When I began to practice medicine back in the early 1990s, there was plenty of room in my office for the doctor-patient relationship and the art of medicine. Most patients paid me up front and then I helped them navigate their insurance companies so that they could be reimbursed.
Visits were relaxed, thorough and involved little paperwork. At the end of each day, I had stacks of patient callbacks that I had to go through; this allowed me to review information with my patients — effective treatments and predictable results, in most cases.
Now medical times have changed and not necessarily for the better. While it is true that advances in the fields of genetics, robotics, immunology and cardiology have brought my patients more exciting life saving options than ever before, at the same time, government interventions have made the process of health-care delivery more cumbersome, bureaucratic and inefficient.
Doctors are suffering, which means patients are suffering, too. Electronic medical records has even eroded away our “pajama time,” with computer time, a disturbing concept. ObamaCare has brought high deductibles and narrow networks of doctors and hospitals that make my job as patient navigator almost impossible to perform.
Critiques of government overreach into health care have focused almost exclusively on cost, which is legitimate when you consider that ObamaCare subsidies are costing taxpayers billions. Over 85 percent of Americans who shop at exchanges qualifying for subsidies, and the “Medicare for All” program that presidential candidates, Sens. Elizabeth WarrenElizabeth WarrenWarren calls on big banks to follow Capital One in ditching overdraft fees Crypto firm top executives to testify before Congress Massachusetts Gov. Charlie Baker won't seek reelection MORE (D-Mass.) and Bernie SandersBernie SandersGOP ramps up attacks on SALT deduction provision Symone Sanders to leave the White House at the end of the year Briahna Joy Gray says Chris Cuomo will return to CNN following scandal MORE (D-Vt.) propose, are expected to cost at least $30 trillion over ten years in transition costs alone.
This past weekend Warren announced that she would reveal how she would pay for her plan. She has not yet acknowledged that she intends to raise taxes on the middle class the way Sanders has.
But no matter how whopping the bill and which taxes are raised as a result, as a physician I am also deeply concerned about the potential impact on quality of care. Government insurance doesn’t pay hospitals or doctors as much as private insurance does.
We rely on private insurance to maintain our bottom line, which enables us to preserve whatever quality of care we can. The doctor-patient relationship, as well as research at medical centers, will be jeopardized if Medicare is expanded to take over the whole health care system.
Currently, Medicare is struggling to cover an amazing personalized new cancer treatment known as CAR-T, where your immune cells are removed from your body and bioengineered to target the cancer. But this crucial treatment, which is typically only used once, costs hundreds of thousands of dollars. Public insurance simply isn’t designed to pay for all the genetic and immune based therapies of the near future.
If Medicare for All ever happens here, there will be long waiting lines for elective and even semi-urgent treatments as there already are in Canada.
Sanders can thank a top hospital in Las Vegas for his timely lifesaving stents, but he used private insurance to pay for them.
American doctors under a Medicare for All program would be paid less, but we would have to go through reams of red tape to appeal a denied test or procedure.
Recently I met an incredible caring Canadian physician who is working as a general practitioner under a universal health insurance program in Australia. She sees four patients per hour for the equivalent of less than $30 per visit — around half of what a similar doctor earns here in the U.S.
She doesn’t complain, though she tells the heartbreaking story of her mother’s unnecessary death in Canada. Her mother was diagnosed with a heart murmur and the doctor ordered an echocardiogram, which took eight weeks to get approved. When the approval finally came, a bureaucrat called the house to notify the patient only to discover that she had died two weeks earlier of a ruptured (repairable) aortic aneurysm that the echo would have uncovered in time.
I don’t want this future for our health-care system. With the ObamaCare individual mandate gone, there is room now for more insurance options including catastrophic policies where more people can afford to be insured, not less.
Offering more options including a basic public option will build on a system that is already covering the vast majority of patients. Concurrently we need more team-based efficiency solutions for doctors, which would free us up for the quality doctor-patient interactions of the past.
Going in the opposite direction, by reducing everything to one coverage option, at a time of expanding health care solutions is an out dated concept which will sink the health care system rather than save it. If Warren and Sanders don’t realize this soon, they will not be viable candidates for president.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent. Follow him on Twitter: @drmarcsiegel.