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Is Barack Obama Any Different Than Other Politicians? Part 1

Posted Oct 02 2008 3:15pm


Stanley Feld M.D.,FACP, MACE

No! He is not.

In the weeks to come I am going to point out the deficiencies in both candidates thinking about healthcare. It is clear that neither has received input from practicing physicians. Please click on the highlighted phrases for more details on each subject.  

I will start with Barack Obama because the Democratic convention is first.

I am astonished by the lack of scholarship and thoughtfulness on the part of either Presidential candidate. The issues have been reduced to sound bites. The pronouncements are picture words that generate false hope. Neither political party is confronting the real issues and the necessary repairs. If any of their proposals are passed into law it will simply be a patch. In the process the proposals will destroy the vital and good elements of our entire healthcare system.

Both the Medicare and the Private Healthcare Insurance system have failed. They have neither decreased costs nor improved medical outcomes. They have been both economic and medical care disasters. The United States can no longer afford the present course. Academically the reasons for the disaster are clear.

1. Price controls do not work!

2. Price transparency is essential to create a free market economy!

3. There are too many monetary incentives in the healthcare system to maintain an inefficient system for all stakeholders. (primary and secondary stakeholders)

4. Punitive measures directed at the weakest stakeholders (primary stakeholders) to correct inefficiencies do not work and lead to greater inefficiencies.

5. The healthcare system must be constructed and run for the benefit of the primary stakeholders.

6. The primary stakeholders must drive the healthcare system for their medical and financial benefit. (Consumer driven healthcare).

7. Secondary stakeholders should be facilitators for the primary stakeholders. (patients).

8. Profit derived from the system should be the result of efficiency and not the result of political influence to protect secondary stakeholder vested interests.

9. Consumers as the primary stakeholders must be responsible for their health, and medical care. Appropriate government subsidy must be provided, if warranted.

10. The government must set up rules to protect the consumer from the healthcare insurance industry, hospital systems, drug companies and physicians

10. Actions should be taken by government across all areas of society ( War on Obesity ) to educate consumers to decrease the incidence of chronic disease.

The consumer must fix the healthcare system. None of the other stakeholders has been successful. In fact, in the last 30 years the healthcare system has been made worse by the insurance industry, government and policy makers.

All their systemic changes have failed because they have, for the most part, been to the advantage of the facilitator stakeholders and not the primary stakeholder, the patient. Facilitator stakeholders’ profits have soared, insurance premiums have skyrocketed while access to care has plummeted. Patients, physicians, hospital systems and the government have adjusted to changes to the detriment of patients. The facilitator stakeholder adjustments have resulted in further dysfunction in the healthcare system.

Presently, employers and all the stakeholders except for the insurance industry are in pain. However, the stakeholder most at risk is the consumer. Only 20% of the population is sick and interacts with the healthcare system at any moment in time. 80% of the population does not interact with the healthcare system. They think everything is fine. However, the entire populations’ health and well being is at risk! If we stay on the present course, I predict the system will break down completely. Access to care will be limited and rationed. Access to life saving medical advances will vanish. Future advances in medical care will disappear.

The goal of the healthcare system should be;

1. To provide patients

a. with access to good quality care
b. with education to judge quality care
c. with incentives to be motivated to be responsible for their medical care
d. with the freedom to judge and select the physician of their choice
e. with the information from their healthcare providers that is truly portable
f. with choice of healthcare insurance vehicles that are affordable
g. with education vehicles to become “Professors of their Chronic Disease” and be truly responsible for their care
h. effective and affordable drug coverage designed to enhance patient compliance with treatment

2. To provide physicians

a. with a precise definition of the meaning of quality care for various chronic diseases
b. with incentives to provide quality care for both acute and chronic disease
c. with the educational opportunity and motivation to improve the quality of care they deliver.
d. with an actual vehicle developed by their peers to prove that they are delivering quality care.
e. with a mechanism for delivering care at a transparent price
f. with the ability to effectively communicate with patients electronically.
g. with the ability to improve the patient physician relationships
h. with the ability to enable patients to practice effective self-management techniques to prevent costly complications of chronic disease
i. with the ability to improve communication and access to patient information so as to reduce the cost of redundant evaluation and treatment

3. To decrease the overall cost of the system

4. To eliminate the 47 million uninsured

5. To align stakeholders’ incentives

6. To provide satisfactory profit margins for hospitals, pharmaceutical companies, insurance companies, and physicians.

These are ambitious goals. Processes must be changed in order for the United States to deliver effective health care to the population now and in the future.

Consumers can not leave it up to the facilitator stakeholders and policy wonks to fix the system. Their policies have distorted the healthcare system in the past to serve their vested interests. Patients today and in the future must drive the process of change through appropriate demands on our politicians in order to repair our healthcare system and install an effective consumer driven healthcare system.

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