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Politicians,Healthcare and Vested Interests

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Another Perverse Medical Outcome of Government Policy

 

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.

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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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Politicians Are Hard To Trust: Part 3

Stanley Feld M.D.,FACP, MACE

 

Why would the Senate initially vote against S. 3101 and H 6331? Why would President Bush threaten to veto it?

Nine Republicans who had voted against cloture last week pivoted to produce a potentially veto-proof 69-30 vote in favor of linking another temporary physician-pay fix to Medicare Advantage (MA) modifications already passed in the House by a 355-59 margin.”

The answer is President Bush is committed to the transfer of Medicare to the healthcare insurance industry (privatization of Medicare). He is subsidizing the healthcare insurance industry through the Medicare Advantage program at the expense of physicians’ reimbursement and to the disadvantage of seniors. The reimbursement reductions are below cost. Seniors are one of the primary stakeholders in the healthcare system.

President Bush’s advisers have convinced him that he has to get rid of the Medicare entitlement program. Medicare was invented by the Democratic Party and initiated in 1965 by President Johnson. It has been pretty clear for a while that Medicare’s business model was faulty. It is predicted to result in a 100 trillion dollar deficit by the time today’s young children become eligible for Medicare at the present level of spending.Source: Social Security/Medicare Trustees Reports 2008. The Medicare payment structure is seriously flawed. The two biggest flaws are the DRG system and the payments to the healthcare insurance industry.

 

Rather than being innovative and repairing the healthcare system by, eliminating waste, inefficiencies, and adverse incentives in order to protect future seniors with guaranteed, effective healthcare coverage, President Bush and his administration have opted to subsidize the healthcare insurance industry, a very powerful secondary stakeholder in the healthcare system.

Unfortunately, Senator McCain is thinking like President Bush. He has pledged to eliminate entitlements. Senator Obama is focused on universal healthcare and a single party payer.Obama’s plan will simply expand the Medicare deficit and yield more profit for the healthcare industry. I have discussed constructive policies that are needed to change the paradigm of the healthcare system. Neither candidate has uttered a word about innovative solutions that provide hope for the healthcare system and the citizens using it.

President Bush is handing our healthcare system over the healthcare insurance industry. He is providing subsidies equal to at least three times the present cost of Medicare to the healthcare insurance industry to take the healthcare system off his hands.

With the White House ideologically committed to protecting MA, the outcome of a veto struggle remains uncertain. Republican senators who changed their votes will be under heavy pressure from the administration to support a veto.”

President Bush’s veto was overridden on July 12, 2008 simply by constituent outcry once they understood the consequences of his actions. Much of the healthcare insurance companys’ profits come from Medicare Advantage (≈10 billion dollars per year).

“As the juggernaut for Medicare privatization, the PFFS plans have been staunchly supported by the Bush administration despite per beneficiary costs that are an estimated 17 percent higher than those of traditional Medicare.

Does anyone think this helps anyone except the healthcare insurance industry? The budgeted money is shifted from physicians’ reimbursement to a healthcare insurance industry subsidy. When President Bush’s veto is rejected he will be decreasing the healthcare insurance industrys’ profit from the Medicare Advantage program. I think he is afraid the healthcare insurance industry will be upset and not want to take over Medicare.

Before Medicare bankrupts the country, it must be reformed. However, this is not the way to do it. By putting the healthcare insurance companies in charge will lead to disaster. The way to do it is to provide incentives to the primary stakeholders, not punish them to the advantage of the secondary stakeholders.

President Bush has not even mentioned medical care outcomes and impacts (i.e., is the nation getting what you pay for?). This is the point when it comes to evaluating whether a program that transfers money from the public sector to the private sector will accomplish a public mission.

All of the research says “NO.” Both types of MA plans provide no more care nor any better care than traditional Medicare does, in terms of health outcomes of seniors. There is no justification to continue this Medicare Advantage program, by any definition of “efficiency” or “effectiveness” that the “market-based” conservatives may use. The Congressional Budget Office points out; the current IME adjustment represents a double payment to MA plans, because Medicare’s fee-for-service hospital rates, on which MA benchmarks are partially based, already include an IME add-on.

President Bush has called himself a “compassionate conservative”. I think he is being an unthinking conservative bent on protecting the vested interests of secondary stakeholders and ignoring the perverse consequences to primary stakeholders…

  • texas medicare supplement

    “The answer is President Bush is committed to the transfer of Medicare to the healthcare insurance industry (privatization of Medicare). He is subsidizing the healthcare insurance industry through the Medicare Advantage program at the expense of physicians’ reimbursement and to the disadvantage of seniors. The reimbursement reductions are below cost. Seniors are one of the primary stakeholders in the healthcare system.”
    Obviously, the Medicare Advantage plan is controversial… at best. I can tell you as an agent who sells both plans (Part C and Medicare Supplements) that many of my clients are extremely happy to have the Med Adv plan. The program that’s popular here in North Texas features a $5 Doctor Visit and and $25 for specialists.
    I’m not saying it’s right… I’m just saying there’s not a whole lot of Sr’s using these programs who are complaining. They’re happy with it!

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McCain Non Health Plan: Part 2

 

Stanley Feld M.D.,FACP,MACE

 

Last week I listened to a speaker defending John McCain’s health plan. He defended the $5000 tax credit for a family of four. Most people know what a tax credit means but would be puzzled by its direct effect on healthcare. The tax credit means one can deduct $5000 dollars from one’s taxable income.

If the average insurance policy for a family of four is $12,000 a year, how does the tax credit translate into an effective healthcare reform? My answer is very poorly! The real message is abstract and can also be a trick to help employers abandon providing healthcare insurance for their employees.

The claim is the tax credit levels the playing field for the self employed and the employed whose employers provide healthcare insurance for them with pretax dollars. The employer pays for the employee’s healthcare insurance. The employee does not pay income tax on the money spent for healthcare insurance and the employer is able to deduct the premium cost from gross revenue. As healthcare premiums have increased rapidly many employers can not afford the benefit and either stop providing healthcare insurance or healthcare insurance that provides fewer benefits.

Presently if someone was self employed he would buy healthcare insurance with post tax dollars. Therefore, a healthcare premium of $12,000 year for healthcare insurance paid for with post tax dollars would require that he earn $17,142.85 in pre-tax dollars. (12000= 1x-.3x x =12000/.7= $5142.85) John McCain’s tax credit makes up the $5,000 difference. The consumer would have to pay the $12,000 premium with $7,000 post tax dollars or $10,000 pre tax dollars The fallacy in McCain’s tax credit plan is that consumers might not be able to afford the $12,000 per year to allocate that much money for healthcare insurance. The plan would be an advantage to employers and not employees. It would get employers out of providing healthcare insurance for their employees. Additionally, it would not level the pre tax and post tax difference that exists today.

Total pre-tax payment of the healthcare insurance dollar is only one step in the repair of the healthcare system. It is not a healthcare plan. Consumers must have control of the healthcare dollar not the healthcare insurance companies. My ideal medical savings account, real price transparency, support for chronic disease management,malpractice reform, patient and physician incentives to prevent chronic disease, and instant physician payment to eliminate non value added administrative cost must be added simultaneously for healthcare reform to make any progress. A consumer driven healthcare system is the only way to create a competitive marketplace.

John McCain’s plan opens the door for employers to abandon this important employee benefit without adding any value or efficiency to the healthcare system. It also eliminates the purchasing power of employers in negotiating healthcare insurance.

If Mr. McCain becomes president he might sneak in as a stand alone item of healthcare reform (an important element of the total package of health care reform), a law that will result in a disadvantage to employees covered with insurance by their employer. It will create an advantage the employer and the healthcare insurance industry.

A lot of smart people are thinking about the healthcare problem. It is time to think about it in terms of the constitution. We are a nation that whose government is chosen by the people for the people and not isolated vested interests. In the season that candidate are begging us for our vote we need to demand our needs be addressed.

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

  • anonymous

    is it a tax credit or a tax deduction?

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Politicians Are Hard To Trust: Part 2 Patient Power Wins Again

Stanley Feld M.D.,FACP,MACE

When citizens understand an issue they are motivated to act. They can put enough pressure on politicians so they act for the citizens’ vested interest. After all, the United States government was created by the people for the people.

HR 6331 called for a stop to the 10.6% reduction in physicians’ reimbursement and continues current rates for the rest of this year, while providing an additional 1.1-percent increase in 2009 to physicians.

Resolution 6331 flew through the U.S. House of Representatives 355 to 59 last week. It was defeated in the Senate by one vote. Both my Texas senators voted against it initially. The resolution needed only one more vote in the Senate to win. Protests were voiced by citizens in Texas and the rest of the country. The citizen outcry resulted in Senators switching their vote from a one vote defeat to a nine vote victory for senior citizens and physicians. (69-30). Both Texas Senators switched their vote from no to yes.

I hope my quick blog entry about the difficulty contacting politicians helped. I intended to provoke an outcry from many readers. I did. Many showed me how easy it is to contact their politicians and let them know their feelings.

The citizen outcry plus Ted Kennedy showing up for the vote won the day for the citizens over 65 years old and physicians. Both were going to suffer from a negative vote. President Bush still threatens to veto the bill.

However, I believe if he does, his approval rating will sink further, and his veto will be overridden.

If physicians continued to see Medicare patients many would be seeing these patients at a loss. Seniors going to physicians who do not take Medicare would be paying huge out of pocket expenses. Medicare costs would escalate because more seniors would be hospitalized for illnesses they could not afford to have treated. They would wait until they had no choice but to be hospitalized for a costly complication of their chronic disease.

The Senate’s rejection of the bill would have also protected the healthcare insurance industry by adding items in the bill to help the Medicare Advantage program’s growth.

 

United Healthcare and Humana are betting on the lucrative Medicare Advantage part of their business. The Medicare Advantage program develops doctor networks that are managed by the insurers in contrast to regular Medicare in which members can choose virtually any doctor, who is paid directly by the government.

“One in five of the nation’s 43 million Medicare enrollees are now in the Medicare Advantage program, which the Bush administration says has brought more choices and better benefits to the federal health system.”

My question is, “who can you trust?” Is President Bush really protecting seniors and the U.S. federal treasury or the healthcare insurance industry?

 

“ Medicare Advantage has become a political target, because — whatever its vaunted enhancements — it costs the federal government 12 percent more for each enrollee, on average, than the regular Medicare system.” “The Congressional critics see the policies as an extravagance whose main beneficiaries are insurers like Humana and UnitedHealth.”

Wake up America! Physicians only receive 20% of the Medicare dollar. Physicians are the people providing medical care, not the healthcare insurance companies.

Americans made the Senate act positively in one week by their outcry. We should make Congress go after the stakeholders that add little value to the healthcare system. The healthcare insurance industry consumes at least 50% of the remaining 80% of the Medicare dollar.

“Under Medicare Advantage, the insurer provides coverage through a network of doctors, and the government pays the insurer a flat annual fee per enrollee. That federal payment varies from county to county, but it averages about $9,000 per enrollee nationwide.

In my blog: Medicare Insurance: It is Not Cheap-Part 1 the maximum an enrollee pays is $3408 per year. If Medicare Advantage is receiving $9000 a year per enrollee the difference is $5592 per enrollee more than the government collects from the seniors who pay the most. The healthcare insurance industry receives $8380.88 extra for an enrollee that pays the least premium for Medicare (1112.60 per year). The dollar difference is large and yields a nice profit for the healthcare insurance industry provider.

“UnitedHealth, in contrast, will get about 15 percent of this year’s projected pretax profit of $7.48 billion from Medicare.”

It is no wonder United Healthcare can afford to pay their former CEO 1.80 billion dollar in stock options over 8 years.

“And Humana is transforming itself into a big-time government contractor. It will get almost three-fourths of its projected $1.28 billion in pretax profit this year from Medicare, mainly from the Medicare Advantage program, according to analysts.”

Clearly a healthcare insurance company can make large profits from Medicare Advantage.

Patient Power works as long as citizens know what is going on. Politicians will act in the citizens’ vested interest if citizens demand it from them. Citizens must demand that Congress and the administration stop this disgraceful behavior.

The media reports most of the information but never connects the dots. I have connected the dots. What I see is not a pretty picture. In fact it is a terrible betrayal of senior citizens and taxpayers.

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

  • Chrissy Dodman

    Hi Stanley,
    Sorry to contact you via comment but your email address failed.
    I work for a news distribution company and wondered if you would be interested in receiving free news releases on healthcare from us?
    If you have any questions just email me at the above address.
    Cheers,
    Chrissy

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It Is Not Only Older Physicians Who Are Discontent: Part 2

 

Stanley Feld M.D.,FACP,MACE

 

The administrative difficulties in the physicians’ work environment are increasing physician discontent.

In a survey last year of nearly 2,400 physicians conducted by a physician recruiting firm, locumtenens.com, 97 percent said they were frustrated by nonclinical aspects of medicine. The level of frustration has increased with nearly every survey.”

The important point is that it is our younger physicians who are complaining about the burdens of medical practice.

“Dr. Bhupinder Singh, 42, a general internist in New York, sold his practice and went to work part time at a hospital in Queens. When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.”

Recently, he confessed, he has been thinking about quitting medicine altogether and opening a convenience store. “Ninety percent of doctors I know are fed up with medicine,” he said.

Many healthcare policy makers dismiss these complaints as the failure of managed care. Managed care was a system policy makers developed to manage costs. It is a system that has failed to manage care and manage costs as well.

“It is not just managed care. Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges. Malpractice worries also remain at the forefront of many physicians’ minds, compounded by increasing liability premiums that have forced many into early retirement.’

Physicians are discouraging their children and their friends’ children from becoming physicians. The opposite was true in past generations.

In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession.

Practicing physicians are not stupid. They are adjusting their practice to decrease practice burdens. Some Ob-Gyn physicians have stopped delivering babies because of the malpractice burden and decrease in reimbursement. They are only practicing gynecology. The adjustments in medical practices are to the detriment of patient care.

“Doctors are working harder and faster to maintain income, even as staff salaries and costs of living continue to increase. Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue. Others are limiting their practices just to patients who can pay out of pocket.”

“There are serious consequences to this discontent, the most worrisome of which is that it is difficult for doctors who are so unhappy to provide good care.”

I have said over and over again that healthcare policy makers do not listen to or ask physicians for advice. The end result will be a severe physician shortage. Physician shortages are here already. The central problem is quality care for patients and not the healthcare insurance company’s bottom line. I hope policy makers are listening.

“Another is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners.”

Last year, residency programs in family practice took only 1,096 graduating medical students, the fewest in the last two decades. The number increased just slightly this year. “For me it’s an endless amount of work that I can never get through to do it properly,” said Dr. Jeffrey Freilich, 38, a primary-care physician on Long Island. “I’m a bit compulsive. There is no time to do it all in a day.”

“On top of all that, there are all the colonoscopies and mammograms you have to arrange, and all the time on the phone getting preauthorizations. Then you have to track the patient down. And none of it is reimbursed.”

The only services primary care physician have to sell is their time and clinical judgment. Both services are undervalued in the present healthcare system.

Once a patient is hospitalized the primary care physician loses track of the patient. Hospitalists take over. Hospitalists call many specialists for consultation and advice.

“The upshot is that the doctor who knows a patient best is often uninvolved in her care when she is hospitalized. This contributes to the poor coordination and wanton consultation that is so common in hospitals today.”

“Years ago you had one or two doctors,” a hospitalized patient told me recently. “Now you’ve got so many people coming in it’s hard to know who’s who.”

Medicare is going to cut payments to physicians 10.6% in July. Why? It is easier to cut physicians who utilize 20% of the healthcare dollar than to cut the stakeholders that absorb 80% of the healthcare dollar. Why? Physicians are not organized! They are also cheapskates and do not support lobbyists. They do not have the powerful a lobbying infrastructure that the healthcare insurance industry and the American Hospital Association.

A 10.6 percent cut in Medicare payments to physicians is scheduled to take effect on July 1. Further cuts are planned in coming years. Many doctors have told lawmakers that if the cuts go through, they will stop seeing Medicare patients.

Unfortunately, politicians do not understand the problems physicians and patients have in the healthcare system. It is going to be up to patients and physicians make these problems clear to politicians in order to Repair the Healthcare System.

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

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Do You Think Politicians Want To Hear From You?


Stanley Feld M.D.,FACP,MACE

The answer is “NO”. Cecelia and I wanted to contact John Cornyn and Kay Baily Hutchison about their vote on HR 6331. Their two votes defeated the House of Representatives proposal to cancel the Medicare cuts.

It is an impossible task to send them an email. Just try to find an email address. We have concluded the best way to contact a congressperson is to send him or her a fax. Actually, many fax’s and break their fax machine. Maybe then you will get their attention.

The next time I hear that a politician wants to hear from his/her constituents, I know he/her wants to seduce us to vote for him/her. He/her has no intention of listening to us.

  • Mark

    I think you are right . . . they tell how much they want to do for us and then they pretty much do what they REALLY wanted to do all along.
    We need to pray for all of them because I believe that the Lord can get through to them better than we can.
    Cheers,
    Mark

  • Sandra Smith

    Dear U.S. Senator John Cornyn,
    I am writing to you because I am very fed up with Washington right now. I have spoken to many people in my area that feel the same way that I do. I have not spoken to anyone that is in favor of this health care bill.
    1. Where did the money come from for the bank bailouts???
    2. Where did the money come from for the auto bailouts???
    3. Where did the money come from for the aid to Haiti???
    4. Where did the money come from for the aid to Chile???
    5. Where is the money supposed to come from for the health care bill???
    I am (along with many people in my area) totally opposed to the health care bill. I hope you strongly oppose this bill. I also hope that you get as many congress people to also oppose this bill. Only our representatives can do as their constituent’s want, so I am counting on you and others to fight this bill every way that you can.

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It Is Not Only Older Physicians Who Are Discontent: Part 1

Stanley Feld M.D.,FACP,MACE

It has been said that the older physicians are the only physicians upset by the way they are being treated by the healthcare insurance industry. The claim is older physicians are spoiled by the golden days of medicine. My reply to that statement is nonsense. When a professional is treated as a commodity no matter what his age discontent is generated. The older physicians are products of the silent generation. When the younger physicians are pushed to the edge we will hear lots of noise and have lots of rebellion. The rumblings have started.

“I love being a doctor but I hate practicing medicine,” a friend, Saeed Siddiqui, told me recently. We were sitting in his office amid his many framed medical certificates.

Uwe Reihardt said it all to my surprise in a letter to the editor of the New York Times in May 2008.

“Any college graduate bright enough to get into medical school surely would be able to get a high-paying job on Wall Street. The obverse is not necessarily true. Against that benchmark, every American doctor can be said to be sorely underpaid.

Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.

This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.

Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.”

Many examples of discontent from younger physicians can be sited. As these physicians gain experience and understand that the healthcare system is a business to the facilitator stakeholders whose only concern is the bottom line the patient-physician rebellion will pick up steam. The facilitator stakeholders account for 80% of the healthcare dollar and add little value.

A doctor in his late 30s, he has been in practice for six years, mostly as a solo practitioner. But he told me he recently had decided to go into partnership with another cardiologist; “Your days aren’t busy enough already?” I asked.

The waiting room was packed. He had a full schedule of appointments, and after he was done with his office patients, he was going to round at two hospitals.

He smiled wanly. “Just look at my eyes.” They were bloodshot.“This whole week I haven’t slept more than about six hours a night.”I asked when his work usually got done. “It is never done,” he replied, shaking his head. “See this pile?” “He pointed to five large manila packages on a shelf above his desk.” “These are reports I still have to finish.”

“As a physician, I could empathize. I too often feel overwhelmed with paperwork. But my friend’s discontent seemed to run much deeper than that. Unfortunately, he is not alone. I have been hearing physician colleagues voice a level of dissatisfaction with medical practice that is alarming.”

The discontent is building. Physicians are fed up with what they perceived as a loss of professional autonomy. They can not stand the unwarranted restrictions on their medical judgment. As demand for physician services increase we are experiencing larger and larger physician shortages.

Another physician complained. “I’d write a prescription,” he told me, “and then insurance companies would put restrictions on almost every medication. I’d get a call: ‘Drug not covered. Write a different prescription or get preauthorization.’ If I ordered an M.R.I., I’d have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache.” Managed care is like a magnet attached to you.

A 42 year old physician complains that he continues to be frustrated by payment denials. “Thirty percent of my hospital admissions are being denied. There’s a 45-day limit on the appeal. You don’t bill in time, you lose everything. You’re discussing this with a managed-care rep on the phone and you think: ‘You’re sitting there, I’m sitting here. How do you know anything about this patient?’ ”

The endless abuse on professional integrity amazes me. A high school graduate sits in front of a computer screen deciding on what a physician can or can not do. Another healthcare insurance company assistant sits in front of a computer billing screen reducing reimbursement on questionable computer programming decisions. The appeals process is difficult and time consuming for physicians.

Dr. Mark Linzer, an internist at the University of Wisconsin who has done extensive research on physician unhappiness, told me. “Fortunately, the data show that physicians are willing to put up with a lot before giving up.””

How long do you think young intelligent physicians will tolerate this abuse? How long do you think it will take to train another compliant work force? America has a physician shortage that is about to accelerate.

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

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Politicians Are Hard To Trust : Part 1


Stanley Feld M.D.,FACP,MACE

It is getting harder and harder for senior citizen on Medicare to find a physician who takes Medicare patients. Many physicians are not taking Medicare reimbursement because the government continually decreases reimbursement. In many cities Medicare reimbursement is lower than the overhead of the physicians’ office practice. This year a 10.6% reimbursement cut is due to go into effect July 1st. The 10.6% decrease in reimbursement for physicians is irrational thinking. Physicians collect only 20% of the healthcare dollar. A ten percent decrease in physician reimbursement will save the government only 2% of its healthcare expenditures. The 10.6% means a lot to the practicing physician. The government should be concentrating on who collects the other 80%. It should be figuring out how it can decrease the other 80% of its expenditures.

Texas physicians and the Texas Medical Association are usually pretty proud of their Republican Texas Senators. The Senators have recognized the importance of standing up for patients and their physicians. However, on June 26th 2008 Sens. John Cornyn and Kay Bailey Hutchison broke their promise to protect our senior citizens ability to obtain Medicare coverage from a physician of their choice. After the house of representative passed a bill 355 to 59, the senate failed to pass it by one vote. Either Texas Senator could have altered the outcome.

“Sens. John Cornyn and Kay Bailey Hutchison last night chose to protect insurance companies’ profits instead of protecting our patients’ health. All Texas physicians should be deeply offended by their decision, and we need to let them know exactly how we feel.”

They voted against the bill to forestall the looming 10.6-percent cut in physicians’ reimbursement. The Senate bill fell one vote short of being passed. Either Texas senator could have made the difference. They played partisan politics with our patients’ health. They also voted to defend unnecessary overpayments to certain Medicare Advantage health plans. The private Medicare Advantage plans have been ripping off seniors for years. Finally, something was going to be done about the proposed reduction in physicians reimbursement. Our Texas Senators let us down after promising to support us.

You can contact both senators at these telephone numbers or email addresses and ask them to change their vote.
• Sen. John Cornyn: (202) 224-2934

http://cornyn.senate.gov/public/index.cfm?FuseAction=Contact.ContactForm

• Sen. Kay Bailey Hutchison: (202) 224-5922

http://www.senate.gov/~hutchison/contact.html

John Cornyn is up for reelection. He is begging patients and physicians for their vote. He is up against an underfunded Democratic underdog. I do not think Senator Cornyn thinks an underfunded underdog can beat him. I think he might be in for a big surprise. I do not think Texans want to vote for someone who does not defend effective patient care.

It is up to the politicians to keep their promises and defend their voters. This is especially true when it comes to patient care.

I am positive he does not understand what has to be done to repair the healthcare system. It is not cutting physicians’ reimbursement. It is changing the healthcare system as I have outlined.

“ Resolution 6331 flew through the U.S. House of Representatives earlier this week. It stalled in the Senate last night. The bill would:

• Stop the cut, continue current rates for the rest of this year, and provide an additional 1.1-percent increase in 2009;
• Give Congress 18 months to devise a long-term replacement for the sustainable growth rate financing formula, as we demand in TMA’s Texas Medicare Manifesto;
• Extend the Geographical Practice Cost Index, which protects physicians practicing in most of Texas; and
• Provide parity for Medicare mental health benefits and increase coverage for preventive services.”

The great disappointment to me is you can not trust politicians. Yet at election time they will say anything to get our vote.

Sen. Kay Bailey Hutchison is a nice woman. She is planning to run for Governor of Texas. It will be very difficult for me to vote for someone who goes back on her word.

I am writing to my senators about my outrage. Will you?

Our vote is a powerful tool. We must use it wisely.

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

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John McCain Describes His Health Plan; In Reality A Non Health Plan

Stanley Feld M.D., FACP,MACE

Politicians give me a headache. John McCain revealed his healthcare plan last week. His healthcare plan is just as poor as Hillary Clinton’s and Barach Obama’s. He goes further than President Bush in shifting the healthcare premium payment from the employer to the employee. This action is just what the large corporations want and the employees don’t want.

“Mr. McCain’s health care plan would shift the emphasis from insurance provided by employers to insurance bought by individuals, to foster competition and drive down prices. To do so he is calling for eliminating the tax breaks that currently encourage employers to provide health insurance for their workers, and replacing them with $5,000 tax credits for families to buy their own insurance.”

Five thousand dollars in tax credits will not help people who can not afford the average $12,000 healthcare insurance premiums for a family of four.

Businesses have been trying for years to relieve itself of the obligation to provide healthcare insurance to employees. The defects in the HSA are clear from my last blog entry. HSA’s will do little to Repair The Healthcare System. The healthcare insurance industry still controls and captures the healthcare dollars. It still sets the premiums for healthcare coverage.

Mr. McCain seems to have no idea of the problems in the healthcare system. The government should create new rules to change the incentives of the stakeholders. The rules must create incentives for the consumers and physicians and not be punitive. One hundred and fifty million people presently have some form of healthcare insurance provided by their employers. Nonetheless, those insured employees can not afford the deductible they are required to pay while receiving less coverage at higher costs.

“Mr. McCain had previously described aspects of his health care plan but on Tuesday offered new details on how to cover people with existing health problems, in a nod to the growing concerns about the difficulties that many sick, older and low-income people have getting insurance. ”

Political expediency is the name of the game. It does not matter what the facts are or if the plan will be effective. However, if the facts of any problem are ignored, problems can not be solved. Neither the Democrats nor the Republicans have a clue regarding the problems in the healthcare system. Neither has presented any viable solutions.

“Elizabeth Edwards, the wife of former Senator John Edwards, recently pointed out that both she and Mr. McCain could be left uncovered by Mr. McCain’s plan because she has cancer and he has had melanoma. Stung by such criticism, Mr. McCain is trying to develop a way to cover people with health problems while still taking a generally market-based approach to solving the health care crisis.”

John McCain has the advantage of ignoring the pre-existing illness problem. As a Senator, he is entitled to participate in both Medicare Part C and Medicare Part B without premium penalty for his pre-existing illnesses. Both plans mandate that people with pre-existing illness must be covered at the universal rate.

“I’ll work tirelessly to address the problem,” Mr. McCain said in a speech here at the H. Lee Moffitt Cancer Center & Research Institute. “But I won’t create another entitlement program that Washington will let get out of control. I won’t do it. Nor will I saddle states with another unfunded mandate.”

McCain is pandering to conservatives who see red at the word entitlement. He is also pandering to the healthcare insurance industry and its executives’ multimillion dollar salaries. His plan will preserve the healthcare insurance industry’s dominance over its $150 billion dollar waste.

“For people who currently get health insurance through their jobs, Mr. McCain’s plan would give them a tax credit that they could put toward buying a different, and potentially less expensive, health insurance plan tailored to their needs — and allow them to keep that health plan, and their doctors, even if they switch or lose their jobs.’

These words have no meaning. Presently people with insurance do not have adequate and affordable insurance coverage. Out of pocket expenses increase yearly. People without insurance can not afford the restrictions on the policies they could buy if they were eligible.

“ Mr. McCain’s speech here implicitly acknowledged some of the shortcomings of his free-market approach. But rather than force insurers to stop cherry-picking the healthiest — and least expensive — patients, Mr. McCain proposed that the federal government work with states to cover those who cannot find insurance on the open market. With federal financial assistance, his plan would encourage states to create high-risk pools that would contract with insurers to cover consumers who have been rejected on the open market."

Mr. McCain does not seem to know that high risk pools have been created and are failing. He might have a between the lines agenda in opposition to consumers needs

“Mr. McCain was vague Tuesday about just how his safety net would be structured, and did not specify how much it might cost, leaving the details to negotiations with Congress and the states.”

This is an interesting admission. The reality is he does not have a healthcare plan that will solve any of the healthcare system’s problems.

"Some health care experts question whether those tax credits would offer enough money to pay for new health insurance plans. The average cost of an employer-funded insurance plan is $12,106 for a family, according to the Kaiser Family Foundation, a health policy group. Paul B. Ginsburg, the president of the Center for Studying Health System Change."

Enough said about the McCain healthcare plan. It is a non healthcare plan to the advantage of the secondary stakeholders and to the detriment of patients.

It is clear to me that we can not depend on our presidential candidates for help. We are going to have to organize and demand the necessary reform essential to eliminate the dysfunction in the healthcare system.

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

  • Patrick

    Coming up with a good healthcare system is not brain surgery. For starters, we could just copy Singapore’s system exactly ( http://econlog.econlib.org/archives/2008/01/singapores_heal.html ) They have a longer life expectancy at 1/3 the per person cost.
    The real question is not how to fix healthcare. The real question is to figure out why our political systems gives us systematically poor results, and then fix the political system.

  • Scott Dalferes

    Right on. Thanks for the well thought out post.

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