I started my career in the late 1980s and retired just recently. I am very grateful that I caught at least a few years of the “golden age” of medicine because those years made all the difference.
Over my career, I witnessed many different efforts at health care reform proposed, attempted and failed. DRGs, Hillarycare, private insurance capitation, “To Err is Human,” Medicare fraud crackdowns, Global and Bundled payments, general reimbursement cuts, anonymous online patient satisfaction scores, “value-based” reimbursement, Obamacare, EMRs and more.
Anyone who practiced during the same time frame would have to conclude two things:
First, that the results of these health reform efforts have been either total failures or mixed at best. And second, physicians’ ability to practice has, and continues, to become much more difficult. Given the fact that we seem to be continuing down the same path, one must ask why? Are the politicians taking the path of least resistance to make it look like they are doing something even though that path runs right over us? Are politicians just insane and doing the same thing over and over hoping for a different result ?
I can imagine meetings years ago between the power players regarding the future of health care with government, lawyers, Big Pharma, and insurance companies at the table. Who was conspicuously absent? Someone to represent physicians!
Then and now, the power players face the same issues they did then. How do we control exploding costs due to rapidly advancing technology and provide it to everyone who is demanding it? After all, to the government, these people provide votes while to everyone else they provide money.
Somewhere along the line someone came up with a brilliant idea: Let’s blame the doctors! They are not represented well so, obviously, we can do whatever we want. Let’s make the case that the doctors are just milking the system. The reason health care costs so much is that those evil doctors are providing tons of low-quality, unnecessary, high-cost care just to make money. Fee for service is the devil’s spawn. Since there are always a few physicians who are this bad, we can paint the entire profession with the same brush and do whatever we want. Even though we know the quality of care is quite good, we can make the claim that it is rotten to get our point across even better.
Thus, the “Bad Doctor Theory” of health care reform was born.
The government was happy because now that had a weak scapegoat that accepted whatever was thrown at them, and they could appeal to as many voters as possible.
Insurance companies were happy because they had an excuse to hold onto the money as long as possible.
Big Pharma was happy because they were untouched.
Lawyers were happy because now they were in the perfect position to act as the “protectors.” All roads led to the courtroom. Too much care, too little care, the wrong care and the right care that did not work out as planned — every road was covered.
So with this basic belief system in place, the march through time began. If one plan fails, no problem — just try something else! We know each plan is doomed to fail. But in the meantime, we will have those evil doctors by the forcing them to continue to work until they burn out or quit, and in the meantime, save a ton of money. There are plenty of naive, gullible medical students desperate to take their place. And now they are hundreds of thousands of dollars in debt, and there is nothing they will do about it.
So here we are — the latest iteration of the “Bad Doctor” theory, MACRA and other “value-based” reimbursement shoved down physicians throats doomed to fail. No matter what, physicians will continue to work until they burn out with the latest crop of up-to -their-necks-in-debt medical students desperate to take their place, the government continuing to get more control and appeal to the masses, the insurance companies continuing to profit and the lawyers remaining untouched.
And the patients remain caught in the middle, not sure where to turn or who to blame.
Thomas D. Guastavino is an orthopedic surgeon.
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