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Reality Vs. Fantasy

Posted Apr 08 2013 7:07pm
Stanley Feld M.D., FACP, MACE.

I’m Busted” ,my last blog, generated several interesting comments.  

The comment below was a standout. It represents a total disregard for historical understanding of what made the healthcare system totally dysfunctional.

It is obvious from the comment that this individual has not gone to any of my links in the blog nor has he been a long time reader. I suggest he read the letters I sent to President Obama at the time after his first election.

“We’ve been through this before Dr. Feld.  While your generation was/is in charge of the U.S. Healthcare System our Quality has Sunk and the Costs have Risen Dramatically.  (  )” 

Physicians are not in charge of the healthcare system.T he government and the healthcare insurance industry is in charge.

I could not open the link this reader sent. He goes on to say,

 “ Take Some Responsibility for this Healthcare Mess.  Stop Crying and Placing Blame on those searching for Workable Options to Fix What You Proudly Created.  Please share this with your readers.  Stop being so one-sided. 

Thank you. 


Key to the understanding of the healthcare system's dysfunction is the need to understand the evolution of the dysfunction . I cover the history in my summary blogs.  

The dysfunction in the healthcare system started in 1965 with the passage of Medicare.

Every subsequent government regulation was followed by a more expensive reaction to the regulation by the stakeholders.

Life was simple pre 1965. The healthcare social contract was between the patient and the physician.


  •  Personal Care – The Physician Knew Me And My Family
  •  The Healthcare System Was Efficient – Consumer Driven
  •   It Was Adequate for 90% of Medical Problems
  •   It Was Democratic – Rich & Poor


  •  Lifespan / Expectancy – Short
  • Lived Unhealthy Lives
  • Misdiagnosed Many Illnesses- Lack of Technology
  • Limited Body of Knowledge- Limited Treatments And Drugs


Patients made their own healthcare decisions. Patients and physicians had positive relationships.

This positive patient/physicians relationship is 50% of the therapeutic outcome.

As the medical knowledge base increased more money was pumped into the healthcare system thanks to Medicare. Secondary stakeholders were needed to deal with the increase in money and complexity. Soon these secondary stakeholders began to dominate the healthcare system.

 Secondary stakeholders have disrupted Patient/physician relationships. These stakeholders have created large barriers between physicians and patients.



Both patients and physicians have become commodities. In its present form, the healthcare system, as it has grown in complexity and expense has precipitously diminished physicians’ control over his medical care and his ability to apply his medical judgment.

Obamacare is adding more layers of complexity to the healthcare system to an already dysfunctional healthcare system.

Obamacare will be difficult to execute and impossible to enforce.

When the reader says, “Stop Crying and Placing Blame on those searching for Workable Options to Fix What You Proudly Created.”

 I am not crying. I am sad for patients and their future medical care within the Obamacare healthcare system.

I am trying to get consumers to see the inevitable.

Past evidence has proven that when government controls and operates any systems the actions proposed are unworkable and unenforceable. The result is great costs and more inefficiency.

  The healthcare system’s incentives will only be aligned when the system is consumer driven . The government must support but not control the healthcare system.

The government should set the rules to align incentives and then get out of the way.

The healthcare system model the government brags about is the VA Hospital System model.

Recently the VA has received bad press in the traditional mainstream media.  VA public relations department has tried to marginalize the criticism.

It has also tried to compensate for the criticism by outsourcing medical and surgical care to the private sector with success.

  Elise Cooper ’s article in the American Thinker: “ The VA: a Culture of Disconnect” says it all. I will add to her title “Coming Our Way” with Obamacare.


  • "Many veterans feel disconnected with the VA. They regard it as a huge bureaucracy that is very impersonal and unhelpful. The vets get frustrated because they do not know where to turn for help.”

American Thinker interviewed veterans and others involved with the VA to reveal some personal examples and to see if the complaints are justified.”

I will discuss in detail these interviews shortly. I will say the complaints are justified.  

America is running out of time to repeal Obamacare. Consumers have to wake up now and see what it is doing to their healthcare system, their taxes and their economy.

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

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