Osteopathic students and physicians agree that an arbitrary system of cutting costs and superseding clinical judgement is a terrible health care system. The debate lies in what type of system is best to avoid these problems.
Cost and wages
Future DOs, who commonly have debt burdens of over $240K, agree that protecting our physician wages is important. As others have noted, $471 billion annually is spent on billing- and insurance-related costs. Formularies are dictating and delaying treatment, and this situation has been worsening since the 1970s.
It has also been significantly contributing to physician burnout rates and threatening wages. However, Medicare for All would make documentation worse, and the decisions will then be centralized and irrefutable. The last traces of physician autonomy will have vanished.
Jared Bernstein, former economic advisor to Vice President Joe Biden, and others are convinced that Medicare is currently underfunded. Meanwhile, a new study by the Mercatus Center in Virginia estimates implementing Medicare for All would cost $32 trillion—a completely unsustainable figure.
Physicians in the backseat
The American Consumer Satisfaction Index shows that patient satisfaction with health care has been steadily decreasing. After the Affordable Care Act has made so many changes to the scope and use of Medicare, it would make sense that we need less Medicare in our system and not more.
Reports that 70% of physicians spend 10 or more hours on administration per week should come as no surprise when the burdens imposed by Medicare, to prevent fraud and misuse, are considered. Adding more requirements, with a higher patient load, to the Medicare system would overwhelm it, as it did the VA, and make health care a nightmare that more funding wouldn’t solve.
Physicians do not pursue years of training to be told how to practice medicine by legislators and business people. Patients do not seek physicians who cannot help them make informed decisions. Alfie Evans stands as a stark and tragic reminder of the consequences of promoting health care models that have neither the patient’s nor the physician’s best interests at heart.
Most would agree that our current situation is not working. Cost of care, quality of care, and physician quality of life are all major considerations.
Americans and physicians need to consider diversifying how medicine is paid for. Cash-based practices and direct primary care models are routes more physicians and patients are seeking as effective solutions.
Direct primary care models are supported by several political parties and companies, including Amazon and Dell. These models and cash-based practices are appealing because they avoid the pricey markups for some procedures when patients use insurance. Cost-sharing groups like MediShare, Good Samaritan, and others are faith-based insurance alternatives that help when the cash price cannot be paid; they currently serve roughly 1 million patients.
More importantly, patients experience better care because their physicians have the freedom to treat them as they judge most appropriate, patients can autonomously select providers, and there are payment solutions available. Administrative time and personnel required are both dramatically reduced in these models, which further lowers costs and improves efficiency. The solution to fixing our health care system is already here and growing.
Call to action
Unscrupulous health insurance companies and unsustainable health policies need to be removed from the system that cannot afford them. We as an osteopathic medical community can stand and ask for better health care, more freedom, and happier patients without Medicare for All, or we can succumb to the sugar-coated ideals of a society where no one pays for anything except through ever-increasing tax rates.