I have been a doctor for twenty years, but I’m also a patient. We are all patients. This summer, my previously mild heart rhythm problem got a lot worse. By July, I was having frequent episodes of heart rates four times normal, causing me to almost lose consciousness. It was dangerous and scary. I consulted with a highly specialized doctor to fix this for good. He threaded four wires to my heart, mapped out the electrical pathways, and burned the part triggering the problem. This is not a procedure that would likely happen at all, much less on demand, in another health care system. Instead, I would be given a pill like the one I tried, which made me sick and didn’t work anyway. This doctor didn’t learn his skills from an online course. He trained for thousands of hours with his hands to fix my heart so I can keep working all five of my jobs. Besides a physician, I am a mother of four children, an air force spouse, a business owner, and a vaccine researcher.
Just two days prior to my procedure, my son also had a surgery by a sub-specialist at the university to reconstruct his eardrum. It was done to stop hearing loss and disability. But this would likely not be considered necessary in a socialized system. We must not allow America to deteriorate into socialized health care.
As a patient, I want the freedom to choose my doctor: Truth be told, I am a little picky about which physician is going to stick wires in me and burn up a piece of my heart!
As a physician, I want my patients to choose me because I am smart, passionate and because they trust me, not because I was the only one their insurance network would allow. Employer-based plans with mandated “bumper to bumper” coverage are expensive and clumsy. The current system, ironically named the Affordable Care Act, has restricted patient choice and led to high out-of-pocket costs for those who most need good and affordable care. If we let Democrats double down on this flawed system or worse, move to health care for all, it will mean choice for none.
In order to build a personalized health care system with patient choice, we must have price transparency. Just like I present risks and benefits prior to a procedure, a patient needs price and value information to make choices. Price transparency is desperately needed for every aspect of our health care supply chain. Health care is the only area of our financial lives in which we spend huge sums of money – ours or someone else’s – with the least amount of information about what it is we are purchasing. It makes no sense.
At my office, I provide some of the least expensive and most valuable products and services to patients: primary care for chronic and acute conditions, preventative care, and prescriptions. Because all patients need primary care, these universally-needed services should not be a part of our insurance-driven system. That is not “insurance.” Insurance should be to cover unexpected and super expensive events. What we call “health “insurance” is really just an extremely inefficient form of pre-paid health care.
Who wants coverage for all? These vertically integrated systems of insurers, hospitals, PBM, and other middlemen that drive up costs and decrease patient choice. Patients and physicians are “locked-in.” Why do these systems fight so hard against published prices? It’s because keeping patients in the dark is the key to keeping profits high. UnitedHealth doubled their profits to $6.6 billion in the second quarter of COVID – during a worldwide pandemic.
Opaque practices and pricing are a means to keep patients from being real consumers and physicians from being wise stewards of resources. Price transparency is an essential first step to lower cost and waste in our system.
Speaking of physician choice, if the unmitigated spread of physician replacement continues, there will not be enough physicians to choose from. I value nurse practitioners and physician assistants, and there is an important place for them on our team. But they are meant to assist physicians, not replace us. Physicians have around 20,000 clinical hours before independent practice, a years-long process.
A nurse practitioner can get an online degree in 1.5 years and just 500 clinic hours, of highly variable quality. There is any old saying, “Time takes time.” There is no replacement for months and years of training and experience.
There is no doctor-replacement that I would accept to rewire my heart or to harvest skin and cartilage to rebuild my son’s eardrum. Over half of the states in the US allow these clinicians to practice independently. For obvious reasons, the medical-industrial complex has eagerly pushed for a cheaper workforce that is easier to control. But only physician-led health care will maintain high quality, cost-efficient care.
Lower drug prices
Making pharmaceuticals affordable for my patients is another passion of mine. In 2017, I was stunned to find out that middlemen in the supply chain mark up drug costs by 60 to 80 percent, collect “legal” kickbacks, and push those high prices to the bottom line for patients at the pharmacy counter. I was dumbfounded. How could this happen?
It is crony capitalism at its finest – legalized grift. Three mega-rich companies called PBM or pharmacy benefit managers have been consolidating their positions and driving up prices since 2003. Why? Because they can. Because Congress created the loopholes. There has been safe harbor for PBMs since 2003, based on a bill giving the same legalized kickbacks to group purchasing organizations since 1987.
I should not have to spend half my time in the exam room trying to figure out how to get insulin for my patient. I should not be paying for three full-time staff members to process paperwork and make phone calls to insurance companies who are denying the prescriptions I have determined are best for my patient. Insulin is a life-sustaining medication. It is unconscionable that prices for the same insulin Eli Lilly created in 1997 have skyrocketed exponentially higher than inflation. All this because of a rigged market, bloated entitlement programs, and greedy middlemen.
The way forward
American health care will work best when physicians are free to practice medicine based on their experience and training, and not on the dictates of bureaucrats, public or private. It works best when patients – being fully informed on basics like price and quality, and free to make choices – free to make their own health care decisions.
I do believe we can fix it, and the answer is not Medicare for all.
We need full transparency and empowerment of patients and doctors to make wise decisions. We must renew and restore the sanctity of the patient-doctor relationship. We need to stop pretending that health care can be “free,” stop calling premium price prepaid care “insurance,” and use market forces like choice and competition to cut our bloated costs. “Insurance” needs to “insure” against the unexpected, not pay for the routine.
I am a proud independent physician. Taking care of patients is what I know. It is what I do best.
Get the government and the insurance company out of my exam room and let us all do what we do best. Patients will be the ultimate winners.
Mary Tipton is an internal medicine-pediatrics physician.
Image credit: Shutterstock.com