Stanley Feld M.D., FACP, MACE Menu

All items for October, 2006


The Ideal Medical Savings Account System

Stanley Feld M.D., FACP, MACE

Medical Savings Accounts for our discussion are tax free trust accounts that are funded by the employer, the self-employed, and the government for the employee, or the Medicare or Medicaid beneficiary. The Medical Insurance provided by the employer, the self employed, or the Medicare or Medicaid beneficiary in addition to the MSA trust account is a high deductible insurance plan. The rating on the high deductible insurance should be community rating without exclusions for preexisting illness.

The deductible is $6,000. The MSA contribution will be $6,000. If the patient does not spend the trust accounts money in the current year that money accumulates tax free until retirement. In the case of Medicare the money accumulates tax free until used at the beneficiaries discretion or is deposited in the beneficiaries’ estate. At that time the rules for traditional IRA’s apply.

It is mandatory to have insurance and the premiums will be subsidized by the government for persons that qualify. Price transparency by the insurance industry, hospitals, and physicians is also mandatory. It is the responsibility of all parties to aid the patient to become an educated consumer. If they want to purchase an unnecessary or inflated medical care product it is their decision and not the insurance industry or government’s decision. The patient pays the inflated price and not the insurance industry and the government.

This is the basic formula for the Medical Savings Accounts. It is important for this system of insurance not be contaminated by modifications made by stakeholders in order to benefit their vested interest. The formula creates a system of insurance that compels the patient to be an informed consumer. It also compels the stakeholders to be competitive for the patients’ healthcare dollar.

The result will be lower prices and increased quality. The advantages to stakeholders are obvious. It would foster individual ownership of the healthcare dollar with individual responsibility for the healthcare dollar. The result would be lowering the cost of health insurance with a high deductible. People would no longer face premium increases resulting from wasteful medical care decisions made by others. This is the famous restaurant effect discussed earlier. It would also lower the administrative costs of adjudicating bills. The charges would be adjudicated at the point of service serving to lowering the cost of insurance further.

Patients would have a vested self interest to avoid unnecessary costs because the result would be additional savings for the patient in their Medical Savings Trust Account. Also, MSAs would eliminate the barriers for the purchase of insurance by the temporarily unemployed. Patients would create a competitive medical marketplace with their individual purchasing power. We will see this happening right now with the Wal-Mart $4 generic drug policy.

The high deductible insurance would be true insurance and not the “managed cost insurance” we have presently. Managed cost insurance simply angers every stakeholder in the system. Patients would now have incentive to think about as well as learn about the risk of certain lifestyles and the need for lifestyle changes to prevent the complications of chronic diseases. The patient by avoiding the complications of chronic diseases with be earning money in their own Medical Savings Trust Account that would continue to grow tax free until retirement.

All of these incentives are free market incentives. None of the incentives force the patient to have certain behaviors. It is in their vested economic interest to make appropriate lifestyle changes and wise medical care decisions.

With pure Medical Savings Accounts the Healthcare System will be in a position to self repair.

  • DH-Richmond, VA

    Do I understand you expect me to pay $500 per month toward tax free trust account and also budget $500/month for medical expenses toward my deductible?
    How does a person making under $28,000 year do this!

  • Savings

    The saving account is good for healthcare system.In which we get lower cost but best quality.

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War on Obesity II

Stanley Feld M.D.,FACP,MACE

I received a comment from Karen Madrono. You can read her complete comment in the “War on Obesity” post.

The point Karen makes below is critical to the understanding of how change must occur.

“Battling against obesity seems easy but I’m telling you, it takes courage and faith in yourself.
One must be conscious about every food that they put in their mouth. It could either make the person healthy or sick. It’s not the teacher’s obligation, though they should teach children the right food to eat but it is still up to person himself not to the doctor.

I am not blaming anybody, all I’m saying is we should be responsible in everything we do with our body. It’s our body and it is irreplaceable so we should learn to take care of it. I’m doing it now so can you.”

Our health is our most precious possession. We inherit our genetic predispositions. For example, twenty percent or more of us have a disposition for Type 2 Diabetes Mellitus. However, the Diabetes declares itself in only 5% of the Caucasian population. In America the percentage of Caucasians with Type 2 Diabetes Mellitus is rising. The incidence is much higher in Hispanics and Blacks. In fact, Clinical Type 2 Diabetes Mellitus is now appearing at a younger and younger age as the epidemic of obesity in America is spreading. Our Super-sized Fast Food portions are contributing to the epidemic.

The rising incidence of Type 2 Diabetes Mellitus is directly related to the increase in Obesity in this country. Obesity represents an environmental abuse to our genetically predisposition. Increasing weight results in insulin resistance. Insulin resistance leads to increasing blood sugars. Type 2 Diabetes Mellitus can be thought of as a disease that results from our inability to overcome the increasing insulin resistance resulting from increasing weight gain. The insulin resistance results in hypertension and a rising cholesterol. The end result is Coronary Artery Disease. The combination of diseases is currently called Metabolic Syndrome. Metabolic Syndrome is the major cause of heart disease in this country. It takes 8 years from the time of onset of Metabolic Syndrome to the time of discovery of Type 2 Diabetes Mellitus. Many times the diagnosis of Diabetes Mellitus is made at the time the patient has a heart attack.
The entire Metabolic Syndrome can be reversed by weight loss. Weight loss can be achieved by decreasing food intake and increasing caloric output. Weight gain is the environmental abuse to our genetic predisposition. Weight loss is difficult to accomplish. It requires a consistent and long lasting change in life style activities. Many “tricks” have been tried. None of the “tricks” seem to work long term. Industries have been built around these “tricks” because we are a nation of instant gratification.

In the long term, it remains the patient’s responsibility to fix the problem by changing his lifestyle. Systems of Care can help the patient develop a lifestyle change. Government campaigns could provide educational tools. However, it is up to us to be responsible for ourselves.
Karen has made the point abundantly clear. Thank you Karen.

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People Power Works!

Stanley Feld M.D.,FACP,MACE

Our little neighborhood in Far North Dallas Texas has spoken!! We have spoken through the use of “People Power”. Far North Dallas is divided into many neighborhoods. Each neighborhood has a Neighborhood Association. All the members in my neighborhood are connected via e-mail. The definition of community in America is being changed by the internet. We are informed about vandalism, robberies, gathering, elected official meetings as well as births and deaths by our neighborhood association’s V.P. of Communications.

Our neighborhood Communictions V.P. is doing a terrific job. She informs and educates us. A few weeks ago the Dallas Area Rapid Transit Authority had a public meeting. Dallas has struggled to have an effective Rapid Transit System. DART has been minimally to moderately effective.
Recently, the DART staff made a decision to build a ground level line using diesel trains on the defunct Cotton Belt tracks. The decision was opposed by neighborhood representatives and the Dallas City Counsel. The Dallas City Council proposed an alternate plan. The plan was a less disruptive below surface electric train line. The Dallas City Council decision is the first unanimous decision I can recall in the 38 years we have lived in the city. The long unused Cotton Belt line touches the back yards of some of the houses in the Far North Dallas area. Over 1000 people from the North Dallas neighborhoods came to a Town Meeting to protest the DART staff’s unilateral decision. The DART staff was overwhelmed by the turn out and our protest.

Below is the e-mail we received today. Cecelia and I have rescheduled our return to Dallas to attend the meeting. We want to be heard. I have a feeling the DART board of trustees will change their plan for the train line. We support a below ground level electric car rail system proposed by the Dallas City Council.

Our local virtual community is a perfect example of “People Power”. Politicians are supposed represent our wishes. They will represent our wished if we know what we want and demand our wishes be expressed. This process requires awareness on the part of the neighbors and education on the part of the leaders. Multiple North Dallas neighborhoods connected by the internet allowed our community to understand the issue, and demand that our interest be represented.

The mobilization of common goals is the future of freedom in America. Networked communities will supersede hierarchical bureaucracy as the representative form of policy making in the future. We are expressing this desire for freedom and choice in our neighborhood.

The healthcare system can be fixed by this type of virtual community. A networked community armed with a logical plan to meet the needs of the people is needed to repair the broken healthcare system.
Effective uncontaminated Medical Savings Accounts is a system that is logical and promotes freedom to manage our own money and permits choice. Once communities of people understand the Medical savings Account system “People Power” by the uses of RSS, and email can demand and affect repair of the healthcare system rapidly.

I believe it is as simple as the methodology of change expressed by our virtual community leader below. We the people have to chance the healthcare system with “People Power”. We can not leave it to the politicians or the next guy any more. Enough is enough!

Below is the recent email to all members of our Virtual North Dallas Community

Thank You! …
To everyone who attended the September 25th public meeting in Addison to protest DART’s plan for diesel trains on the Cotton Belt. Approximately 900-1200 of us burst the seams of Addison Center.
There’s nothing new about citizens protesting changes to their neighborhoods, but the protest we staged in Addison last month has created quite a stir! The feedback we’re getting is that DART and the cities involved have never seen anything like our demonstration of opposition to the DART plan. Our collective efforts are having a positive effect, but OUR WORK IS NOT YET DONE – We cannot claim victory until DART votes to abandon its plan for diesel trains on the Cotton Belt and adopt the Natinsky plan for more sensible light rail instead. THE VOTE TAKES PLACE OCTOBER 24TH.
Ron Natinsky, District 12 Councilman, and Linda Koop, District 11 Council-woman, have the unanimous support of the Dallas City Council and are working hard in our favor. As citizens, we must support their official efforts by attending the DART Board meeting on October 24th, when the Dart Board votes for the “2030 Plan”. We must fill up the entire meeting room and confront each and every DART Board member, face-to-face, as they cast their votes.
There will be an opportunity for citizens to speak directly to the DART Board members. You may make the same eloquent remarks as you did on September 25. Although your previous speeches are on the public record, they may not have been heard in their entirety by every DART Board member.
October 24 will be an incredible evening, an experience in local democracy that you will not want to miss. It will not be as lengthy as the Addison meeting. Please inform all your concerned neighbors and arrange carpools to drive downtown in groups. Anyone who needs a ride should use the contact info below and we will help you coordinate carpools.

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Notice What Could Happen with Medical Savings Accounts

Stanley Feld M.D.,FACP,MACE

With Medical Savings Accounts notice what could happen when you put purchasing power in the patients’ hands. You give patients the incentive to spend money wisely.

Some patients are going to make good medical care decisions. Some patients will make poor medical care decisions. If the patients make poor medical care decision and do not purchase necessary care they will get sick and even experience complications of chronic disease. They will not only lose the money in the trust accounts for that year, they may lose their health. Patients would now be in the position to be responsible for their health care decisions. The decision would not be a bureaucratic and politically influenced decision.

Patients would be the principle buyers of their healthcare, not the insurance industry, the employer or the government. Patients would have the opportunity to compare prices and options for their own medical care

Physicians would be relating care and price to the patient and not to the third party payer. Hospital would no longer be making deals with the insurance industry and the government. They would once again be competing for patients by lowering prices and increasing quality of care.

The insurance industry would have to change. It would have to provide true insurance for expensive illnesses. They would provide insurance coverage for illness costing more than $6,000 in one year. Presently the insurance industry is an industry that owns patients, owns their insurance dollar, and decides the patients’ needs. It tries to control the physician and the hospital.

The employers would provide the money for the trust account and the high deductible policy. The patients would manage the first $6,000. The employer would help the employee pick the best high deductible policy. The employer would also help the employee make informed purchasing decisions.

The government would no longer be the buyer of last resort. It would provide subsidies for senior patients and indigent patients. It would regulate policy for the advantage of the patient. The government would not dictate what the patient should do. The government could create the environment for competitive markets by regulation. If physicians’ services, hospital services and private health insurance would compete for all customers, prices will fall.

We will see the fall in drug prices over the next six months as Wal-Mart rolls the $4 generic plan throughout the country. The government could achieved price competition on a state level by license requirements of price transparency.

I am not the first person to say all of this. However, vested interests other than the patients’ have stood in the way of its implementation. Remember, no one in power likes the balance of power disrupted, even if the system he controls is a failure. Individual interests rule over the common good. This needs to be changed.

There are criticisms and fears of implementing the MSA system. The criticisms and fears all seem lame to me. We will discuss these criticisms and fears shortly.

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Medical Saving Accounts for all Insurance Products for all Patients

Stanley Feld M.D.,FACP,MACE

If we as a society do not become innovative about healthcare delivery, medical care in this country will deteriorate.

The Medical Savings Accounts described in the last posting can be utilized as a motivational tool for patients. A true Consumer Driven System can have a positive impact on cost and quality. I hope to demonstrate that total cost will decrease and quality of care will increase.

With 46.7 million people uninsured, America has a problem. I estimate that 30 million people can afford to pay the true cost of a high deductible insurance. The cost of insurance to an individual not in a group plan is not tax deductible. The group plans are tax deductible to the employer.

A simple change in the tax law would correct this. Additionally, if an individual has a preexisting illness, presently the insurance industry can elect to refuse offering a policy, rate the premium or exclude that illness from the insurance offered. The insurance industry can not do that in a group plan. If they have a group with many patients at risk they can try to raise the premium.

The insurance premium for individuals should be the same as corporate rates. The insurance rates should be transparent in order to shop for rates. The rates should also be calculated as a community rate rather than as and individual rate. A fifty year old male with hypertension, high cholesterol and moderate obesity is at increased risk for a myocardial infarction and the need for chronic cardiac care. In the present system he would be refused an individual insurance policy. If he could get one any care related to his heart disease would be excluded.

A simple regulation mandating community rating would correct the problem of discriminatory rates and ratings. In the Medical Saving Account System, the 55 year old patient would be guaranteed a high deductible policy which could be purchased with after tax dollars.

The system could be set up so that patient could apply and receive state or federal subsidy. This simple change could cure our Medicaid problem. The Medicaid system presently spends more per patient than it would cost the government using an effective Medical Savings Account system. The Medical Saving Account system would also encourage patient compliance. The patient would not longer be a burden to the state because costs could decrease.

The key is motivating the patient to be responsible for his care. He would be in control of purchasing his care and to adhering to the care recommended. There have been many pilot programs rewarding expectant mothers on Medicaid. If the mothers participated and fulfilled their obligations for prenatal care, the fetal and post partum complication rates fell dramatically. The neonatal and post partum care costs plummeted. The reward of some pilots was simply free formula for the first year of the infant’s life.

Consumer driven responsibility for one’s medical care is an invigorating concept to patients long abused by a hierarchical bureaucratic power seeking healthcare system. The power should be given back to the consumer.

One can see how the system could work in Medicare patients. The government subsidizes the insurance of people over 65 years old. Constantly, the government must raise the insurance premium the elderly pay. Ninety percent of Medicare’s payments are for the complication of the chronic diseases. If the system were set up to reward the elderly for effective self management of their chronic disease many unnecessary costly complications could be avoided. The patients could be motivated by the money accumulating in their Medical Saving Account. Since they are retired they could use the unused trust money as a supplement to their Social Security. More on the mechanism of the various plans in the future.

Will it work? Absolutely!!

We will see “Patient Power” in action when Wal-Mart rolls out the $4 per month for generic drugs nation wide. The elderly will force their physicians to order generic drugs. The CVS and Walgreen will also be forced to decrease the cost of their generic drugs. The Medicare Part D fiasco will evaporate. There will be no need for Medicare D. It will be cheaper to buy the medication from Wal-Mart. The price of brand name medication will decrease because of the price competition. Adherence to medication regimes will increase because patients can once again afford their medication.

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The Health Insurance Solution

Stanley Feld M.D.,FACP,MACE

The patients and their ability to be an effective free market consumers have to lead the way. I believe a system controlled by the government will not work. A Healthcare System has to be market-driven by consumers in order to work.

Presently, our healthcare system is any thing but consumer or market-driven. Price and access to care are totally controlled by facilitator stakeholders. Price is opaque. Despite calls for transparency change is very slow. The rate of change from price opacity to transparency will remain slow until State governments mandate price transparency. State agencies control licenses for hospitals, the insurance industry and physicians.

Presently, patients have no idea of the quality of the healthcare product they are purchasing. They also have no idea of the price until service is completed. Access to care and services are also restricted by the government and the insurance industry.

The various parts to the solutions to the insurance issue have to occur very close to one another on a time line in order to be effective. The two main repairs are price transparency and high deductible insurance policy.

A Healthcare System without price transparency and a high deductible option such as Health Savings Account represents a false hope and will fail.

The employer’s average healthcare cost for a family is twelve thousand dollars per year. Employers are providing medical insurance for the employee for $12,000 per year.

The Medical Saving Account plan would provide a six thousand dollar trust fund and a first dollar high deductible coverage plan for $6,000. The total $12,000 could be administered by the insurance industry. The plan could satisfy the insurance industry. It would not provide them with ownership of the first $6,000. However, it would save them spending the second $6,000 because patients would be motivated to be effective shoppers. The patients would retained some of the first $6,000 in their individual trust accounts by seeking cost-effective care and avoiding the complications of chronic disease.

The insurance industry is interested in primarily in two things. They want to control the first insurance dollar for investment. They are also interested in retaining the unspent insurance premium dollar. The original concept of health insurance was to provide an inexpensive job benefit to the employee and provide protection for the employee against the costly expenses generated by complications of chronic illness.

Presently the medical insurance industry wants to keep as much of the insurance premium as it can. It profits by the income generated from the money float of the insurance premiums and unspent premiums. It, therefore, makes the decisions on how the premium dollar is spent. The result is the restriction of access to care.

In my ideal formulation, patients would be motivated not to waste their insurance dollar. The insurance industry would still negotiate fees with hospitals, physicians and other healthcare providers. These fees would be available and transparent to the patient. Patients would make their own decisions on medical care spending.

If the patients do not spend the $6,000 in their trust, that money would accumulate tax free and be available at retirement. The six thousand dollars per year would serve as an incentive for patients to be careful consumers in a price transparent environment.

If the patient had a chronic illness, we have seen average costs as high as $20,000 to $300,000 dollars a year for the treatment of complications of the disease. This is not only a burden to the patient but also to the insurance company. Hospitalizations like recurring congestive heart failure could be totally avoided with the development of systems of care that teach the patient self-management. The patient could then avoid slipping into congestive heart failure and avoid hospitalization. The cost of care would then decrease.

The average cost incurred by a patient with diabetes mellitus is presently $15,000 per year. Some patients with diabetes mellitus do not go to the doctor. Those patients cost nothing that year to the insurance company. The next year each could cost $200,000 to treat the complications of their diabetes mellitus. If a patient with diabetes mellitus could avoid complications with maintenance of the disease the cost should be $4,000 to $5,000 per year. If the patients trust fund owned the first $6,000, the patient might be reluctant to spend the money on preventive maintenance of the disease. However, the insurance company or their employer could easily credit $2,000 back to the trust account complications were avoided. The insurance company would then be able to keep the remaining $6000 of the insurance premium as pure profit. It also would have access to managing the cash in the trust account until the patients retirement.

The government can make this happen with legislations and regulations. It can be done on the state level because states regulate licensure of the insurance industry, hospitals, and physicians.

I will next discuss how this plan can be implemented for Medicare, Medicaid, the unemployed and the self-employed. By increasing the insurance pool the insurance industry could increase profit rather than face increase cost, increasing premiums and decreasing lives covered.


    You aare doing abangup job of introducing an repeating the problems and their solutions. To extend people power to the next level, doctor-entrepreneurs must now formulate their services in a market friendly fashion. That is, for example, we are starting to market our preventive sericees and expertise to companies that are self insured, and we need partners (banks and other financial institutions not stained with absolute greed-read Bill McGuire). It is only by developing an effective product that small and large companies are able to wean themselves from the insurance giants. Am I right?

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In Less Than a Year

Stanley Feld M.D.,FACP,MACE

On May 28, 2006, I wrote that the Steve Case and Rick Scott’s In Store Clinics would fail in the pharmacies and Targets and Wal-Marts.

In less than 1 year Rite Aid is closing their In Store Clinics in Portland Oregon.

In response to an email about this article I replied;

“Creation of free standing “DOC in the Boxes” is one of the complicated mistakes that business people are making.” Their thought is to make money. Their public relations people say their aim is to provide inexpensive and rapid access to healthcare care. I said, “The effective result is to distort the problems in the healthcare systems even further.”

“Both Steve Case and Rick Scott are very smart guys, when it comes to picking the cherries off the trees, and making money. I am sure they will make some money at this venture. They will also bale out just before it crashes.”

“I think Wal-Mart and CVS are indeed putting their reputation and good will on the line and are going to get a nose bleed. “

These are again today’s solution to yesterday’s problems which in turn will become tomorrow’s problems.”

The business plan is to give patients’ easy access to care delivered by Nurse Practitioners. I saw two problems. First, if you do the arithmetic the business can not make money without the clinic receiving reimbursement for medical procedures. Second, when you are sick, you want to have access to a physician. By taking flu shots away from the Family Practitioner, you simply make it harder for him to stay in business.

The correct business to start is one that helps the Family Practitioner increase the efficiency and quality of his practice. This would help rebuild an environment of trust between the primary stakeholders, the patient and the physician.

“For a $30 flu shot, a $45 treatment for an ear infection or other routine services
from a posted price list, patients can visit nurse practitioners in
independently operated clinics set up within the stores whose own
pharmacies can fill prescriptions.

“It was a lot easier to know you can just drive up the block to a
clinic, rather than spend time in the pediatrician’s waiting room,” said
Liz Lyons, who recently took her 9-year-old son to have a check up.”

Again, these In Store Clinics do not answer the real problems facing the healthcare system. The true problems are access to care for the uninsured, affordable and cost efficient delivery of care, and increasing the quality of care for people with chronic disease.

Yesterday, Rite Aid Corp announced they were closing 10 in store clinics in Portland Oregon.
“Rite Aid Corp.’s first experiment offering health clinics inside its stores ended when the clinic operator decided it could not turn a profit.”

Take Care Health Systems LLC is the vendor for the Rite Aid Clinics. “The concept works, we know that, we just have to be in the right place,” said Hal F. Rosenbluth, the chairman and co-founder of Conshohocken-based Take Care.

However, a Rite Aid representative stated “Take Care’s executives helped pick the market after looking at demographic studies and making site visits”.

“In the meantime, Take Care is operating clinics in Walgreen and Eckerd stores in the Kansas City area, St. Louis and Pittsburgh. It plans to open clinics in Walgreen stores in Chicago in November,” Rosenblatt said.

All I can say is, “I told you so”. Watch out Walgreen, Eckerd, CVS, Target and Wal-Mart! You are next. It is not the vendor, it is the business model!

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Patterns in the Healthcare System: Clues to Repair

Stanley Feld M.D.,FACP,MACE

To me, a true entrepreneur is a person, who can see patterns that others can not see and act on those patterns to create an opportunity that no one thought existed.

KKR has a long history of success is discovering these patterns and investing in them in a leveraged way. A current purchase was Hospital Corporation of America. My guess it is the purchase was not through a process of intensive study of endless data and pilot studies. It is through a process of considering information and then visualizing the trends and patterns of the times. Once visualized, then you act and follow through. It is a no brainer unless there are bumps in the road.

Oceans of good and bad information are available about the healthcare system and its ills. In fact there are many nonsensical rules and regulations that distract physicians from their duty of delivering medical care. The easiest thing to do is for physicians to ignore the obligation we have to try and fix the system. At first glance, with all of the healthcare system’s complexity and all of the suggestions to fix the complexity it seems impossible to generate effective change.

It seems that everything that is done to improve the system ends up harming it even further. The most recent example is the windfall the 1983 DRG method created for hospitals. Now, implementation of a new DRG system based on cost rather than charges is delayed for one year. Dr. Mark McClellan resigned as director of CMS. My guess implementing the new system will be delayed even longer with his departure.

Recent examples are plentiful. One is the Medicare Part D benefit. The benefit was developed to help people of Medicare age. A $2,500 doughnut hole has been inserted to the disadvantage of the patient and the advantage of the pharmacy. The details are of the advantage are madding.

Another governmental error is the conversion of the concepts of Medical Savings Accounts into Health Savings Account by the congress who wants to fix the system. The Health Saving Account is a small deductible of $1000 as opposed to the original Medical Saving Accounts deductible of $6000 which gave the patient incentive to spend his dollar wisely. The Health Saving Account is to the advantage of the insurance company and not the patient. Additionally self employed older people can hardly afford or qualify for insurance if they could qualify. If qualified they would have to buy the insurance with after tax dollars rather the pre-tax dollars the employer pays.

In order to be an educated and wise consumer, one needs to know the price of the item. So far, hospitals, insurance companies, pharmacies, and pharmaceutical companies have refused to reveal the price of their services or payments in a transparent way. The government has published their reimburse schedule but you have to be a coding expert to figure it out. Then you have to know what codes the physicians and hospitals will use. Total opacity remains. It is in the hands of State licensing boards to insist of transparency. So far, not one governor has stepped up to the plate. President Bush has call for transparency but it has generated no action because a deadline has not been set.

The Commonwealth Fund just published a preliminary document advocating the government as the single party payer. We have just listed errors the government has made in the past. Imagine if everyone was insured under Medicare, how difficult and inefficient the system might be. I noticed the Chairman of the Commonwealth Fund study is the CEO of Partners Health in Massachusetts. John Monagan has been awarded a salary of over $2 million dollar for the profitable job he has done for Partners Health. I suspect his success is from his figuring out the reimbursement system from the old DRG system.

I truly believe the government wants to help the people. What is the pattern that creates these misfired initiatives? They misfire because of the inefficiency in hierarchical bureaucracy. The hierarchical bureaucracy is imbedded in all of our government agencies and in the body politic. Decisions are influenced by vested interests lobbying and not by common sense.

In the book High Noon, J Rischard points the way of coming to reasonable decisions for all the vested interests. Everyone needs to participate in the decision making process. It is by network problem solving for the common good and not hierarchical bureaucracy influenced by vested interests.

We, the people, can overcome this archaic structure. A system can be repaired that will cost less money. It would be is a system by the people for the people. There are lots of very smart people in America, who can figure out lots innovative solutions.

We, the people, have to be angry enough in order to have the will to act.

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