Back in 2008, before Obamacare became the law of the land, I was among a group of physicians who met with a physician adviser to President Obama. This Harvard trained internist had come to the public sector from McKinsey & Company, a large and well-respected consulting company. The focus of his talk that day was cutting the cost of healthcare while increasing quality of care. He spent 45 minutes educating us on these concepts; shifting from fee-for-service to risk-based approaches, standardizing care to reduce variation, expanding scope of practice for nonphysician clinicians, and utilizing technology to reduce duplicative care. To me and most of my colleagues who were mainly in private, solo, or group practice, these ideas sounded like a death march.
Now, six years after the passage of Obamacare, how close have we come to "righting the ship" of healthcare by applying the concepts of the president's adviser to improve quality at a lower cost? Some of the concepts espoused by the president's adviser have been enacted — such as increasing technology through EHRs, standardizing care through evidence-based guideline development, and increasing the number of nurse practitioners and physician assistants in practice.
Have the benefits for patient care been worth the risk? Has there been any harm to the patient? In my opinion, the benefits of Obamacare — including the changes to the insurance regulations and increased number of patients who have health insurance — have clearly not been worth the significantly increased financial burden on the patient, through higher deductibles and rising drug prices. Because of these overwhelming costs, patients forfeit procedures and treatments and suffer health consequences, while healthcare system costs increase because of delays in these necessary treatments.
Only time will tell if our healthcare system can survive these changes and realize the promised outcomes of Obamacare — increased quality of care at a lower cost. For me the choice is simple. I will never abdicate my role as healthcare advocate for my patients, particularly when the expense of lowering the cost of healthcare may be the patient's life.