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All items for March, 2017

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Obamacare Coverage: The Big Lie

Stanley Feld M.D., FACP, MACE

President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success.

The Obama administration told us that 20 million new people have obtained healthcare insurance because of Obamacare.

We know 14.5 million people lost their healthcare insurance in the individual market the year after Obamacare was passed.

Many assumed they got their insurance back through Obamacare. There is no evidence for that assumption.

I followed Obamacare enrollment carefully on acasignup.net.

This site was supposed to be publishing the exact numbers published by the government weekly. www.acasignups.net

It turns out that the numbers published were inaccurate. They were too high.

“Since the release of the HHS study, the government has published two additional surveys of health-insurance coverage – the Current Population Survey (CPS) and the American Community Survey (ACS). Both offer data through the end of 2015, allowing for comparison with the NHIS estimate.”

The government now claims these studies are only estimates of nonelderly adults, under the age of 65, who gained insurance coverage.

The estimate in increased adult coverage ranges from 13.5 million in the CPS study to 16.5 million in the NHIS study.

Where did the number 20 million new lives covered come from? Bill Clinton boosted the number to 25 million when campaigning for Hilary Clinton.

Edmund F. Haislmaier and Drew Gonshorowski of the Heritage foundation examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.

“Their study found that 14 million people (including children) gained public or private coverage in 2014 and 2015.”

This total is even lower because it includes S-Chip coverage for children.

Compounding the government lies of estimated enrollees was that 84% of the new enrollees was either Medicaid or S-Chip children.

This means only 2,240,000 people signed up in President Obama’s Health Insurance Exchanges.

It also means that there were 11,760,000 new Medicaid or S-Chip patients.

Edmund F. Haislmaier concluded in testimony to congress;

“While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that

for the three year period 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private sector coverage enrollment.”

http://budget.house.gov/uploadedfiles/house_budget_testimony-haislmaier.pdf

Eighty-five percent of the 2.7 million have pre-existing conditions. Most are receiving government subsidies.

The 2.7 million covered under Obamacare have destabilized the healthcare insurance market so that healthcare costs for businesses have become unaffordable.

No one has even mentioned the cost of this Obamacare folly to the average hard working taxpayers with healthcare coverage from their employers.

Obamacare’s failure to has been devastating.

The authors also found that nearly half the new Medicaid enrollees met eligibility standards that were in place before the ACA.”

Maybe Jonathan Gruber is right when he said we, the public, are too stupid to know the wool is being pulled over their eyes.

 

“For all the hoopla about the ACA exchanges, it appears that Medicaid accounts for the lion’s share of coverage gains and that many new Medicaid enrollees would have been eligible for that program even if the ACA had never passed.”

Medicaid is a single party payer system (socialized medicine) that works very poorly. It is almost as bad as the VA Healthcare System.

Is this what the public wants? No

America needs a better healthcare system. Hopefully Dr. Tom Price knows what to do replace Obamacare with once he dismantles all of the Obama administrations regulation.

Maybe Jonathan Gruber is wrong.

The general taxpayer may be smarter than Dr. Gruber thinks. Maybe it is the reason the public elected Donald Trump.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Stop The Noise: Start Working

Stanley Feld M.D.,FACP, MACE

The New York Times is filled with case reports of people helped by Obamacare.

The implication is Obamacare is successful and the Republicans do not have a better plan.

Articles appear daily defending Obamacare despite the fact that premiums and deductibles are up, access to care and coverage is down and the medical profession and consumers are despondent.

Obama Says Healthcare Law is Working Fine

https://www.nytimes.com/2013/05/01/health/obama-says-health-care-law-is-working-fine.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obama Says Healthcare Law is Helping White Americans Despite Perceptions

http://www.nytimes.com/politics/first-draft/2014/12/29/obama-says-health-law-is-helping-white-americans-despite-perceptions/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Is The Healthcare Law Creating More Part Time Work?

http://takingnote.blogs.nytimes.com/2013/09/27/is-health-care-reform-creating-more-part-time-work/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Why Even Some Republicans Are Rejecting The Replacement Bill

https://www.nytimes.com/2017/03/07/upshot/why-even-some-republicans-are-rejecting-the-replacement-bill.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obamacare Users Await Repeal and Replacement With Dread Anticipation

http://www.cbsnews.com/news/obamacare-users-await-repeal-and-replacement-with-dread-anticipation/

All of this is “Fake News.”

I cannot understand how Dr. Ezekiel Emanuel, with a straight face on national television, can say Obamacare is not failing.

Dr. Emanuel thinks Obamacare is a great deal. He is one of its authors.

His problem is he cannot prove it is great in reality.

 

 https://youtu.be/1-PRvZ_R0-0

I guess the Democrats hope is if you tell a lie enough times it becomes the truth.

The conservative media is starting to figure out how to neutralized this tactic that engenders sympathy for Obamacare. The Wall Street Journal published an article “How Obamacare Punishes the Sick.”

This article stimulates feeling against President Obama’s lies.

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions.”

 If one can disregard the fact that one case does not win a medical argument, one can start talking about what might work to create a cost effective quality healthcare system.

Obamacare and its bureaucracies have set up perverse incentives for stakeholders and against consumers.

A recently reported study by Harvard and the University of Texas in Austin demonstrated these perverse incentives.

Obamacare is supposed to help the sick. It turns out Obamacare punishes the sick with certain illness.

“But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.”

Diseases such as multiple sclerosis, rheumatoid arthritis, infertility and others high cost conditions are being charged higher deductibles, experiencing more prior-authorization for drugs, an increase in lesser quality substitution drugs, and often no coverage for the drugs they need.

Most of these conditions require long- term expensive medications.

Therefore consumers with these diseases cannot get treated adequately.

For example, a patient with multiple sclerosis might file a $61,000 claim.

Insurers lose money on every MS patient. An incentive is created for insurers to avoid enrolling patients with MS. The insurers then make its healthcare policy unattractive to people with multiple sclerosis.

Obamacare’s subsidy for patients with multiple sclerosis is inadequate for the cost of the disease’s care.

To mitigate that perverse incentive, ObamaCare lobs all manner of taxpayer subsidies at insurers. Yet the researchers find insurers still receive just $47,000 in revenue per MS patient—a $14,000 loss per patient.”

 

The insurer doesn’t want to loss $14,000 per patient. Patients are not stupid. They find the best coverage at the lowest price,

This insurer suffers high losses. He either leaves the market or decreases coverage. The perverse incentive leads to low quality care.

Patient with multiple sclerosis on Obamacare are not getting high quality healthcare.

Everyone losses. The government loses, the insurer loses but most of all the patient loses.

There is a better way to insure these people. In a free market system driven by my ideal medical saving accounts the creation of a high risk pool funded by all participating insurance companies in the lucrative private market spreads the risk to insurance companies and government while providing high quality care to qualified patients.

Politicians must start thinking smart.

The format of previous high-risk healthcare insurance pools was a disaster for all the stakeholders. High-risk pools can be formatted in a way that works for patients and does not contaminate the private market with spiraling insurance prices.

The Democrats ought to give up Obamacare. It is a dead horse.

Obamacare has failed for the many reasons I have pointed out in my blog over the past 7 years.

The Democrats’ knee jerk reaction would be why not just adopt a single party payer system.

The answer is look at the mess the VA system is in with it bureaucracy and apathy.

Republicans ought to stop trying to prove Obamacare is a failure.

The politicians ought to try to do something right for the people who put them in power.

They ought to get rid of Obamacare in the least disruptive way possible as quickly as possible.

I believe President Trump, Tom Price M.D., and Paul Ryan are trying to do just that with the American Healthcare Act that is being voted on the house tomorrow.

The conservative coalition in the house should get off its high horse and not shoot itself in the foot.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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  • Paritosh C. Dutta, M.D.

    It was your brilliant presentation at the Dallas County Medical Society meeting last week. I learnt a lot of the problems of the health care system of this country. You gave some insight how to repair the broken system.
    You are doing a great service to this great country with your efforts. Best wishes.

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I Was Wrong

Stanley Feld M.D.,FACP,MACE

I was profoundly disappointed when The American Healthcare Act was introduced last week. There was immediate rejection by Republicans and Democrats in both the House and Senate.

The mainstream media commentators emphasized the Republicans’ rejections and added their own scornful objections. The mainstream media painted the Republican Party as a party is disarray.

The media was presumably giving a boost to the Democratic Party and Obamacare’s failure.

Both Paul Ryan and Dr. Tom Price gave complete explanations of their strategies on how this bill, along with its two other components, will repeal and replace Obamacare.

I was profoundly disappointed in the bill until I was able to hear Dr. Tom Price and Paul Ryan’s explanation of their reasons for the initial reconciliation bill and the plan of the other two components necessary for replacement.

Vice President Pence and President Donald Trump then repeated Ryan ad Price’s strategy in less detail.

I reacted immediately to the bill being a sell-out to the healthcare insurance industry and central government control of healthcare. It looked like Obamacare Lite or Obamacare 2.0. There was no other explanation presented.

It took them 24 to 36 hours to explain the logic of the strategy.

By that time there was so much mainstream media noise and politician noise that It was impossible to hear what Tom Price and Paul Ryan were trying to say.

No one listened to what President Trump was trying to say. They were only listening to the media describing Republican caucus’ members outburst against the bill.

President Trump tweeted “it is a beautiful healthcare bill. Everyone will be happy with the result.”

No one listened. No one heard.

The mistake Ryan and Price made was that in the initial introduction of the bill they were being too cute, cunning and clandestine. In reality they were very prepared. They have been working of this repeal and replacement since 2010.

The plan to repeal and replace Obamacare has three parts.

  1. Reconciliation
  2. Administrative Action
  3. Additional Action

It would be very helpful to understand their positions if you watch them explain their positions in their entirety.

 

This lecture by Paul Ryan is an excellent review of the metodology necessary to Repeal and Replace Obamacare

 

Both videos are a must see in order to understand the Trump administration and congressional leadership strategy.

Obamacare was supposed to provide an opportunity for people in the individual insurance market to buy healthcare insurance at an affordable price. It was not meant to affect the employer provided healthcare insurance market.

This was supposed to be done by State Health Insurance Exchanges that would supply this insurance. Much of the individual market would be subsided by the federal government..

Only 22 states signed up and most have failed after receiving over $200 billion dollar loans to cover startup cost. These state health insurance exchanges are never going to pay back the federal loans.

Additionally, Obamacare extended Medicaid coverage by increasing the poverty levels in states. This increased the eligibility for patients to participate in Medicaid.

President Obama completely ignored the fact that Medicaid was a financially unsustainable subsidy that was failing rapidly.

Thirty-three States signed up for this expanded Medicaid coverage because they were afraid to get stuck with the bill.

All states are supposed to have balanced budgets. Most states have budget deficits.

They share the costs of Medicaid with the federal government to provide free healthcare coverage to the poor.

President Obama said he would pay 90% of the Medicaid bill. He then increased it to 95% and then 100% in the first few years in order to induce states to join.

Remember, President Obama’s ultimate goal was to have the federal government be in total control of healthcare with a single party payer system.

Twelve million new people have signed up for Medicaid under Obamacare. Additionally new immigrants have been added to the Medicaid roles.

Only nine million have signed up for Obamacare through the health insurance exchanges. Most of the enrollees have preexisting illness.

Most of the enrollees cannot afford the premiums even though President Obama provides subsides to 85% of these people.

Additionally, these enrollees cannot afford the deductibles that are up to $6,000 in some states.

Obamacare has affected the employer market. Obamacare does not pay the insurers enough or have a high enough enrollment distribution to give the insurance industry a high enough return on investment.

Insurers compensate by increasing insurance rates in the employer sponsored private market in almost all of the states. The industry increased rates in both individual and employer sponsored private market by as much as 116% in Arizona.

This forces small and large employers to decrease insurance coverage for employees.

If they did not provide healthcare insurance many small businesses had to pay Obamacare’s mandated penalty.

A mandated penalty was avoided if people worked less than 29 hours a week. Therefore, large employers reduced full time jobs to part time.

There are many other reasons that Obamacare has failed. It has inhibited economic growth.

Obamacare must be completely repealed.

The Ryan plan’s process is repealing as much of Obamacare as it can through the reconciliation process. This is only the first stage. does.

Congressional reconciliation only needs 50 votes in the reconciliation process thanks to Harry Reed.

“Congress and the Trump Administration must completely repeal the law, beginning by seizing the opportunity to accomplish as much of repeal as possible through the reconciliation process.”

After passage of the American Healthcare Act, Dr. Tom Price will then move on to part two.

He will repeal all the administrative rules and regulations that President Obama and Donald Berwick put in place that hurt Americans and the economy.

He will replace them (one regulation for two eliminated) that will help people obtain affordable healthcare insurance and help our economy grow.

Republicans opposed to the Ryan plan do not seem to get this point.

If Republicans could get total repeal through the House of Representatives with they would not get the 60 votes necessary to get Senate approval.

In stage three Republicans will be able to get the 60 votes necessary for Senate approval.

There are 18 vulnerable Democratic senators up for reelection in 2018.

With Obamacare’s rules and regulations repealed at that time, Democrats’ opposition to things like expanded Health Savings Accounts, malpractice Reform, insurance Reform and insurance across state lines will melt. It will be important for these vulnerable Democrats to vote for these reforms in order to get reelected..

The Ryan plan now looks like an excellent strategy to me. I do not see why the opposition Republicans cannot see it.

Doing it their way with complete repeal a stage one might not work. Then will be stuck with Obamacare and the loss of both Republican controlled of the house and senate in 2018.

There are still refinements necessary to be a consumer driven healthcare plan that is patient-centered.

I hope the Ryan/Price plan is passed by congress.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Profoundly Disappointed

Stanley Feld M.D.,FACP, MACE

I am profoundly disappointed in Paul Ryan, the Republican caucus and the RINO establishment for introducing the Paul Ryan bill to repeal and replace Obamacare.

It doesn’t completely repeal Obamacare or completely replace it.

In fact the supposed anti- entitlement party (Republicans) are adding another entitlement.

They are even leaving the healthcare insurance industry in charge of the money and the access to care.

It doesn’t even fulfill the five principles President Trump listed in his address to congress.

Those five principles alone would not Repair the Healthcare System.

The bill does nothing to encourage consumers to be responsible for their health and their healthcare dollars.

Consumers must be involved in driving the healthcare system in order for the healthcare system to be viable.

The bill continues to allow the government and the healthcare insurance companies to drive the cost and the healthcare system.

The Republican bill does not provide incentives for consumers to use their healthcare dollars wisely.

It does not include malpractice reform.

If President Trump buys the nonsense Republicans are calling a repeal and replacement for Obamacare, then the RINO’s have pulled the wool over his eyes.

It would be a gigantic mistake to push this bill in its present form. You would be producing political capital for the politically bankrupt Democrats.

This bill is a typical bait and switch. Rand Paul is correct. It is Obamacare lite.

It does not put consumers in charge. It keeps the healthcare insurance industry in full control of medicine, healthcare and the government.

Rather than discontinuing an entitlement it creates another one.

Refundable tax credit is another term for redistribution of wealth. You give money to everyone. You then take it back from some and let the others have it.

It does not repeal most of the Obamacare regulations.

It extends many of the programs past 2019.

President Trump, it does not help drain the swamp as you promised. It makes the swamp worse.

The insurance companies are not returned to a free market. It is a clever way to support the insurance companies by switching from a mandate and penalty to a tax credit (giving the money away to everyone).

This is another entitlement to further enrich the healthcare insurance industry.

Americans elected these Republican politicians to drain the swamp. This bill is no different than Obamacare.

Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons said:

Refundable” tax credits – for those who don’t owe taxes – are still a subsidy. It is still redistribution of wealth, with winners (those who get the subsidy) and losers (those who pay for it). And the chief winner is the “health plan.” It gets money; the supposed beneficiary may get nothing, or only rationed care from a narrow network.

“The problem is comprehensive third-party payment,” Orient adds. “The bill perpetuates this disastrous concept. A true free-market bill – “there shall be a free market in health insurance” – would remove all federal mandates, subsidies, barriers to competition, or protections or advantages for cartels.”

“Instead of returning the insurance market to the vigor of a free market, the government will be supporting it with tax credits – the flip side of the ACA insurance penalty.”

Americans are not stupid. The Republican bill will expose all the Republicans who are for the bill. They are not working for the good of the people

Democrats have already demonstrated they do not work for the people.

An group like the tea party can put up candidates against these guys and elect people who are for the people.

Where are the plans for consumer driven healthcare, patient centered healthcare, malpractice reform and the physician patient relationship?

Where are incentives for consumers to focus on their health, to help cure the obesity problem in order to decrease the incidence of diabetes and other chronic diseases?

Where is a free insurance market?

Paul Ryan’s plan is the road to failure.

The next step would be replacement of the Republican’s failure with a government controlled single party payer system.

It will fail as it is in so many countries.

President Trump. Wake up!!! Keep your promise to the American people.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Who Is Tom Price M.D. ?

Stanley Feld M.D.,FACP,MACE

Tom Price M.D. is an Atlanta orthopedic surgeon who had practice orthopedic surgery in a group at Emory University Medical School and who had been active in the Georgia medical Association.

“Thomas Edmunds “Tom” Price (born October 8, 1954). He is an American physician and Republican politician who is currently the 23rd United States Secretary of Health and Human Services. Price was the U.S. Representative for Georgia’s 6th congressional district, encompassing the northern suburbs of Atlanta from 2005 until his resignation in 2017. Price served as chairman of the House Budget Committee[1]and had previously served as chairman of the Republican Study Committee and the Republican Policy Committee

Dr. Price is a patient/physician advocate. All the secondary stakeholders such as insurers, the government establishment, hospital systems, and pharmaceutical companies are terrified of him.

The Democrats are terrified of him because they are afraid he is going to take the evolving government control of healthcare away from the government and try to put it back in the patients’ hands.

The American public had not heard much about Dr. Price from the mainstream media. The mainstream media’s message to the public is he had a hard time getting confirmed by the Senate.

He really should not have had a hard time getting confirmed by the Senate. The Senate Democrats made it look as if there was something wrong with his nomination.

His confirmation should have been a slam-dunk. He was eventually confirmed.

Dr. Price is a strong, gentle, quite man. I think he has mostly figured out how to repair the healthcare system.

There are several soft spots in his previously passed bill. It didn’t matter then because President Obama vetoed it.

Hopefully these have been fixed. I noticed malpractice reform is a big part of his present blue print. Plaintiff attorneys are terrified. Tort reform is finally is on the agenda.

I hope President Trump listens to him. The Republican establishment seems very timid for some reason. Perhaps it is afraid of failure.

The health insurance industry does not know what is in the replacement bill.

It is trying to generate doubt about the wisdom of his replacement bill for Obamacare with the following statements that the public doesn’t understand.

1.   The health insurance industry claims that Dr. Tom Price is going to assault narrow networks.

2.   He will force reimbursement tied to outcomes and related value-based models.

3.   He wants doctors in control of the healthcare system

4.    He wants tort reform.

5.    He wants doctors paid from insurers with fewer hurdles and less barriers.

The healthcare insurance companies are terrified of the abbreviated blueprint. The blueprint represents a threat to the healthcare insurance industry’s power over the healthcare system in both the government and the private insurance sectors.

The mainstream media is babbling about a lack of harmony in the Republican Party. In the next few weeks we are going to hear how disorganized the Republicans in congress are.

Democrats claim the Republicans do not have anything better than Obamacare. They are starting to make up stories about what the Republicans do or do not have. Everything is designed to make the public nervous about President Trump and his administration. These stories are parroted by the Democrat’s ally, the mainstream media.

Meanwhile, the Democrats, the mainstream media, and the public do not know what will be in the replacement act after Obamacare is repealed.

President Trump. Paul Ryan and Tom Price know if all the details are released now most of it would be attacked out of context by the mainstream media.

The Democrats’ goal would be to make the public uncertain about the Republican replacement bill. The Democratic ally, the mainstream media, is all ready spreading the misinformation about the replacement without knowing what is in it.

I even saw a poll published in the mainstream media that said more people like Obamacare than don’t like it.

This is a fake poll. It does not represent the sentiment of the majority of the people.

The political chicanery on the part of the Democrats and the biased mainstream media can be overwhelming.

I do not think the political chicanery is going to overwhelm the public, President Trump or Paul Ryan. I believe they have figured out the Democrats and the media.

Some Republicans have a slightly different opinion on how Obamacare should be replaced. Political action groups oppose some of the methodology being used to replace Obamacare.

The groups—including Heritage Action, the Club for Growth and Freedom Partners, a super PAC funded by billionaire industrialists Charles and David Koch—are troubled by the notion of refundable tax credits to help consumers pay for health insurance, a central tenet of Mr. Ryan’s plan that President Donald Trump appeared to endorse in his address to Congress last week.”

“They also are deeply opposed to a commitment to temporarily maintain an expanded form of Medicaid, as numerous GOP governors are demanding.”

Paul Ryan is trying to transition out of Obamacare so that the 11 million new Medicaid patients and the 9 million Obamacare patients do not lose their insurance as the new Republican plan is put in place. Someone does not understand the word temporary.

Several in congress want immediate repeal and replacement. I believe this will give the Democrats more fuel for the fire to subvert anything Republicans are trying to accomplish.

Reps. Mark Walker (R., N.C.), chair of the Republican Study Committee, and Rep. Mark Meadows (R., N.C.), chair of the Freedom Caucus, both announced their opposition to the Republican leadership’s plans last week. Each of those groups includes dozens of conservative lawmakers, meaning if either bloc votes against Mr. Ryan’s plan, it almost certainly wouldn’t pass.

“To the extent that they’re doing something else with this plan other than full repeal, the concerns that conservatives in the House are expressing are completely valid,” said Michael Needham, chief executive of Heritage Action.”

https://www.wsj.com/articles/conservative-groups-jeopardize-gop-plan-to-repeal-affordable-care-act-1488715237

It is important to remember that190 million Americans and their families receive healthcare insurance from their employers. Obamacare has negatively affected employers. The increases in costs, access, deductibles and coverage provided by employers have negatively impacted employees.

Both are demanding relief. These people, at town hall meetings, have made it clear to the Republican congressmen and Senators not to slow down Paul Ryan and President Trump. They want relief and they want it fast.

I believe President Trump will help Paul Ryan get a bill through congress that will provide relief for the entire population.

Hopefully, they have included some of my suggestions.

I am certain that Republicans will work out their differences before they present the bill to the people and the congress.

It the meantime I would suggest that Republics and Democrats keep the noise of the demagoguery down.

The United States of America desperately needs a financially sustainable healthcare system that will provide everyone with access to affordable healthcare.

We have seen that Obamacare is not that system.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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What Is Patient-Centered Healthcare?

Stanley Feld M.D.,FACP, MACE

Patient-Centered Healthcare is a new buzz phrase. It has become popular among Republicans in the last few years.

I have a feeling most people do not know what physicians mean by patient-centered healthcare.

The true definition is that patients are in the center of the medical care interaction. Patients determine their needs and their physicians. Patients drive the medical encounter. Neither the government nor the insurance industries drive the medical encounter.

A fatal floor in Obamacare was that President Obama wanted the federal government to control the healthcare system.

President Trump’s goal is to have patients in control of their own health and healthcare dollars. It is not a problem if the government or employers provide those healthcare dollars.

I believe Tom Price M.D. understands that the only system that will work is a system in which the consumers (patients) are responsible for their own health and healthcare dollars.

The government’s job is to provide incentives in the healthcare system for consumers to become responsible for their health and healthcare dollars.

I am not at all sure the Republican congressional leadership understands the definition or value of patient- centered care.

Obamacare provided just the opposite. Obamacare provided incentives for consumers/patients to be dependent of government.

This fundamental tenet of patient-centered care was tested by Stewart, et.al. in 2000. 

 Experts studied audio taped doctor-patient interactions while patients also rated these same interactions. 

 Expert opinion could not be correlated with positive results, but patient-perceived patient-centered care correlated with “better recovery from their discomfort and concern, better emotional health.

 A Wikipedia definition of “Patient centered healthcare” does not exist. There are many consumer-driven healthcare definitions.

Most of the Republicans are talking about patient centered healthcare. However, they start and end with Health Savings Accounts and Consumer Driven Healthcare.

The American Association of Clinical Endocrinologist defined patient-centered healthcare in its diabetes guidelines of 1996 and 2002. (on request)

The guidelines were a System of Intensive Self-Management of Type 2 Diabetes Mellitus.

The Type 2 Diabetic was taught to become a “professor of his/her diabetes.”

The goal was to get the diabetic blood sugar as close to normal as possible. It was shown that normalizing the blood sugar helped avoided the vascular complication of diabetes. The treatment of the vascular complications of diabetes absorbed 80% of the money spent on diabetes.

Patients live with their disease 24/7. Blood sugars are very variable. Patients need to learn how to adjust to these variables by managing their medications and lifestyle.

Patients taking a pill or a shot will not control their blood sugar unless they understand the medication and how to adjust it to have the greatest affect on the blood sugar.

The only way a patient can understand how to control their blood sugar is for them to understand how their blood sugar affects the effectiveness of the medication and how their medications and lifestyle affects their blood sugar.

This same phenomenon applies to most chronic diseases.

The only way to decrease the complications of chronic diseases is for patient to drive the treatment of their disease.

This in turn will be the only way to control healthcare costs. This is what I mean when I say patients should be in control of their health.

As an added incentive to control costs, patients should be in control of their healthcare dollars so they figure out how to use medication most affectively.

In the February 2017 Endocrine News published by the Endocrine Society there was an article interviewing four endocrinologists for their definition of patient centered care.

“In 2001, The Institute of Medicine published a book called Crossing the Quality Chasm: A New Health System for the 21st Century.”

“In it, the institute identified six aims for improvement of healthcare delivery, one of which was “patient-centered care,” defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

The Institute of Medicine’s definition moves patients’ needs and attitudes toward patients being in the center of care. It does not place them as responsible for the management of their care. It does not include patients’ responsibility for their care.

All four of the endocrinologists got close to the definition of patient centered care. Only Carol Greenlee, MD, FACE, FACP, of Western Slope Endocrinology in Grand Junction, Colorado nailed the definition. Dr. Greenlee is the only physician in private practice.

She said:

“One of the most important things is partnership with the patient and what is called “contextualized” care, which means taking into account a patient’s needs and circumstances, goals and values.

It is also called developing a physician/patient relationship.

Another aspect is moving from the physician being at the center of the care model, with staff working to help the physician (doing tasks for the physician or other clinician such as “rooming” the patient or “scheduling” the patient for the clinician) to the staff also “taking care of the patient” as their job, with different roles on the patient-centered care team (getting the patient in for a needed appointment).

It is doing what is best for the patient (not giving the patient what they want, e.g. pain meds, MRI, antibiotics) or ask for (those things are not often best for the patient, but takes time to discuss through).

It’s taking our best science and knowledge and technology and then adapting it to meet the patient’s unique needs, circumstances, values, and goals.

It requires clearing up misconceptions (such as asking what the patient currently understands about a condition or a test or treatment), helping discuss risks and benefits in the context of that individual patient.

It requires asking not just telling, but it is not dumping everything back on to the patient.

It is taking into account the “work” (the job) of care (self-care that the patient or family need to do) on top of the illness and the rest of life that the patient and their family have to deal with and do (i.e. consideration)

Most clinicians think that they are already patient-centered because they care about their patients.

But that does not mean they provide patient-centered care or practice in a patient-centered approach.

I thought I was patient-centered because I cared but then I had to uproot my mental model to really become patient-centered.”

Republicans and their advisors do not understand the meaning of the concept of patient centered care.

Tom Price M.D. understands the concept of patient centered care.

Without the patient being in the center of the management of his/her care, the healthcare system can never be repaired and will never be financially sustainable.

I hope President Trump gets the concept in spite of the advice from congressional Republican and Democrats. Congress is trying to satisfy all the secondary vested interests. Healthcare is a big business with many secondary stakeholders. They do not want to lose this important profit center.

These stakeholders are better organized than patients or physicians to influence healthcare policy makers.

The primary stakeholders are patients with their head coaches and assistant coaches being physicians and their healthcare team.

Patients must be in the center of the healthcare team because they are the only ones that can influences the cost of medical care.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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