The Supreme Court’s ruling on the constitutionality of the Affordable Care Act (ACA, Obamacare), gives Governor Romney a valuable opportunity to take a greater role in this debate. The ACA fails to fix the basic problems that were promised if passed- high costs and access to care. It actually exacerbates these problems. The estimated cost of Obamacare, currently almost $1Trillion more than initial estimates and growing daily, will make the already unstable financial situation that our country faces much worse. The claim that Obamacare improves access to medical care is a facade. More people may be eligible for healthcare by giving them access to Medicaid, but when 30% of doctors no longer accept Medicaid patients and even more are limiting the number that they will see, a Medicaid card is merely an opportunity for them to get onto an ever increasing waiting line.
Governor Romney has promised to repeal Obamacare if elected president, and has embraced free market principles to solve many of the problems confronting our healthcare system. He supports an open national marketplace which would allow patients the opportunity to shop on the internet for the insurance policies that best suit their needs. He understands that high deductible health plans combined with health savings accounts (currently being phased out under the ACA) will give patients more control over their healthcare decisions and spending. These measures would allow patients control of their own insurance policies and healthcare decisions. This creates more informed and responsible consumers of healthcare dollars, allowing a return to fiscal responsibility once patients are reconnected with the financial realities and implications of their personal healthcare decisions.
There is little disagreement that America’s health care “system” was in need of reform, however, many of the “solutions” embedded in the ACA are concepts that are untested or have failed historically and in recent CMS demonstration projects. Governor Romney and his team need to be circumspect and deliberate so as not to simply adopt some of these failed and unproven ideas as the debate heats up this year. Among these concepts are state Health Insurance Exchanges, Accountable Care Organizations (ACOs) and Health Information Technologies (HIT), which force the adoption of cumbersome Electronic Medical Record Systems (EMR). These all represent unproven concepts championed in Washington by lobbyists and policy “experts” with the promise of improving care and decreasing costs, with little to no input from the individuals who deliver this care- the doctors.
Accountable Care Organizations are a massive new bureaucratic twist on the failed HMO plans of the 1990s. They have been embraced by many in the hospital industry who see a chance to share in the “savings” accrued by “improving” care. In reality, it is an economic model which gives the hospitals complete control over healthcare delivery and the distribution of reimbursements to the professionals who deliver this care. Regardless of the rhetoric, just like with HMOs, the emphasis will be on maximizing profits, and the only way to do so will be by restricting services to patients. Under this arrangement, physicians are agents of the hospitals and are no longer working for the best interests of their patients.
Health Insurance Exchanges are huge, complex and expensive state bureaucracies designed to regulate economic activity. They are the antithesis of a free market system; rather they highly regulate choice and limit the advantages of being able to shop in an open market for quality and price, just as we currently do for auto insurance. The Exchanges are simply unnecessary, are very expensive to establish and maintain and represent a burden to already stretched state budgets. This concept is in direct conflict with Governor Romney’s desire to allow people to freely choose their own health insurance. The arguments favoring exchanges are specious and have been championed by those who are most likely to profit from their creation and management.
Insurance regulation is necessary and can be accomplished more efficiently and at less cost on both a state and regional level, leading eventually to the changes required for a true national competitive market.
The American public, including politicians and Washington bureaucrats had been led to believe that the adoption of Health Information Technology including EMR systems would be the “cure” for all that ails our troubled healthcare system. However, medicine is exponentially more complex than the banking and credit cards where computerized systems have revolutionized these industries. For a host of reasons, the unproven claim that EMRs would prevent medical errors, make medical records more accessible, result in more efficient healthcare delivery by eliminating redundancy, and do just about everything short of curing cancer, is simply false. There are some great benefits in the management of large volumes of data electronically, however, there is currently no electronic interface that is more effective or more compassionate than your doctor with a pen. The need to complete all of the fields in an EMR actually detracts from patient care. The only reasons for the EMR currently, is to monitor compliance, fulfill certain criteria to justify payment and to comply with government requirements. When a truly useful system is created, every doctor will wait in line to purchase it, just like we do when Apple releases the latest iPhone. The winners in this boondoggle are those who profit from implementation of this nascent technology in healthcare while the losers are the doctors who are forced to purchase expensive, poorly designed systems, and the patients whose doctors’ attention is diverted away from them and given to complying with cumbersome documentation requirements.
Governor Romney can distance himself from President Obama on healthcare by developing a health system reform platform that relies on trust of the American consumers and their physicians, instead of erecting artificial barriers and obstacles that further erode the physician-patient relationship. A leader like Governor Romney with a lifetime of business experience is poised to collaborate with the working physicians of America to set a more hopeful and constructive healthcare course for the future.
Hal C. Scherz, MD is the Founder and President of Docs4PatientCare, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.