Why?

There have been multiple attempts to correct the health care system but none of them have been able to fix it. The tipping point for me was reading that the United States was ranked last of all the high-income countries despite spending the most amount of money. It’s embarrassing as a physician to be part of the health care team that is in such bad shape. It was at that time that I decided I had to try to reverse our rankings. The question was how?

Since I started private practice in 1982, there have been significant improvements in the delivery of health care. CT and MRI arrived later that decade as did screws small enough for foot surgery. Fax machines made it faster to share medical records with other physicians and hospitals. Electronic medical records made it much easier to read others’ progress notes. Telemedicine allowed care during the pandemic and now for those who have transportation issues as well as convenience.

On the other hand, the administrative burdens have detracted from the delivery of health care. Time is wasted on authorizations, credentialling, predeterminations, excessive and duplicative charting. That is time taken away from caring for patients. As a result, the patients feel rushed. The doctor-patient relationship is strained as the patients rightfully don’t feel that they have enough time with their doctor. Providers now worry about charting for the services rendered. Was the word that must be in the progress note to get paid for the service rendered used even though it is not the word taught in school? Were all the ancillary forms signed to demonstrate that the patient received the goods that were documented in the chart?

Wanting to learn what was done in the past, what worked and what didn’t, I read several books on the previous attempts to fix health care starting with Senator Edward Kennedy’s book in 1972 when he was Chairman, United States Senate Health Subcommittee, In Critical Condition The Crisis in America’s Health Care. The books provided the insight that I was looking for. The short comings of the various plans were easy to see when one Monday morning quarterbacks. When an issue arose, changes were made that addressed that issue. Since those making the change were not directly involved in health care, they could not foresee the effects it would have on another part of the system. The most obvious one is the decrease in reimbursement. The goal was to bring down the cost of health care, so premiums didn’t have to continue to be raised. Lowering the fees did not bring down the overall cost of health care. However, it adversely affected the quality of health care as physicians now must see more patients in the same amount of time to pay the increase in overhead due to the extra staff that they had to hire to do all the extra paperwork.

The most amazing fact gleaned was that there was never a coalition of all those who were involved in health care in its redrafting. The more I analyzed it, the clearer it became to me that is why the United States is ranked last. Those involved in the delivery of health care never functioned as a team to reform it. The starting point for Let’s Fix It is bringing all the national associations that have anything to do with health care together to reverse our ranking.

The recent assassination of Brian Thompson, CEO of UnitedHeathcare, on December 4, 2024, is a sign that the American people have had enough in regard to the way their health care system functions. They have sent a clear message to us that the present health care system is dysfunctional. They want a better-quality health care system, and they want it now. We can and must do that for America. Otherwise, we must ask ourselves who’s next.