Imagine you’re a man who recently has been diagnosed with erectile dysfunction.  You go to the pharmacy to pick up your medication that treats this condition only to find out your health insurance will pay for just three pills a month.  Most men will tell you sex just three times a month is like being told you can only have three bites of your favorite food each month and that’s it.

In today’s ever-complicated and messy healthcare system, being a patient is becoming more challenging as you try to figure out what is covered, what’s not and why are your healthcare costs continuing to rise.  

Patient healthcare quality declining

Others patients across the nation are experiencing similar healthcare scenario barriers.  As a prostate cancer surgeon and urologic oncologist, I have the privilege of taking care of men at their most vulnerable times of their lives.  In my practice I see men with prostate cancer, erectile dysfunction, benign prostatic hyperplasia, and other types of urology problems men sometimes face. The majority tell me the gap between them as a patient and me as their doctor, has become wider than ever thanks to insurance companies, bureaucrats, and politics coming between doctors and their patients.

The Affordable Care Act (ACA) passed in 2010, has become a behemoth monstrosity threatening to collapse our entire way of providing quality access to healthcare in this country.  We were promised the ACA would increase health insurance quality and affordability, expand insurance coverage, result in better health outcomes and the real clincher was that it would reduce the costs of healthcare.

Few of those promises have been met.  Small business owners have been hit particularly hard.  Providing healthcare to their employees has been a huge cost factor with increases of health insurance rates skyrocketing up to 30% or higher particularly in the last two years.  This has forced many of these hard-working businesses that drive our economy to penalize employees by increasing their deductibles and out-of-pocket costs for medical expenses.  

Physicians feeling the pinch

For physicians across the country, the ACA has become a broken health care system that is increasingly perplexing.  The majority of doctors will tell you the perception of what once made them choose medicine as a career – their passion for taking care of patients – is no longer like it used to be.  Gone are the days of spending time getting to know patients and having that continuity of care.  Now there are too many rules and regulations that have negatively affected reimbursements, increased non-clinical administrative duties and paperwork and added-on patient care load. 

The one group of people who have benefitted the most from the ACA are those who were previously uninsured, on Medicaid or individuals struggling to afford care.  Doctors are now seeing more and more of these patients who have health insurance, who can now afford prescriptions and be seen by a doctor which is one of the brighter results from the ACA.  Meanwhile, patients with private health insurance are much less likely to have seen those same benefits.

How to overhaul a broken system

Fixing our current healthcare system will not be easy.  It will be one of the hardest, most divisive conundrums we’ve ever had to tackle.  Whatever happens today, will affect all doctors and patients years from now making it imperative to get the job done right this time.  No more foolish statements from politicians of “we must pass it to see what’s in it” or of trying to deceive the American public.  Quit playing politics.  We’re more sophisticated than that as a country and all healthcare providers and patients, deserve better. 

Here’s what really needs to happen to make healthcare in this country work for everyone:

·      Not all, but many patients are unhappy with our current system of healthcare.  The focus must always be on access to quality care.  One example is to make our offices run more efficiently so a patient is not sitting in the waiting room for 3 hours and then only sees the doctor for 5 minutes.

·      If politicians want to know how healthcare should look like in America, bring in the doctors.  Ask them what are the issues, what works, what doesn’t.  What will make your job run more smoothly but with the emphasis on providing the best quality of care to our patients.

·      Everyone should have to buy catastrophic health insurance.  Just like everyone who owns a car is required to carry auto insurance, all of us need this type of coverage. Serious, life-threatening health events happen easily bankrupting us.   

·      Many of the catastrophic plans may also cover a full range of health care services – not just hospital and emergency room costs.  An analogy to this is to make the comparison between those who fly first-class and those who choose to fly coach.  If a person wants to spend more money in order to go to the best doctor they can, then you have the right to buy more insurance for better coverage.

·      Keep the good points of the current ACA - preexisting conditions and young adults staying on their parents coverage up to age 26.

·      Let’s have tort reform with some teeth.  Protect doctors from legal action by placing limits on the amount of money patients can receive in a lawsuit.

·      Put into practice cost-cutting measures such as finding solutions to prevent overmedicating patients and frank discussion on end-of-life issues.

·      From a business perspective, reducing healthcare costs is simple economics – supply and demand.  One driver of high healthcare costs is demand.  We can reduce demand for healthcare by doing a better job of providing preventative care services such as mental health counseling or dietetic counseling for diabetes, heart disease and weight loss.  This can be done at little to no cost to the patient with the government reimbursing the healthcare provider based on a patient’s ability to pay.  Thus, the government would save money by reducing more expensive chronic health conditions. 

To address the supply side of economics, we need to add more doctors, nurses, dietitians, pharmacists and other healthcare providers to the healthcare system.  The 2010 ACA brought in 20 million more people into the system but the number of doctors was kept the same.  Who in their right mind believes we can add millions of more people to the system yet keep the same number of doctors?  Does this improve the quality of our healthcare?  Of course not.  This only jams the system by adding on more surgeries, more patients to see with the doctors running from one patient room to the next not being able to give the kind of quality care each patient expects and has the right to. 

In conclusion

 At no other time in the history of medicine do I as a doctor have the ability to treat and care for my patients as well as I do now.  Let’s take away the roadblocks opening up avenues of excellent patient care for generations to come. 

To really make our healthcare system work better, what needs to be practiced is this – KISS – keep it simple stupid. It has become too complicated, too regulated with too many rules that even the most educated person finds difficult to completely understand.

Now is the time to make quality, affordable healthcare finally happen – otherwise it could be a long time before it ever does. 

Dr. David Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pintrest, SamadiMD.com and Facebook