Stanley Feld
M.D.,FACP,MACE

Paul
Krugman is starting to drive me crazy with all his fact free declarations about
the healthcare system.

He recently declared that consumer driven healthcare has
been a bust everywhere it has been tried. Paul Krugman as an “expert” has once
again made a declaration that contradicts the facts. He is clearly not
interested in being confused by facts.

Paul Krugman is against putting consumers in
control of the healthcare system. He feels,
as President Obama feels, that a central committee (IPAB) should be in charge
of deciding what to do with limited health care resources. 

He has said,

 "Consumer-based" medicine has been a
bust everywhere it has been tried. Medicare Advantage was supposed to save
money; it ended up costing substantially more than traditional Medicare.

Medicare Advantage costs the government more
money because the government gave the private insurance companies a $3,000 bonus
per senior to get Medicare out of the government’s hands.

This is one of the principle reasons I am not a fan of
Medicare Advantage.

In reality Medicare Advantage provides more
services at lower premiums and deductibles for seniors. Seniors with Medicare Advantage use
fewer services resulting in a lower cost of total services and more profit for the
healthcare insurance industry.

“America has the most "consumer-driven" health care
system in the advanced world. It also has by far the highest costs yet provides
a quality of care no better than far cheaper systems in other countries.”

Paul
Krugman is wrong.  Switzerland has the
most consumer driven healthcare system in the world and the Swiss government
pays far less than most countries while the Swiss get a high quality of care.

His ideology
blinds his mind. The healthcare system in Switzerland is a consumer driven
healthcare system that works for the Swiss. The Swiss government makes the
rules and then gets out of the way.

The
Swiss healthcare system can be used to start a constructive conversation about
healthcare reform in America that can satisfy both conservatives and liberals
and save the U.S. from bankruptcy resulting from expanding entitlements.

The
healthcare system in Switzerland is a consumer driven healthcare system in
which consumers have choice. It has resulted in a low income tax rate,
universal healthcare, and satisfied stakeholders

The
Swiss system could not be totally transformed into an American system because
of America’s embedded ideology and prejudices as well as stakeholder vested interests.
However it outlines the government’s role in a healthcare system and highlights
the power of a consumer driven system.

America’s
healthcare system must undergo significant changes. Most of these significant
changes have been ignored by President Obama in Obamacare. It empowers
government and not the consumer.

Paul Krugman has stated flatly, "Patients
are not consumers"

“Patients get illness that others (government) should decide on
whether it is cost effective to treat.”

This
attitude toward patients points out the disrespect for the intelligence and
judgment of consumers.

The elements
critical to meaningful reform of America’s healthcare system must include the
following changes.

1.
There must be significant and meaningful Tort Reform to decrease the practice
of defensive medicine.

2.
There must be significant reform of the healthcare insurance industry’s
financial rules to stop the industry from listing non-direct care expenses as
direct patient care.

3.
There must be regulations to cause the healthcare industry to be competitive
for consumers’ business. Government should not be the consumer of healthcare.

4.
There must be legislation to change the healthcare insurance industry’s incentives
for profitability in order to create innovative healthcare insurance products
that will reduce healthcare costs.

5.
There must be significant financial incentives for consumers to be motivated to
save healthcare dollars.

6.
Consumer must responsible for their health and healthcare dollars. The
entitlement mentality must be eliminated.

7.
Hospital systems should be competing for patients’ healthcare dollars and not
government healthcare dollars.

8.
Physicians must be responsible to consumers and not hospital systems or the
government.

9.
Insurance costs must be community rated.

The
healthcare system must be a consumer driven system just as purchasing
groceries, automobiles, computers and televisions are. If the product is poor
the company will go out of business.

America’s goals should be universal healthcare
coverage with freedom of choice, and reduction of healthcare costs.

It is worth understanding the Swiss healthcare
system as a starting point to meaningful reform of the American healthcare
system. 

These are the major features
of the Swiss Healthcare System:

1.Swiss citizens
buy insurance for themselves.

2.There are no
employer-sponsored or government-run insurance programs.

3.Insurance
prices are transparent to the beneficiary and community rated.

4. The
government defines the minimum insurance benefit packages that must be offered.
 Everyone must have the minimum
healthcare insurance coverage.

5. All
packages require beneficiaries to pick up a portion of the costs of their care
(deductibles and coinsurance) in order to incentivize citizens to be
responsible for their health and the control of healthcare dollars spent.

6. My ideal
medical savings account would provide a positive incentive by rewarding
citizens who did not spend the first $6,000 dollar to keep that money in a
retirement account.

7. Patient
incentive is a critical element in healthcare reform because incentives provide
consumers with a reason to take care of their health and healthcare
dollars 

8.The Swiss government
subsidizes health care for the poor on a graduated basis, with the goal of
preventing individuals from spending more than 10 percent of their income on healthcare
insurance.

9. Citizens
can be responsible for a significant component of healthcare costs in Switzerland.

10. Consumers
often opt for the cheaper healthcare insurance packages. They have freedom of
choice.  Many Swiss consumers choice chose
minimal insurance plans combined with high-deductible insurance plans.

11. Citizens
are free to choose comprehensive insurance coverage or some form of
supplemental coverage. It is not a one size fits all system.

12. Ninety-nine
percent (99.5%) of Swiss citizens have health insurance.

13.There are
about 100 different private insurance companies in Switzerland with multiple
healthcare insurance plans.

14. It is clear
that the government has made the rules and then has gotten out of the way. The
rules have set up a market driven competitive healthcare system.

15. The result
has been that healthcare insurers are competing for consumers’ business on
price and service. Consumers gravitate to the best price and service that fits
their needs.

16. The Swiss
healthcare system not only helps to curb health care inflation but most
beneficiaries have complete freedom to choose their doctor.

17. The setup
of the system has resulted is low waiting times for physician and hospital
services with a minimum of bureaucratic slow downs. 

18. The Swiss healthcare
system aligns all the stakeholder incentives by empowering the consumer while
helping less fortunate consumers.

19. Government
spending on health care in Switzerland is only 2.7 percent of GDP, by far the
lowest in the developed world.

U.S.
government spending on health care was 7.4 percent of GDP in 2008 and will
exponentially grow under Obamacare.

 “ If the U.S. could move its state health spending to Swiss
levels, it would save more than $700 billion a year.”

Dr. Regina Hertzlinger has an excellent description of the
Swiss healthcare system in the following You Tube.

http://youtu.be/E5bsz_oewDA

Switzerland’s
healthcare system cannot be superimposed on the U.S. healthcare system. It can
be used as a starting point to empower consumers to drive the healthcare system
and be part of the solution. 

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

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 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
coverage eligible for federal subsidies.

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

The health insurance
exchanges in all states are not going to be operational on time.

However, Americans of
all income brackets are experiencing the increases in 20 hidden taxes in
Obamacare right now. The increase in taxes is supposed to amount to $1.2
trillion dollars.

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

Their formation is failing
despite President Obama’s publicity.

If they are created President
Obama will have a clear path to the Democratic Party’s cherished Public Option.

This will be a giant
step to achieving a single party payer healthcare system.

Unfortunately, the
single party payer system will in turn fail because it will be unaffordable for
America.

Individual states and
the healthcare insurance industry will do everything they can to undermine the
success of health insurance exchanges.

Federal officials never
thought they would end up running the Health Insurance Exchanges. President
Obama’s plan was to dump this formidable and complex task on the states. Half
the states have 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.”

In other words, 37 states have not signed up
yet. Once those 13 states that have signed up and start calculating their costs
for setting up and running the health insurance exchanges I suspect they will
also withdraw.

The Secretary of Health and
Human Services, Kathleen Sibelius’ plan was to complete the regulations for the
states to start the health insurance exchanges by January 1,2014. 

The Secretary of Health and
Human Service 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 to the central government’s satisfaction.

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 and require the states to execute these rules at the states
expense. President Obama promised to “fund” the exchanges for the states for
two years. After that they are on their own.

The health exchange programs
will be delayed because the government pledged to set up the health exchanges
in the states that opted out of the program. It has not started to set up these
exchanges.

Creation
of Health Insurance Exchanges is a complex and expensive task. States are
required to operate under a balanced budget. States cannot balance their
budgets with health insurance exchanges unless they further increase taxes.

 “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. It will be poorly executed and difficult politically.

President Obama knows the
public fears a federal takeover of the healthcare system. He realizes the
public understands the health Insurance exchanges are one more step toward a
federal takeover of the healthcare system.

The Obama administration
does not want to encourage that fear by taking over the Health Insurance
Exchanges.

Neither does the Obama
administration want to alienate state officials whose help they need to execute
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.
This is duplicity to its highest degree.

He better keep it out of
the mainstream media or Mitt Romney out to get it in the mainstream media
somehow.

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.”

The Federal Government
is not telling us what they are going to do. It is not following its call for transparent
regulations.

It is pretty clear to me
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 the government cannot afford.

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

It is to let Americans
be independent, own their healthcare dollars and their health and not be
dependent on government complexity, inefficiency and rationing of care.

Entitlements do not save
money!

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

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Stanley Feld M.D.,FACP,MACE

As we approach November 6^th (election day)
we will be subjected to more fibs, distortions and lies from President Obama
and his administration.

He has had a miserable record during his first term in
office. The only tactic he has left is to make villains out of Mitt Romney and
Paul Ryan while he makes promises he cannot keep. He has not kept most of the
promises he made before he took office.

As soon as Paul Ryan finished his speech at the
Republic convention he was accused of telling lies.

Carl Sandburg said in The Prairie Years “If you tell a lies enough times it becomes
the truth. The problem is a liar must have a good memory.”

Mr. Sandburg left out the fact that your audience has
to have a good memory to recall your first lie. One of the lies President Obama
told was the lies of Jonathan Gruber in 2009.

At the height of the Obamacare debate, Mr. Gruber’s
lie was all over the op-ed pages throughout the nation. Mr. Gruber, an MIT
economist and architect of Obamacare, stated that Obamacare would reduce the
cost of healthcare insurance for everyone.

“What
we know for sure “is
that [the bill] will lower the cost of buying non-group health insurance.” 

The law
permits children under 26 years old to stay on their parents’ healthcare
insurance plan.

Immediately, the parents’ healthcare insurance premiums rose
significantly.

           Jonathan Gruber
is now telling state governments that the law will significantly increase the
cost of insurance for everyone.

 The result is the opposite of the promise.

President Obama brags about this achievement. In
reality he gave the healthcare insurance industry an excuse to raise premiums.

 Jonathan Gruber asserted that in 2016, young people would save 13 percent, and older
people 31 percent, on their insurance premiums.

 “President Obama, too, touted the
bill’s ability to “bend the cost curve,” repeatedly
promising that the law would “bring down premiums by
$2,500 for the typical family.”

Jonathan Gruber now: “Obamacare will increase premiums by 19-30 percent.”

President Obama now figures he can call Paul
Ryan a liar.

He has a sympathetic audience in the traditional
media. However, President Obama with Obamacare is throwing Grandma over the
cliff. In fact it looks like he is pulling a Thelma and Louise with the United
Sates of America.

 http://youtu.be/4z88U915uq8

President Obama still seems like a nice guy. Everyone
would love to believe in him but they just can’t trust him.

 During
his speech Paul Ryan said,

“And the biggest, coldest power play of all in Obamacare came at
the expense of the elderly.

You see, even with all the hidden taxes to pay
for the health care takeover, even with new taxes on nearly a million small
businesses, the planners in Washington still didn’t have enough money. 
They needed more.  They needed hundreds of billions more.”

 “So, they just took it all away from
Medicare.  Seven hundred and sixteen billion dollars,
funneled out of Medicare by President Obama.  An obligation we
have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn’t even ask for. 
The greatest threat to Medicare is Obamacare.”

Paul Ryan’s statement is correct.  President Obama accused Paul Ryan of leaving
the $716 billion dollars in Medicare. He did but he does not use it for
Obamacare. Mitt Romney will repeal Obamacare his first day in office.  

The
$716 billion left in Medicare by Paul Ryan will shore up the solvency of the
Medicare program itself.

Below
is what President Obama was using the $716 billion dollars in Medicare cuts for.
Notice the $1.2 trillion dollars in new taxes and the $716 billion dollars in
Medicare cuts are being used to pay $644 billion dollars for Medicaid expansion
and $1.19 trillion dollars for subsided exchanges. The a deficit would be $141
billion dollars.

Does
anyone believe the deficit would be that low? I doubt it.

President Obama was going to cut $542 billion from
Medicare in the original CBO scoring.

It
turns out that President Obama is the liar. Someone ought to tell President
Obama, “The public is getting tired of
his lies once they understand them.”

Paul
Ryan also said,

 “President Obama created a bipartisan
debt commission. They came back with an urgent report.  He thanked them,
sent them on their way, and then did exactly nothing.”

Paul Ryan is
absolutely correct. Simpson and Bowles are still steaming about their
commission’s treatment by the President. Paul Ryan then went on to say,

“Republicans stepped up with good-faith reforms and solutions
equal to the problems.  How did the president respond?  By doing
nothing – nothing except to dodge and demagogue the issue.”

This is what Erskine Bowles,
President Clinton’s former chief of staff and the leader of President Obama’s
deficit commission, had to say about Paul Ryan in September of 2011;

“I’m
telling you, this guy is amazing. I always thought I was okay with arithmetic.
This guy can run circles around me. He is honest, he is
straightforward, he is sincere. And the budget he came forward with
is just like Paul Ryan. It is a sensible,
straightforward, honest, serious budget and it cut the budget deficit just like
we did by four trillion dollars.”

President
Obama attacked Paul Ryan by saying Ryan voted against the Simpson-Bowles
commission.

The
traditional mainstream media has supported President Obama’s attack without
fact checking. The media was satisfied that President Obama’s message
neutralized Mr. Ryan’s attack on the President.

The
mainstream media never bothered to find out why Paul Ryan voted against the
Simpson-Bowles recommendations.

The
media figured it, the media, is the message. President Obama figured the
media’s message would take care of Mr. Ryan. Mr. Ryan was clearly a hypocrite
to the mainstream media.

 It’s
true that Paul Ryan voted against the Simpson-Bowles recommendations because Simpson-Bowles
raised taxes while doing little
to nothing about health-care spending, the biggest driver of
growing deficits.

By
rejecting Simpson-Bowles, Ryan decided to put forward his own plan for deficit
reduction the Path
to Prosperity.

On
the other hand this is what Erskine Bowles had to say about President Obama’s
budget:

“President Obama, as you remember, came out with a budget.
And I don’t think anybody took that budget very seriously. The
Senate voted against it 97 to nothing.

He therefore, after a lot of pressure from folks like me, he came
out with a new budget framework. And in that budget framework, he cuts the
budget by four trillion dollars over twelve years. And, to be candid, this four trillion dollars cut was very heavily back-end loaded.
So, that if you looked at it on a ten-year basis and compared apples to apples,
it really was about a two and a half trillion dollar cut.”

More tricks to deceive the public. I could go on and on. Americans
have been fibbed and lied to by its purveyor of hope (President Obama).

However, I think President Obama has lost his tall with the
public. He is now calling for sympathy. He wants the public to let him finish
the difficult work he started.

I hope the public does not give him that chance.

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

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