There are many real issues with the current health care system, but none of these were addressed with the passage of this new law. Cronyism is the nane of the game as far as this new law goes, and in the end, it is going to harm the people, and the leadership is not going to do anything about it. Those that have been in the field for a significant amount of time can remember times in which health care delivery and reimbursements were a simple and unburdened process, but those days are long gone. These are the true impediments of what needs to be reformed in order to continue to have affordable health care for all.
By far, the number one reform that would need to take place is tort reform. Like it or not, the lawyers run health care. This is demonstrated in the fact that malpractice insurance for most providers is obnoxiously high. A good friend of mine, who is an orthopaedic surgeon, told me about his insurance requirements, and stated “it’s when I get sued, not if”. His annual rates he has to pay for his malpractice insurance is nearly what my annual pay is, and it is rather disgusting that anyone should have to pay a significant proportion of their income to simply practice their trade. Insurers also can ‘dump’ a provider for almost any reason, and that is effectively the kiss of death for the provider.
The record keeping aspect is also very cumbersome, and again, is mainly geared towards a defensive posture. We are told constantly in our staff meetings, to write our notes ‘as if they are to be read from a witness stand”. This paperwork is required by insurance companies, and mandated by the ever twisted and contradictory federal laws and guidelines that are increased every year. We have a saying in health care that “we see patients between paperwork”. It is burdensome, and truly takes away from one’s ability to do his job as he would seem fit to do.
There is a great deal of concern over being sued by disgruntled patients, and it was not like this 20 + years ago. I have personally heard more than one psychiatrist say that they went ahead and prescribed psychotropic medication to patients rather than confront them on bad choices and lifestyles they have made. Lawyers constantly bombard the airwaves with “knowing your rights’ and it is reflected in the ever increasing entitled attitudes of the patients. Many of us feel like we are targeted as the enemy. Do you see or hear lawyers advertising to the general population about “knowing your rights” concerning trades like plumbers, architects, auto mechanics, groundskeepers and such and suing them? Not at all.
Secondary to this is, and I believe is related to the above issue, is the lack of personal responsibility taken by many of the patients. Along with feeling entitled to ‘perfect’ care, there is a great resistance in taking personal responsibility for one’s well being, and a belief that they can live any way they want, and it is up to someone else to make them better. I have some patients that have had over 100 medical appointments in a calendar year, and often they are the greatest complainers about the ‘system’ and how ‘it doesn’t work”. Many patients get ideas from television shows, or the internet, and then demand certain tests and procedures be done, regardless of costs and necessity. Providers often are reluctant to give much resistance to this, as any misstep taken by them will more than likely result in lawsuit, or a filing of a complaint against that provider’s license. Again, I have heard many physicians state they ran tests they did not believe were necessary, due to the insistence of the patient.
Then there is the ever increasing numbers of vaccines that are now required, and on top of that, all of the ‘elective’ procedures that many people believe they have a right to, but want others to pay for. This, on top of the fact that people live longer, and are more likely to die from a prolonged, chronic condition versus acute, such as flu or other maladies that would be less controlled for. Then, there is obesity and poor physical fitness, which causes an extreme number of conditions that, requires high maintenance medicine and treatment. Proper health care reform has to look at culpability of the individual and address some sort of accountability for this.
These are the main factors that plague our current system. Obamacare addresses none of these, and actually will create larger bureaucracies, that will only compound the problem. Many young people will decide to not pursue health care as a career option because there will be great risk, with little reward, and those already in will be looking for the exits. Either way, reforms that should take place will not, and excessive burdens, which should be lifted, will be instead added. Typical of any government meddling in areas they should leave to the real experts.