Why We Should Repeal Obamacare and not Replace It with Another Insurance Plan: Thinking Out of the Box for a Health Care Solution

Posted on Monday, May 15, 2017 12:25AMSunday, December 30, 2018 by Carol A Westbrook

by Carol A Westbrook

Before you, progressive reader, quit in disgust after reading the title, or you, conservative reader, quit in disgust after reading a few more paragraphs, please hear me out. I'm proposing that we repeal Obamacare (The Affordable Care Act, ACA) but not replace it with another medical insurance program. Instead, I propose that we re-think the entire concept of how we provide health care in this country.

The ACA's stated purpose is "to ensure that all Americans have access to high-quality, affordable health care." Regardless of whether or not you believe good health is a fundamental human right, it is inexcusable for an affluent, first world country like ours not to provide it for its citizens. The good health of our nation is vitally important to its success, guaranteeing as it does a capable workforce, a strong military, and a healthy upcoming generation. However, I have seen the results of Obamacare from many perspectives, including that of a physician provider in a rural community, as well as that of a personal user of both insurance and Medicare. I do not believe the ACA succeeded in meeting its objectives.

It is true that the ACA provided health care insurance for millions of Americans who didn't have it previously, expanded Medicaid for the uninsured, got rid of the pre-existing condition exclusions, allowed our grown adult children to remain on our policies longer, and started the ball rolling on electronic records. These are great results.

But the ACA also caused the cost of health insurance to skyrocket, caused many people to lose their coverage, and, for some, their jobs. It forced many small doctors' practices to close, especially in rural areas, resulting in an overall decline in the quality of care in many regions. It limited patients' choices of physicians and hospitals, separating patients from their longstanding doctors. There were no checks on health care costs, which even today continue to increase. But worst of all, it mandated that our health care would be taken out of the hands of doctors and put into the hand businessmen–the insurance companies.

Open Your Mouth, Stick Out Your Tongue, and Say “Five”

Posted on Monday, Apr 18, 2016 12:30AMFriday, December 8, 2017 by Carol A Westbrook

by Carol A. Westbrook

6a00d8341c562c53ef01b8d1c5ba95970c “What should I do with this?” my husband asked, as he handed me the letter. It was a Press Ganey survey asking him to evaluate a recent visit to his doctor.

In case you have never seen one, a Press Ganey survey is a multi-page questionnaire in which you asked to rate your experiences during a hospital or outpatient clinic visit, from 0 (bad) to 5 (best). The completed questionnaire is mailed to Press Ganey, which compiles and analyzes the data, and reports the results to the hospital or health care system that ordered the survey.

The survey asks questions like, “Did you have to wait long to see your doctor? Was the staff pleasant? Was the waiting room clean? Did your doctor take enough time to explain things to you? Did your doctor smile and shake your hand? Did the valet parker return your car promptly?” It also does not ask questions that the health care organization does not want to hear, for example, “Was your doctor given enough time with you? Did you actually get to see the doctor instead of the nurse practitioner? “Press Ganey has been called an Angels' List for clinics and hospitals.

That is why administrators love Press Ganey surveys–because they know that good scores will bring in more business. They also have the side benefit of providing an outlet for unsatisfied or angry patients who otherwise would be pounding on their door. Giving a doctor a “0” makes a disgruntled customer feel that he is addressing a problem, without the manager ever having to do anything about it!

Most importantly, though, patient satisfaction scores provide “objective” data that can be used to manipulate physicians by lowering their salaries or even firing them if they do not maintain a high score.

Third World Medicine in a First World Town

Posted on Monday, Sep 9, 2013 12:30AMFriday, December 8, 2017 by Carol A Westbrook

by Carol A. Westbrook

On Wednesday evenings, I volunteer at a free clinic. For a few hours I become a primary care doc in an urban setting, instead of a high-priced oncologist in a modern medical center.

Our clinic, The Care and Concern Clinic, in Pittston, PA, opens weekly at 5:30 pm, and closes when we have finished seeing our 30 to 40 walk-ins. We make no appointments, and we ask for no payments, insurance or Medicare. We can do this because our overhead costs are low, as our space is donated by a church, and all of our staff are unpaid volunteers, from docs to nurses to clerks and social workers. We use our funds to purchase medications, and to pay for lab tests and X-rays, and provide them without charge to our patients as needed, though we have to be sparing in their use, because we have to make sure there is enough to go around. We are a nonprofit supported by charitable donations, and we have a tight budget.

Practicing medicine at C&C is a breath of fresh air for me. I see a sick patient, figure out what's wrong, treat it, make sure the patient gets follow-up, and spend as much time as needed for questions and reassurance. I try to keep the patient's prescription costs as low as possible. I rely on my clinical judgment rather than X-rays or blood tests whenever possible. I don't have to order every possible test to make sure I don't get sued. I write my chart notes and prescriptions by hand, because we don't have electronic records. I don't have to bill, or code my level of service, or fill out innumerable forms. I don't have to turn a patient away for the wrong insurance. I don't have quotas to fill. For one evening a week, I can practice medicine the old fashioned way–by spending my time with the patient instead of with the paperwork.