Physician Perspectives on the Affordable Care Act: What about the Affordable Care Act? What should we do next?

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This is the fourth of a mini-series on the SERMO blog that explores real-world perspectives from U.S. physicians on the Affordable Care Act (ACA). Click here to read the firstsecond, and third installments of this ACA series. The ACA is currently one of the most hotly discussed topics among U.S. doctors on SERMO: recent polling suggests that doctors are split 50/50 about whether they want the next president to repeal the Act, and 43% of doctors are not participating in the health insurance plans offered in the ACA’s federal or state exchanges. Here Richard A. Armstrong MD FACS –SERMO Advisory Board member and member of Board of Directors for the non-partisan physician’s group, The Docs 4 Patient Care Foundations – explores what is next for health care in the U.S. 

For many years it has been apparent that America’s health care “system” needed serious reform.   Too many patients were falling through the cracks and health care costs were rising at an unsustainable rate.   This was a primary goal of the Obama administration in the first term which resulted in a heated national debate culminating in the passage of the ACA in March of 2010.   Unfortunately, not enough input was sought from American physicians and surgeons who are actually doing the real work of patient care day and night, 24/7.   Today we are living the results and a majority of Americans are not pleased.

While the need for American health care reform has existed for many years, we believe that the most recent sweeping legislation, The Affordable Care Act (ACA, aka Obamacare) of 2010, as well as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are flawed. These laws and the regulations resulting from them are unnecessarily complex and have added to the public confusion concerning health care financing rather than constructively addressing the primary problems. Good intentions based upon faulty assumptions have failed to address the underlying causes of America’s health care economic dysfunction. The most recent legislative attempts to address these issues have compounded longstanding problems, when they could have provided necessary remedies.   While the health care debate continues, we need to learn from past mistakes as we craft bold solutions to energize a flourishing new 21st century health care economy.

Lack of transparency, market distortion, limits on patient choice, and pressure to alter medical ethics have led to escalating prices, reduced patient access, decreased patient and physician autonomy, and limitation of treatment options. These tragic consequences were predictable and unnecessary.

Successful reform, based upon a rational and factual analysis of the issues, needs to be a non-partisan effort. Sincere reform efforts will require legislative solutions which directly address the core issues as discussed in the outline below.

A national non-partisan, non-profit organization, The Docs 4 Patient Care Foundation, offers the following recommendations as we move from a top-down, centrally planned and controlled health care economy to one which allows patients greater freedom of choice and physicians expanded opportunities for innovation through the removal of regulatory and legislative barriers to new models of care.

-All Americans must have access to an insurance market devoid of tax discrimination.

-Health insurance must once again become “true insurance”, a hedge against a catastrophic loss, instead of an expensive pre-paid health maintenance plan.

-Individuals and families need to own their health insurance policies which need not be connected to or dependent upon employment.

-A true national competitive market for health insurance is necessary, where insurance is available without artificial boundaries and may be purchased in a variety of ways.

-Medicare, Medicaid and SCHIP must be gradually transitioned to fiscally responsible programs which would support individuals in need and give them the same consumer choices available to Americans who purchase their own health insurance.

-Reform of the current wasteful and dysfunctional medical malpractice system must be addressed.

-Health information technology, currently dictated by the federal government in a top- down centrally controlled manner, needs to be freed from government control and allowed to flourish in a true market as has been the case for all advanced electronic technology.

-States need to be empowered to act as laboratories for innovation in the design and implementation of new healthcare delivery models, including those outside of the traditional third party payment systems.

-Physicians must be freed from the weight of burdensome and ineffective regulation promulgated by governments and other regulatory bodies.

-Barriers to physician-led innovation must be removed at both the state and federal level.

The details of the above recommendations are outlined in The Physician’s Prescription For Health Care Reform which has been published by The Docs 4 Patient Care Foundation after over 6 years of careful and methodical research into the history and causes of the dysfunction of the American health care economy.

As working American physicians and surgeons, it is our fervent hope that this coming election will begin to heal the divide and approach American health care as an American problem, involving all of us.   Who better to outline the best approach to health care reform than America’s healers…the doctors who care for all of you, day and night?

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