What we need is a Big Beautiful Overhaul

This opinion piece, titled Medicaid Is Overdue for a Big Beautiful Overhaul, calls for a significant reform of Medicaid and argues that the Big Beautiful Bill fails to implement meaningful changes. It highlights the complicated nature of Medicaid, which operates under federal and state oversight with dual funding. This dual oversight results in a convoluted set of regulations and conflicting incentives, making Medicaid one of America's most expensive and inefficient insurance products.

To improve Medicaid, a single governing body—either state or federal—is essential. Additionally, the oversight regulations need to be greatly simplified.

Moreover, Medicaid should implement a payment formula for providers that promotes primary care. Offering concierge medicine to Medicaid patients could enhance care quality while significantly reducing overall costs. For more details, visit www.thejourneys-end.org.

What a waste

Three decades ago, there were no healthcare companies in the top 25 of the Fortune 500. Today eight of the top 25 are healthcare companies. Ironically, none of those top eight actually provide care to patients. They are organizations adding greatly to the overall cost of healthcare but creating almost no value for patients. In fact, they tend to create frustration for patients. The murder of United Healthcare’s CEO (number 3 on the list) illustrates the level of frustration created by these overhead entities dominating healthcare.

So why do we spend so much of our healthcare dollars on overhead? It is estimated that we spend one trillion dollars annually for billing alone - what a colossal waste of money. These costs are unnecessarily high because we make everything in healthcare too complex - from coding, to HIPPA, to fraud and abuse. These self-imposed systems are insanely complex and ineffective.

Fundamental progress will require these overhead burdens to be changed or eliminated. Go to www.thejournys-end.org to learn more about our options for reform.

How to rebuild trust in our healthcare system

Felice J. Freyer’s May 8 article in the Boston Globe calls out that Americans’ trust in medicine is declining but that doctors can still turn it around. The piece focuses our attention on an often-overlooked critical issue - trust. To quote Dr. Andrew W. Bazemore (senior vice president of research and policy for the American Board of Family Medicine): “[Trust] is one of the most powerful tools of medicine, and if you don’t have it, no number of drugs, devices or other interventions are going to achieve much.”

So the decline in trust in healthcare is a major issue. In fact, I would go so far as to say that healthcare has lost its soul because trust is not a routine part of healthcare today. The article goes on to describe how TRUST is developed with patients. Dr. Katherine Gergen Barnett offers this description: “Trust is built in the context of human relationships…it is fostered by asking open-ended questions, staying curious about reasons behind the patient’s beliefs, and recognizing that a patient knows their body better than anyone else.”

So why isn’t trust a part of healthcare today? The reason is that healthcare’s billing and coding system cannot measure obtaining or seeking a patient's trust. If the insurer cannot measure something, they will not pay for it. It is hard to measure conversations. Doctors in today's intense world cannot afford to spend significant time on an activity that is not compensated. And by the way - building trust takes real time. I would go so far as to say that healthcare’s billing and coding system does not pay physicians to have conversations with patients - that is why patient visits have to be short. Just as bad is the fact that the billing and coding system does not pay physicians to talk to each other. Referrals today are simply a note in the chart. Referrals used to mean a physician personally discussing their patient to give context for the referral. That effort requires unpaid time for both physicians. One of the biggest problems in healthcare today is fragmented care - no one coordinates care. Why? Because coordination is very time-consuming and depends on conversation.

Until we change how we pay primary care physicians so they have time to build trust with patients and they have time to coordinate patient care, trust in medicine will continue to decline. Now there are physicians - a declining breed -- who do all these things without compensation but they are poorly paid and overworked. Physicians deserve to be paid for building trust with their patients. It would dramatically improve the quality of care and it would lower costs. To learn how to do it, go to www.thejourneys-end.org.