Addressing what’s wrong with the fee-for-service system in health care

The Inflation Reduction Act passed by the Senate over the weekend includes the largest national investments in health care since passage of the Affordable Care Act in 2010. Drug price reform and insurance subsidies will make health care more affordable and more accessible to millions of people.

While voters should rejoice, the deal simply is more of a band-aid (and a very good one) than a cure. There are still gaping holes in the American health care system that frustrate us every time we have to argue over a bill at the pharmacy counter, try to schedule an appointment with a specialist, or stare blankly at an inscrutable Explanation of Benefits statement.

Dissatisfaction with the cost and quality of our nation’s health care system is an American tradition that unites red and blue America, crosses every river, mountain range and city block, and extends into every family, rich and poor.     

We all get sick and we all care for loved ones who are sick. And through it all, we have to cope with the mystery of whether we are getting the right care, or instead, the care that rakes in more dollars for the corporate health care system.

The good news is that, over the years, we’ve made health care better, from Medicare and Medicaid, to the Affordable Care Act, which opened the private health care system to millions more Americans.

Thanks to all of these efforts, the American people today give the health care system among the highest ratings it has ever had. But even with high ratings, about two-thirds of Americans believe we aren’t getting good value in health care, half are worried about affording care, and about one-third actually have to ration care or forgo care altogether. 

There’s an underlying and fundamental problem that’s been unaddressed since the birth of the fee-for-service system. And it’s the fee-for-service system itself. 

Here’s the issue. The incentives attached to the way doctors provide care are completely out of whack. The insurance industry’s emphasis on paying for each and every service puts billing and profits first, not patients’ health and well-being. An emphasis on doing a lot of services and procedures often means your doctor is being pushed to focus on doing more unnecessary and costly stuff, not getting you healthy or keeping you healthy. 

For example, when a patient walks in the door with debilitating back pain, all the incentives bearing down on the doctor are to conduct a never ending-series of X-rays, MRIs, or even perform low-rated and ineffective back surgery. There’s no incentive to look deeper and follow the medical evidence leading to the most effective treatments, which focus on physical therapy, exercise, and strengthen the muscles that support the back.  

We have to tackle the fundamental issues of a system designed to make money by doing more, rather than serving the true health care needs of men, women and children.

Now there’s a movement for change and it’s starting in cutting edge medical groups and other health plans. It’s simple: instead of reimbursing doctors for each service they perform, they’re reimbursed for preventing people from getting sick and keeping them healthy. 

It’s happening at J.P. Morgan Chase, where 285,000 employees and their families now have a system that focuses on better outcomes, invests in promising new ideas and provides personalized care for patients. The same approach is also being piloted at medical groups like Iora Health and Chen Med and community-based groups in Oregon, Minnesota and beyond. 

And One Medical group, which Amazon is set to acquire, also employs these concepts.

Consumers will smartly ask what all this new payment system means for them and if this is going to upend the health care they currently have. Well, it will mean everything and nothing for them. Patients will still get care from the same doctor and the same insurance they get through their employer or health insurance marketplaces. 

And before Sarah Palin starts in with “death panels,” this isn’t a scary upending of the health care we all have. It’s about making what we already have even better.  

Doctors will finally be talking to each other. The neurologist treating an elderly woman’s dementia will have the same information and will be working with her primary care doctor, cancer specialist, and physical therapist. They will be working together to manage her illnesses and keep her as healthy as possible. They also will be working to keep people from getting sick in the first place. It’s what they were trained to do but now it’s also what they’ll get compensated for. 

And patients? They’ll be healthier, happier and more confident in the care we’re getting. In fact, these reforms are driven by what patients have demanded for decades. For once, the experiences of families are driving the change, not big insurance companies and their lobbyists.

With Congress finally on its way to doing its job on pricing and access, we need the health insurance and provider industries to take the lead in doing what every other private sector industry does to succeed: listen to the customer. Because, even in health care, they’re always right. 

Frederick Isasi is executive director of Families USA.