The Huffington Post February 6, 2014
John Geyman
We have heard the promises as the Affordable Care Act (ACA) was being sold to the public, including — you can keep your doctor and insurance if you like it. We now know those promises to be mostly false as the ACA enters its fifth year of implementation.
Under the guise of “competition” and “efficiency,” the ACA has unleashed a new round of disruption throughout the health care system. We are seeing further fragmentation of care, with less continuity of care with patients’ physicians. The physician-patient relationship itself is at risk in a “system” increasingly headed for strangers taking care of strangers.
More than one-half of U.S. physicians are no longer self-employed and now work for organizations, mostly growing hospital systems but also some insurers that are moving into the delivery side of health care. Two examples illustrate the new landscape:
• Several hundred patients at the University of Pittsburgh Medical Center (UPMC) recently received certified letters informing them that they could no longer see their physicians. The reason: their insurance, Community Blue, sold by Highmark, is now both a rival hospital system and an insurer. Patients were cut off from their UPMC physicians even in the middle of cancer therapy. (1)
• United Health Group Inc. is the biggest player in the Medicare Advantage market with almost three million members and 350,000 physicians in its networks. In recent months it has dropped thousands of these physicians from its networks in at least 10 states. At Moffitt Cancer Center in Tampa, Florida, for example, some 2,500 current cancer patients will have to switch plans or find other physicians. (2)
A previous Health Care Disconnects post has described how patients are losing choice of physician and hospital through narrowing networks. (3) People can be in or out of a network at a moment’s notice, a dynamic that almost certainly seems to be driven by money — how can the insurer make more money by ridding its network of higher-cost physicians and patients.
Continuity of care, especially with a primary care physician, has been and should be the foundation of the physician-patient relationship. It facilitates coordination of care by other physicians and providers. But that continuity is now being split apart by market forces from all sides — mergers and consolidation of hospital systems, business decisions of insurers, instability created by evolving accountable care organizations, shortage of primary care physicians, and the lack of inter-operability of electronic medical records, for starters. The challenge of how to coordinate and integrate health care in such a chaotic system increases by the day.
As the supposed signature domestic success of the Obama administration, we have already found that keeping your own physician and insurance plan is difficult, if not impossible. We will soon also find that health care is not more affordable, less
expensive, or better with the ACA.
It
is ironic that much of this could have been fixed before this latest round of health care “reform” kicked in with the ACA in 2009. Under a single-payer financing
system, as embodied in An Improved and Expanded Medicare for All (H.R. 676), we could have a simplified, more efficient, not-for-profit public financing system coupled with a private delivery system, assuring all Americans with a comprehensive set of benefits and full choice of physician and hospital. President Obama recognized this as early as 2003 in this speech to the Illinois AFL-CIO: