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Supreme Court and Healthcare

June 24, 2012
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

This week the Supreme Court is going to rule on whether President Obama’s Healthcare Reform Act is constitutional or not.

The traditional media and blogosphere has spent many hours speculating on the Supreme Court’s decision.

The Supreme Court probably recognizes the many strange issues involved in the passage of Obamacare and the many tricks President Obama played in its passage. It also recognizes than only 32% of the population approves of the plan.

The Supreme Court has cleverly picked the two most important issues dealing with the constitutionality of President Obama’s Healthcare Reform Act. These two issues are intermingled with the multitude of issues that are wrong with the law.

There are two key issues.

One key issue is whether it is constitutional for the central government to mandate that Americans and American companies must purchase healthcare insurance from a private healthcare insurance company. If Americans do not purchase the healthcare insurance, can the federal government fine them?

The second key issue is whether it is constitutional for the federal government to force states to increase the number of people eligible for Medicaid or do the states have the right to determine who they can and should cover at their expense.

 The two core issues are freedom of individual choice and central government control over states rights. Does the federal government have the power under the constitution to limit these constitutional rights?

Once the constitutionality of these two issues are decided by the Supreme Court, Obamacare still has the healthcare system’s original dysfunctional problems.

Obamacare institutes none of the necessary rules or regulations to repair the healthcare system. It adds a patch onto a dysfunction healthcare system.

Effective repair of the healthcare system must be incentive driven with alignment of all of the stakeholders. The primary stakeholders are the patients and physicians.  It must not be a system that is punitive to stakeholders.

The healthcare system must not be an entitlement program. It can be a subsidized program that is consumer owned and driven. Consumers must have financial incentive to be responsible for their health and healthcare dollars.

Any system that promotes government dependency will fail.

The list of initiatives that could repair the healthcare system is large. Obamacare does not include any of them.  

Obamacare omits the need for patients’ responsibility, expands entitlements and promotes government dependency.

These are the initiatives that must be included in a healthcare system that will work:

  1. Eliminate defensive medicine by effective Tort Reform.
  2. Individual patients’ responsibility for their healthcare dollars using the Medical Saving Accounts.
  3. Individual patients must become responsible for their health.  Obesity and the avoidance and control of chronic diseases and complications are in large measure the patient’s responsibility. Financial incentives for effective health along with educational programs to avoid chronic diseases and the complications of chronic diseases should be available.
  4. Dis-intermediate the healthcare insurance industry’s ability to extract 40% of every healthcare dollar for both public and private healthcare insurance sectors: Medical Savings Accounts.
  5. Eliminate the vague regulations and confusing regulations restricting innovative direct medical care programs.
  6. Make all healthcare insurance programs, corporate, small business and individual programs, tax deductible. 
  7. Administrative waste is expanded in Obamacare. Over 250 new agencies have been created already.  
  8. Effective system to implement Electronic Medical Records. The present stimulus is inadequate and will not achieve its goal. It can be done much less expensively.
  9. The hospital reimbursement system must be revised.  The government should institute regulations that monitor transparent real costs of a service and transparent negotiated charges. This should be available to patients and physicians in order to make educated choices.
  10. The government should provide on-line information to patients and physicians about reimbursement for services and need for services based on evidence based medicine recommendations.
  11. The government should help patients save their own money by helping patients decide what are necessary diagnostic tests and treatment.
  12. It should be the patient’s decision and not the government’s decision on necessary treatment.  
  13. Patient should be a Pro-sumer ( Productive Consumer). Patients must learn to be responsible for their care and healthcare decisions.
  14. The central government should stop trying to control the healthcare system and forcing consumers to be dependent on government. This is the Road To Serfdom.  
  15. The government should streamline regulations, eliminate paperwork, and make the healthcare system interaction a pleasant one.
  16. The government should eliminate bureaucracy. The government must approach healthcare reform from the patients’ and physicians’ point of view.

 

 There are many more initiatives I could list that are needed to the repair of the healthcare system. All the initiatives are based on maintaining individual freedoms and promoting individual responsibilities. The initiatives are not based on forcing everyone to be dependent on government.

These are exactly the problems the Supreme Court is considering.

As a society we have been acculturated to accept an entitlement society and central government dependency.

We are also noticing that entitlement societies do not work as witnessed by European socialism.  

America is in a Catch 22 situation. If you want to be fiscally responsible you cannot live beyond your means. America cannot maintain the entitlements any longer because the central government cannot afford them.  

After a finite time a nation runs out of other peoples’ money.

 

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

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The PSA Fiasco

June 20, 2012
inChronic Disese Management, Medicine: Healthcare System, Patients Problems, Physician's Problems
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Stanley Feld MD.FACP,MACE

It is common knowledge that prostate cancer is a slow growing cancer. It is also believed that something happens and suddenly this slow growing cancer becomes aggressive and then metastatic.  

As the cancer increases in size, the Prostatic Specific Antigen (PSA) value increases. It is obvious that a baseline PSA should be obtained. The PSA’s value should be followed yearly to see if it is increases over time. 

The United State Preventative Task Force’s (USPTF’s) conclusions are incorrect. There are problems with the studies reviewed leading to its conclusions.

The media sensationalism of the USPTF’s conclusions was an indictment of PSA testing and urologists’ judgment.

"The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harm," the report stated.

“The U.S. Preventive Services Task Force said in a report that the PSA test is too inaccurate, creates needless anxiety for patients, and can lead to costly and potentially harmful follow-up procedures”.

Clinical judgment by physicians is ignored by the USPTF. The PSA increases as prostate cancer progresses. How are you going to know if the PSA is increasing, if you do not have a baseline PSA?

The nation's leading urology associations are fuming over a USPTF report  that discredits the widely used prostate-specific antigen-screening test for prostate cancer.

 "It's an absurd recommendation. It is ill-researched and ill-conceived," Sanford J. Siegel, MD, a board member with the Large Urology Group Practice Association, told HealthLeaders Media. "This will only do damage to all the great work that has been done for prostate cancer awareness and to control the deaths from prostate cancer."

The USPTF should have at least had an urologist on its task force to evaluate the literature of PSA testing.

The USPTF is a “non-government agency” that will be used by the administration to ration medical care.

How can the government say it advocates preventing cancer when it’s setting us up to restrict access to care (prevention)?

American Urological Association President Sushil S. Lacy, MD, said in prepared remarks that he was "outraged" by the report. "It is inappropriate and irresponsible to issue a blanket statement against PSA testing, particularly for at-risk populations such as African-American men," Lacy said. "Men who are in good health and have more than 10-15 years life expectancy should have the choice to be tested and not discouraged from doing so."

 The American Association of Clinical Urologists issued a similar statement  week,

“The AACU called the USPSTF recommendations "misleading and harmful."

The major urological associations say the USPSTF ignored new studies supporting the value of PSA tests, and that the panel refused to address concerns they raised about the conclusions during the comment period. In addition, the urologists complain that there were no urologists or oncologists on the panel.  

The major urological groups said,

 "It is just a screening test, one of several things we look at when we decide whether a man needs a biopsy or not," he says.

"Yes, it is true that many men can live with this disease their whole life. That is why active surveillance has become a treatment option," he says. "If we knew in advance who would and who wouldn't advance in the cancer, that'd be great!"

"There is no question that men get prostate biopsies that obviously in hindsight shouldn't happen.  But we are looking at improving PSA testing and other testing to help us find out which men will progress with more advanced prostate cancer."

The problem is that no one has yet come up with an alternative to determine which patients will develop advanced prostate cancer

There is case of a famous Texan who yearly had normal PSAs. His physicians told him it was not necessary to get further PSA test since he had been normal all these years. He was now past 80.   

At 86 he presented with severe bone pain.  Laboratory studies and a bone scans revealed a sky-high PSA (over 100) and widely metastatic prostate cancer.

If his PSAs were monitored the rising PSA would have been detected perhaps early enough to cure him. Prior to the bone pain this man felt perfectly well.

Urologists have many of these same stories.

The USPTF conclusion might aid clinical judgment. However, it should not trump clinical judgment.

Obamacare is getting set to make committee judgments about healthcare policy and clinical care while ignoring physicians’ clinical judgment.

 About 250,000 men are diagnosed with prostate cancer each year. The diagnosis is made by physical examination and PSA measurement. The final diagnosis and decision for surgery or radiation is made after a fine needle biopsy of the lesion.

A prospective double blind study does not exist to predict the grade of cancer that will be cured by surgery, radiation or no treatment.

Nor is there a study for the USPTF to grade about quality of life post op compared to the quality of life during progression of disease. Until then the USPTF conclusions on the basis of the studies they did review are relatively meaningless.

The incidence of 250,000 new cases of prostate cancer a year has been stabile over the last 30 years. 

With early detection the number of males dying per year from metastatic prostate cancer has dramatically fallen from 48,000 per year to 28,000.

 The USPTF statement does not seem correct,

“It could find no evidence to support claims that PSA tests are responsible for "reduction in all-cause mortality."

"Many more men in a screened population will experience the harms of screening and treatment of screen-detected disease than will experience the benefit."

The USPTF report ignores the dramatic decrease in deaths from prostate cancer over the last several decades.

Dr. Marc Siegel, a practicing urologist for 30 years, said,

 When I started training, 40% of African-American men at that time presented with metastatic disease. Now that number is miniscule," Siegel says. "Tell me how that happens without early screening? How do death rates go down from 48,000 when I trained to 28,000 now? How do you explain that without screening? You can't! It's impossible!"

I believe the defect in the USPTF conclusions have to do with the specificity of the PSA and not its clinical value. A more accurate PSA test needs to be developed.

The USPTF’s conclusions will save President Obama a little money in the short run.

However, the cost of care for prostate cancer along with the morbidity and mortality will cost Americans greatly in the long term. 

 The USPTF has to re-examine its premises and methodology.

 

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

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President Obama’s False Promises And Trick Plays.

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

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

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

THANK YOU

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

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

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

  

http://youtu.be/UErR7i2onW0

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

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

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

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

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

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

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

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

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

  

http://youtu.be/q8x20P4RpgQ

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Jerry The Diabetic Teddy Bear

May 30, 2012
inChronic Disese Management, Medicine: Healthcare System, War on Obesity
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Stanley Feld M.D.,FACP, MACE

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

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

THANK YOU

 

Last week two young entrepreneurs showed me a fascinating way to teach children age 3 to 8 with Type 1 Diabetes Mellitus how to take care of their disease.

The onset of Type 1 Diabetes Mellitus in young children is devastating for their parents. Many parents blame themselves for the child’s disease. The child is usually frightened and angry about having to take shots. They are also angry about the food restrictions and the fact that they are different from their friends. Often they become rebellious and try to avoid the shots or do not comply with the rules of food intake.   

Everyone has seen a 5 year old mesmerized by Leapster, an educational computer game. Children feel compelled to master Leapster. It keeps their attention for hours.  

Two recent college graduates Aaron Horowitz and Hannah Chung designed and are now marketing Jerry The Bear.

 

 

http://youtu.be/GptPWHLhiZo

They participated in a wonderful program called Design for America program at Northwestern University while in college.

"Without believing in our ability to develop and implement innovative solutions that can address the world’s challenges, we will not even act.

We can’t innovate if we don’t believe that we can. We must work together with those from all different backgrounds and perspectives, we must work with our community, and we must support each other in our efforts improve the world around us.

Design for America’s vision is a world where people believe in their ability to innovate and tackle the most ill-structured challenges of our time.  

Design for America teaches human centered design to young adults and collaborating community partners through extra-curricular, university based, student led design studios to look locally, create fervently and act fearlessly. DFA currently tackles national challenges in Education, Health, Economy and Environment."

 

http://youtu.be/tYppYU6XV5o

Aaron and Hannah produced Jerry the Diabetic Teddy Bear. After graduating college this year they applied and were accepted to a TechStars affiliated accelerator program in Rhode Island Beta Springs to further develop Jerry.

Jerry the Diabetic Teddy Bear is a fantastic teaching tool for young children. Young kids love their Teddy Bears. Jerry helps kids with Type 1 Diabetes adjust to their new lifestyle. By playing with Jerry children will learn to master their medical procedures.

Diabetic children will transfer the anger they feel at the onset of Type 1 Diabetes into an intense responsibility for taking care of their Jerry the Diabetic Bear.

The child with Type 1 Diabetes learns how to vary insulin doses and food intake through a computer chip algorithm game. The game teaches how to determine insulin dosage and food intake in order to keep Jerry the Diabetic Bear’s blood sugar as close to normal as possible.

In turn the child learns how to take care of his own Diabetes.  The child learns to be responsible for Jerry’s care and in turn his/her own care in order to remain healthy. Education must be made entertaining and purposeful. Jerry the Diabetic Teddy Bear is an effective educational vehicle that is simple and purposeful.

There is no reason that innovative teaching applications like Jerry the Diabetic Teddy Bear could not be produced for children with other chronic diseases such as asthma.

Design for America promotes the innovative thinking in young college students. It expands imaginative thinking in order to create new and effective products.

Rather than whine about the obesity epidemic in America we should be teaching children through entertaining and purposeful innovative educational ways to learn about food values, exercise and obesity.

This type of education should be universal if we are going to educate our population about the prevention and care of chronic disease.

This is a powerful way to reduce healthcare costs.

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

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Social Networks, Patient Education And The Healthcare System

May 27, 2012
inMedicine: Healthcare System
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Stanley Feld M.D., FACP, MACE

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

WATCHING THE YOU TUBES ARE IMPORTANT TO YOUR UNDERSTANDING THE POINT OF THIS BLOG.

The value of social networking has been partially understood by society. To me social networking’s potential for improving the quality of medical care has been poorly understood. Social networking can be a valuable educational tool in medical care.

I have always believed that if patients have a better understanding of their disease, they can better understand the reasons for their treatment. The result will be a better treatment outcome. This understanding will increase adherence to treatment. Adherence to recommended treatment nationally is about 50% for most chronic diseases. 

One of the spokes in the business model wheel for the ideal future healthcare system state emphasizes development of social networks within medical practices.

Social networks can act as physician extenders to increase physicians’ ability to teach patients to be a “Professor of Their Disease.” Physicians can increase the quality of care they deliver by creating social networks within their practice. Patients can create a nickname so as to be anonymous to the social network. The physicians would be aware of the nickname.

Slide21

Social networking is another name for participating in a community. Most people participate in multiple communities. Some join communities for social reasons, others for educational reasons, and still others for economic reasons.

Human are social beings. They enjoy interrelating with others.  

There are hundreds of communities on-line. These communities encompass many of the subcultures in our society.

For example, I have joined the on-line TED, Sermo, and Medscape communities to name a few to satisfy my need for continuing life long learning.

Some patients go on-line to find out about their disease. They either did not hear or did not understand their physician’s explanation of their disease.

Some explanations are very complicated. Some are not in agreement with the physician’s explanation. Some physicians do not explain diseases well.

The lack of understanding about their disease could have been because patients were too anxious about their disease to hear or understand the explanation for a particular treatment. A patient could believe the explanation was gibberish.

A great illustration of gibberish is the following explanation of the Turbo Encabulator. Try to understand the following explanation of the Turbo Encabulator.

  

http://youtu.be/MXW0bx_Ooq4

This is pure gibberish. A person can understand all the words if he concentrated but the string of words has no meaning.   Patients need to be able to hear explanations that answer their specific questions over and over again. Disease processes and the effects of treatment can be complicated.

All complicated issues can be explained simply. Complexity is the result of combining multiple simple effects.  The complicated issues can be explained by dissecting these effects to their core.

The trick is to develop the right teaching materials. The following is an example of what I mean by developing the right teaching material.

The main stream media and many people have interpreted Paul Ryan’s claim that President Obama has double counted the $500 billion dollar saving by which the President claims he is reducing the deficit with his healthcare reform act.

Everyone has heard the Carl Sandberg’s statement, “If you tell a lie enough times it becomes the truth.”

If Representative Ryan demonstrated the double counting in plain English as the following animated cartoon does, 100% of people would understand why Paul Ryan is correct in making that claim. It is arithmetic explained simply.

  

 

http://youtu.be/q8x20P4RpgQ

A more complicated subject can be made simple as the following animation, “Changing Education Paradigms” shows

The animation technique is entertaining. It holds the viewer’s attention. It is a powerful teaching tool. This tool can be developed for all chronic and acute diseases. It could be used as a teaching tool in social networks within a physician’s practice. It would be available 24/7.

  

http://youtu.be/zDZFcDGpL4U

 It the government wanted to create an efficient healthcare system it should help physicians set up social networks and develop animated cartoons for chronic disease management.

Physicians could choose web sites of their choice to educate their patients. These social networks could be set up so patients could interact with other patients in their physicians’ practices.

Patients could learn from each other about their treatment successes and failures. The social networks could be broken into subgroups such as diabetes, asthma, heart disease and others.

The social network could be an effective extension of the physician’s care with interactions supervised by the patient’s own physician. A modest reimbursement for the physician’s time should be provided.

Physicians should set up social networks with other physicians in their community to discuss interesting cases. This was the original purpose of hospital grand rounds and other teaching rounds.  This community activity is disappearing as physicians are seeing more patients and cannot break away to get to the conferences. The national online communities are good but a local online community is better.

All medicine is local and medical education should be local to have its greatest impact.

Social networking in medicine is all about educating patients in the care of their disease. Patients are the only ones who can control the course of their disease and its outcome. Physicians have to provide patients with the learning platform and supervise the treatment.

 

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

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  • migraine treatment • July 18, 2012

    Canada’s Medicare system is a universal single-payer system that covers about 70% of the country’s health care expenses. The Canada Health Act requires that all insured are fully insured for hospitalization and basic health care. About 91% of hospital costs and 99% of physician services are financed by the public sector.

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America Is An Innovative And Exciting Nation

May 23, 2012
inInformation Technology in Healthcare, Innovations in Healthcare, Life's Experiences, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

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

Todd Siler, Phd

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

Todd’s analytic skills and creativity are uncanny.

The following quote is from one of his web sites,

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

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

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

Please click on to Todd’s imaginative art. http://www.toddsilerart.com/index.html

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

One of Todd’s trademark symbols is;

  Todd siler png

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

http://www.thinklikeagenius.com/

 

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

Thanks, Todd.

Nextera Healthcare

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

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

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

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

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

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

http://www.nexterahealthcare.com/

TechStars

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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  • Fitness Info • October 26, 2013

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

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It Not About Ideology: It’s About What Could Work

May 19, 2012
inConsumer Driven Health Care, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Jonathan Hiadt has become a very popular author during these difficult times of “class warfare.” In “Righteous Minds” he posits that both the Right and the Left think they are correct about political, social and economic issues. Since the opinions of each are usually opposite disputes occur.

His point is that the Right and the Left need to understand reasons for each groups’ thinking. It might result in tolerance and respect by each side for each other.

I sense a definite leaning toward the Left in his presentation with his condescending attitude toward the Right.

In this political season I have a problem with siding with either the Right or the Left in their political arguments. My impression is both sides are wrong with the Left being more wrong than the Right.

Both sides are trying to condition our minds to side with them. This should indicate how powerful the people really are.

George W. Bush and Ronald Reagan are dirty words to most of the Left.

The Left has demonized George W. Bush and Ronal Reagan because their thinking is not compatible with the thinking of the Left.

The Right loves Ronald Reagan and seems to be a little embarrassed by the mention of George W. Bush.

No one should be embarrassed about George W. He claimed to be a Compassionate Conservative. This phrase drove the Left crazy. George W. co-opted the Left’s claim to fame with the word compassionate.

The Left leaning media was frenzied about it for 8 years.  George W’s problem was he let some vested interests get too strong to the detriment of all Americans.

What is President Obama doing? He promised to “Transform America.” He is driving the Right leaning media crazy. Many Americans sense President Obama’s transformation. Americans do not like President Obama’s interpretation of transformation.

President Obama is increasing government control and decreasing our freedoms. Americans sense that our living standards are worse, our way of life is becoming difficult, the way we think about ourselves as a nation has become unpleasant and economy has gotten worse.

President Obama is also bending the rules to serve his ideological thinking. There is a growing mistrust of him because of his methodology and his ideology. The traditional media appears to be on the President’s side. The traditional media is terrified. They are losing their audience and in turn their ability to make a profit.

To me is all about media manipulation. The media’s agenda is to reach as large an audience as possible. Once this is achieved it can sell advertising space and make as much profit as possible.

The media wants to make a horserace out of every piece of “news” and a scandal out of every piece of non-news. The media on both the Right and the Left omit “news” that doesn’t fit its ideological agenda.

Think about it. This is the reason all political campaign are so expensive. If there were significant campaign finance reform the media would go bankrupt.

Politicians have to become media actors to win the hearts and souls of Americans. This was never more noticeable between and extremely articulate Barack Obama and a relatively inarticulate John McCain and a politically unschooled Sarah Palin.  Politicians have to appear to know something and stay on script.

Folks, we nave been brain washed. 

The most important asset we have as humans is our health. Systems have developed over the past 60 years in medicine that have improved our health and longevity. 

These same systems have launched vast industries and sub-industries that suck the money out of the system.

Where does the money go? Only 10% of the healthcare dollars spent go to physicians. The rest of the healthcare dollars goes to the secondary stakeholders (the middlemen) that add little value to the treatment of disease.

It is up to the people to become engaged in the political system and say we want a healthcare system that works and does not waste money.

We want a consumer driven healthcare system between consumers and physicians.

We want public service announcements that teach us how to drive the system and achieve the advantage of scale.

We do not want the government to make decisions for us.

We want to have the ability to make our own decisions.

We want to have control over our own destiny.

We want to have control over our healthcare dollar.

We want to have economic incentives to make our own medical choices.

We want to have pride in our nation,

We wanted to have trust in our government.

Todd Siler’s three guiding principles says it all:

Todd siler png

Consumers must take responsibility for their medical care and their healthcare dollars. My Medical Savings Account will go a long way to bring this about.

Consumers are the only ones that can make elected officials run our government in a way that supports these guiding principles.

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

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Ignoring The Rules

May 13, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D., FACP,MACE

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

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

The President is supposed to set an example for others.

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

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

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

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

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

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

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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My Ideal Medical Savings Account Is Democratic!

May 9, 2012
inHealth Savings Accounts vs Medical Savings Accounts, Innovations in Healthcare, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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