Stanley Feld M.D., FACP, MACE Menu

Stakeholder Mistrust

Permalink:

President Trump’s Drug Plan

President Trump’s Drug Plan

Stanley Feld M.D.,FACP,MACE

It is very difficult to know the truth in our post truth era. Intellectuals, elites and the well-educated are criticizing every idea the Trump administration brings forward.

He was hampered in moving forward in Repairing the Healthcare System when his own Republican Party did not pass the house of representatives’ bill to repeal Obamacare. The repeal would have enabled his administration to move the repair of the healthcare system forward quickly.

Most of President Trump’s ideas when it has related to repairing the healthcare system have been common sense. They are steps in the right direction.

Common sense solutions sometimes threaten to undermine extremely profitable private and public enterprises. The pharmaceutical industry and all related middlemen are an industry that is threatened by President Trump’s common sense solutions.

The industry will do everything in its power to spin the story so that the Trump administration’s plans sound sinister to the American public.

The American public can only make decisions on the information presented. In the post-true era the public does not know what to believe. The media has been anti-Trump and is not interested in presenting the details of President Trump’s blueprint for lowering drug prices utilizing free market principles.

“The problem of high prescription drug costs is something that’s been talked about in Washington for a long time. But that’s all it’s been: talk, talk, talk.

We are privileged to have a president finally acting, by laying out a blueprint for solving these problems using private-sector competition and private sector negotiation.

We’re not going to propose cheap political gimmicks. The President’s blueprint is a sophisticated approach to reforming and improving our system.

Everyone at HHS is rolling up their sleeves to get to work on this.”

On October 28,2018 the WSJ editorial board wrote a negative view of the Trump administration’s plan to lower drug prices. It is almost as if the editorial board did not read President Trump’s proposal as it appears on the White House web site. 

I believe it is worth discussing President Trump’s blueprint for lower drug prices.

I will then present the main points in the Wall Street Journal editorial.

The blueprint starts by stating:

These are the main problems with drug prices in the U.S.

Drug costs consume 30% of the healthcare dollar. Drug costs are unaffordable to both consumers and the government. Over 40% of elderly patients consume greater than nine drugs daily. Fifty percent of those 40% experience adverse drug reactions due to drug interaction. Many end up being hospitalized thereby increasing the cost of medical care.

If a patient cannot afford to buy a drug because of its cost it will not help control their disease. A hospitalization will occur increasing the cost of healthcare.

One of my greatest priorities is to reduce the price of prescription drugs. Prices will come down.”

President Donald J. Trump” 

The public should take this comment at face value.

These are some of the facts;

  • According to the Organization for Economic Co-operation and Development (OECD), the United States had the highest per-capita pharmaceutical spending in 2015.
  • Senior citizens pay more in Medicare Part B and Part D because government rules prevent health plans and vendors from negotiating the better deals seen in other markets.

Isn’t that crazy? The government negotiates drug prices for the VA and Military but not for seniors. The government pays less than half for drugs in the VA healthcare system than seniors do for Medicare Part B and Part D.

  • Some hospitals that receive drug discounts under the 340B program, ultimately pushing up drug prices for patients with private health insurance.

The 340B program was enacted in 1992 by congress.  Section 340B requires pharmaceutical manufacturers to enter into an agreement, called a pharmaceutical pricing agreement (PPA), with the HHS Secretary.

Under the PPA, the manufacturer agrees to provide front-end discounts on covered outpatient drugs purchased by specified providers, called “covered entities,” that serve the nation’s most vulnerable patient populations. Medicaid patients get drugs free. The government pays the pharmaceutical companies the money through a series of middlemen.

  • Lower-cost drugs are kept out of the market by drug companies gaming regulatory processes and the patent system in order to unfairly maintain monopolies.
  • Lack of transparency in drug pricing benefits special interests and prevents patients from being able to make fully informed decisions about their care.
  • Other countries use socialized healthcare to command unfairly low prices from U.S. drug makers. These lower prices place the burden of financing drug development largely on American patients and taxpayers and subsidizes foreign consumers.
    • The United States pays more than 70 percent of branded drug profits among OECD countries.
  • The drug companies claim this behavior by other countries reduces innovation and the development of new treatments. They have to make the loss of revenue up by increasing the price of drugs.

The HHS executive summary outlines not only the problem it outlines the Trump administration’s solution. President Trump’s HHS team which includes CMS has spent many years studying the abuses that have led to dysfunction of the healthcare system. I believe HHS figured out the solution.

HHS has identified four challenges in the American drug market:

 High list prices for drugs

  • Seniors and government programs overpaying for drugs due to lack of the latest negotiation tools
  • High and rising out-of-pocket costs for consumers
  • Foreign governments free-riding of American investment in innovation

 Under President Trump, HHS has proposed a comprehensive blueprint for addressing these challenges, identifying four key strategies for reform:

 Improved competition

  • Better negotiation
  • Incentives for lower list prices
  • Lowering out-of-pocket costs

 There is nothing sinister about these goals. Some will work. Direct negotiation with drug companies certainly will work. The middlemen get more money per capsule than the drug company that invented and manufactured the drug. The middlemen, who are marketers, are terrified that President Trump is going to destroy their business.

 HHS’s blueprint encompasses two phases:

 1) actions the President may direct HHS to take immediately.

 2) actions HHS is actively considering, on which feedback is being solicited.

  Complex drug networks 11 26

The president and his administration are not a heartless group of politicians who don’t care about cancer drug cost. They are interested in patients receiving the best care at an affordable price. They care about fair pricing. Their goal is to eliminate the mechanisms by which multiple stakeholders game the system. This includes the multiple middlemen and the tremendous bureaucratic load.

Is the diagram complicated enough? Can you visualize all the areas of potential abuse? Do you think a government bureaucracy can control the potential abuse?

Phase one of the blueprint:

  • Lower prices on some Medicare Part B drugs could be negotiated for by Part D plans
  • Leveraging the Competitive Acquisition Program in Part B.
  • Working across the Administration to assess the problem of foreign free-riding.

 

The administration is aware of foreign free riding. They have not published a definite free market solution to change the situation yet.

Further Opportunities

  • Considering further use of value-based purchasing in federal programs, including indication-based pricing and long-term financing.
  • Removing government impediments to value-based purchasing by private payers.

 

ValueBased Purchasing (VBP) Linking provider payments to improved performance by health care providers. This form of payment holds health care providers accountable for both the cost and quality of care they provide. It attempts to reduce inappropriate care and to identify and reward the best-performing providers.”

 This is a stupid idea. It might save money but it tries to direct care and eliminate physician judgement. Healthcare providers will figure out how to game the system.

  • Requiring site neutrality in payment.

 

Site neutrality payment means “Under OPPS 2019, reimbursement for clinic visits in outpatient hospital settings would be capped at the rate paid for clinic visits in physician offices.”

It is about time this is happening. Hospitals are buying more and more physicians’ practices. Hospital systems bill the government hospital reimbursement prices. These prices are twice the government and private insurance companies approved office prices.

I suspect the hospital systems do not credit the physicians with this increase in reimbursement. The hospital systems leverage physicians’ intellectual property and outpatient surgical skills for the hospital systems’ own profit.

Hospital systems will fight this change tooth and nail. President Trump has the courage to go at it. Almost everyone in medicine has known about these unfair payments. However, past U.S. presidents have been afraid of the blowback from the powerful hospital lobby.

President Obama knew that this would drive physicians into selling their practices to hospital systems. The result is obvious. It would be easier to institute a single party payer system.

Evaluating the accuracy and usefulness of current national drug spending data.

Phase two;

  • Incentives for Lower List Prices Immediate Actions
  • FDA evaluation of requiring manufacturers to include list prices in advertising
  • Updating Medicare’s drug-pricing dashboard to make price increases and generic competition more transparent.

Further Opportunities

  • Measures to restrict the use of rebates, including revisiting the safe harbor under the Antikickback statute for drug rebates.

“The anti-kickback statute has been in place since 1971, but these specific safe harbors, protecting drug companies from anti-kickback laws, were introduced more than 2 decades ago.

The federal government provides an excellent resource for information about these safe harbors at the Federal Register website. It tells everything one needs to know about the opportunities for fraud and abuse in the current system. The website describes how the Trump administration plans to eliminate the government support of fraud and abuse.

https://www.federalregister.gov/documents/2016/12/07/2016-28297/medicare-and-state-health-care-programs-fraud-and-abuse-revisions-to-the-safe-harbors-under-the

In brief, the safe harbors define exceptions to situations where organizations are receiving “remuneration” for providing goods or services.

 A rebate given as an incentive to provide a drug (i.e., on formulary) or to utilize more of a product (i.e., “performance rebates”) would currently qualify for safe harbor protection.”

 

https://biosimilarsrr.com/2018/07/24/anti-kickback-safe-harbors-drug-rebate-contracts-biosimilars/

I will discuss this in more detail in the future. This is another act of courage by the Trump administration. It is also a common sense move to reduce the cost of healthcare in our dysfunctional healthcare system.

  • Additional reforms to the rebating system.
  • Using incentives to discourage manufacturer price increases for drugs used in Part B and Part D.

The high retail pricing of new drugs on the market must be control. Many of the new drugs are a reformulation of two old drugs. The reformulation does not change the effectiveness of either drug.

The retail price of drugs used to treat cancer must be controlled someway.

  • Considering fiduciary status for Pharmacy Benefit Managers (PBMs)
  • Reforms to the Medicaid Drug Rebate Program
  • Reforms to the 340B drug discount program
  • Considering changes to HHS regulations regarding drug copay discount cards

 Lowering Out-of-Pocket Costs Immediate Actions

  • Prohibiting Part D contracts from preventing pharmacists telling patients when they could pay less out-of-pocket by not using insurance
  • Improving the usefulness of the Part D Explanation of Benefits statement by including information about drug price increases and lower cost alternatives.

  Further Opportunities to Reduce Drug Costs to Consumers

 More measures to inform Medicare Parts B and D beneficiaries about lower cost alternatives

  • Providing better annual, or more frequent, information on costs to Part D beneficiaries
  •  Insurance Contract Reimbursement for Consumers’ Rx
  • Share of Manufacturer Rebates.
  • Consumers Payers Drug Manufacturer Pharmacies
  • Pharmacy Benefits Manager Formulary Agreement
  • Copayment Network Agreement
  • PBM Agreement Payment for Dispensed Drugs Formulary
  • Rebates & Other Fees Premium Drugs
  • Money Contracting Dispensed Drugs
  • Prime Vendor Agreement Shipped Bulk Drugs Payment for Wholesale Drugs Distributor
  • Payment for Wholesale Drugs Shipped Bulk Drugs Distributor Agreement

 

Most physician do not know about this complicated system. All they care about is taking care of the patients. It is time physicians understand how ancillary providers have been   ripping off the patients. Somehow, the ancillary providers manage to blame drug prices  on physicians.

Finally, we have an administration that not only recognizes the problems but is not afraid to fix them.

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



Copywrite 2006-2018

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

The Mainstream Media Refuses to Understand the Meaning of President Trump’s Healthcare Insurance Associations  

 Stanley Feld M.D.,FACP,MACE

The Mainstream media refuses to acknowledge the advantage of the Presidential order to allow Associations to participate in available health insurance plans.

Democrats do not want the public to understand the advantages President Trump’s healthcare insurance associations will provide to consumers. It is an important step in Repairing the Healthcare System. Obamacare was advertised only to fix the individual insurance market.

Pre- Obamacare there were 14 million people who had individual healthcare insurance plans. Most were unaffordable. Now, there are only 12 million in the individual market on Obamacare. Most are unaffordable.

Medicaid has expanded from 2 million to 10 million under Obamacare. The total on healthcare insurance provide by Obamacare  is 22 million. Medicaid is a failed healthcare insurance plan. It is a socialized medical insurance plan the has failed.

The mainstream media has forgotten that Obamacare was originally sold by President Obama to cover the individual insurance market. The individual healthcare insurance market was unaffordable. Obamacare was supposed to make it affordable. It turns out that 85% of Obamacare recipients are subsidized by the federal government. President Obama has expanded socialized medicine and a single party payer (the government) with Obamacare. Even with government subsidies the insurance is unaffordable because of the high deductibles.

It is difficult for me to understand how President Obama says he always tells the truth. He said he was going to make the healthcare individual market more affordable. He has not.

I remember he also said; “If you like your doctor you can keep your doctor” and “if you like your healthcare plan you can keep your healthcare plan.” Nothing could be further from the truth.

When Obamacare was passed there were requirements in the bill that outlined coverage the healthcare insurance industry must provide for everyone who has any kind of healthcare insurance. These requirements included levels of coverage that many people did not need. This excess coverage raised the cost of healthcare insurance in both the individual healthcare insurance market and the group healthcare insurance market. Both types of insurance became unaffordable.

This, combined with the inefficiency of a bureaucratic government raised prices of healthcare insurance even further. Remember the government outsources all of the administrative services to the healthcare insurance industry.

Now, the Democrats want the government to run the entire healthcare delivery system with “Medicare for All.” The unsustainability of “Medicare for All” is estimated at 32 TRILLION dollars over the next ten years!

Associations will not solve all the problems in the healthcare system.  However, they will start solving a good many of them. The Democrats are scared to death that the public will start to understand the advantages of associations. Consumers will have a choice of healthcare insurance plans. Consumers will be in a position to start controlling their healthcare dollars.

The pundits in the mainstream media seem to have no interest in understanding this dynamic. Their only interest is to despise President Trump and regurgitate the Democrats’ easy to understand talking points.

Trump’s associations will:

  1. allow the healthcare industry to sell healthcare plans without the rigid requirements imposed on them by Obamacare.
  1. make individual healthcare plans tax deductible. The large corporations’ group healthcare insurance plans are tax deductible. The individual healthcare insurance plans presently are not tax deductible.
  1. allow members to buy healthcare insurance across state lines. This will create price competition that will lower premiums.
  1. let small companies and the self-employed band together and buy health insurance outside of Obamacare’s strict rules.
  1. offer a way for people to take advantage of the group insurance market, even if they are self-employed or work for a business too small to provide insurance.
  1. will “level the playing field” by giving small businesses bargaining power.” This statement was made by Labor Secretary Alexander Acosta.

Mr. Acosta said “As the cost of insurance for small businesses has been increasing, the percentage of small business offering health coverage has been dropping substantially,”. “This expansion will offer millions of Americans more affordable health care options.”

The U.S. Chamber of Commerce said the change, “will give employers the relief and flexibility they need to cover more employees at a lower cost with more choices for quality care.”

The Congressional Budget Office estimates that 4 million people, including 400,000 who otherwise would go without insurance, are expected to join association health care plans by 2023.

The introduction of associations is going to disrupt the Democrats plans to take total control of the delivery of healthcare. It is going to start to put healthcare delivery back in the hands of the consumer!

Mr. Trump said at the National Federation of Independent Business’ 75th anniversary celebration in his usual hyperbolic style;

“You’re going to save a fortune,”

I believe he is closer to being right than he is being wrong.

 

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



Copywrite 2006-2018

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Hospital Mergers Don’t Work

Stanley Feld M.D.,FACP,MACE

This article appeared in Kevin M.D. several weeks ago. The article has some valid points. However, it misses the vital reasons hospital mergers are not working.

“In 2010, there were 66 hospital mergers in this country. Since the Affordable Care Act went into effect, the rate of hospital consolidation has increased by 70 percent.

By creating incentives for physicians and health providers to coordinate under accountable care organizations (ACOs), the ACA hindered the ability of regulators to block hospital mergers while incentivizing hospital consolidation.”

The government published reason for encouraging hospital mergers was to increase hospital efficiency and decrease healthcare costs.

I have said over and over again that the real goal of Obamacare was to have total control over the healthcare system. This control could be accomplished by controlling all the providers.

Hospitals realized that physicians controlled the utilization of hospital facilities. As knowledge and technology improved more and more diagnosis and treatment could be performed on an outpatient basis.

All the hospitals had to offer was a brick and mortar facility. Hospitals tried to stop physicians, before Obamacare, from developing their own outpatient facilities. The hospitals lobbied the government to require certificate of need for advanced outpatient technology (MRI, CAT scans, Outpatient Surgical facilities, and laboratories).

It did not work.

Obamacare provided incentives for hospitals to merge and consolidate into hospital systems.

Obamacare also provided incentives for hospital systems to create Accountable Care Organizations (ACOs). I have written about ACOs destiny to fail ad nauseum.

The government’s pretext was that hospital consolidation into hospital systems would increase efficiency with resultant decreases in hospital care costs.

The real reason was to get hospitals to hire physicians. At that point they would lower reimbursement on both. Hospitals and physicians would be totally dependent on the government.

“There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance and the government.”

 

The result is opposite the stated goal and was totally predictable.

 

“It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs and, ultimately, reduce care quality as a result.”

The development of hospital systems led to the expansion of administrative personnel which in turn led to increased administrative salaries and costs. Administrative costs are not government controlled. They are part of the overinflated hospital overhead.

In some cases, the government increased hospital systems’ subsidies because of increased administrative costs.

It did not lead to greater compensation to physicians they hired. Yet the hospital system was totally dependent on staff physicians for revenue production.

Physicians tended to work hard when they owned their own practice. Now that their salary was guaranteed they tended not to work 12-hour days.

Initially, hospital systems paid physicians on the basis of physicians’ previous productivity in their private practice. Additionally, physicians were given a payout for their practice. The payout was never the real value of their practice.

Hospital systems calculated the physicians’ productivity because the hospital system hired all the full-time employees. The hospital systems’ computer systems were also used in the calculation of productivity and overhead.

Hospital systems controlled the overhead and the books. A lot of the time the calculation was inaccurate. This was the result of two fees collected from the government and the insurance companies. One was a technical fee that belonged to the hospital system. The other was a professional fee for the physician.

At times, the professional fees were not collected and the physician groups could not figure out the discrepancy.

There had been a long-standing mistrust by physicians toward hospitals prior to Obamacare. The errors in calculations resulted in greater mistrust by physicians toward hospitals.

If a physician was not producing according to the hospital system’s calculation the physician, at the end of a usual two-year contract, was let go. This created more mistrust and suspicion among physicians toward hospital systems.

It has also caused physicians who anticipated this stranglehold by hospital systems to become concierge physicians or open outpatient clinics of their own.

This has caused hospital systems to provide concierge physicians of their own as well as hospital outpatient ambulatory surgical care clinics. The problem is that the free-standing physician owned ambulatory surgical care clinics (ASC) are more efficient and cheaper than the inpatient hospital care and the hospital’s own outpatient ambulatory surgical care clinics (HOPD). Some privately own ASC are cheaper than the increasing deductibles patients with private insurance have to pay using their insurance.

Below are some examples of Ambulatory Care Surgical Center fees as opposed to Hospital Owned Outpatient Surgical fees.

 ASC – $1250 ($500 out of pocket)

HOPD: $4250 ($1000 out of pocket)

Echocardiogram:

ASC $500 ($200 out of pocket)

HOPD: $4250 ($1250 out of pocket)

Arthroscopy of Knee:

ASC – $3600 ($1070 out of pocket)

HOPD: $13,000 ($3900 out of pocket)

Hernia Repair:

ASC – $2500 ($750 out of pocket)

HOPD: $19,000 ($5700 out of pocket)”

There has been a dramatic increase in hospitals gobbling up independent providers and becoming powerful regional monopolies. These monopolies raise prices not decrease prices.

“According to a 2012 study by the Robert Wood Johnson Foundation, “the magnitude of price increases when hospitals merge in concentrated markets is typically quite large, most exceeding 20 percent.”

 

Forbes’ Avvik Roy of Forbes said, a presentation  in 2012.

You have to get at the errors in public policies which drive the hospitals to merge.” He concluded that government must do more to fight consolidation among hospitals.”

The underlying theme is that President Obama wanted Obamacare to fail so it can be replaced by a single party payer system that has been pushed by progressives since 1935. Obamacare is moribund despite claims by Democrats. They refuse to face the fact that socialism does not work even thought it is a feel-good concept.

“A recent paper authored by Northwestern’s Leemore Dafny, Columbia’s Kate Ho, and Harvard’s Robin Lee provides some definitive proof that when hospitals consolidate, prices increase substantially. The effect is made worse directly in proportion to proximity of the merging hospitals. “If you are doing it because you think in the long run it will serve your community well, you should think twice,” Dafny said.”

Hospital systems are consolidating because they think it is in their vested interests to consolidate. They are falling right into President Obama’s trap. Hospital systems do not control productivity. Physicians control productivity.

A study published by the National Bureau of Economic Research, conducted by Zack Cooper of Yale University, Stuart Craig of the University of Pennsylvania, Martin Gaynor of Carnegie Mellon and John Van Reenen of the London School of Economics, sheds light on the real cost of reduced competition among hospitals: hospital prices are 15.3 % higher when a hospital had no competition compared in markets with four or more hospitals, amounting to a cost difference of up to $2000 per admission. Hospital prices are 6.4% higher in markets with two hospitals and those with three are 4.8 % more expensive when compared to markets with four hospitals.”

The American Hospital Association has been aggressive in criticizing those reports. It has funded a couple of critical reports  defending mergers and consolidations. The American Hospital Association doesn’t understand the progressives’ trap either.

It is backfiring already as hospital systems are saying they are losing money. The government is cutting reimbursement, the insurance companies are raising insurance rates and increased deductibles are unaffordable.  Consumers are experiencing a decreased access to care.

None of the policy makers are focused on the right problems because they want a single party payer system in order to gain total control over the healthcare system. Progressive have no interests in the cost of care, the need to raise taxes or the delivery of efficient care.

America is going to experience an economic disaster as it has been experienced in Canada, England and many other countries in the world.

Consumers are continuing to take it on the chin in other countries because 80% are not sick at any one time. Consumers in other countries feel secure with the guaranteed coverage even if it increases their taxes and decreases access to care.

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



Copywrite 2006-2018

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

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

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

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.



Copywrite 2006-2018

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

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.



Copywrite 2006-2018

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

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

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Senate Republicans Are Making Repeal and Replace Harder Than It Should Be

 Stanley Feld M.D.,FACP,MACE

I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.

It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.

Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.

People like entitlements because they are free. Someone else is paying for them.

Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.

“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.

Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”

The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.

The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.

Congress needs the healthcare insurance industry’s ability to provide administrative services whether it is for Medicare, Medicaid, health insurance exchange coverage (Obamacare) or private insurance.

The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.

President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..

Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.

The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.

Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.

Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.

It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.

They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.

Canada’s health-care wait times costing patients many millions in lost time, wages”

Ontarians wait longer for health care than citizens of other universal health-care countries”

The fact is single party payer systems do not work for all the stakeholders.Both Democrats and Republicans are missing the essential point about what would work to provide an affordable healthcare system that aligns the incentives of all stakeholders.An essential element is to develop a system that encourages consumers of healthcare to be responsible for their health and have control over their healthcare dollars.

The Senate’s present revision does not consider this. The Senate is considering the needs of the healthcare insurance industry and not the needs of consumers.

The Senate should be considering the following in order to repeal and replace Obamacare.

  1. My Ideal Medical Savings Account should be instituted immediately. It will provide financial incentives for consumers as well and incentives to maintain health.

Self-management of chronic disease is essential for a healthcare system to become affordable. My Ideal Medical Saving Account provides that financial incentive.

1. The Ideal Medical Saving Account will provide instant adjudication of medical care claims.

  1. The ideal Medical Savings Accounts will encourage patient responsibility for their health, the care of their disease and their healthcare dollars.
  2. The Republican Party should establish an organized system of disease management education for persons with chronic disease. The education system should be designed to be an extension of physicians’ care. It should not be a free-standing education system. Physicians should be provided with incentives to set up these educational systems.

http://stanfeld.com/chronic-disease-management-and-education-as-an-extension-of-physicians-care/

  1. A system of social networking with physicians and their patients should be developed. The government could provide the template for physicians and their team.

http://stanfeld.com/social-networks-patient-education-and-the-healthcare-system/

The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.

  1. Social networking between physicians should also be developed.
  2. Integrated care systems with generalists to specialists must be developed for both treatment and cost transparency for the physicians and patients.
  1. There must be instant communication between physicians and patient via an effective electronic medical record. The EMR must be a teaching tool for physicians. It must not be a tool to judge physicians’ care and penalize them. The EMR should be cloud based. Maintenance and upgrades should be free and seamless. Physicians should be charged by the click.

http://stanfeld.com/?s=EMRs

  1. Tort Reform is an essential element in a healthcare system that would work and be affordable. It would decrease the cost of over testing. It would also decrease the cost of malpractice insurance and legal fees. These cost are built into the cost of care. The cost of care would be reduced significantly. http://stanfeld.com/?s=tort+reform

The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.

Align patient 1

Align government

Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.

The house bill to repeal and replace Obamacare touches on some alignment.

The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.

The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.

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

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

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

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.