Return the Soul to Medical Care and Thereby Lowering Costs
Why graduate with a degree in Chemical Engineering, leave it behind, and apply to medical school? I wanted to deal with others as they truly were and NOT their pretense of how they wanted others to see them; when people are ill, they tend to be sincere when relating to a physician. I envisioned a conversation reflecting shared respect, such as, “A conversation of mutual exploration has a generally complex topic of genuine interest to the participants……Everyone participating is trying to solve a problem…. All are acting on the premise that they have something to learn” (Ref.1,2). Importantly, if I studied hard, which I did, graduating with honors, I hoped I could provide my patients with the best available care at that point in time. But for that to happen, even as a specialist, I had to develop a truly meaningful patient-physician relationship. A successful patient-physician relationship is known to improve the health of the patient and consists of trust, knowledge, regard, and loyalty (Ref.3). I found great satisfaction in developing this relationship with my patients. As an example, as a nephrologist, I offered optional evening discussions about the benefits and difficulties, both medical and emotional, of chronic dialysis, with the patient having the option of stopping at any time. I initially expected few to participate, but almost all did attend.
This type of personalized care, the soul of medicine, was possible in the early 1980s, before the mass consolidation and corporatization of the medical industry, caused in large part by a federally imposed non-market artificial payment system (Ref.4). As a result, physicians became mostly employed by large impersonal entities with corporate economic demands. This has severely negatively affected the closeness of physicians’ relationships with patients (Ref.5,6). Unfortunately, government attempts to control run-away healthcare costs by removing the patient from control of the funds have failed, partly by creating a massive bureaucracy that consumes about one-third of all healthcare costs (Ref.7,8,9). Because of corporate financial needs and government-mandated decreased reimbursement rates, doctors are forced to see an increasing number of patients/per day, further impeding the patient-doctor relationship and changing the healthcare model to financial rather than patient-centered (Ref.10). Government-mandated electronic medical records emphasizing administrative issues imposed without physician input require an inordinate amount of time contributing to physician burnout (Ref.11,12).
The answer to this impersonal care and accelerated costs that are causing a drag on our economy is to return the medical buying power to the patient. This would re-establish the patient-doctor relationship while the individual, aware of costs, would spend less. Americans should have the CHOICE of present options OR of expanded health accounts. Using these accounts, individuals would pay cash for routine physician services, testing, and drugs, along with nationally available private catastrophic insurance for high-priced items. These accounts would be funded with means-tested federal/state deposits replacing Medicaid, CHIP & the ACA, employers’ pre-tax contributions, and actuarily adjusted Medicare deposits minus bureaucracy costs (Ref.13).
The advantages to these options are many. Those who wish to stay with their current healthcare plan can do so. But for the uninsured, this option ensures that 100% are covered and have equal access to care. Those employed could receive their health benefit directly into their health account, saving considerable middlemen and bureaucracy costs. This would require Congress to extend the employer healthcare tax benefit to the employee. Medicare recipients choosing to control their healthcare spending from their health account with its accompanied catastrophic insurance would insist on price transparency and value.
By individuals directing their own care, a trusting patient-physician relationship would be re-established, while physicians would be paid market value, providing better access to care for the entire nation at far less cost.
1. Andy Golder, Crystal Ro, 26 Things Americans Always Say, And What They Actually Mean, Buzz Feed, September 22, 2019, available at: https://www.buzzfeed.com/andyneuenschwander/what-americans-say-vs-what-they-actually-mean-a
2. Jordan B. Peterson, 12 Rules For Life: An Antidote To Chaos, Random House Canada, 2018, ISBN 978-0-345-81604-7, p. 253
3. Fallen E. Chipidza, Rachel S. Wallwork, Theodore A. Stern, Impact of the Doctor-Patient Relationship, PubMed, October 22, 2015, available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732308/
4. Karyn Schwartz, Eric Lopez, Matthew Rae, and Tricia Neuman, What We Know About Provider Consolidation, KFF, September 20, 2020, available at: https://www.kff.org/health-costs/issue-brief/what-we-know-about-provider-consolidation/
5. Thomas R. Cole, The Rise and Fall of the Doctor-Patient Relationship, Houston History of Medicine Lectures, January 4, 2012, available at: https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1009&context=homl
6. Ron H King, Medicare Cuts Beg the Question: Do Doctors Know How to Make ‘Good Trouble’?, Med Page Today, December 27, 2023, available at: https://www.medpagetoday.com/opinion/wiredpractice/108024?xid=nl_mpt_DHE_2023-12-27&eun=g414653d0r&utm_source=Sailthru&utm_mediu
7. Medicare Finances: A 2023 Update, Center for Retirement Research at Boston College, May 23, 2023, available at: https://crr.bc.edu/medicare-finances-a-2023-update/
8. NHE Fact Sheet, CMS, gov, December 13, 2023, available at: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
9. Jeff Lagasse, Healthcare paperwork cost U.S. $812 billion in 2017 4 times more than Canada, Healthcare, January 17, 2020, available at:https://www.healthcarefinancenews.com/news/healthcare-paperwork-cost-us-812-billion-2017-4-times-more-capita-canada
10. Fact Sheet: Underpayment by Medicare and Medicaid, American Hospital Association, February 2022, available at: https://www.aha.org/fact-sheets/2020-01-07-fact-sheet-underpayment-medicare-and-medicaid
11. Marion Mass, Kenneth A. Fisher, Why Your Doctor’s Computer Is So Clunky, Wall Street Journal, March 20, 2018, available at: https://www.wsj.com/articles/why-your-doctors-computer-is-so-clunky-1521585062?mod=article_inline
12. Nannette Hoffman, If You Really Want to Save Time, Free the Doctors, WSJ, Letters, January 2, 2024, available at: https://www.wsj.com/articles/if-you-really-want-to-save-time-free-the-doctors-55e07015
13. Avik Roy, Obama Administration Denies Waiver for Indiana’s Popular Medicaid Program, Forbes, November 11, 2011, available at: http://bit.ly/2t4vNUH
You are an old timer like me- I finished my ophthalmology residency in 1983. Those were the golden years. with excesses so obvious when billboards advertised a free roundtrip plane trip to California for bilateral surgery if you would simply thank your Florida eye doc for making the diagnosis. There were multiple instances of kickbacks to optometrists in exchange for referrals to the cataract cowboys. It was so obvious Pete Starke and co. had to put a stop to it so we are now paid less for a cataract (in equivalent dollars) than we were in the 1990’s………and it still drops every year!! No adjustment for inflation!
Most of my specialty has now changed to a fee per uncovered service model, throwing in high tech lasers and premium lenses in hopes of extracting cash from all the baby boomers now due for cataract surgery.
Your essay makes me wistful for the old days. Capitalism has fully corrupted our government. Your other essays have been spot-on. EHR is so wasteful and is now a mandatory crutch. What ever happened to interoperability? I signed up for the “free Practice Fusion” and I am now paying $149/month. I do not know how many more years I have left but I still simply enjoy what I do and I saved the money from the past. I do not look forward to getting older and looking for medical care…..where I live in rural Florida the NP’s are everywhere and I demand a real doctor!
“Capitalism has fully corrupted our government.” Disagree Gary. True capitalism by definition cannot be corrupt. The corruption was from government being involved in health care, and exceeding its proper bounds. Government never should have had a role in paying for retiree cataract surgeries, and demagogues like Pete Starke were the corrupt ones for padding their own accounts by denouncing others.
EHRs are not mandatory.
Ummmm, When I practiced, the administration at the group practice where I was at said the gubbermint made EHR mandatory. So I guess the admin screwed us. I did crib notes and dictated my records so other doctors (or lawyers for a matter) could clearly see what I did. I made the transcriptionist type into the computer for me.
Typing is a fricking “waste of time.”
Making doctors “type” into a computer their notes is the most inefficient waste of their time. I dictated and a transcriptionist typed into the computer for me and I signed off later. It sucked as it took a lot of time.
I am soooooooo glad I was able to retire from practice. Yes, I miss some of the patients I had who cooperated with me and had good outcomes. Geez, I run into some of them at WalMart and they tell me how much they miss me!
DO NOT! I REPEAT, DO NOT go into primary care. It was good in the old days but now it’s really bad!! Efffff EHR!
I disagree with the means testing. If you want unity all should get the same benefits and disadvantages. Then it becomes the national plan. We already have multiply progressive income taxes, and means testing just becomes an increased bracket for the mildly affluent and pennies for the truly rich.
A national sales tax or a VAT should help pay so everyone continues whether those working under the table or other illegal income.