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What Should Be Done to Repair the Healthcare System?

March 4, 2020
inConsumer Driven Health Care, Medicine: Healthcare System
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What Should Be Done to Repair the Healthcare System?

Stanley Feld M.D.,FACP, MACE

On March 10, 2020, Obamacare will be ten years old. Obamacare has had many failures. Obamacare’s biggest failure is the resulting distortion of the healthcare delivery system. The distortion is the result of all the stakeholders adjusting to Obamacare’s new rules and regulations.

All of the stakeholders had to adjust the way they delivered or priced healthcare to their individual advantage.

Primary care physicians started moving toward the model of Concierge Medicine. In order to have a primary care physician, consumers must pay primary care physicians between $2,000.00 and $38,000.00 annually to be in their panel.  The movement toward Concierge Medicine is the result of the Obamacare regulations, the healthcare insurance company’s reimbursement cuts, and the increase in malpractice insurance premiums.

Primary care physicians found that in order to make a living and pay their increasing overhead, they must become Concierge Physicians. This is to the disadvantage of consumers since they must continue to buy healthcare insurance.

The insurance industry has adjusted to Obamacare’s regulations by lowering reimbursement to physicians and hospitals while raising premiums. Insurance companies and Medicare Advantage programs have restricted enrollees to only certain physicians in their network and restricted certain treatments and access to certain specialists and groups.

It all goes back to President Obama’s statement, “If you like your doctor you can keep your doctor. If you like your hospital you can keep your hospital.” To my disappointment the AMA accepted President Obama’s obvious lie in 2010.

As the the government and the insurance industry decreased reimbursement physicians have had to increase the number of patients they see in one day in order to make up for their decreased revenue.

Malpractice claims and malpractice payments for claims have increased in most parts of the country. This resulted from a lack of tort reform by congress and the Obama administration. Physicians then increased diagnostic testing in order to cover all possible illnesses.  The increase in testing led to an increase in healthcare cost.

Obamacare has also increased the cost of insurance by requiring payment for additional coverages. The first dollar insurance coverage after deductibles are met has resulted in the overuse of the healthcare system. The government and the insurance industry are trying to decrease the overuse of the system by increasing deductibles.

In fact, some Obamacare insurance plan deductibles are so high that insurance payment never kicks in. People who buy Obamacare insurance plans cannot afford the deductibles and do not use the insurance until they are so sick, they cannot avoid being hospitalized.

It is impossible to figure out how health insurance premiums increases are calculated by the private healthcare insurance sector or the government healthcare insurance sector. It is impossible to figure out how the multimillion-dollar salaries for insurance and hospital executives are calculated. These expenses are part of why insurance premiums are rising.

It is also impossible to determine how hospital systems price their care. The government also pays hospital systems a premium for outpatient hospital care in an outpatient setting. The fees are at least 20% higher than in a free-standing private practice office.  

Hospital systems are figuring out how to manipulate their reimbursement systems to have an advantage over their competitor.  In New York City, Columbia Presbyterian Hospital System has accumulated ownership of many hospitals inside the city and its suburbs. With that ownership, they have acquired many in-patient and out-patient hospital salaried physicians. The hospital system is now demanding increased payment from healthcare insurance companies and the government in order for patients to use their system. The hospital system has hired many of the physicians’ patients desire to see. Columbia Presbyterian has gained control of the reimbursement levels in those markets.

There is an encouraging trend that was started by Keith Smith M.D. in Oklahoma City. Dr. Smith started a cash-only outpatient surgical clinic several years ago. He charges less for procedures than a patient’s deductible from some insurance companies.

This gives us some insight into how much fat is in the healthcare system expenditures.  Dr. Smith and physicians working in his outpatient clinics are happier and are making more money than they were working for local high-cost hospital systems in town. The patients are happier because there are no hidden or surprise costs.

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Dr. Smith’s clinic is drawing patients from all over the United States. He has also inspired the formation of many similar clinics in the U.S.

This is not new. Specialists such as gastroenterologists have opened freestanding centers. They charge less for colonoscopy and endoscopy than the hospital systems. Radiology clinics have done this for many years. The hospital systems have, somehow, worked out payment for their higher costs with the insurance industry and the government.

Dermatology is a specialty that does not need a hospital system. Large physician-owned

dermatology clinics have opened. They charge less than the dominant local hospital system.  

Many of these large specialty centers have sold their clinics to venture capital firms.  

How the venture capital firms are going to leverage their investment is unclear to me.   

Emergency rooms all over the country are overcrowded because primary physicians cannot see all of the patients in their offices in a timely manner. Hospital system emergency rooms are inefficient and overpriced. The ER is an unpleasant experience for many patients.

Venture capital firms have opened free-standing Urgent Care and Emergent Care centers all over the country. (Doc-In The Box). Many of these centers are covered by nurses, nurse practitioners, and physician assistants. All physicians have to do is co-sign with the provider to get reimbursement by the government and the healthcare insurance industry.

This is not my idea of developing patient-physician relationships.    

If a patient has to be admitted to a hospital his primary care physician is not permitted take care of him in many hospital systems. Hospital systems have hired hospitalists to care for patients. A patient might see a different hospitalist each day of the admission.

What happened to the therapeutically valuable physician-patient relationship? This relationship is critical for curing much morbidity from chronic illness. 

 I have covered the Repair of the Healthcare System in great detail in the past.

 I have also covered the errors in the structure of Obamacare leading to the distortions in the delivery of healthcare and the increased costs of the healthcare system.

The stakeholders are physicians, patients, hospital systems, insurance companies, pharmaceutical companies, and the government.

All patients want is to get the best medical care when they get sick. The interest in disease prevention is slowing growing events though many millions of dollars have been spent on programs that could help prevent chronic disease.

All hospital systems, insurance companies, pharmaceutical companies are interested in are maximizing profits and minimizing expenses.

All physicians are interested in is delivering the best care possible.

Patients and physicians are the most important stakeholders in the system.

The government wants to spend the least amount of money possible to enable the best care at the lowest price.

There has been little attempt by congress, the bureaucracy or previous administrations to remedy the defects I have pointed out.

 I have not seen any attempt by Congress to lower the price by decreasing the bureaucratic impact on the price of healthcare. Nor have I seen the exposure of the clandestine deals hospital systems make with insurance companies or the government.

I have not seen any movement toward decreasing the malpractice crisis in America. Tort reform has been vitally necessary for the last thirty years. It has been totally ignored by government officials.

These are some of the basic reforms necessary to start repairing the healthcare system. All our politicians do is kick the can down the road to the advantage of the secondary stakeholders and not the consumers.

These are some of the main reasons the system has to convert to a consumer-driven system that I have outlined previously.

Consumers must control their health and their healthcare dollars. They must be provided with an education that will help them control costs. They must be provided with financial incentives to control costs.

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



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Mechanism Design and the Repairing the Healthcare System

May 15, 2019
inUncategorized
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Stanley Feld M.D., FACP, MACE.      

On November 11, 2007, I published the following blog: “Incentives and Mechanism Design.” The authors Leoid Hurwicz, Roger Meyerson and Eric Maskin were awarded the Nobel Prize in Economics for the concept in 2007.

http://stanfeld.com/?s=mechanism+design

 I suspect few politicians know about Mechanism Design in 2019. I am certain Bernie Sanders and the “Medicare for All” crowd do not know anything about Mechanical Design.

In my last blog, I described how politicians and the mainstream media use Confirmation Bias to try to put the government in control of healthcare against the will and welfare of the public.  

https://en.wikipedia.org/wiki/Confirmation_bias

I think Donald Trump either studied the use of Mechanism Design and its mechanics or he intuitively uses its principles in his thinking.

Mechanism Design is a concept that tries to put science into social science. It mathematically evaluates vested interests of stakeholders in order to eliminate confirmation bias and line up all the stakeholders’ vested interests for the greatest good. It assumes all the stakeholders have expressed their vested interests truthfully.

Please Read Between the Lines

The Democrats want to hold onto (fix) Obamacare. However, the Democrats understand Obamacare is not viable in its present form. I believe “Medicare for All” with central government control of healthcare will be a disaster as it has been in most single party payer systems.

I do not believe Obamacare is fixable. I believe President Obama and the Democrats believed that Obamacare would fail. Then the nation would beg either his public option or Medicare for All.

I think President Obama believes “Medicare for All” and the total government control of healthcare is the ideological solution to the problems in our healthcare system.

His confirmation bias overrules all of the examples of “Medicare for All” failed examples at home (Vermont California and Colorado), as well as Denmark, Sweden, England, and France.  

In 2017, the Republicans with a slim majority in the Senate refused to repeal Obamacare. Whether the Republican failure to repeal Obamacare was because of intramural revenge or ideology is best to question is which system is best for the common good.

If our politicians understood the principles of Mechanism Design and were diligently working for the people who elected them benefit, America would be on the way to “Repairing the Healthcare System.”

Against this backdrop of a hostile Democratic Party, in control of the House of Representatives, Donald Trump and his administration is slowing working its way to “Repairing the Healthcare System” using the principals of Mechanism Design.

In November 2007, pre the Obama administration, I wrote:

Last month the Nobel Prize in economics was awarded to Leoid Hurwicz, Roger Meyerson and Eric Maskin. They were awarded the Nobel Prize for developing the economic theory of “Mechanism Design.” My first reaction was “what is that?”

https://en.wikipedia.org/wiki/Mechanism_design

After some research, I discovered the power of Mechanism Design. It is a brilliant economic theory that could solve many economic problems. Mechanism Design applied to our healthcare system could solve the healthcare systems problems.

What is it? “In economics, mechanism design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested. This is done by setting up a structure in which each player has an incentive to behave as the designer intends. The game is then said to implement the desired outcome. The strength of such a result depends on the solution concept used in the game. It is related to metagame theory, which is the theory of games the play of which consists of developing the rules of another game.

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare. However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers [1], thus significant research in mechanism design involves making trade-offs between these qualities. Other desirable criteria that may be achieved include fairness (minimizing variance between participants’ utilities), maximizing the auction holder’s revenue, and Pareto efficiency. More advanced mechanisms sometimes attempt to resist harmful coalitions of players.”

Lodi Hurwitz contributed to the idea of incentive compatibility. His point is the way to get as close to the most efficient economic outcomes is to design a mechanism in which everyone does best for themselves. He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying.

If everyone’s incentives are aligned, you have a much more efficient economic system. An example is defense contracting. If you agree to pay on a cost-plus basis you have created an incentive for the contractor to be inefficient. If you agree to pay a fixed price you can come close to an efficient price if you have all the truthful information. If you do not you have incentives aligned and truthful information you create the incentive to be overcharged. Most people can do better by not sharing truthful information. If the rules of the game require truthful information you can get close to an efficient market-driven solution.

The concept of Pareto efficiency means no one can be made better off without someone becoming worse off. Therefore, the incentive is to maintain your dominance by not being truthful at the expense of others. Hurwicz observed as others had that the dispersion of information was at the heart of the failure of a planned economy. He observed that there was a lack of incentive for people to share their information with the government truthfully. The free market mechanism was far less afflicted than central planning bureaucracy by such incentive problems. The free market economy was by no means immune to this defect. He observed that the free market economy can get us closer than central planning to incentive compatibility because the end consumer can drive the discovery of truthful information.

The customer creating rules of engagement in a market-driven economy can get you closer to the ideal of Mechanism Design. Since the customer determines success of an enterprise by creating demand in a transparent environment, they can get closer to incentive efficiency. They create the rules of the game for compatible incentive.

Roger Meyerson contributed the revelation principle, a mathematical model that simplifies the calculation to create the most efficient rules of the game. The mathematical model gets people to reveal their truthful private information leading to aligned incentives.

Eric Maskin’s breakthrough was in perfecting Mechanism Design with his “implementation theory.” His theory clarifies how to design mechanisms that heighten incentive alignment and efficiency.

How does Mechanism Design relate to the Repair of The Healthcare System? We have to set the rules of the games so that we align all the stakeholders’ incentives without one stakeholder takes advantage of another. The insurance industry is taking advantage of the patients, doctors and hospital systems. The hospital systems are taking advantage of the patients, doctors and insurance companies. Doctors are taking advantage of the insurance companies, hospital systems, patients and the government. The government is taking advantage of the hospital systems, the doctors and the patients. Employers who pay the insurance bills for their employees are taken advantage of by the insurance companies. The drug companies are taking advantage of patients and unduly influencing physicians.

In our healthcare system, everyone is pursuing his vested interest in a game that has rules that do not lead to “incentive compatibility.”

Some politicians think central planning will straighten out the rules. Historically, central planning has not worked. The winners of this year’s Nobel Prize in economics have proven this fact.

I believe consumers can fix the rules of the game so that all the incentives are compatible. Consumers have to have incentives to force politicians to fix the rules of the healthcare game. Consumer-driven healthcare system will achieve the alignment (incentive compatibility) using the ideal medical saving account.

Twelve years have passed since 2007. America has not gotten closer to the solution to Repair the Healthcare System even though the solution is staring us in our eyes.

www. stanfeld.com

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



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The Expansion Of Personalized Healthcare Insurance Benefits.  

January 3, 2019
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System
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 Stanley Feld M.D.,FACP, MACE

The Senate rejected the  slimmed-down Obamacare Repeal bill as Senator John McCain was the deciding no vote July 27,2017.

“When Senator John McCain of Arizona returned to Washington with a fresh scar from brain surgery, it was widely seen as a dramatic effort to help Republicans overturn Obamacare.

 Little did Mr. Trump know that the Arizona senator would help drive the stake through legislation that sought to realize the Republicans’ seven-year dream of finally dismantling Obamacare.”

 John McCain’s vote was a surprise to everyone. Mitch McConnell then put healthcare reform on hold. Senator McConnell decided to let Obamacare die on its own.

However, the Senate rejection did not deter President Trump from pursuing healthcare reform .

He has already approved the development of purchasing associations through an executive order. The associations will sell health Insurance coverage. The rules will go into effect January 1, 2019.

He has also has attacked the drug industry with his blue print on drugs. The regulations from this will decrease the costs of drugs by decreasing the number of middlemen in the manufacture to sales process.

On October 2017 President Trump issued an executive order to promote healthcare choice and competition in the country.

https://www.whitehouse.gov/presidential-actions/presidential-executive-order-promoting-healthcare-choice-competition-across-united-states/

In the executive order President Trump said his goal was to ‘Expanded Availability and Permitted Use of Health Reimbursement Arrangements.

 The Secretaries of the Treasury, Labor, and Health and Human Services shall consider proposing regulations or revising guidance, to the extent permitted by law and supported by sound policy, to increase the usability of HRAs, to expand employers’ ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with nongroup coverage.

The Departments of Treasury, Labor, and Health and Human Services proposed regulations in October 2018 that would significantly expand personalized health benefits to consumers and would offer increasing price pressure to lower insurance prices tor U.S. businesses. Most U.S. businesses want to continue to provide medical coverage for their employees. However they need affordable prices.

The proposals, issued Tuesday, October 23, 2018 by Treasury ,Labor and HHS were a response to the October 2017  executive order from President Donald Trump.

 “That order instructed the Departments to increase the availability and usability of health reimbursement arrangements (HRAs)—especially those offered in conjunction with non-group insurance.”

The proposal is well thought out. I have a problem with some of the upcoming regulations but they are an excellent step in the right direction.

The regulations do not utilize a most important element in my ideal medical savings accounts. It does not provide financial incentives for consumers to become informed consumers of healthcare or motivated to save healthcare dollars.

Consumers of healthcare have to be incentivized to become savvy purchasers of their own healthcare and healthcare insurance coverage.

“If enacted, the regulations would create two new HRAs: something we’re calling the individual-integrated HRA, and the smaller, excepted benefit HRA.”

HRAs can be viewed as a superstructure for my ideal medical savings accounts. President Obama did everything he could to discourage the purchase of health savings accounts. His goal was to drive everyone into a single party payer system with the individual consumer’s healthcare decision are made by the government.

Despite President Obama’s attempts to discourage health savings accounts, they grew as the fastest and most popular healthcare insurance product. HSAs permitted consumers to have some   control of their healthcare spending and some of their healthcare dollars.

“In 2013, IRS Notice 2013-54 issued guidance on the Affordable Care Act (ACA) that seriously limited businesses’ ability to offer HRAs. The IRS said that while HRAs integrated with group health insurance satisfy key ACA provisions, HRAs integrated with individual health insurance do not.”

This is where Obamacare discouraged consumers to buy HSA as individuals. The insurance was not completely tax free to businesses or individual consumers.

“Congress provided some relief in December 2016 by creating the qualified small employer HRA (QSEHRA). The QSEHRA, a benefit specifically designed for small businesses with fewer than 50 employees, allows businesses to reimburse employees tax-free for their health care costs.”

With his October 2017 executive order, President Trump sought to expand HRAs even further. In the order, he asked the Treasury, the DOL, and the HHS to reexamine past rulings and “increase the usability of HRAs, to expand employers’ ability to offer HRAs to their employees, and to allow HRAs to be used in conjunction with non-group coverage.”

The new proposed regulations are a direct response to that executive order. Unfortunately it does not solve the healthcare insurance problem. The proposal keeps the insurance industry in charge of the healthcare dollars and healthcare decisions. It is a step in the right direction. It helps small business more than it helps the individual.

  QSEHRA  “Qualified Small Employer Health Reimbursement Arrangement”  Individual-integrated HRA
Business size restrictions Only available to businesses with fewer than 50 full-time employees. None.
Employee eligibility requirements All full-time employees are automatically eligible. Part-time employees can be included, but the HRA must be offered on the same terms. Employees can participate in the HRA without individual health insurance, but those without MEC must pay income tax on all reimbursements during the time they were uninsured. The business can set eligibility guidelines according to permitted employee classes, but the HRA must be offered on the same terms to all employees in each class. Employees without individual health insurance, including those covered by a spouse’s group policy, cannot participate in the HRA.
Allowance amount restrictions In 2018, annual allowance amounts are capped at $5,050 for self-only employees and $10,250 for employees with a family. The business can vary allowance amounts only by family status, age, and family size, but not based on employee classes. There are no caps on annual allowance amounts. The business can vary allowance amounts according to permitted employee classes, as well as age and family size.
Group policy requirements Businesses offering the HRA cannot offer a group policy. Businesses offering the HRA may offer a group policy, but it cannot offer both the group policy and the HRA to the same employee class.
Premium tax credit coordination Individuals participating in the HRA are still eligible for premium tax credits, but the amount of the credit is reduced dollar-for-dollar by the amount of the HRA allowance. Individuals participating in the HRA aren’t eligible for premium tax credits.

 

I will explain each category as well as its advantages and disadvantages in the near future. These regulations do much toward Repairing the Healthcare System.

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



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January 03, 2019 in Consumer Driven Health Care, Disinformation and the healthcare system, Innovations in Healthcare, Medicine: Healthcare System | 

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How Jeff Bezos, Warren Buffett and Jamie Diamond Can Disrupt The Healthcare System

February 19, 2018
inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicaid, Medicare
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Stanley Feld M.D., FACP,MACE

Jeff Bezos, Warren Buffett and Jamie Diamond should try this disruptive approach in their venture into healthcare reform.

All the other approaches that have been tried have not worked or have become unsustainable. Most of the approaches have been unfair to consumers and the majority of taxpaying Americans.

The only way to empower all the consumers in a healthcare system is to encourage them to become responsible for their health and healthcare dollars.

I believe it can only be accomplished by providing easily understandable financial incentives for consumers to save money for themselves.

Providing financial incentives to consumers to save money for themselves can be disruptive to the present models used to pay for medical services just as Amazon has been disruptive to retail sales.

The delivery of medical and surgical care has advanced tremendously in the last sixty years.

At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.

The incidence of obesity has risen every year. Over fifty percent of Americans are obese.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well. However the treatment of chronic disease complications are costly.

How do you decrease the incidence of obesity in America?

Physicians must attack the core causes of obesity.

Among those causes are excess food intake, lack of daily exercise, mental depression, cultural milieu and/or a combination of all of the above.

The cure of obesity depends on the ability to eliminate these core drivers. Financial incentives can get patients involved in eliminating the core drivers of obesity.

The responsibility for obese patients’ healthcare depends on patients’ lifestyle, popular cultural milieu, and patient education.

In America, it is almost impossible to buy a meal in any level restaurant without excess calories.

How do you get people to be responsible for their health and healthcare dollars?

The one key element ignored by policy makers to decrease obesity is to give obese consumers of healthcare financial incentives to concentrate on trying to lose weight.

“Obamacare went in the wrong direction. It limits personal liability for their obesity. It does not promote personal responsibility

The only incentive Obamacare provided was the incentive to overuse the healthcare system.

This was especially true for patients on Medicaid. They had zero premiums and deductibles. The only deterrent to accessing medical care was physician availability.

Physicians refused to participate in Medicaid because of low professional reimbursement. Low reimbursement by the government was necessary because of the decreases in funding and participant overuse of the system.

Obamacare planned to cure the shortage of “medical providers” by increasing the number of “valid medical providers” who could bill on their own, such as nurse practitioners and certified physician assistants.

However, the defect there is that patients were not under the supervision of physicians engaged in their care. It ignores the patient physician relationship that is so important to effective medical care.

If Jeff Bezo, Warren Buffet and Jamie Diamond (BBD group) are serious about Repairing the Healthcare System for their employees as a nonprofit organization, they should consider my Ideal Medical Savings Account.

http://stanfeld.com/?s=My+Ideal+Medical+Savings+Account

The Ideal Medical Savings Accounts (MSA) are tax-sheltered accounts used to pay for non-catastrophic medical expenses. These non catastrophic medical expenses account for the bulk of the cost of medical care.

Money left from the Medical Savings Account at the end of the year is put into a consumer’s retirement account.

The MSA provides the financial incentive to not overuse the healthcare system.

Warren Buffet understands the money making potential of re-insurance. He is heavily invested in re-insurance companies.

If one of the BBD Groups employee’s gets sick and spends of all of his MSA money, reinsurance provides first dollar coverage for the illness.

The BBD Group could teach employees how to shop for price and value. Insurance companies are supposed to shop for value. However the shopping is never to the patient’s advantage. It is to the advantage of the insurance company.

“ Critics always claim this is unrealistic:

  1. The claim is that patients are not smart enough to shop for price and value. 2. Are you supposed to shop around from the back of the ambulance?

 The critics’ use the ambulance argument to eliminate the possibility of consumers using their own judgment to make price decisions.

Patients are smart enough to figure out which hospital they want to go to before they get into the ambulance.

Emergency care represents only 6% of health care expenditures.

“But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

ttps://www.wsj.com/articles/the-health-reform-that-hasnt-been-tried-1507071808

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

ttp://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/

“My Ideal Medical Saving Account provides that financial incentive to not overuse the healthcare system. All the articles about my ideal medical saving accounts are attached to this link.

http://stanfeld.com/?s=My+ideal+Medical+Savings+Accounts

“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”

 Medicaid patients also overuse the healthcare system.

Most Medicaid patients can understand the MSA’s financial incentive.

“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”

These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system. It would save the re-insurance company a great deal of money.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and deliver it to consumers retirement accounts.

Both HSA’s and MSAs have the unique advantage of providing the financial incentive to for consumers to save money for themselves.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health. 

 The financial incentives decrease the overuse of the healthcare system.

“ According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”

 https://www.healthaffairs.org/do/10.1377/hpb20160204.950878/full/

 My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ MSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”

MSAs should also apply to Medicaid recipients. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to MSAs should be raised to $6000 or $7000 dollars. If a consumer gets sick and experiences a cost of more that $6000 he should receive 100% (first dollar) coverage through the BBD group’s provided reinsurance policy. A reinsurance policy would cost the BBD Group less than $6000 a year.

The total insurance package to BBG Group employees should cost the BBD Group $12,000 rather than the present cost of $18,000.

BBD is a self insured association. The association has elimated the multiple middlemen in the present healthcare system.

 When a person with an MSA dies, the funds should be allowed to roll over tax-free to surviving family members.

This financial incentive should be included in My Ideal Medical Savings Account.

“The information that patients require to assess value must be made more transparent. 

2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”

A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.

At present healthcare prices are not transparent. Consumers are not motivated to shop prices. The BBD Groups leverage with its employees would force transparency.

“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”

 In this age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines. It would supply instant access to expertize at an affordable cost.

Everything possible should be done to encourage consumer responsibility and provider competition.

The present tax code does the opposite. Consumers in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.

The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.

The BBD Groups volume of consumers would have tremendous leverage with providers.

The younger and healthier the corporate employees are the lower the premiums.

The formation of associations with large memberships of all ages would lower the cost of healthcare. Large associations would have great leverage in negotiating price with providers. They would also spread the risk.

Self- insured associations such as the BBD Group would also spread the risk and lower the cost.

Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars the same as the corporate group plan policy holders.

These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.

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

 All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

 

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Consumers Need To Take Back Their Medical Care And Healthcare Dollars

October 23, 2017
inConsumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

A consumer driven healthcare system is the solution to the dysfunctional and unaffordable healthcare system that americans are presently experiencing.

President Trump wants to create the conditions for consumers to take responsibility for their medical care and their healthcare dollars.

The negative noise in the mainstream media should be ignored.

The Obamacare health insurance exchanges have failed. The Democrats and establishment Republicans should realize that the health insurance exchange plan was a defective system that it can not be repaired with patches and more money.

President Trump has signed an executive order to permit private associations to sell insurance. There are many associations that a person could belong too. Consumers could shop for the right association at the right price.

Democrats are behaving as if associations are a foreign enemy.

UnitedHealth has contracted with AARP (an association) to sell Medicare supplemental insurance. UnitedHealth sells this insurance across state lines.

USAA has contracted with Humana to sell Medicare supplemental insurance and Medicare Drug coverage.

There are many supplemental plans that consumers can choose from in these associations. These plans are sold across state lines and are competitive.

The government has to change the tax law to treat individual healthcare insurance plans bought through the associations to be paid for with pre-tax dollars just as the employer sponsored group plans do.

However, associations selling healthcare insurance are only the first step in empowering consumers.

A well-known retired physician (DEF M.D.) sent me his view on what consumers need to be aware of to survive any healthcare system. He calls it

“My Three Rules For Survival”

Remember my three rules for survival:

1) Stay the hell away from doctors.

They always either want to do something or prescribe something, and all too frequently do both.

A large part of this physician reflex is their need to practive defensive medicine. Physicians are afraid they might miss something and get sued.

Major tort reform is necessary in most states. Defensive medicine accounts for $250 billion to $700 billion dollars in unnecessary expenses each year.

I have outlined the steps necessary to remedy the malpractice (tort) crisis and its resulting overuse of testing and medication.

If anyone in President Trump’s administration wants to review the issue in full click on this link.

http://stanfeld.com/?s=Tort+reform

Nobody confronts the reality you mentioned , people are too fat, they drink too much and smoke, AND they don’t even think about the importance of, and benefits from, exercise.

 I started a war on obesity many years ago. Public officials and poly wonks have ignored my suggestions.

It would be worthwhile to read my post about obesity.

http://stanfeld.com/?s=war+on+obesity

The cost to all of us (including them) of all this denial of personal responsibility is huge!  We need to find ways to get people to focus on taking care of themselves, or to create cost incentives that will encourage them to do so.

While you are in this reading mood you should check out my pleas for the importance of patient responsibility.

ttp://stanfeld.com/?s=patient+responsibility

We simply cannot continue on the path we are on. I don’t recall ever seeing a patient on a “scooter”, and many in wheelchairs that are obese, and only getting fatter and fatter over time.

     2) Take as little medicine as you can.

Pharmaceutical manufacturers are continuing to drive up the cost of their products and are making enormous profits as a result.  Data is available re: the necessity of people getting medicines that they don’t really need, especially if taken long term on an ongoing basis.

To that, one can add the cost of unnecessary procedures that often leave patients worse off than they were before.  Direct to the public advertising of prescription medications creates demand that is often unaccompanied by benefit.

More and more current information regarding side effects and late effects of medications need to be provided, and not just put into the “fine print” on the package stuffers.

     3) Stay out of hospitals.

 They are dangerous places, with a high prevalence of patient injuries and deaths due to various sorts of medical errors that occur all too frequently, despite a host of quality improvement projects that are well-intended, but would be better in terms of effectiveness if they were made public on a regular basis.

 Scott Atlas makes good arguments for encouraging patients to “price shop” for services they must have.  To that information should be appended information about outcomes of what is proposed, which could, over time, become both hospital-specific and physician-specific.

I have expanded on Scott Atlas’ Wall Street Journal article in my last blog.

http://stanfeld.com/the-plan-to-empower-consumers-of-healthcare/

Most doctors and most hospitals have not much of a clue as to the outcomes of the services they provide their patients.

And, that is probably plenty for today.  DEF”

Consumers need to be educated to become aware of the many pitfalls involved in their new responsibility.

The educational process can be accomplished with online information and chat sessions. The government could provide the education necessary.

Consumers also need financial incentives to be encouraged to be responsible for their care and their healthcare dollars

This can be accomplished with my ideal medical saving accounts.

http://stanfeld.com/?s=ideal+medical+savings+accounts

Then and only then can we have a consumer driven healthcare system that will lower the cost of healthcare.

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

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

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The Plan To Empower Consumers Of Healthcare

October 16, 2017
inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System
• Leave a comment

 Stanley Feld M.D., FACP,MACE

The only way to empower consumers of healthcare is to allow them be responsible for their health and healthcare dollars.

The delivery of medical and surgical care has progressed markedly in the last sixty years. Life expectancy has also increased.

At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.

The incidence of obesity has risen every year. Over fifty percent of Americans are obese. The percentage is rising yearly.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well but the treatment of these complications comes at a high cost.

How do you decrease obesity in America?

How do you get people to be responsible for their health and healthcare dollars?

One of the key elements in decreasing obesity is to give consumers financial incentives to use the healthcare system efficiently.

“ObamaCare went in the wrong direction. Its regulations—including required “essential benefits”—raised prices on these plans and limited their availability.”

The only incentive Obamacare provided was the incentive to overuse the system. This was especially true for patients on Medicaid. They had zero premiums and deductibles.

A second tool for motivating patients to consider price is large liberalized health savings accounts. These tax-sheltered accounts are generally used to pay for the noncatastrophic expenses that form the bulk of medical care.

First, equip consumers to consider prices.”

“ Critics always claim this is unrealistic: Are you supposed to shop around from the back of the ambulance?

 The critics use the ambulance excuse argument to eliminate the possibility of consumers using their own judgment to make price decisions.

“But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

http://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/

“My ideal medical saving account provides that financial incentive to not overuse the healthcare system. The many articles about my ideal medical saving accounts are attached to this link.

“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”

 Medicaid patients also overuse the healthcare system.

“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”

These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and delivers it to consumers.

Both HSA’s and MSAs have the unique advantage of providing and financial incentive to save.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health. 

 The financial incentive decreases the overuse of the healthcare system.

“ According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”

My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ HSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”

Scott Atlas has publicized the obvious. This would apply to Medicaid recipient also. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to a MSAs should be raised to $6000 or $7000 dollars. If a consumer get sick and experiences a cost of $6000 he should receive 100% (first dollar) coverage through a reinsurance policy that would cost less than $6000.

There can be many variations on this theme for the consumers benefit.

 When a person with an HSA dies, the funds should be allowed to roll over tax-free to surviving family members.  

This financial incentive should be added to My ideal Medical Savings Account.

“The information that patients require to assess value must be made radically more visible. A 2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”

A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.

“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”

 In his age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines.

It would supply instant access to expertize at an affordable cost.

Everything possible should be done to encourage consumer responsibility and provider competition.

The present tax code does the opposite. Consumers’ in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.

The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.

The younger and healthier the corporate employees are the lower the premiums.

This is where the formation of associations with larger memberships of all ages fits in to lowering the price of healthcare. Large associations would have great leverage in negotiating price with insurance companies. They would also spread the risk.

If financial incentive with my ideal medical saving account was added to the price the association negotiated and the consumer paid for the premium, usage would fall and the cost of insurance would decrease.

Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars as the corporate group plan policy holders.

These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.

The opinions expressed in the blog “Repairing The Healthcare System” are, 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?

March 1, 2017
inChronic Disese Management, Consumer Driven Health Care, Medicine: Healthcare System
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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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Donald Trump on Healthcare Reform

September 16, 2016
inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D. FACP, MACE

Donald Trump’s healthcare proposals are totally different from Hillary Clinton’s. His proposals are a step in the right direction to Repair the Healthcare System.

His advisors tried to create a market based healthcare system. However, they have omitted the most important elements necessary to align all the stakeholders’ incentives.

Unfortunately, their approach is the usual healthcare policy wonks market based policy approach. They do not focus on the most important stakeholder in the healthcare system.

The consumer is the most important stakeholder in the healthcare system. The consumer should be the driver of the healthcare system.

A market based system should:

  1. Promote of consumer driven healthcare system.
  2. Promote consumers’ responsibility for their health and healthcare dollars.
  3. Promote the physician/patient relationships.
  4. Promote a respect for consumers’ intelligence. Consumers can judge what is best for their healthcare needs.
  5. Promotion of accurate education about a consumers’ disease and provide resources to help consumers make the best choices to treat their diseases and use their and healthcare dollars.

Donald Trump’s web site starts by pointing out the defects in Obamacare. The Obama administration and Hillary Clinton’s spin machine uses the traditional media to promote the erroneous concept that all that is needed to fix Obamacare’s small defects are small modifications and more money.

This is a wild fantasy. The real goal is to completely control the healthcare system.

Donald Trump’s web site starts by declaring that Obamacare must be repealed.

“Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act—(Obamacare.”

The average Americans are starting to understand Obamacare economic burden on the economy in general and them individually

“ The Affordable Care Act, (Obamacare), legislation, passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history must be repealed.”

President Obama and majorities in the House and Senate tightly controlled the debate in congress and the traditional media.

Nancy Pelosi said it all when she said “you will not know what is in Obamacare until it has passed.”

“Obamacare has tragically but predictably resulted in runaway costs.”

The runaway costs for the government and individuals were the result of:

“Websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.”

“Obamacare has raised the economic uncertainty of every single person residing in this country.”

This has resulted from the 10 hidden taxes, along the inhibiting effect on the economy and the uncertainty of the potential mandates, that resulted in and from job losses.

“As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.”

Donald Trump concludes that Obamacare cannot be fixed. It must be repealed.

“But none of these positive reforms can be accomplished without Obamacare repeal. On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

Donald Trump recognizes that simply repealing Obamacare will not fix the healthcare system.

He also recognizes that he must work with Congress to have a series of reforms ready for implementation.

“We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country.”

It is refreshing to know that a potential president is willing to work with congress rather than issue executive orders and see if he can get away with them.

“By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.

Any reform effort must begin with Congress.”

Donald Trump says;

Several reforms will be offered that should be considered by Congress so that on the first day of the Trump Administration, we can start the process of restoring faith in government and economic liberty to the people.

This is the correct process according to the constitution.

It is imperative that Republicans maintain their majorities in the House and Senate in order for Donald Trump to lead legislation to repeal and replace Obamacare.

The following are the suggestions a Trump administration will offer the congress according to his website.

  1. Completely repeal Obamacare.                                                         
  2.  Our elected representatives must eliminate the individual mandate (tax according to the Supreme Court). No person should be required to buy insurance unless he or she wants to.
  3. Modify existing law that inhibits the sale of health insurance across state lines.

Donald Trump assumes eliminating state line restrictions will allow full competition in the healthcare insurance market place. He assumes insurance premium costs will go down and consumer satisfaction will go up. The healthcare insurance companies will try to keep the insurance premiums equally high in all states.

It can only work if consumers can buy insurance they believe they need. Costs of unnecessary insurance should not be piled into one insurance plan fits all. i.e. A post menopausal woman does not need to pay a birth control premium.

4. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.

Individuals should be allowed to take the same tax deductions as group insurance plans are allowed.

     5. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

This is where Donald Trump’s proposal weakens. The Medicaid program must be modified. Medicaid recipients should be incorporated into my ideal Medical Saving Account program. The government should act as the funding agent for the eligible poor.

This will put the poor on the same payment footing as everyone else.

The Medicaid eligible poor should be given financial incentives to take charge of their health and healthcare dollars.

Our healthcare system must be moved from a system that fixes you when you are sick or broken into a system that rewards people financially for remaining healthy and controlling their healthcare spending.

It is much cheaper to avoid the cost of emergency care than it is to get sick and have to go to the emergency room.

         6. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate.

Health Savings Accounts (HSAs) should be changed to Medical Savings Accounts (MSAs) to provide better financial incentives for people who choose this form of insurance. The Medical Savings Accounts can easily be customized so that consumers can choose the level of insurance they desire.

The contribution to the MSA can be flexible to provide adequate amounts of money to be put into the savings accounts to incentivize consumers to remain healthy.

Obesity is a huge program that must be consumer driven. Obesity must be cure by the patient and his family, not surgery.

Obese children are becoming diabetic and also hypertensive at a young age. This must be stopped because of the potential explosive effect of complications of both diabetes and hypertension on individual and overall costs of medical care.

      7. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.

Price transparency is an essential provision for individuals, businesses and groups. It provides leverage for consumers to be responsible for their healthcare dollars. It is also necessary to require insurance companies to provide verifiable price transparency for their administrative costs and their direct patient care costs

Consumers must be empowered to be responsible and shop for the most value and best prices for procedures, exams or any other medical related procedure.

This is the way to decrease the cost of healthcare services and medical care services.

Social networking should be used as the backbone for the establishment of consumer empowerment.

The success of Angie’s list, Trip Advisor and Open Table are a result of social networking. Local communities have their individual social networks that empower people in their neighborhood to know which vendors provide the best value in their community.

This simple step can be used to decrease the cost of healthcare and medical care.

This could be a place where government can lead the way in establishing this accurate educational resources.

       8. Block-grant Medicaid to the states.

These block grants can be used by the states to fund MSAs without a threat of increasing state budget deficits or giving states rights to the control of the federal government.

Block grants for social networking should be used to provide incentives to help individuals to seek out and eliminate fraud, waste and abuse of some of its local providers. It would eliminate expensive big data collections that many times are inaccurate in decision making by central federal control.

       9. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

Federal and state governments should help its citizen choose safe, reliable and cheaper products for the treatment of their diseases.

It would help with compliance and adherence to recommended treatment and decrease the cost of care.

It would promote consumers taking responsibility for their own health and healthcare dollars.

     10.  Congressss will need the courage to step away from the special interests and do what is right for America.

One example is allowing consumers access to imported, safe and dependable drugs from overseas. It will provide more options to consumers. This is only one example of many that ways to decrease the cost of drugs in this country.

Donald Trump is proposing a lot of important changes.

However, he is missing the important element of consumer power, consumer initiative, and consumer incentives.

His healthcare changes must include a consumer driven system with an ideal medical saving account otherwise the healthcare system will remain an unmanageable, expensive and abused mess.

Donald Trump admits this is simply a start. His start is much more powerful than Hillary Clinton’s proposal to continue and build on Obamacare.

Obamacare has been a disaster that is unsustainable. It is weekly increasing the cost of care while rationing care and decreasing access to care.

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Why Vermont’s Single Party Payer Healthcare Plan Failed

August 19, 2016
inConsumer Driven Health Care, Defective scientific studies, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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 Stanley Feld M.D., FACP,MACE

Vermont’s single party payer healthcare plan was doomed to fail from the onset for several reasons.

Healthcare policy consultants do not understand the medical care system. The healthcare policy consultants for the Vermont healthcare system were the same consulting architects President Obama used for Obamacare.

The consultants were Harvard’s William Hsiao and MIT’s Jonathan Gruber.

William Hsiao has spent most of his academic career helping governments install healthcare systems. William Hsiao is the K.T. Li Research Professor of Economics in Department of Health Policy and Management and Department of Global Health and Population, at Harvard T.H. Chan School of Public Health.

Jonathan Gruber is a professor of economics at the Massachusetts Institute of Technology, where he has taught since 1992.[1]

He is also the director of the Health Care Program at the National Bureau of Economic Research, where he is a research associate.

Jonathan Gruber has been heavily involved in crafting public health policy.

He has been described as a key architect[2] of both the 2006 Massachusetts health care reform, sometimes referred to as “Romneycare”, and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as the “ACA” and “Obamacare”.

There is little evidence that the systems he and Dr. Hsaio have built are overwhelming successful, cost effective or preserve consumer freedom of choice.

In fact, a study by NPR and Harvard’s T.Chan School of Public Health concluded that Obamacare is a complete failure.

Dr. Hsaio is on the faculty the Harvard T.Chan School of Public Health.

“NPR AND HARVARD T.H. Chan School of public Health SAY: OBAMACARE IS A COMPLETE FAILURE”

In a New York Times interview in 2009 Dr. Hsiao discussed the system of healthcare Reform he installed in Taiwan.

The question was:

What’s the most important lesson that Americans can learn from the Taiwanese example?

Dr. Hsiao.

You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.

The Taiwan government managed to insure 98 percent of the population with a premium cost of 4.6 percent of wages.

Q.

Has your system of healthcare in Tiawan translated into better life expectancy or lower complication rates from major diseases?

Dr. Hsiao.

“There is evidence of positive health results for select diseases, like cardiovascular disease and kidney failure.”

There is no medical or financial data available to prove outcomes have improved.

“Overall, it’s really difficult to say that national health insurance has improved the aggregate health status, because mortality and life expectancy are crude measurements, not precise enough to pick up the impact of more health care.”

“That said, life expectancy is improving, and mortality is dropping. And everyone now has access to good health care”.

This is not good science. It is not even good social science. This is a biased opinion.

Q.

What are the system’s weaknesses?

Dr. Hsaio

“In the legislative process, compromises had to be made. First, the president yielded on payment reform, so Taiwan kept its fee-for-service payment system. Unfortunately, that encourages doctors and hospitals to give more treatment in order to boost their income.

“Second, the Taiwanese system doesn’t have a systematic way to monitor and improve quality of care.”

“Third, in the legislative process, they rejected a provision to adjust the premium automatically when the national health system depletes its reserves.”

“In every country, health care costs are increasing faster than wages. When that happens, the premium has to go up. But that provision wasn’t incorporated into the law. As a result, the system is running a deficit.”

“National health insurance tries to cut the fees for hospital and physician services. But eventually these fee reductions will adversely affect the quality of health care.”

President Obama was so anxious to change the healthcare system in the United States to fit his socialist ideology that he picked two professors, Dr. Hsaio of Harvard and Jonathan Gruber of MIT to be the architects of Obamacare.

Jonathan Gruber has been introduced as the ‘architect’ of the Massachusetts law and/or Obamacare”.[52]

Neither professor had scientific evidence that a single party payer system would work efficiently.

Obamacare was not working efficiently yet the progressives in Vermont hired Dr. Hsaio and Dr. Guber to be the architects for Vermont’s single party payer system.

Jonathon Gruber has turned out to be a honest about the Obama administration’s lies.

Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or “stupid”.

In October 2013, Gruber we said: “the bill was deliberately written “in a tortured way” to disguise the fact that it creates a system by which “healthy people pay in and sick people get money”.

Some of Americans are waking up to the fact that they cannot trust President Obama and his administration to be our surrogate. This is true not only in healthcare but in his decision making in every area of the economy and our live.

Gruber said this obfuscation was needed due to “the stupidity of the American voter” in ensuring the bill’s passage. Gruber said the bill’s inherent “lack of transparency is a huge political advantage” in selling it .[31]

 In 2010, Jonathan Gruber expressed doubts that the ACA would significantly reduce health care costs. He thought lowering costs played a major part in the way the bill was promoted by the Obama administration.[36]

President Obama said he never met Jonathan Gruber and did not think he came to the White House. President Obama forgot he hired him and paid him a $400,000 consultation fee.

In 2014, the Obama administration claimed that Gruber did not have a major role in creating the PPACA.[50]

President Obama acted irresponsibly to the public by hiring healthcare policy wonks to change America’s healthcare system without evidence for the success because their thoughts fit his ideology.

I don’t think President Obama understands he has changed the way hospitals and physicians have changed their approach to healthcare and medical care.

In my opinion, healthcare and medical care has changed for the worse.

Rich Lowry said that the videos were emblematic of “the progressive mind, which values complexity over simplicity, favors indirect taxes and impositions on the American public so their costs can be hidden, and has a dim view of the average American”.[41]

The American public eventually figures it out.

Commentator Charles Krauthammer called the first Gruber video “the ultimate vindication of the charge that Obamacare was sold on a pack of lies.”[42]

 The Vermont governor hired Dr. Hsaio and Dr. Gruber to create a single party payer system in Vermont figuring,the system would be easier in one small state than in the nation.

Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state.

“In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

Watch out Colorado!

Why doesn’t a single party payer system work?

All of the healthcare policy wonks, especial Dr. Hsaio and Dr. Gruber, leave out the most important ingredients in a successful healthcare system.

Consumers cannot be treated as a commodity. Consumers cannot be forced to take what is given to them. The healthcare system must have a viable physician patient relationship provision.

The physician patient relationship is a big part of the therapeutic index. If treatment is to be successful patients must participate in their care.

Consumers of the healthcare system must drive the healthcare system. It must not be government or the healthcare insurance industry.

Consumers must be a the center of the healthcare system.

A system needs to be developed that puts patients in charge, not the government. Consumers must be responsible for their healthcare and their healthcare dollars.

This will motivate doctors and hospitals to compete for patients’ business.

My Ideal Medical Savings Account will provide incentives for the consumers to have a consumer driven healthcare system. This system will in turn drive hospital systems and physicians to compete for their care.

The end result will be to decrease the cost of the healthcare system and improve medical care and consumer satisfaction with the healthcare system.

 

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

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