Stanley Feld M.D., FACP, MACE Menu


Dear President- elect Barack Obama: Part 5


Stanley Feld M.D.,FACP,MACE


Obama Asks Nation for Input On Reforming Health System

‘We Want Your Exact Ideas,’ Daschle Says

I believe Tom Daschle and your healthcare team have preformed ideas on how to repair the healthcare system. Some are good ideas but most are poor ideas. The bad ideas will not work and only make things worse. Their business plan is rooted in an old paradigm. Your administration should change the business plan so that it enables patients to be responsible for their own health and their healthcare dollars.

Here are my exact ideas:

Let’s use common sense to create an innovative system to repair the healthcare system.

In my last letter to you I promised to describe the basic problems causing the dysfunction of the healthcare system. I have previously stated that all the stakeholders are at fault in causing the dysfunction. The biggest villain is the healthcare insurance industry. Government healthcare programs are dependent on the healthcare insurance industry to be the administrative service provider. The healthcare insurance industry’s lack of real financial transparency is the cause of major increases in healthcare costs.

The social contract in the healthcare system is between patients and physicians. If we did not have patients and physicians we would not need a healthcare system. Patients should drive and control the healthcare system. They should not be the victim of a dysfunctional system.

Patients should be responsible for their well being (health) and medical care. Presently, patients’ do not have incentives to be responsible for their health. This attitude can be changed by providing financial rewards for health maintenance. If patients owned their healthcare dollars and had the ability to keep the unspent money in a tax free retirement trust account patients would become skilled purchasers of healthcare. If patients had a pre existing illness and spent the required amount of money to avoid complications of their chronic disease they should receive a reward of additional money. There will be consumers who abuse the system but these outliers should be easy to spot.

Tom Daschle’s plan should be focused on letting patients own and control their healthcare dollars. If he could shift his focus to this concept your administration would be on the way to a solution to fix the system rather than extension of policies that are destined to fail. Massachusetts’ universal care system is a perfect example of healthcare policy that is destined to fail.

How do you get consumers have incentive to be cautious about their health and their healthcare dollar? If s were responsible for the first $6000 of their healthcare insurance dollar you would see a marked reduction in the costs to the healthcare system.

Your administrations should teach consumers how to spend their healthcare dollar wisely. You should also be concentrating on decreasing society’s hazards to our health in a serious way. This approach would be much better than creating a Federal Health Board that dictates access to care.

Repair of the healthcare system could be achieved by instituting my ideal medical saving account. The federal government would end up spending less money and improving care. Patients will be motivated to take better care of themselves. They would be motivated to shop for the best care rather than having care dictated by a panel of experts.

Your administration must create a system where patients are the deterrent to abuse in the healthcare system and not the government. Patients can do it more efficiently. Your administration can set the appropriate rules and regulations.

A recent article in the Journal of Clinical Endocrinology and Metabolism showed that 20% of hospital admissions have undiagnosed diabetes mellitus. These complications could have been prevented if the patients knew they had diabetes and knew how to control their blood sugars before the complications. This awareness could be achieved with the government promoting public service announcement and developing a system of cultural change. I referred to Mayor Blumberg’s subway campaign in my War on Obesity.

Physicians need to be put in a position where they compete for patients. This would result in better service and better care. Punitive damages imposed by your healthcare team will not encourage physicians to excel. It generates more anger and mistrust among your workforce (physicians).

How about some malpractice relief to decrease the national burden of defensive medicine?

How about some recognition for pursuit of excellence by ordinary practicing physicians? The practicing physician is your major workforce and not you academic experts who will be the judges in your Federal Health Board. Recognition is a non punitive way that will encourage physicians to excel.

How about medical informatics crafted as an extension of the physician’s care? Many physicians are opposed to internet information because there is so much junk on the internet. If the information came from the physician’s personal site it would be easier for physicians to put the patient’s disease into clinical perspective.

How about the government providing a universal Electronic Medical Record? The administrator can charge physicians by the click rather than physicians making a capital expenditure they cannot afford. E-prescribing capability should be provided in the same way. The federal government provided us with Electronic billing in the 1980’s and its implementation has worked well.

Money will be saved by creating a better system and not creating a more bureaucratic system.

I hope you will seriously consider implementing some of my suggestions and decrease the fixation on building a consensus without the practicing physicians’ input using the wrong ideas to create healthcare policy. These policies are destined to fail.

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