Repairing the Healthcare System tag:typepad.com,2003:weblog-352923 2009-07-15T15:45:54-07:00 TypePad RepairingTheHealthcareSystemhttp://feedburner.google.com Here Comes The Judge! tag:typepad.com,2003:post-6a00d83451876469e20115711600a5970c 2009-07-15T15:45:54-07:00 2009-07-15T15:45:54-07:00 Stanley Feld M.D.,FACP,MACE Here Comes The Judge!! President Obama has promised that the savings of his healthcare reform plan would be budget neutral. The Congressional Budget office has contradicted his statement by scoring the proposed bills and predicting it will... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

 

Here Comes The Judge!!

President Obama has promised that the savings of his healthcare reform plan would be budget neutral. The Congressional Budget office has contradicted his statement by scoring the proposed bills and predicting it will generate at least 1.5 trillion dollars deficit over 10 years. The independent HSI Network scored the House's initial draft at a heart-stopping $3.5 trillion.

Congress is trying to figure out how to generate increased tax revenue to pay for the healthcare reform plan. The popular press has not discussed the congressional proposals for raising taxes

“House and Senate Democrats appeared yesterday to be on a collision course over how to pay for a sweeping overhaul of the nation’s healthcare system, with the House planning to propose an income tax increase on the wealthiest Americans”

Congress is going to raise taxes for healthcare reform. The President has not opposed the notion. No one is talking about the real issues. The real issue is to fix the defects in the healthcare system effectively.

Can Americans trust politicians? Americans want universal healthcare, affordable healthcare coverage, access to care and an increase in quality of care. President Obama’s generality promises this. He never goes into the details.

“Senate negotiators had been considering a tax on some employer-provided health benefits.”

The Democrats are trying to figure out who to tax first to cover the 1.5-3.5 trillion dollar deficit that will be created by President Obama’s healthcare reform plan. They have decided to tax the “rich.”

Taxing the rich has not worked in the past for many reasons. The house proposal presently is a surcharge on the rich in addition to raising the tax rate to 39%.

“The House Ways and Means Committee was said to be nearing agreement on an income tax surcharge of 2 percent or more on Americans with the highest incomes - those earning more than $250,000. The surtax would rise for those earning $500,000 and rise again for those earning more than $1 million.”

Tax the rich to help the poor. The rich usually disappear as a taxable entity when this occurs.

One commenter said;

“ Look, the "Rich" don't pay taxes. The Kennedys don't pay taxes. Their money is in offshore trusts. George Soris doesn't pay taxes. Al Gore is making bazillions off his energy soapbox but he's not paying taxes.
This will all come out of the hides of the middle class, until we have meaningful tax reform.”

The Senate and the House are now fighting over which tax increases should be incorporated into the healthcare bill. I suspect the public will become aware of the tax increases after they are passed.

“A proposed sales tax on sodas and other sugary drinks and a new payroll tax of 0.3 percent to be paid by employees and employers was in favor last week but has gone underground for now.”

There are lots of ideas on how to increase taxes to pay for President Obama’s healthcare reform plan.

“The Senate seemed to be narrowing their focus on a plan that would tax only the most generous employer-provided health plans - those worth $25,000 or more a year - as well as a modified limit on tax deductions proposed by Obama.”

Democrats’ mode of operation is first spend and then tax. I believe all large employers will have their employees buy insurance through the public option. The penalty will cost less than providing healthcare insurance

“Senators are also considering a plan to apply the Medicare payroll tax of 1.45 percent to nonwage income like dividends and capital gains.”

Congress seems to be doing everything in its power to decrease investment incentives in the name of healthcare reform without even realizing what they are doing. Investment incentives have made America strong.

“One tax increase would bar drug companies from deducting the cost of advertisements as a business expense on their corporate tax returns.”

If congress wanted to fix the healthcare system and lower costs they would restrict direct to public advertising completely.

“Another would end a tax break for healthcare flexible spending accounts.”

Democrats in congress are going to increase taxes in multiple ways to pay for President Obama’s healthcare reform.

“Senators don’t like to raise revenues,’’ Baucus said, using a euphemism for tax increases.

The White House has not expressed a position on the surtax, but lawmakers said they had heard no objections so far.

It seems to me the Democrats have not learned anything in the last 50 years.

They have not learned that :

Entitlements are bottomless pits.

The public does not like bottomless pits because it leads to tax increases.

Increasing tax leads to a decrease in economic growth by decreasing innovation and risk taking.

Government’s role should be to make rules that level the playing field for all the stakeholders and then get out of the way. (Adam Smith)

I believe the Democrats are heading for another 1994 congressional debacle without the Republicans doing one smart thing. The Obama healthcare plan is doing nothing to improve in the healthcare system. Congress is going to pass a bill that spends a lot of money and accomplishes nothing

The Obama method lets others do his dirty work. He makes sure it is what he approves as he stays on the high road.

Obama’s chief of staff, Rahm Emanuel, who visited the Capitol twice this week to discuss healthcare proposals with House Democrats.

He said the president would prefer that money to pay for the legislation come from within the healthcare system.

But unlike a tax on employer-provided benefits, which Obama opposed during the presidential campaign, a tax on the wealthy would be in keeping with his promise not to raise taxes on Americans earning less than $250,000 a year.

America’s healthcare system’s costs are going to escalate with Obama’s healthcare plan just as they have in Massachusetts. The President will be forced to raise taxes even further.

I am afraid this will not stimulate a faltering economy. It will make it worse. With increasing taxes we will all be on the way toward working for the government.

“The trouble with socialism is that you eventually run out of other people’s money” –Margaret Thatcher.

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

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/07/here-comes-the-judge.html The Obama Method tag:typepad.com,2003:post-6a00d83451876469e201157103d9a7970c 2009-07-12T06:42:24-07:00 2009-07-12T06:47:08-07:00 Stanley Feld M.D.,FACP,MACE In the last six President Obama has pushed through congress much legislation. Legislation that will increase the budget deficit to at least $3.4 trillion dollars. Republicans have been unable to express effective opposition because of President Obama’s... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

In the last six President Obama has pushed through congress much legislation. Legislation that will increase the budget deficit to at least $3.4 trillion dollars. Republicans have been unable to express effective opposition because of President Obama’s political tactics.

Much of government spending in the past is has been riddled with inefficiency and unintended consequences. The intent might have been to help the little guy but has consistently created an advantage for large corporations.

How does President Obama do it? Jonthan Chait of the New Republic, a liberal periodical, described the process.

“The thing that people haven't figured out about President Obama's conduct of foreign policy is that it's the same as his conduct of domestic policy. Obama believes in the power of negotiation and public dialogue to split his adversaries--Republicans at home, Islamists abroad--and strengthen his own position.

President Obama begins by finding common ground with his enemies. He then expresses respect for their core beliefs. He follows with profuse hope for cooperation.

“This rhetoric removes the locus of debate from the realm of tribal conflict-- red state versus blue state, Islam versus America--and puts it onto specific questions--Is the American health care system fair? Is terrorism justified?-- where Obama believes he can win support from soft adherents of the opposing camp.”

He keeps the agreement general as he moves the process along. However, the devil is in the details. The common ground in healthcare does not solve the healthcare system’s problems.

Universal healthcare, affordable cost and increased quality are the common ground.He then leaves it up to the congress to write the law. The underlying strategy is to throw money at the problem even if the strategy will fail. The leaders from both parties are starting to see through this tactic.

“In January 2008, Obama told a newspaper editorial board that Ronald Reagan provided a "sense of dynamism and entrepreneurship that had been missing." Paul Krugman complained, "Where in his remarks was the clear declaration that Reaganomics failed?"

Most Democrats believe Reagonomics failed. They are angered at how President Obama could applaud Reagonomics. I believe it was a less than sincere attempt to stand on common ground with Republicans. He removes the debate from the realm of tribal conflicts. He avoids fighting with Republican over Reagan. The populous applauds because they believe he is on their side. He is then free to craft any policy he pleases. He promotes his policy using the new media (internet). He stays on the high ground and avoids discussing details or detail consequences.

“Obama's method entails small acts of intellectual dishonesty in the pursuit of common ground.”

Greg Scandlen exposed President Obama’s healthcare whiz kids and their attempts to shape public opinion.

“ The Obama administration kids are Peter Orszag, Ezekiel Emanuel (Rahm's brother), and outside advisors like David Cutler and Atul Gawande. They are convinced of their own genius. They think they can create the data driven management systems to eliminate $700 billion of wasted care in the American health care system. They are dismissive of any skeptics. Their very hubris causes them to overlook essential factors that may impede their plans.”

The key to fulfillment is to maintain Americans’ anger at the old way and desperation for change.

President Obama stays in a position to spin his story and paralyze the opposition. (Rope a Dope). He used Dr. Atul Gawande’s (an advisor) June 1 article in the New Yorker to demonize physicians. I pointed out that the article was a masterpiece of disinformation.

“ Dr. Gawande ,an advisor on President Obama’s healthcare team, had an article published in the New Yorker about a month ago that laid out in great detail what he viewed as the inadequacies of the health care system in McAllen, Texas.”

He pointed out that Medicare and Medicaid patients cost twice as much in McAllen as in El Paso. He compared the costs in McAllen to the cost of Medicare patients at the Mayo Clinic.

“He concluded that we needed to replicate the management systems (not-for-profit, salaried employees, team approaches to service delivery) of the Mayo Clinic in places like McAllen, and indeed, throughout the United States. Voila! Problem solved.”

Dr Gawande omitted a few important data points. Mayo Clinic does not care for indigent,Medicare or Medicaid patients long term. He ignored the fact that Medicare has the machinery to discover and deal with cost outliers and impose heavy fines.
The Texas Medical Association checked on some of the data Dr. Gawande used and ignored. He overlooked the following in exposing McAllen’s physicians.

  • “Its population is the poorest in the entire United States.
  • It has the fewest physicians per capita in the entire United States.
  • It has the second highest uninsured rate in a state that is the Uninsured Capital of the United States.
  • It is heavily reliant on Medicaid and Medicare payments to finance its entire health care system.
  • It is plagued by very high rates of obesity, diabetes, lack of exercise, and overall poor health status”(chronic disease demanding long term care).

The TMA article explains the poverty rate in McAllen is nearly three times that of the Mayo Clinic. McAllen’s physician supply is half that of the Mayo Clinic.

"Where there is poor availability of outpatient care, patients are far more likely to seek routine care in hospital emergency rooms, where costs are high and diagnostic testing is more frequent. This is also far more likely to result in costly hospital admissions. The data that Dr. Gawande depended on - but did not report - show just this. McAllen has a pattern of unusually high inpatient costs, while outpatient costs are close to average."


Many intelligent people reading the New Yorker article believed physicians in private practice are crooks. This is the point of the disinformation. It is typical of President Obama’s method of winning public support.

If President Obama’s tactics succeed in crafting his healthcare policy the nation is facing a $1.5-3.5 trillion dollar deficit with zero improvement in our healthcare system.

President Obama’s tactics are becoming transparent. Everyone is getting tired of false hope. Policy and plans are ill conceived and destined to fail. However the cost will be dear to tax payers.

Wake up Americans!!!.

Share this article on Facebook!

Twitter!

Make videos for You Tube!

Get the word out!

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/07/the-obama-method.html The Unintended Consequences of President Obamas Public Option tag:typepad.com,2003:post-6a00d83451876469e2011570e53f7c970c 2009-07-08T07:43:42-07:00 2009-07-08T07:43:42-07:00 Stanley Feld M.D.,FACP,MACE What is the problem with President Obama’s public option? It guarantees insurability to all Americans of any age with any pre-existing condition. Providing basic healthcare insurance to everyone might guarantee protection from financial disaster from healthcare expenses.... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

What is the problem with President Obama’s public option? It guarantees insurability to all Americans of any age with any pre-existing condition. Providing basic healthcare insurance to everyone might guarantee protection from financial disaster from healthcare expenses.

An actuary would say the public option is actuarially unsound.

At the heart of President Barack Obama's health-care plan is a healthcare insurance program funded by taxpayers, administered by Washington, and open to everyone. The healthcare plan is modeled on Medicare.

The Medicare model has two important problems. The existing Medicare entitlement is unaffordable. It will have to be funded in the future by taxpayers with some kind of income tax increase.

If enacted, “the public option" will soon become the single dominant healthcare plan. This would represent an expansion of the Medicare entitlement program.

“Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.”

The defects in President Obama’s public option are multiple. The unintended consequences are exponential. President Obama’s healthcare team is not analyzing the public option’s defects and its effects on the healthcare system. The public option goal is to provide healthcare insurance coverage for the uninsured.

The government would charge employees a monthly premium for healthcare coverage. The premium would probably be the same or more than Medicare. The premium would be means tested. It would be calculated from all income reported to the IRS.

It will be cheaper for employers to discontinue healthcare coverage for employees and pay a penalty than provide private healthcare insurance.

“Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.)”

The Lewin Group, a health-care policy research and consulting firm, predicts enrollment in the public option will reach 131 million. It will be open to everyone. The premium will be similar to Medicare premium rates which are not cheap.

“Fully two-thirds of the privately insured will move out of or lose coverage as patients shift to a lower-paying government plan”

Medicare plans to lower physician reimbursement by 20% in 2010. Primary care physician are having difficulty financially with overhead increasing and revenue decreasing. It will only get worse under the public option. The primary care physicians’ only option would be to seek other sources of income.

“Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins.”

Physicians’ overhead will increase under President Obama’s healthcare reform plan. Electronic prescriptions and Electronic medical records (EMR) are mandated. The government is going to subsidize some qualified medical practices. The subsidy for the EMR is estimated, at the maximum, to be $40,000 per physician. A functional EMR costs $65,000 per physician plus a sizable yearly maintenance fee. This subsidy will still be out of reach for most self employed physicians.

“Doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan.”

The government must create regulations and compliance rules in order to control potential abuse. Physicians will need to increased full time employees and documentation experts in order to comply with the new rules. The government promises a crackdown on fraud and abuse and severe penalties.

Sixty percent (60%) of physicians are self-employed. Some of those physicians will be driven into large groups or hospital owned practices to spread their overhead. Some of these newly formed groups are having problems. Some physicians will accept a salary and allow hospitals to deal with the government. The trend will further serve to commoditize medical care. It will destroy the therapeutic benefit of the patient physician relationship.

The primary care physicians who stay self employed will be driven to cram more patients into their schedule in order to increase their net profit. This will further decrease their ability to relate positively to patients and their illness.

The existing trends will increase wait times already high (18 days) for an appointment to see a Family Practitioner and 30 days for specialists. It will also decrease the length of time the physician can spend with patients. The result will be to drive patients into expensive emergency rooms.

Physicians will be forced to close their practices to Medicaid and Medicare (public option) patients when they discover government reimbursement is less than their expenses. This has already happened with Medicaid patients.

Some physicians will opt out of public insurance and only accept cash. The next step is obvious. The government will outlaw the private practice of medicine. This action would be a challenge to the Bill of Rights and the constitution.

I have described some of the unintended consequences of very good goals. The goals are universal healthcare coverage at an affordable cost, with improved quality. I agree with these goals. President Obama is going about accomplishing these goals the wrong way.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/07/the-unintended-consequences-of-president-obamas-public-option.html Medicare is Not Cheap For Either Seniors Or The Government: Part 3: The Real Issues Needed To Be Solved To Reform The Healthcare System Reform tag:typepad.com,2003:post-6a00d83451876469e2011570cc5b89970c 2009-07-05T06:40:49-07:00 2009-07-05T06:40:49-07:00 Stanley Feld M.D.,FACP,MACE President Obama is pushing a healthcare reform plan that will fail. However something has to happen and he is creating a populous uprising. The reason it will fail if his healthcare reform plan is passed is the... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

President Obama is pushing a healthcare reform plan that will fail. However something has to happen and he is creating a populous uprising.

The reason it will fail if his healthcare reform plan is passed is the government cannot afford to pay for Medicare coverage for all. . Expanding coverage to the entire population will create bigger unsustainable defects in addition to the present unsustainable defects for seniors.

Private corporations and small businesses cannot afford to pay for private healthcare insurance coverage either. It is looking for a way to unload their private insurance obligation. The public option will be a way to do it.

This is the dilemma. The present public debate is not discussing the real issues. Healthcare coverage should be universally available at an affordable cost and be high quality. There is no argument with President Obama’s goals. The route he is taking will increase bureaucracy, decrease efficiency of medical care, restrict access to care, decrease quality of care and increase the cost of care. It will also increase government control over healthcare delivery and decrease patient choice.

What are President Obama’s options for reducing the cost of healthcare coverage if he gets his proposal passed?

a. Reduce the medical care coverage to patients

b. Ration care

c. Increase the patient deductible costs

d. Increase patients premiums

e. Decrease payment to physicians and hospitals

f. Decrease administrative waste

g. Decrease profits of healthcare insurance companies who will be the government’s administrative service provider. .

h. Decrease unnecessary medical treatments. Who decides what is unnecessary?

Other options not on the table

i. Develop a plan for end of life ethical decisions. Politicians are not interested in discussing this issue.

I wonder what Ted Kennedy’s bill will be and who will be paying it?

j. Decrease defensive medicine practices by instituting effective tort reform. President Obama said he is not considering this and received boo’s at the AMA meeting. He believes the lawyer claim that the cost is insignificant.

k. Decrease physicians' overhead by decreasing rent, paperwork, committee meetings and needed full time employees for the excessive administrative work.

The government should develop an ideal electronic record and charge users by the click. Upgrades and maintenance would be free. It would create a completely functional EMR. President Obama 50 billion dollar plan will make vendors rich and have little impact on electronic medical record development.

l. Decrease Healthcare insurance industry’s administrative waste. It will not occur in a non price transparent and cost transparent environment.

m. Decrease patient abuse or the healthcare system.

n. Fund effective chronic disease management program.

There is no plan for re-teaching physicians how to run chronic disease management programs. A few poorly designed studies outsourced chronic disease management to proprietary disease management companies. The failed to report improvement in outcomes because they were not extensions of the primary physicians care.

o. Define responsibilities in the therapeutic unit (physician and patient). Patient physician contracts for chronic disease.

Who is responsible for the defects in the healthcare system leading to increased costs?

I believe these are the key questions to ask. Once answered, systems can be set up to correct the defects. The easiest group to blame is physicians. They are the least organized, the least effective lobbying group and the least generous to politicians.

1. Who is responsible for obesity?

Patients become obese by overeating and under exercising. Food industry by producing cheap high caloric value processed food. Government through subsides encourages food industry and farm industry to produce these food. There is little public service campaign to discourage obesity.

2. Who is responsible for AID’s infection?

Patients by sexual habits and behavior. Government has conducted public service education campaign that has encouraged effective prevention but has not been intense enough.

3. Who is responsible for drug and alcohol addiction?

Patients are responsible for their behavior. There are no public service campaigns that discourage this behavior. Many of our entertainment icons encourage the masses misbehavior.

4. Who is responsible for smoking?

Patients are responsible for this behavior. Government has been effective in promoting a non smoking policy. The tobacco companies have gotten around government efforts. Agricultural policy has not discouraged tobacco growth.

5. Who is responsible for air pollution leading to chronic lung disease, asthma and lung cancer?

The government is with its lack of a coherent environmental policy. The bill passed by the House of Representatives does not decrease pollution. It increases the cost to pollute. It is defective in have many negative exceptions.

6. Who is responsible for the epidemic of Diabetes Mellitus, lung disease, end stage renal disease, and osteoporosis?

All the stakeholders with the government most responsible for not having a positive health policy

6. Who is responsible for the high cost of insurance?

The healthcare insurance industry with the nature of its price structure, the practice of defensive medicine by physicians, the patients with first dollar coverage, the government by not enforcing regulations.

The Obama administration is focused on the wrong reforms. It is talking about expanding a broken non functioning system. All the actions by the various stakeholders are driven by perverse incentives. All of these perverse incentives are driven by economics. The economic morass has evolved since the introduction of Medicare in 1965. Most political decisions are driven by vested interests protecting their economic interests.

In order to create an affordable and functioning healthcare system for all, President Obama and his team should be discussing how to align all the stakeholders’ vested interests so all are satisfied with the economic outcomes. The consumers are the primary stakeholder. The systems should be built to empower the consumers. President Obama should be focused on decreasing these factors and issues that stimulating our excessively expensive and dysfunctional healthcare system.

With his stimulus program for electronic medical records and his proposed healthcare plan he is throwing good money after bad. The money will be wasted and the healthcare system will not be improved. More people will be covered by healthcare insurance. The healthcare insurance coverage will be restricted by the government as a third party and not by the patients. Less medical care will be available and that will be bad.

I discuss most of these issues and the solutions in my blog http://stan.feld.com. The summary blogs are at   http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/summary-blogs-to-repair-the-healthcare-system.html

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/07/medicare-is-not-cheap-for-either-seniors-or-the-government-part-3-the-real-issues-needed-to-be-solved-to-reform-the-healthc.html Medicare is Not Cheap For Either Seniors Or The Government: Part 2; The Government tag:typepad.com,2003:post-6a00d83451876469e2011570a375f2970c 2009-07-01T06:34:49-07:00 2009-07-01T06:38:17-07:00 Stanley Feld M.D.,FACP,MACE Medicare is partially funded through payroll taxes of the workforce for the benefit of seniors. The unfunded liability of the government for seniors is enormous. It gets bigger each year. As baby boomers reach Medicare age the... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

Medicare is partially funded through payroll taxes of the workforce for the benefit of seniors. The unfunded liability of the government for seniors is enormous. It gets bigger each year. As baby boomers reach Medicare age the government unfunded liability is going to escalate more rapidly.

President Obama and the Democratic controlled congress are ignoring the Medicare trustee annual report of Medicare’s unfunded liabilities. They keep promising us the public option will provide the same insurance the congress receives under Medicare Part C. The only way to fix the unfunded liabilities is to decrease services or increase taxes or both. These reports are public information.

Medicare is funded by a combination of dedicated revenues (payroll taxes, beneficiary premiums, and state payments) and general revenues.

“Medicare's Hospital Insurance (HI) trust fund, (Medicare Part A) financed by payroll taxes, is currently running a deficit and is projected to be exhausted by 2019” according to the 2005 Medicare trustee report.

“Conversely, the Supplementary Medical Insurance (SMI) trust funds’( Medicare Part B and Part D ) which cover outpatient services and prescription drugs, never face a deficit nor become exhausted, because annual adjustments are made each year—mainly drawing more from general revenues—to match expected costs.”

Nevertheless, with projected increases in demands on the Medicare program by retiring baby boomers and rising health costs, growth in program expenditures, which are already heavily reliant on general revenues, will soon require additional taxpayer funding.

The projection in unfunded liability in the next 75 years increased from $12.7 trillion in 2005 Medicare Trustee report to $34.2 trillion in 2007. The 2008 report estimated the unfunded liabilities will increase to $100 trillion in 75 years. These numbers are estimates for seniors only. If President Obama extends Americans covered under the public option the unfunded liability will be higher. The only way to cover these costs is to increase taxes, decrease coverage or both.

In 2006, total Medicare expenditures were $408 billion, or approximately 3.1 percent of GDP. But as a share of GDP, Medicare expenditures are projected to double to 6.5 percent by 2030 and nearly quadruple to 11.3 percent by 2081.

This was a 2007 estimate. In 2008 the estimate doubled. President Obama’s healthcare reform plan will knock the ball out of the park. $1 or $2 trillion dollars is a lot of money. $100 trillion dollars is unimaginable.

“The Medicare Trustees report shows that Medicare poses the single greatest challenge to taxpayers of all government programs.”

 

In 2005 Senator Judd Gregg R-NH, President Obama’s choice for Secretary of Commerce expressed the need for fiscal responsibility while the U.S. Comptroller General could not express the urgency in more graphic terms.

[W]e as a Congress has an obligation to try to fix [those entitlement programs] today so that they don’t end up bank­rupting our children and our children’s children tomorrow.

—Senator Judd Gregg (R–NH)[1]

There is no way we are going to deliver all the Medicare promises that have been made. No way.

—David M. Walker, U.S. Comptroller General[2]

Now we are hearing from President Obama that we cannot afford not to spend the money. The common invective about the Democratic Party is they are the tax and spend party. President Obama is turning the invective around. He plans to spend and then tax.

The administration is not testing reality. Government estimates are usually notoriously underestimated. In recent weeks the CBO estimated a $1 trillion dollar increase in the next ten years if the government adopts Ted Kennedy’s plan. $1trillion dollars is a big number. I believe the Congressional Budget Office is being kind to Ted Kennedy’s bill and the estimate of costs of the public option.

The Centers for Medicare and Medicaid Services (CMS), the agency that runs the Medicare program, gen­erated its own estimate in 2003 and has continued to do so every year since the bill’s enactment. Though not made public until 2004, the CMS’s 2003 estimate was $534 billion dollars in unfunded liabilities for the period 2004 to 2013. In CMS’s February 2005 estimate, the 10-year price tag of the drug provision is $724 billion dollars for the period 2006 to 2015.

Americans are being numbed by the numbers. A trillion here, several trillion dollars there and everything will be alright. Today the Medicare estimated unfunded liability will increase by $2 trillion in just one year without President Obama’s healthcare reform.

If the government really wanted to reform the healthcare system, be able to afford universal care and increase the quality of care to increase the health of the nation he would focus on the real problems in the healthcare system as I have outlined them.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/07/medicare-is-not-cheap-for-either-seniors-or-the-government-part-2-the-government.html Medicare Coverage Is Not Cheap For Either Seniors Or The Government : Part 1; Seniors tag:typepad.com,2003:post-6a00d83451876469e2011570851e2b970c 2009-06-28T05:55:54-07:00 2009-06-28T05:55:54-07:00 Stanley Feld M.D.,FACP,MACE Many people believe Medicare works well. Many people have said all we need to do to repair the healthcare system is lower the eligibility age from 65 to newborns. America would then achieve a. universal care, b.... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

Many people believe Medicare works well. Many people have said all we need to do to repair the healthcare system is lower the eligibility age from 65 to newborns.

America would then achieve a. universal care, b. affordable costs c. improved quality care. The healthcare system would be fixed. The statement is simplistic but popular.

Medicare coverage does work well for seniors if they have both adequate supplemental coverage and Medicare Part D to cover the Medicare gaps in coverage and drugs.

Medicare Part D( drug coverage) was poorly constructed. It was built to the advantage of the healthcare insurance industry not seniors. If seniors do not have supplemental Medicare insurance (Medigap) they could be bankrupted because of the Medicare deductibles and co-pays. .

Medicare does protect the senior from the retail price of medical care. It does guarantee insurability at a price not determined by pre-existing illness. It does permit choice of provider providing the provider sees Medicare patients.

Fewer and fewer physicians are accepting Medicare patients. Medicare reimbursement and coverage decline with each passing year. In many cases physician reimbursement is lower than the physician’s cost to provide the service.

This has been a constant battle for physicians since the government cost savings program was mandated in the 1980’s. Another 20% reduction in reimbursement is scheduled for 2010.

Seniors can still go to physicians who do not accept Medicare. However, seniors will be responsible to pay the retail price for the service. Seniors will collect directly from Medicare 80% of Medicare’s acceptable fee after they submit the bill to Medicare.

For example, if a medical bill is $200 and Medicare’s allowable fee is $80, Medicare will pay you 80% of the allowable fee or $64. The senior has already paid the physician $200. The senior’s out of pocket expense is $135 . If the physician honors Medicare $120 of his $200 fee is disallowed.

Medicare will pay the physician $64. The senior is liable for $16. If the senior has supplemental insurance (Medigap) the supplemental insurance will pay the remaining $16. .

The Medicare premium paid by seniors monthly is not cheap. The base assessment is $99 per month per senior. This assessment might not be affordable to many who are on a fixed income.

The Medicare Part D helped pay for prescription drugs. Many seniors cannot afford to buy the medication they need. Medication needed to stay well and out of the hospital.

1. Medicare has recently imposed an added assessment to the basic Medicare premium. It is called the Modified Adjusted Income Calculation. The IRS supplies Medicare with a senior’s previous year income tax returns. Capital gains, dividends, tax free dividends, and salaries are including in the Modified Adjusted Income calculation.

2. A married couple with a joint return and income from all sources is going to have an additional assessment of between $51.60 and $284 dollars per person per month depending on their combined Modified Adjusted Income calculation assessment.

3. The assessment starts at $160,000/yr and ends at $410,000 per year. A widow with dividends, capital gains, an annuity and rental income of $164,000 per year is assessed an additional $103.30 per month or $1239.60 per year.

4. This assessment is paid with pre tax dollars. It gets deducted from the Social Security payment. If a person has earned income in addition to passive income the person is also paying additional tax on his Social Security check.

5. The deductible of 20% of the allowable fee and the initial $992.00 deductible for a hospital admission becomes expensive quickly.

6. In order for the Medicare recipient to have full coverage for the deductibles they have to buy Medigap insurance. There are seven Medigap insurance policies. The best and most complete is the Medigap Part F. Several private healthcare insurance companies sell this coverage. For persons under 70 years the cost of the policy is $140 dollars per person per month in after tax dollars. The effective post tax cost per month is $200 per person or $400 per couple. The yearly after tax dollar cost is $4800 per year.

7. If you add Medicare Part D for prescription drug coverage, it adds another $24 per person or $34.28 dollars in after tax dollars per month per person or $822 dollars per couple per year. This cost does not consider the extra cost of the infamous doughnut hole.

8. The total premium for adequate Medicare insurance is $2244 plus $4800 plus $822 or $7866 per year. This calculation excludes the modified adjusted gross income. The modified adjusted income can add $619.20 to $3408 per couple per year to the premium. The MAGI creates a means adjusted premium. The maximum means adjusted premium is $11,274. per year per couple in 2008.

It should be clear that Medicare has its benefits. However it also has limitations because despite these premiums and deductibles the government’s unfunded liabilities for Medicare is escalating to unsustainable levels.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/medicare-coverage-is-not-cheap-for-either-seniors-or-the-government-part-1-seniors.html Are The Wheels Coming Off? tag:typepad.com,2003:post-68430733 2009-06-23T20:14:23-07:00 2009-06-23T20:14:23-07:00 Stanley Feld M.D.,FACP,MACE During the past week the healthcare debate has increased in intensity. President Obama has drawn a line in the sand. He wants a bill on his desk by August 1, 2009. It also looks as if his... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

During the past week the healthcare debate has increased in intensity. President Obama has drawn a line in the sand. He wants a bill on his desk by August 1, 2009.

It also looks as if his healthcare reform plan is being derailed not by Republicans but by his own party.

President Obama has also given the AMA a glimpse of where he stands on malpractice reform. He received boos from members of the AMA.

He has set out the fundament principles of his healthcare reform.

1. Universal coverage

2. Affordable cost

3. Increase in quality of care.

President Obama then asked key committees in both houses to craft a bill compatible with his goals. He is very smart.

“What the president wisely assessed, looking at what did not happen in the early ’90s, was that unless there was some real ownership, unless members of Congress owned drafting and crafting and did some heavy lifting and then owned the final work product, it wasn’t going to work.”

This is clever but it could be the down fall of any healthcare reform. Max Bacchus has presented Tom Daschle’s plan. Ted Kennedy has presented a plan that is fiscally irresponsible according to the congressional budget office. His healthcare reform plan completely ignores the warning of the congressional budget office. The House of Representatives released the Conyer healthcare reform plan that would create an even larger deficit than Ted Kennedy’s plan.

None of the plans from either side of the aisle are focused on the real problems in the healthcare system.

Kathleen Sebelius, secretary of health and human services, summarized the mood that is motivating the country to move forward. The country feels government needs to do something. She disregards the fact that what is done needs to be constructive and must repair the healthcare system.

“ I think the underlying factor is that the status quo is not sustainable and it’s not acceptable. And in many ways the economic downturn has shaken the status quo.”

Economically, emotionally, and morally the status quo is not sustainable. Everyone agrees. The debate is getting very confusing while focusing on the wrong issues.

In the early ’90s, there was a sense that doing nothing was an O.K. alternative. For some people it was better than doing something that they felt would lead us in a wrong direction. I really don’t know of a single stakeholder group or party in this discussion who is willing to say out loud doing nothing is O.K.

Everyone agrees something must be done. The momentum for healthcare reform is compatible with Heidi Klein’s “Shock Doctrine.”

If people are frightened enough about an issue they will accept any policy. She says this is the method politicians use to gain power over the people.

All the healthcare reform proposals are confusing and difficult to follow. At this point citizens are so frightened and disgusted that they relinquish their power to elected officials who they hope understand the problem. They assume these politicians will look after their vested interests.

I think the weight of inertia is always more powerful often than the forces of change. But in this case there’s an underlying turmoil, whether it’s people looking at the moral imperative, people looking at the financial imperative, and people frankly looking at what’s happening to our country in terms of health outcomes. Nobody feels this is acceptable

Kathleen Sebelius explained the legislative confusion away by saying this is how legislation works. The people want a bill.

President Obama is going to prove to congress that the people are demanding a change through his house parties and blogs calling for support of his healthcare plan. The Democrat controlled congress will have no choice but to give them a bill. The problem is the plan will make things worse as proven in Massachusetts.

When Secretary Sebelius was asked the question; “So are you not concerned about the Congressional Budget Office release on the HELP bill? Do you think it doesn’t really pose problems? (The office “scored” the bill produced by Sen. Edward M. Kennedy’s committee as costing at least $1 trillion over 10 years, while leaving 36 million people uninsured).”

She said don’t worry. Whenever you see a big price tag and the notion that lots of people are not covered it will raise questions.

“ What I’ve been told is that we shouldn’t spend a lot of time and energy on that because it( Kennedy’s plan) is a partial hit on a partial bill.

I think the American people are tired of these general responses to some positive data by impartial sources. The administration believes all it has to be do is to respond by repeating President Obama’s generally accepted idealistic principles. The people will believe everything will be alright.

I’m still optimistic at the end of the day that a bill that meets what the president said all along, some fundamental principles — cover every American who lacks health insurance right now, build on what is working in the health system, so people who have coverage and a health provider that they like and they feel is good for their family keep it, that we have a new system in place to really lower costs over all for everybody and that we begin to drive quality, which is now available to some Americans some of the time depending on where you enter the system. So around those principles I’m convinced we’re going to have a proposal.

What are the details of President Obama’s program? What is the cost to the tax payers going be? Is the congressional budget office wrong about the 1 trillion dollars over ten years? Is Senator Kennedy wrong about 36 million uninsured because the government cannot afford it? How is the quality of care going to improve with the bills on the table when quality medical care is not defined properly? Is a board of experts’ going to be able to define and enforce its definition of quality medical care?

This is not the time to give in or give up!

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/are-the-wheels-coming-off.html Summary Blogs to Repair the Healthcare System tag:typepad.com,2003:post-68330869 2009-06-21T06:31:49-07:00 2009-06-21T06:34:02-07:00 Stanley Feld M.D.,FACP,MACE I am posting what I consider summary blogs. It would be difficult to read all the summaries in one sitting. I compiled this list for people who have just started following “Repairing the Healthcare System.” The links... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

I am posting what I consider summary blogs. It would be difficult to read all the summaries in one sitting. I compiled this list for people who have just started following “Repairing the Healthcare System.” The links are intended to get you started and to be used as a reference.

The links below are my view of the policies that must be adopted to Repair the Healthcare System. The letters written to President-elect Obama and then President Obama were written when he promised that everything was on the table and he was open to all ideas. It is now clear to me that nothing was on the table. He will expand a government entitlement the country cannot afford and most people would not want. President Obama should be concentrating on the real problems in the healthcare system.

If you follow the links in each article you will understand my views on the policies needed to repair the healthcare system. I believe it can be repaired without enlarging unaffordable entitlements and the resultant increase in public debt. I have proposed specific policy changes that will enhance quality, improve coverage and decrease costs.

The Healthcare System’s Problems Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/11/fall-2007-what-.html

The Healthcare System’s Problems Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/11/fall-2007-wha-1.html

The Ideal Medical Savings Account

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2006/10/the_ideal_medic.html

The Ideal Electronic Medical Record Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/01/the_complexity_.html

The Ideal Electronic Medical Record Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/01/the_ideal_elect.html

E prescriptions

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/12/e-prescriptions.html

Real Price transparency

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/11/physician-focus.html

The Definition Of The Physician Patient Relationship Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/the-therapeutic-magic-of-the-physician-patient-relationship-part-1.html

The Definition Of The Physician Patient Relationship Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/the-therapeutic-magic-of-the-physician-patient-relationship-part-2.html

Dear President Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president--elect-barack-obama-part-5.html

Dear President Obama Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Rationale for Effective Malpractice Reform Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

Rationale for Effective Malpractice Reform Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

Electronic Medical Record Stimulus Fiasco Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/the-electronic-medical-record-stimulus-fiasco-part-1.html

Electronic Medical Record Stimulus Fiasco Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/the-electronic-medical-record-emr-stimulus-fiasco-part-2.html

Electronic Medical Record Stimulus Fiasco Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/the-electronic-medical-record-emr-stimulus-fiasco-part-3.html

Call to Action

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/to-my-readers-a-call-to-action.html

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/summary-blogs-to-repair-the-healthcare-system.html Republican Healthcare Proposal Executive Summary : Part 2 tag:typepad.com,2003:post-68238445 2009-06-18T06:11:24-07:00 2009-06-18T06:12:51-07:00 Stanley Feld M.D.,FACP,MACE Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice

The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important improvements to both programs without limiting eligibility or benefits by:

• Integrating low‐income families with dependent children into higher‐quality private plans through direct assistance

What is the definition of higher-quality private plans? Who is going to judge quality? How is government going to fund these “higher quality private plans?”

• Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans

How will this be accomplished when Medicaid reimburses so poorly. There is a shortage of Medicaid physicians already. These physicians must do a volume business (Medicaid Mills) to make ends meet. These volume practices (Medicaid Mills) are being investigated for fraud.

• Realigning responsibility between federal and state governments in order to better coordinate benefits by requiring the Medicare program to assume Medicaid responsibility of premiums, cost‐sharing, and deductibles for low‐income seniors

The above is just words. It almost sounds as if the federal and state government are going to be responsible for increased funding for private enterprise.

• Rebalancing long‐term care services to ensure choice between institutionalized and home‐based care

• Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage

Medicare Advantage is recognized as an insurance product designed to rid the government of the Medicare entitlement . The government under the Republican administration paid an extra $3,000.00 per person to outsource the responsibility for Medicaid from the state to the healthcare insurance industry. The cost is unsustainable. Excess profits flow to the healthcare insurance industry.

• Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to

physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction while reducing costs

This is a “pay for performance a system” that ultimately cannot work because of intrinsic defects in the pay for performance concept. Quality medical care has not been defined appropriately. Is it defined as medical outcomes, financial outcomes, number of test performed or disease discovery?

• Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D

Medicare Part D is a poorly constructed in the present form. It is written to the advantage of the healthcare insurance industry, the pharmacies and the pharmachuetical companies. It is not a patient centric plan.

Ensuring Compensation for Injured Patients

Our current legal system does a poor job at compensating patients for medical mistakes in a fair and efficient manner. Instead of nurturing an environment where medical professionals can openly learn from their mistakes, our legal system often forces doctors and patients into contentious courtroom disputes. The Patients’ Choice Act would reform this broken system that helps drive health care costs out of control by:

• Encouraging states to adopt a number of legal alternatives entirely run by the state that would include the establishment of expert medical panels to resolve disputes, creation of health courts, or a combination of both

This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.

Establishing Transparency in Health Care Price and Quality

For a vibrant health care market to function properly, patients must know what services cost and who provides the best service. Uniform and reliable measures of reporting quality and price information should be designed by the stakeholders in health care rather than the heavy‐hand of government. The Patients’ Choice Act would bring this much needed transparency into the health care market by:

• Creating a Healthcare Services Commission that relies on a public/private partnership to enhance the quality, appropriateness and effectiveness of health care services through the publication and enforcement of quality and price information

• Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality with the input from all major stakeholders in health care, as well as the general public

• Ensuring that measures of effectiveness keep pace with innovation

This is the most logical proposal in the plan. It also contains specific action points. However it keeps the power in the healthcare insurance industry’s hands. It should put the power in the consumers’ hands. If the private sector (healthcare insurance industry) does not cooperate, it should be restricted from selling insurance by the state board of insurers.

There is the entire proposal. There is nothing new and no outline of action to accomplish any part of the proposal.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/republican-healthcare-proposal-executive-summary-part-2.html Republican Healthcare Proposal Executive Summary : Part 1 tag:typepad.com,2003:post-68159017 2009-06-16T06:36:17-07:00 2009-06-16T06:36:17-07:00 Stanley Feld M.D.,FACE,MACE It is not fair to criticize the Republican Party’s healthcare proposal without providing the reader with the source material. The source material comes from Senator Tom Coburn’s web site. My negative comments should be judged in light... stanleyfeldmdmace

 

Stanley Feld M.D.,FACE,MACE

It is not fair to criticize the Republican Party’s healthcare proposal without providing the reader with the source material. The source material comes from Senator Tom Coburn’s web site. My negative comments should be judged in light of the original proposal. The executive summary follows.

Preventing Disease and Promoting Healthier Lifestyles

· Critical investments in public health and disease prevention will go a long way in restraining

health care costs and improving the quality of Americans’ lives. The Patient’s Choice Act of 2009 would:

• Encourage increased coordination of federal prevention efforts and bring long‐overdue accountability to these programs

• Require CDC to undertake a national campaign highlighting science‐based health promotion strategies

• Equip recipients of Supplemental Nutritional Benefits with easily understandable information about nutritious food options and target the use of food stamps to healthy food choices

• Invest $50 million annually for increased vaccine availability and bonus grants to states that achieve 90 percent or greater coverage of CDC‐recommended vaccines

• Provide incentives for states to reduce rates of chronic disease like heart disease and diabetes

All of the above proposals should be executed. How will they be implemented? The Republicans do not have a plan but not having a plan does not make the Democrat’s plan a good one.

Creating Affordable and Accessible Health Insurance Options

Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant market for health insurance that is consistent and fair will allow all Americans access to health coverage.

How will Republicans make a vibrant market for healthcare insurance? How will people who cannot afford healthcare insurance pay for it? The tax credits might help a little. However, if you do not have the cash you cannot pay for the insurance.

The Patient’s Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the following:

• Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different health insurance policies and select the one that meets their unique needs

• Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range of choices

• Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating Exchange insurers based on age or health

What will the premium be for those with preexisting illnesses? Will the premiums be higher for patients with preexisting illnesses? The high risk pool premiums have been very expensive.

• Creates a non‐profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre‐existing conditions.

• Expands coverage through auto‐enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year

This is an empty statement. How will this be administered? The devil is in the details and there are no details presented.

• Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’

Risk pooling has been tried and has been unsuccessful. It has been an excuse to allow the insurance industry to spread the risk. The proposal also implies variable premiums.

Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage

Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get their health coverage through their employers, discriminating against the self‐employed, the unemployed, and small businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by:

• Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family

• Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid with HSAs without a tax penalty

• Allowing preventative services to be covered by High Deductible Health Plans

• Increasing the amount of money an HSA owner may annually contribute to their account

Healthcare insurance premiums are $14,000.00 a year for a family. A $5,700.00 tax credit does not cover it. It also assumes the consumer has enough income to have a $5,700.00 be tax liability. Citizens are not subject to income tax if they make up to $38,000.00 year. HSA’s retain the healthcare dollar to be used for future spending on healthcare. The healthcare insurance industry retains control over the premium and the healthcare dollars. It is not a pro consumer proposal. It does not offer financial incentives to consumers .

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/republican-healthcare-proposal-executive-summary-part-1.html Republican Healthcare Plan Unveiled. tag:typepad.com,2003:post-68089873 2009-06-14T06:24:53-07:00 2009-06-14T06:24:53-07:00 Stanley Feld M.D.,FACP.MACE Republicans in Congress have introduced their health care reform plan. "The Patients' Choice Act of 2009," has been introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP.MACE

 

Republicans in Congress have introduced their health care reform plan. "The Patients' Choice Act of 2009," has been introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA).

The proposal that relies heavily on private mechanisms does not contain an individual mandate to have healthcare insurance, It offers insufficient tax credits for families and individuals previously insured and not in a group insurance plan. It must be noted that people who make less than $38,000 per year pay no income tax. A tax credit is meaningless to them. These are the people who are uninsured.

Individuals not in a group insurance plan pay retail for healthcare insurance premiums with after tax dollars. Employers that have group healthcare insurance for employees, pay the insurance premiums with pretax dollars.

The new Republican healthcare plan would eliminate employers tax deductible benefit. This would discourage employers from providing healthcare insurance to employees. The plan is not dissimilar to the proposal championed by John McCain during the presidential campaign. His proposal was considered inadequate.

“The focus of the proposal is to push for a "guaranteed choice of coverage" in the private market through federal-state partnerships know as State Health Insurance Exchanges.

Individuals will have a "one-stop marketplace" to choose plans in the exchange, including the option of keeping their employer coverage and/or existing insurer.

The plan eliminates pre-tax dollar deduction for employers who provide health coverage to their employees. It provides a $5,710 tax credit to families and a $2,290 tax credit to individuals toward the purchase of health insurance coverage.

This is not enough of a tax credit to be effective for those who can afford to buy healthcare insurance. In reality it will save the government money. It would eliminate employer tax deduction. An unintended consequence will be an increase in thenumber of uninsured.

Healthcare insurance premiums average $14,000 per family and $7,000 per individual. The healthcare insurance industry cherry picks patients. It eliminates the sick and over 55 year olds with a high potential for illness. If its ability to cherry pick is eliminated the healthcare insurance premiums will be even higher.

The Republican healthcare plan does not state if the non insurable sick will be subject to the same or higher premiums.

"Participating insurers," meanwhile, would be required to "offer coverage to any individual -- regardless of patient age or health history" though there is no mandate for an individual to purchase that insurance”.

Many things are wrong with the Republican party’s proposal. I am disappointed in Senator Tom Coburn. He is a “practicing M.D” he should know the real problems in the healthcare system..” The proposal has some good ideas but no suggestions on how to implement those ideas.

His plan ignores the real problems. The uninsured cannot afford to purchase healthcare insurance. Some young healthy people do not want spend the money for healthcare insurance. Many people are underinsured. Illegal immigrants are uninsured. They show up for care in our safety net hospitals. Our safety net hospitals are underfunded. The plan does not contain incentives for patients to work hard to remain healthy.

The reasons healthcare costs are so high are many. Price Waterhouse has calculated 1.1 trillion dollars is wasted dollars between defensive medicine and unnecessary administrative cost.

Medical care for the complications of chronic diseases absorbs 80% of the healthcare dollars. The complication rate can be reduced by at least 50% if patients became “professors of their disease” and they themselves prevented the complications. This can only be accomplished through education and financial incentives.

The proposal does not repair any of the abuses of the healthcare insurance industry, the government, the hospital systems or physicians.

The proposal gives employers a perfect excuse to drop insuring employees by the removal of their tax exemption for premiums. President Bush tried very hard to accomplish this and failed. .

The Republican plan would leave a greater number of Americans uninsured with no improvement in the health of the nation.

The Patients’ Choice Act contains many of the popular sound bites. It does not have a plan to achieve change. The only way change will occur is by leveling the playing field and providing incentives for patients. The plan keeps the healthcare insurance industry in control of the healthcare dollars.

It states; “ the Act transforms health care in America: strengthening the relationship between the

patient and the doctor; using the forces of choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans.”

I am disappointed in the Republican proposal. It is a proposal of empty words. The public will not be fooled. The public wants change. I will publish the executive summary so readers can judge for themselves.

Under the Republican plan, instead of a competitive marketplace for healthcare coverage I can visualize a market place dominated by a few healthcare insurance companies. The result will be further increase in cost of premiums. The healthcare insurance industry would continue to own the healthcare dollar and be non transparent.

The healthcare insurance industry would continue to abuse patients, physicians, hospitals and the government.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/republican-healthcare-plan-unveiled.html Rope A Dope tag:typepad.com,2003:post-67934689 2009-06-10T07:08:03-07:00 2009-06-10T07:08:03-07:00 Stanley Feld M.D.,FACP,MACE There are many issues involved in healthcare reform. The major issues to decrease defensive medicine with malpractice reform, rapid affordable installation of electronic health records, control of the obesity epidemic, effective chronic disease management and a change... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

 

There are many issues involved in healthcare reform. The major issues to decrease defensive medicine with malpractice reform, rapid affordable installation of electronic health records, control of the obesity epidemic, effective chronic disease management and a change in the healthcare insurance model are not on the radar screen of the President or Congress.

The issue with effective healthcare reform is about money. In order to save a significant amount of money the above problems must be solved. As President Obama plan progresses in the congress the battle is all about political tactics and positioning for the midterm elections in 201

“On the one hand, President Obama and his party say they're hoping to strike a good-faith compromise on health care. On the other, they're threatening this "budget reconciliation" maneuver to coerce Republicans into rubber-stamping liberal policy.”

The Democrats want to get a handful of GOP Senators to support the bill before in gets to the floor. The goal is to short circuit a bloody debate before it begins. The Democrats are to join their fold. Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe voted for expanding the state children's insurance program (Schip).

SCHIP was a compassionate bill and logical. However it is a bill that does not create patient incentives. It is difficult to imagine Republicans defecting to the poorly constructed bill that will created greater costs and more dysfunction to the healthcare system.

“This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise.”

All the the Democrat’s rhetoric in nonsense. Without a change healthcare insurance healthcare costs will continue to rise . We need only to look at the Massachusetts experience.

The administration is prepared to make promises to Republican such as the government healthcare plan would only be sold to the uninsured and small businesses that can not afford to provide employees with healthcare insurance because of the costs. Once the Republicans on on board and the bill is past the administration could modify this proposal and make it all inclusive.

“ The White House strategy is to dilute the healthcare plans proposal just enough to win over credulous Republicans. That is what has always happened with government health programs:”

President Obama is playing a game of got uh. Some one wrote to me and called it Rope A Dope.

“When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers”.

Medicare’s cost to seniors has also risen with a base month cost of $99 per month per person or $2400 per year per couple. The catch is the deductible are $999 for hospital admission and and 80/20 deductible. The monthly payment per person is means tested and can go to $275 per month per person with after tax dollars. The a senior has to by Medicare Part F for deductible coverage. Its cost is 170 per month per person. Medicare Part D at it least expensive is $47 per month per person with high deductible.

In order to get full coverage the cost can be as high as $15,000 per year in after tax dollars.

Congressional actuaries expected Medicare to cost $3.1 billion by 1970. Medicare today costs $455 billion and rising.

Medicaid was intended as a last resort for the poor. It now covers one-third of all long-term care expenses in the U.S.. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.

Over time end stage renal disease and disabled person have been added to the Medicaid roles Other person also have been included.

“SCHIP was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.”

A common denominator to all of this unsustainable increases is the way the healthcare insurance industry controls the healthcare dollars. This leads to abuse by other stakeholders. Incentives must be aligned with the consumer controlling their healthcare dollars.

The Lewin group estimates that 119 million more persons with private insurance could be added to the 90 million already on Medicare and Medicaid. Health habits must be changed to combat obesity. The only way it will be changed is a change in farm policy and the consumers owning their healthcare dollars. Otherwise we are doomed to every increasing premiums and overuse of the healthcare system.

Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they've guaranteed otherwise.

President Obama is going to mount a public opinion campaign for his plan. The Republicans are going to cave in. They are trapped

Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.

President Obama will have successfully “Roped A Dope” Who is the Dope? All of us unless we get wise quickly.

The only way to Repair the Healthcare System is to enable consumers to own their healthcare dollars and to provide incentives to consumers to be responsible for their health. The government should make the rules to level the playing field and empower consumers to drive the healthcare system to their benefit.

These actions allow healthcare affordable to all including the government.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/rope-a-dope.html What Is Reality?: America Is Heading Toward Financial Disaster tag:typepad.com,2003:post-67771025 2009-06-07T06:30:04-07:00 2009-06-07T06:30:04-07:00 Stanley Feld M.D.,FACP,MACE The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare. “Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare.

“Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi schemes? The new Obama-Democrat budget deficit is $1.8 trillion, four times larger than it was only last year. The national public debt has increased by more than 10 percent since Inauguration Day.”

Social Security and Medicare are underfunded entitlement programs. Medicare for the entire country is not viable.

These are the published numbers for 2008.

  • Social Security's unfunded liabilities stood at $13.6 trillion.
  • Medicare's unfunded liabilities are more than $30 trillion.
  • Medicaid, another severely underfunded and politically untouchable entitlement program, only adds to the total.
  • The federal government's current entitlement bill, including future obligations-based only on promises it has made in the past -- is greater than $57 trillion.”

The first Baby Boomers started drawing early retirement benefits from Social Security last year.”

78 million people are going to stop working, stop paying taxes, stop paying into retirement programs and start drawing Social Security and Medicare benefits. The federal government has made explicit and implicit promises to millions of retiring citizens. It does not have the funds to keep those promises without a big hike in taxes.

“According to a recent forecast by the Congressional Budget Office shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century”

In order to get close to funding our current obligations it is estimated that the income tax rate will have to increase to 66%. With all the bailouts and economic stimulus packages the federal government’s debt can only get worse.

Yet the game of who can have better sound bites and who can win is the only thing that is important to President Obama, the healthcare insurance industry, and the Democratic congress.

Healthcare reform should not be about a National Healthcare Insurance Exchange or universal healthcare with a single party payer. This is not going to fix the healthcare system. It will make our financial problems worse. Our government officials should face reality. It should do what all physicians know needs to be done.

It should be passing legislation to create a less polluted environment. It should revise the Farm Bill. It should eliminate the use of corn syrup. It should fight obesity with public service educational campaigns. It should create an insurance product that provides consumers with financial incentives to stay healthy. It should eliminate the causes of administrative waste and defensive medicine. These should be the areas of discussion in order to repair the healthcare system. These bold topics threaten powerful vested interests and are politically explosive.

America should set up a healthcare insurance system that provides incentives consumers to demand better foodstuff and a healthier environment. Consumers should own their healthcare dollars and be able to save what they do not use. (ideal medical savings account).

The federal government should make the conversion to functional electronic medical records easier and less costly to physicians (ideal electronic medical record). We should have major tort reform to decrease the intolerable cost of defensive medical.

These are areas in which the healthcare reform debate should be focused. If the Republican Party wants to seize the initiative from the Democratic Party and excite the citizens of our country they need to act .

Instead, we have a silly debate pitting the new media (Democratic Party) against the old media (Republican Party) over systems we cannot afford. The new media will win. Americans lose no matter which side wins.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/what-is-reality-america-is-heading-toward-financial-disaster.html Consumers Anger Toward The Healthcare Insurance Industry Mounts tag:typepad.com,2003:post-67581071 2009-06-03T04:22:45-07:00 2009-06-03T04:25:14-07:00 Stanley Feld M.D.,FACP,MACE President Obama is utilizing the well earned anger consumers have for the healthcare industry in order to promote his healthcare reform plan. Eighty percent of consumers are not sick. Those 80% think their healthcare insurance policy is... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

President Obama is utilizing the well earned anger consumers have for the healthcare industry in order to promote his healthcare reform plan. Eighty percent of consumers are not sick. Those 80% think their healthcare insurance policy is great. The 20% of the population that is sick is very unhappy with the healthcare insurance industry.

The internet and the blogosphere have enabled those 20% to express their anger. In less than 5 hours there were 177 negative comments to the article describing how the healthcare insurance industry double crossed President Obama. This anger has been ignored in the past. The new media has created an environment in which the anger cannot be ignored. The healthcare insurance industry has killed the goose that laid its golden eggs.

President Obama has made the internet his town hall to permit consumers to express their discontent for the healthcare system. I suspect President Obama will receive more than 5 million complaints in his campaign to expose the abuse of patients by the healthcare insurance industry.

It will not bring us closer to having an affordable healthcare system. If the complications of chronic diseases were prevented, defensive medicine eliminated by effective malpractice reform, and healthcare insurance companies’ administrative waste stopped, America would have an affordable healthcare system.

Consumers need to control their healthcare dollars, receive incentives and be responsible for their own health and healthcare. ( ideal medical savings accounts).

The following are a few consumer comments

“Not surprised at all by this. The health insurance companies have had an unbelievable advantage, they can do anything they want. The only thing they need to do is keep Congress happy with lobbyists because Congress is not their customer, they have their own insurance paid by you and I. It's gloves off time on health reform. These guys will pull no punches, they are fighting for their yachts. While we lose insurance if we file a claim.”

A consumer terminated from his job.

“I am a 56 year old professional with master degrees and many years of experience in my industry & for 19 years plus I worked for the same large corporation that just terminated me from employment because I was diagnosed with a blood cancer.
My family and I have lost medical coverage because of this and at a time when I need it the most. I would like to continue buying the same insurance even with the termination but I can not do so because I am excluded from group employment. I have lost all my rights to buy insurance like everyone else and with pre-existing medical problems nobody will insure me (or my family which depended on me).
At the very least, because I worked all my life and have never been unemployed, I should have been allowed to keep my insurance that I had while I was healthy. When I tell my friends overseas what my employer, Sun Chemical Corporation has done with me, they all say it is illegal in their country and it is a total horror that our society has chosen to discriminate so savagely against the sick and those unfortunate to lose their employment.
It is a travesty that corporations and health insurance companies collude to cleanse their ranks of those that are sick and those that are getting old as it has happened at Sun Chemical Corporation a multinational division of Dainippon Ink & Chemicals a Japanese conglomerate. “
An abused person”

This man’s corporation dropped him. He should be able to get COBRA insurance but the COBRA premium is at least 150% more than the employer paid premium. The premiums must be paid with after tax dollars. This increases the real cost of the COBRA premiums by an additional 35%.Corporate self insured plan’s can avoid the COBRA coverage requirement.

This consumer is 9 years away from being eligible for Medicare coverage. He cannot qualify for private insurance because of his age and his preexisting illness. The rest of his family might not qualify for more expensive individual healthcare insurance policies.

A byproduct of the new media is others can be made aware of the healthcare systems inequities.

“I am so sorry and hope there is some sort of alternative for you found very soon - for you and your family's sake. This is why we have to hang solidly behind healthcare reform. Personally, I would prefer single payer because these guys do not want to reform, they want to continue holding everyone's health hostage. What you're going through is awful. Please take care...so sorry.”

+ I'm a fan of this user

There are pleas for people to exercise our People Power.

Dear J,

“It's exactly stories like you that need to get out in front of this thing and bury Blue Cross in their hypocritical "we provide better service" grave.
Just like so many scare-tactic politicking, these ads are nothing more than a mirror aimed outward. The private insurance industry is broken because there are really no better options.
If they want to survive, they're just going to have to do better...

As far as I'm concerned, no one will be upset if they don't survive.”

There are even comments containing color words.

Blue Cross Blue Shield s@#%&--they have raised my rates every year for the past three years, even though they have not had to pay ANY medical charges for me. What do you expect these insurance guys to do? They don't want to lower costs. No doubt, if there were a cure found for cancer, there would be some idiots, like insurance companies and republicans, rushing to undermine the cure and bury it because it hurt the chemotherapy industry. That's the way they think. They have NO interest in making health care more affordable, more efficient, and less necessary. Don't threaten the system that helps the fat cats.

The negative comments are endless. President Obama will receive lots of documentation. Documentation he will use against the healthcare insurance industry. He will win. Unfortunately, he will not solve any of the problems in the healthcare system.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/consumers-anger-toward-the-healthcare-insurance-industry-mounts.html How To Neutralize The Healthcare Insurance Industrys Attack. Part 2 tag:typepad.com,2003:post-67475597 2009-05-31T08:42:52-07:00 2009-05-31T08:42:52-07:00 Stanley Feld M.D.,FACP,MACE Move On.org ability to social network is legend. MoveOn.org acted immediately with a call to action as soon as it was obvious that the healthcare insurance industry was going to attack President Obama’s healthcare plan. Its plan... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

Move On.org ability to social network is legend. MoveOn.org acted immediately with a call to action as soon as it was obvious that the healthcare insurance industry was going to attack President Obama’s healthcare plan. Its plan is to attack the healthcare insurance industry

Blue Cross Blue Shield is trying to kill "a key plank in Obama's reform platform." So we're trying to raise $150,000 in two days to fight back. Can you chip in $35 right now?

clip_image001Click Here

“Dear MoveOn member, “

Breaking news on health care: The Washington Post is now reporting that insurance giant Blue Cross Blue Shield "is putting the finishing touches on a public message campaign aimed at killing a key plank in Obama's reform platform."1

The Huffington Post sums it up as "Insurers Planning on Double-Crossing Obama."2

MoveOn.org drew the line in the sand before the healthcare insurance industry using old media tactics finished its storyboard.

“We knew the insurance companies would eventually turn on the president, but this is much sooner than expected. And they're targeting the public health insurance option—the crucial piece that will help cover everyone. So we're immediately launching a rapid-response campaign to go toe-to-toe with Blue Cross Blue Shield and win quality health care for all Americans.”

MoveOn.org makes the point that the insurance companies turned on the President. It has prepared a rapid-response to help the President get his healthcare reform package passed in 2009.

“We need to raise $150,000 in the next two days. It's a lot, but we'll need every penny to take on Goliath. We'll run ads, hold events, and work like crazy to get the real truth out to voters. AND we'll keep the pressure on Congress to make sure they don't get bullied into gutting the president's plan to guarantee health care coverage for everyone. Can you chip in $35 right now to make it happen?”

https://pol.moveon.org/donate/blueshield.html?id=16165-7180088-yqI_hAx&t=3

MoveOn.org’s message is clear. It is asking people to send money to prevent the healthcare insurance industry from destroying a key provision, (“National Insurance Exchange”) in the President’s healthcare reform plan. President Obama’s healthcare reform plan claims it will provide a public health insurance plan option that will not subsidize neither healthcare Insurance companies CEO’s salaries nor stockholders profits therefore reducing healthcare costs.

MoveOn.org ignores the fact that our country presently cannot afford the costs of Medicare . Expanding Medicare will be a disaster.

“If we had the choice of a public plan, private insurers would have to lower rates and improve quality to compete, so they're dead set against it. Today's news just confirms that fact.”

You bet the healthcare insurance industry is dead set against his plan. However the healthcare insurance industry is the administrative service provider for government operated healthcare plans. Everyone will move to the public plan. The healthcare insurance industry will make a greater profit because everyone will be insured. The process of setting price will be in the hands of the healthcare insurance industry.

There will be not improvement in access to care or quality of care because the incentives in the healthcare system will not be changed.

“In the past, Blue Cross Blue Shield has been sued for underpaying doctors and fined for refusing to cover necessary medical treatments for their customers.3 Now, with what watchdog group Media Matters calls a "desperate attempt to deceive,"4 they've gone one step too far.”

The healthcare insurance industry has killed the goose that laid its golden egg. It is impossible for consumers or physicians to sue the government. The government will be forced to underpay physicians as well as restrict access to necessary medical treatment.

The debate is not a debate on Repairing the Healthcare System. It is a debate between the government and the healthcare insurance industry about who controls the healthcare dollar

MoveOn raised $270,000 in 24 hours surpassing the goal of $150,000. The message is loud and clear. Consumers are mad as hell and they do not want to take it any more.

“Dear MoveOn member,

Amazing! After news broke of Blue Cross Blue Shield's new campaign to defeat Obama's health care plan, MoveOn members responded in a huge way. Together, we smashed our goal and raised $270,000 in just one day. (Thanks!)”

Move on.org will not stop there and set a new goal of $350,000 for the next 24 hours.

“If we can hit this mark, we'll send a strong message to the entire industry that if they start trying to block Obama's key health care proposal to cover everyone, we'll be ready to fight back—hard.”

This is too much for Harry and Louise to take on. When consumers realize that President Obama’s plan will not work they will demand control of their healthcare dollars.

There are three take home points.

1. The old media will not work.

2. People power using the new media is very powerful

3. Healthcare will become consumer driven.

4. The debate is focused on the wrong issues

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/how-to-neutralize-the-healthcare-insurance-industrys-attack-part-2.html How To Neutralize The Healthcare Insurance Industrys Attack. Part 1 tag:typepad.com,2003:post-67317083 2009-05-27T05:45:32-07:00 2009-05-27T05:45:32-07:00 Stanley Feld M.D.,FACP,MACE Yesterday Blue Cross and Blue Shield of North Carolina started rolling out the healthcare insurance industry’s attack on President Obama’s National Health Insurance Exchange. The 1993 Harry and Louise attack campaign will not work in 2009. Consumers... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

Yesterday Blue Cross and Blue Shield of North Carolina started rolling out the healthcare insurance industry’s attack on President Obama’s National Health Insurance Exchange. The 1993 Harry and Louise attack campaign will not work in 2009. Consumers do not trust the healthcare insurance industry to look after their needs. President Obama is playing off this mistrust and counter attacking. He sent an email to 20 million consumers asking them to join his call. He wants us ask congress to pass real healthcare reform in 2009. He asked us to join and donate money. After we join his cause we could then tell our story about the dysfunction in the healthcare system. He said your voice will make a difference. He says nothing in specific terms about how he will Repair the Healthcare System.

“Stanley –

You will note every email is personalized.


“The chance to finally reform our nation's health care system is here. While Congress moves rapidly to produce a detailed plan, I have made it clear that real reform must uphold three core principles -- it must reduce costs, guarantee choice, and ensure quality care for every American.”

Healthcare insurance premiums are constantly increasing while coverage is decreasing. Most healthcare insurance policies do not have a choice of physicians (physician networks). Quality healthcare (undefined) is not available for every American (universal healthcare). The healthcare insurance industry’s control of the healthcare system is responsible for most of these defects.


“As we know, challenging the status quo will not be easy. Its defenders will claim our goals are too big, that we should once again settle for half measures and empty talk. Left unanswered, these voices of doubt might yet again derail the comprehensive reform we so badly need. That's where you come in.”

President Obama invites us to fight those who would derail the comprehensive reform we so badly need. He does not define the reform (Hillary Clinton’s 1993 reform?). He does not describe the route to reform. It sounds good is meaningless.


When our opponents spread fear and confusion about the changes we seek, your support for these core principles will show clarity and resolve. When the lobbyists for the status quo tell Congress to hold back, your personal story will give them the courage to press forward.

President Obama’s message is clear. The call to action is to neutralize the healthcare insurance industry’s attack.

Join my call: Ask Congress to pass real health care reform in 2009.


“After adding your name, please consider sharing your personal story about the importance of health care reform in your life and the lives of those you love.”
“I will be personally reviewing many of these signatures and stories. If you speak up now, your voice will make a difference.”


http://my.barackobama.com/HealthCareOrganizing

When I tried to tell my story there was only one place to tell my story to President Obama. The space was to donate and join the call to action. He promises to personally review my story yet he has not listened to my call for a system of patient responsibility or patient reward. He has not listened to the plea for major tort reform. He has not listened to the need for a free electronic medical record in the cloud paid for by physicians by the click. President Obama does not have a clear the way to achieve his goals. He is going to get a bill passed that is worse than the Massachusetts plan.

In our sound bite society one, he wins using the new media. The healthcare insurance industry does not get it.

http://my.barackobama.com/HealthCareOrganizing


“Last November, the American people sent Washington a clear mandate for change. But when the polls close, the true work of citizenship begins. That's what Organizing for America is all about. Now, in these crucial moments, your voice once again has extraordinary power. I'm counting on you to use it.”

Thank you,
President Barack Obama

clip_image001

President Obama followed up with another email call to action. He is organizing People Power, one block at a time, one neighborhood at a time and one city at a time. His costs are minimal.

President Obama, using the new media, has the healthcare insurance industry on its heels. He used the old media to declare that the healthcare insurance industry made a commitment to reduce healthcare costs by 2 trillion dollars in the next 10 years. His sound bite is “ you’ve made a commitment; we expect you to keep it.” Now the healthcare insurance industry has backed down. Implied is how can it be trusted?

Patient power and the new media will not let this happen. “When our opponents spread fear and confusion about the changes we seek, your support for these core principles will show clarity and resolve.”

“On June 6th, in thousands of homes across the country, we'll gather to launch our grassroots campaign for health care. We'll watch a special message from the President. We'll build the teams and draw up the plans for winning health care reform the same way we won the election: Building support one block, one neighbor, one conversation at a time. And we'll put those plans into action.” “Please sign up today to host or attend a kickoff near you.”
http://my.barackobama.com/HCkickoff

This time the healthcare insurance industry must do better than Harry and Louise.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/how-to-neutralize-the-healthcare-insurance-industrys-attack-part-1.html Harry and Louise Are Coming Back: Insurers Planning on Double-Crossing Obama tag:typepad.com,2003:post-67196529 2009-05-23T14:14:37-07:00 2009-05-23T14:18:59-07:00 Stanley Feld M.D.,FACP,MACE One week after President Obama announced that the nation's health insurance lobby pledged to reduce healthcare costs by $2 trillion in ten years, Blue Cross Blue Shield of North Carolina is putting the finishing touches on a... stanleyfeldmdmace

 Stanley Feld M.D.,FACP,MACE

 One week after President Obama announced that the nation's health insurance lobby pledged to reduce healthcare costs by $2 trillion in ten years, Blue Cross Blue Shield of North Carolina is putting the finishing touches on a public message campaign aimed at killing a key plank in the Presidents reform platform.

“Mr. Obama had told the health care executives, “you’ve made a commitment; we expect you to keep it.”

When the healthcare insurance lobby realized the trap it fell into it immediately went to work to defend its control over the healthcare dollar. It is going to roll out Harry and Louise as it did in 1993. I do not think it will work. We are living in different times with different media tools.

“From a distance everything Barack Obama says sounds great. The events of the last eight years have created cynicism and despair. We are a nation thirsty for hope to solve our many problems.”

The healthcare insurance industry is going to try to destroy President Obama’s “National Health Insurance Exchange”. If congress passes the National Health Insurance Exchange it will lead to a single party payer system. The government as the single party payer is unsustainable.

“As part of what it calls an "informational website," the company has hired an outside PR company to make a series of videos sounding the alarm about a government-sponsored health insurance option, known as the public plan.’

The industry argues that creating a public insurance program will undermine the marketplace and eventually lead to a single-payer style system.

Somehow, this isn't surprising. The health insurance industry has showed it is not serious about controlling costs by backing away from the promise they made to President Obama.

Now, it wants to eliminate the public health insurance option. The public insurance option would provide an option for people who cannot afford buy private insurance because of the healthcare insurance industry’s restrictions.

“The public health insurance option is a key provision in President Obama's plan to help cover all of us. It would finally give everyone the choice between keeping our current insurance or switching to a new, high-quality public plan. And under a public health insurance plan our premiums wouldn't subsidize CEO salaries or stockholder profits we'd all save a lot on health care costs.”

There are basic problems with private healthcare insurance. Its premiums are a very rough calculation with large profits built in. The industry has reduced provider reimbursement and restricted access to care while raising premium and maintaining grotesque administrative fees. The process is opaque to all.

The government will do the same as a single party payer because it cannot afford the program.

President Obama’s thinking on cost savings is defective. The government outsources the administrative services of its present government healthcare programs Medicare and Medicaid to these very same healthcare insurance companies. The healthcare insurance companies do the same thing to the government. Its providers (physicians and hospitals) and consumers (patients) will experience the same reductions and rationing of care. The program will fail just as the Massachusetts program has failed to be affordable to the state. A systemic change in the healthcare systems payment structure must occur in favor of patients and physicians.

“If we had the choice of a public plan, private insurers would have to lower rates and improve quality to compete, so they're dead set against it.”

The crafting of a campaign by Blue Cross Blue Shield of North Carolina is the first of many campaigns we will see in the coming months in an attempt to turn public sentiment against the “National Health Insurance Exchange.”

President Obama’s insurance exchange is another way of expanding the Medicare program. His plan is to arrive at a single party payer through the back door while promising to maintain the private insurance option. It is Hillary Clinton’s healthcare plan of 1993 all over again. Nobody asked the practicing physicians for solutions. Physicians’ representing associations have not done of very good job of articulating solutions.

The healthcare insurance industry is not looking to protect its customers (consumers). It is looking to control the healthcare dollars and protect its profits. However they have cooked the goose that laid their golden eggs by abusing consumers, employers and physicians. Harry and Louise will not work.

Consumers are frustrated and angry. They do not trust government or the healthcare insurance industry. They are looking for a creative solution.

The new media, the internet and blogs provide a chance for consumers to express themselves.

“ Obama will backtrack on this one, too! I don't have any hope that America will join the 20th century to become a "progressive" democracy. We are an oligarchy and it will stay that way. Just look how we elect people for office. Millions raised, millions disappearing in someone's pocket. Money rules! ”

Consumers, it is time we drove the healthcare system because our surrogates have let us down.  

“Not surprised at all by this. The health insurance companies have had an unbelievable advantage, they can do anything they want. The only thing they need to do is keep Congress happy with lobbyists because Congress is not their customer, they have their own insurance paid by you and I. It's gloves off time on health reform. These guys will pull no punches, they are fighting for their yachts. While we lose insurance if we file a claim.”

It is time for consumers to demand control of their healthcare dollar. It is time they have incentives to be responsible for their own health and be rewarded for staying healthy. My ideal medical savings account either funded by employers if the consumer is employed or funded by the government with insurance for all is the solution that must be demanded.

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

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/harry-and-louise-are-coming-back-insurers-planning-on-doublecrossing-obama.html President Obamas Healthcare Reform: A Slam Dunk: No Defense tag:typepad.com,2003:post-67051127 2009-05-20T07:36:55-07:00 2009-05-20T07:38:15-07:00 Stanley Feld M.D.,FACP,MACE After a White House meeting with healthcare leaders, President Obama pronounced that is was “a historic day, a watershed event,”. He brought doctors, hospitals, drug makers and insurance companies voluntarily together and they offered $2 trillion in... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

 

After a White House meeting with healthcare leaders, President Obama pronounced that is was “a historic day, a watershed event,”. He brought doctors, hospitals, drug makers and insurance companies voluntarily together and they offered $2 trillion in cost reductions over 10 years.

“The savings, he said, “will help us take the next and most important step — comprehensive health care reform.” The meeting’s results were announced as if President Obama engineering a political coup bringing leaders of the health care industry to the White House and built momentum for his ambitious health care agenda.”

All the proposals from the meeting are vague and unenforceable. None of the proposals guarantee cost savings to the healthcare system. It is another trick play to break down the defense of the major stakeholders in the healthcare system. It represents an attempt at consensus building.

Mr. Obama had told the health care executives, you’ve made a commitment; we expect you to keep it.”

The healthcare insurance executives and the hospital system did not realize what the President was doing. The healthcare insurance industry says nice things in order to have a seat at the table. It knows it is the real villain. The President is saying nice things in order to avoid confrontation, “build consensus ” and impress the media with a sense of agreement among stakeholders for his healthcare reform package.

“The consensus-building approach has already yielded some results. Insurance executives have offered to end certain underwriting practices, like refusing to cover individuals with pre-existing conditions or charging women higher rates than men, and they have invited Congress to impose stringent, uniform federal regulation on their industry.”

The healthcare insurance industry has made promises without realizing what it has done.

“ But even as insurers and health care providers stand shoulder to shoulder with Mr. Obama in vowing to slow the growth of health spending, they oppose him on other fronts.”

“For example, insurance companies are opposed to a new government-sponsored health plan, which Mr. Obama supports but insurers fear could drive them out of business.”

 

The next day the healthcare insurance industry and the hospital systems realized the impact of the President’s coup. They realized he was wooing them but not talking about the same thing they were. President Obama’s noose is tightening around the healthcare insurance industry’s neck.

“Health care leaders who attended the meeting have a different interpretation. They say they agreed to slow health spending in a more gradual way and did not pledge specific year-by-year cuts.”

In separate press releases the American Hospital Association and the American Association of Healthcare Insurers clarified their positions. The American Medical Association seems to have bitten President Obama’s hook. It has not protested President Obama’s healthcare plan nor has it offered effective executable reform measures. It has offered high level goal without a path to achieving the goals.

“There’s been a lot of misunderstanding that has caused a lot of consternation among our members,” said Richard J. Umbdenstock, the president of the American Hospital Association. ”

“The A.H.A. did not commit to support the ‘Obama health plan’ or budget. No such reform plan exists at this time.”

It sounded like President Obama faked out the AHA. They came back strong and denied agreement with the form that was presented by the President.

“Moreover, Mr. Pollack EVP of AHA wrote, “The groups did not support reducing the rate of health spending by 1.5 percentage points annually.” They had agreed to squeeze health spending so the annual rate of growth would eventually be 1.5 percentage points lower.”

The America’s Health Insurance Plans had the same reaction.

“Karen M. Ignagni, president of America’s Health Insurance Plans, said the savings would “ramp up” gradually as the growth of health spending slowed.”

Nancy-Ann DeParle reply tried to appease these two powerful vested interests. Her reply and correction of her reply made things worse.

Nancy-Ann DeParle, director of the White House Office of Health Reform, said “the president misspoke”. After providing that account, Ms. DeParle called back about an hour later on Thursday and said: “I don’t think the president misspoke. His remarks correctly and accurately described the industry’s commitment.”

Few speak of the details of President Obama’s healthcare reform plan. President Obama is going to slam dunk his healthcare reform. Congress and the stakeholders will be defenseless. Everyone will be caught flat footed.

Congressional Democrats are starting to complain about the process being secretive. Only a select group is writing the legislation. Republicans are lost. They are not offering insight or executable alternatives. If they have alternatives have not told stakeholders or the public. Before Americans know it a disastrous healthcare reform plan will pass by 51 votes in the senate.

Americans: Please wake up.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/president-obamas-healthcare-reform-a-slam-dunk-no-team-defense.html President Obamas Healthcare Reform Trick Play tag:typepad.com,2003:post-66907655 2009-05-17T20:56:48-07:00 2009-05-17T20:56:48-07:00 Stanley Feld M.D.,FACP,MACE Healthcare policy definitions are easy to confuse. I am an advocate for universal healthcare coverage. I am not an advocate for a single party payer. I believe the only way to be successful in repairing the healthcare... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

Healthcare policy definitions are easy to confuse. I am an advocate for universal healthcare coverage. I am not an advocate for a single party payer. I believe the only way to be successful in repairing the healthcare system is to remove control of the healthcare dollar from the healthcare insurance industry. Consumers must be in control of their health care dollars. The ideal Medical Savings account can motivate patients to be responsible for their health.

Patients with chronic disease must be motivated to control their chronic disease. If they are motivated to control their disease healthcare costs would decrease. Using the ideal medical savings account a patient with diabetes for example would be expected to spend $4000 dollars a year. It they controlled their disease well and avoided hospitalization their employer or the government could afford to provide a bonus. If they controlled their disease and avoided hospitalization they would have $2000 to put in a retirement account. They could be eligible for an additional $2000 bonus. The result is a savings of $4000 into their retirement account. Patient responsibility and motivation are the only way we have a chance to Repair the Healthcare System.

President Obama healthcare plan is going to make patients more dependent on government and less responsible for their care and choices. In fact choice will be rationed. His allies in the single party payer camp are complaining that he has “caved” in to hospitals and healthcare insurance companies.

They claim he was elected to install a single party payer system. They ignore the point that the government cannot afford to pay for the Medicare single party payer system much less universal coverage for the entire population as the single party payer.

The function of the government should be to make appropriate rules to align the incentives of all the stakeholders in the healthcare system. President Obama is confusing everyone with his position on healthcare reform in order to decrease resistance to his plan. My guess is he is doing it intentionally.

“Although Barack Obama was elected on a health care reform platform, his version ignores single payer. Nor is single payer advocated by his allies in the well-funded coalition called Health Care for America Now, composed of MoveOn, USAction, ACORN, Americans United for Change, the unions SEIU and UFCW and other liberal heavy hitters.”

President Obama is a clever politician. He understands that it would be political suicide to directly advocate a single party payer system. The American public wants choice. They do not want to have healthcare rationed. The American public understands the government cannot afford a single party payer system for all. The public outrage would dominate the debate. His healthcare plan is designed to arrive at a single party payer system by default.

The advocates of a single party payer do not understand the subtlety of President Obama’s positioning in the healthcare reform debate. .

“Journalist Russell Mokhiber, founder of the new group Single Payer Action, notes that no advocate of a single payer system was invited to the recent White House summit on health care reform. Only protests by Progressive Democrats of America and others won an invitation for Congressman John Conyers, sponsor of the United States National Health Care Act: H.R.676.”

The advocates of single party payer system are now attacking President Obama. They are accusing him of caving in to the demand of powerful vested interests.

“Mokhiber quotes Dr. David Himmelstein of Physicians for a National Health Program: “The President once acknowledged that single payer reform was the best option, but now he’s caving in to corporate health care interests and completely shutting out advocates of single payer reform," even though "the majority of Americans favor single payer, and it’s the most popular reform option among doctors and health economists."

This is political spin. President Obama is not caving into anyone. The majority of Americans are do not want rationing of health care that usually follows the high cost of a single party payer by government that exists in other western countries.

The President knows the best way to achieve a single party payer system. His plan is to get there by default.

The Obama healthcare reform plan is create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

I believe his National Health Insurance Exchange will drive the private insurance companies out of the healthcare insurance business. This might not be a half bad idea since the healthcare insurance industry controls healthcare cost and earns a grotesque amount of money.

It could change the healthcare insurance industry but I doubt it. It should become a 6% broker as the administrative service organization instead of 15% broker in a private insurance system. However there is no price transparency. In reality the government pays 18% for Medicare administrative services. President Obama healthcare reform proposals will not repair this abuse. Nothing will change. The government will restrict access and ration healthcare.

Watch out.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/president-obamas-healthcare-reform-trick-play.html Star Trek. The Movie And The Traditional Media tag:typepad.com,2003:post-66752105 2009-05-13T21:39:07-07:00 2009-05-13T21:40:59-07:00 Stanley Feld M.D.,FACP,MACE Saturday on opening weekend Brad and I went to the 12.10 pm showing of Star Trek. the movie in Boulder. The theater was packed on a beautiful sunny day in Boulder Colorado. We both conclude that the... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

Saturday on opening weekend Brad and I went to the 12.10 pm showing of Star Trek. the movie in Boulder. The theater was packed on a beautiful sunny day in Boulder Colorado. We both conclude that the movie was a wonderful extension of the iconic T.V. series and movie sequels. In fact Brad tweeted that it was the best movie of the decade. I know that motivated many to see the movie on Saturday date night. American pop culture is a pacesetter worldwide. It is nothing for Americans to be ashamed of. To my dismay, but not to my surprise the media, evaluation of the movie has been negative.

The America press is on a suicidal path. They are not representing the views of the American public. Frank Rich expressed it beautifully in his op Ed article on Sunday May 10, 2009.

The cultural disconnect between the journalism establishment and the public it aspires to serve could not have been more vividly dramatized.

He said this when describing Stephen Colbert’s address at the annual White House Correspondents’ Association dinner 3 years ago.

“Mr. Colbert delivered a monologue accusing his hosts of being stenographers who had, in essence, let the Bush White House get away with murder (or at least the war in Iraq). The Washington Post reported that it “fell flat.” The Times initially did not even mention it.”

The speech became viral overnight over the internet after You tube put C spans coverage on the internet.

 

On Wednesday, C-Span, the nonprofit network that first showed Mr. Colbert's speech, wrote letters to the video sites YouTube.com and ifilm.com, demanding that the clips of the speech be taken off their Web sites.

Star Trek has a complicated history with a simple plot. It has developed a massive cult following because it is “camp”. To me Star Trek glorifies American pop culture. It excites the imagination of kids and adults alike. Ever though the story plots are not innovative it stimulates the imagination to be innovative. I cannot wait for the invention of a real transporter.

An op ed piece by David Hajdu a professor at the Columbia Graduate School of Journalism highlights traditional journalism misreading of the American public.

“Gene Roddenberry, was a gifted hack writer for TV Westerns like “Have Gun, Will Travel” and cop shows like “Highway Patrol,” and “Star Trek,” though set in a nominally stylized future. Star Trek was essentially a Western cop show.”

So what. The good guys always win. It is the American way. This is Star Trek’s appeal. Someone ought to tell the New York Times editorial board the American public is no longer intimidated by intellectual snobbery. The American public now has control of the distribution of information without newspapers. Blogs, social networks and Twitter will replace traditional newspapers as a form of communication. I would guess Brad’s tweet caused more than 2000 people to go to Star Trek last weekend.

To say America is exploring the universe, one B-movie at a time simply misses the point. People power has spoken. On an early count Star Trek is one of the highest grossing movies of all time in the first weekend.

Paramount's sci-fi movie "Star Trek" opened as No. 1 at the box office in North America this weekend, taking in some 72.5 million dollars over the three-day period, a movie industry-charting firm reported on Sunday. With I-MAX revenue its gross surpassed 85 million dollars.

The film will show major legs in the coming weeks with strong word of mouth propelling it well beyond the opening weekend," said movie industry analyst Paul Dergarabedian

Today many people under 40 years old get their news of the day from the Daily Show with Jon Stewart.

Marc Andreessen in a recent video streamed of the Charlie Rose show said newspapers on dead. If the New York Times woke up and spend 90% of their budget on internet communication they would figure out how to become relevant once more.

The message should be clear. Americans want real information, not manipulated information. The media has to respect the intelligence of the public. Only then will the public support the media.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/star-trek-the-movie-and-the-traditional-media.html The Electronic Medical Record (EMR) Stimulus Fiasco: Part 3 tag:typepad.com,2003:post-66608501 2009-05-10T09:40:45-07:00 2009-05-10T09:40:45-07:00 Stanley Feld M.D.,FACP,MACE President Obama’s goal for healthcare reform is to increase the quality of medical care, increase efficiency of medical care and decrease the cost of care. The goal is admirable. The route he is taking is wrong. In... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

 

President Obama’s goal for healthcare reform is to increase the quality of medical care, increase efficiency of medical care and decrease the cost of care. The goal is admirable. The route he is taking is wrong. In the process he might destroy the medical workforce.

The route the electronic medical record (EMR) stimulus package should take should be flexible and educational for patients and physicians. It should use modern software technology instead of subsidizing old inflexible technology that is set up to be punitive to physicians and patients to the advantage of the government and the healthcare insurance industry.

The term "quality medical care' is used loosely. It has not been appropriately defined. The practice of evidence based medicine has been used to define quality medical care. The problem is evidence based medicine is changing daily.

A better definition should be the best clinical outcome with the most efficient financial outcome. It is assumed that practicing evidence based medicine will lead to the best clinical outcome at the most efficient cost.

Clinical guidelines are defined by “experts” interpreting evidence based medicine. I am/was one of those experts and appreciate its short comings.

Some guidelines are essential and should be inflexible. Others are ever changing and must be flexible. In bureaurocratic systems it is difficult to create flexible rules. Also, all patients are different. Clinical judgment plays an important role in treatment.

Physicians should not be penalized for using clinical judgment. Nonetheless, physicians are penalized in a pay for performance evaluation for deviating from inflexible clinical guidelines. Since some clinical guidelines are always changing the weakness of the approach is obvious.

An example of an inflexible clinical guideline is the need for rules to have a sterile operating room with sterile gowns and tools to avoid surgical infection.

An example of a need for a flexible clinical guideline should be a physician’s approach to a patient with hypertension. The goal should be to normalize the blood pressure. The goal for lowering the blood pressure to normal is to avoid heart attacks and stroke. However, if the patient’s blood pressure was elevated for a long period of time and was severe enough to compromise the renal (kidney)) blood flow, lowering the blood pressure too quickly could result in the patient having a stroke from a relatively low blood pressure. This is an example of the value of clinical judgment.

Physician performance should not be evaluated on static measurements. It must be evaluated on physicians’ medical judgment. Clinical judgment is a function of a physician’s ability to relate to his or her patients. (patient physician relationship)

On the other hand, if a patient felt poorly as a physician tried to lower the blood pressure to normal the patient might stop his medication without telling the physician. The physician’s workup might have been perfect and his choice of medication may have been excellent. This physician might get an excellent mark on his performance but the patient had a stroke because the patient did not comply with treatment. The patient might not have complied because he was not taught to be a professor of his disease. Healthcare is a team sport. The patient physician relationship failed but was not measured. .

The poor performance was missed by the static digital healthcare evaluation imposed by an inflexible EMR. The importance of the patient physician relationship and not including patient responsibility in the clinical outcome should be part of any performance measurement. A performance measurement should be a measurement of both the patients’ and physicians’ performance.

Now that the federal government plans to spend $50 billion to spur the use of computerized patient records, the challenge of adopting the technology widely and wisely is becoming increasingly apparent.

There is no question we should have universal electronic medical records. It should be a teaching tool for patients and physicians. The EMR should be inexpensive and flexible. It should not a tool to judge and penalize clinical performance. President Obama is being ill advised. His EMR stimulus program is going to result in a waste of $50 billion dollars.

“In a “perspective,” Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane portray the current health record suppliers as offering pre-Internet era software — costly and wedded to proprietary technology standards that make it difficult for customers to switch vendors and for outside programmers to make upgrades and improvements.”

The software the government is going to spend $50 billion dollars on is going to be too expensive, inflexible and not widely distributed.

“Instead of stimulating use of such software, they say, the government should be a rule-setting referee to encourage the development of an open software platform on which innovators could write electronic health record applications”.

EMR software platforms in the cloud should be developed. This link by Christopher Barnatt  is an excellent utube explanation of cloud computing. I suggest all watch it.Amazon uses the cloud to sell books. www.Salesforce.com’s business model tracks sales force activity at a minimal cost to the company. It is flexible and maintenance free.

“Such an approach, they say, would open the door to competition, flexibility and lower costs — and thus, better health care in the long run. “If the government’s money goes to cement the current technology in place,” Dr. Mandl said in an interview, “we will have a very hard time innovating in health care reform.”

The rules can be immediately changed. The cost to a medical practice could be minimal. Its effectiveness is maximal. The cost to the government using modern software technology could be between 1-10 % of what the stimulus is proposing to spend. If it is fashioned as an educational tool to patients and physicians the payback will be maximal, quality of care will improve and the cost of care will decrease.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/the-electronic-medical-record-emr-stimulus-fiasco-part-3.html War On Obesity: Part 12 tag:typepad.com,2003:post-66458091 2009-05-06T08:45:54-07:00 2009-05-06T08:45:54-07:00 Stanley Feld M.D.,FACP,MACE Obesity is a major problem for the healthcare system. I am waging a War on Obesity. This article is Part 12 of my War on Obesity. It is essential that a public service campaign at every socioeconomic... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

 

Obesity is a major problem for the healthcare system. I am waging a War on Obesity. This article is Part 12 of my War on Obesity.

It is essential that a public service campaign at every socioeconomic level be mounted to explain the long term danger of obesity and how to combat its occurrence. Obesity is responsible for many chronic diseases and their complications. Its cost to the healthcare system is not sustainable. Diets might work short term. Lifestyle change is the only thing that will work long term.

The new administration should join me in my War on Obesity. It has been very responsive to the potential swine flu pandemic. The media has been very responsive to this important news story. Why can’t the administration develop a public service campaign to create an important healthcare story about the obesity epidemic? It might precipitate lifestyle change.

Neither President Obama nor the congress has suggested such a plan. The main message of my public service campaign would be:

2.2 pounds of fat equal 9000 calories

In order to lose 2.2 lbs weight you must eat 9000 calories less than you burn or burn 9000 calories more than you eat.

9000 calories is hard to lose and easy to gain

The federal government subsidizes school lunch programs in schools K-12. These school lunch programs were set up 50 years ago to counter malnutrition in under-privileged families. In 2009 the problem is childhood obesity. A new approach must be taken.

“The federal school lunch program, which subsidizes meals for 30 million low-income children, was created more than half a century ago to combat malnutrition. A breakfast program was added during the 1960s.”

The federal school lunch program is trying to produce healthy meals. They fail for two reasons. First, many schools do not control portion size. Second, those same schools still have snack bars, vending machines and à la carte food lines.

Federal rules that govern the sales of these harmful foods at schools are limited in scope and have not been updated for nearly 30 years. Until new regulations are written, children who are served healthy meals in the school cafeteria will continue to buy candy bars, sugary drinks and high sodium snacks elsewhere in school.

This is an example of a perverse outcome to a government mandate. The idea is good. The rules to execute the mandate are poor. The government will respond to people power (public opinion).

Public opinion can influence government policy and the media. If the people are passive they will have an environment that is good for vested interests. In the case of school food intake the vested interests are the candy, soda and junk food manufacturers and the school systems. The vending machines are a profit center for school districts that are underfunded by government. The profits are used to finance important school projects.

“Many states’ school districts have taken positive steps. But others are likely to resist, especially districts that sell junk food to finance athletic programs, extracurricular activities, even copier expenses.”

I did a Google search to see the breakfast and lunch menus of some independent school districts. Each has a disclaimer to avoid liability. Most provide between 650 and 1200 calories for lunch and 250 to 600 calories for breakfast depending on the portion size and the number of items a child can pick up.

Menus meet recommended dietary guidelines and may change due to product availability or other market changes. In accordance with Federal law and U.S. Dept. of Agriculture policy this institution is prohibited from discriminating on the basis of race, color, national origin, sex, or disability. To file a complaint of discrimination, write USDA,

Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Ave., SW Washington, DC 20250-9410 or call 202-720-5964. USDA is an equal opportunity provider and employer.

An obese child needs to burn 9000 calories in order to lose 2.2 pounds. An intake of 900 to 1800 calories for two meals is not going to help when a inactive obese child may burn only 1500 calories per day.

In an attempt to increase academic performance test scores, physical education has been eliminated from many school curriculum because of “school funding”. The lack of exercise increases the obesity epidemic.

It is going to take a national educational program for parents and children understand the basic etiology of obesity and caloric intake and output to conquer the obesity epidemic. It is going to take a coordinated effort by local parent teachers associations (PTA) to eliminate vending machines and snack bars from the schools. It is going to take a PTA protest to reinstitute rigorous physician education in school districts. It is going to take “People Power” with educational help from the federal government.

The federal government has the ability to do this in a public service educational campaign. It could use the money for this campaign from the money it saved using my universal EMR and my ideal medical savings account rather than wasting it on ineffective new bureaucratic institutions.

If President Obama doesn’t do something, chronic diseases resulting from obesity are going to continue to drive healthcare costs through the roof.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/war-on-obesity-part-12.html The Electronic Medical Record (EMR) Stimulus Fiasco: Part 2 tag:typepad.com,2003:post-66306529 2009-05-03T05:51:04-07:00 2009-05-03T05:51:04-07:00 Stanley Feld M.D.,FACP,MACE President Obama is counting on electronic health records (EMR) to help modernize the nation’s dysfunctional health care system, improve the quality of care and reduce its cost. He should understand the real costs of an EMR. The... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE

President Obama is counting on electronic health records (EMR) to help modernize the nation’s dysfunctional health care system, improve the quality of care and reduce its cost. He should understand the real costs of an EMR. The cost of disruption of the work flow, the issue of incompatibility and connectivity with other EMRs, and the costs of maintenance, service and software upgrades are all important barriers not taken into account in his stimulus package. If President Obama must think that throwing money at the conversion to electronic medical records (EMR) is going to work, he is wrong. He is using the wrong route.

“His stimulus package will provide $19 billion over the next two years to promote the adoption and use of health information technology, and he has pledged to spend some $50 billion in all over five years.”

Both hospitals and physicians offices have been slow to adopt EMR’s. Most physicians would love to have EMR’s to decrease paperwork and medical errors. However, many practices have legacy EMR systems that do not provide functionality necessary. These practices are struggling with the notion to reinvest in a new EMR as their reimbursement is decreasing, cost flow is ebbing, and physician income is decreasing

“PwC estimates that the average three-physician practice can expect to invest between $173,750 and $296,000 over two years to purchase and maintain an EHR system. “

A three man ophthalmology practice was quoted $65,000 per physician plus service and maintenance. The final figure was $95,000 per physician. The EMR is fairly functional. It would not qualify for a rebate from the stimulus package.

The physicians initially complained about the disruption in their work flow. After three months they started to accommodate to the change in work flow. Now they feel they need an upgrade to add functionality. The physicians are now concerned about the maintenance and service charge per year.

“Individual physicians, not practices, can receive up to a total of $44,000 each for adopting certified EHRs.”

President Obama’s subsidy is helpful but many physicians still cannot afford the upfront cost.

“Hospital systems main impediment is money. Many hospitals simply do not have the capital to buy systems that can cost $20 million to $200 million, especially when so many are struggling to remain solvent. Hospitals also worry about high maintenance costs, an uncertain payoff on their investment, and a lack of staff with adequate technical expertise.”

There is a perverse outcome to installation of an EMR. Physicians and hospital systems may realize some return on their EHR investment. The primary returns on the physicians’ and hospital systems’ investment is expected to mostly accrue to private and public payers.

“The federal government estimates that the conversion to digital records will save $12 billion in healthcare spending over 10 years.”

The federal government saving twelve billion dollars over 10 years is a small return on a $50 billion dollar investment. The investment risk is compounded by the uncertainty of implementation of a fully functional EMR.

The survey also found that:

  • 82% of hospital CIOs have already cut IT spending budgets in 2009 by an average of 10%, with one in 10 making more drastic cuts of greater than 30%.
  • 66% of CIOs say they expect to be asked to make further cuts in IT spending before the end of 2009.

It is not difficult to understand that hospitals want to cut costs. They are reporting cash flow and profit margin problems. The government cannot afford Medicare and Medicaid in its present form. President Obama’s plan is to expand both Medicare and Medicaid while decreasing patient coverage and provider reimbursement. Premiums for Medicare and deductibles have been increasing steadily.

  • 64% of CIOs agreed that it is impossible to balance demand with the need to cut costs.
  • One-half of CIOs with more than 500 beds say that federal funding is "crucial" to their ability to implement EHRs.

The stimulus formula for subsidizing hospital systems is a function of the hospital system’s volume of Medicare and Medicaid patients. With government reimbursement decreasing, hospital systems are reinventing themselves to attract paying customers. They are developing high productivity profit centers such as back centers, cardiovascular centers, and gastric bypass centers. Hospital systems “lose money” on acute illnesses. Hospital systems are trying to move away from their dependence of Medicare and Medicaid patients.

It should be obvious that President Obama’s EMR stimulus plan has not been well thought out.

The American Medical Association seems to be on the right track. It is clear to me that someone is listening to me.

“The American Medical Association is developing a Web-based service offering doctors electronic prescribing, up-to-date reference material and other resources.

The idea is to make it easier for physicians to adopt technology President Obama is promoting for health care reform, to streamline their workload, and improve patient care.”

“Doctors will be able to use it to access numerous electronic medical services, including the latest science on diseases, and electronic health records, said Dr. Joseph Heyman, chairman of the AMA's board.”

http://news.yahoo.com/s/ap/20090422/ap_on_bi_ge/us_med_ama_electronic_health_1

There are no details available yet. It is encouraging that the AMA is trying to be proactive.

President Obama, this is not rocket science. If you put a totally functioning electronic medical record in the cloud in the next few months, the most it should cost the government (taxpayer) is about 5 billion dollars.

The software could be serviced and upgraded at no cost to the providers of healthcare services. The taxpayers return on the dollar would be at least three times that amount in the first year if the providers paid by the click. Payment by the click would not be a burden to physicians or hospital systems.

Physicians and hospital systems would instantly have a fully functioning EMR. The government could use the same business plan credit card companies use. It could even set up an auto pay system.

President Obama, I hope you read this and arrive at an "ah ha" moment and change the route you are taking to convert medicine to an electronic information system.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/the-electronic-medical-record-emr-stimulus-fiasco-part-2.html The Electronic Medical Record Stimulus Fiasco: Part 1 tag:typepad.com,2003:post-66148853 2009-04-29T06:32:54-07:00 2009-04-29T06:32:54-07:00 Stanley Feld M.D.,FACP,MACE. All of President Obama’s goals are commendable. The United States needs to fix the education system, decrease its dependency on fossil fuel, increase production of renewable energy, and repair the healthcare system. These are all big ideas.... stanleyfeldmdmace

Stanley Feld M.D.,FACP,MACE.

All of President Obama’s goals are commendable. The United States needs to fix the education system, decrease its dependency on fossil fuel, increase production of renewable energy, and repair the healthcare system.

These are all big ideas. They must be implemented for the United States to prosper in the future. I have expertise in (healthcare). President Obama’s route to achieving healthcare reform is wrong. He is not attacking the basic problems in the healthcare system.

A PriceWaterhouse Cooper study showed $1.2 trillion dollars is wasted on defensive medicine and administrative costs. Where is malpractice reform on President Obama’s list of big ideas to eliminate the practice of defensive medicine?  If the $1.2 trillion dollars of waste were eliminated we would have an affordable healthcare system.

The administration’s stimulus package for instituting an electronic medical record (EHR,EMR) is going to create more waste and a larger mess than the fiasco that already exists.

“A recent Robert Wood Johnson survey of more than 3,000 U.S. hospitals found that only 9% were using electronic health records (EHR). “The numbers are disappointing and certainly lower than we thought when we went into this study,” says Ashish Jha, the lead author of the study and an associate professor of health policy and management at Harvard University. “

The survey is a well done. Survey responses were received from 63.1% of all acute care hospitals that are members of the American Hospital Association. This is a high percentage response rate for a survey. The survey looked for the presence of specific electronic-record functionalities. More discouraging than the 9% figure is only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units and fully functional).

Only 7.6% of acute care hospitals have a basic system (i.e.present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, urban area hospitals, and teaching hospitals were more likely to have electronic-records systems than small hospitals in smaller cities. Most of the hospitals spent over $100 million dollars for it EMR. The money spent did not enable the hospital systems to implement a fully functioning EMR.

Hospitals and hospital systems are experiencing financially hard times during this recession. They cannot afford the capital requirements and high maintenance costs to implement the installation of an EMR when the end result is not having a fully functioning electronic medical record. Hospital systems board of directors are not interested in going deeper in debt when the government is going to reduce reimbursement for non compliance.

PriceWaterhouse Coopers’ analysis of the stimulus package for EMR points out government subsidies are through the traditional EMR acquisition channels. Their analysis highlights the government’s punishing actions of non compliant providers. It is going to reduce reimbursement as punishment. Isn’t that silly? The government should be worrying about the financial health of these institutions and physicians’ practices

“The stimulus funding for health IT is a small carrot compared to the amount of resources it will take to deploy this technology over the next 5 years. Also, providers will feel a big stick of financial penalties if they fail to use government-certified electronic health record (EHR) in a government-certified manner beginning in 2015.”

It should be obvious that every physician’s office and hospital system should have a functional electronic medical record. One must wonder how physicians feel when they cannot afford an EHR that will probably not have full functionality.

Who will be the winner? Patients should be the winner. Patients will not win under President Obama’s stimulus package.

“With billions in new funding and government regulations, the health IT market will balloon far beyond the provider segment, providing new opportunities for health plans, pharma companies and other vendors.”

Powerful secondary stakeholder with financial vested interests will win.

The net result is will not be a universal and functional EMR. There will be little connectivity.

The government should invest in the purchase of a web based fully functional EMR with all the attributes necessary to build an effective electronic medical record system. The system would provide complete interconnectivity to physicians, hospitals, pharmacies, and insurance companies. Upgrades and maintenance of the software would be automatic and free.

The government would charge each provider entity by the click for the use of the universal Electronic Health Record. The government would recover its investment over a very short time and instantly create a system of price transparency. The system would be affordable to the healthcare providers. The present stimulus plan for EMR is going to waste the $36 billion dollars. It will try to force hospital systems and physician offices to buy an electronic medical record system that they cannot afford, do not want and might not work.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/the-electronic-medical-record-stimulus-fiasco-part-1.html Healthcare Is A Team Sport tag:typepad.com,2003:post-66030635 2009-04-26T06:50:34-07:00 2009-04-26T06:50:34-07:00 Stanley Feld M.D.,FACP,MACE Healthcare is a team sport. The patients are the most important members of the team. They are the players. Physicians are the coaches. They should be adjusting their recommendations after receiving maximum data from the patients. Patients... stanleyfeldmdmace

 

Stanley Feld M.D.,FACP,MACE

Healthcare is a team sport. The patients are the most important members of the team. They are the players. Physicians are the coaches. They should be adjusting their recommendations after receiving maximum data from the patients. Patients must become the “professors of their disease”. In order to have a successful team, physicians need several assistant coaches. The physician extenders must not be physician substitutes. Physician extender are nurse educators, dieticians, psychologists, social workers and exercise therapists. Patients must be at the center of the healthcare team and relate to the entire team in order to have maximum knowledge about their disease. It requires a great deal of responsibility on the part of the patient.

I chaired the American Association of Clinical Endocrinologist Diabetes Guidelines in 2002 in which this team approach is outlined. The AACE diabetes guidelines also contains a patient/physician contract. It spells out the responsibilities of the patient and physician. The team unit cannot be successful if the assistant coaches act independent of physicians.

The internet can provide some infrastructure to aid the assistant coaches. So far, internet based information has not been an extension of physicians’ care (Healthcare 1.0). It has been a failure. The internet assets developed (some of which have been good) have proven to be ineffective in repairing the healthcare system.

Jennifer McCabe Gorman understands the problem. She is working diligently to promote the concept of connecting internet based patient centered information with physicians care (Healthcare 4.0). I believe she understands the concept of patient centered healthcare with healthcare as a team sport and physicians as the leaders of the team. I believe she has the passion and ability to translate this vision into reality.

Until now content on the internet has provided generic information about chronic diseases. Most of the information lacks context and nuance. Most of the internet content does not explain the pathophysiology of the disease process. Internet content out of context tends not to be helpful. Some of the content is inaccurate.

Jen McCabe Gorman describes Web 2.0 as a combination of content and social networking. Disease based social networking is growing rapidly and rightly so. We are all social beings starved for information. We need and seek disease based social interaction. Social networks give patients the opportunity to cluster by disease and share their experiences with a disease process. This can be helpful. However, its limits must be understood. Individual patient uniqueness and disease variation must be taken into account. It would be wonderful if the social network were an extension of the individual patient’s physician’s care. Physicians will gradually understand its value as a teaching tool to help patients become “professors of their diseases”. Presently disease based social networks act as physician substitutes. This use decreases both physicians’ and social networks’ effectiveness.

Patients live with their disease 24/7. If patients understand the dynamics of their chronic disease, they and their physician can be more effective in their decision making. Patients would have a better chance of controlling their disease and avoiding the costly complication of the disease.

I believe that repair of the healthcare system can be partially achieved with effective disease specific social networks as an extension of physicians’ care. Social networks are not focused on that goal yet(Healthcare 2.0). The goal is to get to Healthcare 4.0

Healthcare 3.0 is what Google Health and Microsoft’s Health Vault are trying to do with an internet based Personal Health Record (PHR). I predict they will fail. It is not connected to physicians care. My wife and I carry our PHR on a key ring flash drive. The PHR could easily be carried in an IPhone.

Patients must express outrage and force their physicians to utilize the medical records patients have gathered. Patients input into their own care, control of their own data, participation in the treatment decision making and being responsible for their care is the only way to reduce costs and avoid chronic disease complications.

Healthcare 4.0 will arrive. With the expansion of social networking we are developing more sophisticated patients who will become sophisticated consumers of healthcare. Patients will demand functional EMRs from their physicians. Only then will disease specific social networks become an extension of the physicians care and effectively decrease the complications of chronic disease.

The two primary stakeholders in the healthcare system are the patients and the physicians. All other stakeholders are secondary stakeholders. Additionally, it is essential that all the stakeholders align their collective vested interests in order to repair the healthcare system. With the development of internet based assets including a fully functioning EMR the alignment of vested interests will occur because patients will be empowered to demand it.

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

 http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/healthcare-is-a-team-sport.html