Dear President Trump,
I have been watching your activities over the first month of your presidency with great interest and admiration. I applaud you for the energy that you have brought to the office and your desire and willingness to speak with experts representing groups that you need on board to make America great again. So you might understand why I am both puzzled and disappointed that despite the fact that healthcare and Obamacare repeal are top tier issues, you have failed to bring in the true experts who might give you real insight into the problems and possible solutions- doctors in active medical practice.
The choice of Congressman Tom Price for Secretary of Health and Human Services is excellent, because only someone with his background as a doctor, a legislator and a healthcare policy expert, can properly rehabilitate the healthcare system. He is the best possible person for this job. The fact that his confirmation was stalled for so long by Senator Ron Wyden and his Democratic colleagues, demonstrates the complexity of the problem. Politics aside, he and so many others in Congress are beholden to special interests that stand to lose a fortune if the changes necessary to return healthcare back to the patients are implemented. Insurance companies, for example, have made billions of dollars since the inception of Obamacare, thanks to changes that they had a hand in crafting. The industry has contributed over $600K to Senator Wyden’s campaigns over the last 5 years, and they have given the same or greater to other members of Congress. It is not surprising then, that a health care “solution” coming from Congress means a “replacement plan” that still allows the insurance companies to maintain their primacy in health care.
As the health care debate rages on, please remember that no one is actually discussing health care. The conversation is exclusively about insurance and coverage.
The real problem is that not a single replacement plan for Obamacare nor a single health care “expert” addresses the true cost of health care, which is obscene. There are many reasons why the actual cost of care is so high. Heading that list is the third party payer system, which is how the insurance industry took control of health care in the first place. This system disconnects patients and doctors from the true costs of care. There also exists a perverse payment system which pays more for care delivered in hospitals than for identical services outside of the hospital. Inasmuch as the hospital is the most expensive place in the health care delivery system to deliver care, it should come as no surprise that health care costs continue to soar. Moreover, Obamacare has created an environment where care is being driven into the hospitals while putting private practice doctors out of business. If you are the champion of small business as you claim, this should infuriate you.
I recognize that it is important to solve the insurance mess created by Obamacare, but addressing this alone will do very little to drive down costs, which were in large part the excuse for the creation of the misnamed, Affordable Care Act. The real key to driving down costs is to create an environment where patients can find value for their health care dollar and receive quality care. Quality cannot be measured by checking boxes, which is how Washington bureaucrats have addressed this issue. Health care is not expensive to provide. It only becomes so when doctors have to wade through red tape created by bureaucracy in order to take care of their patients. Or when the care delivered in hospitals costs five to 10 times the amount that it would cost at competing outpatient facilities such as the Surgery Center of Oklahoma, recently featured in a Time magazine article.
Eighty percent of health care can be delivered by primary care doctors. The fastest growing health care delivery model (except for hospital employment of doctors) is Direct Primary Care. This is “concierge medicine for the average Joe” because it costs less than a monthly cell phone bill and gives a patient their own doctor who will see them as often as necessary. The sickest patients can get the care that they currently are not receiving.
Although not a federal but a state issue, Certificate of Need laws restrict competition in the health care marketplace and exist because the federal government gave funding to states to adopt these laws. CON laws, which exist in 35 states, prevent the establishment of new facilities like surgery centers, hospitals, radiology or laboratory facilities without state approval. But before approval is granted, existing facilities must sign off, which of course never occurs. Health care costs will never come down until the playing field is leveled and the shackles are taken off of doctors who have the know-how to deliver better care for lower prices.
My hope and that of thousands of doctors, is that you will recognize that there are real health care experts taking care of your constituents, who know the problems better than the self-proclaimed experts. Please show them the same respect you have given to leaders in other industries and understand that the well-being of their patients is what drives them, and not allegiance to any special interests. Let us help you solve the real problems in health care.