Eliminating the 6 degrees of patient-physician separation


The federal government has been trying to control the health of citizens for nearly a century, increasingly separating patients and their physicians.

WWII wage controls firmly established health insurance as an employee “benefit” in lieu of salary.  This gave the employer power to choose coverage based on its needs, not the employee’s: the first degree of separation.

Since WWII, government has imposed a multitude of programs that add degrees of separation: Medicare, Medicaid, Nixon’s HMO Act, HIPAA, and MACRA are only a few examples.

Empowered by these programs, insurance companies profit by denying payment for care. Claim denials are often arbitrary decisions leaving patients on the hook despite already paying premiums: the second degree of separation.

Third-party payers perpetuate an absurd, inflated retail “chargemaster” price structure.  Actual payments physicians receive from insurers are even more guarded.  Patients are not made aware of costs prior to care, and it they ask are denied information, or are simply billed the chargemaster: the third degree of separation.

Physicians and facilities who participate in insurer networks are forced to accept payment rules like prior authorizations and study precertifications: the fourth degree of separation.

ACA spawned ACOs. These HMOs on steroids are financially encouraged to ration care. Physicians are being pushed into employment for ACOs becoming financial gatekeepers. This violates individual patient’s best interests: the fifth degree of separation.

The government created an epidemic of insurer and hospital consolidation leading to less patient choice and higher costs as meaningful competition fades into the past: the sixth degree of separation.

There are solutions to achieve zero degrees of separation between patient and physician.

Medicaid yields little benefit as billions of taxpayer dollars flow into the pockets of companies administering it. Charity should be a local, person to person concept, not a government to bureaucrat to HMO concept.

You don’t need to imagine patients shopping for care by quality and price. It’s already happening in a burgeoning free market medicine movement. Patients and physicians cooperate in a plethora of mutually beneficial ways, including direct primary care, bundled cash surgery packages, and fee-for-service care.

True insurance is an inexpensive tool to curb catastrophic financial loss. But government regulations prevents its sale, and we are left with junk plans with narrow networks that are more expensive than ever. There should be as many health insurance options as the industry can dream and patients will support.

Health savings accounts (HSAs) allow patients to save for medical care and must be expanded to encourage responsibility and respect for preventive health care.

Government programs create more scarcity, dependency, and despondency. Let’s remove the layers of bureaucracy that delay, deny and raise the cost of care. Strip away the partisan politics that have destroyed the patient-physician healing relationship and restore it to its sacrosanct status. Taxpayer independence, physician independence, and patient lives depend on it.

Craig M. Wax is a family physician.

Image credit: Shutterstock.com


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