Stanley Feld M.D.,FACP,MACE
The healthcare system cannot be fixed using a
broken business model.
It can only be fixed by changing the business
model to a consumer driven business model that would include personal
responsibility and individual freedom of choice.
President Obama believes the healthcare system
can be fixed by a single party payer system run by the government.
I do not believe the government has run things
very well. Many examples come to mind in many areas. Two recent examples are
the Fast and Furious scandal and the lack of security for the murdered ambassador
in Benghsi Lybia.
When things go bad with government policy it is
difficult to discover the reasons. I believe consumers are very hesitant to
trust the government to make their healthcare decisions for them. On the other
hand consumers would be happy to allow the government and taxpayers to pay for
their medical costs.
A cultural shift in the healthcare system must
occur. The shift must be toward
individual responsibility. Consumers must be responsible for their health and
their healthcare dollars if Americans are to be healthier and the cost of
healthcare decreased. The government must allow and encourage the introduction
of innovative forms of healthcare insurance.
The role of government must be to educate
consumers maintain health and to be smart purchasers of healthcare insurance.
Government should make the rules so secondary stakeholder cannot take advantage
of the primary stakeholders (consumers)
and then get out of the way.
Government should help those who are less well
off with subsidies and equal access to medical care. Consumers must be
financially incentivized to take responsibility for their health or healthcare
dollars. They must not be penalized if they do not take responsibility for
their health and healthcare dollars.
I presented a new healthcare business model a
few months ago. It deserves to be restated.
This is the way the healthcare system looks
Since 1965, as a result of government intervention,
healthcare costs have escalated. This escalation has been the resulted of
increasing government intervention over the years. The path to accelerated
collapse of the healthcare system has started.
The result has been destruction of the patient-physicians
relationship. Effective medical care has been disrupted along with the
impersonal fragmentation of care.
President Obama’s goal is to have a single
party payer healthcare system. He believes this is the only way to an efficient
He realizes he cannot achieve this goal immediately.
He must do it one step at a time.
The methodology he is using will not work. He is imposing an accountable care
organizations model onto hospital systems and large physician practices. He
plans to pay one fee for certain diseases based on financial outcomes.
The fee is to be divided between the
stakeholders. President Obama wants to collect data to evaluate and direct
physicians and hospital systems care.
It sounds good but it will not work because he
will encounter physician resistance.
He wants to make cost effective judgments about
patients care without giving patients the right to make their own decisions.
It is going to very difficult to divide the
shrinking pot of money between physicians and hospital systems.
President Obama refuses to admit that the
government outsources the administrative services to the healthcare insurance
industry. The healthcare insurance industry’s fee for this service is about 40%
of the healthcare dollar.
In a recent debate he again stated that CMS’s
overhead is very low at 2.5%
President Obama’s ACA (Obamacare) is proceeding
with the same business model that has failed except he wants complete control
and no competition. If the U.S. continues with the same business model the total
collapse of the healthcare system will accelerate.
The healthcare system is at a critical turn.
The disadvantages of President Obama’s healthcare reform act are obvious. The present
healthcare systems model has lead to all of the disadvantages on the above list.
It is going to take many years to get an
accountable care organization to effectively function if at all. It will take
many years to have a fully functional EMR installed in every hospital system
and physician’s office. If something is not done to correct the business model
we will experience total collapse of the healthcare system.
Two things have to happen to change course. The
business model has to change to transfer power from the government to the
The healthcare system is good at curing
infectious disease and replacing kidneys, lungs, livers or hearts.
The big question is, “how does the healthcare
system prevent disease from occurring?”
The greatest expense is diseases that can be
prevented such as diabetes mellitus and heart disease. The root causes are not
preventable yet because they are genetic. The expression of the diseases and
its resultant and costly complications can be prevented.
Obesity causes the expression of these diseases.
The avoidance of obesity requires a drastic change in society’s food industry
Americans have been programed over time to eat
more calories and do less activity. There is no quick fix for obesity. People
must eat less and be more active in order to lose weight.
The government has not devoted adequate
resources for education and innovation to change this culture.
Mayor Bloomberg had the right idea by
decreasing the size of the soda pop being sold in N.Y.C. but his approach is
He must use education and provide real incentives.
He is trying to legislate behavior. It has never worked in the past.
Americans’ attitude toward food must change by creating
hype for decreasing intake and increasing exercise tied to financial
incentives. Penalties do not work. Incentives and freedom to choose does work.
This is the main problem with President Obama’s
business plan for the healthcare system. He is imposing his will on the
consumers, hospital systems and physicians.
It will not work. It must stop now because it
is unsustainable for taxpayers.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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