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Single Party Payer System Backfires On Great Britain

Stanley Feld M.D.,FACP,MACE

Last year the Great British single party payer system, The National Health Service, backfired.

It occurred just at the time Americans were being suckered into instituting a single party payer system by its progressive politicians..

Winston Churchill was right when he said,“You can always count on Americans to do the right thing—after they’ve tried everything else.”

I hope some of our leaders are listening.

President Obama appointed Dr. Donald Berwick Director of the Center for Medicare and Medicaid Services, during the Senate’s recess July 4th2010 in order to avoid a senate confirmation hearing. The American people did not have the opportunity to hear Dr. Berwick’s philosophy on healthcare reform and his plans for Medicare.

Dr. Don Berwick touted Britain’s National Health Serviceas the America’s ultimate healthcare role model.

Dr. Berwick had some good ideas and many very bad ideas.

President Obama had other ideas. His ideas were not about repairing the healthcare system. His goal for healthcare reform was having the federal government control the entire healthcare system.

President Obama and Dr. Berwick portrayed physicians and patients as the villains in healthcare dysfunction. It is easy to blame the physicians and the patients because both have some blame in the dysfunction.

The main villains are the healthcare insurance industry, the drug companies, the government, and the lack of malpractice reform.

In 2009 the new British coalition government declared the National Health Service a fiscal failure.

The new coalition government had proposed a reorganization of its National Health Serviceand proposed reorganzation.

After 62 years, the British government’s present goal is to decentralize its healthcare system. The goal does not include decentralizing medical decision making. The system continues to put restraints on consumers’ medical spending. The government believes consumers are not smart enough to make their own medical decisions.

 

Baroness Hale had previously written the following for the British High Court, the U.K.’s equivalent of the U.S. Supreme Court:

“Decision-makers must look at [the patient’s] welfare … the nature of the medical treatment in question, … they [decision makers] must try and put themselves in the place of the individual patient.”

“The patient is not the decision-maker.”

The British Healthcare Service has an organization called NICE. Nice is a perfect bureaucratic name for “the National Institute for Clinical Excellence.” NICE sounds nice. Its function is not very nice.

According to the NHS Constitution, “You have the right to drugs and treatments that have been recommended by NICE.”The National Institute for Clinical Excellence is an agency that “advises” the government whether to authorize payments or withhold them for treatments deemed “not cost effective.”

Britain’s National Health Servicehas continually changed over the 62 years. Various British administrations have searched for the formula to deliver high quality care at an affordable price.

Unfortunately,Britain is making another complicated mistake.

The United States is making the same mistake as it marches toward a single party payer system. The mistake is the lack of respect for the intelligence and will of consumers. The mistake is not permitting consumers to be financially and emotionally responsible for their own medical care decisions.

The British incident is chilling. The British High Court recently ruled against parents’ wishes in defense of the National Health Services.

The high court’s decision is the result of British consumers giving total control of the healthcare system to its central government.

The British government believes that the people are not smart enough or responsible enough to figure out how to take care of themselves.

The British thinking is not dissimilar to the thinking of the Obama administration and Dr. Donald Berwick.

The basic conflict is over who is ultimately in charge of medical decision making. Government control of medical decision making is not limited to Great Britain’s single-payer structure.

In all government run health-care systems, whether in Australia, Canada, or even here in the United States under Obamacare, government increasingly makes final medical decisions, not patients in consultation with their doctors.

NICE is an agency that “advises” the government whether to authorize payments or withhold them for treatments deemed “not cost effective.”

“Consumers have the right to do what they or their doctor thinks best medically as long as your decision does not override the decision NICE decides is cost effective for the government.”

Britain has nevertheless experienced increasing costs and demand as quality and access to care has decreased.

What is missing from the British system?

All government has to do is make the right rules, empower consumers with their own money, level the playing field among stakeholders and get out of the way.

I think Americans understand that building bigger and bigger bureaucracies never solves social problems. They make the problems more complicated and more costly to fix.

Americans did not fully understand two recent single party payer events that occurred in Britain. This was partly because the American media did not cover the story’s significance adequately.

Perhaps the American media did not understand the story’s significance to the American debate in reference to a single party payer healthcare system.

First Charlie Gard and now Alfie Evans. These are two 23 month old babies who, though verbally silent, still gave clarion warnings to proponents of single-payer health care: The government — not my parents — is in charge of my life.”

Charlie Gard was born in August 2015 with a rare genetic disorder that carried a poor long-term prognosis.

“In July 2017, little Charlie was just 23 months of age and on a ventilator. Over the objections of his parents, British doctors decided to withdraw life-sustaining care.”

“According to British Courts, the National Health Service (NHS), the country’s single-payer system, is the ultimate medical decision maker — not the family. Ventilator support was withdrawn and Charlie died.”

Less than a year later another 23 month old child hit the British headlines. Alfie Evans was a comatose child whose NHS doctors said his condition was hopeless. His physicians felt he could not survive without ventilating life support. They wanted to terminate his life support.

His parents wanted to transfer their child to Rome’s Bambino Gesu Pediatric Hospital for further care. The Italian Hospital was willing to take him.

The British High Court ruled against the parents’ wishes, leaving Alfie’s fate to the NHS. As Justice-Baroness Hale wrote in Aintree v James: “we [referring to patients] cannot always have what we want.” On April 28, 2018,Alfie’s ventilatory support withdrawn.

Alfie did not die when artifical ventilation was withdrawn. He died because of inadaquate I.V. nutrition.He was able to breath on his own. His physicians were wrong.

NICE is the model on which the Independent Payment Advisory Board (IPAB) was created under the Affordable Care Act.The Independent Payment Advisory Board, or IPAB, was to be a fifteen member agency which was to have the explicit task of achieving specified savings in Medicare without affecting coverage or quality. The system creating IPAB granted IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency’s decisions through supermajority vote.

The Bipartisan Budget Act of 2018repealed IPAB before it could take effect.[1

 In my opinion it should not be the government or the court that decides about who should live or die. It should be the patient or the patient’s family who decides with the advice of the patient’s physicians and clergy.

The institution the patient is being cared in should not be responsible for the bill.

Consider the question “who’s in charge?” from two perspectives: that of the American public and that of physicians.

Americans prize their freedom above all else. When the government makes medical decisions against the patient’s wishes, it directly infringes on personal freedom. It is doubtful that Americans would support a single-payer system if they understood what they have to give up in exchange for the promise of government supplied health care. Americans would be giving up freedom of choice.

http://stanfeld.com/?s=single+party+payer+system

 

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

 All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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More Single Party Payer Noise

Stanley Feld M.D., FACP,MACE

Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.

Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.

The economics of these single party payer systems are seldom discussed in a coherent way. Americans have no idea of the economic burden a single party payer system places on the budget of countries that have such a system.

The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.

In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.

The Canadian healthcare system is unsustainable.

Canada spends 50% of its GNP on healthcare. All of the provinces are experiencing massive deficits due to additional healthcare costs.”

“Canadians who are healthy and do not need to interact with the system are happy and feel secure that their healthcare needs will be serviced without cost. Nothing is free.”

“The United States consumes only 18.5% of our GDP on healthcare. This percentage is rising as access to care is decreasing.”

The Frazer Reportis very specific on the cost of healthcare in Canada although the government is not very transparent.

Each province is having a difficult time figuring out how to fix its healthcare system. Many Canadians are convinced that a single party payer system is not the answer but cannot politically eliminate it.

The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time. People who are not sick think the single party payer system in great. They are happy they have no anxiety about the cost of healthcare if they get sick.

In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.

The private healthcare market is flourishing in Britain for those who can afford it. 

The British healthcare system is unsustainable. The British government has not been able to fix the expensive National Health Service.

America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.

Seniors love Medicare. Most seniors could not afford to get medical treatment if there was not the Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. Most economist agree, as a result of Medicare, the cost of healthcare in America has continued to increase yearly for all Americans.

Congress has ignored the basic defects in the Medicare system that has caused this explosion. Over the years a few brave congressmen have made attempts to correct these structural defects.

The Democrat and Republican establishment have ignored these congressmen.

The political establishment has made feeble attempts to control costs through ineffective regulations. The bureaucracy has grown and the healthcare system has become more costly and inefficient.

The reduction in reimbursement to physicians has resulted in the tremendous increase in concierge medicine. This explosion in concierge medicine has decreased access to medical care in many cities in the U.S.

The result is an increase in cost and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers. The government has imposed more control over the individual’s ability to make his or her own healthcare decisions.

Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.

President Obama’s law (Obamacare) increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from government investigations and penalties in the long run.

The VA system is the purest example of sheer failure. Not only are the patients unhappy but also the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.

The inefficiency, corruption and waste have not been able to be fixed by many notable private sector executives the government has hired to fix it. They have all ultimately resigned or were fired.

The VA system’s single party payer system remains an incurable failure.

These examples are proof that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.

Are these mistakes intentional? Perhaps.

The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.

What is happening now?

The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.

The article, Back to the Health Policy Drawing Board” may be intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.

After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exist. The New York Times article is promoting Medicare for all.

Medicare currently is a single party payer system whosecost is out of control. America cannot continue to print money forever.

America’s politicians are ignoring this fact in order to gain more power.

 

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



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The Reason Congress Does Not Work

Stanley Feld MD,FACP, MACE

I have wondered why either house of congress has not done anything about healthcare reform in the past 6 months.

The reason is that both the Democrat and Republican leadership in both houses of congress do not want to do anything about Repairing the Healthcare System.

On July 2, 2018 CMS released a report on the performance of the health insurance exchanges and the individual Obamacare health insurance markets.  

“Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market.

Reports show individual market erosion and increasing taxpayer liability.”

The CMS conclusions for 2017 were obvious in 2016. Obamacare is on a downward spiral.

In 2017 87% of enrollees were subsidized as opposed to 83% in 2016.

There was an alarming 20% drop nationwide in enrollees in Obamacare’s individual healthcare market without federal premium subsidies.

223,000 subsidized enrollees dropped their subsidized insurance.

These Obamacare enrollees dropped their insurance because even with subsidies their premiums became too expensive. Their average monthly premiums of the subsided and unsubsidized groups spiked by 21%.

Unsubsidized Obamacare enrollment dropped an average of 33% nationally. It dropped an astonishing 73% in Arizona. It is a wonder that neither Arizona senator wants to do anything about Repairing the Healthcare System. It is also a wonder that Arizona citizens continue to support these senators.

Obamacare is dead!

The Democrats are naturally blaming its death on President Trump. President Trump does not want to pour more money into this failed concept while forcing a greater payment liability on taxpaying  Americans.  He wants congress to do something to repair the healthcare system.

President Obama’s plan all along was for Obamacare to fail and be replaced by a single party payer system.

I have written about 20 articles on why a single party payer system is unsustainable and will fail.

http://stanfeld.com/?s=single+party+payer

I am unable to insert links and videos properly. Please insert the links for both into your browser. It is important to understand how the rookie representative view how the government works.

The British National Health Services System is a failure. Single party payer systems close to home are a failure.

For example The VA Health System is a failure. Medicaid is an unsustainable failure. It is unsustainable while offering inefficient care.

http://stanfeld.com/?s=Medicaid+failure

Medicare is a failure because it is unsustainable by the government. Seniors like it because they can get care that they could not afford otherwise.

However, seniors are getting wise. Medicare is becoming unaffordable to seniors. The government construction of Medicare premiums for Part B, Part D and Part F are costing seniors somewhere north of $16,000 a year in post tax dollars.

Medicare used to pay 80% of its approved fee. The approved fee is about 50% of the physicians’ fees. In 2018 Medicare is only paying around 50% of its approved fee. Seniors have to pay the difference.

This will drive seniors out of the Medicare marketplace.

There is a better way. I have gone into excruciating detail describing the better way.

http://stanfeld.com/?s=My+Ideal+Medical+Savings+Account

Newt Gingrich, when he was house leader, said my idea was a BIG IDEA. However nothing ever came of the big idea. The “big idea” empowers the people not the government.

Unlike many other politicians who have promised to take on the establishment and “drain the swamp,” Representative Thomas Massie (R-Ky.) 2012 is actually trying to do just that, and is taking some serious flak for his exposure of the Deep State and its agents on Capitol Hill.”

https://www.thenewamerican.com/usnews/politics/item/29426-in-the-swamp-fearless-reps-expose-the-corruption-on-capitol-hill?src=ilaw

If you click on the newamerican link above you will have all the videos in one article.

In a video series entitled The Swamp, Massie, along with Representatives Dave Brat and Tom Garrett of Virginia, Ken Buck of Colorado, Rod Blum of Iowa, and Ted Yoho of Florida, are showing people “what happens behind the scenes in Congress.”

To date, there are four episodes, each running about 10 minutes.

Besides pulling back the curtain to reveal the names and tactics of those who really pull the legislative levers in Congress, The Swamp videos make it very obvious that, although there are 435 members of the House of Representatives, the key decisions are made by a handful of very powerful leaders bent on controlling the country and that the betrayal is bipartisan.

The first video introduces these non establishment representatives’ chief complaint.

https://www.facebook.com/TheSwamp/videos/1794302460864573/

<iframe src=”https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FTheSwamp%2Fvideos%2F1794302460864573%2F&show_text=0&width=560″ width=”560″ height=”315″ style=”border:none;overflow:hidden” scrolling=”no” frameborder=”0″ allowTransparency=”true” allowFullScreen=”true”></iframe>

<iframe src=”https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FTheSwamp%2Fvideos%2F1794302460864573%2F&show_text=1&width=560″ width=”560″ height=”427″ style=”border:none;overflow:hidden” scrolling=”no” frameborder=”0″ allowTransparency=”true” allow=”encrypted-media” allowFullScreen=”true”></iframe>

An average of 4,500,000 people have viewed these videos.

“Representative Blum responded, “Most all the decisions around here are made by a few people at the very top, without the input of any other congressional members or U.S. senators. That’s not good representative government, wouldn’t you say?”

 “I think both parties are engaged in a quiet deal that we will support our base, and if it leads to bankruptcy, okay, and you will support your base, and if it leads to bankruptcy, okay,” Representative Buck says in Episode 1.

In Episode 2, the perception of a two-party system where the two parties oppose each other and want to achieve different ends is shattered as leaders of Democrats work with their Republican counterparts to shove a bloated, unconstitutional omnibus spending bill through the House without giving members time to read the text of the measure.

https://www.facebook.com/TheSwamp/videos/1807501746211311/

<iframe src=”https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FTheSwamp%2Fvideos%2F1807501746211311%2F&show_text=0&width=560″ width=”560″ height=”315″ style=”border:none;overflow:hidden” scrolling=”no” frameborder=”0″ allowTransparency=”true” allowFullScreen=”true”></iframe>

“One of the most shocking revelations comes in Episode 3, when Rep. Massie details how the party forces members to pay “rent” for their committee assignments and chairmanships. If a congressman wants to sit on a committee, he is expected to raise a certain amount of money for the National Republican Congressional Committee, the body that works to elect House Republicans. There is an identical system on the Democrat side. In an interview, Rep. Buck told me this system has been in place for Republicans since the days of Newt Gingrich, and even longer for Democrats.”

https://www.facebook.com/TheSwamp/videos/1816800768614742/

<iframe src=”https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FTheSwamp%2Fvideos%2F1816800768614742%2F&show_text=0&width=560″ width=”560″ height=”315″ style=”border:none;overflow:hidden” scrolling=”no” frameborder=”0″ allowTransparency=”true” allowFullScreen=”true”></iframe>

Episode 4 of The Swamp was released just a few days ago and covers the consequences faced by those lawmakers brave enough to buck the system and call out the conspirators.

https://www.facebook.com/TheSwamp/videos/1831877993773686/

<iframe src=”https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2FTheSwamp%2Fvideos%2F1831877993773686%2F&show_text=0&width=560″ width=”560″ height=”315″ style=”border:none;overflow:hidden” scrolling=”no” frameborder=”0″ allowTransparency=”true” allowFullScreen=”true”></iframe>

There you have it. This is the complex definition of The Swamp.

The structure has been created whereby our representatives and senators do not represent the will of the people.

Congress represents the will of the vested interests. Anyone that understands this has to play ball or move out.

It will be very difficult for America to get a sensible healthcare reform bill for the benefit of the American people when this pyramid of power exists.

It looks like legislation is driven by money, not the will of the people. These four videos are essential to understanding the process. They must be watched.

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



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Here They Come Again

Stanley Feld M.D.,FACP,MACE

Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.

Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.

The economics of these single party payer systems are seldom discussed in a coherent way. The American public has no idea of its economic burden to its countries.

The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.

In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.

The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time.

In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They also suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.

The private healthcare system is flourishing in Britain for those who can afford it.

The British healthcare system is unsustainable. The British government cannot figure out how to make it more efficient.

America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.

Seniors love Medicare. They could not afford to get treatment if there was not a Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. The price of healthcare has continued to explode yearly.

Congress has ignored the basic defects that have caused this explosion. A few congressmen are making feeble attempts to correct this continuing price explosion.

The political establishment largely ignores these congressmen.

As attempts are made to try to control costs through regulations the bureaucracy grows and the system becomes more inefficient. The reduction of reimbursement to physicians has resulted in the explosion of concierge medicine.

The result is an increase in costs and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers and government.

Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.

President Obama’s law increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from investigations and government penalties in the long run.

The VA system is the purest example of sheer failure. Not only are the patients unhappy but the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.

The inefficiency, corruption and waste have not been able to be fixed but many notable private sector executives. They have all ultimately resigned or were fired.

The VA system’s single party payer system remains an incurable failure.

These examples have proven to me that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.

Are these mistakes intentional?

The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.

What is happening now?

The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.

The article, Back to the Health Policy Drawing Board” is intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.

After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exists.

However, the cost of the Medicare system is out of control. America cannot continue to print money forever. America’s political class is ignoring this fact.

It is so out of control political wonks are starting to talk about having another Debt Jubilee.

https://en.wikipedia.org/wiki/Jubilee_Debt_Coalition

The New York Times article starts by saying:

The Affordable Care Act needs help.

It sure does. The problem is there are too many defects in the structure of Obamacare that led to the increases in costs to the government and consumers. Obamacare is beyond repair.

After scores of failed repeal attempts, Congress enacted legislation late last year that eliminated one of the law’s central features, the mandate requiring people to buy insurance.

There was only one failed repeal attempt not scores of repeal attempts. The one repeal attempt failed by one vote. It seemed to me to be a vindictive vote. It was not on the bills lack of merit. It seemed to me to be on John McCain’s personal animosity toward President Donald Trump.

There has been a total lack of bipartisanship in trying to repair Obamacare. The have been no ideas offered by Democrats. Its goal was to stymie the Republican administration.

Many establishment Republicans’ goal was to also stymie the Republican administration.

Obamacare had three principal features:

  • Insurers could not charge higher prices to people with pre-existing conditions.
  • Those without coverage had to pay a penalty to the government (the “mandate”).

President Trump slipped the elimination of the mandate into the tax bill to bring a speedier death to Obamacare.

  • Low-income people would be eligible for subsidies.

Each feature represented a death bell from the onset

A June 2017 poll showed that 60 percent of Americans said the government should provide universal coverage, and support for single-payer insurance rose more than one-third since 2014.

Americans are frustrated with the dysfunction in the healthcare system. Premiums have increased tremendously since Obamacare. Its regulations and defective principles increased dysfunction.

Enormous deductibles have resulted in individual buying defective insurance policies. Consumers have ended up with essentially no insurance coverage except for catastrophic illness. Only people at risk for high cost treatment have bought these policies.

I cannot imagine what the 60% who want a single party payer were thinking. Can a government run system improve the inherent inefficiency, waste, abuse and unsustainability of Obamacare or a VA like healthcare system?

A government run single party payer system can only make things worse.

The healthcare system will not improve until congress acts to level the playing field and fix the defects inherent in our present healthcare system.

I believe a universal consumer driven healthcare system, available to all, can “Repair the Healthcare System” at a much lower cost to society and individual consumers than a single party payer system.

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

 All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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It Is All about How You Look At Things

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It Looks Like The Dice Are Loaded

Stanley Feld M.D., FACP, MACE

Everyone is probably familiar with Leonard Cohen’s song “Everybody Knows.” If you are not you should read the words and /or listen to it.

https://www.google.com/#q=leonard+cohen+song+everybody+knows

The first paragraph says it all.

“Everybody knows that the dice are loaded
Everybody rolls with their fingers crossed
Everybody knows the war is over
Everybody knows the good guys lost
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
That’s how it goes
Everybody knows”

Leonard Cohen nailed it.

That is what is going on with the repeal and replacement of Obamacare in the congress.

“Everybody knows” the Republicans have shown little enthusiasm in repealing and replacing Obamacare. House Republicans barely got it passed. They had seven years to develop a replacement plan.

I think Republicans do not want replace Obamacare. They have used repeal and replace as a calling card to get a majority in both the house and the senate.

It looks like the American public has been used as a pawn for Republican to gain control of congress.

The Republicans talked a good game for the seven years that Obamacare has been the law of the land.

Obamacare has been a disaster. The majority of people have seen large increases in their healthcare insurance premiums and deductibles along with poor access to care.

Obamacare has cost our treasury trillions of dollars because of it poor business model design and mismanagement.

Obamacare claims it has provided healthcare coverage for twenty million Americans. It is not true. Thirteen million of those twenty million have been added to the enrollees in Medicaid.

Medicaid is a single party payer system that does not provide effective insurance coverage. It does not provide easy access to care in most parts of the country. There is also built in rationing of care.

“Everybody knows”

The healthcare insurance industry insurers are dropping out of Obamacare’s health insurance exchanges. Almost all the state insurance exchanges have gone bankrupt and are out of business.

Americans heard over and over again from Republicans that Obamacare is going to die from it own weight. It is true.

There will continue to be insurance to coverage for the nine million insured with preexisting illness. The government mostly subsidizes these nine million patients. However they have unaffordable deductibles.

“Everybody knows that the dice are loaded.”

This week both Mitch McConnell and other Republican senators were publicly pessimistic about their prospects of repealing and replacing Obamacare this year.

Senate Republicans remain publicly pessimistic about their prospects of repealing and replacing Obamacare this year with several raising concerns this week about the party’s central campaign promise even as one of their leaders vowed to pass such a bill this summer.”  

The fix is in. The dice are loaded! Everybody knows.

Russ Limbaugh blew his top when he heard this.

“Rush Limbaugh said during his show that Republicans are road blocking the President’s agenda to a greater extent than Democrats are.

Limbaugh specifically pointed to remarks by Senate Majority Leader Mitch McConnell (R-KY), specifically about the Obamacare repeal bill.

Check it out:”

“I don’t understand how people don’t get that it’s not just the Democrats in Washington that are road blocking Trump. I mentioned it earlier.

 “Mitch McConnell says he can’t see a way to getting 50 votes for the House Obamacare repeal bill?

Now, stop and think here, folks. Back when the only element that we had was the House of Representatives and Republican voters were constantly saying, “Why aren’t you doing more to stop Obama? Why aren’t you trying to do something to stop Obamacare?”

The answer was always, “Well, all we’ve got is the House. W-w-we can’t get anything through the Senate because the Democrats own the Senate. Obama’s in the White House! He’ll veto anything if it did make it there.”

Limbaugh continued that prior to this year, Republicans always blamed failed policy attempts on a lack of majority in the Senate.

“Then, when we won the Senate, they blamed failed agendas on President Obama.”

So we’ve given Washington a Republican House, Republican Senate, and a Republican president in the White House, and it still feels as though nothing is getting done.”

How come?

“It’s the Republicans standing up and saying, “I just don’t see how we’re — there’s no room here.

“ I don’t know how we’re goanna lower rates when you have this exemption over here and you have this exemption there.”

 Mitch McConnell is giving hollow excuses. The Republican establishment’s motives and method are becoming very transparent.

Everybody knows the dice are loaded.

Rush Limbaugh continues,

“ And I just read this stuff and I shake my head. They don’t want to cut taxes.

  Either they don’t want to cut taxes institutionally, they don’t want to cut taxes economically, or they just don’t want to do the heavy lifting.”

The Republican and Democratic establishment has built a very successful swamp for themselves. It is both socially and economically rewarding. It is a strong powerbase that neither is willing to relinquish.

 “ I don’t know what it is. My guess is they don’t want to help Trump.”

President Trump has pledged to drain the swamp. He has pledged to put power back into the hands of the people. He represents a real threat to the power the establishment in both parties has over the people and their freedoms.

Neither party anticipated his victory and neither party understands his popularity. The Democrats are trying to hobble him directly with fake scandals. The mainstream media are trying to hobble him with fake news.

“They just don’t see how they can do it,” Limbaugh said, remarking how especially incredible it is:”

Because, of course, there’s a way.

 They just don’t want to do it.

I think it’s all establishment, all the time anti-Trump, throw the media in there as well.

 But even in the middle of this I can tell you almost assuredly that Trump is not off his game. He’s not despondent. He’s not sitting there worried about why all these people hate him.

 He’s not worried about all that. He’s just head down and moving ahead full speed as he can…

Rush Limbaugh should not be confused. Republicans are defending the swamp they built. These guys are not going to let President Trump disrupt the powerbase that is in the swamp.

While the Republican establishment is stonewalling President Trump, the Democratic establishment is rolling out a single party payer option again. The Democratic establishment is going to try to sneak it in.

The Democrats argue that it is obvious the Republican establishment does not have a plan. The Democrats proclaim they have a replacement for Obamacare. They claim that a single party payer is easy to understand. Their proclamation is, “Doesn’t Medicare work for seniors?”

“At rallies and in town hall meetings, and in a collection of blue-state legislatures, liberal Democrats have pressed lawmakers, with growing impatience, to support the creation of a single-payer system, in which the state or federal government would supplant private health insurance with a program of public coverage

Medicare does work for seniors. The problem is the premiums and co-payment is becoming higher each year. Supplemental insurance increases each year. Healthcare insurance coverage for seniors is unaffordable to many.

Medicare is also unsustainable for the federal government. The premiums do not cover the costs of coverage.

The Democrat-controlled California State Senate approved a preliminary plan for enacting single-payer system. 

This is a joke. California has a huge budget deficit presently. Where are they going to pay for its proposal?

When are Democrats going to realize the importance of fiscal responsibility?

They don’t now. The expansion of Obamacare to a Medicare model is unsustainable and will bankrupt the state.

This kind of thinking by liberals and Democrats is not going to repair the healthcare system. It will result in collapse of the healthcare system as politicians try to increase their power over the people.

 

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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What Are The Republicans in the Senate Doing?

Stanley Feld M.D.,FACP,MACE

I am rapidly coming to the conclusion that the Republican establishment in both houses of congress are trying to torpedo Donald Trump’s agenda.

Republicans had seven years to coordinate a bill to repeal and replace Obamacare.

The House of Representative’s bill has finally past. Senate committees are stalling progress of the bill.

Both houses should have had all the debates and consensus reached to during the last seven years.

Why would congressmen try to stall the passage of the bill? President Trump has stated that passage of the budget bill is dependent on passage of the healthcare bill.

The reason is obvious to me.

President Trump has pledge to those who voted for him that he is going to drain the swamp in Washington. He is going to eliminate corruption and streamline the bloated bureaucracy.

The Republican establishment is a big part of the swamp. They are thriving in the swamp they helped create.

President Trump represents a direct threat to their power. The Republican establishment does not realize that the only reason they have a majority in both houses is because of the rebellion within the party against the Republican establishment.

Tea partyers and independents voted for unknown candidates and defeated many establishment Republicans in the primaries.

The goal of the Republican establishment is to weaken President Trump’s agenda.

They don’t understand that they are destroying the Republican Party while they are trying to save their own swamp.

It is time the Republicans in the Senate passed the bill.

Regulations that should be eliminated are any regulations that increase bureaucratic control over the healthcare system and the practice of medicine.

The healthcare community knows how to control the costs of chronic diseases. It is by decreasing the onset of complications. Patients have to participate in controlling their chronic disease.

If a healthcare system was developed to control the costs of these chronic diseases, the United States would not only have the best healthcare system in the world we would have the most cost effective healthcare system in the world.

“In the case of diabetes, for example, the American Diabetes Association reports that the total cost of that debilitating disease amounted to $245 billion in 2012. This includes $176 billion in direct medical costs, and $69 billion in lost productivity.”

The key to diabetes control and the avoidance of diabetes complications is to control blood sugar to a close to normal as possible. This takes a lot of work on the patient’s part. Patients need the education and the motivation to become the professor of their disease and control their blood sugar.

  As Rep. Tom Price (R-Ga.), a physician, recently noted, diabetic seniors enrolled in traditional Medicare still do not have access to continuous glucose monitors (CGMs), a medical technology today covered by 95 percent of private health plans. ’’

It is bizarre. Yet, Republican Senators who should have figured this out over the last seven years are debating small points that will have little effect on the clinical outcomes. The Republican Party has an opportunity of a lifetime to fix the healthcare system for the American people.

Republicans are going to waste this opportunity to serve the people in order to preserve their swamp that has gotten the people into this horrible position.

I am afraid we are going to see this behavior of perpetuating waste when it comes to education, the environment and energy.

The Democratic Party is worse. They are not acting in the peoples’ interest. They are trying to obstruct everything President Trump is trying to accomplish.

They criticize every initiative saying it is bad without providing reasons for why it is bad.

I believe it is time for the members of both parties to get off the stick. They must stop thinking about themselves and start thinking about the welfare of Americans.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much: Part 1

Stanley Feld M.D.,FACP,MACE

Elisabeth Rosenthal is editor in chief of Kaiser Health News and a former senior writer at The New York Times.

She wrote an extensive article in the New York Times Sunday Magazine Section on the abuse of a hospital system on a patient without healthcare insurance.

Ms. Rosenthal usually points out defects in the healthcare system in great detail. She usually ignores the primary causes of those defects which leads to stakeholders’ adjustments.

Those adjustments lead to abuses of both the healthcare system and consumers utilizing the healthcare system.

It is important for all consumers and politicians (designated surrogates of consumers) to understand these abuses in detail.

It is doubly important that consumers and politicians understand the primary causes for these abuses.

The ideal goal would be to fix the primary causes so that stakeholders cannot abuse the system. In Ms. Rosenthal’s case study the University of Virginia’s bureaucrats are the decision makers who are far removed from the primarily medical care of patients.

They are far removed from the development of a physician/patient relationship. The patient/physician relationship is so vital to the success of a healthcare system.

These bureaucrats are immune to the tragedy that had befallen Ms. Rosenthal’s example, Ms. Wanda Wickizer. They are stuck in the rules its organization made or their interpretation of these rules.

There does not seem to be any flexibility built into the University of Virginia’s Medical School billing system.

The patient in Ms. Rosenthal story is not entirely immune to the disaster that occurred subsequently.

Her husband died in 2006. He had great city of Norfolk Virginia health insurance. The city of Norfolk continued providing her and her kids with insurance for the next three years.

“Her husband, who died in 2006, worked for the city of Norfolk, which insured their family while he was alive and for three years beyond.”

“After his death, Wanda Wickizer worked in a series of low-wage jobs, but none provided health insurance. A minor pre-existing condition — she was taking Lexapro, a common medicine for depression — meant that her only insurance option was to obtain Obamacare insurance through a health insurance exchange in 2010.

In 2009 only ineffective and costly state administered “high-risk pools” were available. High risk pools disappeared in 2010 with the passage of Obamacare.

She said she could not afford her Obamacare option. However, she did not consider the Obamacare option in her economic condition. Obamacare would have subsidized her insurance coverage up to 100%.

“She thought she would need to pay more than $800 per month for a policy with a $5,000 deductible, and her medical procedures would then be reimbursed at 80 percent. She felt she couldn’t afford that.”

She made a decision that did not take into account a potential medical catastrophe.

“In 2011, she decided to temporarily stop working to tend to her children, which qualified them for Medicaid; with trepidation, she left herself uninsured.”

At this point she probably would, also, have qualified for Medicaid or gotten insurance through the health insurance exchanges that would have been subsidized up to 100% by Obamacare.

Additionally, after she was sick she could have applied for Obamacare insurance. She would have supposedly received full insurance coverage at no cost to her. The application for Obamacare after the onset of an illness is one of the major objections to Obamacare.

This is a defect in Ms. Rosenthal’s story. It could have easily been avoided if Ms. Wickizer applied for insurance available to her at minimal charge.

The casual reader of the Sunday NYT magazine section could easily overlook this defect.

The rest of the story is about the billing catastrophe. Ms. Rosenthal exposes all the defects in the healthcare billing system structure.

A catastrophic illness struck Wanda Wickizer on Christmas Day 2013. It was a subarachnoid hemorrhage that can strike at any time.

“The catastrophe struck Wanda Wickizer on Christmas Day 2013.”

It occurred four years after Obamacare was enacted. She had a debilitating headache. The ambulance paramedics missed the diagnosis. They thought she had food poisoning and did not take her to the hospital.

Later, she, at 3 a.m. became confused and groggy. Her boyfriend raced her to Sentara Norfolk General Hospital. A CAT scan revealed a subarachnoid hemorrhage.

Sentara Norfolk General Hospital felt it could not handle the subarachnoid hemorrhage and air evacuated her by helicopter to University of Virginia Medical Center in Charlottesville 160 miles away.

At UVM the hemorrhage was stopped and the previous accumulation of blood evacuated. She was in the hospital for 3 weeks. When she was home the catastrophe of the healthcare system coding process began.

Ms. Wanda Wickzer’s story will be continued in Part 2 of Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Pre-Election Obama Administration Lies

Stanley Feld M.D.,FACP,MACE

The Obama administration is out in force telling pre-election lies so that the Democrat’s base that loves entitlements stays calm.

New data from Joint Commission on Taxation led the TPC to cut the number of people paying federal income taxes by 3.9 million. In total, 77.5 million individuals and married couples — or tax units. as they are defined by the TPC — won’t pay income tax this year out of a total of 171.3 million. The previous estimate was for 66.2 million out of 163.8 million tax units not paying income tax in 2015.

In 2015, this represented 45.2% of the taxpayer units.  In 2013, 40.4% of taxpayer units paid no taxes. With the influx of illegal immigrants paying no taxes the percentage of non taxpaying units will increase.

The illegal immigrants will receive Medicaid and other entitlements.

Hillary Clinton has pledged to increase illegal immigration with open borders and increase Medicaid enrollment.

Taxes will have to be increased. The middle class will be crushed. Hillary Clinton will hide some of these taxes as President Obama has done for Obamacare..

President Obama is trying desperately to save Obamacare from self-destruction.

I have recently reviewed the phony enrollment figures for 2014, 2015 and 2016 published by the Obama administration. There has not been a significant increase in enrollment in the last three years.

The claim that there are 20 million enrollees as a result of Obamacare is not even a half-truth. There are only 10 million enrollees from the Health Insurance Exchanges.

The failed Medicaid entitlement program has an added 10 million enrollees and insufficient physician coverage.

The first pre-election day lie was HHS Secretary Sylvia Burwell telling a group that the 2017 Open Enrollment period was going to sign up an additional 1 million enrollees. She said the Federal Health Insurance Exchange marketplace was strong.

The Marketplace is strong – and will continue to be strong – because it is offering a product people want and need.

This year, we know the Marketplace is strong, but we think it will grow even more.”

“As we look to this next open enrollment period, we project that the Marketplace will grow by another million people. By the end of open enrollment for 2017, we expect 13.8 million people to have selected a plan.”

Obamacare enrollment through the Health Insurance Exchanges was supposed to grow to 21 million last year according to the CBO estimate. At best, 11 million people are enrolled not 12.8 as claimed. Eighty-five percent of the enrollees receive subsidies.

President Obama’s goal is to have a single party payer in control, namely the government.

Secretary Burwell goes on to conclude;

“In closing, as the President said during the debate over the law, “we did not come to fear the future. We came here to shape it.”

It looks like President Obama is shaping the future in a way Americans did not anticipate or want.

The next big pre-election lie was President Obama’s lie admitting that Health Insurance Exchange premiums will go up 22% in 2017. He also said that the government would cover the premium increases for those receiving subsidies.

He did not discuss the government’s position on the increases in deductibles. Is President Obama also covering the deductible increases?

Where is President Obama getting the money? I think the money for the increased subsidies was built into the budget by telling the CBO that there were supposed to be 21 million enrollees in the Federal Health Insurance Exchanges. Only 10 million enrollees showed up.

The reason for these continuing lies is to calm the public. President Obama and Hillary Clinton want us to believe that Obamacare is good and is working well.

The obvious message of these lies is that the public should vote for Hillary Clinton to continue this good work.

 

https://youtu.be/ziVfvWO8oUE

This You Tube is an excellent summary of all the lies President Obama and the Obama administration have told the America public since the Affordable Care Act (Obamacare) was passed.

It is worth ten minutes of your time to review this deception.

This week he tried to dodge the responsibility for the Health Insurance Exchanges demise and also claimed he should not be blamed for the rise in premiums in the private group insurance market.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker),

Three hundred dollars a month or $3,600 dollars a year is a lot of money for a person making between $40,000 and $50,000 per year.

 The premium increases in Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493).

 “ Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Indianapolis, IN (down -4% from $298 to $286 for a 40-year-old non-smoker), Cleveland, OH (down -2% from $234 to $229), and Providence, RI (down -1% from $263 to $261) and increase just 1% in Little Rock, AR (from $310 to $314).”

 In many states there isn’t any competition in healthcare insurance for consumers business.

“Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.”

Hillary Clinton bragged that healthcare reform was called Hillarycare long before it was called Obamacare.

I would not be very proud of that statement, if I were her.

I do not believe the American public is not going to be fooled again by progressive rhetoric and lies.

Obamacare is a disaster. I have described the disaster and its potential consequences for since its passage in 2010.

It has caused both the public and private healthcare markets to escalate insurance premiums to unaffordable levels for all Americans. The cost to the federal government is unsustainable.

The present awareness of the Obamacare disaster is the straw that is going to break the back of Hillary Clinton’s campaign.

All Americans deserve a better healthcare system than Obamacare.

My ideal medical saving account is the solution to the healthcare problem.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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