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The author is a family physician in San Marino, CA.
Medical Economics editorial board member Jeffrey K. Pearson, DO, shares his opinion about the Supreme Court's Affordable Care Act ruling.
Editor's Note: We asked our editorial board members to share their opinions of the Supreme Court ruling on the Affordable Care Act. Here's what Jeffrey Pearson, DO, said.
What my patients and I really need from the U.S. government is not the mishmosh more commonly referred to as the Affordable Care Act (ACA). From my readings (not of the ACA text itself, because I doubt that few, if any, have actually waded through the entire actual 4.5-MB PDF file or the 2,409 printed pages into which this translates), the only thing the act has going for my patients is its title and intentions. Bear in mind that I am not partisan to any particular political party. All I know is what my staff and I must deal with on a daily and ongoing basis.
To find the problem with the status quo, I quote Deep Throat of Watergate fame: “Follow the money.” The way that things currently work is that both patients and providers are at the mercy of the insurance companies. They control the entire game from start to finish. They select who is a good risk for them to insure, what to charge them for coverage, what to cover and what to exclude, and what to pay providers. Their sole fiscal responsibilities are to their shareholders; hence, it’s best to take in lots of money and not pay it out. Simple economics, and it works well enough for most commodities, i.e. any marketable item produced to satisfy wants or needs.
However, I submit that the health and wellbeing of humans is too important and far-reaching, impacting societies as a whole and hence should not be treated as a commodity.
Obtaining insurance is a notoriously difficult process fraught with frustration. Any process that encourages honest people to be somewhat less than honest during the application process or with their physicians has something wrong with it. How many of us have received requests from patients, sometimes begging us, not to enter certain subjects into their medical records for fear of losing or paying more for their insurance?
Looking on the provider side, it doesn’t matter what a physician might want to charge (presumably taking our legitimate costs into concern); unless we have created a concierge practice, many of us are at the mercy of those who set our fees and can do little about it. For example, in San Diego where I practice, our fees have been based on rural rates ever since I moved here, despite the fact that our overhead costs clearly deserve an urban classification. These lower reimbursement rates across the board have made it difficult for solo practitioners such as me to be able to afford bringing on additional physicians, for example.
We have the federal government to thank for this incorrect classification, and they’ve known about this for as long as I can remember, yet it has not been fixed in the 20 plus years that I’ve practiced in the county. That being said, if it is designed properly, I am entirely behind a national government-sponsored single-payer health care system, as this would greatly simplify the lives of both my patients and my staff.
Here’s a dream: Imagine patients of all socioeconomic groups walking into a hospital or physician’s office and simply showing their national identification card and receiving appropriate care. No haggling whatsoever. Staffs wouldn’t have to waste valuable minutes with each and every patient on a daily basis verifying their plans, eligibility, and co-pay amounts. No arguing over what’s covered and what’s not. There would be many very happy offices. (And the money saved by eliminating this bureaucratic hell could be used to reimburse all physicians fairly for their skills and for what they do. We physicians should not be divided over reimbursement issues, e.g., primary care versus specialty rates. The problem lies with the insurance system, not with us. We should work together to develop a single system that is fair for all.)
I worked as a volunteer camp physician in Canada 2 years ago and had to take a teenager to the emergency department of a local hospital for suspected appendicitis. A national medical card was flashed and the kid was in. Sure, some will argue that you’d have harder access to some technologies such as computed tomography and magnetic resonance imaging, but that’s Canada. In my neck of the woods, there are so many of these machines that the radiology groups market directly to the general public, offering highly discounted screening studies for preventive health.
The ACA touts that all Americans would have access to healthcare by requiring individuals to purchase their own insurance. Great. Make the insurance companies richer and even more powerful. Per a recent Forbes article, a single taxpayer, currently uninsured, making $70,000 a year, would have the option of purchasing private insurance for >$4,000 year or pay a penalty of somewhere around $620. When money is tight, as it certainly is in today’s economy, I think that it’s a safe bet that this taxpayer will remain uninsured, and this will definitely not improve the state of healthcare in our country.
Government is designed to serve the people and do “the right thing” even when it’s not the most popular. Look back at integration in the school systems as an example. I attribute the government’s historical inability to create a simplified, single-payer system to the influence of the powerful insurance lobby. However, it’s about time that our elected officials step up and do the right thing for their constituents. The obscene amount of money that is currently being skimmed by the insurance and pharmaceutical vultures would be freed up and could be used to support such a system.
There are many who believe that healthcare is not an innate human right. In fact, they’re right. We are, after all, simply animals inhabiting this planet just like any other. Creatures who encounter difficulties must find ways to cope or perish. This happens all of the time, and the result is evolution, i.e., survival of the fittest.
As humans, we consider ourselves above all other life forms on this satellite hurtling through space. Our higher cognitive functions are associated with a greater capacity for caring, with many of us constantly struggling to make this world a better place to live. Healthcare might not be a human right, but fixing our broken system is the right thing, the humane thing, to do for our fellow man.