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All items for February, 2013


Hospital Systems’ Abuses Of The Healthcare System


In my very first blogs in
2006 I made the point that all the stakeholders are to blame for the dysfunctional
healthcare syste

Most of the incentives that
created a technology driven healthcare system have been perverse. All the major
stakeholders’ incentives are misaligned.

The major stakeholders are
consumers, physicians, government, healthcare insurance companies,
pharmaceutical companies and employers.

The primary stakeholders
are consumers and physicians. The government, healthcare insurance companies,
pharmaceutical companies and employers are secondary stakeholders. Some
secondary stakeholders provide administrative services and some reimbursement.
None provide medical care.

None of the actions of any
of the stakeholders are transparent. All the stakeholders are trying to take
advantage of the payers (consumers, employers and the government).

The government should be
the neutralizing force. It should level the paying field for all the stakeholders.
Government should not permit one stakeholder take advantage another

Everyone except the
primary stakeholders “patients and physicians” figured out the money game in
the healthcare system early on.

Government and employers
were next to last in figuring out the game of money gouging.  This happened in the early 1980’s when both
said they cannot pay any higher price for healthcare services.

At that point the hospital
systems and the healthcare insurance industry figured out another way to continue
the money gouging. The result was HMOs and managed care. They did not work.

The opacity of pricing
continued, cost shifting flourished, and the price of medical care continued to

Physicians are not
blameless. However, they are the easiest to blame. Physicians are the least
organized and least aggressive stakeholders in the healthcare system.

In the past, I have
pointed out the real problems that have resulted in the dysfunctions of the
healthcare system.
Health policy wonks seem to ignore the real problems.

Consumers and physicians
are mere pawns in this money game.

Without consumers or
physicians there would be no healthcare system.
They generate the engine that
provides the need for medical care and administrative services.

I have covered much of the
abuse of the healthcare system by most of the stakeholders.

I have been relatively
easy on hospital systems and pharmaceutical companies until now.

However, the basic problems
in the healthcare system must be to be recognized and then fixed. All of the
problems have to be recognized at the same time and fixed simultaneously.

A patch on one problem
simply intensifies the overall problems.

Obamacare does not solve
any of the real problems. It is an attempt at patching a problem. It will only
make the problems worse and will not reduce the cost of care.

On February 20,2013 TIME
Magazine published an article by Steven Brill. The article is an excellent article
pointing out the abuses of the hospital systems.

“Bitter Pill Why Medical Bills are Killing Us” presents
examples of the abuses of large and small hospital systems.

The basic philosophy that
hospital systems should operate by should be “Patients First.”  It is not. It is how much money can I make
from each patient.

Steven Brill asked the
major question. “ Why are hospital bills so high?”

He presented the answer:,32068,2178453595001_2136781,00.html

The answer is obvious to
all physicians.

One fellow physician


we know much of this, this is an excellent overview of healthcare costs.


All Americans ought to
understand the distortions hospital system pricing creates. The government
ought to make hospital pricing transparent to everyone..

The government should include
the hospital system’s retail price, wholesale price and actual cost for an item
or service.

Then, consumers can choose
the hospital system to go to.

Policy makers continually criticize
this ideal saying that illnesses are sudden and patients are not in a position
to choose a hospital system or negotiate price.

If the hospital system is
compelled to compete on price the price will be the same as the competitive
price when the patient gets sick. If one hospital is much higher than the next
hospital the patient will know this before hand.

Hospital system charges
are actually higher than they appear. Most hospital systems are non-profit
organizations. The hospital systems do not pay taxes.

Hospital charges are
opaque to everyone, including physicians. Physicians generate the services
hospitals charge for.

As seen in Steven Brill’s
article oncology charges are extremely high.

One oncologist wrote to me
and said he could administer the same therapy in his office for one-tenth the hospital

However, neither the government nor the healthcare insurance industry
would reimburse him for the office procedure. It is the same procedure he performs
in the hospital.

Doesn’t that seem strange? What is going on?

Steven Brill discovered
that it is almost impossible to find out what hospital systems are charging.

The same opacity is true
for pharmaceutical charges.  The
pharmaceutical charges are further inflated by multiple middlemen involved in
drug distribution.

This has been less true
for drugs since Internet Drug stores publish drug prices.

However, since the patients’
physicians prescribed the drug patients are hesitate to use substitute drugs.
The patients’ attitude is that the healthcare insurance company will pay for
the drug less the copay.

Therefore the patients are not interested in looking
up the difference in price or the options for substitution.

This is the reason consumers need skin in the game.

The result of consumer apathy is an increase
in healthcare insurance premiums.

Steven Brill covers the
grotesqueness of retail hospital system charges. He also points out the amount
Medicare reimburses for the grossly inflated charge.

The consumers without
insurance are the consumers that get stuck with the retail charges. Insurer consumers recieve a large discount.  The uninsured
consumers are least likely to be able to afford these charges.

In some cases Medicare
reimbursement is less than 20% of the hospital retail charge. Steven Brill
points out that at this time Medicare reimbursement to hospitals is still 10
times its actual costs.

The article “Bitter Pill” is
excellent. It covers many categories of hospital system abuse by the use of
case studies.

The facts are
overwhelming.  I am going to try to
categorize these facts in my next blogs. The abuses will be easier to remember.

Consumers must be educated.
The hope is consumers can be activated by education. Only a consumer driven
healthcare system can drive the abuse out of the healthcare system. 

Americans will have an affordable healthcare system.

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

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Why Not Avoid The Financial Problems?

 Stanley Feld M.D.,FACP,MACE

It is
very clear to me that neither the Obama administration nor the senate wants to
solve the root causes of the federal deficit problem.

sequestration debates are not getting to the root causes of the deficit. Eighty
five billion dollars will not make a dent in America’s 16 trillion dollar
budget deficit.

Obama is running around the country scaring everyone with the notion that vital
services must be cut or else the country will be paralyzed.

the congress and the President appropriated $60.2 billion dollars for aid to
Sandy victims. This is almost as much as the sequestration is going to

The Senate voted
Monday to provide $50.5 billion in aid for victims of Superstorm Sandy
. The
vote means Congress has approved a total of $60.2 billion in aid for Sandy

big deficit problem is created by out of control entitlement programs. Obamacare
is adding to entitlement spending. It will only increase the deficit.  

politicians’ should be working hard to figure out a solution to increasing entitlement
spending. Yet the Obama administration has refused to consider entitlement

two largest entitlements are Medicare and Social Security. Food stamps, and unemployment
insurance, among others has some impact on the deficit.

reforms and a decrease in waste could solve the problem.

following two articles summarize the illusion of the existence of Social
Security and Medicare Trust Funds

reality the money goes into these trust funds from payroll withholdings. The
government then borrows the money to pay general expenses. It provides an IOU
to the trust funds. In essence the trust funds are broke and the IOUs are an
unfunded liability of the federal government..

“And since the
federal government borrows the surplus from both funds (Social Security and
Medicare) to pay other expenses, the only thing in those trust funds own
special, non-negotiable, interest-bearing IOUs.”

In order
to pay Social Security and Medicare obligations the government shifts revenue
of current accounts into the trust fund accounts.

paying into Social Security and Medicare all those years thought they were
paying for a retirement annuity. The assumption was the money would grow with
wise government investments and those funds would be able to pay their promised
liability to seniors.

payments were really a disguised tax. As baby boomers become eligible for
Medicare and Social Security the obligation is increasing.

is reaching the point where more people are receiving these entitlement
benefits than the younger people who are funding them.

The logical result is the premium price for
Medicare coverage is scheduled to double in 2014. The deductibles for services are
scheduled to increase. The age requirement for eligibility is about to rise.  Access to care is decreasing as physicians
refuse to take Medicare. Rationing of care is increasing as hospitals are being
forced to assume risk. No one wants to assume the risk of taking care of sick
people. Especially when they are not very good at evaluating the risk.

knows all of this. Nevertheless they turn away as the government either borrows
more or prints more money.

have been told by multiple administrations that citizens could not handle their
own Social Security or Medicare annuity very well. Therefore the government
must do it for them.

government has done an awful job managing our retirement annuities.

Security and Medicare Trust Funds must become real trust funds that grow in
value in the future or the government should hand control over to the people.

The Obama
administration refuses to believe the significance of defensive medicine.
Defensive medicine’s cost to the healthcare system is somewhere between 300 to
700 billion dollars a year.

The Obama
administration’s estimate is it costs 3 billion dollars a year. They are wrong. Ask any physician.

should physicians or hospital systems assume the risk of missing a diagnosis by
not doing a test?

emotional and financial consequences of a frivolous lawsuit can be devastating.

and fair tort reform will save the healthcare system around 500 billion dollars
a year.  The 500 billion dollars is more
than 5 times the cost of the 85 billion dollar sequestration. The administration
is wasting 500 million dollars to protect the business of malpractice trial

administration claims its overhead for Medicare is only 2 ½ %.
This represents
the cost to pick an insurance company to adjudicate insurance claims. The true
cost is not clear. However, it is somewhere between 40-60% of every Medicare
dollar spent.

insurance company is permitted by the government to pack many expenses into the
direct patient care column and avoid going over the 15% medical loss ratio

The ten
hidden taxes written into Obamacare are now starting to be felt
. The Obamacare taxes
are going to increase the cost of medical care not decrease the cost as the
affordable care act promises. 

are directly responsible for many of their own medical outcomes
.  If patients had skin in the game and
financial incentives they would pay attention to their self -care and their
physicians’ recommendations. 

There are
no incentives in Obamacare for patients to manage their care effectively.
Financial gain would get their attention.

These are
just a few of the solutions to the real problems in healthcare. There is much
more waste in federal spending than $85 billion dollars a year.

All you
have to do is look at the list of extraordinary waste
that Senator Tom Coburn
has compiled

Rand Paul
did a clever thing. He sent $600,000 of his senate office budget back to the
U.S. Treasury
after carefully trying to save money. The 49 other senators and
over 400 congressperson ought to do the same. It would set an example for all
of the bureaucracy to do the same. In fact President Obama ought to demand it.

Kentucky Republican returned $600,000 in funds he saved from his Senate office
budget in the last year, the 
Louisville Courier-Journal reported.

the only budget I control,”
Paul said at a news conference in Louisville. “It’s
not enough, but it’s a start.”

If every
congressperson saved 600,000 a year as Rand Paul did the deficit would be
reduced by $321 million dollars more a year. If all the cabinet positions and
their agencies tried to save money and were rewarded for saving money we would
start to make some progress in decreasing the deficit.

The Simpson
Bowles Report commissioned by President Obama would be helpful in eliminating
unnecessary agencies and duplication.
Their report has been ignored by the
Obama administration.

Why has
President Obama refused to listen to people who have exposed the many areas of
government waste? It is incomprehensible.  

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

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My First Date With Cecelia



Cecelia and I are
approaching our 50th wedding anniversary. We were married on June

Our first date was on March
31,1959. March 31st has been a magical day for me.

I had my Bar Mitzvah on March
31st even though my birthday is March 17th.   

and I became engaged on March 31st

I all began with my Aunt
Anna. My aunt Anna was a friend of Cecelia’s mother. Aunt Anna met Cecelia. She
liked her. She told Cecelia’s mother she had the perfect boy for Cecelia.

Cecelia did not need to be
introduced to any boys. At 161/2 years old she was already a
beautiful woman.

Aunt Anna was a persistent
woman. She bothered my brother Charlie at least 3 times a week for months to
call Cecelia and take her out.

My brother was a senior in
high school. He played on the high school’s basketball and baseball team. He
was a big man on campus. In addition to all of that he had a steady girlfriend.

He had no time or interest
in taking Cecelia out.

My family lived in a small
three story attached two bedroom house. My brother and I shared a bedroom. One
night he asked me to help him get Aunt Anna off his back.

He asked me to take Cecelia

I said sure. I made a date
to take her out for pizza on a Wednesday night. I took her to the Pizza Parlor
on Boston Post Road and Gun Hill Road in the Bronx. The Pizza Parlor is gone

Years later I found out that
she was not impressed with the pizza. She was impressed with my father’s baby
blue 1959 Pontiac Bonnieville convertible and its gigantic fins.



I fell in love with Cecelia
at first sight.

She was beautiful in her
blue button down shirt and jeans. She was very intelligent. She had many
interests. She was a great conversationalist.

I dated many girls in high
school and college. I was never as impressed as I was by the brightness of this
woman. As my father would say, I was smitten”.

Cecelia was going to High
School of Music and Art. We had many of the same interests.

At Columbia College I was a
pre-med with a concentrates in chemistry and fine art.

Columbia College was my first
exposure to fine art and its history. At that point Cecelia knew as much or
more about the arts than I did.

Her élan blew me away.

When I got home that night I
told my brother I thought I would be marrying Cecelia.

He looked at me as though I
was nuts. We then turned the light off and went to sleep.

The rest is history. Cecelia
and I have had a wonderful trip through life together. We have always had mutual
respect for each other. We have grown in life together by cultivating mutual
interests. We have supported each other’s dreams.

Cecelia has always been my
heroine. I know I have always been her hero.

We raised two sons, Daniel
and Brad. When I think about it, they are a combination of both of us in
different proportions.

Daniel and Brad are fine men
and dedicated husbands. Both are married to wonderful women.  Cecelia and I are very proud of them.

As Cecelia and I approach
our 50th wedding anniversary with a great family, I can only think
of the corny phrase my mother used
over and over again when she was alive and the family was together,

“My cup runneth over”.

It was a very lucky first date.

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

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Why Obamacare Will Fail

Stanley Feld M.D.,FACP,MACE

Obamacare will fail because none of the stakeholders’ vested
interest are aligned.

The storm is brewing in the healthcare system.

Even Democrats are concerned.

Recently, I have been criticized for blaming the impending failure
on President Obama. President Obama would rather blame the impending failure on

 A reader wrote;

“President Obama is a nice
guy. He is trying very hard. Give him a chance.”

It is true. He seems like a nice guy. My criticism is not personal.
The fact is his philosophy and tactics are responsible for the mess. As time
goes on it seems more likely that Obamacare will not work out.

There are multiple reasons for the impending failure. A major
reason is Obamacare is developing new perverse incentives for stakeholders
rather than aligning all the stakeholders’ vested interests.

Obamacare is extraordinarily complex. It is confusing to all the stakeholders,
 especially as new rules and regulations
are being written.

By forcing the development of programs such as health insurance
exchanges, accountable care organizations, pay for performance plans,
functional electronic medical records, and the consolidation of healthcare
hospital systems and physicians against their will, Obamacare is creating
tensions and uncertainties that will be difficult to overcome.

Patients’ medical care and their relationships with their
physicians are personal issues. Obamacare is commoditizing medical care. It is
destroying the patient physician relationships. These relationships account for
at least one half of the therapeutic effect of medical treatment.

The 2300 page law usurps the power of the legislative branch of
government and shifts it to the executive branch. This is dangerous. It has
created additional tension and uncertainty for the nation.

Many congressmen who voted for the law did not read the law’s 2300
pages. The implications of much of the law were not understood. It did not have
bipartisan support.

In 2012, the executive branch of the federal government issued another
70,000 pages of guidance for participants in Obamacare. The executive branch
has created at least 22,000 new regulations and 68,000 new ICM codes.

The more complex a law becomes the more likely it is to be unsuccessful.

There is no question the healthcare system nears repairing. Healthcare
costs are exploding. Waste and bureaucracy are expanding.  Dysfunctional interactions between
stakeholders are mounting.

All of this results in an inability to deliver effective medical

At present 55% of Americans of all ages receive healthcare
insurance through an employer sponsored healthcare plan. An additional 32% receive
healthcare insurance through government programs.

Thirteen percent (13%) of the population are uninsured or under
insured. Obamacare’s goal is supposed to provide healthcare insurance for that

Present predictions are that Obamacare will not provide universal
care. It is predicted that it will not save $850 billion dollars. The CBO, on
the basis of numbers provided by the administration,
predicted the law would
save $850 prior to the passage of the law.  The CBO’s current prediction is Obamacare will
cost the nation an additional  $1.2
trillion dollars over 10 years.

Healthcare insurance rates are rising by double digits each year.
Employers are passing the costs of the increasing insurance rates to their
employees through higher deductibles and copays along with lower healthcare
coverage plans.

 Obamacare will require
employers, who offer skimpy healthcare benefits such as Mini-med insurance, to
provide more robust ones.

To date the Obama administration has waived more than 2000
employers from providing more robust healthcare insurance coverage. At the time
these waivers expire companies with waivers, such as McDonald’s, will scream
bloody murder.

They will opt out of providing any healthcare insurance at all and
avoid government penalties. They will accomplish this by decreasing the number
of hours an employee will work to less than 30 hours a week. This is not good
for minimum wage workers. The uninsured rolls will increase.

The penalty of $3,000 per employee is less than the $15,000 healthcare
insurance cost per employee for employees working more than 30 hours a week.

Surveys have been published concluding that more than 50% of
employers are planning to drop healthcare insurance coverage.

The federal government is trying to discourage this by invoking
the IRS anti-abuse rules;

“The IRS has indicated that anti-abuse rules
will be implemented to curtail the use of Obamacare loopholes to
dodge the play or pay requirement.

  Yet as
some have already questioned, can the IRS legitimately utilize rule-making to modify
core components of a federal act? Or will this rule-based clean-up effort
simply spawn more lengthy litigation?”

Obamacare’s health insurance exchange program is in big trouble.
Less than half the states have signed up to participate.

 States have opted out
because of the potential cost overruns. States are struggling to balance their
budgets. The federal government is only going to pay for health insurance
exchanges’ development and execution for the first two years.  The cost burden will then fall on the states.

The federal government keeps extending the deadline for states to
sign up. The federal government does not have infrastructure or manpower to set
them up.

The health insurance exchanges are supposed to be up and ready to sign
up consumer up in October 2013 and operating in January 2014.

Physicians do not know what to do about Obamacare. Physicians feel
helpless. They know Obamacare cannot work. Physicians do not have a leadership
organization that can direct physicians to have an effective voice.

Accountable Care Organizations (ACO’s) will fail because physicians
are trained to use medical judgment. They have not been trained to obey the
rules of hospital administrators.

They bristle when their value is determined by hospital systems or
federal agencies such as IPAB. They prefer to have their value determined by
their patients.

Physician leadership needs a new mentality to enable physicians to
act and articulate  the steps needed to
be taken to repair the healthcare system.

Physicians want the healthcare system to function equitably for
all the stakeholders and effectively for their patients.

Medical organizations have been consistently losing membership
because it has not represented or articulated the needs of practicing

If Obamacare works as President Obama hopes, he will have secured
his legacy and solved the long-festering problem of the uninsured.

Obamacare will not solve the problems of increasing healthcare
costs nor provide universal care in its present form. This has been a pipe
dream all along.

Another reason Obamacare will fail is because it does not consider
the cost of defensive medicine significant. President Obama is not interested
in tort reform.

Obamacare doesn’t align any of the stakeholders’ vested interests.

When Obamacare fails it will provoke a citizen backlash that will
be very difficult to overcome.

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

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Patients’ Responsibility And Hospital Readmissions

Stanley Feld M.D.,FACE,MACE

has rules to penaliz
e hospital systems if a patient was readmitted to the
hospital before 30 days of initial admission.

Prior to October 1,2012 Medicare revised hospitals' readmissions penalties
. On October 1 Medicare started fining hospitals
that have too many patients readmitted within 30 days of discharge due to
complications of their disease.

The formula for determining these penalties is
extremely complicated
. The formula is almost impossible to understand.   

Hospitals whose admission rates are above the
national average will be penalized. The data analytics are supposed to risk
weight patients to see if the hospital should be penalized.

Patients with multiple co-morbidities have a higher
chance of readmission.

The penalties are part of a broader
push under President Barack Obama's
health care law to improve quality while
also trying to save taxpayers money.”

The gigantic perverse incentive is for hospitals to
avoid the initial admission of sick patients with multiple morbidities. Those are
the patients that have a better chance of being readmitted within 30 days.

It is also impossible to evaluate quality of medical
care using claims data. False  conclusions will not be a true reflection on who
is at fault and should be blamed and penalized for the readmission.

 It could be
that patients did not adhere to the discharge instructions.  

two-thirds of the hospitals serving Medicare patients, or some 2,200
facilities, will be hit with penalties averaging around $125,000 per facility
this coming year, according to government estimates.”

The formula for penalty
assessment  is extremely complicated. The
Centers for Medicare & Medicaid Services has discovered errors in its
initial calculations in August 2012.  

one in five Medicare patients return to the hospital within a month of
discharge, costing the government an extra $17.5 billion in 2010.”

A total of 2,217 hospitals are being
punished in the first year of the program, which began Oct. 1. Of those, 307
will be docked the maximum amount: 1 percent of their regular Medicare

Only acute myocardial infarction,
congestive heart failure and pneumonia will be evaluated the first year.


Overall, Medicare has estimated it will recoup about $280 million
from hospitals where it determined too many heart attack, heart failure or
pneumonia patients returned within 30 days

Dartmouth Atlas of Health Care and the Robert Wood Johnson Foundation latest
report "The Revolving Door Syndrome on
hospital readmissions points out highly variable rates.

Ninety two (92) academic
medical centers and 37 hospitals saw readmission rates for their patients
actually increase. 

                                               Double click to see legend

David Goodman, MD, co-principal investigator
for the Dartmouth Atlas Project said
. "Despite
awareness of the problem, progress and improvement has been slow."

report divided readmissions into two types, those affecting patients whose
first admission was for a surgical procedure and those affecting patients whose
first admission was for a medical condition such as congestive heart failure,
pneumonia, or heart attack.

The surgical 30-day readmission
rate dropped from 12.7% in 2008 to 12.4% in 2010, while the medical 30-day
readmission rate went from 16.2% to 15.9%.

The report shows wide
among academic medical

“The highest readmission rates in 2010 were the
Cleveland Clinic, with 21.6%
, and the Hospital of the University of
Pennsylvania, with 21.4% among AMI, congestive heart failure and pneumonia.

The hospital with the lowest rate was NYU Langone Medical Center, with
14.4%. “ 

The University of
Medicine and Dentistry in New Jersey (UMDNJ) had the highest surgical
readmission rate with 20.7%, and the Stony Brook University Medical Center on
Long Island, with 20.6%.

If this data is correct
academic institutions will not be in the mood to be penalized for taking care
of sick patients.

Other studies have shown
that there is only a 50-60% adherence rate by patients to prescribed treatment.
This lack of adherence can be a significant driver to readmission rates. There
is no data evaluating patients’ role and responsibilities in re-admission

What are patients’
responsibility for their care? If patients do not receive enough education to
avoid hospitalization they should demand the education.

If patients are not
interested in self-management of their disease they should tell their

If the patient is too sick
to learn to self-manage a family member should be involved.

Patients have responsibility
for their self management to avoid readmission is high!

Yet the government is quick
to blame hospitals and physicians for high re-admission rates without examining
all the facts.

Another factor not
evaluated in determining readmission rates is the pressure on the hospitals to discharge
patients quickly.

doctors feel they are caught in a squeeze play
," the report says.
"Hospital administrators carefully monitor length of stay—they are eager
to send people home because the longer a patient stays, the less money they
make. Thus providers said that the prevailing pressure is to discharge
patients as early as possible" even if it's too soon.”

is the slippery slope the healthcare system is on. The data management is
faulty. The government is not evaluating all the complex variables resulting in
hospital readmissions. This defect leads to faulty decisions. Those decisions
lead to more complicated unintended consequences.

should be driving the healthcare system not the government. The government
should make the rules to level the playing field for all stakeholders.

government should defend the interests of patients.

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

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A Wonderful Thing Happened Last Week

Stanley Feld M.D.,FACP,MACE

Dr. Benjamin Carson gave the keynote address at
the National Prayer Breakfast. Dr. Carson is the director of pediatric
neurosurgery at  John Hopkins University
in Baltimore.

He is the son of an single mother. He grew up
living in poverty. He hated poverty. Among the things his mother taught him
were that excuses were not acceptable. Once that declaration is accepted one
can start figuring out solutions.

The You Tube of his speech is entertaining, riveting
and inspirational. Only 18,000 people have watched the You Tube so far. I
believe this speech should be watch by every American for its inspirational

If the media is the message people watching
this You Tube should play close attention to President Obama’s body language
during the delivery of Dr. Carson speech..

One commenter noted;

Worth watching this 26 minute
video. Interesting to watch the president grimace as he gives a complete
opposite solution to every problem the country faces. One smart pediatric brain

Every topic Dr. Carson covered pointed out the
potential greatness of Americans. He makes a strong case for the solutions to
the many problems America faces.

Embedded in each solution to each problem is
individual responsibility and not government dependence.


He makes the case for self-respect and
self-reliance.  He makes a plea for the  respect for others’ opinions whatever their
political or religious leaning.


Carson’s solution to the healthcare system can be found at the 20-minute point
in the You Tube.

covers the solutions to the problems education, the tax code and several other
problems we face. Some will say he is simplistic. I implore those who say he is
simplistic  to think about the potential
liberating power of his solutions as opposed to the potential freedom
stifliling solutions of big government.

Government must be a facilitator not a dominator.

Dr. Carson reminds his audience that five (5)
physicians signed the Constitution and the Declaration of Independence. He says
America needs physicians to speak out now and not worry about being politically
correct (PC) in our PC world

Dr. Carson says,

“Here's my
solution to the healthcare systems problem:
When a person is born, give him a birth certificate, an electronic
medical record, and a health savings account to which money can be contributed
– pretax — from the time you're born 'til the time you die. When you die, you pass
it on to your family members, so that when you're 85 years old and you got six
diseases, you're not trying to spend up everything. You're happy to pass it on
and there's nobody talking about death panels.

Number one.
And also, for the people who were indigent who don't have any money we can make
contributions to their HSA every month because we already have this huge pot of
money. Instead of sending it to some huge bureaucracy, let's put it in their
HSAs. Now they have some control over their own healthcare”.

Funny, isn’t it?

This is exactly what I have been saying the
past six years as our healthcare system has been becoming more complex, more
dysfunctional, more costly, more controlling and more bureaucratic.

This is the advice I gave President Obama in
six letters as President-elect and in the early weeks of his presidency

Obamacare is a ineffective patch on a
dysfunctional healthcare system. It has generated thousands of new regulations
that will be costly and difficult to comply with. The new regulations will be
impossible to enforce even though there have been 18.000 new IRS agents hired
to enforce them.

Dr. Benjamin Carson has injected common sense
into the national discussion without trying to offend anyone.

The key is to get politicians to listen to him.
If you agree, please send this on to people you know.

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

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“What A Revoltin’ Development This Is !!”

Stanley Feld M.D.,FACP,MACE

President Obama stated that he believes that deficit
spending is harmless. It follows that any amount of deficit spending will do no

President Obama rhetoric causes him to contradicts


The Life of Riley, with William
 in the title role as Chester Riley, was a
situation comedy on radio in the 1940s and early black and white television in
the 1950s.

Chester Riley always inserted his exclamation of indignation about a
situation he experienced into in the comedy,

"What a revoltin' development this

The statement became one of the most famous catchphrases in American popular culture.


 Americans find
themselves in a similar situation weekly just as Chester did in the 1950s

In the CBO's analysis of the
president's preliminary 2013 budget, the spending is $3.72
trillion. The CBO predicted that collections will be $2.5 trillion dollars. The
CBO predicted that there will be a $1.22 trillion dollar deficit added to
America’s debt in 2013.  

If the economy slows as many predict the projected deficit get

On February 5, 2013, a day after President Obama missed his budget
due date, the CBO revised its preliminary prediction.

The CBO said the deficit spending for 2013 would be reduced from a
predicted $1.22 trillion to “only” $845 billion dollars without a decrease in
unemployment, a decrease in government spending or an increase in the 1.2%
growth of the economy.

This decrease in deficit spending is a result of the increase in taxes
January 1,2013 to avoid the fiscal cliff.

The reality is that
President Obama is increasing government spending yearly.   

“Obama's yearly budgets are record-breaking.

Here's a
summary of a fact-check analysis:

The correct figure to use is the CBO's analysis of the
president's 2013 budget, which clocks in at $3.72

So this is what we end up with: 

2008:  $2.98 trillion 

2009:  $3.27 trillion

2010:  $3.46 trillion

2011: $3.60 trillion

2012: $3.65 trillion

2013:  $3.72 trillion”

“Starting in 2008 as the base year and ending
with 2012, the compound annual growth rate for Obama's spending starting in
2009 is 5.2 percent.”

Obama's deficit-to-
Gross Domestic Product
(GDP) ratio is huge. Democrats and the traditional media complained that George
W. Bush was overspending.

 George W.
Bush’s overspending was tame compared to President Obama’s.

“George W. Bush

2001-08 2.0
2002-09 3.4
Average 2.7

Barack Obama

2009-12* 9.1
2010-12 8.7
Average 8.9

*Fiscal 2012 ends Sept. 30, 2012, so this figure
is estimated”

 The median annual income has dropped in the last 4 years under President Obama’s

“Using constant 2012 dollars (to adjust for
inflation), the median annual income of American households was $53,718 as of
June 2009, the last month of the recession.
  Now, after 38 months of this
"recovery," it has fallen to $50,678 – a drop of $3,040 per

Senate, controlled by Democrats, voted unanimously against Obama's 2012 and
2013 budget proposals 0-97 and 0-99 respectively. The House of Representatives
voted 0-414.

Both the Senate and the House knew that
continuing deficit spending is economic suicide.

The U.S. government’s economic problems are
never solved by increased regulations.

Regulations costs the government billions of dollars
to write and execute. It also costs businesses additional billions to comply
with new regulations. This spending detracts from investments in economic

Regulatory costs have skyrocketed during the
Obama administration.

The costs of regulations have more than doubled since
President Clinton’s administration and tripled President George W Bush’s
administration.  The present regulatory
costs are almost double the combined costs of Presidents Clinton and Bush.

What does this have to
do with Repairing the Healthcare System?

The massive increases in healthcare regulations
are distorting the physician-patient relationship. They are commoditizing
medical care.

The result is large increases in healthcare
costs for consumers. The increases are occurring long before Obamacare has been
fully implemented.

The administration’s regulations have not
touched on the major causes of the rising costs in the healthcare system. The
top two causes are defensive medicine and the need for tort reform and
effectively challenging the abuse of the healthcare insurance industry.

The short-term effects will be devastating to
the delivery of medical care to patients.

The long-term effects are not being talked

are blamed for the rising medical costs. Each year the government threatens
physicians with a 25-30% reduction in reimbursement.

collect only 10% of the total healthcare dollars spent. A major question is
what is the rest of the money being spent for?

do you measure the value of physicians’ services? Medicare and Medicaid pay
physicians a small percentage of the value for their services. 

Obamacare is fully implemented payment to physicians will be lower. Physicians
will be responsible for their financial performance and penalized if
performance is poor.

“When people
don't get paid adequately, the quality of their work suffers over the long
haul.  The best and brightest would-be doctors 
won't sign up for medical school when they figure out they
won't get paid enough.”

Another option is that physicians will unionize.
They will hire effective negotiators to be paid their true value.

Obamacare’s hidden taxes are fudging our real
unfunded obligations. The ballooning deficit will slow our economic growth. Millions
will remain unemployed and uninsured.

The Independent Payment Advisory Board's cost-cutting measures will ration medical care. The board will decide what
treatment is worthy of reimbursement not the consumers of

“ Remember
the recent replacement refs for the NFL?  The NFL went downhill, and the
fans booed and demanded a change.

replacement doctors in our medical care.”

Healthcare consumers are confused and angered
by swiftly rising premiums and high deductibles, according to focus groups in four U.S. cities conducted by researchers for the
Robert Wood Johnson Foundation.

These focus groups were likely to question
physicians’ recommendations and compare costs and quality information just like
shopping for a car or a TV set. They knew their costs “practically down to the

Consumers are not stupid!

They are starting to say, as Reilly did on his
weekly sitcom,

“ What a revolting development this is.”


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

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Unintended Consequences Mount

Stanley Feld M.D.,FACP,MACE

On January 1, 2013, as part of the law
to delay the “Fiscal Cliff” congress and the President delayed the Doctor fix
for another year.

The Medicare Sustainable
Growth Rate
is a method currently used by the Centers for Medicare and Medicaid Services (CMS) in the United States to
control spending by Medicare on
physician services.

In the last several years
the SGR calculated reductions in physician reimbursements have been delayed.
The yearly percentage reduction has been cumulative over the last five or six

The percentage reduction
for 2013 was supposed to be 29%. The cumulative reduction due in 2014 will be
over 30% unless the SGR is permanently fixed.

The formula for the yearly
SGR reduction is complicated and defective. Physicians’ reimbursement for
service has been reduced over the years so that a 29% reduction in Medicare’s
physician reimbursement would surpass physicians’ overhead costs for providing
their service. 

Physicians could not stay
in business if it cost more to service patients than they would be reimbursed.
Physicians accepting Medicare cannot charge more than the law permits.

Therefore, with the threat
of massive reductions, more and more physicians are opting out of Medicare.
These physicians will serve Medicare patients but the patients have to pay for
the services out of pocket.

In the past patients would
send their paid bill to Medicare and receive reimbursement for Medicare
allowable fees.

The administration’s goal
is to force all physicians to participate Medicare. A new administration
regulation eliminates direct Medicare reimbursement to patients for services
provided by physicians that do not participate in Medicare.

The losers are seniors on

I predicted there would be
a mass exodus of physicians from the Medicare program.
if the “Doc Fix” were
not enacted for 2013. Physicians opting out of the Medicare program would put
an added burden on seniors.

Physicians are happy that the reimbursement cuts have
been delayed for another year because they want to be able to service their patients
without putting an additional burden on them.

The government postponing the cut for another year continues
to frustrate physicians because they have to face the same uncertainty next

Neither congress,
physicians nor the administration support the present SGR formula. However the
government is unwilling to spend $200 million dollars to fix the SGR formula.

This year hospital systems are being
forced by the government to receive less Medicare reimbursement in order to pay
for half of the cost of the temporary “Doc Fix.” Hospital systems are not very

Texas hospitals have already
faced painful cuts,” said Dan Stultz, president and chief executive officer of
the Texas Hospital Association.

“Although addressing the
Medicare physician payment formula is imperative, cutting reimbursement to one
health care provider to pay another is shortsighted.

These cuts come at a time when
hospitals are making significant investments in technology and facilities to
provide for an aging population.”

Hospital systems claim they continue to struggle with
past decreases in Medicare and Medicaid reimbursements.  Government reimbursement represents about 60
per cent of hospital system’s revenue. Hospital systems assert that decreasing
one healthcare providers (physicians) reimbursement to pay for delaying the
“Doc Fix” is coming at a time when hospital systems are struggling for survival.

These cuts come at a time
when hospitals are making significant investments in technology and facilities
to provide for an aging population.”

Patients who have recently been in the hospital
recently uniformly complain about hospital bills and hospital co-pays.

When patients study the “Explanation of Benefits (EOB)” carefully they complain about being
billed for procedures they did not receive.

Most hospital bills are impossible to interpret.

Patients also complain about the high salary of
hospital CEOs. These salaries are usually published in local newspapers.

 The high
salaries paid to the multitude of hospital administrators are not available to

The way hospital systems report their expenses are
not available to the government or consumer protection groups either.

The government should not take the hospital systems
word that the hospitals are losing money because of expenses and low reimbursement.

I suspect there is a great deal of waste, overpayment
and duplication that the government could question.

If all of these expenses are justified the government
should reimburse hospital systems for expenses and provide them with a
reasonable net return. The government should not indiscriminately cut

There are a lot of dysfunctional activities in the
healthcare system. The dysfunction is a result of massive regulations that are

It is important to find the root causes of the
dysfunction. The administration should help hospital systems fix the dysfunction
rather than penalize them indiscriminately.

Hospital systems have already been adjusting to these
stresses. They are consolidating and forming regional monopolies in the name of

The result of eliminating hospital competition will
only increase the costs of hospitalization for patients.

Hospital systems are also buying physicians practices
at an alarming rate. Physicians want to practice medicine and not deal with all
the complicated regulations.

 Once these
physicians realize that their independence and intellectual freedoms are
compromised there will be further unintended consequences.

 If the
administration does not help fix the dysfunction hospital systems will figure
out a way to decrease the impact of the cuts.

The unintended consequence will mount. The cost of
the healthcare system will escalate while the healthcare system will become
more dysfunctional.

The burden of cost increases due to this dysfunction
will fall on Medicare and Medicaid recipients.

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




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