Dear President-Elect Obama: Part 4

Stanley Feld M.D.,FACP,MACE

You made a promise to the American people. You would listen to everyone and choose the best plan. If it did not work you would change the plan. You campaigned on a platform of universal healthcare without mandates. It has recently been reported that a consensus is emerging on universal healthcare.

“The prospect of bold government action appears to be accepted among players across the ideological and political spectrum, including those who opposed the idea in the 1990s”.

I see no evidence that this consensus includes the opinions of practicing physicians. There is some evidence that you have included large well known universities, clinics and hospital systems. However they do not represent the majority of the practicing physicians in the country. The practicing physicians  are your workforce and they are the people whose opinion you should seek.

“The answer says leading groups of businesses, hospitals, doctors, labor unions and insurance companies — as well as senior lawmakers on Capitol Hill and members of the new Obama administration — is unprecedented government intervention to create a system of universal protection.”

This sounds like the typical government way of doing things. The consensus crafts the laws and regulations. When the programs fail the law makers are confused. The programs fail because the laws and regulations do not get to the basic problems. This leads to more regulations leading to more failure.

I am afraid you are going to rely heavily on Tom Daschle. He is a nice man and an effective legislator. He is also a self appointed healthcare expert. I have written an extensive review of Mr. Daschle’s book and plan. His plan is dead wrong. His policies do not solve the basic problems of the healthcare system. 

I beg you. Please do not rely on his plan to solve the healthcare problems. It will only increase the cost, decrease compliance and drive the country into healthcare bankruptcy more quickly.

There are some good ideas in his plan but they are poorly crafted. The recession and rising unemployment will certainly increase the uninsured to well over 250,000. I believe universal healthcare is a concept that has come of age.

“Mr. Daschle wants to open to all Americans the Federal Employee Health Benefits Plan–a menu of private-insurance options now accessible only to government workers.”

He suggests there would also be some form of means-tested premium support (or tax benefits) for Americans who couldn’t afford one of the presently available plans. This could solve the uninsured problem. It would at least put the uninsured premium payment on a pretax dollar schedule and level the playing field. Private health plan contributions made by employers enjoy pre tax status. 

However, by making the Federal Employee Health Benefits Plan available to all citizens you are providing a perfect excuse for employers to drop the health benefit.

Providing a healthcare benefit to employees has become too costly. The Bush administration, by distorting the goals of my ideal Medical Savings Accounts, with Health Savings Accounts tried to provide an excuse for employers to drop the healthcare benefit

Employers have had to decrease healthcare coverage to keep the premium prices within reach. Many citizens are under insured. Employers would rather pay the government and let you be the provider of healthcare insurance for their employees. Universal healthcare with a single party payer then becomes socialized medicine with restriction of freedom of choice by the patients and restrictions on practice of physicians.

Your administration would have to continue to outsource the administrative services to the private healthcare insurance industry. This would thrill the healthcare insurance industry as I have described previously.

Your expanded government program would experience the same financial debacle the state of Massachusetts is experiencing with its universal healthcare plan. In fact the state of Massachusetts has applied for an addition 8 billion dollar bailout after receiving 2 billion dollars from the federal government already.

The Federal Health Board is an example of a bad idea with potential for terrible results. Rather than being a board that creates educational programs for physicians to improve the quality of care (an attribute that has not been clearly defined) it is punitive to physicians and restrictive to patients’ access to care. Remember ,when the CEO of Winn-Dixie was asked what his secret to success was. He said, “Don’t get the A&P mad”.

“The health board would manage the pricing, and use, of tens of thousands of medical products and procedures. How can a single board (instead of, say, the market) make so many decisions, and wisely? Mr. Daschle proposes a dozen or so “experts” who would be “chosen based on their stature, knowledge, and experience, ensuring that the decisions they make have credibility across the health-care spectrum.”

Mr. Daschle admits that the board is loosely based on the National Institute for Clinical Excellence in Britain and the Federal Joint Committee in Germany. Both are charged with managing the public’s access to higher-cost drugs, medical devices and procedures. “But both are growing increasingly unpopular in their home countries–precisely because they’ve become a triumph of cost-containment over patient access and choice.”

“Despite the fresh enthusiasm Mr. Daschle shows for his federal health-board proposal, it’s not exactly a new idea. Mr. Daschle himself proposed it as part of the failed American Health Security Act of 1993.”

This is not the way reform the U.S. healthcare system. The healthcare system needs to be reformed using common sense. I am hoping you will use common sense and get to the core of the healthcare systems problems. I will discuss common sense reforms in my next letter to you.