By Carmel J. Barrau, MD
The health care system in the United States is sick, and Congress is not helping. While health care delivery is complex, offering a multitude of second-order challenges, the ability of patients to access medical care is the foundation upon which everything is built. Once that foundation crumbles, health care systems collapse. Make no mistake that our system is collapsing because of policies that have fundamentally altered how patients access medical care. Only Congress can pull us out of this death spiral.
The timing of this article coincides with the release of the proposed Medicare Physician Fee Schedule for 2024, which proposes another 3.36% reduction in reimbursement for physicians unless Congress ends their pound-foolish budget neutrality policy. If the cuts are allowed to take place, the effective cumulative decrease in physician reimbursement since 2001 will reach 26%.
To put that into perspective, the average age of physicians completing their residency training in the U.S. is 30; therefore, generations of physicians practicing under the age of 53 have never seen the value of their services increased by the U.S. government.
We need to look no further than the United Kingdom to see the warning signs of the collapse of the health care system due to prolonged neglect of physician compensation. Doctors in the UK are on strike, protesting the reduction in real term pay levels of 35% since 2008-2009. While strike action by doctors in the National Health Service started with physicians-in-training, this summer, they were joined by Senior Physicians who voted in mass to join the strike. According to the Guardian, the 2-day walk-out will result in 350,000 cancelations of appointments adding to the additional 651,000 that have been cancelled since the start of the NHS strikes in December.
The possibility of strike actions hitting our shores are highly unlikely, however due to the fact the U.S. physicians still have greater mobility in the workplace. I would argue that this shifting landscape of physician practice patterns in the U.S. masks the visual of a system in decline and creates more long-term detrimental impacts to the health care system that ultimately will have much greater impact than short-term strikes in the UK.
The long-term consequences of this flawed Medicare policy will be a permanent shift in how patients access health care in the U.S. More health care will be delivered by hospitals, health systems, and corporations, which will drive health care costs higher, further exasperating the devastating impact of the affordability of health care insurance and treatment costs.
The situation for patients is dire. The expansion of high deductible plans in the U.S. comes at a time when fewer Americans have emergency savings to pay for unforeseen circumstances. And the consequences of getting sick when you are uninsured or on a high deductible plan with no emergency savings are catastrophic. According to RetireGuide, “In America, medical bills are the most common reason for bankruptcy. In fact, medical bankruptcy statistics suggest that 17% of adults with health care debt had to declare bankruptcy or lose their homes because of it as of 2022.”
Admittedly, advocating for more spending as a means of lowering overall health care costs does require a degree of nuance and understanding. However, if Congress fails to act and restore sustainability to physician medical practice, the deterioration of our health care delivery system will continue unabashed causing permanent damage to health care delivery and negatively impacting countless Americans.
Dr. Carmel J. Barrau is President, Dade County Medical Association.
