MILBRIDGE — Once again the Republican Party is pounding its collective chest and saying repeal and replace of Obamacare is close. If it is anything like the last disaster they presented, what they really mean is a watered-down weakened version called RyanCare, consisting of tax breaks for wealthy Americans, 24 million fewer insured Americans and rising premiums for the rest of us. That hardly solves the issue.

The Affordable Care Act was passed after many provisions were struck from the original version – including a public option. If the current administration were truly serious about engendering competition and bringing costs down, then a public option should be in play. Let people buy into Medicare.

Frankly we could have a single-payer, Medicare for all system: Simply increase the Medicare tax by 3.5 percemt (about $59 per $20,000 earned) and everyone is covered. I just don’t think either side of the aisle will bite given the strength of the insurance lobby. Given that the government already pays the majority of health care costs, between Medicare, Medicaid, Tricare, the Veterans Affairs system and the various federal employee programs, it would be logical to have single-payer – but logic has not always been a strong point of government.

In overhauling the morass of health care, Washington would do well to do something about the enormous administrative burden that has been placed on those of us who provide the care. Lost in all the discussion of insurance and coverage is physician burnout. The more spent on administration as opposed to actual care, the worse the experience for both physicians and patients.

Physician dissatisfaction is directly related to this increase in administrative burden. Physicians are dropping out, retiring and committing suicide. This is an additional financial toll. The cost of training physicians is only partly covered by tuition. The rest is covered by Medicare funds that the hospitals receive. If you do not have physicians, you do not have health care. Wake up, Washington.

Physicians are tired of chasing payment for services rendered – especially when it is a fraction of what we bill. We are tired of prior authorizations. We cannot make sense of why a medication was on the plan last week but is not there this week – particularly generic medications that cost pennies. When this decision is being rendered by a customer service representative with no medical (or other) degree, it is particularly degrading.

None of us spent thousands of hours training for this. That is not the calling we answered. The mind-numbing waste of our time is obscene. According to the Commonwealth Fund, the United States ranks last among 11 developed nations on measures of access to care, efficiency of care and equity of care. We should be embarrassed.

We fought for the ACA to keep insurance companies from canceling consumers’ coverage retroactively. We fought to stop lifetime caps. We fought to stop gouging patients with pre-existing conditions (including babies born with them).

We fought to stop gender discrimination – being a woman should not be a pre-existing condition! I will not go back to that. I personally was affected by that. When I graduated from medical school, I was 12 weeks pregnant. I arrived for residency and could not get insurance because my pregnancy was a pre-existing condition. You cannot make this up.

When I finally did get insurance (through the hospital I was working for), they did not want to cover the newborn exams we required as a hospital. Yes, I was just as mystified as you are reading this.

By definition, insurance companies collect your money and try not to pay out. With health care, this is just a no-win proposition. When they are answering to shareholders and paying exorbitant CEO salaries, that money is not available to those actually providing care.

If we were to join the rest of the developed world with single-payer, then the government would cover most of the cost, private insurance companies could compete for the co-pays (or offer more extensive products) and consumers could elect to purchase these policies or not. This would allow a true free market to develop – one that could actually cross state lines. Perhaps I am dreaming but it really is time to put patients over politics.

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