Stanley Feld M.D.,FACP,MACE

It is easy for the presidential candidates to promise healthcare for all during a presidential election year. However this promise is made without testing reality. The reality is America can not afford to deliver healthcare to all. The country is having difficulty keeping its public hospitals open. These public hospitals are centers for last resort care.

“The prospects that Grady Memorial could close, and that Atlanta’s health infrastructure could crumble, have forced a civic re-examination of the region’s commitment to its least fortunate, a reckoning that has revived old antagonisms over race, power and class.”

“Some have suggested that Grady must compete for paying customers in Atlanta’s fierce medical marketplace, while others say that taxpayers should contribute more to continue its mission. Will Grady outsource, or simply downsize? And if it must downsize, which patients should be turned away?”

None of the presidential candidates have suggested viable solutions to the healthcare system’s problems. I think the Democratic Party wants its declared initiatives to fail. After the initiatives fail they will claim there is no other choice but universal healthcare system with the government as the single party payer. The failure of the proposed insurance paradigm is a back door entry to a single party payer system.

A recent Fortune magazine article said: “Medicare is poised to wreak havoc on the economy. And our presidential candidates are avoiding the issue.”

Alan Greenspan has been quoted as saying “the biggest threat to the American economy is Medicare. You’d think that the greatest threat to America’s economy would be Topic A for the presidential candidates. But it’s actually a topic they hate to touch.”

Instead, the great debate between Hillary Clinton and Barach Obama is to mandate universal coverage or not. If you require people to buy healthcare insurance using a defective healthcare insurance model all you will be doing is providing more customers for the healthcare insurance industry.

“An analysis of their speeches shows that last year Senators Hillary Clinton, John McCain, and Barack Obama would occasionally mention the Medicare mess. But recently, with the economy slowing and voters feeling insecure, all three candidates have turned more populist: Their economic talking points are about feel-good reassurances, not about facing hard realities.”

Americans should be suspicious of Sen. Clinton’s promises. I mention her because she has been the most vocal in diverting us from the reality of the government run healthcare systems mess.

“Unfortunately the day of reckoning is imminent. Sometime in the next President’s first term, Medicare Part A (hospital insurance) will go cash-flow-negative, and it’s all downhill from there.”

“Medicare services more than 40 million old and disabled Americans. As the country ages, Medicare and Medicaid will devour growing chunks of U.S. economic output.”

This is especially true if our obesity epidemic continues. Obese people are more prone to chronic diseases such as diabetes mellitus, hypertension and coronary artery disease.

If we institute universal coverage and single party payer the estimate of healthcare costs consuming 18% of our GNP will jump to 40% of our GNP by 2020.

“In 2070, when today’s kids are retiring, Medicare, Medicaid, and Social Security will consume the entire federal budget, with Medicare taking by far the largest share. No Army, no Navy, no Education Department – just those three programs.”

“Those estimates, reported in the latest Financial Report of the U.S. Government, assume that Medicare payments to doctors will be slashed drastically, by some 41% over the next nine years, as required by current law. It won’t happen. Every year for the past five years, Congress has overridden the mandatory cuts.”

It is obvious something has to change. The estimate of healthcare costs is base on a defect financial reporting by the US Government. The financial report admits these defects.

“As for future cuts, the Financial Report says drily, “Reductions of this magnitude are not feasible and are very unlikely to occur fully in practice.” So in reality, Medicare will go into the hole even faster than official projections reflect. And they show that if Medicare had to be accounted for like a company pension fund, it would be underfunded by $34 trillion.”

The Congress has been correct in its override of proposed Medicare cuts yearly. However, they have done it for the wrong reasons. I have been against the Medicare cuts to cognitive physicians. Medicare cuts do not solve the basic structural healthcare problems.

There are many other constructive solutions. These solutions include a War on Obesity, effective malpractice reform, encouragement of effective disease management and incentives for both patients and physicians to practice effective disease prevention and disease management to decrease the onset of complications of chronic diseases. The solution can only be accomplished with real price transparency by all the stakeholders, an ideal medical saving account, an ideal electronic medical record, and the creation of a system of competition so that the patients own their healthcare dollars and all the other stakeholders compete for their healthcare dollar. These elements of the solution can not be done piece meal. They have to be introduced and enacted as a complete package in order to be effective.

The solution proposed will probably never be enacted. The people (“People Power”) have to make the demand for effective change. There are too many powerful stakeholders who will lose and will not let effective change occur.

Physicians do an excellent job of fixing things that are broken. The government, corporate policies, patients, the healthcare insurance industry and physicians do little to prevent our bodies from becoming broken.
If Mr. Greenspan is correct and the healthcare crisis is “ the greatest threat to the U.S. economy and the candidates haven’t told us what they’d do about it, they haven’t told us a thing.”
The candidates should develop an understanding of the problems and viable solutions to the problems. However, they are avoiding them.

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

Stanley Feld M.D.,FACP,MACE
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Public hospitals in cities throughout America have been safety net hospitals for the indigent in its communities. Grady Memorial Hospital is such a large public hospital in Atlanta Georgia. It is in financial crisis as is many public hospitals in many cities in our country. A majority of Americans have no idea of the difficulty these invaluable resources have had in the last 20 years. In fact there were 1,600 public hospitals in the country 15 years ago. Three hundred have been force to close because of financial insolvency. The remaining 1,300 are struggling.

“Grady Memorial Hospital is home to Atlanta’s only emergency ambulance fleet and only Level 1 trauma center in north Georgia.. A teaching hospital, Grady owes $71 million to Emory University and Morehouse School of Medicine, which provides it with doctors.”

Grady Memorial Hospital does not have the money to pay its medical schools to provide physicians. The medical schools can not afford to donate their time to Grady Memorial nor can the medical schools survive without the income from Grady Memorial. It is in a Catch 22.

“To generations of Georgians, this city is unimaginable without Grady. Yet that has been the prospect facing the region for the last year, the result of a multimillion-dollar shortfall in the cost of providing charity and emergency care that no one — not the counties, the state nor the federal government — has been willing to cover, though Grady provides vital services to the entire region.”

The counties, the state and the federal government can not afford to cover Grady Memorial’s shortfall. How can we expect the state or the federal government to provide universal healthcare insurance?

“Once admired for its skill in treating a population afflicted by both social and physical ills, Grady, a teaching hospital, now faces the prospect of losing its accreditation. Only short-term financial transfusions have kept it from closing its doors, as Martin Luther King Jr.-Harbor Hospital in Los Angeles County did last year. That scenario would flood the region’s non-profit hospitals with uninsured patients and eliminate the training ground for one of every four Georgia doctors.”

The community hospitals are non-profit hospitals. They enjoy tax free status because they have made a commitment to provide indigent care for 20% of their admission. Most of the community hospitals do not fulfill that commitment. However the government does not enforce the community hospital’s commitment.

“Grady is among the most distressed of the country’s 1,300 public hospitals, others have faced similar challenges in recent years, including those in Miami, Memphis and Chicago, said Larry S. Gage, president of the National Association of Public Hospitals and Health Systems. Public hospitals have been forced to close in Los Angeles, Washington, St. Louis and Milwaukee.”

In order to survive, services are curtailed and access to care is restricted. If one definition of quality medical care is the right care at the right time our public hospitals are going in the wrong direction.

“Providers feel the strains when each counselor has to counsel 20 patients in a day, twice as many as they did only five years ago. Or when they have to tell diabetics at risk of blindness that it might take four months to get an eye appointment.”

As funds diminished, newer technology has not been installed at Grady Memorial.

“Its outdated technology is obvious in the emergency room, where patients are tracked not by computer but by hand on a greaseboard and on forms passed from tray to tray.”

” A third of the hospital’s patients, including those treated as outpatients, are uninsured, among them a rapidly growing group of immigrants. Another third are covered by Medicaid, which reimburses at rates well below Grady’s actual costs. Many hospitals use their privately insured patients to subsidize indigent care, but at Grady, only 8 percent of inpatients fit the privately insured category.”

The public hospital systems as well as the private and non profit hospital systems are operating under healthcare models that are no longer sustainable and will all implode unless they reinvent themselves.
With Medicare and private insurers reducing reimbursement hospitals are going to have to start decreasing salaries. Rather than decreasing administrative salaries they have started reducing nursing and other ancillary workers’ salaries. The hospitals have started to complaint they have a shortage of personnel.

“ The National Association of Public Hospitals says its members account for 2 percent of all hospitals, but provide 25 percent of the nation’s uncompensated care to uninsured and under insured.”
“Over the years, the cost of caring for the uninsured and underinsured has grown while taxpayer support has stagnated. Suburban counties have declined to pay a share of those costs, though their residents regularly wind up in Grady’s emergency room and its highly regarded centers for burn and poison treatment.”

This is a major problem in all the public hospitals in the country. Many cities have a dumping problem. The for profit and not for profit hospitals send extremely ill patients into the public hospitals for care even though many of these hospitals are in suburban counties that do not contribute to the public hospitals’ budget.

“Grady officials estimate it would take $366 million to meet long-ignored capital needs, like replacing quarter-century-old beds, antiquated computers, and the trauma ward X-ray machine, which conked out two years ago. Department chiefs predict a growing difficulty in recruiting physicians and residents.”

Even though the patient mix is extremely interesting and educational physicians in training simply do not want to learn in an antiquated infrastructure.

“Despite the efforts of the hospital’s passionately committed staff, patient care is clearly suffering. There are interminable waits for appointments, some services have been discontinued and the hospital ranks below average on safety measures like preventing bed sores, infections, and even death in low-risk procedures. One study, for example, ranks Grady nearly dead last in the nation in following standards for treating pneumonia.”

Grady Memorial Hospital must survive and must be upgraded.

“ Grady’s value is more than sentimental — it is essential to the region’s health.

None of the presidential candidates have mentioned the problems in the public hospital system. I think they should.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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Stanley Feld MD,FACP,MACE

The beauty of Medicare is that patients are automatically insurable despite preexisting illness without a premium penalty.

I received this note today;

“ Did you know that diabetes is considered an “uninsurable diagnosis” as stated by the insurance industry. Unless a person is covered under an employer, or under someone else’s policy, as an individual seeking health care coverage, that individual has an “uninsurable diagnosis”….. that’s health care in this country.

M K, RN”

The answer is yes I do know. That is one of the great defects in the healthcare system.

The only premium penalty is a means testing penalty. I believe means adjusted premiums are an excellent idea. The slight defect is Medicare’s means adjustment formula. This defect could easily be repaired.

The big problem with Medicare and the private healthcare insurance industry is their payment structure. There are few incentives for patients to save premium dollars and disincentives for physicians to accept the endless reductions in reimbursements. All recent actions to improve the system such as P4P are punitive action. Punitive rules are impossible to enforce.

If the healthcare system has to mandate something it should mandate the prevention of complications of chronic disease. Ninety percent of Medicare’s healthcare dollar is spent on the complications of chronic disease. If this happens we could decrease the cost of care by at least 50%.

It should be every patient’s obligation to become the professor of his chronic disease. Financial incentives could help patients realize their obligation to themselves.

We are on the verge of a severe physician shortage because of overuse of the system despite the fact that 47 million people are uninsured. The payments for the treatment of the complications of chronic diseases are bankrupting the healthcare system even in the face of decreasing provider reimbursement.

The healthcare insurance industry is not interested in making any structural changes. It is doing just fine earning ever increasing profits and paying outrageous executive salaries. The insurance industry’s focus is to collect the highest premium from the least sick patients.

The exposure of abuses to the healthcare system by the healthcare insurance industry in California can lead the way to effective reform if the abuses are handled appropriately.

Wellpoint inc. with BC/BS of California and BC Life & Health and Health Net are not the only companies abusing the system.

“The lawsuit is the latest action by state regulators, lawmakers, doctors, patients and now law enforcement officials targeting insurance company practices — notably canceling policies when they become too expensive for the insurers.”

Surveys of the other plans — Kaiser, and PacifiCare — are ongoing.

This lame excuse given by a healthcare company should result suspension of its license to sell insurance in the state as opposed to a meager fine.

The healthcare insurance companies, however, maintain that they do this to keep costs down by weeding out people who may have failed to disclose preexisting conditions when they applied for coverage.”

There should be no exclusions for preexisting conditions. Preexisting condition exclusions lead to more uninsured and bigger strains on patients. The results would be increasing personal bankruptcies and bigger burdens on local charity hospitals.

The revelation that Health Net plans have cancellation goals and employee bonuses for rescinding the insurance coverage comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

Most of the state’s major insurers have cancellation departments or individuals assigned to review coverage applications. They typically pull a policyholder’s records after major medical claims are made to ensure that the client qualified for coverage at the outset.

Anyone with any knowledge of healthcare insurance companies’ operations knows about their cancellations department. The State Boards of Insurance are our surrogate for fair insurance practices. They should review and act promptly and automatically on all unfair practices.

”Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.”
This is typical of bureaucratic systems. Usually intentions are good. The details and compromises with healthcare insurance companies’ lawyers decrease the bureaucratic systems ability to act.

“Eight months after pledging to put the brakes on retroactive cancellations of individual health insurance policies, the state agency that regulates HMOs said Tuesday that new rules were taking longer than anticipated because of the variety of health plans involved.”

Governor Schwarzenegger got the solution to the problem half right.

”The reforms sought by Gov. Arnold Schwarzenegger would require individuals to carry health insurance and would require insurers to sell it to everyone regardless of preexisting medical conditions.”

All California needs is to require insurers to sell it to everyone regardless of preexisting medical condition. They should not have the ability to rescind the insurance coverage. Governor Schwarzenegger caved into the healthcare insurance industry when he mandated insurance coverage. The insurance industry would love nothing better than to require everyone to buy healthcare insurance. They want the sick people to be paid for by the state and collect the premium from the young and healthy.

An industry trade group has long opposed new rules, saying they are unnecessary.

“Once proposed, new rescission rules could take as long as a year to be publicly aired and then revised and adopted or dropped. “

If the healthcare insurance industry did not have so much power and could not get away with all their abuses they would have to give people a good deal to be profitable. Everyone wants a good deal. Most of us understand the importance of health insurance. Some reject buying insurance because it is a bad deal for a low risk person paying with pretax dollars and healthcare insurance industry’s control over pricing, eligibility and rescissions.

“People Power” can solve the problem when public awareness of the healthcare industry’s abuse increases and the power of public opinion is activated.

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

Stanley Feld M.D.,FACP.MACE

In my first blog I said all the stakeholders are responsible for the dysfunction of the healthcare system. Patients, physicians, hospitals, drug companies, the government and the healthcare insurance industry are all to blame. In my view the healthcare insurance industry has done the most to destroy America’s healthcare system. In its quest for short term profit they are killing the goose that laid its golden egg.

California usually recognizes trends in America early. A trend has surfaced in Los Angeles. In the last year a number of law suits have been filed in California by political leaders, regulators and consumers. Decisions made in Los Angeles highlight the healthcare insurance industry as the big bad guy in America’s healthcare crisis. Patients’ complaints have sparked state hearings of Blue Cross policies.

“Regulators want to see whether the healthcare firm is adhering to an accord with California. California has received more than 1,600 complaints from consumers, physicians and hospitals about Blue Cross of California since the state’s largest health insurer was acquired by an Indiana firm in 2004, officials said Tuesday.”

One could guess the complaints are warranted. If complaints are surfacing in Los Angeles, one could also assume there is cause for complaint in the rest of the U.S. Hopefully the state boards of insurance in other states are heeding the complaints of citizens.

”The state announced plans this week to hold a public hearing in Los Angeles on July 19 on how well Blue Cross has lived up to promises it made nearly three years ago as part of the $21-billion acquisition.”

“It is the latest sign that state regulators are stepping up scrutiny of insurers, particularly Blue Cross, a unit of Indianapolis-based WellPoint, which has more than 8 million customers in California.”

The state regulators in each state have control over the issuing of permits to sell healthcare insurance in its state. State regulators are hopefully starting to flex their muscle in favor of patients. This should have been happening all along.

“The Department of Insurance, another California regulator, last week issued a report of an investigation that found BC Life & Health, another WellPoint unit, had revoked 1,880 individual health insurance policies in California in 2004 and 2005, and a review of 83 sample cases cited more than half for alleged violations of fair claims handling laws. The citations could lead to fines of as much as $10,000 per infraction.”

The way healthcare insurance companies increase their profits is to increase patients’ premiums, decrease patients’ healthcare insurance coverage, eliminate the sickest patients from their insurance roles, and reduce payment to providers. It seems that BC,BC of California a Wellpoint unit has done all of the above.

“This summer, Blue Cross is imposing fee reductions on physicians at the same time it is sending letters to policyholders notifying them that their premiums are going up because of increasing medical expenses, said Karen Nikos, a spokeswoman for the California Medical Assn., the state’s largest physician trade group.”

“This is exactly what we said would happen,” she said. “This is what happens when you only have a few insurance companies controlling all insurance. They do it because they can.”

Wellpoint, the parent company of Blue Cross, received reimbursement from Blue Cross. Blue Cross listed the reimbursement as an administrative expense. Blue Cross of California financial statements then justified an increase in healthcare premiums because of increasing expenses.

”Regulators also are troubled by a $950-million payment Blue Cross made this spring to WellPoint. The department is investigating whether the payment violates the state’s terms for the acquisition.”

The $950 million is the administrative fee of Wellpoint in California alone. It partly explains the $150 billion spent nationally for administrative fees to the healthcare industries.

California has many consumer rights organizations trying to protect the consumer.

“The Foundation for Consumer and Taxpayer Rights said it conducted an analysis of money Blue Cross has sent out of state to WellPoint and its affiliated companies since the acquisition, and the latest dividend was only the tip of the iceberg. The Santa Monica-based group, a frequent critic of the insurance industry, urged regulators to investigate as much as $6.5 billion in transfers from Blue Cross to WellPoint and its affiliates out of state.”

Blue Cross and Blue Shield is not the only company playing this game.

“The city attorney of Los Angeles says Health Net defrauded policyholders by dropping patients who needed costly care.”

“The company defrauded thousands of policyholders using “a wide range of unlawful, unfair and fraudulent acts and practices” aimed at avoiding payment for expensive treatment by canceling the policies of those who needed it, “rendering that coverage largely illusory,” the suit maintained.”

“Los Angeles City Atty. Rocky Delgadillo said in an interview Wednesday that he was opening a separate criminal investigation into Health Net’s practice of paying employee bonuses based in part on canceling policies of people who have submitted substantial medical claims.”

This lawsuit concentrates on individual healthcare insurance policies not group policies. The individual policy holders paid a premium for these policies with after tax dollars. For a company to create incentive bonuses for employees to find the sick patients and cancel their policies is unconscionable.

“Health Net has been in government investigators’ cross hairs before. In November, the company’s bonus program was made public in an arbitration hearing and sparked outrage. Within a week, Health Net was socked with a $1-million fine by state regulators for lying twice to investigators about such payments. The state is still investigating the company’s bonus and cancellation practices.”

“One of a handful of insurers that dominate the California marketplace, Health Net is the first to be tagged by a city task force investigating tactics throughout the industry that make it difficult or impossible for consumers to get the coverage for medical care they believed they were buying with their premiums.”

This week an arbitration judge ordered Health Net to pay one patient 9 million dollars for its behavior.

“Arbitration judge Sam Cianchetti found that by canceling the insurance policy of Patsy Bates, a breast cancer patient who used Health Net for her health insurance, the company violated numerous California laws, the Los Angeles Times said”.

“It’s difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive,” the retired Los Angeles County Superior Court judge said.”

I am happy to see the California Medical Association speaking out for patients. I am also happy to see that multiple state agencies and authorities are stepping up to solve these abuses to patients and providers.

“Dr. Richard Frankenstein, president of the California Medical Assn., applauded the effort to put an end to what he said looked like a scheme “to rapidly take people’s money and slowly tell them they won’t pay their claims.”

The state agencies are imposing fines. I do not believe fines are enough of a deterrent for these misdeeds. The following statement says it all.

“It is sort of like giving a bank robber a speeding ticket for driving too fast in the getaway car,” said Jerry Flanagan, a patient advocate with the Foundation for Consumer and Taxpayer Rights. “The real question is, what will they do next and are they looking at the underlying crime as opposed to a misdemeanor?”

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

Stanley Feld M.D.,FACP,.MACE

Neither the Democrats nor the Republicans are discussing the real causes of the escalating costs of healthcare.

The media, policy wonks and pundits are on another insignificant tangent about costs. I also believe our Presidential candidates are not interested in understanding the real problems in the healthcare system.

The solutions to the real problems challenge the vested interests of important and powerful secondary stakeholders. Secondary stakeholders finance the Presidential candidates’ campaigns.

America needs less costly political campaigns. Campaign finance reform would diminish the influence of secondary stakeholders in favor of the interests of the consumer. Candidates should be advocate for their most important constituent, the consumer.

Consumers have written to tell me the issues involved in healthcare reform are too complex to understand. I believe it is the consumers’ obligation to themselves and their families to understand the issues. It is the media’s obligation to truthfully present the issues. Politicians need to be shown the level of consumer concern or they will do nothing to reform the system.

The media is probably opposed to campaign finance reform. Its revenue would be severely decreased by campaign finance reform. None of the candidates would be able to afford advertisements on television or radio. Occassionally the media touches on a core issue that the politicians avoid. The issue is inequality in the tax code for healthcare.

“Democrats, and even a few Republicans, are in a populist mood, and fair enough. But if they really want the tax code to be more “progressive” — i.e., from each according to his means — they ought to forget the Bush tax cuts and address the way the government subsidizes health insurance. On the advice of our doctors, we’re not holding our breath.”

A progressive tax code is one core issue. Politicians are not dealing with the issue of the tax code and healthcare reform.

“According to the Democratic consensus, too many people lack health insurance, and the liberal remedy is to protect the status quo while expanding public programs for the uninsured.”

We know most public programs such as Medicare and Medicaid are on the verge of bankruptcy. Patients are constantly faced with diminished access to care and increasing out of pocket expenses for services not covered by these entitlements. Physicians are faced with ever decreasing reimbursement for services.

What makes anyone think that expanding public programs for the uninsured would lead to an increase in efficiency of care? How could expanding public programs decrease the cost of care and increase the quality of care or access to care?

“Not only does the current system cause unnecessary problems for the insured, but many of the gaps in coverage are the result of the way tax subsidies shortchange the uninsured, particularly working-class and middle-income families.”

This represents a perverse outcome to the Democratic Party’s declared mission to help working-class and middle income families.

“If such inequality and unfairness existed anywhere other than health care, the Democrats would be raising hell. Instead, they’re silent — which is politically telling.”

The Democrats are clever. They want to pass a healthcare policy that will fail. Then the only remaining option will be universal healthcare with a single party payer. The politicians’ goal is to keep consumers frighten and not in control of their own destiny. Frightened consumers lead to political power.

“The core problem is that people who get insurance through their employers pay no income or payroll taxes on the value of the benefit. The Treasury defines this as”tax expenditure,” meaning its revenue the government forgoes to encourage certain behavior. If these losses were converted to the equivalent of direct spending, the tax exemption would have cost more than $208 billion in 2006. The only federal programs that cost more are Social Security, Medicare and national defense.”

This deduction is in favor of employer and high income earners. The deduction is not reflected in the federal budget. The self insured do not enjoy an equal benefit.

“If the purpose of health-care reform is to decrease the ranks of the uninsured, these job-related tax breaks are poorly targeted, even regressive. The more generous the employer health plan, the more the subsidies increase. On average, lower-wage workers have more limited coverage as part of their compensation, usually from small- or medium-sized businesses. Estimates show that the subsidy is worth more than $3,000 for upper-income families (with higher marginal tax rates), and less than $1,000 for those on the lower income rungs.”

If the politicians really wanted to subsidize the poor, they would reverse structure of this subsidy. This is not a new insight. It is an insight that is simply ignored by politicians.

“So why the Democratic silence? Perhaps it’s because they think such a change would interfere with their main policy goal, which is slow but steady progress toward government control of the health-care market. Or possibly it’s because many of the most generous tax-subsidized health plans come from union-negotiated contracts. Or maybe Democrats simply don’t want to concede that President Bush has a point.”

All of the above are true. However, President Bush has not shown political will, nor does he have the political capital or courage to declare that all the reforms he suggested must occur simultaneously in order to be affective in repairing the healthcare system.

“If the Republican Party came to their senses, they would recognize an opportunity to poach a traditionally Democratic issue. Whatever the Democratic Party’s other ambitions, how can they stand by a system that offers the least assistance to the working class and nothing at all to the uninsured?”

Healthcare is a major national issue. Let us get on with the business of Repairing the Healthcare System. Consumers must understand the issues and demand reform.

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

Stanley Feld M.D.,FACP,MACE
The insurance industry is attempting to sound sympathetic to the plight of the uninsured. I think the attempt is an effort to diffuse their role as villain in our healthcare system.

“America’s Health Plans an association representing the healthcare insurance industry is saying their suggested steps are a way in which states and private insurers can work together to provide coverage in which insurers try to address shortcomings of the individual market.”

I would suggest the states proceed with caution. The states should carefully examine the details of the proposals and the motivation of the healthcare insurance industry.

The goal of the healthcare insurance industry is to increase its insurance roles with the state subsidizing the insurance policies. The defect is that it would be following the rules of the present healthcare insurance premium structure. It would not be creating incentives for the patients, physicians, or hospital systems.
Massachusetts recently reported a doubling of the insurance premium under the state Romney plan of universal coverage.

A self employed person between 50 and 65 years old can not buy affordable healthcare insurance with after tax dollars using the present actuarial rules for determining premiums.

“Currently, about 11 percent of all individuals who apply for coverage are not offered a policy after the insurers review their medical conditions, according to a new survey of the trade group’s members. And nearly 30 percent of individuals who are in their 60s but too young for Medicare are denied coverage.”

“To extend coverage to high-risk people with expensive medical problems, or likely to incur them, would cost money, and states might not go along. In states that already have programs for high-risk individuals, significant numbers of people still do not obtain coverage because the premiums are high.”
“Few states are willing to come up with the money to subsidize them so they can cover enough people,” Mr. Ginsburg said.

The states high risk pools have failed because of the premium structure and actuarial rules. The healthcare insurance industry refuses to adopted a community rating system. It would be unfavorable to its bottom line.

“In fact, only about 180,000 people around the country were covered by existing high-risk pools, said Katherine Swartz, a Harvard professor who studies health insurance issues. “

“The new proposals call for states to provide affordable coverage to anyone whose medical costs are expected to be at least twice the average. For other higher-risk patients who do not meet those criteria, the insurers would agree to cap the premiums at 150 percent of the market rate.”

There you go. The devil is in the details. The goal of the healthcare insurance industry is revealed.

“I have optimism that the states and the country will step up to the issue,” said Ronald A. Williams, the chief executive of Aetna, a large insurer in Hartford.”

I believe everyone is fed up with the healthcare systems’ structure. However, no one seems to be willing to relinquish his agenda in favor of the patients. The patients have to be responsible for their care and in control of their healthcare dollar.

“The trade association declined to provide any estimates for the cost of its proposals.”

“The insurance industry has backed health care change before. Insurers were at first supportive of the initiatives of President Bill Clinton in the mid-1990s, until they felt threatened and unleashed the memorable “Harry and Louise” advertising campaign that helped derail the effort.”

But Ms. Ignagni said her group was ready to push for change. “What’s different than in 1992 is we as an industry did not have a proposal of our own,”

I believe the healthcare insurance industry wants to sound as if it are going to help solve the problem of the uninsured. Patients’ ability to become insured might improve slightly. The healthcare insurance industry’s proposal will lead the states and federal government to create an entitlement with a single party payer system. This is exactly what the Democratic Party wants to accomplish.

I think the healthcare insurance industry is acting for short term maintenance of control over the healthcare system. When it realized the error in its ways in 1994 it introduced Harry and Louise to the healthcare system. I have a feeling we are going to be seeing Harry and Louise soon.

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

Stanley Feld M.D.,FACP,MACE

In 1994 the insurance industry produced an advertising campaign that torpedoed Hillary Clinton’s healthcare plan. The campaign introduced Harry and Louise to America.

Hillary Clinton’s plan would have been a disaster if enacted. I believe it would have left the healthcare system in worse shape than it is now. I was against Mrs. Clinton’s healthcare plan. (HillaryCare). I was rooting for Harry and Louise. One tends to ignore the subtext of modern advertising campaigns when it seems to be competing with a policy one is against. Harry and Louise was simply a mass mind manipulation campaign by the healthcare insurance industry in order to retain control over the healthcare system.

I predict the healthcare insurance industry is getting prepared for another Harry and Louise campaign.

“Acknowledging that too many people simply cannot obtain health insurance on their own, the insurance industry plans to propose a series of steps the companies say would let more individuals, even those who have health problems, obtain coverage.”

The insurance industry’s strategy seems to be to get the heat off it during the presidential campaign and appearing to be sympathetic to the middle class individual with a preexisting illness and issue insurance to previously unqualified applicants.

“The industry’s announcement comes at a time when dozens of states are already considering some kind of health reform and insurers are increasingly being vilified by the Democratic presidential candidates.”

“The devil is in the details.” Unfortunately our sound bite society is not interested in the details. I believe the healthcare insurance industry is generating false hope in order to decrease the vilification during this presidential campaign season. I believe their intent is to maintain their control over the healthcare system. .

“The proposals, approved by a board of the industry’s main trade group (America’s Health Insurance Plans), would make it harder for insurers to cancel policies or deny coverage to people with pre-existing medical conditions. The steps would also limit the premiums that could be charged for such people.”

It sounds great. The catch is the healthcare industry is going to dump all of the problems on the taxpayer rather than take any more risk.

“The trade group also called on states to provide individual coverage for people who were likely to incur very high medical bills.”
“The effort is meant to help address the problem of 47 million Americans without health coverage. And it signals a willingness by insurers to abandon practices that have seemed aimed at excluding all but the healthiest individuals.”

If we read the details carefully nothing is substantially changed except a positive public relations push.

“We are taking responsibility for ensuring that no one falls through the cracks,” said Karen Ignagni, the chief executive of the trade group, America’s Health Insurance Plans.”

The healthcare insurance industry seems to be playing into the hands of the Democratic Party’s candidates by provide universal coverage for all. It wants to help set the rules so they can continue to cherry pick the lower risk patients.

“It is far from certain whether any of the specific proposals will be enacted or states will finance the cost of broader coverage. But the industry’s position indicates a willingness to move toward a system in which everyone can find coverage.”

The healthcare insurance industry wants to sound like it is going to help the people.

This month, former Senator John Edwards pledged to take on the insurance companies, saying “the American health care system is broken because wealthy insurance corporations and their lobbyists have rigged the system against the American people.”

I believe in reality they want to get the presidential candidate’s off its back.

“ The industry is trying to have a greater say in any state changes that may be enacted. Many insurers chafe, for instance, over what they consider an overly regulated approach in Massachusetts. Despite the Massachusetts controls the cost overrun are unmanageable.”

It seems pretty clear that the healthcare insurance industry wants to look like it is going to help while keeping the system rigged.

“The health insurance is coming to grips with the fact that practices that are clearly driven by market forces are giving the industry a black eye,” said Paul B. Ginsburg, the president of the Center for Studying Health System Change. “

Paul Ginsburg is correct. I think the insurance industry is trying to get society to vilify some other stakeholder. The weakest stakeholder in the system is the physician. I think we will be seeing this shift shortly.

“The insurance industry has backed health care change before. Insurers were at first supportive of the initiatives of President Bill Clinton in the mid-1990s, until they felt threatened.”

The healthcare insurance industry is shooting itself in the head with this initiative. If this faulty reform is turned into legislation sixty to seventy percent of the population will be on a government entitlement program. Once the industry sees this they will roll out Harry and Louise to turn public opinion against the lawmakers. I don’t doubt that this is part of its strategic plan.

The Harry and Louise campaign had the most direct impact on the downfall of Hillarycare in 1993.

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