Clinton, Obama Clashing On Healthcare – Part 1: Democrats Debate Requiring People To Buy Coverage

Stanley Feld M.D.,FACP,MACE

“ Sen. Hillary Rodham Clinton is on the attack against her main rival, charging that Sen. Barack Obama’s health plan would leave millions of Americans without medical protection while hers provides coverage to all.”

The real issue should be that everyone should be the able to purchase healthcare insurance if they want to. It should not be mandated with a penalty. There should be no restriction on eligibility. Everyone should be able to purchase healthcare insurance with pre-tax dollars. The government should subsidize the less fortunate on a means tested basis. Everyone should own their healthcare dollar. Everyone should have financial incentives to use their healthcare dollar wisely.

Patient education is critical for the prevention of the complications of chronic disease.Patient education should be adequately compensated. Patient education programs to teach patients to use their healthcare dollar wisely should be available on the internet.

Consumers can force the healthcare insurance industry to compete for their healthcare dollar. If real price transparency was required for hospital systems and physicians, both would be forced to compete for the consumers’ healthcare dollar.

With consumer driven healthcare, the market economy would force the healthcare insurance industry to become more efficient. It would decrease its 150 billion dollars in administrative costs.
Consumer driven healthcare would also stimulate hospital systems and physician groups to deliver more efficient medical care. Both groups would be interested in eliminating administrative waste through the use of information technology. The consumer must be the primary driver of the healthcare system, not the government nor the healthcare insurance industry.

Consumer driven healthcare would create a more orderly evolution toward the adoption of information technology rather than the punitive administrative rules and bureaucratic inefficiency advocated by Gingrich and Kerry in their E-prescriptions article.

I have mentioned that it costs a physician $7 to pull a chart from his filing racks. It costs another $15 to complete the chart. The use of the ideal electronic medical record would decrease this cost to pennies. In turn, it will decrease the physicians costs to deliver medical care which would reduce fees.

If an innovative software company provided universal software to physicians and hospital systems and charged physicians and hospital systems by the click, we could eliminate the burden of start up costs and capital expenditure.

Hospital systems’ pharmaceutical charges and bed charges should be based on its cost plus a reasonable profit.

Healthcare premiums must be community rated and available to all with pre-tax dollars and subsidies if necessary. Consumers electing not to purchase healthcare insurance would be responsible for the retail charges. This might create incentives for those would choose not to take advantage of the universal coverage opportunity.

Incentives should be given to physicians to develop patient education services to prevent the complications of chronic diseases. All the presidential candidates are ignoring the fact that 80-90% of the healthcare dollars are spent on the complications of chronic disease.

“ Hillary Clinton’s assertion, flatly rejected by the Obama campaign, rests on a pivotal difference between the two Democratic presidential candidates’ health proposals. Clinton says she wants the government to require all citizens to buy insurance or face a penalty. Obama relies on a mandate for children only, and instead emphasizes ways to make coverage more affordable.”

I believe the basic difference between Hillary and Obama is Hillary thinks you have to force people to do things and Obama thinks you have to provide the environment and incentives to get people to do things. Obama has more respect for our intellect than Hillary does. However, both candidates are advocating systems that will fail. After they fail the next step is universal coverage by a single party payer. The single party payer will be a disaster for America.

“ The seemingly technical distinction has launched an impassioned debate among economists, health care analysts and politicians, and has fueled a key campaign argument in early-voting states such as Iowa. It will likely receive more attention as the election season grinds ahead.”

Here we go again. The media seeks openings to make the election a spectator sport. Americans want serious discussion of the issues and well thought out solutions.