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President Obama Please Re-examine Your Premises

Stanley Feld M.D.,FACP,MACE

President Obama’s goal might be for his healthcare reform plan to fail. Once it fails the default plan will be a public option with a single party payer system.

Everyone will be forced to opt into the public option. There will not be a private option.

The cost of healthcare will not decrease. The government will be paying the private healthcare insurance industry to administer the public option. Hospitals and physicians will figure out how to game the new system. The increasing costs will force a restriction to access to care.

President Obama must re-examine his premises. The medical care crisis is neither a Democratic nor Republican problem. It is an American problem. Americans need to be motivated to live a healthier existence. Only then will the cost of care diminish.

Consumers must be provided with education to live a healthier existence. The culture must be changed to emphasize better nuitrition and exercise.

Brad Feld pointed me to a fascinating paper by Carliss Y. Baldwin (Harvard) and (Brad’s mentor) Eric von Hippel (MIT). The paper suggests that some of the most basic theories on which the patent system is based are wrong. The thesis is our present patent system might hinder innovation.

The same logic can apply to the premises President Obama and his healthcare policy wonks apply to medical care. President Obama’s healthcare reform plan is punitive to both patients and physicians. It does not promote patient responsibility. It penalizes physicians for poor patient care outcomes.

Effective healthcare reform should promote patient responsibility and physician innovation. Inappropriate patient incentives and punitive regulations for physicians encourage patients and physicians to get around the healthcare reform system. President Obama’s healthcare reform plan does not achieve its goal of saving money and building efficient medical care systems.

A way to develop efficient medical care systems is through a consumer driven healthcare system with patients being in control of their healthcare dollars.

Nevertheless, President Obama’s healthcare plan is law. He won the election and forced through a partisan vote for a healthcare reform plan the overwhelming majority of the public and the physician community oppose. Only time will demonstrate the impending disaster in the healthcare system.

“Mindful that the new health care law’s ability to slow rising medical costs will depend to a great extent on how it is put in effect, President Obama is assembling a high-level team to carry out key elements of the overhaul and is considering moving faster than the law requires to put them into action. “

Kathleen Sebelius, the secretary of health and human services is reorganizing the Centers for Medicare and Medicaid Services. She is developing an innovation center whose goal is to test ways to reduce reimbursing providers.

She can enforce ideas she deems important nationwide without Congressional approval. The power of the secretary of health and human services has been expanded greatly without checks and balances.

She has started working on new regulations in an attempt control Medicare, Medicaid costs. She is also working on regulations to control independent private health care providers. President Obama wants an Independent Payment Advisory Board for controlling Medicare spending before 2014.

The problem with the Independent Payment Advisory Board is its total independence of congressional oversight. In the past Congress has ignored the Medicare Trustees’ recommendations to reduce costs. President Obama’s healthcare reform bill eliminates congressional oversight. Congress has not exercised its responsibility. However congress is accountable to the public and the Independent Payment Advisory Board is not.

The new board’s responsibilities will be in the hands of a 15 member board nominated by President Obama and confirmed by the Senate for the six-year term. The memberships will be full-time positions.

“Each year that Medicare spending exceeds annual targets, as most analysts expect it will, the board must propose ways to reduce payments to care providers.”

The Independent Payment Advisory Board provides Congress with an excellent opportunity to shirk its responsibility. The executive branch will have a firm grasp on control of the healthcare system.

“With the federal debt projected to rise to levels that many economists consider unsustainable, mainly due to growing health costs and an aging population, Congress might have little choice in coming years but to accede to unpopular limits on payments for doctors, hospitals and other health care providers of the kind that lawmakers have ignored in the past. The board would give them political cover to do so. “

“It’s a very promising structure,” said Peter R. Orszag, Mr. Obama’s budget director. “But like anything else in life, it’s what you make of it. So whether it realizes its potential depends on how it’s implemented.”

Tom Daschle, wants the board to be expanded to deal with not only Medicare but also all healthcare insurance.

Otherwise, he said, doctors will shift their costs that Medicare does not fully reimburse to patients with private insurance, “which really exacerbates the problem.

Tom Daschle said it. It is all about the government takeover of the healthcare system. It is about government regulating the healthcare system at the expense of all the stakeholders including patients. It is not about healthcare reform to produce efficient and safe systems of care through patients influencing physicians to develop innovative systems of medical care.

When was the last time a government controlled system was efficient and cost effective? Government should make the rules and then get out of the way.

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

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