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Real healthcare revolution taking place under the radar, an editorial


The real healthcare reform revolution is happening under the radar of media and politics.

Put in perspective, "Obamacare" (like it or not, that's the name associated with healthcare reform now) is about health insurance reform. The mandate that everyone have health insurance is its most controversial element. Remember, however, that that mandate is the part of the plan mostly promoted by the American Medical Association, and it was started in Massachusetts by then-Gov. Mitt Romney, a Republican. It reflects the philosophy of personal responsibility usually associated with conservatives.

Because physicians are required to treat everyone who comes to an emergency department (ED), mandating that people have health insurance means that we do not have to pick up the tab for this care through higher health insurance premiums. Healthcare is not an option when you are sick or injured, and all of us become sick or inured at some point. But the mandate part bothers some people.

The automobile and the telephone have driven how we have given and received healthcare for the past 40 years. People call for appointments and then drive to a doctor visit. Before that, doctors made house calls, and there were no appointments. My general practitioner from the 1950s did not even have a sign-in sheet. The nurse went to the waiting room and called "next." You had better be sure you figured out who came in before and after you.

Now this "telephone/automobile, make an appointment, and come and get it" process is becoming outdated, too. As with other service industries, more and more healthcare is being delivered online, and this practice will continue to grow in popularity. In my practice, I have an average of three online communications with patients for every one phone call or office visit. My patients pay a modest charge in advance-$30 to $50 a month-for this convenient and efficient service. Everybody wins, and money is saved because fewer patients need to visit urgent care centers or the ED. Wise insurance plans are starting to pay for this medical home-focused communication and care.

Soon, smartphones and applications on other portable devices will connect us to an increasing amount of our healthcare. People will communicate with doctors' offices using new technology, and face-to-face visits will occur only when necessary. New financial models to support all of this change will replace the traditional fee-for-service practice that requires in-person visits for revenue generation.

Although we may be in the decade of "Obamacare," it also will be the decade when the process of giving and receiving healthcare changes radically, driven by Internet technologies. I'm excited about that. How about you?

The author is a family physician and vice president for primary care at Eisenhower Medical Center in Rancho Mirage, California. Send your feedback to

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Jennifer N. Lee, MD, FAAFP
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