Health Care ‘BARRCOME’ Kills Patients – Commentary

By Deane Waldman, M.D.

When a federal government regulates healthcare (or anything for that matter), it does so by creating BARRCOME (bureaucracy, administration, rules, regulations, compliance, oversight, mandates, enforcement).

Many people believe when government regulates something, like lowering drug prices built into the U.S. Inflation Reduction Act of 2022,  there is no cost to the public, and the effect is what is written in the bill, such as reducing inflation or cutting the price of drugs.

Nothing could be further from the truth.

In health care, BARRCOME kills patients,  and could even destroy a nation. This review focuses primarily on the U.S. healthcare system with examples taken primarily from it. However, the analysis and conclusions apply equally to any government-run healthcare system such as those in the European Union (EU).

Stealing Time

A common patient complaint is, “When I finally get in to see the doctor, she (or he) stares at the computer and pays no attention to me!” Sadly, this is too often true. The physician is tasked with an enormous regulatory and administrative burden, which takes time that should go to talking with, examining, and thinking about the patient.

Time-wasting tasks include electronic medical records and e-prescribing, hospital efficiency scorecards, HIPAA compliance requirements, diversity confirmation, billing forms, security protocols, health plan requirements, and numerous mandatory surveys.

Theft of time hurts patients in two ways. First, it shortens the clinical time devoted to the patient when the patient is with the doctor. Second, time stolen by BARRCOME lengthens the time patients wait to see the doctor, much less get care.

In the U.S., before the Affordable Care Act (ACA) maximum average wait time to see a primary care physician was an unacceptable 99 days. The ACA increased the maximum wait time to 122 days. In EU single-payer systems, wait times can be even longer.

Excessively long wait times are medically dangerous. They allow illnesses to progress, become more severe, and lead to what is called death by queue: dying waiting for technically possible care that is not provided in time to save the patient.  In the U.S., death by queue has been well-documented in Medicaid as well as Tricare, government-supported health insurance for veterans. [32-34] Great Britain has a long history of death by queue. In fact, the phrase was coined in the NHS based on the definition of a queue

Stealing money

The public tends to assume BARRCOME costs them nothing when in fact, it is massively expensive. Someone must pay the millions of non-clinical (BARRCOME) healthcare workers, both public and private, plus the buildings, computers, and pencils they use.

Euphemistically called “bureaucratic diversion,” BARRCOME consumes 31 percent to 50 percent of all U.S. healthcare spending. As the U.S. expended $4.3 trillion on healthcare in 2022, approximately two trillion “healthcare” dollars were diverted from health care – two words, the voluntary, fiduciary, legally protected, confidential service contract between patient and physician – to healthcare – one word, the system. BARRCOME denied Americans two trillion dollars’ worth of patient care.

How much shorter would wait times for care be with two trillion additional dollars for providers? How many lives could be saved with those $2 trillion?

Stealing freedom

Finally, BARRCOME kills the most important American right: freedom. By taking away medical and financial decision-making authority, BARRCOME has stolen medical autonomy or medical freedom.

Health plans, not patients, choose a patient’s physician. Pharmacy benefits managers, neither patients nor doctors, choose patients’ medications. Insurance contracts decide on patients’ surgery, not patients and not doctors. Despite laws supposedly protecting patients’ right to choose, the examples above and patients’ everyday experiences prove that federal BARRCOME has killed medical autonomy in the U.S. and elsewhere.

Destroying a Nation

Out of control (unrestrained) BARRCOME can destroy a nation in two ways. It can spend the host country into default, or it can budget frugally and fail to provide care so that its citizens die unnecessarily. The latter describes Great Britain and Canada. The U.S. is unique in that it suffers from both “unsustainable” (per President Obama) overspending and death-by-queue.

Third parties use BARRCOME as justification for making financial and medical decisions that should legally, morally, and optimally be done only by patients.

Third parties have decision capability because they are the payers in the only market that has three parties – the buyer, the seller, and the payer. The buyer is the consumer but is not the payer. Seller does not decide what goods or services to provide nor how much will be paid. Third-party is Washington, directly or indirectly in control through contracts with health plans and insurers

The solution to disconnection is obvious and politically radioactive: reconnect buyer/patient with the seller/provider, cutting the third party out of the decision-making process. Restore free market forces so they can make their magic: the highest quality at the lowest price available when needed to the most people.

Reconnection returns decision-making – both medical and financial – where it belongs, in the hands of We the People. Such “patient-controlled healthcare” would make the vast bulk of BARRCOME unnecessary, to be discarded thus saving literally trillions of healthcare dollars. And best of all, reconnection would restore freedom – it would re-establish medical autonomy.

Deane Waldman, M.D., M.B.A (dw@deanewaldman.com) is professor emeritus of pediatrics, pathology, and decision science, University of New Mexico; former director of the Center for Healthcare Policy at Texas Public Policy Foundation; and former director, New Mexico Health Insurance Exchange. A version of this article appeared in the American Journal of Biomedical Science & Research, August 30, 2023. Reprinted with permission.