By Sandra Penn, MD, FAAFP

I believe in evidence. As a Western-trained physician, I was taught that half of what I learned in medicine would be proved wrong and that I would have to continue to study, learn and seek evidence that what I was doing continued to be appropriate.

When I came into medicine in 1973, Medicare had already proved itself. Seniors were able to get care as they never had before. By the time I started practicing in the 1980’s, Diagnostic Related Groups was changing the payment system for hospital care because physicians had cleverly moved some diagnostics into in-patient procedures and thus kept patients in hospital longer. Changing the payment system, it was clear, would change the amount that was charged.

During my eight years in private practice, I often wrestled with insurance companies about how they paid. Each company had a different requirement and I would be encouraged to see a person many times for a lesser rate rather than allowing me to charge more and have a longer visit. The insurance companies delayed payment because a single block was not checked on their form, driving up my office expenses because I had to hire more staff to service their forms. Medicare, at least, remained the insurer of all my patients over 65, thus reducing the number of changes I had to make when my patients were forced to switch insurances. That experience has driven me for the last 20 years to be an advocate for health payment reform (I am no longer in family practice although I still do primary care).

The last eight years have seen the deterioration of our health care and our safety net. A safety net is essential because our country has not provided us with the universal, accessible, accountable and affordable health care that is enjoyed by the rest of the developed world.

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