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Innovations in Healthcare


Senate Republicans Are Making Repeal and Replace Harder Than It Should Be

 Stanley Feld M.D.,FACP,MACE

I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.

It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.

Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.

People like entitlements because they are free. Someone else is paying for them.

Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.

“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.

Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”

The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.

The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.

Congress needs the healthcare insurance industry’s ability to provide administrative services whether it is for Medicare, Medicaid, health insurance exchange coverage (Obamacare) or private insurance.

The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.

President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..

Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.

The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.

Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.

Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.

It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.

They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.

Canada’s health-care wait times costing patients many millions in lost time, wages”

Ontarians wait longer for health care than citizens of other universal health-care countries”

The fact is single party payer systems do not work for all the stakeholders.Both Democrats and Republicans are missing the essential point about what would work to provide an affordable healthcare system that aligns the incentives of all stakeholders.An essential element is to develop a system that encourages consumers of healthcare to be responsible for their health and have control over their healthcare dollars.

The Senate’s present revision does not consider this. The Senate is considering the needs of the healthcare insurance industry and not the needs of consumers.

The Senate should be considering the following in order to repeal and replace Obamacare.

  1. My Ideal Medical Savings Account should be instituted immediately. It will provide financial incentives for consumers as well and incentives to maintain health.

Self-management of chronic disease is essential for a healthcare system to become affordable. My Ideal Medical Saving Account provides that financial incentive.

1. The Ideal Medical Saving Account will provide instant adjudication of medical care claims.

  1. The ideal Medical Savings Accounts will encourage patient responsibility for their health, the care of their disease and their healthcare dollars.
  2. The Republican Party should establish an organized system of disease management education for persons with chronic disease. The education system should be designed to be an extension of physicians’ care. It should not be a free-standing education system. Physicians should be provided with incentives to set up these educational systems.

  1. A system of social networking with physicians and their patients should be developed. The government could provide the template for physicians and their team.

The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.

  1. Social networking between physicians should also be developed.
  2. Integrated care systems with generalists to specialists must be developed for both treatment and cost transparency for the physicians and patients.
  1. There must be instant communication between physicians and patient via an effective electronic medical record. The EMR must be a teaching tool for physicians. It must not be a tool to judge physicians’ care and penalize them. The EMR should be cloud based. Maintenance and upgrades should be free and seamless. Physicians should be charged by the click.

  1. Tort Reform is an essential element in a healthcare system that would work and be affordable. It would decrease the cost of over testing. It would also decrease the cost of malpractice insurance and legal fees. These cost are built into the cost of care. The cost of care would be reduced significantly.

The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.

Align patient 1

Align government

Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.

The house bill to repeal and replace Obamacare touches on some alignment.

The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.

The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.

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

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

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Why Is Obamacare A Mess?

Stanley Feld M.D.,FACP,MACE

Obamacare is a mess because the architects of Obamacare created a system that does not align all the stakeholders’ incentives.

Pre Obamacare we had a dysfunctional healthcare system because no one developed a system to improve the care of patients. When a consumer of medical care got sick he received very good treatment or the illness.

Consumers were not taught how to avoid illness. If consumers of medical care had a chronic disease they were not taught how to self-manage their chronic disease.

Medical care in the healthcare system became too expensive for employers to pay for. Consumers were the recipients of this largess. They had no responsibility or incentive for controlling their healthcare cost.

The healthcare system became more expensive because all the stakeholders except consumers tried to maximize their profit at the expense of each other.

President Obama promised to transform the healthcare system. Initially Tom Daschle was his chief. He wrote a book about healthcare after he was defeated in his bid for the Senate.

Any physician who practiced medicine knew that Tom Daschle’s ideas could not work. He had some good ideas to make healthcare delivery more efficient. The ideas were presented in an impractical way. He did not know who the customer was.

Dr. Donald Berwick was next. He tried to extend and implement some of Tom Daschle’s ideas with his own ideas.

Dr. Berwick was the co-founder the IHI (Institute for Healthcare Improvement).

Dr. Berwick has some excellent ideas. The ideas are an adaptation from the Institute of Medicine's six improvement aims for the health care system: care that is safe, effective, patient-centered, timely, efficient, and equitable.

The Institute of Medicine’s report “ Crossing The Quality Chasm” points out how to develop a new healthcare system for the 21st Century utilizing 21st century technology.

The problem is Dr. Berwick’s ideology is defective. His famous quote, “the very definition of a equitable healthcare system is the redistribution of wealth”  does not sit well with the American psyche.

There has never been a system of successful redistribution of wealth system.

Most people have experienced the deadening effect of bureaucratic systems on innovation. This is what we are experiencing right now with the Obamacare rollout.

People still cannot sign up. People are still spending hours on the telephone and not getting insurance. These are not glitches. These are system disasters.

I have long thought President Obama wants to destroy the present healthcare system so that the masses will demand a single party payer healthcare system with the government in control. Such a system will not be any different than Obamacare.

The government will still be dependent on consumers of healthcare, physicians, pharmaceutical companies, device companies and most of all insurance companies.

Insurance companies will still do the administrative services for the government at a very high price.

Obamacare has not even gotten to the problems it is going to have with the delivery of care, the access to care and the rationing of care. 

Obamacare’s business model is defective. It will be impossible to utilize the advances in technology under a system of increased government bureaucratic control.

I have previously presented a new business model. It’s possible it has not caught on for several reasons.  

1. My business model could have been presented too early in the course of  Obamacare’s demise.  

2. My business model is not politically correct.

3. My business model challenges legacy stakeholders. They do not want to give up any power.

 Legacy stakeholders are having a horrible time figuring out how to make a living under the evolving Obamacare system. Maybe by that adopting my new business model, one that aligns everyone’s incentive costs will decrease and profits for everyone will increase.

4. The presentation of my new business model could have been too complicated.

Over the next several months I am going to present my new business model.

This business model aligns all the stakeholders’ incentives except the government takeover of the healthcare system.

The government’s role should be that of a facilitator and not the director of the healthcare system.

I hope it will start making sense to people who can and want to do something to improve the healthcare system.

It will make life better for everyone.

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

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Pure Genius Or Pure Stupidity?

Stanley Feld M.D.,FACP,MACE

Obama’s actions as leader of this country have been either pure genius or purely

I think it
is pure genius. He promised Americans he was going to fundamentally change
America. He has!

have been under stress during the last few weeks. First it was the government
shutdown. Now it is the nation going into default. It is common knowledge the
shutdown and default is political theater.

Obama has run circles around Republican in the game of political theater.

traditional media has ignored the underlying causes of America’s problems.

We are increasing
debt to the point of unaffordability. The only way out is to increase taxes
further or decrease government spending while lowering taxes.

deficits are not good. Deficit increases devalues our currency. America’s currency
has already been devalued by the Federal Reserve increase in printing money.

taxes leads to decreased jobs creation. Decreased employment leads to decreased
discretionary spending. The result is decreased economic growth.

than trying to decrease spending rationally by increasing government
efficiency, President Obama has closed down silly things to make it most painful
and noticeable to the public. These noticeable services have little overhead.
These closures are not an example of reducing inefficient spending.

In the
meanwhile his administration has spent over $600 million dollars for a health
insurance exchange software program. The program is poorly designed and does
not have an integrated back end.

Even if
the software was great, the cost of healthcare insurance through the exchanges
is increased and out of reach of the individual buyers.

 The cost of insurance is cheap for the poor who
qualify for government subsidies. The poor will receive a tax credit which will
be credited to the insurance company whose policy the poor person buys.

The math
is grotesque. If a healthcare policy costs $10,000 and a patient makes $30,000
dollars a year, he pays only 2% of his net income for the policy or $600 per
year. The taxpayer pays $9,400 a year for that policy.

This is
an example of hidden “redistribution of
” and another entitlement.

Obama administration has waived the verification requirement for receiving a health
insurance exchange subsidy. Verification of need does not have to be fulfilled
by the health insurance exchanges. Anyone can lie and receive a subsidy to
purchase healthcare insurance threw an exchange.

big mistake was the design of the roll out to promote electronic medical
records. After 4 years only 11% of these records are functional. Physicians have
spent money for EMRs they could not afford. Hospital systems spent money they
could not afford. The government wasted $30 -60 million dollars of taxpayers
money in the unsuccessful effort to implement EMRs.

is a long way away from being computerized with a functional EMR.

care organizations (ACO) are another important cog in Obamacare’s success or
failure. The administration brags about the fact that 250 ACOs are in

are over 5,000 ACOs that need to be developed. A premier organization such as
the Cleveland Clinic had to drop out of the program because of the cost to the
institution. The Mayo Clinic refused to participate.

At the
same time ACO’s are turning out not to be cheaper or have better outcomes than
traditional medical care.

were supposed to improve quality. ACOs were supposed to be a free market
solution to the dysfunctional healthcare system.

administration has been bragging about the greatness of the VA system. The
bragging stopped when the system’s poor quality of care was exposed. Veterans
are receiving poor treatment.

would certainly have to admit Obamacare has been disruptive to the delivery of healthcare
in America.

months of healthcare insurance open enrollment for people is starting. People
are starting to see massive increases in their healthcare premiums. In order to
avoid these premium increases and the Obamacare penalties, large organization
such as Home Depot are hiring only part time workers.

Obama administration has developed a low cost insurance plan for the McDonalds
of the world. These health insurance policies cost little a cover less.

Obama has also provided waivers for congress and its employees. He is at
present trying to sneak in waivers from Obamacare to unions.

First, there was the delay of
 Medicare cuts until
after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement,
buried in the
Federal Register, that the administration would delay
enforcement of a number of key eligibility requirements for the law’s health
insurance subsidies, relying on the “honor system” instead. Now comes word that another
costly provision of the health law—its caps on out-of-pocket insurance
costs—will be delayed for one more year.”

Obama administration has issued a blizzard of mandates and regulations. These
regulations have increased the cost of health insurance.

The caps
on out-of-pocket insurance costs, such as co-pays and deductibles have not been
publicized. On January 1, 2014, deductibles were supposed to be limited to $2,000 per year for
individual plans, and $4,000 per year for family plans.

February 2014, the Department of Labor published a little-noticed rule delaying
the cap until 2015. The costs of these deductible limits were already built into
the 2014 healthcare insurance premiums and were not removed.

government did nothing to reduce the increased healthcare premiums after the
limits did not apply.

 “Federal officials said that many insurers and
employers needed more time to comply because they used separate companies
help administer major medical coverage and drug benefits, with separate limits
on out-of-pocket costs. In many cases, the companies have separate computer
systems that cannot communicate with one another.”

had to balance the interests of consumers with the concerns of health plan
sponsors and carriers.”

How is it in the consumers’ interests to pay far
more for health insurance than they do already?

I have a theory.

President Obama’s ultimate goal is to have a complete
government takeover of the healthcare system. A takeover the government cannot

He figures by creating as much chaos as possible
now in the “not so free market healthcare system”, he can declare the free
market healthcare system has failed.   

There will be a resulting public outcry for the
government to help and take over the system.

The takeover will be with a single party payer

What are the chances a government takeover will
result in an efficient, cost effective system that will provide access to care
without rationing of care while being affordable?

With all the delays, exemptions and regulations,
it looks as if Obamacare is destined to fail. Obamacare is going to be
impossible to execute effectively.

Obamacare’s ultimate failure is playing right
into President Obama’s     ideological goal
of a single party payer system.

President Obama is not stupid. He is a genius.

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

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Price Competition for Medical Care

Stanley Feld

Thank goodness many physicians are starting to recognize the problems of abuse
and waste in government run healthcare programs.  The run up in cost is secondary to the
healthcare insurance industry taking 40% of the healthcare dollars off the top
as patient care dollars and the hospital systems over inflating the costs to
patients because of inflated operating expenses and administrative salaries.

Physicians realize that an efficient free market system will reduce the
cost of care. Physicians are tired for being blamed for the entire healthcare
systems problems. They do not deny being part of the problem.

Many physicians have decided to move forward and develop consumer driven
free market systems of care. 

One example is Nextera Health in Longmont Colorado. I have discussed this

Nextera Healthcare
is a new model for delivering primary care at an affordable price. It follows
many of the principles embodied in my ideal medical savings account
model.  Nextera delivers compassionate care at an affordable cost and
encourages patients to be responsible for their health.

services all of a families needs at an affordable monthly cost. It is
combined with a high deductible healthcare insurance plan to cover costly

reason I am so high on Nextera Healthcare is that it closely fits a model of
healthcare delivery that will work to decrease the cost of medical care. It
will increase the quality of medical care and permit primary care to be a
viable specialty. 

Nextera Healthcare has the potential to permit the patient
to be responsible for managing their health and their healthcare dollars.

Healthcare has the potential to reduce healthcare cost to individuals, employer
sponsored self insured plans, associations and even government funded
healthcare plans while permitting consumers to make their own healthcare

Surgeons are developing their own innovative systems.  In free standing surgery centers they are
developing surgical procedures that cost at least 70% less than Medicare is
paying hospitals for the same procedure.   

 Dr. Keith Smith, co-founder and managing
partner of the Surgery Center of Oklahoma, took
an initiative that would only be considered radical in the health care

Dr. Smith posted a
list of prices
 online for 112 common surgical
procedures. Dr. Smith ,an anesthesiologists, became disillusioned about how
patients were treated and charged at St. Anthony Hospital in Oklahoma City.  

Dr. Smith’s goal
was to create a for-profit facility that could deliver first-rate care at a
fraction of what traditional hospitals charge. The goal was to eliminate the
hospital and healthcare insurance industry as the middlemen while decreasing
the cost of surgical care without decreasing the quality of care.

He wanted to create a system in which consumers and their employers
could receive surgical value at an affordable price. In the existing healthcare
system patients have no incentive to look for dollar value.

A healthcare system in which consumers buy goods or services from a
physician, surgeon or hospital systems all being paid for by the healthcare
insurance industry or government does not constituent incentive for consumers
to seek value and quality.

The lack of patient responsibility and value hunting is one of the major
causes of exploding U.S. heath care costs.

Physician owned transparent Surgery Centers are becoming increasingly
common as Americans look for alternatives to the traditional health care market
which is unaffordable and out of reach.

Consumer-driven models are appearing as fewer people have healthcare
coverage from their employers and are on their own

The unintended consequences of Obamacare are creating more uninsured not
less. The Medicaid insurance coverage that Obamacare is offering is

Patients may have no choice but to look outside the traditional health
care industry in the face of higher costs and reduced access to doctors and
hospitals. It is only going to get worse as we get deeper into Obamacare.

The Oklahoma Surgery
Center demonstrates that it’s possible to offer high quality care at low
Surgeons can do twice as many surgeries in an outpatient surgery center
than they can in a traditional hospital surgical suite.

Most industries
try to improve efficiency. However, simple efficiencies have not occurred in
most traditional hospitals. Surgeons spend half their time waiting for the
patients to come to the operating room or for the availability of operating
rooms and equipment.

The Surgery
centers have solved these efficiency problems. They can service surgeons’ needs
at less than half the cost without the wasted time.

A key reason is
there are not multiple administrators creating multiple regulations and
collecting multiple $500,000 to $3 million dollar a year salaries. Surgical
centers have one head nurse responsible for everything and zero administrators.

The cost of a “complex
bilateral sinus procedure” at the Surgery Center was an all-inclusive $5,885.
The traditional hospital bill totaled $33,505 without the surgeon’s and
anesthesiologist’s bill included.

It was discovered
at the time of the nasal surgery that the hospital charged $360 for a
dexamethasone injection. A dexamethasone injection cost the hospital $.75.

 A fentanyl shot which is a pain-killer cost the
hospital system $1.50 but the bill to the insurance company was $630.00 dollars.
Everyone has heard of the $45.00 hospital aspirin   

A traditional
hospital discounted non-inclusive bill to the healthcare insurance industry for
a carpel-tunnel release would be $7,452. The fee for the procedure pre-op is
not be available. The same procedure done for the all-inclusive transparent
cost at the Surgery Center was $2,775.

More tragic was
that the patient would have had to pay $5,299 out-of-pocket  to cover her deductible and co-pay for the
hospital bill before she even received the bills for physicians’ services. 

Below are some
examples of the differences in costs for procedures.

Transparency-Matters-larger jpg
A list of the surgical fee for the Oklahoma Surgery Center is on its web

How do hospital systems get away with this?

The more the hospital bills the more the insurance company puts in reserve.
The reserves are in the medical costs column and include the non-discounted
costs. The result is greater profit for the insurance company.

President Obama does not want physicians to be innovative in this way.
He wants physicians to be dependent employees of hospital systems. His goal is
to control physicians and dictate their medical care.

President Obama has provided some non-transparent favors to hospital systems
that are forcing physicians to be employed by hospitals. 

"A new provision buried in Obamacare effectively prohibits doctors from starting their
own hospitals or expanding the hospitals they already own, which has been
widely interpreted as a give-away to the American Hospital Association."

Hospital systems claim they must charge more to cover their overhead and
bureaucratic inefficiencies. So fix your system. Surgery centers have.

Dr. Smith says: "Everyone can
see what the prices are at the Surgery Center, and that affordable health care
is possible. So the jig is up.”

Dr. Smith believes that despite the obstacles being put in the way by
Obamacare, market-driven facilities like his will thrive and proliferate as
consumers catch on to costly collusion between big government and big health

I totally agree. As Obamacare’s unintended consequences proliferate
consumers and captured physicians (hospital employed) will pay more attention
to physician innovation. The jig for big government and big healthcare will
certainly be up.

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

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    Repairing the Healthcare System: Price Competition for Medical Care

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Business Model For Medical Care 2020. The Ideal Future State

Stanley Feld M.D.,FACP,MACE


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

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

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

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

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

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

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

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

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

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

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

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

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


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


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



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

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


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

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

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

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


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

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

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


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

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

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

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

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


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

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

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

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

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


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

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

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

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America Is An Innovative And Exciting Nation

Stanley Feld M.D.,FACP,MACE

I had several wonderful intellectual experiences last weekend. These experiences served to confirm my thinking that intelligent Americans are less interested in politics, rhetoric and empty promises and more interested in innovative solutions to all the ills that our bureaucratic political processes have brought upon us.

Todd Siler, Phd

My first stop was a visit with Todd Siler, Phd. Todd is a famous American multimedia artist, author, educator, and inventor. He is equally well known for his art and for his work in creativity research.

Todd’s analytic skills and creativity are uncanny.

The following quote is from one of his web sites,

 In 1890, the psychologist and philosopher, William James, described “Cerebralists” as “those who combine the sensual and spiritual, the physical and intellectual” in their creations. “

Clearly, we’ve lost sight of the broader meaning and reality of this practice. 

Cerebralism encompasses all forms and expressions of art. Through art, we can connect and transform everything (information, knowledge, ideas, experiences), to create new meanings and purposes for everything. Art makes life meaningful. It inspires wonder, while challenging the limits of our vision and imagination."

Please click on to Todd’s imaginative art.

In our rapidly changing world, where it seems, to many, confusing and scary Todd’s message is brilliant and enlightening. His course “Think Like A Genius” is enabling. It enables people to think expansively through art and science to develop strategies and actions that are innovative. He promotes mutual respect, trust and love.

One of Todd’s trademark symbols is;

  Todd siler png

It would serve everyone well to “Think Like a Genius” rather than think selfishly and try to take advantage of others.


My wife and I met Todd three years ago through an introduction from my son Brad (both MIT graduates). Since then Todd and I have been in constant communication via Skype. Last week was special.

Thanks, Todd.

Nextera Healthcare

My next visit was to Nextera Healthcare. Nextera Healthcare is a new model for delivering healthcare. It follows many of the principles embodied in my ideal medical savings account model.  It delivers compassionate care at an affordable cost.

Nextera Healthcare combines the compassionate practice of medicine with advanced information technology. My impression is that the founders have fire in their belly for delivering the best medical care for their patients.

I will explain more about Nextera Healthcare in the near future.  

The reason I am so high on Nextera Healthcare is that it closely fits a model of healthcare delivery that I believe will work. It will increase the quality of medical care and decrease the cost of healthcare. 

Nextera Healthcare has the potential to permit the patient to be responsible for managing their health and their healthcare dollars.

Nextera Healthcare has the potential to reduce healthcare cost to individuals, employer sponsored self insured plans, associations and even the government while permitting consumers to make their own healthcare decisions.


Next I stopped in at the TechStars fancy new dungeon. TechStars was co-founded by my son Brad Feld and David Cohen in Boulder, Colorado in 2007. It has been a very successful start up accelerator.

TechStars has expanded to Boston, New York, Seattle, and San Antonio. TechStars also has a number of affiliates in many cities in the U.S. and throughout the world.

Bloomberg TV has a special about TechStars concepts in 2011. TechStars business model is compelling to me.

I show up at TechStars Boulder’s office every year with permission from Brad and David. The goal is see if the 10 selected companies can explain their company’s business model to me is a way that I can understand.

It is a fascinating experience for me to see how these start-up companies hone their product and their story for Demo Day. Each company is mentored for three months to develop their model and hone their presentation.

On Demo Day Brad and David invite venture capitalist from all over the country to listen to these technology start-ups’ story and have the opportunity to invest in them.

The success rate for investment has been very high each year and at every site.

Last Thursday was the second day of the new session in Boulder. It was the first Demo Day practice session.

The first practice sessions blew my mind. I think the kids are getting smarter, more articulate and more creative each year.  Someone told me it was harder to get into TechStars than it was to get into Harvard Business School.



GoldLab’s 3rd Annual Symposium “Time: Tempus Fugit”  

The purpose of the trip was to attended GoldLab’s 3rd Annual Symposium “Time: Tempus Fugit” at the Colorado University as an invited guest.

Dr. Larry Gold is a legendary Biotechnology guru. His mission for these Symposia is to synthesize the confluence of science and humanity. His goal is to stimulate the thinking of bench scientists, practicing physicians and social scientists to understand progress and thinking in each discipline.

Once the participants are stimulated they are encouraged to focus on actionable solutions to the complex problems society faces through each discipline’s lens.

“This was a symposium that truly, truly, truly engaged all four organs of the participants — the head, the heart, the gut and the hoo-ha organ (ah-ha) organ. Larry Gold’s  Symposium  “Time: Tempus Fugit” did so it in grand style.’

It was certainly an invigorating weekend for me. The levels of intellect and the abilities to “Think Like a Genius” are very high.

I am certain the younger generation is not going to let President Obama get away with his “Obamacare” and other government controlling baloney he is pushing.

The challenge is going to be how to get their attention now and not later when the disintermediating task will be much harder.

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

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  • Fitness Info

    I constantly spent my half an hour to read this blog’s posts everyday along with a mug of coffee.

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My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Spokes 5 and 6- Future State Of Healthcare Business Model

Stanley Feld M.D.,FACP,MACE

Spokes 5 and 6 of future state business model for the healthcare system’s survival must be understood as one unit.  Chronic Disease Management and Education As An Extension Of The Physicians Care are two simple concepts.






Patient education is a crucial element in the care of patients whether the disease is acute or chronic. Systems must be set up so that education is an extension of the physician’s care in order to be effective.

Education is less effective if it is not personalized and unrelated to the patient’s physician.

Both concepts have been devalued by President Obama’s healthcare reform plan. The chronic disease management concept has been devalued with the administration’s pilot studies showing that chronic disease management programs do not decrease the quality of care or cost of care.

The pilot studies were conducted by freestanding clinics. The education was not an extension of the patient’s physician care. Medical care is a personalized endeavor that requires a personal relationship between patients and physicians.

At its core the quality of medical care is enhanced by a strong physician patient relationship. This relationship is critical to a successful patient outcome and decreases in the cost of medical care.

An analogous educational event happened to me in my junior year in high school.

I was on the high school baseball team. Baseball practice started in February. It rained and snowed a lot in New York City in February. If it rained we would practice in the gym. We couldn’t have baseball practice outside one day.

On that day the gym was taken. The baseball team was sent to the study hall the last period of the day. My year before geometry teacher was in charge of that particular study hall.

I was an excellent high school student. I never missed a question on a geometry test.

I loved my geometry teacher. It was easy for me to understand everything she taught.  This was an example of a positive teacher student relationship.

I was taking trigonometry that spring term. The chairman of the math department was my teacher.

I had a poor relationship with that teacher. He was not enthusiastic about trigonometry.

He was detached from his students and their needs. He had no interest in relating to us.

I could not understand a thing he taught.  I figured I could tolerate him.  I thought I had to ability to learn the course directly from the textbook.

To my surprise I could not understand any of the concepts in trigonometry when I was studying at home. I was resigned to the fact that I was going to fail trigonometry.

My geometry teacher saw me in the study hall. She came up to me an asked me how I was doing. I told her I was going to fail trigonometry.

I could not stand Dr. B and I could not retain anything he taught. I also found it impossible to teach myself trigonometry from the text.

She asked me what period I had lunch and which period I had trigonometry. I had lunch the 5th period and trig the 6th period.

She said she taught trigonometry the 5th period and she could transfer me into her class and into 6th period lunch. She was also a student advisor.

Her words were as if a weight was lifted from my back. She said there was one problem. The departmental first quarter test in trigonometry was being given tomorrow. If you do not know anything you will fail. I said I understood.

After dinner I went into my room to study for the test. I started on page one of the text. Everything I read stuck. All of a sudden trigonometry was understandable and every trigonometry problem was easy to solve. All my anxiety about trigonometry melted away.

The next day I took the departmental test in my new 5th period trigonometry classroom. I got 100% on the trigonometry test. I received an A+ in trigonometry at the end of the semester and 100% on the New York Regent examination. I did not miss a trigonometry question the whole term.

This lesson stuck with me throughout my medical career. A positive physician patient relationship is just as powerful as the positive teacher student relationship. Both enable patients and students to reach their potential.

Obamacare is interfering and methodically destroying the ability to form a positive patient physician relationship.

The regulations are punitive. Patient care is becoming depersonalized and commoditized.

I predict Obamacare is going to make the medical outcomes worse and the cost of healthcare higher.

After 30 years of practicing Clinical Endocrinology I am convinced that the therapeutic effect of the patient physician relationship is a major factor contributing to the healing process.

Chronic disease management does not work unless the patient physician relationship is intact.

President Obama has proven this with his pilot studies in chronic disease management.

President Obama has not proven that chronic disease management as an extension of physicians care does not work.

Combined with a positive patient-physician relationship, chronic disease management with education as an extension of the physicians care can work.  Patients can be motivated to maintain control of their disease. Patients controlling their disease will decrease the complications, morbidity and mortality of the chronic disease.

The result will be a decrease in the cost of healthcare.

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

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  • Education Management Software

    Do yourself a favor and learn them while you’re young. They have a lot of practical applications, including remembering people’s names.

  • Practice Management Software

    A lot of what you say is absolutely correct. It’s no use longing for the better “old” days ’cause there was no such thing. It was precisely becuase there was a problem with healthcare, that Obamacare became a reality. Yes, the doctor-patient relationship is sacred, but at whose expense? If the patient has no respect for the associated costs, takes little, if any, responsibility for his/her healthcare, the burden falls elsewhere. Despite our increasing standards of living, healthcare cost increases has seen no abatement. I see Obamacare as an attempt to do something about this. We do not have unlimited resources, even though healthcare is a basic human right.

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Holy Cow!! A MakerBot Thing-O-Matic

 Stanley Feld M.D.,FACP,MACE

 Last week I flew to New York City to speak to a group of venture capitalists about my ideas on how to Repair the Healthcare System from a physicians point of view.

All of the software innovation in healthcare comes from software engineers who are influenced by secondary stakeholders that are trying to increase their profit from the healthcare system and not by physicians who have been in the trenches practicing medicine day after day. 

 My son, Brad Feld, was in Boston involved in a project at his alumni MIT. He decided to come down to New York and sit in on my meeting. 

I love hanging out with Brad. It is always a learning experience for me. My readers have guessed by now that I love to learn and especially from my son. I especially love to learn about the potential of the future.  It stimulates me to think.

Two months ago Brad sent me a MakerBot Thing-O-Matic. MakerBot is a company in which he and his venture capital firm Foundry Group invested. The MakerBot Cave is in Brooklyn, N.Y.

 My MakerBot Thing-O-Matic came in five boxes weighing 25 pounds. I opened the boxes and it looked like at least a million pieces (o.k. at least a half million).

It reminded me of the time I was a medical student. My roommate’s father bought him a HealthKit HiFi. I helped him put it together.

It took us months to finish. When we finished the HealthKit I thought it was going to explode when we plugged it in. It worked to our joy!!.

A MakerBot Thing-O-Matic is a 3D printer. I saw it with Brad at CES in 2011. He invested in it then.



I told Brad I thought he lost his mind. I thought the MakerBot was just a toy making little kids’ toys.

Construction of my MakerBot Thing-O-Matic looks like a 10-12 hour project with a lot of software interaction.

After our N.Y.C meeting he took me to the Bot Cave in Brooklyn. Manufacturing things in Brooklyn has a nice ring to it.

As soon as I walked into the Cave I decided Brad once again made a brilliant decision.

The first thing that impressed me was the number of young (25-40) people working in the Cave (about 100).

 If President Obama wants to create jobs he should visit the Bot Cave in Brooklyn. He would learn a thing or two.

I was told the next iteration of the MakerBot would be pre-built.

After watching these kids build them I got pumped to get home and build my MakerBot. I was also promised a personal assistant if I got stuck.

 3 dimensional printing is beyond toys. There is a web site called Thing-O-Matic that lets users post their creations for other users. The MakerBot community has become an organic social network.

 For example, someone designed a wall coat hook that is being reproduced all over the country. The Bot Cave had coats hanging on them everywhere.

I have been looking for flat electric outlet covers without curves. They have been impossible to find. All I have to do is scan my design into the computer, size it and print out a very sturdy electric outlet plate.

 Three weeks ago I needed a replacement plastic gear. I had to buy all the parts for the machine just to get one part. Now (after I put my MakerBot Thing-O-Matic together) I will be able to reproduce any plastic part I want. The practical potential for 3D dimensional printing is infinite.

 How does it work? It is all about software innovation. Your smartphone takes multiple pictures of an item. You import the pictures to the computer software. Maker Bot recommends multiple pictures at many angles to get the proportions perfect. The pictures are transformed into 3 dimensional co-ordinates. You hit go button and the machine melts the right amount of plastic at the weight you specify and extrudes your part or model in 3 dimensions.

Who would have thought there were people that smart to create an appliance like this machine for consumers.

The more intriguing thing is I could not understand the MakerBot’s potential until now. Brad understood it as soon as he saw it.

The reason is clear. He could visualize MakerBot’s potential. I predict everyone will have a MakerBot Thing-O-Matic in 10 years just like everyone has a smartphone after 4 years.

I have a gut feeling “we ain’t seen nothin yet.”

Everything will be consumer driven. Even healthcare will be consumer driven.

 The MakerBot people gave me an iridescent expandable plastic bracelet for my wife.

It reminded me of the bracelet Hank Rearden in Atlas Shrugged. Hank Rearden gave to his wife a bracelet made out of Reardon steel after it was invented.

Reardon bracelet

 She did not understand its significance. His wife traded it with Dagny Taggatt, the heroine, for a diamond bracelet.

The future is in 3 D printing.

 Brad thanks for taking me to the Brooklyn Maker Bot Cave and opening my eyes again.


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

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