Stanley Feld M.D.,FACP,MACE

I love it! These are the type of comments I wanted to stimulate. My comment is below the quoted article.

Stan

That is according to a phone survey in which American and Canadian adults were asked about their health. Less than a month ago, other researchers reported middle-aged, white Americans are much sicker than their British counterparts.
“We’re really falling behind other nations,” said Dr. Steffie Woolhandler, a co-author of the Canadian study.
Canada’s national health insurance program is at least part of the reason for the differences found in the study, Woolhandler said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.
James Smith, a Rand Corp. researcher who co-authored the American-English study, disagreed. His research found that England’s national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.
Woolhandler said her findings were different in at least one important respect: In the Canadian study, insured Americans and Canadians had about the same rates of disease. The uninsured Americans made the overall U.S. figures worse, she said.
The study, released Tuesday, is being published in the American Journal of Public Health. It is based on a telephone survey of about 3,500 Canadians and 5,200 U.S. residents, all 18 or older, in 2002-2003.
The results are based on what those surveyed said about their health. The researchers in the American-English study surveyed participants and also examined people and conducted lab tests on them.

I just finished a book call Fooled by Randomness by Nassim Nicholas Talas

It is a book on how to judge stock trading statistics. The subtitle is “The Hidden Role of Chance in Life and in the Markets . Telephone surveys have a gigantic selection bias. The selection bias does not flatten out with large sampling. The conclusions if forceful enough or impact full enough become the eventually become the truth in decision making. However, the evidence in this article, in reality, is observational and not randomly controlled scientific evidence.

This data would be classified at Level 4 data. It suggests a difference in health but does not prove a thing. How many Hispanics and Blacks were in the American survey as opposed to the Canadian survey? Is the survey reproducible with the same number of participants, and a controlled mix of patients? These are just a couple of the many questions that must be answered.

People are not stupid when they have enough accurate information. The challenge to our healthcare system is to provide accurate and transparent information. The patient can then make a wise choice. We must work our way through all the noise presented daily.

People also become very smart when they have some skin in the game. My goal is to teach physicians and patients how to demand both so that the facilitator stakeholders feel they have to produce to satisfy the will of the major stakeholders, the patients and the physicians.

Stanley Feld M.D.,FACP,MACE

Stanley Feld M.D. FACP, MACE

Canada has been very proud of its government directed single party payer Healthcare System. Everyone in Canada automatically has health care coverage. The system in Canada has been compared to the American Healthcare System. The impression through the media has been that Canada’s System is what an effective healthcare system should be However, last year, the Canadian Supreme Court ruled that people of Canada should be entitled to buy private health insurance. Prior to the Supreme Court decision, a choice of private insurance was forbidden.

The headline in The National Post of Canada on Saturday June 3, 2006 read,

“51% say private care OK”.

The Supreme Court decision has brought the argument about the purchase of private healthcare insurance into public debate. A percentage of the population has been dissatisfied with the Medicare system for a long time. However, no one talked about it. In theChaoulli decision, the Supreme Court declared Quebec’s ban on private health insurance is unconstitutional.

A survey of 3,000 Canadians brought out some incredible opposing opinions. Fifty-one per cent of respondents identify with the statement “If we are unhappy with the service we receive from Medicare, we should have the right to spend our
own money to buy health care outside the public Medicare system.”

49% believe that “when it comes to health care, everyone should be equal and no one should be allowed to spend their own money to get better services.”

An overwhelming majority of respondents believe the government should focus on making the public system better so no
one feels any need to pay for private health care. This is a clear indication that there are endogenous defects in the single party payer government directed healthcare system in Canada.

The identical sentiments are prevalent in England. The Hillary Clinton “Healthcare Reform initiative”
advocated a single party payer system similar to the Canadian system. The advantages of both the Canadian system and British system were widely quoted at that time.

Why is our system and their system creating such discomfort among patients and physicians? One is supposedly a private system (United States Healthcare System) and one is a government run system (Canada). The answer is obvious to me. Each of them limits access to care.

A system that is truly market driven, and lets the patients exercise control over their choice of care would be a system that would work. If the patients were responsible for their care and had control of their own healthcare dollars the defects in the system would be their responsibility.

The answer is found in examples in the retail arena. Wal-Mart and Target have done so well because they sell quality products at a transparently affordable price. If the quality decreases or the price is too high, people will switch to a different vendor. Why has Target done better in the clothing area than Wal-Mart? Target has better quality and style at about the same price! Target figured out how to get a competitive advantage. Wal-Mart is presently redoing the clothing section of its business to compete.

People are not stupid. They know when their freedom of choice and access is restricted. When freedom is restricted the people react; hopefully our politicians respond. If things get bad enough, people will elect different representatives.

Stanley Feld MD,FACP,MACE
Part 3

In the late 1950’s and early 1960 pace of medical bench research and clinical research accelerated. The government invested heavily in an effort to increase medical knowledge. Medical schools expanded. The medical schools increase medical student and Phd. enrollment. Medical schools became medical research factories. The era has been referred to by some as the Golden Era in Medical Research

The medical knowledge base was growing at the rate of 10% per year. The growth of medical knowledge resulted in a growth of subspecialties in medicine and surgery. There simply was too new much medical information growing at a very rapid rate. The rate of growth of medical information and procedures were too much for a generalist to master.

These advances improved the quality of medical care for acute illness. It expanded our ability to “fix things that were broken.” We were able to save patients from death in a very skilled way. The survival rate for cancer improved markedly. Specialties such as Oncology, Pulmonology, Endocrinology, Cardiology, Gastroenterology to name a few grew rapidly. In turn, the cost of this specialized care produced accelerating cost of medical care. Patients stayed alive longer. Diseases were cured or stabilized. Our ability to help people medically was much more effective than after WWII.

By early 1980, Medicare’s burdens for medical costs were out of control as the population aged and treatment were improved. The government said: “ Stop! We can not pay the fees we have been paying. We have to have cost reductions and controls“

This generated to the next problem for the health care system.