By Ed Weisbart, M.D.
“Don’t ask me to do one more thing.”
This is the battle cry heard loud and clear from physicians across the country. Our fragmented way of paying for health care has each private insurance company demanding something just a little different from each other. One insurer wants documentation of our efforts at smoking cessation, another about how we’re treating diabetes this week, and another wants to know when the last mammogram was done. And they each promise to pay me a little bit more if I would give them the right answers.
Sure, these are all examples of good medical care, but many doctors today feel like we work in a discotheque, with a mirror ball reflecting hundreds of ever-moving spotlights that we’re supposed to focus on. Implicit in each of these pay-for-performance schemes is the assumption that we’ll only provide good medical care if we’re paid a little extra to pay attention to today’s featured special.
Turns out, there’s plenty of evidence that these well-intentioned programs actually erode the very quality of care they were intended to enhance. Anyone who has ever tried to raise more than one child at a time knows how precious your sanity feels when you’ve got a bunch of kids all demanding your attention. And that’s if they’re all good kids.
Now stretch the metaphor: Turn the out-of-control children into insurance companies (okay, not much of a stretch), realize that they’re trying to out-compete each other, and that they will never grow up and leave home. You’ll start to understand the demoralized nature of physicians today. It’s overwhelming, and there’s no end in sight. Very few of the discussions about health care reform have addressed this issue.
The Affordable Care Act offers little to simplify the unnecessarily complex demands today’s environment places on medical practice. By preserving the role of the private insurance industry in health care, the ACA guarantees that each physician remains at the mercy of a stream of uncoordinated demands. And that we have to continue to employ legions of staff to help our patients navigate safely through. We waste $215 billion a year just on that, according to MIT economics professor Gerald Friedman writing in Dollars and Sense, April 2012.
It makes much more sense to provide everyone in the country with a single health plan, comprehensive enough to meet our medical needs, fair enough to stop driving people into bankruptcy when they get sick, and American enough to offer us all complete choice among doctors and hospitals. We don’t have any of those things today, and the ACA is not bringing them to us.
Just fix the payment model, give us all an improved version of Medicare, and let doctors practice medicine with patients who chose them because they like them – not because they’re “in network” and affordable. Save lives, save money, and help doctors recover their sanity.
Dr. Ed Weisbart is a member of Physicians for a National Health Program – St. Louis. He resides in Olivette, Mo.