Results found: 61

Permalink:

My Ideal Medical Savings Account Is Democratic!

May 9, 2012

inHealth Savings Accounts vs Medical Savings Accounts, Innovations in Healthcare, Medicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) “was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrictions on freedom of choice and a decrease in access to care.

I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health. Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk is low.

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust. If they spent over $6,000 they would have first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes, or health disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

Please have a friend subscribe

Permalink:

The Main Reason Behind Rising Medical Costs

October 2, 2018

inMedicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama and progressive Democrats such as John Kerry and Barney Frank wanted the healthcare system to become a single party payer system. Their problem was that they could not get enough votes in the house or senate.

https://youtu.be/f3BS4C9el98

https://youtu.be/-522hcm3woA

This goal for a single party payer by the progressives and Democrats must not be forgotten as the Trump administration tries to make a serious attempt to repair the healthcare system.

The Democrats and progressive will try to block this attempt at every turn.

All the stakeholders have played an important role in distorting the healthcare system including the government, the healthcare insurance industry, the pharmaceutical industry, the hospital systems, the physicians and patients.

A starting salary for a starting hospital administrator is $250,000 a year. A starting salary for a pediatrician is $90,000 a year. Top hospital administrators are paid between five (5) million and fifteen (15) million dollars a year. Mature pediatricians make $150,000 to $200,000 a year.

Which professional adds more value to medical care? Physicians add more value to the medical care system. Hospital administrators do not understand why physicians resent them.

Physicians also resent hospital systems ripping off consumers with $50 aspirins and $100 sleeping pillows. Consumers who care about the cost of healthcare do not understand why the government and insurance companies let hospital systems charge these obscene prices.

Most physicians do not pay attention to these costs until they are patients.

All of the stakeholders except the government and patients try to optimize the amount of money they take out of the system. Surgeons are much further ahead of primary care physicians in figuring out their value to the healthcare system.

As a result of advances in technology, physicians figured out that 70-80% of the work-ups done requiring hospitalization 30 years ago could be done as outpatient care.

The brick and mortar value of hospital facilities has decreased.

As soon as hospitals realized this they started to build ambulatory surgical care facilities and outpatient clinics. Hospital system procedures are more expensive than free standing outpatient ambulatory surgical care facilities.

http://stanfeld.com/hospital-mergers-dont-work/

Hospital administrators somehow convinced the government that if they formed hospital systems and merged hospitals in an area they would increase their efficiency and they could decrease costs.

At the same time the management of private practices became complicated as a result of government regulations. Expensive electronic medical records were required but did not work as advertised. Overhead increased while reimbursement decreased.

Many physicians became disgusted managing their complicated private practices. Some physicians quit practicing early.

The hospital systems offered to buy private practices for a “reasonable cash price”, provide an electronic medical record, do the billing and management of the practice and hire and pay full time employees.

Hospital systems usually paid physicians under contract the same take home pay they had for two years. After the two-year contract expired the hospital systems offered new contracts depending on a physician’s productivity or fired the physician. Physicians had no say in the matter.

Physicians and surgeons signing with the hospital system did not consider the criteria to be used for determining salary after their contract expired .

This hospital arrangement seemed attractive to many primary care physicians and some surgeons. The growth of hospital owned physicians increased from 20% to 70% of physicians in a region.

Organized medicine, the AMA and physician specialty groups, did little to warn or educate physicians of these unforeseen consequences.

Hospital systems did their best to isolate private practicing physicians from using their hospital facilities.

The only private practice physicians who were not marginalized by the hospital systems were physicians who were needed by the hospital system for the services they performed. As soon as the hospital systems were able to hire physicians to cover those services the private practice physicians were marginalized.

Large hospitals systems are making deals with insurers that squelch competitive hospitals.

President Obama’s plan was to allow hospital systems to hide prices from consumers and corporations. The goal was to discourage use of less-expensive rivals. This tactic would force the less-expensive competition to join the regional hospital systems as affiliates.

At first hospital systems did not grasp the ultimate significance of enlarging hospital systems. They figured merging hospitals would increase efficiency and decrease the cost of medical care.

They also thought owning physician practices would decrease their reliance on in-patient hospital billings and their brick and mortar structures.

During the Obama years there was a tremendous increase in building growth on the campus of most hospital systems.

I never understood the hospital building growth. More building meant more hospital administrators and more overhead. I thought the government must have created some economic incentive for hospital systems to build more buildings on campus. I could not find the incentives given to hospital systems.

As hospital systems merged all the hospitals in a region the hospital systems realized they had a monopoly on not only hospital services but also physician services.

They could negotiate with healthcare insurance companies from strength.

Initially the healthcare insurance companies were in control of the costs and services that were available. The healthcare insurance companies lost their control over cost to the regional hospital systems.

“Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.”

There are hundreds of regional hospital system giants throughout the United States. In many cities there are two or three giant hospital systems. It is difficult for independents to negotiate contracts in these cities.

“The Wall Street Journal has identified dozens of contracts with terms that limit how insurers design plans, involving operators such as NewYork-Presbyterian, Johns Hopkins Medicine in Maryland, the 10-hospital OhioHealth system and Aurora Health Care, a major system in the Milwaukee market. National hospital operator HCA Healthcare Inc. also has restrictions in insurer contracts in certain markets.”

This is a very big deal.

The goal of the government should be to lower the price of healthcare to all of its citizens including seniors, workers who get insurance from their employers and people who do not have employer sponsored healthcare.

The Obama administration did nothing about stopping hospital system monopolies. In fact, it encouraged them.

“Certain hospital systems are able to command advantageous terms because they have grown through years of deal-making, shifting the balance of power between hospitals and insurers. In 2010, the year the Affordable Care Act passed, the annual number of hospital mergers shot up 40% to 59, and the number of deals has remained above 60 every year since, according to IrvingLevin Associates, a research firm that tracks health-care transactions.”

The Obama administration did nothing about it because the distortion in pricing is going to lead to collapse of the private segment of our healthcare system. Once the private segment of the healthcare system collapses a progressive government hungry to have power and control over the populous will install a single party payer system.

As proven over and over again, a single party payer system does not work. The government has to outsource all of the infrastructure to administrative services. The government does not control the administrative services overhead. Also, the government does not want to develop another uncontrolled and inefficient bureaucracy like the VA Healthcare System.

A single party payer system will lead to increases in unsustainable deficits and decreasing healthcare services.

It will take many years for the public to recognize that a universal single party payer system is inefficient. The government will hide the system’s inefficiency from the public.

The government should make common sense rules, enforce those rules and get out of the healthcare administration business.

Medicare and Medicaid costs have not been recognized by the general public yet.

The VA inefficiency and lack of service by the VA Healthcare System has been recognized in the last two years by the general public. The government has assured the public that the VA Healthcare System is improving.

The insurance industry is trying to fight back.

“No hospital system should be able to exercise market power to demand contract agreements that prevent more competitively priced networks,” said Cigna’s chief medical officer, Alan Muney, in a written statement provided by the company.

The Trump administration is aware of all of these problems. President Trump is trying to figure out a way of negotiating a deal with all the providers who are taking advantage of consumers and the government. His administration’s actions have been delayed by the slow death of Obamacare.

If Obamacare was repealed last year I am sure the topic of hospital monopolies would be a hot topic of debate today.

President Trump is presently attacking the middlemen who have made drug prices so obscene. This is a big problem and an easier target.

“The effect of contracts between hospital systems and insurers can be difficult to see directly because negotiations are secret. The contract details, including pricing, typically aren’t disclosed even to insurers’ clients—the employers and consumers who ultimately bear the cost.”

Hospital contracts forbids healthcare insurance companies to cover many procedures that can be performed as outpatient services outside the hospital environment. I have listed some of the price differences between the more expensive outpatient hospital care facilities and the independent ambulatory care facilities.

There are many examples of how hospital systems rip off consumers and increase the cost of healthcare insurance for all including employers, individuals and the government. It is also decreasing the access to care for all.

If the government is really looking for a system that would work it should look at my Ideal Medical Saving Accounts are Democratic.

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

Copywrite 2006-2018

Please have a friend subscribe

Permalink:

Obamacare Is Increasing Health Savings Account Participation

January 25, 2016

inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

• Leave a comment

Stanley Feld M.D.,FACP,MACE

Patients’ responsibility for their health and their healthcare dollars is one of the most important elements in a functioning and cost effective healthcare system.

Despite the fact that my ideal medical savings account (MSAs) would be more effective than health savings accounts (HSAs) in encouraging patient responsibility for their health and healthcare dollars, health savings accounts are flourishing because of Obamacare is costly and has taken freedom of choice away from individuals.

Devenir is a HSA Mutual Fund that accepts and invests HSA trust contributions and invests those contributions. Devenir just published a study that showed that:

“1. As of June 30, 2015, the number of HSAs had climbed 23% from the previous year to 14.5 million.”

“2. Account balances jumped 25% to approximately $28.4 billion over the same time period.”

In 2010 the year Obamacare was passed, there were 5.7 million HSAs with balances totaling $7.7 billion.

The Obamacare bronze plan is the least expensive federal health insurance exchange plan. Its coverage is poor and it has a high deductible that most people cannot afford.

The premium and deductible are only good for patients with pre-existing illnesses that have no other place to purchase insurance. That is the reason the demographic for enrollees from healthcare.gov is so poor.

The government is loosening the noose on HSAs even though it is still restrictive.

“For the 2016 tax year, you can make a deductible HSA contribution of as much as $3,350 if you have qualifying high-deductible self-only coverage or as much as $6,750 if you have qualifying high-deductible family coverage. If you are age 55 or older as of the end of 2016, the maximum deductible contribution goes up by $1,000.

For 2015, the contribution caps are the same, except the maximum deductible contribution for family coverage is $6,650. These amounts are increased by $1,000 if you were 55 or older as of December 31, 2015. You have until April 18, 2016, to make an HSA contribution for the 2015 tax year.”

You must have a qualifying high-deductible health insurance policy — and no other general health coverage — to be eligible for this HSA contribution privilege. For 2015 and 2016, a high-deductible policy is defined as one with a deductible of at least $1,300 for self-only coverage or $2,600 for family coverage.

For 2016, qualifying high-deductible policies can have out-of-pocket maximums of as much as $6,550 for self-only coverage and $13,100 for family coverage. For 2015, these amounts are $6,450 and $12,900, respectively.

If you are eligible to make an HSA contribution for a tax year, the deadline is April 15 of the following year (adjusted for weekends and holidays) to open an account and make a contribution for the earlier year.”

The government has increased the maximum deductible in 2015 and continues to increase in 2016.

For the 2016 tax year, you can make a deductible HSA contribution of as much as $3,350 if you have qualifying high-deductible self-only coverage or as much as $6,750 if you have qualifying high-deductible family coverage.

“ If you are age 55 or older as of the end of 2016, the maximum deductible contribution goes up by $1,000.”

More large companies are Increasingly offering workers high deductible health saving account. However, the employee is responsible for the high deductible and most of the plans are 70/30 coverage after the deductible is reached up to a maximum of $10,000.

Most large and small employers can afford to pay all or some of the high deductible and buy reinsurance for first dollar coverage beyond the deductible.

Both large employers and small employers are offering their employees health savings accounts. The full insurance premiums have become so high that employers are shifting the burden to employees by having the employee pay the deductible and the employer paying the reinsurance.

UnitedHealth has about 40 individual high deductible plans with 70/30 copays over the limit of the deductible. The maximum out of pocket cost is $10,000. The premium for a young married couple without kids is from $125 to $350 per month depending oo the deductible chosen. The premium increases with the number of children.

A great advantage to these plans now is that UnitedHealth has already negotiated the physicians’ and hospitals’ fees for you. The uninsured would pay retail price for the same services.

The cost to small to large companies is relatively difficult to find in an online search.

Most companies are self-insured and would not fall under the rigid coverage rules of Obamacare. The company can decide on the amount of the deductible they would pay for the employee.

The point of all this is health saving accounts are not as good as my ideal medical saving account. HSA’s do not provide enough incentive for employees or individuals to manage their health or healthcare dollars wisely as an MSA would.

A large defect in Obamacare is patients do not have incentive to be wise shoppers of their healthcare. They have restricted choice. They have little incentive to stay healthy because they have an entitlement program available that will take care of their expenses. There is no financial incentive for them to try and reduce the cost of healthcare.

If the consumers managed their health and healthcare dollars well the cost of healthcare would drop because the complications of chronic diseases would decrease to at least 50%.

If Republicans are looking for an alternative plan to the liberals’ and progressives’ inevitable march to a singe party payer system most of the infrastructure is already in place.

Only small modifications to the HSAs have to be made by the congress and the President and America would be on its way to a free market healthcare system.

This alternative healthcare system would align all of the stakeholders incentives including the government’s incentives, if the Obama administration did not want to increase its power by having more control over its people and its people’s freedom of choice.

My ideal Medical Saving Accounts would be democratic and cover everyone.

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

Permalink:

Combining My “Ideal Medical Savings Accounts” And “Reference Pricing”

November 3, 2013

inUncategorized

• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama has declared over
and over again that no one has presented ideas better than Obamacare.

I believe he has no interest in
listening to anyone.

I sent him 6 letters between 2008-2009
presenting my solution to repairing the health care system. These ideas were
from a practicing physician’s perspective. President Obama paid no attention.

President Obama fooled many people
with his intentions, including me. The traditional media is finally catching on
to him.

All of the stakeholders are at fault
in causing the dysfunctional healthcare system. The dysfunction is the result
of all the stakeholders trying to adjust to ever changing government regulations
during the last 48 years

Obamacare is making that dysfunction
worse.

A consumer driven healthcare system
is the only way to Repair the Healthcare System.

I think President Obama wants the
healthcare system to fail. He wants to prove that the free market cannot
succeed.

He is deaf to the fact that the
healthcare system is not a very free market system. Government regulations, tax favors, and tax
barriers over the years have interfered with the free market in healthcare.

The Affordable Care Act (Obamacare) intends to transform the
health-care system, extend coverage, reduce costs and increase quality—all
without asking anything of the patients.

Consumers will pay
with higher taxes, of course, but otherwise will face no incentives to make
wise choices, compare price with performance or shop for value.

Doctors, hospitals,
insurers and, most of all, the government will do that for them, which is
hardly reassuring.

This reflects what I
call the "impossibility theorem" in health care. The impossibility theorem maintains that patients cannot
make good choices, but, rather, must be dependent on the well-intentioned
decisions of others.

Policy makers believe this theorem by
definition. But, just to make sure, they have structured the health-insurance
system to ensure that patients are never asked or allowed to make
price-conscious choices.

The arrangement underlies the innumerable
rules, subsidies, entitlements, mandates and prohibitions that collectively
make health care the least efficient part of the economy.

ObamaCare makes it worse.

I do not think consumers believe or trust President
Obama. Consumers certainly do not believe “the impossibility theorem.”

Consumers are ready for some common sense healthcare
policy. They just do not know what to do.

Consumers must be given incentives to control
healthcare costs. This can be done in several ways.

Consumers must be put in charge of their health and
healthcare dollars.

The
central pillar of effective healthcare reform is the creation of a system that
forces the healthcare insurance industry to be competitive and answerable to
consumers.

Consumers
must have incentives to control costs. This, in turn, would force hospital
systems and physicians to be competitive and reduce costs.

The government’s
role should be to empower consumers to have greater control over their
healthcare decisions, their health, their healthcare dollars and their
healthcare coverage.

The
government should teach consumers to make educated choices in their healthcare
decision-making.

Price
transparency of healthcare fees and parity of tax deductions between the individual
insurance market and the group healthcare insurance market is essential.

It is fool
hearty to assume that the redistribution of wealth, raising taxes by means
testing and price fixing will solve the problems in the healthcare system.

“Why on earth would we want a system,
especially with something as personal as health care, where all of these free market
signals are lost, and insurers responding to regulators, not to us?”

Entitlement programs have never produced free market
efficiencies. Entitlements have created unsustainable, unfunded liabilities.

Leadership must face this problem not add to the
problem.

In the past seventy years medical advances through
research and technology have improved medical care and medical outcomes. Medical
advance has focused on fixing diseases after they have occurred.

Consumers are the only ones that can prevent most
medical and surgical problems.

They can prevent most chronic diseases such as Type 2
Diabetes, heart disease, lung disease and others.

Consumers are also the only ones that can prevent the
costly complications of a chronic disease.

A healthcare system must be constructed to incentivize
consumers to be responsible for their health and healthcare dollars.

Eighty percent of the healthcare dollars spend on
diabetes care is spent treating the complications of diabetes.

A healthcare system must be developed to align all of
the primary and secondary stakeholders’ incentives.

Only consumers can align all the stakeholders’
incentives.

Government control of the healthcare system cannot and
has not aligned those incentives.

Right now we are seeing bureaucracies making a $634
million dollar error with healthcare.gov. This is only the tip of the iceberg
for the problems in store for Obamacare.

The solution is not a single party payer. We will have
the same problems or worse because of the expansion of Medicaid. President
Obama’s hope was the cost of increasing Medicaid would be shifted to the
states.

The increase in cost will increase the federal deficit
and unfunded liabilities.

A healthcare system must be constructed to empower
consumers. I have written in detail about my ideal medical savings accounts.

I have pointed out that it can be very democratic.
Everyone can be insured while decreasing the costs.

The ideal medical
saving accounts will motivate and empower consumers to save money by staying
healthy, staying out of the emergency rooms, and decrease over testing and over
treatment.

Consumers would be
motivated to shop for the top value and quality care.

The government would
require providers to publish the discounted prices paid by the government and
the healthcare insurance companies to all consumers.

My ideal medical
saving account would incentivize consumers to save money. It would be the
responsibility of consumers to shop for the best price at the best quality.

Consumers would
carry their medical records digitally on a flash drive or on their smart phone
to avoid over testing. They would reap the financial benefits of these cost savings.

Consumers, after
the initial $6,000 dollars was spent, would receive first dollar healthcare coverage.

I have always been
satisfied with the front-end incentives. I have never been satisfied with the
catastrophic coverage. It does not provide financial incentive for consumers to
save.

I finally figured
it out. Consumers would continue to receive first dollar coverage if they spent
over the initial $6,000 after the initial stakeholders.

The discounted
hospital, surgical and medical device costs would be published along with
outcomes.

Discounted prices
for services could also vary for the same services. The outcomes could be the
same.

A hospital system
with better outcomes should receive more. If the hospital system negotiates a
higher fee than another hospital system but has the same outcome the consumer
should be liable for the difference.

In this way the decision for choosing the
provider is in the hands of the consumer.

Combining my ideal medical saving account and “reference
pricing” will incentivize consumers to be in control of their healthcare costs
and their health and healthcare dollars.

Consumers should receive pretax dollar treatment for
all expenditures.

Consumers will then shop for price and quality to
their financial advantage. This will
incentivize providers to compete on both price and quality.

The Oklahoma Surgical Center has forced local
hospitals to do just that. The Surgical Centers’ online prices were one half to one
fifth the prices of the local hospital. The hospital centers are now starting to
compete on price and quality.

The combination
of the ideal medical saving accounts and reference pricing will incentivize
providers to be aligned with consumers’ goals.

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

Please have a friend subscribe

Permalink:

Business Model For Medical Care 2020. The Ideal Future State

October 28, 2012

inEMR, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Information Technology in Healthcare, Innovations in Healthcare, Medicine: Healthcare System, Summary Blogs

• Leave a comment

Stanley Feld M.D.,FACP,MACE

Please click on all the links to study
the references to each spoke. It will help you visualize the power of the business
model.

The ideal future state business
model for the healthcare system must include the execution of ideas in the specific spokes outlined below.. These spokes
will serve to align all of the stakeholders’ interests.

The business model must
contain appropriate rules for a consumer driven healthcare system, an ideal
electronic medial record, and an ideal medical savings account.

The ideal medical saving
accounts can work optimally when there is significant tort reform and patients
take full responsibility for their health and healthcare dollars.

Consumer education is critical to the business
model of the future. Educational modules can be available to consumers 24/7 via
the Internet. These educational modules must be an extension of consumers
physicians’ care in order to be effective. The education can become available
using a series of social networks.

Chronic disease self-management education can
be achieved by the use of interactive online teaching programs. Patients can be
linked to share their disease experience through private social networks.

Most believe that the healthcare system must
have greater integration of care. This integration of care can be done
virtually through a series of private integrated networks.

Effective integration can be achieved without
disruption of the entire healthcare system. Obamacare has been disruptive to
the entire healthcare system.

Obamacare is forced integration by the
government will be slow, costly and unsuccessful.

Physicians must be compensated for the presently
uncompensated time necessary to execute each one of the spokes of the wheel.

Each spoke is necessary to convert the
healthcare system into a system that once more makes the physician patient
relationship paramount.

The future business plan removes control of the
healthcare system from the government. It permits the patient to have the freedom
to choose his own healthcare course.

Tort reform is vital to the 2020 business model.
It will decrease costly over-testing to avoid frivolous malpractice suits.
There are many ways to set up a tort reform system that truly protects patients
from real harm while eliminating over-testing. It limits the malpractice
litigation system. Punitive damages must be lowered. Losers in lawsuits must
pay all fees. These two provisions will decrease lawyers’ incentive to sue.

Consumer driven healthcare will create a system
that promotes personal responsibility by the consumers’ for their health and
health care dollars.

The major spoke necessary to successfully
accomplish a consumer driven healthcare system is my ideal medical saving
accounts.

The ideal medical savings accounts would
provide the financial incentive for consumers to drive the healthcare system.
It would dis-intermediate the healthcare insurance industry’s grasp on first
dollar coverage and profits. The insurance industry would realize that its
profit margin would increase under this system.

In order for consumers to be in a position to
lower the cost of healthcare they must be taught to understand how to self
manage their disease and be responsible for the decisions they make in their
choices for medical care.

In order to decrease patients’ dependency on
the government and increase being
responsible for themselves, a system of education using information technology
as an extension of their physicians’ care has to be developed and put into
place.

Social networking is in its infancy at present.
It must be developed and used as an educational tool between physicians, patients
and physicians, and patients and patients.

All the social networking must be an extension of
the physicians’ medical care to their patients. Social networking must be
developed to enhance and promote the physician/patient relationship because
this relationship is critical, at its core, to successful medical treatment.

Social networking and information technology
can extend physician educational resources for patient care.

Systems of care for the self-management of chronic
disease as an extension of their physicians care have already been developed.
The unsuccessful chronic disease self-management systems are the programs that
are not an extension of physicians’ care. The reason these third party systems
are unsuccessful is because they undermine the patient physician relationship.

President Obama has done pilot studies using
those third party self-management companies to prove that chronic disease
self-management systems work. They have all failed to reduce the cost of care.

Therefore the administration has reached the
conclusions that self-management of chronic disease does not work. Nothing
could be further from the truth. The government simply does not understand the
magic of the physician-patient relationship.

In order to decrease the cost of medical care,
medical care must be integrated. At present, primary care physicians recommend
specialists. The primary care physicians know whether the specialists are doing
a good job by the specialists’ treatment results with their patients.

Most of the time physicians do not know their
specialists’ fees. These fees must be totally transparent to primary care
physicians and their patients. The primary care physicians can then be in a
position to help their patients choose appropriate specialists.

It will also reduce the specialists’ prices
because they will be forced to become competitive by the patients in a consumer
driven system.

Hospital fees must also be transparent. One of
the reasons I am opposed to hospital systems hiring physicians and paying them
a salary is the hospital systems would then be able to develop a monopoly in a
town or area of town. This would permit the hospital system to raise prices
without informing patients or physicians.

Hospital systems could erase physicians’ choices
and hindered patients from having the freedom to choose a hospital or
specialist of their choice with their primary care physicians. It devalues the
patient physician relationship.

The way President Obama is going about
developing a universally functioning electronic medical record is foolish and
costly. Most physicians cannot afford a fully functional electronic medical
record. This fact is being used to drive physicians into being employees of
hospital systems. The problem is hospital systems are paying hundreds of
millions of dollars for electronic medical records that are not fully
functional.

Many of these records are hard to use and
provide inflexible data. The inflexible data leads to healthcare policy
decisions that are wrong. The data is also used to commoditize medical care.

Commoditized medical care is not the best quality
of medical care.

If the government is so smart it should develop
a fully functional electronic medical record and provide it to all hospital
systems and practices for free.

The EMR should be put in the cloud. Providers
should be charged by the click. The government can service and upgrade the EMR
in one place and improve the quality of data collected. The data should be used
for educational purposes only and be owned by the patients and physicians. It
should not be used for punitive purposes. The inaccurate data is now used for
punitive purposes. The result has been a lack of physician cooperation.

The healthcare journey to an ideal future state
must begin in an orderly way. The principle goal is to be consumer centric. It
must be consumer driven and force the secondary stakeholders to be transparent
and competitive.

This journey will wring the excess costs out of the healthcare
system. It will create a democratic system affordable to all.

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

Please have a friend subscribe

Permalink:

The Second Spoke Of The Wheel: The Ideal Medical Savings Account

February 8, 2012

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

• Leave a comment

Stanley Feld

"Dear Dr. Feld

If your ideal Medical Savings Account is such a good idea why has it not become more popular?"

The reason is simple. The Ideal Medical Savings Account does not exist as a healthcare insurance option. The healthcare insurance industry has obfuscated the purpose of creating financial incentives for consumers with the offer of Health Savings Accounts.

The Health Savings Accounts keep premium dollars in the healthcare insurance industry’s control at the end of the year. Consumers are able to use unspent money on healthcare deductible in the future.

The Ideal Medical Saving Account puts the money not spent in a separate tax-free trust for consumers’ retirement. The logic is to reward consumers for good health financially and to encourage consumers to be responsible for their health and healthcare choices.

The goal is not to reward the healthcare insurance company it is to reward consumers. The healthcare insurance industry is controlling the consumer’s money for its own profit.

Despite its faults HSA’s are becoming very popular. It is the fastest growing healthcare insurance product in America.

President Obama wants to eliminate HSAs. His goal is to increase government control over consumers’ healthcare choices. He does not want consumers to control their healthcare dollars. He wants to control consumers.

The healthcare insurance industry’s goal is to maximize its profit. It is not concerned about the consumer’s health. The more consumers in the healthcare system the more premium dollars the healthcare insurance industry controls.

Using the power of lobbying and the influence of lobbyists it has been able to rig the game against the consumer.

"Wendell Potter, former senior executive^[1] at Cigna turned whistle-blower, has written that the insurance industry has worked to kill "any reform that might interfere with insurers' ability to increase profits" by engaging in extensive and well funded, anti-reform campaigns."

"This is nothing new. However, as consumers (patients in all three categories) the Internet and social networking can empower us to have more influence over the politicians than lobbyists."

"After all, we are the people who give them their jobs. Some might say this is a naïve view. However, recent events have shown the effect of People Power and its ability to disrupt the establishment and its lobbyists.

The industry, however, "goes to great lengths to keep its involvement in these campaigns hidden from public view," including the use of "front groups." Indeed, in a 1998 effort to successfully kill the Patient Bill of Rights at that time, “the insurers formed a front group called the Health Benefits Coalition to kill efforts to pass a Patients Bill of Rights.

While it was billed as a broad-based business coalition that was led by the National Federation of Independent Business and included the U.S. Chamber of Commerce, the Health Benefits Coalition in reality got the lion’s share of its funding and guidance from the big insurance companies and their trade associations."

The question is why would the National Federation of Independent Business or the U.S. Chamber of Commerce do this? They either don’t understand the healthcare insurance industry’s motives or they received grant money from the healthcare insurance industry. Both groups are working against the benefit of it own people.

"Like most front groups, the Health Benefits Coalition was set up and run out of one of Washington’s biggest P.R. firms. The P.R. firm provided all the staff work for the Coalition. The tactics worked. Industry allies in Congress made sure the Patients’ Bill of Rights would not become law."^[2]"

Obamacare and the Democratic congress have also yielded to the demands of the healthcare insurance industry. President Obama’s goal is to control all medical decisions for patients to keep healthcare costs down. Most advocates of Obamacare overlook this fact.

President Obama’s individual mandated purchase of healthcare insurance would increase the number healthcare industry’s customers. Its profits would increase.

Medicare and Medicaid are totally dependent on the healthcare insurance industry for administrative services. This results in keeping the healthcare insurance industry in control of healthcare spending. The 2.5% overhead for Medicare and Medicaid continuosly repeated by government officials is completely bogus.

The healthcare insurance industry receives at least 30% of every Medicare and Medicaid dollar spent.

The administrative services costs are supposed to be no more than 15%. However, large sums of administrative costs are applied to direct patient care. Each administrative cost has a profit center attached to it.

These profits center increases the healthcare industry’s profits. In turn the salaries of the executives increase.

The Ideal Medical Savings Account eliminates all these layers of bureaucracy, profits and abuses.

It is a perfect opportunity for “People Power” to demand through social networks that the Ideal Medical Saving Account be added to healthcare insurance choices.

The Ideal Medical Savings Account puts the power back in consumers’ hands.

Neither traditional insurance plans or Medicare or Medicaid provide financial incentives for patient to be responsible for their disease nor their healthcare needs.

Financial incentive for all categories of patients (consumers) can serve to increase adherence to physician’s treatment instructions.

Financial incentives can stimulate consumers to be educated consumers of both healthcare and medical care.

Financial incentives can serve to incentivize patients to become professors of their chronic disease. Self-management can avoid many emergency room visits and hospitalizations.

Instant adjudication of claims can decrease many of the excessive administrative costs.

The Ideal Medical Savings Account is simple and transparent to consumers.

IMSAs revives the patient physician relationship. It drives the government and the healthcare insurance industry to the edge of the medical care transaction. It disrupts the hairball and will instantly disrupt the food chain that is failing under the weight of healthcare costs.

The Ideal Medical Savings Account is a perfect healthcare insurance product if deployed properly. Social networks must be formed to demand its availability in order to permit consumers’ (patients) to drive the healthcare system.

Social networks on other levels can force physicians to be more competitive.

The result would be a reduction in the healthcare system’s cost while eliminating administrative abuse, waste and fraud.

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

Please send the blog to a friend

Permalink:

Can You Believe This? Health Savings Account Threatened By The “Taxpayer Assistance and Simplification Act

April 22, 2008

inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

The House of Representatives passed a bill called the “Taxpayer Assistance and Simplification Act” last week that will essential destroy Health Savings Accounts and the quest for consumer independence from the government’s control of the healthcare system. I have criticized HSAs in the past because they only give consumers partial control and not full control of their healthcare dollar. If you do not use the money you lose it. In my opinion this creates a perverse incentive that does not stimulate wellness. It stimulates potential abuse. Patients keep the money they do not spend with my Ideal Medical Savings Account. The MSA would increase incentives for wellness and decrease abuse, because if patients abused the system they losing their own money.

“Democrats have made affordable health care a mainstay of their election agenda, but apparently only if you’re willing to get insurance through the government. Witness their stealthy assault on Americans who prefer the private-sector option of Health Savings Accounts.”

No one in the Democratic Party dominated House of Representative nor the Democratic Party’s presidential candidates seem to understand the government can not afford to have a government dominated system. It is also clear they do not trust patients to pursue their vested interest.

“The House passed legislation on Tuesday, the mis-named “Taxpayer Assistance and Simplification Act,” that contained the awful provision that would throw a mountain of paperwork at Health Savings Accounts.”

<President Bush sent a note to congress stating that he would veto the bill if it contained the anti HSA provision. I do not think the Senate will accept the provision either. The frightening thing is the lack of understanding by the Democratic Party of what is necessary to Repair the Healthcare System.

“A key player here is Ways and Means Health Subcommittee Chairman Pete Stark, whose main purpose in politics is to give the U.S. a government-run health-care system. He is a known opponent of HSAs – once comparing them to “weapons of mass destruction” – because they introduce more individual choice into the health-care marketplace.”

“Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money. The Senate should stop this one dead in its tracks.”

I thought Pete Stark finally understood the folly of his thinking. He trusts neither physicians nor patients. I was misled by his comments in Forbes magazine when he admitted he made a mistake with his Stark Laws.

“This week, the House passed legislation that included a provision to require every HSA transaction be reviewed and verified as a legitimate medical expense. Democrats say this is to ensure that consumers are using their tax-free withdrawals for a knee replacement, rather than a new iPod. In reality it adds a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs.”

Presently the healthcare insurance industry administers these health savings accounts and does not permit misuse to occur. Maybe the only way the Democratic Party can reach its goal of government controlled single party payer healthcare system is to destroy HSAs?

“Pushing for the provision was a company called Evolution Benefits, which has patented a system for the substantiation of health-care expenses. Evolution’s lobbyist, John McManus, was the former staff director of the Health Subcommittee under Republican Bill Thomas.”

Unfortunately, this is how the government works. It is influenced by vested interested other than the people it is suppose to represent. Republicans are furious at John McManus, a former Republican congressman’s staff director now a lobbyist.

“Liberals claim HSAs are insurance for the “healthy and wealthy,” but there’s little evidence this is true. “

There is no evidence that HSAs are only for the healthy and wealthy. It is a potential mechanism for the government to subsidize insurance for the poor and not so poor to promote patient responsibility and stimulate a substantial reduction in cost and increase incentive for citizens to improve healthcare habits. All congress has to do is pass a law saying everyone automatically will be insured using a community rating system and pre tax dollars.

“The high deductable insurance permits the insured to open an HSA and make an annual contribution up to $2,900 for an individual in 2008, which he can use to pay for ordinary health needs. Savings not spent in any given year can build up tax-free for medical expenses. HSAs also give consumers more reason to care about prices, bringing much-needed market discipline.”

A family contribution is over $5,000 in 2008.

“ In any case if people cheat on their HSAs, they are only cheating themselves.”

I wonder how many congresspersons really understand the problems in the healthcare system and what will motivate the people they represent?

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

Permalink:

Slowly But Surely :Trump Is Quietly Reforming Healthcare

June 27, 2019

inUncategorized

• Leave a comment

Stanley Feld M.D.,FACP, MACE

Since congress did not want to help President Trump repeal Obamacare and fix the healthcare system, he decided to quietly repair the healthcare system by himself. He has no choice. Obamacare will self-implode and disappear.

President Trump has kept his steps toward healthcare reform under the radar. It is all published and there for everyone to see.

President Trump is hoping that after the 2020 election he will have a friendlier congress. A congress that wants to do something to help him help American consumers of healthcare obtain affordable healthcare.

Consumers need relief from the Obamacare disaster. Obamacare has caused increased dysfunction on top of an already dysfunctional healthcare system.

Obamacare has caused a previously unaffordable healthcare system to become more unaffordable.

I hate to say it. I predicted Obamacare would fail in 2010. Basically Obamacare did not align stakeholders’ incentives.

Will Obamacare Fail?

I explained why Obamacare was failing in each subsequent year of its passage.

http://stanfeld.com/?s=Obamacare+will+fail

I also offered my concept of repair of the healthcare system with my ideal medical savings accounts.

My Ideal Medical Savings Account Is Democratic!

President Trump has taken important steps to repair the healthcare system. He has brought back the power of “Associations.” Associations now have the ability to negotiate with healthcare insurance companies and sell healthcare insurance to its members.

The Trump Administration Makes Progress On Health Care

In addition, Associations now have the ability to offer its members healthcare insurance at pre-tax dollars. This is a very big deal. Previously individuals seeking individual insurance had to pay for that healthcare insurance with post-tax dollars.

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

Instantly, healthcare premiums are effectively reduced to consumers by 20-40% using pre-tax dollars. This make present premiums more affordable.

Associations are growing very rapidly as final rules are being created to make their healthcare insurance available. The significance of Associations has been largely ignored by the mainstream media.

Associations will create competitiveness among healthcare insurers and help individuals, small business and even giant corporations eliminate the need to negotiate and provide healthcare insurance to their employees. It might even help the government’s unsustainable programs such as Medicare, Medicaid and the VA rid itself of these unsustainable programs.

The traditional mainstream media has been busy publicizing the socialist concept of “Medicare for All.”

I have pointed out that “Medicare for All” doesn’t work. It has never worked in a financially sustainable way for many countries. In countries that have socialized medicine consumers are dissatisfied because there are long waiting times and a shortage of the access to medical and surgical care.

The Concept of “Medicare for All” is Misguided

Bernie Sanders’ Proposed Tax Hikes To Pay For “Medicare for All”

Our leftist politicians say socialist medicine has worked beautifully in countries like Sweden, Denmark, Canada, and England to name a few.

I have published the difficulties consumers have had in these socialized medicine countries.

Swedes Are Frustrated Over Their Socialized Healthcare System

Do Finland’s and Britain’s Healthcare System Work

Unfortunately, our leftist politicians are either ignoring the truth or do not know what they are talking about. The traditional mainstream media are simply acting as puppets for our leftist Democratic politicians who want to control the healthcare system.

Everyone knows the larger the bureaucracy the more inefficient the system. The VA healthcare system is a perfect example of this statement.

Associations Are Growing

“Last week, the executive order was initiated that will empower consumers in the individual healthcare insurance market and those consumers in the small corporations to purchase healthcare insurance through associations. It will allow the employers in small corporations to pay for their employees the healthcare insurance through the Associations with pre-tax dollars.”

“It will level the playing field to enable individuals in both groups to negotiate healthcare insurance premium prices through their associations with the same purchasing power that large corporations have.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

It could also work for consumers working for large corporations. Those employees who are displeased with their corporate provided healthcare insurance coverage can change to association provided insurance.

The new rules can potentially get employers out of the healthcare insurance providing business.

These new regulation has had little coverage in the New York Times, network television or any other mainstream media.

The traditional main stream media have been pushing the Democratic Socialists’ idea of “Medicare for All.” “Medicare for All” cannot work.

The Concept of “Medicare for All” is Misguided

“On Thursday June 20^th 2019, the Department of Health and Human Services announced a final regulation that allows businesses to fund employees who buy health insurance on the individual market–something that until now has been illegal.”

“The U.S. Departments of Health and Human Services, Labor, and the Treasury issued a new policy that will provide hundreds of thousands of employers, including small businesses, a better way to provide health insurance coverage, and millions of American workers more options for health insurance coverage.”

Since this new policy is a President Trump initiative, the elites in the media must have concluded that is a silly policy and it cannot work.

“ The Departments issued a final regulation that will expand the use of health reimbursement arrangements (HRAs). When employers have fully adjusted to the rule, it is estimated this expansion of HRAs will benefit approximately 800,000 employers, including small businesses, and more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.”

A close study of Health Reimbursement Arrangements (Associations) will make it clear that these numbers are correct. In fact, these estimates might be a gross underestimation of increased number of consumers with healthcare coverage.“Under the rule, starting in January 2020, employers will be able to use what are referred to as individual coverage HRAs to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market, subject to certain conditions. … Individual coverage HRAs are designed to give working Americans and their families greater control over their healthcare by providing an additional way for employers to finance health insurance.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

Associations allow everyone to be participants in the large corporation negotiating healthcare market. It allows consumers to avoid the trap of large, bureaucratic and by definition inefficient government control healthcare.

“The HRA rule also increases workers’ choice of coverage, increases the portability of coverage, and will generally improve worker economic well-being. This rule will also allow workers to shop for plans in the individual market and select coverage that best meets their needs. … [T]he final rule should spur a more competitive individual market that drives health insurers to deliver better coverage options to consumers.”

The new policy empowers individual consumers to shop the market and select the healthcare coverage that best meets the needs of their family.

The insurance industry will not have to comply with the burdens of Obamacare’s regulations for healthcare coverage. They can create new products including medical savings accounts without restriction.

This will create an extremely competitive healthcare insurance environment.

“This is a good example of how the Trump administration is moving forward in practical ways on important issues, empowering consumers and freeing up markets. The Democrats don’t like it, of course. But the new HRA system will be popular with millions of Americans whose ability to access the individual market and exercise consumer choice will be enhanced.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

The only big barrier is that it will make consumers become responsible for choosing their healthcare coverage and be responsible for their healthcare dollars.

I believe most Americans are up for the challenge.

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

Copywrite 2006-2019

Please have a friend subscribe

Permalink:

A Thoughtful Solution To Repairing The Healthcare System

January 17, 2019

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests

• Leave a comment

Stanley Feld M.D., FACP,MACE

President Trump might be going in the right direction. Unfortunately, the media’s hatred of him and the Democratic Party’s ideology and obstructionism might prevent him from potentially pursuing a new and sustainable direction that gives consumers the power to choose their healthcare goals. There is no reason that the government could not incentivize and subsidize the needy and less fortunate with this simple system.

I think everyone is tired of the political noise in the healthcare system. There seems to be no room for an understandable signal. However, I believe that effective technology and social networking can serve to decrease that noise to signal ratio and provide a less complex system.

President Trump is offering association directed healthcare plans, a blueprint to reduce decrease drug costs and health reimbursement arrangements to reduce the cost of healthcare insurance.

All three initiatives, if kept simple, can put control of the healthcare system in the hands of consumers.

Associations can provide healthcare plans to its members. An association health plan (AHP) can provide multiple medical insurance plan options. Smaller employers, freelancers and self-employed association members can buy healthcare insurance through the association.

President Trump’s new regulations have made it easier for the members of associations to be equal to large corporations in negotiating the purchasing for health care insurance. They can also offer multiple healthcare plans and still have a high enough enrollment to obtain deeply discounted premiums and deductibles for small businesses, freelancers and self-employed that the members cannot get on their own.

These consumers will also be able to spend pre-tax dollars on their healthcare plans.

“Access to the savings and benefit flexibility enjoyed by large group health plans is the foundation of the new association health plans. These savings can range from 8 to 18 percent for the same health insurance policy.”

“ Savings can be increased further through tactics such as self-insuring. Avalere Health, a healthcare research and consulting firm, has projected in a recent report that “premiums in the new AHPs are projected to be between $1,900 to $4,100 lower than the yearly premiums in the small group market and $8,700 to $10,800 lower than the yearly premiums in the individual market by 2022, depending on the generosity of AHP coverage offered.”

I think Jeff Bezos, Jamie Diamond and Warren Buffet’s new alliance has the right idea. They will provide deeply discounted healthcare coverage for their combined employees.

The primary advantage of offering health insurance through an association is the ability for an association to aggregate multiple employers so that the resulting health plan:

“Operates under a large group health plan rules, which can be less costly than Affordable Care Act rules for small group plans.”
“Leverages its scale of participants in negotiations with health providers in order to obtain more favorable rates for medical services.”

The country has not been given enough information nor data to understand Obamacare’s inefficiency. The media has not been helpful in letting consumers understand Obamacare’s inefficiency and deficiencies.

President Trump is interested in having associations form and compare their success to the failed structure of Obamacare. Obamacare would seize to exist.

If associations are done right they can become a simple system that consumers can easily understand and use. This was Steve Jobs vision when Apple developed the iPod, iPhone, and iPads.

The insurance product that could achieve this vision for healthcare is my Ideal Medical Savings Accounts.

Americans need the new option to create a sustainable healthcare system.

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

Copywrite 2006-2019

Please have a friend subscribe