Stanley Feld M.D.,FACP,MACE
“The President’s $634 billion "down payment" on health care reform in his proposed budget depends on raising taxes and saving money largely through administrative payment changes in existing entitlement programs. That is not exactly fundamental reform.”
John Goodman’s analysis of Nicholas Kristof New York Times editorial is perfect. He starts off by saying: “I have observed before that when people start talking about health care their I.Q. tends to fall about 15 points.”
“The same error in reasoning appears in almost every speech on health care given by Barack Obama and by just about everybody else on the political left as well.”
I am not interested in partisanship. I am only interested in logical problem solving. If a plan for medical treatment makes sense and has good clinical evidence to prove a positive outcome, I am for it. The same applies to solving social and economic problems.
President Obama’s healthcare team is in the process of formulating a plan that is not logical . The healthcare plan has not succeeded in the past and will fail at a greater cost to taxpayers and society.
John Goodman has outlined the logic used by Nicholas Kristof and the administration to justify the validity of the administration’s healthcare reform plan.
Classic syllogisms are taught to every high school student ;
All men are mortal
Socrates is a man
Therefore Socrates is mortal
John Goodman points out the syllogism used about by Nicolas Kristoff and the administration:
Whoa! Something’s wrong here.”
You bet there is something wrong. It is not logical. The proposed solution of taxing the rich does not follow expanding failed programs (Medicare and Medicaid).
President Obama’s healthcare reform proposal;
1. Down Payment or Unknown Costs
President Barack Obama’s budget sets aside $634 billion over 10 years in a health care reserve fund, which is earmarked for the enactment of unspecified policies intended to bring down costs and expand coverage but its true costs are still unknown..
The congressional budget office’s estimates are much higher.
2. Key Provisions in the Health Care Budget
Higher Taxes. The President is proposing tax increases on those making over $250,000 annually. This revenue is projected to finance approximately half of the projected health care spending, an estimated $318 billion.
The President’s healthcare team is proposing to throw money at a broken system and use the tax increases to pay for it. The result will be a further increases in future taxes. President Obama should be developing a healthcare system that will provide incentives to the primary stakeholder (consumers) and promote innovative thinking and behavior by the other primary stakeholder (physicians) to promote efficiency and decrease costs.
His plan does not initiate real change in the healthcare system. The government will still outsource administrative services to the healthcare insurance industry. The healthcare insurance industry will still control the healthcare dollar.
3. Medicare Private Plan Payment Changes.
4. Medicare Prescription Drug Premiums.
Under this proposal, higher-income seniors would pay higher premiums than lower-income seniors for Medicare Part D prescription drug coverage.
Medicare Part D is presently too expensive. Its premiums have tripled in the last two years. Medicare Part D has benefited the healthcare insurance industry. The healthcare insurance industry’s net profit is $5 billion dollars per year. Only 20% of Medicare patients participate.
5. Medicaid Prescription Drug Payment.
6. Medicare Payment Changes.
“Systemic delivery reforms, such as "pay for performance" (where physician and hospital reimbursement are tied to compliance with government practice guidelines), are intended to result in securing better value for dollars.”
Similar “reforms” have lead to providers adjusting by gaming the system. Centralized medical decision making in Washington will lead to political manipulation of the system by healthcare lobbyists. It does not repair the healthcare system.
7. Medicaid Family Planning.
8. Prescription Drug Re-Importation.
President Obama’s healthcare plan does little to empower the patient. It does little to change our healthcare system’s flawed public and private payment system. The power to manipulate the system’s payment remains in the healthcare insurance industry’s hands. Its appeal is to the populist notion to “soak the rich” to help the poor. It does not add value to individual freedom of choice and ability to secure valuable healthcare. It does not repair the healthcare system.
If President Obama really wanted to repair the healthcare system he would place control and decision making for healthcare needs in the hands of the consumers and their families.