The destruction of patient-centered care

“Medicare-for-all” medicine is the ultimate goal of progressives or “liberals,” fully embraced by Democrat candidates in the midterms. Candidates claim “single-payer” government-run medicine will “solve” all the problems of Obamacare and our “broken,” purportedly free-market system.

Liberal proposals ignore or deny the massive cost burden to taxpayers of “free healthcare,” the long delays, and the limited treatment options that plague every taxpayer-funded (socialized) medical system in the world, from Canada and the UK, to Cuba and Venezuela—and increasingly to U.S Medicare and Medicaid. 

Venezuela Hospital Patient unattended

Some claim to have received fine medical care in such a system. But having been a patient – and had a family member as a patient – in several countries with socialized medical care, I can personally attest to the difficulty of getting proper care at all.

The U.S. system has similar problems because of the flip side of the same coin: the corporatization of medicine. High cost, long delays to see specialists, limited doctor networks, “insurance” (managed care) companies dictating clinical “guidelines” to be followed, pharmacy benefit mangers (PBMs) causing harm to patients by adding another layer of costs and restricting access to optimal medications, and a deluge of prior authorizations and other administrative barriers are keeping patients from the medical care their doctors would like to provide.

I see these problems daily in my own medical practice as I help coordinate care outside my field for patients from different parts of the U.S. as they struggle with getting insurance approval for the referrals, medications, and treatment they need, often from physicians treating only one organ system or body part without coordination with the patients’ other physicians.

Even though I am independent of insurance contracts and able to focus on serving patients according to their individual needs, I am still restricted in testing and treatment options by what “insurance” plans and PBMs will pay for.

Two behemoths control medical care around the world: socialized medicine with government-run massive bureaucracies (Canada, UK, Europe, etc.) and corporate bureaucracies (AetnaAnthemCaremarkHumanaUnitedHealthcare) controlling most “healthcare delivery” in the U.S., including an increasing proportion of care funded by Medicare and Medicaid. The single-payer chorus has yet to acknowledge this, or to ask whether their proposal will affect it. (It won’t.)

Neither socialism or corporatism is about serving individual patients. The collective or the corporation comes first. “Healthcare” is simply the pretext for bringing revenue into the system.

Physicians, on the other hand, have for 2,500 years stood on the foundation of the Oath of Hippocrates to use our best abilities and judgment for the benefit of the individual patient who seeks our help. Physicians cannot effectively serve two masters—the corporate or government entity AND the patient. When inevitable conflicts arise, it is the patient who ultimately suffers.

“Medicare for all” is no solution—it just perpetuates and cements the flaws we already have—while destroying the prospect for genuine reform.

The real answer is to get ALL the third parties out of the physician-patient relationship.

We need:
• Patients spending their own money as they choose, as through Health Savings Accounts.
• Price transparency to allow patients to make sound choices, through genuine patient value-based purchasing.
• True risk-based catastrophic, reasonably priced medical insurance plans, formerly called “major medical” coverage, which were outlawed by the ironically named Affordable Care Act.
• Competition in the pharmaceuticals market, and removal of safe harbors for kickbacks to PBMs.
• Tort reform

These are the very hallmark features that Candidate Trump espoused that helped his election to President. Sadly, Congress, the FDA, and HHS have so far blocked these reforms that businessman Donald Trump proposed to cut costs and put decisions back into the hands of patients and physicians.

Obstruction of true reform has been from both political parties, evidenced recently by the failure of the Republican-controlled Congress to successfully repeal costly Obamacare, a betrayal of their many campaign promises to undo damage inflicted by Democrats in 2010.

Free-market solutions have consistently worked best and served the most people at the lowest cost. Would-be reformers should be looking at places like Chile and Malaysia, which have thriving private sectors, rather than the tired, failing systems of Canada and the UK, for examples of excellent care at a fraction of U.S. prices.

Free markets in medicine have not been broken, as Democrats like to say. True free-market approaches have not been allowed to work since Congress started to Impose more and more regulations and restrictions in a futile attempt to rein in the soaring costs of Medicare soon after it was implemented in 1965.

More of the same socialist or corporate interference and control will have the same effect: outrageous costs and declining quality. To restore excellent affordable medical care, we must first restore medical freedom and unleash the competitive market forces that help all sectors of our economy thrive.

About the author:
• Dr. Vliet has been a leader in patient centered, individualized medical care. Since 1986, she has practiced medicine independent of insurance contracts that interfere with patient-physician relationships and decision-making. Dr. Vliet focus is medical freedom and free market approaches to healthcare. Dr. Vliet is the founder of Vive Life Center and Hormone Health Strategies with medical practices in Tucson AZ and Dallas TX, specializing in preventive and climacteric medicine with an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems from puberty to late life.

Dr. Elizabeth Lee Vliet

• Dr. Vliet is a 2014 Ellis Island Medal of Honor recipient for her national and international educational efforts in health, wellness, and endocrine aging in men and women, and is recognized in the US as a motivational speaker in health and wellness and a powerful patient advocate, proponent of free market approaches to lower healthcare costs.

• Dr. Vliet is the recipient of Voice of Women Award from Arizona Foundation for Women in recognition of her pioneering advocacy for the overlooked hormone connections in women’s health.

• Dr. Vliet’s consumer health books include: It’s My Ovaries, Stupid; Screaming To Be Heard: Hormonal Connections Women Suspect– And Doctors STILL  Ignore; Women, Weight and Hormones; The Savvy Woman’s Guide to PCOS,  The Savvy Woman’s Guide to Great Strength, and Stamina.

• Dr. Vliet is a past Director of the Association of American Physicians and Surgeons (AAPS), a member of the AAPS Editorial Writing Team on healthcare reform, and a member of International Menopause Society and the International Society for The Study of the Aging Male (ISSAM). She received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, and completed specialty training at Johns Hopkins Hospital.  She earned her B.S. and Master’s degrees from the College of William and Mary in Virginia.

• Dr. Vliet has appeared on FOX NEWS, Cavuto, Stuart Varney Show, Fox and Friends, Sean Hannity and many nationally syndicated radio shows across the country as well as presented hundreds of Healthcare Town Halls addressing the economic and medical impact of the 2010 healthcare law and free market reforms, as well as seminars and radio shows on healthcare reform, Men’s Health and Women’s Health.

Dr. Vliet speaks as an independent physician, not as an official spokesperson for any organization or political party. Dr. Vliet has no financial ties to any health care system or health insurance plan.  Her allegiance and advocacy is to and for patients.

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