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How We Can Improve the Quality of Healthcare & Pay Less for it?

The Affordable Care Act is not the death knell for medicine nor has it fundamentally changed healthcare. The business of medicine is a mess. Two years into the Affordable Care Act, we have a record amount of people enrolled to receive healthcare insurance. Wonderful, the system is still broken, we just found a new way to fund it. What this legislation has brought to light and created discussion about is the affordability (or lack thereof) of healthcare. It got us talking and thinking about healthcare.

It has also increased the ability for insurance to cover preventative healthcare. In our society, we go to a doctor when we are sick or injured. Our expectation is that our doctor will have the experience, protocol, or medication to fix us. Whereas this works for chronic or acute conditions, it does little to proactively address the underlying cause of what makes us sick or ill in the first place. This holistic approach to preventative healthcare has been prevalent in Traditional Chinese Medicine (TCM/TOM) for centuries. Interestingly enough, during my recent trip to Beijing, I was told by a few Chinese citizens that they have an on- going relationship with their TCM Physician. When they get sick or contract a disease, they turn to Western Medicine because they feel it is more effective.

The Affordable Care Act has required that more people have health care insurance. It has made healthcare insurance available to people who have pre-existing medical conditions by making it illegal for insurance companies to deny coverage. Sadly, the underlying problems in medicine have not been fixed and this means that more people are now paying into a broken system. Our current system incorporates a mediator (insurance companies) which tell physicians how much they can charge for their services. With all of its resources and investment in research and development, the US Healthcare system costs more per capita than any other developed country.

As an industry, Western Medicine has done little to further preventative healthcare and nothing to provide the education and resources to help keep us healthy. Western Medicine could benefit by the adoption of many of the preventative healthcare practices of TCM. If so, the chances of getting sick or contracting a disease could be reduced. Less need for acute or chronic medical care means less money, lower cost.

Consumer acceptance of preventative healthcare will occur with education, increased personal involvement in their care and as they have to pay higher and higher fees for medical services. This needs to be coupled with the willingness of insurance carriers to reimburse practitioners fairly for providing care. Some insurance carriers are currently increasing their rate of reimbursement to Naturopathic Physicians. Hopefully, this will also happen with Primary Care Physicians who are currently reimbursed approximately $40 for a well care consultation. This is why Primary Care practices have either been forced to limit patient diagnosis time to 7-10 minutes to maximize sales volume or sell the practice to hospitals.

Hopefully the insurance companies who are vested heavily in the current system will help facilitate this change. I think we can impact the cost of medicine and how we pay for it by not paying health insurers to cover Primary Care. If we all were participants in patient paid clinics that provide all basic care up to and including EKG's and blood panels, the quality of care would improve and practices would be profitable. This would require that we pay a monthly fee for access to our physician. The cost to us would be less than what we are paying for health insurance that currently requires a copay and only reimburses 80% of the cost of care. Primary care physicians would be the true gatekeepers that refer patients to specialists when there is a need. They would have more time to listen to our health concerns and be more involved with providing care that encourages a healthy lifestyle and inspires us to live one. Care such as this will help us achieve optimal health, and educate us in nutrition, diet, sleep, movement/exercise, stress, breathing, heart health, brain health, pain management, and other lifestyle issues. Wouldn't it be great if insurance companies would eliminate Primary Care from their programs? Payment for "referred care" by the Primary Care physician will require that we all have an HSA and/or a high deductible catastrophic care insurance policy for when we need it. Because of more preventative care, there would be less demand and lower prices for specialist services and the treatment of disease.

The Affordable Care Act should support these efforts and recognize that paying for health care this way will meet the qualification that everyone has insurance. Over time, we will be healthier. 67% won't be overweight or obese and we could lower the incidence of heart attack and stroke. From my vantage, this type of program is within our grasp and is will go a long way to helping us live a healthy lifestyle, achieve optimal health, and lower the cost of healthcare.


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