Stanley Feld M.D.,FACP,MACE
President Obama is pushing a healthcare reform plan that will fail. However something has to happen and he is creating a populous uprising.
The reason it will fail if his healthcare reform plan is passed is the government cannot afford to pay for Medicare coverage for all. . Expanding coverage to the entire population will create bigger unsustainable defects in addition to the present unsustainable defects for seniors.
Private corporations and small businesses cannot afford to pay for private healthcare insurance coverage either. It is looking for a way to unload their private insurance obligation. The public option will be a way to do it.
This is the dilemma. The present public debate is not discussing the real issues. Healthcare coverage should be universally available at an affordable cost and be high quality. There is no argument with President Obama’s goals. The route he is taking will increase bureaucracy, decrease efficiency of medical care, restrict access to care, decrease quality of care and increase the cost of care. It will also increase government control over healthcare delivery and decrease patient choice.
What are President Obama’s options for reducing the cost of healthcare coverage if he gets his proposal passed?
a. Reduce the medical care coverage to patients
b. Ration care
c. Increase the patient deductible costs
d. Increase patients premiums
e. Decrease payment to physicians and hospitals
f. Decrease administrative waste
g. Decrease profits of healthcare insurance companies who will be the government’s administrative service provider. .
h. Decrease unnecessary medical treatments. Who decides what is unnecessary?
Other options not on the table
i. Develop a plan for end of life ethical decisions. Politicians are not interested in discussing this issue.
I wonder what Ted Kennedy’s bill will be and who will be paying it?
j. Decrease defensive medicine practices by instituting effective tort reform. President Obama said he is not considering this and received boo’s at the AMA meeting. He believes the lawyer claim that the cost is insignificant.
k. Decrease physicians' overhead by decreasing rent, paperwork, committee meetings and needed full time employees for the excessive administrative work.
The government should develop an ideal electronic record and charge users by the click. Upgrades and maintenance would be free. It would create a completely functional EMR. President Obama 50 billion dollar plan will make vendors rich and have little impact on electronic medical record development.
l. Decrease Healthcare insurance industry’s administrative waste. It will not occur in a non price transparent and cost transparent environment.
m. Decrease patient abuse or the healthcare system.
n. Fund effective chronic disease management program.
There is no plan for re-teaching physicians how to run chronic disease management programs. A few poorly designed studies outsourced chronic disease management to proprietary disease management companies. The failed to report improvement in outcomes because they were not extensions of the primary physicians care.
o. Define responsibilities in the therapeutic unit (physician and patient). Patient physician contracts for chronic disease.
Who is responsible for the defects in the healthcare system leading to increased costs?
I believe these are the key questions to ask. Once answered, systems can be set up to correct the defects. The easiest group to blame is physicians. They are the least organized, the least effective lobbying group and the least generous to politicians.
1. Who is responsible for obesity?
Patients become obese by overeating and under exercising. Food industry by producing cheap high caloric value processed food. Government through subsides encourages food industry and farm industry to produce these food. There is little public service campaign to discourage obesity.
2. Who is responsible for AID’s infection?
Patients by sexual habits and behavior. Government has conducted public service education campaign that has encouraged effective prevention but has not been intense enough.
3. Who is responsible for drug and alcohol addiction?
Patients are responsible for their behavior. There are no public service campaigns that discourage this behavior. Many of our entertainment icons encourage the masses misbehavior.
4. Who is responsible for smoking?
Patients are responsible for this behavior. Government has been effective in promoting a non smoking policy. The tobacco companies have gotten around government efforts. Agricultural policy has not discouraged tobacco growth.
5. Who is responsible for air pollution leading to chronic lung disease, asthma and lung cancer?
The government is with its lack of a coherent environmental policy. The bill passed by the House of Representatives does not decrease pollution. It increases the cost to pollute. It is defective in have many negative exceptions.
6. Who is responsible for the epidemic of Diabetes Mellitus, lung disease, end stage renal disease, and osteoporosis?
All the stakeholders with the government most responsible for not having a positive health policy
6. Who is responsible for the high cost of insurance?
The healthcare insurance industry with the nature of its price structure, the practice of defensive medicine by physicians, the patients with first dollar coverage, the government by not enforcing regulations.
The Obama administration is focused on the wrong reforms. It is talking about expanding a broken non functioning system. All the actions by the various stakeholders are driven by perverse incentives. All of these perverse incentives are driven by economics. The economic morass has evolved since the introduction of Medicare in 1965. Most political decisions are driven by vested interests protecting their economic interests.
In order to create an affordable and functioning healthcare system for all, President Obama and his team should be discussing how to align all the stakeholders’ vested interests so all are satisfied with the economic outcomes. The consumers are the primary stakeholder. The systems should be built to empower the consumers. President Obama should be focused on decreasing these factors and issues that stimulating our excessively expensive and dysfunctional healthcare system.
With his stimulus program for electronic medical records and his proposed healthcare plan he is throwing good money after bad. The money will be wasted and the healthcare system will not be improved. More people will be covered by healthcare insurance. The healthcare insurance coverage will be restricted by the government as a third party and not by the patients. Less medical care will be available and that will be bad.
I discuss most of these issues and the solutions in my blog http://stan.feld.com. The summary blogs are at http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/summary-blogs-to-repair-the-healthcare-system.html
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
