High hospital prices in California are going to trial. Medical practice reform is needed now, and here’s how to fix it.

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Corporate medicine in the USA is killing medicine, killing patients and burning out the doctors who are trying to support it all, even at their high salaries.   This patient (our healthcare system) is terminally ill and needs a heart transplant.  The American ethos of bigger is better isn't, and gone are the personal relationships most of us had with our doctors.   It is quite likely that your older doctor may have joined a hospital system after selling their practice and now they work for the man.   Doctors were always used to production quotas except that they are now required to keep referrals in the hospital system and are incentivized to refer to other providers in that system. They need to enter all their findings into the hospital's electronic notes systems which are time-consuming. Todays primary care doctors are rarely willing to spend more than 10 minutes during a visit because they will fall behind and their reviews on the hospital's web site may be affected.   Doctors who work for large practices or hospital systems give patients advice according to hospital guidelines and do what they are told.  They have become a cog in the wheel of corporate-style medicine that profits from each encounter as well as any of the tests that are more likely to cost much more at the hospital system than elsewhere.   What is a poor patient to do if they want to find someone who will take the time to help the patient figure their problem out instead of sending them from doctor to doctor? Just today,  Meridian Health added Englewood Hospital in NJ to its growing hospital system.   Bigger is better we have been told because of population health which is a system of care than requires scale to work. Recently, Calfornia will put Sutter Health, a sprawling system of 24 hospitals and 5,500 doctors on trial beginning on Thursday. They are accused of being a major hospital group that used its dominance in Northern California to stifle competition and force patients to pay higher medical bills. If you have not been paying attention lately, NJ healthcare prices are rising yearly as well as the healthcare systems get larger. Many systems grew as a result of small hospitals becoming tier 2 in the Horizon Omnia Plan.  These hospitals initially sued Horizon for doing this and eventually realized it was more productive to pay a fee to join a large hospital system and become tier 1 which has lower costs for patients to visit.   The Horizon Omnia plan was sold as a less expensive plan but in reality, hospitals raised their prices as there was less competition and your premiums went up for that plan the following year. Those of you who have Omnia are now realizing they have consistently increased premiums year after year. Years ago, healthcare was visiting your doctor or doctors would visit you with what was known as a house call.  Now,  entering the doctor's office is the gateway to the system, that prices everything they do in ways people could never imagine.   Insurance companies under Obamacare make more when premiums cost more and the game has worked for them until recently when it has gotten out of control.   California's Sutter health is an example. Lowering healthcare costs means finding a better way to keep someone healthy so they stay out of the system.   The profit motive is about keeping them in the system and offering departments and procedures that are big moneymakers such as heart transplants.   Recently, Newark Beth Israel Medical Center kept a patient who had a heart transplant in a vegetative state to improve their reputation.  This story should alarm you because your insurance company may have paid for that care. Hospital culture has become a mess or wards, orders, people waiting for stuff and being stuck and prodded throughout the night.   Doctors who used to be primary care used to take care of you holistically, although most of them knew very little about musculoskeletal diagnosis, which results in referrals for more tests.

The system is broken, and needs fewer people and better care, so how do we get there?

Perhaps, we need to start with simplifying the current system, becoming less specialized and perhaps learning from other healthcare systems that do more to keep us healthier for a lower cost. Perhaps, doctor visits need to be longer.  Functional medicine needs to be embraced and insurance must keep us healthy, for lower upfront costs.  High deductible plans are inflationary for both hospitals and the people who wait for their problems to worsen before getting the help they need. Chiropractors who are primary care for the musculoskeletal system must see more of those patients who are in pain first, to reduce cost as well. Hospitals must not be huge conglomerates but must compete.  Physicians must be able to run their own practices without being consumed with procedures and paperwork. Something needs to change.