As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system has evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.
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The Patient Protection and Affordable Care Act (ACA) was enacted by the United States Congress in 2010 to guarantee basic health insurance to all citizens. People who object to the ACA ,aka Obama Care, dislike or even fear government involvement in medical care; they consider it interference, control, or even nationalization of the United States healthcare system.
I think many people, even physicians, don’t realize or forget, how involved the government already is in healthcare. As far back as the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system has evolved into the current military health care system which covers service members and the Veterans’ Administration system for veterans.
a Veterans Administration clinic (photo by Dr. Aletha )
American soldiers serving in Afghanistan
The year 2015 marked the 50th anniversary of two other government healthcare programs- Medicare and Medicaid. The Journal of the American Medical Association, (JAMA), devoted an entire issue to them,the ACA and the implications for the future of healthcare in the United States.
Medicaid provides insurance coverage for adults and children who are unemployed or low income.
Medicare covers disabled children and adults and persons 65 years and older.
The numbers are rather staggering.
Together these programs cover at least 30% of Americans.
Together they comprise 25% of all federal spending.
Together they pay 40% of total U.S. health care spending.
Disabled children and adults may qualify for Medicare.
Children may be eligible for Medicaid if their families cannot obtain health insurance for them.
You may not be eligible for either of these programs now, but chances are eventually you or someone close to you will.
Anyone can become disabled from a serious illness or freak accident.
You or your spouse may lose your job and your employer sponsored health insurance.
Your child may have a disability that will prevent them from working when they grow up.
We may all live long enough to qualify for Medicare on the basis of age alone. Your parents or grandparents are near or already at Medicare age.
Senior adults age 65 and older use Medicare.
It’s important to understand how Medicare works, since it’s not automatic; even if you qualify, you need to sign up to be covered (with a few exceptions). The rules are summarized here. Or consider an easy to understand book here.
photos courtesy of volunteer photographers at Pixabay
Use these links to share the heart of health wherever you connect.
Since the late 1970s, the medical profession has transformed considerably, largely due to government interventions and technological advancements. These changes, which were initially predicted by Dr. Jeffrey Singer in 2013, include the integration of technology via electronic medical records (EMR), linkages of compensation to medical coding, and the shift toward 3rd party payors like insurance companies. Furthermore, the profession has seen a surge in nurse practitioners and physician‐assistants, limiting the role of traditional physicians. However, a small market for cash‐only, personalized, private care remains resilient amidst these transformations.
updated February 1, 2022
“Since the late 1970s, I have witnessed remarkable technological revolutions in medicine, from CT scans to robot-assisted surgery. But I have also watched as medicine slowly evolved into the domain of technicians, bookkeepers, and clerks.”
Jeffrey Singer, MD, 2013
photo from Prixel Creative at LIGHTSTOCK.COM, affiliate link
Since Dr. Jefferyh Singer wrote this article in 2013, most of the changes he predicted had or were in the process of occurring.
By 2013
Medicare imposed price controls based on codes for the diagnosis and the doctor’s service.
Private insurers linked compensation to coding and diagnosis, not the service the doctor performed.
Change from patients paying for their care to 3rd party payors, usually insurance companies.
Health maintenance organizations, HMOs, required in-network care only, restricting patient choice (these largely have gone away)
Practicing by evidence based medicine, treatment protocols, and guidelines, sometimes enforced with financial penalties
But some of what he wrote was yet to come-and it did.
Trend toward replacement of physicians by nurse practitioners and physician‐assistants
All physicians and hospitals converted to electronic medical records (EMR) by 2014 or faced Medicare reimbursement penalties.
Doctors more often selling their practices to hospitals, thus becoming hospital employees.
Growth of a small but healthy market for cash‐only, personalized, private care.
photo compliments American Academy of Family Physicians
What patients should know
(according to Dr. Singer)
The increased regimentation and regularization of medicine is a prelude to the replacement of physicians by nurse practitioners and physician‐assistants.
It is true that, in many cases, routine medical problems can be handled cheaply and efficiently by paraprofessionals. But these practitioners are limited by depth of knowledge, understanding, and experience. Patients should be able to decide for themselves if they want to be seen by a doctor. It is increasingly rare that patients are given a choice about such things.
Medicare continues to demand that specific coded services be redefined and subdivided into ever‐increasing levels of complexity. Harsh penalties are imposed on providers who accidentally use the wrong level code to bill for a service. Sometimes the penalty can even include prison.
A small but healthy market exists for cash‐only, personalized, private care. For those who can afford it, there will always be competitive, market‐driven clinics, hospitals, surgicenters, and other arrangements—including “medical tourism,” whereby health care packages are offered at competitive rates in overseas medical centers. Similar healthy markets already exist in areas such as Lasik eye surgery and cosmetic procedures. The medical profession will survive and even thrive in these small private niches.
In 2011, The New England Journal of Medicine reported that fully 50 percent of the nation’s doctors had become employees—either of hospitals, corporations, insurance companies, or the government. Just six years earlier, in 2005, more than two‐thirds of doctors were in private practice. As economic pressures on the sustainability of private clinical practice continued to mount, this trend continued and grew
exploring the HEART of physicians practicing medicine
I am more optimistic than Dr. Singer. I see doctors of my generation still actively practicing, many still in their own practices. And I see the younger generation of physicians entering practice with new skills, tech savvy, influencers, and just as dedicated to taking care of patients as we were 40 years ago.
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watercress words by Dr Aletha 