Stanley Feld M.D.,FACP,MACE

Massachusetts will receive $10.6 billion dollars over three years from the federal government to help fund its mandated universal healthcare insurance debacle. President Bush’s goal is to move government entitlement programs to the private sector. Medicare and Medicaid would be moved to the domain of the private healthcare insurance industry if he gets his way.

From the onset Mitt Romney’s ill conceived bipartisan universal healthcare legislation in Massachusetts was destined to fail. It was destined to fail because it would be financed by the state but run by the private sector without changing the structure of the healthcare system. It was clear to me the universal healthcare plan would go through a series of modifications at taxpayers’ expense while the healthcare insurance industry profited and access to and coverage for healthcare decreased. The Massachusetts’s universal healthcare plan is failing despite the disinformation and misinformation of Massachusetts officials.

“At a time when many states are facing substantial cuts in federal financing, Massachusetts will be able to expand its first-in-the-nation healthcare law because of a federal promise of $10.6 billion dollars over the next three years, Governor Deval Patrick said yesterday.”

The federal government is bailing out the universal healthcare coverage program because of increased premiums demanded by the healthcare insurance industry.

Making things worse is new state legislation raising taxes on employers not offering enough employees healthcare insurance.

“Under Massachusetts’ landmark health care law, employers who did not enroll at least a quarter of their workers in an insurance plan or contribute a third of the premium costs faced a $295 annual fee per worker.”

The reasoning is faulty after the state’s promise to guarantee universal care at no penalty to employers. The error made by the state was to provide universal care with the healthcare insurance industry being in control of the healthcare dollars rather than the consumers being in control of their healthcare dollars.

If patients were in control of their healthcare dollars and had the right to save for retirement the healthcare insurance dollars not spent for retirement two things would happen. Consumers would be motivated to carefully spend their own healthcare dollars and the administrative costs in first dollar coverage would be eliminated.

“Sarah Iselin, commissioner of the Massachusetts Division of Health Care Finance and Policy, said the new regulations would help ensure that all businesses are making a fair contribution to support the new insurance law.”

In addition to the $10.6 billion dollar bailout the division of healthcare finance is taxing employers. Employers are first, consumers are next and then providers. The state and federal government are presumably finished contributing.

“The long-term success of health care reform requires the continued shared commitment of consumers, employers, providers and government to achieve near-universal coverage in Massachusetts,” Iselin said.

Businesses said the changes run counter to the original intent of the so-called “fair share contribution” portion of the original law, which was designed to encourage employers to offer insurance to workers — but stop short of a mandate.

Businesses should not be surprised at this turn of events. Romney’s universal healthcare plan used the wrong formula in the wrong state.

“The deal, struck after months of delicate negotiations, gives Massachusetts about $2.1 billion more than it received from the government in its last round of negotiations three years ago for its Medicaid waiver package. The waiver allows Massachusetts to provide subsidized health insurance to some residents with incomes higher than would typically be allowed under traditional Medicaid rules.”

People who cannot afford healthcare insurance should be subsided. However, they have to be motivated to take care of their health and be concerned about spending their healthcare dollars. This connection is not made by anyone in government.

“Several state leaders characterized the agreement as a federal stamp of approval for Massachusetts’ historic healthcare law, which was enacted in 2006 and requires nearly every resident to have coverage.”

State leaders are living in a fantasy world. Citizen of the state will pay the price for state leaders inability to think clearly about this issue.

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

Stanley Feld M.D.,FACP,MACE

We have not heard much about the healthcare issue in the last three weeks. The 47 million uninsured have been ignored by both candidates. The upcoming 100 trillion dollar Medicare deficit has been ignored. I guess if politicians ignore a problem it goes away.

The present administration and congress is ignoring the middle class during this financial crisis. In Naomi Klein’s Shock Doctrine the basis premise is only a crisis actual or perceived produces a real changes. Klein credits the theory to Milton Friedman. This You Tube link is worth seeing.  She provides numerous examples of recent applications of the premise to advantage the rich at the expense of the middle class.

A crises permits unimagined change. It produces increased citizen dependency on government. The government officials can imposes policies to the advantage of the few in the guises of helping the many. These changes must be imposed before society recovers from the shock. The Republican administrations has declared goal is the elimination of entitlements and regulations. President Bush and potential President John McCain want to privatize Social Security and Medicare. The only way to do this is to create a crisis on Main street and shift the costs to Main Street for the advantage of a few. 

I believe this is what is happening right now with Secretary Paulsen’s proposal to bailout the financial system. His bailout package does not offer assistance  to people with mortgage problems that resulted from the banking systems irresponsible but profitable actions.

The financial community will get relief. The taxpayer will not get relief with his proposal. The taxpayer will foot the bill without any hope for payback or profit. This present crisis has not happened overnight. Yet neither Presidential candidate took the lead in exposing the problems. The problems have been common knowledge for a long time. Neither has either candidate taken the leadership to articulate the unfairness of the proposed bail out to the American people.

The healthcare systems problem have not happened over night either. The Shock Doctrine principles will rear its ugly head. When the healthcare system collapses the Shock Doctrine will result in a disaster in either direction. Either the new Republican administration will hand unregulated total control of the healthcare system to the healthcare insurance industry. or we will have socialized medicine with the Democratic administration.

Yet, “No one is speaking about healthcare any more. The economy, price of gas, war in Iraq have surpassed the uninsured and healthcare insurance premiums as top election issue for candidates”

“Public opinion polls have shown that among the top issues of concern to Americans, health care is languishing far behind the economy, the war and the price of gas. One CBS poll from July put voter interest in health care at just 3 percent. In August, it was at 8 percent.”

How can this happen? It can happen very easily. The media is the message. Only 20% of the population uses the healthcare system at any one time. Healthcare is not the concern of 80% of the population at any one time. The bigger issue of Repairing the Healthcare System so Americans can receive the best care on the planet is not a vital issue to either candidate when Americans are preoccupied with the present shock. Barack Obama has tried to generate a conversation about healthcare but John McCain has no new healthcare plan or the interest in a  discussion about healthcare. He knows the Shock Doctrine will prevail when the healthcare system collapses. He will then be able to eliminate the entitlement he hates.

American’s most precious asset is health. A functional healthcare system is vital to our health as a nation.

“For a lot of people who have health insurance, they are paying more for health care, but it may not show up as concretely as paying $70 to fill their gas tank,” said Anna Greenberg, a Democratic pollster.”

The candidates do not seem to have an interest in healthcare because the majority of Americans are not affected. When we have a severe economic downturn the majority of Americans will be affected. However it will be after the election. It will be too late to deal with the healthcare issue rationally. Also the candidates must realize how shallow and uninformed their concepts of the problems of the healthcare system are.

“There were no conference calls to talk about health care. There were no television ads about health care”

Barack Obama’s campaign claims healthcare is a top issue but does not force it to be a top issue. His solution to the healthcare system is not a viable solution.

“Obama’s spokesman, Bill Burton, said the problem is the press, not the campaign.” 

“The issue of health care may be getting less attention than it deserves from the media, but it’s still a top concern for voters and among the top issues that Sen. Obama talks about on the campaign trail,” said Burton.

Tucker Bounds, a spokesman for McCain, acknowledged that the issue has not been prominent so far but when pressed with why the conversation is not a priority he says,

“However,” he said, “There is a stark contrast in the way both candidates would address the issue. Because the views on providing affordability, accessibility and portability of health care are so divergent, it could hardly escape the conversation each candidate will have with voters.”

As usual Tucker Bounds  is making a  meaningless statement.

I believe more and more Americans are waking up to the existence of these  non-specific answers to specific problems. Americans will express themselves at the polls next month. The traditional politicians better wake up. They had better start expressing the will of Main Street and not the will of Wall Street or else they will be out of power.

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

Stanley Feld M.D.,FACP, MACE

From a distance everything Barack Obama says sounds great. The events of the last eight years have created cynicism and despair. We are a nation thirsty for hope to solve our many problems.

In healthcare the basic problem is not how we are going to pay for healthcare for all of our citizens but how to change the healthcare delivery system to create a healthier society and less chronic disease. Eighty percent of our healthcare dollars are spent on the treatment of chronic disease.

Barack Obama’s National Health Insurance Exchange does not address the basic problem in a meaningful way. It creates another bureaucracy that will drive competition out of the market place. It will result in socialized medicine with all of its bureaucratic and monetary problems.

“National Health Insurance Exchange:

The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

I believe his National Health Insurance Exchange will drive the private insurance companies out of the healthcare insurance business. This might not be a half bad idea since the healthcare insurance industry controls healthcare cost and earns a grotesque amount of money. Also the government outsources and will continue to outsource its Medicare administrative services to the healthcare insurance industry at an equally large profit.

“ Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.”

The only option remaining would be the new public plan similar to Medicare Part C the coverage that Senator Kennedy has. In recent years Medicare Part B has experienced increasing deficits. The increasing deficits have resulted in increasing costs to seniors and decreasing healthcare benefits. Increasing costs and deficits are inevitable in a single party payer system if the basic problems in the healthcare system are not addressed.

I believe the goal of the Democratic Party is to convert our healthcare system to a system of universal care with a single party payer. Hillary Clinton tried it in 1993 and Barack Obama will try in 2009 if elected.

It has been said that democratic countries in the west with single party payers do just fine. Canada and England have healthcare systems with universal care with a single party payer. All one has to do is look online at newspapers in Canada (National Post) and London ( Evening Star) to see how well these systems are really doing for their citizen. The following articles appeared in the National Post in Canada

1. Millions of Canadians lack family doctor

MD uses lottery to cull patients Not first such case as lack of doctors causes huge caseloads. In the latest jarring illustration of the country’s doctor shortage, a family physician in Northern Ontario has used a lottery to determine which patients would be ejected from his overloaded practice.

2. Let private sector into health care: CMA president Day

“We must not deny any patient access to essential health care based on ability to pay; nor should we deny access based on a shortage of doctors, hospital beds or operating time.

“Competition, consumer choice and market principles barely exist in our health system. The CMA President is asking for the basic principles that stimulate organizations to work properly

“Let’s note that three of the main Olympic values — excellence, universality, sustainability — are similar to our values and aspirations for a truly great health system. “And, of course, an integral part of the Olympics is competition. Without competition we cannot expect improvement, let alone excellence. “I believe that if we are to preserve universal health care for the next generation, we need to embrace similar principles.”

He clearly pointed out the problems with the Canadian system.

“And he bemoaned the fact that more than one million Canadians were on waiting lists for health care and that five million people did not have access to a family doctor. Yet neither the governing Conservatives nor the Liberal opposition seemed to care, he charged.”

This is what I worry about with Barack Obama’s healthcare plan.

“Individually, most [politicians] have a deep understanding of the plight of our health-care system.”Collectively, especially at the federal level, they are reluctant — even afraid — of engaging in a meaningful public policy discussion on health.

Claude Castonguay, a former health minister in Quebec summarized the findings of a report he submitted to the provincial government. He said that public health care system, as it now stood, was not financially sustainable.

The following articles appeared in the London Evening Star

1. Doctors call for ‘rationing’ of NHS services

“Rationing of services in the NHS is a ‘fact of life’, doctors insisted. The British Medical Association said a postcode lottery operates nationwide with some treatments denied to patients simply because of where they live.

It called for a charter that would tell patients exactly what ‘core’ services they are entitled to receive in England.

But in order to make the NHS work successfully, the BMA says the day-to-day running of the service must be wrested from politicians.

James Johnson, chairman of the BMA’s council, said there had to be an end to the ‘constant political dabbling’ and ‘micro-management’. “

2. London’s healthcare is lagging

3. Third of broken hip victims have to wait two days for surgery

“Thousands of elderly people with broken bones caused by falls are being betrayed by a postcode lottery in NHS care. A report says around one in three broken hip victims had to wait more than 48 hours for surgery – a delay that could have put their lives in danger. “

Enough said about the glories of socialized medicine in Canada or England. Is this what the American people want? Some say most people are satisfied with the healthcare service they receive in Canada and England. Only 20% of the population is sick at any one time. Therefore (most) have no idea what is going on in the healthcare system. It is easy to say they are satisfied with the system when they are not sick.

Rather than our next President creating another ineffective bureaucracy and costly entitlement program all he would have to do is

1. level the tax playing field for the self employed to be able buy insurance with pre tax dollars
2. permit the purchase of insurance across state lines
3. produce purchasing power and negotiating power for consumers with hospitals and physicians and insurance companies in a real price transparent environment
4. impose community rating with universal coverage regardless of pre-existing illness

5. provide ownership of the first $6000 to the consumer

I would bet consumers would use their healthcare dollar wisely.

Barack Obama’s National Health Insurance Exchange is a bad idea. It will not work if passed. The fact is the plan is not hopeful. It is the opposite of Barack Obama’s message of hope. A message America dearly needs.

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