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The author is a family physician in Tacoma, WA, and a member of the <i>Medical Economics</i> Editorial Board
Medical Economics editorial board member Richard W. Waltman, MD, shares his opinion about the Supreme Court 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 Richard E. Waltman, MD, said.
I applaud the Supreme Court ruling.
Since my specialty is geriatrics, my practice has been greater than 75% Medicare for a long time. Although I share the usual concerns about reimbursement, I must say that Medicare works well for most of my patients. I am able to provide them the care that they need and am usually able to make timely referrals.
I struggle more now with my patients who have private insurance, in terms of getting approval for testing I know they need and finding "preferred" specialists and surgeons.
Based on my experience, I am a "Medicare-for-all” advocate. We have a system that is already working well, and I see no need to create anything else. Let's offer Medicare to everyone. Those who want "better care" (concierge medicine) can pay additionally for it.
I do believe as well that a strong primary care focus to our health care system is vital. A large portion of my patients see only me, with occasional visits to the dermatologist or to the ophthalmologist. I send them to specialists when they have an acute problem when I need help (usually tests) or for a complicated decompensation of a known problem. I truly believe I can take care of their chronic problems better than can my specialty colleagues. I see no benefit in a yearly visit to the cardiologist, to the pulmonologist, to the endocrinologist, or to the rheumatologist for a patient who[se condition] is stable and doing well under my care.
Let's encourage medical students to enter primary care, let's train them well, and then let's provide them fair reimbursement. The wide discrepancy in compensation for physicians must stop. Some of should be been getting paid more, and, sorry to say it, guys, but some of should be getting paid less.
Primary care physicians should be rewarded not only for the work that they do but also for the cost savings they bring to the system.