{"id":5068,"date":"2012-08-06T19:51:17","date_gmt":"2012-08-07T00:51:17","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=5068"},"modified":"2022-03-21T15:10:12","modified_gmt":"2022-03-21T20:10:12","slug":"worrisome-trends-in-health-care","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2012\/08\/06\/worrisome-trends-in-health-care","title":{"rendered":"Worrisome Trends in Health Care"},"content":{"rendered":"\n

Philosophically, by now you\u2019ve gathered I was pleased that the Affordable Care Act<\/a> (ACA) leaped nearly all its hurdles and will be taking effect in a couple years. It was simply wrong that the US has within its borders 40 million citizens with no access to our health care system, and also that insurers could cherry-pick people without \u201cpre-existing conditions\u201d and legally exclude patients who needed care.<\/p>\n\n\n\n

But based on my healthcare reading, I\u2019m here to warn you that the next few years are going to be a rough ride. There\u2019s too much money at stake and some very powerful players calling the shots for any patient, physician, or institution to remain unscathed, for anything like the status quo to be maintained.<\/p>\n\n\n\n

If your idea of an ideal physician is someone who\u2019s always there for you, who grows older right along with you, who knows your family, your job stresses, and your life, well, forget all that. If you follow the website America\u2019s Health Insurance Plans<\/a>, the policy and advocacy group for our 1,300 (!) health insurance plans, you\u2019ll see changes afoot. Some new trends are promising, like more emphasis on wellness coverage. Others are downright spooky, and probably illegal in many countries. But, what the heck, we\u2019re used to corporations running our lives. And didn\u2019t the Supreme Court affirm with its Citizens United<\/a> decision that corporations have a voice equal to the rest of us?<\/p>\n\n\n\n

By eliminating the public option (which for simplicity\u2019s sake ought to have been called Medicare for All) from the ACA, our government turned over the health care reins to their friends in the health insurance industry, probably the single largest lobbying group in Washington. Never forget that most health insurance companies are publicly traded, for-profit companies beholden first to their CEOs, second to their Boards of Directors, third to senior management, fourth to stockholders, fifth to middle management, sixth to low-level employees, seventh to whoever pays the premiums (usually your employer), eighth to you, the patient, and last–ninth in line–to me, your health care provider.<\/p>\n\n\n\n

Strictly speaking, the Blue Cross franchises are not-for-profit entities, but all this really means is they don\u2019t have to pay corporate taxes or answer to pesky stockholders<\/p>\n\n\n\n

The health insurance industry essentially regards hospitals and physicians as a swarm of annoying gnats that interfere with both the bottom line and executive bonuses. The words \u201cbenefit,\u201d \u201cauthorization,\u201d and \u201cpayment\u201d don\u2019t sit easily. To counter the dreaded act of \u201cpayment,\u201d the industry has already created obstructions sufficient to stop Attila, Hannibal, and Genghis Kahn in their tracks<\/p>\n\n\n\n

And now, with the ACA, we\u2019ve turned over everything to them.<\/p>\n\n\n\n

Two concepts you\u2019ll want to grasp<\/strong><\/h2>\n\n\n\n

There are two phrases you need to understand if you want to see where US health care is headed. The first is Accountable Care Organizations (ACOs). The second is \u201cevidence- based medicine.\u201d Both have a nice consumer-oriented ring to them. Yes, we want evidence that the pill we just swallowed is going to help. We\u2019ll discuss ACOs now, and evidence-based medicine in a future health tip.<\/p>\n\n\n\n

The ACA makes repeated references to ACOs as if they were a panacea to our health woes, like charter schools will solve everything wrong with education. We do all like the word \u201caccountable\u201d as in \u201cheld accountable\u201d when it applies to someone other than ourselves, especially if that someone is powerful. We want our politicians, bankers, CEOs, attorneys, and doctors to be accountable. But it also depends on who\u2019s accountable to whom. Certainly all of Eastern Europe bristled at being held accountable to the Soviet bloc. You would definitely not wish to be held accountable to an incompetent supervisor on your job, especially one with a personality disorder.<\/p>\n\n\n\n

Thirty years ago, the phrase Health Maintenance Organization (HMO) also had a nice ring to it when first introduced (\u201cYes, I like the idea of my health being \u2018maintained\u2019 by my doctor\u201d), but it turned out to be a disaster for everyone. An ACO is really the same animal with a slightly different financial spin. Although what follows may seem complex, it\u2019s worth reading because you\u2019ll be inextricably involved in it if you need a physician.<\/p>\n\n\n\n

In an ACO, doctors (or doctors and hospitals) formalize a group with the intention of reducing costs and improving patient outcomes. If the ACO fails, it\u2019s financially penalized. Obviously there are numerous ways to reach the ACO\u2019s apparently admirable goal of cost reduction and better patient care. As you\u2019d expect, many are sensible, others a bit lame, and still others probably dangerous to your health. In an ACO, health care providers are accountable to two groups: the payor (health insurance company or, in the case of Medicare patients, the government) and to each other. If one physician member appears to be overspending, all members pay the price.<\/p>\n\n\n\n

As a physician, signing onto an ACO means loss of control <\/strong><\/h2>\n\n\n\n

And this has ramifications for you, the patient. Everything is linked to everything else and the whole kit and caboodle is constantly monitored. Independent thinking is toast, innovation gone forever. It\u2019s the ultimate Big Brother of health care.<\/p>\n\n\n\n

A few highlights:<\/p>\n\n\n\n