I admit to bias and narrow perspective. I am in the health care business. I see things from that point of view. A narrow perspective can distort perception – missing the forest for the trees – but a narrow perspective can occasionally provide a kind of forced focus on the whole picture and yield an epiphany: “I can’t tell if those are oaks or elms, but that’s a forest!”
They say we are red and blue “trees” and that we are more divided than at any time since the Civil War. They try keeping us in a red box or a blue box. Even when they admit most of us are in the middle, they want us to think that occupying the middle is really running from red to blue every other election. Blue box Democrats favor big government. Red box Republicans favor big business.
They pretend otherwise but, at the end of the day, they promote big government/business, and there is not a significant difference between the two.
We are not really caught (or left) in the middle between blue and red. We are not failing in our patriotic duty if we do not choose one or the other. The truth is they are big and we are small. We favor small solutions. One size does not fit all. We are the people, and we contain multitudes.
The health care business has gotten a lot of attention from red and blue.
What does it really mean to the middle? We need to stop focusing on the trees reformed by the so-called Obamacare and to watch the evolving shape of the forest.
Monopolies are rising; small independents are declining. The separation between big health systems and big insurance companies – thin now – is disappearing. The methodologies by which doctors and hospitals are paid by insurance companies are universally morphing into Medicare lookalikes.
The decreasing number and variety of health systems/insurance companies will make it easier for government to “negotiate” reform because there will be fewer points of view in the room.
I do not care whether red or blue wins the battle of the trees. The goal is to reduce the amount America is spending on health care while improving the quality of care.
I believe there is one, best way to accomplish that goal. We have to empower and compensate independent primary care physicians.
I am CEO of a health system that is rapidly expanding the number of PCPs we employ, and it should be against the law for PCPs to be employed. It should be against the law to exclude a PCP from an insurance network (an effective “any willing provider” law). It should be, but I doubt anyone will be passing such laws anytime soon. So, I intend to continue employing an increasing number of PCPs.
Why would it be best to empower independent primary care to reform health care? The buzzword of reform is “medical home,” but a medical home is really a primary care doctor surrounded by a team of people staying in contact with the patient in order to know what is going on with that person.
We can easily imagine how a medical home would best accomplish the goals of increased preventive care, better chronic disease management, reducing emergency room visits and hospital admissions, but the advantages of an independent medical home are perhaps less obvious.
Primary care providers employed and therefore controlled by big health systems/insurance inevitably feel compelled to feed the system -– its ancillary services, specialist and medical towers – and referrals are restricted to the tightly defined “network” controlled by that employer/system.
Medical home decision-making would be more efficiently performed if the physician and patient were independent: free to decide against hospital care when the physician and patient feel that is the right choice; and free to decide which system’s specialist or ancillary service to use. Competition for referrals from independent PCPs would improve cost and performance by specialty-focused systems.
I am acutely aware of the counter-rationale in favor of integrated health care systems. They make perfect sense – from a certain perspective – but the advantages of integration remain once the patient is referred from the medical home and enters the specialty system tower of care, and they do not depend on integration of the medical home.
However, I am not interested in waging a quixotic battle against big health systems. My interest in resisting the rising tide of monopolistic integration and the one-size-fits-all reform strategy of big government is to prevent them from swamping the independent safety-net and rural health providers.
Small, independent rural health providers are more vulnerable to the adverse consequences of reform; yet, they are the last, best defense of independent primary care providers. They are true incubators of meaningful reform.
We are endangering our future. Save the rain forest.
Paul Taylor is CEO of Ozarks Community Hospital. He can be reached at info@ochonline.com.
