GOP proposal ignores how modern care is delivered
I am a doctor, a cardiologist to be specific. I have been in private practice for 35 years. As the debate on the Affordable Care Act rages, I would like to share a few things about health care and health insurance that nobody seems to be talking about.
1 Depriving people of access to affordable health care is very expensive. It is more costly for us to leave a large segment of the population without accessible, affordable health care. Leaving aside issues of justice and empowerment, the fact is that if you cannot care for your health in a proactive way, then your health care becomes much more expensive.
Take, for example, hypertension, a common, easily identifiable problem that costs less than a dollar a day to treat. Left unidentified, it will cause kidney failure, stroke, heart attack. The typical uninsured patient will show up in an emergency room in need of, say, dialysis, which will be provided, by law. The patient will go on disability and be unemployed. He will live with family for a few years and then have a stroke or another catastrophe, and he will end up in a nursing home.
There are other scenarios, other diseases, all with the same message. The point is this: All this care is now paid for, and will be paid for, by community institutions and health care providers and by all existing and proposed government plans being put forth — one way or another.
If arguments of humanity are not convincing, then what about plain, oldfashioned (conservative) principles, such as efficiency, or everyone paying to their ability, or cost effectiveness, or preventive maintenance? 2 Modern medicine uses a team approach.
Health care has evolved from an enterprise based on encounters between you and your doctor over isolated events of trauma or illness into one based on organizations structured to provide broad-based and long-term disease prevention and management. This approach has proved to be highly effective.
It involves best practices of credentialing panels, electronic medical records and approved pharmacies. The structure is driven by medical leaders and doctors and has been embraced by payers.
It has nothing to do with the federal government or the form of payment. The days of the individual medical doctor practicing in isolation, doing his or her best for you as he or she sees it, are over.
3 There is a broad consensus that the Affordable Care Act is the correct approach.
Structuring health organizations around disease prevention and management efforts that include everyone — as the Affordable Care Act attempts to do — is mainstream medical thought. Voices in the Trump administration (think, Tom Price) are eccentric to this view. They are stuck on a vision of the individual doctor practicing alone that any number of the leading medical publications, such as the New England Journal of Medicine, consider outmoded.
I cannot help but make the analogy here to the voices attempting to forestall climate change. Climate change denial and this outmoded view of medicine are part of the same anti-intellectualism; they are not the result of a well-thought out critique. Our country has a tradition of embracing science, new thought, new direction, and running with it.
To discount expert opinion because it is not expedient or does not fit into one’s worldview is dangerous, counter-productive and leads to errant policy. 4 The Affordable Care Act is working.
I practice in a variety of settings — urban, suburban, rich and poor. I see the positive effects of the Affordable Care Act every day.
The main medical industry associations do not support the GOP replacement, the American Health Care Act: the American Medical Association; Catholic Healthcare, the American College of Physicians, the American Academy of Pediatrics, the American Hospital Association.
The Affordable Care Act can and should be improved. But so much time and money has been spent on just keeping it alive politically that there has been little energy left for improving it. Likewise, the uncertainty has left many institutions watching and waiting rather than investing and developing. Given the political resistance, it is amazing that the Affordable Care Act has done as well as it has! Is the answer really starting over? Again, I know of what I speak: I have been in the trenches. We need to stand up for truth.
Dr. David J. Anderson helped to develop the program at Summit Medical Center that trained cardiologists in the techniques of coronary intervention, i.e., angioplasty, atherectomy and stenting. He practices at Stanford Health Care. To comment, submit your letter to the editor at http://bit.ly/SFChronicleletters