Stanley Feld M.D.,FACP,MACE

The problem with the economic recovery is increasing unemployment and the increasing deficit spending. A new healthcare entitlement will increase the deficit leading to increased taxes. Increased taxes on large and small business will lead to fewer jobs and less tax revenue. We are experiencing this in our jobless economic recovery. All the new jobs are going to third world countries. Government jobs is the only sector growing.

The House’s 1900 page bill that was passed in less than 72 hours after publication. This was after the Democratic Party controlled congress pledged to be totally transparent.

Americans have a Democratic controlled congress that ignores the will of the people. Americans had no idea of what President Obama meant by change. The Democratic Party leaders do not realize they were elected by independent voters and women. Both groups now seem to have become disillusioned with President Obama and the Democratic majorities.

Last week we heard former President Clinton. He told the Senate to past any healthcare bill even if it is not perfect. You can fix it later.

This week I received the following note. It is a heartfelt note from a practicing obstetrician. She expresses the anger and frustration of many physicians. The note shows the impact the bill will have on the practice of medicine.

My generation of physicians has been told that the new younger physicians will accept change in the future because they do not know any better. We lived in the golden years of medical practice. .

My answer is you are wrong. The satisfaction of being a physician is to have the privilege of relating to patients and treating patients the best you can. The special quality of the patient physician relationship will not be lost on the new breed of physicians.

President Obama’s control and ineffective quantification of healthcare will destroy the patient physician relationship and medical care in America.

President Obama’s task forces will outsource the quantification of healthcare to groups like Leapfrog. Leapfrog knows much about the economics of healthcare but little about the practice of medicine.

Dear Family and Friends,

Where to start……how about from the  beginning……
I’ve been in private practice for 15+ years now.
I’m  44yo. That means I started when I was 29yo….that is YOUNG for a physician.

Consider you are 18yo when you get out of high school (17 yo in my 
case). Add 4 years of college, 4 years of medical school and 4 more years of  residency.
So 12 years of graduate/postgraduate work. Consider being 
200K in debt after those 12 years.
Want to know who is running your  healthcare? It’s not doctors………It’s not people who have one minute of  training in medicine.

Let me share what has happened at MY hospital  in the last 2 weeks. Two examples will follow;
There is an  "organization" called Leapfrog. Here is their link  http://www.leapfroggroup.org/ . Hospitals are buying into their "program" for rewards and incentives.

Go to the link…..look at their board members. What do you see?? BIG EXECUTIVES…….not a single doctor….not one. Study their website…..It is driving YOUR
healthcare…..no where does  it mention how they get their medical "quality" other than saying our  "experts"……..oh, and yes they have a disclaimer stating they aren’t responsible for anything (in tiny print at the bottom of their website  page).
Now, you can search for hospitals to see Leapfrog’s "Quality" 
of care….. Money driven quality…..
Lets take my department for example… OBSTETRICS: Leapfrog has ONE (ONLY ONE) criteria for quality…..you have to deliver after 39 weeks. Doesn’t matter your fears, 
discomforts, family, prenatal care, baby’s outcome….NOTHING besides you are 39 weeks or greater.
My hospital has now MANDATED that I deliver you  at 39 weeks or greater…..because they want Leapfrog to give them 4 bars  (i.e. highest quality) Now this has NOTHING to do with
true medicine. By text book definition, a full term pregnancy is 37 weeks or  greater.

If you look at my hospital on Leapfrog….we have 1 bar, implying poor quality. Leapfrog even goes so far as to say we have a 31.7% PRETERM delivery rate. This is a LIE! Remember full-term to Leapfrog is 39 weeks……which has NO medical basis.

Consider the patient who previously had a 39 week stillborn…….the patient who is losing her insurance…..the patient whose husband is a pilot and is leaving town…the  patient whose husband is in the military….the patient whose family is  flying in from overseas. The physician hears the patient over and over  again, every office visit….it’s called a relationship.
Do you think  Leapfrog, who is simply bargaining with big executives for better prices, 
cares about the patient’s individual situation……NOT AT ALL….but hospitals want Leapfrog’s 4 bars (better quality) rating, so they get  "rewarded" better. 
So as it stands now, if I deliver a patient before 39 weeks, the hospital will place that in my permanent file. Then they can  choose to "deselect" me and not allow me to deliver at their  hospital.
Physicians are now faced with making ethical  decisions…..do I do what is truly right and best for this patient and get  "deselected"? Or do I do what the hospital tells me to do……..

The unintended consequences will destroy medical care in this country.

This physician is thinking of quitting the practice of obstetrics and gynecology at a time we have a shortage of physicians doing obstetrics. President Obama refuses to deal with the structural problems in the healthcare system such as the need for malpractice reform.

The President must think that when his healthcare plan evolves to complete socialized medicine all physicians will work for the government. Physicians will then be immune to malpractice suits.

Wake up America!! Write the President, Congress, and your local newspaper. Tell your congressional representatives who vote for this bill that you will not vote for them.

Enough is enough.

http://www.whitehouse.gov/CONTACT/

https://writerep.house.gov/writerep/welcome.shtml

http://www.senate.gov/general/contact_information/senators_cfm.cfm

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

Stanley Feld M.D.,FACP,MACE

Let us assume it is important to have universal care, affordable healthcare insurance and increase an in quality of care. The House of Representative’s (Pelosi’s) bill will not accomplish these goals. It will provide increased government control over our lives, a loss of freedom of choice, a large increase in our national deficit and increased taxes for all.

The economic impact to the government and the public as well as the implications to our freedom of choice must be understood by everyone. The implications regarding the delivery of medical care must also be understood.

1. The initial defect in the bill is in estimating the cost of the new entitlement. Nancy Pelosi estimates a cost of $829 billion over 10 years.

“Initial Congressional Budget Office (CBO) figures suggested $1.055 trillion. However, the CBO estimates assume that:

• Doctors will accept more than 20% cuts in Medicare payments for their services. President Obama supposedly waived this portion of the bill to obtain the AMA support. It looks like the AMA made a deal with the devil.
• Middle-class Americans will accept an arbitrary distribution of benefits. The distribution of benefits has not been defined. President Obama panel of experts will dictate best practices. The panel has already been funded by the economic stimulus bill. The $30 billion dollars will not be charged to the healthcare reform bill.
• Congress ‘finds’ additional funding in 2017, 2018, 2019 and 2020.”

Entitlement programs are notorious for exceeding budgetary estimates. My guess is the cost will be close to $3 trillion dollars over 10 years if all the bureaucratic costs are included. This cost will force taxes to be increased for all Americans. Additionally, there will be an absolute need for rationing care.

2. The Obama/Pelosi plan is a government takeover of the U.S. Healthcare system. Some Americans want a government takeover because the healthcare insurance industry has been irresponsible in the past during the quest for increased profit. The healthcare insurance industry’s irresponsibility has led to the hospital systems and physicians becoming almost as irresponsible. All of these actions have been to the disadvantage of patients, patient care and affordability of care.

3. The Pelosi bill passed by a very slim partisan majority. The bill dictates that the federal government will tell you what insurance you have to buy, where you have to buy it and what you will pay.

If you refuse to purchase government-approved insurance, the government will assess a penalty tax on 2.5% of your income. Your tax return will be attached to the government mandated insurance just as seniors’ tax returns are attached to Medicare to determine seniors’ yearly means tested insurance premium for Medicare coverage.

The house bill will raise $572 billion in new taxes to be deficit neutral. The majority of the new tax will be charged to small businesses.

“All businesses will have to pay at least 72.5% of their workers’ insurance. If a business does not pay 72.5% of the healthcare insurance premium, it will be charged an additional 8% payroll tax.”

The negative effect of this tax increase will be to decrease job creation by businesses of all sizes and increase the unemployment burden in our jobless recovery.

Americans will be forced out of their current insurance plans into government qualified healthcare plans despite President Obama’s frequent promise that "you can keep your current plan, if you like it.”

By creating yet another massive entitlement program, President Obama will dramatically expand the federal deficit. The plan will significantly increase the size of the burden of the federal government’s unfunded liabilities.

The burden to consumers will be just as massive. In addition to increases in taxes to small businesses, there will be increases in taxes to all consumers, even those making under $250,000 a year. Consumer healthcare insurance premiums will be means tested as Medicare premiums are.

 
“ The Congressional Budget Office estimated what the government qualified healthcare plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income.”

If consumers have to pay for their healthcare insurance premiums with after tax dollars the real price will be at least 30% higher.

“ A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income.”

“ Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.”

A reader sent me this note expressing his frustration.

The House bill passed last Saturday is so remarkably bad. Hopefully it will wake up the entire citizenry to realize what is about to happen to all of us.  Certainly very few will have the time or stamina to read the entire bill but there have already been enough headlines and short summaries to inform anyone who cares about the consequences to see the bill for what it is and reject it.

In all of this I am aghast about the willingness of the members of congress to allow President Obama to lead them by their noses.  Why is Congress willing to give up its prerogative to be the legislative branch and subjugating itself to the executive branch?

The members of congress need to reread the Constitution and also remember they are to be representatives of their constituents, not lapdogs for this or any other president.

Furthermore, it is very cheeky for Obama especially to goad Congress to vote on a short timetable on a matter so important since he seldom voted on any bill when he was a member of the Senate.

The house consensus bill is hardly an affordable healthcare bill. Premiums will not be affordable. The tax increases necessary will decrease job creation at a time our country needs to stimulate job creation. I encourage everyone to say enough is enough. Please write or call your representatives and express your displeasure.

https://writerep.house.gov/writerep/welcome.shtml

http://www.senate.gov/general/contact_information/senators_cfm.cfm

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

Stanley Feld M.D.,FACP,MACE

President Obama was elected on the themes of change and hope. He captured the imagination of all generations. Americans were starved for innovative change. He inspired many with hope for the future.

Voters did not dream that the change Democrats had in mind was making health care even more expensive and rigid than the broken existing healthcare system most Americans were dissatisfied with.

The combined 1900 page House of Representatives bill released last week is more ominous than the 1100 page HR 3200.Few have had the energy to read and comprehend the full implications and unintended consequences of Nancy Pelosi’s bill President Obama has raved about.

President Obama said Nancy Pelosi is not only the first woman speaker of the house but the greatest speaker in the history of the United States.

“Speaker Nancy Pelosi has reportedly told fellow Democrats that she’s prepared to lose seats in 2010 if that’s what it takes to pass ObamaCare, and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a "critical milestone.”

The bill contains increased new spending, higher taxes, higher insurance premiums, rationed care, plus a lot of dishonest accounting.

The bill ignored the citizen protests of last summer.

It is not paying attention to the American public’s needs at the time of the worse economic recession since the depression. America’s economic growth depends on consumers spending. The economy cannot grow in a time of increased taxes on the middle class and a jobless recovery.

It is not paying attention to the historically underestimation of costs of a new entitlement program.

“With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle-class entitlement that is designed to expand over time.”

“ Taxes will need to rise precipitously, even as ObamaCare so dramatically expands government control of health care that eventually all medicine will be rationed via politics.”

The middle class independent voters have caught on. They have forcefully expressed themselves in the November 2 elections even though the administration denies it.

“Democrats have dumped any pretense of genuine bipartisan "reform" and moved into the realm of pure power politics as they race against the unpopularity of their own agenda. The goal is to ram through whatever income-redistribution scheme they can claim to be "universal coverage." The result will be destructive on every level—for the health-care system, for the country’s fiscal condition, and ultimately for American freedom and prosperity.”

President Obama and the congress either do not understand medicine and basic economics or they are sinister. I choose to believe they do not understand medicine or basic economics. In either case the President and congress are doing a tremendous disservice to this country and its citizens.

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

Stanley Feld M.D.,FACP,MACE

There are many reasons President Obama’s plan for healthcare reform is failing. The public is not dumb enough to believe the public option will work and save money at the same time.

The public does not believe that the creation of a new entitlement program with a massive bureaucracy can save money without rationing care. President Obama has not directly denied there will not be rationing of care.

The public does not believe President Obama’s promises anymore. He has been responsible for the mess created by the economic stimulus package, the bank bailouts, and the automobile bailout while increasing the deficit and devaluing the dollar. When is he going to bailout the people? He is increasing government control over our freedoms and limiting corporate ability to compete for consumer business.

The American public does not believe President Obama when he says he has saved a million jobs. Each month the unemployment rate increases as companies lay off workers. He said unemployment would not surpass 8.5% with his economic stimulus package. Unemployment is greater than 10% as Fed chairman Ben Bernanke declares the recession is over. President Obama said the bailouts would increase lending and yet small businesses cannot obtain loans.

President Obama also promised that people making under $250,000 dollars a year would not be taxed yet it is obvious that taxes are going to increase for everyone if the healthcare bill is passed.

President Obama has made many false promises and created much false hope. I believe President Obama does not understand the core problems with his healthcare plan. He wants to change the healthcare system but not eliminate its major defects. He is trying to impose a government takeover of the healthcare system. The winners will be special interests with increased government power over our lives. Patients will not be the winners.

There are no incentives for patients or physicians in his healthcare plan. There is only punishment and restrictions on access to care.

Americans deserve more credit than President Obama is giving them. America’s opinion is showing up in the polls. The problem is neither the President nor the Democratic congress is listening. The net result is going to be an increase in public anger.

“According to the Gallup polling organization, the percentage of Americans who believe the cost of health care for their families will "get worse" under the proposed reforms rose to 49% from 42% in just the past month. The percentage saying it would "get better" stayed at 22%.”

The public has no great love for the healthcare insurance industry either. The healthcare industry has abused its responsibility to consumers for the sake of profit. Consumers want a free market system in which the government makes rules to level the playing field for them. The public option will not do that because the healthcare insurance industry remains the administrative service provider.

President Obama is ignoring what Americans’ core beliefs in a free enterprise culture, namely the importance of individual choice, personal accountability, and rewards for ambition.

He cannot say “trust me” to take care of America. There are too many contradictions. Harry Reid says there is not going to be a public option one week and the next week he says there is going to be a public option. The public is weary of this double talk

“First, Americans recoil at policies that strip choices from citizens and pass them to bureaucrats. ObamaCare systematically does so. The current proposals in Congress would effectively limit choice across the entire spectrum of health care: “

“ The government will determine what kind of health insurance citizens can buy, what kind of doctors they can see, what kind of procedures their doctors will perform, what kind of drugs they can take, and what treatment options they may have.”

These limitations on choice are directly opposed to main stream America’s beliefs. Most Americans’ believe they should be responsible for the consequences of their actions.

President Obama’s healthcare plan removes individual responsibility. The government will take care of all of us at great cost to the taxpayers. The $1.5 trillion dollar cost estimate has historically been incorrect for other entitlement programs

“ ObamaCare discourages personal ambition. The proposed reforms will institute a set of government mandates, price controls and other strictures that will make highly trained specialists, drug researchers and medical device makers less valued now and in the future.”

Americans understand that when you take away the economic incentives new therapies and medical innovations of tomorrow may never be discovered.

A survey of the follow propositions were tested for public sentiment.

" (a)Government policies should promote fairness by narrowing the gap between rich and poor, spreading the wealth, and making sure that economic outcomes are more equal";

“or (b) Government policies should promote opportunity by fostering job growth, encouraging entrepreneurs, and allowing people to keep more of what they earn."

“Sixty-three percent chose the second option; just 31% chose the first.”

I have no doubt that President Obama wants to help people in need. However, he is proposing government control over a population that is extremely uncomfortable with increasing government control of institutions and businesses. The public is suspicious of government restrictions and proven inefficiency. They do not want to put their healthcare needs in the hand of the government.

I believe he missed his opportunity for effective Repair of the Healthcare system by not leveraging that repair congruent with America’s culture.

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

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform plan will not repair the healthcare system. It will not provide universal coverage, it will not provide affordable coverage and it will not increase the quality of care.

Not repairing the healthcare system is unacceptable. I have proposed an ideal medical saving accounts that will align all the stakeholder’s interests while not letting any stakeholder take advantage of the other. It is dependent on appropriate, enforceable state and federal rules and regulations that permit the market system to flourish and maintain freedom of choice.

Government should make rules to level the playing field for all stakeholders and then get out of the way. An efficient healthcare system can be created by permitting the consumer to drive the healthcare system.

Many employers have adjusted to the present healthcare rules and regulations. The result has been greater dysfunction in the healthcare system .

As healthcare insurance premiums increased employers could not afford full coverage for their employees. They changed to providing partial insurance coverage. Employees are required to pay for a significant portion of their insurance policy. The money comes out of the employee’s salary with pretax dollars. .

Other employers have provided high deductible insurance for their employees. The initial deductible costs are paid for with after tax dollars and have been an unaffordable burden to employees. Some cannot afford to pay the deductible and avoid care.

This scheme has the same effect on employees’ purchasing power as a federal tax increase. It should be viewed as a hidden tax increase.

There are many ways to fix the inequities to consumers in the present healthcare insurance system. .

“Substantial improvements to private insurance markets can be much more targeted and straightforward.

1. These include changes to HIPAA and COBRA provisions to ensure portability between employer insurance plans,

1. Measures to prevent higher premium upticks for customers moving from group to individual insurance markets,

1. Ensuring that market entrants only face a single risk evaluation,

1. Opportunities for the uninsured to opt back in to the system under new protections.”

1. Correct accounting standard for incurred claim and Medical-Loss ratio.

1. Instituting ideal medical savings accounts with patients owning and controlling their healthcare dollars would result in consumers being educated purchasers of healthcare services. Permitting consumers to retain the unused portion of the deductible in a tax retirement trust account would motivate the consumer to have a healthy lifestyle.

1. Developing rules and regulations that calculate healthcare insurance premiums for the entire population and not rates determined by age or pre-existing illness.

1. Taxing employers appropriately so that they provide adequate healthcare insurance for their employees with tax deductible dollars.

    9. Creating malpractice reform that has caps on liability. It will decrease defensive medicine and over testing by physicians in order to avoid malpractice suits. This simple rule could decrease healthcare costs by $750 billion dollars a year.

“STEPHANOPOULOS: The president has drawn one other very red line in the sand, that he won’t sign any health care bill that increases the deficit.”

“OBAMA: I will not sign a healthcare reform plan that adds one dime to our deficits, either now or in the future.”

However the history of government entitlement programs estimates has consistently contradicted President Obama’s statement. With the CBO’s estimates changing weekly and a large bureaucracy being set up, President Obama’s estimates are certain to be underestimates.

Next let’s examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing.

In many states a person living in poverty but earn more than the poverty level defined in 1955, does not qualify for Medicaid coverage.

Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that’s before the health-care bill covers millions of new beneficiaries.

The bureaucratic process for Medicaid coverage requires reapplication every six months. Moises’ reapplication was rejected by bureaucratic error without explanation. He and his wife do not have coverage. Now his children are uncovered. So much for bureaucratic efficiency in Medicaid.

Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren’t small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion.

Even if one gave President Obama the benefit of the doubt on his budget estimates his plan will not repair the real defects in the healthcare system.

There is strong historical precedent that his new entitlement program will create large deficits no matter what tricks he plays with the numbers.

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

Stanley Feld M.D.,FACP,MACE

President Obama is doing exactly what a good lawyer does. He wears you down with trick plays. Voters are getting sick of hearing all about the benefits of his healthcare reform plan while not being told about the downside of healthcare reform. The administration and the Democratic congress are not listening to voter objections and voter mistrust.

Senator Baucus has gotten his bill out of committee. President Obama has hailed it as a bipartisan victory since one Republic Senator, Olympia Snow, voted for it. Most voters would say President Obama’s statement is a joke. It sounds as if he thinks voters are stupid.

The polls show that the Democrat congresspersons approval rating is less than 30%. President Obama’s approval rate is under 50%. Voters see massive tax increases coming down the pike. They feel powerless to stop them until they vote in November 2010.

Voters also know that newly formed bureaucratic agencies and entitlements are difficult to reverse. These new bureaucratic agencies and entitlements are about to be rammed through Congress. The public is frustrated.

Americans are witnessing a rapid recovery in the stock market. However, the country is facing larger deficits, increasing failures in the commercial real estate industry and an impending credit card debt crisis.

Bailed out banks defy President Obama’s plea to decrease bonuses using taxpayers’ dollars. These banks are getting ready to come to the government once more for more federal bailout money. Just change the rules so a person can only get paid on performance instead of bonus by contract. If someone receives a bonus by contract it should be a non tax deductible expense to the company.

The congress and President Obama are ignoring the basic systemic problems as promised. Most problems can be fixed by changing regulations with simple logical regulations.

The stimulus package is not stimulating the economy. President Obama is bragging about the stimulus package creating 30,000 jobs so far while the unemployment rate increases weekly. America is experiencing a jobless economic recovery. Where are the jobs? The only job growth is related to government job growth.

Locally real estate taxes are rising as out housing values are declining. However, cities and state are running large deficits and cannot afford to assess taxes on actual housing values.

We were told America is a government by the people for the people. However, our surrogate representatives are acting in the interest of special interests and not the people.

President Obama’s healthcare reform is not going to provide universal care as promised. His healthcare reform plan is going to increase our taxes and the deficit by at least 1.5 trillion dollars in ten years. President Obama has said he will not sign a bill that would increase the federal deficit.

“The problem for Mr. Obama is that the Baucus bill is being sold on the strength of accounting tricks that make it appear that it won’t add to the deficit. If fiscally conservative Democrats sign on to the bill now after publicly saying they are doing so because it doesn’t add to the deficit, they may end up bailing once the tricks are revealed to the public.”

The trick play is he is going to collect increased taxes and cut benefits (ration care to seniors) in the first five years before instituting reform. Meanwhile he will create a massive government bureaucracy.

President Obama healthcare reform plan will fail because the plan he is proposing escalates costs of healthcare not decreases it. The costs will be shifted from the government to the consumer by non transparent increases in taxes and increased out of pocket expenses.

“One trick is easily explained. The bill imposes tax hikes and benefit cuts right away, including $121 billion of Medicare reductions between 2011 and 2015. But new spending really doesn’t start until five years out (2015) and isn’t fully operational until 2017. The bill uses 10 years worth of tax hikes and benefit cuts to fund a few years worth of benefits.”

Shouldn’t voters have a say in this folly?

The Democrats and President Obama will see what will happen when the voter figure out what they are doing to us. I think the independent voters have figured it out already and will not vote Democratic in the next election.

“The Congressional Budget Office (CBO) released a report last week claiming the bill won’t add to the deficit.”

“But this assumes that employers who dump employee coverage under the Baucus bill will then increase worker paychecks by an amount equal to what they had spent on health care. This replaces a nontaxable event (providing health insurance) with a taxable one (increasing worker paychecks), magically producing $83 billion in revenues. Without this windfall, the Baucus bill adds billions of dollars to the federal deficit in the first decade.

Of course, why would a company drop employee coverage just so it could pay more (in fines, taxes and wages) than it did before?”

How we are going to pay for this ineffective plan that is destined to fail. Voters have only to look at what has and is happening in Massachusetts. Massachusetts is having massive cost overruns. It has been forced to decrease coverage and ask for increased federal funds.

Nonetheless, President Obama states that Congress has taken a massive step toward the passage of a healthcare reform package that will provide universal care, affordable insurance and improve quality.

Does anyone believe President Obama and his trick plays anymore?

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

Stanley Feld M.D.,FACP,MACE

Why will President Obama’s Healthcare Reform Plan fail? Medicare and Medicaid have unrelenting increases in its yearly deficits. Both programs as well as the available private health insurance do not provide incentives to consumers or physicians to improve the healthcare system.

Consumers, who have healthcare insurance have been passive until now. “If I get sick my insurance will take care of me.”

As more people get sick they realize they are uninsured.

Therein lies the problem with President Obama’s Healthcare Reform Plan. It forces the consumer to be dependent on the government rather than to be responsible for health and healthcare.

Sometimes patients cannot help it if they get sick. Some illnesses are genetic. Some illnesses are environmental. Many illnesses are preventable.

Healthcare reform should put an emphasis on disease prevention. It should provide incentives for consumers to prevent disease and incentives for physicians to teach patients to avoid complications once they have a chronic disease.

Prevention of the onset of chronic disease and the complications of chronic disease require motivated consumers. It also requires the elimination of environmental hazard that precipitate chronic disease. There are many examples of environmental hazards (air pollution, toxic wastes, cigarette smoking, and obesity to name a few).

Let us take obesity as an example.

Is there any language provided in any of the bills before congress addressing the obesity epidemic?  No, yet obesity predisposes consumers to Type 2 Diabetes and coronary artery disease. Medical care of these two problems cost the nation $400 billion dollars a year.

In a March 26, 2008 article in the New York Times, New York City was declared Fat City? Ten (10) million pounds were gained in 2 years according to the April issue of Preventing Chronic Disease, a medical journal published by the Centers for Disease Control and Prevention.

“About 173,500 adult New Yorkers became obese and more than 73,000 received new diagnoses of diabetes from 2002 to 2004, according to a new study by the New York City Department of Health and Mental Hygiene. Put another way, “the citywide weight gain totaled more than 10 million pounds in just two years,” the city noted in a news release summarizing the study.”

President Obama should be concentrating his efforts on how to motive people to lose weight in order to avoid the onset of Diabetes Mellitus and Heart Disease. He and his healthcare reform team should study my “War on Obesity.”

None of the necessary steps are being taken by the administration to solve Obesity in America. Without a solution to the obesity epidemic, the Type 2 Diabetes Mellitus epidemic will continue and the cost of President Obama’s new entitlement plan will escalate.

How should President Obama motivate people to be responsible for their own care? He should provide incentives. He should propose and enforce regulations that provide consumers with a healthier food environment.

A first step would be to deal with farm subsides that encourage obesity. It can be done. He must also provide effective education to the public to combat obesity. He must provide economic incentives to consumers to exercise and lose weight. This can be accomplished by the ideal medical savings account.

President Obama should become serious about dealing with malpractice reform. The cost of defensive medicine is $750 billion /year. Consumers must be educated to demand tort reform. Defensive medicine would affect the remaining balance in their medical savings accounts. Consumers should be taught to demand an explanation for the tests from their physicians. Consumers could be taught to waive physicians’ liability if there is no good reason for a test. Physicians have not been sued for tests they have done. They have been sued for tested they have not done.

President Obama should be spending money on a system that encourages innovation (the ideal medical savings account) rather than spending and wasting money on a new entitlement for a healthcare system that is broken.

I will repeat my answer to your question. Your employer or the government pays for your ideal medical savings account.  The entire policy (the $6,000 deductible and the $6,000 high deductible policy) remains tax deductible to your employer.

You have the responsibility to use the first $6,000 wisely and remain healthy. If you do not spend it you keep it in a trust account tax free for retirement and not for future healthcare needs. If you use it before you retire you pay ordinary income tax plus a penalty. If you spend more than $6,000 you receive first dollar healthcare coverage.

If you are self employed and qualify for government aid or a subsidy the government pays for healthcare premium. If you are on Medicaid the government remains the payor.

All citizens would have the same healthcare coverage. Everyone would be responsible for their choice of lifestyle. President Obama would instantly have 300 million consumers repairing the healthcare system. It would take major control of the healthcare system out of the healthcare insurance industry’s hands.

Stimulating innovation would decrease the cost of healthcare while insuring everyone. It would improve wellness and quality care.

Expanding an entitlement is not the answer to Repairing the Healthcare System.

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

Stanley Feld M.D.,FACP,MACE

I agree with the general goals of healthcare reform as outlined by President Obama. They are universal healthcare, affordable healthcare, and quality healthcare. The problem is the route he is taking will not achieve his goals.

His route will increase bureaucracy, decrease freedoms of individuals to choose, decrease quality and increase the cost of care.

A reader question highlights the confusion about the ideal medical saving account.

“ Do I understand you expect me to pay $500 per month toward tax free trust account and also budget $500/month for medical expenses toward my deductible?

How does a person making under $28,000 year do this!

The answer to the question is no.

The government or your employer would pay the $500 per month for you into a trust account. This would put the first dollar coverage in consumers’ hands rather than the healthcare insurance industry’s hands. The trust account would serve as an economic incentive for consumers to become wise shoppers for medical care and for them to be responsible for their own wellness. What was not spent of the first $6,000 would be in consumers’ retirement account rather than in an account for future healthcare expenditures.

Consumers would force providers to be innovative and compete for the consumers’ healthcare dollars just as Wal-Mart, Target, and Amazon do. Government’s position should be to provide appropriate consumer education to protect them and become informed shoppers for their healthcare needs.

There are several new innovative practice and healthcare insurance systems being developed by physicians that will reduce the cost of care by marginalizing the healthcare insurance industry’s influence and control over the healthcare system while reducing physician overhead.

I will discuss some of these innovative practice and healthcare insurance systems in the near future.

President Obama is willing to spend 1 trillion dollars over the next ten years to repair the healthcare system in addition to the many billions President Obama has secured in the hastily prepared “economic stimulus package.” It is money that will be wasted because his healthcare reform package can only increase healthcare complexity and decrease access to care. It will also increase the healthcare industry’s profit at the expense of medical care to consumers.

Consumers should be motivated to be in charge of their healthcare needs and expenditures. President Obama’s healthcare team thinks a large and inefficient bureaucracy will do it. He has only to look at the failed system in Massachusetts.

Everyone agrees that Medicare and Medicaid have failed. Seniors, in general, are satisfied with Medicare coverage until they have to pay all the deductible costs.

Some are able to cover the deductible costs with additional insurance (Medigap or Medicare Advantage) coverage. The premiums for Medicare are high with the upper limit for full coverage being $15,000 a year. The cost of the Medicare premium is not noticed because it is taken out of their social security payment.

The premiums with coverage for deductibles and drugs can vary from $3,000 per persons to $7,500 per person with after tax dollars. Seniors are all means tested by direct communication between the IRS (tax returns) and Medicare.

Despite high premiums the government has to subsidize healthcare costs at an unsustainable rate. New innovative delivery of healthcare is essential in order to deliver healthcare at an affordable cost, universally, and with increased quality.

Expanding the Medicare system to all citizens will simply make the deficit worse. The CBO estimates that in 40 years the yearly deficit will increase by 100 trillion dollars with the present healthcare system.

There are ways to accomplish President Obama’s goals. The system has to be simplified. Consumers have to be in control of their healthcare dollars and be responsible for their health. President Obama’s healthcare reform plan will make consumers more dependent on government and healthcare more expensive.

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