Stanley Feld M.D.,FACP,MACE
The solution to repairing the healthcare system is simple. The
healthcare system must be consumer driven. If consumers were in control of their
healthcare dollars and were responsible for their health and their healthcare
choices the cost of the healthcare system would decrease to manageable levels.
My ideal Medical Savings Account puts the consumer in charge. Its
success is totally dependent on real transparency by all stakeholders including
healthcare insurance companies, hospital systems and physicians.
A Health Savings Account does not give consumers enough of an
incentive to shop for price and quality with the present lack of transparency.
In a transparent healthcare system Medical Saving Accounts would provide more
incentive than Health Savings Accounts.
Presently President Obama is trying to eliminate Health Savings
Accounts. HSAs are the single greatest threat to his goal for a single party
payer system. They are also the fastest growing healthcare insurance product.
The lack of transparency for hospitals, healthcare insurance
companies, drug companies and physicians must be eliminated. The public must
demand that the healthcare insurance industry make their expenses transparent
so that its exorbitant salaries and profits can be clearly understood.
There is no reason that this one stakeholder receives 40% of
every premium dollar spent either by private corporations or the government.
The medical loss ratio as it is presently constructed by the Obama
administration provides 20% for expenses. The other 20% of the $40% is in the
direct patient care column.
The government should help consumers understand these prices and
understand the measurement of quality. Consumers of healthcare must be turned
into Prosumers of healthcare (Productive Consumers.)
When this happens the consumers can become independent
intelligent consumers. Consumers will become independent of government and its
The Obama administration wants consumers to be more dependent on
government not less dependent.
Intelligent independent Consumers will force the other
stakeholders to be competitive. Competition will drive healthcare costs down.
Government cost controls will not drive prices down. They will
simply distort prices and cause more spending.
Private sources such as Angie’s list help consumers decide on
which plumber to hire. It is important and creates competition and price
lowering. However the defect in Angie’s list is that it is based on other
It is not based on specific costs or origins of the cost to the
plumber or the measurement of the plumber’s skill. It only deals with price and
consumer satisfaction. Angie’s list does make plumbers competitive.
Competition for consumers will bring down the cost of healthcare.
By forcing consolidation of doctors and
hospitals Obamacare will decrease competition and increase prices.
policy wonks dismiss this concept because they believe consumers are not smart
enough or interested enough in learning to be intelligent healthcare consumers.
They are wrong.
Their thnking is correct if a system exists where consumers are
spending other people’s money. Obamacare is such a system. It will drive costs
up just as the private first dollar coverage system has driven healthcare
There is no financial incentive for healthcare consumers to try
to save money and preserve their health.
Obamacare is a huge entitlement with an overwhelming budget that
will be impossible to execute. We have seen that to be true with ever increasing
waivers and the most recent delay in the mandate until 2015. There will be delays in other critical
portions of Obamacare in the near future. It could be delayed forever because
it cannot be executed.
In my last blog I forgot to mention the delay in forming and
activating the Independent Physician Advisory Board.
I also wrote about Canadian consumers’ healthcare experiences in
two provinces I visited. The fact is the
system doesn’t work well and is unsustainable.
The Fraser Institute in a
2011 report concluded that Canada’s health care
system is spending money at an unsustainable rate. Six of ten Canadian
provinces are on track to spend half of their revenues on health care,
according to the institute.
By 2017, four more
provinces — Saskatchewan, Alberta, British Columbia and New Brunswick — will
spend half of their revenues on health care, according to the institute.
Total federal, provincial
and territorial government health spending has grown by 8.1 percent annually.
Canada’s GDP increased by 6.7 percent during the same period. The math is
obvious. The Canadian healthcare entitlement system is not working.
“In response to the rapidly
rising costs, provincial governments have raised taxes and rationed care,
increasing patient wait times. Provincial drug plans have also more often refused
to pay for most of the drugs that are certified as “safe and effective” by
“Unsustainable rates of
growth in health care spending crowd out the resources available for other
purposes including education, public safety, and economic growth-enhancing tax
relief,” Fraser Institute Senior Fellow Nadeem Esmail told The Daily Caller
News Foundation in an email.”
Only 20% of the people utilize the healthcare system at any on
time. If consumers know they are entitled to healthcare and the healthcare
system will fix them if they get sick, consumers of healthcare feel protected. The
feelings of eighty percent of consumers who are not sick believe the system is
great until they have to interact with the system. In this system of
entitlement consumers have a tendency to not take care of their health. This makes them more likely to interact with
the system in the future when they are very sick. The result is increasing
Once an entitlement is created it is almost impossible to
eliminate it even though it has proved ineffective and costly.
England’s NHS has shown this to be true. The NHS is struggling
right now to modify the NHS so it works better for physicians and patients.
However, the new reform rules have been contaminated with so many amendments
that I suspect no progress will be made.
Consumers are realizing that Obamacare is much too complicated
and impossible to execute. Rather than demanding repeal and eliminating the
concept of instituting an entitlement program, the New York Times is publishing
letters from readers that are demanding a single party payer system to simplify
Let us stop making the same mistakes over and over again.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
Please have a friend subscribe