Stanley Feld M.D.,FACP,MACE

Barack Obama’s goal is to institute a universal healthcare system. I have pointed out that America has a demoralized primary care physician work force. It also has a shortage of primary care physicians. The physician workforce will not be able to care for the influx of patients that will occur in a universal healthcare system. This is especially true as the charity hospitals are on the verge of bankruptcy because of the Medicaid payment system and restrictions on Medicaid eligibility for indigent patients.

The Physicians Foundations completed a survey that asked physicians across the country how they see the medical practice environment? How do they feel about the state of their profession, and that of the industry at large? What plans do they have for the future of their individual practices? Do they believe there are enough of them to handle an influx of more patients?

The Physicians Foundation is an organization with $98 million dollars in available grant money that seeks to advance the work of practicing physicians and to improve the quality of healthcare for all Americans.

“The Physicians Foundation is unique is in its commitment to patient safety, physician education, and quality improvement in physician practice.”

Interestingly the foundation was founded in 2003 as part of a settlement in an anti-racketeering lawsuit among physicians, medical societies, and insurer Aetna, Inc.

The survey was mailed to 270,000 primary care doctors and 50,000 practicing specialists. The survey managers received 11,950 responses. Chad Autry PhD, Professor of Statistics at Texas Christian University said the margin of error for this survey is less than one percent.

The responses to the survey are vital to the future of medical care in America in a universal care setting and the present primary care practice environment.

· An overwhelming majority of physicians – 78% – believe there is a shortage of primary care doctors in the United States today

· 49% of physicians – more than 150,000 doctors nationwide (extrapolation) – said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely. In that same time frame:

· 11%, or more than 35,000 doctors nationwide(extrapolation), said they plan to retire

· 13% said they plan to seek a job in a non-clinical healthcare setting, which would remove them from active patient care

· 20% said they will cut back on patients seen

· 10% said they will work part-time

· 60% of doctors would not recommend medicine as a career to young people

Paperwork

· 63% of doctors said non-clinical paperwork has caused them to spend less time with their patients

· 94% said time they devote to non-clinical paperwork in the last three years has increased

Government

“Declining reimbursement” rated highest on list of issues physicians identify as impediments to the delivery of patient care in their practices, followed by “demands on physician time”

82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursement were made

65% said Medicaid reimbursement is less than their cost of providing care and 36% said Medicare provides reimbursement that is less than their cost of providing care

Over 33% of physicians have closed their practices to Medicaid patients and 12% have closed their practices to Medicare patients

Finances

· Only 17% of physicians rated the financial position of their practices as “healthy and profitable”

· If they had the financial means, 45% of doctors would retire today

Morale

· “Patient relationships” rated highest on the list of things physicians find satisfying about medicine, while “reimbursement issues” and “managed care issues” rated the highest on the list of issues physicians find unsatisfying about medicine

· Only 6% of physicians described the professional morale of their colleagues as “positive.” 42% of physicians said the professional morale of their colleagues is either “poor” or “very low”

· 78% of physicians said medicine is either “no longer rewarding” or “less rewarding”

· 76% of physicians said they are either at “full capacity” or “overextended and overworked”

The results are clear. America is destined to have a medical care system meltdown unless conditions are changed for primary care physicians. Most physicians trained in America are going into subspecialties. A good start for the Barack Obama’s administration would be to permit states and the federal government to redefine the antiquated definition of poverty, and recognize the value of cognitive services and increase reimbursement to attract more primary care physicians into this specialty.

Primary care physicians should be given incentives (educational support and reimbursement) to treat chronic diseases with systems of care that will prevent the complications of those diseases.

It would be a disaster to use physician substitutes for the treatment of chronic diseases. This approach would not only compromise the potential quality of medical care it would be wasting the valuable resource of physician education that both the physicians and society paid for dearly.

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

Stanley Feld M.D.,FACP,MACE

I believe President-elect Obama is a smart fellow and wants to do the right thing for all healthcare consumers regardless of class. His decisions will only be as good as the information he receives. Some of his published policies are correct and some are wrong.

His advisors are focused on manipulating the payment systems as they attempt to provide universal healthcare. They are not focused on the abuse by all the stakeholders in the system including patients. Their focus has to be redirected to the abuses in the healthcare system and the repair of those abuses.

I believe in a free enterprise system with appropriate rules and regulations and not in socialized medicine. The rules and regulations have to be in favor of the consumer and not the healthcare insurance industry, the drug companies, the hospital systems or the government. Consumer’s in a price transparent environment with appropriate incentives will make sure they are treated fairly by their physicians.

Patients should control their healthcare dollar and be responsible for their health and healthcare needs in a totally transparent environment. Price transparency and not price controls must be negotiated for the consumer by the government and the healthcare insurance industry.

If patients were motivated by incentives such as retaining healthcare dollars not spent we could eliminate the complications of chronic diseases as well as the obscene administrative costs and excess profits of the healthcare insurance industry.

As readers of my blog you are well aware of my positions as well as the logic of these positions.

President-elect Obama has asked us, ordinary citizens, for input. I am asking for your help in getting these positions before President-elect Obama, his healthcare advisors and your congresspersons before they make a mistake. Below are links to President-elect Obama and your congresspersons.

Thank you,

Stanley Feld M.D.,FACP,MACE

Stanley Feld M.D.,FACP,MACE

Governor Bobby Jindal of Louisiana is about to unveil an overhauled Medicaid program for his state. It remains to be seen whether he is going to do it correctly and whether the federal government will support him.

He has hinted that he understands the healthcare system’s problems. Governor Jindal is a Republican governor. The Republican Party’s mandate is to transfer all entitlement programs to the private sector. The result will not be favorable to patients or physicians. Total control of Medicaid by the healthcare insurance industry would mean less access to care and greater profits for the healthcare insurance industry.

“Louisiana’s efforts to improve health-care outcomes must put more power in the hands of doctors and patients and should also include broad public health measures, such as improving nutrition and boosting physical education requirements in schools, Gov. Bobby Jindal said Wednesday.”

The social contract of medical care should be between the doctor and the patient. It should not be between a third party such as the government or the healthcare insurance industry and the physicians or patients.

The government should be responsible for broad public health measures such developing a culture of good nutrition and physical activity in the schools and public service campaigns to combat obesity and promote healthy living.

“It really is looking at health, not just health care,” Jindal said, citing Louisiana’s higher rates of diabetes, obesity and asthma as chronic conditions that can be improved through a sharper focus on public health.”

“Without providing specifics, Jindal said he would favor legislation to encourage more physical education in schools and improve nutrition in school vending machines and lunches.”

Governor Jindal’s plan to revise Medicaid is called Louisiana Health First. Early indications are that it will be a sweeping overhaul of the ineffective Medicaid system. Early indications are that it will not support the concept of a social contract between patients and physicians.

“The plan, dubbed Louisiana Health First, would turn over large chunks of the program to privately run managed-care organizations, which would oversee the health care of as many as 380,000 residents, mainly children.”

We have seen that managed care does not work. It is really managed costs. Managed care usually restricts access to care in order to manage costs.

Governor Jindal is right in the public health area but dead wrong with his managed care organization proposal. He will just be providing a money making vehicle for managed care organizations (healthcare insurance industry) while not improving the health of the people of Louisiana.

“Jindal said he hopes to get the changes approved before the Bush administration leaves office Jan. 20, as the change to a new president could delay the state’s plans. “We simply don’t want to start over from scratch,” Jindal said”.

He wants the change before January 20^th 2008. He would love to sneak in a plan that would outsource state and federally subsidize Medicaid to managed care organizations. The Republican Party’s goal is to abandon entitlement programs and hand them over to the private sector (healthcare insurance industry).

President Bush tried to privatize social security. If he was successful it would have been a disaster given the present financial crisis. The President is in the process of privatizing Medicare with the Medicare Advantage program. The administration is paying a premium to the healthcare insurance industry to accomplish the transfer at the expense of taxpayers and seniors. Massachusetts is privatizing universal care and experiencing large cost overruns.They will all fail.

Who do you think will lose? Patients and physician will lose. The only reform program that will work will be to provide incentives for consumers to be in control of their healthcare dollar along with a reward system for consumers if they responsibly maintain their health.

Stanley Feld M.D., FACP,MACE

A reader asked why I am spending so much time on the Massachusetts universal healthcare plan?

It is because many states are trying to install a similar plan. There must be some deal where the government will support states that adopt such a plan. Massachusetts just collected 10.2 billion dollars extra from the Bush administration for the plans’ failure.

I believe it was a bipartisan bill because the Republicans thought they would get a political advantage over the Democrats from the bill, and the Democrats thought they would get a political advantage over the Republicans.

The Bush administration wants to shift the responsibility of universal coverage from the federal government to the states and avoid another entitlement program.

Romney was running for president at the time and wanted to do something big. The Massachusetts Democrats did not want to be against something that might make a big difference.

However, the Massachusetts healthcare plan was not thought out. Massachusetts did not control the premiums costs they promised to subsidize while putting a ceiling and floor on premiums to the consumers. They did not set appropriate incentives for employers to continue to provide healthcare to employees.

The number of enrollees was underestimated. The premiums the healthcare insurance industry was demanding increased and is inflated. Rather than the normal laws of insurance cost prevailing (the more lives insured the lower the premium cost) the opposite is happening. The cost of the healthcare system is rising in Massachusetts at a more rapid rate than in other parts of the country.

Emergency Room charges are higher than physician office visit charges for the same illness. However, in the new system family practitioners and internists are overbooked. The waiting list is at least three months.

Thousand of newly insured patients have figured out that the fastest way to see a physician is to go to the Emergency Room.

“Thousands of newly insured Massachusetts residents are relying on emergency rooms for routine medical care, an expensive habit that drives up healthcare costs and thwarts a major goal of the state’s first-in-the-nation health insurance law.”

Citizens in Massachusetts are going to the emergency room at a 40% higher rate than the national average and a 20% higher rate than before  the present universal healthcare system.

The 2006 law is a mandated universal healthcare law. It requires nearly everyone to have health insurance coverage. The policy wonks hoped would ease overuse of ERs as the newly insured went instead to primary care doctors for non-urgent health needs. They cannot see their primary care doctor for months because of overuse of the system.

“Routine care in ERs is considerably more expensive than at a doctor’s office or community health center. The average charge for treating a non-emergency illness in the ER is $976, according to a 2007 report by the state Division of Health Care Finance and Policy, which estimated that the total bill for non-urgent ER care in Massachusetts exceeded $1 billion in 2005. In comparison, it costs between $84 and $164 to treat a typical ailment such as strep throat in a primary care doctor’s office, according to Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer. “

What happened? No state official thought out the perverse outcomes. No one thought to  motivate patients to save money. No one thought of teaching physicians to change their practice patterns to make room for acute medical illness. No one thought of setting up a system of education to teach patients to take care of illnesses that do not need to be seen.

What is the reason no one thought of these things? It is because no one asked practicing physicians what they thought the problems were.

John McCain doesn’t address the issue. Barack Obama’s plan for universal coverage will follow the Romney plan except it will be a federal government entitlement program. Neither the Massachusetts plan nor the presidential candidates’ healthcare plans create incentives for patients to be responsible for how they spend their healthcare dollar.

Stanley Feld M.D.,FACP,MACE

In the waning hours of his administration President George W Bush is trying to sneak in legislation to weaken a woman’s right to choose. It took Hillary Clinton and Cecile Richards writing an op ed in the New York Times on September 19th to expose his scheme.

“ a proposed rule from the Department of Health and Human Services that would govern family planning. It would require that any health care entity that receives federal financing — whether it’s a physician in private practice, a hospital or a state government — certify in writing that none of its employees are required to assist in any way with medical services they find objectionable.”

President Bush’s proposed rule is another attempt to attack Roe v. Wade. The larger issue is an attack on our constitutional freedom as described in Roe v. Wade’s decision. His proposed rule is another way to undermine the Supreme Court decision.

“Laws that have been on the books for some 30 years already allow doctors to refuse to perform abortions. The new rule would go further, ensuring that all employees and volunteers for health care entities can refuse to aid in providing any treatment they object to, which could include not only abortion and sterilization but also contraception.”

The government is threatening to remove federal financing from any entity providing healthcare or medical care, if the federal government found that entity in noncompliance with the proposed rule.

“Health and Human Services estimates that the rule, which would affect nearly 600,000 hospitals, clinics and other health care providers, would cost $44.5 million a year to administer.”

I thought Republicans and the Republican administration opposed unnecessary spending. This proposal has not been highlighted until Hillary Clinton’s op ed. The fourteenth amendment defines the constitutional right to privacy. America was built on the premise of separation between church and state as stated in the first amendment.

Religious beliefs should not be translated into federal law. Larry Tribe makes that clear in his book “The Invisible Constitution”.

Roe v. Wade, 410 U.S. 113 (1973) is a controversial United States Supreme Court case that resulted in a landmark decision regarding abortion.

According to the Roe decision, most laws against abortion in the United States violated a constitutional right to privacy under the Due Process Clause of the Fourteenth Amendment. The decision overturned all state and federal laws outlawing or restricting abortion that were inconsistent with its holdings. Roe v. Wade is one of the most controversial and politically significant cases in U.S. Supreme Court history. Its lesser-known companion case, Doe v. Bolton, was decided at the same time.^[2]

Roe v. Wade centrally held that a mother may abort her pregnancy for any reason, up until the “point at which the fetus becomes ‘viable.’ The Court defined viable as being potentially able to live outside the mother’s womb, albeit with artificial aid. Viability usually occurs at about seven months (28 weeks) but may occur earlier, even at 24 weeks.”^[1] The Court also held that abortion after viability must be available when needed to protect a woman’s health, which the Court defined broadly in the companion case of Doe v. Bolton. These rulings affected laws in 46 states.^[3]

Abortion is a religious issue and not a state issue. It is not an emotional issue that can be debated into law. It is an constitutional individual rights issue about freedom. The Supreme Court made this very clear in 1973. Citizens of the United States should have the right to their religious beliefs but the government  should not impose religious beliefs on the rights of others.

President George W. Bush in his proposed new rule left open the interpretation of abortion.

“The definition of abortion in the proposed rule is left open to interpretation. An earlier draft included a medically inaccurate definition that included commonly prescribed forms of contraception like birth control pills, IUD’s and emergency contraception. That language has been removed, but because the current version includes no definition at all, individual health care providers (and the federal government) could decide on their own that birth control is the same as abortion.”

The Bush administration always tries to justify its many attacks on freedoms granted by our constitution by hiding behind protecting our rights and freedoms. He is attacking a basic freedom with this rule.  I believe the American people are too smart to buy into his thinking.

“The Bush administration argues that the rule is designed to protect a provider’s conscience. But where are the protections for patients?” (and patient’s freedoms)

I read about this proposed rule on September 28^th. The comment period ended Sept 25^th. The goal of the administration was to sneak the proposal past the public. Why didn’t our presidential candidates publicize the proposed rule?

“The 30-day comment period on the proposed rule runs until Sept. 25. Everyone who believes that women should have full access to medical care should make their voices heard. Basic, quality care for millions of women is at stake.”

Even though the 30 day comment period has ended, it is never too late to contact our legislators, They must listen! We elect them!  I believe everyone opposed to this proposal should write their representatives in congress as well as their local newspapers. They should send their objections to both John McCain and B
arack Obama. 

The Republican Party declares it is against government regulations. Yet it wants to impose regulations on one of our basic freedoms. The right to privacy. 

Does anyone want four more years of Stinkin Thinkin?

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

Stanley Feld M.D.,FACP,MACE

I believe Americans can repair the healthcare system. I received a comment that said,

“Stan

Your solutions are clearly the most ideal but, I think, unrealistic.  We would have to educate the consumer very quickly and that isn’t likely to succeed in the near future.”

I do not agree. As a nation Americans can do it with appropriate leadership. Great leadership would inspire our government to create a cultural change that can stimulate and motivate consumers to learn very quickly. I do not believe change necessarily succeeds in a gradual fashion.

In his new book, “Hot, Flat and Crowded”, Thomas Friedman nails the mechanism of change in his first few pages.

“America is at its most powerful and most influential when it is combing innovation and inspiration, wealth building and dignity building, the quest for big profits and the tackling of big problems. When we do just one, we are less than the sum of our parts. When we do both, we are greater than the sum of our parts- much greater” Thomas Friedman

Thomas Friedman’s opening statement applies to many areas of policy in our society. Policy decisions include energy, environment, transportation, public education, immigration and medical care, to name a few. Gradual change results in an adjustment by vested interests to cripple the original goal of the change.

The Presidential candidates have touched on each policy area with sound bytes. Neither has outlined a plan that combines each couplet of Friedman’s to make America greater than the some of its parts. Inspiring Americans to have self respect and self responsibility with a motivational carrot of money could result in rapid change. Instead, the candidates are embattled in discrediting each other for media attention. They are not defining the issues or proposing solutions.

An example that reverberates in my mind is John McCain’s acceptance speech. He said he was going to fight for us, fight terrorism, fight for the economy, fight for medical care and fight for a lot of other things. He did not tell us what policies he is going to fight for. He did not tell us who he is going to fight for whom. His handlers obviously disrespect our intelligence and ability to think. They think we are incapable of asking the critical questions. Who is going to fight and how is his fighting going to help us as individuals and as a nation? In healthcare he is going to fight to get rid of the Medicare entitlement. He is going to feed the healthcare insurance industry’s quest for big profits and not tackle the big problems with big ideas. I have presented big ideas for the repair of the healthcare system and with the appropriate leadership Americans can be stimulated to respond.

There is no inspiration or reward for innovative thinking. There is the probability of wealth building for the healthcare insurance industry without dignity building for Americans in John McCain’s healthcare plan. Thomas Friedman is correct in declaring that by combining the couplets America can be greater than the sum of its parts. If we focus on only one side of his couplets the result is less that the sum of its parts.

Leadership inspiring cultural change and innovative thinking about changing the healthcare system in a way that respects the average citizen’s intelligence and has empathy for the less fortunate without decreasing dignity is what we need in a leader. We have plenty of smart Americans who can focus on the big picture. but the big picture does not create an exciting enough story for the media. However, by focusing on the big picture we would start creating solutions to our problems.

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

Stanley Feld M.D.,FACP,MACE

Barack Obama’s medical plan wants to guarantee universal insurance coverage similar to that offered through the Federal Employee Health Benefits Program. (Medicare Part C)

“The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP),

the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”

I stated that forming a new bureaucracy to improve medical care is not the answer. Bureaucracies are inefficient and at time wasteful.

The answer is not Mr. Obama’s proposed National Health Insurance Exchange . I think a new bureaucracy will make things worse.

“· National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.”

Medicare has been proud to advertise that it is an efficient bureaucracy. It has declared that its overhead is only 2.5%. We now know this is not true. Medicare outsources most of its administration services to the healthcare insurance industry. The healthcare insurance industry builds in its administrative fees to the cost of care. The New York Times obtained a draft of a report prior to being made public. The inspector general is studying the report before it is released and might change it.

“Medicare’s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system.” “But according to a confidential draft of a federal inspector general’s report, those claims of success, which earned Medicare wide praise from lawmakers, were misleading.”

Medicare told outside auditors to ignore government policies that would have accurately measured fraud.

“For example, auditors were told not to compare invoices from salespeople against doctors’ records, as required by law, to make sure that medical equipment went to actual patients.”

“As a result, Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.”

This miscalculation does not represent direct patient care. These supplies are essential to manage chronic disease. However the abuse of responsible sales these supplies by secondary stakeholders is not controlled by Medicare. 

I campaigned to have Medicare pay for home glucose monitoring strips. It is an essential part of diabetes care. To my astonishment, private companies were formed to refill glucose strips automatically. Patients would not need strips because they were not compliant with physicians’ orders. Compliance rate for home glucose monitoring is only 50%. Medicare is spending twice as much as they would if the patient was responsible for buying the glucose strips.

The extra money paid could be directed to paying for disease management. Patients could be taught the importance of measuring their blood sugars three times a day. Instead the private companies are profiting from the sales extra glucose strips.

“That same year Medicare officials told Congress that they had succeeded in driving down the cost of fraud in medical equipment to $700 million.”

“ Pete Stark claimed, “We’re speechless”. Mr. Stark and his ilk consistently claim that Medicare is a model for government-run “universal” health care because it spends less on overhead than the private sector.”

“To look better to the public, you cook the books,” Mr. Stark continued. “This agency is incompetent.”

The report points out a basic problem of bureaucracies. The goal always seems to be to look good rather than perform its job efficiently. The people must force our leaders to face reality. Congress and the administration must begin to trust citizens to be responsible for their own Medicare dollars rather than have a bureaucracy or healthcare insurance company in charge of their needs.

“Some lawmakers and Congressional staff members say the irregularities that the inspector general found were tantamount to corruption and raise broader questions about the credibility of other Medicare figures.”

Senator Grassley who has praised Centers for Medicare and Medicaid Services for efficiency in the past has demanded that heads roll.

“Congressional staff said the Centers for Medicare and Medicaid Services — the agency overseeing Medicare — was lobbying the inspector to play down the report’s conclusions.”

This response is only natural and to be expected when bureaucracies are challenged and exposed.

“A spokesman for Medicare said that the agency agreed with the inspector general that the agency’s reported level of improper billing for durable medical equipment, or D.M.E., should have been higher. But Medicare says the $2.8 billion figure is unsupported.”

The media is the message in our sound byte society. Once the day of the reporting has passed the story is forgotten. Unfortunately the implications of the story are profound

“Fraudulent and improper payments have long bedeviled Medicare, a $466 billion program. In particular, payments for durable medical equipment, like power wheelchairs and diabetic test kits, are ripe for fraud.”

There is a simple plan for Barack Obama to adopt. It is my ideal Medical Savings Account. Medicare patients should be responsible for spending the first $6,000.00 dollars. They would be careful to not waste their Medicare insurance money. Maybe they would not get the best wheelchair in the world or let companies send them diabetes kits they do not use.

A government bureaucracy should make the rules. If vendors break the rules patients should report them. The government bureaucracy should act quickly to enforce the rules. With my ideal medical savings account you create an enormous policing agency. People will not tolerate waste when their money being wasted. This will eliminate fraud and the waste of the peoples money.

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

.

Stanley Feld M.D.,FACP,MACE

Both Presidential candidates have claimed they have specific proposals for change for many policies. If we decide on whom to vote for on the basis of healthcare policy we will be making a mistake. They both want to change the wrong things. They also have not given us an idea of how they are going to execute their promised changes.

Neither candidate is going to have a positive effect on Repairng the Healthcare system because they are focused on the wrong changes. If they can get congress to approve of any of their proposals, they will only make the healthcare system worse.

My last ten blog entries have reviewed both Barack Obama’s and John McCain’s healthcare proposals specifically. I am disappointed in each candidate. Neither is focused on the basic problems in the healthcare system

Both candidates advocate universal coverage. Barack Obama wants universal coverage with a single party payer.

The sound bytes Barack Obama uses suggests a competitive environment between the government and the healthcare insurance companies. If the government was serious, the healthcare insurance industry would not want to compete. The rules and regulation promised would be intolerable. They would rather run the single party payer system for the government.

John McCain is against entitlements. His goal is to shift the burden of acquiring healthcare insurance to the citizens. John McCain plans to provide tax credits to citizens. The tax credits are suppose to be used to purchase healthcare insurance. In affect, John McCain wants to relieve government and employers from providing healthcare insurance for their constituents and employees. The sound bytes John McCain uses suggest that all citizens will have the opportunity to buy healthcare insurance. This is not quite universal coverage. His tax credits are not large enough to buy the healthcare insurance even if consumers could afford it.

The basic problem is the healthcare insurance industry will set the price of the insurance premiums as it does in the present system using antiquated actuarial systems and bloated administration fees. This is a basic problem in the healthcare system. Neither candidate is focused on this problem. Neither candidate respects the consumer’s ability to manage his own healthcare dollar.

The cost of universal care in Massachusetts has doubled. Massachusetts outsources the universal healthcare insurance coverage to a couple of insurance companies. Government officials in Massachusetts claim the reason for the high premium costs is more people are obtaining subsidized insurance than anticipated. Economics 101 dictates that the more people are insured the less the premium should be. Unfortunately, the healthcare insurance company controls the money and the bids.

Consumers should own their healthcare dollar. They do not need first dollar insurance coverage. Consumers should manage their own first dollar coverage. The first dollar coverage should be funded by their employer or the government, tax free. This would eliminate the insurance companies’ administrative cost for the first $6,000 in healthcare coverage. If consumers do not spend the first $6,000 the remainder would be deposited in a tax free retirement trust fund. It would not be deposited in a health savings account to be paid back to the healthcare insurance industry for future co-payments and deductibles.

Consumers would then be motivated to use the first $6,000 wisely. They would be motivated to remain healthy. If a patient had a chronic disease that required medical care and spent $4,000 to avoid complications of their chronic disease, the employer or the government would provide a bonus for their retirement trust. If a patient developed a chronic disease and spent the first $6,000 then the high deductible insurance would provide first dollar coverage for the remaining expenses.

Consumers responsible for their own healthcare dollar would then shop for the best treatment at the best price. They would also be motivated to stay healthy and exercise regularly, The economic gain would motivate consumers not to smoke, drink or become obese. Consumers would also be motivated to demand environment clean-up in order to protect their health. Politicians might listen. There is no reason Dallas, Texas should be out of EPA compliance except for the polluting effects of coal plants. Soot and cigarette smoking cause chronic lung disease and asthma. Consumers would demand rapid change if they were denied being rewarded for staying healthy because of circumstance beyond their control, but in the hands of the politicians.

This innovative healthcare plan would eliminate the healthcare insurance industry’s excessive administrative costs for the first $6,000, provide incentive for healthcare insurance companies to compete for highly profitable high deductible insurance plans , and provide incentive for consumers to be responsible for keeping themselves healthy. It would also provide incentive for physicians and hospitals to become more efficient. Consumers would be shopping for the best care at the best price. The government would have to force and enforce real transparency. If stakeholders were not really transparent they would be denied a license to sell insurance, hospital services or physicians’ services in that state. The states, not the federal government must be in charge. Insurance premiums would have to be calculated on a community rating basis. Electronic medical records must be uniform and interchangeable. EMR software should be distributed via the web download. So should electronic prescriptions software. Physicians should pay for the software by the click. This would promote rapid adoption and avoid unaffordable capital expenditures. Compliance by physicians and patients should be rewarded, not like present proposals for punishing non compliance.

In my review of the Presidential candidates’ healthcare plans none of these solutions are mentioned. Instead, both candidates make proposals that are not well thought out. They do not offer basic solutions. They do not motivate or trust consumers to be responsible for their health.

The consumers’ healthcare dollar should be under consumer control. They have to be taught how to use their dollar wisely. The government should set and enforce rules to prevent abuse by the vendors. America’s healthcare crisis will not be solved until a leader listens to the primary stakeholders, the patients and the physicians.

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