Stanley Feld M.D.,FACP, MACE
No! He is not.
In the weeks to come I am going to point out the deficiencies in both
candidates thinking about healthcare. It is clear that neither has received
input from practicing physicians. Please click on the highlighted phrases for
more details on each subject.
I will start with Barack Obama because the Democratic convention is first.
I am astonished by the lack of scholarship and thoughtfulness on the part of
either Presidential candidate. The issues have been reduced to sound bites. The
pronouncements are picture words that generate false hope. Neither political
party is confronting the real issues and the necessary repairs. If any of their
proposals are passed into law it will simply be a patch. In the process the
proposals will destroy the vital and good elements of our entire healthcare
Both the Medicare and the Private Healthcare Insurance system have failed.
They have neither decreased costs nor improved medical outcomes. They have been
both economic and medical care disasters. The United States can no longer afford
the present course. Academically the reasons for the disaster are clear.
3. There are too
many monetary incentives in the healthcare system to maintain an inefficient
system for all stakeholders. (primary and secondary stakeholders)
measures directed at the weakest stakeholders (primary stakeholders) to
correct inefficiencies do not work and lead to greater inefficiencies.
5. The healthcare system must be constructed and run
for the benefit of the primary stakeholders.
as the primary stakeholders must be responsible for their health, and medical
care. Appropriate government subsidy must be provided, if warranted.
10. Actions should be taken by government across all areas of society (War
on Obesity) to educate
consumers to decrease the incidence of chronic disease.
The consumer must fix the healthcare system. None of the other stakeholders
has been successful. In fact, in the last 30 years the healthcare system has
been made worse by the insurance industry, government and policy makers.
All their systemic changes have failed because they have, for the most part,
been to the advantage of the facilitator stakeholders and not the primary
stakeholder, the patient. Facilitator stakeholders’ profits have soared,
insurance premiums have skyrocketed while access to care has plummeted.
Patients, physicians, hospital systems and the government have adjusted to
changes to the detriment of patients. The facilitator stakeholder adjustments
have resulted in further dysfunction in the healthcare system.
Presently, employers and all the stakeholders except for the insurance
industry are in pain. However, the stakeholder most at risk is the consumer.
Only 20% of the population is sick and interacts with the healthcare system at
any moment in time. 80% of the population does not interact with the healthcare
system. They think everything is fine. However, the entire populations’ health
and well being is at risk! If we stay on the present course, I predict the
system will break down completely. Access to care will be limited and rationed.
Access to life saving medical advances will vanish. Future advances in medical
care will disappear.
The goal of the healthcare system should be;
1. To provide patients
a. with access to good quality care
education to judge quality care
c. with incentives
to be motivated to be responsible for their medical care
d. with the freedom
to judge and select the physician of their choice
e. with the information
from their healthcare providers that is truly portable
f. with choice
of healthcare insurance vehicles that are affordable
g. with education
vehicles to become “Professors of their Chronic Disease” and be truly
responsible for their care
and affordable drug coverage designed to enhance patient compliance with
2. To provide physicians
a. with a precise definition of the meaning of quality care for various
b. with incentives to provide quality care for both acute
and chronic disease
c. with the educational opportunity and motivation to
improve the quality of care they deliver.
d. with an actual vehicle developed
by their peers to prove that they are delivering quality care.
e. with a
mechanism for delivering care at a transparent price
f. with the ability to
communicate with patients electronically.
g. with the
ability to improve the patient physician relationships
h. with the
ability to enable patients to practice effective self-management techniques to
prevent costly complications of chronic disease
i. with the ability to
improve communication and access to patient information so as to reduce the cost
of redundant evaluation and treatment
3. To decrease the overall cost of the system
4. To eliminate the 47 million uninsured
5. To align stakeholders’ incentives
6. To provide satisfactory profit margins for hospitals, pharmaceutical
companies, insurance companies, and physicians.
These are ambitious goals. Processes must be changed in order for the United
States to deliver effective health care to the population now and in the future.
Consumers can not leave it up to the facilitator stakeholders and policy
wonks to fix the system. Their policies have distorted the healthcare system in
the past to serve their vested interests. Patients today and in the future must
drive the process of change through appropriate demands on our politicians in
order to repair our healthcare system and install an effective consumer driven