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All items for May, 2014

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Keeping Obamacare Out Of The News

Stanley Feld M.D.,FACP,MACE

President Obama has tried to keep the bad news about Obamacare from us.  The bad news concerning errors in design and execution are being recognized daily. The administration has not published the demographic figures of those who enrolled in Obamacare yet.

It is going to be impossible for the administration to keep Obamacare implementation errors out of the news. Even the traditional media, big Obamacare fans, are starting to realize the huge defects in Obamacare and the hardships it is about to bring.

The defects are becoming obvious because they are affecting the majority of the working middle class signed up through the health insurance exchanges. 

Bureaucracy has created evaluation of care panels. While the panel members, most of them clinicians, agreed that a study could be impressive in its implementation and results, they have concluded that some studies were not good enough to recommend a new coverage policy to the CMS.

The members of the committees are usually not the most expert in the field they are evaluating. Thus, access to care through government coverage is denied when it should not be.

I previously gave the example of Medicare’s discussion to not pay for lung cancer screening even though the U.S. Preventive Services Task Force made the following recommendation based on their review.

"Smoking-related lung cancer kills about 130,000 Americans each year. The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease. The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented."

The USPSTF is not the ultimate authority in my view, but even using it as the ultimate authority Medicare ignores its recommendation because of the cost burden.

The Affordable Care Act (Obamacare) has touted Preventive Services.

What is the meaning of Preventative Services?

I guess it is to prevent diseases from occurring.

I believe if we could prevent obesity, stop cigarette smoking and alcoholism we could prevent a lot of diseases from occurring.

However, patients are the only ones' who can only prevent these diseases from occurring.
 

If we could genetically type diseases and alter those genes we could prevent the disease from occurring. This would relieve individuals of their own responsibilities.

The government defines Preventive Services as identifying disease by screening for disease in people who have no signs or symptoms of disease. 

The idea of screening patients for diseases is to make the diagnosis early enough in a disease process so that when treated early patients can be cured. 

In other words, a 40 year- old woman can have a free screening mammogram.

If the same woman notices a breast lump by self-examination and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram.

The mammogram can be as much as $300. With a high deductible Health Insurance Exchange plan she would pay out of her pocket because of the high deductible.

It means that a woman with no breast lump and at lower risk for cancer has incentive to be tested because it is free while the woman with a lump at higher risk of cancer faces financial disincentive to get a mammogram.

Isn’t that a little crazy? That’s the problem with giving patients things for free under different circumstances.

Subsequent interventions are an integral part of all screening. Were I a mammographer, I’d happily argue that additional mammographic views, ultrasounds, M.R.I.s and breast biopsies are all part of screening.”

This decision should not be made by the by a committee of non-experts. Individual patients should make these decisions after discussion with their physicians.

This is a defect in the bureaucratic definition of Preventative Services. Should the government provide the entire work up free?

A crazier example is a 50 year old undergoing a screening for colon cancer.

If a patient had a fecal test for occult blood for screening for colon cancer and it was positive, the patient would have to have a colonoscopy. Occult blood screening is inaccurate. It is cheap and free. It has a lot of false positives.

If the patient had an initial colonoscopy for screening it would also be free according to the Obamacare rules.

If during a colonoscopy a polyp were found the screening test would be reclassified as a diagnostic test. If it were a diagnostic test patients would have to pay for it. It would be an out of pocket expense for the patient on Obamacare making over $50,000 a year.

The outcry caused the government to change the rule. The polyp biopsy would be part of the colonoscopy and still be free to the patient. Do not forget someone is paying for it.

Medical decisions should not be made by government rules. Patients should make the medical decisions for themselves with the advice of their physicians.   

If patients had control of their health care dollars with the ideal medical savings account they would become true consumers of healthcare.

Patients would become responsible for making the decision on when to screen and what diagnosis to screen for and how often to screen for disease.

Patients would have to have the information to make those decisions. With the state of the information available and their physicians’ help responsible patients can make those judgments.

Patients have to drive the healthcare system. The government should be concentrating on setting up systems to teach patient how to be educated purchasers of healthcare.

The confusion created by confusing and ever-changing rules puts an emotional and a financial burden on all stakeholders.

Some use the argument that patients are not smart enough to be responsible for they health and healthcare dollars. It is their reason for totally free healthcare for all.

I believe this is disrespectful to our intelligence and our ability to learn to survive.

Paul Krugman a devoted liberal/progressive has shown little respect for the average Americans’ intelligence.

In my view Paul Krugman has been wrong about almost everything. He writes articles of opinion for the New York Times that are not based on any facts.

In 2011 he wrote an article  “The VA Is A Huge Policy Success Story’

Paul Krugman wrote;  “The V.H.A. is a huge policy success story, which offers important lessons for future health reform.”

And yes, this is “socialized medicine”.  But it works — and suggests what it will take to solve the troubles of U.S. health care more broadly.

Where is Paul Krugman’s evidence?  The VA healthcare system didn’t work in 2011 and it doesn’t work today. The VA produces nice reports that do not have anything to do with reality.

There is much to write about the recent VA problems.  I promise to get to these problems shortly.

The lessons to be learned from the VA’s problems are these problems a precursor to the Obamacare problems.

I fear this is what the American public is going to be facing as the Obama administration tries to implement Obamacare.

Obamacare is a terrible business model. America cannot afford this business model that is destined to failure.

A effective business model is needed which will be advantageous for all the stakeholders must replace it.

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

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What Is Net Neutrality?

Stanley Feld M.D.,FACP,MACE

Net neutrality is the idea that broadband operators shouldn't be allowed to block or degrade Internet content and services–or charge content providers an extra fee for speedier delivery or more favorable placement.

In November 2011 I wrote about the government attempt to control the Internet Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261).

  The title of the article was “The Government and American Censorship: 1984 in 2011.”

I searched the New York Times to see what the newspaper that (“Prints all the news fit to Print”) had to say about the bills. My search produced this reply.

 Your search – Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261). – did not match any documents under All Results Since 1851.

 The most vital part of our economy and job growth at the moment is the Internet. These two bills will destroy this monumental jobs creating machine.

 It is another piece of lunacy brought to you by our federal government. I wonder how many Representatives and Senators have read the bills.

There are two very disturbing bills making their way through Congress: These bills are coated in rhetoric that I find disgusting since at their core they are online censorship bills. It’s incredible to me that Congress would take seriously anything that censors the Internet and the American public but in the last few weeks PIPA and SOPA have burst forth with incredibly momentum, largely being underwritten by large media companies and their lobbyists.”

 Let me remind everyone that large media companies offered huge support to President Obama and the Democrats in congress. These bills are congruent with the large antiquated media”s vested interest and President Obama’s goal of central control over our lives.

EFFFree Software FoundationPublic Knowledge, Progress, Fight, Participatory Politics Foundation, and Creative Commons in support of free speech and a free and open Internet are opposing the bills and have organized American Censorship Day for tomorrow (11/16/11). The goal is to make every American aware of this new trick play and stop this lunacy.

 This video does a great job of explaining the two bills’ potential primary and secondary impact. I do not believe our congressional representatives understand the impact of the bills.

Someone is trying to railroad passage through congress.

 

PROTECT IP Act Breaks The Internet from Fight for the Future on Vimeo.

Both failed to pass in congress because of the overwhelming outcry by the technology community.

President Obama promised the American public he would issue regulations through executive orders and agency powers to enact laws that congress failed to enact.

When President Obama was running for president in 2007 and 2008 he was a strong proponent of Net Neutrality.

At that time President Obama was asked: "Would you make it a priority in your first year of office to reinstate Net neutrality as the law of the land? And would you pledge to only appoint FCC commissioners that support open Internet principles like Net neutrality?"

"The answer is yes," Obama replied. "I am a strong supporter of Net neutrality."

The White House announced: President Obama is strongly committed to Net Neutrality in order to keep an open Internet that fosters investment, innovation, consumer choice, and free speech.  The announced action by FCC Chairman Genachowski, building on the work of Chairman Waxman's collaborative effort to craft legislation in this area, advances this important policy priority. 

 

http://youtu.be/-Lz-bPHojVE

 <iframe width="420" height="315" src="//www.youtube.com/embed/mP01t0Z4Hr8" frameborder="0" allowfullscreen></iframe>

http://youtu.be/mP01t0Z4Hr8

 

In 2014 President Obama hires a lobbyist Tom Wheeler who is a former telecommunication lobbyist. Mr. Wheeler is opposed to Net Neutrality. The president has the FCC issuing regulations that oppose Net Neutrality and transfer great power and a complex bureaucracy to the federal government.

 It represents another broken promise by President Obama.

“Federal Communications Commission Chairman Tom Wheeler went ahead with his proposal on Thursday to give his agency the power to decide whether the terms and prices of broadband Internet services are "reasonable."

 

 

http://youtu.be/km1AhFkt4Dk

This is another power grab by the central government to have control of the Internet. The concept is once again not covered by the traditional media in an understandable way.

As a reaction to satisfy the “Net Neutral” community Mr. Wheeler said the goal is not to have a fast and slow speed Internet no matter how much broadband they consume.

Mr. Wheeler said he prefers the "reasonable" pricing standard. But he also suggested another, even worse option to regulate broadband prices: reclassifying Internet connections as "telecommunications services."

A reader of my blog wrote, "Can you think of anything that the U.S. government does really, really well?" 

“For two decades Congress has wisely refused to give the FCC the same power over the Internet that it holds over the telephone system. And for two decades the Internet has enabled a gusher of creativity that was unimaginable over a century of regulated telephony. “

Regulators from every state will also be able to get into the act. I cannot imagine it will be regulated for the benefit of consumers. There is something strange about all the telecoms companies merging with each other in the past few months.

“Mr. Wheeler's brainstorm to change all this is simply to pretend the Internet is a phone network.”

Since this designation would automatically impose myriad obligations that have nothing to do with current customer needs—and that many modern firms could not possibly fulfill—the commission would then have to issue a flurry of exemptions ("forbearance" in FCC parlance) to prevent chaos in the market for Internet connections.

The FCC is inventing an Obamacare for the Internet. It is enacting an unworkable system upon a system (the Internet).  Then the FCC will have to get busy issuing waivers which will prevent the new system from operating as it was theoretically designed to operate.

 The telecommunication industry will have a field day at the expense of the public.

“GOP Commissioner Michael O'Rielly, who also dissented, notes that the FCC's net-neutrality campaign "rests on a faulty foundation of make-believe statutory authority."

Imagine all the costs, confusion, lawsuits, legal fees, and regulations that will occur to restrict the freedom of the internet and all the innovations in commerce the Internet has created.

The elimination of Net Neutrality is all about increasing government power, restricting individual freedoms and shifting the costs of government’s inefficient control on to consumers.

Anna Eshoe is the ranking Democrat on the Communications and Technology Subcommittee.  She has pointed out that the new FCC wording has not fooled Silicon Valley entrepreneurs.

 Like many Internet users, I fear that the latest round of proposed Net Neutrality rules from the FCC will not do enough to curtail discrimination of Internet traffic, but rather leave the door open to discrimination under more ambiguous terms.”

The new regulations diminish Net Neutrality while empowering government bureaucracy. The online gatekeepers threaten free speech, harm competition and diminish the continued openness of the Internet. The proposed regulations do not protect the freedoms and available to  consumers and businesses in a Net Neutral environment.

Barack Obama promised in the 2008 and 2012 campaigns that he would enforce Net Neutrality. He has not kept that promise.  

The affect on Americans’ freedoms will be as bad or worse than Obamacare.

Please write to your congressmen and President Obama and ask them to preserve Net Neutrality.

Thank you

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

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Another Obamacare Trick Exposed And Backfiring

Stanley Feld M.D., FACP, MACE

The drug industry has been quiet during the Obamacare debate. However, the industry’s lobbying group worked with the Obama administration to get Obamacare.

Why would PhRMA do that when President Obama encouraged everyone to buy generic drugs in order to get full coverage for their drug costs?

It is because President Obama promised PhRMA huge concessions and windfall profits after the health insurance exchanges were successful.

PhRMA is not going to make those windfall profits. When Americans see that the health insurance exchanges are more expensive than the private plans. Only those who cannot buy private insurance because they have pre-existing illnesses will sign up for Obamacare.

This will drive the health insurance exchange premiums higher,cover less, restrict access to care and drugs and ration care.

President Obama provided waivers from the implementation of Obamacare to many special groups except the individual market. Those waivers delayed implementation of Obamacare for one to two years.

The administration was concerned that implementation of Obamacare to everyone would cause a storm of protest that the administration could not contain.

These special groups will lobby for the continuation of those waivers as they realize that premiums and deductibles will be higher in the health insurance exchange market than the private market. 

The profits PhRMA expected will evaporate.  

Consumers not subsidized by Obamacare who bought Silver plans in the individual market through the health insurance exchanges are cooked.

They will pay one and one half to two times the price for drugs next year than they are paying this year.

The government will be paying drug companies for the increased price of drugs for people whose Silver plans are subsidized.

The result will be an increased cost of Obamacare to the public as President Obama redistributes wealth on the backs of the middle class making $50,000.01 or more

How did PhRMA help President Obama get Obamacare passed?

PhRMA paid for the multimillion dollar Harry and Louise ad campaign on TV during the debate for passage of Obamacare.

It financed a false message that was in support of Obamacare as opposed to its original Harry and Louise message that sunk the passage of Hillarycare in 1993.

   

http://youtu.be/fOr17a4ZOIU

 “A new report by Milliman, Inc. finds that Silver plans with combined deductibles offered through the Health Insurance Exchanges may require patients to pay more than twice as much out of pocket for prescription medicines overall as they would under a typical employer plan.”

“This is a far larger increase in out-of-pocket costs than was found for other medical care.”

The cost of drugs to consumers buying a Silver plan through the Health Insurance exchange without government subsidy and high deductibles will cost twice as much as employer sponsored plans.

 “Americans participating in the Exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” said John Castellani, President and CEO of PhRMA.

Patients’ with high deductible Silver plans will have difficulty affording medicines necessary to manage their illnesses. Paying for medications will be especially difficult for consumers earning more than $50,000.00 who are not subsidized and have chronic diseases. These people need multiple medications to control their chronic disease in order to avoid complications of their disease.  

Eighty percent of the healthcare dollars are spent on treating the complications of chronic disease.

The unaffordability of medication to prevent acute and chronic complications of chronic diseases such as Diabetes Mellitus results in an increase in hospitalizations and higher health care costs overall.

Conversely, programs that encourage better adherence have been shown to reduce emergency department visits, hospitalizations, and other preventable, costly care.

The Obamacare rules and regulations are going to encourage an increase, not a decrease, in healthcare costs for non-subsidized Americans.

This contradicts President Obama’s pledge to encourage prevention of illness.

However, it fulfills President Obama’s goal of redistribution of wealth. It could also be interpreted as increasing the tax on the middle class.

If the public realized this would happen with Obamacare it would have protested the passage of Obamacare.

A house panel uncovered the secret deal in an email between PhRMA and the Obama administration in 2012. It was not revealed to the public until recently.

Nancy Pelosi’s statement about not knowing what is in Obamacare until it is passed was an ominous signal that the public would be taken advantage of. No one picked up the signal.

 

http://youtu.be/QV7dDSgbaQ0

President Obama’s signal legislation is leaving hard working Americans no option but to demand that Obamacare be repealed.

 It must be replaced by a healthcare plan that will work.

 It must be replaced by a plan that gives consumers the opportunity to be responsible for their health and their healthcare dollars.

It must be replaced by a plan where common sense prevails.

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

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Seniors Should Be Madder Than Hell About Obamacare And Not Take It Anymore

Stanley Feld M.D.,FACP,MACE

President Obama promised seniors on Medicare that Medicare would not be affected by Obamacare. He has also told us Obamacare is a success.  

President Obama lied to seniors.

One way to stop the lies is to vote against all the Democrats up for reelection in both houses of congress. The Democrats were the only ones who voted for Obamacare. Both representatives and senators rely on the senior vote to be elected or re-elected. Democrats in congress are terrified by the threat of losing the senior vote.

Many of my friends read the New York Times and listen to network news. These people believe they are well informed. They are constantly arguing with me about what they think President Obama has accomplished with Obamacare.

They believe President Obama’s sound bites about Obamacare.

Many seniors trust President Obama. They believe he would not deceive them about Medicare. Seniors have held on to their beliefs about Obamacare until it affects them personally.  

 In November 2013 I wrote a blog entitled “Medicare’s Perverse Incentive Against Seniors.”

Many seniors did not believe my post until they or a friend personally experienced the perverse incentive Obamacare had on Medicare.

A senior named Evelyn, who sometimes publishes my blog, received a letter about Medicare from a gentleman and sent it to her contacts.   

This letter was about the perverse incentives Obamacare has imposed on hospitals. Seniors are being penalized by not receiving Medicare coverage and having to pay out of pocket expenses.

The new Medicare rules were intended to decrease the number of re-hospitalizations within 30 days of discharge. Many seniors are admitted to the hospital in congestive heart failure. Many of those seniors have difficulty staying out of congestive heart failure. They have to be readmitted in 30 days.

If a senior is readmitted in 30 days after discharge from the hospital, Medicare does not cover the hospital bill. The senior is not responsible for the bill. The hospital system takes the financial hit.

The implication of the readmission is the hospital system did not do a good job in treating the patient.

It could be that the patient did not do a good job taking care of himself and staying out of congestive heart failure. It could also be that the patient is too sick to stay out of congestive heart failure.

Hospitals can avoid being penalized by admitting seniors for outpatient observation.

This is a glaring defect in government rules created by bureaucrats who have little clinic experience.   

Hospitals can admit patients to observation and send them home in less than 48 hours. If they are readmitted within 30 days it does not count as a re-hospitalization. Medicare would cover the bill for the seniors’ readmission. The hospital will get paid.

Medicare will not cover the outpatient observation admission bill.

I wrote:

 “It is all about money. It is about the government spending less, the hospital collecting more and the patients getting stuck with the bill.

Government officials realize that Medicare costs are unsustainable. CMS creates rules and regulations to expose Medicare to less liability.

Unfortunately the unintended consequence is that CMS exposes Medicare patients to more liability in the process.”

Once more President Obama lied to us.

“People are shocked when they receive the bill. Nobody is required to tell them they’re outpatients.”

Those patients who have been outpatient observation admissions do not qualify for the rehabilitation benefits. Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services

 Evelyn’s friend writes about his experience with a recurring urinary tract infection that has been easily treated of the years:

 “I just found myself in the middle of a medical situation that made it very clear that "the affordable care act" is neither affordable, nor do they care.”

 This is where Evelyn’s friend’s story gets interesting.

 He said he was diagnosed as having of prostate cancer diagnosed by needle biopsy in 2007. He had a “radical prostatectomy.”  The final pathology report of the tumor turned out to be benign.

Since surgery he has had numerous “urinary tract infections (UTIs).” He assumed the UTIs were a side effect of the surgery since he never had a UTI pre surgery. His Family Physician confirmed his assumption.

In March 2014 he developed a UTI. He went to an Urgent Care Center (Doc In The Box) to get his usual urine culture and an appropriate antibiotic.

After a forty-five minute wait for a physician he had to urinate. He also became nauseous and light headed. The receptionist told him he should not to go to the bathroom until after he saw the doctor and he (the patient) provided a urine specimen.

He then passed out. This can happen with a full, irritated and distended bladder. Hypotension (low blood pressure) can occur and cause a patient to faint.

He woke up with dry heaves and was confused. He tried to stand but was still hypotensive.

He was told by the Urgent Care Center that an ambulance was called to bring him to the nearest hospital emergency room for evaluation.

The cause of the hypotensive episode was clear. However because of  malpractice concerns the Urgent Care Center staff was required to send him to the nearest hospital emergency room for complete evaluation.

If an emergency room physician could have used his clinical judgment (not the dictated care rules) the physician would have concluded, after work-up, past history, and clinical evaluation of the work-up, that the patient could get necessary treatment as an outpatient at home.

The patient wrote;  

 “Now, "the rest of the story", and the reason for sending this to so many of you.”

 “I finally got to see a Doctor.   I asked "what is going on." I'm just having a UTI, just get me the proper medication and let me go home.” 

The Emergency Room Physician told him;

“That his symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.”

The appropriate studies were done over the next three hours. At about 7:30 pm the nurse came back to his room to tell him that one of the tests takes 1- 2 days to complete.

He asked if the hospital could email the (the results) to him. I assume the missing test were a urine culture and a blood culture.

The nurse informed him that he wouldn't need the tests emailed because he wasn't going anywhere. 

He told her he had no intention of staying overnight. He wanted to see the doctor. He asked the physician if he was going to be admitted for treatment or admitted for outpatient observation.

“He told me that I would be admitted for observation.   I said Doctor, correct me if I'm wrong, but if you admit me for observation Medicare will not pay anything.  The non Medicare coverage was due to the affordable care act ( An Obamacare regulation). The doctor said that's right, it won't.”

Another physician came into the room as he was getting dressed to leave the hospital ER against doctor’s orders. The next physician confirmed the patient’s interpretation of Medicare rules.

After the last physician prepared his discharge papers, the discharge nurse came into the room for him to sign the papers in order to relieve the hospital of any liability.

The patient told her; “ I wasn't trying to be obstinate, but I wasn't going to be burdened with the full (financial) responsibility for my hospital stay.”

 After making sure the door was closed, she said, "I don't blame you at all, I would do the same thing."  

 She went on to say, "You wouldn't believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney." 

 She further said, "The 'Affordable Care Act' is going to be a disaster for seniors. 

Yet, if you are in this country illegally, and have no coverage, you will be covered in full."

The patient went for a follow up appointment with to his Family Practitioner since his white blood count was pretty high. 

“During the visit I shared the experience at emergency, and that I had refused to be admitted. “

“His response was "I don't blame you at all, I would have done the same thing".  

 “He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.”

 “I told him that I had heard that the affordable care act (Obamacare) would no longer pay for cancer treatment for those 76 and older, is that true?

“His understanding is that it is true.”

 “The more I hear, and experience the Affordable Care Act (Obamacare), the more I'm beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they'll be.”

Evelyn is doing a great service by publishing this man’s letter. I hope it makes seniors aware of what is happening to Medicare coverage.

I am repeating a lot of this letter to re-emphasize, to followers of my blog, much of what I have said in the past. It is important to point out that all of Obamacare’s defects are becoming a reality to patients.

The defects are directly affecting seniors and their access to healthcare coverage.

Seniors must become “professors of their diseases” and control  their health and healthcare dollars.

Remember, politicians are supposed to be working for seniors, not controlling them.

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

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Physicians Have To Wake Up!


 

 Stanley Feld M.D.,FACP,MACE

It is time for physicians to wake up and take an active part in Repairing the Healthcare System.

Physician job satisfaction is at an all time low. Physicians are uncertain about staying in private practice. Others who have joined hospital systems as salaried physicians are uncertain about the wisdom of that decision.

Patient satisfaction is even lower as medical care is becoming less personalized. The patient/physician relationship has all but disappeared.

None of the secondary stakeholders (hospital systems, insurance companies, pharmaceutical companies and even government) are having a good time. The government is unable to sustain the costs without raising taxes and restricting access to care.

Today, I want to concentrate on the problems as physicians are feeling them.

A reader sent me this commentary a few weeks ago.

                                                              

"Have you ever been to Sea World?"

 

"Last evening I was at a staff meeting at my community hospital.  The hospital had recently rolled out “Computerized Physician Order Entry” software that was supposed to enable improvements in the orders and delivering of pharmaceuticals to the patients in the hospital. 

 Apparently, it did not go well.  One of the speakers at the meeting was an articulate physician from the “world headquarters” who came to offer encouragement and reassurance.  He cited the benefits: instant transmittal of the doctors’ orders to the pharmacy. 

Orders were legible, reducing the risk for misreading of the doctor’s handwriting.  Quicker delivery of medication to the patient was also cited. 

After the doctor’s presentation, questions rained down upon his head from the physicians in the audience.

They cited a wide range of problems, and the speaker attempted to answer them with patience and courtesy.

Finally one physician asked, “Why are we doing this at all, when there are so many problems?”  Another added, “Why is the company using an antiquated platform for the new software, since the platform is 20 years old, and so obsolete?”

And so it went lots of problems, and no solutions except a request for patience as the problems are addressed, with remedies apparently months away. 

 That set me to thinking:

 If we go back to the formulation of the >2000 pages that evolved to become “Obamacare”, we would be hard pressed to find evidence of the input from working doctors as the legislation and the resulting regulations were formulated and decreed.

We can, if we want to feel really good, go back to Medicare itself and the rules that came along as to what could and could not be done without pre-approval.

Medicare part D added another layer of similar rules that seemed to appear de novo from sources other than working doctors.

Managed care, in its various ramifications showed a similar tendency to be created by people who didn’t have patients as their first concern, but rather the cost of services. 

So, how, you ask, does all this relate to “Sea World”?

Think about the trained seals act.  The seals do their thing on command from trainers who are not seals.

The seals bark loudly, the crowd applauds, and if the seals perform well, they each get a fish.

Doctors are much like that, in that they do their thing the best way they can, but they are abiding by rules they had little input in their creation, reporting their charges using codes they did not write, accepting payments that have no relation to the charges they report, using a system they did not create and one that gets sillier by the year.

So, fellow physicians, welcome to Sea World, as long as we continue to act like the seals, we’ll be able to get a fish now and then, I suppose."

Ladies and gentlemen, we are highly trained professionals. Our job is to solve and fix medical illness using clinical judgment gained through clinical experience and life long learning.

We are not trained seals.

 It is time for physicians to wake up and take an active part in Repairing the Healthcare System.

 The medical profession got itself into this position because it did not step up and fix the dysfunction itself.

 There would not be a healthcare system with consumers and physicians.

 Neither consumers nor physicians know how powerful they are. Consumers must exercise their power and drive the healthcare system by owning their healthcare dollars and be responsible for their health and their medical care

Physicians must teach consumers how to drive the healthcare system.

The politicians, businessmen and bureaucrats think they can fix it.

They can’t. 

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

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Bureaucratic Barriers To Medical Care

Stanley Feld M.D.,FACP,MACE

The greatness of America lies in the freedoms provided by the constitution and the bill of rights.

These freedoms have stimulated Americans to be innovative, creative and inventive.

The constitution promotes individual freedoms with the federal government being held in check by the states.

Many feel that over the last 50 years as society has become more complex the power of Federal government has increased. The central government has increased its power, limited individual freedoms and increased control over the people.

The usurping of power by the Federal government seems to have accelerated over the last 5 years.  President Obama has even usurped power over the congress and might have intimidated the Supreme Court. He has decreased the effectiveness of the checks and balance system.

It could be argued that congress has given President Obama and his administration the power and control in the checks and balances system that congress is supposed to have.  

Obamacare is the best example of this. When Sarah Palin screamed about the Independent Physician Advisory Board (IPAB) being a “Death Panel” she was ridiculed as being ignorant.   

Sarah Palin’s fear was that government bureaucrats, opposed to individuals making that decision, would usurp the individuals’ right to make their own life-and-death medical decisions.

The argument for the formation of the IPAB is that this board will make rational and cost effective medical treatment decisions that individuals are incapable of making.

The IPAB will take the freedom of treatment choice out of the individual’s hands.

I contend that the ultimate goal of Obamacare is to work toward a single party payer system. The government will be the single party payer.

Since the government is the payer, the government will say it is entitled to make the best and most cost efficient treatment decisions for patients.

I have heard cries from Democrats that this is not President Obama’s intention.

The irony is that it is happening right now. CMS is issuing regulations to restrict care even before the IPAB has been formed.

“The introduction of a powerful and largely unaccountable board into health care merits special scrutiny.”

In the Affordable Care Act unfettered power to make policy decisions has been given to the Secretary of Health and Human Services by a partisan Democratic congressional vote.

Last year (2013) government bureaucrats had already usurped a life-and-death medical decision. Health and Human Services Secretary Kathleen Sebelius refused to waive the bureaucratic rules barring access to the adult lung-transplant list by 10-year old Sarah Murnaghan.

 A judge ultimately intervened and Sarah received a lifesaving transplant June 12,2013. 

There will not be recourse for patients to any IPAB decision once the IPAB is formed. Obamacare also stipulates that there "shall be no administrative or judicial review" of the board's decisions. Its members will be nearly untouchable, too.

 “But the grip of the bureaucracy will clamp much harder once the Independent Payment Advisory Board gets going in the next two years.”

“An Obamacare Board Answerable to No One.”

The IPAB is directed to:

  1. Develop detailed and specific proposals related to the Medicare program.
  2. Include proposals cutting Medicare spending below a statutorily prescribed level.
  3. Encourage to make rules "related to" Medicare.

 The IPAB will control more than a half-trillion dollars of federal spending annually. After the health insurance exchanges failure the IPAB will control the 2.7 trillion dollar healthcare industry.

Once the board acts, its decisions can be overruled only by a three-fifths supermajority in Congress. If the IPAB fails to implement cuts in spending, all of its powers are to be exercised by the HHS Secretary.

None of the Republican congressmen have made a stink about this board since Democrats shot down Sarah Palin for being so ignorant as to call the IPAB “Death Panels.”

The Obama administration is feeling its oats even before the IPAB has been formed.

CMS created its own panel to restrict access to care. The panel is called Medicare Evidence Development and Coverage Advisory Committee.

Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers. The nine-member panel is against Medicare paying for the screening tool.

 A December 2013 recommendation by the U.S. Preventive Services Task Force said current or past heavy smokers ages 55 to 80 should get the scans. The two government agencies have contradicted each other.

I wonder if there was a pulmonologist or lung cancer special on either panel. Is this what we are to look forward to with the IPAB?

Under Obamacare, the U.S. Preventative Services Task Force's recommendation means that private insurers are required to cover the screening with no out-of-pocket obligation for their non-Medicare members.

The reason is Obamacare offers better insurance policies through the health insurance exchanges than insurance coverage pre Obamacare. The increased cost is passed on to the consumer in higher premiums.

This is called redistribution of wealth.

The CAT scan should typically cost $300 to $400. If the patients were responsible for the bill under present law, it might cost $1,000- $2,000 dollars.
 
The Medicare Evidence Development and Coverage Advisory Committee advises CMS on coverage determinations. The committee gave a lame explanation for the reason to discontinue coverage.

 The committee members said they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.

The USPSTF made their decision based on the National Lung Screening Trial, which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays.

Smoking-related lung cancer kills about 130,000 Americans each year.

 The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease.

The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented.” 

Which government agency is right?

It is not enough for the Medicare panel to say, “they agreed the study was impressive in its implementation and results, they concluded it was not enough to recommend a new coverage policy to the CMS.”

Is the makeup of the committee qualified to make that judgment that will affect 20,000 patients’ lives?  Unknown.

Please note that patients (consumers) had no input on the decision. We are told that President Obama is an advocate of disease prevention.

This recommendation contradicts President Obama’s pledge to prevent the onset of disease or to catch disease early in order to cure the disease.

 The two agencies even contradict each other. Which one is right? Where is the scientific discussion?

Should Americans give up their freedom of choice to inconsistent government bureaucrats who might not be qualified to make the personal decisions for them?

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

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Who Can You Trust?

Stanley Feld M.D.,FACP,MACE

On April 16th President Obama declared that Obamacare is a success. He said over 8 million people had enrolled through the health insurance exchanges.

He did not know how many had paid the first month’s premium or how many enrollees would be subsidized by the government.

He did not know how many had a chronic illness or pre-existing conditions. He said that 35% of the enrollees were under 34 years of age. This is short of the 37% needed to make Obamacare financially viable but he said it was close enough.

 It turns out that only 66% of the enrollees paid their first month’s premium by the April 15th.  This was the deadline set by the administration. Republican lawmakers issued a report last week using healthcare insurers data.

If the insurers knew the numbers the Obama administration and President Obama certainly knew the numbers.

My guess is less than 2 million people who were previously uninsured obtained insurance. The administration is withholding the figures to avoid protest about its failure to provide insurance for the uninsured.

In his press conference he declared Obamacare is a success and Republicans and the media should stop talking about Obamacare’s failure

“Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.”

"The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working and I know the American people don't want us spending the next 2½ years refighting the settled political battles of the last five years."

It turns out President Obama’s success numbers of 8 million enrollees contradicts all the healthcare insurance companies’ tallies of insurance holders.

Why did President Obama lie? President Obama’s goal is to manipulate the media and fulfill his agenda.

The mainstream media does not believe him or his administration any more. This mistrust has been accentuated by the recent Benghazi information that the administration had tried so desperately to withhold.

I do not want to talk about these lies.

I want to talk about other promises about Obamacare that are turning out to be lies and deceptions.

In a recent report a New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan.

She suffers from a disease known as Arnold Chiara Malformation and Syringomyelia.

This 49-year-old woman said, "I've been vomiting. I lost 22 pounds. The pain is unbearable.”  "My medication helps me function during the day."

The Obamacare plan she purchased assured her that she was covered for her medications and her disease.

Nevertheless her insurance card was denied when she went to fill her prescriptions. None of her doctors have accepted her Obamacare plan.

In all of Staten Island there are only six doctors who accept her plan. She has been unable to get an appointment with any of them.

This is one of many complaints that patients are making to their congressmen who face the same problem with Obamacare’s narrow networks and the extreme restrictions of Obamacare to physicians and hospitals.

 "Even though the insurance company cashed your check, it doesn't mean it (the policy) has been implemented."  

These stories are just beginning since most of the people who have signed up have pre-existing illnesses. Obamacare is already making people furious. The fury might be disguised by the traditional media’s ignoring the fury or downplaying it. The complaints might be further diluted by the fact that President Obama has given waivers to the majority of people covered by their employers or unions.

This strategy is clever. After people in the individual market get tired of complaining Obamacare will be so rooted that the rest of the populations will find it unproductive to complain.

I think President Obama is miscalculating the American peoples’ resolve. The strategy will not work.

Obamacare’s narrow networks are limiting specialty centers. The Associated Press says just 4 of 19 nationally recognized comprehensive cancer centers offer Obamacare access through all insurance plans in their state Obamacare exchanges.

President Obama’s promise of access to care and the lack of rationing of care is turning out not to be true.

All one has to remember is that President Obama ridiculed the Republican’s suggestions that Obamacare was going to create “death panels.”

He said it would never happen. It looks like it is happening.

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

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