Chicago-area emergency physician: “I struggle every day because of our system” to help patients access care

Dr. Colleen Smith, an emergency medicine physician and visiting fellow at the Center for Modern Health, said the current U.S. healthcare system creates daily challenges for both doctors and patients.

“I struggle every day because of our system to get the… healthcare that… they need,” Smith said, describing the barriers she encounters in practice.

Smith said frustration with the system is widespread and spans both professional and personal experiences.

“I’m frustrated… both as a patient and as a doctor,” she said.

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She said recent policy proposals aimed at breaking up large healthcare systems may not address underlying structural issues.

“There is sort of something kind of underhanded going on,” Smith said, referring to financial relationships among healthcare entities, but added that simply breaking them apart would leave “the same regulatory landscape.”

Smith said government policy has contributed to the current structure of the healthcare system over time. “We’ve had increasing regulations on healthcare… and the way that it can be practiced,” she said, pointing to policies tied to Medicare, Medicaid, and the Affordable Care Act.

She also highlighted the role of certificate of need laws in limiting competition. “You’re actually giving… the giant, vertically integrated companies a… veto power over… their competition,” Smith said.

Smith said the lack of competition affects patients directly. “The patient… doesn’t spend any money and doesn’t have any choice,” she said, arguing that consumer decision-making has been reduced in the current system.

She said reforms should focus on increasing flexibility for both providers and patients. “You have to free the producers… and… free the consumers,” Smith said, pointing to deregulation and expanded health savings options as potential steps.

Smith practices emergency medicine in New York City and works on healthcare policy issues through the Center for Modern Health, a think tank focused on regulatory reform and market-based approaches to healthcare.