By Dr. Timothy Harrington, The Capitol Times guest columnist, Oct 12, 2019

As a retired Madison rheumatologist, I hear from my physician and nurse colleagues, and many others, about the increasing problems that Dane County residents face every day in accessing necessary health care.

People who have developed new chronic disease problems are waiting three to six months, or even longer, to see the medical specialists who can best diagnose and treat them, while established patients cannot be seen when necessary. I recently spoke to a UW diabetes specialist whose next available new patient appointment is in one year, which means that her scheduled new patients are already waiting that long. As a result, patients who should be receiving outpatient medical specialty care clog up our equally overloaded primary physicians’ practices, urgent care centers and emergency rooms, as they get sicker and may eventually require more costly hospital stays.

A business executive new to Madison described to me how he waited three months to establish a primary physician relationship, and how his partner has maintained her health care elsewhere because she fears not being able access specialty care for her chronic disease in Madison. These people, like most Dane County residents, are well-insured, and yet they are unable to obtain necessary, timely care in a community that has more physicians per capita than almost anywhere else in the United States.

Our city and county governments project Dane County’s population will grow by 80,000 in the next decade, and they are beginning to address the unmet affordable housing and transportation needs of current and future residents. I suggest that accessible health care is as critical, and that our hospitals and large medical groups need to admit to and address this problem. Doing nothing or more of the same will not solve this problem.

To begin, UW Health, SSM Health and the Veterans Health System should publish their new and established patient wait times each month for their outpatient medical clinics. Then they need to redesign how their existing work force is organized, staffed and functioning. Exceptional health systems in other cities have done this after they learned that hiring more health professionals to practice the same way was not only difficult and expensive, but also failed to improve access or control costs.

— Dr. Timothy Harrington is a physician and health care consultant from Madison.

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By Dr. Timothy Harrington I The Cap Times, Madison, WI — guest columnist, Sept 12, 2019.

The Democratic presidential debates about health insurance are offering primary voters with two alternatives: replacing private insurance entirely with a government-managed plan similar to what Medicare provides to senior Americans now, or allowing citizens to choose between their current insurance and a public option within the Affordable Care Act insurance exchanges.

In either case, Americans in poverty would receive government subsidies to make adequate insurance affordable. The first alternative proposes to replace the current for-profit health insurance industry and employer-based insurance with a government-mandated, tax-funded, single-payer system, while the second would allow employers and citizens to choose their best insurance options over time.

My preference, as a physician with 50 years of experience in practice and medical administration, is to add the “public option” to the Affordable Care Act as a first step toward creating the high-value, affordable, universal health care we all desire. Here’s why.

Advocates of “Medicare for All” believe it will work better for everyone, and cost a lot less. Their belief is based on how single payer systems have functioned in other countries, and how Medicare enjoys high ratings from older Americans. They fail to recognize that other countries’ delivery systems were built to provide high-value, affordable health care for all, rather than to maximize revenue and profits for corporations and delivery systems, as is generally true here, or that Medicare payment rates do not cover the costs of the care provided to Medicare patients. Universal Medicare rates could be especially devastating for financially-strapped inner-city and rural health systems.

“Public option” advocates believe instead that adding onto Obamacare is a pragmatic first step toward achieving universal access to health care — change by evolution rather than revolution. This incremental approach recognizes that changing incredibly complex systems such as our health care financing is best approached with step-by-step tests of change. This would give delivery systems and health professionals time to adjust to these shifting financial realities and would reduce unintended consequences. A marketplace competition would rapidly determine whether Medicare for the currently insured would actually work better than what they have now. It’s a fair bet that employers and the public will choose the insurance that provides better access to more care at a lower cost, and that private insurers would have to become more competitive or go out of business. In the end, hospitals and medical practices will only provide necessary care to everyone at an affordable cost by transforming how care is provided, as my colleague and I described in the recently published book, “Great Heath Care Value.”

In fact, high-capacity, high-access, less costly health care is already being provided in a few exceptional American medical practices that have built interdisciplinary teams and adopted disease population management processes to replace traditional approaches. Their patients are healthier, and experience on-time care, fewer hospital admissions and less waste. These practices care for many more patients per physician at a lower per-patient cost, which translates into higher profits and/or lower prices.

Americans need to understand these advantages and insist that this high-value care becomes the rule, rather than the exception, no matter how we decide to pay for it.

— Dr. Timothy Harrington is a physician and health care consultant from Madison

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