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The Gun Debate as it Relates to Private Practice and Direct Care

Matthew Mintz, MD says that inaction on gun safety demonstrates why healthcare reform will not happen in the foreseeable future; now is the time to leave our dysfunctional insurance-based system.

I am going to attempt to discuss politics without trying to get political.  Apologies if (and when) I don’t succeed.

The recent murders in Uvalde, Texas are indeed horrific.

It is not surprising that there have been cries of outrage and demands that change must happen.

Politicians will posture. People will post their views on social media.  However, nothing will happen.

Just like nothing happened after Columbine, Marjory Stoneman Douglas, Sandy Hook, and so many more.

 

It is not surprising that there have been cries of outrage and demands that change must happen. Politicians will posture. People will post their views on social media. However, nothing will happen. Click To Tweet

 

The irony is that while our country is split down the middle when it comes to political party affiliation, the majority of Americans agree with some for of gun safety policies in terms of background checks and banning of certain weapons.

With most Americans agreeing both that something should be done as well as what could be done, why has nothing been done despite each passing tragedy?

I am neither a government, policy, or any other kind of expert in this matter; so, my attempts to explain our country’s current inability to get anything done will likely have multiple gaps and flaws.  However, I will point out two reasons that I think are important.

First, our campaign finance laws allow big corporations to have an inordinate influence on policy.  In the case of gun safety, the gun lobby’s influence plays a huge role. Second, political gerrymandering (on both sides), has made it such that more extreme candidates (again, on both sides) are likely to win primaries and advance to general elections, than more moderate candidates who would likely to better in a general election.

The Republican Party in particular, seems to be letting the views of a minority of Americans influence their political stances, to the point where virtually any Republican in Congress will oppose virtually anything a Democrat proposes.

Regardless of which side is right or wrong, the lack of any foreseeable compromise leads to inaction.

 

This is critical as it relates to healthcare reform because if the murder of children can not lead to action where solutions are clear and backed by most Americans regardless of political affiliation, there is no possible way that anything will happen to change our inefficient and costly healthcare system where there is neither any agreement nor consensus of what to do.

(Remember the Democratic Presidential debates a few years ago, when the views of what to do about healthcare varied widely, sometimes very far apart?)

It’s important to note that not only did the Affordable Care Act barely pass, but it really didn’t change the system.

While the ACA may have made some important changes to health care (eliminating pre-existing conditions for example), ultimately the issue was about how to cover the uninsured, with the Republicans (the Ryan plan) wanting to use tax credits to allow patients to pay for insurance, and the ACA using tax dollars to fund insurance exchanges.

Ultimately, both parties wanted to keep the current insurance system intact, which it currently remains and is unlikely to change anytime soon.

And, if you think the gun manufacturers have money to spend on lobbying, check the latest Fortune 500 list, where nearly half of the top 20 companies are in health care (not counting companies like Amazon, Walmart and Apple that have a substantial interest in healthcare). There are simply too many people making too much money on the backs of our broken healthcare system, and our currently political system is too broken to fix it.

 

There are simply too many people making too much money on the backs of our broken healthcare system, and our currently political system is too broken to fix it. Click To Tweet

 

Which leads to my main point connecting the current gun safety debate and private practice/direct care.

If you are stuck in the current system, what are you waiting for in order to get out?

Things are not going to get better anytime soon, and unfortunately, will likely get worse.

The results of midterm elections or Presidential elections, while important, will not lead to substantial healthcare reform for decades to come.

You may ask, “but if I leave insurance-based care, who will see the patients who can’t afford healthcare without insurance?”

 

While this is certainly an understandable concern, I would argue that

 

a) they currently aren’t getting good care anyway and

b) by staying in the broken system you are only further prolonging its existence and thus adding to patient suffering.

 

Only when doctors say “enough” with their actions and not just words, will anything ever change.  In the meantime, for many doctors, staying in the current insurance-based system is leading to burnout, poor patient care, doctors leaving medicine altogether, and tragically suicides.

 

Only when doctors say “enough” with their actions and not just words, will anything ever change. In the meantime, for many doctors, staying in the current insurance-based system is leading to burnout, poor patient care, doctors leaving… Click To Tweet

 

Now is the time to embraced direct care.

This can be pure direct primary care (DPC) where insurance is not involved at all, it could be simply not accepting insurance company contracts and directly billing patients cash fee for service (allowing them to submit invoices and collect from their insurance companies), or a variety of other models where doctors no longer accept the restrictions and low payments from insurers.

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