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John McCains Plan for Healthcare System Reform Is Much Worse Than Barack Obama's Healthcare Plan. Part 4

Posted Sep 22 2008 4:36pm

 

Stanley Feld M.D.,FACP,MACE

I feel it is necessary to evaluate John McCain’s healthcare plan point for point. His task force does not understand the basic problems in the healthcare system. This is the last part of my analysis of John McCain's healthcare plan because he doesn't have anything else to say. The healthcare system will remain unchanged. He is not a patient advocate. He will permit the control of the healthcare system to remain in the hands of the healthcare insurance industry. Patients should be in control of their healthcare dollar.    

A Specific Plan of Action: Lowering Health Care Costs Continued


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?

INFORMATION TECHNOLOGY:

Greater Use Of Information Technology To Reduce Costs. We should promote the rapid deployment of 21st century information systems and technology that allows doctors to practice across state lines.

Is this an information technology plan? No! Many have tried to stimulate the use of information technology. All of the attempts have failed so far for good reason. My ideal EMR describes the barriers to the use of information technology by physicians that John McCain seems to be unaware of.

He also seems fixated on destroying the state control of regulating the healthcare insurance industry. The states have done a poor job of protecting the consumer against the healthcare insurance industry. Allowing physicians to practice across state lines will weaken state control and state medical and insurance board even further at a time they are trying harder to protect the consumer.

MEDICARE:

Reforming The Payment System To Cut Costs. We must reform the payment systems in Medicaid and Medicare to compensate providers for diagnosis, prevention and care coordination. Medicaid and Medicare should not pay for preventable medical errors or mismanagement.

The payment system needs to be reformed. Cognitive medical care must be recognized and appropriately compensated, if we are going to make progress with chronic disease management. John McCain does not explain how that will cut costs. Reforming the payment system can start encouraging the use of systems of care for chronic disease management. Who is going to train physicians groups to practice chronic disease management and how much will that cost? John McCain wants to hand Medicare to the healthcare insurance industry. I believe this action will be a disaster.

SMOKING:

Promoting The Availability Of Smoking Cessation Programs. Most smokers would love to quit but find it hard to do so. Working with business and insurance companies to promote availability, we can improve lives and reduce chronic disease through smoking cessation programs.

This is an important point. Again, the proposal is open ended. There is no financial advantage for patients to stop smoking. 

STATE FLEXIBILITY:
Encouraging States To Lower Costs. States should have the flexibility to experiment with alternative forms of access, coordinated payments per episode covered under Medicaid, use of private insurance in Medicaid, alternative insurance policies and different licensing schemes for providers.

This policy sounds like it is going to redirect the costs of entitlements to the states. He also want the states to shift Medicaid to the private healthcare insurance companies.  The states can not afford to increase Medicaid spending without increase local taxes. John McCain would be happy with this because he would not raise federal taxes. 

TORT REFORM:

Passing Medical Liability Reform. We must pass medical liability reform that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols. Every patient should have access to legal remedies in cases of bad medical practice but that should not be an invitation to endless, frivolous lawsuits.

This is the most specific part of John McCain specific plan for healthcare reform. It is absent from Barack Obama’s plan. If the proposal is effectively designed it would decrease the cost of the practice of defensive medicine. It would also decrease the cost of physician malpractice insurance. The result would be lower medical costs. 

TRANSPARENCY:

Bringing Transparency To Health Care Costs. We must make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs and prices. We must also facilitate the development of national standards for measuring and recording treatments and outcomes.

John McCain’s transparency must be real transparency. Real price transparency means cost of producing the service compared to the prices charged for that service by healthcare insurance companies, hospital systems, and physicians. It sound as if price transparency will be directed at physicians. It will be an unsuccessful initiative if it is only directed at physicians.  

Confronting the Long-Term Challenge
John McCain Will Develop A Strategy For Meeting The Challenge Of A Population Needing Greater Long-Term Care. There have been a variety of state-based experiments such as Cash and Counseling or The Program of All-Inclusive Care for the Elderly (PACE) that are pioneering approaches for delivering care to people in a home setting. Seniors are given a monthly stipend which they can use to hire workers and purchase care-related services and goods. They can get help managing their care by designating representatives, such as relatives or friends, to help make decisions. It also offers counseling and bookkeeping services to assist consumers in handling their programmatic responsibilities.

This is about the only innovative idea in the entire healthcare policy that is directed to the people. It is a concrete idea with some hint of operational strategy. This proposal is strange. It will create subsidized service for elderly. John McCain is against entitlement programs and yet offers a new entitlement. It is a contradiction in his philosophy in order to attract the senior vote.

I have described John McCain’s entire healthcare policy. He does not tell us how he is going to make his sound bites operational. He has little idea of what to do about the “broken” healthcare system except to protect business and the healthcare insurance industry at the expense of the people.

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