We are at a watershed moment. The COVID-19 pandemic has forced us to reevaluate our priorities both economically and with regard to public health. Living with a healthcare system that was created in response to an emergency measure during World War II, US consumers have struggled for more than a decade to control and understand the rising cost of healthcare. Unfortunately, employer-based health insurance and government-subsidized care continue to be the major drivers of cost and policy.
As our economy undergoes a seismic shift during the COVID-19 pandemic – with unemployment numbers reaching levels not seen in more than 70 years – the US healthcare system must provide access to self-employed individuals, or those who may not immediately qualify for federal programs. Now is the time for an affordable direct-to-consumer healthcare option.
More Expensive Care Does Not Mean Better Care
Prior to the COVID-19 pandemic, patients faced significant delays in care, high premiums and escalating out-of-pocket expenses. Hospitals struggled to keep pace with the burdens of government regulations, payor denials and the demand for price transparency. Now, as the country once again faces COVID-19 surges and peak hospitalization rates, elective procedures will once again be deprioritized or paused, and the steady stream of patients seeking preventive, or for subacute or chronic care, is likely to stop altogether. Hospitals have received much-needed bailouts, but with these funds come another layer of regulations that will further restrict patient access and choice.
Hospital payrolls have already grown exponentially with non-essential personnel, or individuals who are not directly responsible for patient care. Hospitals also employ an expanding army of providers including nurse practitioners, physician hospitalists, primary care physicians and specialists. Even under the best of circumstances, insurers and CMS do not pay enough for these services – but during COVID-19, the entire healthcare industry is more vulnerable than the airlines.
When the dust settles and we move past this pandemic, the US healthcare system will unlikely recover completely. But is that such a bad thing? Should we return to a pre-pandemic healthcare system, in which low income patients spend 35 percent of their pre-tax income on healthcare? Or should we seize this opportunity to build a leaner, more efficient healthcare system, and one that is affordable to all patients?
Good medicine does not have to be complicated, and spending more money on healthcare does not ensure better outcomes. Though the US spends more on healthcare than any other nation, we have lower life expectancy and worse health outcomes. Ordering more tests may negatively impact a patient’s survival; finding abnormalities that are clinically irrelevant, but are treated nonetheless, can lead to further complications. Ultimately, medicine is rooted in peer-to-peer relationships, and each treatment plan should be tailored to the patient based on the best evidence available, as well as the patient’s unique physiology and response. Money has little to do with experience or skill – but complications are costly and when the unanticipated occurs, like a global pandemic, the economics fail.
Putting Healthcare in Patients’ Hands
If our healthcare system were more appropriately aligned to meet the individual needs of patients, and if priority were given to the treatment of illness – rather than simply the maintenance of wellness – we could redirect resources to where they would have the best outcomes. Advances in biotechnology and artificial intelligence allow for increased data collection to aid decision-making, but ultimately physicians require the latitude to do what is best for patients, based on both experience and research – instead of technology dictating patient care. Stopping to discuss treatment options with health plans does not reduce costs or improve outcomes, but rather increases delays and insurance premiums. Medical technology is moving at a lightning pace and the US’s pre-COVID-19 healthcare system has held it back like a drag chute. Patients will simply need a better payment option.
We have already seen how consumer-driven models reduce the price of care. Physicians overwhelmingly prefer a transparent fee-for-service model, especially for routine office visits or minor procedures. Elective outpatient surgery is less expensive at independent centers that offer direct pay options, rather than at hospitals that only discuss price with insurers – and this further benefits patients who are reluctant to visit hospitals during the COVID-19 pandemic. The cost of billing and collecting has outpaced the actual cost of providing service, and because patient deductibles are often higher than their insurance, what is the point of paying to process a claim that is ultimately the patient’s responsibility?
When the dust settles, we can rebuild the system like a Phoenix from the ashes. Healthcare post-COVID-19 can correct itself. Technology such as telemedicine will create a more efficient method to maintain wellness and diagnose risk when incorporated into routine medical practice. Illness, however, requires a different approach. Treatment of disease requires physicians on the frontlines of care, unfettered and unobstructed by a system that for too long has kept those most qualified out of reach. Taking good care of patients is not difficult or expensive when experienced physicians and nurses are involved.
The system should simplify, and shed the excess that has slowed progress. Allow patients better access to care, provide physicians the autonomy to decide what is best for the patient, require price transparency, and eliminate incentives and regulations that require – among other things – the collection and sharing of an enormous amount of private patient data. All of these measures will immediately mobilize existing resources and redirect them where they are needed most.
We must recognize that it is the consumer who is paying the price for healthcare and it is the consumer who must be protected. Our post-COVID-19 economy will not be the same; there will be fewer employers, but not necessarily fewer people working. Consumers will need to buy their healthcare for a transparent price and have more flexible insurance options. The marketplace can no longer ignore the needs of the consumer, as it is time that they became part of the solution.
About Paula Muto
Paula Muto, M.D., F.A.C.S., is the founder and CEO of UBERDOC, and the owner of the Vein Center at Mutosurgical. A graduate of Amherst College and New York Medical College, Dr. Muto is a fellowship-trained vascular surgeon by specialty and also practices general surgery.