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All items for March, 2009


President Obama, We Are Looking For Inspirational Leadership Not More Spending and More Taxes


Stanley Feld M.D.,FACP,MACE


President Obama, you won the election because you are articulate, confident, logical and inspirational. You projected a vision for the country that included fairness and opportunity for all. You promised to return to America’s ethical and moral base. The country was tired of congressional bickering, gridlock, threats to constitutional freedoms, gamesmanship, and unproven or hidden corruption. Americans were tired of corporate privilege and abuse.

In early 2008 America was told the economy was doing great. America was winning the war in Iraq. America was winning the war on terrorism. There was no inflation in the U.S. Housing prices were rising. No of these declarations made any sense to the average American.

All an average American had to do was wake up in the morning and experience rising prices, housing foreclosures, and a bombs exploding in Iraq to know there was something wrong with these declarations.

In January 2009 the government told us we had been in a recession since October 2007. Is the individual’s testing of reality better than the government’s. The government has all those fancy, incomprehensible indices. Indices that happen to be derivatives of derivatives such as gross national product, housing starts and the consumer price index

America has a generalized mistrust of government and its agencies,politicians, banks, corporations and other commercial entities. The United States has had an ethical and moral deficiency leading to our economic collapse.

To me, the A.I.G. bonuses simply highlight this deficiency. Congress’s action to remedy A.I.G. bonuses highlights congressional impotence and showboating. It underlines its inability to act to cure our ethical and moral problems. Its actions also highlights congress’s inability to problem solve for the peoples benefit. It problems solves for its own benefit and desire to increase power over our lives.

America elected you, President Obama, in the hope that you would restore us to our ethical and moral center. Please do it quickly. Please abandon outmoded systems that you are preparing to reregulate. It will only hinder Americans ability to be innovative and it will surpress worthy incentives. Please let us develop and promote fresh new ideas that will put us on a stronger footing for economic growth in the future.

Tom Freidman expressed it beautifully last Sunday.

“President Obama missed a huge teaching opportunity with A.I.G. Those bonuses were an outrage. The public’s anger was justified. But rather than fanning those flames and letting Congress run riot, the president should have said: “I’ll handle this.”

He should have gone on national TV and had the fireside chat with the country that is long overdue. That’s a talk where he lays out exactly how deep the crisis we are in is, exactly how much sacrifice we’re all going to have to make to get out of it, and then calls on those A.I.G. brokers — and everyone else who, in our rush to heal our banking system, may have gotten bonuses they did not deserve — and tells them that their president is asking them to return their bonuses “for the sake of the country.”

I bet they would be compelled by public sentiment to return their bonuses for the sake of the nation. It would be better for them and the country to return their bonuses voluntarily than return them through unconstitutional taxation. This tax moves America further from its ethical and moral base. President Obama ,you should inspire, not coerce ethical and moral behavior.

President Obama, I am sure you know inspiring conduct has a greater impact that trying to enforce conduct. The government bureaucracy is usually poor at enforcing regulations. There are usually loopholes in new regulations. Rich vested interests have a way of wiggling through these loopholes at citizens’ expense. You were elected because of your populist notions and the promise to return America to our ethical and moral base. You have expressed the notion that you cannot legislate ethics and morality. You must inspire Americans to do what they should do and not force them to do it. Regulations and increased taxation have a way of precipitating unintended negative consequences.

There is nothing more powerful than inspirational leadership that unleashes principled behavior for a great cause,” said Dov Seidman, the C.E.O. of LRN, which helps companies build ethical cultures, and the author of the book “How.”

Dov Seidman’s principles hold true in healthcare. Loopholes in healthcare regulations have permitted stakeholders to adjust. Further regulations to close loopholes resulted. These adjustments to regulations have permitted the healthcare insurance industry to capture the greatest share of the money at the expense of the primary stakeholders (consumers).

Your healthcare team is doing nothing other than expanding failed programs (Medicare and Medicaid). Congress has given you the money to repair the healthcare system by the force of your personality and oratory. Your team is in the process of handing the appropriation over to the healthcare insurance companies. Think about it. Why do you think the healthcare insurance industry is in favor of universal care extension of Medicare and Medicaid ? Look at the profit they are generating in Massachusetts.

It is time to be inspirational and innovative. You promised if something did not work you would try something else. You have the money for healthcare, put it in the hands of the consumer with rules and regulations that protect consumers. I believe you and the country will be pleased with the results.

America needs inspiration and innovation, not false hope from failed systems in order to repair the healthcare system.

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


President Obama Don’t Confuse Us With Illogical Thinking.


Stanley Feld M.D.,FACP,MACE

Medicare and Medicaid flunk the Institute of Medicine’s criteria defining an effective healthcare plan.

The President’s $634 billion "down payment" on health care reform in his proposed budget depends on raising taxes and saving money largely through administrative payment changes in existing entitlement programs. That is not exactly fundamental reform.”

John Goodman’s analysis of Nicholas Kristof New York Times editorial is perfect. He starts off by saying: I have observed before that when people start talking about health care their I.Q. tends to fall about 15 points.”

“The same error in reasoning appears in almost every speech on health care given by Barack Obama and by just about everybody else on the political left as well.”

I am not interested in partisanship. I am only interested in logical problem solving. If a plan for medical treatment makes sense and has good clinical evidence to prove a positive outcome, I am for it. The same applies to solving social and economic problems.

President Obama’s healthcare team is in the process of formulating a plan that is not logical . The healthcare plan has not succeeded in the past and will fail at a greater cost to taxpayers and society.

John Goodman has outlined the logic used by Nicholas Kristof and the administration to justify the validity of the administration’s healthcare reform plan.

Classic syllogisms are taught to every high school student ;

All men are mortal

Socrates is a man

Therefore Socrates is mortal

John Goodman points out the syllogism used about by Nicolas Kristoff and the administration:

“Major Premise:

The United States spends twice as much per person on health care as Canada and most European countries and has worse outcomes.

Minor Premise:

Spending twice as much in return for less is bad.


We should tax the rich and spend even more on health care.

Whoa! Something’s wrong here.”

You bet there is something wrong. It is not logical. The proposed solution of taxing the rich does not follow expanding failed programs (Medicare and Medicaid).

President Obama’s healthcare reform proposal;

1. Down Payment or Unknown Costs

President Barack Obama’s budget sets aside $634 billion over 10 years in a health care reserve fund, which is earmarked for the enactment of unspecified policies intended to bring down costs and expand coverage but its true costs are still unknown..

The congressional budget office’s estimates are much higher.

2. Key Provisions in the Health Care Budget

Higher Taxes. The President is proposing tax increases on those making over $250,000 annually. This revenue is projected to finance approximately half of the projected health care spending, an estimated $318 billion.

The President’s healthcare team is proposing to throw money at a broken system and use the tax increases to pay for it. The result will be a further increases in future taxes. President Obama should be developing a healthcare system that will provide incentives to the primary stakeholder (consumers) and promote innovative thinking and behavior by the other primary stakeholder (physicians) to promote efficiency and decrease costs.

His plan does not initiate real change in the healthcare system. The government will still outsource administrative services to the healthcare insurance industry. The healthcare insurance industry will still control the healthcare dollar.

3. Medicare Private Plan Payment Changes.

4. Medicare Prescription Drug Premiums.

Under this proposal, higher-income seniors would pay higher premiums than lower-income seniors for Medicare Part D prescription drug coverage.

Medicare Part D is presently too expensive. Its premiums have tripled in the last two years. Medicare Part D has benefited the healthcare insurance industry. The healthcare insurance industry’s net profit is $5 billion dollars per  year. Only 20% of Medicare patients participate.

5. Medicaid Prescription Drug Payment.

6. Medicare Payment Changes.

“Systemic delivery reforms, such as "pay for performance" (where physician and hospital reimbursement are tied to compliance with government practice guidelines), are intended to result in securing better value for dollars.”

Similar “reforms” have lead to providers adjusting by gaming the system. Centralized medical decision making in Washington will lead to political manipulation of the system by healthcare lobbyists. It does not repair the healthcare system.


7. Medicaid Family Planning.

8. Prescription Drug Re-Importation.

President Obama’s healthcare plan does little to empower the patient. It does little to change our healthcare system’s flawed public and private payment system. The power to manipulate the system’s payment remains in the healthcare insurance industry’s hands. Its appeal is to the populist notion to “soak the rich” to help the poor. It does not add value to individual freedom of choice and ability to secure valuable healthcare. It does not repair the healthcare system.

If President Obama really wanted to repair the healthcare system he would place control and decision making for healthcare needs in the hands of the consumers and their families.

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

  • jacksmith

    Finally, the time has arrived to fix Americas Healthcare crisis, and Americas healthcare nightmare. Hundreds of thousands of you are killed needlessly every year by your healthcare delivery system in a rush to profit. And because of a rush to profit Hundreds of thousands more of you are needlessly dying from treatable illness that people in other developed and civilized countries don’t DIE! from. Rich, middle class, and poor alike. Insured, and uninsured. Men, women, children, and babies.
    Additionally, thousands more of you are driven into financial ruin, and bankruptcy just because you, or one of your loved ones got sick or injured. And all of this is happening at a time when America spends twice as much of it’s GDP (Gross Domestic Productivity) on health care than any other country in the developed world. Individual Americans spend about ten times as much on health care as any other people in the developed world. This is a CRIME AGAINST HUMANITY. AND IT MUST END!
    But before we can truly fix this healthcare crisis and disgrace, everyone needs to clearly understand what the problem is. And everyone needs to clearly understand the real enormity of the problem. The problem is that HEALTHCARE AND MEDICAL DELIVERY IN AMERICA IS SEVERELY CORRUPTED AND COMPROMISED BY GREED! AND THE PRIVATE FOR PROFIT MOTIVE. And it is corrupted, and compromised IN EVERY ASPECT, AND EVERY PLACE OF HEALTHCARE AND MEDICAL DELIVERY. Unfortunately for all Americans, compromised healthcare ALWAYS results in needless suffering, injury, disability, and or death. Which is exactly what is happening now in America in shocking numbers.
    Health care is NOT! a private for profit business. Healthcare is an essential public service. Like police, and fire. And healthcare is also a human right! PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON, AND AN IMMORAL AND UNETHICAL PERVERSION OF HEALTHCARE AND HUMAN RIGHTS.
    So how do we fix this healthcare disgrace? I believe the fix for Americas healthcare disaster is essentially the same thing that every other developed country in the World has essentially done. “NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL. Essentially HR676 (enhanced, and expanded medicare for all). Just like every other CIVILIZED! country in the developed World has. There is no other way to truly fix and reform our current disastrous healthcare delivery system.
    All Universal health care systems work best when everyone participates. But I know that the healthcare lobby, and some politicians will try and undermine “Not For Profit, Tax payer supported, Single payer, Automatic, Free Universal Healthcare for all” by falsely claiming that it will limit your choice, and require you to participate.
    So, I propose that everyone be included in the national plan unless they choose to opt out. If you opt out and need medical care the national plan will insure your provider that they will be reimbursed under the rules for members in the national plan. But those who opted out, and their insurer will be responsible for the FULL! cost to the national plan for providing your care if you or your private insurer fails to reimburse the provider or the national plan in a timely manor to at least the standards of the national plan.
    Including reporting you to credit agencies, withholding of taxes, leans, and garnishment of wages for unpaid medical bills. Just like you have now under private for profit healthcare, and private for profit health insurance.
    Further, people who opted out will be required to provide proof of financial responsibility for future illness or be required to participate in the national plan. And everyone with children will be required to participate in the national plan. Or provide proof of insurance coverage on each child to the standards of the national plan. It will be against the law to report anyone in the national plan to a credit agency for unpaid medical bills.
    Frankly, only a dope would want to opt out of the national plan and opt to keep our current disastrous private for profit medical, and insurance plans. But they will be free to choose. The most important thing is that the vast majority of Americans that want the protection, benefits, and higher quality of a universal national plan have that choice.
    You see, one of the most important aspects of a universal healthcare system is easy access, and patient protection. This is accomplished by having a single payer without a conflict of interest in patient care. And by having a payer who has the power to enforce minimum standards of excellence in healthcare delivery for everyone in the plan. This is much of what Medicare does now for senors. “Aeger Primo” (The patient comes first). Unfortunately in our healthcare system the patient comes last. We are just a peace of meat to them. Cash cows to be slaughtered for profit.
    So this is IT! my fellow Americans, My fellow human beings, My fellow World Citizens. And my fellow Cyber Warriors. 🙂 The time has come. D day. H hour. HEALTHCARE REFORM THIS YEAR! Let no one stand in our way. Contact your representative and tell them you want “Not For Profit, Tax Payer Supported, Single Payer, Automatic, Free Universal healthcare for all. And tell them you want that choice now. Tell them you want President Obama’s budget passed without delay. President Obama’s budget is brilliant. And exactly what is needed now.
    President Obama, and his allies will need all the support you can give them. The healthcare lobby will try to take out his people if they can, like they did with Tom Daschle and Nancy Killefer. And they will try to neutralize President Obama’s popularity, and political power. Or they will try to take him down someway. Don’t stand for it. If they attack him. Go after them ten times harder and remove them from office. We had an election. And you the people chose President Obama’s leadership, and change agenda. Let no one in government disrespect the will of the American people and remain in office.
    Let’s get this healthcare reform done now my fellow Americans. This year. Take no prisoners.
    God Bless All Of You
    Jack Smith — Working Class 🙂

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President Obama: Massachusetts Healthcare Reform Is The Wrong Model

Stanley Feld M.D.,FACP,MACE

After I wrote the article about consumer driven healthcare a Washington lobbyist said to me; “ many people in Washington do not think that the Massachusetts healthcare plan has failed. In fact President Obama and many congressmen think the Massachusetts plan should be the model for the federal government’s healthcare reform plan.”

This is difficult for me to believe. The Massachusetts healthcare reform plan fails all five criteria the Institute of Medicine’s use to define an effective healthcare plan. The plan not only fails all five criteria for healthcare reform, it has encountered obscene cost overruns.


“ The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.”

The Massachusetts healthcare reform plan flunks by all five criteria.

    1. Universal healthcare coverage : The state still has more than 200,000 citizens without coverage. The number is rising as a result of increasing unemployment.

    2 . Continuous coverage: Coverage is not continuous if individuals lose their jobs. The healthcare insurance premiums have risen. Small businesses can not afford to cover employees. It is less expensive to pay the state imposed penalty tax.

   3. Affordable for individuals and families: Individuals and families cannot afford coverage.

For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications. “

   4.Affordable to Society : The original budget for the Commonwealth Care subsidized program was $387 million dollars. It almost doubled in the first year to $630 million dollars. The estimated cost in 2009 is $1.3 billion dollars. Massachusetts has already received a federal government bailout of $2 billion dollars for healthcare. These cost increases are not sustainable nor affordable to society.

   5.Access to high-quality care for everyone : High deductible plans are cheaper but the deductibles are so high many consumers can not afford care when they are sick. Much of the population is under insured. The goal is to assure affordable healthcare insurance while providing quality care.

If the plan flunks all five Institute of Medicine criteria how can policy makers in Washington think it is a success? They are deceiving themselves and the public. Why bother study the effectiveness of the plan when you can believe in the buzz?

There are other issues that compound the failure. They include local political issues of power.

1. “Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals.

2. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world.

3. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.”

President Obama , please be aware of the unintended consequences of Tom Daschle’s healthcare plan. Throwing money at defective and unsustainable systems will not work. It will fail no matter how much plan is intellectualized by healthcare policy wonks at thirty thousand feet above reality.

Some think the Medicare model meets the Institute of Medicine’s five criteria for healthcare reform. They are convinced Medicare for all is the answer.

They argue;“Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country.

Medicare does satisfy the first three criteria. It insures everyone over 65 regardless of preexisting illness. It provides access to care and not tied to a job.

However, it has not be affordable to every senior. High deductibles, massive copayments and services approved and therefore billable but not covered must be taken into account when deciding on Medicare’s affordability for seniors on a fixed income. Medicare Part D (drug coverage) has failed to be affordable from the onset. The premiums have tripled in the last 2 years.

The cost of Medicare is not affordable to society. If fact bureauocrats have tried to decrease its costs, limit its coverage and limit reimbursement. The Bush administration tried to eliminate Medicare as an entitlement. The increasing cost of Medicare is unsustainable to society. According to the CBO the cost per year will reach 100 trillion dollars in 50 years. Adding the entire population to Medicare will be folly.

The only system that will repair the healthcare system is a system in which consumers control their initial healthcare dollars and is taught to be responsible for their health maintenance. .

President Obama, you should take a hard look at the ideal Medical Savings Account option to control costs and improve the health of America.




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




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Consumers’ Must Control Their Healthcare Dollars

Stanley Feld M.D.,FACP,MACE

I. Consumer Control of their healthcare dollars:

     A. How would a medical savings account work to reduce cost, while encouraging physicians, hospitals and the healthcare insurance industry to become more competitive and efficient?

1. By creating a system in which consumer’s demands drive competition and efficiency because they are spending their own money.

2. The government’s role should to support assets designed to teach consumers to drive the healthcare system’s efficiency so that consumers could save their own money for retirement.

     B. The cost of healthcare insurance for a family of four is presently over $12,000 per year. Who should be the payers for healthcare?

1. Both consumers and employers should be able to pay for healthcare insurance with pre tax dollars.

2. Medicare and Medicaid should be abolished. Both Medicare and Medicaid are unsustainable entitlement programs that must be restructured to create a sustainable system. They should replaced by The Ideal Medical Savings Account. Medicare recipients should pay a means tested premium directly from their monthly Social Security check. It should be paid with pre-tax dollars.

3. The government should subsidize the uninsured using economic means testing methodology similar to the economic means testing used to determine Medicare premiums. The premium should be paid monthly rather than yearly. The more you earn the more you pay.

4. Consumers who were Medicaid would not pay a premium. They would be totally subsidized by the government as they are presently. They would get the identical healthcare insurance that other consumers have.

The physicians’ and hospital systems’ fees have already been negotiated or imposed by the healthcare insurance industry or government. There are many reimbursement overpayments and underpayments in the system that can be corrected. There are many prices for healthcare services. There are retail and multiple discounted prices.

Presently, uninsured consumers are charged retail price for healthcare services. Under appropriate rules with real price transparency, consumers can negotiate an affordable price acceptable to all. If a consumer elects to overpay it reduces the money in the consumer’s Medical Savings Account. The government’s role should be to support a variety of assets to provide consumers with education. The government should enforce appropriate rules and regulations to protect consumers. The Ideal Medical Savings Account will create incentives for consumers to save their money and maintain their health.

II. Healthcare System Errors

        A. The healthcare system does not provide payment for prevention care.

        B. There are no good criteria defining preventive care.

        C. There is no payment for systems of medical care that will prevent the complications of chronic diseases.

        D. There are duplications of testing and costs in the system due to perverse incentives and lack of appropriate information technology.

        E. There is overpayment for some procedures and tests and underpayment for others.

This can be fixed by a system of both government and consumer education. Government must educate consumers to be wise purchasers of medical care. It can be done with effective websites. .

III. Mechanics Of The Ideal Medical Savings Account:

      A. Goal: Provide consumers with incentives to become wise purchasers of medical care and maintain good health.

1. Employers are willing to pay $12,000 per year for healthcare premiums. Presently it costs $15,000

2. $6,000 of the $12,000 should be put into a medical saving trust account. The second $6,000 is for first dollar insurance coverage beyond the initial $6,000.

3. At the end of each year the unused portion should be transferred to a retirement account.

4. All consumers would be motivated to have healthcare insurance. They benefit from money saved, if they remained healthy.

5. Government subsidies should be available to self employed and uninsured consumers who could not afford healthcare insurance. Universal coverage would be instantaneous. Consumers would maintain free choice. Each consumer would be his own deterrent to abuse of his health and overuse of the healthcare system

6. It is to society’s benefit to maintain a healthy and fit population.

7. Consumers with a chronic disease should be motivated to learn to avoid acute or chronic complications of the disease.

        a. For example: A diabetic could be motivated to learned how to avoid acute complications eliminating costly emergency room           visit. Continuous control of blood sugars would reduce complications by at least 50%.

         b. Diabetics need maintenance with follow up care. If they maintain perfect control he would spend part of the $6,000.

         c. If they spent $4,000 but avoided hospitalization or a complication of his disease his employer or the government could afford to give him a   $2,000 bonus. Their total retirement account deposit at the end of the year would be $4,000 rather than $2,000. They would have avoided hospitalizations and ER visits . Diabetics would be on the way to avoiding the costly complications of their chronic disease.

         d. They would enjoy good health and increase their retirement account. The government or their employers would save money decreasing   their premium costs.

Simply providing healthcare insurance (private insurance or public insurance) will not solve the problem of the ever increasing cost of care.

Motivating and teaching consumers to take care of their health short term and long term will decrease healthcare costs.

8. Ideal Medical Savings Accounts would make actuarial sense to the healthcare insurance industry if it could get past its desire to control the first healthcare dollars. It would be able to reduce premiums because fewer people would get sick.

If the Ideal Medical Saving Account would come to pass America would have a positive impact on our epidemic of obesity, environmental pollution and lung disease.

America let us force our politicians to finally do something that makes sense.


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

  • Medical Billing Software

    Consumer must care about its present health rather than the money for retirement. Government should give some rebate on the medical billing.

  • Sara Hoffman

    Where did you get your information, “The cost of healthcare insurance for a family of four is presently over $12,000 per year. Who should be the payers for healthcare?

  • •••
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Consumer Driven Healthcare Plans Trickle


Stanley Feld M.D.,FACP,MACE


As the healthcare debate heats up the meaning of consumer driven healthcare (CDHC) needs repeating. The true meaning of CDHC has been bastardized by the healthcare insurance industry as represented by Health Savings Accounts (HSA).

The healthcare insurance industry feared that if Medical Savings Accounts dominated it would lose control of the initial healthcare premium dollars. The result would be a decrease in profit and an increase in price competition and real price transparency.

The reality would be America would have universal healthcare in a more efficient healthcare system. The system would be more efficient because it would be driven by the consumer for their benefit and not a third party payer. A more efficient system will maintain healthcare insurance industry’s profit while permitting a decrease in healthcare system costs.

“A lack of consumer understanding has contributed to the glacial growth of consumer-driven plans. Can better information from health plans help CDHPs take hold?”

HSAs place limits on consumers’ incentives. All of the healthcare premium dollars are eventually paid to the healthcare insurance industry.

Our economic recession along with increasing unemployment have set the stage for consumers to accept any help government will provide. Enter a single party payer and all its problems. Since Medicare and Medicaid have proven to be unsustainable, it is foolish to throw money at a failing system. It is time to revitalize the system.

Just the opposite should be occurring. CDHC should be promoted and not be marginalized. President Obama’s universal healthcare with a single party payer system marginalizes CDHPs. The route he is taking to achieve everyone’s goals and will not repair the healthcare system.

“The idea behind consumer-driven health plans is to transform members into healthcare consumers through education and place more responsibility on the individual.”

Health Saving Accounts (HSA) do little to encourage patient responsibility or make patients informed consumers. HSA were a political compromise designed by the healthcare insurance industry. The resulting plan gutted the intent and effect of the CDHC movement.

“ Studies show that the percentage of Americans insured in CDHPs is still in the single digits, largely for two reasons: Consumers simply don’t understand the tax-free savings accounts that are connected to CDHPs, and few health plans are providing cost and quality information to allow consumers to compare doctors, hospitals, and treatment options.”


Consumers do not see a financial advantage of the HSA because there are none. The money has to be used to pay present deductibles and future deductibles. There is no reason the future deductable will not be increased reducing the present value of the money in their health savings account. The healthcare insurance industry wants health savings accounts to fail. It feels its margins are presently excellent and does not need a change.

“More than one-quarter those respondents said that HSAs are difficult to open/manage, or too complicated, or they simply didn’t understand the accounts.”

Consumer driven healthcare is the only thing that can repair the healthcare system. It would take control out of the healthcare insurance industry’s hands. The route to take is the ideal medical saving accounts.

Healthcare insurance would convert to real at risk insurance. Consumer would own and control their healthcare dollar. The government could teach the consumer to use the healthcare dollar wisely. The government could provide clear price and quality transparency. It would force all the secondary stakeholders to compete for the consumers’ healthcare dollar. This competition would force an increase in efficiency and decrease in administrative waste.

The government should act as the facilitator for the competition. The time has come for politicians to do something for consumers and not for secondary stakeholders.

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Here We Go President Obama


Stanley Feld M.D.,FACP,MACE

President Obama, here we go down the road of unintended consequences and wasting taxpayers’ money.

Baylor Health Care System plans to ask for some of the state’s federal economic stimulus money for two of its multimillion-dollar projects.”

You have given states economic stimulus money without control over how it is to be spent. Is a grant to Baylor Health Care System going to stimulate the economy? Is this going to repair the healthcare system?

Baylor’s request reminds me of a story about the University of Texas, Southwestern Medical Center’s legendary former chief of medicine Donald Seldin M.D., MACE.

In 1952, at the age of 33, was named chief of medicine at Southwestern Medical School. He came to Dallas from Yale as an accomplished nephrologist. Southwestern Medical School’s physical facilities at the time were a group of Quonset huts.

At that time Dr. Seldin was invited to attend a meeting on how to cure arthritis in the indigent community. The committee for the cure of arthritis had already decided on it plan for cure.

The plan was presented by a retired army general. He said the city fathers had to fund twenty fully equipped ambulances at $20,000 each. The ambulances would bring indigent people to Parkland Memorial Hospital for treatment.

As the story goes, Dr. Seldin had one of his now famous outbursts. He told them it was totally illogical and a grand waste of 1952 dollars. He said city fathers should grant Southwestern Medical School $200,000 for him to establish an annuity. With this annuity he would bring one of the most famous arthritis researchers in the country to Dallas to find the cure for arthritis. Somehow he convinced the city fathers of his logic. He had an endowment to bring Dr. Morris Ziff to Dallas to head a new form Department of Rheumatology. In his lifetime Dr. Ziff almost found the cure for rheumatoid arthritis. He trained hundreds of Rheumatologists. They will find the cure.

“Baylor is seeking money for a cancer center to be built near downtown Dallas and a diabetes center in South Dallas. Baylor would not say how much it intends to request.”

President Obama, your stimulus money should be going to finding a cure for the dysfunctional healthcare system, not throwing money at an old system.

“A request for stimulus money could raise eyebrows because Baylor has said it has enough money for the projects. The stimulus money, if granted, would be used to hire more people from within the community, said Kristi Sherrill, Baylor’s vice president of government affairs.”

Isn’t that a sweet answer? The money will be used by Baylor to build a facility. In turn Baylor will charge the government for care of the patients that come to the clinics.

"Any additional funding granted to these two projects, both already under way, would be used to directly help patients fight two of the biggest health issues affecting North Texans," cancer and diabetes, said Sherrill.”

Doesn’t this sound like the rheumatoid arthritis story? It seems like someone in the state of Texas gets it. It is not clear whether Governor Perry gets it.

“Talmadge Heflin, director of the Center for Fiscal Policy at the Texas Public Policy Foundation in Austin, said his organization believes that stimulus money should be used for one-time projects.”

"We believe they should not use the money in a way that would create an ongoing obligation for the state," Heflin said. "And we don’t believe the money should be spent just because you can get it."

Think about it President Obama. You gave the money to the states. The states are going to spend it as they wish. It might not comply with your good intentions to repair the healthcare system or stimulate the economy. Your goals are good. The route you are taking neither repairs the healthcare system nor stimulates the economy.

The most pointed statement was made by a comment at the end of Jason Roberson in the Dallas Morning News article revealing Baylor’s intentions

“Watch all the little piggys run to the big, fat Federal teat.
I got a hog pen that needs finishing. Could I get some stimulus funds for that? It would be the compassionate thing to do.”

Enlightened Rogue

Baylor does not need the money. They have plenty of funding and creditworthiness. Nonprofit hospitals already receives 32 billion dollars in subsidies from the federal government to service the indigent. The nonprofit hospital only spend 5 billion retail dollars in service.

“Regardless of what economic stimulus money it receives, Baylor appears to have the money and creditworthiness to complete its projects.”

President Obama, a request of this sort has plenty of destructive unintended consequences. I suggest you hire people to figure out the cure of the healthcare system and not throw taxpayers money out the window for worthless ambulances that will neither cure the problems nor stimulate the economy.

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

  • emr

    Well something needs to be done and at least Obama is trying to make a difference. Unfortunately the whole healthcare situation is bittersweet because the long term economic effects from profits lost to pharmacuetical companies will be enormous

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Our Sound Bite Society: The Media Is The Message


Stanley Feld M.D.,FACP,MACE


America’s present healthcare crisis is neither a Democratic nor a Republican issue. It is an American issue. It can be solved logically and swiftly using common sense. Let the American consumers control their healthcare dollars. Provide consumers with financial incentives for wise healthcare purchases and education for good health maintenance to prevent the onset of a chronic disease.

President Obama’s healthcare team is setting up a healthcare system where the government will make the healthcare choices for Americans. Ultimately government will ration care.

Daily, Americans are overwhelmed by bad news sound bites. For years we have heard that our healthcare system is broken. It is broken because the government has broken it. Only 20% of the people are sick at any one time. The other 80% do not think there is a problem with the healthcare system. In the last 25 years most Americans have heard of or experience horror stories about the dysfunctional healthcare system. The goal should be to repair the problems and not impose another dysfunctional healthcare system on us.

First, it was HMO’s and the restrictions of access to care. Then, it was Managed Care. Managed Care turned out to be managed costs and restrictions on access to care. Then, it was the ever increasing healthcare insurance premiums. Now, it will be the government‘s experiment with a single party payer system. An experiment that is destined to fail.

The Bush administration did nothing about repairing the healthcare system. Correction. Everything President Bush tried to do the congress rejected. The healthcare insurance industry and its executives made grotesques profits while restricting access to medical care and decreasing physician reimbursement.

Medicare and Medicaid’s costs have continued to rise. The healthcare insurance industry controls Medicare’s dollars. The Bush administration did nothing to stop it. The Bush administration recognized that bureaucratic entitlements would destroy our economy. The administration tried to get rid of the Medicare entitlement by providing a bonus to the healthcare insurance industry for the takeover of Medicare with Medicare Advantage and Medicare Part D. The cost to seniors and the profit to the healthcare insurance industry has been huge.

Neither Republicans nor Democrats in congress have done anything logical to fix the healthcare system. The executive and legislative branches have only generated greater mistrust among all the stakeholders in the healthcare system.

Congress knows the increasing Medicare costs are unsustainable. The Congressional Budget Office predicts a 100 TRILLION dollars per year deficit for Medicare alone in 50 years.

Why would a responsible member of congress or the executive branch want to increase an entitlement that does not work to included the entire population?

Today’s sound bites have frightened most of the population. Americans are anxious to be rescued by anything that sounds good. All that is needed is a well crafted public relations campaign of sound bites promising salvation.

Liberal Democrats have put together such a public relations campaign. President Obama has captured the lead to be society’s savior. It does not matter whether his proposals are logical or if they will work. It sounds good. America is ready to go for it.

Republicans are feeling overwhelmed. They intuitively understand that a government controlled single party payer system will not work. Massive government programs have not worked effectively in the past. Why should they work now? Consumers should be empowered to make their own decisions. Government should not make decisions for them.

An organization call the “Leadership Conference for Guaranteed Healthcare , the national single pay alliance” has crafted such a public relationship program. They have cobbled together a group of social networks to express the anger and fears felt by the American public. Their sound bites are compelling.

President Obama will play off these social networks to force his change in the name of goodness and justice for all. It is Tom Daschle’s doctrine. Most of the proposals will fail. They will fail not because they are unjust. They will fail because the route to achieve them is wrong. The costs will be unmanageable as we have seen in the Massachusetts experiment..

The sound bites are indeed compelling:

  1. Everybody In, Nobody Out. Universal means access to health care for everyone, period.
  2. Portability. If you are unemployed, or lose or change jobs, your health coverage stays with you.
  3. Uniform Benefits. No Cadillac plans for the wealthy and Pinto plans for everyone else, with high deductibles, limited services, caps on payments for care, and no protection in the event of a catastrophe. One level of comprehensive care for everyone, regardless of the size of your wallet.
  4. Prevention. By removing financial roadblocks, a universal health system encourages preventive care that lowers an individual’s ultimate cost and pain and suffering when problems are neglected and societal cost in the over-utilization of emergency rooms or the spread of communicable diseases.
  5. Choice. Most private insurance restricts your choice of providers and hospitals. Under the U.S. National Health Insurance Act, patients have a choice, and the provider is assured a fair payment.
  6. No Interference with Care. Caregivers and patients regain their autonomy to decide what’s best for a patient’s health, not what’s dictated by the billing department. No denial of coverage for pre-existing conditions or cancellation of policies for "unreported" minor health problems.
  7. Reducing Waste. One third of every private health insurance dollar goes for paperwork and profits, compared to about 3% under Medicare, the federal government’s universal system for senior citizen healthcare.
  8. Cost Savings. A guaranteed health care system can produce the cost savings needed to cover everyone, largely by using existing resources without the waste. Taiwan, shifting from a U.S. private health care model, adopted a similar system in 1995, boosting health coverage from 57% to 97% with little increase in overall health care spending.
  9. Common Sense Budgeting. The public system sets fair reimbursements applied equally to all providers, private and public, while assuring that appropriate health care is delivered, and uses its
    clout to negotiate volume discounts for prescription drugs and medical
  10. Public Oversight. The public sets the policies and administers the system, not high priced CEOs meeting in private and making decisions based on their company’s stock performance needs.

Who can argue with any of these points? The major question is can a government bureaucracy administer this system effectively without impinging on citizens’ choices, rights and freedoms.

Is this the solution to the high incidence of chronic disease and the dysfunctional healthcare system?

My answer is no. Americans are being duped once more by cool sound bites.

The Alliance has put together interesting groups. They have used the internet to leverage the Alliance. They have used the same technique that President Obama used to become President. They have formed giant social networks and put them together. President Obama can easily play off this coalition as evidence for the need by the public for a single party payer system.

The social networks and President Obama have outflanked common sense. They have created a false hope and it will fail to repair the healthcare system. .

Leadership is needed to formulate a common sense strategy to solve the healthcare system’s dysfunction for all American at every socioeconomic level. Neither the Democrats or the Republicans have such a plan.

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

  • Stanley Feld M.D.

    Everyone should have healthcare. It is the route the government is taking that will restrict access to care. Look at the ideal medical savings account. It gets the vested interest of the healthcare insurance industry and the hospital out of the system. It gives patients incentives to save money and shop wisely. The government needs to subsidize the people whole cannot afford it. It is a sliding scale subsidy. The premiums will be less, patients will be motivated, and the physicians billing overhead would vanish.

  • nurse triage

    This is a very interesting article on the new stimulus package including healthcare. I was actually very happy to hear about it and also believe in the innovations and upsides as well. But as I was blindsided and I think Obama was as well, the immediate reaction from this was the healthcare stocks dropped dramatically. It is kind of like a downward spiral for our economy. I truly hope that everything pulls together as we all are equal and we should all have decent healthcare as well.
    We should all be able ask a nurse
    a question from personal health questions to disease management and be able to get a straight answer without getting charged a million dollars

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Another Complicated Mistake: New Jersey’s Proposed Health Plan to Cover All

Stanley Feld M.D.,FACP,MACE

It is refreshing to know that state politicians are becoming aware of the need to do something to help the uninsured. Most states are going about it the wrong way. They are funding a healthcare insurance model that has failed. This healthcare insurance model has caused states, the federal government and businesses to have huge deficits and unaffordable healthcare costs.

The model encourages patients to be passive about their health and dependent on a third party payer for their healthcare. Patients have to have incentives to be proactive and responsible for their health and healthcare. If consumers owned their healthcare dollar they would have an incentive to improve their health and spend their healthcare dollar wisely.

New Jersey is a state attempting to adopt mandatory universal healthcare coverage even though the state is in serious financial difficulty.

A bipartisan group of legislators unveiled a proposal on Monday that would require all residents to have health care coverage within three years. New Jersey is reeling from financial problems. The country appears headed toward a recession. The plan would avoid adding to the budget. It would instead try to redistribute federal and state dollars in a more efficient way.”

It would be a nice trick if they could do it. This is pie in the sky thinking. You will recall Massachusetts healthcare budget experienced an 85% increase in one year from the baseline budget after passage.

“About 1.4 million of New Jersey’s residents — or nearly 1 in 5 (20%) — do not have health insurance. To bridge that gap, State Senator Joseph F. Vitale, a Democrat from Middlesex County who is chairman of the health committee, recommended that the state focus first on enrolling more children in the existing NJ Family Care program for families who earn as much as 350 percent of the federal poverty level, or about $74,200 for a family of four.”

The fact that states are beginning to recognize that hard working people earning over the federally defined poverty level of $20,000 a year can not afford healthcare insurance and are not eligible for federal or state aid is encouraging. Everyone should review Moises’ story and his ineligibility for Medicaid in Texas.

“Then, Mr. Vitale said, the state would focus on cutting costs while establishing a self-financed plan, run by the state, to provide individuals with health insurance at affordable rates on a sliding scale.”

New Jersey’s has a very large budget deficit. The sliding scale concept is important. However the state does not plan to change the healthcare insurance system of outsourcing healthcare insurance to the healthcare insurance industry for administrative services. New Jersey is making the same mistake that Massachusetts made.

“Thrusting New Jersey again into the vanguard of social change, If adopted, New Jersey would become the fourth state to require universal health coverage, following Massachusetts, Maine and Vermont.”

Every state wants to be a vanguard of social change. No one state has had the vision to change the structure of healthcare insurance. New Jersey’s “new” plan is destined to fail.

The need for social change is valid. The method of change does not represent change at all. It represents an increase in an entitlement without a change in patients’ responsibility for their healthcare or healthcare dollar. It also represents an impending increase in the New Jersey budget deficit.

“The insurance would be required, not an option: Residents would need to prove they have health insurance, similar to the way drivers must obtain auto insurance.”

This is a good idea that will be difficult to enforce. Check points in various neighborhoods would have to be constructed and manned to enforce the mandate.

The healthcare insurance program would be financed, Mr. Vitale said, by using small surpluses in NJ Family Care and Medicaid and revamping the costly and much-maligned system of Charity Care, under which the state reimburses hospitals for costs associated with caring for the poor, often in emergency rooms.

The plan looks like President Obama’s 100 billion dollar stimulus package for Medicaid. The stimulus money will be wasted.

Gov. Jon S. Corzine, a Democrat, has said he favors universal health care. Given the state’s fiscal difficulties, he offered a guarded assessment of the legislators’ proposal.

“The public is well aware that there is nothing closer to my own agenda than providing universal health care, I’m a realist, and I understand that the current budget circumstances may inhibit our ability today to reach that common goal.”

David L. Knowlton president of the New Jersey Health Care Quality Institute thinks New Jersey’s plan is better than the faulty Massachusetts plan. In my view it does not matter whether you have one administrative service organization or several.

There will be cost overruns because the administrative services organization’s incentive is to have cost overruns. The state cannot control these overruns because the state does not have control over the healthcare dollars.

“Unlike Massachusetts, New Jersey would use a single plan administered by the state rather than requiring individuals to buy such a plan in the private market, which David L. Knowlton, said drove costs higher.

The New Jersey plan is no different than the Massachusetts plan or President Obama’s plan. The cost will be driven up not down. The end result will be the government will say it has no choice but to nationalize the healthcare system.

We only have to look at Medicare to see all the problems and cost overruns that have occurred to know we need a different healthcare system. We need a healthcare system in which the consumers are in charge of their health and healthcare dollar. We need a healthcare system in which consumers are effectively taught to be the” professor of their chronic disease” so they can avoid the complications of chronic disease. Only then will we solve our healthcare systems escalating costs.

“New Jersey’s plan would be similar in that the responsibility for obtaining the insurance would rest with residents and would expand existing state and federal health insurance programs. “

States are all jumping on a bandwagon guaranteed to fail because it has been proven to fail. California is next. Some one has to wake up in America.

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

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