By Peter Galuszka
Reforming health care is perhaps the most important issue confronting Virginia and the country today and also one of the most contentious.
One hears opinions and solutions of every ilk anywhere — on blogs like this one, television, newspapers and private conversations. One important turn came when the U.S. Supreme Court upheld most of the Patient Protection and Affordability Act, otherwise known as Obamacare.
But the controversial law still fails to address the vast majority of the issues confronting health care, such as the strange oligarchy of faceless bureaucrats at Medicare and their counterparts at for-profit commercial insurers setting prices in a way that completely takes the consumer out of the equation. The “fee for service” system encourages doctors to order uneeded tests while the demanding paperwork for the gatekeepers forces them to see more and more patients.
For a birds-eye view, I spent a day with a Richmond-area family practioner for Style Weekly. My photographer and I signed privacy agreements and were allowed to sit on a number of sessions with patients and Dr. Rick Gergoudis, of Commonwealth Primary Care. The highly-regarded doctor was very hospitable and let us take the story where we wished. The article shows a number of unresolved questions:
- Managed care and payment systems demand that doctors spend less time with patients.
- The system does not reward preventive medicine that could save billions by keeping patients from becoming sick.
- “Free market” solultions, such as “boutique” practices in which doctors are paid salaries see a dramatically short list of patients who pay extra, do nothing to solve problems because the vast majority of patients can’t afford them. The are a convenience for the wealthy – that’s all.
- Doctors confront an ethical quandry if they try to balance what they believe a patient needs and how much its costs.
- Although medical practices try to help patients understand costs, it is nearly imposible to do so since Big Insurance negotiates any number of prices according to the patients’ employer and policy.
- More cost is being shoved back onto patients by cost-cutting employers while free market cheerleaders haul this as a major step forward. They are simply cheering ordinary Americans getting abused.
- The Supreme Court decision and Obamacare do not address any of these issues.
- Read for yourself.