With all the demagoguery between this election’s presidential candidates, few details have surfaced about the future of our health-care system and the role physicians will play in those changes. The political decisions that affect health-care are being made with little physician oversight or insight. In fact, in the most recent 2016 Survey of America’s Physicians, 54% rated their morale negatively, 49% felt burnt out and 80% reported that they were so strained that they felt unable to see more patients [1].
In 2015 alone, the uninsured rate dropped 5% and the number of new patients with health insurance knocking on physician doors increased by approximately 20 million people [2]. Yet, with physicians owning the greatest stake in caring for all these new patients, why aren’t more practicing physicians involved in driving health-care reform?
Few training programs for physicians offer any health economics or public health education to help physicians understand the increasing complexity of the US health-care system. That needs to change. Meanwhile, the rising cost of medical school education has left physicians graduating with massive amounts of debt [3]. They also have unrealistic expectations, fueled by the rhetoric of a generation of older, more affluent physicians—who are in turn bitter at losing a very profitable health-care system that had rewarded them for the quantity of the care they provided over its quality.
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Physicians are the workhorses of the American health-care system. Yet they seem collectively ignored in health-care reform discussions. Often, their only representation is by physician advocacy groups. But those groups function much like our representatives in Congress, in that they’re frequently backed by corporate interests and their allegiances can be questionable [4].
Young, et al. argued that while public opinion played a role in getting health care on the political agenda, the true stakeholders who had the most significant influence on actual policy making were the corporate interests—the pharmaceutical, insurance and hospital industries [5].
There is no doubt that our pre-reform health-care system wasn’t working well for the whole of America, and that physicians were profiting. It covered fewer people, was costing our citizens more than citizens in other developed countries and did not provide better outcomes than countries that have universal health-care coverage or single payer systems [6]. In 2010, the American health-care system was ranked 37th in the world (NEJM) by the World Health Organization [7]—an unbefitting ranking for such a great nation.
With the implementation of the Affordable Care Act (ACA), the Census Bureau reported a sharp decline in the rate of the uninsured. An additional 8.8 million people gained insurance coverage between 2013 and 2014. This, in and of itself, is a success—but not without new problems. Only 25% of physicians have given the Affordable Care Act a favorable rating [1]. The reason is twofold.
First, the ACA increased the number of people seeking access to health care in an already overburdened system that was ill equipped to take on more patients. Note that 81% of physicians felt “overextended or at full capacity.” Well, they felt that way before the ACA was ratified. Then along came a new surge of patients with decreasing reimbursements; increasing regulatory requirements imposed by the ACA; forced implementation of electronic medical records (EMRs) that not only work poorly, but also cost a fortune and disrupt workflow; increased time-wasting nonclinical paperwork; and more hostile relationships between a growing number of hospitals and insurances companies—the true beneficiaries of the new health-care system.
The corporatization of health care isn’t a novel concept. But the ACA has acted as an enzyme that accelerated the “corporate buyout” of our health-care system. For example, the insurance industries claim that they’re losing money. That complaint seems at odds with their stock price history since the time ACA took effect. In fact, with ACA, these companies have managed to raise enough capital to buy each other out, leaving much of the multitrillion-dollar industry controlled by 3 major insurance companies [8]. This is a testament to the efficiency of the ACA catalyst.
