Restore American Health Care by Reconnecting Patient with Physician

By Deane Waldman, MD MBA - 03/03/20

The U.S. healthcare system is failing both the American public as well as Americans doctors. Fundamental change is needed but Washington keeps adjusting the financing and never deals with the root cause-breakdown of the doctor-patient relationship.

Failing both patients and physicians

In 2018, the average American family spent $28,166 on healthcare costs. More than 80 percent went to insurance companies, not to providers. For the vast majority of Americans, who are healthy, this wasted one third of total family compensation.

American patients often have great difficulty accessing timely care. Death-by-queueing-preventable demise while waiting in line for care-has been documented in both Medicaid and military populations.

U.S. healthcare harasses physicians trying to provide care with onerous, time-consuming administrative tasks, increasing regulatory burdens, and immediate guilty verdict when there is an adverse outcome, even when the doctor has done nothing wrong.

The two primary reasons to become a physician-financial gain and psychic reward-are shrinking. A doctor's income is now decided by a third-party, not by the physician, while Washington constantly lowers reimbursement schedules.

Doctors and nurses will tell you the real reason to go through all that schooling, training, time, and expense is the psychic reward of being a healer. The combination of government control and third-party payments has nearly extinguished that good feeling.

Many clinicians are no longer willing to work under these oppressive conditions. The increasing doctor shortage is more than just "troubling," it is becoming critical. Dr. Kevin Pho explains. "Sadly, there are many physicians who love their patients, and love being their doctor, but are fed up with extraneous roadblocks that make it difficult to do the job. A new electronic health record. An uptick in insurance denials. Increasingly onerous board certification maintenance requirements. Fewer support staff. Decreased reimbursements. More metrics measured without any demonstrated benefit."

Root cause of failure

Healthcare is failing Americans both medically-quality and access-as well as financially. The root cause is extension of federal control into all aspects of healthcare including the practice of medicine combined with third-party decision making

A third party, whether government bureaucrat or insurance executive, is interposed between patient and doctor, "disconnecting" them. Patients have lost their right to choose their care or decide their spending. Doctors cannot choose their patient's care or what they are paid.

Though the doctor is legally responsible, he or she does not have requisite authority, and quality of care degrades. Pharmacy benefit managers tell doctors what drugs to prescribe and which ones they cannot use. Government clinical algorithms must be followed even when they go against the doctor's superior judgment. When bureaucrats displace physicians and practice medicine, patients die needlessly.

The majority of Americans do not experience how different the "market" in healthcare is from other day-to-day commercial activities. Whether purchasing a service or a product, the consumer decides whether to buy, what to buy, from whom, and how much to pay. Service providers as well as manufacturers compete for consumers' business based on price and quality determined by the consumer, who is also payer and evaluator. Competition keeps prices down and availability high. Spending is minimized because the consumer pays out of pocket.

In the healthcare market, buyer and seller (patient and doctor) are "disconnected" by a third-party payer who is also decision maker. Consumers do not pay doctor for services provided. Thus, consumers have no incentive to save money. Meanwhile, because sellers do not compete for consumer dollars, there is no downward pressure on prices.

Figure 1: Third Party Disconnects Patient from Physician

With no incentive to economize and no competition among sellers, prices, erroneously called costs, keep increasing without limit while access to care becomes a thing of the past.

Disconnection of patient from doctor, i.e., destruction of the doctor-patient relationship, is the root cause of overspending and inadequate access.

Curing patient Healthcare

Since disconnection of patient from doctor is the root cause for healthcare system failure, the cure is reconnection. Reestablish the direct doctor-patient relationship. By cutting out third-party decision makers, Americans regain their autonomy and can access timely, affordable, high quality health care.

Figure 2: Patient Reconnects with Physician When Third Party is Removed

With reconnection, decision making, both medical and financial, returns to We the People, who are free to shop for and choose both providers and care, and pay for it from an unrestricted family HSA. The federal government should no longer be involved in healthcare and stay within the limits of authority established by the Tenth Amendment.

The insurance market should be unrestricted and return to its original function: protection against financial disaster. While sellers can offer any policies they think will sell, consumers are free to choose and likely to want simple, very high deductible, catastrophic policies.

Both personal and corporate income taxes should be reduced by the amount currently allocated to healthcare by Washington. The tax advantage currently given to employers for their support of employee health insurance should be transferred to the employee.

For the medically fragile, states should be free to devise whatever safety net will optimally serve their residents. Because of reduced federal taxes, states will have the funds necessary funds to accomplish create medical protections.

The plan noted above, called StatesCare with market-based medicine, has been called radical, and it is. Healthcare needs a radical cure before it "dies."

A good doctor chooses speed of treatment based on how sick the patient is. When a patient has a six-month history of mild abdominal pain, the physician has time to go through a careful sequence of history, physical exam, tests, review of records and literature, further tests, eventually leading to root cause diagnosis and proper treatment.

When a patient is brought into the ER unconscious and bleeding after an automobile accident, a good medical team goes into its fire drill. As quickly as possible, all at the same time, breathe for the patient, start IV fluids and blood, support blood pressure, stop the bleeding, take x-rays, identify other injuries, and rush into the operating room. If you don't use this "radical" treatment, you will lose the patient.

U.S. healthcare is critical, spending money we can't afford and wasting time patients don't have. Either we adopt a radical approach to cure patient Healthcare or more Americans will die needlessly and the country will die financially.