Our American medical system with its deep pool of highly trained specialists, the best in the world when it accrued inside a culture of science and learning, is Humpty Dumpty falling off the wall.  It has had to focus its priority away from the doctor-patient relationship and more toward appeasing ever-expanding federal and bureaucratic control.  Doctors and patients are pawns caught in a game of power.  All the king's horses and all the king's men, so they say...but is there any way to save the best parts of our health care?

As the federal government hurtles toward a Medicaid-for-all system, justifying the expansion of access and affordability as its primary goals, it is alienating those who are supposed to provide that care.  It is impossible to have access, affordability, and quality co-exist in any proposal.  Access assumes there will be enough doctors to see all the patients and assumes efficiency in the doctor's offices.  Nothing is as unaffordable as "free" anything when it comes to the federal government.  Quality plummets when the best doctors quit.

Many doctors are losing their love of medicine.  (Make no mistake: there are few professions as challenging and rewarding.  Name another job where you are thanked for saving a life, even when that is often an exaggeration, on a daily basis.)  But advances in care like the electronic medical record, while awesome in some respects, are a real time sink.  In order to fulfil EMR billing requirements and still see enough patients to be able to cover their overhead, it is difficult to produce a factually accurate, non-fraudulent medical record. 

Reimbursement is plummeting as unpaid busy work is accelerating.  Doctors, as a result, are looking to retire early or try a new career.  Older specialists, an irreplaceable reservoir of knowledge and skill, are the least pleased.  While their merit as physicians is often close to peak value, their pay is not.  Physicians over 65 represent 21% of the total number of practitioners in the United States.  When talking about doctors over 55 years old, this represents 42% of the total.  That's 336,000 out of 800,000 physicians, and a lot of them do not like the way medicine is changing.

The bureaucrats who study the problem of access think overwhelmed primary care providers will get real help from physician extenders like physician assistants and nurses.  But the training is just not commensurate, and the quality of care suffers as a result.  And even if they become excellent providers, we are seeing burnout of them as well.

So we have a federal takeover of health care coming with a rapidly dwindling cohort of doctors.  Most of the happiest remaining primary care doctors are turning to concierge medicine, hardly an affordable alternative for most Americans.  Many of the older specialists are leaving altogether because of a general feeling that their work is not properly valued.  The doctors who choose to continue have to deal with a bunch of people telling them how to practice and how many people that they need to see a day, all the while knowing that every patient represents a lawsuit waiting to happen.

Patients are consequentially overtreated, over-tested, and over-scanned.  This stems directly from the fact that providers don't have the time to get a full grasp of the patient's illnesses.  But there are answers out there that could catch Humpty Dumpty and put him back up on the wall.

Dr. Tom Price was a successful orthopedist in Roswell, Georgia before he felt called to leave patient care and try to help find a way to fix the country's health care problem.  He introduced a bill that would get all Americans covered and could actually bring down the cost of care while he was in the House of Representatives.  Eight hundred of us involved in the newly formed "Docs 4 Patient Care" went to Washington, D.C. in support of that bill back in September 2009.  Despite being dressed in white coats and scrubs, taking the stage on the National Mall, and flooding the halls of the House and Senate buildings, we got no news coverage.  Dr. Price's bill got hung up in the Democratically controlled House, never seeing the light of day.  The mainstream media had four "pink ladies" supporting abortion on all of the news channels but no mention of our group or what we supported.  It was obvious that cutting costs and getting everyone covered for care was not a Washington, D.C. priority.  Obamacare was the priority.

Unless the ideas of Dr. Price are revisited, we will have less access to real doctors, "free" yet unaffordable care, and much greater exposure to poor-quality health care providers.

Docs 4 Patient Care and their commitment to the doctor-patient relationship still exist.  Dr. Price thought a combination of insurance pooling of at-risk individuals, health care savings accounts, tax credits, malpractice reform, and options for pre-existing conditions were the keys to a better future.  Will we find out the truth of this before we lose our most experienced providers?

Image via Pixy.