Welcome to AzACOFP!
The AzACOFP works with its members to provide all of the resources possible to receive the latest information on practical and technical advances in osteopathic family medical practice, continuing medical education to provide for continued learning opportunities, and a wide variety of specific member services designed to help AzACOFP members and their patients.
The President’s Message
Much of the recent change to our healthcare system has focused on improving or extending insurance coverage. While I laud the effort to improve access I think that it is misguided. Let us step back for a minute and think about what insurance actually is. “… guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.” An insurance policy reimburses the holder for financial loss. We use our homeowner’s and automobile policies this way but we expect much different things from our medical insurance, we expect it to pay for everything. This is played out daily in my office when a patient calls wondering why one service or another was not covered. They rarely understand deductibles, co-insurances, ABNs and the like. They wonder why medical insurance is so costly and we don’t have the heart or willpower to tell them it is patients’ and doctor’s fault alike. Imagine how expensive your auto insurance would be if it covered routine maintenance? If it covered wiper blades and car washes, paint retouches and the like. And imagine the auto owner would take maximum advantage of these services because they “have insurance” and are thereby unlinked from the cost of the service. Imagine the industry that would grow to take advantage of this full-service auto coverage. This is what happened to medicine.
A financial advisor warned me, “never buy insurance for something you can afford to pay for yourself if lost.” So I set my auto and home deductibles to the maximum I can afford and buy the highest deductible plan from my employer for the same reason. As a physician, I can afford a high deductible, whereas most people cannot. Their options are either to spend an ever-growing part of their salary on full-coverage plans, or to skimp and hope that either they don’t get that sick or forgo coverage all together and take the ACA tax penalty and risk bankruptcy if they do get sick.
One side of the political spectrum will talk of personal responsibility and free-market systems as the answer for our troubles and this would be a great answer if we hadn’t already gotten ourselves in so much trouble. A free market economy in medicine means more companies springing up to provide more medicines and devices to an ever-growing share of Americans to the point that we cannot afford it anymore.
The other side of the political spectrum will talk of a “single payer system” which sound like insurance but is really socialized/nationalized medical care. In 2009, 58 countries had universal socialized medicine. Most of Europe has it. Detractors point out failures in the VA health system as evidence that socialized medicine will not work. They cite anecdotes of patients in other countries “waiting months or years” before elective hip replacement. I agree that rationing will occur with socialized medicine but before you say “aha!”, realize that we have a de-facto rationing system in place already. The un-insured and under-insured either cannot or choose not to get healthcare due to cost. Most of these are working-class Americans. Before you trot out the VA as the example of socialized medicine, take a look at Medicare, one of the most beloved of government programs. People talk about how they wouldn’t trust doctors or bureaucrats in Washington to make choices about medical coverage but they are okay with it when it comes to Medicare and the VA and how is this any worse than an insurance company CEO or CMO deciding the same thing?
We need to stop looking at medical care from an insurance standpoint. There is a compelling national interest in keeping our populace healthy. More healthy people mean more workers. It means a stronger economy and higher tax revenue. It means fewer disability payouts and a happier nation. I don’t have a roadmap of how we get from where we are to universal healthcare but we need to start trying.