I have been concerned about the health of the American health care “system” for several years. In late 2013, my interest was rekindled to a more intense degree when I learned—as did many other Americans—that my president had lied to me about his administration’s intentions; and working people around me became faced with an insurmountable and intolerable dilemma.
I have five friends–middle-aged independent practitioners of cardiology–whose business operates in the red despite them having a thriving clinical practice. I, like you, had to ask, how can that be? The answer is simple, and chilling. Nonhospital clinicians in subspecialties such as cardiology, neurosurgery, orthopedics, urology, etc. cannot collect enough on their billing to make ends meet. They are leaving private practice in droves. However, hospitals and other large health organizations can only hire so many physicians; and, because supply of physicians applying for those jobs outstrips the demand offered by the HMOs and hospitals is now quite low, the only alternative for my friends and doctors like them is to retire early and usually to get new jobs outside of medicine. That flies in the face of a critical shortage of doctors to serve our population and constitutes healthcare delivery nonsense.
Newly graduated physicians are in an even worse position. They have mountains of debt; and for many, decent jobs are not available. Many of them will never practice clinical medicine and even insurance companies and large corporations are overstaffed by overqualified medical personnel. The patients out there in the country are having real difficulty obtaining a doctor. Physicians’ assistants and nurse practitioners cannot absorb the whole load because–although they are fine people–their educations are limited; and crucial skills possessed by physicians are becoming less and less available.
The PPACA [Patient Portability and Affordable Care Act of 2010, or “Obamacare”, as it is pejoratively known] has failed miserably to deliver on its promise. The concepts were excellent: patient centered health care delivery systems managed by a number of different accountable care organizations; payment based not on fee-for-service, but rather on evidence based performance and efficiency; bringing into the system the forty-sis million uninsured who were—and, unfortunately, still are–clogging our emergency rooms. This included a mandatory agreement by all Americans to have insurance and therefore to remove ‘free-riders’ from the equation which would go a long way to alleviate costs of our system. Better preventative care and better early care would prevent paying the huge costs of taking care of late stage problems, especially in chronic diseases. Better life-style decisions on the part of better educated patients would help to eradicate the health consequences of obesity, high blood pressure, diabetes, sedentary life styles and the like. More family practitioners and nurse practitioners and physicians would be available to take care of patients earlier and better to lessen the impetus to be treated by expensive specialists. Doctors, hospitals, insurance companies, drug manufacturers, and medical device companies would unite in their own best interests to improve the health of the nation and to reduce our skyrocketing costs. Waste, fraud, over usage, defensive medicine, and a host of other evils would be eliminated.
However, the PPACA had three fatal flaws that doomed it from the beginning, and the rate of decline of our health care system has not improved, nor has its role as a driving force towards national bankruptcy been removed. At the get-go, the Affordable Care Act was guaranteed to fail because it was conceived in partisan politics and its qualities were determined by a win and lose Democrat versus Republican stand-off. Second, no viable provision was made to deal with medical malpractice; the American Trial Lawyers Association won that issue—a Democrat victory which resulted in the continuation of defensive medicine, waste, corruption, and over usage for self-protection of the doctors, nurses, and hospitals. The final major flaw–and one rife with secrets, lies, and corruption–was that the insurance companies were allowed, or, more accurately, they prevailed, because of their enormous financial power—to continue business as usual. The president promised, lied, and obfuscated. The insurance companies quietly dropped patients who were sick or old or poor—so much for the portability portion of the PPACA. The most egregious action by the insurance companies was to raise premiums as much as triple, and to decrease coverage by foisting incredibly high deductibles on the unsuspecting and struggling middle class. The most telling symptoms of the sickness of the PPACA is that unfortunate middle class citizens are electing to pay an unproductive fine–$695 a head–or as the Supreme Court termed it, a “tax”, rather than go broke trying to pay for their family’s insurance premiums, their tax credits notwithstanding. This is a pure lose-lose-lose arrangement, and it will be fatal for the nascent PPACA, the American middle class, and the American economy.
The Republicans won that capitalist part of the political struggle; and between them, the two parties made great strides towards wrecking the middle class thereby reducing the nation’s tax revenues and its ability to pay on the principle of the national debt or even the interest. Ladies and gentlemen, we have been going around trying to milk a duck for years. It is time to quit, to remove decent medical care from the greed and politics of the capitalist market place, and to provide a simple, honest, efficient, evidence-based, single payer, health insurance system. We have never had a “system”. It is time, posthumous, that we did; and its form needs to be a National Health Care System. We need to stop the national angst over having a “socialized” medicine system like the rest of the civilized world, and get on with the solution instead of wallowing in the quick-sand of what passes for our present medical care delivery hodge-podge.
