Stanley Feld M.D.,FACP,MACE
Our healthcare system is broken. It is not getting better. The dysfunction in the healthcare system increases as time goes by and nothing is happening to fix the system.
I have introduced some “big ideas” in the past year.
The goal is to increase understanding of how the system became broken and what we have to do it. If the ideas necessary to repair the healthcare system are going to work the ideas have to be enacted as a comprehensive package. Unfortunately, this is not the way politicians work unless we are in a meltdown situation. For example, real price transparency of negotiated prices has to be linked to an accurate assessment of quality which has to be linked to patients owning their healthcare dollar and having the ability to chose and evaluate their care. The patients have to be given the ability to negotiate the price with hospitals and physicians or chose an insurance company that will fight to protect expenditure of their healthcare dollars. Patients must be given the incentive to be an informed consumer and educated to spend their healthcare dollar wisely and be penalized if they do not.
Medical practices have to be given the incentives to develop their practices that are dedicated to chronic care of particular diseases (focused factories). The incentives for these focused care clinics must be adequate compensation for their care to make patients professors of their disease. These focused factories will help prevent the complications of chronic diseases. The complications of chronic diseases absorb 90% of the healthcare dollar. There has to be monetary incentives for medical practices to emphasis preventive medicine in order to avoid the onset of chronic disease.
The patients must be responsible for their care and their healthcare dollar. Access to care must not be restricted. Patients are capable of being responsible consumers of healthcare given the appropriate incentives.
Systems of care have already been developed to achieve these goals. I have explained how the Ideal Medical Savings Account as an insurance vehicle can achieve the goal. I do not believe the presently available Health Savings Accounts is a step in the right direction. Health Savings Accounts (HSA) will fail because they lack patient motivation and physician incentives. The failure of HSA’s will move us closer to a single party payer system as a proposed solution. In my view a single party payer system will be a terrible solution for the patients and the physicians.
We will need strong leadership. We need a leader who really understands the problems in the dysfunctional healthcare system. A leader who is not afraid to act contrary to the pressure of facilitator stakeholder vested interests There does not seem to be one around. We will need groups of citizens who are angry enough at the present system who will be willing to demand a consumer driven healthcare system. People power can demand that leadership. First they have to understand the problem and solutions.
Some of the comments I have received in the last few weeks express our generalized cynicism, pessimism and depression about the healthcare system from both patients and physicians.
Paula Hartzell, MD’s sad story in Medical Economics tells it all. It is truly a worthwhile read. I was directed to Dr. Hartzell’s story by KevinMD .Dr. Kevin Pho, a primarycare physician and internal medicine specialist who operates one the top 10 medical blogs in the country. He has a wonderful blog and is providing a great service for both the general population and physicians. If you want to know what is going on in healthcare and medicine read KevinMD. Kevin’s blog provides the information that exposes the ills of the healthcare system and will help stimulate the demand for change.
Richard H. Rowe M.D. is another Family Practitioner who confirms Dr. Hartzell’s story.
“Family practitioner Paula J. Hartzell’s “Medicine is a blame game” [“The Way I See It,” Apr. 20] is sobering. I agree with her commentary entirely.
After 32 years, I am totally disillusioned with medical practice and all the hassles associated with trying to care for patients. Let’s go down the list:
• The government and health insurers blame doctors for overcharging patients.
• The legal profession blames doctors for practicing poor-quality medicine—while these same lawyers are getting rich off the system.
• Regulatory agencies blame us for not doing enough or spending more time in the office.
• Liability insurers blame us for the ever-increasing number of lawsuits.
Meanwhile, organized medicine appears powerless, sitting on the sidelines. If the current trend persists, I am afraid we are heading for a medical meltdown. Perhaps future topics in Medical Economics will be: Where are all the doctors?”
Richard H. Rowe, MD
Richard Rowe M.D. confirms the story as many others have. People must remember when they are sick they want a well trained physician who understands disease processes.
I received some comments as a result of my post” We Are Not Healthcare Providers, We Are Medical Care Providers” saying “you doctors are only trying to protect your guild.” It sounds to me that healthcare providers think physicians are in a turf war with them. As I stated previously the healthcare providers should be called physician extenders. They should be joining the medical care team to provide a team approach to medical care through focused factories rather than trying to compete with physicians and devalue treatment.
I received this comment from a famous oncologist.
“Having worked for several years in a community in which nurse practitioners, physician assistants and oriental medicine physicians (“DOM”) are accorded primary care status by regulatory and insurance entities, I can tell you that they have no clue about disease process. This leads to an enormous number of esoteric laboratory studies and imaging studies in the search of some or ANY diagnosis to explain symptoms. Eventually the patients are referred to a medical specialist and with them come myriads of pieces of unfocused medical data. “..just what is the significance of the elevated serum zinc in the patient with chronic weakness and fatigue who has negative imaging studies?” Nada! Excess healthcare costs and healthcare providers, as opposed to medical care providers, always go together!”
Physicians are calling for leadership to save a broken healthcare system. However, the Democrats think physicians are all crooks. The Republicans seem to make healthcare more profitable for the secondary stakeholders, namely the hospital systems, the insurance industry and big Parma. No leader seems to realize that the patient is the most important stakeholder.
The perception of the people is physicians are making a fortune overcharging us, over testing us, and over treating us with medication that hurt us. They use treatments I can not afford or insurance company will not pay for. Unfortunately, this is the perception generated by all the stakeholders and encouraged by the medias need at sensationalism.
A person who is uninsured wrote; “ I am frightened that I will get sick. I will be stuck with an outrageous hospital bill that will bankrupt me. I am a hard working person who lost my job and can not buy affordable individual health insurance.” This needs to be fixed immediately.
My view is that the consumer of healthcare and the giver of medical care have to unite and force our politicians to do something logical and constructive to change all of this.
Pessimism never got anyone anywhere.
Harry Truman said.” A pessimist is one who makes difficulties of his opportunities. An optimist is one who makes opportunities of his difficulties.”
To the pessimists out there I say read my blog. To the optimist out there I say read my blog. With things as bad as they are, the opportunities for improvement and innovations are limitless and awesomely rewarding both emotionally and financially.
Winston Churchill said,” I am an optimist. It does not seem too much use to be anything else.
Franklin Roosevelt said, “The only limit to our realizations of tomorrow will be our doubts of today.”
Ronald Reagan said “There are no great limits to growth because there are no limits of human intelligence, imagination, and wonder.”
Finally, Dwight D. Eisenhower said “Pessimism never won any battle.”
Our most valuable possession is our health. We must be optimistic in the battle to save the medical care system by reformatting the healthcare system. A system needs to be developed that protects patients, the most important stakeholder in the medical care system, not a system that protects the vested interests of the facilitator stakeholders in the healthcare system. The facilitator stakeholders add little value to our medical care system.