President Reagan once said, “The nine most terrifying words in the English language are: ‘I’m from the government, and I’m here to help.’” A principal foundation of conservatism is the idea that an overreaching government can do more harm than good. In that vein, I fear our health care system is moving towards a more obstructive government-controlled health care model. Many health care practices we, as Americans, consider either necessary or important are slowly becoming things of the past or a recent memory. Frighteningly the most important component of our health care system — the patient and doctor relationship — will soon join this list. My dad, a doctor and surgeon, left Canada’s system of socialized medicine because the centralized control of care was too restrictive to the practice of medicine. I believe preserving the doctor-patient relationship is the foundation of providing quality and personalized care.

Unfortunately, it seems as though the proliferation of insurance company driven policies into our current health care system often focuses more on the art of paperwork than on time spent with patients. The complexity of our system has added unnecessary layers of bureaucracy that have resulted in lost time, limited resources, and significant delays in care. Though it is important to ensure that administrative care resources are being properly utilized, there are certain policies like prior authorization that warrant modernization since they are driving a wedge between doctors being doctors and patients receiving quality care.

Prior authorization is often used as a tool to ensure that physicians are prescribing the most appropriate treatment plan; however, last year in a survey of Texas physicians, 85 percent said prior authorization delays access to care. In another survey, the American Medical Association questioned over 1,000 physicians on prior authorization policies, with 79 percent saying that prior authorization sometimes even leads to treatment abandonment. From personal experience working as a physician, it is extremely troubling to me that an administrative burden is blocking patient access to treatment. What is the value of developing a relationship with your patient if the insurance company or the government is just going to tell you how to treat your patient? Did they go to medical school?


Instead, we should be seeking solutions that provide models of care that encourage quality care over insurer overreach. Value-based models are most effective at increasing the quality of care, while controlling cost and improper utilization. Patients and their providers should be empowered to decide on the treatment plan, including medications prescribed, that will be the most appropriate and effective for them. Not an insurance company employee or a government bureaucrat who has never even met the patient. That is why I am an original co-sponsor of the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018). This legislation will standardize and streamline prior authorization usage under Medicare Advantage plans and enhance transparency from the Centers for Medicare and Medicaid Services regarding the use of such policies. 

My home state of Texas is taking steps to reduce delays caused by prior authorization through the Gold Card Law that went into effect last month. This law rewards and incentivizes physicians who have a proven track record of consistently meeting prior authorization criteria, while maintaining oversight for those who do not meet the program requirements. Similar to a gold card rewards program that may be offered at a local restaurant or even through your credit card company, this law will award “gold card status” to physicians who meet a 90 percent prior authorization approval rate over a six-month period. Physicians with a “gold card” will be exempted from having to seek prior authorization from state-regulated insurers for certain services, allowing them to focus on the patient instead of spending time on paperwork.

Streamlining and reducing the amount of unnecessary bureaucracy would not only benefit physicians and patients, but also representatives from other parts of the health care system, such as pharmacists, hospitals, and insurance companies. In fact, several of these organizations jointly cosigned a consensus statement highlighting improvements that should be made to the prior authorization system both within the public and private markets, including policy suggestions that were ultimately added to the Improving Seniors’ Access to Timely Care Act and the Texas Gold Card law. These are policies that are broadly supported and seen as having the potential to reduce delays to care and unnecessary administrative burdens on physicians while improving the doctor-patient relationship.

Having practiced for nearly 30 years prior to coming to Congress, I know that the patient and doctor should be dictating treatment and care plans, not the insurance companies and certainly not the federal government. The doctor and patient relationship is the cornerstone of America’s health care system and is what distinguishes our high-quality care from the rest of the world.

Michael BurgessMichael Clifton BurgessDemocrats livid over GOP's COVID-19 attacks on Biden Maintaining the doctor-patient relationship is the cornerstone of the U.S. health care system Burgess: Artificial intelligence key for future diabetic care MORE represents the 26th District of Texas and a senior member of the Energy and Commerce Committee.