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Americans Should Be Listening

Stanley Feld M.D.,FACP,MACE

Bernie Sanders and the progressive Democrats are not interested in learning from other countries’ mistakes.

Their ideology blinds them to the fact that socialized medicine does not work. I vividly remember John Kerry and Barney Frank telling President Obama that the Affordable Care Act needs a Public Option. The Affordable Care Act would fail if it did not have a Public Option. With a Public Option included they said America would be well on its way to a single party payer system.

They said a single party payer system is the only healthcare system that would work

President Obama told them he had a clandestine “Public Option” built into Obamacare. However, he was never able to bring it about.  

Progressives believe deeply in their ideology. They do not consider past history, present reality or facts. 

Neither does the American College of Physicians. In a position paper it recommended Medicare for All. It was followed up with a letter published in the New York Times with 2,000 signatures out of the 159,000 members advocating Medicare for All.

“In a separate but related move to the ACP’s announcement, more than two thousand physicians on Monday announced an open letter to the American public, prescribing single-payer Medicare for All, in a full-page ad in The New York Times that will run in the print edition on Tuesday, January 21, 2020.”

https://www.nakedcapitalism.com/2020/01/in-historic-shift-second-largest-physicians-group-in-us-has-new-prescription-its-medicare-for-all.html

I wonder how many of these signatories have any idea of what the economic impact of “Medicare for All.” I really wonder how many members out of the 159,000 would support the position. I know I do not support the ACP’s position.  

All progressives have to do is look at what is happening to socialized medicine all over the developed western world and notice it is unsustainable and its citizens are dissatisfied with it.

Healthcare systems in the developed world are failing even as the ideologs believe it is succeeding.

America’s healthcare system is also having many problems. Americans are dissatisfied with our healthcare system. The healthcare system has gotten worse since Obamacare was passed. The government is responsible for making our healthcare system worse. It has not done the things I have suggested to repair our healthcare system.

 The Commonwealth Fund (a private progressive foundation) with a focus on healthcare is certain that a single party payer system is the only viable healthcare system.

The report ranked healthcare systems throughout the developed western world.  In its 2014 published ranking the National Health Service of Great Britain was considered the best medical system among the 11 of the world’s most advanced nations, including Canada, France, Germany, Switzerland and Sweden.

 The United States came in last.

 Few “experts” have the time or patience to read the complete report or pick out the defects in the report.

Most people read the summary. The summary in this report does not reflect the truth about the evidence present in the report.

The Commonwealth Fund’s rankings of countries is contradicted by objective data about access and medical-care quality in these countries in peer-reviewed academic journals.

The Commonwealth Fund’s methodology is defective. Its conclusions relied heavily on subjective surveys about “perceptions and experiences of patients and physicians.”

Kenneth Thorpe made an important point by examining differences in disease prevalence and treatment rates for ten of the most costly diseases between the United States and the ten European countries with a single payer system.

He used surveys of the non-institutionalized population age fifty and older. Disease prevalence and rates of medication and treatment are much higher in the United States than in these European countries.

Why would that be?

There are many reasons for this finding. The main one is the availability of care in the United States compared to the ten socialized western countries.

Another is lifestyle and incidence of obesity in the United States. Both lead to the onset of chronic disease and increased treatment.

 “Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.”

“Americans are diagnosed with and treated for several chronic illnesses more often than their European counterparts are.”

Americans diagnosed with heart disease receive treatment with medications and procedures more frequently than patients in Western Europe.

In the past local peer review was all that was needed along with confidence in the treating physician’s judgment. This confidence in physicians’ judgment has been destroyed by excessive media sensationalism. The real percentage of abuse is small and easily discoverable by peers and the use of social media.

Cancer treatment survival rates in America are far greater than the survival rates in Britain, and countries in western Europe.

The reasons for the higher cure rates is the availability of early detection and treatment.

Cancer treatment costs are high. The government should look into the reasons for this high cost and try to lower the cost.

The Commonwealth Fund’s report does not consider any of these factors.

“Over a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than 36,000 have been in treatment queues for nine months or more.

Long waits for care are endemic to government-run, single-payer systems like the NHS. Yet some U.S. lawmakers want to import that model from across the pond. That would be a massive blunder.”

https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#d1df33b36b89

The NHS has a waiting list of 3.2 million people for admission to the hospital. In London alone over 500,000 patients are on a waiting list for diagnosis and treatment.

A large percentage of patients triaged as urgent after being diagnosed with suspected cancer have a 62-day wait time to receive therapy.

Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That’s well below the country’s goal of treating 95% of patients within four hours — a target the NHS hasn’t hit since 2015.

Now, instead of cutting wait times, the NHS is looking to scrap the goal.

Wait times for cancer treatment — where timeliness can be a matter of life and death — are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn’t start treatment on time despite an urgent referral by their primary care doctor. That’s the worst performance since records began in 2009.

Today In: Industry

And keep in mind that “on time” for the NHS is already 62 days after referral.

Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America.

The British Health and Social Care Act 2012 authorized the use of the small private sector of healthcare to help the NHS with its problems.

The share of NHS-funded hip and knee replacements by private doctors increased to 19% in 2011-12, from a negligible amount in 2003-04. Each year there is an increase in NHS funded care by the private sector.

It sounds like the VA Healthcare System’s solution to its problems.

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of “limited clinical value.”

It’s hard to see how a surgery that can prevent blindness is of limited clinical value. Delaying surgery can cause patients’ vision to worsen — and thus put them at risk of falls or being unable to conduct basic daily activities.

It’s shocking that access to this life-changing surgery is being unnecessarily restricted,” said Helen Lee, a health policy manager at the Royal National Institute of Blind People.

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same “limited clinical value” label on them.

Patients face long wait times and rationing of care in part because the NHS can’t attract nearly enough medical professionals to meet demand. At the end of 2018, more than 39,000 nursing spots were unfilled. That’s a vacancy rate of more than 10%. Among medical staff, nearly 9,000 posts were unoccupied. Many physicians have left the NHS and have gone into private practice. Many do both NHS service and private practice.

These shortages could explode in the years to come. In 2018, the Royal College of General Practitioners found that more than 750 practices could close within the next five years, largely because heavy workloads are pushing older doctors to retire early.

English people who can afford private care and private healthcare insurance to avoid the NHS are switching to private insurance even though they have to pay $3,500 for each man, woman and child in a family into the NHS.

Physician shortages are the result of inadequate funding. The cost of the NHS with all these restrictions are unsustainable.

The single party payer system (NHS) is struggling with unsustainable costs even though we hear from progressives how great socialized medicine is in England.

The key ingredient missing in all these systems is patient responsibility for their health and their healthcare dollars. Both are powerful motivators for healthy living and detecting disease early.

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



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Swedes Are Frustrated Over Their Socialized Healthcare System

Stanley Feld M.D.,FACP,MACE

Sweden has a universal healthcare system that has been touted, by Bernie Sanders, to be the premier socialized medical system model in the world. The Swedish socialized medical system has hardly lived up to the praise. The fact is Sweden’s healthcare system is falling apart.

The Swedes have lost interest in their socialist healthcare system. Their tax rate is almost 50% of earnings. Swedes are losing interest in the concept of a socialist society. The complaint is that it is inefficient, and, in most areas, the socialistic system does not work to the benefit of the people.

All Bernie Sanders has to do is read the local Swedish newspapers. He would learn that socialized medicine is not working in Sweden. He might even stop pushing his lie to the American public about how great “Medicare for All” will be for America.

“That Sweden no longer keeps up with those countries is largely due to its inability to reduce its patient waiting times, which are some of the worst in Europe, as the latest edition of the Euro Health Consumer Index (EHCI) revealed in Brussels on Monday.”

The 2014 EHCI also confirms other big problems within Swedish healthcare.

This is not primarily due to the fact Sweden has become worse – rather it is the case that other countries have improved faster.” 

https://www.thelocal.se/20150127/swedens-health-care-is-a-shame-to-the-country

According to 2017 OECD figures, Sweden does have the fifth-highest life expectancy in Europe. Its cancer survival rates are among the continent’s highest. This could be because the rest of Europe’s socialized medicine systems are not as good as they could be.

One of the main pillars of the Swedish welfare state is its universal healthcare system. The Swedish people are totally frustrated by the healthcare system’s inefficiency. The inefficiency is due in large part to the government bureaucracy.

Swedes have little confidence that politicians will solve this,” said Lisa Pelling, chief analyst at progressive think tank Arena Ide. 

“There is a risk their faith in the welfare state will be eroded,” she told AFP. 

As an example of the frustration of the Swedes:

Asia Nader didn’t know whether to worry more about being diagnosed with a hole in her heart at the age of 23 or having to wait a year for Swedish doctors to fix it. 

“I completely fell apart when I found out,” she told AFP, remembering the long agonizing months until she finally had her operation in June this year, one month before her 23rd birthday. 

Credit: George Hodan/public domainhttps://medicalxpress.com/news/2018-09-swedes-world-class-healthcarewhen.html 

There are long lines waiting for access to care due to a shortage of nurses and available doctors in some areas.

The average income tax rate paid by Swedes is 50%. Immigrants cannot pay 50% of their earnings and survive. Immigrants are entitled to social services including medical care. The voters are angered over the flood of immigrants putting a tremendous strain on the healthcare system and delaying regular citizens’ access to care.

 The rules set up by Swedish law about access to medical care are being ignored and unenforced.

Swedish law stipulates patients should wait no more than 90 days to undergo surgery or see a specialist. Yet every third patient waits longer, according to government figures.”

“Patients must also see a general practitioner within seven days, the second-longest deadline in Europe after Portugal (15 days).” 

 Dental appointments can take a wait of 6 months.

The median wait for prostate cancer surgery was 120 days. It has taken up to 271 days.to get prostate cancer surgery.

Swedes complain that they can’t see their own GP. There is little chance to develop a physician/patient relationship. Patients are being seen by temporary hires provided by outsourced staffing companies.

Telemedicine has mushroomed. Physicians are complaining about the fragmentation of care. There is little chance for continuing follow-up and assessing the result of therapy.   

The number of hospital beds has declined in recent years. There is a hospital bed shortage in many communities.    

In Solleftea, the premier’s northern hometown with nearly 20,000 residents, the only maternity ward was shut down last year to save money.” 

“With the closest maternity ward now 200 kilometers (125 miles) away, midwives offer parents-to-be classes on how to deliver babies in cars—which some have since done.”

Despite the bed shortages and delays in access to care, Sweden is the third highest spender on healthcare in the European Union. Sweden spends 11% of its GDP on its healthcare system.

 Socialism and healthcare for all are not as great as Bernie Sanders is telling Americans. We should not believe him.

There is no question we have to improve our healthcare system to make it affordable and available to all.

However, we should not go down the path of Sweden and Finland with Bernie Sanders’ socialistic program of “Medicare for All.”

We will not only bankrupt America but also make access to care impossible.

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The original was published in April 2019.

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



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Why Did Finland’s Healthcare System Fail? Part 3

Stanley Feld M.D.,FACP,MACE

https://legalinsurrection.com/2019/11/finlands-healthcare-system-still-flounders-bernie-and-warren-hardest-hit/

https://apps.who.int/iris/bitstream/handle/10665/327538/18176127-eng.pdf?sequence=1&isAllowed=y

The healthcare system is not rosy for the people in Finland.  It has been getting worse since March 2019 despite the New York Times’ glorification of it nine months later in December 2019.

Bernie Sanders continually ignores Finland’s healthcare system’s reality as he tries to convince people that “Medicare for All” will fix our health care system.

Finland’s healthcare system’s problems are multiple. Finland’s government collapsed due its massive socialized medicine program even though the healthcare system is not completely free.

Finland has struggled to keep its promises to its people.    

What are the principle reasons for the failure?                   `       

  1. Finland’s “Free” Healthcare: Fiscally Unsustainable

Governments cannot provide quality healthcare to the masses in a fiscally sustainable way. Period.

In March, just after Juha Sipila’s Finish government resigned, the governor of the Bank of Finland, Ollie Rehn, warned that reform remained urgent “from the point of view of fiscal sustainability.”

The Finish population is aging, and birth rates are falling. The number of taxpayers paying into the system is decreasing. The overall population is living longer. All three reasons are putting a greater strain on medical resources.

 In 2018, the average single Finn faced a net average tax rate of 30%. With President Trump’s tax cut the average U.S. rate is 23.8%. If a U.S.tax payer is earning $250,000 a year or more in the U.S. there is an additional 3.8% supplemental Medicare tax increase despite President Trump’s tax cut from 38% to 23.8%. Our Medicare and Medicaid programs are unsustainable and presently require more tax revenue or severe service cuts.

“Finns are having less and less children. People are getting older. So we need more people here because we need taxpayers,” says Juha Tuominen, the CEO of the largest hospital in Finland, which provides one in four Finns with specialized care.”

The solutions are to have more tax-paying people, increase the tax rate on tax-paying workers or cut services. With the government being in control it could try to do all three. Bernie Sanders’ $60 baby is a pipe dream.  

In Finland, there have to be effective reforms. Right now, the system is unequal.  The poor and people who live in remote areas are not being served.

Bernie, Elizbeth Warren, and the U.S. traditional media are glorifying the Finish system for unsuspecting Americans.

“People outside of Finland tend to see only the good sides of the system,” says Hiilamo.

“Normally, we show people the sunny side of the street, but there is a dark side of the street. And health care is on the dark side, and for many years we have had a problem.”

2.    Finland’s “Free” Healthcare: Long Waits

Long wait times are one of the most predictable consequences of anything that is government-run, including health care.

In addition to long wait times, the government’s efforts to cut costs and be more efficient have resulted in ill people, including at emergency care facilities, not getting to see a physician until they can “justify” the need to see a physician to a nurse.

A Finnish patient gave the newspaper The Guardian this case history.

https://www.theguardian.com/society/2016/feb/23/finland-health-system-failing-welfare-state-high-taxes


“Imagine going to your nearest doctors’ office at 9 am on a weekday with your sick six-year-old daughter because you cannot make an appointment over the phone.

After your drive to the doctor’s office in another part of the city, you can’t simply book a time with the receptionist. There isn’t one.

Instead, you must swipe your daughter’s national insurance card through a machine, which gives you a number. Then you and your feverish child simply sit and wait. Or rather, you stand, because the room is so crowded that people are sitting on the floor, on steps, or leaning against walls.

The numbers come up on a screen every 10 minutes or so, in no particular order so you’ve no idea how long your wait will be as your daughter complains of feeling cold then hot and then cold again.

By 10.45 a.m., another patient’s dad exclaims he’s been there since 8.15, he’s had enough, and he’s going to go to a private GP. “You used to just be able to make an appointment with a doctor!” he says angrily.

You see, you are not even waiting to see a GP. You’re waiting to see a nurse in order to justify to her how quickly your child needs to see a GP or whether she needs to see one at all.

At 11.30, you give up and take your daughter to see a private doctor as well, forking out £50 for the privilege.

This isn’t some nightmare vision of the NHS after 10 years of Tory cuts. This happened to me recently in a country I have moved to from Britain that is normally lauded as the shining example of a successful welfare state.”

 Finland has one of the worst health services in Europe according to The Guardian. Its health service has been in a perilous state for decades and it is getting worse. Nothing has been done since its government collapsed in March 2019.

Bernie is leading America down the garden path with a misrepresentation.

http://www.oecd.org/els/health-systems/Country-Note-FINLAND-OECD-Health-Statistics-2015.pdf

A publicly run and funded health care system — known as “Medicare for All” — is now the senator’s big ideas!

  1. Finland’s “Free” Healthcare: Doctor Shortages, Patients Fleeing to Private Healthcare

Doctors and patients who can leave Finland’s centralized health care system are doing so in droves. Only the well off can afford to buy healthcare insurance.

According to [Samuli] Saarni, the President of the Finnish Medical Association, the number of doctors has not increased on a par with the larger workload – for example, in the last 15 years 4,200 new doctors have entered the workforce but only 330 of them have gone to work in healthcare centres.

Doctors are now responsible for extra paperwork, including renewing electronic prescriptions.  These time-consuming tasks take away from the time they can spend with patients.

“The current set-up doesn’t support doctors spending as much time as possible with patients,” Saarni told HS.

 The shortage of physicians and extra scut work has resulted in long waiting times for medical appointments. Over 1.1 million of the 5 million people living in Finland have now opted for private medical insurance.

Every second child born has private medical insurance. Only fifty percent of child deliveries are done by the health service.

Despite this, the public healthcare sector is still under great strain.

Public healthcare centres have lost experienced physicians to the private sector.

The public sector physicians’ patient loads have resulted in an increasing percentage of physician burnout by young doctors at healthcare centres according to Dr. Saarni.

Minister of Family Affairs and Social Services Krista Kiuru announced on Tuesday that each and every citizen should be guaranteed a doctor’s appointment within seven days of asking for one. This is easier said than done.

Tampere’s Daily Aamulehti reported that the challenge is great. In the city’s municipal clinic at Hatanpää, patients waited for an appointment for a median of 42 days.

The Tammela health centre reported average waiting periods of 11 days, while private Mehiläinen clinics in the city saw patients in just two days.

“The situation simply cannot continue,” Kiuru said.

4.    Finland’s “Free” Healthcare: Requires More Taxpayer Funding

The Finnish government is pouring more of its taxpayers’ money into the flailing system, but it’s not clear that throwing money at the myriad problems is the answer.

Finland is planning to plow some 200 million euros into municipal healthcare services in the next four years to try to reduce waiting times for non-urgent appointments.

In 2020, an initial 70 million euros will be available as part of the new government’s drive for reform of health and social care reform, as stated by the Minister of Family Affairs and Social Services Krista Kiuru.

Long waiting times, few physicians, ill-equipped and poorly maintained hospitals, and a long list of other failures have resulted in broad discontent with the extremely expensive Finnish healthcare system.

All socialistic healthcare systems are constructed incorrectly. A viable healthcare system can be constructed so that consumers are responsible for their care and not the government.

There are no government-run healthcare systems that are viable anywhere on the planet. Norway is the only country whose free healthcare system is surviving in. It survives only through the massive infusions of cash from an oil-rich government.   

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



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Finland’s Government Collapses Over Universal Healthcare Costs. March 2019 :Part 2

Part 2

Stanley Feld MD,FACP,MACE

https://blogs.scientificamerican.com/observations/finland-is-the-happiest-country-in-the-world-and-finns-arent-happy-about-it/

Bernie Sanders (I-VT) has been hanging his socialistic rhetoric on the success of Finland’s socialist society and especially Finland’s healthcare system which is supposed to be a free healthcare system for all. 

The New York Times published the article “Finland is a Capitalist Paradise” on December 2, 2019.

On March 3,2019, Finland’s government collapsed because the universal healthcare costs were unsustainable.                                                                                                                                                  

 President Donald Trump was correct when he said,

“Finland, of course, is one of those Nordic countries that we hear some Americans, including President Trump, describe as unsustainable and oppressive — “socialist nanny states.”

The New York Times ridiculed President Trump in December 2, 2019 for saying that Finland is a socialist nanny state.

https://legalinsurrection.com/2019/03/finland-government-collapses-over-universal-health-care-costs-bernie2020-hardest-hit/

https://freebeacon.com/politics/finnish-government-collapses-due-to-rising-cost-of-universal-health-care/

“Similar problems are bedeviling Sweden and Denmark, two other countries frequently held up as models to follow on health care. Finland’s crisis in particular comes as calls for universal health care have grown louder among Democrats in the United States.”

Americans have heard from few in the mainstream media about the collapse of Finland’s government or the reasons for that collapse.

Norway is excused from this discussion because Norway has become a very rich country from its North Sea oil income and its restrictive immigration policies. It is the citizen’s sugar daddy along with a 50% tax rate. 

The Kaiser Family Foundation found that 58 percent of Americans oppose “Medicare for all” if told it would eliminate private health insurance plans, and 60 percent oppose it if it requires higher taxes.

Reuters reported that soaring treatment costs and longer life spans have particularly affected the Nordic countries financial problems.

“Nordic countries, where comprehensive welfare is the cornerstone of the social model, have been among the most affected,” according to Reuters. “But reform has been controversial and, in Finland, plans to cut costs and boost efficiency have stalled for years.”

Just a few days before Finland’s government collapsed over its inability to foot the bill for its expansive socialist experiment, Sanders took to Twitter in an attempt to shame America.

https://pbs.twimg.com/profile_images/1097820307388334080/9ddg5F6v_bigger.png

Bernie SandersVerified account @BernieSanders

FollowFollow @BernieSanders


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“In the United States it costs, on average, $12,000 to have a baby. In Finland it costs $60. We’ve got to end the disgrace of our profit-driven health care system and pass Medicare for all.”

Bernie Sanders is not being honest with the American people.

“With the collapse of Finland’s government over its inability to financially support its massive socialist agenda, Bernie will undoubtedly do the same thing he always does when socialism (or communism) fails: ignore, obfuscate, and deflect.”

 We only have to remember Vermont’s “Medicare for All” failure. 

Bernie Sanders and AOC should read Finland and Sweden’s newspapers to understand that the people are unhappy with free but unavailable medical care. The unhappiness of the citizens historically happens in every socialist state run healthcare system..

If Democrats are successful in getting “Medicare for All” into law, America will face the same dilemma in the future

“The social welfare and health care reform was one of our government’s most important objectives,” Sipilä said at a press briefing. “The snapshot of the situation that I got from the parliament obliged me to examine if there was a possibility of continuing the reform process. There wasn’t.”

“My conclusion was that my government had to hand in our note of resignation,” he added. “I take my responsibility.”

https://www.politico.eu/article/finlands-government-collapses-over-failed-health-care-reform/

Finland has a decentralized system of health and social welfare programs, where much of the administration is left to local municipalities. This arrangement has led to widespread geographic variation when it comes to quality and access to health care services.

The reform was meant to address these inequalities and reduce the growing cost of the country’s health care system, which has come under increasing stress from an ageing population. It included centralization of the administration at a regional level.”

Finland has been held up as a model welfare state. The distribution of the resulting high taxes is spent on the social issues the politicians think are most important and not what the citizens think are most important.

The government should not be telling the people what they need if a healthcare system is to succeed. The people should decide on what they need and be responsible for their own care. The government should protect the people from both government and corporate abuse in a free enterprise system.

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



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A New York Times Article Misleads Americans Part 1

Stanley Feld M.D.,FACP ,MACE

On 12/7/2019 the Times published an article by Anu Partanen and Trevor Corson

 entitled “Finland is a Capitalist Paradise.”

The media is the message. The article will resonate with many young couples trying to live a happy life in New York City.

The article also resonates with Bernie Sanders’ primary message.

Bernie: “Take a look at what Finland, the happiest country in the world, is doing. If Finland can provide everyone with health care, send everyone to college for free and provide affordable childcare, why can’t the US?”

The problem is the message is false.  

 “Two years ago, we were living in a pleasant neighborhood in Brooklyn. We were experienced professionals, enjoying a privileged life.

 We’d just had a baby. She was our first, and much wanted. We were United States citizens and our future as a family should have seemed bright. But we felt deeply insecure and anxious.”

There is no dispute with that statement. The college debt burden could be added to that feeling of insecurity.

“Our income was trickling in unreliably from temporary gigs as independent contractors. Our access to health insurance was a constant source of anxiety, as we scrambled year after year among private employer plans, exorbitant plans for freelancers, and complicated and expensive Obamacare plans.

Obamacare was supposed to solve the healthcare insurance problem for this young couple. Obamacare hasn’t solved the problem because of its faulty construction, its top-heavy government bureaucracy and its inefficient administration.

 “With a child, we’d soon face overwhelming day-care costs. Never mind the bankruptcy-sized bills for education ahead, whether for housing in a good public-school district or for private-school tuition. And then there’d be college. In other words, we suffered from the same stressors that are swamping more and more of Americans, even the relatively privileged.

“As we contemplated all this, one of us, Anu, was offered a job back in her hometown: Helsinki, Finland.”

As usual, the New York Times could not help taking a shot at President Trump’s philosophy when they said,

“Finland, of course, is one of those Nordic countries that we hear some Americans, including President Trump, describe as unsustainable and oppressive — “socialist nanny states.”

It turns out President Trump is right.

The couple moved to Finland from Brooklyn. The evidence they used to make their decision was all hearsay from friends and family living in the United States.

Their impression, after living in Helsinki for over a year, sounds like Utopia.

“We’ve now been living in Finland for more than a year. The difference between our lives here and in the States has been tremendous, but perhaps not in the way many Americans might imagine.” 

“What we’ve experienced is an increase in personal freedom. Our lives are just much more manageable. To be sure, our days are still full of challenges — raising a child, helping elderly parents, juggling the demands of daily logistics and work.”

The authors do not describe the meaning of personal freedom.

“But in Finland, we are automatically covered, no matter what, by taxpayer-funded universal health care that equals the United States’ in quality (despite the misleading claims you hear to the contrary), all without piles of confusing paperwork or haggling over huge bills.

This assertion has been disputed by many physicians and people living in Finland. https://www.ess.fi/uutiset/kotimaa/2015/07/30/terveyskeskuslaakarille-voi-paasta-nyt-tai-kuukauden-kuluttua—katso-oman-kuntasi-tilanne

https://legalinsurrection.com/2019/11/finlands-healthcare-system-still-flounders-bernie-and-warren-hardest-hit/

Is this true? What is really happening in Finland?

If you are not sick and do not need the Finnish healthcare system, you will feel very secure. However, if you need to use the healthcare system it is not so good.

Why the New York Times, along with Bernie Sanders and Elizabeth Warren, does not tell us the truth about Finland is obvious. The truth does not fit their agenda.

Finland has more doctors per capita than the UK but, at the level of primary care, a far higher proportion of these physicians are in private practice than is the case in Britain.

Seventeen percent (17%) of Finnish doctors work solely in the private sector. Most of these physicians are general practitioners. This is twice the percentage of physicians that were in the private sector twenty years ago.

An additional twenty percent of physicians work in both the private sector as well as the public sector. 

The bizarre thing is most employers in Finland pay for their workers to have private primary healthcare. Employers do not pay for their employees’ families. The families remain in the public sector.

The public sector is far from free. A visit to a family practitioner cost 16.10 euros. However, patients only pay for the first three visits and then it is free.

According to a Dr. Saarinen of Ula “the more experienced and “better” doctors end up in the private sector, leaving the “inexperienced” and “inefficient” doctors running the health centers.”

 Private practitioners are better paid and work under less pressure than public practitioners.

“A hospital consultation in the public sector costs patients about €38, and you pay for each night that you spend in hospital, up to a maximum of €679.”

The free healthcare service in Finland is not really free. Municipalities pay for the free service. The result is service in poorer areas of the country tend to have bad health service and limited access to medical care.

Private GPs usually set up practices in more affluent areas where they are more likely to get paid.

It looks like a grim socialized medical system. No wonder Finns deny the finding they are the happiest people in the world.

In Helsinki there are reports of huge queues at health centres (GP surgeries), waits for appointments of many weeks, and greater and greater demands with less and less funding. In south-eastern Finland it takes about a month to see a GP. Back in December 2013, it was reported that Finns were increasingly using private doctors in neighbouring Estonia to save time and money.”

Dr. Saarinen explains that the system essentially forces people to go private or rely on friends who are doctors.

Finland’s healthcare system has been a mess for at least two decades.

The couple writing this article are ignoring the facts. They said:

“Our child attends a fabulous, highly professional and ethnically diverse public day-care center that amazes us with its enrichment activities and professionalism. The price? About $300 a month — the maximum for public daycare, because in Finland day-care fees are subsidized for all families. 

And if we stay here, our daughter will be able to attend one of the world’s best K-12 education systems at no cost to us, regardless of the neighborhood we live in. The college would also be tuition-free. If we have another child, we will automatically get paid parental leave, funded largely through taxes, for nearly a year, which can be shared between parents. Annual paid vacations here of four, five or even six weeks are also the norm.”

Nothing is free!

The New York Times reported on a UN study proving Finland is the happiest country in the world. The problem is the Finns do not think the study is accurate. The Finns claim that the study was poorly designed and inaccurate.

https://blogs.scientificamerican.com/observations/finland-is-the-happiest-country-in-the-world-and-finns-arent-happy-about-it/

The New York Times has once again printed fake news story to influence readers to believe in the wisdom of “Medicare for All.”

Bernie Sanders, has long been touting Finland, Sweden, Denmark and Norway as the shining examples of socialism and socialized medicine.

Bernie says:

“Take a look at what Finland, the happiest country in the world, is doing. If Finland can provide everyone with health care, send everyone to college for free and provide affordable child care, why can’t the US?”

Carl Sandberg said, in “The Prairie Years”, “If you tell a lie enough times it becomes the truth.

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



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Healthcare Policy in The Post Truth Era

Healthcare Policy in The Post Truth Era

Stanley Feld M.D.,FACP, MACE

 The government has been deficient in trying to do anything to Repair the Healthcare System.

Unfortunately, John McCain’s vote blocked the repeal of Obamacare which froze any progress.  His reason was feeble and politically naïve.

John McCain wanted congress to work together and have bipartisan agreement on healthcare reform. The entire majority of the present House of Representatives has no desire to be bipartisan or help President Trump create or pass any bipartisan legislation.

Democrats in the house only want to impeach the president. They have no time for positive legislation to repair the healthcare system.

I believe the Trump administration has the right idea. 

President Trump and his administration have decided to make structural changes to the healthcare system by executive order until it can make big legislative changes. Their hope is they win a more cooperative Congress in 2020.

We are living in a Post-Truth era.

Post-truthpolitics(also called post-factual politics[1]and post-reality politics)[2]is a political culturein which debate is framed largely by appeals to emotion disconnected from the details of policy, and by the repeated assertion of talking pointsto which factual rebuttals are ignored.

Post-truthdiffers from traditional contesting and falsifyingof facts by relegating facts and expert opinions to be of secondary importance relative to appeal to emotion. While this has been described as a contemporary problem, some observers have described it as a long-standing part of political life that was less notable before the advent of the Internetand related social changes.”

https://en.wikipedia.org/wiki/Post-truth_politics

 The media is the message. Donald Trump threatens the Democratic Party, the bureaucracy and the traditional mainstream media.  He also threatens some of the Republicans.

He is a crude speaking person from Queens, New York. He has been called a brawler by some. He says he never starts a fight. He fights back. Many say he fights back in an unappealing way.

He says his goal is to drain the swamp. We have all gotten a glimpse of the inefficient and at times corrupt bureaucracy within our government. We can see the swamp’s depth only because of the Internet and the availability of alternate news opinions.

President Trump is working hard to streamline and increase the efficiency of the ever-expanding bureaucracy. He is a direct threat to their well-being. This is their justification for hating him.

The traditional mainstream media has promoted the Democrats’ agenda. They have helped obstruct President Trump’s agenda. The media has ignored or criticized the continual successes of President Trump.

It has either published disinformation or misinformation, ignored critical thinking on issues, or simply published non-truths.

President Trump has had no choice. Obamacare remained the law. It has been expensive and unsuccessful. It is impossible to know its yearly cost to the federal government. It is self-imploding and will disappear shortly.

Obamacare has just completed its open enrollment period for 2020. The enrollment period is supposed to end on December 15th. The Obama administration extended it to March 31 during some enrollment years. The Trump administration has extended the 2020 open enrollment period until December 31, 2019 this year.

85% of people who enrolled in Obamacare have a preexisting illness. The Obama administration has subsidized most of the premiums. It did not subsidize the deductibles. Obamacare participants still could not afford to pay the deductible. In essence, participants have no healthcare insurance because they could not afford to use it.

Open enrollment as of December 7, 2019, was awful.

2020 enrollment
http://acasignups.net/blogs/charles-gaba

There are only 6,134,477 who have enrolled in 2020 compared to 16.1 million enrollees in 2014. Medicaid was expanded by 9.3 million in 2014. With the Medicaid expansion, a total of 25 million people received insurance in 2014. 

Medicaid is a single party payor. It is inefficient. It has a problem getting physicians to participate because reimbursement does not cover most physician’s overhead.

President Obama decided to have the federal government pay over 90% of the state-run Medicaid programs for a few years.  The states, which signed up for the Medicaid expansion, did not have an increase in costs.

When states have to start paying more for the Medicaid expansion, they will have to raise taxes because by law they cannot have a budget deficit. At the moment most of those states have unauthorized budget deficits. Those deficits will become worse when they have to fund expanded Medicaid.

The mainstream media and Democratic congress continually publish the figure that Obamacare has decreased the uninsured by 20 million. However, eleven million were that result of the expanded Medicaid program.

2014

2014 graph

The numbers do not match. The government graphs are complex and confusing. However, they are very informative. The graphs tend to confuse us with estimates and actual enrollees.

 In 2016 the numbers decreased to 9.3 million with open enrollment extended to February 1, 2016

 2016

2016 enrollment

 Medicaid enrollment increased in 2016 to 15.3 million.  The Medicaid increase is included in the total number of previously uninsured, Obamacare provided healthcare insurance. Obamacare’s increase in previously uninsured is, in fact, an expansion of Medicaid.  The mainstream media use the number 20 million newly insured patients which is a misleading justification for fixing Obamacare. Some of Medicaid’s increase enrollment could represent the illegal immigrants who are now entitled to healthcare coverage.

2016 increase Medicaid

The net Medicaid increase since March 2010 in 2016 was 16.3 million. It looks like Obamacare’s goal was to increase Medicaid. The next step is to have “Medicaid/Medicare for All.”

2018 remained the same as in 2016, with many more dropouts because people realized Obamacare’s unaffordability. Since it was unaffordable, they realized they could not afford care event thought they paid their premium. Therefore, they dropped out and stopped paying their premiums.

2018 enrollment

2020 has been the expected disaster. Consumers needed relief from the Obamacare disaster. Obamacare has caused a further increase in dysfunction in an already dysfunctional healthcare system for people insured by Medicare, Medicaid and Private Healthcare insurance. 

Everyone is dissatisfied.

2020 enrollment

Only 6.1 million consumers have enrolled in Obamacare for 2020.

President Trump is hoping that after the 2020 election, he will have a friendlier Congress. Obamacare will be repealed. Congress will want to do something to help him repair the healthcare system. Meanwhile, he can only do some structural changes to lead us on the path toward an affordable healthcare system.

I predicted Obamacare would eventually fail when it was passed in 2010. Obamacare did not align stakeholders’ incentives!

Obamacare was destined to become unaffordable to consumers, the states and the federal government.

Bernie Sanders’ and Elizabeth Warren’s “Medicare for All” will suffer the same fate as Obamacare.

Most of all the taxpayers in the nation will suffer the most.

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



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Slowly But Surely :Trump Is Quietly Reforming Healthcare


Stanley Feld M.D.,FACP, MACE

Since congress did not want to help President Trump repeal Obamacare and fix the healthcare system, he decided to quietly repair the healthcare system by himself. He has no choice. Obamacare will self-implode and disappear.

President Trump has kept his steps toward healthcare reform under the radar. It is all published and there for everyone to see.   

President Trump is hoping that after the 2020 election he will have a friendlier congress. A congress that wants to do something to help him help American consumers of healthcare obtain affordable healthcare.

Consumers need relief from the Obamacare disaster. Obamacare has caused increased dysfunction on top of an already dysfunctional healthcare system.

Obamacare has caused a previously unaffordable healthcare system to become more unaffordable.

I hate to say it. I predicted Obamacare would fail in 2010. Basically Obamacare did not align stakeholders’ incentives.

I explained why Obamacare was failing in each subsequent year of its passage.

http://stanfeld.com/?s=Obamacare+will+fail

 I also offered my concept of repair of the healthcare system with my ideal medical savings accounts.

President Trump has taken important steps to repair the healthcare system. He has brought back the power of “Associations.”  Associations now have the ability to negotiate with healthcare insurance companies and sell healthcare insurance to its members.

In addition, Associations now have the ability to offer its members healthcare insurance at pre-tax dollars. This is a very big deal. Previously individuals seeking individual insurance had to pay for that healthcare insurance with post-tax dollars.

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

Instantly, healthcare premiums are effectively reduced to consumers by 20-40% using pre-tax dollars. This make present premiums more affordable.

Associations are growing very rapidly as final rules are being created to make their healthcare insurance available. The significance of Associations has been largely ignored by the mainstream media. 

Associations will create competitiveness among healthcare insurers and help individuals, small business and even giant corporations eliminate the need to negotiate and provide healthcare insurance to their employees. It might even help the government’s unsustainable programs such as Medicare, Medicaid and the VA rid itself of these unsustainable programs.

The traditional mainstream media has been busy publicizing the socialist concept of “Medicare for All.”

I have pointed out that “Medicare for All” doesn’t work. It has never worked in a financially sustainable way for many countries. In countries that have socialized medicine consumers are dissatisfied because there are long waiting times and a shortage of the access to medical and surgical care.

Our leftist politicians say socialist medicine has worked beautifully in countries like Sweden, Denmark, Canada, and England to name a few.

I have published the difficulties consumers have had in these socialized medicine countries.

Unfortunately, our leftist politicians are either ignoring the truth or do not know what they are talking about. The traditional mainstream media are simply acting as puppets for our leftist Democratic politicians who want to control the healthcare system.

Everyone knows the larger the bureaucracy the more inefficient the system. The VA healthcare system is a perfect example of this statement.     

“Last week, the executive order was initiated that will empower consumers in the individual healthcare insurance market and those consumers in the small corporations to purchase healthcare insurance through associations. It will allow the employers in small corporations to pay for their employees the healthcare insurance through the Associations with pre-tax dollars.”

“It will level the playing field to enable individuals in both groups to negotiate healthcare insurance premium prices through their associations with the same purchasing power that large corporations have.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

It could also work for consumers working for large corporations. Those employees who are displeased with their corporate provided healthcare insurance coverage can change to association provided insurance.

The new rules can potentially get employers out of the healthcare insurance providing business.

These new regulation has had little coverage in the New York Times, network television or any other mainstream media.

The traditional main stream media have been pushing the Democratic Socialists’ idea of “Medicare for All.”  “Medicare for All” cannot work.

“On Thursday June 20th 2019, the Department of Health and Human Services announced a final regulation that allows businesses to fund employees who buy health insurance on the individual market–something that until now has been illegal.”

 “The U.S. Departments of Health and Human Services, Labor, and the Treasury issued a new policy that will provide hundreds of thousands of employers, including small businesses, a better way to provide health insurance coverage, and millions of American workers more options for health insurance coverage.”

Since this new policy is a President Trump initiative, the elites in the media must have concluded that is a silly policy and it cannot work.

“ The Departments issued a final regulation that will expand the use of health reimbursement arrangements (HRAs). When employers have fully adjusted to the rule, it is estimated this expansion of HRAs will benefit approximately 800,000 employers, including small businesses, and more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.”

A close study of Health Reimbursement Arrangements (Associations) will make it clear that these numbers are correct. In fact, these estimates might be a gross underestimation of increased number of consumers with healthcare coverage.“Under the rule, starting in January 2020, employers will be able to use what are referred to as individual coverage HRAs to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market, subject to certain conditions. … Individual coverage HRAs are designed to give working Americans and their families greater control over their healthcare by providing an additional way for employers to finance health insurance.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

Associations allow everyone to be participants in the large corporation negotiating healthcare market. It allows consumers to avoid the trap of large, bureaucratic and by definition inefficient government control healthcare.

“The HRA rule also increases workers’ choice of coverage, increases the portability of coverage, and will generally improve worker economic well-being. This rule will also allow workers to shop for plans in the individual market and select coverage that best meets their needs. … [T]he final rule should spur a more competitive individual market that drives health insurers to deliver better coverage options to consumers.”

 The new policy empowers individual consumers to shop the market and select the healthcare coverage that best meets the needs of their family.

The insurance industry will not have to comply with the burdens of Obamacare’s regulations for healthcare coverage. They can create new products including medical savings accounts without restriction.

This will create an extremely competitive healthcare insurance environment.

“This is a good example of how the Trump administration is moving forward in practical ways on important issues, empowering consumers and freeing up markets. The Democrats don’t like it, of course. But the new HRA system will be popular with millions of Americans whose ability to access the individual market and exercise consumer choice will be enhanced.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

The only big barrier is that it will make consumers become responsible for choosing their healthcare coverage and be responsible for their healthcare dollars.

I believe most Americans are up for the challenge.

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



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Mechanism Design and the Repairing the Healthcare System


Stanley Feld M.D., FACP, MACE.      

On November 11, 2007, I published the following blog: “Incentives and Mechanism Design.” The authors Leoid Hurwicz, Roger Meyerson and Eric Maskin were awarded the Nobel Prize in Economics for the concept in 2007.

http://stanfeld.com/?s=mechanism+design

 I suspect few politicians know about Mechanism Design in 2019. I am certain Bernie Sanders and the “Medicare for All” crowd do not know anything about Mechanical Design.

In my last blog, I described how politicians and the mainstream media use Confirmation Bias to try to put the government in control of healthcare against the will and welfare of the public.  

https://en.wikipedia.org/wiki/Confirmation_bias

I think Donald Trump either studied the use of Mechanism Design and its mechanics or he intuitively uses its principles in his thinking.

Mechanism Design is a concept that tries to put science into social science. It mathematically evaluates vested interests of stakeholders in order to eliminate confirmation bias and line up all the stakeholders’ vested interests for the greatest good. It assumes all the stakeholders have expressed their vested interests truthfully.

The Democrats want to hold onto (fix) Obamacare. However, the Democrats understand Obamacare is not viable in its present form. I believe “Medicare for All” with central government control of healthcare will be a disaster as it has been in most single party payer systems.

I do not believe Obamacare is fixable. I believe President Obama and the Democrats believed that Obamacare would fail. Then the nation would beg either his public option or Medicare for All.

I think President Obama believes “Medicare for All” and the total government control of healthcare is the ideological solution to the problems in our healthcare system.

His confirmation bias overrules all of the examples of “Medicare for All” failed examples at home (Vermont California and Colorado), as well as Denmark, Sweden, England, and France.  

In 2017, the Republicans with a slim majority in the Senate refused to repeal Obamacare. Whether the Republican failure to repeal Obamacare was because of intramural revenge or ideology is best to question is which system is best for the common good.

If our politicians understood the principles of Mechanism Design and were diligently working for the people who elected them benefit, America would be on the way to “Repairing the Healthcare System.”

Against this backdrop of a hostile Democratic Party, in control of the House of Representatives, Donald Trump and his administration is slowing working its way to “Repairing the Healthcare System” using the principals of Mechanism Design.

In November 2007, pre the Obama administration, I wrote:

Last month the Nobel Prize in economics was awarded to Leoid Hurwicz, Roger Meyerson and Eric Maskin. They were awarded the Nobel Prize for developing the economic theory of “Mechanism Design.” My first reaction was “what is that?”

https://en.wikipedia.org/wiki/Mechanism_design

After some research, I discovered the power of Mechanism Design. It is a brilliant economic theory that could solve many economic problems. Mechanism Design applied to our healthcare system could solve the healthcare systems problems.

What is it? “In economics, mechanism design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested. This is done by setting up a structure in which each player has an incentive to behave as the designer intends. The game is then said to implement the desired outcome. The strength of such a result depends on the solution concept used in the game. It is related to metagame theory, which is the theory of games the play of which consists of developing the rules of another game.

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare. However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers [1], thus significant research in mechanism design involves making trade-offs between these qualities. Other desirable criteria that may be achieved include fairness (minimizing variance between participants’ utilities), maximizing the auction holder’s revenue, and Pareto efficiency. More advanced mechanisms sometimes attempt to resist harmful coalitions of players.”

Lodi Hurwitz contributed to the idea of incentive compatibility. His point is the way to get as close to the most efficient economic outcomes is to design a mechanism in which everyone does best for themselves. He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying.

If everyone’s incentives are aligned, you have a much more efficient economic system. An example is defense contracting. If you agree to pay on a cost-plus basis you have created an incentive for the contractor to be inefficient. If you agree to pay a fixed price you can come close to an efficient price if you have all the truthful information. If you do not you have incentives aligned and truthful information you create the incentive to be overcharged. Most people can do better by not sharing truthful information. If the rules of the game require truthful information you can get close to an efficient market-driven solution.

The concept of Pareto efficiency means no one can be made better off without someone becoming worse off. Therefore, the incentive is to maintain your dominance by not being truthful at the expense of others. Hurwicz observed as others had that the dispersion of information was at the heart of the failure of a planned economy. He observed that there was a lack of incentive for people to share their information with the government truthfullyThe free market mechanism was far less afflicted than central planning bureaucracy by such incentive problems. The free market economy was by no means immune to this defect. He observed that the free market economy can get us closer than central planning to incentive compatibility because the end consumer can drive the discovery of truthful information.

The customer creating rules of engagement in a market-driven economy can get you closer to the ideal of Mechanism Design. Since the customer determines success of an enterprise by creating demand in a transparent environment, they can get closer to incentive efficiency. They create the rules of the game for compatible incentive.

Roger Meyerson contributed the revelation principle, a mathematical model that simplifies the calculation to create the most efficient rules of the game. The mathematical model gets people to reveal their truthful private information leading to aligned incentives.

Eric Maskin’s breakthrough was in perfecting Mechanism Design with his “implementation theory.” His theory clarifies how to design mechanisms that heighten incentive alignment and efficiency.

How does Mechanism Design relate to the Repair of The Healthcare System? We have to set the rules of the games so that we align all the stakeholders’ incentives without one stakeholder takes advantage of another. The insurance industry is taking advantage of the patients, doctors and hospital systems. The hospital systems are taking advantage of the patients, doctors and insurance companies. Doctors are taking advantage of the insurance companies, hospital systems, patients and the government. The government is taking advantage of the hospital systems, the doctors and the patients. Employers who pay the insurance bills for their employees are taken advantage of by the insurance companies. The drug companies are taking advantage of patients and unduly influencing physicians.

In our healthcare system, everyone is pursuing his vested interest in a game that has rules that do not lead to “incentive compatibility.”

Some politicians think central planning will straighten out the rules. Historically, central planning has not worked. The winners of this year’s Nobel Prize in economics have proven this fact.

I believe consumers can fix the rules of the game so that all the incentives are compatible. Consumers have to have incentives to force politicians to fix the rules of the healthcare game. Consumer-driven healthcare system will achieve the alignment (incentive compatibility) using the ideal medical saving account.

Twelve years have passed since 2007. America has not gotten closer to the solution to Repair the Healthcare System even though the solution is staring us in our eyes.

www. stanfeld.com

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



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Please Read Between the Lines

Please Read Between the Lines

Stanley Feld M.D., FACP, MACE

Most of us have trained ourselves to speed read the daily newspaper. I have asked my readers to read between the lines of the New York Times’ healthcare articles. Most articles are not factual or half-truths. The articles are an opinion and express a confirmation bias. 

“Confirmation bias is the tendency to search forinterpret, favor, and recall information in a way that confirms one’s beliefs or hypotheses while giving disproportionately less attention to information that contradicts it.[32] The effect is stronger for emotionally charged issues and for deeply entrenched beliefs. People also tend to interpret ambiguous evidence as supporting their existing position.”

https://en.wikipedia.org/wiki/Bias#Confirmation_bias

Often, the application of confirmation bias is subtle.  During speed reading, one’s opinion can be influenced by the presentation of confirmation bias. The bias is interpreted as fact because the “media is the message.”

The traditional media is losing its influence on our culture because peoples are realizing it is feeding us a confirmation bias that does not comport with reality.

The development of ideological manipulation is a science unto its own. The print media and television media are its masters. The traditional mainstream media leans towards the progressive left. 

Conclusions should be backed by facts and not by opinion. All sides of an opinion should be presented. A huge problem is social science is imperfect. It does not use scientific principles utilizing reproducible double-blind studies.

Much of the traditional media sound like an echo chamber. It repeats the same soundbites over and over again rather than studying all the facts and reaching a logical conclusion.

In Carl Sandberg’s book, “The Prairie Years’ he said, If you tell a lie it over and over again it eventually becomes the truth.” If the confirmation bias is wrong, the public pays the price to correct it down the line.

Charles Blahous, a former Social Security and Medicare public trustee, has estimated that under Bernie Sanders’ plan of “Medicare for All”, the government could pay about 40 percent less than what private insurers now pay for medical care.

There are large discrepancies in these payments among experts. It has been estimated that there will be a 32.2 trillion-dollar deficit in a “Medicare for All” program over a ten-year period.

I would not believe the saving predicted by Chares Blahous. He was involved in creating a large deficit in our seniors’ Medicare program with the implication that Medicare would be financially viable.

It is predicted by a pro “Medicare for All” advocates, if this version of “Medicare for All” worked as planned, everybody would be insured, health care usage would rise sharply because it would be free without even a co-payment, and America would spend less overall on health care.

The math does not prove this theory. It does appeal to the notion that free is good.

This is a Democratic party pipedream to get more votes. I hope Americans do not fall for this false promise. The Democratic party has done this to taxpaying citizens of all ethnic groups over and over again in the past.

The New York Times has become a propaganda machine for progressives. 

On March 3, 2019, David Brooks’ article headline washttps://www.nytimes.com/2019/03/04/opinion/medicare-for-all.html?searchResultPosition=1

David Brooks really didn’t mean it. He is just setting the reader up in order to express his confirmation bias.

“The Brits and Canadians I know certainly love their single-payer health care systems. If one of their politicians suggested they should switch to the American health care model, they’d throw him out the window.”

The reality is 80% of Brits and Canadian are not sick and do not interact with their healthcare system.

However, they have a false sense of security that they have good healthcare insurance. When they get sick or need emergency specialty care they realize the system is less than they thought it was. Both Canada and Britain have provider shortages, lack of access to care, long appointment waiting times and large financial deficits.

The defects in their healthcare systems can be followed in the local newspaper and not in the government’s press releases.

David Brooks goes on trying to convince us that “Medicare for All” is a good idea. Progressives have been telling us this since 1935 when Wilber Mills tried to ram a single party payer system down America’s throat in the midst of the great depression.

It didn’t work then, and I hope Americans do not fall for it now.

David Brooks says; “So single-payer health care, or in our case “Medicare for all,” is worth taking seriously.”

” I’ve just never understood how we get from here to there, how we transition from our current system to the one Bernie Sanders has proposed and Elizabeth Warren, Kamala Harris and others have endorsed.”

He implies he doesn’t understand how it could work but says a lot of top-flight politicians have endorsed it. Therefore, they know more than he does.

“Despite differences between individual proposals, the broad outlines of Medicare for All are easy to grasp.”

“We’d take the money we’re spending on private health insurance and private health care, and we’d shift it over to the federal government through higher taxes in some form.”

I cannot think of a government-run agency that runs efficiently, without a large bureaucracy, red tape, or corruption. Inefficiency and corruption mean waste and higher cost.

“Since health care would be a public monopoly, the government could set prices and force health care providers to accept current Medicare payment rates.”

Price fixing has never worked. It leads to corruption

 Medicare reimburses hospitals at 87 percent of costs while private insurance reimburses at 145 percent of costs.

The important question should be, why would the insurance companies pay a 58% premium when the healthcare insurance industry knows exactly what Medicare pays? The healthcare insurance industry knows exactly what the government pays because it does the administrative services for the government.

The answer is the healthcare insurance companies are competing with each other for providers, hospitals and patients.

On April 21, 2019, a New York Times headline read: Hospitals Stand to Lose Billions Under ‘Medicare for All’

A reaction by a reader is who cares if hospitals lose billions. They have been ripping off consumers forever.

The headline immediately established the enemy. The first two paragraphs of the article confirm the enemy. It also sets up the liberal or independent reader to develop the same confirmation bias the New York Times has.

“For a patient’s knee replacement, Medicare will pay a hospital $17,000. The same hospital can get more than twice as much, or about $37,000, for the same surgery on a patient with private insurance.”

“Or take another example: One hospital would get about $4,200 from Medicare for removing someone’s gallbladder. The same hospital would get $7,400 from commercial insurers.

Yes, this pricing is too high in my opinion for both Medicare and private insurance. However, it is the result of insurance companies lobbying and financial reporting that permits the rise in premiums.

As hospital systems become less efficient, they hire more administrators and increase executive salaries.

Many hospitals say they spend their last penny on excessive overhead. If they cannot raise prices, they claim they would go out of business.

The progressives like Bernie Sanders then chime in with their talking points that the New York Times keeps repeating.

“If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers.”

The propaganda worked. The confirmation bias of “Medicare for All” is solid.

The only problem is, it will not reduce the cost of healthcare. This has been proven over and over again in many countries and in many of our government run agencies.

“The Sanders plan would increase federal spending by about $32.6 trillion over its first 10 years, according to a Mercatus Center study that Charles Blahous led.

This is the same Charles Blahous that said the cost would be 40% less. What does that study do to the confirmation bias the New York Times tried to promote? Which one is fake propaganda?

“Compare that with the Congressional Budget Office’s projection for the entire 2019 fiscal year budget, $4.4 trillion.”

The 32 trillion-dollar deficit over ten years is a fair estimate. The estimate could be correct if one simply examines the Medicare and Medicaid deficits.  All we have to recall is Obamacare’s website. It was riddled with inefficiency and was a financial disaster.

 Usually, as a result of cost overruns, there is a decrease in access to care. The glaring example is the VA Healthcare System.

 “That kind of sticker shock is why a plan for single-payer in Vermont collapsed in 2014 and why Colorado voters overwhelmingly rejected one in 2016.”

“It’s why legislators in California killed a single party payer system In the California plan, the taxes are upfront, the purported savings are down the line.”

All it takes is a little reading between the lines to realize that we are subjected to ideological manipulation. “The media is the message.”

The New York Times is supposed to be “the nation’s newspaper of record with all the news that is fit to print.” With the advent of the internet and social media, Americans have more information to decide on what is the truth. People now have the ability to examine multiple sides of an issue.

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



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