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 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.