Written by Mark Schroer, MD
Someone told me the other day that as a physician I was a “stakeholder” who had “skin in the game” when it came to healthcare. I soon figured out we were not discussing my affinity for red meat or his opinion that I needed plastic surgery. No, we were discussing the spending changes in Medicaid.
Apparently, these changes in Medicaid as outlined in the Big Beautiful Bill will be a disaster for our region. Why do I say this? Enter stage left, the fear mongers. You know these people. They hang out with the weather prognosticators who gave us the “heat index” and “wind chill factor.” This is why you cannot sleep at night. Evidently if there is any change at all to rein in Medicaid spending, the economic sky will fall, and patients who depend on Medicaid will not have access to care. Perhaps there is another way to look at this. Where there is adversity there is opportunity. There is more to all of this than Medicaid funding. Here is another opportunity to reform health care in our community. However, my prediction is this: we will not take advantage of the chance given us. Quite the contrary. More of the same will continue. The solution will be the same, old, tired fix. Stakeholders will cry out, “We need more money!” Given the current political climate in our state, they will probably get what they ask for. I am skeptical this alone will maintain, let alone improve, healthcare delivery. I am afraid the stakeholders will win and the patients will _____. You, dear reader, may fill in the blank.
Injecting more money into the healthcare system is not the only answer. Need I state the obvious solution? Promote better jobs in our area to get people off the Medicaid rolls. Another is this – deliver healthcare more efficiently. There is lots of talk in clinical medicine about something being “cost-effective.” Is the lab test, X-ray, medication or operation a cost-effective way to diagnose and treat this illness? I am frequently reminded by other stakeholders to be careful how I spend the health care dollar. Many times, I am told I cannot order a test or prescribe a medication because “it costs too much.” And yet, this concept of cost effectiveness is lost on these other stakeholders. They seem to have no problem making money or improving their infrastructure or marketing their services and products. This all seems very odd to me and I am sure to you, the patient, as well.
I have been vocal with my peers and policy makers that American medicine is in need of reform. We need reform from top to bottom. Physicians need to do their part. We can start with improving pre-medical and medical school education, residency training and ongoing professional development. We can continue to be cognizant of delivering cost-effective care in the best interests of our patients. But we are not the only ones who have skin in the game. Hospitals, insurance companies and Big Pharma must do their part as well. Will they? My concern is they will not. We need to examine why we have so many administrators and managers. We have a nursing shortage, in part, because so many go into administration. Why do patients pay monthly premiums but still are denied services? Why are so many drugs prohibitively expensive? Will we finally find a way to better deliver healthcare or will we take the easy way out and continue to find ways to pour money into a system that delivers subpar care?
Enter stage right, our state policy makers. You know these people. You voted for them. This is why you cannot sleep at night. What will they do during the next legislative session to improve healthcare in our state? I don’t know yet as they are not on stage until January. They are already talking about it amongst themselves. For my part, I will advise, wait and watch.
And now I have a request for all the patients out there. You see, you are the real stakeholder. Patients have more skin in the game than anyone else. After all, their lives are on the line. We need to remember that. And so, dear patient, demand better. Start the long overdue process of improving American health care. Demand better from me, my peers, the hospital, the insurance company and the drug manufacturer. You can do it with your vote, your voice and your wallet. Show us the way.