Page 8 - Summer 2024 Bulletin

President’s Message
State of the Union of Medicine – What the HCMA and organized
medicine can do for you.
Damian Caraballo, MD dcaraballo44@gmail.com
Congressman Dr. Greg Murphy recently testified before Congress that “the state of medicine in this country is in crisis.” As co-chair of the Congressional Doctors Caucus, he was highlighting the looming US physician shortage and recent Medi- care reimbursement cuts. US health- care is in desperate need for serious reform and leadership from physi- cians.
I learned firsthand the inseparable nature of politics and medicine during our advocacy fight for the Florida balance billing bill which went into effect in 2016. While I can’t say we had a flat-out victory in our fight with payers, had physi- cian groups such as the FMA folded, health insurers would have enacted a reimbursement ceiling on all physicians in Florida which would have bankrupted multiple physician groups. We took what we learned from the Florida fight and used it in Washington D.C., where working through orga- nized medicine groups, we were able to stop the insurer price ceilings as being the sole determinant of reimbursement for out-of-network providers. In 2020, Congress passed the No Surprises Act, which like Florida’s balance billing ban, would have been a deathblow to independent physician groups and a led to 20% pay-cut to physicians if we had not fought for protections in the bill.
Today, the problems for US physicians and the delivery of healthcare have compounded. Current US healthcare sta- tistics are staggering. The US spends more money per capita on healthcare than any other country in the world, yet more than 70% of Americans feel the US healthcare system has failed them. Life expectancy in Europe surpasses that of all Americans by 3 years, even when adjusted socioeconomical- ly. Over 100,000 Americans died from overdose in 2021, and over one million Americans have died from overdose in the past 20 years. Out of industrialized nations western nations, the US has the highest per capita rate of infant deaths, ma- ternal deaths, assault deaths, overdose deaths, and avoidable deaths. On top of this, medical debt is the number one cause of bankruptcy in the US, and 60% of those with medical debt have health insurance.
On an economic front, we have a $5 Trillion healthcare industry which makes up 20% of the US GDP. If US health- care was a country, it would be the 3rd largest economy in the world. The United States spends approximately twice as much on administrative costs, over $1 Trillion per year, than on reimbursement for physicians. Approximately 75-90% of those administrative costs are wasteful and do not contrib- ute to care. Healthcare inflation over the past twenty years has increased 114%, yet physician reimbursement from Medicare has decreased by $3.40 in 25 years. Adjusted for inflation, every doctor working today is being paid half as much per patient as a doctor working in 1998. Meanwhile the number of physicians in private practice sits at 46.7%, compared to 60% in 2012. It’s no wonder 2/3 physicians ex- perience burnout, and 1⁄4 physicians have symptoms of de- pression.
In self-defense, many colleagues turned to anger, cyni- cism, disillusionment, or left medicine all together. Twenty percent of doctors said they plan on leaving medicine in the next 2 years in an AMA survey. Any (doom) scrolling through social media would find disheartened and morally injured physicians sounding off at whatever institution they can to express their frustration at the system. It’s a sad situa- tion when FIRE (Financial Independence, Retire Early) is as popular on social media as FOAM (Free Open Access Medi- cal Education). As George Carlin said, “inside every cyni- cal person, there is a disappointed idealist,” and physicians across the country are let down by what American medicine has become.
All these are a reaction to the moral injury physicians have suffered while dealing with the seemingly endless frus- trations and difficulties created in a fractured, for-profit, upside-down medical system where bureaucrats, computers, and actuaries have placed barriers between physicians and their patients. They’ve replaced our autonomy to heal with algorithms to make money. Our medical code and oaths have been betrayed, and the powers that be continue moving the medicine goalposts further away from our actual goals.
What can we do about it? The bad news is there’s no one coming to help us--we are on our own. In fact, in the $5 tril- lion zero-sum game that is US healthcare, if you are not ac-
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HCMA BULLETIN, Vol 70, No. 1 – Summer 2024