Stanley Feld M.D.,FACP,MACE

I believe Americans can repair the healthcare system. I received a comment that said,

“Stan

Your solutions are clearly the most ideal but, I think, unrealistic.  We would have to educate the consumer very quickly and that isn’t likely to succeed in the near future.”

I do not agree. As a nation Americans can do it with appropriate leadership. Great leadership would inspire our government to create a cultural change that can stimulate and motivate consumers to learn very quickly. I do not believe change necessarily succeeds in a gradual fashion.

In his new book, “Hot, Flat and Crowded”, Thomas Friedman nails the mechanism of change in his first few pages.

“America is at its most powerful and most influential when it is combing innovation and inspiration, wealth building and dignity building, the quest for big profits and the tackling of big problems. When we do just one, we are less than the sum of our parts. When we do both, we are greater than the sum of our parts- much greater” Thomas Friedman

Thomas Friedman’s opening statement applies to many areas of policy in our society. Policy decisions include energy, environment, transportation, public education, immigration and medical care, to name a few. Gradual change results in an adjustment by vested interests to cripple the original goal of the change.

The Presidential candidates have touched on each policy area with sound bytes. Neither has outlined a plan that combines each couplet of Friedman’s to make America greater than the some of its parts. Inspiring Americans to have self respect and self responsibility with a motivational carrot of money could result in rapid change. Instead, the candidates are embattled in discrediting each other for media attention. They are not defining the issues or proposing solutions.

An example that reverberates in my mind is John McCain’s acceptance speech. He said he was going to fight for us, fight terrorism, fight for the economy, fight for medical care and fight for a lot of other things. He did not tell us what policies he is going to fight for. He did not tell us who he is going to fight for whom. His handlers obviously disrespect our intelligence and ability to think. They think we are incapable of asking the critical questions. Who is going to fight and how is his fighting going to help us as individuals and as a nation? In healthcare he is going to fight to get rid of the Medicare entitlement. He is going to feed the healthcare insurance industry’s quest for big profits and not tackle the big problems with big ideas. I have presented big ideas for the repair of the healthcare system and with the appropriate leadership Americans can be stimulated to respond.

There is no inspiration or reward for innovative thinking. There is the probability of wealth building for the healthcare insurance industry without dignity building for Americans in John McCain’s healthcare plan. Thomas Friedman is correct in declaring that by combining the couplets America can be greater than the sum of its parts. If we focus on only one side of his couplets the result is less that the sum of its parts.

Leadership inspiring cultural change and innovative thinking about changing the healthcare system in a way that respects the average citizen’s intelligence and has empathy for the less fortunate without decreasing dignity is what we need in a leader. We have plenty of smart Americans who can focus on the big picture. but the big picture does not create an exciting enough story for the media. However, by focusing on the big picture we would start creating solutions to our problems.

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

Stanley Feld M.D., FACP, MACE

John McCain’s healthcare plan goes on to have “specific” proposals. His specifics are in reality generalities. He does not describing a plan to execute any of his “specific” proposals.I believe the American people deserve more than John McCain is offering.

“A Specific Plan of Action: Lowering Health Care Costs”

“John McCain Proposes A Number Of Initiatives That Can Lower Health Care Costs. If we act today, we can lower health care costs for families through common-sense initiatives.”

How can we lower healthcare costs if we act today with common sense initiatives ?

“Within a decade, health spending will comprise twenty percent of our economy. This is taking an increasing toll on America’s families and small businesses. Even Senators Clinton and Obama recognize the pressure skyrocketing health costs place on small business when they exempt small businesses from their employer mandate plans.”

Amer ica is being bankrupted by many dysfunctional policies. Medicare alone will cost 100 trillion dollars a year in 60 years. It is essential that politicians understand the basic problems with the healthcare system before making specific proposals without having a mechanism for executing the proposals. One basic problem with the healthcare system is the healthcare industry’s control of the healthcare dollar. John McCain plans to keep the healthcare insurance industry in control of the money. He should give patients control of their healthcare dollar.

CHEAPER DRUGS:

“Lowering Drug Prices. John McCain will look to bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs.”

Did anyone ever consider why brand name drugs cost less in Canada than in the United States? It is because the Canadian government can not and will not pay a higher price. The pharmaceutical companies want Canada’s drug market. They simply cost shift the difference for the same drug to the United States market. If the Food and Drug Administration is doing its duty correctly generic drugs should be no different that brand name drugs.

Drug patents protect the pharmaceutical companies’ return on investment. When the patent expires the drug can be sold generically. In order to maintain a return on investment the pharmaceutical industry needs to discourage patients and physicians from using generic drugs and re-importing brand name drugs. At the same time the government wants the pharmaceutical industry to have incentives to produce new drugs.

There is clearly a conflict of interests that is not resolved. It will not be easy for John McCain to fulfill the statement to lower drug prices without a program to lower prices that is fair to all. How is he going to do this? Is he going to create another entitlement program for drugs? It is easy to make a promise. It is hard to fulfill poorly thought out promises.

CHRONIC DISEASE:

“Providing Quality, Cheaper Care For Chronic Disease. Chronic conditions account for three-quarters of the nation’s annual health care bill. By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology, we can reduce health care costs. We should dedicate more federal research to caring and curing chronic disease.”

What programs are going to be created for “prevention, early intervention, healthy habits, new treatment model, ect”. Is his government going to reward physicians and patients for preventing the complications of chronic diseases? How is he going to encourage cognitive physicians to create infrastructure to practice chronic disease management? Decreasing reimbursement for cognitive physicians will not encourage chronic disease management.  So far there has been little or no payment for prevention of the complications of chronic disease.

How is he going to fight the war on obesity? Is he going to penalize baseball teams that sell baseball tickets offering all you can eat? Is he going to restrict restaurants from serving larger portions in order to raise prices and attract customers as well? Is he going to reward patients for healthy lifestyle changes? John McCain has to present solutions and not sound bites? He has no solutions.

COORDINATED CARE:

Promoting Coordinated Care. Coordinated care – with providers collaborating to produce the best health care – offers better outcomes at lower cost. We should pay a single bill for high-quality disease care which will make every single provider accountable and responsive to the patients’ needs.

This is a good idea. How is he going to do this? Does he mean making the patient the center of the team and the team an extension of the physicians care? Does he mean making the patients the professor of their chronic disease and equally responsible for the outcome as the physician and his chronic disease team? 

GREATER ACCESS AND CONVENIENCE:

Expanding Access To Health Care. Families place a high value on quickly getting simple care. Government should promote greater access through walk-in clinics in retail outlets.

This is a bad idea. One the one hand John McCain calls for co-coordinated care and on the other hand he promotes fragmented care. Disease management and effective medical care work when there is a strong physician-patient relationship. The team approach can promote the physician-patient relationship if the team is an extension of the physician’s care. The government should train or retrain physicians’ practices to provide greater access to quick simple care rather than encourage a new entity in the healthcare industry that could potentially abuse and overcharge the healthcare system. Uncoordinated home healthcare and nursing home care absorb a large portion of the healthcare dollar. If the care was coordinated it could add value to the medical care system. 

John McCain’s  healthcare plan outlines specific proposals. He does not offer specific solutions for his proposals. His proposals also highlight his lack of understanding of the healthcare system’s basic problems.   

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

Stanley Feld M.D., FACP, MACE

John McCain does not have a healthcare plan to improve the healthcare system. His goal is to eliminate the healthcare entitlement provided by the government for seniors and Corporate America for its employees.

In my view he is not focused on the basic problems with the healthcare system. John McCain is going to leave the control of the healthcare system in the hands of the healthcare insurance industry. He is not going to empower patients to drive the healthcare system by providing appropriate information, education and incentives.

John McCain’s healthcare plan is worse than Barack Obama’s because it is simplistic thinking. He makes the appropriate pronouncements as slogans. However, he simply strengthens the hand of Corporate America and the healthcare insurance industry to the disadvantage of present and future patients. In a search of his healthcare plan for improvement in the healthcare system none exists.

His healthcare plan starts with:

 “A Call to Action”

“John McCain believes we can and must provide access to health care for every American. He has proposed a comprehensive vision for achieving that. For too long, our nation’s leaders have talked about reforming health care. Now is the time to act.”

He is saying nothing but the obvious. One can assume he is for universal healthcare when he says “we can and must provide access to health care for every American.” It is important to review his actual words. One then realizes the words lack substance or strategy.

“Americans Are Worried About Health Care Costs. The problems with health care are well known: it is too expensive and 47 million people living in the United States lack health insurance.”

John McCain does not list the problems with the healthcare system. He declares that they are well known. He avoids stating the basic problems or the reasons for the basic problems. Why is it too expensive? Why are so many people uninsured?
John McCain’s Vision for Health Care Reform

“McCain Believes The Key To Health Care Reform Is To Restore Control To The Patients Themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care. John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit – effectively cash – of $2,500 for individuals and $5,000 for families to offset the cost of insurance.

I certainly believe that patients should have control of their healthcare dollar. A tax credit of $2500 for low or middle income individuals is not enough to help pay a $6,000 a year healthcare policy. The $5000 tax credit will not help a low income family pay for a $12,000 healthcare policy. What about people at the poverty level or just above the poverty level? How it a tax credit going to help them? How does this solve the abuses of the healthcare insurance industry? Can Moises with $22,000 income afford a $12,000 a year healthcare policy? The answer is obviously no!

Meanwhile the Republican administration (Bush)is methodically destroying America’s safety net hospitals. The Republican administration is not funding these critically important county hospitals. The lack funding will not result in an increase in these hospitals efficiency. It will leading to a lack of modernization of safety net hospitals and an inability to provide adequate healthcare to the underprivileged and uninsured.

Making Health Insurance Innovative, Portable and Affordable

John McCain Will Reform Health Care Making It Easier For Individuals And Families To Obtain Insurance.

How is he going to make it easier to obtain affordable insurance without government intervention? There is no plan or ideas published in his plan. It is just a slogan without a plan to help the middle class and lower class workers obtain healthcare coverage.

“An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people’s needs, lower prices, and portability. Families should be able to purchase health insurance nationwide, across state lines.”

I have changed my mind about consumers being able to by insurance across state lines. It would be good to increase competition among insurance companies. It might force them to lower premium prices and make less profit. It would be bad for the patients because patients would not have a mechanism to stop healthcare insurance company’s abuse of the healthcare system.

Each state is responsible for which companies they issue permits to sell healthcare insurance. Theoretically the individual states have control of the quality of healthcare insurance product sold in their state. Many State Insurance Boards have not functioned exactly how they were intended to function. This has lead to healthcare insurance abuse that has been slow to discover. Once discovered the legal process is tedious. Some State Boards have imposed penalties so weak they have not acted as deterrents to further abuse.

We need leadership to make State Insurance Boards stronger and not federal legislation that will make the State Insurance Boards less powerful. The healthcare insurance industry has not proven itself to be benevolent.

“Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.”

If the insurance plans are underinsuring people at high rates now, how is John McCain going to decrease cost of healthcare insurance with this proposal? There is nothing in his healthcare plan to control the healthcare insurance industry’s premium rates.

“John McCain Proposes Making Insurance More Portable. Americans need insurance that follows them from job to job. They want insurance that is still there if they retire early and does not change if they take a few years off to raise the kids.

If there are multiple plans available and a new employer does not provide a healthcare plan as good as the person’s previous healthcare plan that is going to pay for the premium for the previous plan?

There it is! John McCain’s goal is to get the employer out of the healthcare insurance plan provider business. He wants to place the responsibility of paying the premium for healthcare insurance in t
he consumers’ hands. The goal is to protect the employer and not the employee (patients). The goal of John McCain’s non existent healthcare plan is not to put the Patient First but to put Corporate America first.

John McCain should devise a plan that gives employees an incentive to take care of themselves and not an excuse for employers to avoid responsibility for their employees. I believe employees should own the first $6,000 of his healthcare plan and should have first dollar healthcare insurance coverage after that $6,000 is spent. If employees keep the portion of the first $6,000 they do not spend they will have incentive to use their healthcare dollar wisely. John McCain’s non healthcare plan is corporate America friendly and not patient friendly.

 
John McCain does not have a plan to limit the healthcare insurance industry’s profit, increase efficiency or contain abuse of the healthcare system. He might care but he does not get it.

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