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Swedes Are Frustrated Over Their Socialized Healthcare System

Stanley Feld M.D.,FACP,MACE

Sweden has a universal healthcare system that has been touted, by Bernie Sanders, to be the premier socialized medical system model in the world. The Swedish socialized medical system has hardly lived up to the praise. The fact is Sweden’s healthcare system is falling apart.

The Swedes have lost interest in their socialist healthcare system. Their tax rate is almost 50% of earnings. Swedes are losing interest in the concept of a socialist society. The complaint is that it is inefficient, and, in most areas, the socialistic system does not work to the benefit of the people.

All Bernie Sanders has to do is read the local Swedish newspapers. He would learn that socialized medicine is not working in Sweden. He might even stop pushing his lie to the American public about how great “Medicare for All” will be for America.

“That Sweden no longer keeps up with those countries is largely due to its inability to reduce its patient waiting times, which are some of the worst in Europe, as the latest edition of the Euro Health Consumer Index (EHCI) revealed in Brussels on Monday.”

The 2014 EHCI also confirms other big problems within Swedish healthcare.

This is not primarily due to the fact Sweden has become worse – rather it is the case that other countries have improved faster.” 

https://www.thelocal.se/20150127/swedens-health-care-is-a-shame-to-the-country

According to 2017 OECD figures, Sweden does have the fifth-highest life expectancy in Europe. Its cancer survival rates are among the continent’s highest. This could be because the rest of Europe’s socialized medicine systems are not as good as they could be.

One of the main pillars of the Swedish welfare state is its universal healthcare system. The Swedish people are totally frustrated by the healthcare system’s inefficiency. The inefficiency is due in large part to the government bureaucracy.

Swedes have little confidence that politicians will solve this,” said Lisa Pelling, chief analyst at progressive think tank Arena Ide. 

“There is a risk their faith in the welfare state will be eroded,” she told AFP. 

As an example of the frustration of the Swedes:

Asia Nader didn’t know whether to worry more about being diagnosed with a hole in her heart at the age of 23 or having to wait a year for Swedish doctors to fix it. 

“I completely fell apart when I found out,” she told AFP, remembering the long agonizing months until she finally had her operation in June this year, one month before her 23rd birthday. 

Credit: George Hodan/public domainhttps://medicalxpress.com/news/2018-09-swedes-world-class-healthcarewhen.html 

There are long lines waiting for access to care due to a shortage of nurses and available doctors in some areas.

The average income tax rate paid by Swedes is 50%. Immigrants cannot pay 50% of their earnings and survive. Immigrants are entitled to social services including medical care. The voters are angered over the flood of immigrants putting a tremendous strain on the healthcare system and delaying regular citizens’ access to care.

 The rules set up by Swedish law about access to medical care are being ignored and unenforced.

Swedish law stipulates patients should wait no more than 90 days to undergo surgery or see a specialist. Yet every third patient waits longer, according to government figures.”

“Patients must also see a general practitioner within seven days, the second-longest deadline in Europe after Portugal (15 days).” 

 Dental appointments can take a wait of 6 months.

The median wait for prostate cancer surgery was 120 days. It has taken up to 271 days.to get prostate cancer surgery.

Swedes complain that they can’t see their own GP. There is little chance to develop a physician/patient relationship. Patients are being seen by temporary hires provided by outsourced staffing companies.

Telemedicine has mushroomed. Physicians are complaining about the fragmentation of care. There is little chance for continuing follow-up and assessing the result of therapy.   

The number of hospital beds has declined in recent years. There is a hospital bed shortage in many communities.    

In Solleftea, the premier’s northern hometown with nearly 20,000 residents, the only maternity ward was shut down last year to save money.” 

“With the closest maternity ward now 200 kilometers (125 miles) away, midwives offer parents-to-be classes on how to deliver babies in cars—which some have since done.”

Despite the bed shortages and delays in access to care, Sweden is the third highest spender on healthcare in the European Union. Sweden spends 11% of its GDP on its healthcare system.

 Socialism and healthcare for all are not as great as Bernie Sanders is telling Americans. We should not believe him.

There is no question we have to improve our healthcare system to make it affordable and available to all.

However, we should not go down the path of Sweden and Finland with Bernie Sanders’ socialistic program of “Medicare for All.”

We will not only bankrupt America but also make access to care impossible.

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The original was published in April 2019.

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



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Finland’s Government Collapses Over Universal Healthcare Costs. March 2019 :Part 2

Part 2

Stanley Feld MD,FACP,MACE

https://blogs.scientificamerican.com/observations/finland-is-the-happiest-country-in-the-world-and-finns-arent-happy-about-it/

Bernie Sanders (I-VT) has been hanging his socialistic rhetoric on the success of Finland’s socialist society and especially Finland’s healthcare system which is supposed to be a free healthcare system for all. 

The New York Times published the article “Finland is a Capitalist Paradise” on December 2, 2019.

On March 3,2019, Finland’s government collapsed because the universal healthcare costs were unsustainable.                                                                                                                                                  

 President Donald Trump was correct when he said,

“Finland, of course, is one of those Nordic countries that we hear some Americans, including President Trump, describe as unsustainable and oppressive — “socialist nanny states.”

The New York Times ridiculed President Trump in December 2, 2019 for saying that Finland is a socialist nanny state.

https://legalinsurrection.com/2019/03/finland-government-collapses-over-universal-health-care-costs-bernie2020-hardest-hit/

https://freebeacon.com/politics/finnish-government-collapses-due-to-rising-cost-of-universal-health-care/

“Similar problems are bedeviling Sweden and Denmark, two other countries frequently held up as models to follow on health care. Finland’s crisis in particular comes as calls for universal health care have grown louder among Democrats in the United States.”

Americans have heard from few in the mainstream media about the collapse of Finland’s government or the reasons for that collapse.

Norway is excused from this discussion because Norway has become a very rich country from its North Sea oil income and its restrictive immigration policies. It is the citizen’s sugar daddy along with a 50% tax rate. 

The Kaiser Family Foundation found that 58 percent of Americans oppose “Medicare for all” if told it would eliminate private health insurance plans, and 60 percent oppose it if it requires higher taxes.

Reuters reported that soaring treatment costs and longer life spans have particularly affected the Nordic countries financial problems.

“Nordic countries, where comprehensive welfare is the cornerstone of the social model, have been among the most affected,” according to Reuters. “But reform has been controversial and, in Finland, plans to cut costs and boost efficiency have stalled for years.”

Just a few days before Finland’s government collapsed over its inability to foot the bill for its expansive socialist experiment, Sanders took to Twitter in an attempt to shame America.

https://pbs.twimg.com/profile_images/1097820307388334080/9ddg5F6v_bigger.png

Bernie SandersVerified account @BernieSanders

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“In the United States it costs, on average, $12,000 to have a baby. In Finland it costs $60. We’ve got to end the disgrace of our profit-driven health care system and pass Medicare for all.”

Bernie Sanders is not being honest with the American people.

“With the collapse of Finland’s government over its inability to financially support its massive socialist agenda, Bernie will undoubtedly do the same thing he always does when socialism (or communism) fails: ignore, obfuscate, and deflect.”

 We only have to remember Vermont’s “Medicare for All” failure. 

Bernie Sanders and AOC should read Finland and Sweden’s newspapers to understand that the people are unhappy with free but unavailable medical care. The unhappiness of the citizens historically happens in every socialist state run healthcare system..

If Democrats are successful in getting “Medicare for All” into law, America will face the same dilemma in the future

“The social welfare and health care reform was one of our government’s most important objectives,” Sipilä said at a press briefing. “The snapshot of the situation that I got from the parliament obliged me to examine if there was a possibility of continuing the reform process. There wasn’t.”

“My conclusion was that my government had to hand in our note of resignation,” he added. “I take my responsibility.”

https://www.politico.eu/article/finlands-government-collapses-over-failed-health-care-reform/

Finland has a decentralized system of health and social welfare programs, where much of the administration is left to local municipalities. This arrangement has led to widespread geographic variation when it comes to quality and access to health care services.

The reform was meant to address these inequalities and reduce the growing cost of the country’s health care system, which has come under increasing stress from an ageing population. It included centralization of the administration at a regional level.”

Finland has been held up as a model welfare state. The distribution of the resulting high taxes is spent on the social issues the politicians think are most important and not what the citizens think are most important.

The government should not be telling the people what they need if a healthcare system is to succeed. The people should decide on what they need and be responsible for their own care. The government should protect the people from both government and corporate abuse in a free enterprise system.

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



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Please Read Between the Lines

Please Read Between the Lines

Stanley Feld M.D., FACP, MACE

Most of us have trained ourselves to speed read the daily newspaper. I have asked my readers to read between the lines of the New York Times’ healthcare articles. Most articles are not factual or half-truths. The articles are an opinion and express a confirmation bias. 

“Confirmation bias is the tendency to search forinterpret, favor, and recall information in a way that confirms one’s beliefs or hypotheses while giving disproportionately less attention to information that contradicts it.[32] The effect is stronger for emotionally charged issues and for deeply entrenched beliefs. People also tend to interpret ambiguous evidence as supporting their existing position.”

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

Often, the application of confirmation bias is subtle.  During speed reading, one’s opinion can be influenced by the presentation of confirmation bias. The bias is interpreted as fact because the “media is the message.”

The traditional media is losing its influence on our culture because peoples are realizing it is feeding us a confirmation bias that does not comport with reality.

The development of ideological manipulation is a science unto its own. The print media and television media are its masters. The traditional mainstream media leans towards the progressive left. 

Conclusions should be backed by facts and not by opinion. All sides of an opinion should be presented. A huge problem is social science is imperfect. It does not use scientific principles utilizing reproducible double-blind studies.

Much of the traditional media sound like an echo chamber. It repeats the same soundbites over and over again rather than studying all the facts and reaching a logical conclusion.

In Carl Sandberg’s book, “The Prairie Years’ he said, If you tell a lie it over and over again it eventually becomes the truth.” If the confirmation bias is wrong, the public pays the price to correct it down the line.

Charles Blahous, a former Social Security and Medicare public trustee, has estimated that under Bernie Sanders’ plan of “Medicare for All”, the government could pay about 40 percent less than what private insurers now pay for medical care.

There are large discrepancies in these payments among experts. It has been estimated that there will be a 32.2 trillion-dollar deficit in a “Medicare for All” program over a ten-year period.

I would not believe the saving predicted by Chares Blahous. He was involved in creating a large deficit in our seniors’ Medicare program with the implication that Medicare would be financially viable.

It is predicted by a pro “Medicare for All” advocates, if this version of “Medicare for All” worked as planned, everybody would be insured, health care usage would rise sharply because it would be free without even a co-payment, and America would spend less overall on health care.

The math does not prove this theory. It does appeal to the notion that free is good.

This is a Democratic party pipedream to get more votes. I hope Americans do not fall for this false promise. The Democratic party has done this to taxpaying citizens of all ethnic groups over and over again in the past.

The New York Times has become a propaganda machine for progressives. 

On March 3, 2019, David Brooks’ article headline washttps://www.nytimes.com/2019/03/04/opinion/medicare-for-all.html?searchResultPosition=1

David Brooks really didn’t mean it. He is just setting the reader up in order to express his confirmation bias.

“The Brits and Canadians I know certainly love their single-payer health care systems. If one of their politicians suggested they should switch to the American health care model, they’d throw him out the window.”

The reality is 80% of Brits and Canadian are not sick and do not interact with their healthcare system.

However, they have a false sense of security that they have good healthcare insurance. When they get sick or need emergency specialty care they realize the system is less than they thought it was. Both Canada and Britain have provider shortages, lack of access to care, long appointment waiting times and large financial deficits.

The defects in their healthcare systems can be followed in the local newspaper and not in the government’s press releases.

David Brooks goes on trying to convince us that “Medicare for All” is a good idea. Progressives have been telling us this since 1935 when Wilber Mills tried to ram a single party payer system down America’s throat in the midst of the great depression.

It didn’t work then, and I hope Americans do not fall for it now.

David Brooks says; “So single-payer health care, or in our case “Medicare for all,” is worth taking seriously.”

” I’ve just never understood how we get from here to there, how we transition from our current system to the one Bernie Sanders has proposed and Elizabeth Warren, Kamala Harris and others have endorsed.”

He implies he doesn’t understand how it could work but says a lot of top-flight politicians have endorsed it. Therefore, they know more than he does.

“Despite differences between individual proposals, the broad outlines of Medicare for All are easy to grasp.”

“We’d take the money we’re spending on private health insurance and private health care, and we’d shift it over to the federal government through higher taxes in some form.”

I cannot think of a government-run agency that runs efficiently, without a large bureaucracy, red tape, or corruption. Inefficiency and corruption mean waste and higher cost.

“Since health care would be a public monopoly, the government could set prices and force health care providers to accept current Medicare payment rates.”

Price fixing has never worked. It leads to corruption

 Medicare reimburses hospitals at 87 percent of costs while private insurance reimburses at 145 percent of costs.

The important question should be, why would the insurance companies pay a 58% premium when the healthcare insurance industry knows exactly what Medicare pays? The healthcare insurance industry knows exactly what the government pays because it does the administrative services for the government.

The answer is the healthcare insurance companies are competing with each other for providers, hospitals and patients.

On April 21, 2019, a New York Times headline read: Hospitals Stand to Lose Billions Under ‘Medicare for All’

A reaction by a reader is who cares if hospitals lose billions. They have been ripping off consumers forever.

The headline immediately established the enemy. The first two paragraphs of the article confirm the enemy. It also sets up the liberal or independent reader to develop the same confirmation bias the New York Times has.

“For a patient’s knee replacement, Medicare will pay a hospital $17,000. The same hospital can get more than twice as much, or about $37,000, for the same surgery on a patient with private insurance.”

“Or take another example: One hospital would get about $4,200 from Medicare for removing someone’s gallbladder. The same hospital would get $7,400 from commercial insurers.

Yes, this pricing is too high in my opinion for both Medicare and private insurance. However, it is the result of insurance companies lobbying and financial reporting that permits the rise in premiums.

As hospital systems become less efficient, they hire more administrators and increase executive salaries.

Many hospitals say they spend their last penny on excessive overhead. If they cannot raise prices, they claim they would go out of business.

The progressives like Bernie Sanders then chime in with their talking points that the New York Times keeps repeating.

“If Medicare for all abolished private insurance and reduced rates to Medicare levels — at least 40 percent lower, by one estimate — there would most likely be significant changes throughout the health care industry, which makes up 18 percent of the nation’s economy and is one of the nation’s largest employers.”

The propaganda worked. The confirmation bias of “Medicare for All” is solid.

The only problem is, it will not reduce the cost of healthcare. This has been proven over and over again in many countries and in many of our government run agencies.

“The Sanders plan would increase federal spending by about $32.6 trillion over its first 10 years, according to a Mercatus Center study that Charles Blahous led.

This is the same Charles Blahous that said the cost would be 40% less. What does that study do to the confirmation bias the New York Times tried to promote? Which one is fake propaganda?

“Compare that with the Congressional Budget Office’s projection for the entire 2019 fiscal year budget, $4.4 trillion.”

The 32 trillion-dollar deficit over ten years is a fair estimate. The estimate could be correct if one simply examines the Medicare and Medicaid deficits.  All we have to recall is Obamacare’s website. It was riddled with inefficiency and was a financial disaster.

 Usually, as a result of cost overruns, there is a decrease in access to care. The glaring example is the VA Healthcare System.

 “That kind of sticker shock is why a plan for single-payer in Vermont collapsed in 2014 and why Colorado voters overwhelmingly rejected one in 2016.”

“It’s why legislators in California killed a single party payer system In the California plan, the taxes are upfront, the purported savings are down the line.”

All it takes is a little reading between the lines to realize that we are subjected to ideological manipulation. “The media is the message.”

The New York Times is supposed to be “the nation’s newspaper of record with all the news that is fit to print.” With the advent of the internet and social media, Americans have more information to decide on what is the truth. People now have the ability to examine multiple sides of an issue.

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.  

 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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The Mainstream Media Refuses to Understand the Meaning of President Trump’s Healthcare Insurance Associations  

 Stanley Feld M.D.,FACP,MACE

The Mainstream media refuses to acknowledge the advantage of the Presidential order to allow Associations to participate in available health insurance plans.

Democrats do not want the public to understand the advantages President Trump’s healthcare insurance associations will provide to consumers. It is an important step in Repairing the Healthcare System. Obamacare was advertised only to fix the individual insurance market.

Pre- Obamacare there were 14 million people who had individual healthcare insurance plans. Most were unaffordable. Now, there are only 12 million in the individual market on Obamacare. Most are unaffordable.

Medicaid has expanded from 2 million to 10 million under Obamacare. The total on healthcare insurance provide by Obamacare  is 22 million. Medicaid is a failed healthcare insurance plan. It is a socialized medical insurance plan the has failed.

The mainstream media has forgotten that Obamacare was originally sold by President Obama to cover the individual insurance market. The individual healthcare insurance market was unaffordable. Obamacare was supposed to make it affordable. It turns out that 85% of Obamacare recipients are subsidized by the federal government. President Obama has expanded socialized medicine and a single party payer (the government) with Obamacare. Even with government subsidies the insurance is unaffordable because of the high deductibles.

It is difficult for me to understand how President Obama says he always tells the truth. He said he was going to make the healthcare individual market more affordable. He has not.

I remember he also said; “If you like your doctor you can keep your doctor” and “if you like your healthcare plan you can keep your healthcare plan.” Nothing could be further from the truth.

When Obamacare was passed there were requirements in the bill that outlined coverage the healthcare insurance industry must provide for everyone who has any kind of healthcare insurance. These requirements included levels of coverage that many people did not need. This excess coverage raised the cost of healthcare insurance in both the individual healthcare insurance market and the group healthcare insurance market. Both types of insurance became unaffordable.

This, combined with the inefficiency of a bureaucratic government raised prices of healthcare insurance even further. Remember the government outsources all of the administrative services to the healthcare insurance industry.

Now, the Democrats want the government to run the entire healthcare delivery system with “Medicare for All.” The unsustainability of “Medicare for All” is estimated at 32 TRILLION dollars over the next ten years!

Associations will not solve all the problems in the healthcare system.  However, they will start solving a good many of them. The Democrats are scared to death that the public will start to understand the advantages of associations. Consumers will have a choice of healthcare insurance plans. Consumers will be in a position to start controlling their healthcare dollars.

The pundits in the mainstream media seem to have no interest in understanding this dynamic. Their only interest is to despise President Trump and regurgitate the Democrats’ easy to understand talking points.

Trump’s associations will:

  1. allow the healthcare industry to sell healthcare plans without the rigid requirements imposed on them by Obamacare.
  1. make individual healthcare plans tax deductible. The large corporations’ group healthcare insurance plans are tax deductible. The individual healthcare insurance plans presently are not tax deductible.
  1. allow members to buy healthcare insurance across state lines. This will create price competition that will lower premiums.
  1. let small companies and the self-employed band together and buy health insurance outside of Obamacare’s strict rules.
  1. offer a way for people to take advantage of the group insurance market, even if they are self-employed or work for a business too small to provide insurance.
  1. will “level the playing field” by giving small businesses bargaining power.” This statement was made by Labor Secretary Alexander Acosta.

Mr. Acosta said “As the cost of insurance for small businesses has been increasing, the percentage of small business offering health coverage has been dropping substantially,”. “This expansion will offer millions of Americans more affordable health care options.”

The U.S. Chamber of Commerce said the change, “will give employers the relief and flexibility they need to cover more employees at a lower cost with more choices for quality care.”

The Congressional Budget Office estimates that 4 million people, including 400,000 who otherwise would go without insurance, are expected to join association health care plans by 2023.

The introduction of associations is going to disrupt the Democrats plans to take total control of the delivery of healthcare. It is going to start to put healthcare delivery back in the hands of the consumer!

Mr. Trump said at the National Federation of Independent Business’ 75th anniversary celebration in his usual hyperbolic style;

“You’re going to save a fortune,”

I believe he is closer to being right than he is being wrong.

 

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



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Democrats’ New Election Issue Is Ridiculous

Stanley Feld M.D.,FACP,MACE

Just before the midterm elections Democrats came up with a brilliant idea in order to fix the healthcare system. They are recommending “Medicare for All.”

Isn’t this what they have recommended since 1935? The Democrats are trying to make a mid-term election issue out of a recommendation that will create a more dysfunctional healthcare system. I have pointed out this plan on multiple occasions is destined to fail.

Democrats refuse to admit that Obamacare made a terrible mess in the healthcare system worse. America needs an innovative system that will get us out of this expensive, nonfunctioning mess.

Instead, the Democrats are proposing a system that makes consumers captives of past government failures and whims of American politicians and political bureaucrats.   The innovative systems needed would promote consumer choice, independence, responsibility and control.

I believe My Ideal Medical Savings Accounts will do just that. It is fair, democratic and promotes patient responsibility to become a medical care prosumer (a productive consumer of medical care).

Democrats and the media now have a “new” most important issue. They have ignored the Obamacare disaster until now in this mid-term campaign season. Democrats did not have any issues except hating President Trump.

Now many Democrats are running in the 2018 midterm elections on a promise to provide “Medicare for All.” The issue is almost as old as the hills. Progressives have been trying to pass socialized medicine since 1935. They finally passed Medicare and Medicaid in 1965.

Both Medicare and Medicaid have created trillions of dollars of deficit for the federal and state governments. Costs have been unfunded or have incurred unsustainable liabilities. The inefficiency of the bureaucracies of state and federal governments have created these unsustainable liabilities.

Some of the unsustainability is because of inefficient management and terrible management of government funds.

Democrats are proving Republicans right: the GOP warned Obamacare was a “Trojan Horse,” designed to fail so Democrats could replace it with a totally socialist system.”

Hopefully Americans’ will not try to support “Medicare for All.” Socialized medicine is bankrupting countries all over the planet. I have pointed out the reasons for the failures repeatedly.

Below are a couple more examples for not having Medicare for all.

Medicare for All failed in Bernie Standers’ home state of Vermont. It failed because in this small state it was too expensive and too complicated. 

 Medicare for All failed to pass in Colorado and even in California because the people realized it was too expensive and it would put the state government in control of consumer healthcare decisions.

 “A recent study showed “Medicare for All” would cost $38 trillion over the first 10 years — again, twice the current federal budget.”

“Medicare for All” would end up looking like Medicaid. Medicare would have to reduce reimbursement paid to providers once it was expanded to all. Medicaid has its own unsustainability problems. States already have huge budget deficits. State deficits are against the law. Many physicians will not participate in the Medicaid program. Medicaid patients have trouble finding physicians because Medicaid reimbursement is too low. Since Obamacare was passed many Medicare patients are having trouble finding physicians who participate in Medicare because its reimbursement is too low.

Medicare presently has many problems and does not need an additional 250 million enrollees. A few of the problems are an endless bureaucracy leading to overspending and fraud and abuse from all provider including hospital systems big pharma and the healthcare insurance industry that services the Medicare bureaucracy.

“Adding 250 million consumers to the roughly 50 million Medicare now serves would be a recipe for disaster.”

The Democrats who say we should have “Medicare for All” also want to allow as many immigrants into the country as possible — legal or illegal. That would swiftly bankrupt and destroy whatever health care the government managed to provide, leaving Americans with nothing.”

The Democrats’ “Medicare for All” is another phony gimmick to promise consumers a free ride no one can afford. They have no intention of being able to pass Medicare for All.

 Making “Medicare for All’ an issue is designed by Democrats with the help of the traditional media to get votes during this midterm election.

Any thinking person will know that it cannot work. I think it will backfire on the Democrats.

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



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More Single Party Payer Noise

Stanley Feld M.D., FACP,MACE

Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.

Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.

The economics of these single party payer systems are seldom discussed in a coherent way. Americans have no idea of the economic burden a single party payer system places on the budget of countries that have such a system.

The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.

In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.

The Canadian healthcare system is unsustainable.

Canada spends 50% of its GNP on healthcare. All of the provinces are experiencing massive deficits due to additional healthcare costs.”

“Canadians who are healthy and do not need to interact with the system are happy and feel secure that their healthcare needs will be serviced without cost. Nothing is free.”

“The United States consumes only 18.5% of our GDP on healthcare. This percentage is rising as access to care is decreasing.”

The Frazer Reportis very specific on the cost of healthcare in Canada although the government is not very transparent.

Each province is having a difficult time figuring out how to fix its healthcare system. Many Canadians are convinced that a single party payer system is not the answer but cannot politically eliminate it.

The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time. People who are not sick think the single party payer system in great. They are happy they have no anxiety about the cost of healthcare if they get sick.

In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.

The private healthcare market is flourishing in Britain for those who can afford it. 

The British healthcare system is unsustainable. The British government has not been able to fix the expensive National Health Service.

America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.

Seniors love Medicare. Most seniors could not afford to get medical treatment if there was not the Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. Most economist agree, as a result of Medicare, the cost of healthcare in America has continued to increase yearly for all Americans.

Congress has ignored the basic defects in the Medicare system that has caused this explosion. Over the years a few brave congressmen have made attempts to correct these structural defects.

The Democrat and Republican establishment have ignored these congressmen.

The political establishment has made feeble attempts to control costs through ineffective regulations. The bureaucracy has grown and the healthcare system has become more costly and inefficient.

The reduction in reimbursement to physicians has resulted in the tremendous increase in concierge medicine. This explosion in concierge medicine has decreased access to medical care in many cities in the U.S.

The result is an increase in cost and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers. The government has imposed more control over the individual’s ability to make his or her own healthcare decisions.

Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.

President Obama’s law (Obamacare) increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from government investigations and penalties in the long run.

The VA system is the purest example of sheer failure. Not only are the patients unhappy but also the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.

The inefficiency, corruption and waste have not been able to be fixed by many notable private sector executives the government has hired to fix it. They have all ultimately resigned or were fired.

The VA system’s single party payer system remains an incurable failure.

These examples are proof that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.

Are these mistakes intentional? Perhaps.

The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.

What is happening now?

The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.

The article, Back to the Health Policy Drawing Board” may be intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.

After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exist. The New York Times article is promoting Medicare for all.

Medicare currently is a single party payer system whosecost is out of control. America cannot continue to print money forever.

America’s politicians are ignoring this fact in order to gain more power.

 

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



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President Trump’s Drug Plan Is On Target

Stanley Feld MD,FACP,MACE

https://www.cbsnews.com/news/trumps-medicare-rx-blueprint-has-a-tricky-wrinkle/    

President Trump’s proposal for lowering drug prices to an affordable range is on target.

I have received a several requests asking me to explain the administrations plan. The “media is the message.” The traditional media has once again missed President Trump’s message completely. I suspect the traditional media has missed President Trump’s message on purpose because of their bias against the president.

The traditional media jumped on Trump’s plan as a non-plan aimed to penalize the middle class for the benefit of the pharmaceutical industry.

Either the traditional media hates Trump and his administration so much that they are against everything he does or they have not read his plan with an open mind because it has too many words in it.

It is pretty clear that Nancy Pelosi did not read President Trump’s drug plan or if she did she did not understand it. She said:

“This weak plan abandons the millions of hard-working families struggling with the crisis of surging drug prices.”

Nancy Pelosi’s statement is otter nonsense.

Her statement is reminiscent of the statement she made about Obamacare;

“You have to pass the plan in order to see what is in it.”

Any thoughtful Democrat should be ashamed that Nancy Pelosi is their leader.

I picked the coverage of only a few of the traditional media, CBS news, The New York Times and the Washington Post’s. All the progressive leaning media are really echo chambers of each other.

Each media outlet missed the Trump administrations’ point. They all are looking through their progressive lens. They believe the only plan that would work is a single party payer system controlled by the government.

They also see a tired public looking forward for the government to take over the complicated issue of healthcare. They have not interest is looking at the unintended consequences of a government takeover of the healthcare system.

A single party payer system will not work because public dependence on bureaucrats and politicians has never worked.

Simple examples are the VA Healthcare System and Medicaid. Government controlled health plans such as the VA system became too inefficient, costly, corrupt and unsustainable. The quality of care decreased and consumer choice and input has been eliminated.

People would never know what President Trump’s drug plan is all about it if they just read about it in the traditional media. If they made it easier for themselves and just read the headlines, as some of my friends have, they would know nothing about Trump’s drug plan.

One must listen carefully and read the source material.

President Trumps YouTube

https://youtu.be/Cds8h9DbTdc

This is the official outline document of the steps that need to be taken to fix the broken drug plan system.

CBS new got it wrong right off the bat.

http://www.cbsnews.com/trumps-medicine-rx-bluprint-has-a-trickly-wrinkle/

“The Trump administration’s “Blueprint” to lower drug prices and reduce patient costs made one thing clear: The government will not directly negotiate with drug companies to secure lower prescription prices. But that doesn’t mean it isn’t proposing changes that would dramatically alter the way Medicare pays for some of the most expensive drugs, and in the process, potentially raise out-of-pocket costs for some of the country’s sickest patients.”

CBS News then brings up an issue that part of President Trump’s solution. The news agency criticizes the administration before it knows the administration’s solution.

A cornerstone of the Trump plan calls for all Medicare drug payments to be consolidated under Medicare Part D, the prescription drug plan for Medicare enrollees administered by private insurers. Under Part D, insurers and middlemen known as pharmacy benefit managers (PBMs) negotiate with drug companies for discounted prices in exchange for the drug companies’ products being included in the PBMs’ list of covered drugs.

But drugs intravenously administered in physicians’ offices, such as chemotherapy and vaccines, are usually covered as a medical treatment under Medicare Part B. Physicians buy these drugs directly from manufacturers, and Medicare reimburses doctors for the drugs’ average sales price plus 6 percent.

A perfect example is the yearly flu shot. Most flu shots are given at local pharmacies and supermarkets for Medicare patients’ convenience.

Medicare Part B pays $120 for a $15 injection dose. How is that for a colossal waste of Medicare dollars?

Pharmaceutical companies are against the idea, partly because they generally are paid more under Part B than Part D.

Alex Azar, Health and Human Services secretary and former president of the U.S. division of pharmaceutical giant Eli Lilly (LLY), has been touting the move to consolidate Medicare drug payments.

“Bringing negotiation to Part B drugs is such a potent way to bring down prices that PhRMA is already protesting the idea,” Azar said in a recent speech at the American Enterprise Institute in which he referred to the drug industry trade group called Pharmacuetical Research and Manufacturers.

Nonetheless, CBS points out a potential paper tiger to leave the message that the plan is no good. The “media is the message” even if it is a lie.

“But Azar and others have shed little light on exactly how this change would take place, leaving patients worried about the potential for astronomically higher out-of-pocket costs”.

The plan is there. CBS news has not read the plan.

“Medicare Part B presently creates incentives for doctors to purchase more expensive drugs to get a higher dollar profit”

This is a negative incentive that the President promised to eliminate. Physicians to not profit from higher drug prices. In the case of the flu shots pharmacies and supermarket pharmacies administering the flu shots profit.

“Azar said; it will create incentive for insurance companies and PBMs in Medicare Part D to negotiate discounts and lower prices and pass them on to patients.”

President Trump said he promises to eliminate the extreme profit the pharmacy benefit managers take from the system.

The New York Times took a different negative slant in order to criticize Present Trump.

“President Trump has the power to sink pharmaceutical stocks with a single jab about high drug prices.”

“But in a much-anticipated speech on the topic on Friday, Mr. Trump largely avoided the issues the industry fears the most, such as allowing Medicare to directly negotiate drug prices, or allowing Americans to import drugs.”

President Trump’s plan is to force pharmacy benefit managers to negotiate the best price for Medicare and patients with private insurance in a free market system and not in a government controlled system.

The government negotiates much lower drug prices for itself in the military and VA systems. The drug companies just cost shift and charge the rest of us a higher price

“Investors noticed: Stocks of major drug companies rose after his speech, as did those of pharmacy benefit managers, or the “middlemen” that Mr. Trump said were getting “very, very rich.”

Last weekend I asked a retired friend what he thought of the Trump plan. He said President Trump is going to make the drug companies and the pharmacy benefit managers very, very, rich.

This is regurgitation of the NY Times coverage from a well-educated man. The media is the message!

 

Time Magazine coverage was no better. It, too, was anti-Trump. Time Magazine did not bother to understand that the Trump drug program is a free market system without cronyism.

“ President Donald Trump’s long-promised plan to bring down drug prices would mostly spare the pharmaceutical industry he previously accused of “getting away with murder.” Instead he focuses on private competition and more openness to reduce America’s prescription pain.”

Why can’t the media discuss the facts and let us decide what will work or not work? What is wrong with competition? It works. Government control doesn’t seem to work.

“The administration will pursue a raft of old and new measures intended to improve competition and transparency in the notoriously complex drug pricing system.”

“But most of the measures could take months or years to implement, and none would stop drug makers from setting sky-high initial prices.”

I believe the public is starting to see how the traditional media does not want to understand President Trump’s proposal or how President Trump is going to execute on his promises.

“Trump called his plan the “most sweeping action in history to lower the price of prescription drugs for the American people.”

“But it does not include his campaign pledge to use the massive buying power of the government’s Medicare program to directly negotiate lower prices for seniors.”

Actually President Trump’s drug plan does use the massive buying power of the Medicare program to negotiate lower prices for seniors. He is doing it indirectly but through a free market system.

The traditional media’s prime focus is to criticize President Trump’s programs regardless of the facts.

In fact, with his drug plan, President Trump has published a blueprint that is going to change the metrics of how drugs are priced. His plan will make prices transparent to patients and physicians.

Patients will be given the choice to pick the best price. Physicians will be given the choice to decide if the price charged for new medication is worth the increase in price.

President Trump is going to eliminate the present failed system of pricing medication. It has not worked for consumers.

His blueprint cannot be evaluated in the context of the present pricing system.

I will describe the potential for improving the system with his blueprint in my next article.

All I can say at this point is let us see what is going to happen.

 

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



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Here They Come Again

Stanley Feld M.D.,FACP,MACE

Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.

Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.

The economics of these single party payer systems are seldom discussed in a coherent way. The American public has no idea of its economic burden to its countries.

The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.

In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.

The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time.

In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They also suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.

The private healthcare system is flourishing in Britain for those who can afford it.

The British healthcare system is unsustainable. The British government cannot figure out how to make it more efficient.

America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.

Seniors love Medicare. They could not afford to get treatment if there was not a Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. The price of healthcare has continued to explode yearly.

Congress has ignored the basic defects that have caused this explosion. A few congressmen are making feeble attempts to correct this continuing price explosion.

The political establishment largely ignores these congressmen.

As attempts are made to try to control costs through regulations the bureaucracy grows and the system becomes more inefficient. The reduction of reimbursement to physicians has resulted in the explosion of concierge medicine.

The result is an increase in costs and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers and government.

Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.

President Obama’s law increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from investigations and government penalties in the long run.

The VA system is the purest example of sheer failure. Not only are the patients unhappy but the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.

The inefficiency, corruption and waste have not been able to be fixed but many notable private sector executives. They have all ultimately resigned or were fired.

The VA system’s single party payer system remains an incurable failure.

These examples have proven to me that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.

Are these mistakes intentional?

The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.

What is happening now?

The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.

The article, Back to the Health Policy Drawing Board” is intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.

After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exists.

However, the cost of the Medicare system is out of control. America cannot continue to print money forever. America’s political class is ignoring this fact.

It is so out of control political wonks are starting to talk about having another Debt Jubilee.

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

The New York Times article starts by saying:

The Affordable Care Act needs help.

It sure does. The problem is there are too many defects in the structure of Obamacare that led to the increases in costs to the government and consumers. Obamacare is beyond repair.

After scores of failed repeal attempts, Congress enacted legislation late last year that eliminated one of the law’s central features, the mandate requiring people to buy insurance.

There was only one failed repeal attempt not scores of repeal attempts. The one repeal attempt failed by one vote. It seemed to me to be a vindictive vote. It was not on the bills lack of merit. It seemed to me to be on John McCain’s personal animosity toward President Donald Trump.

There has been a total lack of bipartisanship in trying to repair Obamacare. The have been no ideas offered by Democrats. Its goal was to stymie the Republican administration.

Many establishment Republicans’ goal was to also stymie the Republican administration.

Obamacare had three principal features:

  • Insurers could not charge higher prices to people with pre-existing conditions.
  • Those without coverage had to pay a penalty to the government (the “mandate”).

President Trump slipped the elimination of the mandate into the tax bill to bring a speedier death to Obamacare.

  • Low-income people would be eligible for subsidies.

Each feature represented a death bell from the onset

A June 2017 poll showed that 60 percent of Americans said the government should provide universal coverage, and support for single-payer insurance rose more than one-third since 2014.

Americans are frustrated with the dysfunction in the healthcare system. Premiums have increased tremendously since Obamacare. Its regulations and defective principles increased dysfunction.

Enormous deductibles have resulted in individual buying defective insurance policies. Consumers have ended up with essentially no insurance coverage except for catastrophic illness. Only people at risk for high cost treatment have bought these policies.

I cannot imagine what the 60% who want a single party payer were thinking. Can a government run system improve the inherent inefficiency, waste, abuse and unsustainability of Obamacare or a VA like healthcare system?

A government run single party payer system can only make things worse.

The healthcare system will not improve until congress acts to level the playing field and fix the defects inherent in our present healthcare system.

I believe a universal consumer driven healthcare system, available to all, can “Repair the Healthcare System” at a much lower cost to society and individual consumers than a single party payer system.

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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