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.

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  1. larryg Avatar

    thanks for the article Peter.

    People don’t understand how our current health care system works because it is none huge convoluted mess that basically degenerates to one question for most people: “Am I covered”?

    The CEO of Mary Wash Hospital in Fredericksburg pulled no punches. He said that doctors are financially incentivized to order as many tests and procedures as the companies and govt will allow – no matter whether or not the patient actually benefits from them.

    Each doctor looks at what tests and procedures have already been ordered and then they find the ones that will still be reimbursed and order them.

    Obamacare did not intend to fix that specific problem but it did want to address how we pay for people who are currently uninsured.

    The question that people think they are hearing is ” do you want to pay for health care for the uninsured”?

    But that’s not the question. The question is “HOW do you want to pay”?

    People who are uninsured do get health care but they get it after they don’t see a doctor for 5-10 years and then something bad is wrong and they go to the ER where they proceed to burn dollar bills like there is no tomorrow and the hospital just passes that cost on to you.

  2. Peter, you nailed this one — the fee-for-service billing system is a huge part of our problem. The question is, what are the alternatives? And how do we find out which alternatives are workable, and which ones will prove to be will ‘o the wisps.

  3. larryg Avatar

    ” how do we find out which alternatives are workable, and which ones will prove to be will ‘o the wisps.”

    is that what the GOP has been promoting as “REPLACE”?


    the trouble with “fee for service” is that it’s a bonanza for those that making their living at it and those folks are opposed to fixing it and our GOP friends basically support those “small businesses” that comprise most private sector medical practices.

    free, “tax-free” employer-provided health care in the enabler.

    but even for those who have their own HSA accounts, comparison shopping for price and quality is not an easy thing.

    Most people who have insurance are basically lazy and quite often financially illiterate when it comes to health care. All they really want is to haul their kid to the doctor and have it “covered” by their insurance.

    We “shop” for auto and homeowners insurance and as a result we usually know what it costs and we usually know what is (and is not) covered (sort of) but when it comes to employer-provided insurance, you get what you get, you do not get to “shop” around much.

  4. Very good article. Clearly, the system we have is a total mess.

    Obviously, we need more Primary Care M.D.’s. If the biggest challenge facing a young M.D.’s is debt, perhaps we should, as a country, subsidize that aspect of the system.

    If your talented enough to be a M.D., and you choose to go into Primary Care, maybe the taxpayers should foot the bill for that. Lord knows we waste money on other, less critical things.

  5. larryg Avatar

    the interesting thing to me is that the GOP also seems to believe the system is a mess and as bad as ObamaCare seems to be depending on who you’re listening to – the GOP seems to have no real plan for fixing the mess.

    At least not a unified visible alternative – actual legislation – that they will push through and lay on the table as a challenge to ObamaCare.

    So they hate ObamaCare but their primary response has been a cacophony of “ideas”of which one is tort reform – which CBO has scored as about 1.5% of health care costs.

    Here is what Fred Rankin, the CEO of Medicorp in Fredericksburg said:

    ” One of the problems with America’s health care system, Rankin said, is that the major players, such as doctors and hospitals, act independently to further their self-interests. As he put it, “There is no coordination. The economic incentives are not aligned.”

    In addition, the system is entrenched—at least 60 years old—and rewards providers for “doing stuff,” such as operations, scans, procedures and lab tests, he said.

    “Our whole system of American health is procedure-based,” he said.”

    I’m waiting for competitive legislation from the opponents of ObamaCare to solve this.

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