Stanley Feld M.D.,FACE,MACE

It is not fair to criticize the Republican Party’s healthcare proposal without providing the reader with the source material. The source material comes from Senator Tom Coburn’s web site. My negative comments should be judged in light of the original proposal. The executive summary follows.

Preventing Disease and Promoting Healthier Lifestyles

· Critical investments in public health and disease prevention will go a long way in restraining

health care costs and improving the quality of Americans’ lives. The Patient’s Choice Act of 2009 would:

• Encourage increased coordination of federal prevention efforts and bring long‐overdue accountability to these programs

• Require CDC to undertake a national campaign highlighting science‐based health promotion strategies

• Equip recipients of Supplemental Nutritional Benefits with easily understandable information about nutritious food options and target the use of food stamps to healthy food choices

• Invest $50 million annually for increased vaccine availability and bonus grants to states that achieve 90 percent or greater coverage of CDC‐recommended vaccines

• Provide incentives for states to reduce rates of chronic disease like heart disease and diabetes

All of the above proposals should be executed. How will they be implemented? The Republicans do not have a plan but not having a plan does not make the Democrat’s plan a good one.

Creating Affordable and Accessible Health Insurance Options

Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant market for health insurance that is consistent and fair will allow all Americans access to health coverage.

How will Republicans make a vibrant market for healthcare insurance? How will people who cannot afford healthcare insurance pay for it? The tax credits might help a little. However, if you do not have the cash you cannot pay for the insurance.

The Patient’s Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the following:

• Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different health insurance policies and select the one that meets their unique needs

• Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range of choices

• Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating Exchange insurers based on age or health

What will the premium be for those with preexisting illnesses? Will the premiums be higher for patients with preexisting illnesses? The high risk pool premiums have been very expensive.

• Creates a non‐profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre‐existing conditions.

• Expands coverage through auto‐enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year

This is an empty statement. How will this be administered? The devil is in the details and there are no details presented.

• Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’

Risk pooling has been tried and has been unsuccessful. It has been an excuse to allow the insurance industry to spread the risk. The proposal also implies variable premiums.

Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage

Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get their health coverage through their employers, discriminating against the self‐employed, the unemployed, and small businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by:

• Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family

• Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid with HSAs without a tax penalty

• Allowing preventative services to be covered by High Deductible Health Plans

• Increasing the amount of money an HSA owner may annually contribute to their account

Healthcare insurance premiums are $14,000.00 a year for a family. A $5,700.00 tax credit does not cover it. It also assumes the consumer has enough income to have a $5,700.00 be tax liability. Citizens are not subject to income tax if they make up to $38,000.00 year. HSA’s retain the healthcare dollar to be used for future spending on healthcare. The healthcare insurance industry retains control over the premium and the healthcare dollars. It is not a pro consumer proposal. It does not offer financial incentives to consumers .

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

Stanley Feld M.D.,FACP.MACE

Republicans in Congress have introduced their health care reform plan. "The Patients’ Choice Act of 2009," has been introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA).

The proposal that relies heavily on private mechanisms does not contain an individual mandate to have healthcare insurance, It offers insufficient tax credits for families and individuals previously insured and not in a group insurance plan. It must be noted that people who make less than $38,000 per year pay no income tax. A tax credit is meaningless to them. These are the people who are uninsured.

Individuals not in a group insurance plan pay retail for healthcare insurance premiums with after tax dollars. Employers that have group healthcare insurance for employees, pay the insurance premiums with pretax dollars.

The new Republican healthcare plan would eliminate employers tax deductible benefit. This would discourage employers from providing healthcare insurance to employees. The plan is not dissimilar to the proposal championed by John McCain during the presidential campaign. His proposal was considered inadequate.

“The focus of the proposal is to push for a "guaranteed choice of coverage" in the private market through federal-state partnerships know as State Health Insurance Exchanges.

Individuals will have a "one-stop marketplace" to choose plans in the exchange, including the option of keeping their employer coverage and/or existing insurer.

The plan eliminates pre-tax dollar deduction for employers who provide health coverage to their employees. It provides a $5,710 tax credit to families and a $2,290 tax credit to individuals toward the purchase of health insurance coverage.

This is not enough of a tax credit to be effective for those who can afford to buy healthcare insurance. In reality it will save the government money. It would eliminate employer tax deduction. An unintended consequence will be an increase in thenumber of uninsured.

Healthcare insurance premiums average $14,000 per family and $7,000 per individual. The healthcare insurance industry cherry picks patients. It eliminates the sick and over 55 year olds with a high potential for illness. If its ability to cherry pick is eliminated the healthcare insurance premiums will be even higher.

The Republican healthcare plan does not state if the non insurable sick will be subject to the same or higher premiums.

"Participating insurers," meanwhile, would be required to "offer coverage to any individual — regardless of patient age or health history" though there is no mandate for an individual to purchase that insurance”.

Many things are wrong with the Republican party’s proposal. I am disappointed in Senator Tom Coburn. He is a “practicing M.D” he should know the real problems in the healthcare system..” The proposal has some good ideas but no suggestions on how to implement those ideas.

His plan ignores the real problems. The uninsured cannot afford to purchase healthcare insurance. Some young healthy people do not want spend the money for healthcare insurance. Many people are underinsured. Illegal immigrants are uninsured. They show up for care in our safety net hospitals. Our safety net hospitals are underfunded. The plan does not contain incentives for patients to work hard to remain healthy.

The reasons healthcare costs are so high are many. Price Waterhouse has calculated 1.1 trillion dollars is wasted dollars between defensive medicine and unnecessary administrative cost.

Medical care for the complications of chronic diseases absorbs 80% of the healthcare dollars. The complication rate can be reduced by at least 50% if patients became “professors of their disease” and they themselves prevented the complications. This can only be accomplished through education and financial incentives.

The proposal does not repair any of the abuses of the healthcare insurance industry, the government, the hospital systems or physicians.

The proposal gives employers a perfect excuse to drop insuring employees by the removal of their tax exemption for premiums. President Bush tried very hard to accomplish this and failed. .

The Republican plan would leave a greater number of Americans uninsured with no improvement in the health of the nation.

The Patients’ Choice Act contains many of the popular sound bites. It does not have a plan to achieve change. The only way change will occur is by leveling the playing field and providing incentives for patients. The plan keeps the healthcare insurance industry in control of the healthcare dollars.

It states; “ the Act transforms health care in America: strengthening the relationship between the

patient and the doctor; using the forces of choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans.”

I am disappointed in the Republican proposal. It is a proposal of empty words. The public will not be fooled. The public wants change. I will publish the executive summary so readers can judge for themselves.

Under the Republican plan, instead of a competitive marketplace for healthcare coverage I can visualize a market place dominated by a few healthcare insurance companies. The result will be further increase in cost of premiums. The healthcare insurance industry would continue to own the healthcare dollar and be non transparent.

The healthcare insurance industry would continue to abuse patients, physicians, hospitals and the government.

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

Stanley Feld M.D.,FACP,MACE

The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare.

“Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi schemes? The new Obama-Democrat budget deficit is $1.8 trillion, four times larger than it was only last year. The national public debt has increased by more than 10 percent since Inauguration Day.”

Social Security and Medicare are underfunded entitlement programs. Medicare for the entire country is not viable.

These are the published numbers for 2008.

• Social Security’s unfunded liabilities stood at $13.6 trillion.
• Medicare’s unfunded liabilities are more than $30 trillion.
• Medicaid, another severely underfunded and politically untouchable entitlement program, only adds to the total.
• The federal government’s current entitlement bill, including future obligations-based only on promises it has made in the past — is greater than $57 trillion.”

The first Baby Boomers started drawing early retirement benefits from Social Security last year.”

78 million people are going to stop working, stop paying taxes, stop paying into retirement programs and start drawing Social Security and Medicare benefits. The federal government has made explicit and implicit promises to millions of retiring citizens. It does not have the funds to keep those promises without a big hike in taxes.

“According to a recent forecast by the Congressional Budget Office shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century”

In order to get close to funding our current obligations it is estimated that the income tax rate will have to increase to 66%. With all the bailouts and economic stimulus packages the federal government’s debt can only get worse.

Yet the game of who can have better sound bites and who can win is the only thing that is important to President Obama, the healthcare insurance industry, and the Democratic congress.

Healthcare reform should not be about a National Healthcare Insurance Exchange or universal healthcare with a single party payer. This is not going to fix the healthcare system. It will make our financial problems worse. Our government officials should face reality. It should do what all physicians know needs to be done.

It should be passing legislation to create a less polluted environment. It should revise the Farm Bill. It should eliminate the use of corn syrup. It should fight obesity with public service educational campaigns. It should create an insurance product that provides consumers with financial incentives to stay healthy. It should eliminate the causes of administrative waste and defensive medicine. These should be the areas of discussion in order to repair the healthcare system. These bold topics threaten powerful vested interests and are politically explosive.

America should set up a healthcare insurance system that provides incentives consumers to demand better foodstuff and a healthier environment. Consumers should own their healthcare dollars and be able to save what they do not use. (ideal medical savings account).

The federal government should make the conversion to functional electronic medical records easier and less costly to physicians (ideal electronic medical record). We should have major tort reform to decrease the intolerable cost of defensive medical.

These are areas in which the healthcare reform debate should be focused. If the Republican Party wants to seize the initiative from the Democratic Party and excite the citizens of our country they need to act .

Instead, we have a silly debate pitting the new media (Democratic Party) against the old media (Republican Party) over systems we cannot afford. The new media will win. Americans lose no matter which side wins.

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

 Stanley Feld M.D.,FACP,MACE

 One week after President Obama announced that the nation's health insurance
lobby pledged to reduce healthcare costs by $2 trillion in ten years, Blue
Cross Blue Shield of North Carolina is putting the finishing touches on a public
message campaign aimed at killing a key plank in the Presidents reform
platform.

“Mr.
Obama had told the health care executives, “you’ve made a commitment; we expect
you to keep it.”

When the healthcare insurance lobby realized the trap it fell into it
immediately went to work to defend its control over the healthcare dollar. It is
going to roll out Harry and Louise as it did in 1993. I do not think it will
work. We are living in different times with different media tools.

“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.”

The healthcare insurance industry is going to try to destroy President
Obama’s “National Health Insurance Exchange”. If congress
passes the National Health Insurance Exchange it will lead to a single party
payer system. The government as the single party payer is unsustainable.

“As part of what it calls an "informational website," the company has
hired an outside PR company to make a series of videos sounding the alarm about
a government-sponsored health insurance option, known as the public
plan.’

The industry argues that creating a public insurance program will undermine
the marketplace and eventually lead to a single-payer style system.

Somehow, this isn't surprising. The health insurance industry has showed it
is not serious about controlling costs by
backing away from the promise they made to President Obama.

Now, it wants to eliminate the public health insurance option. The
public insurance option would provide an option for people who cannot afford buy
private insurance because of the healthcare insurance industry’s
restrictions.

“The public
health insurance option is a key provision in President Obama's plan to help
cover all of us. It would finally give everyone the choice between
keeping our current insurance or switching to a new, high-quality public
plan. And under a public health insurance plan our premiums wouldn't
subsidize CEO salaries or stockholder profits we'd all save a lot on
health care costs.”

There are basic problems with private healthcare insurance. Its premiums are
a very rough calculation with large profits built in. The industry has reduced
provider reimbursement and restricted access to care while raising premium and
maintaining grotesque administrative fees. The process is opaque to all.

The
government will do the same as a single party payer because it cannot afford the
program.

President
Obama’s thinking on cost savings is defective. The government outsources the
administrative services of its present government healthcare programs Medicare
and Medicaid to these very same healthcare insurance companies. The healthcare
insurance companies do the same thing to the government. Its providers
(physicians and hospitals) and consumers (patients) will experience the same
reductions and rationing of care. The program will fail just as the
Massachusetts program has failed to be affordable to the state. A systemic
change in the healthcare systems payment structure must occur in favor of
patients and physicians.

“If we had the choice of a public plan, private insurers would have to
lower rates and improve quality to compete, so they're dead set
against it.”

The crafting of a campaign by Blue Cross Blue Shield of North Carolina is the
first of many campaigns we will see in the coming months in an attempt to turn
public sentiment against the “National
Health Insurance Exchange.”

President Obama’s insurance exchange is another way of expanding the Medicare
program. His plan is to arrive at a single party payer through the back door
while promising to maintain the private insurance option. It is Hillary
Clinton’s healthcare plan of 1993 all over again. Nobody asked the practicing
physicians for solutions. Physicians’ representing associations have not done of
very good job of articulating solutions.

The
healthcare insurance industry is not looking to protect its customers
(consumers). It is looking to control the healthcare dollars and protect its
profits. However they have cooked the goose that laid their golden eggs by
abusing consumers, employers and physicians. Harry and Louise will not
work.

Consumers are frustrated and angry. They do not trust government or the
healthcare insurance industry. They are looking for a creative solution.

The new media, the internet and blogs provide a chance for consumers to
express themselves.

“ Obama
will backtrack on this one, too! I don't have any hope that America will join
the 20th century to become a "progressive" democracy. We are an oligarchy and it
will stay that way. Just look how we elect people for office. Millions raised,
millions disappearing in someone's pocket. Money rules! ”

Consumers, it is time we drove the healthcare system because our surrogates
have let us down.  

“Not surprised at all by this. The health insurance companies have had an
unbelievable advantage, they can do anything they want. The only thing they need
to do is keep Congress happy with lobbyists because Congress is not their
customer, they have their own insurance paid by you and I. It's gloves off time
on health reform. These guys will pull no punches, they are fighting for their
yachts. While we lose insurance if we file a claim.”

It is time for consumers to demand control of their healthcare dollar. It is
time they have incentives to be responsible for their own health and be rewarded
for staying healthy. My
ideal medical savings account either funded by employers if the consumer is
employed or funded by the government with insurance for all is the solution that
must be demanded.

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