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Where Is The Transparency and Accountability In Obamacare?


Stanley Feld M.D., FACP,MACE

President Obama where is your promise about transparency and accountability in Obamacare?

A major problem in the healthcare system is the lack of transparency and accountability. It has been unchecked for a very long time.

Both primary and secondary stakeholders act in their self-interest. These stakeholders have had ample opportunity to be non-transparent and non-accountable. All the stakeholders have abused the healthcare system. 

I hit a nerve with my last blog “Patients And Physicians Must Control Costs”. Multiple readers responded with the usual comments:

Patients are not smart enough to handle their own healthcare dollars.”

“Your basic idea makes sense, but in reality I doubt that a patient knows enough to make intelligent medical/financial decisions, because there are too many unknowns and variables.”

“Physicians over use the fee for service system in order to make more money.”

“If a physician tells a patient that there is only a 1/10,000 chance that an MRI will yield something useful, if the patient doesn’t have to pay for it, the patient wants the MRI. 

 Patients (consumers) must be taught and motivated to manage their own healthcare dollars. Patients’ choice can create competition among physicians and other stakeholders for the consumers’ benefit. Consumers can force the entire healthcare industry to be transparent and accountable with the appropriate government support. 

In 2011 with an ever-evolving consumer oriented Internet few consumers would  buy appliances or electronic gadgets without reviewing the many comparative reviews by experts and consumer peers on the Internet. 

If consumers feel their plumber is ripping them off, they would join Angie's List to find a new plumber. Angie's List has forced transparency and accountability on plumbers in order for them to stay in business. Angie’s List has empowered consumers.  Consumers who do not care about being ripped off can continue to use those non-transparent non-accountable plumbers.

The hotel and restaurant business has experienced the same with consumer driven Internet sites such as Trip Advisor and Open Table. Many other B-C Internet sites have empowered consumers to make choices for their advantage. 

This is called free market forces. It can happen in medicine. It must happen in medicine. It is not wishful thinking.

Americans do not want politicians and bureaucrats to make their healthcare decisions for them. 

President Obama and Dr. Don Berwick are not interested in market forces or in respecting congresses constitutional responsibility. They are interested in dictating healthcare policy by executive order. One such executive order has recently created a political storm in congress.  

“Democrats and Republicans are joining to oppose one of the most important features of President Obama’s new deficit reduction plan, a powerful independent board (independent Physicians Advisory Board) that could make sweeping cuts in the growth of Medicare spending.

"Last week, in his speech on deficit reduction, Mr. Obama said he wanted to beef up the board’s cost-cutting powers in unspecified ways should the growth of Medicare spending exceed certain goals."

President Obama’s goal is to have an unelected commission make healthcare decisions for the electorate without the check and balance of the electorate or congress. 

Representative Allyson Y. Schwartz, a Pennsylvania Democrat prominent on health care issues, said: “It’s our constitutional duty, as members of Congress, to take responsibility for Medicare and not turn decisions over to a board. Abdicating this responsibility, whether to insurance companies or to an unelected commission, undermines our ability to represent our constituents, including seniors and the disabled.”

President Obama doesn’t care. He is going to ignore the protests from both Democrats and Republicans.

Congress has given him the authority to do what he thinks best with its passage of his healthcare reform act.

Britain is turning away from the National Health Service and its Independent Physicians Advisory Board called the National Institute for Clinical Excellence (NICE). It has not saved money.   

Both Democrats and Republican have realized they have given President Obama too much power. 

 Because Britain is an entirely socialized medical system, NICE wields power over the health care options of all residents of Great Britain.  IPAB, initially, will make decisions regarding only the government-administered programs of Medicare and Medicaid. 

Americans have more freedom of choice at the moment. This freedom will disappear if President Obama gets his way.

 NICE is "health cost watchdog" that assesses everything medical, from new technologies to drugs and clinical procedures, and issues guidelines for their use by the NHS. These guidelines include criteria by which certain patients will be made ineligible for both routine and life-saving procedures. The method is known as Comparative Effectiveness Research and Evidence-Based Decision Making

“Our insurance companies weigh costs as well, but there is a difference. If your insurance company denies access to a procedure you feel you need, you have recourse through the company's own appeals process and, if need be, the judicial system. Both parties to the dispute have incentive to reach an accord: the patient wants to get well, and the insurance company's wants to avoid subverting its profit motive through legal action, which says nothing of the bruising a lawsuit lays upon its commercial image.

When you are denied a test or procedure in the British system, you get to ask them to reconsider…and then you are invited to go pound sand.” 

To President Obama this advisory board is the first step in his non-transparent quest for complete control of the healthcare system by the executive branch of government.

How many of you ever have reviewed a hospital bill or doctors bill after Medicare or private insurance have paid? How many of you have concluded that the bills are incomprehensible?  

Physicians, just as patients, receive EOB (explanation of benefits). Physicians’ EOBs are equally as incomprehensible.  

Physicians, hospitals, insurance companies, and pharmaceutical companies must be accountable for their charges and treatment recommendations. 

Why should a cancer treatment cost $37,000 per treatment? How much money did Medicare or Aetna pay that provider for that $37,000 treatment? How much did the provider pay to the pharmaceutical company for the medication? What should the true cost of the medication be? How much did the provider mark up the charges to the patient?

It is easy to remember the $45 dollar aspirin charges by hospitals.  What was the mark ups along the way? Are there providers in the area that charge less and get comparable results?

An Independent Physicians Advisory Board could do all the research for consumers (patients). It could help patients decide on the value of the treatment. It could allow for consumer input as does Trip Advisor and others.

All the information should be available to consumer on the Internet by either the   government agency or a private organization. 

There should also be an effective appeals process for the provider. 

 Consumers should make their own choices and not be forced to be dependent on the government for their healthcare choices.

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



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