The American health-care system is broken, but it is not really “health-care” that is the problem. The science of medicine, the tests, and the treatments available are better than ever. It is health-care bureaucracy that is the problem. But doctors, nurses, and patients bear the brunt of the dysfunction. Medical professionals are unable to practice, and patients are denied the care they need, even though it is readily available. Careers are being ruined, and lives lost along the way. It is time to fight back.
Instead of focusing on ways to improve patient care, medical professionals today have to wade all day through a jungle of red tape just to get paid, order tests, and deliver treatments. Cumbersome government rules control the details of how we write notes, use a computer, calculate a bill, how much we can charge, who we can admit to the hospital, how long we can treat them, and much, much more.
And for everything we do, there must now be data. The bureaucracy is obsessed with data, to the detriment of everything else. It is tyranny through data. We spend so much time collecting data and running after all of these things that it is a challenge to find the time to actually care for patients! On top of that, newer health insurance policies with high premiums, high deductibles, prior authorizations, and narrow, inscrutable coverage block us from delivering the care patients need. It is health care by government and insurance company fiat. Medical professionals and patients have few choices and little control.
And now, on top of everything else, we face Medicare’s complicated new MACRA “value-based payment” program, which collects data across four categories: Quality Measures, Advancing Care Information, Performance Improvement Activities, and Cost. A physician’s annual score will be compared to the scores of other physicians to determine future Medicare pay increases or penalties. There is a huge effort being made to explain the intricacies of the new program, the first sign that it is too complicated to be of benefit.
Has American health care improved under this rule-bound and data-crazed regime? No! These approaches have demonstrated little of their intended effect. What is the bureaucracy’s answer to this? More rules and more data collection, and now, even penalties! They are trying to box us in like lab rats, and with rewards and punishments, make us perform tricks in our cages.
What has been the medical profession’s response? Adjust, learn the rules, and do it again, and again. We grumble. We retire early. We hide in bigger organizations that are supposed to protect us from it all. We look to our professional organizations for leadership. But this is not working. We lose more and more ground. We are now on a tiny island—but many of us are falling into the water and drowning.
When we begin our careers in the medical profession, we take an oath to do no harm. But today we practice in a system that is harmful by design. To honor our oath, we must find ways to fight back.
I think the answer is to better organize—even to form unions (though they are legal for physicians only in certain circumstances)—to find ways to actively fight against this out-of-control bureaucracy. We must bring balance to a system where today we have absolutely no control. What we must demand is a system that works for us rather than against us at every turn, that helps us to deliver better care rather than blocks us and then penalizes us when we fail.
I am sick and tired of worrying about the system, and not my patients. We must organize to turn things around. We can have the best health care in the world. It starts by organizing the system around those it affects most, patients and their health care teams.