Physicians Under Attack

 

Your doctor is under attack. Not by you, the patient, but by the federal and insurance industry bureaucracy that has inundated doctors with paperwork and regulations that now demand more of their time than patient care.

Grace-Marie Turner and Carol Monaco, writing in Forbes, report the conclusions of a recent conference in Washington called “The Doctor-Patient Relationship.” They report, “Rather than providing the right care at the right time through shared medical decision-making, current health care policies are driving doctors and patients apart – draining time and resources from actual patient care and appropriate medical treatment.”

The needs of patients and doctors are getting lost in the system as payment and coverage policies for medical treatment become more complicated and more time-consuming. The result is doctor-burnout and patient frustrations and delayed treatments.

According to a study released by the American Association of Medical Colleges (AAMC) on March 14, 2017, the United States faces a physician shortage of 100,000 physicians by 2030. A growing population and an increasing number of physicians retiring early fuels this shortage. To combat this problem, the AAMC is requesting Congressional approval of an additional 3,000 residency positions over the next five years.

Why are physicians retiring early?

A recent American Medical Association study found that physicians spend twice as much time on clerical and data entry activities as they do with face-to-face time with their patients. This diminishes the effectiveness of patient care and leads to physician burnout. The AMA study found that “an average of 16.4 hours of physician and staff time each week is spent on completing prior authorization requirements to get patients the medicines, medical services or procedures they need.”

That time computes to 853 hours per year consumed by prior-authorization tasks. When this time is converted into dollars, the national time cost to practices of interactions with insurance plans is at least $23 Billion to $31 Billion each year.

Billions are also spent on complying with and reporting on quality measures that physicians say are not clinically relevant to patient care. A study by the Physicians Foundation found physician practices spend an average of 785 hours per physician and $15.5 Billion annually – an average cost of $40,069 per physician per year – reporting quality measures to Medicare, Medicaid, and private payers.

The impact on physicians’ mental and physical health is difficult to calculate – but the growing physician shortage compounded by early retirements is one measure.

The Hippocratic Oath, taken by most physicians for the last 2500 years, has recently been modified to reflect this trend. The World Medical Association recently made substantive changes designed to encourage focus on physicians’ mental health. Among other changes, the following has been added to the oath:

“I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”

In this modern healthcare reform debate, too much attention has been focused on providing healthcare insurance for more Americans at an affordable price. While this is important, it becomes a mute point when the number and quality of physicians available to provide treatment is declining at a rapid rate. We must preserve the high quality doctor-patient relationship and remember that health insurance without that is an exercise in futility.

Demagoguery in the Tax Reform Debate

 

A demagogue is one who distorts the truth for political gain. While both political parties are guilty of this at times, the liberal media has allowed Democrats to use this technique much more under the Obama and Trump administrations.

Case in point is the current tax reform debate. You would think that all politicians would welcome tax relief for their constituents, especially the middle class, which is the goal of the Trump tax reform plan. But rather than let Trump score political points, they have chosen to demagogue the issue.

As I have discussed in recent posts, the latest proposal from Senate Republicans is the elimination of ObamaCare’s Individual Mandate (The Individual Mandate – Worst Tax Ever?). Rather than embrace this proposal, which seeks to eliminate a tax that unfairly and disproportionately targets the poor, Democrats are claiming it is a tax increase for the poor!

Avik Roy, writing in Forbes, exposes this misrepresentation or demagoguery. He explains that this myth comes from the distortion of a report by the Joint Committee on Taxation (JCT), a Congressional agency that estimates the fiscal impact of tax legislation. The JCT estimated tax bills for various income brackets if the Individual Mandate were repealed.

The Tax Increase Myth

The distortion comes for those in the $10,000 to $30,000 income bracket who are eligible for refundable tax credits – subsidies on the ObamaCare exchanges to purchase health insurance. If the Individual Mandate is repealed – and you voluntarily decline the subsidies – two things happen:

  • You get a tax cut because the mandate penalty has been eliminated
  • You don’t get the tax credit for buying health insurance

 

Roy explains this is not a tax increase – it is the voluntary foregoing of a tax credit. When this is taken into account, every income bracket sees their taxes reduced.

The Lost Health Insurance Myth

The second issue Democrats are distorting is the health insurance coverage after repeal of the Individual Mandate. The Congressional Budget Office (CBO) has estimated repeal of the Individual Mandate will result in 13 million fewer Americans having health insurance coverage. Senate Minority Leader Chuck Schumer has falsely claimed, “We’re kicking 13 million people off health insurance to give tax cuts to the wealthy.”

This is classic demagoguery – and Schumer is quite good at it. This simple statement has two falsehoods in it and both conjure up emotional reactions.

The first, “We’re kicking 13 million people off health insurance . . .” provokes the specter of a cruel government stealing the health insurance coverage of poor people without their consent. But this is patently false. All those people will still be able to purchase health insurance coverage, with the same subsidies they were eligible for before – but there will be no tax penalty if they choose not to purchase the insurance!

The fact that the CBO estimates 13 million Americans will refuse to purchase a subsidized insurance policy should tell you how valuable they consider these policies! The GOP plan is simply eliminating the heavy hand of the federal government that currently taxes you if you fail to purchase this insurance.

The full truth is the CBO has recently admitted its own projections are inaccurate. In a recent statement they said, “The preliminary results of analysis using revised methods indicates that the estimated effects of repealing the mandate on the budget and health insurance coverage would probably be smaller than the numbers reported in this document.”

They now estimate about 5 million people will drop out of the Medicaid program in 2026, even though the program is effectively free to the patient. This should tell you how valuable it is to be on Medicaid. Another 2 million are estimated will drop their employer-provided coverage after repeal – but that is entirely voluntary.

The second part of this false statement is “. . . to give tax cuts to the wealthy.” As stated above, no one is being kicked off health insurance, and certainly not in order to provide tax cuts for the wealthy. The main purpose of the tax reform is to stimulate the economy, to increase the number of good jobs and the wages of those jobs.

The main focus of the reform is tax cuts for the middle class (the poor are not paying any income taxes now), but tax cuts for upper middle class and the wealthy creates more jobs. These people are the small business owners that are the heart and soul of our economy – and the source of most new jobs. When they are over-taxed they avoid those taxes by changing their residences, moving their investments off-shore, and finding tax loop-holes. Everyone benefits when taxes are kept lower and the economy prospers. “A rising tide lifts all ships.”

Beware the demagogue who cares more about the political impact than the truth. It’s time the American people were told the truth.

Lower Cost Healthcare is the Solution – Not Insurance Coverage

 

Last post I said that the problem in healthcare is poor access to treatment, not healthcare insurance coverage. Today we’ll talk about the solution.

The Bureau of Labor Statistics gives us some useful information about changes in the healthcare industry between 1970 and 2010:

  • Healthcare administrators grew more than 3000 percent
  • Physicians grew by only 200 percent
  • S. healthcare spending grew by 2300 percent
  • Doctors’ fees account for only 8 cents of every healthcare dollar spent

 

Add to these statistics that since 2010, when ObamaCare was passed, the number of hospital administrative jobs created has increased by more than a million to handle the new bureaucracy. There are now 10 administrators for every one doctor.

Marni Jameson Carey is the executive director of the Association of Independent Doctors, a trade organization that represents those doctors not employed by hospitals or governments. She writes in Forbes that the United States spends far more on administrative costs than any of the next eight leading countries. She points to a recent study that concludes that if the U.S. per capita spending for hospital administration were reduced to Scottish or Canadian levels we would save more than $150 billion a year.

I’m not certain this is a fair comparison since those two countries have socialized medicine systems that have access to healthcare problems worse than ours. But she does point to the high administrative cost of healthcare in this country and that certainly is a problem.

Cost of Consolidation

The reason for this trend is the cost of consolidation. ObamaCare changed the dynamics of healthcare in a way that forces providers (especially hospitals) to consolidate. Hospitals have been purchasing physician practices, medical clinics and smaller hospitals in a wave of consolidation to improve their bottom line.

These consolidation efforts enable hospitals to charge higher fees for the same treatments previously performed by doctors in their own offices. They are permitted to add “facility fees” that private doctors cannot charge. They can control the referrals of these doctors to their own doctors and hospitals in a way not possible when doctors are independent. The result is they get paid more for the same services.

Consolidation also limits competition – which permits even higher charges. All of this results in higher costs of healthcare – but at no additional benefit to patients.

The Solution is Lower Healthcare Costs

As stated in the previous post, the problem in healthcare today is poor access to treatment. The solution is lowering healthcare costs.

Carey says healthcare costs could be lowered by these changes:

  • Eliminate facility fees
  • Mandate insurers pay all doctors the same amount for the same procedure
  • Enforce antitrust laws
  • Require true price transparency

 

Healthcare should be treated like any other commodity and let the free market determine the price. But for this to happen there must be a level playing field. Independent doctors must be paid the same amount as hospital-employed doctors. Hospitals must not be permitted to charge more than the price charged for the same procedure outside the hospital. Prices must be transparent so patients can shop for the best deals. The lowest price is not always the best deal but consumers can choose the price they want to pay.

When prices come down, patients will have improved access to healthcare. New healthcare legislation that incentivizes patients to choose the lowest cost healthcare will fuel this change through Health Savings Accounts and other innovations.

Carey concludes her article with these insights:

“Moreover, these moves, by driving costs down, would put access to care in reach. Because coverage isn’t the problem. The problem is that America is being crushed by a top-heavy system of profiteers who are exceptionally good at extracting money and convincing the rest of us that they deserve it.”