We Need Healthcare Reform, But Obamacare Is Not It

Gerald B. Healy and Donald Palmisano | Presidents Emeritus, American College of Surgeons, American Medical Association

Imagine a world in which anyone with little medical training, education, or knowledge can place a sign in the window or on the lawn claiming to be a doctor.

This isn’t imaginary – it is the United States at the beginning of the 1900s. Theodore Roosevelt is president. He is faced with myriad complex issues: the protection of American workers, the preservation of our natural resources, and protection of the sick. He quickly recognizes – perhaps because of his own personal experience – that American health care needs extensive reform. He asks the Carnegie Foundation to support a study of American medical education. A landmark evaluation is begun, and in 1910, the study’s leader, an educator named Abraham Flexner, publishes the Flexner Report.

The Flexner Report formed the framework for the American healthcare system; one that is still used 105 years later. The report outlined a blueprint for the education, training and validation of physicians, and led to the closing of hundreds of bogus “medical schools.” It created the current day academic medical center, a system of medical and nursing care and education, with three critical core elements: patient care, teaching and research. This system became the model for the world.

In the 2008, President Obama ran on a platform of change, including healthcare reform. Many medical professionals held out hope that we could finally have the opportunity – after almost 100 years – to examine all facets of healthcare in America. This examination would include not only how we pay for care, but also how we prepare health care professionals, pay for their education and validate and re-validate their practice in the 21st Century.

Would the president commission a new “Flexner Report” to carefully study and assess America’s unique healthcare system, recommending the most effective ways to prepare healthcare professionals, and to care for patients in this new era of technology and information while addressing payment and cost?

No. Instead, Congress passed a 2010 insurance scheme known as the Patient Protection and Affordable Care Act (PPACA/ACA/Obamacare) under unusual circumstances. Its idea – that simply giving people a card that says they are insured would guarantee access – signified a significant misunderstanding of America’s healthcare workforce problems. It’s analogous to buying a ticket for a train that never leaves the station. In addition, showing a total lack of understanding of methods to measure the true quality of care being delivered, the PPACA framers set in place mandates and some vanilla quality “measures” that remain untested as to their usefulness. There was minimal, if any, contribution from actively practicing physicians.

Today, we have what Washington likes to call “healthcare reform.” It is not reform. It is an insurance scheme, voted into being by a partisan divide, which healthcare providers are forced to live with. As a result of the PPACA, Medicaid rolls are rising, and many providers and hospitals are struggling to remain solvent. In a recent survey by the Physicians Foundation, 46 percent of MDs say the PPACA is a failure and in a Gallup poll just released, 56 percent of Americans disapprove of the law. Many rural hospitals are on the verge of disappearing as a result of this “reform.” Mandates such as the Electronic Health Record (“EHR”), proposed in the name of patient safety, have cost hundreds of billions of unreported healthcare dollars – and hours. Worse, EHR requirements force doctors and nurses to stare at screens instead of patients thus decreasing efficiency and satisfaction.

The PPACA is simply not working to improve care as it now stands. It is a loose, wet Band-Aid on a system that needs major, life-saving surgery. Despite presidential promises, many insurance policies cost more; patients have lost their doctors because of narrow insurance networks, and the validity of the federal health exchanges to sell insurance is before the U.S. Supreme Court because the law stated only state exchanges get subsidies and more than half the states did not set up a state exchange. And after the recent revelations by the Administration’s highly paid consultant, Professor Jonathan Gruber, about the deception employed to hide the true cost of PPACA, trust in PPACA is getting worse each day.

Where might the change from PPACA begin? Here are some ideas:

1) Change the current insurance payment system. Our current method of payment and insurance leaves no one happy: neither patients nor caregivers like it. The patient is disconnected from the cost of care. So what can work? Health Savings Accounts funded with tax-free money from the patient and supplemented with catastrophic insurance coverage. Have transparency of all fees and allow insurance purchase across state lines to eliminate the market power of some health insurers that aren’t forced to compete.

The patient should become a prudent purchaser of medical care. Allow balance-billing. Get the government out of the current Sustainable Growth Rate (SGR) price-fixing in Medicare plus the micromanagement and issuing of thousands of pages of bureaucratic regulations. Allow balance-billing in Medicare as is done in Australia. Let competition begin.

Unfortunately, if government is involved, the system will continue to be a political football, tossed around by politicians. The bureaucrats showed their prowess in the website fiasco of the PPACA rollout. Healthcare professionals are at the end of their rope. Any reasonable system would be welcomed. In 2014, we can all bank with a Smartphone and a plastic card. Why does the provision of health care need to be so complex and convoluted? Insurance companies now respond to complex government regulations and do not place the same emphasis on the welfare of the patients. It is past time to ask what is their real purpose in 21st century care? How many dollars are being diverted to profit rather than to care?

2) Convert Medicaid to a voucher system. Give all in the program an array of choices of insurance. Think of the Federal Employees Health Benefits Program (FEHB).

3) Train and support healthcare workers. We must have an adequate workforce of professionals who can deliver care quickly and efficiently to our entire population. America’s health care workforce needs must be addressed immediately. This includes examining the number of physicians, nurses, and other mid level caregivers necessary to provide team based care to all citizens regardless of where they reside. It is essential to address the cost of training these professionals. The current cost of education is prohibitive, depriving the population of access to the best and brightest medical professionals from all socioeconomic sectors.

Methods of support from current wasted health care dollars can be redirected for this purpose. The curriculum and length of training should be reviewed to make it relevant to the 21st century. This reform alone could save billions of dollars. Opposition to this will likely be strong, as it will disrupt the status quo.

4) Medical liability reform. Others have made the case for medical liability reform well and we support proven reforms. Health insurance is of no value if one cannot find a specialist in an emergency. The overwhelming defeat in November of California Proposition 46 to increase the cap on non-economic damages shows citizens want to keep the excellent medical liability reform of 1975 (MICRA) with a cap on non-economic damages.

It will take strong leadership and true bipartisan cooperation to move toward true reform. Right now no one appears to have the will or credibility to get the ball rolling. So we complain and argue. Meanwhile politicians pontificate as the system goes on life support.

The talking needs to end and the action needs to start. Immediately.

Gerald B. Healy, MD, FACS is a past president of the American College of Surgeons. Dr. Healy currently is CEO of Healy Practice Solutions, working with physicians to improve the health of their practices. Donald J. Palmisano, MD, JD, FACS is a past president of the American Medical Association and author of On Leadership and The Little Red Book of Leadership Lessons.
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