Assignment 16 Luke de Castro

         Healthcare has become a hot button issue in America. Obama passed sweeping legislation to extend coverage to Americans, and President Trump is trying to eliminate these expansions. This debate is over how people access the American healthcare system, not what kind of system they should be accessing. Yes, the former is important, but the latter is just as pressing. The problems with US healthcare extend beyond just lapses in insurance. They include high costs and worse outcomes than most other developed nations, which can be attributed to fee-for-service models of payment and lack of preventive care.

         Preventive care through an increase in primary care doctors would drastically change and improve the way we treat patients. Our current system of healthcare is great at emergency response and highly technical surgeries, but oftentimes, these systems are insufficient for improving health. Why should a person endure a high-risk heart surgery when their diet was the original problem? According to the documentary Escape Fire, over 75% of healthcare costs go to chronic, preventable problems, and the earlier these problems are caught, the less they cost (Escape Fire). Preventive care comes in the form of lifestyle changes or similar treatments, which include exercising more, changing diets, or altering a stressful work schedule. Traditional medicine is still extremely important to healthcare, but early prevention like these lifestyle changes are often cheaper and free of dangerous side effects.

         The main force behind preventive care is primary care doctors. These general practitioners attend to patients’ day-to-day problems and help coordinate more serious ones with the specialists. However, Jamie Koufman in a New York Times article states that only 1/3 of doctors are primary care doctors (Koufman). People mistakenly see specialists for their everyday needs rather than a primary care doctor, which causes uncoordinated treatment for the same problem. An obese person might see multiple specialists to fix different symptoms like heart issues or skin rashes. While these doctors will happily address the symptoms, they often don’t address the underlying cause: their obesity. A primary care doctor would better coordinate these different specialists as well as prevent the problem before the patient even needs that heart surgery (Fernandopulle). Primary care doctors help prevent diseases and reduce future costs.

         Although primary care doctors hold great potential to provide all the benefits I described, they are hampered by the current fee-for-service payment model. This model stipulates that doctors get paid for the services they provide be it an expensive surgery or a cheap check-up. This means that specialist doctors are paid more for providing pricey, sometimes unnecessary, services, and primary care doctors are paid less for a check-up. The only way for primary care doctors to increase their pay is by increasing patient volume, which reduces the quality of service they provide. A new, better model would be one that rewards doctors for improved patient health, not just patients seen. Hospitals would receive more reimbursements based on patient experience and improved health. (Aroh). This would allow patients to have a better experience with their doctor and receive the treatment that truly fits their needs, not just the most profitable one.

         With primary care doctors providing preventive care, people still need to afford to go to the doctor. Too many people are waiting for their health problem to become an emergency before seeking help. A federally funded, single-payer healthcare system might be the answer here. The insurance system works by individual insurance providers bargaining for prices with hospitals and other healthcare providers. The more people on an insurance plan, the more bargaining power that insurance has (“The real reason”). A national insurance policy also would not seek the high profits that current insurance agencies do. This model already works in Europe where hospitals adhere to a national price list. The government decides how much it pays for every procedure, and with the whole country on the insurance, hospitals would have to accept these prices. This ensures the people receiving the healthcare have the best price and the best care.

         So what’s stopping these changes from happening? The biggest reason is that the medical industry is extremely powerful due to decades of American overspending. It pours billions of dollars into lobbying each year to protect the status quo. Pharmaceutical companies don’t want you to seek preventive care solutions because they have a pill to push. Hospitals don’t want to offer cheaper treatments because they profit on unnecessary procedures.

         The solution to rising healthcare costs isn’t expensive or necessarily difficult. Preventive care, more primary care doctors, and better payment models are all cheaper and more effective ways to maintain this nation’s health. If we say no to medical lobbyists, we could drastically improve health care for everyone, for it’s not just how people access healthcare, it’s what kind of healthcare they access.  

Works Cited

Aroh, Dianne, et al. "An Example of Translating Value-Based Purchasing into Value-Based Care." Urologic Nursing, vol. 35, no. 2, Mar/Apr2015, pp. 61-74. EBSCOhost, doi:10.7257/1053-816X.2015.35.2.61.

Escape Fire. Directed by Matthew Heineman and Susan Froemke. Lionsgate, 2012.

Fernandopulle, Rushika. “More or Different? Rethinking the need for increasing the supply of primary care physicians in the light of health reform.” The Blue Shield Foundation, January 2013, blueshieldcafoundation.org/sites/default/files/publications/downloadable/More%20or%20Different_Jan_2013.pdf.

Koufman, Jamie. “The Specialists’ Stranglehold on Medicine.” The New York Times, 3 June 2017, www.nytimes.com/2017/06/03/opinion/sunday/the-specialists-stranglehold-on-medicine.html.

“The real reason American health care is so expensive.” YouTube, uploaded by Vox, 30 Nov 2017, www.youtube.com/watch?v=tNla9nyRMmQ.