Insurance lobbyists may influence the writing of a health law, but they don’t provide actual care. We doctors don’t want the same things they do.

I have fallen into the same trap that many of my fellow doctors have: I have analyzed the potential options for repealing and replacing the Affordable Care Act from the same place that politicians and policy wonks do

— choosing and arguing about alternatives that may have no real bearing on the day to day functioning or dysfunctioning of the doctor’s office. Democrat or Republican, liberal or conservative, this was the same mistake we all made back in 2009 and we are making it again today.

So as the so-called debate over health care continues in the Senate, let me take a step back and look at actual health care reform through the lens of my daily experience as a physician, and yours as a patient. Not theory but practicality.

The first relevant issue is computerization. Since 2009, Electronic Health Records have been mandatory, and though they present an advantage in terms of the speed of information exchange, they also saddle doctors to their chairs, where a routine 20-minute visit is doubled by the time the documentation is complete. For this doctors receive no additional reimbursement.

A physician survey by the consulting firm Deloitte back in 2013 revealed that six in 10 physicians reported that the practice of medicine is in jeopardy. The greatest reason given by primary care doctors like me was not enough time to spend with our patients. Instead we are dealing with the computer, reimbursements, approvals and referrals.

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According to the Deloitte survey and every physician I speak to, we are increasingly unhappy because of shrinking reimbursements (especially but not exclusively Medicare and Medicaid), fear of malpractice, and increasing regulations. We are also swamped with too many patients, in the middle of a growing doctor shortage. The Association of American Medical Colleges estimates that we will be more than 100,000 doctors short by 2030. Obamacare added more cars to the train, but there are fewer engineers to drive it.

I recently traveled to a Federally Qualified Health Center in Dunkirk, N.Y. which had received increased funding under the Affordable Care Act. The clinic was clearly doing its job coordinating care throughout the community for patients who had insurance as well as those who didn’t. But a crucial concern of the clinic’s CEO, Mike Pease, was the lack of doctors available to work there.

What is the solution to the health care crisis? It isn’t a question only of which patients have health insurance, but who is available to take care of them. More doctors (generalists as well as specialists), nurse practitioners and physicians assistants must be trained and they must be paid more by insurance, especially Medicare and Medicaid. A recent survey found 31% of doctors won’t see new Medicaid patients, mostly because it doesn’t pay enough. Initiatives to reward quality outcomes too easily lose sight of the fact that we deserve to be paid for our time no matter what, as any professional is. Malpractice reform will take pressure off us to practice defensively, which will decrease unneeded tests and save the health care system billions of dollars.

I have a Cadillac health insurance plan in a land of jalopies. How is that fair?

Remember, insurance lobbyists may influence the creation or alteration of a health law, but they don’t provide actual health care. We doctors don’t want the same things that insurers do.

In order to function effectively, doctors need less regulation, not more. We need fewer insurance denials, not more. Remember, portability of health insurance, expanded Health Savings Accounts, and a variety of insurance options bring more choice to the doctor’s office which means better quality health care for you. If we are paid more for our time and there are more of us and we are threatened with fewer frivolous lawsuits, we will be much happier and can take better care of you.

Marc Siegel, a member of USA TODAY's Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel

 

By: Marc Siegel

Source: http://www.floridatoday.com/