To the editor:
The PTACA was necessary because we have a crisis in health care cost, health care quality, and uninsured patients. Above that, we are rationing many out of necessary services.
The insurance companies rule the Market Place and are one of the top reasons our health care expenditures exceed all other countries. This is one of the reasons we need health care insurance reform. No one else is offering any means of controlling insurance company abuse. Certainly giving insurance companies a green light to operate with no state oversight is not a good idea. When a consumer buys a policy from an insurance company from another State, who is responsible for oversight? The Market Place in Florida could have worked much better for us if our insurance commissioners and those agencies who knew our market had given input. Our Governor took it upon himself to order them not to work on our behalf. Despite this, there was good value and improved premium prices never before seen in Florida on the health care Market Place. Now our state has been more than four years in the formation of a health care Market Place which will offer grab bag insurance policies with only value equal to catastrophic coverage to a few people.
The ACA is not a burden on our economy compared to our already existing industry. We currently spend 20 cents out of every dollar we make on health care, yet compared to other industrial nations we get only a "C" rating in outcome. Much of our dollars are wasted on inefficient care, administration failure, over use, and abuse by and for a number of reasons. The major reason for the absence of oversight is the disconnect between the patient, insurer, and surrogate. The insurance company could charge whatever the market would bear. Now under the ACA, there are some rules. In addition in most cases, the surrogate has to take what the insurer pays. The insurer, nor the surrogate has any reason to control cost.
Patients must learn about insurances. They must question why things are not done in their best interest and question the cost. After all, they pay for every lab test, procedure, (x-rays, etc.), office, hospital, surgery center, and medication used in their care.
The ACA will give patients a voice. Patient information technology and a staff at the Medical Home practicing patient centered care will save money and deliver quality care. The payment system will be based on value and rewards for the care given, not per visit or referral to another specialist.
Florida is a wonderful example of how patients get caught up in the referral system. I was talking to a Medicare patient who had recently returned to Florida from the north. Her complaint was that she was sick of seeing doctors. She thought she had a day off, but received a call that morning reminding her of the next day's appointment with another doctor.
There is a lot of talk about one size fits all, and bureaucracy. I find it difficult to believe people would say such things if they had knowledge about how health care works. Perhaps they do not use the system and are privileged to concierge care. Remember the health care Market Place offers private insurers a place to sell their insurance so that the buyer can compare them.
The ACA will improve quality and reduce cost. The accountable care organizations have been in existence for a little over a year and already has returned almost 130 million dollars to the Medicare Trust.
I say if we do not let the naysayers cause us to take our eye of the ball, we have a hit. "Play Ball"
Lewis Robinson, M.D.