.

Sadly, even those of us in the profession who know the intricacies of the system suffer similar problems when needing aid for ourselves and our families. Besides trying to support those who have provided good care to you in the past, and expressing your feelings to those officials in government who are driving many of the changes, there is little any of us can do. As the lobbying power of the hospitals and industry far outweigh those of doctors, the war no longer seems winnable. Perhaps the best we can hope for is that those of you who have children considering entering medicine as a profession do your best to instill in them the values that make them fight for the welfare of their patients over the dictates of the organization that will likely employ them. Otherwise, as one of my retiring associates recently told me, “we are never going to get the care we gave.”

This entry was posted in America, Health and wellness, Medicine, News and politics, Thoughts & Musings. Bookmark the permalink.

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