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What Should Be Done to Repair the Healthcare System?

What Should Be Done to Repair the Healthcare System?

Stanley Feld M.D.,FACP, MACE

On March 10, 2020, Obamacare will be ten years old. Obamacare has had many failures. Obamacare’s biggest failure is the resulting distortion of the healthcare delivery system. The distortion is the result of all the stakeholders adjusting to Obamacare’s new rules and regulations.

All of the stakeholders had to adjust the way they delivered or priced healthcare to their individual advantage.

Primary care physicians started moving toward the model of Concierge Medicine. In order to have a primary care physician, consumers must pay primary care physicians between $2,000.00 and $38,000.00 annually to be in their panel.  The movement toward Concierge Medicine is the result of the Obamacare regulations, the healthcare insurance company’s reimbursement cuts, and the increase in malpractice insurance premiums.

Primary care physicians found that in order to make a living and pay their increasing overhead, they must become Concierge Physicians. This is to the disadvantage of consumers since they must continue to buy healthcare insurance.

The insurance industry has adjusted to Obamacare’s regulations by lowering reimbursement to physicians and hospitals while raising premiums. Insurance companies and Medicare Advantage programs have restricted enrollees to only certain physicians in their network and restricted certain treatments and access to certain specialists and groups.

It all goes back to President Obama’s statement, “If you like your doctor you can keep your doctor. If you like your hospital you can keep your hospital.” To my disappointment the AMA accepted President Obama’s obvious lie in 2010.

As the the government and the insurance industry decreased reimbursement physicians have had to increase the number of patients they see in one day in order to make up for their decreased revenue.

Malpractice claims and malpractice payments for claims have increased in most parts of the country. This resulted from a lack of tort reform by congress and the Obama administration. Physicians then increased diagnostic testing in order to cover all possible illnesses.  The increase in testing led to an increase in healthcare cost.

Obamacare has also increased the cost of insurance by requiring payment for additional coverages. The first dollar insurance coverage after deductibles are met has resulted in the overuse of the healthcare system. The government and the insurance industry are trying to decrease the overuse of the system by increasing deductibles.

In fact, some Obamacare insurance plan deductibles are so high that insurance payment never kicks in. People who buy Obamacare insurance plans cannot afford the deductibles and do not use the insurance until they are so sick, they cannot avoid being hospitalized.

It is impossible to figure out how health insurance premiums increases are calculated by the private healthcare insurance sector or the government healthcare insurance sector. It is impossible to figure out how the multimillion-dollar salaries for insurance and hospital executives are calculated. These expenses are part of why insurance premiums are rising.

It is also impossible to determine how hospital systems price their care. The government also pays hospital systems a premium for outpatient hospital care in an outpatient setting. The fees are at least 20% higher than in a free-standing private practice office.  

Hospital systems are figuring out how to manipulate their reimbursement systems to have an advantage over their competitor.  In New York City, Columbia Presbyterian Hospital System has accumulated ownership of many hospitals inside the city and its suburbs. With that ownership, they have acquired many in-patient and out-patient hospital salaried physicians. The hospital system is now demanding increased payment from healthcare insurance companies and the government in order for patients to use their system. The hospital system has hired many of the physicians’ patients desire to see. Columbia Presbyterian has gained control of the reimbursement levels in those markets.

There is an encouraging trend that was started by Keith Smith M.D. in Oklahoma City. Dr. Smith started a cash-only outpatient surgical clinic several years ago. He charges less for procedures than a patient’s deductible from some insurance companies.

This gives us some insight into how much fat is in the healthcare system expenditures.  Dr. Smith and physicians working in his outpatient clinics are happier and are making more money than they were working for local high-cost hospital systems in town. The patients are happier because there are no hidden or surprise costs.

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Dr. Smith’s clinic is drawing patients from all over the United States. He has also inspired the formation of many similar clinics in the U.S.

This is not new. Specialists such as gastroenterologists have opened freestanding centers. They charge less for colonoscopy and endoscopy than the hospital systems. Radiology clinics have done this for many years. The hospital systems have, somehow, worked out payment for their higher costs with the insurance industry and the government.

Dermatology is a specialty that does not need a hospital system. Large physician-owned

dermatology clinics have opened. They charge less than the dominant local hospital system.  

Many of these large specialty centers have sold their clinics to venture capital firms.  

How the venture capital firms are going to leverage their investment is unclear to me.   

Emergency rooms all over the country are overcrowded because primary physicians cannot see all of the patients in their offices in a timely manner. Hospital system emergency rooms are inefficient and overpriced. The ER is an unpleasant experience for many patients.

Venture capital firms have opened free-standing Urgent Care and Emergent Care centers all over the country. (Doc-In The Box). Many of these centers are covered by nurses, nurse practitioners, and physician assistants. All physicians have to do is co-sign with the provider to get reimbursement by the government and the healthcare insurance industry.

This is not my idea of developing patient-physician relationships.    

If a patient has to be admitted to a hospital his primary care physician is not permitted take care of him in many hospital systems. Hospital systems have hired hospitalists to care for patients. A patient might see a different hospitalist each day of the admission.

What happened to the therapeutically valuable physician-patient relationship? This relationship is critical for curing much morbidity from chronic illness. 

 I have covered the Repair of the Healthcare System in great detail in the past.

 I have also covered the errors in the structure of Obamacare leading to the distortions in the delivery of healthcare and the increased costs of the healthcare system.

The stakeholders are physicians, patients, hospital systems, insurance companies, pharmaceutical companies, and the government.

All patients want is to get the best medical care when they get sick. The interest in disease prevention is slowing growing events though many millions of dollars have been spent on programs that could help prevent chronic disease.

All hospital systems, insurance companies, pharmaceutical companies are interested in are maximizing profits and minimizing expenses.

All physicians are interested in is delivering the best care possible.

Patients and physicians are the most important stakeholders in the system.

The government wants to spend the least amount of money possible to enable the best care at the lowest price.

There has been little attempt by congress, the bureaucracy or previous administrations to remedy the defects I have pointed out.

 I have not seen any attempt by Congress to lower the price by decreasing the bureaucratic impact on the price of healthcare. Nor have I seen the exposure of the clandestine deals hospital systems make with insurance companies or the government.

I have not seen any movement toward decreasing the malpractice crisis in America. Tort reform has been vitally necessary for the last thirty years. It has been totally ignored by government officials.

These are some of the basic reforms necessary to start repairing the healthcare system. All our politicians do is kick the can down the road to the advantage of the secondary stakeholders and not the consumers.

These are some of the main reasons the system has to convert to a consumer-driven system that I have outlined previously.

Consumers must control their health and their healthcare dollars. They must be provided with an education that will help them control costs. They must be provided with financial incentives to control costs.

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



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Canada Has Big Single Party Healthcare System Problems

Stanley Feld M.D., FACP, MACE

There are big problems in Canada that have been undisclosed by Democrats to the public in the United States.

There were two articles in American newspapers in 2011 that applaud the Canadian system.

 Article 1. Debunking Canadian health care myths – The Denver Post .

Article 2. Everything you ever wanted to know about Canadian health care in one post. Washington Post.

Both articles are opinion articles and lack concrete evidence. The articles contain both misinformation and disinformation.  The articles are in essence  fake news designed to mislead the American public into believing that a single party payer system is the answer to America’s healthcare systems problem.

The articles are precisely why the American public should not and does not trust politicians and the traditional mass media.

The Fraser Institute is a well-respected Canadian think tank. Its research is considered accurate, with a libertarian slant.

Its 2011 report contradicts the statistics in both the Washington Post’s and the Denver Post’s articles about the Canadian government healthcare costs.

 Article 1. “Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s.”

Article 2.  “In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries.”

This is not true according to the Fraser report. Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the Frazer Institute. To be specific, in 2011, health care spending consumed 50% GDP in Canada’s two largest provinces, Ontario and Quebec.

“Total federal, provincial and territorial government health spending has grown by 8.1 percent annually, while the national GDP in Canada rose by only 6.7 percent during the same period.”

 The provincial governments have raised taxes and rationed care, while increasing patient wait times.  

“Provincial drug plans have also more often refused to pay for most of the drugs that are certified as “safe and effective” by Health Canada.”

“Unsustainable rates of growth in health care spending crowd out the resources available for other purposes including education, public safety, and economic growth-enhancing tax relief.”

One has only to think about the Obama administration’s initial propaganda and the stunning reality we are facing presently. 

The VA is now asking for additional funding to clear up its disaster.

The problem is entitlements are too expensive for governments.  Entitlements do not work because governments cannot legislate behavior by directives. Individuals must be responsible for their health and healthcare dollars.

The other problem is government entitlement programs generate a large bureaucracy. The bureaucracy stimulates the development of inefficiencies and corruption. The new bureaucracy practically guarantees the failure of the entitlement.

The government never gets to the core problems that must be repaired when they try to construct a healthcare system that is efficient, cost effective and will benefit consumers. 

The primary stakeholders are consumers of healthcare. Physicians are a close second. Secondary stakeholders are hospital systems, healthcare insurance companies, drug companies, malpractice insurance companies, and the government.

In order to Repair America’s Healthcare System, the government must focus on the primary stakeholders’ (patients’) needs and ways to satisfy those needs. The key is to set up a system that provides the primary stakeholders (consumers of healthcare) with incentives to maintain their health and conserve their healthcare dollars. This applies to healthy consumers as well as patients with chronic diseases.

Patients with chronic diseases must become professors of their disease. They must understand the latest techniques and use the latest tools to prevent the progression of their disease.  

The healthcare system must help consumers be prosumers (productive consumers) of their own healthcare.

The Canadian system is not the answer to our healthcare system’s problems. The United States has a much larger population than Canada. The Canadian government cannot support its universal healthcare system.

 How will we? Bernie Sander’s state of Vermont has abandoned its “Medicare for All” program.

The only way the portion of our population in favor of Medicare for All is going to believe it is unsustainable and destined for failure is going to experience its failure. It seems Bernie and his followers have little interest in learning from previous experience.

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

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Swedes Are Frustrated Over Their Socialized Healthcare System

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

As an example of the frustration of the Swedes:

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

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

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

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

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

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

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

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

 Dental appointments can take a wait of 6 months.

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

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

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

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

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

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

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

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

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

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

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

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The original was published in April 2019.

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



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

Part 2

Stanley Feld MD,FACP,MACE

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

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

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

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

 President Donald Trump was correct when he said,

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

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

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

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

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

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

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

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

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

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

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

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

Bernie SandersVerified account @BernieSanders

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

Bernie Sanders is not being honest with the American people.

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

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

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

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

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

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

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

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

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

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

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

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



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Please Read Between the Lines

Please Read Between the Lines

Stanley Feld M.D., FACP, MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Price fixing has never worked. It leads to corruption

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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Politics of Electronic Medical Records

Politics of Electronic Medical Records

Stanley Feld M.D.,FACP,MACE

The EMR project that President Obama forced on the medical profession in 2009 has not yet produced any evidence that EMR will save the country $350 billion in inpatient care and $150 billion dollars in outpatient care over a 15 year period of time.

The RAND analysts claim that more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care over a 15-year period of time. 

The RAND EMR study was wrong. The study sounded good to President Obama because he thought EMRs would enable the federal government to control medical and surgical practices in America.

Unfortunately, data from three other studies, a cardiology group, a Harvard group and Canadian group showed there is no savings difference between paper records and electronic records.

The project has been a $38 billion dollar failure. I predicted the EMR project would fail in 2011. EMRs are a great idea. The EMR projects goals were wrong.

Wall Street Journal article in 2012 stated,  The electronic medical record (EMR) is touted as the key to containing costs, reducing errors, improving quality, and simplifying administration: an “elegant exercise in wishful thinking.

The RAND Corporation study was paid for by all the vested interests stakeholders involved in medical care except physicians and patients.

Allscripts Healthcare Solutions, the Cerner Corporation and Epic Systems of Verona, Wis. are the major EMR software companies who paid for the study.

In February 2009, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill.

GE and the healthcare insurance industry were also major funders of the RAND Study. The Obama administration funded the implementation of the EMR project to the detriment of the healthcare system.

The healthcare system has not contained costs, reduced errors, improved quality or simplified administration. Each category has gotten worse.

I do not think the Obama administration’s primary interest was to fix the existing healthcare system.   If the EMR project hobbled the healthcare system, the population would beg the government to completely take over institute his “Public Option” and subsequently “Medicare for All.” There was no consideration of the fact that that Medicare and Medicaid are unsustainable.

The complete control of the VA Healthcare System has not worked out very well for the government. One important reason for the VA Healthcare System’s failure is the bloated government bureaucracy. Effective medical care takes instantaneous judgement and rapid execution. Government regulations inhibit the process leading to long waiting times and ineffective and costly treatment.

Medicare and Medicaid costs have been unsustainable and are getting worse. Why would a politician think complete government control over 20% of the GDP, the healthcare system, would be any better than a free market system where patients would take responsibility for their healthcare and healthcare dollars?

The government could provide the dollars to the needy with financial incentives attached for all in the system.

Ideal EMR should be for the benefit of physicians and their patients. The EMR should not be only for the financial benefit of healthcare insurance companies, the government,  the pharmacy benefit managers and the software companies.

The EMR project places the secondary stakeholder in the position to judge physicians’ behavior and subsequently penalize them if they do not comply with government regulations and expected results.

The EMR should be a tool to continually educate physicians to help them become better. It should educate patients so they can become professors of their disease and help them avoid the complications of their chronic diseases.

The EMR should not be a tool used by secondary stakeholders to penalize physicians and patients. This will not decrease the ever-increasing cost of healthcare.

At the moment EMRs are relatively useless. A lot of money has been spent by all the stakeholders with very limited benefit. There have been hundreds of examples published by all stakeholders about the defects in the present EMRs that do not allow for an increase in the quality of care and a decrease in the cost of care.

 My ideal EMR along with my ideal medical saving accounts can go a long way toward repairing the healthcare system. http://stanfeld.com/is_an_ideal_ele/

 

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



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Why Vermont’s Single Party Payer Healthcare Plan Failed

Stanley Feld M.D., FACP,MACE

Vermont’s single party payer healthcare plan was doomed to fail from the onset for several reasons.

Vermont had a Republican governor for eight years. He decided to retire.  Peter Shumlin (D.) won the Democratic nomination for governor after progressive activists demanded that each candidate for the Democratic Party nomination promise to enact single-payer health care if nominated.

Shumlin’s got the nod, won the election. He was anxious to pass the single party payer system.

Vermont’s consultants were Harvard’s William Hsiao and MIT’s Jonathan Gruber.

William Hsiao has spent most of his academic career helping governments install single-payer healthcare systems.

There is little evidence that the systems by developed in Taiwan and other countries by William Hsiao have been successful. They have not been cost effective or sustainable. They have not preserved freedom of choice.

Gruber and Hsiao made the same mistakes for Vermont that they made for America with Obamacare.

Hsiao and Gruber promised that single-payer health care in Vermont could save $1.6 billion over ten years. With that endorsement in hand, Shumlin and the legislature passed Act 48, a law instructing the state to figure out how to finance a single-payer system. They dubbed it Green Mountain Care.

Governor Shumlin said, “If Vermont gets single-payer health care right, which I believe we will, other states will follow,” pronounced Shumlin. “If we screw it up, it will set back this effort for a long time. So I know we have a tremendous amount of responsibility, not only to Vermonters.”

Unfortunately, Americans have a short memory, the short memory promoted by the conformational bias of the traditional mass media toward a progressive agenda.

Progressive Americans and their progressive politicians had better wake up fast. “Medicare for All” does not work.

Medicare does not work in a financially sustainable way for the government or seniors. It was not sustainable in the Bernie Sanders small state of Vermont. It is nice to believe you can provide healthcare benefits for nothing to all. However, nothing is free especially when it is run by central bureaucrats. It has been proven over and over again.

First, bureaucrats and healthcare policy consultants do not understand the medical care system. The history of Vermont’s single- payor story is interesting.

In December 2014 Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug after four years on Vermont’s single-payer, government-run health care system.

“In my judgment,” Governor Shumlin said, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

Rather than saving $1.6 billion the Green Mountain Care would cost an additional 2.6 billion dollars in tax revenue for 2017 alone. The law would require a 151 percent increase in state taxes.

“Fiscally, that’s a train wreck. Even a skeptical report from Avalere health had previously assumed that the plan would “only” cost $1.9 to $2.2 billion extra in 2017.”

“In 2019, Costa estimated that Green Mountain Care would have required $2.9 billion in tax revenue vs. $1.8 billion under pre-existing law: a 160 percent increase in revenue.”

The result should explain why the dream of single-payer health care in the U.S. should be dead for the foreseeable future.

Daily, we read articles calling for “Medicare for All” from progressive politicians running for office.

How stupid do they think Americans are?

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



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Associations Are  Growing

Stanley Feld M.D. FACP, MACE

Any initiative President Trump and his administration presents to the public is criticized as junk as soon as it is presented. It is criticized without any evidence for the criticism because it does not fit into the Democrat’s narrative of “Medicare for All.”

When the Trump administration rolled out the plan to once again let associations sell healthcare insurance plans to its individual and small businesses Democrats charged that these plans would be worthless.

The mainstream media did not publicize the Trump administration’s initiative. The fact that Obamacare has resulted in higher premiums and deductibles for small businesses and individuals has been downplayed by the mainstream media. In fact, we occasionally see articles declaring that the people like Obamacare. Only twelve million people are insured by Obamacare.

It is not true that people like Obamacare. The fact is premiums and deductible are not affordable for many on Obamacare despite the fact that 85% of the enrollees receive federal government subsidies

The fact is that individuals without healthcare insurance and who do not qualify for Medicaid need insurance. They are stuck buying Obamacare insurance because they do not have any other option. Many have had to go uninsured because they could not afford premiums and deductibles. Many have gotten jobs in our excellent economy where the large employers pay for group healthcare insurance.

The associations’ plans were proposed to provide a less expensive alternative to Obamacare by allowing workers and small businesses to pool together to buy healthcare insurance through the association.

An association, like big corporations, has the ability to negotiate with healthcare insurance companies to lower premium prices and deductible. The tax treatment is also favorable.

The association initiative started in January 2019. Early evidence suggests that the initiative is working out — at least for now.

“The administration’s alternatives, known as “association health plans,” have been covering the same benefits that Obamacare plans do, even though they are not obligated to, according to a new analysis by the industry publication Modern Healthcare and another by AssociationHealthPlans.com.”

 

Just like Obamacare plans, the associations’ plans are paying for prevention, visits the doctor’s office and the hospital, emergency medicine, prescription drugs, maternity care, and mental healthcare.

The plans are also covering people with pre-existing conditions, such as cancer or diabetes.

 “In fact, the plans are required to cover all of the above. This is an aspect of their coverage that was not well publicized by the mainstream media, according to Kev Coleman, president of AssociationHealthPlans.com. “That’s something that was lost in the mix.”

 The requirement is part of Obamacare’s regulations. Since Obamacare has not yet been repealed by Congress the rules will remain.

“Officials in the Department of Labor announced new rules for the plans in June, with some of the plans allowed for purchase beginning in September. Since then, at least 28 plans have launched in 13 states, according to Coleman’s analysis.”

Self-employed consultants working out of their homes, plumbers, and massage therapist are joining associations to have the negotiating power of large numbers of people seeking healthcare insurance.

Chambers of commerce and small cities have been forming state trade associations and their employees are joining these rapidly forming associations and enrolling in their insurance plans.

The Nebraska Farm Bureau Federation has 59,000 farmers and ranchers in their association. The associations are similar to what Jeff Bezo,Jamie Diamond and Warren Buffett are planning to do for their 700,000 employees. They plan on selling the insurance across state lines which will reduce the price even further than the 33% reduction the associations are anticipating offering.

The Obama administration had limited the formation of associations selling healthcare insurance. Associations were selling their own plans. They were inexperienced administrating them. Some associations went bankrupt. Large healthcare insurance companies have strict criteria and oversite. Self-run associations are going to take longer than.

Associations are being formed. Outside health insurers have run a few association plans since September 2018. Associations were only allowed to begin running their own plans beginning in January 2019.

Critics complain that the healthcare insurance industry is providing teaser rates to associations now. The critics claim the healthcare insurance companies will eventually raise the premiums. It is a possibility. However, with the increase contributions allowed for Medical Savings Accounts and Health Savings Accounts, association members will have a financial incentive to become a prosumer. Consumers would have incentive to become responsible for their health and healthcare dollars.

A more recent study by the Congressional Budget Office projected that 5 million would be enrolled in the plans each year, 1 million of whom would otherwise have been uninsured. The analysis did not assess how many people on Obamacare would become uninsured.”

The Trump administration plan is truly a disruptive plan to the healthcare industry and government healthcare establishment. The Democrats are terrified because it might work much better than Obamacare and result in a total rejection of “Medicare for All.”

https://www.washingtonexaminer.com/policy/healthcare/uninsured-rate-rises-during-trumps-first-two-years-in-office

“It’s not clear from the Gallup poll whether those who are now uninsured used to have an Obamacare plan or had one through an employer or government program. Other data, from the Department of Health and Human Services, show that the number of people in Obamacare plans has dropped only slightly since Obama left office.”

The problem is that enrollment in Obamacare has not risen while the uninsured has.

The number of people on Medicaid has risen dramatically due to some states accepting  Medicaid expansion. The federal government is due to stop paying over 90% of the bill for Medicaid and transfer the burden of payment to those states. Most of those state have large budget deficits that are only going to become larger.

“The highest increases in the uninsured rate were among women, people living in households with annual incomes of less than $48,000 a year, and adults under the age of 35. The young adults had an uninsured rate of more than 21 percent, a 4.8 percentage point increase from two years earlier. Among women, the uninsured rate increased from 8.9 percent in 2016 to 12.8 percent by the end of 2018.”

People cannot afford Obamacare premiums or deductibles. Associations might provide more affordable options. People working for large organizations presently have healthcare coverage.

Consumers understand how inefficient government-run programs have been. It is appropriate to let the free market give it a try. The formation of associations with appropriate regulations is certainly a free market step as opposed to the Democrats’ Obamacare that has failed. It is clear that government control of medical care is financially unsustainable.

We will see how associations and consumers responsible for healthcare dollars works out.

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



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Did Obamacare Cause The Increase In Private Healthcare Insurance Premiums?

Stanley Feld M.D.,FACP, MACE

A reader of my blog received this question from one of his friends.

The reader asked me his friend’s question  “I have a question and I don’t want it to be political (as I stay away from that for many reasons).                                                                                                                                 
Health insurance is so expensive and it does not cover hardly anything. We had to get the worst plan with the worst coverage. But it was not this way 6 years ago. We could afford good coverage.   

 The question is: Did Obamacare cause this change in healthcare insurance and these problems in access to care?

A reader asked:

Which of your blogs would be the best one to show him to answer his question?

The answer to the question is YES!! I will try to explain.

If I sent all the links to your friend would be overwhelmed. There are too many to count.  I will summarize some of the major reasons Obamacare is to blame for some of the increases in private healthcare insurance premiums and the decrease in the access to care. Obamacare has led us into a financial disaster. “Medicare for All” is not the answer.

I believe the goal of Obamacare was to create greater dysfunction in the healthcare system which would lead to huge premium increases for private healthcare coverage. The public would then beg the government to adopt a single party payer system with “Medicare for all.” This has been the progressives”  goal since 1935. Do you remember Barney Frank and John Kerry saying we cannot have a single party payer system yet because we do not have the votes?

https://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2018/10/the-main-reason-behind-rising-medical-costs.html

The government has not had a very successful single party payer systems record.  The VA Health Administration, the Indian Health Service, Medicare and Medicaid are all inefficient and financially unsustainable.

“Our federal government already runs three single-payer systems—Medicare, the Veterans Health Administration, and the Indian Health Service—each of which is in a shambles, noted for fraud, waste, and corruption.”

“Why would we want to turn over all of the American medicine to those who have proved themselves incompetent to run large parts of it?”

https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

The federal government depends on healthcare insurance companies to do the administrative services for Medicare, Medicaid and Obamacare. Administrative services include negotiating payments to hospitals, nursing homes, physicians and providers on all levels.

The various healthcare insurance companies are supposed to bid for these service contracts. The insurance companies receive one global fee.  The healthcare insurance company with the contract must pay providers on a fee for service basis. The healthcare insurance companies do not have good enough data to make an accurate bid estimate.  Actuary science is not rocket science. The healthcare insurance company builds in a twenty percent cushion to the bid. If the bid was low and the healthcare insurance company that lost money Obamacare guaranteed through a complicated reinsurance formula reimbursement to the company for its loss.

Recently the government audit discovered an overpayment of $10 billion dollars to the healthcare insurance industry for Medicare Part D.

I believe there is much more overpayment in Medicare Part A, B and D because of the government bureaucracy. The government only had the money to pay 12% of the reinsurance claims of the healthcare insurance company one year. The insurance industry simply raised the premium in the private sector.

http://stanfeld.com/president-obama-somehow-finds-the-money/

http://stanfeld.com/accelerating-the-destruction-of-the-healthcare-system/

http://stanfeld.com/the-deception-and-disinformation-continues/

Nationwide, the Obama administration made $7.3 billion in reinsurance payments to health insurers. The reinsurance program, funded by taxes on health insurers and self-funded employer health plans, has been criticized by Republicans as a “bailout” for insurers.

https://www.ibj.com/blogs/12-the-dose-jk-wall/post/53906-obamacare-shovels-another-122m-to-indiana-insurers

The healthcare insurance industry then once again raised premiums on the private healthcare sector to make up for its losses. to

The government reinsurance payments weren’t enough in all cases. New York-based Assurant Inc. asked for a 26 percent hike in private premiums for 2016, due to high claims in Indiana, before that company decided to exit the Obamacare markets in all states.

This was typical price shifting.

http://stanfeld.com/?s=price+shifting

Healthcare insurance companies projected that Obamacare would result in them losing money because of adverse selection. Obamacare’s increase required benefits for both public and private insurance. Obamacare’s rules included coverage for oral contraceptives for all and coverage of pre-existing illnesses among others. A sixty-year-old male does not need an insurance policy the receives oral contraceptives.

The healthcare insurance industry asked for double-digit increases in private healthcare insurance in every state. The logic was that these enrollees would pay for the loses that would occur from the Obamacare enrollees.

http://stanfeld.com/managing-points-of-view-and-healthcare/

The government’s argument is all should pay for everyone ’s healthcare needs. These healthcare needs have increased as the population has gotten more obese and has had a rise in drug addiction. These increased healthcare risks resulted in increased actuary estimates of healthcare cost. It does not put a burden on consumers who do not act responsibly.

The increased healthcare premiums caused many employers to drop healthcare coverage for their employees. The decrease in healthcare insurance coverage added to the pressure of healthcare premium increases.

The healthcare insurance industry also plays games with the Medical Loss ratio. The result is an increase in healthcare premiums and deductibles while decreasing services. The Obamacare issued regulations that the insurance industry must dedicate 80% of the healthcare premium to direct medical care and 20 % can be used for administrative expenses for both the public government insurance and private insurance. It is the state insurance regulators responsibility to enforce the regulation.

The expenses the industry wanted to be included are;

Expenses to be included in direct medical care are:

  1. The cost of verifying the credentials of doctors in its networks.
  2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.
  3. The cost of programs that keep people who have diabetes out of emergency rooms.
  4. The sales commissions paid to insurance agents.
  5. Taxes paid on investments.
  6. Taxes paid on premium income.

All these expenses are administrative expenses in my view and not medical expenses. If these expenses are permitted as benefit expenses, premium money available for direct medical care would decrease. The eighty percent required for direct medical care would be markedly reduced. The result would be an increase in healthcare insurance premiums.

http://stanfeld.com/medical-loss-ratio-how-did-the-healthcare-insurance-industry-do/

http://stanfeld.com/what-is-the-medical-loss-ratio/

The calculation for direct medical care helps the healthcare insurance company prove it lost money. The insurance company then applies to state regulators for a premium increase. The state regulators permit the premium increases.  If the premium increase is refused by the regulators the insurance company threatens to leave the state. The other option the healthcare insurance company uses is to decrease the insurance services and/or increase the insurance deductibles.

Another problem has developed in the healthcare insurance industry that is causing it to raise premiums and reduce services and access to care as a result of Obamacare.

Hospital systems are buying out physicians’ practices. Obamacare has put many restrictions on physician practices. It has increased practices overhead. Obamacare has decreased the ability for physicians to use their medical or surgical judgment that they have become happy to sell their practices to hospital systems. The hospital systems now have to deal with the problems of medical practice. The cost of electronic medical records, which have not added to the quality of medical care, increased many physicians’ willingness to sell their practices to hospital systems. At the moment the percentages of hospital-owned practices are up to 65% from only 17% ten years ago.

http://stanfeld.com/physicians-barriers-to-practice-their-profession/

https://www.wsj.com/articles/SB10001424052748704122904575315213525018390

As premiums have gone up physicians have not experienced an increase in reimbursement. They have been forced to see more patients quickly to earn almost as much as before Obamacare. Obamacare has destroyed the patient-physician relationship which in my view is essential in medical care. Physicians simply do not have time to talk to patients.

Hospital systems have taken over physician populations in many communities. This gives the hospital leverage over the healthcare insurance industry. The hospital system can demand higher reimbursement because it provides all the physicians.

The large hospital systems can demand that the insurance company only use the physicians in its hospital system even if there are lower cost of care options in a community.

The result is an increase in healthcare premiums and decreased the quality of care.

All of this is the result of Obamacare. There are about ten more reasons why Obamacare has increased premiums and decreased access to care. I have left link exposed. You are encouraged to look at them to see the full explanation for some of the point I have made.

I hope this blog answers your friend’s question. :  Did Obamacare cause this change in healthcare insurance and these problems in access to care? 

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



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