Stanley Feld M.D.,FACP,MACE
The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important improvements to both programs without limiting eligibility or benefits by:
• Integrating low‐income families with dependent children into higher‐quality private plans through direct assistance
What is the definition of higher-quality private plans? Who is going to judge quality? How is government going to fund these “higher quality private plans?”
• Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans
How will this be accomplished when Medicaid reimburses so poorly. There is a shortage of Medicaid physicians already. These physicians must do a volume business (Medicaid Mills) to make ends meet. These volume practices (Medicaid Mills) are being investigated for fraud.
• Realigning responsibility between federal and state governments in order to better coordinate benefits by requiring the Medicare program to assume Medicaid responsibility of premiums, cost‐sharing, and deductibles for low‐income seniors
The above is just words. It almost sounds as if the federal and state government are going to be responsible for increased funding for private enterprise.
• Rebalancing long‐term care services to ensure choice between institutionalized and home‐based care
• Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage
Medicare Advantage is recognized as an insurance product designed to rid the government of the Medicare entitlement . The government under the Republican administration paid an extra $3,000.00 per person to outsource the responsibility for Medicaid from the state to the healthcare insurance industry. The cost is unsustainable. Excess profits flow to the healthcare insurance industry.
• Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to
physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction while reducing costs
This is a “pay for performance a system” that ultimately cannot work because of intrinsic defects in the pay for performance concept. Quality medical care has not been defined appropriately. Is it defined as medical outcomes, financial outcomes, number of test performed or disease discovery?
• Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D
Medicare Part D is a poorly constructed in the present form. It is written to the advantage of the healthcare insurance industry, the pharmacies and the pharmachuetical companies. It is not a patient centric plan.
Ensuring Compensation for Injured Patients
Our current legal system does a poor job at compensating patients for medical mistakes in a fair and efficient manner. Instead of nurturing an environment where medical professionals can openly learn from their mistakes, our legal system often forces doctors and patients into contentious courtroom disputes. The Patients’ Choice Act would reform this broken system that helps drive health care costs out of control by:
• Encouraging states to adopt a number of legal alternatives entirely run by the state that would include the establishment of expert medical panels to resolve disputes, creation of health courts, or a combination of both
This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.
Establishing Transparency in Health Care Price and Quality
For a vibrant health care market to function properly, patients must know what services cost and who provides the best service. Uniform and reliable measures of reporting quality and price information should be designed by the stakeholders in health care rather than the heavy‐hand of government. The Patients’ Choice Act would bring this much needed transparency into the health care market by:
• Creating a Healthcare Services Commission that relies on a public/private partnership to enhance the quality, appropriateness and effectiveness of health care services through the publication and enforcement of quality and price information
• Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality with the input from all major stakeholders in health care, as well as the general public
• Ensuring that measures of effectiveness keep pace with innovation
This is the most logical proposal in the plan. It also contains specific action points. However it keeps the power in the healthcare insurance industry’s hands. It should put the power in the consumers’ hands. If the private sector (healthcare insurance industry) does not cooperate, it should be restricted from selling insurance by the state board of insurers.
There is the entire proposal. There is nothing new and no outline of action to accomplish any part of the proposal.