To fix the US healthcare system, start with helping burned-out doctors and providers | Opinion [Miami Herald]

The life expectancy of Americans has dropped for two consecutive years. The first year, attributed to the COVID-19 pandemic, was consistent with other countries. The second year was not.

In spite of how much our nation spends on healthcare services, which reached $4 trillion in 2020 or around $12,500 per person, these funds are providing less health benefit value for Americans.

Physicians are at the center of our healthcare system. They are emotionally and physically stretched, with a growing number simply burned out. Many felt this way before the COVID-19 pandemic; the pandemic exacerbated their plight. Physicians and health professionals are fleeing the profession at alarming rates, reducing the quality and quantity of healthcare services available.

Many issues are contributing to this situation. Here are two that are particularly concerning.

No. 1 is prior authorization for health insurance: Health insurers are increasingly controlling the delivery of patient care, usurping this authority from physicians. Prior authorizations force physicians to spend resources fighting for their patients and, ultimately, to get paid for the services that they deem necessary.

Many of the problems cited by physicians can be resolved by reforming health insurance. Recent legislation to fix prior authorization for Medicare recipients is a welcome advance. The No Surprise Act is also a step in the right direction. It protects patients and physicians when emergency services must be delivered out-of-network. Yet it is just a bandage on a deeply damaged compensation system. How healthcare is paid for demands a complete makeover.

The biggest loser from such reforms would be health insurance companies. They make large profits on the backs of physicians and other healthcare providers. The industry generated over $31 billion of profits in 2020, an increase of more than 40% from 2019.

To defend their position, health insurers give large contributions to elected officials. Such a conflict of interest keeps the entire health insurance industry insulated from changes that threaten the status quo.

The second concerning issue is direct-to-consumer marketing: The pharmaceutical industry provides the medical products that physicians rely on. It targets patients with direct-to-consumer marketing, which gives patients impetus to inquire about such products when visiting their doctor. That places physicians in a position of explaining their benefits and disadvantages.

Many such products are new. There are often less expensive alternatives. With patients using “Dr. Google” before their visit, physicians must use valuable patient time to deflect self-diagnosed issues.

An informed patient offers many benefits to physicians. However, when such information crosses the line to self-diagnosis and treatment, physicians end up using their time defending the results of their own examinations.

The net effect of this dysfunction contributes to physician and provider burnout that threatens the viability of our nation’s health care system.

Sensible changes are needed to how healthcare is delivered and paid for. What are some possibilities?

Health insurers should adhere to a common set of rules. The concepts of in-network and out-of-network should be abandoned. Every provider in the nation should be classified as in-network.

Fee for service should be replaced by fee for health, enhancing the value of services that offer the most benefits to patients and their well-being. This places a premium on preventive medicine.

Physicians and other providers must steer the nation’s healthcare ship. They must be trusted stewards so that prior authorization is eliminated or only used to protect patient well-being. With health insurance companies usurping such authority, everyone loses, except the companies.

To achieve positive results demands meaningful changes that place the health of patients first.

Spending more does not mean better health, as evidenced by numerous countries that spend less than the United States, yet have longer life expectancy. It depends on what the money is being spent on.

Until such changes are made, physicians and other providers will continue to leave the profession.

COVID-19 did not cause this situation; it exposed it. At the root of the problem is a disconnect between health and healthcare, and how it should be paid for. Restoring physicians to their rightful position can begin the healing process.

Sheldon Jacobson is a professor of computer science at the University of Illinois at Urbana-Champaign.

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