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All items for September, 2008


Stinkin Thinkin Part 3 President Bush Does It Again!


Stanley Feld M.D.,FACP,MACE


In the waning hours of his administration President George W Bush is trying to sneak in legislation to weaken a woman’s right to choose. It took Hillary Clinton and Cecile Richards writing an op ed in the New York Times on September 19th to expose his scheme.

“ a proposed rule from the Department of Health and Human Services that would govern family planning. It would require that any health care entity that receives federal financing — whether it’s a physician in private practice, a hospital or a state government — certify in writing that none of its employees are required to assist in any way with medical services they find objectionable.”

President Bush’s proposed rule is another attempt to attack Roe v. Wade. The larger issue is an attack on our constitutional freedom as described in Roe v. Wade’s decision. His proposed rule is another way to undermine the Supreme Court decision.

“Laws that have been on the books for some 30 years already allow doctors to refuse to perform abortions. The new rule would go further, ensuring that all employees and volunteers for health care entities can refuse to aid in providing any treatment they object to, which could include not only abortion and sterilization but also contraception.”

The government is threatening to remove federal financing from any entity providing healthcare or medical care, if the federal government found that entity in noncompliance with the proposed rule.

“Health and Human Services estimates that the rule, which would affect nearly 600,000 hospitals, clinics and other health care providers, would cost $44.5 million a year to administer.”

I thought Republicans and the Republican administration opposed unnecessary spending. This proposal has not been highlighted until Hillary Clinton’s op ed. The fourteenth amendment defines the constitutional right to privacy. America was built on the premise of separation between church and state as stated in the first amendment.

Religious beliefs should not be translated into federal law. Larry Tribe makes that clear in his book “The Invisible Constitution”.

Roe v. Wade, 410 U.S. 113 (1973) is a controversial United States Supreme Court case that resulted in a landmark decision regarding abortion.

According to the Roe decision, most laws against abortion in the United States violated a constitutional right to privacy under the Due Process Clause of the Fourteenth Amendment. The decision overturned all state and federal laws outlawing or restricting abortion that were inconsistent with its holdings. Roe v. Wade is one of the most controversial and politically significant cases in U.S. Supreme Court history. Its lesser-known companion case, Doe v. Bolton, was decided at the same time.[2]

Roe v. Wade centrally held that a mother may abort her pregnancy for any reason, up until the “point at which the fetus becomes ‘viable.’ The Court defined viable as being potentially able to live outside the mother’s womb, albeit with artificial aid. Viability usually occurs at about seven months (28 weeks) but may occur earlier, even at 24 weeks.”[1] The Court also held that abortion after viability must be available when needed to protect a woman’s health, which the Court defined broadly in the companion case of Doe v. Bolton. These rulings affected laws in 46 states.[3]

Abortion is a religious issue and not a state issue. It is not an emotional issue that can be debated into law. It is an constitutional individual rights issue about freedom. The Supreme Court made this very clear in 1973. Citizens of the United States should have the right to their religious beliefs but the government  should not impose religious beliefs on the rights of others.

President George W. Bush in his proposed new rule left open the interpretation of abortion.

The definition of abortion in the proposed rule is left open to interpretation. An earlier draft included a medically inaccurate definition that included commonly prescribed forms of contraception like birth control pills, IUD’s and emergency contraception. That language has been removed, but because the current version includes no definition at all, individual health care providers (and the federal government) could decide on their own that birth control is the same as abortion.”

The Bush administration always tries to justify its many attacks on freedoms granted by our constitution by hiding behind protecting our rights and freedoms. He is attacking a basic freedom with this rule.  I believe the American people are too smart to buy into his thinking.

“The Bush administration argues that the rule is designed to protect a provider’s conscience. But where are the protections for patients?” (and patient’s freedoms)

I read about this proposed rule on September 28th. The comment period ended Sept 25th. The goal of the administration was to sneak the proposal past the public. Why didn’t our presidential candidates publicize the proposed rule?

“The 30-day comment period on the proposed rule runs until Sept. 25. Everyone who believes that women should have full access to medical care should make their voices heard. Basic, quality care for millions of women is at stake.”

Even though the 30 day comment period has ended, it is never too late to contact our legislators, They must listen! We elect them!  I believe everyone opposed to this proposal should write their representatives in congress as well as their local newspapers. They should send their objections to both John McCain and B
arack Obama. 

The Republican Party declares it is against government regulations. Yet it wants to impose regulations on one of our basic freedoms. The right to privacy. 

Does anyone want four more years of Stinkin Thinkin?

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

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Healthcare Disappears As An Election Issue


Stanley Feld M.D.,FACP,MACE


We have not heard much about the healthcare issue in the last three weeks. The 47 million uninsured have been ignored by both candidates. The upcoming 100 trillion dollar Medicare deficit has been ignored. I guess if politicians ignore a problem it goes away.

The present administration and congress is ignoring the middle class during this financial crisis. In Naomi Klein’s Shock Doctrine the basis premise is only a crisis actual or perceived produces a real changes. Klein credits the theory to Milton Friedman. This You Tube link is worth seeing.  She provides numerous examples of recent applications of the premise to advantage the rich at the expense of the middle class.

A crises permits unimagined change. It produces increased citizen dependency on government. The government officials can imposes policies to the advantage of the few in the guises of helping the many. These changes must be imposed before society recovers from the shock. The Republican administrations has declared goal is the elimination of entitlements and regulations. President Bush and potential President John McCain want to privatize Social Security and Medicare. The only way to do this is to create a crisis on Main street and shift the costs to Main Street for the advantage of a few. 

I believe this is what is happening right now with Secretary Paulsen’s proposal to bailout the financial system. His bailout package does not offer assistance  to people with mortgage problems that resulted from the banking systems irresponsible but profitable actions.

The financial community will get relief. The taxpayer will not get relief with his proposal. The taxpayer will foot the bill without any hope for payback or profit. This present crisis has not happened overnight. Yet neither Presidential candidate took the lead in exposing the problems. The problems have been common knowledge for a long time. Neither has either candidate taken the leadership to articulate the unfairness of the proposed bail out to the American people.

The healthcare systems problem have not happened over night either. The Shock Doctrine principles will rear its ugly head. When the healthcare system collapses the Shock Doctrine will result in a disaster in either direction. Either the new Republican administration will hand unregulated total control of the healthcare system to the healthcare insurance industry. or we will have socialized medicine with the Democratic administration.

Yet, No one is speaking about healthcare any more. The economy, price of gas, war in Iraq have surpassed the uninsured and healthcare insurance premiums as top election issue for candidates”

“Public opinion polls have shown that among the top issues of concern to Americans, health care is languishing far behind the economy, the war and the price of gas. One CBS poll from July put voter interest in health care at just 3 percent. In August, it was at 8 percent.”

How can this happen? It can happen very easily. The media is the message. Only 20% of the population uses the healthcare system at any one time. Healthcare is not the concern of 80% of the population at any one time. The bigger issue of Repairing the Healthcare System so Americans can receive the best care on the planet is not a vital issue to either candidate when Americans are preoccupied with the present shock. Barack Obama has tried to generate a conversation about healthcare but John McCain has no new healthcare plan or the interest in a  discussion about healthcare. He knows the Shock Doctrine will prevail when the healthcare system collapses. He will then be able to eliminate the entitlement he hates.

American’s most precious asset is health. A functional healthcare system is vital to our health as a nation.

For a lot of people who have health insurance, they are paying more for health care, but it may not show up as concretely as paying $70 to fill their gas tank,” said Anna Greenberg, a Democratic pollster.”

The candidates do not seem to have an interest in healthcare because the majority of Americans are not affected. When we have a severe economic downturn the majority of Americans will be affected. However it will be after the election. It will be too late to deal with the healthcare issue rationally. Also the candidates must realize how shallow and uninformed their concepts of the problems of the healthcare system are.

“There were no conference calls to talk about health care. There were no television ads about health care”

Barack Obama’s campaign claims healthcare is a top issue but does not force it to be a top issue. His solution to the healthcare system is not a viable solution.


“Obama’s spokesman, Bill Burton, said the problem is the press, not the campaign.” 

The issue of health care may be getting less attention than it deserves from the media, but it’s still a top concern for voters and among the top issues that Sen. Obama talks about on the campaign trail,” said Burton.

Tucker Bounds, a spokesman for McCain, acknowledged that the issue has not been prominent so far but when pressed with why the conversation is not a priority he says,

“However,” he said, “There is a stark contrast in the way both candidates would address the issue. Because the views on providing affordability, accessibility and portability of health care are so divergent, it could hardly escape the conversation each candidate will have with voters.”

As usual Tucker Bounds  is making a  meaningless statement.

I believe more and more Americans are waking up to the existence of these  non-specific answers to specific problems. Americans will express themselves at the polls next month. The traditional politicians better wake up. They had better start expressing the will of Main Street and not the will of Wall Street or else they will be out of power.

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

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Stinkin’ Thinkin’ Part 2 Health Costs: More Cost Burden on the Employee

Stanley Feld M.D., FACP, MACE  

Sound Bytes are deceiving. The Republican Party’s Presidential candidate, Republican Party politicians, and Republican policy wonks have often quoted reports that health care costs are expected to ease slightly for employers in 2009. There is deception in this fact. The overall decrease in healthcare costs for businesses is the result of its shifting the burden of costs to their employees. The result is a decrease in cost for the employers nationally. Therefore the sound byte is inaccurate. The cost of healthcare actually will rise 5.7% for the employers. This represents a decrease from last years rise of 6.1%. The direct costs to the consumer increases 29% next year. Once again, the devil is in the details. We can not rely on sound bytes.  The healthcare insurance industry triumphs again.  The result will be an increase in healthcare insurance industry net profits.   



What does all this mean in the present Presidential campaign?  Why are healthcare insurance premiums increasing when the provider reimbursement is decreasing? Why is the burden of the cost of healthcare insurance shifting to patients away from the government and the employers? President Bush and a McCain presidency’s goal is to shift the burden of healthcare costs to the employee. Is this going to improve the uninsured problem? No! It will make it worse.

It looks like the healthcare insurance industry is killing the goose that lays its golden egg. It looks like John McCain wants to help the healthcare insurance industry accomplish this feat without either of them realizing it.  It will happen at the expense of the consumer until the consumer cannot tolerate it any more.

It also looks like John McCain’s policy of more of the same is helping Barack Obama and the Democratic Party justify universal healthcare coverage by a single party payer. An equally disasterous strategy. Where are the principles that have made America great? All politicians should be forced to read Adam Smith’s “Wealth of Nations“.

Dick Swersy’s comment on my blog about the Nobel Prize winning technique to repair the healthcare system is noteworthy.   Mechanism Design to Repair the Healthcare  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 will then implement the desired outcome. The strength of such a result depends on the solution concepts used in the 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. Significant research in mechanism design must decide on making trade-offs between these qualities and vested interests. The most desirable outcome in the healthcare system should be sustaining patients’ welfare and physicians’ incentives for innovations in care. These goals will strengthen our healthcare system not weaken it.

Our Presidential candidates are not thinking of these goal as they formulate programs to sustain the goals of the secondary stakeholders. How can you create affordable insurance when coverage decreases, deductibles increase, and the price decreases are defined by increasing the price 5.7% vs. 6.1% a year. It is a charade designed to fool Americans. The charade works because Americans are not paying attention to what is going on. We will complain when it is too late.

“America is at its most powerful and most influential when it is combing innovation and inspiration, wealth building and dignity building, the quest for big profits and the tackling of big problems. When we do just one, we are less than the sum of our parts. When we do both, we are greater than the sum of our parts- much greater” Thomas Friedman

  Our Presidential candidate are way off base. It is up to the people to pay attention and force  politicians to stop their Stinkin Thinkin.

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

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Stinkin Thinkin! Part 1


Stanley Feld M.D.,FACP,MACE


Unfortunately John McCain has misrepresented Barack Obama’s positions on many issues. John McCain has changed his own position on many issues. He seems to have a meager or shallow grasp of most issues. He claims he is going to fight for the middle class but he has not defined what he is going to fight or a strategy to fight it. He has chosen a Vice Presidential running mate who is being sold to the public as a champion of the middle class. I believe this has been her appeal. However, I have not hear her define any substantive issues or strategies. He is running a campaign of symbolism rather than substance.

He has not spoken substantially about most issues. He does not seem to understand the needs of the middle class. He said on many occasions that the economy is basically sound. On September 17 he said he is going to clean up the financial mess. His plan is to appoint a committee like the 9/11 committee. He has also has stated he does not understand the economy. His campaign chairwoman says he would not make a good corporate CEO.

John McCain’s sound bytes are not even good. He is an embarrassment to the Republican Party. Nevertheless the “polls’ say almost 50% of us will vote for him. How can this be? How is it possible that he can be pulling the wool over the eyes of the American public?

On the issue of healthcare he is way off the mark. His major proposal is his tax credit to consumers.

“Senator John McCain’s top domestic policy adviser, former Congressional Budget Office director Douglas J. Holtz-Eakin, recently said in a conference call with reporters that Mr. McCain’s health care proposal would “put 25 to 30 million individuals out of the ranks of the uninsured, into the ranks of the insured.”

In an article released Tuesday, a panel of prominent health economists concludes that Mr. Holtz-Eakin’s projection is off by, well, 25 to 30 million.

Simple logic tells us there is no way to decrease the number of uninsured by 25 to 30 million by creating a tax credit of $2,500 per individual and $5,000 per family to buy healthcare insurance. The tax credit is insufficient to have very much impact. It is not even a good sound byte because healthcare insurance costs $6,000 per individual and $12,000 per family. The families will still not be able to afford healthcare insurance.

However, the sound byte represents a major tenet of his healthcare plan. Even if he was correct the common man would still be at the mercy of the abusive healthcare insurance industry. He has said nothing about correcting healthcare insurance industry abuse and inefficiency. The abuse is directly related to how the healthcare insurance industry calculates the healthcare premiums.

“The article, published in the journal Health Affairs, argues that “initially there would be no real change in the number of people covered as a result of the McCain plan.” After a short-term reduction of 1 million in the number of people without coverage, the number of uninsured would increase by 5 million after five years, the authors predict. There are currently 45 million people without insurance, or 15 percent of the population, according to the Census Bureau.”

This misrepresentation of the true effect of his policy is pervasive in all of John McCain’s campaign assertions. His healthcare policy will not create more competition among insurance companies. It will give the healthcare insurance industry more control of the premiums charged and an opportunity for great net profits. Have media sound bytes become more influential in decision making than logic and facts? I believe Americans are smarter than that.

That, the McCain campaign asserts, would drive more people into the individual market, fomenting competition, reducing premiums and discouraging consumers from buying more coverage than they need or can afford. The economists wrote that many “people are likely to have far less generous policies than those they have today.”

The economists are from the University of Michigan, Columbia, Indiana University and Harvard. Their estimates of the effect of McCain’s healthcare tax credits are comparable to those made in July by the Urban Institute and Brookings Institution. The Urban Institute and Brookings Institute projected that 1 million people would gain coverage after one year under Mr. McCain’s plan, that almost 5 million people would gain coverage after four years, and that the number of uninsured would then creep upward.

John McCain is obsessed with the growth of entitlements like Medicare, Medicaid and Social Security. He is correct. They have gotten out of hand because of their defective structure. His goal is to shift these entitlements over to the private sector. The private sector loves his goal because it is an opportunity to increase profits.

John McCain should be asking why the entitlements are failing rather than giving them away to institutions that have abused systems such as the healthcare industry and the financial industry. These entitlements are failing because of their structure. These institutions will have to be restructured to correct their defects and inefficiencies. The current bureaucracies are incapable of creating initiatives linked to innovation and change.

Privatizing these institutions is not going to make things better for our middle class. John McCain’s plans will drive the middle class toward poverty for the benefit of big business. The pity is John McCain does not know the effect his plan is destined to have.

The strength of America is in a vibrant middle class with incentives to advance through education. It is in the creation of the desire and capability for upward mobility for the lower and middle class that will make us stronger. Government has to set rules that are fair to all and permit the lower class to rise to the middle class. People must have hope, security and goals. The middle class should not be conditioned to live in fear of war, economic collapse, and lack of adequate healthcare.

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

  • Elliott Klug

    Dr. Feld – I commend you and thank you for such a frank analysis. Sound Byte policy is scary and Mr. McCain’s fighter pilot approach is scarier.
    Will your fellow republicans take heed?
    An Independent.

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Here’s To Good Health!: The Feld Men’s Trip 2008


Stanley Feld M.D., FACP, MACE

Every year my brother, Charlie his two adult son’s Jon and Kenny, me, and my two adult sons Brad and Daniel ,go on a trip for two days. The purpose of the trip is to simply be with each other and relate to each other without wives, kids or other distractions. The trip is always a wonderful bonding experience as well as intellectually stimulating. I believe we each learn something from each other and about the others’ dreams and goals. I have always said if you do not have goals you cannot score baskets.

In recent years we’ve gone to spring training baseball games. Last year we went to Fenway Park. This year we decided to go to Wrigley Field and the Cubs, but the plans changed and we decided to go to a game at Yankee Stadium in its last season. IMG_5212

Brad was in charge of getting the tickets. He polled everyone in March 2008 for a weekend. With our schedules and the Yankee schedule plus sellouts he could only get tickets to the Yankee game on September 13th. The Yankees were to play the Tampa Bay Devil Rays (The Rays). I was disappointed because Tampa Bay was the worst team in baseball in March 2008.

It turned out last weekend was the last homestand in the “House that Ruth Built”. It also turned out that Tampa Bay is currently the best team in baseball. Brad is a genius. Tampa Bay slaughtered the Yankees 7-1. As we watched the first two innings Jon noted that Derek Jeter did not jump after balls hit that he could have easily gotten. We also noticed lethargy in the stands. A-Rod and Pugh Rodriguez were not in the Yankee starting lineup. The crowd was not in the game. Mike Mussina stunk. We left in the fifth inning.

The terrible game hardly ruined the weekend. First stop on Friday night was Dizzy’s Club at Lincoln Center.IMG_5174 On Saturday my brother hired a car ( a great big Suburban) driven by a great big guy (Frank) to take us to the neighborhoods we grew up in.

Frank drove us from the New York Palace via the East River Drive to Buckner Boulevard. I had never seen Buckner Boulevard completed as a highway. It was being built for over 20 years. He connected with the Bronx River Parkway and exited on Gun Hill Road.

Kenny commented that it looked like a neighborhood somewhere in Europe. We passed the site of the pizza place I took Cecelia on our first date. It was gone. It was replaced by a shiny stainless steel Diner. I told the boys what clothing Cecelia was wearing on our first date. They immediately called her to see if I was making it up. She confirmed my description. She was wearing bermuda shorts and a blue button down man tailored shirt. I fell in love with her at first sight and we have remained in love for 50 years so far.

Our house in the Bronx was smaller than I remembered.IMG_5180  The basketball court across the street was still there. I played endless hours of pickup street basketball with the kids in the NYC Projects. I learned to use my elbows to survive. Next we passed Cecelia’s house. It brought back memories of our fabulous courtship.

Frank then drove down Allerton Avenue. I made him stop at the White Castle for old times sake. It was still in the same spot for at least 65 years. The facade had been modernized. Everyone thought I was crazy when I jumped out of the car to take a picture and get a White Castle hamburger.IMG_5184

As a kid we would clip the 5 for twenty-five cent coupons out of the New York Daily News on Mondays. My brother and I would eat 10 at a time. My mother’s friends would clip extra coupon for us. My hamburger cost 75 cent now.

We then passed Columbus High School (my brother went there) and then down Moshula Parkway to Kingsbridge Road. Kingsbridge Road to the Grand Concourse to Mount Eden Avenue. We lived in an apartment building on the corner of Mount Eden Avenue and Topping Avenue from 1945 to 1954. It had been torn down, replaced by a parking lot and presently a row of three story apartments.

Claremont Park as not the same. The playground where we played punch ball was gone. Our baseball field was gone. The “rocks” which always seemed monstrous to me as a kid were only about 4 feet high.IMG_5197 My stepping stone good luck rock on the rock wall border of the park was still there.IMG_5192  IMG_5195 It was a thrill to see it once again even if it was a little worn.

Geller’s Candy Store was gone. The only store left in the neighborhood was a little grocery store. It has not been updated.

Saturday night we had dinner and walked around Broadway and Times Square. It was hot, muggy, rainy and wall to wall with people. When we got to 42nd St and 6th Ave. we finally got to some peace and quiet.

As usual there was stimulating political discussions. And as usual no one changed the other guys’ mind. The weekend gave us a chance to hang out and feel each others progress.

We laughed and talked endlessly. I recommend this kind of experience with siblings and your siblings’ children. The togetherness is inspiring, educational and therapeutic.

Next year’s trip will/might be to Chicago in May. Chicago Cubs will play the Chicago White Sox in interleague play. I assume it will be another cold and rainy weekend in May because it always seems to be cold and rainy in Chicago in May.

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

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Can Americans Repair the Healthcare System?


Stanley Feld M.D.,FACP,MACE

I believe Americans can repair the healthcare system. I received a comment that said,


Your solutions are clearly the most ideal but, I think, unrealistic.  We would have to educate the consumer very quickly and that isn’t likely to succeed in the near future.”

I do not agree. As a nation Americans can do it with appropriate leadership. Great leadership would inspire our government to create a cultural change that can stimulate and motivate consumers to learn very quickly. I do not believe change necessarily succeeds in a gradual fashion.

In his new book, “Hot, Flat and Crowded”, Thomas Friedman nails the mechanism of change in his first few pages.

“America is at its most powerful and most influential when it is combing innovation and inspiration, wealth building and dignity building, the quest for big profits and the tackling of big problems. When we do just one, we are less than the sum of our parts. When we do both, we are greater than the sum of our parts- much greater” Thomas Friedman

Thomas Friedman’s opening statement applies to many areas of policy in our society. Policy decisions include energy, environment, transportation, public education, immigration and medical care, to name a few. Gradual change results in an adjustment by vested interests to cripple the original goal of the change.

The Presidential candidates have touched on each policy area with sound bytes. Neither has outlined a plan that combines each couplet of Friedman’s to make America greater than the some of its parts. Inspiring Americans to have self respect and self responsibility with a motivational carrot of money could result in rapid change. Instead, the candidates are embattled in discrediting each other for media attention. They are not defining the issues or proposing solutions.

An example that reverberates in my mind is John McCain’s acceptance speech. He said he was going to fight for us, fight terrorism, fight for the economy, fight for medical care and fight for a lot of other things. He did not tell us what policies he is going to fight for. He did not tell us who he is going to fight for whom. His handlers obviously disrespect our intelligence and ability to think. They think we are incapable of asking the critical questions. Who is going to fight and how is his fighting going to help us as individuals and as a nation? In healthcare he is going to fight to get rid of the Medicare entitlement. He is going to feed the healthcare insurance industry’s quest for big profits and not tackle the big problems with big ideas. I have presented big ideas for the repair of the healthcare system and with the appropriate leadership Americans can be stimulated to respond.

There is no inspiration or reward for innovative thinking. There is the probability of wealth building for the healthcare insurance industry without dignity building for Americans in John McCain’s healthcare plan. Thomas Friedman is correct in declaring that by combining the couplets America can be greater than the sum of its parts. If we focus on only one side of his couplets the result is less that the sum of its parts.

Leadership inspiring cultural change and innovative thinking about changing the healthcare system in a way that respects the average citizen’s intelligence and has empathy for the less fortunate without decreasing dignity is what we need in a leader. We have plenty of smart Americans who can focus on the big picture. but the big picture does not create an exciting enough story for the media. However, by focusing on the big picture we would start creating solutions to our problems.

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

  • Jen McCabe Gorman

    Dr. Feld –
    Excellent. Two words: thank you.

  • Health Care

    Great article! Our broken health care system needs to be addressed. All of us can fix the health care system if we just help each other attain that goal. As of now, the health care budget has been given a radical boost by President Obama. Many Americans feel that this issue needs to be addressed, and the sooner the better since the reform of health care was one of his biggest campaign platforms. The budget for the program tops out at about $650 billion, which is one of the largest health care budgets ever. The big pharmaceutical and insurance lobbies are annoyed, because they may not get to profit as much as they would like. Their crocodile tears pale in comparison to the tears cried due to the amount of deaths in this country that arise from inadequate access to health care which is universal in other industrialized nations.

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Is Medicare An Effective Bureaucracy? Part 1


Stanley Feld M.D.,FACP,MACE

Barack Obama’s medical plan wants to guarantee universal insurance coverage similar to that offered through the Federal Employee Health Benefits Program. (Medicare Part C)

“The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP),

the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”

I stated that forming a new bureaucracy to improve medical care is not the answer. Bureaucracies are inefficient and at time wasteful.

The answer is not Mr. Obama’s proposed National Health Insurance Exchange . I think a new bureaucracy will make things worse.

“· National Health Insurance Exchange: The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.”

Medicare has been proud to advertise that it is an efficient bureaucracy. It has declared that its overhead is only 2.5%. We now know this is not true. Medicare outsources most of its administration services to the healthcare insurance industry. The healthcare insurance industry builds in its administrative fees to the cost of care. The New York Times obtained a draft of a report prior to being made public. The inspector general is studying the report before it is released and might change it.

Medicare’s top officials said in 2006 that they had reduced the number of fraudulent and improper claims paid by the agency, keeping billions of dollars out of the hands of people trying to game the system.” “But according to a confidential draft of a federal inspector general’s report, those claims of success, which earned Medicare wide praise from lawmakers, were misleading.”

Medicare told outside auditors to ignore government policies that would have accurately measured fraud.

“For example, auditors were told not to compare invoices from salespeople against doctors’ records, as required by law, to make sure that medical equipment went to actual patients.”

“As a result, Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.”

This miscalculation does not represent direct patient care. These supplies are essential to manage chronic disease. However the abuse of responsible sales these supplies by secondary stakeholders is not controlled by Medicare. 

I campaigned to have Medicare pay for home glucose monitoring strips. It is an essential part of diabetes care. To my astonishment, private companies were formed to refill glucose strips automatically. Patients would not need strips because they were not compliant with physicians’ orders. Compliance rate for home glucose monitoring is only 50%. Medicare is spending twice as much as they would if the patient was responsible for buying the glucose strips.

The extra money paid could be directed to paying for disease management. Patients could be taught the importance of measuring their blood sugars three times a day. Instead the private companies are profiting from the sales extra glucose strips.

“That same year Medicare officials told Congress that they had succeeded in driving down the cost of fraud in medical equipment to $700 million.”

Pete Stark claimed, “We’re speechless”. Mr. Stark and his ilk consistently claim that Medicare is a model for government-run “universal” health care because it spends less on overhead than the private sector.”

To look better to the public, you cook the books,” Mr. Stark continued. “This agency is incompetent.”

The report points out a basic problem of bureaucracies. The goal always seems to be to look good rather than perform its job efficiently. The people must force our leaders to face reality. Congress and the administration must begin to trust citizens to be responsible for their own Medicare dollars rather than have a bureaucracy or healthcare insurance company in charge of their needs.

“Some lawmakers and Congressional staff members say the irregularities that the inspector general found were tantamount to corruption and raise broader questions about the credibility of other Medicare figures.

Senator Grassley who has praised Centers for Medicare and Medicaid Services for efficiency in the past has demanded that heads roll.

“Congressional staff said the Centers for Medicare and Medicaid Services — the agency overseeing Medicare — was lobbying the inspector to play down the report’s conclusions.”

This response is only natural and to be expected when bureaucracies are challenged and exposed.

“A spokesman for Medicare said that the agency agreed with the inspector general that the agency’s reported level of improper billing for durable medical equipment, or D.M.E., should have been higher. But Medicare says the $2.8 billion figure is unsupported.”

The media is the message in our sound byte society. Once the day of the reporting has passed the story is forgotten. Unfortunately the implications of the story are profound

“Fraudulent and improper payments have long bedeviled Medicare, a $466 billion program. In particular, payments for durable medical equipment, like power wheelchairs and diabetic test kits, are ripe for fraud.”

There is a simple plan for Barack Obama to adopt. It is my ideal Medical Savings Account. Medicare patients should be responsible for spending the first $6,000.00 dollars. They would be careful to not waste their Medicare insurance money. Maybe they would not get the best wheelchair in the world or let companies send them diabetes kits they do not use.

A government bureaucracy should make the rules. If vendors break the rules patients should report them. The government bureaucracy should act quickly to enforce the rules. With my ideal medical savings account you create an enormous policing agency. People will not tolerate waste when their money being wasted. This will eliminate fraud and the waste of the peoples money.

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


  • Josh

    I believe their are very few people that understand the healthcare system and Dr. Stanley Feld is one of them. However, can the healthcare system truly be changed by such a minute force?

  • Medical Equipment

    I forgot to mention I am just trying to stimulate a conversation and hear peoples opinions on the matter.

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Politicians Give Me A Headache. We Must Vote! But For Whom? For The Best Person.

Stanley Feld M.D.,FACP,MACE

Both Presidential candidates have claimed they have specific proposals for change for many policies. If we decide on whom to vote for on the basis of healthcare policy we will be making a mistake. They both want to change the wrong things. They also have not given us an idea of how they are going to execute their promised changes.

Neither candidate is going to have a positive effect on Repairng the Healthcare system because they are focused on the wrong changes. If they can get congress to approve of any of their proposals, they will only make the healthcare system worse.

My last ten blog entries have reviewed both Barack Obama’s and John McCain’s healthcare proposals specifically. I am disappointed in each candidate. Neither is focused on the basic problems in the healthcare system

Both candidates advocate universal coverage. Barack Obama wants universal coverage with a single party payer.

The sound bytes Barack Obama uses suggests a competitive environment between the government and the healthcare insurance companies. If the government was serious, the healthcare insurance industry would not want to compete. The rules and regulation promised would be intolerable. They would rather run the single party payer system for the government.

John McCain is against entitlements. His goal is to shift the burden of acquiring healthcare insurance to the citizens. John McCain plans to provide tax credits to citizens. The tax credits are suppose to be used to purchase healthcare insurance. In affect, John McCain wants to relieve government and employers from providing healthcare insurance for their constituents and employees. The sound bytes John McCain uses suggest that all citizens will have the opportunity to buy healthcare insurance. This is not quite universal coverage. His tax credits are not large enough to buy the healthcare insurance even if consumers could afford it.

The basic problem is the healthcare insurance industry will set the price of the insurance premiums as it does in the present system using antiquated actuarial systems and bloated administration fees. This is a basic problem in the healthcare system. Neither candidate is focused on this problem. Neither candidate respects the consumer’s ability to manage his own healthcare dollar.

The cost of universal care in Massachusetts has doubled. Massachusetts outsources the universal healthcare insurance coverage to a couple of insurance companies. Government officials in Massachusetts claim the reason for the high premium costs is more people are obtaining subsidized insurance than anticipated. Economics 101 dictates that the more people are insured the less the premium should be. Unfortunately, the healthcare insurance company controls the money and the bids.

Consumers should own their healthcare dollar. They do not need first dollar insurance coverage. Consumers should manage their own first dollar coverage. The first dollar coverage should be funded by their employer or the government, tax free. This would eliminate the insurance companies’ administrative cost for the first $6,000 in healthcare coverage. If consumers do not spend the first $6,000 the remainder would be deposited in a tax free retirement trust fund. It would not be deposited in a health savings account to be paid back to the healthcare insurance industry for future co-payments and deductibles.

Consumers would then be motivated to use the first $6,000 wisely. They would be motivated to remain healthy. If a patient had a chronic disease that required medical care and spent $4,000 to avoid complications of their chronic disease, the employer or the government would provide a bonus for their retirement trust. If a patient developed a chronic disease and spent the first $6,000 then the high deductible insurance would provide first dollar coverage for the remaining expenses.

Consumers responsible for their own healthcare dollar would then shop for the best treatment at the best price. They would also be motivated to stay healthy and exercise regularly, The economic gain would motivate consumers not to smoke, drink or become obese. Consumers would also be motivated to demand environment clean-up in order to protect their health. Politicians might listen. There is no reason Dallas, Texas should be out of EPA compliance except for the polluting effects of coal plants. Soot and cigarette smoking cause chronic lung disease and asthma. Consumers would demand rapid change if they were denied being rewarded for staying healthy because of circumstance beyond their control, but in the hands of the politicians.

This innovative healthcare plan would eliminate the healthcare insurance industry’s excessive administrative costs for the first $6,000, provide incentive for healthcare insurance companies to compete for highly profitable high deductible insurance plans , and provide incentive for consumers to be responsible for keeping themselves healthy. It would also provide incentive for physicians and hospitals to become more efficient. Consumers would be shopping for the best care at the best price. The government would have to force and enforce real transparency. If stakeholders were not really transparent they would be denied a license to sell insurance, hospital services or physicians’ services in that state. The states, not the federal government must be in charge. Insurance premiums would have to be calculated on a community rating basis. Electronic medical records must be uniform and interchangeable. EMR software should be distributed via the web download. So should electronic prescriptions software. Physicians should pay for the software by the click. This would promote rapid adoption and avoid unaffordable capital expenditures. Compliance by physicians and patients should be rewarded, not like present proposals for punishing non compliance.

In my review of the Presidential candidates’ healthcare plans none of these solutions are mentioned. Instead, both candidates make proposals that are not well thought out. They do not offer basic solutions. They do not motivate or trust consumers to be responsible for their health.

The consumers’ healthcare dollar should be under consumer control. They have to be taught how to use their dollar wisely. The government should set and enforce rules to prevent abuse by the vendors. America’s healthcare crisis will not be solved until a leader listens to the primary stakeholders, the patients and the physicians.

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

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