It is astonishing that treatises, white papers, editorials, and articles regarding the cost of health care consistently overlook the core of care and lack adequate physician input. Insurance does not equate to health care; authentic health care can only occur with the participation of doctors. Ultimately, real care is provided through a doctor building a relationship of mutual trust with a patient, instead of through detached entities in a corporatist structure or through the bureaucracy of insurance firms and government initiatives.
Doctors must be the “best and the brightest,” as the level of health care directly relies on the skills of physicians. However, attracting top talent to a rigorous medical education lasting 12 to 15 years is difficult, especially as remuneration has been declining over the past two decades. This trend threatens to foster mediocrity and a deficit of medical care.
The rising operational expenses for physicians, influenced by regulations, staff salaries, and essential care requirements, along with dwindling reimbursements, worsen the scenario. This has led to premature retirements, burnout, and the troubling trend of doctors choosing hospital employment to alleviate these demands. Physicians are not intended to be workers in extensive hospital systems, where service to bureaucratic authorities frequently detracts from patient care. These systems suffer from inefficiencies, excessive managerial layers, and outdated business models.
Moreover, legal regulations such as Certificate of Need (CON) laws, Stark laws, non-compete agreements, and various payment mandates hinder market innovation and competition among physicians. Pricing in health care deviates significantly from free-market principles. Medicare and Medicaid arbitrarily establish prices, with private insurers following suit, intensifying the financial and professional strain on physicians and rendering the current system unviable.
Malpractice and its related direct and indirect expenses cast a large shadow over the industry, evolving into a litigation bonanza for lawyers. Tackling these issues, for instance, with loser-pays systems and enlightened juries, could potentially lower medical care costs.
The present health care system has descended into disorder, heightened by mounting government interference. Academic and political discourse, often lacking physician involvement, has repeatedly fallen short. The function of market principles in health care remains largely unexamined.
Regrettably, physicians’ organizations, such as the AMA, have become politicized, frequently failing to represent the majority physician perspective and not offering a forum for authentic input. Recognizing and involving thought leaders within the physician community is vital for restructuring the health care system to provide optimal care to those in need.