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Disinformation and the healthcare system

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What Is The Ryan Plan All About?

August 22, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP,MACE

The need for effective Medicare reform is becoming
increasingly apparent. Both the public and providers do not like Obamacare.

The cost overruns for Obamacare are hidden
from the public but are becoming evident.

There is an ideological divide between policies
that work and policies that don’t work.

President Obama believes the only policies
that work are government policies that control providers, insurers, and
consumers.

There are multiple examples that have shown
that these policies have never worked. Government has never controlled spending
for any projects for myriads of reasons.

What makes President Obama think his
government can force the healthcare system to become more efficient and control
healthcare costs?

Price controls and restriction of access to
medical care will not work.  

Entitlement programs have been fertile
grounds for fraud and abuse by all the vested interests including government
agencies.

Government should be of the people for the
people.

Government should level the playing field so
secondary stakeholders compete for primary stakeholders’ business.

I voted for President Obama because I thought
he offered this hope. He fooled me as he has fooled millions of other Americans.

President Obama has a cool, seductive
speaking delivery. He is general enough to make one think he believes in what
you believe but his agenda is central government control over all areas of life.

The agenda is the opposite of the individual
freedoms our country stands for.

None of President Obama’s policies have
worked in the last 3.5 years.   

He has snuck in higher taxes on the middle
class for his healthcare bill and has not lowered healthcare costs.  Healthcare costs have increased.

Americans are not dumb. They are beginning to
realize they are on the road to serfdom.

President Obama is using every dirty trick
known in American politics to attack Governor Romney and now Representative
Ryan in order to keep  from talking about
his record on jobs, the economy, healthcare costs, the deficit and its meaning,
our National Security, foreign policy, energy, and immigration.

For some reason the traditional media is on
President Obama side. The result has been a loss of their audience by newspapers,
magazines, and network television.  

America is in a fiscal crunch. Entitlement
spending is at the center of the fiscal crunch and must be reformed effectively.

 “Medicare
is at the center of our fiscal crunch, with outlays that have grown about twice
as fast as the economy over the past decade, according to the Congressional
Budget Office (CBO)”.

 The fiscal crunch is only going to get worse
as 76 million baby boomers retire in the next two decades.

“Medicare
will consume an ever-increasing share of the federal budget unless policies are
adopted to bend Medicare's cost curve.”

The Medicare trust fund has been depleted by the
federal government borrowing from the trust fund. Over time and as unemployment
rises less Americans are paying into the fund. The government’s depletion of
the fund has occurred since the beginning of Medicare.

The Medicare premiums paid by seniors for
Medicare Part B is going to double in the next two years. This is a tax on
seniors on fixed incomes that no one is talking about and few can afford.  

President Obama is expanding an entitlement
with Obamacare.  It will accelerate the
consequences of the fiscal crunch.

“Even
if the substantial reductions in payments to health care providers included in
the Affordable Care Act (ACA) are fully implemented and Congress allows the
27.4% reduction in physician payments required under current law to go through,
Medicare spending will continue to grow at unsustainable rates.”

 The Ryan
plan can change the direction of Medicare and save it.

         What does
the Ryan Plan do?

  • No one over 55 years old is affected.
  • People younger than 55 will have the option to choose
    between traditional Medicare or premium support from government to pay for
    competing private healthcare insurance plans.
  • Traditional Medicare is a defined benefit plan. The
    government decides on the price
    it will pay for medical services.
  • Ryan’s plan is a "defined contribution" plan. The
    government decides on an amount of money ("premium
    support") to provide to individuals to buy private insurance of
    their choice.
  • Consumers will choose from an approved set of competing
    private insurance plans along with traditional
    Medicare.
  • There is an open enrollment period each year, allowing
    people to choose either of the
    plans.

 

The goal is to force the healthcare
insurance industry to compete for patients
as well as give seniors the right to choose the most appropriate plan for
their needs.

 The Ryan plan allows competition among
in the private sector which will increase efficiency and drive down
costs.

President
Obama is scorning this system as a “voucher system.” 

Nonsense!

Once
again President Obama is obfuscating the truth with a sound bite.

Americans
55 years old and younger have paid into the system all their working life jus
as senior 55 years and older have. The “premium support” is not a free give
away as are food stamps.

Premium support is determined each year by the government
calling for competitive bidding by the healthcare insurance industry.

“ The government would then provide seniors
in each region of the country with a "premium support" equal to the
second-lowest bid in that region, or one equal to the bid of the federal
fee-for-service Medicare program — whichever is lower”.

Seniors could choose the traditional Medicare, since the
government would still contain a package of required benefits that would
constitute its comprehensive insurance coverage, just as Medicare does today.

Seniors would be guaranteed freedom of choice. A private
healthcare insurance option would equal the “premium support” payment.  

The premium of the private insurance might even become
cheaper than the Medicare premium seniors would have to pay.

The Ryan plan would allow the healthcare insurance
industry to compete with Medicare.  

The healthcare insurance industry could be forced to
lower its net profit by the competition just like it has occurred in other
industries. The competition could also force increase efficiency and quality of
product.

Tort Reform and fraud and abuse are not addressed in the
Ryan Plan yet.

The Ryan Plan is a good start to change from central
control to individual choice. It I not there yet.

 Presidential candidate
Romney’s pick of Paul Ryan as running mate has made Romney the good guy in the
Medicare issue.

“ It's
President Obama who has put Democrats in the position of being the party that
is cutting current seniors' benefits, rationing care (thanks to the IPABs), and
letting the program collapse as it becomes unsustainable.”

If
you're a senior now or in the future, Democrats are offering you nothing except
a grim, mean, rationed future when it comes to medical care.

It's the
Republicans who are offering hope for a sustainable Medicare future with
freedom of choice.

“Given
the serious fiscal problems facing this country, slowing the growth of Medicare
spending is no longer optional. The only question is how to do it.

The
Wyden–Ryan proposal outlines a strategy for Medicare reform that harnesses
market forces to control costs. It provides a real alternative to the top-down
controls favored in the Obamcare.

 Paul Ryan and Ron Wyden have defined the
policy parameters that could be the basis for real Medicare reform in 2013.

   Amazingly,
the Washington Post and liberal healthcare policy wonks are starting to think
the Ryan Plan might be a good idea.

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

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Health Insurance Exchanges And The Federal Government

August 8, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D., FACP,MACE

Health Insurance Exchanges are supposed to be state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

 All exchanges must be fully certified and operational by January 1, 2014 under federal law.[1] 

It is not going to happen on time. However the 20 hidden taxes in Obamacare are happening right now.

The health insurance exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing.

President Obama will then have a clear path to a Public Option and a single party payer healthcare system.

Unfortunately, the single party payer system will fail because it will be unaffordable for Americans and the federal government.

The states and the healthcare insurance industry will do everything they can to undermine its success.

Federal officials never thought they would end up running the Health Insurance Exchanges. Their plan was to dump this formidable and complex task on the states. Half the states refused to participate.

“Obama administration officials are getting ready to set up and operate new health insurance markets in about half the states, where local officials appear unwilling or unable to do so.”

 “So far, Governors of 13 states with nearly one-third of the United States population have sent letters to the Obama administration saying they intend to set up exchanges. Complete applications are due on Nov. 16, 2013.”

Stated another way, 37 states have not signed up yet. Once those 13 states that have signed up calculate the cost to setting up and running the health insurance exchanges I suspect they will withdraw.

The Secretary of Health and Human Services, Kathleen Sibelius’,plan was to create regulations for the states to develop the health insurance exchanges by January 1,2014. She has emphasized that states must meet her standards of transparency and accountability.

The federal government requires state exchanges to develop budgets and project operating costs, revenues and expenditures.

 There are a great many regulations attached to qualify as a state exchange.

States must explain how the revenue will be generated and how the exchange will address any financial deficits.

 The federal government wants to set up the rules that require the states to execute these rules at the states expense after the federal government funds the exchange for two years.

The health exchange program will be delayed because the government pledged to set up the health exchanges in the states that opted out of the program.

Creation of Health Insurance Exchanges is a complex and expensive task. States have to operate under a balanced budget. States cannot afford this undertaking.

“Federal and state officials and health policy experts expect that the federal government will run the exchanges in about half of the 50 states.”

 

My guess is it will be closer to 35 states. Federal officials are preparing to do the job but it will be a difficult political task.

The public fears a federal takeover of the healthcare system. This takeover is one more step by the government to increase its control over the healthcare system.

The Obama administration does not want to encourge that fear with its takeover of Health Insurance Exchanges.

The Obama administration does not want to alienate state officials whose help they need in the execution of the federally run healthcare exchanges.

The federal government does not have the manpower to run all these exchanges. It is outsourcing the work to private contractors.

We have seen the disastrous abuse to physicians by outsourcing fraud and abuse investigations to private contractors.

“The Obama administration has invited advertising agencies to devise an elaborate “outreach and education campaign” to publicize the federal exchanges and their potential benefits for consumers.” 

The Federal officials are hiring private contractors to provide “in-person assistance” to consumers and to operate call centers.

President Obama’s administration has attacked Mitt Romney and Bain Capital for outsourcing of jobs.

President Obama is now outsourcing these jobs to a foreign company, while America desperately needs jobs here.

Federal officials have turned to the American subsidiary of a Canadian company, the CGI Group, to provide information technology services to the federal exchanges under a contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency of state health insurance exchanges yet planning for the federal exchanges has been done almost entirely behind closed doors.

“We have gotten little bits of information here and there about how the federal exchange might operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance Department.

“I was on a panel at Rockhurst University here, and I was asked, ‘Where is the Web site for the federal exchange?’ I chuckled. There really isn’t any federal exchange Web site.”

In New Hampshire, Thomas M. Harte, the president of Landmark Benefits, which arranges health insurance for 300 employers of all sizes, said:

“Nobody has any idea what the federal exchange will look like. There has not been much communication between officials drafting plans for the federal exchange and the people who will use it: consumers, employers, brokers and insurers.”

Administration officials have not set forth a budget for the federal exchanges.

“They said they intended to charge “user fees” to the participating health insurance plans.

It is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.”

I get it.

The Federal Government is not telling us what they are going to do because they probably want to follow its non-transparent regulations.

It is pretty clear this will be one of many steps toward the destruction of the healthcare system. The healthcare system will self implode. At that point everyone will be begging the government to take over.

It will be impossible for President Obama to take over a business system it cannot afford.

A key to Repairing the Healthcare System is to decrease the outsourcing and bureaucratic complexity.

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

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  • Securedinsurancemarketing • September 30, 2012

    Thanks for keeping the overview so simple, this helps in understanding if there is a need for information about health insurance

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President Obama Is Faking Out Seniors For Their Vote.

July 31, 2012
inDisinformation and the healthcare system, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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 Stanley Feld M.D.,FACP,MACE

I have never been a fan of the Medicare Advantage Program because it rips off taxpayers and senior citizens.

I wrote a blog on July 13, 2008 exposing the Medicare Advantage as a scam to enrich the healthcare insurance industry. The title was “Politicians Are Hard To Trust. ”

Seniors initially think it is great because their premium is cheaper than traditional Medicare.

If seniors are not sick they would think they have great insurance because it is cheaper than traditional Medicare insurance. If those seniors would get sick they would realizes the insurance coverage is not as great as their healthcare insurer chooses the physicians and hospitals. Neither might be the “best in town.”

 The healthcare insurance companies wine and dine seniors to get them to sign up with their company.

 The profit the insurer receives from Medicare Advantage is estimated to be $8 billion dollars a year.

“United Healthcare and Humana are betting on the lucrative Medicare Advantage part of their business. The Medicare Advantage program develops doctor networks that are managed by the insurers in contrast to regular Medicare in which members can choose virtually any doctor, who is paid directly by the government.

“One in five of the nation’s 43 million Medicare enrollees are now in the Medicare Advantage program, which the Bush administration says has brought more choices and better benefits to the federal health system.”

My question is, “who can you trust?” Is President Bush really protecting seniors and the U.S. federal treasury or the healthcare insurance industry?”

“ Medicare Advantage has become a political target, because — whatever its vaunted enhancements — it costs the federal government 12 percent more for each enrollee, on average, than the regular Medicare system.” “The Congressional critics see the policies as an extravagance whose main beneficiaries are insurers like Humana and UnitedHealth.”

Wake up America! Physicians only receive 10% of the Medicare dollar. Physicians are the people providing medical care, not the healthcare insurance companies.

None-the-less many seniors are happy with the lower Medicare Advantage premiums. They would be very unhappy if President Obama eliminated Medicare Advantage before the presidential election.

The decrease in Medicare Advantage’s availability was snuck into Obamacare without debate. Few in congress absorbed every detail of Obamacare.

 

 The reductions were supposed to take effect on October 15,2012.

 

This Medicare Advantage elimination date is part of the $500 billion dollar reduction in Medicare expenditures.   

On May 6, 2012 I reported President Obama’s impending trick was pulled not to upset seniors and loss their vote for his reelection.

 

“President Obama’s politics are a dirty business. Manipulating the traditional media and American public’s thinking rather than presenting the truth seems to be President Obama’s goal.

The traditional media has omitted the fact that President Obama is going to make major disruptive changes to Medicare on his own. He is going to decrease Medicare funding by $500 billion dollars.

In fact, the decrease funding was to take effect before the election.

He conveniently delayed the scheduled reduction until after the election in order to not upset seniors and lose the senior vote.”

“ President Obama has been planning to get rid of Medicare Advantage with his Medicare funding reductions. Seniors will then be in an uproar.” 

President Obama’s plan to delay the implementation of the cut I Medicare Advantage is a trick that is costing the American Taxpayers $8 billion dollars. The cost of the additional study will not prove anything.

http://my.brainshark.com/The-President-s-8-Billion-Coincidence-356086344

PLEASE CLICK ON THE ABOVE LINK TO SEE THIS VIDEO.

It is just another trick play to deceive voters to vote for him.

It will not work. I hope President Obama’s disinformation and manipulation of the traditional media are wearing thin on everyone.

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

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Obamacare Tax Increases That Have Been Forgotten

July 8, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens making 250,000 dollars a year or less. These taxes contradicts President Obama’s promise.

Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

These taxes and Mr. Norquist’s summary is ignored by the traditional media.

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said citizens earning under $250,000 would not pay one single dime more in taxes.

  

http://youtu.be/56c1fSdTAWI

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organizes the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my last blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in taxes.

 “Obamacare contains 20 new or higher taxes on American families and small businesses. 

Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.

 

Capital Gains

Dividends

Other*

2012

15%

15%

35%

2013+

23.8%

43.4%

43.4%


*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

 

First $200,000
($250,000 Married)
Employer/Employee

All Remaining Wages
Employer/Employee

Current Law

1.45%/1.45%
2.9% self-employed

1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike

1.45%/1.45%
2.9% self-employed

1.45%/2.35%
3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that take effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

 

1 Adult

2 Adults

3+ Adults

2014

1% AGI/$95

1% AGI/$190

1% AGI/$285

2015

2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085


Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

Mr. Norquist left out the worse tax of all. This “tax” is under everyone’s radar. It has never  been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present
Monthly Fee of $96.40, rising to:
$104.20 in 2012

$120.20 in 2013

And

$247.00 in 2014."

 

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.

These are provisions incorporated in the Obamacare legislation, purposely

delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus.  Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare must be repealed.   

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.  

It is time for everyone to get angry and vote him out of office in November.

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

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  • Daniel Silver • July 11, 2012

    The number 9 tax note that the insurance premiums paid by your employer will be reported on the W2 and then at some later date a tax will applied to that amount. This is the most dangerous precedent for all citizens in this country.
    I do not think that the excise tax on indoor tanning salons is going to hurt many nor make a lot of revenue for our legislators to play with.

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The Supreme Court And Obamacare

July 2, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System
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Stanley Feld M.D., FACP, MACE

On June 28, 2012 the Supreme Court ruled on the constitutionality of President Obama’s Healthcare Reform Act. Chief Justice Roberts read the majority opinion. He sided with the four liberal judges in ruling it constitutional.

The pundits on the left and the right have been speculating on the significance of the decision for the past five days. It can make anyone who is trying to understand the significance of the decision, as I have, dizzy.

The fact is Obamacare is a terrible law. It must be repealed. It is a super entitlement program that will bankrupt our nation.

Recently, the CBO said is would increase the budget deficit $1.76 trillion dollars over the next 10 years. President Obama has claimed Obamacare will decrease the deficit.

Obamacare is going to be difficult to execute because of programs such as Accountable Care Organizations. Deadlines have already been extended. This will result in increased cost and increased budget deficits.

States do not want to increase their spending, raise taxes, or go into further debt States are required to balance their budgets. Most will not cooperate with the expansion of Medicaid or the Heath Insurance Exchanges.

The role of the executive branch of the government has already been expanded on President Obama’s watch. Non-elected officials are making policy decisions without congressional approval.

The end result will be that the healthcare system will collapse. The federal government will then socialize medicine completely.

I believe this is President Obama’s goal. It is the reason he did not insist on the Public Option before passage of the bill.

President Obama has used many trick plays to achieve his goal. The last trick he played was to try to intimidate the Supreme Court.

 

 

http://youtu.be/yWZ9JVvUG0g

 I was positive President Obama could not intimidate the Supreme Court justices. It is hard to know if President Obama’s intimidation tactic influenced Chief Justice Roberts’ decision.

Some believe Chief Justice John Roberts has handed a remarkable victory to American Independents, Libertarians, and Republicans by declaring Obamacare’s application of the commerce clause unconstitutional.

The effect would be to limit broad application of the commerce clause. In the past the federal government has used the commerce clause to justify its intrusion in Americans’ personal life and limit their freedom of choice.

Nancy Pelosi was grinning from ear to ear and made a couple of incomprehensible comments about President Obama, Harry Reid and her victory in the Supreme Courts decision. She even had a party before congressional members.

We can all remember Nancy Pelosi gloating and saying,  "we cut half a trillion dollars from Medicare” to pay for ObamaCare.

She has been credited with being the mother of “double counting.” She also made this brilliant statement, "We have to pass the bill to find out what’s in it.”

 

Sixty percent of Americans do not like Obamacare. They want it repealed.

If the commerce clause was upheld the federal government could force Americans to buy and eat broccoli.

 The error the Chief Justice made is that by declaring it a tax the government can tax people who choose not to eat broccoli. 

“However, with Chief Justice Roberts almost surreptitiously joining with Justices Scalia, Thomas, Alito, and Kennedy in ruling that ObamaCare is barred by the federal Commerce Clause, a new era has begun in Commerce Clause jurisprudence.” 

This is a big deal. It limits the federal government’s power over its citizens by resetting the rules for lower courts.  

 Long after many of us are gone, this 5-4 opinion finally setting limits on the reach of the Commerce Clause will continue to affect American lives and protect private citizens from Washington's intrusions.

In order to pass Obamacare with 60 votes needed in the Senate, President Obama threatened some Democratic senators into voting for his bill.

President Obama jammed an unpopular healthcare reform act through a barely willing Democratic dominated congress.

President Obama insisted on the mandate. He claimed it was constitutional according to the commerce clause.

President Obama did not want to impose a tax at a time the economy was so poor. A tax on families earning less than $250,000 a year would have been political suicide.

President Obama would not have gotten 60 Democratic votes in the Senate if he was imposing a tax on those corporations, organizations, and individual who chose not buy healthcare insurance.

The Healthcare Reform Act was passed without bipartisan support. Therefore, President Obama cannot claim that the bill was passed by a bipartisan congress.   

“Chief Justice Roberts majority decision said the Federal Government does not have the power to order people to buy health insurance . . ..

His error was to give the President some help by calling it a tax.

 The Federal Government does have the power to impose a tax on those without health insurance." (National Federation of Independent Business v. Sebelius, Slip op. at 3, 41-42, 44)” 

President Obama has insisted it is not a tax but a mandate. Today he is insisting it a not a tax. It is a penalty for not buying insurance. The legal definitions of taxes, penalties and mandates are all different.

  

http://youtu.be/TdgPauuMmJI

No one can know if John Roberts was intimidated by President Obama’s admonition or if he thought he was acting to defend the constitution.

In effect, he and the liberal justices rewrote Obamacare as it was originally written.

Democratic congresspersons are starting to catch on. Many are declining to attend the Democratic Party’s convention.

“The ObamaCare tax does not apply to those who presently are untaxed, (50% of the public).

It will not apply to the more wealthy, who will be excused because they carry health insurance anyway.

Guess who absorbs the bullet? Families earning under $250,000 a year.

The President who promised no new taxes against the middle class conclusively has been "outed" by the Chief Justice as having imposed the biggest tax on middle-class Americans in a generation. 

President Obama has “outed” his supporters with false hope throughout his presidency using trick plays. Seniors will be unhappy when they start realizing the impact of the $500 billion dollars removed from Medicare.

Employers will be hesitant to employ greater than 50 employees in order to avoid the tax. Unemployment will rise. Obamacare in offering money for unfunded liabilities as more people will need subsided insurance.

This represents the largest tax increase in United States history along with 20 other new taxes in Obamacare. These new taxes are going to affect everyone including taxpayers’ earning under $250,000 a year.

President Obama knew all along Obamacare’s mandate is not constitutional. He was trying to pull a trick play. He knew Americans would not buy an added tax.

He then faked out the Supreme Court when his lawyer asked if Obamacare would stand as constitutional if the mandate would be considered a tax.

“The idea that if Congress had mustered the courage to pass the mandate as the tax it is, it would have been well within its right to tax the people.  But Congress didn't do that.  They manipulated the language, and thereby the people, playing us for fools.”

 The economy remains the major issue in the 2012 elections. President Obama will use every trick he can to divert America’s attention from the main issue. Obamacare is making the economy worse.

“The number-one national issue in the 2012 presidential election is economic, but as a cultural question, the scope, limits, and trustworthiness of government looms large and ominous to those who perpetrated the fraud of duplicity:

Disguising a wolfish tax in the sheep's clothing of moral imperative, just long enough to pass it.  It's at least as unwise to scam voters, as it is not nice to fool Mother Nature. 

Some believe that Chief Justice Roberts has given Republicans the ability to tie the healthcare issue back to the economy.

Chief Justice Roberts returned Obamacare front-and-center back into the November elections debate.  Defining it for what it really is — a new, enormous federal tax on at least four million Americans (Slip op. at 37)

It will be up to Mitt Romney and the Republicans to define the connection of the two issues.

I have a feeling President Obama will outsmart the Republicans once again with additional trick plays.  

John Roberts did not do Conservatives, Libertarians, the constitution, the economy or the American people a favor with his decision.

It is up to the people to speak at the voting booth on November 6nd.

 

 

 

 

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A Genius Wrote

June 16, 2012
inConsumer Driven Health Care, Disinformation and the healthcare system, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests
• Leave a comment

Stanley Feld M.D.,FACP,MACE

Todd Siler is a famous artist and scientist. He is much more that. He is a genius. He has written many books about visualizing and solving problems. The most famous is “Thinks Like A Genius”.

For many years he created “Truizms” for the Rocky Mountain News. These Truizms deserve a publication of their own. His Truizms’ are insightful and inspiring. Todd sent me some Truizms to help me illustrate the points I am trying to make.

It is an honor to have Todd become a great friend. He is extremely perceptive and a phenomenal teacher, in addition to being a wonderful human being.

Todd wrote a great response to my last blog “Lets (Not) Do Physicals.”    

Stanley, the frustrating situation you've accurately described here invokes Joseph Heller's classic novel Catch-22:

"There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he were sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle. (p. 56, ch. 5)…."Catch-22 says they have a right to do anything we can't stop them from doing." 

Quoting my blog , Todd wrote,

“It is not enough for the Obama administration to say it is interested in prevention of disease when it restricts access to prevention measures.

It is not right to restrict access to steps needed to prevent the debilitating or deadly complications of hip fracture.   

“The USPSTF concludes that, for men, evidence of the benefits of screening for osteoporosis is lacking and the balance of benefits and harms cannot be determined.” 

To me the trend to reduce physical examinations and lab screening is a ridiculous trend. The present spending on physicals probably should be modified some but not discontinued.” 

I agree!

Todd

One of Todd’s insightful Truisms’’ follws

Finger pointing

Our bureaucratic society with its multiple and conflicting rules does not permit us to honestly do the right thing for Americans, especially when money is involved.

President Obama says the right things, but he does not do the right things.

The Healthcare System’s policies should let consumers decide on what is logical for them after listening to the advice of their physicians.

Consumers should control their healthcare dollars with financial incentives  provided for them to stay healthy, become educated about their diseases,  and control their chronic diseases.  

The evidence medicine debate should be between the medical community and the USPTF without creating a media circus.

Healthcare insurance should be a high deductible first dollar coverage plan that would cover everyone.

I covered how this would work in my blog “The Ideal Medical Saving Account is Democratic.

America’s healthcare system is at the home in a “Catch 22”.

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

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  • EndlessImprovement Blog • December 13, 2012

    Hey! I was pleased as soon as I loaded this web page of your blog. What was the biggest reason the moment when you to create your future website?

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President Obama’s False Promises And Trick Plays.

June 3, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

 IF YOU CANNOT SEE THE YOU TUBE PRESENTED IN THIS BLOG POST IN YOUR EMAIL OR YOUR RSS FEED PLEASE CLICK ON TO THE TITLE OF THIS BLOG POST ABOVE TO CONNECT TO THE ORIGINAL ONLINE BLOG POST OR OPEN THE URLS POSTED IN THE EMAIL OR RSS FEED.

The You Tubes are usually at the bottom of the email feed.

THANK YOU

I believed President Obama when he made his many refreshing and seductive promises of hope before the 2008 election. I did vote for President Obama. I have regretted it ever since.

All President Obama’s promises of transparent government, working for the people, and fixing healthcare have turned out to be false hope.

President Obama has not listened to the wishes of the people. He is issuing executive orders as he tells the nation what they want to hear.  

  

http://youtu.be/UErR7i2onW0

Barack Obama faked all of us out in 2008 with his promises.

He is doing the same thing during this campaign season for his re-election. He is saying he has not had enough time to fulfill his promises. He said he would accomplish his goals in the first year after his election. Some people still believe him even though his actions are making things worse.

President Obama has created a myriad of problems as he has shifted the balance of power from congress to the executive branch of government. The shift is destroying our economy and our healthcare system with rules and regulations that are not practical.

His re-election campaign is trying to distract Americans from the real problems he has created. The key issues facing the nation are the economy, Obamacare, freedom of religion, freedom of choice, class warfare and the distortions of the American constitution’s principles.

President Obama’s personality is intoxicating. He fooled us once. He is betting he can fool us again.

I have tried to look at President Obama’s actions through the eyes of my liberal friends. I cannot see what they see.

President Obama’s latest trick is to disguise pulling the rug out from under the seniors on Medicare until after the presidential election.

Aside from double counting his Medicare reductions which he continues to deny, he is delaying the implementations of his reductions in Medicare benefits until after the election to not anger seniors.

“About half of Obamacare’s costs are to be covered with money taken from an already nearly bankrupt program for seniors.” Medicare

  

http://youtu.be/q8x20P4RpgQ

He is continuing to double count, ignoring America’s impending debt crisis.

 “Under the implementation schedule stipulated in Obamacare, many seniors would either lose their plans, or learn that they are going to lose them, before the election that will likely decide Obamacare’s—and Obama’s—fate. “

 President Obama, anticipating a senior revolt if they got wind of the scheduled reductions, launched a public relations campaign to distract seniors. The traditional mainstream media has promoted the distraction.

President Obama launched an $8.35 billion “demonstration project” to postpone the majority of Obamacare’s scheduled Medicare Advantage cuts until after election. Over 30% of seniors are on Medicare Advantage.

His goal was to keep awareness of the effects Obamacare will have on seniors who have Medicare Advantage under their radar until after the seniors vote for him in November. After November seniors will have lost their chance to respond effectively.

President Obama’s own Government Accountability Office (GAO) has said this “demonstration project” is a sham. The GAO has reported that the demonstration project has multiple “design defects”.  The GAO has recommended to Kathleen Sebelius that the demonstration project should be cancelled because it will not demonstrate anything and is a waste of money.

The design does not conform to the principles of “budget neutrality.” This waste of taxpayer money is obvious. President Obama is increasing the national debt by  $8.35 billion in order to increase his reelection chances by obtaining seniors’ votes.

He is also trying to distract seniors from his goals by running taxpayer funded TV ads.

“ President Obama ran millions of dollars’ worth of taxpayer-funded TV ads featuring Andy Griffith saying things like, “That new health care law sure sounds good for all of us on Medicare!” It mailed out full-color, taxpayer-funded propaganda brochures singing the same tune.”

“ It repeatedly claimed (and continues to claim) that money taken out of Medicare to fund Obamacare would—magically—also stay in Medicare and be used to extend its solvency. “

The $8.35 billion dollars of taxpayers money might be illegally being used by President Obama. He is using it to shore up presidential reelection chances without anyone noticing or saying anything in protest.

“In fact, according to the GAO, Obama’s $8.35 billion gambit will cost more than all 85 other Medicare demonstration projects combined.”

The $8.35 billion is taxpayer money. It will increase the budget deficit with no value added except to President Obama’s election potential.

The $8.35 billion dollars is more than the combined annual profits of the nation’s two largest and most profitable health insurance companies..

I hope President Obama cannot pull the wool over seniors and all of our eyes once more with another trick play before the election.

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

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Ignoring The Rules

May 13, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

 

Stanley Feld M.D., FACP,MACE

 President Obama and his healthcare agencies do not follow the rules required for agencies to write new regulations.

If President Obama does not follow the rules and regulations how can he expect agencies in the government as well as private businesses to follow the rules and regulations?

The President is supposed to set an example for others.

The Congress has relinquished its watchdog power over the executive branch of government. Even the head of CMS, the agency writing the regulations, was an appointee not approved by congress.

Government is supposed to be elected by the people for the people. President Obama has side stepped this obligation. He feels he knows what the people need.

“In a series of papers for the Mercatus Center at George Mason University, Christopher Conover and Jerry Ellig provide evidence to suggest that “the involvement of both White House and high-ranking agency staff” suggests that “the administration likely got the [ObamaCare] rules it wanted written.”

This series of papers were published in January 2012. I missed them. The traditional media ignored their findings. The Mercatus Center’s papers were not picked up by the alternative media either.   

I have noted, in the past, that President Obama and his staff have consistently “cooked the books” on budget estimates of the costs of his Healthcare Reform Plan.

 His numbers did not add up. His assumptions are usually incorrect. The data presented to the CBO has been inaccurate.

 

 

 

 

 

In summary, these Mercatus Center papers demonstrate how President Obama overrode the normal checks and balances used to ensure that federal regulations impose the smallest possible burden on the private sector.

He bypassed the required regulations used in evaluating the regulatory impact for interim rules.

"Rather than posting required regulatory impact analyses (RIAs) with interim rules and allowing time for analysis and comment, the White House and its agency heads dictated the rules that would be written, curbed the Office of Management and Budget (OMB) review function, and then simply declared that the interim rules were final."

Dr. Jerry Ellig is the study's co-author.  He said;

 "In this study, we looked at the federal government’s analysis for the 8 major “interim final” regulations issued in 2010 to implement key components of the Patient Protection and Affordable Care Act (ACA)."

"The intent of regulatory analysis is to inform decisions by identifying the problem the regulation is supposed to solve, and assessing the pros and cons of alternative solutions. But we found these key ACA analyses to be rushed, seriously incomplete, and rarely used to inform decisions.'

 In 2008, the average regulation received 56 days of OMB review. In 2009, the average regulation received 27 days of review. 

 In 2010, the average ObamaCare regulation received 5 days of review.

The review was brief because it was not done according to the rules and regulations.

President Obama cannot possibly understand the economic impact of the resulting regulations. Their economic impact is poorly defined and therefore not understood.

The authors suggested that Congress should consider establishing an independent review agency that would do a regulatory impact analysis of the proposed regulation using widely accepted standards before the regulations are final. 

“The RIAs accompanying the regulations were “seriously incomplete, and they fell far short of federal agencies’ normal practice.”

The Mercatus Center’s Regulatory Report Card criteria, the best analysis of the 8 regulations studied received just 25 out of 60 possible points—the equivalent of an ‘F’.

“President Obama’s regulatory impact analyses also regularly under-estimated costs, over-estimated benefits, and ignored alternatives that would have had lower costs or greater benefits.”  

The defects in the regulations are too numerous to list and too aggravating to contemplate.

Health care economists have estimated that these defects will result in between a 10 and 41 percent cost overrun in health care spending

My major point is not the defects in the final interim regulations.

My point is the regulatory process using rules of the regulatory impact analysis have been ignored.

The rules of the process have been ignored in order to reflect President Obama’s ideology.

The issue is a process issue.  President Obama’s administration circumvented processes that were constructed to protect the American people from government abuse.

He has disrespected the will of the people and the checks and balance system, has marginalized congress, tried to intimidate the judiciary system and ignored the constitution.

How can President Obama expect the American people to respect or trust him? Americans are smart but only if their sources of information are not bias or controlled.

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

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Pay For Performance (P4P) Pilot Project Fails

April 11, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Pay for Performance (P4P), Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

The CBO announced that the P4P pilot project did not reduce the cost of providing healthcare nor yielded long-term gains in mortality.

"Tying financial incentives to performance, often referred to as pay for performance, has gained broad acceptance as an approach to improving the quality of health care.1-4 

The Centers for Medicare and Medicaid Services (CMS) recently completed a 6-year demonstration of pay for performance for hospitals through the Premier Hospital Quality Incentive Demonstration (HQID), and the Affordable Care Act calls for CMS to expand this program to nearly all U.S. hospitals in 2012. 

P4P sounds good theoretically. The government paying more money for better outcomes sounds logical from the payer’s point of view.  It is not logical from the payees’ (physicians’) point of view.

The emphasis of P4P is on physicians and hospitals practice process to improve quality through the use of evidence based medicine.

The evidence based medicine guidelines are determined by the Independent Physician Advisory Board (IPAB). The evidence based medicine should improve quality and lead to better patient outcomes and decrease healthcare costs..

This pilot project showed that P4P does not produce the desired result. The hope was to inspire poor performing centers to improve and good performing centers to perform better in order to receive incentive pay for performance as a bonus.

"In summary, we found little evidence that participation in the Premier HQID program led to lower 30-day mortality rates, suggesting that we still have not identified the right mix of incentives and targets to ensure that pay for performance will drive improvements in patient outcomes.

  Even though Congress has required that the CMS adopt pay for performance for hospitals, expectations with regard to programs modeled after Premier HQID should remain modest."

This last sentence is great advice.

Congress and President Obama should reexamine their premise.

Patients’ performance is left out of the P4P program. Patients’ attitude toward their disease, adherence to taking medicine prescribed, compliance with prescribed therapy and patients ability to make rapid therapeutic adjustment of medications depends on patients and not physicians or physicians’ practice process.  

There is no question that the process of care is important. There is no question that processes based on evidence must be learned by all physicians. There is also no question that processes based on evidence rapidly change and must be swiftly adjusted.

The most important determinant in patients’ outcome depends on patients. Physicians’ practices should not be judged disregarding patients’ behavior.  

It is the physicians’ responsibility to teach patients how to be “Professors Of Their Diseases.”

Just imagine how many re-hospitalizations could be avoided for congestive heart failure if patients were motivated and educated to detect the onset of congestive heart failure and how to increase the dosage of medication to abort the episode.

Think of all the heart disease that could be prevented if obesity was prevented.

Think of all the acute asthma attacks and uncontrolled diabetes whose hospitalizations could be prevented.

Think about all the complications of diseases could be prevented if patients were incentivized to lead a healthy lifestyle.

At present the administration is trying to change incentives. It will not work.

The reason is simple.

I have written several blogs on why P4P will fail. 

When will someone listen?

I clearly explained the reasons for predicting P4P’s failure in a blog written in April 2007.

 Pay for Performance(P4P): Another Complicated Mistake.

 

April 15,2007

Stanley Feld M.D.FACP,MACE

The intuitive meaning of Pay for Performance (P4P) is the better you perform the more you get paid. This is true in many industries. The concept is well advertised in the well publicized salaries of professional athletes. Recently we have heard of grotesques salaries of fired CEO that get hundreds of millions of dollars in termination salaries for doing a bad job. They are getting paid well for poor job performance.

The underlying assumption is that with P4P, physicians should be responsible and accountable for medical outcomes. The physicians will be reimbursed for medical outcomes. The reimbursements made to the physicians are under the control of the government or insurance industry. These entities are interpreting the criteria for the quality of medical outcomes.

We have seen what happened to Dr. Petak even though his treatment is correct and saves money for the health care system. Many physicians feel P4P is simply code for reducing physician reimbursement. In an environment of existing mistrust between all the stakeholders, the potential is great for generating more mistrust. The growth of the mistrust will result in more dysfunction in the healthcare system and increased cost.

The definition of quality medical care has not been made clear by the secondary facilitators while proposing the P4P rollout. Organized medicine has not been outraged by the proposal. No one has analyzed it with all the potential for unforeseen consequence. Can P4P prevent the onset of disease or decrease complication rate for chronic disease? Who are the responsible stakeholders for increasing quality? The stakeholders responsible for medical quality care are the physician and the patient. If the patients do not adhere to the medical regime prescribed, the quality of care will not improve. Many studies have shown that compliance rates are as low as 30% for certain treatments. Patients will not have improved medical outcomes if they do not follow a treatment plan. Why should the physician be penalized? Why doesn’t the government and the insurance industry declare that patients are equally responsible for both good and bad medical outcomes? The structures of bureaucratic systems would not permit it because not only would it be judged to be insensitive it would be socially incorrect and result in a public outrage.

Patients have to be educated and become professor of their disease, be responsible for their health behaviors such as filling their prescriptions, exercising , decreasing obesity, not smoking or drinking. All preventive measures must be promoted. Patient need to be responsible their behavior and adherence to therapy. The physicians should not experience all of the brunt of poor outcomes or the credit for good outcomes. The P4P movement is misguided.

They are misguided when they think this is the fix. P4P represents another false hope and complicated mistake that in my opinion will lead to great cost to the healthcare system without improvement in medical outcomes.

I have defined quality medical care in a measurable way. None of these criteria are individual indicators of quality medical care. The system of quality of care should be the quality measure of prevention of medical complications and not the measurement of the parts on the path toward quality medical care. The patients’ activity is at least half of the quality equation to reduce the complications of chronic disease.

However, the secondary stakeholders are making a mistake with P4P. They have developed artificial quality indicators that do not measure quality medical care accurately. They want to force physicians to follow their indicators rather than use their medical skill and medical judgment. The way to improve quality is not to be punitive to the physicians. They are only one half of the quality equation to reduce medical care cost. The way to do it is to set up a competitive environment.

Lasik surgery is a perfect example. It stated with all ophthalmologic doing Lasik for $3000 an eye. Insurance did not pay for Lasik surgery. Some ophthalmologists’ developed focus factories that did just Lasik surgery. They developed economies of scale and expertise that enabled them to reduce the price. Patients chose these focused factories on the bases of price, and outcomes rather than the local opthalmologists. The price in some cities is now $250 an eye. Remember patients are not stupid. However, they are the 50% of the quality care equation. They will spend their money wisely and drive quality, if they own their healthcare dollar. It is our job to teach patients how to make the correct decisions. It is not the insurance industry or the government to restrict access to care and judge what is best. I believe the market place can do it.

In diabetes the healthcare system sends 15% of the healthcare dollar on 5% of the population and rising. Ninety percent of those dollars is spent on the complications of diabetes. If patients with diabetes were given control of their healthcare dollar and were rewarded for avoiding complications of diabetes we would be on our way to a competitive environment for the treatment of diabetes. The patients would search for physicians that had economies of scale and expertise to help them improve their quality of medical care. They would drive the creation of focus factories in diabetes as well as any other chronic disease. The system would then be stimulating competition and improving quality medical care not punishing physicians and patients. A negative and faulty penalty system (P4P) will not solve any of our problems. I predict it will only make it worse for the patient and the physician and more profitable for the insurance industry and hospitals. The physician and patient community ought to be outraged. They are not because we are a sound byte society and do not pay attention to the details of issues.

The P4P fad is simply another reason why patients need to be in control of their healthcare dollar. They should be rewarded if they avoid complications and improve their health. Physicians should compete to develop focus factories in order to generate economies of scale and improved medical outcomes. All of this has to be done in a price transparent environment.

 

April 15, 2007 in Medicine: Healthcare System | Permalink

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