Commentary

Washington’s Princes of Paperwork Are Crushing Physicians and Bankrupting, If Not Killing, Patients

In the rancorous to and fro over the repeal of ObamaCare and its possible replacement with the American Health Care Act, an elephant in the room has remained unnoticed. It’s that giant bundle of burdensome regulations that is crushing physicians, their staffs, and sending the costs of healthcare soaring.

A recent, detailed study published by the American Medical Association (AMA) sheds a common-sense light on what Washington chooses to ignore. For every hour physicians spent with patients, almost two additional hours are spent pushing papers. Even when face-to-face with patients, doctors spent 37% of their time filling out forms.

It’s time for Washington to wake up and cut the needless medical red tape.

Burdened with the weight of regulatory paperwork, doctors are becoming increasingly unhappy — more paperwork, less time with patients. Indeed, in a typical day, during office hours, doctors spent only 27% of their time attending to patients face-to-face and 49.2% on electronic health records (EHR) and desk work. Even during after-hours work, doctors spent a whopping 59% of this time dealing with electronic health records.

The following table summarizes the AMA’s stunning findings. It tells the red-tape tale in horrifying detail.

Just why do regulators promulgate so many regulations and produce so much red tape? For one thing, it creates jobs for the boys (read: the Princes of Paperwork). There is no better bulletproofing for a bureau’s bloated budget than a complex maze of regulations that “must” be enforced to protect the public’s health and safety.

But, there is another, perhaps more important, reason why regulatory bureaus produce endless miles of red tape to wrap around doctors, medical staffs, and the U.S. healthcare system. Bureaucrats are conservative. They like to avoid risks, and decision making is an inherently risky activity. After all, decisions can prove to be wrong, unpopular, or both. So, to avoid the risks and responsibilities that come with discretion and decision making, regulators produce rigid rules and red tape — the more, the merrier. The regulators’ check-the-box mentality allows them to slip out from under any responsibility if something under their regulatory purview “goes wrong.” The regulators are protected, and the onus is placed on the doctors and their staffs who must check all those boxes — boxes that cover everything under the sun.

The fallout has been enormous. The cost of healthcare has shot to the moon — lots of forms to fill out and massive gold-plating of treatment to cover all those regulatory bases. Also, a great deal of discretion has been removed from doctors’ hands (read: Doc, you must follow the rules, even if a different prescription is advisable, and you must fill out all the forms, even if it is a distraction). Thus, the quality of patient care has suffered.

Doctors have been forced to push too much paper and too many pills. And that’s not all. The plethora of rules and regulations has exposed doctors and their staffs to lawsuits and sky-high medical malpractice insurance rates. What if something is alleged to have “gone wrong” and you failed to check all those regulatory boxes? After all those years in medical school and the big bucks to finance them, you are still just one missed checkbox away from a medical malpractice suit. It’s time for Washington to wake up and cut the needless medical red tape.

Steve Hanke is a professor of applied economics at The Johns Hopkins University and a senior fellow at the Cato Institute.