Stanley Feld M.D., FACP, MACE Menu


Reality Vs. Fantasy

Feld M.D., FACP, MACE.

I’m Busted” ,my last blog, generated
several interesting comments.

The comment below was a
standout. It represents a total disregard for historical understanding of what
made the healthcare system totally dysfunctional.

It is obvious from the
comment that this individual has not gone to any of my links in the blog nor
has he been a long time reader. I suggest he read the letters I sent to
President Obama at the time after his first election.

“We’ve been through
this before Dr. Feld.  While your generation was/is in charge of the U.S.
Healthcare System our Quality has Sunk and the Costs have Risen
Dramatically.  ( )” 

Physicians are not in charge of the healthcare
system.The government and the healthcare insurance industry is in charge.

I could not open the link this reader sent. He goes on to say,

 “ Take Some Responsibility for this Healthcare
Mess.  Stop Crying and Placing Blame on those searching for Workable
Options to Fix What You Proudly Created.  Please share this with your
readers.  Stop being so one-sided. 



I have stated innumerable times that all stakeholders including
physicians are responsible for the dysfunction in the healthcare system.

Key to the understanding of the healthcare system's dysfunction
is the need to understand the evolution of the dysfunction
. I cover the history
in my summary blogs. 

The dysfunction in the healthcare system started in 1965 with
the passage of Medicare.

Every subsequent government regulation was followed by a more
expensive reaction to the regulation by the stakeholders.

Life was simple pre
1965. The healthcare social contract was between the patient and the physician.


  •  Personal Care – The Physician Knew Me And
    My Family
  •  The Healthcare System Was Efficient – Consumer
  •   It Was Adequate for 90% of Medical Problems
  •   It Was Democratic
    – Rich & Poor


  •  Lifespan / Expectancy – Short
  • Lived
    Unhealthy Lives
  • Misdiagnosed
    Many Illnesses- Lack of Technology
  • Limited
    Body of Knowledge- Limited Treatments And Drugs


Patients made their own healthcare decisions. Patients and
physicians had positive relationships.

This positive patient/physicians relationship is 50% of the therapeutic

As the medical knowledge base increased more money was pumped
into the healthcare system thanks to Medicare. Secondary stakeholders were
needed to deal with the increase in money and complexity. Soon these secondary
stakeholders began to dominate the healthcare system.

 Secondary stakeholders have disrupted Patient/physician
relationships. These stakeholders have created large barriers between
physicians and patients.



Both patients and physicians have become commodities. In its
present form, the healthcare system, as it has grown in complexity and expense
has precipitously diminished physicians’ control over his medical care and his
ability to apply his medical judgment.

Obamacare is adding more layers of complexity to the healthcare system
to an already dysfunctional healthcare system.

Obamacare will be difficult to execute and impossible to

When the reader says, “Stop Crying and
Placing Blame on those searching for Workable Options to Fix What You Proudly

 I am not crying. I am sad for patients and their
future medical care within the Obamacare healthcare system.

I am trying to get consumers to see the inevitable.

Past evidence has proven that when government
controls and operates any systems the actions proposed are unworkable and unenforceable.
The result is great costs and more inefficiency.

 The healthcare system’s incentives will only be aligned
when the system is consumer driven
. The government must support but not control
the healthcare system.

The government should set the rules to align
incentives and then get out of the way.

I have made a strong case for consumer driven

The healthcare system model the government brags
about is the VA Hospital System model.

Recently the VA has received bad press in the traditional
mainstream media.  VA public relations
department has tried to marginalize the criticism.

It has also tried to compensate for the criticism
by outsourcing medical and surgical care to the private sector with success.

 Elise Cooper’s article in the American Thinker:
VA: a Culture of Disconnect”
says it all. I will add to her title “Coming Our
Way” with Obamacare.


  • "Many veterans feel disconnected with the VA.
    They regard it as a huge bureaucracy that is very impersonal
    and unhelpful. The vets get frustrated because they do not know where to
    turn for help.”

veterans and others involved with the VA to reveal some personal examples and
to see if the complaints are justified

I will discuss in detail these interviews shortly.
I will say the complaints are justified.  

America is running out of time to repeal Obamacare.
Consumers have to wake up now and see what it is doing to their healthcare
system, their taxes and their economy.

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

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