Editor's note: This article is part of a multi-page special report, 8 Ways to Fix the Affordable Care Act.
The politicians in Washington have struggled and failed to come to an agreement about how to fix the Affordable Care Act. Now it's time to call the doctor. Because you can't fix the healthcare system without involving the physicians, nurses and others who are at its very heart.
“Would you want to fly in a plane with no input from a pilot?” Matthew Moeller, M.D., a gastroenterologist, asked in a post on the popular doctor’s blog KevinMD. “Or design a curriculum without a teacher’s input?”
Throughout the fight over the ACA, physicians—or at least the medical organizations that represent more than half a million frontline doctors—have stood in opposition to plans that would result in patients losing healthcare coverage.
Doctors want a healthcare system that supports the physician-patient relationship that drew most of them to medicine in the first place.
While they are strong advocates for their patients, doctors can still make a difference in controlling costs. If you want to change the "more is more" culture in medicine, doctors can help.
Physicians are the ones who order tests, write prescriptions, hand out referrals and perform complex treatments. They can adjust their clinical practices to accommodate cost considerations without shortchanging patient care.
Does a patient with high blood pressure really need to come to the doctor’s office every 3 months? Wouldn’t it make economic sense to teach a capable patient how to check his or her own blood pressure at home and fax or email results into the office?
In fact, some of the most revolutionary healthcare reform ideas center on doctors. For example, Jody Tallal, a personal finance manager, says the country could ensure healthcare for low-income Americans by offering tax credits to doctors. Instead of reimbursing doctors through Medicare and Medicaid, the country could provide a dollar-for-dollar income tax credit to doctors who provide care for the poor.
Many doctors like the idea of a single-payer system, even if it’s a pipe dream for now.
Fred N. Pelzman, M.D., of Weill Cornell Internal Medicine Associates in New York City, for instance, says it’s time the country moves toward providing Medicare for everyone in order to provide a baseline level of care, which could be supplemented by private insurance for those who want and can afford it.
"This country needs a safety net that is a little less exclusive,” he says. “You should be able to get the care you need and if you want to see the world's greatest heart surgeon, you figure that out.”
Doctors are already central to one reform movement: the change away from fee-for-service medicine to value-based payment. They're in the first year of a new Medicare payment system established under the Medicare Access and CHIP Reauthorization Act of 2015, which will determine how clinicians get reimbursed under the Medicare program.
But the regulatory and administrative burdens continue to increase. For many doctors, the start of any healthcare reform needs to ensure there is less regulation, with its demoralizing administrative requirements dictating how they provide care, drowning them in paperwork and leaving them struggling with poorly designed electronic health record systems.
Doctors have long complained that all of it takes them away from providing care for their patients. The goal of any healthcare reform legislation should be to ensure that the patient-provider relationship remains sacrosanct.