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Dr. Feld, it is refreshing to hear your voice. Very few have the courage to speak up about ambitious stakeholders in healthcare - stakeholders who would have consumers believe that bureaucrats, healthcare IT executives and insurance MBAs are as critical to healthcare delivery as doctors and patients.

With all due respect, Dr. Feld, I see that someone has successfully taught you to thoughtlessly accept the label “stakeholder” for yourself and your patients. The label you were pushed into buying brings doctors and patients down to the vendor’s level of importance. It is an old stakeholder trick based on semantics. It has to do with spin and other stakeholder PR talents. These guys are slick. And they are empowered.

On December 21, 2007, the National Committee for Vital and Health Statistics (NCVHS) - an assortment of stakeholders who tell HHS what HHS likes to hear - submitted a letter recommending actions for “Enhanced Protections for Uses of Health Data” to Secretary Michael Leavitt encouraging the elimination of the term “secondary uses” for patient health records.

“NCVHS observes that ‘secondary use’ of health data is an ill-defined term and urges abandoning it in favor of precise description for each use of health data.”

The subtle underlying rationalization is that all stakeholders, including doctors and patients, are equally important in a democracy. Since doctors and patients are intentionally poorly represented in stakeholder committees that report happy things to the HHS, such as the NCVHS, CCHIT and the future AHIC Successor Inc., stakeholders unanimously win their power in fair democratic fashion, again and again. And that is why one can expect things to fall short of swell for doctors and patients.

We are not stakeholders. As doctors and patients, we are principles and we must aggressively fight for the welfare of patients, just like you are doing. Otherwise patients have no representation at all.

We must be transparent and doctors must be paid fairly. This is too harsh for some to imagine, much less to say out loud, but consumers should be aware that ethics is not free, and you get what you pay for. There are no bargains in spite of what glossy managed care folders advertise.

Patients and their doctors are principles, not stakeholders. Healthcare is not a natural, renewable resource and mandates are not windfall profits. Patients always suffer the final bill.

Keep up the good work, Dr. Feld. We’ll overcome stakeholders. We must. Darrell K. Pruitt DDS

You are right on here Stan. Government approved hikes in premiums should be pegged to the profit these insurance companies are making. Crying with two loafs of bread under each arm is just not right!!

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