We may be tired of discussing healthcare in the political realm, but it’s not going away. The systemic problems in our healthcare system continue to exist, with the shortage of providers being a critical problem. It’s especially an issue in clinic-based care. The margins there are much less than for procedural care, as clinic-based care providers receive far less for their services performed (from both private insurance and Medicaid and Medicare). More broadly, Medicare and Medicaid reimbursement in general is so low that providers are sometimes losing money when seeing primarily Medicare and Medicaid patients – aside from that amounting to what I view as an unfair tax (in fact, if not in law), it is exacerbating the problem of access as providers stop seeing Medicare and Medicaid patients altogether.
Additionally, increasingly onerous government regulations have made the practice of medicine less appealing, as MDs are more and more often acting as paperwork administrators instead of working to heal their patients. You’ve probably noticed that your provider has spent less and less time with you in your appointments throughout the years. That is a shame, not only because it decreases the quality of care, but it decreases the time for the patient-provider relationship to be established – and trust is a key aspect of care.
This doesn’t even begin to address the issues surrounding rising costs in light of defensive medicine performed to prevent lawsuits (i.e., procedures/tests recommended only because a provider is concerned about the chance of a lawsuit, rather than thinking the procedure/test is medically warranted).
But if the foregoing doesn’t already make you think that we need to take action, I’ll highlight my concerns by sharing a recent example I was told about. An individual with Medicare needed to see a mental healthcare provider – however, because there is only one provider in that person’s area who is accepting Medicare, it is expected to take several months to get an appointment. That hugely increases the risk of a mental health issue spiraling – which would be terrible for the individual, and ultimately be more costly to society. That is an unacceptable situation, and one we need to address.
As with all of the big issues, there are not easy solutions, and I’m not sure how many of solutions in this area can come from the government. But government’s first objective here should be simple: Do not make things worse. Healthcare for all is a noble objective, and one that I agree with, but it is not something we should ask the medical community to bear the financial brunt of. Medical providers should be properly reimbursed for their work – not only because it is fair, but because the result of not doing so is to have Medicaid and Medicare patients be dramatically under-served. There needs to be an incentive for providers to accept all forms of insurance, which in turn will provide better access to all Oregonians, regardless of income. Congress needs to act on Medicare rates, and Oregon needs to act on Medicaid rates. We should also be looking at steps we can take to cut down on administrative burdens for providers, wherever plausible. This issue isn’t going away anytime soon, and we need to work together so that we have a healthcare system that meets our basic needs.