Yang's Healthcare Policy critique
3. Improve the Economics of Healthcare
This is where the rubber meets the road & we see Yang's policy actually move the healthcare needle forward. (A few missteps not withstanding -- payment models & MD/DO shortages)
(Warning: long thread)
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3. Improve the Economics of Healthcare
This is where the rubber meets the road & we see Yang's policy actually move the healthcare needle forward. (A few missteps not withstanding -- payment models & MD/DO shortages)
(Warning: long thread)
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1. Payment models
Much ink has been spilled on this topic, and opinions remain diverse. Here's a previous tweet of mine on the subject.
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Much ink has been spilled on this topic, and opinions remain diverse. Here's a previous tweet of mine on the subject.
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Every payment model has pros & cons, and I appreciate the policy indicating as much. Fee-for-service is much maligned, but in reality works well for many (not all!) specialties. Capitated models can be good, as the policy advocates for (again, depending on structure).
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We should not, however, fall into the trap of applying a single compensation model to all clinicians as that ignores their various pros & cons. AND (really important, don't miss this) we should consider not only HOW doctors are paid, BUT BY WHOM.
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One of the (few?) honest things about lawyers is their clarity for WHO they work for.
Whoever pays them.
For the last 50+ years doctors have generally been paid by third parties, not patients directly. This breeds distrust and concerns for ulterior financial motives.
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Whoever pays them.
For the last 50+ years doctors have generally been paid by third parties, not patients directly. This breeds distrust and concerns for ulterior financial motives.
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We need to consider "first-party" financial models like direct primary care which build trust and enhance longitudinal care and cost savings. What's more, this can be funded by government, employers, and others while retaining patient ownership of the money.
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2. Tort reform
FINALLY! A policy that addresses a MAJOR SOURCE OF MISERY for both patients (cost and needless care) and doctors (self explanatory).
America has become, and admits to, being an overly litigious society. Which means our solution is to... stop suing everyone.
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FINALLY! A policy that addresses a MAJOR SOURCE OF MISERY for both patients (cost and needless care) and doctors (self explanatory).
America has become, and admits to, being an overly litigious society. Which means our solution is to... stop suing everyone.
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Here's our dilemma.
Lawsuits are profitable. (bad justification)
Patients are sometimes harmed beyond reason and deserve restitution. (good justification)
But medicine isn't perfect, and neither are doctors.
We need to balance these, but currently there is no balance.
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Lawsuits are profitable. (bad justification)
Patients are sometimes harmed beyond reason and deserve restitution. (good justification)
But medicine isn't perfect, and neither are doctors.
We need to balance these, but currently there is no balance.
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50% of US doctors are sued. This is both wrong and stupid, with obvious unintended consequences. It is estimated that 20% OF ALL US HEALTHCARE SPENDING is medically unnecessary. Tort reform, patient expectations, and third-party payment models drive this number.
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Tort reform will help protect doctors, protect patients from needless care (and inevitably complications and cost), lower total cost, and encourage more students to become doctors (which we desperately need).
HUGE credit to Andrew for including this in his policy.
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HUGE credit to Andrew for including this in his policy.
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(This twitter stuff is exhausting! I'm on duty tonight and patient care is so much easier than this.)
3. Decrease Administrative Waste
ALSO exhausting, as it happens. Do not underestimate how miserable clinicians are (docs, nurses, pharmD, everyone) with EMR documentation.
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3. Decrease Administrative Waste
ALSO exhausting, as it happens. Do not underestimate how miserable clinicians are (docs, nurses, pharmD, everyone) with EMR documentation.
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Once upon a time the (now infamous) Electronic Medical Record was being developed side-by-side with physicians and, lo and behold, we liked it! We voluntarily used EMRs because they improved our practices. That is, until one day ambitious companies devised an evil plan...
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The story of EMRs is a casebook study of the dangers of legislating good intentions. We are, no joke, 20 years behind development of what should have been world-class EMRs.
Instead, EMRs are the #1 reason cited for physician burnout and early retirement. (Thank you Epic!)
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Instead, EMRs are the #1 reason cited for physician burnout and early retirement. (Thank you Epic!)
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Andrew's policy mentions this utterly demoralizing, but very true, statistic.
For every 1 hour of patient care, doctors spend 2 hours on administrative tasks (namely EMR documentation).
In fact this was a major reason why I myself quit rural primary care.
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For every 1 hour of patient care, doctors spend 2 hours on administrative tasks (namely EMR documentation).
In fact this was a major reason why I myself quit rural primary care.
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Government must stop mandating EMRs. So much corruption, waste, and misery... They must be allowed to develop organically, not force-fed to us. I work with a few different EMR companies and it's depressing to see so many good ideas die due to regulations.
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Want to know why we don't trust government w/ M4A?
EMRs.
Bureaucrats who know NOTHING of medicine make well intended decisions that do nothing but make billionaires of people like Judy Falkner while destroying patient care.
We need actual experts with skin in the game.
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EMRs.
Bureaucrats who know NOTHING of medicine make well intended decisions that do nothing but make billionaires of people like Judy Falkner while destroying patient care.
We need actual experts with skin in the game.
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Yang calls for opening APIs. This is a great start. We also need to stop the carrot-STICK enforcement of EMRs
"This will allow doctors to spend more time doing what they love—treating patients."
Honestly, strip away the govt BS, and being a doctor is actually pretty great.
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"This will allow doctors to spend more time doing what they love—treating patients."
Honestly, strip away the govt BS, and being a doctor is actually pretty great.
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Almost done with this thread, promise.
4. Increasing Availability of Primary Care
We've had a PC shortage for decades now. Know what the government's response has been this whole time?
More paperwork and less money.
<insert brain surgeon joke here>
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4. Increasing Availability of Primary Care
We've had a PC shortage for decades now. Know what the government's response has been this whole time?
More paperwork and less money.
<insert brain surgeon joke here>
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Other countries spend TWICE as much on primary care as we do. Why? Because good primary care is the FOUNDATION for a healthy population.
As the policy suggests, loan payment is a major part of this. We also need to increase payment. (ironically, the AMA is to blame on this)
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As the policy suggests, loan payment is a major part of this. We also need to increase payment. (ironically, the AMA is to blame on this)
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The bit on NPs is bad policy. We actually want to most seasoned, well-trained individuals in primary care. It should be HARDER to be a primary care physician than a specialist. NPs are great in certain settings, but not as PCP replacements.
Again... for you to decide.
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Again... for you to decide.
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Last story.
I once signed up for a rural loan repayment program of $13k/yr (3% of my loans). I found a job in another state which paid significantly better (i.e. pay off loans faster). I was threatened with $160k fine from the state.
THAT'S the insanity of bureaucracy.
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I once signed up for a rural loan repayment program of $13k/yr (3% of my loans). I found a job in another state which paid significantly better (i.e. pay off loans faster). I was threatened with $160k fine from the state.
THAT'S the insanity of bureaucracy.
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So, all in all, a much better part of Yang's policy. He actually acknowledges and addresses the real-world problems we doctors, nurses, and patients deal with. This isn't what most people think of when discussing healthcare reform, but real reform won't happen without it.
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p.s. Just stirring the pot, hoping to draw some friendly lawyer fire with this one. 😉 Appreciate the good lawyers out there!
