PNHP

US Physician EHR Burden = Less Clinical Focus, More Burnout

US Physician EHR Burden = Less Clinical Focus, More Burnout

Summary: The electronic health record is now ubiquitous. Doctors complain about its time demands and its emphasis on billing. This review quantifies that burden – more than 4 hours per day, far higher than in countries with simpler insurance.

How much time do physicians spend in the EHR?, KevinMD, April 10, 2022, by Thrisha Gogineni, James G. Kahn, Sigal Maya

Doctors often find the Electronic Health Record (EHR) time-consuming and annoying. … We assembled evidence on hours dedicated to the EHR each day by physicians. The result is impressive – 4.5 hours.

Ninety percent of office-based physicians in the US use an EHR system. However, many report negative experiences. Two recent studies found that physician EHR effort lowers clinical focus and contributes to burnout. EHRs are often described as having poor usability and being unintuitive and inefficient, detracting from clinical focus and sometimes even leading to patient harm.  These systems also decrease collaboration and communication between doctors and nurses.

… To estimate the magnitude of EHR burden in the U.S. and potential savings with streamlined EHR function, we collated existing published evidence. …

The figure summarizes what we found. Median daily physician EHR time ranged from 3.5 to six hours with the observation, log file, and web tracking methods. … The time burden of the EHR in US was significantly higher than in other countries where reported daily EHR time was one hour.

This is a striking amount of time.

Greater demands in the U.S. for billing and regulation related documentation contribute to the excess time burden of EHR systems compared with other countries. …

Only half of a doctor’s day remains for direct clinical interactions with patients.

The essential lesson from this EHR evidence is that the time burden it imposes on physicians is substantial in the US, occupying hours that could otherwise be spent building truly meaningful relationships with patients (not “meaningful use” metrics!) and providing quality care.

Comment:

By Jim Kahn M.D., M.P.H.

Doctors are forced to use the electronic health record, including entry of large amounts of clinically-irrelevant data, especially billing-related details about procedures and overly precise diagnostic codes. This degrades the clinical experience for doctor and patient alike.

This study (full disclosure: I’m an author) assembles evidence on the time burden. It is indeed large.

Although the EHR can improve access to medical information, it is a data-hungry beast that exacts a huge toll as measured in hours, clinical focus, communication quality, and quite likely clinical outcomes.

Single payer would permit us to streamline the EHR to focus on clinically relevant information, as in other wealthy countries.

(P.S. a podcast on this is coming, I’ll let you know)

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

US Women of Reproductive Age Hurt by Insurance Barriers

Summary: “Among women of reproductive age in high-income countries, rates of death from avoidable causes, including pregnancy-related complications, are highest in the United States. U.S. women of reproductive age are significantly more likely to have problems paying their medical bills or to skip or delay needed care because of costs.” This says it all.

Health and Health Care for Women of Reproductive Age, The Commonwealth Fund, April 6, 2022, by Munira Z. Gunja et al

The maternal mortality crisis in the United States has been well documented: U.S. women have the highest rate of maternal deaths among high-income countries, while Black women are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be a bellwether for the U.S.’s wider failures with respect to women’s health and health care.

Among women of reproductive age in high-income countries, rates of death from avoidable causes, including pregnancy-related complications, are highest in the United States.

U.S. women of reproductive age are significantly more likely to have problems paying their medical bills or to skip or delay needed care because of costs.

U.S. women of reproductive age have among the highest rates of multiple chronic conditions and the highest rate of mental health needs.

High health care costs are significant burdens for many U.S. households, even those covered by health insurance. Over one-quarter of women of reproductive age in the U.S. and Switzerland spend USD 2,000 or more in out-of-pocket medical costs, as compared with less than 5 percent of women in the U.K., France, and Netherlands.

Half of women of reproductive age in the U.S. reported skipping or delaying needed care because of costs. U.S. survey respondents were significantly more likely to report skipping care than respondents in all other countries. In the Netherlands, only 12 percent of women said they had forgone care for cost reasons. America’s outlier status on this measure likely stems from the large number of women who lack health insurance — 10 million — as well as the high copayments, coinsurance, and deductibles that many U.S. women enrolled in commercial health plans face when seeking care.

Compared to their counterparts in the other 10 countries, women of reproductive age in the U.S. were significantly more likely to report one or more medical bill problems, with over half saying they had experienced one or more. Only one in 10 women in the U.K., which provides free care to all residents through the country’s National Health Service, reported a medical bill problem.

When looking at all women, we found that those in the U.S. have the highest rate of avoidable deaths: nearly 200 in 100,000 deaths could have been prevented or treated with the right care provided at the right time.

Research shows that investing in women’s health results in a healthier overall population, healthier future generations, and greater social and economic benefits. Yet the U.S. remains the only wealthy country without universal health care, leaving about 10 million women without insurance.

Comment:

By Don McCanne, M.D.

How is the United States doing in providing adequate health care for its residents? Let’s just look at women of reproductive age – a group that plays such an important role in family and community life and should not be afflicted by medical risks more characteristic of older age.

Compared to other wealthy nations that spend less on health care than us, our record is miserable. Not only do our insurance programs leave many unacceptable gaps in coverage, we leave ten million women with no insurance coverage at all, thus potentially unnecessarily exposed to physical and financial suffering and even death. We are already spending the funds that could prevent this, but we are spending them on the wrong health care financing system – a highly dysfunctional, fragmented system designed to benefit venture capitalists and private equity investors, with insurance and much patient care being primarily a tool to enable wealth accumulation.

We are spending enough money to do it right, but it appears that our health care infrastructure is now so distorted by capital interests that even single payer Medicare for All may not be enough to ensure adequate health care for all. Maybe all of us, as communities, need to play a greater role. For those who missed it, several HJM contributors last week published an article in The Nation how communities, not corporations, should own our most vital health care assets.

With public financing and community control, women of reproductive age would no longer have to worry about their own health care access and affordability, and also would no longer have to worry about health care for their loved ones, or for everyone else.

Maybe women are best positioned to lead the march toward health care justice for all.

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Big Insurer Explosive Growth & Profits Since ACA Passage

Summary: An excellent review of 12-year financial trends for the largest six insurers reveals: a) skyrocketing revenue and profits, b) based mainly on growth in the public insurance sector, and c) acquisition of pharmacy benefit plans. Half of Americans are in their plans.

A decade-long look at how Big Insurance profiteers American taxpayers and the sick, Wendell Potter NOW, April 4, 2022

Those six companies–Anthem, Centene, Cigna, CVS/Aetna, Humana, and UnitedHealth–are massively bigger today than they were 12 years ago [when the ACA was passed] as a result of numerous mergers and acquisitions and a new love interest: the government. In 2010, the companies took in a combined total of $245.2 billion dollars in revenue. Last year, that number had more than quadrupled to $1.1 trillion. …

Two of those companies–United and CVS/Aetna–have grown so fast they have leapfrogged into the top five of the Fortune 500 of America’s biggest companies. Only Walmart, Amazon and Apple took in more money last year than those two companies. (Cigna, the third largest in terms of revenue and my former employer, is now the 13th largest on the Fortune list.)

The big six insurers’ profits have soared along with their revenues. Last year they made $60.7 billion in profits collectively, compared to $16.9 billion in 2010. …

Relatively little of the six companies’ growth in health plan revenues and profits has come from private paying customers. By far most of the money they now collect to administer health plans comes from us as taxpayers. That’s because all of the companies have shifted their focus away from the private sector and toward various government-funded programs: Medicare, Medicaid, federal employees and the military. …

In 2010, 16.9 million Americans were enrolled in the Medicare Advantage, Medicare supplement and Medicaid plans operated by the big six. In 2021, that number had increased by 46 million–373%–to 63 million. …

Thanks to the many mergers and acquisitions since then, one of every two of us are now enrolled in one of their health plans. (And 31.1 million of us remain uninsured.) …

AND THEN THERE IS …

The Big Three of the Big Six make more money “managing” Americans’ prescription medications than by administering our health insurance plans. Aetna supersized itself when it merged with CVS, which operates the country’s largest pharmacy benefit management [PBM] company, Caremark, in 2017. Cigna bulked up the next year when it merged with Express Scripts, the second largest PBM. And United’s fastest growing and most profitable division is Optum, which encompasses the country’s third largest PBM. Together, CVS, Cigna, and United control nearly 80% of the national PBM market. At all three companies, the PBMs now generate more profits than their health plan businesses.

Those three companies are also far bigger than the biggest company that actually makes prescription medications. Johnson & Johnson, the biggest U.S. drug company, ranks a distant 36 on the Fortune 500. To put that in perspective, J&J was #33 on the Fortune list in 2010. Cigna, which is now #13 was #129 in 2010.

Comment:

By Jim Kahn, M.D., M.P.H.

The Affordable Care Act will strengthen the hand of private insurers, single payer advocates said in 2010. Oh how I wish we’d been wrong.

Wendell Potter’s review highlights just how right we were. Half of us are enrolled in plans (both private and public) run by the top six insurers, with $1.1 trillion in annual revenues and $61 billion in profits. (Lest you think, oh, that’s not such a big profit margin, consider that the rate of return on real investment is 6 to 9 times higher.)

Most of the gains are for publicly funded programs, primarily Medicare Advantage and Medicaid Managed Care.

They’ve even taken over pharmacy benefit management companies (PBMs), which specialize in extracting more profits from health care.

All in all, a dismal state of affairs. Profits grow exponentially, while access to care and health outcomes plummet. Shareholders gain and beneficiaries lose.

Time for disintermediation. Seriously.

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Nurse Conviction for Fatal Error vs System Harm

Summary: A nurse mistakenly gives an incorrect drug that kills a patient, and is convicted of homicide. Our system kills up to 100,000 a year due to un- and under-insurance, and nobody is indicted. Where is the justice and sense of proportion? Our inaction is outrageous.

Why Nurses Are Raging and Quitting After the RaDonda Vaught Verdict, KHN (Kaiser Health News), April 5, 2022, by Brett Kelman and Hannah Norman

Vaught, who worked at Vanderbilt University Medical Center in Nashville, was convicted in the death of Charlene Murphey, a 75-year-old patient who died from a drug mix-up in 2017. Murphey was prescribed a dose of a sedative, Versed, but Vaught accidentally withdrew a powerful paralyzer, vecuronium, from an automated medication-dispensing cabinet and administered it to the patient. …

Vaught was acquitted of reckless homicide but convicted of a lesser charge, criminally negligent homicide, and gross neglect of an impaired adult.

Comment:

By Jim Kahn, M.D., M.P.H.

A nurse in a university hospital was convicted of unintentionally killing a patient due to a medication error. She’ll likely get 8 years in prison.

Yet those who defend our dysfunctional health insurance system and extract tens of billions in profits by restricting access to care are causing 100,000 excess deaths per year. Do they know of these horrendous effects? They must; it’s plain to see in the stories and research (eg, here and here).

Where is justice? Proportionality? Common sense? Humanity?

I’m sick about our indifference to large-scale systematic harm. We punish one nurse for her inadvertent, if tragic, error. We protect and enable those who cause deaths on a massive scale.

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

‘Apartheid’ Health Care? Why Medicaid Isn’t Cutting It for America’s Poor

By Brenda Gazzar
Code Wack Podcast, April 4, 2022

Why should people who have great health insurance care about people who don’t? Listen as guest Dr. Paul Y. Song, radiation oncologist and president of Physicians for a National Health Program – California, and host Brenda Gazzar, discuss the roots of America’s unequal healthcare system. Why did the Lyndon B. Johnson Administration develop two different public insurance programs – Medicare for retirees – and Medicaid for low-income people? How is that decision still impacting American communities over 50 years later?  What can we do now that would help?

Transcript

Dispatcher: 911, what’s your emergency?

Caller: America’s healthcare system is broken and people are dying!

(ambulance siren)

Welcome to Code WACK!, where we shine a light on our callous healthcare system, how it hurts us and what we can do about it. I’m your host Brenda Gazzar. This time on Code WACK! What are inequities in American health care and why should everyone – even those with great health insurance – be concerned about them? The truth is they can have far-reaching consequences for us all — impacting public health, creating conditions for the spread of disease and even hindering economic productivity. We recently spoke to Dr. Paul Song, president of Physicians for a National Health Program-California, about how the COVID pandemic highlighted these longstanding  inequalities and what the Biden administration can do about them.

Welcome back to Code WACK!, Dr. Song!

Q: We’ve talked a lot about inequities in health care. How do these inequities affect people of color specifically?

Song: Unfortunately, with regard to our healthcare system, the majority of disadvantaged communities of color are in the Medi-Cal system – very few work in jobs that provide real healthcare benefits. If you look at people who work at Walmart or some of those other stores, they don’t really get health insurance. So they’re asked to then get their health care through the government, which is through Medi-Cal, or many times through a subsidy, through the exchange, for which many of them can’t afford. And you know unfortunately we saw it again exposed during COVID is that when you saw the disproportionate amount of deaths among communities of color compared to white communities or more affluent communities, it really was a reflection of the long lack of health care that these people have had, meaning many of them had uncontrolled diabetes or high blood pressure that was uncontrolled. So when they got COVID, they were more likely to succumb to its effects.

At the same time, some of them, particularly frontline workers who were cleaning hotels or working grocery stores or in the food service industry or construction, many of them didn’t have health care and yet when they got sick, they couldn’t afford to go get tested. They couldn’t afford to go to the emergency room. They subsequently lived in multi-generational homes. They passed this on to all of the relatives in their houses and, you know, unfortunately it was very detrimental to communities of color disproportionately compared to everyone else.

Q: Right. And this is something that we’ve seen even before COVID, correct? COVID just kind of brought it to light even more.

Song: Correct and COVID just really did expose so much that’s broken and then you actually had hospitals in poorer communities that actually had to ration care because one, when you have a hospital like Martin Luther King Hospital, 75% of their revenue comes from Medi-Cal or uninsured compared to a hospital like Cedars (Sinai) or UCLA (Medical Center), where it’s such a small fraction. When you are getting reimbursed so little, you don’t have the luxury to go invest in additional ICU beds or ventilators or respiratory therapists. You’re basically scraping by just to serve your community. So when you get overwhelmed with people that are sick and you don’t have enough of those things that are required to really adequately address the problem, you’re going to have more death and, and that’s what we saw as well.

Q: Right. Great. Thank you. The last time we talked about the three major sources of health insurance and the obvious and not so obvious inequities inherent to each. Let’s talk about solutions. Instead of addressing inequities with more market reforms, what do you think is the first step the Biden administration should take toward promoting health equity in our country?

Song: Wow, it’s a complicated question, but for me, I think the answer’s quite simple. One is I think, due to the political climate, I don’t think we’re anywhere close to getting a federal Medicare for All, but I would like to see the Biden administration immediately sign a waiver allowing states to innovate and develop their own in-state single payer solutions. Next one I would do is instead of keeping Medi-Cal as is, I would immediately put all those enrollees on Medi-Cal into our Medicare system and just further make Medicare the de facto fallback insurance for everyone who needs it, whether it be seniors or the really poor. And so if you had between the seniors and then number of people on Medi-Cal, if you’ve just rolled that into one and gave everyone the same benefits as the Medicare beneficiaries, rather than Medicaid, I would feel like that would be significant, a significant starter until we got to a full federal single-payer Medicare for All system.

Q: Great, and that would allow them to be seen by doctors more quickly. So like you said, they wouldn’t have to wait a year before they got treated for cancer?

Song: I think it would do a lot. It would help lower income communities and their hospitals get much better reimbursement because now you’d be reimbursing at Medicare rates versus Medi-Cal or Medicaid rates and then as a result, these hospitals could invest more in equipment, in building out ICUs, bringing in more staff. It would also incentivize more doctors in these communities to take care of patients and as a result, I think it would increase access to care versus the system we have right now.

Q: Is this an idea that was ever considered seriously by any administration?

Song: No. Again, I think if you go back to Medicaid, it was always meant to be a second class in some respects, subtle wink and a nod apartheid system, right, who are mostly the poor that would qualify for this. It was predominantly people of color back in the 60s when Lyndon Johnson, you know, proposed this instead of trying to make Medicare and Medicaid, all one, they had to have this separate system. I think that if you were able to roll all that into one, it would have a significant impact on lower income communities and it would greatly reduce the disparity in health care that exists right now and until we got to a full Medicare for All, then you could have those people who got coverage through their employer continue to do so. It wouldn’t take away the complexities of our healthcare system, which is part of the administrative waste and all of the shenanigans that go on. But at least it would elevate the healthcare level for those that are the most disadvantaged and particularly in communities of color to those of what our seniors would be getting.

(5-second stinger)

Thank you, Dr. Paul Song.

Do you have a personal story you’d like to share about our ‘wack’ healthcare system? Contact us through our website at heal-ca.org.

Find more Code WACK! episodes on ProgressiveVoices.com and on Nurse Talk Media. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.

https://heal-ca.org…

Medicare for All Explained Podcast: Episode 74

Highlights from the House Oversight Committee Hearing on Medicare for All

April 2, 2022

Podcast host Joe Sparks highlights testimony from a recent U.S. House Committee on Oversight and Reform hearing on “Examining Pathways to Universal Health Coverage,” including remarks from Rep. Cori Bush on the urgent need for single payer, and powerful personal stories from patients and activists who have struggled to navigate our fragmented, expensive, and unjust health care system.

Additional episodes will be uploaded twice monthly. Subscribe in iTunes, or access a complete archive of the podcast, below.

https://medicareforallexplained.podbean.com

Health Insurers to Disintermediate

Summary: A very surprising and hugely important announcement: US health insurers have decided to “disintermediate” – step back from their traditional position between purchasers of health care (e.g., policyholders) and providers of health care (e.g., doctors and hospitals). The implications of this change are far-reaching.

Health Insurer Trade Association Announces Disintermediation, USA Wire Service, April 1, 2022 , by Ziua Pācālelilor

Today the trade group America’s Health Insurance Plans, known as AHIP, announced that its members – scores of health insurers – voted to “disintermediate”. In a press release, AHIP explained that “disintermediation” means removing themselves from playing an intermediary role between insurance purchasers and healthcare providers, and between patients and clinical care.

The insurance companies represented by AHIP voted unanimously at the annual conference to make this drastic change in their business model. During the meeting, which was off limits to the press, one insurance CEO reportedly said, “It’s about time that we place efficiency and medical care over bureaucracy and profits. I for one am quite set financially, and would like to make this socially responsible action my swan song.”

The decision was completely unexpected. Health policy analysts expressed shock and confusion. One asked, stuttering, “But then what’s their purpose for existence, if not intermediation?”

A representative of the federal Center for Medicare and Medicaid Services, or CMS, said, “Well, that’s quite a course change. Seems like we’ll need to reinstate traditional Medicare, paying doctors and hospitals directly.”

Former insurance company executive and whistleblower, now a leading advocate for single payer universal health care, Wendell Potter said, “What? Holy shit! Really? This is transformative. Kudos to AHIP and their members. Finally, they’ve seen the light.” Mr. Potter popularized the term “disintermediation” in 2011, soon after leaving Cigna Insurance Company. At the time, he said it was the greatest fear of health insurers.

Today AHIP’s membership vigorously embraced that fear, and apparently conquered it.

Comment:

By Jim Kahn, M.D., M.P.H.

Whoa? For real? Health insurers voluntarily throwing in the towel on their half-century role in financing – and influencing – US health care.

The motivations of AHIP and its members are pure speculation. By adopting this position, they are abandoning their highly lucrative business model. Perhaps they have decided that the profit-taking cannot continue indefinitely, and this is a good time to get out. Perhaps, if we believe the quoted CEO, some had a change of heart regarding the purpose of health care financing – to pay for care and improve health, rather than bring giant financial returns to shareholders.

We can now look forward to settling on the details of the successor financing system – efficient, equitable, and health-maximizing single payer.

Let’s also remove corporate intermediaries on the provider side.

Alas, were it so. Today is, I remind our dear HJM readers, April Fool’s Day.

Keep working to make it real. With single payer, and community control.

http://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

10 administrators for every 1 doctor. We deserve a better healthcare system

By James Fieseher, M.D.
Foster’s Daily Democrat (Dover, N.H.), April 1, 2022

Our current model of healthcare was conceived in the late 1960s and launched during the Nixon administration as a not-for-profit, managed care system.  Wealthy entrepreneurs saw an opportunity to make a fortune and by the Clinton administration, U.S. healthcare was managed by for-profit companies.

The exceptions were the VA system, Medicare and Medicaid.

The argument used for turning healthcare into a for-profit industry centered around competition.  For-profit health insurers insisted that competition would foster innovations in health and keep rising prices in check.

So how has that worked out?

According to the World Health Organization (WHO), the United States ranks first in health expenditures by almost twice as much per capita as the next closest country (Switzerland).  But in terms of outcomes, we rank 37th overall out of 191 countries surveyed.  That ranking is by far the lowest of the 11 most advanced industrialized nations and doesn’t fare well against many third world nations.

That 37th place ranking has been unchanged since the WHO first started the comparisons in the year 2000.

So, what went wrong? Where was the competition to innovate and lower prices?

Since managed care went into effect in 1970, the number of doctors in America has risen approximately 200%. But the number of healthcare managers (administrators) has risen over 3,800%.  In the same time frame (1970 to 2019) healthcare costs have risen 3,100% or on a per-person basis, from $353 in 1970 to $11,582 in 2019 (the dollar amounts have been adjusted for inflation). See healthsystemtracker.org.  There are now 10 administrators for every physician in the United States.

Ironically, competition and innovation are the reasons that prices and the number of administrators has risen.

In turning healthcare into a profitable business enterprise, insurance companies have used competition and innovation to reduce their expenses.  Since a health insurer’s expenses are sick patients and their medical claims, health insurers have innovated ways to cut down on the number of unhealthy patients that they cover while aggressively denying as many medical claims as possible.  They don’t compete for lowering prices, they compete for a larger percentage of healthy patients (fewer medical claims), innovate new ways of denying medical claims, and innovate methods of dropping their medically neediest patients from their insurance panels!

To accomplish this, they have hired more and more managers or administrators to find ways to deny requests from doctors and patients to pay for tests, services, and medications.  The added cost of hiring additional managers is more than offset by the money saved by paying out fewer medical claims. The for-profit system of health insurance is designed for people who don’t need a lot of medical care.

Responding to the denial of medical claims generates needless paperwork for all parties involved: hospitals, doctors/clinicians, and patients.  Those medical claims denials have prompted doctors and hospitals to hire their own army of administrators to respond to the additional paperwork generated by the insurers. This further drives up the costs within the system.  Many patients have faced the complexity of that paperwork and have simply given up or given in to the insurance companies and accepted the denial of services, tests, and medications they needed.

That accounts for some of the WHO’s ranking.  But the sheer expense of health care in the US has prevented millions of Americans from having health insurance in the first place. The uneven distribution of healthcare accounts for the majority of that 37th place ranking.  Most of us know at least one person who died prematurely or developed severe medical complications from a lack of access to some form of health care (a health provider, adequate testing, or medication).

The enormous number of administrators (non-medical personnel) remains the single biggest expense in our medical system.  But drug prices come in second.

Americans spend more money on medications than in any other country.  It’s not that we use more medications per capita than in other countries, in fact, we tend to use less.  It’s that the medications we buy are priced so much higher than in other countries.

We can thank the lobbying efforts and large political contributions of the pharmaceutical industry for that.  Where other countries have put limits on the amount of profit a company can make on a life-saving medication, the US has left that up to each individual pharmaceutical company.  Instead of lowering prices, these companies have offered gimmicks and coupons.  Even with those discounts in place, we still pay more per medication than citizens of other nations.

The business of medicine has changed the profession of medicine in the US.  Doctors, nurse practitioners and other medical clinicians often must balance the quality of care with the patient’s ability to afford the proper treatment.  Additionally, they’re paid on how much they do, not how they do it.  For example, two doctors can successfully treat the same medical problem, but one doctor can do it in two visits while the other doctor needs four visits.  Since reimbursement is based upon the number of visits, the system rewards the doctor needing more tests and more visits.

None of these problems would exist under a universal system of healthcare.  Since every person would need to be covered, competition would be geared towards finding ways to preventing people from getting sick in the first place and then minimizing the number of hospital or medical office visits needed to maintain a functional lifestyle.

Both the VA system and Medicare work this way to some degree, but because of Congressional restrictions, neither has reached the full potential that a true universal system can achieve when it comes to prevention, access to care, and extent of services offered.

New Hampshire doctors have expressed concern and frustration over the limitations that managed care has placed on their ability to effectively treat everyone in the Granite State.  In a recent poll conducted by the New Hampshire Medical Society, an overwhelming majority of physicians indicated support for a universal style system of health care.

The medical society poll indicates that across all medical disciplines (primary care, surgery, specialty care, etc.), New Hampshire doctors preferred a system of medical care that would allow all Granite Staters equal access to providers and hospitals regardless of income or amount of care needed.

For the enormous cost of medical care in the United States, we shouldn’t have a 37th place medical system.  The highly profitable pharmaceutical and health insurance industries have pitched false promises of better care and lower prices.  After 52 years, it’s time to change the narrative. We deserve a better healthcare system.

Dr. James Fieseher, of Dover, is a recently retired family physician.

https://www.fosters.com…

Dr. Adam Gaffney on “Democracy Now”

PNHP immediate past president Dr. Adam Gaffney appeared on “Democracy Now” on March 31, 2022. He discussed the end of free COVID-19 testing, treatment, and vaccines, and how the pandemic has led to a renewed push for Medicare for All.

Dr. Gaffney was joined by Dr. Oni Blackstock, who discussed the recent report, “The State of Black America and COVID-19.”