Health reform: Forward progress or a temporary dislocation?

A little over a month ago, my family of five moved to a more spacious and modern house in the same neighborhood. I’m slowly getting adjusted to our new place — the locations of the light switches, how to operate the refrigerator’s automatic ice maker, which cycle to choose among the dozen different options displayed on our high-end washing machine. It still takes me a few minutes longer to get ready in the morning, while groping through still-unfamiliar dresser drawers in novel locations. (We purchased a new bedroom set after we moved in.)

There are undeniable advantages to our new home, including central air conditioning, larger appliances, and energy-efficient windows that don’t require covering with plastic when the outside temperature plummets. But it may be a while before I think of it as home, and overcome my automatic instinct to take the turn that leads to our old house when returning from work. I know in my heart that this move is forward progress, but now it feels more like a dislocation.

Our country’s health care system is experiencing a similar sort of dislocation, driven not only by the error-plagued implementation of the Affordable Care Act, but trends that have been in motion for decades. Soaring medical technology costs and physician subspecialization have bloated health care spending to nearly one-fifth of the U.S. economy. An employment-based health insurance system that made sense when many people worked for a single company for their entire adult lives is gradually collapsing under its own weight.

The ACA’s requirement that insurers pay for a minimum set of “essential health benefits” and remove lifetime coverage limits has driven up premiums and shrunk provider networks for millions of people, even as state Medicaid expansions have made millions of others eligible for health insurance for the first time in their adult lives.

Based on the number of new patients I’m seeing in my office because “my new insurance plan won’t cover visits to my old doctor,” I would not be surprised if more Americans end up changing doctors this year than in any year before. But will they then settle comfortably into permanent patient-centered medical homes? Will newly formed alliances of clinicians and hospitals succeed in organizing themselves to provide accountable care that improves population health outcomes?

In other words, is this seemingly inexorable movement toward a brave new health system forward progress, or a temporary dislocation?

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • Mengles

    “…and physician subspecialization have bloated health care spending”
    Yes, a great way to help is to blame specialists for everything. Just wondering what the solution is here. Do you want to actually FORCE students to select primary care, so that they can share in the misery? Would you like to make it an admission requirement?

  • rtpinfla

    My opinion is that health care is inexorably marching forward to the past. I believe that in the next 5-10 years health care will be exactly like it was when I was a kid in the 70′s. Doctors and most prescriptions will simply not be covered and health insurance will mean hospitalization coverage. I think that will be a good thing too.

  • Margalit Gur-Arie

    I wonder if that “more spacious and modern house” was more expensive than the older house that needed to have plastic on the windows….. and then I wonder if we are moving from a three stories Victorian house with old leather couches and crystal candelabra, to a one bedroom health care apartment on the 12th floor, duly furnished with electronic dishwashers and fluorescent track lighting….

    • Deceased MD

      you would literally be describing academia hospitals; the buildings are hotels. or at least look like them

  • whoknows

    What i have actually noticed with the very fragmented system we have that many PCP’s are not familiar with all the specializations in their HUGE academic center. More than once I had to investigate myself and more than once I was met with misbelief. Once I finally got to the specialist it was clear how disconnected they are. And the specialists block access to their clinics by requiring internal referrals.

  • guest

    I am not entirely convinced that physician subspecialization has “bloated health care spending” nearly as much as the proliferation of millions of healthcare administrators, none of whom appear to be held to anything even close to the standard of efficiency and accountability that your average doctor is these days.

    This was brought home to me yesterday, when I had to personally call the QA managers of two separate hospitals to address the fact that their medical records departments had not sent me essential medical records on two different patients, in spite of repeated faxed and phoned requests from our unit receptionist, and even phone calls from me.

    On the other hand, if I were to ignore requests from our medical records department to complete some document (even one that I was not responsible for completing) I run the risk of being very quickly called on the carpet by the department chair and possibly being reported to the State Medical Board for “unprofessional” or “disruptive” behavior.

  • NewMexicoRam

    Healthcare reform: Multiple trauma, in the ICU.

  • Dub

    Recently my primary doc (for whom I have the highest regard)(hospital owned practice) sent me to a hematologist (hospital owned) and a cardiologist (hospital owned). The cardiologist, when searching my records said I can’t find why you are here, I responded I guess he got the memo from the hospital requiring more referrals to hospital owned specialties. The cardiologist made the suggestion I have a stress test and an echo cardiogram, said yes to the echo and no to the stress test. Made me wonder.

    My next contact with my doc was after I received a letter from the hospital stating their contract with the doc had been terminated. He is not quitting medicine and was upset when I stopped in to see him the day after I received the letter. At this time he cannot divulge where he will be practicing due to a clause in his contract. The letter did make some recommendations for other docs, all owned by the hospital.

    I suppose he was not making enough money for the hospital and the easy recourse was for them to terminate the contract.

    Again I wonder why more PCPs don’t go into a membership or retainer practice.

  • RocK8Doc

    Health care is bloated with work force that have no business or add no real value in the delivery of healthcare.

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