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The Healthcare System Needs Disruption

Stanley Feld M.D.,FACP,MACE

The announcement that Amazon.com, JP Morgan Chase and Berkshire Hathaway are forming a non-profit company to try to improve the American healthcare system caused some ripples in the stock market.

The mere specter of its disruptive potential was enough to send some investors scurrying away from large payer providers like UnitedHealth, Aetna and Humana.

The reason for the panic is obvious. These large insurance companies have been ripping off the healthcare system for decades. They have had their fortunes improved with Obamacare and its regulations. They are afraid they are going to lose their stronghold.

The three innovations, Jeff Bezos, Warren Buffet and Jamie Diamond are disruptors that might destroy UnitedHealth, Aetna, and Humana’s kingdom.

Mitch McConnell has supposedly taken Repeal of Obamacare off the agenda for 2018.

I believe Mitch McConnell doesn’t know what to do about Obamacare. He is hoping that it fails on its own. He has passed the budget that will force the government to cover the tremendous financial short falls the defectives in the structure of Obamacare is going to precipitate.

Only then will the public hear about Obamacare’s effect on America’s budget deficit.

The American taxpayer will be force to continue to fund this failed program.

Obamacare has failed because of its structure. It encourages over use of the healthcare system by sick people. It does not encourage consumers to be responsible for their health and healthcare dollars.

The Democrats and the Republican establishment have failed the American consumer again.

Bravo to three of America’s premier disruptors Jeff Bezos, Warren Buffet and Jamie Diamond.

If they bother to understand the elements of medical care and the reasons for the healthcare systems dysfunction they have a chance for success.

If they follow the previous attempts to repair the healthcare system by the government, healthcare insurance industry and hospital systems they will fail miserably just as these other institutions have failed.

“The industry certainly offers plenty of opportunities for reinvention, of course. Healthcare in the United States is expensive, and its quality varies wildly.” says Christopher Rowe, managing director at Korn Ferry.

Jeff Bezos has the best shot at reducing drug price significantly. The government cannot negotiate prices. The private carriers through drug benefit plans do a little better.

The military and the VA system do 30 to 75% better than Medicare Part D and the private sector.

Jeff Bezos knows how to market via the Internet. With the large cadre of consumer employees of Jeff Bezos Warren Buffet and Jamie Diamond, Mr. Bezos can probably negotiate the drug prices down by at least 50%. I’ll bet he can negotiate drug prices almost as low as the VA system and also provide the pharmaceutical companies an increase in reimbursement for their drugs.

Mr. Bezos usually eliminates most of the middlemen. He will be able to offer the medication at a 40 or 50% lower price than Medicare Part D and the private benefit managers and still make a sizable profit while providing a better quality of service.

He knows the customer is the consumer.

When it comes to the delivery of medical care and the use of technology in the delivery of medical care, I am not sure Bezos, Buffet and Diamond know who the real customers are.

I am not sure they know how to get around the stronghold the healthcare insurance industry, the federal government and the hospital systems have over the control of healthcare.

Many other corporations have tried to break the stronghold and have failed.

I will try to tell Jeff Bezos, Warren Buffet and Jamie Diamond what they have to do in my next blog.

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

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 Changing The Rules: It Is Just The Beginning

 Stanley Feld M.D.,FACP, MACE

A proposal to cut Medicaid payments to some insurers with excessive reserves stirs concern from healthcare insurers.

Progressive politicians refuse to believe that entitlement programs like Medicaid are not viable. Politicians should be looking at creative ways to structure the Medicaid form of insurance for both physicians and patients.

https://www.politico.com/states/new-york/albany/story/2018/01/22/proposal-to-cut-medicaid-payments-to-some-insurers-with-excessive-reserves-stirs-concern-206875

I have not written a blog lately because both the Democrats and the establishment Republicans in both the house and the senate disillusion me. Neither house or senate members are interested in being creative.

Neither body knows how medicine works.

These politicians have no interest in doing what is best for the people who elected them. They are only interested in maintaining power and extending their power over the people they govern.

The result will be to decrease to quality of care to patients forever.

In the meantime there have been news stories on how different corporate organization and big businesses are trying to take over medicine.

Many readers have noticed that emergency clinics are popping up in every city and town.

I believe these emergency clinics centers are in reality real estate plays waiting for so that big corporations, like Aetna; to buy them out in order to expand their plans to take over medical care.

It feels similar to the proliferation of small banks in the 1980’s. These new small banks’ plan was to grow and be bought out at a premium by larger banks in order to enlarge the sale premium.

When the defective program (Medicaid) is a failure one should learn from that failure. One should not continue to try fixes to the program (Medicaid) when each fix creates greater dysfunction.

One should institute another plan that might work. However, government officials continuously apply an additional patch that leads to more unintentional consequences.

This week New York State governor Andrew Cuomo put another patch on its failed Medicaid system. I predict this patch will lead to more unintended consequences. The result will be to make Medicaid coverage worse for its New York State’s Medicaid recipients.

Governor’s Cuomo’s initial mistake was expanding Medicaid at President Obama’s request. He then compounded the mistake by subsequently allowing illegal immigrants in the state to receive Medicaid coverage.

It is not wise to take a financially failed system and expand it. It is much better to change the system.

Now Governor Andrew Cuomo’s budget is proposing to cut Medicaid payments to certain health insurance companies with excess reserves, a move that is alarming insurers because of its intent and its ambiguity.

“The proposal, part of the $168.2 billion executive budget released last week, says that any Medicaid managed care or long-term care Health Maintenance Organization that has excess reserves across all lines of business would be subject to a prospective cut in Medicaid rates.”

 Why would an insurance company want to participate in these programs?

The immediate unintended consequence is that the insurance company that found a defect in the payment schedule for HMO’s and managed care would leave the Medicaid market.

The second unintended consequence is it would discourage companies from having incentive to make a profit.

“Under current law, all Health Maintenance Organizations are subject to minimum reserve requirements,” said Erin Silk, a spokeswoman for the Department of Health. “This policy will provide the commissioner with the discretion to make rate adjustments to plans holding reserves in excess of the statutory requirements for reasons that cannot be explained or justified.”

The state did not project any savings from this proposal.”

The state cannot run Medicaid without insurance companies being the administrative service providers. It is the same old story. This comes on top of a proposed fourteen percent tax on for-profit insurers as well as the state receiving a cut of the proceeds when a nonprofit insurer converts to a for-profit insurer as a result of the new tax law.

Governor Coumo wants this additional money because he thinks the insurance industry is going to have a windfall from President Trump’s new tax law. He figures the state will collect $640 million dollars more as a result of this move.

“There were 3 million New Yorkers enrolled in these types of plans in 2014, according to a report from the United Hospital Fund.”

The insurance industry gave the usual illogical reason for opposing Cuomo’s proposals.

These insurance companies are there to make money. They are not going to let Coumo out of his commitment. I believe they will walk away from providing administrative services for the states Medicaid insurance coverage.

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

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It Is Getting Worse

Stanley Feld M.D.,FACP,MACE

Charles Gabe’s graph of enrollment as of 12/9/2017 was published with only six days of open enrollment left.

There are only 5,894,342 confirmed enrollees. There is no indication of how many enrollees paid the first month’s premium. The low-ball estimate was 7.2 million.

Of those enrolled only 3,604,44 were enrolled in President Obama’s Health Insurance Exchanges to buy healthcare insurance.

2,289,902 were enrolled in Medicaid. The number of illegal immigrants in that number is unknown.

December 15th is the deadline for enrollment in 42 states. Eight states have already extended the deadline.

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This is an extremely disappointing outcome for Democrats who refuse to believe Obamacare has failed. Last year the Democrats and President Obama were bragging that Obamacare provided healthcare insurance for 20 million people.

The problem was that 13 million of those 20 million were enrolled in Medicaid and of the 9 million who bought insurance through the health insurance exchange many did not complete their premium payment for the whole year.

The government subsidized eighty-five percent of those people who bought healthcare insurance through the health insurance exchanges.

Organized medicine has not provided leadership for the medical and surgical community or its patients.

In turn medical professional feel powerless. I believe the profession is about to give up on trying to influence positive change in the healthcare system for its benefit and its patients benefit.

A reader, D.F. M.D., responded to my last blog writing;

“That nothing much is happening in Washington re: healthcare reform may be one of the largest blessings our country has seen this year.”

It might be a blessing because the politicians do not have a clue as to what can be done to repair the healthcare system.

Politicians are not interested in listening to physicians or patients. The people that stand to lose the most in this dilemma are patients.

D.F., M.D. goes on,

 “ We are agreed that our congress hasn’t done much, but there are other activities afoot that will almost certainly be game changers and they are largely un-noticed when it comes to their impact on healthcare services.”

his is very true. When President Trump was running for president he kept declaring that the “government” made the worse deals for the American people with NAFTA, Iran nuclear deal, and the pacific trade deal. He essentially called President Obama and congress stupid.

Now congress is asking big business to help them out of the healthcare mess. The pending take over of medicine by big business is going to destroy medical care in America while they are claiming to save the healthcare system.

D.F. MD writes

“The CVS/Aetna merger, and today’s announcement that United Healthcare is buying DaVita, a healthcare group with over 300 sites of service to add to it’s Optum, segment, with 1,100 care sites of various sorts, not to mention US Oncology, owned by McKesson, that sees about 14-15% of patients with cancer in the US.”

The corporate take over of medical care is growing daily. Without physicians and patients there would not be a need for a healthcare system. Physicians have voluntarily given up their intellectual property and freedom to use their own clinical judgment to the will of corporations.

America is in the early stages of this phenomenon. Medical care is becoming a commodity. Physicians and patients have given up the thought of a personal relationship embodied in the physician patient relationship. Good medical care (in my opinion) is predicated on the patient physician relationship because much morbidity and negative emotional responses to treatment can vanish with an effective patient physician relationship.

Truly, corporate medicine, once outlawed in many states, (for good reason) is on track to become the biggest player in healthcare.  Add to that the report that 60% of physicians are now employed by hospitals, which is in some ways creating a body of spokespersons for healthcare that has not been seen before.”

The result is massive Medicare and Medicaid cost overruns that are not approved by congress. The Democrats are trying hard to blame the costs overruns and Obamacare’s failure on President Trump without good reason.

However, the media is the message and the media is on President Obama and the Democrats side.

D.F., MD continues,

“I have always believed that the medical profession though organized medicine has been remiss by maintaining a low profile where change is concerned, either in the development of programs or the creation and passing of legislation.”

Edward Annis M.D. a former president of the AMA was organized medicine leaders who lead the fight to outlaw corporate take over of the healthcare system and the takeover of medical practice. Dr. Annis wrote an excellent book called Code Blue in 1993.

A reviewer,  Frank J. Primich M.D. in 1994 wrote;

“Code Blue takes its name from the most common term used by hospital public address systems to signify cardiac arrest.

The announcement sends an assortment of specially trained personnel scurrying to the designated site. Modern techniques and technology, when given the timely opportunity, have been highly successful in restoring life.”

“The protagonist in Dr. Annis’s book is the private practice of medicine, which has been declared dead by some of its adversaries. Resuscitation requires an understanding of what has gone wrong, and what can be done about it.”

Dr. Annis was right on target. No one involved in organized medicine has taken this stand presently.

The reviewer goes on;

“In every field, there is an internal rating system. Ed Annis is the acknowledged superstar of those of us who have pleaded the cause of fee-for-service medical practice and maintenance of the traditional doctor-patient relationship.”

All of the healthcare policy wonks and congress people ignore the importance of the physician patient relationship. When they get sick and do not have a patient physician relationship they yearn for one.

“The same time span has seen a steady encroachment into the process from a variety of third parties, particularly government.”

“The concept of socialized medicine, discredited elsewhere in the world, has been introduced, through gradualism, to the point where we are now, in effect, semi- socialized. The current proposals for national health care threaten to push us beyond the point of no return.”

These quotes were taken from the article written in 1994 at the peak of the Hillary-care debate. Wilbur Mills started the socialized medicine debate in America in 1935.

D.F. MD note goes on to say,

“Now they are increasingly tied to large business entities one sort or another.”

 Soon, advocates for patients with no financial axe to grind may end up being only us old retired docs, some of whom have retired because of “improvements” like the electronic medical records which have managed to make their developers rich while not doing all that much to enhance patient care. Unfortunately the old docs lack organization, money, and voice.”

Organized medicine has not provided leadership to help patients understand that when large corporations take over the infrastructure of medicine medical care will be totally commoditized and the important physician patient relationship will be lost forever.

 “Then there are the CBO projections https://www.cbo.gov/publication/53090 which are sometimes wide of the mark, but which the liberal media trumpet as the gospel in projecting the effect on patient care is certain healthcare reforms are enacted and implemented.”

 “The result of all that is that almost anything that is proffered as change is shouted down by one interest group or another, often by people who don’t have much of a clue re: what they are protesting about.”

DF, MD

The only thing that can turn this trend around is patients and a consumer driven healthcare system along with some organized medicine leadership.

   

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

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Is Anyone Confused Or Convinced?

Stanley Feld M.D.,FACP, MACE

Obamacare has failed. You wouldn’t know it by the massive misrepresentation by the mainstream media.

The mainstream impression is that registration during the open enrollment period for 2018 ending December 15,2017 is doing well.

I have not written a blog in about a month because there has been nothing to write about.

I have laid out my ideas about what is necessary to repair the healthcare system. It is all about personal responsibility and physician/patient relationships for both acute and chronic diseases.

It is the only way to control costs and decrease waste in the healthcare system.

Frankly, I am saddened that our representatives in congress don’t give a damn about the costs to the American people.

They simply want Americans to be dependent on government. The government wants to control Americans rather than Americans controlling the government.

Both the Republican and Democratic establishment have been brain dead on how to effectively repair our healthcare system.

Republicans had seven years to figure out an efficient system. The have controlled the house for two terms. They have controlled the senate for one term.

Then they failed. Almost 100 bills passed the house. any passed both houses and were vetoed by President Obama.

Why couldn’t they send one of those bills to President Trump?

Tom Price M.D. had some ideas on how to repair the healthcare system. However he was disposed of by claims of misuse of government funds.

There has been little published since the Republican establishment failed it its effort to repeal and replace Obamacare in November 2017.

It is unclear to me whether the Republican effort failed because it was a step in the wrong direction or the Republican establishment hates Donald Trump.

In any case the Democratic establishment is trying to blame Donald Trump for the Obamacare failure.

They claim it is Donald Trump’s fault the healthcare insurance industry is not being paid the unauthorized supplement President Obama promised but could not pay. He could not find the money.

It is the House of Representative that authorizes expenditures. The cost of those promised subsidies that were unauthorized was 88% short of the healthcare insurance industry’s claims.

The Obamacare cost overruns were gigantic. It must be remembered that the Health Insurance Exchanges only provided insurance for less than 10 million people in the individual healthcare market.

Many factors added to the cost overruns including subsidizes of over $15,000 dollars a year for these premiums in the individual market. The 2018 subsides will be over $20,000.

The healthcare system has become such a partisan issue that the truth about Obamacare’s failure is not the point anymore.

It seems that the Republican establishment is not any smarter than the Democrat establishment in trying to repair the system.

The end of the open enrollment period for 2018 is supposed to be December 15, 2017.

I posted two graphs in this post. One represents enrollment until 11/25/2017 and the second represents enrollment until 12/2/2017.

They bring out several points about Obamacare’s failure.

Seven states of the 39 states have already extended their open enrollment period. California has extended open enrollment until 1/31/2018.

On 11/25/2017 confirmed but not paid enrollment was only 2,660,938 with only 2,277,079 through Healthcare.gov and 383,859 for Medicaid.

Open enrollment projected for 11/25/2017 was 4.2 million with 2.6 million through Healtcare.gov. and 1.6 million through Medicaid.

These projected numbers were revised upward during the summer of 2017 to 4.6 million with 2.8 million through Healthcare.gov and1.8 million through Medicaid.

This represents a 500,000 person enrollment short fall for healthcare.gov. It also must be remember that 85% of the people enrolling through healthcare.gov have preexisting illnesses and are subsidized by the government.

  Chart 1 3 8

The open enrollment numbers look worse on December 2, 2017 although there is not a word of it in the mainstream media.

On 12/2/2017 confirmed but not paid enrollment was 3,491,164 with only 2,751,260 through Healthcare.gov and 709,904 for Medicaid.

Open enrollment projected for 12/2/2017 was 5.1 million with 3.5 million through Healtcare.gov. and 1.6 million through Medicaid.

These projected numbers were revised upward during the summer of 2017 to 5.8 million with 4 million through Healthcare.gov and1.8 million through Medicaid.

This represents a 1,248,840 (4,000,000-2,751,260= 1,248,840) person short fall for healthcare.gov with 13 days to go for the open enrollment period.

Chart 2

It is difficult seeing these numbers by casually studying these charts.

Obamacare is an unmitigated failure. Democrats want to throw more money at it.

Republicans do not know what to do.

I suggest they look at my blog entitled The Ideal Medical Saving Accounts are democratic.

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

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Consumers Need To Take Back Their Medical Care And Healthcare Dollars

Stanley Feld M.D.,FACP,MACE

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

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

The negative noise in the mainstream media should be ignored.

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

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

Democrats are behaving as if associations are a foreign enemy.

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

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

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

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

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

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

“My Three Rules For Survival”

Remember my three rules for survival:

1) Stay the hell away from doctors.

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

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

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

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

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

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

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

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

It would be worthwhile to read my post about obesity.

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

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

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

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

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

     2) Take as little medicine as you can.

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

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

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

     3) Stay out of hospitals.

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

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

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

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

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

And, that is probably plenty for today.  DEF”

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

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

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

This can be accomplished with my ideal medical saving accounts.

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

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

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

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

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The Plan To Empower Consumers Of Healthcare

 Stanley Feld M.D., FACP,MACE

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

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

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

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

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

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

How do you decrease obesity in America?

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

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

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

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

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

First, equip consumers to consider prices.”

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

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

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

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

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

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

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

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

 Medicaid patients also overuse the healthcare system.

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

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

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

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

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

 The financial incentive decreases the overuse of the healthcare system.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Failure Of The Republican Establishment To Repeal and Replace Obamacare

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Describing Fake News

Stanley Feld M.D.,FACP,MACE

The front-page headline in the Sunday New York Times on August 26 read;

“Health Insurers Start To Prosper.

The subtitle was; Trump’s Warnings on Affordable Care Act Masks Upside.”

 “Supporters of the Affordable Care Act achieved a major victory this past week when, thanks to cajoling and arm-twisting by state regulators, the last “bare” county in America — in rural Ohio — found an insurer willing to sell health coverage through the law’s marketplace there.”

“So despite earlier indications that insurance companies would stop offering coverage under the law in large parts of the country, insurers have now agreed to sell policies everywhere.”

 A casual Sunday Times reader would respond to this headline and initial paragraph by thinking that President Trump is frightening the public about Obamacare’s failures.

The casual reader would conclude this is just another one of President Trump lies. Obamacare is not failing. He is just trying to scare the public.

The New York Times is telling the public that the insurance industry is going to offer insurance through Obamacare in every county in the country.

The American people cannot trust President Donald Trump.

The causal reader got the message. Obamacare is doing fine. It is not necessary to continue reading the article.

The online Sunday NY Times headline of the dame article was different than the headline that appeared in print.

Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers”

This headline is also misleading. One insurer in a bare county signed up. This does not represent a upside gain or create a competitive market place.

“The Centers for Medicare and Medicaid Services (CMS) reported that 1,476 counties, over 45 percent of counties nationwide, will only have one health insurer on the Obamacare exchanges next year.”

This article is an example of “fake news.” It is totally misleading to the casual reader

Why a single insurance company will sell insurance in that bare county in Ohio is not explained. All the other insurance companies have pulled out of that county.

If the reader got this far into the story he could still be satisfied that Obamacare was not imploding.

However, the article goes on to explain the potential failure of Obamacare.

“But a moment of truth still looms for the industry in the coming weeks under the law known as Obamacare.”

“Companies must set their final plans and premiums by late September, even as the Trump administration continues to threaten to cut off billions of dollars in government subsidies promised by the legislation.”

This is more fake news aimed at blaming Donald Trump for Obamacare’s failure.

The NYT ignores the fact that President Obama promised the healthcare insurance industry the reinsurance subsidy in order to get them to participate in Obamacare in the first place.

President Obama paid the healthcare insurance industry only 12% of what the insurance companies claimed President Obama promised them in their reinsurance package.

President Obama promised the healthcare insurance industry a subsidy through the government backed reinsurance package, if there were cost overruns in Obamacare.

The costs overruns were massive according to the healthcare insurance industry. The legislator only budgeted 12% of that claimed by the healthcare insurance industry.

President Obama could not find the money to pay the remaining 88%.

The industry continues to demand the remaining 88% promised in order to participate in this year’s (2018) Obamacare health insurance exchanges.

All twenty-two of the state run insurance administrative companies that received loans from the federal government have gone bankrupt and have not paid the insurance industry.

Those federal loans will never be paid back to taxpayers.

The Democrats and the mainstream media are trying to blame President Trump for this deficiency in payment and the lack of insurance company participation.

The shortfalls resulted in healthcare insurance premium raises for both the Obamacare health insurance exchanges and the premiums for private group insurance.

Subsequently, most of the healthcare insurance companies have dropped out of providing the insurance through the Obamacare health insurance exchanges.

A third piece of fake news is the success of providing insurance for twenty million enrollees.

The NYT article ignores the fact that Obamacare through the health insurance exchanges only enrollee nine million people in the individual market. Fourteen million lost individual coverage lost their insurance at the onset of Obamacare.

The 22 million additionally insured includes the additional thirteen million were added to the Medicaid roles. Some of those thirteen million are illegal immigrants.

Soon a portion of the financial burden of the Medicaid increase will be dumped on the states.

The Obamacare law requires comprehensive insurance coverage packages for both the individual market and the group markets driving the price of coverage up.

These increases make Obamacare unaffordable. Obamacare is not successful as implied in the New York Times article.

President Trump did not do anything to distort the Obamacare coverage. President Obama did it with his tremendous cost overruns.

It is possible President Obama wanted to prove that an insurance-based healthcare system couldn’t work. It would have to be replaced with a government controlled single payer system.

It is the reason he wanted to include the “Public Option.”

However he placed so many regulations in the way of any possible success.

President Obama believes that the only system that would work is a single party payer system with the government being in control of the money, the coverage and the freedom to choose by the public.

President Obama had no concern for the government inefficiency or cost to the government.

There was no consideration for a more cost efficient and affordable healthcare system.

“The fate of the landmark law, Obamacare, depends in large part on the health of the insurance marketplaces and the ability of insurers to make a viable business out of selling coverage to individuals.”

Healthcare insurers have tried to make a viable business plan out of Obamacare. When the law passed seven years ago, insurers saw a potential bonanza: tens of millions of brand-new paying customers, many backed by generous government subsidies and required by the new law to have health coverage.

The burdensome regulations, lack of coverage flexibility and one size fits all coverage all have cause people not to sign up for Obamacare. They would rather pay the penalty even though they can ill afford it.

On Thursday, Northwell Health, the largest hospital system in New York State, announced that it would shut down its insurance unit, CareConnect, which had been selling coverage in the state marketplace. The move forces tens of thousands of its customers to find another plan for 2018. Northwell’s chief executive put much of the blame on Washington.

As we get closer to enrolling participants in Obamacare for 2018 and the insurance industry’s publishing their premiums more insurance companies are dropping out of participating in the health insurance exchanges.

Most of the startup insurance companies and state sponsored have closed down their business.

The article quoted is fake news.

The article starts off giving the casual reader the impression that Obamacare’s insurance coverage is doing fine.

The reality is It is not fine. Americans have to worry about it. Affordable healthcare insurance will not be available at an affordable price.

The Democrats are happy because then the country will be offered a single party payer system.

The problem is that the federal government cannot afford a single party payer system. At this moment Medicare and Medicaid are not sustainable. A single party payer system will be inefficient and unsustainable.

I don’t know how Mitch McConnell can to say most of the news is not fake news.

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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Stanley Feld M.D.,FACP,MACE

The Republicans committing suicide ?

Mitch McConnell is a politician. He goes where the wind blows.

He does not like President Trump. He has never liked President Trump. During the 2016 primary he said he would do everything in his power to prevent Donald Trump from becoming the Republican candidate for President.

He likes President Trump even less now because President Trump criticized him for not being able to pass the simplified repeal of Obamacare.

Mitch McConnell, as Senate majority leader, did promise the people of Kentucky for the past seven years that he would repeal and replace Obamacare

At present Mitch McConnell’s approval rating in Kentucky has plummeted to 18%.

There is a movement afoot to fire him as senate majority leader if he cannot get President Trump’s agenda passed. The house has passed 518 bills; 396 are stuck in the Senate.

Why? The answer is becoming obvious.

“Of the 518 bills or joint resolutions passed by the House since January 2015, only 122 have passed the Senate, according to Congress’s Legislative Information System, which tracks the status of legislation.”

http://thehill.com/blogs/floor-action/281536-nearly-400-house-bills-stuck-in-senate-limbo

t looks like Mitch McConnell is trying to destroy President Trump’s agenda. It also looks like he is helping Chuck Schumer and the Democratic establishment destroy Don Trump’s presidency.

“Mitch McConnell acknowledges that path forward on healthcare is ‘murky’.”

http://thehill.com/blogs/floor-action/senate/347373-mcconnell-path-on-healthcare-murky

Before leaving Washington for recess in August, McConnell indicated that the Senate would leave behind its campaign to replace Obamacare and turn to tax reform.

Nevertheless, one version of legislation to change Obamacare ended up just one vote shy of passage, and McConnell could bring another bill up at any time.”

A GOP push to pass a “skinny repeal” of ObamaCare failed in a dramatic 49-51 vote before the August recess. A broader repeal proposal and measure to repeal and replace the Affordable Care Act simultaneously also failed to get enough votes to pass in the Senate.

Unfortunately John McCain’s vote defeated the bill. John McCain is another establishment Republican who does not like Donald Trump partly because President Trump challenged his heroism.

McConnell has previously acknowledged that the next steps on healthcare are unclear after Republicans campaigned for years on repealing and replacing the Obama-era law.

“Obviously we had a setback on the effort to make dramatic changes on ObamaCare. The way forward now is somewhat murky,” the Senate GOP leader said at a Chamber of Commerce event in Kentucky.”

McConnell added that lawmakers were “going to see” what the negotiations between Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.).

“We have … collapsing individual insurance markets around the country. Requests to continue to subsidize the insurance companies. It’s a pretty controversial subject to subsidize insurance companies without any reforms.”

“So when we get back after Labor Day we’ll have to sit down and talk to them and see … what the way forward might be.”

Mitch McConnell did not seem to try very hard to get even the skinny repeal passed after promising the republicans in Kentucky he would see to it that Obamacare is repealed and replaced.

Since the phone call from President Trump almost two weeks ago Mitch McConnell has gone out of his way to disagree with President Trump. They have not spoken to each other since.

Mitch McConnell said “My view is that most news is not fake, but I do try to look at a variety of sources,” McConnell said at a Chamber of Commerce event in Louisville, Kentucky, according to Time Magazine.

https://www.cbsnews.com/news/mitch-mcconnell-says-most-news-is-not-fake/

This statement is untrue. It also directly contradicts President Trump’s position.

“President Trump has tweeted about “fake news” over 100 times since January, according to the Trump Twitter Archive. In fact, he mentioned the “fake news” in two tweets on Monday, in one replying to a user who tweeted, “Every single day the #FakeNews media try to take you down.”

“You never falter, you always stand strong!” Mr. Trump agreed, tweeting in response that “the very dishonest Fake News Media is out of control!”

Another example of opposing President Trump was the president’s suggestion about the debt ceiling.

President Trump targeted Senate Majority Leader Mitch McConnell (R-Ky.) and Speaker Paul Ryan (R-Wis.) over the debt ceiling.

“I requested that Mitch M & Paul R tie the Debt Ceiling legislation into the popular V.A. Bill (which just passed) for easy approval,” Trump tweeted.

“They didn’t do it so now we have a big deal with Dems holding them up (as usual) on Debt Ceiling approval. Could have been so easy-now a mess!”

The most critical news story appeared in the New York Times on August 22,2017. This does not seem to be fake news. Mitch McConnell had not denied it yet.

McConnell, in Private, Doubts if Trump Can Save Presidency”

https://www.nytimes.com/2017/08/22/us/politics/mitch-mcconnell-trump.html

 

This is ridiculous. Mitch McConnell is a grown man who is supposed to be a master politician. He is playing right into the Democrats’ hand. The Democrats’ goal is to destroy President Donald Trump’s presidency.

For the first time in 37 years we have a President who seems to want to help all the people. Why are politicians in his own party trying to undermine him?

His methodology might be a little weird but he seems to be making progress. Most people believe there is corruption in government.

Are they trying to undermine him because they are part of the swamp?

Most Americans believe the corruption leads to inefficiency and subsequently a failed country.

President Trump has said several important things.

  “All Americans bleed the same color blood and we all should love our country.”

We should all remember Donald Trump won the election. He is trying to do things his way not the way of the lobbyists and the traditional media. If he is wrong neither he nor his party will be reelected.

Whst the world needs now

Let us as Americans try love and not hate. It applies to Democrats, Republicans and the traditional media also.

.

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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