Stanley Feld M.D.,FACP,MACE
Obamacare is a mess because the architects of Obamacare created a system that does not align all the stakeholders’ incentives.
Pre Obamacare we had a dysfunctional healthcare system because no one developed a system to improve the care of patients. When a consumer of medical care got sick he received very good treatment or the illness.
Consumers were not taught how to avoid illness. If consumers of medical care had a chronic disease they were not taught how to self-manage their chronic disease.
Medical care in the healthcare system became too expensive for employers to pay for. Consumers were the recipients of this largess. They had no responsibility or incentive for controlling their healthcare cost.
The healthcare system became more expensive because all the stakeholders except consumers tried to maximize their profit at the expense of each other.
President Obama promised to transform the healthcare system. Initially Tom Daschle was his chief. He wrote a book about healthcare after he was defeated in his bid for the Senate.
Any physician who practiced medicine knew that Tom Daschle’s ideas could not work. He had some good ideas to make healthcare delivery more efficient. The ideas were presented in an impractical way. He did not know who the customer was.
Dr. Donald Berwick was next. He tried to extend and implement some of Tom Daschle’s ideas with his own ideas.
Dr. Berwick has some excellent ideas. The ideas are an adaptation from the Institute of Medicine's six improvement aims for the health care system: care that is safe, effective, patient-centered, timely, efficient, and equitable.
The Institute of Medicine’s report “ Crossing The Quality Chasm” points out how to develop a new healthcare system for the 21st Century utilizing 21st century technology.
The problem is Dr. Berwick’s ideology is defective. His famous quote, “the very definition of a equitable healthcare system is the redistribution of wealth” does not sit well with the American psyche.
There has never been a system of successful redistribution of wealth system.
Most people have experienced the deadening effect of bureaucratic systems on innovation. This is what we are experiencing right now with the Obamacare rollout.
People still cannot sign up. People are still spending hours on the telephone and not getting insurance. These are not glitches. These are system disasters.
I have long thought President Obama wants to destroy the present healthcare system so that the masses will demand a single party payer healthcare system with the government in control. Such a system will not be any different than Obamacare.
The government will still be dependent on consumers of healthcare, physicians, pharmaceutical companies, device companies and most of all insurance companies.
Insurance companies will still do the administrative services for the government at a very high price.
Obamacare has not even gotten to the problems it is going to have with the delivery of care, the access to care and the rationing of care.
Obamacare’s business model is defective. It will be impossible to utilize the advances in technology under a system of increased government bureaucratic control.
I have previously presented a new business model. It’s possible it has not caught on for several reasons.
1. My business model could have been presented too early in the course of Obamacare’s demise.
2. My business model is not politically correct.
3. My business model challenges legacy stakeholders. They do not want to give up any power.
Legacy stakeholders are having a horrible time figuring out how to make a living under the evolving Obamacare system. Maybe by that adopting my new business model, one that aligns everyone’s incentive costs will decrease and profits for everyone will increase.
4. The presentation of my new business model could have been too complicated.
Over the next several months I am going to present my new business model.
This business model aligns all the stakeholders’ incentives except the government takeover of the healthcare system.
The government’s role should be that of a facilitator and not the director of the healthcare system.
I hope it will start making sense to people who can and want to do something to improve the healthcare system.
It will make life better for everyone.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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