Providing healthcare to all is a noble goal. Providing choice, however, is an entirely separate issue. Successful partnerships between doctor and patient are developed over time. These partnerships do not happen easily and most, just like a long standing marriage, take a great deal of work. As I have mentioned in previous blogs, when patients are engaged and participate in their care, outcomes are improved. It is easy to see how costs can be lowered through improved outcomes–the focus is shifted to prevention rather than “salvage”.
Last week in the Wall Street Journal, author Anne Mathews discusses the issues surrounding “choices” in the healthcare marketplaces that begin functioning in October. Many insurers are making “deals” with hospitals and physicians–they will be included in their plans as preferred providers if they are willing to settle for pre-negotiated lower reimbursement rates. Many major healthcare systems such as UCLA in California, Rush and Northwestern in Chicago and Vanderbilt in Tennessee are being excluded as preferred providers in many plans due to the fact that they are unwilling to accept the terms dictated by the insurers. These institutions, and many others like them, employ many of medicine’s leaders in patient care and research. Many patients have developed long standing relationships with physicians at these institutions and are now forced to make a “choice”—either continue with their preferred provider at an increased out of pocket cost or change physicians and start over in their new healthcare plan.
Starting over with a new physician is a lot like divorce. Divorce is not easy–it is fraught with uncertainty and can be emotionally painful. It is difficult to face change when so much time has been invested in building a productive doctor-patient relationship. However, with the pending implementation of the Affordable Care Act (ACA), patients are now being forced to choose between a doctor they trust and lower insurance premiums. Physicians and hospital systems are being forced to accept payments at whatever level the insurers choose to dictate–irrespective of the cost of the procedure or the staffing and overhead incurred. Once again, the reform of healthcare in the US is doing little to assist the patients who need help the most. Instead of working to build relationships, streamline care and focus on prevention, the ACA is forcing “divorce” proceedings on many doctors and their patients. Moreover, the “choice” that is supposedly supplied by the pending healthcare exchange marketplaces will be severely limited when they open in October. The government cites a lack of time to prepare for the healthcare law rollout–Others cite a poorly thought out, complicated and unworkable plan. More than a dozen ACA “deadlines” have already been missed and there will certainly be more to come.
No one argues that the current healthcare system in the US is on life support and badly in need of reform. However, the current ACA plan is not the answer. Based on the basic tenet of coverage for all at affordable prices, the ACA is not living up to its billing. Now, as the law begins its rollout process, many of the finest academic medical institutions in the country are not going to be accessible to many Americans due to contractual issues with the insurance industry. Ultimately this will create more of a medical care divide in the US. Academic teaching hospitals provide cutting edge care and access to new potentially life saving technologies before these are available in the mainstream. Those with rare diseases or those with disease processes that have failed other treatments often turn to academic institutions such as Vanderbilt, UCLA and Rush for experimental therapies that may provide hope for a cure. Now, as long as the healthcare exchange plans are able to dictate which physicians and institutions are included in their respective plan, only the wealthy and privately (non government exchange or marketplace) insured will be able to have an opportunity to participate in ground breaking and potentially life saving clinical trials. Ultimately patients will suffer. Ultimately human beings will be denied potential life saving therapy–all because of limited choice and the coverage “assigned” by insurance companies hoping to limit cost–but at what price?