Robert W. Morrow, M.D.
I’ll start with a story. A friend and kayak paddling mate runs a solo, independent business. Under the Affordable Care Act (aka Obamacare), he was able to buy appropriate health insurance for himself at an affordable price. He joined my family medical practice as a patient. I agreed to accept his insurance as payment, though I had previously no relationship with this insurance company.
All was well until my friend’s insurance company (a “payer” in industry jargon) went bankrupt, leaving my practice with unpaid bills.
Of course, since he now had no insurance himself, he found another payer. This turned out to be one which I already accepted thanks to my membership in an Independent Practice Association. I had even previously signed a contract directly with this new payer.
The second payer, however, placed my friend in a plan with a new, narrower “panel” of “in-network” physicians. In spite of my established relationship with this payer, the new panel excludes my practice. They do not accept my bills for my friend’s visits as a patient.
Did I mention that this friend takes a really expensive medicine, one which likely will not be fully covered anyway? A very high deductible is an almost assured outcome with passage of the latest assault on the Affordable Healthcare Act, the so-called Tax Cuts and Jobs Act of 2017. That Act intentionally undermines the delicate financing balance of payers participating in Obamacare exchanges.
And this story is about just one patient out of the 3000 or so in my practice, and by no means an exception.
Whose Healthcare is This?
One insurer goes bust, the next is doing its best to manipulate the market to maximize its profits. All the while, my friend is on the receiving end of an increasingly dysfunctional system. What is the US healthcare system good for, anyway?
From my vantage point as an independent primary care physician in a major metropolitan market, what I see is a “healthcare” system that is far more oriented toward financial transactions than concerned with delivering a good product. After all, a good healthcare product, though not easy to achieve, is easy to define: treatment at a reasonable price for my friend, for example.
There are, of course, more general measures of good healthcare: reducing infant and maternal mortality, lowering the cost/accessibility of healthcare to the general population, making the education for health professionals more affordable, and improving the financial and social status of health workers generally.
By any of these measures, however, the US healthcare system is performing abominably. Perhaps not entirely surprisingly, these are not the measures which the system, i.e. the ever-larger healthcare conglomerates that dominate the field, applies to itself.
High Finance in Healthcare
What I see is the subordination of the product – delivery of good healthcare to the general population – to financial transactions, i.e. the ability of the healthcare organizations to “bulk up” via acquisitions and to indulge in capricious spending aimed not at better healthcare outcomes, but increasing the monetary value of the organization itself.
In practical terms, the financial transactions of selling financial instruments, “growth” bonds, etc., are far more important to the major healthcare organizations than a good product.
And the financial driver of today’s healthcare organizations is not a distant mechanism unrelated to the day-to-day delivery of healthcare. It impacts my practice every day, from the lack of funding for primary care in general to the almost malignant inability of the system to address public health emergencies such as the ongoing crisis with Type 2 diabetes or rampant opioid abuse.
It seems to most people that the system is simply struggling to address all the competing demands. But whereas we can all see the US healthcare system is not optimizing patient outcomes, I believe the system is working well to optimize financial value, enriching those at the pinnacle of these organizations and the many financial support organizations that feed off of it. In my next post, I’ll share some every-day examples where financial transactions trump the health of the public.
Bob Morrow is a family physician in the Bronx with a long standing commitment to the health of his community, sometimes in spite of the constraints of the “healthcare system” that he operates. He is a Associate Professor in the Department of Family and Social Medicine at Albert Einstein College of Medicine.