Here’s what large healthcare systems want us and their doctors to believe. When was the last time anyone asked you personally how you would feel about having cradle-to-grave universal coverage? Other than the regular rantings of Bernie Sanders from Vermont, who has been attempting to raise awareness for years, nobody. President Clinton attempted to do this in the early 1990’s but failed due to a campaign by Cigna using the Harry and Louise commercials to sway the public to go a There is a reason Universal Healthcare costs less. It is simpler to administrate, without middlemen and denials of clean claims. Do we really need a Veterans Administration, Medicaid, Medicare, and monopolistic healthcare companies that can no longer effectively negotiate with insurance companies when Medicare can scale and do it all while keeping most costs in line? Since the cost of administration is lower and the cost of administration for hospitals and large systems is simpler, they do not need large rooms of people chasing clean claims that were denied. Most of the precertification nonsense would disappear as some of it has recently due to pressure from the public. The high-pressure boiler rooms will also go away as seniors will just be insured under a Medicare Universal model. The model will not allow for price gouging in or out of network and will continue to offer low deductibles, while patients can purchase secondary insurance to cover all the other costs from traditional insurers. Think of how much money the system will save by paying for care instead bait and switch ads for more costly and inferior Medicare Advantage plans during the annual November and December membership drives. The ads from insurers also go away on television, which may show up on your cable bill, but the money we taxpayers pay for healthcare will go to healthcare.. Patients would no longer jump to other insurance plans when one unreasonably raises prices. Medicare has always been a public-private partnership that we should all have. Medicare should even cover chiropractic and functional medicine fully. Dentistry should also be covered as well. Think of the simplicity and how much money it would save. Healthcare costs are a tax. It is a better use of our tax dollars. I am over 65, and I can tell you that everyone in Medicare trusts and loves it. Do they sav this about other health insurance plans? I doubt it. The doctors who are on the front lines are never asked for their opinions on how to fix our system, either because the stakeholders, which include drug companies, rehab companies, hospitals, and testing companies, all want things to stay as they are. As long as profits are before patients, their business models are immensely profitable. Healthcare has become corporate welfare disguised, and we are the pawns. We have caring people in uncaring systems. I have seen this when my mom was ill, and the doctor looked more at the electronic chart than at my mom, who was complaining of leg pain. The doctor wrote in a script for more pills for pain, and I worked with my mom for 10 minutes, who was sitting in a chair more comfortably for hours afterward. Is effective hands-on care so difficult to imagine, or can we admit that the thing we are treating, whether it is an infection or otherwise, may also require hands-on providers to directly help the patient get out of pain naturally, vs. another pill resulting in today’s problems becoming more chronic? As I said in an earlier post, I have never seen a greater need for chiropractic in a hospital than when my mom was there. Doctors, not corporations, should have larger stakes in these systems. It is also true that many of them are also corrupted by outsized salaries and a caste system that exists in these systems, amplified by the wrong incentives. As mentioned in the first article, so many doctors are now realizing that the outsized salaries and RVU requirements are causing so many of them to burn out due to the hours, the pace, and the fact that they cannot put in the extra time they need to because they may get in trouble for it. One story I heard over the weekend was from a woman who worked in Queens, NY, for Optum, a company that runs clinics and pays chiropractors, and runs clinics owned by United Healthcare. A caring neurologist wanted to see a patient who needed immediate attention during their lunch hour, but got in trouble doing so due to corporate rules. In their own practice, they would have done so because it was the right thing to do, serving patient needs. Another doctor was recently laid off. They could not generate enough RVUs because they would often give patients some extra time needed during their visit. This is money over care. The systems just don’t care because they create images and own your doctors’ practices. Doctors who signed these contracts are having real fears of losing their jobs if they do not keep up with the work and produce. They must also refer internally within the system. For the hospital, this means $$$. For the patient, are we just passing them around, hoping one of our many tests can show something? Worse, the public has been brainwashed into thinking that this is good healthcare. The system, as it is set up, is horribly expensive and inefficient. The system rewards tests and specialist salaries and procedures over care designed to keep you well. Years ago, we had a simpler system that was imperfect, but personal. We need a new model with incentives to truly reduce costs by focusing on wellness, and doctors need to stop ignoring the musculoskeletal system, which is often responsible for so many painful symptoms. We can start by reverting to a primary care approach and reward good manual evaluation and less reliance on tests, which are often overused and unhelpful. Solutions to place patient care first While it seems radical, the idea that all doctors are now primary with a specialty makes dollars and cents. If the incentives to test more are reduced and to evaluate and be rewarded for referrals that improve the patient’s health, we will spend less, and you will have better care. Better exams reduce testing naturally. Broaden the types of care covered to fully include providers such as chiropractors in primary care. I practice primary care for the musculoskeletal system. This is something I rarely see in medical practice other than in osteopathic offices. Currently, our system of castes is inefficient, and we do not benefit from healthcare by committee. Reduce the prescriptions and work towards natural remedies. Improve our culture of nutrition since this drives so many of the diseases we treat medically for much higher costs years later. This includes more organic farming and more people purchasing healthier ingredients in the store. The wealthiest country in the world can reduce healthcare costs by improving health at mealtime. The reasons for so many Americans being obese and now looking to GLP-1 drugs do not mitigate the juice boxes our children drank filled with sugar, or the sugary breakfast cereals, and the Cheerios boxes used as a snack to keep the children busy. Healthier guts begin when we are young. The right vegetables give us the nutrition we need. Stop ignoring early problems with medications that do nothing other than make problems more chronic. Foot and gait imbalances early on can cause knee pain. They are not growing pains. 50 years later, these same patients are likely to have bad knees, hips, plantar fasciitis, and other preventable conditions with the same cause: Gait. Solving the problem using chiropractors early on leads to healthier and less painful adults. A set of foot orthotics can make a huge difference. The chiropractor can give the patient the proper device on their first visit, saving the system thousands by avoiding the poor choices of custom foot orthotics on growing children, a bad idea, as they are likely growing out of them by the time they receive them. Care must be sensible. The system must allow for true competition and reward those who help solve problems. This seems simple in concept, but the payors have been discriminatory to certain types of providers, often underpaying them while overpaying medical specialists. The rewards are for tests and procedures, not for making sure the child who had knee pain in their youth has healthy knees as they age. Poor gait affects balance. Growing evidence shows that declining balance affects the brain and may be an indicator of brain health due to years of better gait mechanics. Fewer people would fall. Incidentally, in our current pill-laden system, medications drive many of the balance issues later in life. The falls are best prevented with healthier lifestyles, not walkers. Doctors must be able to survive and thrive in private practice. When their name is on the door, the experience and reputation help build their practice. Currently, large hospitals are making it very difficult for the average doctor to thrive due to costs, politics, monopolistic activities, and the fact that the money is going to the hospitals rather than the doctors. Providers who get results that reduce costs now and in the future should be rewarded for doing so. Those who require extra time on a visit should be reimbursed for it. Delivering better care is not that difficult. Wellness approach to care should be the norm, as compared to our illness-based approach. This begins with our youth and should follow us through our lives. It took us two years to get here. It will take years to change course, but we can no longer afford this. Eliminate tiers; universal healthcare must be the norm. We already have the system. We must reform incentives. We must allow competition. We must more readily embrace and properly integrate and pay all providers, and allow them to thrive. The public understands their value. Universal healthcare can level the playingfield and doctors who refer to more effective providers should be incentivized to do so. When your insurance again gets worse, and you are told that cost is the problem. This article has the solutions. Other countries have systems people trust to keep them healthy. Their countries invest knowing that, in the long term, the costs will be lower. The time to start is now.