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John McCains Plan For Healthcare System Reform Is Much Worse Than Barack Obama's Healthcare Plan. Part 3

Posted Sep 22 2008 4:36pm

Stanley Feld M.D., FACP, MACE

John McCain’s healthcare plan goes on to have “specific” proposals. His specifics are in reality generalities. He does not describing a plan to execute any of his "specific" proposals.I believe the American people deserve more than John McCain is offering.

"A Specific Plan of Action: Lowering Health Care Costs"

"John McCain Proposes A Number Of Initiatives That Can Lower Health Care Costs. If we act today, we can lower health care costs for families through common-sense initiatives."

How can we lower healthcare costs if we act today with common sense initiatives ?

"Within a decade, health spending will comprise twenty percent of our economy. This is taking an increasing toll on America’s families and small businesses. Even Senators Clinton and Obama recognize the pressure skyrocketing health costs place on small business when they exempt small businesses from their employer mandate plans."

Amer ica is being bankrupted by many dysfunctional policies. Medicare alone will cost 100 trillion dollars a year in 60 years. It is essential that politicians understand the basic problems with the healthcare system before making specific proposals without having a mechanism for executing the proposals. One basic problem with the healthcare system is the healthcare industry’s control of the healthcare dollar. John McCain plans to keep the healthcare insurance industry in control of the money. He should give patients control of their healthcare dollar.

CHEAPER DRUGS:

"Lowering Drug Prices. John McCain will look to bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs."

Did anyone ever consider why brand name drugs cost less in Canada than in the United States? It is because the Canadian government can not and will not pay a higher price. The pharmaceutical companies want Canada's drug market. They simply cost shift the difference for the same drug to the United States market. If the Food and Drug Administration is doing its duty correctly generic drugs should be no different that brand name drugs.

Drug patents protect the pharmaceutical companies' return on investment. When the patent expires the drug can be sold generically. In order to maintain a return on investment the pharmaceutical industry needs to discourage patients and physicians from using generic drugs and re-importing brand name drugs. At the same time the government wants the pharmaceutical industry to have incentives to produce new drugs.

There is clearly a conflict of interests that is not resolved. It will not be easy for John McCain to fulfill the statement to lower drug prices without a program to lower prices that is fair to all. How is he going to do this? Is he going to create another entitlement program for drugs? It is easy to make a promise. It is hard to fulfill poorly thought out promises.

CHRONIC DISEASE:

"Providing Quality, Cheaper Care For Chronic Disease. Chronic conditions account for three-quarters of the nation’s annual health care bill. By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology, we can reduce health care costs. We should dedicate more federal research to caring and curing chronic disease."

What programs are going to be created for "prevention, early intervention, healthy habits, new treatment model, ect". Is his government going to reward physicians and patients for preventing the complications of chronic diseases? How is he going to encourage cognitive physicians to create infrastructure to practice chronic disease management? Decreasing reimbursement for cognitive physicians will not encourage chronic disease management.  So far there has been little or no payment for prevention of the complications of chronic disease.

How is he going to fight the war on obesity? Is he going to penalize baseball teams that sell baseball tickets offering all you can eat? Is he going to restrict restaurants from serving larger portions in order to raise prices and attract customers as well? Is he going to reward patients for healthy lifestyle changes? John McCain has to present solutions and not sound bites? He has no solutions.


COORDINATED CARE:

Promoting Coordinated Care. Coordinated care - with providers collaborating to produce the best health care - offers better outcomes at lower cost. We should pay a single bill for high-quality disease care which will make every single provider accountable and responsive to the patients’ needs.

This is a good idea. How is he going to do this? Does he mean making the patient the center of the team and the team an extension of the physicians care? Does he mean making the patients the professor of their chronic disease and equally responsible for the outcome as the physician and his chronic disease team? 

GREATER ACCESS AND CONVENIENCE:

Expanding Access To Health Care. Families place a high value on quickly getting simple care. Government should promote greater access through walk-in clinics in retail outlets.

This is a bad idea. One the one hand John McCain calls for co-coordinated care and on the other hand he promotes fragmented care. Disease management and effective medical care work when there is a strong physician-patient relationship. The team approach can promote the physician-patient relationship if the team is an extension of the physician's care. The government should train or retrain physicians' practices to provide greater access to quick simple care rather than encourage a new entity in the healthcare industry that could potentially abuse and overcharge the healthcare system. Uncoordinated home healthcare and nursing home care absorb a large portion of the healthcare dollar. If the care was coordinated it could add value to the medical care system. 

 

John McCain’s  healthcare plan outlines specific proposals. He does not offer specific solutions for his proposals. His proposals also highlight his lack of understanding of the healthcare system's basic problems.   

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

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