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The Real Problems with Healthcare

Posted by Steve Markowitz on December 25, 2013

The current focus on healthcare in the United States is on the botched government website and rollout of Obamacare.  However, it is reasonable to assume that even the incompetence of government will ultimately get the website working.  More problematic will be the reality that follows that Obamacare has not fixed any of the underlying problems of the current healthcare system and its related costs and in fact may exasperate these problems.

Dr. Chad Krisel, M.D., recently posted an op-ed in the Asheville Citizen-Times titled Missing ingredient in the ACA, posted belowKrisel proffers the view that the very limited time primary care physicians have with patients is a key problem affecting America’s health care system that is not addressed by the Affordable Health Care Act.  This forces doctors to make quick decisions affecting their efficacy and leads to overuse of medications as quick fixes.

Krisel correctly points out that medical insurance was initially never intended to cover primary care needs.  In fact it is difficult to find insurance that covers any nonmedical item that covers such incidental costs.  This quirk in medical insurance increases overhead costs by about $83,000 per physician per year.  Increased overhead cost is a key driver forcing doctors to see more patients per day thereby lowering the quality of service and its efficacy.

Krisel also reminds us that many of the “illnesses” affecting modern society are the result of lifestyle choices including some types of diabetes, high cholesterol and high blood pressure.  Given that primary care physicians currently spend only about 10 minutes per patient, they go to the quickest solution which focuses on dispensing medication prescriptions, which do not get to the root cause of the illnesses.

A solution, according to Krisel, is to remove primary care physicians from being covered under healthcare insurance.  This will lower doctors’ overheads leading to lowered costs per minute of service and improve patient care that will ultimately lower the overall cost of healthcare in the United States.

The Affordable Health Care Act (Obamacare) is a bureaucratic nightmare that does nothing to lower the overall cost of healthcare.  This is a major flaw in the program. Out-of-the-box solutions are required to address the real problems.  The suggestion from this one small-town doctor is a reasonable starting point.

Missing ingredient in the ACA? Time by Chad Krisel, MD

Now that the Affordable Care Act is off and running, I am pleased to see that many more people will be protected against a financial catastrophe due to soaring health care costs.  At the same time, I am also very dissatisfied that the root of the problem with American healthcare has been largely ignored.  Namely, the ACA does very little to address the problem of status quo primary care – the lack of time that doctors have with patients.

The problem

Insurance was never meant to cover primary care.  The very purpose of insurance is to protect from catastrophic events.  We would never think to use home insurance for a small sink leak, but would do so if there was a catastrophic roof failure.  Similar to home insurance, the place of health insurance is to protect against financial catastrophe due to unforeseen events.  As insurance has taken more of a role of paying for routine primary care, we have seen the price go up and the quality go down.

Interacting with insurance companies forces a medical practice to pay about $83,000 per physician per year in extra overhead.  This creates a need for doctors to see an excessive volume of patients to meet their overhead costs.  This is what has led to the national average office visit length of 10 minutes or less.  Very few of the root causes of problems can be worked out in 10 minutes.  We also know that as visit length shortens, medication prescription increases.  Instead of solving the root cause of problems, doctors will prescribe medication to address symptoms, which has the possibility of causing still more problems.  This practice has contributed to the dismal statistic that iatrogenic (physician-caused) deaths are the third leading cause of death, after heart disease and cancer.  Of course, medications are needed at times, but nowhere near the rate of current use.  Surely there must be a better way to do things.

Many of the current epidemics afflicting our society are preventable and treatable through lifestyle choices that we make every day.  Type 2 diabetes, elevated cholesterol, and high blood pressure are prime examples.  As a physician, it is my duty to help guide and educate people in how to prevent problems first and, when necessary, treat with modalities that have the least chance of causing harm.  If I am to address the root cause of problems, then I need more than 10 minutes.

A solution

There is a solution to this problem.  Within primary care, a remedy is to remove insurance from the healthcare interaction. This idea is being propelled by a new movement that is sweeping across the country called Direct Primary Care.  Direct meaning directly between the doctor and the patient with no third-party middleman.  We have been practicing this model at Integrative Family Medicine for the past two years.  Removing insurance from our medical practice has allowed us to increase a patient’s office visit face time with physicians by two-three times the national average.  Since we have a fraction of the overhead of a standard medical practice, we are able to cut the cost dramatically for patients.  Patients are able to enjoy an average wait time of 5 minutes since there is less patient turnaround and no overbooking.

This combination allows us to see a diverse population of patients and spend the time that’s needed to address the underlying cause of problems.  Every day, we see people who are avoiding medication altogether or cutting in half the amount of medication they need.  They are living lives in more control of their own destinies, becoming empowered about nutrition and lifestyle choices that will benefit them for years to come.

Perhaps we can work on future national healthcare policy that seeks to bolster primary care by providing patients with what they most need from their doctors.  Time.

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