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Hi Dr. Feld,

I'm in my residency in Canada and look forward to see where this blog takes you and your ideas!

I will try and comment when I have time in between on-call duties. I thought I'd add two early comments in this note.

The first is that I agree with your philosophy about personal empowerment in healthcare. Many years ago the providers were about 6-degrees of kevin bacon away from the patient. New concepts such as 'patient-centered care' are shifting that toward 2- or 3-degrees from true informed consumers of healthcare. I think the huge reforms will be seen as we get in the 1- or 2- degrees of separation between patient and healthcare - ie they make the informed decision to balance insurance costs/interventions/lifestyle etc.

The second point that all these academic articles (and newspapers like USA Today) fail to consider the question, Who drives health innovation? The answer is clearly the US. Canada and other single payer systems operate on a stall and defer investment until public outcry/tragedy. The US churns through various models pretty quickly (with many ill side effects), but does select for true innovations in delivery of care which is so different than the areas of biotech, devices, etc.

As much as Canada dislikes admitting it, we import all our health models after years of watching American experimentation in open delivery.

I would argue without an open model, the world would be decades behind in health innovations (public school comparison here?).

Just some early thoughts. Good luck!


ps - i also write some of my thoughts about health care IT on www.opennorthvc.com (i love learning about healthcare startups)

Could you please provide a reference that supports the 80% statistic ("Fixing the complication absorb 80% of the healthcare dollar")? I am not questioning this number, but I would like to read more about it. Thanks!

Dear Buddamouse

Here is a link to an article where Mark McClellan CMS Director calculated that 90% of the medicare cost is for chronic disease. This is a more recent figure than the 80% figure calculated by many previously.

It is a gigantic problem and a gigantic opportunity to save the healthcare system

Stanley Feld MD,FACP,MACE

This is a good start. Search the Institute of Medicine site and you will get additional confirmation.



Wanted to let you know that I have been reading your blog from the start, keep up the good work! On a personal note, happy 43rd to you and Mrs. Feld. Whatever your secrets to a long and happy marriage, we should try and bottle that, we could all use some. Also, Happy Father's Day!


Thanks for the comment.

The key is mutual respect and mutual trust.


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