Why socialized health care is not right for America [PODCAST]

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“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.

She shares her story and discusses her KevinMD article, “Why socialized health care is not right for America.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Mary Tipton. She is an internal medicine-pediatrics physician, and she wrote the KevinMD article “Why socialized health care is not right for America.” Mary, welcome to the show.

Mary Tipton: Thank you so much, Kevin. It’s great to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Mary Tipton: I would be happy to. I’m a med-peds physician in the Salt Lake City area, in a southern suburb. I own a medium-size private practice, and I have for the last 15 years. I also have four children and an amazing husband who helps me manage all that. He’s a full-time dad and a part-time Air Force reservist.

Let’s see. I also do primary investigative research, mostly for vaccines, and a few years ago I became more involved in local and national politics, specifically health care reform. I was increasingly interested in trying to make health care more accessible and affordable for my patients.

I was lucky enough to connect with some like-minded physicians. It started in a Facebook group, but I now work with several national groups of physicians, and we believe that health care should be personalized and not partisan. Health care reform should be led by physicians, and that’s what I’m trying to do.

Kevin Pho: The number of physicians who have private practices has been slowly declining over the years. Tell me what you think are some of the biggest challenges to staying in private practice.

Mary Tipton: There are lots. This year, though, I’ve seen a lot of the benefits as well, because we’re able to be a lot more nimble and responsive during a pandemic and less constrained by bureaucracy. But the challenges are essentially the bureaucracy. There are just so many regulations that you have to keep up with.

It’s hard to compete sometimes for good staff and physicians, because a big corporation like the University of Utah here can say, “Oh, we can provide tuition for your medical assistants.” We can’t provide tuition as a private practice, so we have to provide other benefits to make them come to us.

But there is just a lot. There’s a lot of pressure, and physicians are tired. You know, it’s busy just to be a physician. A lot of physicians don’t want to be businesspeople. They don’t want to run a practice, understandably. So a lot of people have kind of given up, I think. They think it’s impossible to do private practice, so they become employed.

Kevin Pho: So talk about the flip side. What are some of the benefits of staying in private practice today?

Mary Tipton: Oh, the benefits have been many, especially during the pandemic. We were able to switch to telemedicine within a week. We’ve been able to pivot very quickly to provide testing for our patients, way before other large corporations in our area were able to manage that. We set policies that match our patient population, our current levels of COVID, and that sort of thing, and we can change them when we need to.

So the benefits really are that added ability to adjust to the market and to serve your patients, and to not have to go through, you know, five meetings and someone worrying about what other people are going to think to make a change.

Kevin Pho: And if you were to do it all over again, would it be private practice or an employed model?

Mary Tipton: Definitely private practice.

Kevin Pho: All right. So let’s transition now into your KevinMD article. It’s titled “Why socialized health care is not right for America.” This is a question that we’ve been debating in health care policy for decades now as we try to fix our American health care system. For those who didn’t read that article, can you walk my audience through it and share the story of why you decided to write it?

Mary Tipton: Yes. Last year, mid-pandemic, like always happens, we had health care needs. I needed to get an SVT ablation. I was having episodes of heart rate over 200 and passing out in dangerous places, and I needed that. My son needed reconstruction of his eardrum, and that was something that was going to need to be done by a highly specialized physician. So we wanted to get these things done. It happened to be during a pandemic, but we got them done close to home. We had a highly trained physician help us, and we got excellent results.

At that same time, my sister, who currently lives in England with her five children, had to fly here just to get her son a tooth pulled. A 6-year-old could not get into the dentist to get a tooth pulled for a repeated abscess, for which she’d had repeated courses of antibiotics with no success. So she had to fly all the way to Utah to get a tooth pulled.

Just the dichotomy, you know, between that socialized health care system and our privatized health care system in being able to respond to a pandemic was the basis of what I started to say, why one of the main problems in socialized health care is the inability to accommodate, you know, problems like a pandemic. That became kind of obvious personally, and I decided to write an article about why socialized health care is not the answer to our health care system’s problems.

Kevin Pho: Of course, in the United States, we’re not without our many, many problems in our health care system. Specifically, we don’t have universal health care. Not everyone is covered by some type of health insurance, and that is an advantage that socialized health systems have. So what do you say to that?

Mary Tipton: The main thing being that coverage is not care. Everyone in England right now still has coverage, but very few have care. There have been staggering delays for people trying to get care. I was just reading an article that routine hospital care, you know, surgeries like a gallbladder, the waits are 100 times longer now in England than they were before the pandemic. I mean, about 12 months is what it used to be for gallbladder surgery, and now it’s 100 times that. It’s essentially not even possible to get care there.

So coverage doesn’t equal care, and we’re increasingly realizing that, and yet we have not been very good, I think, at coming up with solutions for that. I feel like the main things that we need to have in whatever system we go forward with. I’m not specifically, you know, advocating that one thing we do is wrong or right exactly at this point, but we’ve got to look at three main issues. We have to figure out how we can provide quality, still high quality, but have lower costs and maintain choices for our patients.

I mean, I don’t know about you, but I’ve never heard of anyone traveling to a country with socialized medicine to get care. People come here. Here is where we have the highest quality.

Kevin Pho: There are several charts that I’ve read: The United States also, you know, has the highest cost in the world. Like 20 percent of our GDP is funneled to our health care system, and I’m sure that a lot of us have seen those charts comparing administrative costs in the United States to other, say, single-payer health care systems, like in Canada, for instance. So what is your opinion in terms of how we can decrease costs in the United States?

Mary Tipton: I agree. Cost is the crux of everything. If we already have high quality and we want to maintain it, the main factor that’s preventing us from being able to do that forever, I guess, is this spiraling cost. We can’t continue to dedicate or utilize more and more and more of our resources to pay for really excessively priced health care, beyond maybe what the value indicates. You know, like the charts you said: Why do we spend so much and then maybe not get as much as we should for that dollar?

What I’ve found by looking into this and learning the things I have in the last few years is that we have a big problem with middlemen in our market, and a lot of the prices are just basically jacked up because we have increasingly consolidated markets, no transparency of these prices, and patients don’t have the ability to choose and maybe make choices that would create a balance between value and high cost.

You know, if you were just given the choice to have a car and someone said, “Well, you can have a car, whichever one you want,” if you didn’t have to pay the cost, you’d probably just grab the Ferrari and say, “Well, why not?” But in every other market in our country, we have a balance where we can choose cost versus value, and we don’t have that in health care.

So I think price transparency is the key to lowering costs. Unless there’s a connection between the consumer and the provider of services, there’s just not going to be a market-based adjustment. Price transparency is one of my main focuses because I believe it will lead to some of the other improvements, where patients could say, “Oh, yeah, I don’t need that. I’m not going to pay that highest-price thing, because it’s not going to provide me that much added benefit.” But the problem right now is that we don’t have price transparency. We also have a broken supply chain and high drug prices, and those just add to the high insurance prices.

Kevin Pho: Some patients, when they go to the hospital, if they go to the emergency room, are just not in a position to choose based on price. So how can we help those patients who have high health care costs when they go to the hospital for an emergent reason and they can’t choose based on price? How can we help these types of patients?

Mary Tipton: Yeah, that’s a good question. There has to be some crisis care. You know, just like with your car, you may not choose bumper-to-bumper coverage for every little thing. You don’t need it for the oil change, you don’t need it to fill the gas tank, but you need it when you get in a crash, and you didn’t know that was going to happen, and everything gets wrecked. So high-deductible crisis insurance, truly, is reasonable. I feel like there has to be some way in our market that we do have coverage for those emergencies.

But it’s been found that 85 percent of health care expenses are shoppable. You know, they are planned: like my ablation, like my son’s surgery, like most dental care. Just 85 percent, and people can’t even do that. So if we could transform to at least have options in the market where people could shop for the things they can shop for, and then get insured for crisis and emergency care at a much lower price point than we have right now for these Cadillac plans, then we could have some sort of balance and decrease overall cost and lower waste.

Kevin Pho: So you mentioned price transparency and having catastrophic care as two of the pillars that we need going forward. What other changes would you recommend for our health care system if you were to design the ideal health care system?

Mary Tipton: We definitely need to have, like I said, patient choice. Currently the system, the Affordable Care Act, has restricted patient choice, because there are so many really high out-of-pocket costs for those who want good and affordable health care that they can’t make the choices. And it’s through their employer, so they don’t have a choice of which plan they get, or even, you know, how much it costs, and they’re really not paying those costs.

So patient choice is going to be essential. In that case, we really need to get insurance companies out of the focus of the whole thing. I mean, everything is focused, like you said, on coverage and on insurance, and yet insurance does not equal health care. If we could somehow remove, like I said. The sanctity of the whole process, I think, is that physician-patient relationship. And so I’m always at odds in my exam room, sadly, with my patients, discussing what I can and can’t do for them and what the barriers are for care, because they’re not paying me, and I’m not able to provide them, you know, directly something that they want, the value that they want, because of this third-party payer.

So insurance, I believe, has been sort of the solution, but now it’s part of the big problem, because we need to be able to allow options. I mean, if there’s a public option that we have at some point, that could be good. We need something, you know, like you said, to cover the urgency. But if we choose things like the Medicare for All policy that was proposed, it outlaws privatized health insurance. I mean, that would be devastating and change our complete landscape of what we have.

So if we do have some, you know, network, which we need, to capture indigent care and some sort of basic health care, then that can’t exclude private health care and private practice, I guess, or direct primary care, which is also a very good example. You may have talked to some of your early podcast members about things that can solve this. So a direct relationship between the providers and consumers, that’s key.

Kevin Pho: In your ideal health care system, what do you envision the role of government to be?

Mary Tipton: I guess minimized. One thing I wanted to point out: I really believe that people think a government-run system would solve some of these perverse incentives and things that exist. But I have found in my experience that that’s not the case. Government health care now is basically privatized. Medicare Part D was ushered in under the Bush administration, and they’re making millions. The Affordable Care Act is just a pipeline of money from Medicare programs that are all privatized and managed by private businesses, basically.

They just funnel money to those businesses and those cronies, at the dime of all of us in health care, you know, taxpayers. So government should be less involved, I guess, or maybe it’s hard to say, but the problem is that our current government is a crony system.

I mean, our current government, how do you encourage these government officials to not continue down the same road when they’re basically bought and sold and paid for by big business, you know? They have lobbying. Almost all HHS secretaries have transitioned to be lobbyists after, and that tells you something. So the current Congress and politicians are getting a lot of money for maintaining the status quo and doubling down on health insurance-heavy and care-for-all policies, you know, because that funnels the money to the same people. Not to the government exactly, but to the government, who gets money from private companies, if that kind of makes sense.

So I think people think, “Oh, by choosing the government or the socialized health care system, then we’ll get away from this, you know, crony capitalism.” But our current system is crony capitalism, and I have no reason to believe it would be different. So I’m just afraid that people are not going to get what they think they’re going to get. They’re going to choose this and say, “Oh, yeah, government’s going to be free from the influence of these perverse incentives,” and yet why would it be? It’s been the same for 20, 30, and it’ll probably just be more of the same.

Kevin Pho: Now, does government have a role in terms of negotiating drug prices? I think that’s one of the things that was previously restricted in Medicare, that Medicare wasn’t able to negotiate its own drug prices. I think that’s a big mistake.

Mary Tipton: I think I agree. It’s asinine. It’s like, wait, they’re a huge consumer, we pay the bills because we are the taxpayers, and they can’t negotiate drug prices? I mean, that was a backroom deal made by Bush and Part D Medicare that he agreed to. [Remark removed by the editor.]

So a lot is broken in our system, and it’s been manifested on both sides of the aisle for a long time. And unless, I think, physicians who are like me. I have no conflicts of interest. I go to D.C. and talk to lawmakers, and I don’t get a penny. It is all funded by me. I’m a private practice mom of four in South Jordan who just wants to help my patients and get government out of the exam room. So I should be a more valid or unbiased type of opinion, I believe, and I’m trying to make my voice a little bit more heard, because certainly the other voices and politicians that have so far shaped our system are heavily conflicted.

Kevin Pho: Now, what’s your opinion of the Affordable Care Act? If you had a choice, do you feel like that’s something that needs to be repealed, or is it something that could be built upon?

Mary Tipton: I don’t think repeal is a good mantra or really going to be popular. A lot of people really like a lot of the fundamental parts of the Affordable Care Act that helped them. You know, we definitely need to have pre-existing conditions protected. People like to have their children covered up to age 26. So repeal is not something that I have pushed or opted for.

I just don’t think we should expand upon it, and I think we need to emphasize that these disruptors in the system be allowed to continue, whether that’s direct primary care, whether that’s, you know, independent physicians being more than employed physicians, so that people can speak out. I just want, you know, a robust system where the patients can choose and the market can kind of self-select to maintain quality, keep costs lower, and provide good health care. So I wouldn’t say repeal, or necessarily replace, maybe just modify and have other systems alongside that compete with it.

Kevin Pho: One of President Biden’s promises is to introduce some type of public option eventually into the Affordable Care Act. Do you think that’s a step in the right direction?

Mary Tipton: I do not. I think it’s what I said. I think it’s a doubling down on policies that have just made the rich people in health care and the broken supply chains more powerful and richer, and it would really be the same. And a public care option would definitely, or could really, reduce.

As an employer myself, I have 50, 60 people, and I pay a lot of money to provide health care to my employees. Why would any business continue to provide private health care if there was a cheap public option? They would say, “Well, I’m pushing everyone to this public option.” And then why would physicians continue to provide care if they get paid less and less?

So we’re going to have a problem where there’s a public option, but it’s not quality, or it’s not, and we’ll have a two-tier system. That’s what’s happened in many of the other socialized countries. I mean, as you know, people in England, people in other countries, they pay for the doctors, and everyone else gets everything else, which is not fast or good.

Kevin Pho: We’re talking to Mary Tipton. She is an internal medicine-pediatrics physician, and she wrote the KevinMD article “Why socialized health care is not right for America.”

Mary, I want to pivot now into physician advocacy, and that’s something that I’ve been talking about on my blog for years now: Physicians need to be involved more in health care policy, because any health care decision that’s made on a political level is going to affect our lives as physicians, and of course the lives of our patients as well. What are some ways that you could recommend that physicians can become more active in the policy arena?

Mary Tipton: Thank you for asking this question. I think it’s very important. Just because I’m in private practice, I have been able to speak up a little bit more. I’ve learned that I can just write something, and maybe people will read it. I share information with my local and even national politicians, and these politicians don’t know anything about health care. They really don’t. They want to hear from physicians, and so do patients, because they trust physicians.

You know, trust in Congress, for example, is at an all-time low, but trust in physicians is at an all-time high, probably, in most cases. So your opinion and your information are valued. You know, my patients look to me to know what to do about this COVID vaccine. They look to me to know a lot of things. And so that power is a great responsibility, but it should be utilized, I think, because then you can share with patients.

So I’ve been involved, like I said, in local and national things, and speaking out is one way to let people know what you think. But it is hard when you’re not in private practice, I’ll tell you that. A lot of physicians are basically muzzled these days by their corporations, and they’re afraid for their jobs. So I think a drawback to emphasizing the physician voice is the increasing employed physician status.

Kevin Pho: And when you talk to your physician colleagues about becoming more involved politically or advocating on behalf of physicians, what’s their interest level generally in doing that?

Mary Tipton: Fairly low, to be honest. People are afraid. And physicians especially, we have had a rough year, right? Like, what is one last thing? I mean, I’m just like everyone else, super busy. And I think they’re afraid to get involved. They’re afraid of what people would think, and they’re afraid of the time commitment. So there are definitely a lot of barriers there. But maybe, like people who were brave to help me, to show me how I could use my voice, maybe I can be like them and show other people the same thing.

Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?

Mary Tipton: I believe we’ve got to keep the incentives aligned. We need more models where Americans, and not insurance companies, and certainly not government, can make the rules. We need a health care system where people are free to choose their physician and where physicians are free to practice medicine based on their experience and their training, and not the dictates of bureaucrats, public or private.

It’s going to work best when we’ve got patients who are fully informed. If they know about prices, if they can make choices based on price and quality, they can make their own health care decisions, and it will be better for everyone and cheaper for everyone. So I do believe we can fix this, but I really, really believe that we should be extraordinarily cautious about the basically socialized direction that our current administration wants to take things.

Kevin Pho: And how can people reach you?

Mary Tipton: I am available on Twitter, @MDTiptonMD. I’m also involved, like I said, nationally in a group called Free to Care. That’s “free,” then the number two, then “care.org.” This is a coalition of private citizens and also physicians who want to push some of these principles and really fight for our patients. So I encourage you to look at both of those options.

Kevin Pho: All right. Thank you so much for sharing your time and insight, and thanks again for being on the show.

Mary Tipton: Thank you so much.

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