The American health care system is in dire need of reform. The system is highly fragmented, but so is the patient’s knowledge of the issues. Health care spending reached an all time high in 2011, accounting for 18.2% of GDP. Expenditures are also expected to reach $2.5 trillion this year. Consequently, businesses and families are finding it increasingly difficult to afford health care. A key reason to the skyrocketing health care costs in the United States is the higher costs charged by American physicians. “We pay doctors for every single service, which creates bad incentives to do more; we sue and sue, upping the cost of insurance for doctors and the amount of care. We do waste a lot…why does this matter? Even if we cut waste by as little as five percent we could pay for the uninsured” (Health Care Half Truths, xiii). As a result, American physicians are paid more for each service than physicians in other developing countries, including, Australia, Canada, France, Germany and the United Kingdom. Primary care physicians in the United States had the highest annual pretax earnings after expenses. American physicians made an average of $186,582 in 2008 compared to physicians in Australia and France who had average earnings of $92,844 and $95,585, respectively. In order to remediate the issue of soaring health care costs, immediate nation-wide deregulation of the medical profession needs to be implemented by the United States Department of Health and Human Services, Department of Education and Association of American Medical Colleges.
Combating high health care costs in the U.S. has historically been controversial and unsuccessful. Much of the burden has been placed on the government. U.S. government programs pay 47 percent of health care costs, which accounts for 20 percent of the federal budget, and most state budgets. This means that 20% of the taxes that Americans paid last year went into healthcare alone. Funding health care poses a financial burden for the United States government; these expenditures account for a significant amount of the national deficit and withdrawals from the budget available for other economic needs. According to health care experts, “rising health costs represent the greatest threat to our long-term economic stability. The Center of Medicare and Medicaid Services Office of the Actuary estimates that by 2018, over one-fifth (20.3%) of our economic output will be tied up in the health system, limiting other investments and priorities” (Health Care, 24).
The health care crisis affects every American citizen that currently requires medical attention or will potentially need it in the future; therefore, this issue warrants immediate attention. The increasing costs directly impact everyone and serve as a threat to an individual’s ability to provide food and shelter to his or her families. Since everyone shares the burden of these health care costs, the crisis warrants national concern, as the costs will only get worse. According to the Kaiser Family Foundation, the annual cost of coverage for a family of four is estimated at over $10,000, which is approximately what a person earning minimum wage and working full time at Wal-Mart would earn in a year. We care about these medical expenditures because they impact our financial well-being and can be detrimental barriers to our future. Medical expenses account for approximately 50% of all personal bankruptcies and this number will only increase if changes are not made to this persistent crisis NOW.
Why does the problem persist? Is this really a problem?
If this is a social crisis, then why has the issue remained unresolved? The issue of skyrocketing health care costs has remained unresolved despite the numerous efforts made by the American government. The system is highly fragmented and there is a lot of controversy over what policy is appropriate for the American people. For over a century, the United States has debated over what the government’s level of involvement in health care should be. The sustainability of Medicare, the ability of the U.S. government to manage the escalating health care costs, and understanding why the U.S. is trailing behind other developing countries in health care has remained a priority for the United States’ political leaders. On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. This was different from former models of reform and was expected to create drastic changes to the health care system in the United States. However, much debate remains over whether this new health care model will really help cut savings.
The main reason why health care costs continue to soar is the United States is inefficient spending. “There’s the 30% of health spending that’s wasted on worthless care – about the price of the $700 billion mortgage bailout, squandered each year. Plus, there’s the 10% or so of medical spending that covers avoidable administrative costs – another $200 billion a year”(The Hippocratic Myth, 49). Will the Affordable Care Act remediate these problems? Critics have argued that the law will only modestly reduce the costs of care, which prompts the need for a better solution.
Health care is not a real social problem
However, a group termed the “mega-rich” by Warren Buffet would argue that the rising health care costs are not a problem. This group includes the upper class, the pharmaceutical companies, private insurance companies and the medical professionals that have not been impacted by the rising health care costs or have benefited from the crisis. As discussed by Warren Buffet in his New York Times editorial, “Stop Coddling the Super-Rich,” “while most Americans struggle to make ends meet, we mega-rich continue to get extraordinary tax breaks” (New York Times, 1). The wealthy were exempt from the “shared sacrifice” of the financial crisis that the lower and middle classes have been forced to endure. Warren Buffet claims, “these and other blessings are showered upon us by legislators in Washington who feel compelled to protect us. It’s nice to have friends in high places.” Unfortunately, this shows that only limited groups of people are currently entitled to exemption from the shared sacrifice. This luxury shields them from seeing that this is a real problem.
Although these individuals have been shielded from the financial burden created by the soaring health care costs, social responsibility pressures will force these individuals to eventually bear a proportionate share of the costs. Warren Buffet and Bill Gates are among the key players that have announced the need for the “mega-rich” to participate in the shared sacrifice. In response to Warren Buffet’s cry for top earners to participate in remediating the financial crisis, Obama proposed a new tax rate for individuals making over $1 million; this was coined the “Buffet Rule.” Others in the upper class will be forced to follow suit in order to maintain a positive public image for their businesses and as public support for such initiatives escalate. As such, the soaring health care costs will serve as a problem for every American citizen regardless of social class. The impact is only a matter of timing.
The Culprit – The Doctor
Patients instill their trust and well-being into doctors; however, because of the expanding medical capabilities created by technology and the rising costs of health care, this promise has become compromised. Health plan bureaucrats, public officials, national security, and the courts of law have amplified the strain between a doctor’s role as caregiver and cost-cutter. These pressures have molded the current doctor – patient interaction and caused its deviation from our historical perceptions of a doctor as our sole caregiver to cost-cutter; this accounts for the high health care costs. Pressures on the doctor’s behavior have evolved over the years to create moral dilemmas that can compromise our liberties. The physician’s actions serve as the underlying reason behind the increased health care costs and shows why health care reform should be focused on the physician.
“We spend twice as much per person as Canada, Germany, and France and two and a half times as much as the United Kingdom, Italy and Japan. And as good as our health care is, it’s not twice as good as that in these other [developing] countries” (The New Health Care System, 158-159). According to a study performed by Miriam Laugesen, Columbia University professor, and Sherry Glied, Mailman School of Public Heath professor, American physicians are paid more for each service than physicians in other developing countries. American patients are charged more, but get lower quality care and less efficiency. According to the Commonwealth Fund report, the US ranked last in health care when compared to six other countries - Britain, Canada, Germany, Netherlands, Australia and New Zealand. But this math does not add up, how do we get charged more and get less care? The health care system needs reform.
The Solution
In order to combat the issue of skyrocketing health care costs, deregulation of the medical profession would be required. On average, it currently costs more than $100,000 to attend medical school. Practicing physicians are also required to attend at least 8 years of higher education and countless hours in residency. The competitive environment surrounding admission into the medical profession (high GPA and MCAT score) as well as the cost of attendance accounts for the shortage of health care providers in the United States. This allows the small number of physicians to charge higher health care costs. Physicians are also faced with pressures from health plan bureaucrats, public officials, and the courts of law that encourage them to charge more. By allowing less educated individuals to do some of the work performed by doctors, competition would increase in the profession and ultimately lower costs. Every physician should not have to go through the standard academic process that is currently implemented to become a doctor. There will be a tier system that will allow less educated individuals to treat patients, thus, the administrative costs that high paying physicians currently charge will decline. This information will be publicly available so that the patient will still have the ability to determine which level of care they prefer and the tier level that is required for a given condition. Therefore, uninsured individuals with a common cold or anyone that requires a simple annual visit can find health care at a much more affordable cost.
Each physician that is currently practicing will be considered a part of Tier I, which is further disaggregated into different areas of specialty, consistent with our current health care model of primary physician to specialist. These physicians have completed the entire academic process. Tier II and Tier III will also be disaggregated based on qualification. The health care costs charged by physicians in Tier I are highest and is proportionately decreased in each of the following tiers. Tier III physicians will be qualified in the performing general medical tasks, including household illnesses, general prescription refills and blood work. Tier I and Tier II will be able to provide more extensive care based on their respective academic achievements. The general academic guidelines applicable to each tier will be as follows:
Each doctor will be expected to refer patients to physicians higher up in the hierarchy if the treatment requested is beyond his or her expertise. The medical curriculum will not need to change during a student’s attendance in medical school. The primary change will be over the duration of time the student is in residency. However, given the lower academic rigor, each medical state board will be highly accountable for licensing only qualified physicians within each tier. The Department of Health and Human Services (HHS), Department of Education and Association of American Medical Colleges (AAMC) will need to concurrently determine the necessary qualifications for each tier’s licensure.
Who will implement this solution? When will the solution be implemented?
The U.S. government and Boards of Higher Education will play a critical role in the deregulation of the health care field. The government is responsible for protecting the health of all American citizens and for providing essential human services. The U.S. Department of Health and Human Services (HHS), Department of Education and the Association of American Medical Colleges (AAMC) will need to implement the solution. These governing bodies will first need to enforce each existing medical school to expand their program to include a Tier II and Tier III educational route for students that are interested in a less rigorous medical path or for students that are not interested in specializing in the medical fields that are currently offered. The AAMC, which is responsible for forming the medical curriculum, will need to revise its programs to ensure that each student in residency will get educational training that is consistent with the level of care they will be offering within their tier.
How much will this cost?
It currently costs approximately $15 to $20 million to staff a new medical school and $50 to $100 million to construct new medical facilities. There are currently 134 accredited medical schools in the United States. Based on the budget required to construct a new medical school, it is estimated that $100 million will be required to expand the curriculum at all 134 accredited medical colleges to account for the increased enrollment in the two new tiers. Campus expansion and staffing is expected to take four years; therefore, enrollment will open for interested students in 2014.
The Opposition and Why the Opposition is Wrong
Cases of malpractice will increase
Some will argue that deregulation of the medical profession will result in increased cases of malpractice. Opponents of the solution will attribute the malpractice to less skilled physicians. However, the regulating bodies of the United States retain the right to revoke an individual’s ability to practice medicine in cases of malpractice or serious misconduct. Under the proposed solution, each physician that undergoes the less rigorous academic path will still be subject to the same licensure requirements of medical professionals today. This will prevent a physician from treating a patient that is outside of his or her realm of expertise. The referral system will mitigate the problem of increased malpractice due to less skilled physicians entering the industry.
The current solutions will work
Opponents will also argue that the Patient Protection and Affordable Care Act will mitigate the problem of the soaring health care costs and that there is no need for another solution. “The Congressional Budget Office (CBO) estimates that an additional 32 million people will get coverage under the health care bill, expanding health care bill, expanding health care coverage to 95% of Americans. The CBO estimates that the new health care reform will cut the federal deficit by $130 billion in its first years and by $1.2 trillion in its second years” (Health Care). The new law is expected to extend health care insurance by expanding Medicaid and by providing federal subsidies to help more Americans buy private coverage. To reduce the cost of Medicare, the law will also create an expert panel that will limit government reimbursement to treatments that have proven effective.
However, the new law has faced much opposition from critics and the Republican Party. The law is “an intrusion by the government that would prompt employers to eliminate jobs, create an unsustainable entitlement program, saddle states and the federal government with unmanageable costs, and interfere with the doctor-patient relationship…the law would exacerbate the steep rise in the cost of medical services (New York Times, 1).
This is the BEST solution
Current reforms are not focused on doctors; consequently, current reforms will only heighten the pressures that are placed on this group and will not serve as long-term solutions. Doctors are able to continually charge patients higher prices through current reform initiatives. This is the best solution to the increasing health care costs as it focuses on the physician. The solution can also be quickly implemented; it requires less political sleuthing to gain widespread public support because people have the freedom to choose how much they want to pay. The patient maintains the right to choose the level of expertise they want from their physician. Not everyone will be subject to the high health care premiums if they go to a lower tier doctor.
This is also the most appropriate solution because it does not significantly impact current physicians, pharmaceutical companies and health care providers. The impact is limited to the medical institutions that must tailor its residency program to incoming Tier II and Tier III applicants.
The solution does not require continual investment to remediate the issue of soaring health care costs. The only recurring cost is the amount required to pay the new Tier II and Tier III faculty; however, this will be funded by student tuition. The investment in the facility expansions at each medical school will also be paid off by student tuition. The solution will be sustainable in the future because there will be no other recurring costs and because increased competition will force current practicing physicians to lower their costs in order to attract patients that want expert care at a reasonable price. It is necessary that the soaring health care crisis be resolved; otherwise, patients that are in need of care will avoid seeking help. This will lead to a decreased life expectancy and increased mortality rate in the U.S. Rising health care costs has been unresolved because former solutions do not target the physician as the cause of increased costs; therefore, this is the best solution as it expands the physician population and as it creates initiatives to lower costs in light of increased competition.
Works Cited
1. Bloche, Maxwell G. The Hippocratic Myth: Why Doctors Have to Ration Care, Practice
Politics, and Compromise their Promise to Heal. New York City : Palgrave Macmillan, 2011.
2. Merino, Noel. Health Care. Detroit : Greenhaven Press, 2011.
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Rowman & Littlefield Pub., 2007.
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