Chuck Schumer says he knows that Obamacare is flawed but that we should fix it and not repeal it. What exactly is the problem with Obamacare and how is it to be fixed? In the eyes of the politicians, specifically all of the Democrats and many of the Republicans, the illness of our health care system is that some of us are "uninsured" and that the government should arrange to "insure" those who are lacking. If we work that out they will have done their job and everyone will be happy.
That fact is that the problem with medical care economics in our country is much more fundamental. Our peculiar system of indirect payment and insurance company and government intervention where none is needed is responsible for price inflation, wasted medical goods and services and gross bureaucratic interference that produces no health benefit at all. Obamacare is the wrong treatment for the wrong diagnosis and "fixing" it will not cure our illness. It simply adds more people to a bad system and does a lot of counterproductive things at the same time.
I recently visited a doctor for my own problem. At the registration desk I waited 10 or 15 minutes for the lady in front of me to get all her insurance information recorded, get her picture taken, put her signature on several items and on and on. We're all so used to this nonsense that we think of it as normal. In my practice there were personnel whose whole function was to attend to billing. Others oversaw adherence to Medicare and Medicaid regulations. My nurse spent hours daily seeking pre-authorization rather than interacting with patients. I was obliged to buy expensive computer systems and pay regular high IT fees just to comply with billing activities and documentation to justify my claims to the payers. The bill payers on their end required personnel and computers to handle similar administrative work. All of this activity depends on a system of extensive coding of each of thousands of medical items and services. Millions of dollars are spent paying organizations to devise these coding systems. Millions more are spent on bureaucrats and consultants to meet, categorize and devise value to each code.
To make claims to the payers for my service I used these codes and I documented what was necessary to justify each code. Such documentation requirements were far in excess of what I would need for actual medical communication and took large amounts of time from patient interaction. Many doctors because of this have added a new employee called a "scribe" whose function is to attend to the documenting, another layer of personnel cost. One study recently estimated that 50% of physician time is spent on administrative work.
Space limitations preclude a full description of the regulatory cost and time loss of our present system just in this one area of the doctor visit, none of which has any patient care value. It is a tremendous waste of resources, the cost of which is ultimately borne by medical consumers.
The alternative to this system would be simply for the patient to pay at the desk by cash, check or credit card. With direct payment major personnel and equipment reductions as well as the office space to house them would occur. In addition major diversions of doctor and nursing time would return to patient care. My best estimate is that direct payment would translate to at least a 25% reduction in my office fees and at the same time an increase of about 20% in time spent with patients. I cannot estimate the savings derived from decreased involvement of insurance companies and government bureaucracies but they would clearly be substantial.
I often hear people say that they had such and such a procedure and didn't pay a cent. It's an illusion friends, a scam really. Not only is your treatment not free, it is very, very expensive. All these billers, coders, clerks, scribes, bureaucrats and consultants must be paid and none of them are doing a blessed thing to attend to your medical problems. And all these goings on are just the tip of the iceberg that is the wasteful, inefficient, paternalistic, bureaucratic system that we've become adjusted to over the past 50 years or so. Stay tuned.
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