Stanley Feld M.D.,FACP,MACE

I continue to look at Barack Obama’s statement puny statement on subsidies.

Subsidies.

“Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.”

Is this a false hope? Another example of a deficient subsidy is Medicare Part D. Again, the intention was good but the construction of the subsidy resulted in subsidizing the healthcare insurance industry.

UnitedHealthcare paid AARP $4 billion dollars to be the only provider of AARP’s Medicare Part D plan. Would UnitedHealthcare do this if they thought they would lose money? No! Part D is supposed to be a plan subsiding drug benefits for seniors. The government is supposed to fix the premium for all seniors regardless of health risk.

Last year UnitedHealthcare’s net income from Medicare Part D was over $1 billion dollars. UnitedHealthcare expects this net income to increase in the future as more baby boomers qualify for coverage. Despite all the profit from Medicare Part D next year the premium for seniors is going to increase from $25 to $28 per month per senior in post tax dollars.

The government does not negotiate directly with the pharmaceutical companies for drug prices as it does in the VA and Military healthcare systems. The healthcare insurance industry does the negotiating. The prices set are non transparent.

If the government wanted to be effective it would do its own negotiating. However, this does not seem to be the bureaucracy’s way. This is one of the reasons the government should not be a single party payer.

“Medicare’s drug plans will cost beneficiaries an average of $28 a month in 2009, about $3 more monthly than this year, according to the U.S. health-care program for the elderly.”

This increase represents an 11.5% increase from the previous year monthly cost of $25. It brings up the question again as to whether we can trust our politicians to look after our welfare and not the welfare of a secondary stakeholder?

“Premiums paid by beneficiaries for basic prescription plans cover about one-fourth of the program’s cost, with the government paying the remainder, according to Medicare. Medicare will spend about $36 billion this year to subsidize drug coverage.”

This is ridiculous. A generic drug estradiol cost $4 a month in Wal-Mart outside the Medicare Part D system. Inside the Medicare Part D system the patients benefit (“Doughnut”) is charged $20. The patient’s co-pay is $4 for the generic estradiol. Does anyone think Wal-Mart charged the healthcare insurance company $18 for this prescription? Does anyone think the Healthcare insurance company didn’t charge CMS (Medicare) $18 plus an additional administrative fee for this prescription? All we are told is Medicare will spend about $36 million this year to subsidize drug coverage.  

Who is benefiting from all this money? In reality the government is subsidizing the healthcare insurance industry at a sizable profit. One can blame it on the Republicans. However it was a bipartisan bill with politicians being influenced by the vested interests of the healthcare insurance industry.

I have received many complaints about Medicare Part D. An outstanding complaint of a patient reaching the $2500 drug subsidy limit was a patient with glaucoma. The drops the patient was prescribed was not generic. The patient had a $65 co-pay. She paid this amount without noting the amount charged to her. After she paid $65 a month for 5 months she was out of drug coverage and into her Medicare Part D doughnut hole. She was charged $500 for her sixth month prescription. This was an out of pocket expense.

She complained to her ophthalmologist. Her ophthalmologist discovered that the retail price on the glucoma eyes drops was $90 for a one month supply bottle rather than $500 charged Medicare by the pharmacy. Her Medicare Part D account was charged $500 each month. She tried to complain but got nowhere. She did not receive a response from the healthcare insurance carrier or the government. The pharmacy said this was the price. They could not tell her how much the healthcare insurance company paid the pharmacy.

“The new estimates for Medicare Part D were based on bids submitted by companies that receive government subsidies to offer the plans.” “About 25.4 million Americans have drug coverage through Medicare, 17.7 million of them in standalone plans and 7.7 million in Medicare Advantage plans that provide health care through private insurers.”

My guess is the healthcare insurance companies make a greater net profit from Medicare Advantage than Medicare Part D because the subsidy is greater.

The point of these examples is the government will overpay the healthcare insurance companies and undercover patients for care. It continuously cuts the reimbursement to physicians while a facilitator stakeholder increases its profit.

George Bush recently proposed consumers pay for Medicare Part D on a means tested bases. He did not demand price transparency or cut the profit from the subsidy to the healthcare insurance industry.

“Republican President George W. Bush proposed raising the premiums paid by individuals earning more than $82,000 a year and married couples making more than $164,000. Democrats in Congress have said the government should have to power to negotiate directly with drug makers to hold down prices.”

Barack Obama plan will simply extend the charade. The only way to fix it is to have the consumer control their healthcare dollar and motivate him to use is healthcare dollar wisely.

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

Stanley Feld M.D.,FACP,MACE

Barack Obama’s healthcare policy calls for subsidies.

Subsidies

“Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.”

Barack Obama should do some arithmetic. A minimum wage worker without a healthcare insurance benefit does not qualify for Medicaid coverage in most states.

Presently in Texas a family can not earn more than $800 a month in order to receive Medicaid. A family of four can not live on $10,000 a year and think of buying health insurance. Moises has a very difficult time supporting his family earning $22,000 a year. He worries about getting sick every day of his life but can not spare a penny of his income for healthcare coverage. .

Poverty today is defined by a 1955 definition. It is not adequate. President Bush rejected the SCHIP program twice because he sees the deficit writing on the wall. Republicans want to eliminate entitlement programs not add them. An additional entitlement will bankrupt the country at a faster rate than our present Medicare and Medicaid programs.

Maybe we could help the needy with a healthcare insurance program that would create incentives to be responsible for their health (exercise, lack of obesity and adherence to medication), and medical care? Maybe we could create programs to stimulate corporate America to promote wellness and exercise social responsibility to combat obesity? This would be a worthwhile investment for our government. It might even be a better investment that protecting corporations in search of increasing markets in the name of globalization.

Obesity, addiction, non-compliance with recommended medical treatment is a huge cost to our system. It must be dealt with. Only the consumer can deal with these issues on a personal level.

Some states like Indiana and New Jersey have tried to increase the income level for the eligibility for Medicaid. The federal government has refused to fund these new definitions because it does not have the money to pay for it.

States that are in worse shape financially than the federal government need to fund the difference. The only way it can be done is by raising taxes.

Michael Bloomberg seems to be the only politician with constructive ideas.

The “bipartisan Romney plan” of universal healthcare coverage in Massachusetts is shaping up to be another disaster of fuzzy thinking. The intention was good. The cost overrun this year is in the range of over $400 million dollars. The present Massachusetts administrators are hailing their universal healthcare plan as a success because more people are insured. The problem is the administrators have left the pricing and control of the healthcare insurance coverage in the hands of the healthcare insurance companies. The plan has not eliminated any of the administrative inefficiencies of the healthcare insurance industry or encourages medical practice efficiencies. It does not encourage patient responsibility nor chronic disease management incentives.

The Massachusetts plan is certainly going to result in an increase in state tax is Massachusetts.

Barack Obama’s policy statement on Subsides is naive. It presents a false hope without a plan. All government subsides so far have gone to the wrong stakeholder. The result of a policy executed with this open ended philosophy will result in increased government cost. In effect the government is providing an entitlement for the healthcare insurance industry. They are leaving control of pricing and administration in the healthcare insurance industry’s hands. An increase in government spending will result in a decrease in healthcare coverage for the average person as well.

How can I say that? Recent past history has demonstrated it. As long as the healthcare insurance industry is in control of the pricing, government bureaucracy is suppose to oversee that pricing. Historically the price has increased and healthcare coverage has decreased.

To paraphrase Yogi Berra “it is the $600 toilet seats all over again”.

Stanley Feld M.D.,FACP,MACE

Every week the words used to describe Barack Obama’s healthcare policy change. I am going to review his healthcare platform as described during the week of August 5-11^th. Each platform revision has the same bottom line. The bottom line is universal coverage with the government being the single party payer.(socialized medicine with all its regulations and inefficiencies).

However, each week his words are refined to made them more palatable. It gets to the point where one could believe the words are something more significant than they are. Clearly Barack Obama’s platform is not a solution to our dysfunctional healthcare system. I will evaluate each of his heading separately.

Comprehensive benefits. “The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”

This sounds perfect because 90% of the healthcare dollars is spent on the complications of chronic diseases. However, the restrictions to access to care and the availability of care have to be analyzed to be understood. Does anyone think Senator Kennedy suffered any of these restrictions for the treatment of his brain tumor?

When Senator Edward M. Kennedy disclosed on May 20 that he had brain cancer, three days after suffering a seizure, doctors did not list surgery as a possibility. A news release from Massachusetts General Hospital in Boston left the impression that radiation and chemotherapy were the main options for his pernicious type of cancer.

Precisely why Mr. Kennedy’s treatment course changed is not known; he and his doctors are not talking to reporters.

What is known is that a few days after Mr. Kennedy learned he had a malignant brain tumor in the left parietal lobe, he invited a group of national experts to discuss his case.

The meeting on May 30 was extraordinary in at least two ways.

One was the ability of a powerful patient — in this case, a scion of a legendary political family and the chairman of the Senate’s health committee — to summon noted consultants to learn about the latest therapy and research findings.

The second was his efficiency in quickly convening more than a dozen experts from at least six academic centers. Some flew to Boston. Others participated by telephone after receiving pertinent test results and other medical records.

Is this what Senator Obama means by The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have.” Does anyone believe this policy would produce the care Senator Kennedy received? If it were true it would be great. However, this is an expansion of an entitlement America can not afford without improving the many inefficiencies and loopholes in the present healthcare system.

Stanley Feld M.D.,FACP.MACE

A few weeks ago Thomas Schweich wrote an article in the New York Times magazine section entitled “Is Afghanistan a Narco-State?” This was in the midst of President Bush drawing down troops in Iraq and sending them to Afghanistan to suppress the Taliban and Al Qaeda once more. Senator Obama has said for over a year the real threat is in Afghanistan and not Iraq. This is the fight against our terrorist enemy. Senator McCain has said we need to win both wars.

John Moore/Getty Images

"POPPY FIELDS FOREVER A crop in Helmand Province in 2006. An unlikely coalition of corrupt Afghan officials, timorous Europeans, blinkered Pentagon officers and the Taliban has made poppy cultivation stubbornly resistant to eradication. "

How does Afghanistan’s production of 90% of the world’s heroin relate to Repairing America’s Healthcare System? Both candidates have pledged to reduce the costs of the healthcare system but have ignored this $180 billion dollar a year medical cost to the healthcare system.

“Thomas Schweich was a senior counternarcotics official in 2006 and had recently arrived in Afghanistan the country that supplies 90 percent of the world’s heroin. Hamid Karzia thanked the American people for all they had done for Afghanistan." Mr. Schweich took to heart Karzai’s strong statements against the Afghan drug trade. He now declares that “it was my first mistake” and his NYTimes article brilliantly describes his mistake.

It is an eye opening article because the Karzai government supports the drug trade and the United State Defense department and our European allies have turned their back on eradicating the poppy fields and the heroin trade for “political reasons”. The article is an absolute must read even if it is only 75% accurate.

What is our present administration thinking?

“The Afghan government is involved in protecting the opium trade — by shielding it from American-designed policies. While it is true that Karzai’s Taliban enemies finance themselves from the drug trade, so do many of his supporters. He is not going to let the narco trade disappear”

Our government is putting our soldiers in harms way to support a corrupt narcotic producing government in the name of the “War on Terror”. The present administration does not have a cohesive anti-drug policy nor is it thinking of the problem’s impact on the cost of healthcare.

”The cost to society of illicit drug abuse alone is $181 billion annually.”

This does not include any of the societal costs. When combined with alcohol and tobacco costs, they exceed $500 billion including healthcare, criminal justice, and lost productivity. The administration is not connecting the dots or using common sense. There is no sign that the next administration will do differently. The cost of drug addiction is a tremendous burden to the healthcare system.

“It is not just dollars and cents, but there is a human cost in tragedies across this Nation. There are nearly 1.6 million Americans, in jail because of illegal narcotics crime activities. There have been 15,200-plus deaths, up almost 8 percent over the previous year, drug-induced deaths not to mention lost opportunities for so many Americans.”

The Bush administration’s actions remind me of the “Mole and Grub” story. Moles eat grubs. Our government is killing moles one at a time. In the process we are getting our soldiers killed along with our citizens who become drug addicts. It is a very difficult, costly and unconquerable process. If we killed the grubs the moles would starve to death.

I believe some of the people in our government have the courage to kill the grubs. However, the officials that count (the administration) refuses to see the consequences of their present inaction. It does not look like it is going to get any better during the next administration unless the citizens demand action.

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

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