Repairing Our Broken U.S. Healthcare System

We commonly hear that healthcare in the U.S. is broken, but it is not the healthcare itself that is broken but the financing and administration of healthcare. More than just broken. Severely broken. The question is how can the problems be fixed. We just need to look at who controls our healthcare and how that control is done with threats from Washington DC, managed care, big pharma, and the 3000 percent increase in healthcare administrators. I wrote about the danger of these growing healthcare entities 30 years in my book Modern Medicine: What You’re Dying to Know.

I’ve written on Substack before on the takeover of physician decisions by corporate entities in “Big Business Medicine” and “Let Them Eat Cake.” I’ve been interested in this topic for 30 years. I recently read  a LinkedIn newsletter by Dr. Robert Pearl who writes about this topic frequently. He has suggested several solutions for repairing our healthcare system:

• Shore up primary care. (expand)

• Use technology to expand access. The ACA, (Affordable Care Act,) quadrupled the cost of health insurance for the average family. More of that later.

• Reduce disparities in medical care.

These are good suggestions. But how can we bring about these needed changes. Fixing big pharma, the Center for Medicare and Medicaid Services (CMS), insurance payers, and managed care is horrendously complicated. These three problems are systems problems. Problems which would require cataclysmic changes in how the U.S. healthcare system operates. 

The total annual cost of healthcare in the United States is approximately $4 trillion. If we decided to stop paying all physicians, the bill would go down to 3.7 trillion. So, doctor’s salaries are not the cause of our overly expensive healthcare system. If doctors can be blamed for something, they should assume the responsibility for simply failing to say no to the outrageous erosion of medical care over the last
50 years caused by removing medical decisions from physicians and turning those decisions over to insurances, managed care companies, and big pharma.

A simple solution which would be effective immediately would be for CMS and all insurances to make the electronic medical record (EMR) half as complicated as it is, requiring half as much time for physicians to complete. As simple as this sounds, this  would essentially double our healthcare workforce, increase provider and patient satisfaction, and decrease physician “burnout.”

Certainly reducing the time physicians spend filling out the EMR would free up physicians to actually see patients and provide medical care. Part of this approach involves relieving physicians from the noose of prior authorizations from payers. Payers should not be allowed to negate the medical diagnosis and treatment of physicians. Doctors often spend hours trying to get a payer to authorize a treatment. This prevents doctors from seeing many patients in a given day, denying access to care for patients who need the attention of a physician.

Another huge problem with our healthcare system is the belief that the collection of data is somehow more important than providing patient care. There is a strong and common belief that complex and abstract processes can be accurately transposed into a series of numerical codes. Those who receive the codes think the codes are accurate, have some meaning, and based on the collection of this data, perform endless but meaningless “evidence-based” studies.

This data, any way you look at it, represents a subset of the patients being studied because patients are complex. I’m not saying the studies are not useful. I’m only saying that as a physician, for example, I know the complexity of managing a woman in labor to a successful and safe delivery. No data filtered for a few of the elements involved in a labor will represent the entire spectrum of decisions involved. The results of the study may well be evidence-based, but that does not make the research results somehow correct all of the time.

 It certainly would be difficult to argue with Dr. Robert Pearl’s suggested goals for helping to repair the U.S. broken healthcare system. Any improvement in the dysfunction and expense of our U.S. healthcare system will only come with the removal of the interference of corporate medicine, government, and big pharma preventing physicians from making medical decisions in the best interests of their patients.