Stanley Feld M.D.,FACP,MACE

The Canadian Healthcare system does not offer us a better option. We are told Canadians are happy with their system. However, only 20% of the potential patients use the system at one time. When Canadians need Immediate care they often come to the U.S. and pay cash for their treatment rather than face the lines resulting from rationed care.

“*Canada has one-third fewer doctors per capita than the OECD average. "The doctor shortage is a direct result of government rationing, since provinces intervened to restrict class sizes in major Canadian medical schools in the 1990s," Dr. David Gratzer, a Canadian physician and Manhattan Institute scholar, told the U.S. House Ways & Means Committee on June 24.”

Many Canadian physicians have come to the United States to practice medicine in the last 20 years.

“ Some towns address the doctor dearth with lotteries in which citizens compete for rare medical appointments”.

Massachusetts’ universal healthcare system has failed. In Massachusetts there is an overwhelming shortage of Primary Care Physicians. Patients are trading or selling physician appointments in many small towns.

Canada has the same horror stories. Eighty percent of Canadians are not sick. They feel their healthcare system is fine.

There are many deficiencies in Canada’s single party payer system that are not advertised by politicians in the U.S. that want a single party payer.

"In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment," Pacific Research Institute president Sally Pipes, a Canadian native, wrote in the July 2 Investor’s Business Daily. "That’s 86 percent longer than the wait in 1993, when the [Fraser] Institute first started quantifying the problem."

* This includes a median 9.7-week wait for an MRI exam, 31.7 weeks to see a neurosurgeon, and 36.7 weeks – nearly nine months – to visit an orthopedic surgeon.”

These waiting times are rationing of care. Patients have sued the government and the Supreme Court ruled in favor of patients.

“ The Canadian supreme court justice Marie Deschamps wrote in her 2005 majority opinion in Chaoulli v. Quebec, "This case shows that delays in the public health care system are widespread, and that, in some cases, patients die as a result of waiting lists for public health care.”

The healthcare debate in the U.S. is not about improving the health of Americans. It is about shifting the control over the healthcare system to the government from the private sector.

If healthcare reform was about improving the health of Americans, our politicians would be focusing on how to decrease our mortality and morbidity rate due to the major chronic illnesses, how to decrease the abuse of the healthcare insurance industry, how to decrease the waste of defensive medicine, how to get people insured that are refused insurance with pre existing illness and how to give people incentives to keep themselves healthy.

These are the major issues. There is no need to have to take over the healthcare system. The government should make the rules, level the playing field in favor o the consumer, let the consumer drive healthcare and then get out of the way.

“The public option – for which Democrats lust – would fuel an elephantine $1.5 trillion overhaul of this life-and-death industry. Guess who goes home with the goodies?”

It is not the consumer. It will be the government bureaucracy, the healthcare insurance industry, and the pharmaceutical companies.

It will be the government having control over the public and its ability to choose its healthcare. It will increase government’s dominance over our lives and our freedoms.

Is this what Americans’ want?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Stanley Feld M.D.,FACP,MACE

The single party payer system in Great Britain and Canada is not as good as Democrats and the mass media have led us to believe. The United States pays more of our gross national product for its healthcare than Great Britain and Canada do but they do not get the same or better outcomes than we do.

The healthcare system in the U.S. could be repaired. The cost can be reduced significantly if the U.S adopted the changes I and others have advocated

The changes are significant malpractice reform, reduction in waste and abuse by the healthcare insurance industry, consumer driven healthcare through a medical savings account and the institution of a universal electronic medical record funded by the government and paid for by physicians and hospital systems by.usage

The sound bite of effective care given in Great Britain and Canada for less money is false. Here are just a few outcome comparisons between our healthcare system and theirs. You be the judge;.

• “Breast cancer kills 25 percent of its American victims; in Great Britain, the Vatican of single-payer medicine, breast cancer extinguishes 46 percent of its targets.”

Why? Early diagnosis with timely mammography and immediate and intensive treatment at the time of diagnosis.

“ Prostate cancer is fatal to 19 percent of its American patients. The National Center for Policy Analysis reports that it kills 57 percent of Britons it strikes.”

It is fatal in 19 percent of American males because of delayed diagnosis and treatment in some males. Males are not good about routine checkups. They go to the physician when they hurt. Some without insurance cannot afford to get a routine PSA screening test..

“ Organization for Economic Cooperation and Development data show that the U.K.’s 2005 heart-attack fatality rate was 19.5 percent higher than America’s. This may correspond to angioplasties, which were only 21.3 percent as common there as here.”

Why? The difference is caused by a delay in access to care.

“The U.K.’s National Institute of Health and Clinical Excellence (NICE) just announced plans to cut its 60,000 annual steroid injections for severe back-pain sufferers to just 3,000. This should save the government 33 million pounds (about $55 million). "The consequences of the NICE decision will be devastating for thousands of patients," Dr. Jonathan Richardson of Bradford Hospitals Trust told London’s Daily Telegraph. "It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

It is not very smart or efficient to restrict access to care to end up with patients being addicted to narcotics and/or needing surgery that will be delayed because of restrictions on access to care.

"Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets," Daniel Martin wrote last year in London’s Daily Mail. "Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour [party] pledge. The hold-ups mean ambulances are not available to answer fresh 911 calls. Doctors warned last night that the practice of ‘patient-stacking’ was putting patients’ health at risk."

Unintended consequences are usually the result of bureaucratic mandates. It is similar to the airlines leaving the gate to leave on time and then keeping us waiting on the tarmac for takeoff so that it looks good for on time takeoff statistics. It is not about service. It becomes about statistical targets to cover defects.

There are many more examples of defects in the National Health Service of Great Britain that we never hear about. The average person is not sick and does not complain about the healthcare system. Many are passive about the abuse they experience in the healthcare system.

President Obama’s healthcare team is going to create a Federal Healthcare Board similar to the NICE and have a panel of experts decide on best practices for Americans in order to improve our healthcare system.

When has a consensus committee ever improved anything? A consensus panel will eliminate individual freedom to make healthcare choices.

Is this what Americans’ want?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Stanley Feld M.D.,FACP,MACE

Both noise and facts drive decision making in all areas of policy making. The trick is to separate noise from facts. The devil is usually in the details. Americans have been conditioned to sound bites. We do not have the patience to understand the details and their ramifications.

Sound bites can be misinterpreted as being valid. The healthcare debate has made the public more interested in the details and the potential unintended consequences.

A typical example is the cost of care for Type 2 Diabetes Mellitus in Dallas compared to five Texas cities. The claims data is probably noise disguised as valid facts.

The public has become very cynical about the traditional media. Reporters can easily be manipulated by government and special interest groups’ press releases. Policy should be made for the benefit of the people. It should not be made for the benefit of special interest groups or the government.

The public mistrusts the government because of its discoveries of frequent disinformation fed to the media. This disinformation extends to all areas of its daily life including the two wars, the economic meltdown, the bank bailout, and automotive bailouts. All seem to be done at the expense of taxpayers and not to taxpayers’ advantage.

What doesn’t the public know about the healthcare debate? The public does not believe President Obama’s generalities. His plans contain too much bureaucracy, inefficiency, waste, taxes, and too much tax payer dollars. Special interests groups such as the healthcare insurance industry and hospital system will gain at the expense of the taxpayers and their freedoms.

The public is very hesitant to let the government take over the management of its healthcare. It mistrusts the government and its inefficiency. It knows something must be done to repair the healthcare system. However, it does not know what. President Obama’s plan sounds too convoluted, tricky and bureaucratic. His healthcare reform plan has little chance to be efficient and fair to the public.

Americans trusted President Obama during the election campaign. They are having their doubts now especially with the implications of his healthcare reform program.

The public trusts the healthcare insurance industry less than it trusts the government. .

The easiest way to accomplish healthcare reform is to allow consumers to control their healthcare dollar and teach them how to spend it wisely.

Both the public and the physician community are unhappy that 45 million people are uninsured and many more are under insured.

Qualifications for Medicaid depend on the definition of poverty. Most states and the federal government utilize the outdated 1995 definition of poverty. The definition disqualifies people who make more than $12,000 and less than $60,000 a year. If this group is self employed they cannot afford $14,000 a year for a private insurance plan with after tax dollars.

Some states have tried to increase the poverty level to permit more patients to qualify for Medicaid. The federal government has refused to supplement these states with increase Medicaid funding.

Physicians are under reimbursed by Medicaid. Therefore most physicians do not participate in the program. Physicians cannot make a living seeing Medicaid patients unless they create Medicaid mills and see 200 patients a day per physician using lots of patient extenders.

Newt Gingrich calls this Medicaid fraud. He has proposed fining these physicians or putting them in jail. This will only intensify the primary care physician shortage for Medicaid.

Another proposal hidden in the Baucus bill is to require all physicians to participate in all government programs.

Both of these Medicaid problems are easily fixed with correct regulation by the government without a costly bureaucracy resulting in unintended consequences..

Consumers who lose their jobs cannot afford Cobra insurance with after tax dollars. Consumers over 55 years old with a pre-existing illness, even if they wanted to pay with after tax dollars, would not qualify for private insurance.

Simple federal regulations can require insurability without a massive and wasteful bureaucracy.

The enemy is the healthcare insurance industry not patients or physicians. Patients and physicians are partly to blame. However, it is a response to the unlevel playing field created by the government.

The public is convinced that a government directed healthcare system will not protect or adequately insure them. Government healthcare reform will be inefficient. It will shift medical decisions away from patients and physicians.

President Obama does not seem to care about the opinions of the people who elected him. He is convinced that government control with a single party payer is the only system that will repair the healthcare system. He is doing everything he can to evolve the healthcare system into a single party payer system.

“The fact that America is even considering government medicine is equally wacky. The state guides health care for our two closest allies: Great Britain and Canada. Like us, these are prosperous, industrial, Anglophone democracies. Nevertheless, compared to America, they suffer higher death rates for diseases, their patients experience severe pain, and they ration medical services.”

The government and the pundits are telling us that we spend one third more for healthcare than other industrialized countries and do not have better medical outcomes.

I will discuss the myths about healthcare in the near future. President Obama and the Democrats are making healthcare reform decisions on the basis of the validity of these myths. They are convinced the only way to fix the healthcare system is to have the government control the healthcare system.

It makes no sense based on the experiences of others. We need only to review the disaster in Massachusetts as a result of unintended consequences.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Stanley Feld M.D.,FACP,MACE

I am a retired Dallas Clinical Endocrinologist who has no financial vested interest in this new report. I also was the chairman of the American Association Clinical Guidelines on the Treatment of Type 2 Diabetes Mellitus: A System of Care Of Intensive Self-Management of Diabetes Mellitus.

I am disheartened the lack of science that is presented as scientific information in this new study of claims data for Type 2 Diabetes Mellitus.

An article about the report was published in the Dallas Morning News on Thursday September 12, 2009. The article demonstrates how well intended people can be mislead by data that has little scientific or social scientific validity.

Misleading data can lead to inaccurate conclusions. Inaccurate conclusions lead to incorrect healthcare policies.

The federal and state governments as well as private industry rely heavily on medical claims data to make healthcare policy decisions. Medical claims data are derived from healthcare insurance industry’s computer systems. Claims data relate variables to each other and produce data.

The study reported in the Dallas Morning News relates the diagnosis of Type 2 Diabetes Mellitus to the average cost per Type2 Diabetic patient per year in five cities in Texas. There are many defect in the claims data because they do not consider the many confounding variables that might affect the conclusions (variables that can influence the data in one direction or another). Accurate conclusions cannot be derived from the data.

Healthcare policy makers have used similar inaccurate claims data to formulate healthcare policy for years. Inaccurate conclusions lead to incorrect healthcare policy. The new healthcare policy in turn distorts the dysfunctional healthcare system even further.

Well intended corporations want to help employees improve their health and healthcare coverage. However, they adopt incorrect policies that fail to achieve their goals and increases their healthcare costs.

“Dallas-area doctors charge more to treat patients with the most common form of diabetes than doctors in any other Texas city, according to a report set for release Thursday.”

“Doctors here charge an average of $6,992 annually per patient with Type 2 diabetes, compared with $2,079 in Austin, $3,067 in El Paso, $1,578 in Fort Worth and $2,226 in Houston. “

Let us assume these claims data are correct. The implication is in Dallas physicians charge more for the treatment of Type 2 Diabetes Mellitus than in the other major cities in Texas and do not do a better job of caring for Type 2 Diabetic patients. If you are going to get Type 2 Diabetes Mellitus don’t get it in Dallas, get it in El Paso. 

What is wrong with these claims data? What are the confounding variables and their effect on the conclusion?

1. Physicians in Dallas see Type 2 Diabetics more frequently and do more tests than physicians in other cities.

What is wrong with these claims data and what are the confounding variables.

One confounding variable could be that Clinical Endocrinologists in Dallas have been teaching Primary Care Physicians how to practice evidence based medicine for Diabetes Mellitus for years

Best practices for Type 2 Diabetes Mellitus dictates that patients are followed up 4 times a year.

HbA1c levels which measure the blood sugar control over 3 months should be done four times a year. A minimum of twice a year is acceptable in some guidelines. These criteria are adopted by the NCQA. NCQA will be President Obama “expert guideline panel.

Patients with Type 2 Diabetes Mellitus in the other cities might not see physicians as frequently. Some physicians see Diabetics once a year because the Diabetic is told they have a touch of Diabetes and follow up is not that important. Type 2 Diabetics are usually not symptomatic even if they are walking around with a high blood sugar.

However, high blood sugar levels cause micro and macro vascular disease leading to the complications of diabetes such as eye disease and blindness, kidney disease and renal dialysis, neuropathy or nerve disease, leg amputations and heart disease. High blood sugars increase cholesterol and LDL (bad cholesterol), low HDL (good cholesterol) and subsequent heart attacks.

All of these complications need to be monitored according to guidelines. Effective treatment intervention can stop the progression and even reverse the onset of complications.

1. The claims data might indicate that the physicians in other cities do not take care of patients with Type 2 Diabetes Mellitus as well as physicians in Dallas.
2.   It might also mean that despite physicians in Dallas following up patients and  practicing evidence based medicine patients do not comply with treatment recommendations resulting in expensive complication.

Physicians can do tests, see patients often, prescribe the correct medication and diet and patients still gain weight and have very high blood sugars and cholesterol levels. Patients must be responsible for their care between doctor visits.

3. In Dallas there might be more Obesity, Type 2 Diabetes, heart attacks and renal dialysis leading to a higher cost per patient per year than other cities despite physician effort.

None of this data is reflected in the claims data collected and compared. This is great deficiency of claims data.

We have claims data about physicians in Dallas. They do a higher percentage of HbA1c’s than physicians in other cities. They probably do a greater number also.

The implication is Dallas physicians should have a lower cost than other cities because a higher percentage of HbA1c’s. Patients should be better controlled and have less complications.

The HbA1c is simply a marker of blood sugar control. It does not decrease the complication rate. It should not be a measure of quality of care. If done once a year rather than four times a year it will decrease the cost of care. Lowering the HbAic should be the measurement of the quality of care. It will reduce the complication rate of Type 2 Diabetes. Claims data does not measure the improvement in HbA1c levels.

The complications of Type 2 Diabetes Mellitus consumes 80% of the healthcare dollars spent on Type 2 diabetes.

4. The majority of Type 2 Diabetes Mellitus is discovered in the CCU after a male has a myocardial infarction. These patients are expensive patients. They are included in the diabetes claims data.

5. Physicians in El Paso might not code for Type 2 Diabetes Mellitus in a patient with a myocardial infarction. We do not know this from claims data.

Claims data tell us nothing about the care of the patients. Yet health policy makers assume studies are valid. The only thing valid about this new report is that it was done. Claims data confuses health care policy makers and leads to wrong conclusions about the quality of care. .

"This confirms what we already know from other recent studies that medical charges in Dallas are among the highest in the country," said Marianne Fazen, executive director of the Dallas Fort Worth Business Group on Health.”

“The state average is $3,399 per patient with
Type 2 diabetes, the form of diabetes that occurs when insulin the body produces doesn’t work well enough to process sugar into energy. “

The treatment of Type 2 Diabetes Mellitus is a team sport. The physician should be the coach and the patient is the player. The patient has to be taught to be a professor of diabetes care. Physicians have to measure patients’ progress and help patients make adjustments to their care.

This new report is worthless. It does not shed any light on what needs to be done to prevent the complications of Type 2 Diabetes Mellitus nor improve the quality of diabetes care in Texas.

Once we abandon the notion that claims data can tell us something about quality of care we will start making progress to improve quality of care.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Stanley Feld M.D.,FACP,MACE

President Obama’s speech on healthcare reform to a joint session of congress added nothing new to the healthcare reform debate.. It was just spun differently.

He did give a tepid nod to tort reform. Defensive medicine results from a defective tort system. The defective tort system generates between $300 and $700 billion dollars a year in excessive diagnostic testing. Lawyers and insurance companies make large sums of money from the malpractice system. The tort system adds little value to the health of citizens.

President Obama said he will set up a few demonstration projects. Government demonstration projects have not worked in the past. His tort reform projects are too few and will have little effect. Everyone knows the problem as well as the solution. Our healthcare system needs significant tort reform immediately. The President is protecting the plaintiff attorneys because he doesn’t want to take them on. They have been large contributors to Democratic Party member election campaigns.

President Obama said the “Public Option” is the best way to control costs. However, he will not have a Public Option if he gets a bill passed. He is going to try to sneak a single party payer system through the back door as Barney Frank has stated.

The President said no one will have to spend more than $5,000.00 a year in out of pocket expenses.

Who is going to pick up the costs after consumers spend $5,000.00? I assume the government will. Consumers have to buy government mandated and approved healthcare plans.

Consumers will have to pay for policies that have a 40% deductible with after tax dollars as opposed to the 20% deductible with pre-tax dollars. The Obama administration has been convinced by the healthcare insurance industry that it needs the increase in deductible percentage in order to produce a lower “affordable” premium.

Consumers, by paying with after tax dollars, will be paying 35% more for their healthcare policies and 20% more in deductibles expenses. If the tax rate goes up to 40% they will pay 40% more for both. This is a hidden increase in consumers’ taxes and a government increase in revenue.

The big winner is the healthcare insurance industry, not consumers. The healthcare insurance industry will have a greater number of people insured on its roles because of a presidential mandate that he had promised to avoid.

President Obama said he will subsidize businesses and individuals who cannot afford healthcare insurance.

Who is going to make that judgment? The government will make that judgment. He asks us to stop being skeptical and trust his administration. He will take care of consumers in the spirit that made our country great.

President Obama, how can we trust your administration with our healthcare needs when we have had experience with so much false hope from your administration in the last 8 months?

He is leaving the control of the healthcare dollars in the healthcare insurance industry’s hands. The healthcare insurance industry provides administrative services. Can we trust the healthcare insurance industry to be fair and look out for the well being of consumers? No!!

President Obama said there are almost 400 insurance companies in the nation. He claims his plan will force them to be competitive. There are only five major healthcare insurance companies (Unitedhealthcare, Aetna Blue Cross/Blue Shield, Cigna, and Humana). Most of the other healthcare insurance companies are subsidiaries of those five major companies.

There will be no competition. The administration says a “Public Option” is the only effective way to lower the costs of healthcare. It will make healthcare insurance companies compete. However the insurance industry will define the costs and the price of the government’s public option. It has done so for Medicare Part D at the expense of taxpayers and it will do it again.

Medicare Part D is another failed government entitlement whose monthly premium has gone from $14 to $37 in three years. The patient deductibles have increase and the onerous donut still exists.

In addition to increasing the premium price the government subsidizes Medicare Part D with of billions of dollars a year. I predict the premiums for the “Public Option” will slowly escalate at tax payers’ expense.

The only creative way to break this healthcare insurance industry stranglehold is to institute a system with Medical Savings Accounts. The government or employers, as providers, should give consumers first $6,000 for their healthcare needs and teach them how to spend it wisely. What consumers do not spend they keep. The second $6,000 would be used to buy high deductible first dollar healthcare coverage.

This is the only way to reduce the healthcare insurance industry’s influence and grasp on healthcare spending. Medical Savings Accounts will provide consumers with incentives to use their healthcare dollar wisely. It will also provide incentives for patients to comply with medication and treatment prescribed. America might even make serious progress combating our obesity epidemic.

Stanley Feld M.D.,FACP,MACE

Politicians and healthcare policy makers have not included consumer driven healthcare in the healthcare reform debate. They have not included tort reform in the debate either.

The debate is about a public option. President Obama is going to redefine his meaning of the public option in his message to congress. He will make it sound benign. It will not sound like a government takeover of healthcare. He will omit the details and consequences of the bill.

President Obama must know the government cannot afford a public option. He knows he must control costs somehow. His policy makers believe the only way to control cost is by total government control over the healthcare system. Ultimately the goal is a single party payer system.

This way of thinking about the problem is wrong. Government control does not reduce costs in most projects. It usually increases costs. The President is focused on reducing physicians’ and hospitals’ reimbursement. He believes they are the reason for increasing costs. Medicare has continually decreased reimbursement to physicians and hospitals. Yet costs have increased.

To some extent decreased reimbursement leads to increased utilization but it is not the principle reason for the increase in utilization. A principle reason is an increase in the need to practice defensive medicine. Plaintiff attorneys deny it. The Massachusetts study confirms that defensive medicine leads to a large increase in utilization and costs.

Physicians are an easy target because they are not well organized. The Democrat controlled government is timid about attacking the plaintiff attorneys and tackling tort reform. Defensive medicine results in about a $700 billion dollar a year cost to the healthcare system. 

Howard Dean said it a few weeks ago. “Congress will not face the issue of tort reform because it does not want to take on plaintiff attorneys.” Consumers can solve this for congress by signing a valid limited liability waiver. Patients can put their own cap on damages. It would not require any courage on the part of congress or the President to face this difficult political issue. All congress and the President have to do is declare the waiver valid.

Texas and California have had the courage to place caps on damages. It has been very successful. If there were caps on damages and they were effective the need for defensive medicine practices would decrease.

The public does not trust congress or the President with control over its healthcare coverage. The public experience with unintended consequences of government control is obvious to all.

Recent examples are the unintended consequences of the bank bailouts, Goldman Sachs bailout, the economic stimulus package promise, the auto bailout, and the war in Afghanistan. All these bailouts are increasing the deficit at the expense of the taxpayers and future generations.

The public mistrusts the healthcare insurance industry as much as it mistrusts the government to control healthcare. The healthcare insurance industry has restricted access to care and rationed care. It has not reimbursed physicians and hospitals in a timely fashion. It has found it is cheaper to pay the negotiated settlement rather the medical bills for its insured.

Nancy Pelosi is right about one thing and only one thing. The real villain is the healthcare insurance industry. However, she does not understand with a public option she is not controlling the healthcare insurance industry fees for administrative services. The government outsources administrative services to the healthcare industry and will still be subject to grotesque administrative services fees.

The healthcare insurance industry has lobbied to change the law to increase co pays to 35-40% of bills so it can lower premiums to affordable levels. Increasing deductibles and lowering premiums would satisfy President Obama’s goal of affordable premiums. At the same time, it will increase the out of pocket cost of medical care for consumers who might need to use their “affordable healthcare insurance.”

The healthcare insurance industry will be forced to offer insurance to consumers with preexisting illness at an affordable cost. Some states have a high risk pool. The premiums in the high risk pools are at least 11/2 times higher than normal premiums and have higher deductibles. High risk patients must be put into the general insurance pool.

There has not been a word in the healthcare reform discussion about patient responsibility for their health. We are in the middle of the worst Obesity epidemic in American history. President Obama should declare a War on Obesity. He should promote legislation that could help eradicate obesity. He should provide patients with financial incentives to eliminate obesity and adhere to prescribed therapy. Obesity is a leading driver of increasing healthcare costs. The costs will only become grater as the obesity epidemic continues.

It is time consumers took control of their own health care dollars and their own health and well being. The defensive medicine/tort reform issue can be solved by consumers. Obesity can be solved with the government rewriting farm subsidies and a substantial public service health campaign to change our eating habits.

A consumer driven healthcare system along with the ideal medical savings accounts could solve many of the healthcare system’s problems without total government control. The government’s job should be to help with educating the public, negotiating prices that are transparent and fair and enforcing regulations to create a level playing field for consumers among the other stakeholders.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Stanley Feld M.D.,FACP,MACE

Dear President Obama;

Please listen. The American public doesn’t want the public option. They know America cannot afford another entitlement program. Americans do not want increased taxes. They are afraid China is lending us too much money. If and when they pull out it will be doomsday.

The healthcare insurance industry would love you to get your healthcare reform bill passed. It would increase their profits at taxpayers’ expense. The healthcare insurance industry did it to Massachusetts. The federal government had to bail out Massachusetts. Why not the entire country?

Americans want healthcare reform. They would love to provide universal care, have affordable insurance coverage, and increased quality of care. Your strategy is wrong.

There is another way to accomplish these things. It requires you to have faith in the intelligence of the American public. The strategy would decrease the cost to the healthcare system instantly. It would decrease the obscene costs for administrative services to the healthcare insurance industry. It would diminish the need to develop a massive government bureaucracy.

It eliminates the influence of lobbyists for vested interests. It would create competition among physicians, hospital systems and healthcare insurance companies. The healthcare insurance industry is drooling over your healthcare reform plan.

Americans know government bureaucracy can be cruel and inefficient. There are too many generalities that are wide open to abuse.

I received this note from a reader summing up America’s mistrust of government control. This person is neither a Republican nor Democrat. He is an American.

Stanley,

To sum up the recent post you can simply remind readers of the laughable old line, "I am from the government and I am here to help".

It was gaggy enough to see all the pigs at the trough getting 100’s of billions.  It will make everyone wretch just watching the same participants helping themselves to trillions of dollars worth of slop.

Heaven help us.  Neither the press nor the Obama fans can see through this smokescreen.  God, haven’t people figured out that when the government doles out money poor people don’t get helped, rich people do.  Does foreign aid help poor people in other countries.  If it did poverty in Africa would have ended decades ago.

Go back to the days of Lyndon Johnson.  We fought the war on poverty and lost that.  We lost the Drug War.  We lost the Vietnam War, we are losing the Afghan and Iraq Wars and we are well on our way to losing the war on the high cost of healthcare.  All of these efforts were lost not because they weren’t laudable goals, but because they were not properly considered.  As you know, some we should not have fought, others we should have fought differently.

Interestingly, the only real win we have had in the last forty years was the war on welfare and it came about because something was taken away, not added. 

Is there a lesson here?

L

How do you accomplish your goals and have the American public trust you once more? You can accomplish your goals of universal care, affordable insurance and increase in quality of care by putting individuals in control of their health and healthcare dollars.

This must sound radical to a liberal. If you permit consumers to drive the healthcare system they will drive the prices down.

How would a consumer driven healthcare system work using an ideal medical savings account?

Employers, states, and the federal government are currently paying healthcare premiums at very high administrative service fees to the healthcare insurance industry. Many self employed are paying the entire healthcare insurance premium with after tax dollars making their cost at least 35% higher than employer based coverage. Most cannot qualify for insurance because of preexisting illness.

The healthcare insurance industry controls the premium dollars. Patients have no financial incentive to be responsible for their health or healthcare dollars. The goal of a consumer driven healthcare system is to create a system that would provide incentives for consumers to be a watchdog for their healthcare dollars.

If these payers gave half of the $12,000 per family per year to consumers and permitted them to keep monies unspent in a retirement account, then patients would be motivated to use their healthcare dollar wisely

If consumers with chronic diseases perform well (weight loss, diabetes control, asthma prevention, COPD and heart disease prevention) and stay out of the ER or hospital because of proper maintenance they should receive a bonus for their retirement fund.

The fees for services would have to be negotiated beforehand as we presently do. All fees should be totally transparent. You would have 300 million people watching and reporting their costs or care.

The remaining $6,000 would buy high deductible coverage that would provide first dollar coverage. The healthcare insurance industry would do very well. If they quit Fidelity or Vanguard could do the bookkeeping.

Think of all the administrative costs saved on the first $6,000. Think of all the middlemen expenses avoided.

Medicare cost per patient in only $6600 per year including the last 30 days of life. The average cost of younger persons is much lower. Cost of care would be decreased because physicians would be paid at point of service. If the cost for medical care was over $6000 for a patient’s care first dollar high deductible insurance would take over.

Medical care is the relationship between the patient and the physician. If you provide the tools and money to create a transparent relationship without middlemen the patients would make the cost decrease as we have seen in other industries. America would have an affordable system.

If the employer became an extender of the physicians care and a patient advocate the costs would drop.

Employers, patients and physicians have the same goals. All are at the mercy of the middlemen (healthcare insurance industry).

This is the American way. It can be done.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.