Stanley Feld M.D., FACP, MACE Menu


The Role Of Government In Healthcare


Stanley Feld M.D.,FACP,MACE

I believe in the power of the free market if the rules are fair to all.  Logic and common sense should determine healthcare policy. I am suspicious of the validity of pilot studies designed to test healthcare policy initiatives. The studies usually are defective in their design. 

The rules of the free market in healthcare should be in favor of the consumer driven healthcare model . Physicians will listen to patients if the patients control the healthcare dollar. The primary stakeholders (patients) should own their healthcare dollar and their employer should continue to pay for the healthcare benefit. The healthcare insurance industry should not be in control of the healthcare dollar.

The proposed healthcare reforms of both presidential candidates cannot work because the healthcare insurance industry  controls the healthcare dollar and therefore the healthcare system.

Neither Presidential candidate has a chance at constructive healthcare reform.

In order for America’s economy to grow and prosper, America must promote the growth of a strong working middle class. A nation without a strong middle class having an opportunity to enjoy upward mobility is a nation that is stagnating and on the way to bankruptcy. The middle class has experienced a lack of growth lately because they have been disadvantaged to the benefit of the wealthy. They have been disadvantaged in healthcare, housing, finance, education and other social systems that have been declared broken.  Our artificial free market economies have rules that promotes the growth of narrow vested interests and stimulates greed.

The middle class must have the opportunity be educated. It must be provided with incentives to be innovative. It must have affordable healthcare and housing. These incentives must be available for all Americans. Education and health are our most valuable assets. America must develop a cultural atmosphere to encouraged citizens to practice civic and self responsibility. The environment must be free of pollution to protect citizens from disease and illness. The air that we breathe and the food that we eat must not be influenced by the greed of special vested interests.

In recent weeks we have experienced bailout proposals for our financial system.  The proposal initially ignored the protection of the middle class. In my view the first draft of the Bush bailout proposal was an insult to America’s intelligence. It favored special vested interests and furthered citizen mistrust of the federal government. The terms of the initial bailout were for the protection of Wall Street and not the protection of Main Street. The protection of Wall Street was supposed to trickle down to Main Street. The final agreement will hopefully have protections for Main Street  as well as Wall Street with no pork. These dual protections should have been embodied in the initial proposal. We should not reward corporate executives’ failure.

I have written to both John McCain and Barack Obama about my thoughts on Repairing the Healthcare System. All I have gotten back is pleas from both campaigns requesting donations. My input has as many other citizens’ input been ignored by both campaigns.

The media has characterized the presidential campaign and debates as a boxing match. The media count who outscored who on points. I hear platitudes but no specific proposals on how to protect the middle class.

I hear John McCain say he is going to fight and fight hard for the middle class as he has done for 28 years. The few specific proposals he has presented protect wealthy vested interests.

Barack Obama says he is going to look after the middle class at the expense of the vested interested  high wage earners and investors. He does not tell us how he is going to go about it.

John McCain says he is opposed to regulations yet deregulation has gotten us in the position we are in. He reversed himself at twhen it was obvious our economy was about to collapse. A few days earlier he said our economy was basically sound. He did not project the perception of knowledge of economics to America. 

It sounds like Barack Obama wants to fix everything with regulations.  We have seen historically that regulating everything does not work. A simple example is the failure and perverse effects of price controls. A true market economy works if the correct rules are in place for the benefit of all. I am against government regulations that are oppressive to incentives and innovation.

Our legal system is also broken. It is not easy to enforce the law. Corporations, organizations, and citizens get around the law if they can afford the legal expense at the expense of the middle class. There is little penalty for misrepresentation. Congress is controlled by lobbying groups. Who are the peoples’ lobbying groups? The congress should be the lobbying group for the all citizens. Instead, Congress is lobbied and influenced by vested interests.

Government should make and enforce appropriate and fair rules. It should get out of the way and let consumers drive the system. Americans are smart enough to purchase the best products for themselves given the appropriate information. 

I have criticized the healthcare insurance industry. John McCain wants to give the control of the institutions of Medicare and Medicaid to the healthcare insurance industry in order to eliminate this entitlement. The healthcare insurance industry does nothing for the middle class and small businesses and everything for its own bottom line. Obscene healthcare insurance executives’ salaries and corrupt payoffs occur at the expense of ordinary people.

Once again, it is healthcare insurance contract time for hospital systems and employers paying for healthcare insurance. Again, there have been examples of difficulty between the healthcare insurance industry, hospitals physicians and employers. Once again Unitedhealthcare  is using the same tactics they used in the Denver market last year. Neither Congress nor the State Insurance Boards have taken action to protect the middle class.


The headline in the Kansas City Star reported that

“St. Luke’s Hospital system in Kansas City and UnitedHealthcare go their separate ways as the price of healthcare insurance goes up and the coverage goes down.”

“In July, after a year and a half of trying to come to agreement, the nonprofit St. Luke’s — which encompasses 11 hospitals and several physician practices in the region — said it was done negotiating and would stop accepting United benefits after Feb. 28, 2009”

“St. Luke’s perspective, negotiations had been going on for a year and a half without significant progress. It announced a firm split with United in July so patients and businesses would have ample time to find new coverage if they wanted to stay in St. Luke’s network

Bonner, who is senior vice president of business development for St. Luke’s, said the increase the hospital asked for would have brought reimbursement rates from United in line with other insurance carriers.”

I suspect both are wrong. I suspect the negotiating tactic UnitedHealthcare uses is the same used in Denver. They yield when they start losing subscribers.

United, which has 504,000 “members” in northwest Missouri and all of Kansas, would continue negotiating if St. Luke’s came back to the table, Tracy said, but he admitted reconciliation is highly unlikely.”

“United’s insurance-carrier competitors said they are seeing a windfall. Since St. Luke’s announcement this summer, Humana has been writing about 40 policies a month for companies leaving United, said David Miller, president of Humana in Kansas and Missouri.

The losers are the middle class who would buy insurance if they could afford the premiums. The State Insurance boards must develop and enforce real  transparency rules for the healthcare insurance industry. If the rules are not followed the healthcare insurance company should lose its license to sell insurance in the state.  The rules must be made and enforced by the insurance board and state hospital boards before negotiation comes to this point. Presently, there is no simple mechanism for adjudications. State boards of insurance and hospital systems’ mandates must have effective consumer protection.

Patients are not included in the free market determination of price. They are the victims of a market price controlled by the healthcare insurance industry (secondary stakeholders).

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