On October 26th, 2014, “the New York Times,” published an article called, “Is the Affordable Care Act Working?” Naturally the report begins with emphasis that more people are insured.
At least the Times mentioned that over half of those newly insured are from Medicaid enrollment and also noted that 3 to 4 million young adults are insured thanks to changes where parents can insure their grown children which was accomplished prior to Affordable Care.
The article is better than some because it at least brushes with reality noting that subsidies helped make insurance affordable for some while others saw costs rise. The article also notes that meaningful data about actual care is sparse and that slowing down healthcare spending is merely a “perhaps, but mainly around the edges.” (10/26/2014, “The New York Times,” “Is the Affordable Care Act Working?”)
But the article fails to mention meaningful data for consumers that speaks to issues of money and care, two important aspects of consumer experience that should certainly be relevant to an affordable CARE act.
While it is too early to determine with data whether our care improves, stays the same, or worsens under the act, the text of the act, its provisions and our experience likely will mirror the act’s strong adherence to insurance industry guidelines that focus on prevention rather than more costly treatment and taking away coverage to preserve affordability—meaning the traditional formula of more expensive and/or less coverage.
Certainly the evidence-supported conclusions of the article point to what we already knew, more covered individuals by spreading costs of such coverage to taxpayers, privately insured and parents of young adults…quality of care unknown, costs up for some individuals (down for others), spending really not down, and the healthcare industry got more paying customers, (10/26/2014, “The New York Times,” “Is the Affordable Care Act Working?”)
There is evidence that we consumers have gotten the message: Obamacare is a massive law designed to spread around a little bit of coverage to many while charging those most in need of health insurance coverage (those in need of medical care and treatment) more through increases in cash payments required for copayments, coinsurance and for those with unsubsidized premiums.
An October 2014, “New England Journal of Medicine,” article addresses, “Public Trust in Physicians — U.S. Medicine in International Perspective,” Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero, M.P.H., N Engl J Med 2014; 371:1570-1572October 23, 2014DOI: 10.1056/NEJMp1407373, http://www.nejm.org/doi/full/10.1056/NEJMp1407373.
In that article, The New England Journal of Medicine discusses recent research that indicates that US citizen trust in our healthcare system is at about 23% and that the US ranks near the bottom of 29 industrialized nations researched in that category. The study notes, “We believe that the medical profession and its leaders are seen as a contributing factor,” (http://pnhp.org/blog/2014/10/24/improving-trust-in-the-profession/).
There was an anomaly in the results. 56% of adults polled in the US said they were “satisfied” with the care they received. As reported, “Of the 10 countries that rank lowest in public trust…all but the US also rank 19th or lower in patient satisfaction,” Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero, M.P.H., N Engl J Med 2014; 371:1570-1572October 23, 2014DOI: 10.1056/NEJMp1407373, http://www.nejm.org/doi/full/10.1056/NEJMp1407373.
So, we’re satisfied with our care but don’t trust our healthcare system and providers.
The article recommends that physicians should “deliberately take visible stands favoring policies that would improve the nation’s health and health care…” specifically regarding “high costs,” as a means of raising trust levels to the higher percentage of US citizens satisfied with care. I agree that cost is crucial in understanding the anomaly, but I disagree that “taking a stand,” is likely to improve physician trust numbers.
The article is designed as food for thought for physicians about preserving their authority in healthcare decisions and warns that without improving trust physicians are “likely to find that many policy decisions affecting patient care will be made by others, without consideration of their [the physicians’] perspective,” NEJM, 10/23/2014.
The research explains the seeming anomaly of low public trust yet high satisfaction (note, satisfaction is not that high at 56%...a little over half, NEJM, 10/23/2014, but certainly better than the 23% with confidence in the health system) as possibly due to a variety of factors but does indeed recognize that “…nearly two thirds of the public (65%) believes these costs are a very serious problem for the country,” http://pnhp.org/blog/2014/10/24/improving-trust-in-the-profession/.
Loathe to address how much they’re charging, physicians will likely contribute to the full demise of their credibility.
Consumers are saying what the problem is pretty clearly, “The care we get is satisfactory much of the time (56%) but few of us trust our healthcare system (23%) likely because we believe we’re paying too much (65%).”
No amount of spin will budge those facts and more rhetoric designed to manipulate consumers also will likely fail.
But there’s more at risk for physicians than having others take the lead in medical decision-making and that is that is the risk of consumers going from feeling they’re charged too much to feeling that their treatments are being manipulated to maximize profits which will erode the 56% satisfaction with care.
It’s not an impossible scenario and physicians have certainly contributed to the problem by making money the priority in discussions of health. Sure, money has always been an issue, but the perception used to be health first, money second and now that is reversed oftentimes.
For example, physicians blabbed about defensive medicine the practice of protecting themselves financially from claims of negligence, admitting to putting patients through unnecessary treatments and tests. While the discussion included tort reform, obviously it showed a new face of medicine, wallet first, patient second.
Then we have many physicians who go off-insurance, not accepting insurance plans—maximizing their profits by avoiding accepting a “negotiated” rate with an insurance company. Anyone trying desperately to cling to some old-time notion of a healer would have a hard time fitting such physicians into their mold.
More and more instances of whether care is worth it have been codified by Obamacare often penalizing practices for going the extra mile with patients where outcomes are deemed likely to be “poor.” This likely means that the most desperate among us will have reduced choice and unspeakable expense in pursuing a “chance” even if they’ve decided they have the strength to pursue that chance.
These are dollar-priority decisions that while in existence before Obamacare, now dominate discussions of treatment creating an environment where asking who is worthy of our best medicine has moved us farther away from notions that healing should at least be the primary goal of healthcare.
Today, few if any consumers would react to a patient claim that a doctor pushed for a more expensive procedure and test as crazy. That’s a credibility problem for physicians.
But a bigger problem for physicians is that mistrust of what we’re being charged by providers will ultimately lead to mistrust of how we’re treated, after all, there are two ways to preserve money, earn more and spend less…whether it’s in substandard medical supplies used, or treatment on the cheap, or something else.
More than taking a “stand” is required, though hearing patient care thrown in as more than afterthought in enriching our healthcare system would be helpful.
For consumers, return to policy and practice that incentivizes greater group coverage and group plans that truly negotiate with providers for best rates in exchange for more customers would be better than Obamacare which incentivizes individual plans and plan selection.
Obamacare has decimated group insurance, the strongest power citizens had for trading lots of customers for a cheaper rate by creating mandates and taxes in order to fund the artificial “marketplace” created by the subsidy and Medicaid expanded entitlements of Obamacare leaving the majority of Americans paying higher prices for needed medical care in order to fulfill the imaginary idea that simply having insurance regardless of its quality could somehow improve healthcare.
Physicians could be advocates in this task of supporting policy to encourage group insurance and by simultaneously leading their professionals against the practice of not accepting insurance plans, Medicaid or Medicare “…even if doing so might be disadvantageous to some physicians,” NEJM, 10/23/2014.
