Healthcare Costs Are Out Of Control
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On February 24th, the Times Union published an article “NY hospital spending has tripled as quality declines.”
New York (like every state) is about 30 years overdue for a massive health care overhaul, according to a new report, as healthcare costs spiral out of control. Costs are spiraling in Connecticut, too.
“New York’s per patient spending has risen from $14,000 in 2020 to $26,000 in 2023.”
A lot of this has been due to the consolidation of our healthcare system and the disappearance of private practice. Private Practice was critical to community care.
As a Physician, I know Private Practices have disappeared for two key reasons:
- Hospital Networks (consolidated healthcare systems) have much stronger bargaining power than individual physicians, and therefore get paid much more than private practitioners for the same care. This is a trend that has been going on for over a decade. The Office of the Massachusetts Attorney General conducted a study over a decade ago that concluded that there could be up to a 300% difference in cost for the same services based on the bargaining power of the provider.
- Our regulatory state has made it increasingly difficult for private practitioners to comply with all of the increasing complex and unnecessary regulations imposed by the Federal Government. Many simply give up and seek employment in hospital systems and large groups.
THE PROBLEM OF CONSOLIDATION - 70% of our expensive emergency room visits could be replaced with more cost effective primary care visits if they were available.
WHAT ARE THE SOLUTIONS?
As D.O.G.E. looks to streamline the Federal Government, the Healthcare solutions are simple. It starts with the ABCs:
A. Allow Private practitioners to bargain collectively and get higher fees.
- This can be accomplished by State and/or Federal Law.
It sounds counterintuitive to pay doctors more to lower healthcare costs.
- A 25% increase in private practice fees would have a major impact on their income and still allow them to provide care at costs that are significantly lower than hospital systems.
- Private practitioners are more accessible to their patients and many patients with semi-urgent conditions would shift from Emergency Room care to the private office if given the opportunity. This was the premise behind the Urgent Care facilities, but those have mostly become part of the Hospital Networks and do not reduce emergency room usage.
B. Broaden Availability of Primary Care Physicians
- No income tax on Physician Overtime. President Trump is proposing legislation that would allow workers who work overtime to earn their overtime income tax free. If we allowed doctors and other healthcare professionals to have the same benefit of tax free income when they work overtime treating patients, we would have more access to primary care and other physicians without increasing healthcare costs.
- We need to incentivize primary care physicians to extend their hours. Doctors, unlike others employed in private practice of medicine (like Admins, Technicians, RNs, LPNs, Nursing Assistants), do not get time and a half or overtime for working additional hours. Longer hours without incentives is not happening and cost of care increases for the staff without a commensurate offset for physicians.
- Providing medical care is grueling, burnout is high and with the current state of medicine, many younger healthcare workers are likely to exit healthcare.
- This change would not impact insurance reimbursement, as insurance companies and the government would pay the same fees for service, but by making it tax free the doctor would increase their take home pay. Without the incentive to work overtime, doctors would stay home so there would be almost no loss of income tax revenue with this plan.
- If every patient was given that option, they would likely prefer to go to someone they know over a cold, impersonal and inefficient Emergency Room.
- This could save over $1,000 per visit in Connecticut. The current average emergency Room visit in Connecticut is $1,633 and the average cost in the NYC Metro Area is $3,556.30.
- Many of these services could be provided in private offices for less than 20% of what it would costs to provide them in an Emergency Room.
C. Conserve Medicaid (Husky in CT). The final extra cost to our healthcare system is the availability of free Medicaid for Illegal Aliens while businesses, middle class people and self employed struggle with increasingly higher healthcare costs.
- By law, any ER has to take patients and take care of patients in the ER. No one is advocating denying care for ERs, but there needs to be a reduction in full medical benefits for illegal aliens to have better care than most private payers who struggle with deductibles that are several thousand dollars and even higher for families.
D. Deregulate Administrative Paperwork - Physicians spend 20+ hours a week complying with healthcare paperwork which provides little to no benefit to healthcare outcomes. Your sexual history and gender are not relevant when you walk into an ER with a broken arm.
The patient intake form which was 3 pages when I worked in an ER is now 50 pages or more. And 47 plus extra pages do NOT improve outcomes - it reduces outcomes as fatigue from paperwork and administration results in a healthcare team that may not be focused on your care but compliance with bureaucracy.
As a Congressional Candidate in 2024 I advocated on a platform for a more cost effective healthcare system with more competition and less regulation.
Team Goldstein knocked doors this weekend for a Special State Senate Race for Connecticut’s 21st District for Jason Perillo (which he just won).
We know Healthcare and Immigration are major topics for Connecticut voters that we talked to, including unaffiliated voters. There is a justified resentment of private sector workers paying for healthcare and watching illegal aliens with carte blanche health care on Husky. They would not trade their lives for those on welfare or other public assistance, but seek equality of healthcare not subsidizing their own health for worse coverage than those who do not contribute to our system.
We are still fighting for lower healthcare costs and better quality healthcare.
No disrespect, but your prescriptions are not consistent with the D.O.G.E initiative as it unfolds.
The very first remedy, “Allow private practitioners to bargain collectively… “, speaks volumes. As accurate as your observations may be, the balance of the agenda appears to simply rearrange the deck chairs on the Titanic.
The almost reflexive, conditioned dependence on the variations of collectivism that we now assume in this State and nation is our bane and is appalling.
Both the entitlement and the sense of entitlement reek.
We need to be honest with ourselves when, couching our true intentions to seek and apply State remedy, we artificially don the cloak of Americanism.
Few are willing to consider that exorcism and amputation, as harsh they may be (but are what D.O.G.E is), are the only remedy to this dilemma.
So, can anyone imagine what shape an actual D.O.G.E. effort toward healthcare might take?
Please do not think that I am sniping from the gallery, Doc. I applaud that you entered and remain in the arena.
My perspective, though, understands that over decades or more, the U.S. and CT have abandoned the constitutional system for a gruesome hybrid of utter Statist intention - the fore-mentioned Titanic.
We must commit to refuse to abide this fetid amalgamation, and also to slay it.
So again, imagine... say, eradicating the health insurance paradigm altogether?
It was the Healthcare Maintenance Act of 1973 that began the destruction of the Doctor Patient Relationship in the United States and assured Doctors worked for HMOs and Government monetary support of them that began the destruction of quality healthcare in this country hands-down. Read my article last week about it!
I have read it and cannot argue with your logistics as you present the case. I can't say that I have hope for a repeal, the system is unfathomably convoluted. My acerbic call to 'deep six health insurance altogether, just as futile.
I contend the deeper root is that most, nearly all Americans are conditioned to expect that
any and every avenue toward the relief of their malady be on the table and explored, no matter the cost, preferably to someone else.
In a word, entitlement.