Stanley Feld M.D.,FACP,MACE
Both Presidential candidates have claimed they have specific proposals for change for many policies. If we decide on whom to vote for on the basis of healthcare policy we will be making a mistake. They both want to change the wrong things. They also have not given us an idea of how they are going to execute their promised changes.
Neither candidate is going to have a positive effect on Repairng the Healthcare system because they are focused on the wrong changes. If they can get congress to approve of any of their proposals, they will only make the healthcare system worse.
My last ten blog entries have reviewed both Barack Obama’s and John McCain’s healthcare proposals specifically. I am disappointed in each candidate. Neither is focused on the basic problems in the healthcare system
Both candidates advocate universal coverage. Barack Obama wants universal coverage with a single party payer.
The sound bytes Barack Obama uses suggests a competitive environment between the government and the healthcare insurance companies. If the government was serious, the healthcare insurance industry would not want to compete. The rules and regulation promised would be intolerable. They would rather run the single party payer system for the government.
John McCain is against entitlements. His goal is to shift the burden of acquiring healthcare insurance to the citizens. John McCain plans to provide tax credits to citizens. The tax credits are suppose to be used to purchase healthcare insurance. In affect, John McCain wants to relieve government and employers from providing healthcare insurance for their constituents and employees. The sound bytes John McCain uses suggest that all citizens will have the opportunity to buy healthcare insurance. This is not quite universal coverage. His tax credits are not large enough to buy the healthcare insurance even if consumers could afford it.
The basic problem is the healthcare insurance industry will set the price of the insurance premiums as it does in the present system using antiquated actuarial systems and bloated administration fees. This is a basic problem in the healthcare system. Neither candidate is focused on this problem. Neither candidate respects the consumer’s ability to manage his own healthcare dollar.
The cost of universal care in Massachusetts has doubled. Massachusetts outsources the universal healthcare insurance coverage to a couple of insurance companies. Government officials in Massachusetts claim the reason for the high premium costs is more people are obtaining subsidized insurance than anticipated. Economics 101 dictates that the more people are insured the less the premium should be. Unfortunately, the healthcare insurance company controls the money and the bids.
Consumers should own their healthcare dollar. They do not need first dollar insurance coverage. Consumers should manage their own first dollar coverage. The first dollar coverage should be funded by their employer or the government, tax free. This would eliminate the insurance companies’ administrative cost for the first $6,000 in healthcare coverage. If consumers do not spend the first $6,000 the remainder would be deposited in a tax free retirement trust fund. It would not be deposited in a health savings account to be paid back to the healthcare insurance industry for future co-payments and deductibles.
Consumers would then be motivated to use the first $6,000 wisely. They would be motivated to remain healthy. If a patient had a chronic disease that required medical care and spent $4,000 to avoid complications of their chronic disease, the employer or the government would provide a bonus for their retirement trust. If a patient developed a chronic disease and spent the first $6,000 then the high deductible insurance would provide first dollar coverage for the remaining expenses.
Consumers responsible for their own healthcare dollar would then shop for the best treatment at the best price. They would also be motivated to stay healthy and exercise regularly, The economic gain would motivate consumers not to smoke, drink or become obese. Consumers would also be motivated to demand environment clean-up in order to protect their health. Politicians might listen. There is no reason Dallas, Texas should be out of EPA compliance except for the polluting effects of coal plants. Soot and cigarette smoking cause chronic lung disease and asthma. Consumers would demand rapid change if they were denied being rewarded for staying healthy because of circumstance beyond their control, but in the hands of the politicians.
This innovative healthcare plan would eliminate the healthcare insurance industry’s excessive administrative costs for the first $6,000, provide incentive for healthcare insurance companies to compete for highly profitable high deductible insurance plans , and provide incentive for consumers to be responsible for keeping themselves healthy. It would also provide incentive for physicians and hospitals to become more efficient. Consumers would be shopping for the best care at the best price. The government would have to force and enforce real transparency. If stakeholders were not really transparent they would be denied a license to sell insurance, hospital services or physicians’ services in that state. The states, not the federal government must be in charge. Insurance premiums would have to be calculated on a community rating basis. Electronic medical records must be uniform and interchangeable. EMR software should be distributed via the web download. So should electronic prescriptions software. Physicians should pay for the software by the click. This would promote rapid adoption and avoid unaffordable capital expenditures. Compliance by physicians and patients should be rewarded, not like present proposals for punishing non compliance.
In my review of the Presidential candidates’ healthcare plans none of these solutions are mentioned. Instead, both candidates make proposals that are not well thought out. They do not offer basic solutions. They do not motivate or trust consumers to be responsible for their health.
The consumers’ healthcare dollar should be under consumer control. They have to be taught how to use their dollar wisely. The government should set and enforce rules to prevent abuse by the vendors. America’s healthcare crisis will not be solved until a leader listens to the primary stakeholders, the patients and the physicians.