With the Republicans in Congress sharpening their knives against Obamacare, and President Trump predicting repeal-and-replace by March, the war of rhetoric over American health care is taking place in newspapers and cable-TV debates, not in the medical trenches of the doctor’s office. Don’t get me wrong; my patients have opinions, some for repeal and some against, but the daily concerns of their illness and recovery matter most. Disease is neither left nor right — it is dead-center and all-consuming. Few of my patients are clinging steadfastly to Obamacare’s government-regulated policies marred with roadblock deductibles, soaring premiums, or narrow choices, and few are openly campaigning for the Republicans’ proposed state-run high-risk pools, Medicaid reform, tax credits to buy more-flexible policies, or Health Savings Accounts. But all patients, left or right, are seeking more time with their doctors and more immediate cures.
From a doctor’s perspective, it is not a given that insurance will give you access to the care you need. This was true before Obamacare but is worse now. Fear of illness may cause you to buy a comprehensive policy, and Obamacare regulations may demand it, but that doesn’t mean the latest personalized treatment will be covered.
Keep in mind that health insurance was first developed in the 1930s to make sure you didn’t go bankrupt when you were hospitalized for a heart attack or stroke; it wasn’t intended to have the nimbleness to respond to every possibility. Today’s doctors are overwhelmed with regulations and documentation, today’s patients with waiting times and coverage that doesn’t quite cover.
So what is the solution? Clearly we need more flexibility, choice, and price transparency throughout the health-care system. The current overstuffed Obamacare policies lead to skyrocketing premiums, which are largely absorbed by government subsidies (80 percent of the policies on the state exchanges are subsidized), insulating patients from the true cost of their policy. Patients are also insulated from knowing the true costs, or even the contracted lower rate that their insurance company pays, for a blood test or an x-ray. In fact, the only price my patients are aware of is what they have to pay out of their own pocket for co-pays, or when their deductible kicks in.
Last week I asked every patient who came to see me to guess the price of the test I was sending them for. All guesstimates were way below the actual price. I wondered if my patient would have gone for a precautionary x-ray if she had known that it actually cost $300. The radiologist found a slight bony abnormality on the inside of her foot (the sprain was on the outside) and ordered a CT scan — again as a precaution — for $900 (covered by insurance) — which was normal. Would the patient have agreed to that test if she had to pay for it?
Patients everywhere are understandably afraid of getting very sick and dying, but insurance converts this into a false sense of protection from illness. Doctors also over-order tests for fear of being sued.
What is needed is a bridge to a more flexible national insurance marketplace, coupled with medical-malpractice reform.
What is needed is a bridge to a more flexible national insurance marketplace, coupled with medical-malpractice reform. Because the state exchanges are propped up by subsidies paid for by 21 Obamacare taxes and the individual mandate, the transition needs to be gradual (beginning with removal of the medical-device tax, the individual mandate, and the required health benefits). Introduction of catastrophic-style policies will lead to lower premiums and the need for fewer subsidies. More taxes can then be removed.
The new HHS secretary, Dr. Tom Price, has promised to restore the central importance of the doctor-patient relationship for medical decision-making, as opposed to making decisions based on insurance or government edicts. This is something that all doctors long for.
In the meantime, the doctor’s office struggles along with too many insurance regulations and too few choices to fit the emerging new technologies and treatments. If my patient with the sprained ankle had to pay for her x-ray or CT scan out of a Health Savings Account she would have thought twice. And I would think twice before ordering these tests if I knew I could avoid a lawsuit for an extremely unlikely finding. We all hope and pray for a better future, which is in reality a return to a less regulated past.
— Marc Siegel is a professor of medicine and the medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.