Prof. Kelly Paul
November 1, 2011
The Future of Healthcare: Are We Heading for Disaster? With healthcare costs rising at an alarming rate, twice the rate of household income, many will agree that the reformation of healthcare now before the number of uninsured reaches epidemic levels is the best course of action. While this is widely agreed upon, people must understand that this problem will not go away overnight and to overcome this looming issue will take a well thought out, calculated plan. When President Barack Obama took office on January 20, 2009, he immediately began work on a healthcare reform plan with the support of a large partisan Congress. With the passage of the Patient Protection and Affordable Care Act (PPACA) being forced through Congress in near record time, roughly one year from concept to passage on March 23, 2010, many experts agree that this hastily formed bill opens numerous negative possibilities, including overstressing the healthcare infrastructure, exploitation, human rights infringement, and underfunding. President Theodore Roosevelt was the first president credited with attempting to pass healthcare reform laws. Since that time, with the exception of President Lyndon Johnson succeeding in the passage of legislation creating Medicare/Medicaid, many failed attempts have been made to reform the healthcare industry due mainly to the American public aversion of interference by the federal government in the private sector. While this has been the prevailing thought for many decades, statistics are starting to change people’s minds. The United States spends 17.3% of Gross Domestic Product on healthcare while the United Kingdom and Canada spend 8.4% and 10.1% respectively, yet in comparison to other industrialized nations, the United States still ranks last in mortality rates of conditions preventable with timely and effective care. Adding to this the fact that even though Americans spend almost double for healthcare per person, we live on average two years less than our counterpart in the United Kingdom, and three years less than our neighbors to the north in Canada (Gable 342). It can be argued that this problem definitely needs attention, but a bill that spends merely one year in Congress being debated amid other political problems is hardly enough time to properly conduct research and deliberate solutions to set healthcare reform in the direction that best serves this country. The PPACA will provide health insurance to many who could not afford it otherwise, but as more people are covered by insurance this will create a large influx of newly insured patients that will flood the already imbalanced healthcare system. According to Dr. John Goodson, “in countries with similar economies, 50% to 60% of physicians practice in the primary care disciplines…in contrast, only about 30% of U.S. physicians practice in primary care, whereas 70% are specialists” (742). Many would-be doctors choose to become specialist due to the fact that the current payment model, what is referred to as a fee-for-service model, gives a larger reimbursement, 30% to 60% more, to specialists for services rendered (Goodson 742). Once the initial illness is dealt with, the specialist will return the care of the patient back to the primary care physician. This gives specialists minimal investment in patients and receiving maximum pay, while generalists continue the majority of treatment plans set forth with minimal pay.
The PPACA includes two solutions for this problem. One solution is improving payment models in an effort to offset the disparity between generalists’ and specialists’ reimbursement. Several new payment models are put forth in the PPACA but none directly address the depreciation of generalists’ services, instead offering expanded bundling payments and letting doctors debate over what percentage is fair. Other possible payment methods included in the bill are