Stanley Feld M.D., FACP, MACE

During the debate on October 7 the presidential candidates were asked if healthcare was a right or a responsibility. In my view neither candidate answered correctly. It demonstrated each candidate’s lack of understanding of the issue.

McCain said:

“I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. … But government mandates I — I’m always a little nervous about. But it is certainly my responsibility.”

John McCain’s answer is  incomprehensible. He is desperately trying to stay on message. He wants to transfer all entitlements including Medicare, and Social Security to the private sector. One has the think of the disaster the privatization of Social Society would have been during this economic meltdown. I think John McCain understands the weakness of his position on entitlements. He weakened himself even further with unconnected gibberish.

Obama said:

“I think it should be a right for every American. … for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that”

Barack Obama’s answer does not prove it should be a right. It shows the power and callousness of the healthcare insurance industry. I have said over and over again that the healthcare insurance industry is not the solution, it is the problem

Both candidates’ get a poor grade for their answer. Their answers indicate neither one has an understanding of the healthcare problem. If you do not understand a problem you can not develop a viable solution to fix the problem. The solution has to be fair to all stakeholders.

The correct answer is the individual’s healthcare should be both a right and a responsibility. Healthcare coverage should be the right of every citizen regardless of age, preexisting illness or income. If citizens choose not to be responsible for their health they should suffer a penalty. If a person is ill he should be responsible for adhering to the medical treatment and follow up or suffer a penalty.

If a citizen suffers a random non-curable illness it is an actuarial hazard that insurance should protect against. If a citizen takes care of his chronic disease to avoid complications he should receive a reward. The process will stimulate responsible behavior for the person’s well being.

Obesity should be discouraged. It is a self inflicted major risk for chronic disease. Nothing is being done to reduce its’ incidence.

Affordable availability of healthcare should be a right of every citizen. At the far end we have  viable safety net hospitals. It seem the present administration is doing everything in it power to eliminate these facilities. John McCain’s thinking implies he will do the same.

Citizens should own their healthcare dollar as outlined in my ideal medical savings account. Employer based healthcare insurance has been the foundation of our healthcare system. In recent years employers have been ripped off by the healthcare industry. If the first $6000 of healthcare coverage was the responsibility of the employee and the employee could keep any money not spent for retirement, the employee would have the incentive to shop for the best medical care at the best price. A communications system could be set up to direct patients to this best care model. This system would provide incentives for caregivers to provide better care.

If a person was self employed or unemployed, means testing would determine the subsidy or payment on a fair basis.

Educational programs for avoiding chronic diseases must be set up or supported through grants by the government to encourage citizens to be responsible for their right.

The government must be responsible for passing legislation to promote environment reforms. Dirty coal plans should be banned. We could prevent at least 21,850 hospital admissions per year nationally. There were 26,000 Emergency room visits for asthma alone last year. Asthma is the No. 1 cause of kids ending up in the Emergency Room. Dirty coal burning power plants cause 554,000 asthmatic attacks, 16,200 attacks of chronic bronchitis, 38,200 heart attacks and 23,600 deaths per year.

I have emphasized that preventing chronic disease and its complications is the key to reducing our healthcare costs. Eighty percent of our healthcare dollar is spent on the complications of chronic disease. Ninety percent of the Medicare dollars are spent on the complication of chronic disease.

The narcotics industry is another big problem ”The cost to society of illicit drug abuse alone is $181 billion annually.”

Societal costs combined with alcohol and tobacco costs, exceed $500 billion including healthcare, criminal justice, and lost productivity.

The cost of drug addiction is a tremendous burden to the healthcare system. Yet we are supporting a government in Afghanistan where both the enemy and the government profit from narcotics without the United States doing anything about it. There is no sign that the next administration will do differently.

Americans must wake up. The Presidential candidates must wake up. We need universal healthcare. It is a right and responsibility of every citizen. It is the responsibility of the government to promote a healthy environment so we can exercise our responsibility to remain healthy.

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