Despite the passage of the Affordable Healthcare Act, healthcare is still not affordable in the United States. In addition to an increase in premiums and deductibles, we are witnessing the quality of our healthcare decrease substantially due to administrative run healthcare initiatives over the past decade.

With the continued increase of government directives and the time required by physicians to stay ahead of open-ended mandates, it has sadly become the end point to many quality physician practices. No longer can they afford to be in business for themselves – the overhead including competent staff, medical liability, rent, utilities combined with a constant loss of revenue from federal payers, is just too much to bear and most find themselves confronted with the decision of whether to secure their future as an employee of a larger entity or retire.

In addition, the monolithic American Board of Internal Medicine, who oversees board certification for internists and subspecialists in the US, recently overhauled their requirements for Maintenance of Certification, adding more regulatory mandates to adhere to.

Increased requirements for board certification should be applauded – there are many a physician who should not be practicing.  However, the current modification does nothing to ensure quality physicians are board certified and frankly, these same physicians have an innate ability to circumvent any stipulation thrown their way.

Further contributing to the climate is the dissention between physicians and faceless insurance physician reviewers, who of note, do not care for patients on a face to face basis  – a common denominator with physicians who sit on dictating boards and medical flagships that regulate healthcare.

On any given day, the majority of practicing physicians have found themselves faced with the responsibility to justify specific treatment and with proof of how effective (code word for monetary savings to the carrier) it will be in the long run on a daily basis to physician reviewers.

I illustrate a rearward view; what the patient encounters is a very long wait for an authorized service or a complete reroute to a physician who plays along with the managed care group.

In addition, we sadly received verbal acknowledgement of what many have suspected without formal proof: the lack of quality care provided to the Americans who serve and have served our country.

Many lives were lost just waiting for an appointment with a Veterans Administration physician.

President Barack Obama ordered a White House investigation. On June 27, 2014, Obama’s Deputy Chief of Staff, Rob Nabors, reported “significant and chronic system failures” and a “corrosive culture” inside the Veterans Health Administration ¹

The public disclosure of the VA culture only underscored Americans distrust of their healthcare options.

It is not difficult to interosculate the increase in Americans seeking care in an alternative market and decrease in quality healthcare in America but it would be remiss to neglect to mention the additional factors that have contributed to the increase: health conscious and internet savvy patients, continued globalization in workforce, the introduction of affordable long haul flights, a huge growth in the ASEAN medical industry, proven success in hip, cardiac, dental and cosmetic surgeries in facilities abroad, an unsubstantiated fear about the sterility of such facilities and the continuity of care.

1. Kuhnhenn, Jim (June 27, 2014). “VA review finds ‘significant and chronic’ failures”. bigstory.ap.org. Associated Press. Retrieved January 10, 2015.