Healthcare Reform Needs to be Top Priority for Presidential Contenders

By Jason Fodeman, Sentinel Doctor and a practicing physician in Philadelphia

Recently the Department of Health and Human Services announced that the premiums for the Affordable Care Act (ACA) plans will increase by an average of 25 percent next year. While the numbers are striking, particularly for a law that was implemented to lower health care costs, they are by no means surprising.

During my final year of medical school in 2009, I took a break from the rigors of medicine and spent some time in Washington, D.C. as a health policy fellow. As Democrats and Republicans debated health care reform, there was much discussion how to bend the cost curve. However, there was very little discussion as to why health care costs so much to begin with.

As a physician, I know that in order to best help my patients, finding the right cure is dependent on discovering the right diagnosis. As such, I imagined diagnosing the etiology of rising health care costs would be crucial to find our nation’s health care cure. Thus during my time in Washington I studied and researched the drivers of exploding health care costs. Ultimately, the research concluded that the disparate theories may in fact be interconnected and a major cause of increases in health care spending relate to a third party payer system that typically insulates physicians and patients from cost at the time of consumption.
According to the Congressional Budget Office, out of pocket health care spending fell from 52 percent in 1965 to only 15% in 2005. It is likely no coincidence that as this has happened, health care spending has increased substantially with real per capita health care expenditures increasing approximately six-fold over this same period.

As this happened, health care has become inundated with lawyers, regulators, consultants, and administrators with more and more resources being devoted to the administration of medicine and less and less to the practice of medicine by highly educated, trained, and devoted doctors and nurses.

Quality medicine has become replaced with quality documentation and quality box checking with a system that treats patients like a car moving down an assembly line. Unfortunately, this approach to cost control and quality assurance generally did not work in medicine before the ACA, and certainly does not work now as it becomes even more ingrained into our health care system under the ACA.

The problem is that patients are individuals with varied backgrounds, perspectives, needs, and desires. Different patients can also respond very differently to medical interventions and treatments. They are not machines.

By burdening, the health care system and providers with new mandates and taxes, the ACA has expanded and worsened many of the challenges facing our health care system. The ACA and its advocates correctly identified concerning symptoms like rising health care costs. Yet, the cure is predicated on the wrong diagnosis, and we are starting to see the effects of that error.

Keeping that in mind, it is no surprise health care premiums are soaring. It is also no surprise that physician dissatisfaction and physician burnout already at very high levels are escalating as well. Research published last year in Mayo Clinic Proceedings found that from 2011 to 2014 physician burnout had increased from 45.5 percent to 54.4 percent.

This should not be a political issue. Efforts are needed to bend the cost curve down and improve quality. The needs of patients are way too complex, variable, and unique for one-size-fits all top-down regulations. Instead policymakers should sponsor policies that remove barriers to and facilitate local solutions that empower patients and physicians to better use scarce resources to tackle rising health care costs and the challenges facing our health care system.

*Originally published in The Hill, click here.

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