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The Government’s Role In A Free Society

Stanley Feld M.D.,FACP,MACE

U.S. Congressman Paul Ryan gave a speech in January 2010 at Hillsdale College's Allan P. Kirby, Jr. Center for Constitutional Studies and Citizenship defining the role of government in a free society with particular reference to healthcare.

Paul Ryan understands the constitution and uses a lot of common sense.

Mr. Ryan traces the history of the progressive movement of the Democratic Party in America.

“The social and political programs of the Democratic Party’s progressive movement came in on two great waves: the New Deal of the 1930s and the Great Society of the 1960s”.

“Today, President Obama often invokes progressivism and hopes to generate its third great wave of public policy.”

 This desire by President Obama leads him to believe he will be judged as one of the greatest Presidents in American history.

President Obama believes his ideology will save the healthcare system, the financial system, and the country.

There is no question the healthcare system needs to be reformed. It has become unaffordable and inaccessible to people who need healthcare insurance coverage.

The need for reform leads Dr. Don Berwick former Director of CMS to conclude that by definition effective healthcare system means the redistribution of wealth.

The debate in healthcare is not whether we need healthcare reform but what form that reform should take.

“Under the terms of our Constitution, every individual has a right to care for their health, just as they have a right to eat.”

“These rights are integral to our natural right to life. It is the government's chief purpose to secure our natural rights.”

 But the right to care for one's health does not imply that government must provide health care, any more than our right to eat, in order to live, requires government to own the farms and raise the crops.

The government's chief purpose is to secure our natural rights. It is a critical sentence defining the role of government by our constitution.

It is not the role of government to provide healthcare any more than it is our right that the government feed us. It is the individual’s responsibility to do both. 

It is the government’s obligation to protect our rights. The government’s obligation is to establish free market conditions so providers and vendors cannot take advantage of us and abuse our rights. We should not be entitled to food or healthcare.

Paul Ryan goes on to say,

“ With good reason, the Constitution left the administration of public health—like that of most public goods—decentralized.

 If there is any doubt that control of health care services should not have been placed in the federal government, we need only look at the history of Medicare and Medicaid—a history in which fraud has proliferated despite all efforts to stop it and failure to control costs has become a national nightmare.”

All the stakeholders are experiencing this nightmare after 47 years of the government making adjustments to the Medicare and Medicare rules.

No one predicted the adjustments made by both the government and the stakeholders would result in unsustainable costs for the government, private sectors and the people.    

This national nightmare is going to expand with the passage of Obamacare, the funding of the multiple agencies formed and the proposed 32 million more uninsured people to be added to Medicaid along with the increasing number of baby boomer going on Medicare.

Democrats, Republicans and Independents believe in fairness to all. Americans are very charitable people and are frequently mobilized to help the needy.

However, President Obama has tried to appeal to our sympathy for him by painting a contrast between himself and his opponents.  He is trying to persuade us that he is the good guy and the rest are bad guys.

“If you believe this economy grows best when everybody gets a fair shot and everybody does their fair share and everybody plays by the same set of rules, then I ask you to stand with me for a second term as president.” 

On closer examination his actions have gotten us deeper into our fiscal dilemma. He has not leveled the playing field; he has wasted money and increased our deficit.  The U.S. is at the point where it cannot borrow itself out of its jam.

If the U.S. continues to try to print (money) itself out of the jam the economy will implode.

President Obama’s ideology has created uncertainty and decreased the private sector willingness to create jobs and stimulate the economy. He has not created enough jobs with his massive stimulus packages.

A reader wrote,

We ran out of money a long time ago.  Every dollar we spend is 40% borrowed money and healthcare in our country is comprised of 50% taxpayer money.  What else do we need to see in terms of the math to believe we are on an unsustainable path?

Paul Ryan argues,

“President Obama urges us today—out of compassion—to support the progressive model; but placing control of health care in the hands of government bureaucrats is not compassionate."

Bureaucrats don't make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus.

 Dr. Ezekiel Emanuel, one of the administration's point people on health care, advocates what he calls a “whole life system”—a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.”

“ In keeping with this, the plans that recently emerged from Congress have a Medicare board of unelected specialists whose job it would be to determine the program's treatment protocols as a method of limiting costs.”  (USPTF and IPAB)

I believe there are very few Americans who would be satisfied with this kind of halthcare system once they understand what is happening.  

Ryan goes on to say:

"The good news is that we have a choice.

 There are three basic models for health care delivery that are available to us:

 (1) Today's business-government partnership or “crony capitalism” model, in which bureaucratized insurance companies monopolize the field in most states."

Medicare and Medicaid’s administrative services are outsourced to the healthcare insurance industry by the government. The healthcare insurance companies charge the government 40% of the Medicare and Medicaid healthcare dollars for overhead.

President Obama claims that the medical loss ratio will limit the overhead to 20% and 80% will go to direct medical care. Wrong!

 The overhead is disguised in direct medical care costs.

How do you think top healthcare insurance executives can receive many millions of dollars in compensation each year?

 "(2) The progressive model promoted by the Obama administration and congressional leaders, in which federal bureaucrats tell us which services they will allow."

We have seen over and over again unintended consequences, excessive waste created by cumbersome rules and regulations, and stakeholders adjustment to take advantage of the rules and regulations, all of which lead to intolerable costs, taxes and the erosion of the value of the dollar. Obamacare is going to result in greater administrative waste plus rationing of care.   

" (3) The model consistent with our Constitution, in which health care providers compete in a free and transparent market, and in which individual consumers are in control."

 The government's chief purpose is to secure our natural rights by leveling the playing field for all the stakeholders and enforcing the rules. It is essential that the rules are transparent and simple.

The patients must be empowered to be responsible for their healthcare dollars and their health. Entitlements do not promote personal responsibility

One of Paul Ryan’s concluding points is,

“The answer is that the current health care debate is not really about how we can most effectively bring down costs.”

 It is a debate less about policy than about ideology. It is a debate over whether we should reform health care in a way compatible with our Constitution and our free society, or whether we should abandon our free market economic model for a full-fledged European-style social welfare state.

 This, I believe, is the true goal of those promoting government-run health care."

My Ideal Medical Saving Account can be an extremely democratic and fair model. By changing a couple of existing healthcare insurance rules the administration would create a truly free competitive free market for healthcare consumption.

The government should also educate patients to assess the value of the medical care they freely choose. It should be the consumer’s decision, not the government’s decision.

These actions would reduce the cost of healthcare and create a sustainable healthcare system.

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

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Supreme Court and Healthcare

Stanley Feld M.D.,FACP,MACE

This week the Supreme Court is going to rule on whether President Obama’s Healthcare Reform Act is constitutional or not.

The traditional media and blogosphere has spent many hours speculating on the Supreme Court’s decision.

The Supreme Court probably recognizes the many strange issues involved in the passage of Obamacare and the many tricks President Obama played in its passage. It also recognizes than only 32% of the population approves of the plan.

The Supreme Court has cleverly picked the two most important issues dealing with the constitutionality of President Obama’s Healthcare Reform Act. These two issues are intermingled with the multitude of issues that are wrong with the law.

There are two key issues.

One key issue is whether it is constitutional for the central government to mandate that Americans and American companies must purchase healthcare insurance from a private healthcare insurance company. If Americans do not purchase the healthcare insurance, can the federal government fine them?

The second key issue is whether it is constitutional for the federal government to force states to increase the number of people eligible for Medicaid or do the states have the right to determine who they can and should cover at their expense.

 The two core issues are freedom of individual choice and central government control over states rights. Does the federal government have the power under the constitution to limit these constitutional rights?

Once the constitutionality of these two issues are decided by the Supreme Court, Obamacare still has the healthcare system’s original dysfunctional problems.

Obamacare institutes none of the necessary rules or regulations to repair the healthcare system. It adds a patch onto a dysfunction healthcare system.

Effective repair of the healthcare system must be incentive driven with alignment of all of the stakeholders. The primary stakeholders are the patients and physicians.  It must not be a system that is punitive to stakeholders.

The healthcare system must not be an entitlement program. It can be a subsidized program that is consumer owned and driven. Consumers must have financial incentive to be responsible for their health and healthcare dollars.

Any system that promotes government dependency will fail.

The list of initiatives that could repair the healthcare system is large. Obamacare does not include any of them.  

Obamacare omits the need for patients’ responsibility, expands entitlements and promotes government dependency.

These are the initiatives that must be included in a healthcare system that will work:

  1. Eliminate defensive medicine by effective Tort Reform.
  2. Individual patients’ responsibility for their healthcare dollars using the Medical Saving Accounts.
  3. Individual patients must become responsible for their health.  Obesity and the avoidance and control of chronic diseases and complications are in large measure the patient’s responsibility. Financial incentives for effective health along with educational programs to avoid chronic diseases and the complications of chronic diseases should be available.
  4. Dis-intermediate the healthcare insurance industry’s ability to extract 40% of every healthcare dollar for both public and private healthcare insurance sectors: Medical Savings Accounts.
  5. Eliminate the vague regulations and confusing regulations restricting innovative direct medical care programs.
  6. Make all healthcare insurance programs, corporate, small business and individual programs, tax deductible. 
  7. Administrative waste is expanded in Obamacare. Over 250 new agencies have been created already.  
  8. Effective system to implement Electronic Medical Records. The present stimulus is inadequate and will not achieve its goal. It can be done much less expensively.
  9. The hospital reimbursement system must be revised.  The government should institute regulations that monitor transparent real costs of a service and transparent negotiated charges. This should be available to patients and physicians in order to make educated choices.
  10. The government should provide on-line information to patients and physicians about reimbursement for services and need for services based on evidence based medicine recommendations.
  11. The government should help patients save their own money by helping patients decide what are necessary diagnostic tests and treatment.
  12. It should be the patient’s decision and not the government’s decision on necessary treatment.  
  13. Patient should be a Pro-sumer ( Productive Consumer). Patients must learn to be responsible for their care and healthcare decisions.
  14. The central government should stop trying to control the healthcare system and forcing consumers to be dependent on government. This is the Road To Serfdom.  
  15. The government should streamline regulations, eliminate paperwork, and make the healthcare system interaction a pleasant one.
  16. The government should eliminate bureaucracy. The government must approach healthcare reform from the patients’ and physicians’ point of view.


 There are many more initiatives I could list that are needed to the repair of the healthcare system. All the initiatives are based on maintaining individual freedoms and promoting individual responsibilities. The initiatives are not based on forcing everyone to be dependent on government.

These are exactly the problems the Supreme Court is considering.

As a society we have been acculturated to accept an entitlement society and central government dependency.

We are also noticing that entitlement societies do not work as witnessed by European socialism.  

America is in a Catch 22 situation. If you want to be fiscally responsible you cannot live beyond your means. America cannot maintain the entitlements any longer because the central government cannot afford them.  

After a finite time a nation runs out of other peoples’ money.


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

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The PSA Fiasco

Stanley Feld MD.FACP,MACE

It is common knowledge that prostate cancer is a slow growing cancer. It is also believed that something happens and suddenly this slow growing cancer becomes aggressive and then metastatic.  

As the cancer increases in size, the Prostatic Specific Antigen (PSA) value increases. It is obvious that a baseline PSA should be obtained. The PSA’s value should be followed yearly to see if it is increases over time. 

The United State Preventative Task Force’s (USPTF’s) conclusions are incorrect. There are problems with the studies reviewed leading to its conclusions.

The media sensationalism of the USPTF’s conclusions was an indictment of PSA testing and urologists’ judgment.

"The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harm," the report stated.

“The U.S. Preventive Services Task Force said in a report that the PSA test is too inaccurate, creates needless anxiety for patients, and can lead to costly and potentially harmful follow-up procedures”.

Clinical judgment by physicians is ignored by the USPTF. The PSA increases as prostate cancer progresses. How are you going to know if the PSA is increasing, if you do not have a baseline PSA?

The nation's leading urology associations are fuming over a USPTF report  that discredits the widely used prostate-specific antigen-screening test for prostate cancer.

 "It's an absurd recommendation. It is ill-researched and ill-conceived," Sanford J. Siegel, MD, a board member with the Large Urology Group Practice Association, told HealthLeaders Media. "This will only do damage to all the great work that has been done for prostate cancer awareness and to control the deaths from prostate cancer."

The USPTF should have at least had an urologist on its task force to evaluate the literature of PSA testing.

The USPTF is a “non-government agency” that will be used by the administration to ration medical care.

How can the government say it advocates preventing cancer when it’s setting us up to restrict access to care (prevention)?

American Urological Association President Sushil S. Lacy, MD, said in prepared remarks that he was "outraged" by the report. "It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations such as African-American men," Lacy said. "Men who are in good health and have more than 10-15 years life expectancy should have the choice to be tested and not discouraged from doing so."

 The American Association of Clinical Urologists issued a similar statement  week,

The AACU called the USPSTF recommendations "misleading and harmful."

The major urological associations say the USPSTF ignored new studies supporting the value of PSA tests, and that the panel refused to address concerns they raised about the conclusions during the comment period. In addition, the urologists complain that there were no urologists or oncologists on the panel.  

The major urological groups said,

 "It is just a screening test, one of several things we look at when we decide whether a man needs a biopsy or not," he says.

"Yes, it is true that many men can live with this disease their whole life. That is why active surveillance has become a treatment option," he says. "If we knew in advance who would and who wouldn't advance in the cancer, that'd be great!"

"There is no question that men get prostate biopsies that obviously in hindsight shouldn't happen.  But we are looking at improving PSA testing and other testing to help us find out which men will progress with more advanced prostate cancer."

The problem is that no one has yet come up with an alternative to determine which patients will develop advanced prostate cancer

There is case of a famous Texan who yearly had normal PSAs. His physicians told him it was not necessary to get further PSA test since he had been normal all these years. He was now past 80.   

At 86 he presented with severe bone pain.  Laboratory studies and a bone scans revealed a sky-high PSA (over 100) and widely metastatic prostate cancer.

If his PSAs were monitored the rising PSA would have been detected perhaps early enough to cure him. Prior to the bone pain this man felt perfectly well.

Urologists have many of these same stories.

The USPTF conclusion might aid clinical judgment. However, it should not trump clinical judgment.

Obamacare is getting set to make committee judgments about healthcare policy and clinical care while ignoring physicians’ clinical judgment.

 About 250,000 men are diagnosed with prostate cancer each year. The diagnosis is made by physical examination and PSA measurement. The final diagnosis and decision for surgery or radiation is made after a fine needle biopsy of the lesion.

A prospective double blind study does not exist to predict the grade of cancer that will be cured by surgery, radiation or no treatment.

Nor is there a study for the USPTF to grade about quality of life post op compared to the quality of life during progression of disease. Until then the USPTF conclusions on the basis of the studies they did review are relatively meaningless.

The incidence of 250,000 new cases of prostate cancer a year has been stabile over the last 30 years. 

With early detection the number of males dying per year from metastatic prostate cancer has dramatically fallen from 48,000 per year to 28,000.

 The USPTF statement does not seem correct,

“It could find no evidence to support claims that PSA tests are responsible for "reduction in all-cause mortality."

"Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit."

The USPTF report ignores the dramatic decrease in deaths from prostate cancer over the last several decades.

Dr. Marc Siegel, a practicing urologist for 30 years, said,

 When I started training, 40% of African-American men at that time presented with metastatic disease. Now that number is miniscule," Siegel says. "Tell me how that happens without early screening? How do death rates go down from 48,000 when I trained to 28,000 now? How do you explain that without screening? You can't! It's impossible!"

I believe the defect in the USPTF conclusions have to do with the specificity of the PSA and not its clinical value. A more accurate PSA test needs to be developed.

The USPTF’s conclusions will save President Obama a little money in the short run.

However, the cost of care for prostate cancer along with the morbidity and mortality will cost Americans greatly in the long term. 

 The USPTF has to re-examine its premises and methodology.


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

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A Genius Wrote

Stanley Feld M.D.,FACP,MACE

Todd Siler is a famous artist and scientist. He is much more that. He is a genius. He has written many books about visualizing and solving problems. The most famous is “Thinks Like A Genius”.

For many years he created “Truizms” for the Rocky Mountain News. These Truizms deserve a publication of their own. His Truizms’ are insightful and inspiring. Todd sent me some Truizms to help me illustrate the points I am trying to make.

It is an honor to have Todd become a great friend. He is extremely perceptive and a phenomenal teacher, in addition to being a wonderful human being.

Todd wrote a great response to my last blog “Lets (Not) Do Physicals.”    

Stanley, the frustrating situation you've accurately described here invokes Joseph Heller's classic novel Catch-22:

"There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he were sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle. (p. 56, ch. 5)…."Catch-22 says they have a right to do anything we can't stop them from doing." 

Quoting my blog , Todd wrote,

“It is not enough for the Obama administration to say it is interested in prevention of disease when it restricts access to prevention measures.

It is not right to restrict access to steps needed to prevent the debilitating or deadly complications of hip fracture.   

“The USPSTF concludes that, for men, evidence of the benefits of screening for osteoporosis is lacking and the balance of benefits and harms cannot be determined.” 

To me the trend to reduce physical examinations and lab screening is a ridiculous trend. The present spending on physicals probably should be modified some but not discontinued.” 

I agree!


One of Todd’s insightful Truisms’’ follws

Finger pointing

Our bureaucratic society with its multiple and conflicting rules does not permit us to honestly do the right thing for Americans, especially when money is involved.

President Obama says the right things, but he does not do the right things.

The Healthcare System’s policies should let consumers decide on what is logical for them after listening to the advice of their physicians.

Consumers should control their healthcare dollars with financial incentives  provided for them to stay healthy, become educated about their diseases,  and control their chronic diseases.  

The evidence medicine debate should be between the medical community and the USPTF without creating a media circus.

Healthcare insurance should be a high deductible first dollar coverage plan that would cover everyone.

I covered how this would work in my blog “The Ideal Medical Saving Account is Democratic.

America’s healthcare system is at the home in a “Catch 22”.

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

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Let’s (Not) Get Physicals

Stanley Feld M.D.,FACP, MACE

When  ELISABETH ROSENTHAL’s article was published in the New York Times on June 3,2011, I bristled.

This article could be President Obama’s way of using the traditional media to set us up for restricting access to care as the government is moving toward complete control of medical care.

In my opinion this New York Times healthcare article does not inform consumers.  The article Let’s (Not) Get Physicals confuse consumers.  

The article implies the US Preventive Task Force (USPTF) has advocated no more physicals and no more standard lab screenings.

“The last few years have produced a steady stream of new evidence against the utility of popular tests:

“Prostate specific antigen blood tests to detect prostate cancer? No longer recommended by the United States Preventive Services Task Force.

Routine EKGs? No use.

Yearly Pap smears? Nope. (Every three years.) 

The only routine blood test currently recommended by the United States Preventive Services Task Force is a cholesterol check every five years.”

The U.S. Preventative Services Task Force is a precursor to President Obama’s Independent Payment Advisory Board (IPAB). Many physicians object to a non-specialty board of physicians deciding unilaterally on best practices in specialties they do not represent.

One of my chief objections to the USPTF is its method of evaluating clinical research.

President Obama’s Independent Payment Advisory Board (IPAB) is going to reimburse physicians on the recommendation made by the USPTF without consulting subspecialty experts and dismissing clinical experience or judgment.

The USPTF should present its finding to the clinical specialists’ organizations in open forum for debate. There is plenty wrong with many of evidence based medicines’ conclusions.

Otherwise, the USPTF’s conclusions will simply undermine the patient physician relationship.

I believe I am qualified to critique the USPTF’s conclusions about osteoporosis in males.

The USPFT conclusions are dead wrong about evaluating and treating 70 year old men who might have osteoporosis. It is true that there are no large, long term, clinical studies evaluating the value of Bone Mineral Density studies and treatment of males over 70 years old for osteoporosis.

The USPTF concluded there is no clinical evidence to prove that osteoporosis evaluating and treatment in men is necessary. True, but it does not follow that if bone density studies are done and treatment started the treatment would not reduce the incidence of hip fracture by 50% as it does in women.

The incidence of osteoporosis in 70 year old men is high. All anyone has to do is go to a Wal-Mart anywhere in the nation on a Monday morning and stand at the front door. Clinical observation of retired 70 year old men will provide evidence for osteoporosis’ prevalence.

These men should be evaluated by bone density and then treated to prevent further fractures.

It would be cheaper for Obamacare to do this evaluation than restrict evaluation because of the lack of large studies to evaluate and treat.

The subsequent hip fractures will cost more in terms of morbidity, mortality and dollars than restricting access to early evaluation and treatment.

The government should collect the data to see how many men over 70 years old develop hip fractures. Then, calculate the cost of those hip fractures to Medicare against the cost of evaluation and potential treatment.

Males with osteoporosis do not present with back pain at the onset of a vertebral compression fracture. These fractures are mostly silent compared to women’s vertebral fractures. They will have a decrease in height and a low bone density.  

It is not enough for the Obama administration to say it is interested in prevention of disease when it restricts access to prevention measures.

It is not right to restrict access to steps needed to prevent the debilitating or deadly complications of hip fracture.   

“The USPSTF concludes that, for men, evidence of the benefits of screening for osteoporosis is lacking and the balance of benefits and harms cannot be determined.”

 †For a list of current Task Force members, go to

I do not see one osteoporosis specialist in the entire task force group.

 The USPTF recommendation is in the vested interest of the government and the healthcare insurance. 

" Dr. Mehrotra, an assistant professor at the University of Pittsburgh School of Medicine, has estimated that unneeded blood tests during physical exams alone cost $325 million annually.

The healthcare insurance industry and the government take 40% off the top of every healthcare dollar spent.

What percentage of the $2.5 trillion dollar healthcare bill is spent on the complications of chronic disease such as osteoporosis and other chronic diseases. The answer is 80% of the direct patient care dollars spent. The direct care dollars are $1.5 trillion dollars (150,000,000 million dollars) makes $325 million dollars a trivial amount at 2.16%. of the total spent on healthcare.

If Dr. Mehrotra was misquoted and the number is $325 billion dollars then the total spent on direct care for physicals and lab testing is 21.6%. or 11% of the total $2.5 trillion of healthcare dollars spent.  

To me the trend to reduce physical examinations and lab screening is a ridiculous trend. The present spending probably should be modified some but not discontinued.

It has been shown it takes 8 years from the onset of asymptomatic Type 2 Diabetes Mellitus for a complication, myocardial infarction to occur. Diabetes Mellitus is first discovered in the cardiac ICU 8 years after the onset of Diabetes.

It has also been shown that males avoid going to physicians unless they are sick.

If Diabetes Mellitus was discovered early and treated effectively, there is a 50% chance the myocardial infarction could have been avoided.

Many diseases  can be discovered on physical examination and routine lab testing. I takes time in the course of the natural history of a disease for the disease to become symptomatic or develop complications.

If discovered early and treated the complications of that disease can be avoided.  Many patients’ lives can be saved with proper treatment.

USPTF drawing conclusions without input from specialists is dangerous and irresponsible.

Ignoring the diagnosis can be more costly in the long run for the government than avoiding testing for the diagnosis.

I have pointed out previously the poor quality of some clinical studies.

The USPSTF by drawing conclusions on the basis of insufficient evidence and potentially defective clinical studies without consultation with the proper specialists must be avoided.

Unfortunately, it is going to get worse because there are no checks and balances in the Obamacare bureaucracy.

 Next I will discuss the PSA fiasco.


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

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Why Aren’t Physicians Upset About Obamacare?


Stanley Feld M.D.,FACP,MACE

Physicians are upset. They have been marginalized during the entire healthcare reform debate.

Patients are upset about Obamacare. Many states are upset about Obamacare. These states are suing President Obama and his administration for impinging on states rights.

Recent approval /disapproval polls on average showed that patients disapprove of Obamacare by a 43.1%/52.2% average..


Do you approve/disapprove of Obama's handling of health care?

Some of the polls included in the average may be outdated since the latest poll for each of the pollsters are averaged in. “













ABC Washington Post
























USA Today Gallup












A critical question in all of this is, “ Why are we not hearing from physicians?”

There are several reasons for the public not hearing from physicians.

First, the is practicing physicians’ input has been muted or ignored by President Obama, his administration and the traditional media.

The members of the Association of American Physicians and Surgeons are on the front lines of caring for patients and would like to discuss the bill's effect on the patient-doctor relationship. Media coverage has been poor or non existant.

This You Tube expresses the AAPS view of Obamacare’s effect on the patient-physician relationship. It features Congressman Michael C Burgess, MD, Jane Orient, MD, & Richard Amerling, MD.. This briefing was held in the Canon House office Building in Washington DC on May 26, 2011.

For many years physicians relied on the AMA for leadership. There is no leadership from the AMA at this time.

Second, the majority of physicians don’t see eye to eye with the AMA on Obamacare. There have been many reports of physicians fleeing the AMA because of a lack of leadership and advocacy for practicing physicians’ views. The AMA has not represent physicians and their patients’ interests.

“Obamacare changes the health care system in several ways that harm physicians. It also fails to address the pivotal issues facing physicians today—for example, low government reimbursement rates that fail to cover the cost of care, or the need for state-by-state medical malpractice reform.”

The AMA is out of touch with practicing physicians’ views.  

During the health care reform debate, the American Medical Association (AMA) emerged as one of the new law’s supporters. But rather than symbolizing physicians’ support for the left’s health care overhaul, the AMA’s stance on Obamacare just proves how detached the organization has become from physicians’ best interests. 

A physician survey by Jackson and Coker affirms this growing gap between the AMA and physicians the AMA should represent. The survey showed:

  1. Only 11 percent of the physicians surveyed agreed that “the AMA’s stance and actions represent my views.” Of those who are members of the AMA, only 40 percent agreed.
  2. 13 percent of all physicians, and just 35 percent of AMA members, agreed with the AMA’s position on health reform; 70 percent disagreed.
  3. Of those who had dropped their AMA membership, 47 percent said it was because of the AMA’s support for Obamacare, and 43 percent who said AMA’s ideology was too far to the left.
  4. Only 15 percent of physicians considered the AMA a successful advocate of physicians’ issues. 75 percent of physicians surveyed said that “the AMA no long represents physicians.

Physicians need a more representative voice. Sermo has been moderately successful but has not been permitted to have an appropriate hearing in the traditional media.

 A recent polling underscores deep physicians' discontent.

Athena Health and Sermo did a recent survey of physicians

    1.     79 percent of physicians are less optimistic about the future of medicine.

    2.      66 percent indicated that they would consider dropping out of government health programs.

    3.      53 percent would consider opting out of insurance altogether.

Third-party payment arrangements have compromised the independence and integrity of the medical profession.

Obamacare will reinforce the worst of these features in the present healthcare system. Physicians will be subject to more government regulation and oversight and more bureaucratic direction.

At the same time, Obamacare is ignoring the most important issues facing physicians such as Tort Reform, third party payment reform and increasing government red tape.

Physicians will be more dependent on unreliable government reimbursement for medical services. Physicians are presently under tremendous pressure. It will only become worse under Obamacare.

Dr. Martha Boone is an Atlanta urologist. She explains the consequences of the Obamacare. She explains her fears about Obamacare.

Dr. Boone has moved to a less-expensive office to avoid dropping Medicare patients or laying off an employee.

The is a wonderful You Tube.

Medicare and Medicaid reimbursement, are already well below the prevailing rates in the private sector.

Medicare pays physicians 50-80 percent of the negotiated private sector fee.

The negotiated private fees are at least 50% less than the customary fees.

Medicaid pays 15-30% of the already reduced private sector fees. Medicare payment has resulted in sporadic access problems for Medicare patients,

Obamacare is going to lower these fees. We are already seeing serious problems with access to care for Medicaid patients. The result is an increase in  hospital emergency room use. This increases the emergency room prices for the private sector as it decreases private sector ER capacity. It also increase healthcare insurance premiums.

Sixty seven (67) percent of primary care physicians said that under current conditions new Medicaid enrollees would not be able to find a “suitable primary care physician” in their area.

“Like most seniors, Ann Lorenz relies on Medicare as she copes with serious health care challenges, including Parkinson's Disease. Ann sees a number of doctors and depends on a variety of prescription drugs and therapies to stay independent.

She worries that Obamacare threatens her access to doctors, treatment options and insurance plans and her neurologist shares her concerns."

“Obamacare does not address physicians’ most pressing concerns, such as tort reform, and it worsens the already painful problems with third-party payment and government red tape.”

President Obama has also ignored the states’ pleas.

Governor Mitch Daniels of Indiana has been a leader in health care reform. He has made a lot of progress in reforming healthcare in Indiana. Obamacare is going to destroy his progress in healthcare reform.

Governor Daniels is speaking out and urging his fellow governors to take a serious look at the threat posed by Obamacare.

Individual practicing physicians are trying to stimulate public uprising through the media with minimal success.

Dr. Marc Seigel reported that 74% of doctors will retire, work part-time or quit if Obamacare takes effect.

This is not what Pelosi and Obama promised.

Politicians do not ask physicians and physicians do not have a powerful representative. Physicians are never included in the healthcare policy discussions.

Physicians are going to have to figure out a way to get their patients to get President Obama’s attention.

Here is one idea: Physicians could give their patients a list of talking points that patients could broadcast to their email and Facebook friends.

All of these patients and their friends could be instructed to send these talking points to their local newspapers, their congressmen and President Obama.It would make everyone aware of how physicians feel about Obamacare.

You can help your physician be heard!

Heightening public awareness usually gets politicians to rethink their destructive policies. Obamacare is one such a destructive policy.

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

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President Obama’s False Promises And Trick Plays.

Stanley Feld M.D.,FACP,MACE


The You Tubes are usually at the bottom of the email feed.


I believed President Obama when he made his many refreshing and seductive promises of hope before the 2008 election. I did vote for President Obama. I have regretted it ever since.

All President Obama’s promises of transparent government, working for the people, and fixing healthcare have turned out to be false hope.

President Obama has not listened to the wishes of the people. He is issuing executive orders as he tells the nation what they want to hear.

Barack Obama faked all of us out in 2008 with his promises.

He is doing the same thing during this campaign season for his re-election. He is saying he has not had enough time to fulfill his promises. He said he would accomplish his goals in the first year after his election. Some people still believe him even though his actions are making things worse.

President Obama has created a myriad of problems as he has shifted the balance of power from congress to the executive branch of government. The shift is destroying our economy and our healthcare system with rules and regulations that are not practical.

His re-election campaign is trying to distract Americans from the real problems he has created. The key issues facing the nation are the economy, Obamacare, freedom of religion, freedom of choice, class warfare and the distortions of the American constitution’s principles.

President Obama’s personality is intoxicating. He fooled us once. He is betting he can fool us again.

I have tried to look at President Obama’s actions through the eyes of my liberal friends. I cannot see what they see.

President Obama’s latest trick is to disguise pulling the rug out from under the seniors on Medicare until after the presidential election.

Aside from double counting his Medicare reductions which he continues to deny, he is delaying the implementations of his reductions in Medicare benefits until after the election to not anger seniors.

“About half of Obamacare’s costs are to be covered with money taken from an already nearly bankrupt program for seniors.” Medicare

He is continuing to double count, ignoring America’s impending debt crisis.

 “Under the implementation schedule stipulated in Obamacare, many seniors would either lose their plans, or learn that they are going to lose them, before the election that will likely decide Obamacare’s—and Obama’s—fate. “

 President Obama, anticipating a senior revolt if they got wind of the scheduled reductions, launched a public relations campaign to distract seniors. The traditional mainstream media has promoted the distraction.

President Obama launched an $8.35 billion “demonstration project” to postpone the majority of Obamacare’s scheduled Medicare Advantage cuts until after election. Over 30% of seniors are on Medicare Advantage.

His goal was to keep awareness of the effects Obamacare will have on seniors who have Medicare Advantage under their radar until after the seniors vote for him in November. After November seniors will have lost their chance to respond effectively.

President Obama’s own Government Accountability Office (GAO) has said this “demonstration project” is a sham. The GAO has reported that the demonstration project has multiple “design defects”.  The GAO has recommended to Kathleen Sebelius that the demonstration project should be cancelled because it will not demonstrate anything and is a waste of money.

The design does not conform to the principles of “budget neutrality.” This waste of taxpayer money is obvious. President Obama is increasing the national debt by  $8.35 billion in order to increase his reelection chances by obtaining seniors’ votes.

He is also trying to distract seniors from his goals by running taxpayer funded TV ads.

“ President Obama ran millions of dollars’ worth of taxpayer-funded TV ads featuring Andy Griffith saying things like, “That new health care law sure sounds good for all of us on Medicare!” It mailed out full-color, taxpayer-funded propaganda brochures singing the same tune.”

“ It repeatedly claimed (and continues to claim) that money taken out of Medicare to fund Obamacare would—magically—also stay in Medicare and be used to extend its solvency. “

The $8.35 billion dollars of taxpayers money might be illegally being used by President Obama. He is using it to shore up presidential reelection chances without anyone noticing or saying anything in protest.

“In fact, according to the GAO, Obama’s $8.35 billion gambit will cost more than all 85 other Medicare demonstration projects combined.”

The $8.35 billion is taxpayer money. It will increase the budget deficit with no value added except to President Obama’s election potential.

The $8.35 billion dollars is more than the combined annual profits of the nation’s two largest and most profitable health insurance companies..

I hope President Obama cannot pull the wool over seniors and all of our eyes once more with another trick play before the election.

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

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