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What Was John McCain Thinking?

Stanley Feld M.D., FACP, MACE

I remember when President Obama held a meeting in 2009 with congressional Republicans in the House and Senate to discuss Obamacare before its passage.

This was to get input from Republicans before the Democrats excluded Republican input and were ready to vote in their Democratic Party dominated house and senate.

John McCain offered a constructive comment to improve Obamacare. President Obama’s response was “John I won the election.”


Now that Obamacare is an unmitigated failure John McCain voted against a simple repeal of Obamacare.

John McCain ran for reelection in his Senate primary and again in the general election on the platform that he would repeal and replace Obamacare.

 Many forget that he almost lost his primary election to a Republican tea party challenger. He and the Republican Party outspent the tea party challenger.

During his Senate race, he was also anti-Obamacare.

In fight of his political life, McCain hammers Obamacare

I think it’s a very strong issue,” McCain told POLITICO about his focus on Obamacare. “Eight of the counties in my state will now only have one [health insurer]. They’re looking at 65 percent increases in their premiums. They’re very upset.”

Why did he vote against the simple repeal? Is he a political hypocrite?

Does he hate President Trump so much that he will do anything to undermine his agenda?

Paul Ryan’s original bill allowed for an easy transition from Obamacare to a replacement bill.

Congressional leaders, especially John McCain, must listen to this lecture.

The traditional media critiques should listen to Paul Ryan’s lecture carefully and report on it fairly.


His plan would eliminate many of the Obamacare punitive regulations and permit Health Savings Accounts to grow. It would stabilize the health insurance markets. Some Republicans in the House are still opposed to his bill. They wanted immediate repeal and replace. They could not comprehend Paul Ryan’s subtle strategy.

Speaker Ryan finally got a watered down version of his proposal passed and ready for a joint conference. The Democrats fought it all the way.

In the senate, the Democrats said no to any proposal President Trump supported.

Both Chuck Schumer and Nancy Pelosi said it is the Democrats job to say no to everything in President Trump’s agenda. The job in their view is to destroy the Trump presidency.

Their plan is to destroy the Trump presidency with the help of the traditional media and the deep state. The deep state consists of Obama administration holdovers and anti-Trumpers in administrative positions. Some are career administrators. It is becoming obvious that they are also the leakers.

Chuck Schumer has done everything in his power to slow down confirming President Trump’s nominees. He has openly admitted this.

The members of the deep state have been leaking classified information to the press about President Trump’s administration. These are federal crimes. Secretary Sessions is starting to do something about catching these leakers.

President Trump has pledged to clean up the swamp. The swamp consists of the deep state plus many Democrats and some Republicans are both houses.

President Trump has the ability to confirm his nominees when both houses in congress are in recess.

By a strange sounding rule, both houses of congress can be considered in session when all the congresspersons are in recess.

Lisa Murkowski (R Alaska) set it up so that while the senate is in recess it is still in session. This is denying President Trump the opportunity to make recess appointments.

Senator McConnell did not do anything to stop her. It looks like the Republican establishment is also trying to destroy President Trump’s presidency.

Why would I think that?

President Trump has not had any cooperation from the Republican establishment to date.

President Trump pledged to clean up the swamp. All of the parties mentioned are the swamp that has hampered the growth of our economy.

I guess John McCain did his job for both the Democratic and Republican political establishment by voting against the simple repeal of Obamacare.

“The Senate GOP’s healthcare bill failure is a political debacle that will compound for years, and the first predictable fallout is already here:

“Republicans in Congress are under pressure to bail out the Obama Care exchanges, even as Donald Trump threatens to let them collapse.

The GOP needs to get at least some reform in return if it’s going to save Democrats and insurers from their own failed policies.”

 “Mr. Schumer may figure he can bludgeon the GOP into surrender because his press-corps buddies will blame the GOP for rising premiums.”

Let’s see what happens as a result of the swamp’s victory.

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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A Single Party Payer System Will Not Work

Stanley Feld M.D.,FACP, MACE

Why am I opposed to a single party payer healthcare system?

I am concerned about America’s $20 trillion dollar deficit and $180 trillion in unfunded liabilities.

I am also concerned about China being a reliable buyer of American debt.

The deficit should be viewed as a house of cards that might crumble at any time.

Our country has suffered a massive increase in the deficit the last eight years under Barack Obama and Obamacare. The public knows the debt has increased at lease 1 trillion dollars a year.

No one has seen a good accounting the deficit increase. Everyone knows we have had massive inflation even though we have been told that inflation is only one percent.

The public knows Obamacare is imploding.

The public knows about the waste incurred during the Obamacare website roll out and the scandalous contracts to venders. The public knows about the massive increasing in insurance premiums and the massive subsides that were not anticipated.

The Democrats that the people have elected to congress do not seem to care about the deficits created. Now, we have finally realized that the Establishment Republicans do not seem to care about Obamacare failures either.

These officials do not care how much money the government wastes on bad deals at all levels of the economy. Obamacare has made terrible deals with the insurance industry, the pharmaceutical industry and hospital systems.

It has not made a good deal for the middle class or their primary providers namely physicians.

I do not think American healthcare policy makers or congress can afford to make another mistake.

Winston Churchill’s famous quote about Americans stands out here.

“You can always count on Americans to do the right thing after they’ve tried everything else.”

America cannot try something that is destined to fail. Socialism, especially in healthcare, does not work. Our government officials refuse to believe this even though it is demonstrated by our own failed entitlements such as the VA Healthcare System, Medicare and Medicaid.

Government officials refuse to believe that the socialistic universal healthcare systems in the rest of the world are unsustainable.

Britain is the perfect example of this as the system is crumbling.

Socialism does work in the long term.

Winston Churchill said it again.

“Socialism does not work because it is not consistent with fundamental principles of human behavior. The failure of socialism in countries around the world can be traced to one critical defect: it is a system that ignores incentives.”

The key to the solution of the healthcare system problem is to provide incentives to all the stakeholders, especially the consumers.I believe “My Ideal Medical Saving Account” will work to provide universal coverage at an affordable cost.

America does not need a healthcare system that makes consumers dependent on government. It needs a system that makes them independent of government.

Butch Mazzuca is a local Vail Valley Resident who wrote this article about socialism and the healthcare system that appeared in the Vail

Valley News on July 9, 2017.

Mr. Mazzuca has given me permission to republish his article.

“When it comes to socialism, will they ever learn? 

Editor’s note: Find a cited version of this column at

“Several weeks ago on ABC’s Sunday morning talk show “This Week,” Senate Minority Leader Chuck Schumer told host George Stephanopoulos, “The democrats need a strong, bold, sharp-edged and common-sense economic agenda. … That’s what’s been missing.”

So I find it a bit ironic that seven months after losing the 2016 presidential election, Schumer feels the Democratic Party is still struggling to articulate a coherent message. Meanwhile, the Bernie Sanders-Elizabeth Warren wing of the party delivers a very clear message. Unfortunately for their constituency, it’s about a failed ideology — socialism.

Sanders and Warren are advocates of redistributing wealthlax immigration rules, governmental intervention into health careenergy and business; and the acceptance that Washington should be the final arbiter of all problems.


While socialism is antithetical to the ideals of the Founding Fathers, it tends to gain its strongest support among the young and those who are uninformed. On the surface, socialism sounds great; it has always sounded great and will continue to sound great within certain precincts. The only problem with socialism is that history exposes it as a bankrupt ideology.

But rather than describing socialism’s failures tenet by tenet, the following apocryphal story illustrates socialism’s inherent defects in an easy-to-understand way.

An economics professor at a local college made a statement that he had never failed a single student before but had once failed an entire class. The class insisted that wealth redistribution, aka socialism, worked because then no one would be poor and no one would be rich — a great equalizer.

The professor then said, “OK, let’s try an experiment.” Henceforth, all grades would be averaged; everyone would receive the same grade, and no one would fail.

After the first test, the grades were averaged and everyone received a B. The students who studied hard were upset but the students who studied little were happy. As the second test rolled around, the students who had studied little now studied even less and the ones who studied hard decided they wanted a free ride, too, so they too decided to study little. The second test average was a D.

Now no one was happy. When the third test rolled around, the class average was an F; and from that point forward, the scores never increased, as bickering, blame and name-calling all resulted in hard feelings with the result that no one would study for the benefit of anyone else and the students all failed the class.

The professor then told them socialism as a form of government always fails because of human nature, i.e., when the reward is great, the effort to succeed is great, but when government takes the rewards away, no one will try to succeed.


Similar to the aforementioned students, the far left consistently overlooks the fact that human nature is part of any ideological equation. They fail to understand that socialism has never and will never work because it’s based on a premise that’s inconsistent with human behavior.

When people work, they expect to be compensated commensurate with their effort and skill level. And capitalism does that more effectively than any economic system yet devised by man. Capitalism provides an incentive for people to achieve because they know their efforts will be rewarded.

Conversely, socialism is a disincentive to achievement because people also know their work is valued only collectively, rather than being valued individually.

Quote of the day: “The inherent vice of capitalism is the unequal sharing of blessings; the inherent vice of socialism is the equal sharing of miseries.” — Winston Churchill.”

Butch Mazzuca, of Edwards, writes regularly for the Vail Daily. He can be reached at

Our politicians should stop fooling around with America’s healthcare system, our fiscal viability, and the welfare of our citizen.

It is time to try something that will work, and not another thing that is doomed to failure.

Elizabeth Warren and Bernie Sanders, you are both dead wrong.


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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They Are Getting There

Stanley Feld M.D.,FACP, MACE

As Obamacare implodes, President Trump is trying to get a Republican congress to repeal and replace Obamacare in an orderly fashion with a minimum of disruption to the present healthcare system.

The Republican establishment in congress is trying to disrupt his goal. All the Democrats are going to stonewall him.

Republicans won both houses of congress because they promised to repeal and replace Obamacare. They had seven years to create a plan. They have failed to achieve a consensus in the Republican caucus.

Democrats are starting to talk about making it easy. They are suggesting congress replacing Obamacare with a government run single party payer healthcare system.

You may recall President Obama told John Kerry and Barney Frank that America would get to a single party healthcare system via Obamacare. He told them not to worry.

The reality of the situation is America is inching its way to a universal single party payer healthcare system.

Medicaid, Medicare and the VA system are already single party payer systems. Each one of these programs has been declared unsustainable.

It is incomprehensible to me that the Republican politicians who the American people elected in good faith are not hearing their complaints

Presently 41.5% of the population is in one of these single party payer healthcare plans. 49% of Americans pay no taxes. This means that 51% of Americans are paying the healthcare bill for 49% who do not pay taxes.

This is the redistribution of wealth that Dr. Donald Berwick said was essential in America.

If fact many of the 49% receive additional monies from the government such as food stamps, free mobile telephone service and free housing.

America is on its way to European socialism, This ideological system has failed in Europe.

The following calculation is how I came up with the percentage of Americans that are in an entitlement healthcare system. I use U.S. agency census data.

The current population of the United States of America is 326,613,397 as of Monday, July 24, 2017, based on the latest United Nations estimates.”


The chart below displays the total number of individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in the current month (April 2017) and the period prior to the start of first Marketplace open enrollment period or “baseline” period (July – Sept. 2013).

The current enrollment is obviously post Obamacare.

Month Expansion States Non-Expansion States Total
Baseline July-Sept 2013 (Monthly Average) (49 states) 37,069,415 19,733,676 56,803,091
Apr 2017 (preliminary) (51 states) 52,058,495 22,472,507 74,531,002

Medicaid and Chip increased by 22,472,507 since the onset September 2013.

74,531,002/326,613,397 equals 22.81% of the population is on Medicaid so far.

Medicare enrollment is lower than present Medicaid enrollment. As of May 2017, 37,976,052 are on original Medicare and 20,089,220 are on Medicare Advantage or others Medicare plans for a total of 58,065,272 on this single party payer entitlement.

Medicare is an entitlement program with high premiums. The premiums are means tested. People in the upper tax brackets pay over $18,000 a year in after tax dollars premiums for Part B, Part D and Part F.

The people in lower tax brackets pay less. The premium deduction for Part B is taken out of their monthly Social Security check. This creates a burden on their standard of living.

The additional 58,065,272 to the 74,531,002 bring the total percentage of the population on a single payer healthcare system to 40.6%.

(132,596,274/326,613,397= 40.6%)

If the VA healthcare system enrollees are added to the analysis of the number enrollees to a government run single party payer healthcare system the percentages increase.

In Fiscal Year 2014 the total veteran population was 21,619,731. 9,111,955 veterans were enrolled. 6,616,963 veterans used the VA Hospital System. The VA System brings the total number enrollees in a single party payer system to 133,508,229 or 40.9%

9,111,955 + 132,596,274= 133,508,229

133,508,229/326,613,397= 40.87%

The IHS provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who belong to 567 federally recognized tribes in 36 states.

133,508,229+2,200,000= 135,708,229

135,708,229/326,613,397= 41.5%

41.5% of the American population is already in a government controlled single party payer healthcare system. President Obama was right. He promised he would get there

Barney Frank and John Kerry did not have to worry. The only problem is that Obamacare is collapsing because it is unsustainable.

It is a pity is Republicans cannot agree to an innovative plan to repeal and replace Obamacare. Maybe the Republican want to have control over the healthcare system and deny Americans their freedoms.

The Democrats don’t care about the welfare and freedoms of Americans or the fiscal health of the nation.

Something needs to be done about this madness now.

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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The Republican Establishment’s Failure

Stanley Feld M.D.,FACP, MACE

I am coming to the conclusion that the Republican establishment does not want to Repair the Healthcare System.

The Republican establishment has the same goal as the Democratic establishment.

Recently the mainstream media is saying that a single party payer system is looking good.

Neither party has any interest is having consumers control their healthcare dollars. It looks as if both parties want the government to control the consumer’s healthcare dollars.

All the politicians ignore the fact that government control is unaffordable. It also ends up not working.

The best example is the bureaucratic VA Hospital System and its system wide corruption.

A reader wrote:

I have read your last blog post carefully and agree with many of the points put forward but there is a glaring omission.” 

 “How are patients supposed to be responsible for their healthcare dollars when there is absolutely no transparency and no consistency in pricing.”

The lack of transparency is a major defect in our present healthcare system.

Only 20% of consumers use the healthcare system at any one time. Eighty percent of the consumers have not run into the lack of transparency problem in the healthcare system.

Most consumers do not care about transparency because they have first dollar coverage provided by their employer. They think their medical care is free. They believe they have excellent healthcare insurance.

President Obama took care of that notion with Obamacare. The defective structure of Obamacare caused healthcare insurance premiums and deductibles to skyrocket. First dollar healthcare insurance became too expensive for most employers.

Employers stopped providing first dollar coverage. Middle class employees are now noticing that out of pocket expenses have made their healthcare insurance unaffordable. Consumers have tried to compare prices of competitive providers. They have discovered that it is impossible!

Consumers are becoming aware of the lack of transparency. They have been astonished by this lack of transparency.

There is nothing in the new Republican bill that addresses Republican politicians’ awareness that the lack of transparency is a major defect in the healthcare system.

The lack of transparency is only one of the major defects in our healthcare system.

There is nothing in the Republican bill that speaks to the consumers’ responsibility for their health and healthcare dollars. Consumer driven healthcare is completely ignored.

There is nothing in the bill that addresses effective tort reform. The Massachusetts Medical Society survey showed that defensive testing to avoid lawsuits costs the healthcare system between $250 billion to $700 billion dollars a year.

The lack of the development of systems of care for chronic diseases cost another $700 billion dollars a year that our healthcare system does not address. There is nothing in the bill that emphasizes this very important defect in the healthcare system.

The Republican establishment thinks consumers are too stupid to take care of themselves.

The mainstream media likes to tell us that people love entitlements. The public does not want to give up these entitlements.

My question is how come less than 9 million people signed up for Obamacare’s individual healthcare plans last year if they love entitlements?

It is because they cannot afford to buy the health exchange insurance even though 85% of the premiums of those 9 million consumers are subsided by the government. Their high deductibles are not subsidized.

The Republicans are going claim they are promoting health savings accounts. The public is not told the amount of money they can put into a health savings account or whether it will provide first dollar coverage over that amount if they get sick.

There is no financial incentive for consumers to be responsible for their healthcare or their healthcare dollars.

My Ideal Medical Saving Account is a much better idea.

These are only a few of the major defects in the Republican establishment’s concept to fix the healthcare system.

President Obama did some of the awful things to Obamacare through rules and regulations after certain vested interests complained about the law. Obamacare’s rules and regulations have to be eliminated

There were crony waivers that would make one’s blood boil. In fact, elected congressional members got the best exemptions.

It is becoming apparent that congress doesn’t want to fix the healthcare system for the majority of Americans. The congressional establishment wants to control consumers.

Socialism does not work!

Socialsim for blog

Our political establishment does not tell us about the economic result in other countrys’ single party payer universal healthcare systems.

We don’t have to go to other countries. We only have to go to the indigent areas in California were everyone is covered by Medicaid.

The Republican establishment needs to get off the stick before all of them are kicked out of congress.

Just imagine the healthcare systems savings if every consumer were empowered to shop for the best healthcare at the best price.

The result would be a free market healthcare system in which competition would cleanse the system and make it affordable to everyone.

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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How Can I Be So Misinterpreted?

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Better Care Reconciliation Act (BCRA)

Stanley Feld M.D.,FACP,MACE

It looks like the Senate is making a mess out of its version (BCRA) of repeal and replace Obamacare.

My first reaction was that Better Care Reconciliation Act is a stupid name for a bill to repeal and replace Obamacare.

I have not heard a single specific criticism of BCRA by the Democratic leadership.

Nancy Pelosi said the bill will kill hundred of thousands of people. Hillary Clinton said it was a death bill. Chuck Schumer told the American people it is a terrible bill and leave millions uninsured. They all said it is going to make the rich richer and the poor poorer.

The evidence for these statements has not been presented.

Democrats have used these scare tactics so often that no one believes them anymore.

Americans are smarter than that.

Republicans have not explained the strategy behind BCRA in making the healthcare system better than Obamacare either.

All I have heard from President Trump is that it is a beautiful bill. It will make our healthcare system great.

If no one understands BCRA how can a media driven public poll with a 17% approval rate have any meaning?

The survey of public opinion is meaningless.

At present Obamacare has left 26 million uninsured and rising. It has only insured less than ten million people in the individual market.

Obamacare is also unaffordable. The deductibles are as high as $6500 before any insurance kicks in. People who buy the insurance have no insurance until they spend more than $6500.

I don’t understand the Senate Republicans who want a perfect conservative bill. They are not going to get it. They will yield the floor to the minority Democrats.

The turkey buzzards are circling the corpse already. The corpse being Obamacare and the Republican replacement

Elizabeth Warren said we must go to the next steps which is a single party payer system now.

I believe Obamacare is going to self-destruct in 2018 if nothing is passed immediately.

The choice for the Republicans who are oppose compromise and the passing of BCRA is clear to me.

Either the Republicans pass this bill and have a chance for a free market healthcare system or reject it and end up with a failed Obamacare healthcare system.

Everyone knows the replacement for a failed Obamacare system is a single party payer system just like the VA Healthcare System.

A single party payer system will be an unaffordable disaster.

I will not comment on the specifics of the Better Care Reconciliation Act (BCRA) except to say it is not perfect.

Let us see if it passes and what form takes. I will make some comments at that time.

President Trump needs BCRA to pass in order to make significant inroads in reforming the tax code.

I would be a pity if his fellow Republicans tied his hand on significant tax reform to simplify the tax code.

My hope is that Tom Price knows how to fix the healthcare system once the house and senate agree on specifics of the bill in conference.

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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It Is All about How You Look At Things

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

 Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Align patient 1

Align government

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

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

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

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

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

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

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Trump Is Not the Real Target – You Are

Stanley Feld M.D.,FACP,MACP

Many of my readers have been upset by the slowness and the lack of progress from the Republican senate in repealing and replacing Obamacare.

The country is approaching enrollment time for 2018. Insurance companies need to submit available healthcare plans to the health insurance exchanges soon.

Maybe there will be no healthcare plans available for people in the individual healthcare market with pre-existing illness. This will signify total collapse of Obamacare.

Maybe the Republicans are hanging around waiting for the public to realize that there will be insufficient healthcare plans submitted.

Then the Republicans could blame the Democrats for Obamacare’s failure.

Obamacare has failed for all the reasons I have already written about. There is no reason to debate if it has failed. There is also no reason to debate that President Obama’s vision for Obamacare failed.

President Obama and the Democrats are responsible for its failure. Obamacare was an ill conceived healthcare plan that could not be sustainable.

There are plenty of reasons to support the people who might lose insurance. Those people do not include the 12 million new enrollees in Medicaid.

President Trump is not going to touch their insurance.

The 9 million people enrolled with pre-existing illnesses that have signed up for Obamacare on the individual market must be covered with affordable insurance in some way.

There are many more people in this category who do not have insurance under Obamacare because it is unaffordable.

Within the House Republican plan there are provisions for these people.

It is clear that the liberal mainstream media is on the Democrats’ side.

It’s goal is to do everything it can to obstruct President Trump’s agenda and what he promised the American people.

President Trump won the election on his agenda, not on his personality.

It is clear that the mainstream media is against President Trump. A recent study showed that over 80% of articles written in our daily newspapers are negative articles about the Trump administration.

Many of the 20% positive articles have a negative subtext. Many of these negative articles have no basis in fact and have been proven to be untrue.

President Trump uses the words “fake news” because it angers the press and excites his base.

The Democrats are trying to make as many issues as possible treasonous without any basis for the use of the word treason.

In fact they roll out Maxine Waters every day saying President Trump should be impeached without her presenting a single piece of evidence for impeachment.

It should be clear that is a Saul Alinsky tactic. I have not heard one conservative or Republican accuse the Democrats of using Alinsky tactics.

President Obama did many things that were unconstitutional. He was never called out for them with congressional investigation. When the issues were investigated they were all given a pass. I can think of the IRS and Lois Lerner investigation, the attorney general issue, the CIA issue, and most of all the Hilliary Clinton hearing in which she said nothing for nine hours. The press, the congress and the President let her get away with it without at least an indictment.

James Comey of the FBI said she was careless and unindictable.

The other day I received the following article from a reader declaring the target of these attacks is not President Trump.

The target is the voters who want constructive legislation in Washington for the people. The country cannot survive with the corruption and unconstitutional behavior much longer.

Tim Daughtry is a conservative speaker and co-author of Waking the Sleeping Giant: How Mainstream Americans Can Beat Liberals at Their Own Game wrote a beautiful article explaining what is going on.

I have never thought of the establishment game in these terms. I have reprinted Mr. Daughtry’s entire article so that all of us will take a moment “to reexamine out premises” as Ayn Ryan suggested 70 years ago in Atlas Shrugged.

Trump Is Not the Real Target; You Are

Tim Daughtry

“As we watch the daily barrage of accusations and innuendo directed against President Trump by the far left, the liberal media, and even some in his own party, those of us who voted to put him in the Oval Office need to remember one crucial point: President Trump is not the real target.  You are.

Even considering his outsized persona and the stunning phenomenon of an outsider who has never held political office winning the presidency against one of the most powerful political machines in American history, the new movement that elected Donald Trump has never been about Trump. In the 2016 election, the “forgotten men and women of America” were hell-bent to send a message to the powerful elites of both parties.

The message was that the Washington elites are serving themselves and their own agenda and ignoring the rest of the nation.  The message was that Washington has become a swamp of corruption and self-serving collusion among powerful interests and that Main Street America is ready to see that swamp drained. 

Donald Trump was our messenger.

Because his candidacy was not about Trump the man but Trump the messenger, he was able to withstand the smears and assaults of the Clinton Machine that would have sunk any other candidate.  They siphoned all the way to the bottom of their slime barrel, and still the message prevailed. 

That message was simple and grounded in common sense.  No country can survive unless it has control over its borders.  People coming into American should be vetted to make sure that they pose no danger to us.  After eight years of stifling taxes and regulations, we should once again make America a healthy place in which to do business, make products, and create jobs.  Political correctness may seem silly and laughable, but in reality it poses a serious threat to free expression and open exchange of ideas. If it’s terrorism, call it that.  Say what is obvious to our common sense even if it offends the delicate sensibilities of the elite.

Now the denizens of the Washington swamp are sending a message back to the forgotten men and women who voted for Trump and his reforms: “Forget you.” 

The leftists who worked to radically transform the nation under Barack Obama are telling us that they hold the reins of power and that we the people don’t run anything.  They are telling us that their agenda will prevail regardless of how we vote or what we want.  They are telling us that they can subvert, attack, and destroy any messenger that we send into their territory.  And feckless leaders in the GOP seem, at best, more afraid of displeasing the Democrats than betraying their own voters, and, at worst, in cozy collusion with the opposition.

What is at stake in the barrage of innuendo, twisted news, and “investigations” is not just the future of the Trump presidency, but the future of the very idea that governmental power rests ultimately on the consent of the governed.

Of course there is much at stake in the actual policy questions facing the country.  But underneath the debates about border security, court appointees, tax and regulatory policy, and so on lies a deeper question that is at the very heart of our system of government: Can the American people still change the direction of the country if we believe that the country is headed in the wrong direction?  Or will the powerful and self-serving elites impose their agenda even when we don’t consent to it?

When the voters put leftists in power, as they did with the election of Barack Obama in 2008, the country moves left.  But when voters try to change course, as we did in the elections of 2010 and 2014, the country still careened towards open borders, government control of healthcare, rule by rogue judges, and lawless license for those in the power elite.

And so we went outside the traditional path and elected Donald Trump in 2016.  The liberal news anchors had barely dried their tears after Election Day when the left began to cloud the real meaning of Trump’s election by pushing the bizarre claim that the Russians had somehow hacked the election.

In their gaslighting version of reality, you didn’t really vote to drain the swamp.  You didn’t really vote to secure our borders.  You didn’t vote to repeal and replace Obamacare and put doctors and patients back in charge instead of Washington bureaucrats.  You didn’t vote to restore rule of law and common sense to Washington.  The Russians somehow threw the election to Trump.  You can go back home now and let the experts run things.

It’s swamp gas.  Don’t breathe it.

There is plenty in Washington that merits investigation, from foreign influence through the Clinton Foundation to Obama’s use of intelligence data for political purposes.  Congress has the power to do just that, but we need to give them the will.

Let’s remind our representatives that they might forget us, but we won’t forget them.”


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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