Murphy & Joyce Op-Ed: This is our prescription to fix a broken health care system

As physicians who have practiced for decades and the co-chairs of the GOP Doctors’ Caucus, we have witnessed firsthand the breakdown of our health care system. We pay too much for care that is too often delayed or denied altogether by those who never directly touch a patient. Too many of these middlemen have been allowed to come between our patients and the care they need. Composed of some of the only members of Congress who have ever directly cared for patients, the GOP Doctors’ Caucus brings a critical patient-focused perspective to healthcare policy debates.

Access to Quality Healthcare

Patients across America, particularly in rural and underserved communities, are losing access to their trusted physicians as independent practices close. When a family doctor closes an independent practice, Medicare beneficiaries face the painful reality that they have to travel further to find another practice or hospital system that accepts their insurance or go without care.

This growing crisis stems directly from Medicare’s continued underfunding of physician services. Hospital-owned practices typically charge more for the same services, creating higher out-of-pocket costs that Medicare patients bear through increased copays and deductibles. Patients also lose the trusted relationships that they’ve built with local doctors who know their medical history, preferences, and unique needs, disrupting continuity of care. For elderly and disabled patients, increased travel distances create significant hardships, especially for those with limited mobility or transportation options, resulting in a lower quality of life. These combined factors place vulnerable patients at even greater risk of poor health outcomes and financial strain.

Medicare patients deserve a stable and predictable payment system that incentivizes providers in all settings and all areas to keep their doors open and to serve their communities.

Medicare Advantage Reform

Insurance companies are playing games with their own customers’ health for record-breaking profits. Medicare Advantage (MA) was created with the premise of providing wrap-around services for seniors at lower costs. Unfortunately, profit-driven insurance companies have destroyed that model. While MA continues to provide important benefits to millions of seniors, these plans must stop seeing rewards for delaying or altogether denying care to beneficiaries that need it. Even worse, insurance companies that provide MA plans “upcode” beneficiaries with diagnoses that are clinically irrelevant and often dangerous. Despite the goal of saving money through better preventive care, evidence indicates these plans currently cost taxpayers up to 20% more than traditional fee-for-service, without better outcomes. Stopping these unfair and unethical practices will mean better healthcare now and protecting Medicare benefits for the future.

Prior Authorization Burdens

Another dirty game that insurance companies play is utilizing the prior authorization process. Denying the care that you and your doctor believe to be necessary is a common tactic used by insurance companies to wear down beneficiaries and their care team. This results in worse care for patients and costs both the federal government and providers more, as patients and providers must then spend time fighting these useless denials.

When decisions on patient care are made by faceless bureaucrats with no experience or expertise, care is often delayed or denied altogether. We must pass policies that reduce these burdens of prior authorization by demanding peer-to-peer reviews for these conversations and streamline processes so that patients and physicians know when prior authorization is needed.

Pharmacy Benefit Manager Reform

Patients throughout the country are faced with higher costs for the prescription drugs that they need which limits their ability to get the care that they deserve.

One factor driving up costs is the Pharmacy Benefit Managers (PBMs), yet another group of middlemen, who play a problematic role in determining pricing and access to medication. PBMs negotiate with manufacturers, develop formularies, and even own pharmacies further consolidating the American health care system. They capture monies from pharmaceutical companies to gain access to formularies and then keep the rebates meant for the patients. PBMs also keep drug prices higher because they earn a commission rather than just a simple fee.

Congress needs to establish greater transparency in how medications are priced and selected for coverage. Patients and prescribers deserve a process that protects the doctor-patient relationship and not the PBMs’ bottom line. Establishing flat fees for PBM services would remove the incentives that drive prices higher and deliver relief for American patients.

The Path Forward

While not comprehensive, these small reforms provide practical steps toward true relief to our system and improve the care that American patients receive.

Meaningful health care transformation demands collaboration across all stakeholders. Americans deserve care that both preserves the sacred doctor-patient relationship and ensures access to affordable high-quality care. The Trump administration has called for needed improvements to strengthen our healthcare system, and we in the Doctors’ Caucus look forward to continuing our great partnership with the administration to deliver results for American patients.

The time for these focused reforms is now.