By Sharla Hooper
As we prepared to look at aspects of the government’s role in healthcare in this month’s edition, we issued a survey seeking physician perspective. We had an unprecedented participation rate of respondents in a one-week period. Thank you to everyone who took the time to share perspectives and insights!
The role of state government
When asked about whether the Arizona government should consolidate the majority of health regulatory board into a single licensing entity (as was proposed in 2016 legislature), the majority of respondents felt that the current board structure, and process for handing out disciplinary rulings, should remain unchanged.
Ultimately, physicians feel that other physicians are best qualified to review conduct and potential disciplinary action: “Due to the complexity of medical practice, physicians should maintain control of licensing and investigation into the practice of medicine and complications of such.”
When asked if alternative patient payment models such as those of concierge care should be subject to the same regulation as insurance companies, 68.3% of respondents felt that physician groups who offer this type of direct pay model should be free to work directly with their patient populations, and should not be subject to regulation by that state’s Department of Insurance. “This is not an insurance model; why should it be regulated as something that it isn’t?”
However, 19% of respondents did indicate support for a lesser degree of regulation on this direct pay model. By way of explanation, one respondent offered “I don’t object to this model, but I do think the group offering the care should be required to publish the extent of what they will and will not cover. That would protect the patient and the group practice against devastating illness and/or malpractice litigation.”
Most respondents favored the role of state government in ensuring that all citizens have access to coverage, although, again, the shape of that role varied in the comments. One physician offered, “The state government should be the venue through which we can modify the shape and form health care takes in individual states…Physician leaders in these states and the Legislature should work together to create a system that works with the ultimate goal being affordable access for every citizen.”
The role of federal government
An overwhelming majority of respondents agreed that HHS should be allowed to negotiate all drug prices. A number of respondents cited the prohibitive cost aspects of prescriptions and subsequent substantial impact on their patients’ lives; this, in turn, causes worry for physicians.
One physician pointed out that the current inability of HHS to negotiate prices was a result of Congressional decision; another physician stated that “HHS should control its own costs by evaluating the parts of its business that are ineffective and intrusive without value added and eliminate those expenses.” And another physician felt that “Drug prices need much more exposure to market forces, including competition from imports.”
Twenty-six percent of respondents thought the government should play NO ROLE in setting quality and safety standards for patients and leave hospitals, clinics, facilities, and physician practices to determine their own quality and safety metrics. A majority of respondents, 54.6 %, thought the government should put in place guidelines as recommendations for hospitals, clinics, facilities, and physician practices.
Comments ranged from “There is clearly a role of guidelines as long as they are evidence-based,” to the more frustrated, “Keep the government out of medicine. [Government] screws up everything it meddles in.” A number of comments concurred with the position that “guidelines should emanate from professional societies and boards.”
A little more than half of the respondents felt the federal government has a duty to ensure all citizens have access to coverage but fell short of supporting a mandate or requirement for health coverage.
A number of respondents identified a single-payer system as consolidation of the existing structure, making the points that “the government is already paying for most health care, but in a very fragmented system that has at least 30% overhead for insurance company marketing and profit.”
Most comments offered nuanced discussion of solutions, desiring to see patients not lose their insurance, but achieving universal health coverage through a la carte access to health insurance, “The federal government has a duty to the permit insurance companies to offer a variety of types of coverage, unrestricted by state boundaries, and allows plans like the Health Savings Account, and help states fund for the indigent and non-insurable.”
While 70.2% of respondents supported universal coverage as an appropriate and achievable goal, 47.3% felt it was not achievable based on the current structure of healthcare system.
Among comments to this question was some consideration of what “universal coverage” really implies. One respondent pointed out that this is often considered to have the same meaning as “single payer.” And there were an equal number of comments indicating their opposition to a single payer and looking to market solutions as there were in support of a single payer. One physician felt, “But we are headed to a 3 tier system; Government funded healthcare, Health Insurance as part of Employment benefits, and, Cash or Private Pay.” Another stated, “We should have the free market decide coverage for all who are not insured. Insurance companies to have access across all state lines, Tort reform and block grant Medicaid to the states and have them manage the care.”
Given the rancor often encountered in media coverage of the medical community toward the ACA, there were a surprising number of comments offering that the ACA should have been fixed or improved rather than outright repealed. In the words of one physician, “The ACA has some excellent components. Expanding coverage within Medicare, extending parental coverage of kids to 26, no pre-existing conditions, etc. It is too much of a compromise, and too bureaucratic and too expensive to manage. We would have been better off to include the favorable points and expand Medicare and Medicaid.”