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The Chautaugua: The Feld Men’s Trip

Feld M.D, FACP,

Two weeks ago
after I wrote “A Tribute To Jack Feld”, I received a bunch of requests to write
about the upcoming Chautaugua we had scheduled at the Aspen Institute for this
year’s Feld Men’s Trip.

The Tribe Aspen Institute 8 2012

Left to Right: Daniel, Stan, Kenny,
Jon, Brad in front and Charlie. There was no room on the rock for Brad so he
was pushed off.

Our private
Chitaugua took place August 23rd-26th. Each of the 6 of us had 2-3
hours to talk about anything we wanted. During that time there would be
discussions and reactions to the ideas each of us presented.

My brother,
Charlie Feld, requested that he go first and that I be the cleanup presenter.

I figured
that was good because I would try to pull everyone’s ideas together.

distributed statistics about the United States for the last 70 years.  There are many categories that can be compared
such as population, the unemployment rate, the national debt and the baseball

The only
thing that remained stable was that on August 23 of each decade the New York
Yankees were in first place in their league or division.

The major
point that was made was there has always been uncertainty and change in the

change has accelerated social, political and economic change.

PC’s are 30
years old. Smart phones are 12 years old. Our son’s kids don’t know what a
typewriter is. Imagine the rate of change in the next ten years.

We did a
lot of imagining.

concluded that change is not random. Technological change has stimulated innovation,
which in turn stimulated more innovation.

evolves, and initiatives are started. The ability to change and progress lies
with Americans’ individual freedom.

The U.S.
constitution gives Americans these freedoms. We must protect these freedoms.

My son,
Brad Feld, was next. Brad is in the midst of creating a “Start Up

He just
finished a book called” Start Up Communities, Building an Entrepreneurial
Ecosystem in Your City.”

Brad spoke
about the value of entrepreneurial ecosystems. He outlined how networking can increase
the efficiency of all organizations.

He stated
that society is in the process of changing from a hierarchical society to a
networked society. Hierarchical society was an invention of the industrial
revolution. The networked society is an outgrowth of the Digital society as we
progress through the  Electronic

He also
spoke about the importance of social networking to communities and the vital
need for mentees to become mentors in their community.

community should become a non-zero sum community to enhance innovation in the
community. Community meet-ups are vital to enhancing entrepreneurial

For more
details, buy his book. I think it is great even if I am his father.

The level
of the discussion of the first two sessions overwhelmed me. In fact the
discussions spilled over well into dinner.

Jon Feld
was up next. Jon talked about the mechanism for being great at something. First
you have to have a passion for the activity. Then it takes 20,000 hours of
intense practice. Sometimes putting in your 20,000 hours does not result in

Jon talking
Daniel Feld
is missing because he is taking the picture. Jon  is speaking and Charlie, Brad, Kenny and Stan  are listening.

He gave us
examples. The discussion then went to kids and their inability to be exposed to
multiple activities because of the intensity of competition.

The lack of
concentration on one activity puts them too far behind children who have perfect
one activity.

examples given were basketball, baseball, piano, orchestra playing, dancing, singing
or acting.

children of today must concentrate on becoming expert in one activity and make
the grade in middle school or high school.

I remember
being perfect in nothing but exposed to everything. I wanted my boys to have
the same exposure. It worked.

In my view
a one- dimensional exposure to activities can be stifling when a child reaches

combination of a one-dimensional child exposed to fierce competitive stress can
burn out a child rapidly. If the parent is living through the child’s success
is can affect the parent/child relationship.

 “Kids are
people too.”

I reminded
the guys that my father said to me “I could do anything I wanted as long as I
became a doctor.”

reminded us all that I said to him, “he could do anything he wanted.”  I ended the sentence there and he appreciated

discussion lasted a long while with lots of great ideas and opinions.

Kenny was
terrific. He analyzed the way he problem solves. He is very perceptive and very
optimistic. We discussed decision making in the context of reality vs. fantasy.

discussion became deeper and deeper as we progressed. This enhanced our bonding
with each other. Jon brought up the concept of the six of us being a tribe and
something special was happening here.

asked us to define the meaning of charitable giving. Of the six of us Brad’s
concepts and methodology wins the prize. He and Amy have done a lot of thinking
about the concept. They have developed a well-designed plan for giving.

There were
many meaningful ideas presented.  We all
agreed that charity was a lousy word. The common denominator should be that
giving be self-satisfying.

I was the
cleanup hitter. I started off by saying a mentor somewhere along the line gave
my brother and me the thirst for lifelong learning. I have learned from this meeting
that we have somehow transmitted this thirst to all four boys.

 I also said
we all have to be involved in our community whether national or local.

statement pressed my Repairing the Healthcare System button. My brother is a
fan of my concept.

 The boys
understand that the healthcare system is self-destructing. There is nothing
anyone can do because of the political irrationality of the day.

My point
was we should never stop trying.

This led to
the last question. Which character did each of us identify most with in “Atlas
and why?

I will leave
the answers for another time.

It was a
fascinating weekend. When I spoke to Cecelia during the weekend all I could say
was it was a phenomenal weekend as I was savoring the concepts discussed.

Wow. Same
time next year.

Charlie and Stan 8 2012 Aspen institute

 My Brother
and I discussing the progress of the Chautaugua at breakfast

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

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    Dad – you did an awesome job of capturing the essence of The Chautauqua. Wow. Chills.

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“Here You Go Again”


Stanley Feld M.D.,FACP,MACE

recent days President Obama and his team have ramped up a coordinated effort to
depict Paul Ryan as a candidate that will destroy Medicare with vouchers. His
team is doing this to scare seniors into voting for President Obama.

Obama has been disingenuous throughout this campaign. He has had little success
in fixing the economy despite his promise to do so.

are less better off in 2012 than they were is 2008. I believe President Obama
has weakened institutions that have strengthened American democracy and the freedoms
its citizens enjoy.

executive orders and the bully pulpit he has weakened the balance of power
between the executive branch, the legislative branch and the judicial branch. He
has ignored many of the principle tenets of the U.S. Constitution.

He has trampled States Rights in favor of his
notion of central government control. In turn, Americans are feeling the freedoms
they have enjoyed are being taken away by central government executive orders.  

Obama does not have a record of achievement to sell to the American people. The
only option he has is to destroy the character and credibility of  his opponents. He character assassination
tactics have been disingenuous and irrelevant.

traditional media have been our surrogates in the past for news and
information. However the traditional media have been biased and have supported
President Obama’s tactics. The traditional media have ignore the real issues of
the day. 

could Governor Romney’s perfect reaction be to President Obama’s now hollow
promises for America’s future?

perfect response could be Governor Reagan’s reaction to President Jimmy Carter
during the 1980 Presidential Debate.

Carter’s unsuccessful policies were not congruent with America’s desires for economic
prosperity and freedom. During the debate Reagan’s response to a Carter
soliloquy on what he wanted to achieve was simple.    

One big issue is the escalating deficit. A
principle cause of the increasing deficits is President Obama’s excessive
spending on failed entitlement programs. Medicare is a failing program.
Obamacare is adding 30 million more people to a failing program and increasing
its complexity. This new entitlement program is increasing the deficits and will
bankrupt the U.S. quicker.

None of the “improvements” have been proven or
shown to be executable. This certainly will lead to increased central
government control of the distribution of medical care.

Former vice
presidential candidate Sen. Joe Lieberman said last year
, "We can't save
Medicare as we know it. We can only save Medicare if we change it."

Obama isn’t taking the deficit crisis seriously. He has caused in excess of 1
trillion dollars in deficits yearly for a total of 4 trillion dollars during he
term as President.

has no regard for fiscal responsibility. He has ignored the recommendations of
his own Bowles Simpson commission on deficit reduction.

Through a disingenuous marketing campaign he ridicules Paul Ryan’s  comprehensive alternative.

Erskine Bowles, President Clinton's former chief of staff
and the co-chairman of the Bowles-Simpson commission, described the Ryan budget
that passed the House in March as "sensible, straightforward, honest,
[and] serious."

About President's Obama's budget, which failed in the
Senate in May by a vote of 97 to zero, Mr. Bowles said, "I don't think
anybody (
President Obama)  took that budget very seriously."

Since President Obama doesn’t take the deficit
crisis seriously, the traditional media has not taken the deficit crisis
seriously. The traditional media are President Obama fans.

How can we expect the public to understand the
seriousness of the deficit crisis?

It is hard to imagine the meaning of a 16
trillion dollar deficit much less the significance of an increase of 1 trillion
dollars a year. It is difficult to understand the deficit reduction compromise
the congress has come to with respect to the deficit as these numbers are
thrown around.

It is difficult to visualize the breadth of the
deficit when speaking in trillions of dollars.

Last week a reader sent me an easy to
understand explanation.  Everyone needs
to understand the scope of the deficit. President Obama should not take us to
be fools. 

It is easy to become agitated by these numbers.

 U.S. 2011 Financial Statement


U.S. Revenue                
$ 2,170,000,000,000   or       
$2.17 trillion dollars


Federal Money Spent     $
3.820,000,000,000   or        
$3.82 trillion dollars


New Debt                       
$ 1,650,000,000,000   or       
$1.65 trillion dollars


National Debt                   
$14,271,000,000,000          $
14.271 trillion dollars


Recent Budget cuts            
$  35,500,000,000           $ 35.5 billion dollars


Congress and President Obama have agreed to
$35.5 billion dollars of recent budget cuts. It sounds like a lot of money. There
has been a lot of tradition media babble and coverage on this insignificant reduction.

It makes us think the President and congress
are doing something significant to reduce the deficit. Everyone understands the
waste inherent in government spending on government programs.

If we pretend these financial figures are a
family budget, we can see that the budget cuts are ludicrous. 

Let us remove all the zero’s from the trillion
dollar numbers to arrive at understandable amounts. Then let us pretend it represents
a family financial statement.

Family 2011 Financial Statement 

Annual Family Income is  $ 21,700 dollars in the year.


The family spends $ 38,200 dollars that year.


New credit card interest bearing debt increases
by $16,500.


Outstanding Balance on the credit card
increases to $142,710 dollars.

The reaction of most people is this is crazy.
He will never repay the family debt.       

The head of the family promises the credit card
company he is going to decrease


He cuts family spending by $35.50 a year after
he promises the credit card company he would decrease his debt by 50% in 4

The head of the family has three choices. He
can increase revenue somehow but his boss does not want to raise his salary. He
can raise the debt ceiling. His lender does not want to raise his debt ceiling
because he is a bad risk. Raising the debt ceiling means he has to manufacture
more money with credit card borrowing. The lender said enough is a enough.

His last choice is to decrease his family’s
unnecessary spending.

President Obama’s decrease in spending is a
joke and an insult to a lender.  

President Obama is not serious about lowing the
deficit. Paul Ryan is. He has presented a sensible way to save Medicare.

Whom do you think the creditors of the United
States would trust more?

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

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What Is The Ryan Plan All About?


The need for effective Medicare reform is becoming
increasingly apparent. Both the public and providers do not like Obamacare.

The cost overruns for Obamacare are hidden
from the public but are becoming evident.

There is an ideological divide between policies
that work and policies that don’t work.

President Obama believes the only policies
that work are government policies that control providers, insurers, and

There are multiple examples that have shown
that these policies have never worked. Government has never controlled spending
for any projects for myriads of reasons.

What makes President Obama think his
government can force the healthcare system to become more efficient and control
healthcare costs?

Price controls and restriction of access to
medical care will not work.  

Entitlement programs have been fertile
grounds for fraud and abuse by all the vested interests including government

Government should be of the people for the

Government should level the playing field so
secondary stakeholders compete for primary stakeholders’ business.

I voted for President Obama because I thought
he offered this hope. He fooled me as he has fooled millions of other Americans.

President Obama has a cool, seductive
speaking delivery. He is general enough to make one think he believes in what
you believe but his agenda is central government control over all areas of life.

The agenda is the opposite of the individual
freedoms our country stands for.

None of President Obama’s policies have
worked in the last 3.5 years.   

He has snuck in higher taxes on the middle
class for his healthcare bill and has not lowered healthcare costs.  Healthcare costs have increased.

Americans are not dumb. They are beginning to
realize they are on the road to serfdom.

President Obama is using every dirty trick
known in American politics to attack Governor Romney and now Representative
Ryan in order to keep  from talking about
his record on jobs, the economy, healthcare costs, the deficit and its meaning,
our National Security, foreign policy, energy, and immigration.

For some reason the traditional media is on
President Obama side. The result has been a loss of their audience by newspapers,
magazines, and network television.  

America is in a fiscal crunch. Entitlement
spending is at the center of the fiscal crunch and must be reformed effectively.

is at the center of our fiscal crunch,
with outlays that have grown about twice
as fast as the economy over the past decade, according to the Congressional
Budget Office (CBO)”.

 The fiscal crunch is only going to get worse
as 76 million baby boomers retire in the next two decades.

will consume an ever-increasing share of the federal budget unless policies are
adopted to bend Medicare's cost curve.”

The Medicare trust fund has been depleted by the
federal government borrowing from the trust fund. Over time and as unemployment
rises less Americans are paying into the fund. The government’s depletion of
the fund has occurred since the beginning of Medicare.

The Medicare premiums paid by seniors for
Medicare Part B is going to double in the next two years. This is a tax on
seniors on fixed incomes that no one is talking about and few can afford.  

President Obama is expanding an entitlement
with Obamacare.  It will accelerate the
consequences of the fiscal crunch.

if the substantial reductions in payments to health care providers included in
the Affordable Care Act (ACA) are fully implemented and Congress allows the
27.4% reduction in physician payments required under current law to go through,
Medicare spending will continue to grow at unsustainable rates.”

 The Ryan
plan can change the direction of Medicare and save it.

         What does
the Ryan Plan do?

  • No one over 55 years old is affected.
  • People younger than 55 will have the option to choose
    between traditional Medicare or premium support from government to pay for
    competing private healthcare insurance plans.
  • Traditional Medicare is a defined benefit plan. The
    government decides on the price
    it will pay for medical services.
  • Ryan’s plan is a "defined contribution" plan. The
    government decides on an amount of money ("premium
    support") to provide to individuals to buy private insurance of
    their choice.
  • Consumers will choose from an approved set of competing
    private insurance plans along with traditional
  • There is an open enrollment period each year, allowing
    people to choose either of the


The goal is to force the healthcare
insurance industry to compete for patients
as well as give seniors the right to choose the most appropriate plan for
their needs.

 The Ryan plan allows competition among
in the private sector which will increase efficiency and drive down

Obama is scorning this system as a “voucher system.” 


again President Obama is obfuscating the truth with a sound bite.

55 years old and younger have paid into the system all their working life jus
as senior 55 years and older have. The “premium support” is not a free give
away as are food stamps.

Premium support is determined each year by the government
calling for competitive bidding by the healthcare insurance industry.

The government would then provide seniors
in each region of the country with a "premium support" equal to the
second-lowest bid in that region, or one equal to the bid of the federal
fee-for-service Medicare program — whichever is lower”.

Seniors could choose the traditional Medicare, since the
government would still contain a package of required benefits that would
constitute its comprehensive insurance coverage, just as Medicare does today.

Seniors would be guaranteed freedom of choice. A private
healthcare insurance option would equal the “premium support” payment.  

The premium of the private insurance might even become
cheaper than the Medicare premium seniors would have to pay.

The Ryan plan would allow the healthcare insurance
industry to compete with Medicare.  

The healthcare insurance industry could be forced to
lower its net profit by the competition just like it has occurred in other
industries. The competition could also force increase efficiency and quality of

Tort Reform and fraud and abuse are not addressed in the
Ryan Plan yet.

The Ryan Plan is a good start to change from central
control to individual choice. It I not there yet.

 Presidential candidate
Romney’s pick of Paul Ryan as running mate has made Romney the good guy in the
Medicare issue.

President Obama who has put Democrats in the position of being the party that
is cutting current seniors' benefits, rationing care (thanks to the IPABs), and
letting the program collapse as it becomes unsustainable

you're a senior now or in the future, Democrats are offering you nothing except
a grim, mean, rationed future when it comes to medical care.

It's the
Republicans who are offering hope for a sustainable Medicare future with
freedom of choice.

the serious fiscal problems facing this country, slowing the growth of Medicare
spending is no longer optional. The only question is how to do it.

Wyden–Ryan proposal outlines a strategy for Medicare reform that harnesses
market forces to control costs. It provides a real alternative to the top-down
controls favored in the Obamcare.

 Paul Ryan and Ron Wyden have defined the
policy parameters that could be the basis for real Medicare reform in 2013.

the Washington Post and liberal healthcare policy wonks are starting to think
the Ryan Plan might be a good idea.

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

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The Ryan Medicare Plan And President Obama’s Criticism

Stanley Feld M.D.,FACP,MACE

President Obama has said over and over again that Paul Ryan’s budget is going to end Medicare coverage as WE KNOW IT and leave seniors without healthcare coverage. The first part is TRUE and the second part is FALSE.

President Obama’s spin miesters (David Axelrod et al)  have a knack for distorting facts with lies.  The Obama team couples the distortions of the truth together with powerful visual distortions in the media. If the visual distortion is seen enough times it is interpreted as the truth no matter what the facts are.

As an example, President Obama’s grandma ad has appeared over and over again. The grandma ad is totally false. However “the media is the message. ” 

This false message has become part of the American psyche.

Who needs facts or the truth when the media presents such a vivid image?

Paul Ryan’s plan will change Medicare as we know it.  The simple truth is Medicare is going broke. If nothing is done the Medicare program will be bankrupt and disappear.  Then seniors will not have any healthcare insurance coverage.

Paul Ryan’s Medicare change is the way to save the Medicare insurance coverage for senior of future generations.


Obamacare will hasten the bankruptcy of Medicare and balloon our debt and deficit. Medicare coverage will be forced to disappear.

In order to convince the American public that he is going to reduce spending President Obama played an accounting trick play on the American public.

It goes by the name of "double counting."

It is clear to me that neither Democrats nor some Republicans understand President Obama’s double counting. Double counting will hasten the demise of Medicare.

Paul Ryan is trying to explain double counting once more to seniors. He is calling out President Obama and David Axelrod as they try to obfuscate the truth about double counting and the Paul Ryan’s plan to save Medicare.

American seniors are starting to catch on slowly but surely. The public is getting tired of the Obama/Axelrod false hope, half-truths and outright lies.

In short, the Medicare scoring convention is not widely understood and thus obscures the double-counting.”

Putting the Medicare payroll tax hikes and spending constraints on the "pay-as-you-go" ledger was instrumental in getting the health law through Congress, because doing so fostered a widespread misperception that the law would reduce future deficits.

No such prohibition exists in the budget process against committing Medicare savings simultaneously to Medicare and to pay for a new federal program (Obamacare).”

“It's this budget loophole, unique to Medicare, that gives the health law's spending constraints and payroll tax hikes the appearance of reducing federal deficits.

But it is appearance, not reality. If you have only $1 of income and are obliged to pay a dollar each to two different recipients, then you will have to borrow another $1. This is effectively what the health law does. It authorizes far more in spending than it creates in savings.

It is one of President Obama’s many trick plays on the American public.

The cartoon presents a simple explanation of double counting. Paul Ryan should use this simple explanation of double counting.

It is important to listen carefully with our eyes wide open and hear President Obama’s lies about Medicare spending and Obamacare in the next two months.

Now President Obama says he is going to reduce fraud and abuse in Medicare by $731 billion dollars.

Who is he kidding?

His plan is to reduce payment to physicians and hospitals. He will be forced to play favorates with certain hospital systems.

A reduction in Medicare cost will not will not happen as long as President Obama permits the healthcare insurance industry to do the administrative services for Medicare and not address the issue of Tort Reform.

The Accountable Care Organizations and its payment changes will not save money. In fact it might cost more if ACOs can be organized at all.

Medicare’s administrative services have been outsourced to the healthcare insurance industry since 1965. Medicare has never had a chance of being fiscally viable and sustainable. The healthcare insurance industry takes 40-60% of every healthcare dollar spent of the top.

Obamacare does not change this procedure one bit.

President Obama continues to say that Mitt Romney and Paul Ryan allegedly are going to end Medicare and leave seniors without coverage. 

The exact opposite is true. However, Romney and Ryan have not explained this simply enough to be understood by all. They must explain in detail and sound bites why President Obama’s assertion is false.

In fact, Obamacare is going to change Medicare as we now know it. Actually it already is causing the rationing of cancer drugs and a de facto rationing of care.

It is ObamaCare that was specifically designed to destroy Medicare, and to herd seniors into a one-size-fits-all plan where care to them can be rationed with impunity.”

“ And even Dr. Donald Berwick, President Obama's personal choice to run Medicare and Medicaid, admitted that this rationing is one of ObamaCare's ultimate aims, as did Dr. Ezekiel Emanuel, one of the president's chief health care advisers.”

Under Obamacare, Medicare has already changed as we know it. In 2014 it will change drastically.

In view of this fact for President Obama to say that the Ryan plan will change Medicare as we know it is arrogant and disingenuios.

There are many differences in both plans. I will try to explain the differences in simple terms in future blogs.

The huge difference is Obamacare is an entitlement that promotes dependence on the central government where the Ryan plan promotes self-responsibility and independence from government and government controls over our freedoms of choice and decision-making.

President Obama is taking a dangerous chance with his criticisms of the Ryan plan.

Hopefully the Romney/Ryan ticket will be able to explain away President Obama’s criticisms in simple, understandable terms.

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

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  • adipex

    What an precise manner of journalism, which does the article visual along with elegant.

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A Tribute To My Father Jack Feld


Stanley Feld M.D.,FACP,MACE

Every year the Feld men get together somewhere and talk about life. I have two sons, Brad and Daniel and my brother has two sons, Jon and Kenny.

All four are leaders.

My brother and I are very close. I came to Dallas in 1969. My brother and his wife followed one year later. Charlie was working at IBM’s corporate headquarters working up the corporate ladder. He requested a transfer to Dallas so our families could be together.

The first two boys are one year apart with Brad being the oldest. Daniel and Kenny followed three years later and are also one year apart.

This year we are going to have a personal chautauqua at the Aspen Institute. It will be a two day session where all six of us will have two one hour talks. The goal is to try to teach each other something.

There are no agenda and no published topics.

Chautauqua/ʃəˈtɔːkwəu/ shə-TAW-kwə) was an adult education movement in the United States Lectures were the mainstay of the chautauqua.  The reform speech and the inspirational talk were the two main types of lecture until 1913.[5] Later topics included current events, travel and stories, often with a comedic twist.”

The mission is to try to understand each others perception of the issues of the day, discuss present life experiences and our hopes for the future.

It is simply a bonding experience.

I am dedicating the Feld Men’s Group to my dad, Jack Feld.

My dad was never short of having opinions nor afraid to express them

He was a very intelligent man who was serious, pragmatic and passionate about his work and his ideas.

He was a victim of the depression as well as tragedies during the depression. His family was very rich prior the depression.

In fact he had a driver driving him to school every day. During the depression he parents got sick and died.

At 16 years old he had to leave Dewitt Clinton High School in the Bronx his junior year and go to work to support his three young sisters.  He started sweeping the floor in a small factory in downtown New York City. He ended up owning a very large factory in both New York City and Miami.

Jack Feld was a self taught man. He always had big ideas and was never afraid to express them or take risks. He had an uncanny ability to see around corners and recognize the next big thing.

At 78 years old he bought out a company that had washing machines that stone washed jeans before stone washed jeans were fashionable.

Sometimes his timing was off but that never deterred him.  He would say , “All you have to do is hang around long enough and the world will catch up to you.”

Most of the time his timing was impeccable. He had a brilliant mathematical mind. He could figure out a price for an item and give a good deal to the buyer in seconds as well as figure his sizable net profit.

He was passionate about everything in a very quiet way. One of his passions was buying new automobiles.   

In 1935 he bought a Model T Ford for $320 dollars. He and my mother drove it for 11 years. He sold it through the classified section of the New York Post for $395 in 1946.


 I was in third grade and I understood that $395 was greater than $320 arithmetic  I did not know anything about inflation.

I asked my father why that guy would spend more for that 11 year old piece of junk than he paid for it new.

He said inflation. He explained how FDR devalued the dollar. He said World War II inflated prices even further. In retrospect it was a pretty good concept for an 8 year old to understand.

He then bought a 1946 Ford with a jump seat with the money he got for his 1936 Ford plus some.

  800px-1946_Ford_coupe jpeg

One of the more attractive 1946 Ford models was the Super DeLuxe coupe sedan (also sometimes called the sedan coupe).

My father kept that car until Ford remodeled their cars in 1949. He traded it in for a 1949 dark red Ford convertible. Red was the only color the convertible came in.

 The You Tube describes the automotive revolution. My father spotted the revolution the moment Ford started delivering the new cars to the dealerships.

He kept the 1949 Ford convertible for 2 years.

Our family vacationed every year for two weeks in a hotel in the Catskill Mountains.

My father was bored after the first day of vacation. He had no work.

Everyday he went off to the dealerships in Monticello and Newburg New York. His excuse was to take a spin in his convertible. He also was dealing for a new car.

My mother said that it was really his way of going fishing.

In 1951 he caught a fish. He traded in the 1949 Ford convertible for a 1951 Ford convertible. The trade cost him $200.

In 1953 he snagged an incredible looking 1953 Mercury. The red was a “cherry” red.


1953 Mercury jpg

The trade in price was always favorable, if you knew how to negotiate. My father was great at negotiating.

He had some problems with his 1953 Merc’s universal joint. In the summer of 1955 while on vacation he traded it in for a 1955 Mercury convertible.



My dad had a knack for picking the classic cars of the future.

He was now on a roll. He had his dealerships all lined up. The next car he drove back to the hotel was a 1957 black Mercury convertible. I took a coupe of pictures of those cars then.




I was 19 years old and a junior at Columbia College at the time. This car got a WOW from me. It also got a WOW from the girls I dated.

My dad figured it was time for a change in 1959 with a son graduating from Columbia College and going to medical school.

He stepped it up a notch. He bought a baby blue (Columbia Colors) 1959 Pontiac Bonneville convertible with gigantic fins. The Mercury’s fins were nothing compared to the Bonneville’s fins.

He picked another classic car.

 1959 bonneville


Bonnevile front jpeg

This is my lucky car. I drove this car on my first date with my wife Cecelia. The first date started us on a magnificent journey of knowing each other for 53 years and 49 years of marriage.

I did not know what my dad liked better the Mercury or the Mercury dealership but in 1961 he bought this black Mercury convertible.

  1961 merc 2 jpeg

I could go on and on. I present these cars as an example of my dad’s eye for spotting future classics. These perceptions applied to many areas of his life and work.

Some of his perceptions have rubbed off on my brother and me.

We now know that some of our perceptions have rubbed off on our sons. We are very proud of them.

As The Feld men are about to embark on the Annual Feld Men’s Trip  I had the urge to reminisce about my dad. He meant a lot to all of us.  

It reminds me how important it is to bond with your kids and your parents.

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

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Romneycare 2012 vs. Obamacare

Stanley Feld M.D.,FACP, MACE

Recently President Obama said his Healthcare Reform Act at its core is the same as Romneycare.

Romneycare is different. Romneycare gives a tax credit to people who purchase insurance. Obamacare penalizes those who do not purchase insurance.

Governor Romney wanted to incentivize people to be responsible and buy insurance while President Obama wants to expand an entitlement and increase public dependency on government.

When Romneycare (Massachusetts) was passed I predicted it would result in cost overruns, restrictions of access to care and rationing of care.

Mitt Romney admits the bill was not ideal. There were things he wanted in the bill but the Democrat controlled Massachusetts legislature refused to let him put them in.

This You Tube represents a recent defense of his bill. He has pledged to repeal Obamacare if elected President.

I predicted that cost overruns would get to a point where the state of Massachusetts would have to force physicians to participate in Romneycare as a condition for state licensure.

“The New Romneycare” is going to penalize the good hospitals that keep people alive and reward hospitals where those people would die. The good hospitals’ readmission rates would be higher than the hospitals where patients died. If a patient died in the hospital the overall readmission rate would fall.

This example illustrates one problem with the interpretation of remote claims data.

President Obama’s Healthcare Reform Act (Obamacare) will end in failure just as Romneycare has only on a grander scale with greater deficits and less access to medical care.

 Both Romneycare and Obamacare have the same defects. Neither gets to the core of the problems in the healthcare system.

A core problem is the unnecessary testing resulting from defensive medicine and the need for effective tort reform.

Another core problem with the healthcare system is the financial abuse of healthcare insurance. Both the state of Massachusetts and Obamacare are dependent on the healthcare industry to provide administrative services for government run plans.

The insurance companies take 40% of the healthcare dollar and blame physicians and hospitals for the rising costs. The 40% is disguised under direct patient care in its financial statements.

An important factor in rising costs is the increasing administrative paperwork for hospitals and physicians for government information gathering. It leaves less time for patient care.

Policy wonks make up rules resulting in the increased documentation in the name of increased quality care. No one has defined quality care precisely.

In 2009 President Obama bailed out Romneycare to the tune of 8 billion dollars.

The mainstream media constantly reports that over ninety plus percent of the population is insured. Reportedly the patients are happy.

No one reports the appointment and emergency waiting times.

There is very little negativity in our press about the Canadian healthcare system. This You Tube presents a former Canadian physician’s experience.

Governor Romney must stop defending RomneyCare. It is a hollow defense.

 I could not find any negative press in the Boston Globe about the Massachusetts plan in a long while.  The August 3, 2012 Wall Street Journal has a devastating article about the Massachusetts Plan.

The headline was, With costs rising fast, Massachusetts moves to dictate medical care.” 

My inevitable postscript for Romneycare is cost containment with price controls and the increased bureaucratic dictating how medicine should be practiced.

Rather than Democratic Governor Deval Patrick trying to patch the law and make things worse he should repeal the law and deal with the underlying problems.  

 “The claim then, as with the Affordable Care Act, was that health care would be less expensive if everyone had insurance.”

The claim seems naïve to me if there is no cure for the healthcare insurance industry taking 40-60% off the top and defensive medicine is not reduced through tort reform.

Unless the healthcare industry is consumer driven “bending the cost curve” will not happen.

So what in happening in Massachusetts?                                          

    1. 79% of the newly insured are on public programs.

   2. Health costs—Medicaid, Romneycare's subsidies, public-employee compensation—will consume some       54% of the state budget in 2012 up from about 24% in 2001.

  3. Health spending in real terms has jumped by 59%.

  4. Spending for education has fallen 15%, police and firemen by 11% and roads and bridges by 23%.

  5. Massachusetts spends more per capita on health care than any other state.

   6. Costs are 27% higher than the U.S. average.

Healthcare premiums and taxes are rising and the physicians are the target instead of the health-care insurance industry.

    1. Under the plan, all Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure—that is, permission to practice.

    2. They'll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics.

    3. An 11-member board known as the Health Policy Commission will use the data to set and enforce rules to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017, and 0.5 percentage points lower thereafter.

    4. The data collected will be claims data and it will stink. If past results are a predictor of future results price control do not work.

    5. No registered provider is allowed to make "any material change to its operations or governance structure," the bill says, without the commission's approval.

    6. The commission can also rewrite the terms of provider contracts with insurers and payment levels and methods if they are "deemed to be excessive."

    7. The commission can decide to supervise the behavior of any provider that exceeds some to-be-specified individual benchmark.

    8. These delinquents must submit a "performance improvement plan" that the commission must endorse.

    9.The commission is empowered to control the practice and organization of medicine.

   10. Some complain this government control is too weak because the delinquents can only be fined $500,000 for disobeying the commission's dictates.

What ever happened to individual freedom of choice and other freedoms?

It is obvious that Romneycare is a bust and getting worse.

However in my view Romneycare is a pretty tame failure compared to what is going to happen down the road with Obamacare. 

Everyone agrees that the healthcare system needs to deliver medicine more efficiently and be more accountable.


Accountable to whom?  

The healthcare system must become more accountable to consumers. The only system that will work is a consumer driven healthcare system with the consumers responsible for their healthcare dollars.

I believe is important for our elected officials to do well.

However it is more important to do well doing the right things.

Our government is not doing the right thing for the people with Obamacare.

It is only going to make things worse as government tries to exercise more control.


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

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Health Insurance Exchanges And The Federal Government

Stanley Feld M.D., FACP,MACE

Health Insurance Exchanges are supposed to be state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

 All exchanges must be fully certified and operational by January 1, 2014 under federal law.[1] 

It is not going to happen on time. However the 20 hidden taxes in Obamacare are happening right now.

The health insurance exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing.

President Obama will then have a clear path to a Public Option and a single party payer healthcare system.

Unfortunately, the single party payer system will fail because it will be unaffordable for Americans and the federal government.

The states and the healthcare insurance industry will do everything they can to undermine its success.

Federal officials never thought they would end up running the Health Insurance Exchanges. Their plan was to dump this formidable and complex task on the states. Half the states refused to participate.

Obama administration officials are getting ready to set up and operate new health insurance markets in about half the states, where local officials appear unwilling or unable to do so.”

 “So far, Governors of 13 states with nearly one-third of the United States population have sent letters to the Obama administration saying they intend to set up exchanges. Complete applications are due on Nov. 16, 2013.”

Stated another way, 37 states have not signed up yet. Once those 13 states that have signed up calculate the cost to setting up and running the health insurance exchanges I suspect they will withdraw.

The Secretary of Health and Human Services, Kathleen Sibelius’,plan was to create regulations for the states to develop the health insurance exchanges by January 1,2014. She has emphasized that states must meet her standards of transparency and accountability.

The federal government requires state exchanges to develop budgets and project operating costs, revenues and expenditures.

 There are a great many regulations attached to qualify as a state exchange.

States must explain how the revenue will be generated and how the exchange will address any financial deficits.

 The federal government wants to set up the rules that require the states to execute these rules at the states expense after the federal government funds the exchange for two years.

The health exchange program will be delayed because the government pledged to set up the health exchanges in the states that opted out of the program.

Creation of Health Insurance Exchanges is a complex and expensive task. States have to operate under a balanced budget. States cannot afford this undertaking.

“Federal and state officials and health policy experts expect that the federal government will run the exchanges in about half of the 50 states.


My guess is it will be closer to 35 states. Federal officials are preparing to do the job but it will be a difficult political task.

The public fears a federal takeover of the healthcare system. This takeover is one more step by the government to increase its control over the healthcare system.

The Obama administration does not want to encourge that fear with its takeover of Health Insurance Exchanges.

The Obama administration does not want to alienate state officials whose help they need in the execution of the federally run healthcare exchanges.

The federal government does not have the manpower to run all these exchanges. It is outsourcing the work to private contractors.

We have seen the disastrous abuse to physicians by outsourcing fraud and abuse investigations to private contractors.

The Obama administration has invited advertising agencies to devise an elaborate “outreach and education campaign” to publicize the federal exchanges and their potential benefits for consumers.” 

The Federal officials are hiring private contractors to provide “in-person assistance” to consumers and to operate call centers.

President Obama’s administration has attacked Mitt Romney and Bain Capital for outsourcing of jobs.

President Obama is now outsourcing these jobs to a foreign company, while America desperately needs jobs here.

Federal officials have turned to the American subsidiary of a Canadian company, the CGI Group, to provide information technology services to the federal exchanges under a contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency of state health insurance exchanges yet planning for the federal exchanges has been done almost entirely behind closed doors.

“We have gotten little bits of information here and there about how the federal exchange might operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance Department.

“I was on a panel at Rockhurst University here, and I was asked, ‘Where is the Web site for the federal exchange?’ I chuckled. There really isn’t any federal exchange Web site.”

In New Hampshire, Thomas M. Harte, the president of Landmark Benefits, which arranges health insurance for 300 employers of all sizes, said:

“Nobody has any idea what the federal exchange will look like. There has not been much communication between officials drafting plans for the federal exchange and the people who will use it: consumers, employers, brokers and insurers.”

Administration officials have not set forth a budget for the federal exchanges.

“They said they intended to charge “user fees” to the participating health insurance plans.

It is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.”

I get it.

The Federal Government is not telling us what they are going to do because they probably want to follow its non-transparent regulations.

It is pretty clear this will be one of many steps toward the destruction of the healthcare system. The healthcare system will self implode. At that point everyone will be begging the government to take over.

It will be impossible for President Obama to take over a business system it cannot afford.

A key to Repairing the Healthcare System is to decrease the outsourcing and bureaucratic complexity.

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

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Where Is The Healthcare Money Going ?

Stanley Feld M.D.,FACP,MACE

The article in the Dallas Morning News on Sunday, July 29,2012 entitled “Your Doctor’s Big Fat Paycheck” by Eli Lehrer is misleading. The article ignores the real cause of the rising costs in the healthcare system.

Physicians are the easiest stakeholder to criticize because they are the least organized and least represented. This makes them the easiest and most vulnerable target.

The subtitle is “High wages in the medical sector are the underlying cause of ballooning healthcare costs.”

Eli Lehrer does a disservice to the medical profession as well as to patients. It does not represent the truth-value added effect of a physician's services to patients.

Mr. Lehrer article devalues physicians’ services. He has a lack of understanding of the costs of medical care vs. healthcare.

He quotes the Bureau of Labor statistics saying that primary care physicians earned just over $200,000 a year while specialists earned $355,000 per years in 2010.  The Bureau of Labor Statistics used Medical Group Management Association (MGAMA) data for this estimate.

Those numbers are pretty close to the numbers reported by MGMA physician Compensation and Production Survey for 2011.

The number needs some correction but it is unnecessary to quibble.

The MGMA has a group of consultants that teach physicians how to make more money from the healthcare system.

Physician Compensation


Median compensation levels for primary and specialty care physicians

Source: MGMA Physician Compensation and Production Survey: 2012 Report Based on 2011 Data 

Physician com 8 4 2012

Anesthesiology   $407,292

General surgery  $343,958

Obstetrics/gynecology   $281,190

Internal medicine   $205,379

Psychiatry   $200,694

Pediatrics/adolescent medicine   $192,148

Family practice (without obstetrics) $189,402


Quick Facts: Physicians and Surgeons 

2010 Median Pay 

This wage is equal to or greater than $166,400 per year or $80.00 per hour.

Entry-Level Education 

Doctoral or professional degree

Work Experience in a Related Occupation


On-the-job Training


Number of Jobs, 2010


Job Outlook, 2010-20

24% (Faster than average)

Employment Change, 2010-20


The MGMA summarize physicians scope of work layman’s terms on its web site.

What Physicians and Surgeons Do

"Physicians and surgeons diagnose and treat injuries and illnesses in patients. Physicians examine patients, take medical histories, prescribe medications, and order, perform, and interpret diagnostic tests. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.

Work Environment

Many physicians work in private offices or clinics, often helped by a small staff of nurses and other administrative workers. Surgeons and anesthesiologists usually work in sterile environments while performing surgery and may stand for long periods.

How to Become a Physician or Surgeon

Almost all physicians complete at least 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on their specialty.


Wages of physicians and surgeons are among the highest of all occupations. According to the Medical Group Management Association, physicians practicing primary care received total median annual compensation of $202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010."


I am temped to answer Mr. Lehrer’s article point by point. There is so much misinformation and disinformation in this article that it makes Yellow Journalism look tame.

 The more important issues are how much does the healthcare system cost and where is the money going?

 Then, and only then, can we begin to know the underlying cause of the ballooning healthcare cost.

 There are 691,000 practicing physicians in the U.S. Let us assume that the average salary is $250,000 dollars. This is probably a high average number.

The healthcare system costs America approximately $2.5 trillion dollars ($2,500,000,000,000) a year.

691,000 physicians averaging $250,000 equals $172,750,000,000 ($172 billion 750 million dollars).

$172,750,000,000 billion divided by $2,500,000,000,000 trillion equal 6.91% of the healthcare dollars spent for physicians’ salaries.

Let us assume that each practicing physician’s overhead is 50%. This is also a high average. Therefore, physicians’ overhead and salaries are 13.8% of the total healthcare dollars spent.

There real issue in the raising cost of healthcare is where is the 86.2% of the U.S. healthcare costs going?

Mr. Lehrer ignores this issue.

The money is wasted on administrative bureaucracy, healthcare insurance executives’ salaries, hospital administrator salaries and an exorbitantly complex  and expensive pharmaceutical bureaucracy.

Over 20 WellPoint executives make more than 10 million dollars a year with these numbers being stratified upward to over 25 million dollars a year plus bonus and stock options.

Some healthcare insurance executives receive over a billion dollars a year in bonuses and stock options.

Many levels of hospital administrative executive make over one million dollars a year with chief executives making over $15 million dollars a year.

I have been told “it is hard to get good help.”

With these sobering numbers on board the critical question is how much is a physician worth that has the education and ability to save lives?

This is the main reason Mr. Lehrer’s article in the Dallas Morning News is worse that Yellow Journalism.

The editors of the Dallas Morning News should be embarrassed by their publication of this article.


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