Premises Must Be Re-examined
Stanley Feld M.D.,FACP,MACE
A few weeks ago I had a terrific exchange with Steve Brachet M.D. who forwarded my blog to Steve Gregg.
I forwarded your recent blog featuring the five essential steps for HC reform to Stephen Gregg of Portland Oregon.
Steve Gregg is a former senior hospital executive, turned CEO of a managed care plan (successful in WA and OR), developer of alternative healthcare products, developer of patient care informatics, and thought leader in past 10 years on dimensions and confounding variables of health care in all its complexities.
He asked me to send the attached (very brief) piece recently published in the Oregon main media.
I don’t know if he expects a comment or two – but if you care to comment feel free to respond to Steve Gregg directly.
I take it that you are continuing to do your best to ‘right this HC ship’ that seems unlikely to improve on its own – nor with the help of the current Congress.
Steve Barchet M.D.”
I was fascinated with the article Steve Gregg wrote. I agree with many of the points he makes. I am publishing his article with Steve Gregg’s permission. I wrote back and said;
I welcome your article.
My blog explains the elements needed to Repair the Healthcare System from a physician’s point of view.
As a result of the Internet and improved software, consumers have become king and are driving the consumer consumption market. Amazon and ebay have led the way. Opaque purchasing models have been replaced by price transparent purchasing.
Wal-Mart has been forced to close stores because of online purchasing to remain competitive.
A consumer driven transparent online purchasing model has replaced airline ticket purchasing through travel agencies.
Online banking is transforming banking services. Hardly anyone goes into banks anymore.
There is no reason that shopping for healthcare services cannot transform the healthcare industry with all its opacity.
Consumers must be put in a position to drive the healthcare system and be responsible for their health and healthcare dollars.
Our 2020 business model can transform the dysfunctional healthcare system that can align all the stakeholders’ vested interests by empowering consumers and letting them drive the system.
The result will be a decrease in cost. It will eliminate the entitlement mentality of healthcare consumers and create a competitive mentality for all stakeholders as it has done in the examples above.
All Obamacare is doing is trying to put a patch on a healthcare system whose demise has been accelerated since passage of the Affordable Care Act.
Your articles describe many essential premises that must be reexamined.
However, consumers must be involved and be the responsible party in the healthcare system. They have to be given financial incentive to be involved and responsible.
Thank you for letting me reprint your article.
Health Reform…What Next?
With the expensive collapse of Oregon’s Health Exchange, a New Year, and approaching changes at the Federal level, it is time to reconsider the formative assumptions driving health care reform.
Ten Game Changing Assumptions Shaping Health Reform:
- The ideologies of the left and right will not sustain a reform solution grounded in compromise and “deal making”. The endless search for consensus confuses the problem, and is a recipe for failure.
- The State’s public bureaucracy is too conflicted with its own self interest to impartially govern health reform.
3.The plethora of proposed actions to reduce demand will not reduce costs. “Supply” being a more important driver of costs than ”Demand”.
- Sustainable reform cannot tolerate the variation in provider pricing to patients with differing sources of payment. Perhaps less than 15% of the typical hospital’s patients pay what the hospital bills.
- It is wrong headed to view reform as a matter of amending the existing system.
- Financial goals stabilizing health care costs cannot be achieved without prospectively stated and independently measured metrics.
- Equal access is not a realistic expectation. Universal coverage must be.
- Genuine Altruism is a deceptive and widely abused value of our non- profit institutions and trade associations.
- The United States spends twice as much per capita on health care because our health care workers of all stripes (including insurance companies,hospital sytems, government and pharmaceutical companies) s(take out twice as much from the system.
- The health care structures of other countries, while instructive, are not transferrable to the United States.
The Oregon Healthcare Project rationing experiment was a colossal hoax that channeled billions of new dollars to Oregon’s health care interests. Never measured, never critically evaluated. It was a severe case of the “Emperor Wears No Clothes”.
Conclusion: Think in terms of 2-3 alternative systems reflecting differing ideologies: Liberal / Conservative / Libertarian.
What would this suggest for process?
- Form 3 small task forces assembled around three ideologies: Liberal, Conservative, and Libertarian to articulate assumptions, problem definition, and a broad solution compatible with each ideology.
- At the end of the process examine what consolidation can occur and if not presume the development of 3 systems available to the free will of people to chose.
Liberal: Socially and fiscally liberal
Conservative: Fiscally and socially conservative
Libertarian: Socially liberal / Fiscally conservative
Note: The prospect of 3 systems capturing U.S. Healthcare, sounds daunting but in reality we have more than that now: Employer, Medicare, Medicaid, TriCare, Municipal, Insured, Self funded etc.
Alternative List of Assumptions:
- A sustainable health reform strategy cannot be achieved without the foundation of a well-conceived definition of the problem and formative assumptions.
- Subsidized or “free” health care is inflationary and will overwhelm administrative protocols for cost reduction.
- Genuine Altruism is rare and a widely abused cover for proprietary agendas. Excessive profit is a measure of good management.
- The community’s health care pathology is infinite and those making a living and profits from health care will seek to capitalize on that.
- Our health care system in the main is a proprietary endeavor with millions of economic interests seeking to protect or increase revenues. Any initiative that threatens that cash flow will be vigorously resisted.
- Does the system tilt toward choice and self – determination or equalness, limited choice, and a central authority?
- “Nearly half of all care delivered produces no medical benefit” is in obvious conflict with a prevailing view of vast health manpower shortages. Does increasing supply reduce prices and the costs of health care?
- If the national will demands universal coverage, the utility of competing traditional insurance companies should be called into question.
- The reformed system must promote individuals seeking care from the “best” provider of care as early as possible in the development of any adverse health care condition. Forcing patients into an inferior food chain of care is unethical and probably more costly in the end.
- There is something wrong with a requirement to select a health plan, provider network, and insurance in advance of acquiring a dire condition, and then being locked out of access to the “best” provider.
I do not see consumers playing an active role in your assumptions to Repair the Healthcare System.
Obamacare is wasting money developing an entitlement system that cannot work. The only stakeholder that can develop a healthcare system that can work is a system driven by consumers.
Consumers can force the secondary stakeholders to be competitive and transparent, as they have done in other industries.
It would be cheaper for the government to invest in empowering all consumers using the revolution in information technology and providing financial incentives to all using My Ideal Medical Saving Accounts.
Everyone could be insured as I have described in my article The Ideal Medical Saving Account Is Democratic.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE