Stanley Feld M.D.,FACP,MACE

I have been distracted from my main theme, the ideal Medical Saving Account as the vehicle needed to repair the healthcare system. I have been building the case for this system of self responsibility as the mechanism to repair the best medical care system in the world. The theme is patients’ must control their healthcare dollar to repair the healthcare system.

We must develop a system of incentives where provider prices are transparent and providers compete for the patient’s healthcare dollar. We must create a system where providers (hospitals, physicians, and other healthcare providers) are forced to become efficient to compete for the patient’s healthcare dollar on quality of care and cost of care. The result will be that healthcare costs will decrease and the quality of care will increase. This is the meaning of consumer driven healthcare.

The last few weeks have been spent on the “Dirty Coal Plants” TXU is proposing for Texas. These “Dirty Coal Plants” are being proposed all over the country because of the abundance of cheap dirty strip mined coal. Presently $34 billion dollars are wasted healthcare costs to treat illnesses resulting from the present levels of pollution. The healthcare costs resulting from the proposed “Dirty Coal Plants” in Texas and around the country could easily double and perhaps triple.

The point is that Dirty Coal Plants polluting the environment result in large avoidable costs to the healthcare system. These costs can not be controlled by the patient exercising patient responsibility.

Patients will be afflicted with unavoidable environmentally caused diseases once these Dirty Coal Plants are built and operational. The Dirty Coal Plants will be operational for the next fifty years. The illnesses and costs of medical care for these illnesses could be avoided if we do not pollute our environment.

One could look at building these Dirty Coal Plants as “man’s inhumanity to man in pursuit of the mighty dollar.” I have been amazed by how many people believe that the EPA standards are the state of the art, that the present EPA rules will protect us from pollution. If the levels were a concern the EPA would change the rules. Therefore, we do not have to become pollution experts. The EPA’s mission is to protect us from any environmental toxin that might be dangerous. We have delegated the EPA as our surrogate to protect us from pollutants that could harm us.

Unfortunately, this has proven not to be true. Two court judgments have gone against the EPA rules in recent months. The EPA has for some reason loosened standards of pollution since 2000. One should question why. Our advances in technology have given us the ability to decrease coal burning pollution markedly by building IGCC Coal Plants. Our advances in understanding the medical effects of pollution have demanded that we decrease our exposure to these pollutants.

I understand our need to reduce our dependence on foreign oil as an energy source. If the new Dirty Coal Plants result in an additional $68 billion burden to our healthcare system by avoidable disease healthcare costs, shouldn’t a prudent government be investing in creating incentives for renewable sources of clean energy such as wind and solar energy? At the same time shouldn’t we be investing in creating incentives for energy conservation? We could use the extra $68 billion saved to promote these efforts.

TXU claims there are other sources of pollution such as our automobiles. Shouldn’t we create incentives for automobile companies to decrease the pollution and increase conservation of fuel for our automobiles more than they have? Look at the impact of the Toyota Prius, without incentives. Toyota is not even an American company. Toyota has created a competitive advantage for their product. Other companies have been slow to follow with as efficient a product. In fact it seems they are trying to undermine the efficiency of the product.

America is a brilliantly creative marketing country. America has created many “hypes” in my lifetime. My first recollection was promoting cigarette sales even though the cigarette companies knew they were not good for us. I could not wait to be old enough to smoke a cigarette. Recently, it is flat screen high definition television. Congress has even taken time out from their busy work to set a deadline for digital HDTV.

Why can’t Congress create incentives for us to stop harming ourselves with environmental pollution? Perhaps there is not enough lobbying money in the effort.

Why can’t Congress get smart and use its creative energy to promote the health of our citizens, rather than bending to the vested interest pursuit of the almighty dollar resulting in more pollution and more medical costs to society.

It can only be done if the politicians, the government officials, and the government agencies are challenged by the citizens they are supposed to be serving. It is clear to me the evolution of the rules in our legal system and the institution of lobbying has removed citizen input for demanding what is in the citizens best interest.

The time has come to express ourselves. The citizens of Texas are trying to do that right now. However, we have a very refractory Governor Rick Perry and a very powerful corporation in TXU. TXU has not demonstrated any corporate community responsibility to date. I hope our legislative officials in Austin will be able to respond to the cries of the citizens and force this folly to stop!!

Stanley Feld M.D.,FACP,MACE

If we as a society do not become innovative about healthcare delivery, medical care in this country will deteriorate.

The Medical Savings Accounts described in the last posting can be utilized as a motivational tool for patients. A true Consumer Driven System can have a positive impact on cost and quality. I hope to demonstrate that total cost will decrease and quality of care will increase.

With 46.7 million people uninsured, America has a problem. I estimate that 30 million people can afford to pay the true cost of a high deductible insurance. The cost of insurance to an individual not in a group plan is not tax deductible. The group plans are tax deductible to the employer.

A simple change in the tax law would correct this. Additionally, if an individual has a preexisting illness, presently the insurance industry can elect to refuse offering a policy, rate the premium or exclude that illness from the insurance offered. The insurance industry can not do that in a group plan. If they have a group with many patients at risk they can try to raise the premium.

The insurance premium for individuals should be the same as corporate rates. The insurance rates should be transparent in order to shop for rates. The rates should also be calculated as a community rate rather than as and individual rate. A fifty year old male with hypertension, high cholesterol and moderate obesity is at increased risk for a myocardial infarction and the need for chronic cardiac care. In the present system he would be refused an individual insurance policy. If he could get one any care related to his heart disease would be excluded.

A simple regulation mandating community rating would correct the problem of discriminatory rates and ratings. In the Medical Saving Account System, the 55 year old patient would be guaranteed a high deductible policy which could be purchased with after tax dollars.

The system could be set up so that patient could apply and receive state or federal subsidy. This simple change could cure our Medicaid problem. The Medicaid system presently spends more per patient than it would cost the government using an effective Medical Savings Account system. The Medical Saving Account system would also encourage patient compliance. The patient would not longer be a burden to the state because costs could decrease.

The key is motivating the patient to be responsible for his care. He would be in control of purchasing his care and to adhering to the care recommended. There have been many pilot programs rewarding expectant mothers on Medicaid. If the mothers participated and fulfilled their obligations for prenatal care, the fetal and post partum complication rates fell dramatically. The neonatal and post partum care costs plummeted. The reward of some pilots was simply free formula for the first year of the infant’s life.

Consumer driven responsibility for one’s medical care is an invigorating concept to patients long abused by a hierarchical bureaucratic power seeking healthcare system. The power should be given back to the consumer.

One can see how the system could work in Medicare patients. The government subsidizes the insurance of people over 65 years old. Constantly, the government must raise the insurance premium the elderly pay. Ninety percent of Medicare’s payments are for the complication of the chronic diseases. If the system were set up to reward the elderly for effective self management of their chronic disease many unnecessary costly complications could be avoided. The patients could be motivated by the money accumulating in their Medical Saving Account. Since they are retired they could use the unused trust money as a supplement to their Social Security. More on the mechanism of the various plans in the future.

Will it work? Absolutely!!

We will see “Patient Power” in action when Wal-Mart rolls out the $4 per month for generic drugs nation wide. The elderly will force their physicians to order generic drugs. The CVS and Walgreen will also be forced to decrease the cost of their generic drugs. The Medicare Part D fiasco will evaporate. There will be no need for Medicare D. It will be cheaper to buy the medication from Wal-Mart. The price of brand name medication will decrease because of the price competition. Adherence to medication regimes will increase because patients can once again afford their medication.