After over two decades of medicalpractice, I have witnessedseveral perceived threats to the practiceof medicine. There was the riseand fall of HMO’s, initiated by theHealth Maintenance OrganizationAct of 1973. The act was meant to reducehealthcare costs by helping providers(gatekeeper physicians) moreeffectively manage their resources. In1983, the Graduate Medical EducationNational Advisory Committee(GMENAC) concluded that there would be a 70,000 physiciansurplus in the United States by 1990. In 1985, the introduction ofDiagnosis Related Categories (DRG’s) as an alternative to per diemMedicare payments was meant to promulgate the demise of inpatientcare. In 1990, “Hillary Care” was to supplant the third partypayment system with a cumbersome, single payer, governmentrunbureaucracy. To date, none of these menaces of medicine havecaused the collapse of healthcare.

You would think that my experience with unrealized catastropheswould have tempered me to the current turmoil created bya failing healthcare system and its proposed repairs. Nevertheless,in this election year, I am even more concerned about the viabilityof medical care as we know it. I believe that we may have the“perfect storm” for catastrophic change in the way that we deliverhealthcare. With a declining economy, increasing deficit, wartimeexpenses and rising fuel prices, the general public is desperate forrelief. The option of “free” healthcare through a single party systemhas never been more enticing. Unfortunately, as I tell my patients,“free healthcare will be worth every penny you spend for it.” Nothingis truly free. Somebody always pays and the value that you willget with your single payer plan will validate that our current systemis arguably the most patient–friendly system in the world.

As you prepare to cast your vote in November, please considerthe following:

1. Contrary to popular opinion, we do not have a physician and resource shortage. We have a physician and resource maldistribution problem. We need to create incentives for physicians to relocate to areas of need.
2. The rising cost of doing business in the setting of decreasing reimbursement and increasing non–billable activities must be curbed immediately and effectively.
3. The days of the third party intervention between the patient and physician must end. The regulations by federal and state entities as well as the pathetic encumbrances to prompt and accurate reimbursement are at a critical state and are driving many of my experienced colleagues to early retirement. A new system will re–connect the fiduciary relationship between doctor and patient. Patient empowerment and accountability are critical to a successful plan.
4. The healthcare system must be 4. free to engage in entrepreneurial innovation and competition. A new system of consumer driven economics will resurrect a dying healthcare delivery system.
5. As my physician colleagues know by assessing their accounts receivable write offs, most of the 47 million uninsured citizens are getting healthcare. Unfortunately, it is accessed via the most expensive point of entry: the emergency department. We must create clinics for the indigent that will enforce good prevention and wellness programs with regular follow up. Tax incentives for physicians and hospitals willing to provide indigent care would essentially alleviate our current healthcare access issues.
6. The discrepancy in drug costs between the U.S. and other countries is unconscionable. The United States’ citizens must be given favored status as it relates to drug costs.
7. Ironically, your freedom and privilege to vote for a single payer system will be a vote to reduce your freedom of choice and eliminate the privilege of getting good, non–rationed healthcare.

My valued physician colleagues, I encourage your discernmentand course–correction if you find that you are having days when youfeel like acquiescing to the fatigue and frustration. Make our stateand national physician representatives responsive and accountableto their constituency. Remember, you may have one chance to castyour vote, but you hold the ultimate trump card…the power to say,“No. Enough is enough.” Sadly, the current system is systematicallydegrading, discounting and disenfranchising doctors. If this trendpersists, we can no longer serve as our patients’ advocates, confidants,facilitators and protectors. Seize the day, for tomorrow maynot come.

For all the readers of this article, I wish you God speed and goodluck. Your future is in your hands. Make your vote count!

Until next time, live well!

Max Gerald Garoutte, MD, FACC, FCCP, “Dr. Max”, is a San Antoniophysician, patient advocate and motivational speaker specializingin general, non–invasive, invasive and interventional cardiology. Hehas a special interest in wellness and prevention with a focus on integrativemedicine. Dr. Max is regularly featured on local television andradio including San Antonio Solutions on KTSA and JACK–FM. He isthe author of Maximum Destiny: Realizing Your Path to Ultimate Fulfillment.He can be contacted at 210.654.6000 or by visiting his websiteat maximumdestiny.com.