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The Republican Misguided Alternative to Obamacare


Stanley Feld M.D., FACP, MACE

Several important ideas can be derived from the Republican’s preliminary alternative to Obamacare.

Obamacare had been poorly conceived. Its execution has been worse.  Obamacare was developed by academic policy wonks that had no idea of  the culture of the physician practice community.  

These academic health policy wonks designed a system that is rigorous in the sense that outlines how all physicians should practice medicine. Physicians should use algorithms outlining this year’s best practices as developed by the interpretation of this year’s best clinical studies.  Obamacare was designed to measure physicians’ performance and inhibit physicians’ judgment. Healthcare policy wonks decided that the only way to accomplish this was by demanding an integrated care.

In order to effectively measure physicians’ efficiency, physicians must be under one hospital system. Physicians’ efficiency should be measured by a hospital’s bureaucrats. The government should control the rules and regulations. The set-up was satisfactory to President Obama because his goal was always central control of the healthcare system along with a single party payer (socialized medicine)

 If a hospital system performs better than some goal set the year before it gets a modest reward and shares it with the physicians on staff.  If their performance is more costly than the previous year they will be penalized.

This is a bad formula because success depends on the hospital staff, the physician staff and patient performance. Patient performance is not measured in Obamacare. No one even considers the patient’s responsibility to effectively improve outcomes of care.

patients are being treated as commodities. Physicians are being treated as commodities.

Patients are run through a bureaucracy with various physicians and physician extenders. They do not have one doctor caring for them.  The system is not going to improve patients’ knowledge of their disease or improve their outcomes. Patients must have ownership in their diseases.

All one has to consider is President Obama’s lie “if you like your doctor you can keep your doctors,” along with the tremendous growth of concierge medicine and out of pocket medical expenses since Obamacare was passed.

Concierge medicine adds $2,000 to $10,000 dollars to consumers’ out of pocket expense for the patients desire to have the ability to have contact with their their doctor and their desire to have the ability have questions answered and care coordinated by their doctor.   

Positive physician/ patient relationships will improve outcomes and decrease the cost of care.  

Most of the practice of medicine and surgery has been performed by independently practicing physicians. 

No one in the Obama administration has asked leading physicians in the practicing community what they think should be done to fix Obamacare.

Neither has the Republican Party listened to leading physicians in the practicing community about what should be included in their alternative to Obamacare.

I suspect the Republican leadership in the Senate is ignoring the few Republicans in the house and senate who were practicing physicians.

I know Rep. Michael Burgess, MD (R-TX-26) OB/GYN. Both Michael and his father used to send me Endocrine consultations when we all were in practice. I think the Republican leadership in the Senate has probably marginalized Michael  and the nine other Representatives  in the GOP House’s Doctors Caucus.  

Michael knows what has to be done after Obamacare is repealed and replaced. So far the GOP house caucus has only produced generalities.

he GOP Doctors Caucus: Utilizing medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

The Republican congresspersons as well as President Obama and Democratic congresspersons have left out the most important elements necessary for real healthcare reform.

The maintenance of the physician/patient relationship, with built in consumer responsibility for their own healthcare maintenance plus consumers’ responsibility for their own health and healthcare dollars, whatever their income, is the key to Repairing the Healthcare System.

Congress should pass a law with a light bureaucracy that provides a subsidy for the qualified indigent to receive healthcare insurance and financial incentives to stay healthy as well as education to learn to manage their chronic disease.

Effective Healthcare reform must include financial incentives for consumers to remain healthy.

I will review the Republican Party’s proposal in my next blog. They have some good ideas.

However, the Republican Party totally misses the key elements needed to  Repair the Healthcare System

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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