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Canada Has Big Single Party Healthcare System Problems

Stanley Feld M.D., FACP, MACE

There are big problems in Canada that have been undisclosed by Democrats to the public in the United States.

There were two articles in American newspapers in 2011 that applaud the Canadian system.

 Article 1. Debunking Canadian health care myths – The Denver Post .

Article 2. Everything you ever wanted to know about Canadian health care in one post. Washington Post.

Both articles are opinion articles and lack concrete evidence. The articles contain both misinformation and disinformation.  The articles are in essence  fake news designed to mislead the American public into believing that a single party payer system is the answer to America’s healthcare systems problem.

The articles are precisely why the American public should not and does not trust politicians and the traditional mass media.

The Fraser Institute is a well-respected Canadian think tank. Its research is considered accurate, with a libertarian slant.

Its 2011 report contradicts the statistics in both the Washington Post’s and the Denver Post’s articles about the Canadian government healthcare costs.

 Article 1. “Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s.”

Article 2.  “In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries.”

This is not true according to the Fraser report. Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the Frazer Institute. To be specific, in 2011, health care spending consumed 50% GDP in Canada’s two largest provinces, Ontario and Quebec.

“Total federal, provincial and territorial government health spending has grown by 8.1 percent annually, while the national GDP in Canada rose by only 6.7 percent during the same period.”

 The provincial governments have raised taxes and rationed care, while increasing patient wait times.  

“Provincial drug plans have also more often refused to pay for most of the drugs that are certified as “safe and effective” by Health Canada.”

“Unsustainable rates of growth in health care spending crowd out the resources available for other purposes including education, public safety, and economic growth-enhancing tax relief.”

One has only to think about the Obama administration’s initial propaganda and the stunning reality we are facing presently. 

The VA is now asking for additional funding to clear up its disaster.

The problem is entitlements are too expensive for governments.  Entitlements do not work because governments cannot legislate behavior by directives. Individuals must be responsible for their health and healthcare dollars.

The other problem is government entitlement programs generate a large bureaucracy. The bureaucracy stimulates the development of inefficiencies and corruption. The new bureaucracy practically guarantees the failure of the entitlement.

The government never gets to the core problems that must be repaired when they try to construct a healthcare system that is efficient, cost effective and will benefit consumers. 

The primary stakeholders are consumers of healthcare. Physicians are a close second. Secondary stakeholders are hospital systems, healthcare insurance companies, drug companies, malpractice insurance companies, and the government.

In order to Repair America’s Healthcare System, the government must focus on the primary stakeholders’ (patients’) needs and ways to satisfy those needs. The key is to set up a system that provides the primary stakeholders (consumers of healthcare) with incentives to maintain their health and conserve their healthcare dollars. This applies to healthy consumers as well as patients with chronic diseases.

Patients with chronic diseases must become professors of their disease. They must understand the latest techniques and use the latest tools to prevent the progression of their disease.  

The healthcare system must help consumers be prosumers (productive consumers) of their own healthcare.

The Canadian system is not the answer to our healthcare system’s problems. The United States has a much larger population than Canada. The Canadian government cannot support its universal healthcare system.

 How will we? Bernie Sander’s state of Vermont has abandoned its “Medicare for All” program.

The only way the portion of our population in favor of Medicare for All is going to believe it is unsustainable and destined for failure is going to experience its failure. It seems Bernie and his followers have little interest in learning from previous experience.

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

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Swedes Are Frustrated Over Their Socialized Healthcare System

Stanley Feld M.D.,FACP,MACE

Sweden has a universal healthcare system that has been touted, by Bernie Sanders, to be the premier socialized medical system model in the world. The Swedish socialized medical system has hardly lived up to the praise. The fact is Sweden’s healthcare system is falling apart.

The Swedes have lost interest in their socialist healthcare system. Their tax rate is almost 50% of earnings. Swedes are losing interest in the concept of a socialist society. The complaint is that it is inefficient, and, in most areas, the socialistic system does not work to the benefit of the people.

All Bernie Sanders has to do is read the local Swedish newspapers. He would learn that socialized medicine is not working in Sweden. He might even stop pushing his lie to the American public about how great “Medicare for All” will be for America.

“That Sweden no longer keeps up with those countries is largely due to its inability to reduce its patient waiting times, which are some of the worst in Europe, as the latest edition of the Euro Health Consumer Index (EHCI) revealed in Brussels on Monday.”

The 2014 EHCI also confirms other big problems within Swedish healthcare.

This is not primarily due to the fact Sweden has become worse – rather it is the case that other countries have improved faster.” 

https://www.thelocal.se/20150127/swedens-health-care-is-a-shame-to-the-country

According to 2017 OECD figures, Sweden does have the fifth-highest life expectancy in Europe. Its cancer survival rates are among the continent’s highest. This could be because the rest of Europe’s socialized medicine systems are not as good as they could be.

One of the main pillars of the Swedish welfare state is its universal healthcare system. The Swedish people are totally frustrated by the healthcare system’s inefficiency. The inefficiency is due in large part to the government bureaucracy.

Swedes have little confidence that politicians will solve this,” said Lisa Pelling, chief analyst at progressive think tank Arena Ide. 

“There is a risk their faith in the welfare state will be eroded,” she told AFP. 

As an example of the frustration of the Swedes:

Asia Nader didn’t know whether to worry more about being diagnosed with a hole in her heart at the age of 23 or having to wait a year for Swedish doctors to fix it. 

“I completely fell apart when I found out,” she told AFP, remembering the long agonizing months until she finally had her operation in June this year, one month before her 23rd birthday. 

Credit: George Hodan/public domainhttps://medicalxpress.com/news/2018-09-swedes-world-class-healthcarewhen.html 

There are long lines waiting for access to care due to a shortage of nurses and available doctors in some areas.

The average income tax rate paid by Swedes is 50%. Immigrants cannot pay 50% of their earnings and survive. Immigrants are entitled to social services including medical care. The voters are angered over the flood of immigrants putting a tremendous strain on the healthcare system and delaying regular citizens’ access to care.

 The rules set up by Swedish law about access to medical care are being ignored and unenforced.

Swedish law stipulates patients should wait no more than 90 days to undergo surgery or see a specialist. Yet every third patient waits longer, according to government figures.”

“Patients must also see a general practitioner within seven days, the second-longest deadline in Europe after Portugal (15 days).” 

 Dental appointments can take a wait of 6 months.

The median wait for prostate cancer surgery was 120 days. It has taken up to 271 days.to get prostate cancer surgery.

Swedes complain that they can’t see their own GP. There is little chance to develop a physician/patient relationship. Patients are being seen by temporary hires provided by outsourced staffing companies.

Telemedicine has mushroomed. Physicians are complaining about the fragmentation of care. There is little chance for continuing follow-up and assessing the result of therapy.   

The number of hospital beds has declined in recent years. There is a hospital bed shortage in many communities.    

In Solleftea, the premier’s northern hometown with nearly 20,000 residents, the only maternity ward was shut down last year to save money.” 

“With the closest maternity ward now 200 kilometers (125 miles) away, midwives offer parents-to-be classes on how to deliver babies in cars—which some have since done.”

Despite the bed shortages and delays in access to care, Sweden is the third highest spender on healthcare in the European Union. Sweden spends 11% of its GDP on its healthcare system.

 Socialism and healthcare for all are not as great as Bernie Sanders is telling Americans. We should not believe him.

There is no question we have to improve our healthcare system to make it affordable and available to all.

However, we should not go down the path of Sweden and Finland with Bernie Sanders’ socialistic program of “Medicare for All.”

We will not only bankrupt America but also make access to care impossible.

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The original was published in April 2019.

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



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Why Vermont’s Single Party Payer Healthcare Plan Failed

Stanley Feld M.D., FACP,MACE

Vermont’s single party payer healthcare plan was doomed to fail from the onset for several reasons.

Vermont had a Republican governor for eight years. He decided to retire.  Peter Shumlin (D.) won the Democratic nomination for governor after progressive activists demanded that each candidate for the Democratic Party nomination promise to enact single-payer health care if nominated.

Shumlin’s got the nod, won the election. He was anxious to pass the single party payer system.

Vermont’s consultants were Harvard’s William Hsiao and MIT’s Jonathan Gruber.

William Hsiao has spent most of his academic career helping governments install single-payer healthcare systems.

There is little evidence that the systems by developed in Taiwan and other countries by William Hsiao have been successful. They have not been cost effective or sustainable. They have not preserved freedom of choice.

Gruber and Hsiao made the same mistakes for Vermont that they made for America with Obamacare.

Hsiao and Gruber promised that single-payer health care in Vermont could save $1.6 billion over ten years. With that endorsement in hand, Shumlin and the legislature passed Act 48, a law instructing the state to figure out how to finance a single-payer system. They dubbed it Green Mountain Care.

Governor Shumlin said, “If Vermont gets single-payer health care right, which I believe we will, other states will follow,” pronounced Shumlin. “If we screw it up, it will set back this effort for a long time. So I know we have a tremendous amount of responsibility, not only to Vermonters.”

Unfortunately, Americans have a short memory, the short memory promoted by the conformational bias of the traditional mass media toward a progressive agenda.

Progressive Americans and their progressive politicians had better wake up fast. “Medicare for All” does not work.

Medicare does not work in a financially sustainable way for the government or seniors. It was not sustainable in the Bernie Sanders small state of Vermont. It is nice to believe you can provide healthcare benefits for nothing to all. However, nothing is free especially when it is run by central bureaucrats. It has been proven over and over again.

First, bureaucrats and healthcare policy consultants do not understand the medical care system. The history of Vermont’s single- payor story is interesting.

In December 2014 Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug after four years on Vermont’s single-payer, government-run health care system.

“In my judgment,” Governor Shumlin said, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

Rather than saving $1.6 billion the Green Mountain Care would cost an additional 2.6 billion dollars in tax revenue for 2017 alone. The law would require a 151 percent increase in state taxes.

“Fiscally, that’s a train wreck. Even a skeptical report from Avalere health had previously assumed that the plan would “only” cost $1.9 to $2.2 billion extra in 2017.”

“In 2019, Costa estimated that Green Mountain Care would have required $2.9 billion in tax revenue vs. $1.8 billion under pre-existing law: a 160 percent increase in revenue.”

The result should explain why the dream of single-payer health care in the U.S. should be dead for the foreseeable future.

Daily, we read articles calling for “Medicare for All” from progressive politicians running for office.

How stupid do they think Americans are?

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



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Did Obamacare Cause The Increase In Private Healthcare Insurance Premiums?

Stanley Feld M.D.,FACP, MACE

A reader of my blog received this question from one of his friends.

The reader asked me his friend’s question  “I have a question and I don’t want it to be political (as I stay away from that for many reasons).                                                                                                                                 
Health insurance is so expensive and it does not cover hardly anything. We had to get the worst plan with the worst coverage. But it was not this way 6 years ago. We could afford good coverage.   

 The question is: Did Obamacare cause this change in healthcare insurance and these problems in access to care?

A reader asked:

Which of your blogs would be the best one to show him to answer his question?

The answer to the question is YES!! I will try to explain.

If I sent all the links to your friend would be overwhelmed. There are too many to count.  I will summarize some of the major reasons Obamacare is to blame for some of the increases in private healthcare insurance premiums and the decrease in the access to care. Obamacare has led us into a financial disaster. “Medicare for All” is not the answer.

I believe the goal of Obamacare was to create greater dysfunction in the healthcare system which would lead to huge premium increases for private healthcare coverage. The public would then beg the government to adopt a single party payer system with “Medicare for all.” This has been the progressives”  goal since 1935. Do you remember Barney Frank and John Kerry saying we cannot have a single party payer system yet because we do not have the votes?

https://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2018/10/the-main-reason-behind-rising-medical-costs.html

The government has not had a very successful single party payer systems record.  The VA Health Administration, the Indian Health Service, Medicare and Medicaid are all inefficient and financially unsustainable.

“Our federal government already runs three single-payer systems—Medicare, the Veterans Health Administration, and the Indian Health Service—each of which is in a shambles, noted for fraud, waste, and corruption.”

“Why would we want to turn over all of the American medicine to those who have proved themselves incompetent to run large parts of it?”

https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

The federal government depends on healthcare insurance companies to do the administrative services for Medicare, Medicaid and Obamacare. Administrative services include negotiating payments to hospitals, nursing homes, physicians and providers on all levels.

The various healthcare insurance companies are supposed to bid for these service contracts. The insurance companies receive one global fee.  The healthcare insurance company with the contract must pay providers on a fee for service basis. The healthcare insurance companies do not have good enough data to make an accurate bid estimate.  Actuary science is not rocket science. The healthcare insurance company builds in a twenty percent cushion to the bid. If the bid was low and the healthcare insurance company that lost money Obamacare guaranteed through a complicated reinsurance formula reimbursement to the company for its loss.

Recently the government audit discovered an overpayment of $10 billion dollars to the healthcare insurance industry for Medicare Part D.

I believe there is much more overpayment in Medicare Part A, B and D because of the government bureaucracy. The government only had the money to pay 12% of the reinsurance claims of the healthcare insurance company one year. The insurance industry simply raised the premium in the private sector.

http://stanfeld.com/president-obama-somehow-finds-the-money/

http://stanfeld.com/accelerating-the-destruction-of-the-healthcare-system/

http://stanfeld.com/the-deception-and-disinformation-continues/

Nationwide, the Obama administration made $7.3 billion in reinsurance payments to health insurers. The reinsurance program, funded by taxes on health insurers and self-funded employer health plans, has been criticized by Republicans as a “bailout” for insurers.

https://www.ibj.com/blogs/12-the-dose-jk-wall/post/53906-obamacare-shovels-another-122m-to-indiana-insurers

The healthcare insurance industry then once again raised premiums on the private healthcare sector to make up for its losses. to

The government reinsurance payments weren’t enough in all cases. New York-based Assurant Inc. asked for a 26 percent hike in private premiums for 2016, due to high claims in Indiana, before that company decided to exit the Obamacare markets in all states.

This was typical price shifting.

http://stanfeld.com/?s=price+shifting

Healthcare insurance companies projected that Obamacare would result in them losing money because of adverse selection. Obamacare’s increase required benefits for both public and private insurance. Obamacare’s rules included coverage for oral contraceptives for all and coverage of pre-existing illnesses among others. A sixty-year-old male does not need an insurance policy the receives oral contraceptives.

The healthcare insurance industry asked for double-digit increases in private healthcare insurance in every state. The logic was that these enrollees would pay for the loses that would occur from the Obamacare enrollees.

http://stanfeld.com/managing-points-of-view-and-healthcare/

The government’s argument is all should pay for everyone ’s healthcare needs. These healthcare needs have increased as the population has gotten more obese and has had a rise in drug addiction. These increased healthcare risks resulted in increased actuary estimates of healthcare cost. It does not put a burden on consumers who do not act responsibly.

The increased healthcare premiums caused many employers to drop healthcare coverage for their employees. The decrease in healthcare insurance coverage added to the pressure of healthcare premium increases.

The healthcare insurance industry also plays games with the Medical Loss ratio. The result is an increase in healthcare premiums and deductibles while decreasing services. The Obamacare issued regulations that the insurance industry must dedicate 80% of the healthcare premium to direct medical care and 20 % can be used for administrative expenses for both the public government insurance and private insurance. It is the state insurance regulators responsibility to enforce the regulation.

The expenses the industry wanted to be included are;

Expenses to be included in direct medical care are:

  1. The cost of verifying the credentials of doctors in its networks.
  2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.
  3. The cost of programs that keep people who have diabetes out of emergency rooms.
  4. The sales commissions paid to insurance agents.
  5. Taxes paid on investments.
  6. Taxes paid on premium income.

All these expenses are administrative expenses in my view and not medical expenses. If these expenses are permitted as benefit expenses, premium money available for direct medical care would decrease. The eighty percent required for direct medical care would be markedly reduced. The result would be an increase in healthcare insurance premiums.

http://stanfeld.com/medical-loss-ratio-how-did-the-healthcare-insurance-industry-do/

http://stanfeld.com/what-is-the-medical-loss-ratio/

The calculation for direct medical care helps the healthcare insurance company prove it lost money. The insurance company then applies to state regulators for a premium increase. The state regulators permit the premium increases.  If the premium increase is refused by the regulators the insurance company threatens to leave the state. The other option the healthcare insurance company uses is to decrease the insurance services and/or increase the insurance deductibles.

Another problem has developed in the healthcare insurance industry that is causing it to raise premiums and reduce services and access to care as a result of Obamacare.

Hospital systems are buying out physicians’ practices. Obamacare has put many restrictions on physician practices. It has increased practices overhead. Obamacare has decreased the ability for physicians to use their medical or surgical judgment that they have become happy to sell their practices to hospital systems. The hospital systems now have to deal with the problems of medical practice. The cost of electronic medical records, which have not added to the quality of medical care, increased many physicians’ willingness to sell their practices to hospital systems. At the moment the percentages of hospital-owned practices are up to 65% from only 17% ten years ago.

http://stanfeld.com/physicians-barriers-to-practice-their-profession/

https://www.wsj.com/articles/SB10001424052748704122904575315213525018390

As premiums have gone up physicians have not experienced an increase in reimbursement. They have been forced to see more patients quickly to earn almost as much as before Obamacare. Obamacare has destroyed the patient-physician relationship which in my view is essential in medical care. Physicians simply do not have time to talk to patients.

Hospital systems have taken over physician populations in many communities. This gives the hospital leverage over the healthcare insurance industry. The hospital system can demand higher reimbursement because it provides all the physicians.

The large hospital systems can demand that the insurance company only use the physicians in its hospital system even if there are lower cost of care options in a community.

The result is an increase in healthcare premiums and decreased the quality of care.

All of this is the result of Obamacare. There are about ten more reasons why Obamacare has increased premiums and decreased access to care. I have left link exposed. You are encouraged to look at them to see the full explanation for some of the point I have made.

I hope this blog answers your friend’s question. :  Did Obamacare cause this change in healthcare insurance and these problems in access to care? 

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



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Thinking About The Healthcare System’s Problems

Stanley Feld M.D.,FACP, MACE

President Trump’s administration has developed an alternative to Obamacare.

The press is suddenly saying the public considers the healthcare system its biggest problem. The healthcare system has been a huge problem all along. Obamacare was supposed to fix the problem. Obamacare has only enrolled twelve (12) million people in an individual healthcare market in 2019. Eighty-five percent of those enrolled are receiving government subsidies. Many of the enrollees have unaffordable deductibles and cannot afford to use the healthcare insurance.

Obamacare is methodically destroying the infrastructure of the healthcare system. Consumers of healthcare are becoming commodities. The healthcare system is complex. Obamacare has increased its complexity. It has increased costs to Medicare and Medicaid and made the entire healthcare system unsustainable.

Unfortunately, Democrats have ignored Obamacare’s effect on our national deficit while not increasing the efficiency of delivering healthcare. There has been some press quoting Democrats who have said that Republicans are starting to believe that our budget deficit is not significant.

It was recently discovered that insurance companies have overcharged the government’s Medicare Part D more than ten billion dollars.

What are consumers thinking as their savings are worth less and drugs cost more each year? Do they believe that the government’s bureaucracy is efficient? Is it any wonder that Congress’ approval rating is close to single digits?

When people feel they have less freedom to choose their doctor, hospital or insurance company and are being compelled by their government to settle for what is available, does anyone think they want more of the same?

Now, the narrative heard all over the land is “Medicare for All.” Medicare for all will not solve the healthcare system’s problems. It did not solve the VA Healthcare systems problem. The VA system is being privatized.

I do not believe that the way to solve our healthcare problem is to enlarge an unsustainable program. It is illogical. It will make the healthcare system worse and more unsustainable.

The first thing to do to solve any problem is to understand the problem. Everyone wants the best medical care for the entire population. Everyone says the healthcare system is so complex that it is impossible to fix.

The best way to cut through the healthcare system complexity and find a solution is to a clearly define the goal. The goal should be quality medical care available for all at an affordable cost. This means that all of the waste must be eliminated from the healthcare system. This is the goal of the Trump administration’s three-point approach.

Next, is to search for an approach devoid of politics and ideology that will have the highest impact. In my view, this means developing a system that provides consumers with the most control and responsibility for their medical care decisions.

The highest impact can be provided by the development of a system using technology to put the healthcare system in the hands of consumers. It must provide consumers with the greatest control over their choices and generate incentives to be responsible for their medical care and healthcare dollars.

There will be outliers who will be a potential burden to the system. However, if a system is developed with financial incentives to consumers, those outliers will realize they are hurting themselves. I do not believe consumers are stupid. They have simply been uneducated, unaware and unmotivated to control their health and healthcare dollars because a system to motivate them to be healthy and responsible for themselves is unavailable.

Steve Jobs said it all when he told his engineers that the consumers are not too stupid to use the machines, we are too stupid to make machines that easy to use. The same holds true for our healthcare system.  The goal in the healthcare system would be to reorient our thinking.

Obamacare is beyond improving because it put more power in the hands of the government which translates to more control over consumers’ freedom. An “improvement” such as an attempt to provide “Medicare for All” will lead to disaster.

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



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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.



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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.



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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.



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Single Party Payer System Backfires On Great Britain

Stanley Feld M.D.,FACP,MACE

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

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

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

I hope some of our leaders are listening.

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

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

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

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

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

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

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

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

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

 

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

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

“The patient is not the decision-maker.”

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

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

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

Unfortunately,Britain is making another complicated mistake.

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

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

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

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

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

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

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

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

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

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

What is missing from the British system?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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