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I Gave You A Better Plan In 2008

Stanley Feld M.D., FACP, MACE

“The hardest thing to explain is the glaringly evident, which everybody has decided not to see.”

Any Rand, The Fountainhead


                                                                        December 7,2013

Dear President Obama;

Last week you said no one has showed you a better plan for healthcare than Obamacare.

You were the dysfunctional healthcare system’s great hope in 2008. Your problem is you listened to the wrong people when you wanted to repair the healthcare system.

 Unfortunately, these people believe as you believe. Their ideology believes in central government control and the redistribution of wealth. This ideology has only led to the failure of national economies in the past.

There are better plans than Obamacare.

In fact, I sent you six letters right after you were elected President explaining how the healthcare system had gotten into the mess it was in and what must be done to repair the mess.

You ignored me completely. I understand why. Your ideology is to increase central government control and redistribute wealth.

I believe in giving individuals the ability to control their own destiny, make free choices, and have incentives to improve and become innovative.

Increasing incentives promotes innovation. You believe in decisions by committee. I have never seen that work in business.

There are several key elements needed to Repair the Healthcare System.

The first is consumers must be responsible for their own healthcare dollars and their own health. Government should not be responsible for consumers’ healthcare dollars.

Consumers must be given positive financial incentives and education to use their healthcare dollars wisely and take care of their health.

A system of financial incentives can be set up so that people who are sick with a chronic disease such as diabetes, heart disease or lung disease can be rewarded if they keep themselves from getting a complication of their chronic disease.

Eighty percent of the healthcare dollars are spent on the complications of chronic diseases. Clinical research studies have shown that appropriate medical care and appropriate self-management can decrease the complications of chronic disease by at least 50%.

People are not dumb. If they had control of their money and freedom to choose they would choose to keep themselves healthy.

Past government attempts at redistributing wealth have never worked. Redistribution of wealth by increasing taxes on “the wealthy” has never historically increased efficiency or productivity.

What makes you think total government control and the redistribution of wealth will work now?

I appreciate your desire to have all Americans covered with healthcare insurance.

What makes you think healthcare coverage will make Americans healthy?

If you would provide incentives to American consumers to practice healthy habits and save money you would better serve us.

The healthcare insurance industry takes at least 40% of the healthcare dollars off the top of both private and public insurance.

You have done nothing with Obamacare to decrease the insurance industry’s incentives except try to penalize them. Obamacare has been unsuccessful.

The reason is clear. Obamacare is totally dependent on the administrative services of the insurance industry.

If fact, because of your disastrous web site you have asked the insurance industry to tell you how much the government owes them. This is the fox in the hen house.

What have you done about Tort Reform?

You have done nothing. Why?

Your healthcare policy advisors know little about medical care and the problems in the practice of medicine.  They believe that the practice of defensive medicine has a minor effect on the cost of medical care.

An estimate is that defensive medicine costs the medical care system $300 billion to $750 billion dollars a year in unnecessary testing.

Obamacare’s solution is to pay less money for those tests, not to eliminate the need to do those tests.

At the same time Obamacare lets secondary stakeholders take advantage of the system. It costs the government $1700 dollars for a fifteen minute ambulance drive to a hospital. Why? What are the basic costs and a reasonable profit to the ambulance company?

Physicians who treat those Medicaid patients brought in by the ambulance receive $24 dollars in reimbursement for his care. Does that make any sense to you?

Your government bureaucrats say we need to save money somewhere.

Hospital systems also receive special deals from the government.

Every hospital has a least two sets of books. One set for the government to see how much the hospital system is losing and the other set to show the hospital administration and board of trustees how much they are making.

Why are hospital administrator salaries increasing as physician salaries are decreasing?

Physicians are smart people. They will figure out how to get around the distortions being created by Obamacare. The result will be a more costly healthcare system and a further increase in the redistribution of wealth.

Who approved of the $640 million dollars contract to CGI for  only to receive a system that doesn’t function and is probably about half built using an antiquated software program that should not be used?

Is it cronyism or stupidity? I know you are not stupid.

We have seen many examples of cronyism. In healthcare the multiple waivers from Obamacare are egregious. Two of the most agregious waivers were the waivers to congress and the unions.

What should the role of government be in healthcare?  Government should work to align everyone’s vested interests. It should set conditions to give all stakeholders real incentives to improve the healthcare system efficiently.

Consumers should be given the most incentive. Consumers are the only one that will be able to lower the costs. Consumers and physicians generate those costs. You do not impose restrictions by penalty. You increase incentives to get consumers to save money.

Try my ideal medical savings accounts.

Below are the links to the letters I had written to you when you were President-elect in case someone in your administration misplaced them.

In those letters is the course you should have followed to have a legacy to be proud of.

I have also provided a host of summary blogs that have explained repairs in detail.

Dear President-elect Obama Part 1

Dear President Obama-elect Part 2

Dear President Obama-elect Part 3

Dear President Obama-elect Part 4

Dear President Obama-elect Part 5–elect-barack-obama-part-5.html

Dear President Obama-elect Part 6

Summary Blogs

You are the one who asked to “show me a better plan.”

I hope you pay attention to my letters this time.

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

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