An ideal health system would look a lot like the market for cell phone repairs. In the city where I live, I can pop into any one of a dozen or so repair facilities without an appointment and get high-quality, low-cost service. There are even firms that will send someone to my home and repair my iPhone in my condo.
If something happens to my body, on the other hand, the average wait to see a new doctor in the United States is three weeks. In Boston, where we were told there was “universal coverage” even before there was Obamacare, there is an extra month of waiting on top of that. Before the coronavirus crisis, the average wait in California hospital emergency rooms was 5½ hours. At one hospital, almost one in ten patients left without ever seeing a doctor or completing their care – presumably because they got tired of waiting. Late last year a lady in Georgia waited in a hospital emergency room for seven hours before leaving. She later received a bill for $700 even though she was never seen.
If the reformers wanted to make the market for medical care look a lot like the market for cell phone repair, they would get my attention in a heartbeat. They don’t come close to saying so, however.
Let’s take a handful of reform plans: Obamacare itself, Bernie Sanders’ plan to provide Medicare for all and the half dozen other Democratic proposals to expand Medicare or create some other public option. We can even include California’s failed Single-Payer initiatives, and others over the past few years in Vermont and Colorado.
What do any of these plans have to say about my being able to talk to my doctor by phone? Not a word. What about being able to email my doctor day or night? Zilch. How about video conferencing? Nada. How about reducing the time patients spend waiting in ERs? Zero. How about reducing the time it takes to actually see a doctor? Nope, not at all.
Strangely, health reform in all its guises has almost nothing to do with real patients, real doctors and how people are going to get medical care.
So, what is health reform typically about? It’s usually about blurry, unfocused, ill-formed, ill-thought-out ideas – usually just emotions — that are rarely explained or properly examined.
A revolution is occurring in the way medical care is being delivered in the United States. It is happening almost overnight. Patients and doctors are communicating by means of phone, email, Skype, Zoom and other devices.
If you are like a great many people, you are probably wondering why it took so long.
Before COVID it was illegal for doctors to bill Medicare for consultations by phone, email or Skype – except under special circumstances. Also, employers faced huge fines if they provided funds that allowed employees to purchase individually owned health insurance that travels with the worker from job to job and in and out of the labor market.
All that has changed. And these changes began in the Trump administration.
On more than one occasion, President Trump promised a health plan that would be “phenomenal” and he promised to make the GOP “the party of health care.” That’s actually been happening. The health policy community just hasn’t been paying attention.