Doctors have lost faith in politicians supporting a real health care fix

While politicians have largely fallen silent regarding health-care reform, patients continue to suffer under the growing fissures in our current healthcare system.  Many bills were introduced into the halls of Congress during 2017 and they all failed to gain significant support. We watched these proposed regulations build momentum and then fizzle out. But did any of them even address the problems patients are facing?

Many politicians called for a repeal and replacement of the Affordable Care Act (ACA) or ObamaCare as it is commonly known. Was the ACA an adequate solution to the woes we are now facing? Obviously not. Patients are paying higher premiums and footing the bill for extravagant deductibles.

{mosads}Many plans now resemble catastrophic coverage only plans where the insurer will only pay in the event of a true disaster. For many people, this is a heavy burden to bear. Tough decisions are being made regarding medical care and many patients are now self-rationing because they cannot afford the care they need.

Another issue our lawmakers failed to address is the fact that third parties have kidnapped the system. Third party insurance companies seemingly stole medical decision-making capabilities out of the hands of doctors and patients alike.

A patient will only get an MRI if the insurance company allows it. The guidelines they use to determine coverage for diagnostic tests is murky and archaic, often using decades old evidence. Those guidelines are  not readily available to the treating clinicians and often a decision as “not medically necessary” is expected to suffice as a reason for not covering a service. Insurance companies pretty much hold free reign with little oversight, while at the same time reaping profits from the medical services they deny.

Why are no politicians calling out this clear conflict of interest and demanding more transparency from these companies? One can only speculate how many health-care dollars will be saved and/or better spent if true transparency happens into the business practices at these huge companies where the CEO’s earn tens of millions of dollars annually?

Pharmaceutical companies operate in a similar fashion, with little oversight or transparency. In fact, when a new medication comes to market, those companies basically hold a monopoly over their products.  Many medications, even generics, are largely unaffordable. Insurance companies having been greatly narrowing their formularies over recent years.

Recent studies show that many patients are not taking all their medications or skipping doses, just because they cannot afford to take them as prescribed. We all saw what happens when pharmaceutical companies are driven for profits instead of patient care in the examples of the Epipen suddenly rising to hundreds of dollars as well as Martin Shkreli raising the price of a toxoplasmosis drug over 1000 percent.

But, what about all the other examples that we don’t see? Where is the cry for pharmaceutical companies to make their business practices transparent as well? As a doctor, I am at a loss when a mother asks me how she is supposed to get her child’s asthma inhaler when her insurance company doesn’t want to cover any.

While patients and doctors struggle to survive these inhumane conditions, politicians try to refine how Americans will get health insurance coverage. They neglect the fact that coverage does not equal medical care. Rather, it is increased revenue for insurance companies when more people buy their products. You have to wonder why these lawmakers are looking out more for insurance companies’ interests than that of patients.

Some people hold out hope that a fix is coming. But, as for physicians, the majority of us do not believe there is any chance that it will come from our lawmakers. In a joint survey of over 1,000 U.S. physicians, approximately 73 percent do not have faith that any political party will have any impact on improving patients’ access to appropriate health-care (as opposed to health-care coverage).

Until our lawmakers recognize the real problems in the health-care system, no real reform will happen. We can debate the ACA for years, but the truth is that it ended up costing more than anyone expected it would without fixing all the problems it set out to do. However, repealing it at this point without a clear replacement is reckless.

Did the ACA solve any problems? Yes, it did such as prohibiting the pre-existing clause many insurance companies wrote into their policies excluding certain patients from receiving medical care. But, we are still facing many more. The only repair will come when lawmakers put aside their political agendas and open their own minds. Will this ever happen? According to most physicians the answer is no.

Linda Girgis M.D. is a family physician and an assistant clinical professor at Rutgers Robert Wood Johnson Medical School. She is an author and and a medical adviser for Physician’s Weekly and SERMO