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Aim Carefully Then Fire: Dont Fire, Then Aim

Posted Dec 22 2009 6:54pm

Stanley Feld M.D.,FACP,MACE

Dr. Val Jones publishes Get Better Health a smart health an excellent healthcare website. http://getbetterhealth.com/

It is composed of a selection of many of her chosen healthcare bloggers. Val publishes blog entries of many contributors in her network daily. Val published my December 19th entry. It generated the following comment.

“Comment:
I am surprised that a diabetes doctor let his politics permeate his opinion of the AHRQ? We know that over 50% of the time patients don't receive the standard of care and I would be interested to know what the numbers are like in his practice?
If he had given any research or documentation to his claims (the CBO for example predicts 130 billion dollar drop in the deficit) so he lost all credibility in his first few sentences. Does his practice have better outcomes than the standard of care? Is he worried that he will lose income for practicing medicine that makes huge profits but doesn't increase lifespan or other measurable outcomes?
This blog seems to be a little bit behind the times. Quality matters and is here to stay. Guys you not only lost the election but large employers and other purchasers know that what we have been paying for doesn't work.”


The commenter would do well to follow my blog at http://stanleyfeldmdmace.typepad.com/. He might learn something about what is necessary and effective to repair a broken healthcare system.

 President Obama’s healthcare reform plan will not achieve his goals.  “The legislation has no master plan for dealing with the problem of soaring medical costs. And this is a source of deep unease.” It also does not have a master plan to deal with the dysfunction in the healthcare system

It is unnecessary for the commenter to take pot shots with sound bites on issues whose details are ignored.

I refer the commenter to my summary blog category section

My guess is the commenter is a salaried surgeon in a comfortable subspecialty that fixes things that are broken and does not practice preventive medicine.

It is not necessary, in a surgeon’s world, to understand that medicine needs to develop systems of care that put patients in charge of the care of their disease in order to prevent disease complications. Doing that will generate great savings because 90% of the healthcare dollars are spend on the complications of chronic diseases.

Patients need to be taught how to be responsible for their own care.

I am an Independent voter. I am apolitical and have never been affiliated with either Party. I voted for President Obama. I thought it was going to be a good thing when he promised to fundamentally reform America’s way of doing things following the wishes of powerful vested interest as opposed to the vested interests of the people. He has been a catastrophe.

I am a retired Clinical Endocrinologist. I have no economic vested interest in the financial aspects of the practice of medicine. I do have a vested interest in keeping medical practice a highly regarded profession and maintaining the patient physician relationship.

I oppose medical care becoming a commodity.

The secondary stakeholders (the healthcare insurance industry, big pharma, and the hospital systems and big government) have taken over healthcare. They have made medical care a commodity.

President Obama has played right into the hands of these vested interests in order to increase the scope of government. The devil is always in the details.

The details of his healthcare reform bill will tax all income groups, increase the budget deficit, decrease access to care and increase out of pocket expenses. It has been done in a non transparent way ignoring the wishes of the majority of Americans.

The healthcare reform bill does not consider to malpractice reform. Defensive medicine and unjustified law suits are wasteful and costly.

I suggest the commenter read critically some of the guidelines the USPHTF has written with an emphasis on Breast Cancer, Coronary Artery Disease and Osteoporosis.

He should study some of the defects in the clinical research studies the Task Force has chosen.

Our medical care system needs flexible standards of care that are disseminated to the medical community in an educational fashion and not in a punitive and disruptive way. Evidence medicine is ever changing and these changes need to be integrated in a physicians work flow in an education way. The Breast Cancer guidelines have been implemented already by California

No one has defined quality care effectively to this point or developed systems to measure the financial impact of care. In diabetes for example, the definition of quality medical care should not be defined as the measuring HbA1c’s four times a year. It is measuring clinical outcomes against financial outcomes and comparing its value. It should be defined by patient compliance with treatment. Claims data analysis is meaningless.

President Obama’s healthcare plan makes medical care worse for patients and physicians, not better. His plan is going to produce unintended medical and financial consequences that will render effective care more difficult for physicians to give and patients to get. There is plenty of evidence that it will make care more expensive, raise taxes, and increase the deficit.

None of the secondary stakeholders will be hurt as badly as patients and physicians. Reading my blog and following the links will give the commenter an in depth understanding of my reasoning.

I had hoped President Obama would provide a transparent administration as promised and not an administration for vested interests and lobbying groups. Unfortunately, this has not happened. This point is demonstrated by many examples including Tom Daschle’s access to the White House and private Democratic congressional meetings.

President Obama’s healthcare reform is about increasing government control over the healthcare system and commoditizing medical care. It will fail. The government has been unsuccessful at this as demonstrated by Medicare’s mounting deficits.

Secret Democratic caucus sessions and 2000 page bills that have to be evaluated in less than 72 hours are not my idea of transparency. My vote for President Obama was a big mistake.

If the commenter studied the various scorings by the CBO, I am sure he would not use the invective against me and challenge my credibility.

The CBO changed its scoring from a one trillion dollar deficit increase in ten years to a 130 billion dollar reduction in deficit overnight. These estimated are based on the changing assumptions provided by either Harry Reed or Nancy Pelosi. The last estimate was based on increasing taxes from 2010-2014 and not providing benefits until 2014. Ninety eight percent of the benefits will kick in after 2014. The CBO states its scoring can be in error because the assumptions provided could be wrong.

The $130 billion dollar decrease in the deficit is another trick play. It seems everyone within the Beltway understands this trick play.

Entitlement programs always cost more than estimated.

Primary care physicians’ and all cognitive subspecialists’ intellectual property is undervalued and underpaid. Cognitive intellectual property provides the most valuable element of medical care. It is embedded in the patient physician relationship.

The details in President Obama’s healthcare reform plan will undervalue cognitive services even further through punitive mechanisms. It could increase its value through educational mechanisms.

The healthcare insurance industry will not take a big hit because antitrust exemption and Medical Loss Ratio are not dealt with effectively.

I believe it is much wiser to aim and carefully learn the real details before firing.

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

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