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Stakeholder Mistrust

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President Obama Is Faking Out Seniors For Their Vote.

 Stanley Feld M.D.,FACP,MACE

I have never been a fan of the Medicare Advantage Program because it rips off taxpayers and senior citizens.

I wrote a blog on July 13, 2008 exposing the Medicare Advantage as a scam to enrich the healthcare insurance industry. The title was Politicians Are Hard To Trust. ”

Seniors initially think it is great because their premium is cheaper than traditional Medicare.

If seniors are not sick they would think they have great insurance because it is cheaper than traditional Medicare insurance. If those seniors would get sick they would realizes the insurance coverage is not as great as their healthcare insurer chooses the physicians and hospitals. Neither might be the “best in town.”

 The healthcare insurance companies wine and dine seniors to get them to sign up with their company.

 The profit the insurer receives from Medicare Advantage is estimated to be $8 billion dollars a year.

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

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

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

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

Wake up America! Physicians only receive 10% of the Medicare dollar. Physicians are the people providing medical care, not the healthcare insurance companies.

None-the-less many seniors are happy with the lower Medicare Advantage premiums. They would be very unhappy if President Obama eliminated Medicare Advantage before the presidential election.

The decrease in Medicare Advantage’s availability was snuck into Obamacare without debate. Few in congress absorbed every detail of Obamacare.

 

 The reductions were supposed to take effect on October 15,2012.

 

This Medicare Advantage elimination date is part of the $500 billion dollar reduction in Medicare expenditures.   

On May 6, 2012 I reported President Obama’s impending trick was pulled not to upset seniors and loss their vote for his reelection.

 

“President Obama’s politics are a dirty business. Manipulating the traditional media and American public’s thinking rather than presenting the truth seems to be President Obama’s goal.

The traditional media has omitted the fact that President Obama is going to make major disruptive changes to Medicare on his own. He is going to decrease Medicare funding by $500 billion dollars.

In fact, the decrease funding was to take effect before the election.

He conveniently delayed the scheduled reduction until after the election in order to not upset seniors and lose the senior vote.”

“ President Obama has been planning to get rid of Medicare Advantage with his Medicare funding reductions. Seniors will then be in an uproar.” 

President Obama’s plan to delay the implementation of the cut I Medicare Advantage is a trick that is costing the American Taxpayers $8 billion dollars. The cost of the additional study will not prove anything.

http://my.brainshark.com/The-President-s-8-Billion-Coincidence-356086344

PLEASE CLICK ON THE ABOVE LINK TO SEE THIS VIDEO.

It is just another trick play to deceive voters to vote for him.

It will not work. I hope President Obama’s disinformation and manipulation of the traditional media are wearing thin on everyone.

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

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Mr. Romney: Wake Up!!

Stanley Feld M.D.FACP,MACE

 

It will be up to Mitt Romney and the Republicans to define the connection of President Obama’s policies to:

  • The faltering economy
  • The disastrous healthcare bill
  • The lack of job growth
  • The growth of entitlements
  • The tremendous increase on the deficit
  • The slow but steady imfringement of the federal government on Americans’ freedoms

“I have a feeling President Obama will outsmart the Republicans and Mitt Romney with additional trick plays.” 

President Obama is using trick plays to fake out Mitt Romney and the Republicans. He is keeping them on the defensive.

Everyday he changes the subject and grabs the traditional media’s headlines.

  • President Obama is avoiding debate on all these interconnected issues.
  • President Obama’s strategy is to blame the Republicans for all America’s ills.
  • He is issuing executive orders that have little impact on the basic policy defects.
  • He is ignoring the budget deficits created by excessive bureaucracy.
  • The power of the pulpit is in his favor.
  • He has the momentum because he is controlling the conversation in a relaxed and natural way.

I believe Mitt Romney needs more media training. Americans love charisma.

Mitt Romney needs to be taught how to be charismatic. Mitt Romney must articulate his vision with vigor. He must be less wooden.

Otherwise Mitt Romney will lose the election even thought President Obama’s vision of America is not the vision of most Americans.

  • He needs advisors who will get him on the offensive.
  • He has to explain why President Obama’s Healthcare Reform Act and economic policies have created a multi-trillion dollar increase in America’s deficit without improvement in America’s economy.
  • He needs to explain how President Obama is devaluing the dollar.
  • He needs to explain how President Obama stimulus packages are decreasing Americans’ purchasing power.  
  • Mitt Romney needs to explain how President Obama’s ideology is counter to most Americans’ vision of America.
  • Mitt Romney has to point out on President Obama’s defects in foreign policy.
  • Mitt Romney should not be giving President Obama a pass on issue especially Obamacare.

Mitt Romney needs to tell us his plans. Simply saying he knows how to create jobs is meaningless. Americans have seen how large corporations have taken advantage of a free market economy.

Mitt Romney has to tell American’s his plans to fix healthcare, the economy, and unemployment.  Simply saying he knows how to create jobs is meaningless and hollow.

Diehard Democrats are going to vote for President Obama without thinking about his disastrous policies of spending and taxing that are driving America over a financial cliff.

Remember Thelma and Louise. 

 

Republicans are going to vote Republican.

Mitt Romney must ignite the imagination of Independents and Libertarians with the sense that he has a plan to fix America. 

He must generate a sense of real hope and neutralize President Obama’s false hope.

A thoughtful physician wrote this letter to Mitt Romney. This reader sent a copy to me.  I asked him if I could publish it. He asked me to reveal that he quotes an editorial written in the Wall Street Journal heavily. The quotes in Dr. Nunn’s letter are from the editorial.

The first sentence in the WSJ editorial says it all.

“If Mitt Romney loses his run for the White House, a turning point will have been his decision Monday to absolve President Obama of raising taxes on the middle class. He is managing to turn the only possible silver lining in Chief Justice John Roberts's ObamaCare salvage operation—that the mandate to buy insurance or pay a penalty is really a tax—into a second political defeat.” 


 Dear Mitt
 
You're losing the battle for POTUS over Obama, and need to take immediate action.  In Texas, we ask, are you going to fish, or cut bait?  So far, you're cutting bait.  Time to step up to the plate and do the right thing.

For the following, I lean heavily on the July 5, 2012 WSJ Review and Outlook article.
http://online.wsj.com/article/SB10001424052702304141204577506652734793044.html?KEYWORDS=romney%27s+tax+confusion

In my opinion, here's what you need to do.  You will have my vote.  If you want my financial support, you'll need to show solid prompt evidence that you 'get it' and decide to fight for the win.

"The health-care tax debate [is not] closed!"

Make sure you and your senior advisors are on the same page.

Eric Fehrnstrom is out of touch.  Replace him.

Reverse your "tax absolution gift to [Mr.] Obama."

Quit "muddying] the tax issue" over the mandate tax.

"Admit your [Romney care Massachusetts] mistake" about the individual mandate.

Call the mandate "a tax" and "work to repeal it."

Acknowledge that Obama's plans will tax "the middle class," not just the wealthy.

Reply to Democrats who will point out your Massachusetts record, that "that was before [SCOTUS] had spoken," and adopt the "policy to repeal the tax" and "the rest of Obamacare."

You are jeopardizing your chances of winning the election by "not abandoning [your] faulty [Massachusetts] health-care legacy."

Quit "squandering an historic opportunity" to take advantage of the weakening "economic recovery" which is hurting Obama.

Articulate, "why the [POTUS'] policies aren't working and how [you]… will do better."

Counter Obama's characterization of you as "out-of-touch," wealthy, and "with foreign bank accounts."  It was OK for JFK, and it's OK for you.  Counter it!

Fight the Bain Capital assaults, and "job outsourcer" issues.  Do not "let [it] go unanswered."

You can't live by your history alone.

People are 'results-oriented.'  Let us "know how [you] are going to improve [our] future."  "Offer… a larger economic narrative and vision than [you have] so far provided."

"Point…out [your] differences… on higher taxes, government-run health care, punitive regulation[s], and…[government] waste," driven by political concerns, and entitlement programs.

If you're "the best man to make the case against [Obama], whom [Republicans really] want to defeat, [you're so far,] letting them down."  

http://online.wsj.com/article/SB10001424052702304141204577506652734793044.html?KEYWORDS=romney%27s+tax+confusion

Now, please go and do the right thing, or we'll see our nation go further down the tubes under a 2nd Obama administration!

Sincerely,

Roger D. Nunn, MD, FACS

Dr. Nunn’s letter represents the thinking of many Americans. Mitt Romney has to go on the offensive with effective advice and media delivery.

President Obama has seduced a lot of people and will continue to be seductive. He seduced me once with his half-truths. These half-truths had generated hope for America that turned out to be false hope.

Some people are so disenchanted that the call his half-truths outright lies.

 

http://youtu.be/56c1fSdTAWI

 

Perhaps prevarication is a better term than half-truths.

 A prevarication is a statement that deviates from or perverts the truth.

 Mr. Romney, don’t let President Obama get away with these prevarications.

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

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  • Carl

    What is the difference between ObamaCare and RomneyCare? It’s either Gary Johnson or socialized medicine.

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President Obama’s False Promises And Trick Plays.

Stanley Feld M.D.,FACP,MACE

 IF YOU CANNOT SEE THE YOU TUBE PRESENTED IN THIS BLOG POST IN YOUR EMAIL OR YOUR RSS FEED PLEASE CLICK ON TO THE TITLE OF THIS BLOG POST ABOVE TO CONNECT TO THE ORIGINAL ONLINE BLOG POST OR OPEN THE URLS POSTED IN THE EMAIL OR RSS FEED.

The You Tubes are usually at the bottom of the email feed.

THANK YOU

I believed President Obama when he made his many refreshing and seductive promises of hope before the 2008 election. I did vote for President Obama. I have regretted it ever since.

All President Obama’s promises of transparent government, working for the people, and fixing healthcare have turned out to be false hope.

President Obama has not listened to the wishes of the people. He is issuing executive orders as he tells the nation what they want to hear.  

  

http://youtu.be/UErR7i2onW0

Barack Obama faked all of us out in 2008 with his promises.

He is doing the same thing during this campaign season for his re-election. He is saying he has not had enough time to fulfill his promises. He said he would accomplish his goals in the first year after his election. Some people still believe him even though his actions are making things worse.

President Obama has created a myriad of problems as he has shifted the balance of power from congress to the executive branch of government. The shift is destroying our economy and our healthcare system with rules and regulations that are not practical.

His re-election campaign is trying to distract Americans from the real problems he has created. The key issues facing the nation are the economy, Obamacare, freedom of religion, freedom of choice, class warfare and the distortions of the American constitution’s principles.

President Obama’s personality is intoxicating. He fooled us once. He is betting he can fool us again.

I have tried to look at President Obama’s actions through the eyes of my liberal friends. I cannot see what they see.

President Obama’s latest trick is to disguise pulling the rug out from under the seniors on Medicare until after the presidential election.

Aside from double counting his Medicare reductions which he continues to deny, he is delaying the implementations of his reductions in Medicare benefits until after the election to not anger seniors.

“About half of Obamacare’s costs are to be covered with money taken from an already nearly bankrupt program for seniors.” Medicare

  

http://youtu.be/q8x20P4RpgQ

He is continuing to double count, ignoring America’s impending debt crisis.

 “Under the implementation schedule stipulated in Obamacare, many seniors would either lose their plans, or learn that they are going to lose them, before the election that will likely decide Obamacare’s—and Obama’s—fate. “

 President Obama, anticipating a senior revolt if they got wind of the scheduled reductions, launched a public relations campaign to distract seniors. The traditional mainstream media has promoted the distraction.

President Obama launched an $8.35 billion “demonstration project” to postpone the majority of Obamacare’s scheduled Medicare Advantage cuts until after election. Over 30% of seniors are on Medicare Advantage.

His goal was to keep awareness of the effects Obamacare will have on seniors who have Medicare Advantage under their radar until after the seniors vote for him in November. After November seniors will have lost their chance to respond effectively.

President Obama’s own Government Accountability Office (GAO) has said this “demonstration project” is a sham. The GAO has reported that the demonstration project has multiple “design defects”.  The GAO has recommended to Kathleen Sebelius that the demonstration project should be cancelled because it will not demonstrate anything and is a waste of money.

The design does not conform to the principles of “budget neutrality.” This waste of taxpayer money is obvious. President Obama is increasing the national debt by  $8.35 billion in order to increase his reelection chances by obtaining seniors’ votes.

He is also trying to distract seniors from his goals by running taxpayer funded TV ads.

“ President Obama ran millions of dollars’ worth of taxpayer-funded TV ads featuring Andy Griffith saying things like, “That new health care law sure sounds good for all of us on Medicare!” It mailed out full-color, taxpayer-funded propaganda brochures singing the same tune.”

“ It repeatedly claimed (and continues to claim) that money taken out of Medicare to fund Obamacare would—magically—also stay in Medicare and be used to extend its solvency. “

The $8.35 billion dollars of taxpayers money might be illegally being used by President Obama. He is using it to shore up presidential reelection chances without anyone noticing or saying anything in protest.

“In fact, according to the GAO, Obama’s $8.35 billion gambit will cost more than all 85 other Medicare demonstration projects combined.”

The $8.35 billion is taxpayer money. It will increase the budget deficit with no value added except to President Obama’s election potential.

The $8.35 billion dollars is more than the combined annual profits of the nation’s two largest and most profitable health insurance companies..

I hope President Obama cannot pull the wool over seniors and all of our eyes once more with another trick play before the election.

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

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It Not About Ideology: It’s About What Could Work

Stanley Feld M.D.,FACP,MACE

Jonathan Hiadt has become a very popular author during these difficult times of “class warfare.” In “Righteous Minds” he posits that both the Right and the Left think they are correct about political, social and economic issues. Since the opinions of each are usually opposite disputes occur.

His point is that the Right and the Left need to understand reasons for each groups’ thinking. It might result in tolerance and respect by each side for each other.

I sense a definite leaning toward the Left in his presentation with his condescending attitude toward the Right.

In this political season I have a problem with siding with either the Right or the Left in their political arguments. My impression is both sides are wrong with the Left being more wrong than the Right.

Both sides are trying to condition our minds to side with them. This should indicate how powerful the people really are.

George W. Bush and Ronald Reagan are dirty words to most of the Left.

The Left has demonized George W. Bush and Ronal Reagan because their thinking is not compatible with the thinking of the Left.

The Right loves Ronald Reagan and seems to be a little embarrassed by the mention of George W. Bush.

No one should be embarrassed about George W. He claimed to be a Compassionate Conservative. This phrase drove the Left crazy. George W. co-opted the Left’s claim to fame with the word compassionate.

The Left leaning media was frenzied about it for 8 years.  George W’s problem was he let some vested interests get too strong to the detriment of all Americans.

What is President Obama doing? He promised to “Transform America.” He is driving the Right leaning media crazy. Many Americans sense President Obama’s transformation. Americans do not like President Obama’s interpretation of transformation.

President Obama is increasing government control and decreasing our freedoms. Americans sense that our living standards are worse, our way of life is becoming difficult, the way we think about ourselves as a nation has become unpleasant and economy has gotten worse.

President Obama is also bending the rules to serve his ideological thinking. There is a growing mistrust of him because of his methodology and his ideology. The traditional media appears to be on the President’s side. The traditional media is terrified. They are losing their audience and in turn their ability to make a profit.

To me is all about media manipulation. The media’s agenda is to reach as large an audience as possible. Once this is achieved it can sell advertising space and make as much profit as possible.

The media wants to make a horserace out of every piece of “news” and a scandal out of every piece of non-news. The media on both the Right and the Left omit “news” that doesn’t fit its ideological agenda.

Think about it. This is the reason all political campaign are so expensive. If there were significant campaign finance reform the media would go bankrupt.

Politicians have to become media actors to win the hearts and souls of Americans. This was never more noticeable between and extremely articulate Barack Obama and a relatively inarticulate John McCain and a politically unschooled Sarah Palin.  Politicians have to appear to know something and stay on script.

Folks, we nave been brain washed. 

The most important asset we have as humans is our health. Systems have developed over the past 60 years in medicine that have improved our health and longevity. 

These same systems have launched vast industries and sub-industries that suck the money out of the system.

Where does the money go? Only 10% of the healthcare dollars spent go to physicians. The rest of the healthcare dollars goes to the secondary stakeholders (the middlemen) that add little value to the treatment of disease.

It is up to the people to become engaged in the political system and say we want a healthcare system that works and does not waste money.

We want a consumer driven healthcare system between consumers and physicians.

We want public service announcements that teach us how to drive the system and achieve the advantage of scale.

We do not want the government to make decisions for us.

We want to have the ability to make our own decisions.

We want to have control over our own destiny.

We want to have control over our healthcare dollar.

We want to have economic incentives to make our own medical choices.

We want to have pride in our nation,

We wanted to have trust in our government.

Todd Siler’s three guiding principles says it all:

Todd siler png

Consumers must take responsibility for their medical care and their healthcare dollars. My Medical Savings Account will go a long way to bring this about.

Consumers are the only ones that can make elected officials run our government in a way that supports these guiding principles.

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

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Ignoring The Rules

 

Stanley Feld M.D., FACP,MACE

 President Obama and his healthcare agencies do not follow the rules required for agencies to write new regulations.

If President Obama does not follow the rules and regulations how can he expect agencies in the government as well as private businesses to follow the rules and regulations?

The President is supposed to set an example for others.

The Congress has relinquished its watchdog power over the executive branch of government. Even the head of CMS, the agency writing the regulations, was an appointee not approved by congress.

Government is supposed to be elected by the people for the people. President Obama has side stepped this obligation. He feels he knows what the people need.

“In a series of papers for the Mercatus Center at George Mason University, Christopher Conover and Jerry Ellig provide evidence to suggest that “the involvement of both White House and high-ranking agency staff” suggests that “the administration likely got the [ObamaCare] rules it wanted written.”

This series of papers were published in January 2012. I missed them. The traditional media ignored their findings. The Mercatus Center’s papers were not picked up by the alternative media either.   

I have noted, in the past, that President Obama and his staff have consistently “cooked the books” on budget estimates of the costs of his Healthcare Reform Plan.

 His numbers did not add up. His assumptions are usually incorrect. The data presented to the CBO has been inaccurate.

 

 

 

 

 

In summary, these Mercatus Center papers demonstrate how President Obama overrode the normal checks and balances used to ensure that federal regulations impose the smallest possible burden on the private sector.

He bypassed the required regulations used in evaluating the regulatory impact for interim rules.

"Rather than posting required regulatory impact analyses (RIAs) with interim rules and allowing time for analysis and comment, the White House and its agency heads dictated the rules that would be written, curbed the Office of Management and Budget (OMB) review function, and then simply declared that the interim rules were final."

Dr. Jerry Ellig is the study's co-author.  He said;

 "In this study, we looked at the federal government’s analysis for the 8 major “interim final” regulations issued in 2010 to implement key components of the Patient Protection and Affordable Care Act (ACA)."

"The intent of regulatory analysis is to inform decisions by identifying the problem the regulation is supposed to solve, and assessing the pros and cons of alternative solutions. But we found these key ACA analyses to be rushed, seriously incomplete, and rarely used to inform decisions.'

 In 2008, the average regulation received 56 days of OMB review. In 2009, the average regulation received 27 days of review. 

 In 2010, the average ObamaCare regulation received 5 days of review.

The review was brief because it was not done according to the rules and regulations.

President Obama cannot possibly understand the economic impact of the resulting regulations. Their economic impact is poorly defined and therefore not understood.

The authors suggested that Congress should consider establishing an independent review agency that would do a regulatory impact analysis of the proposed regulation using widely accepted standards before the regulations are final. 

“The RIAs accompanying the regulations were “seriously incomplete, and they fell far short of federal agencies’ normal practice.”

The Mercatus Center’s Regulatory Report Card criteria, the best analysis of the 8 regulations studied received just 25 out of 60 possible points—the equivalent of an ‘F’.

“President Obama’s regulatory impact analyses also regularly under-estimated costs, over-estimated benefits, and ignored alternatives that would have had lower costs or greater benefits.”  

The defects in the regulations are too numerous to list and too aggravating to contemplate.

Health care economists have estimated that these defects will result in between a 10 and 41 percent cost overrun in health care spending

My major point is not the defects in the final interim regulations.

My point is the regulatory process using rules of the regulatory impact analysis have been ignored.

The rules of the process have been ignored in order to reflect President Obama’s ideology.

The issue is a process issue.  President Obama’s administration circumvented processes that were constructed to protect the American people from government abuse.

He has disrespected the will of the people and the checks and balance system, has marginalized congress, tried to intimidate the judiciary system and ignored the constitution.

How can President Obama expect the American people to respect or trust him? Americans are smart but only if their sources of information are not bias or controlled.

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

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A Real Marketplace For Healthcare.

Stanley Feld M.D.,FACP,MACE

President Obama’s Healthcare Reform Act is all about government control of 19% of the U.S. economy.

The media has publicized ridiculously high charges for cardiac bypass and other complicated procedures. It ought to find out what the actual contracted reimbursement fee is.

All the stakeholders are at fault for the lack of transparency, misinformation, administrative waste, misuse of taxpayers’ dollars and the manipulation of the media.

It is important for the government and the healthcare industry to continue to blame physicians for being the villain in our dysfunctional healthcare system.

Remember physician receive only 10% of the healthcare dollars spent in our healthcare system. Who receives the other 90%? What value do the other recipient add to medical care?

The medias quoted prices are a scare tactic to keep government’s control of the healthcare system advancing.

What is going to happen after Obamacare is repealed?

There will still be millions uninsured.

There will still be millions who cannot buy insurance because of pre-existing conditions.

There will still be millions who choose not to purchase coverage.

There will still be inefficiency and waste in the healthcare system.

Stakeholders are adjusting to the potential restrictions of Obamacare. They are finding new ways to game the healthcare system.

Healthcare costs will rise and inefficiency in the healthcare system will increase whether we have Obamacare or not.

President Obama is trying to set rules and create regulations to eliminate potential solutions to our healthcare system’s problems.

He is trying to regulate and eliminate high deductible insurance plans and Health Savings Accounts. Under Obamacare it will be much cheaper for employers to pay the penalty than provide healthcare insurance for their employees.

Employees will be forced to buy insurance from President Obama’s health insurance exchange (Public Option). There will be no other options. At that point the government has full control of healthcare.

It wouldn’t be a bad thing if the government could afford another potentially inefficient entitlement program. President Obama is clearly trying to squeeze complete government control of healthcare through the back door.

It will not work!

What should be done?

The government must create a real marketplace for healthcare insurance. A marketplace constructed for the benefit of consumers and not secondary stakeholders’ vested interests. Stakeholders would adjust because of their competitive compulsion to get customers. They will compete for consumer business by lowering healthcare costs.

The mindset must change to a consumer driven system not a government driven system.

My Ideal Medical Saving Account would be an excellent way to provide full first dollar healthcare insurance coverage for unplanned medical expenses. It would also provide financial incentive for consumers to be responsible for their health and healthcare dollars.

These are some of the rules that government should have.

1. Healthcare insurance policies should be “guaranteed renewable.”

2. Healthcare policies should include a right to purchase insurance in the future regardless of pre-existing illness.

3. Healthcare insurance policies should follow you from job to job regardless of a move across state lines.

4. Individual healthcare insurance policies should have the same tax-deductible status as employer provided healthcare insurance policies.

The government could form a successful individual insurance market place with these simple rules or regulations.

 “Most pathologies in the current system are creatures of previous laws and regulations.”

“ Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: “The individual market does not provide affordable health insurance,” he noted, “because the multibillion dollar subsidies that are available” for the “employer market are not available in the individual market.”

My Ideal Medical Savings Account could apply to Medicare and Medicaid. It provides incentives and real healthcare insurance coverage. It allows the consumer to choose. It encourages consumers to be knowledgeable shoppers for healthcare. 

The main argument for a mandate before the Supreme Court was that people of modest means can fail to buy insurance, and then rely on charity care in emergency rooms, shifting the cost to the rest of us.

The government is spending that money already. The mandate will not stop the emergency room use.

 A consumer driven healthcare system using My Ideal Medical Saving Accounts would provide incentives for the indigent or those of modest means to try to save money for them by taking care of their health. The government provides those educational resources already. This might encourage its use.

The emergency room treatment expenses for indigent and uninsured are not the central reason for rising healthcare costs. Costs are rising because people, who do have insurance, and their doctors, overuse health services and don’t shop on price.

The Ideal Medical Savings Accounts should be fully tax deductible to both individual and groups.  The healthcare system would then become consumer driven. Consumers would become price sensitive because of financial incentives. A competitive healthcare market would then be created. The result would be a decrease in the cost of healthcare. It certainly would be cheaper than the artificial, bizarre, government controlled healthcare market for we have today.

Enlarging government control would make the healthcare market more expensive and less efficient than the unsustainable government controlled healthcare system that exists.

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

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Pay For Performance (P4P) Pilot Project Fails

Stanley Feld M.D.,FACP,MACE

The CBO announced that the P4P pilot project did not reduce the cost of providing healthcare nor yielded long-term gains in mortality.

"Tying financial incentives to performance, often referred to as pay for performance, has gained broad acceptance as an approach to improving the quality of health care.1-4 

The Centers for Medicare and Medicaid Services (CMS) recently completed a 6-year demonstration of pay for performance for hospitals through the Premier Hospital Quality Incentive Demonstration (HQID), and the Affordable Care Act calls for CMS to expand this program to nearly all U.S. hospitals in 2012. 

P4P sounds good theoretically. The government paying more money for better outcomes sounds logical from the payer’s point of view.  It is not logical from the payees’ (physicians’) point of view.

The emphasis of P4P is on physicians and hospitals practice process to improve quality through the use of evidence based medicine.

The evidence based medicine guidelines are determined by the Independent Physician Advisory Board (IPAB). The evidence based medicine should improve quality and lead to better patient outcomes and decrease healthcare costs..

This pilot project showed that P4P does not produce the desired result. The hope was to inspire poor performing centers to improve and good performing centers to perform better in order to receive incentive pay for performance as a bonus.

"In summary, we found little evidence that participation in the Premier HQID program led to lower 30-day mortality rates, suggesting that we still have not identified the right mix of incentives and targets to ensure that pay for performance will drive improvements in patient outcomes.

  Even though Congress has required that the CMS adopt pay for performance for hospitals, expectations with regard to programs modeled after Premier HQID should remain modest."

This last sentence is great advice.

Congress and President Obama should reexamine their premise.

Patients’ performance is left out of the P4P program. Patients’ attitude toward their disease, adherence to taking medicine prescribed, compliance with prescribed therapy and patients ability to make rapid therapeutic adjustment of medications depends on patients and not physicians or physicians’ practice process.  

There is no question that the process of care is important. There is no question that processes based on evidence must be learned by all physicians. There is also no question that processes based on evidence rapidly change and must be swiftly adjusted.

The most important determinant in patients’ outcome depends on patients. Physicians’ practices should not be judged disregarding patients’ behavior.  

It is the physicians’ responsibility to teach patients how to be “Professors Of Their Diseases.”

Just imagine how many re-hospitalizations could be avoided for congestive heart failure if patients were motivated and educated to detect the onset of congestive heart failure and how to increase the dosage of medication to abort the episode.

Think of all the heart disease that could be prevented if obesity was prevented.

Think of all the acute asthma attacks and uncontrolled diabetes whose hospitalizations could be prevented.

Think about all the complications of diseases could be prevented if patients were incentivized to lead a healthy lifestyle.

At present the administration is trying to change incentives. It will not work.

The reason is simple.

I have written several blogs on why P4P will fail. 

When will someone listen?

I clearly explained the reasons for predicting P4P’s failure in a blog written in April 2007.

 Pay for Performance(P4P): Another Complicated Mistake.

 

April 15,2007

Stanley Feld M.D.FACP,MACE

The intuitive meaning of Pay for Performance (P4P) is the better you perform the more you get paid. This is true in many industries. The concept is well advertised in the well publicized salaries of professional athletes. Recently we have heard of grotesques salaries of fired CEO that get hundreds of millions of dollars in termination salaries for doing a bad job. They are getting paid well for poor job performance.

The underlying assumption is that with P4P, physicians should be responsible and accountable for medical outcomes. The physicians will be reimbursed for medical outcomes. The reimbursements made to the physicians are under the control of the government or insurance industry. These entities are interpreting the criteria for the quality of medical outcomes.

We have seen what happened to Dr. Petak even though his treatment is correct and saves money for the health care system. Many physicians feel P4P is simply code for reducing physician reimbursement. In an environment of existing mistrust between all the stakeholders, the potential is great for generating more mistrust. The growth of the mistrust will result in more dysfunction in the healthcare system and increased cost.

The definition of quality medical care has not been made clear by the secondary facilitators while proposing the P4P rollout. Organized medicine has not been outraged by the proposal. No one has analyzed it with all the potential for unforeseen consequence. Can P4P prevent the onset of disease or decrease complication rate for chronic disease? Who are the responsible stakeholders for increasing quality? The stakeholders responsible for medical quality care are the physician and the patient. If the patients do not adhere to the medical regime prescribed, the quality of care will not improve. Many studies have shown that compliance rates are as low as 30% for certain treatments. Patients will not have improved medical outcomes if they do not follow a treatment plan. Why should the physician be penalized? Why doesn’t the government and the insurance industry declare that patients are equally responsible for both good and bad medical outcomes? The structures of bureaucratic systems would not permit it because not only would it be judged to be insensitive it would be socially incorrect and result in a public outrage.

Patients have to be educated and become professor of their disease, be responsible for their health behaviors such as filling their prescriptions, exercising , decreasing obesity, not smoking or drinking. All preventive measures must be promoted. Patient need to be responsible their behavior and adherence to therapy. The physicians should not experience all of the brunt of poor outcomes or the credit for good outcomes. The P4P movement is misguided.

They are misguided when they think this is the fix. P4P represents another false hope and complicated mistake that in my opinion will lead to great cost to the healthcare system without improvement in medical outcomes.

I have defined quality medical care in a measurable way. None of these criteria are individual indicators of quality medical care. The system of quality of care should be the quality measure of prevention of medical complications and not the measurement of the parts on the path toward quality medical care. The patients’ activity is at least half of the quality equation to reduce the complications of chronic disease.

However, the secondary stakeholders are making a mistake with P4P. They have developed artificial quality indicators that do not measure quality medical care accurately. They want to force physicians to follow their indicators rather than use their medical skill and medical judgment. The way to improve quality is not to be punitive to the physicians. They are only one half of the quality equation to reduce medical care cost. The way to do it is to set up a competitive environment.

Lasik surgery is a perfect example. It stated with all ophthalmologic doing Lasik for $3000 an eye. Insurance did not pay for Lasik surgery. Some ophthalmologists’ developed focus factories that did just Lasik surgery. They developed economies of scale and expertise that enabled them to reduce the price. Patients chose these focused factories on the bases of price, and outcomes rather than the local opthalmologists. The price in some cities is now $250 an eye. Remember patients are not stupid. However, they are the 50% of the quality care equation. They will spend their money wisely and drive quality, if they own their healthcare dollar. It is our job to teach patients how to make the correct decisions. It is not the insurance industry or the government to restrict access to care and judge what is best. I believe the market place can do it.

In diabetes the healthcare system sends 15% of the healthcare dollar on 5% of the population and rising. Ninety percent of those dollars is spent on the complications of diabetes. If patients with diabetes were given control of their healthcare dollar and were rewarded for avoiding complications of diabetes we would be on our way to a competitive environment for the treatment of diabetes. The patients would search for physicians that had economies of scale and expertise to help them improve their quality of medical care. They would drive the creation of focus factories in diabetes as well as any other chronic disease. The system would then be stimulating competition and improving quality medical care not punishing physicians and patients. A negative and faulty penalty system (P4P) will not solve any of our problems. I predict it will only make it worse for the patient and the physician and more profitable for the insurance industry and hospitals. The physician and patient community ought to be outraged. They are not because we are a sound byte society and do not pay attention to the details of issues.

The P4P fad is simply another reason why patients need to be in control of their healthcare dollar. They should be rewarded if they avoid complications and improve their health. Physicians should compete to develop focus factories in order to generate economies of scale and improved medical outcomes. All of this has to be done in a price transparent environment.

 

April 15, 2007 in Medicine: Healthcare System | Permalink

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

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ObamaCare Is Not A Cost Savings Act

Stanley Feld M.D., FACP,MACE

The evidence is mounting that President Obama’s healthcare reform act will not make healthcare more efficient or more affordable.

I have pointed out that Obamacare will create a healthcare system that will limit innovation, lead to healthcare rationing, and lower the quality of care.  All this is coming our way.

The theoretical cost savings proposed and confirmed by the CBO on data given to it by President Obama has not worked out as promised.

It couldn’t work out as I predicted with the creation of a massive bureaucracy and its generation of massive rules and regulations to enable the government to control the healthcare system.

I would have loved to see President Obama create a system of affordable healthcare that is accessible to everyone. President Obama’s did not. He has created a financial and healthcare delivery mess.

He has the wrong business model.

He was able to pass his healthcare reform act by faking out the congress and the CBO using unrealistic numbers about cost saving.

President Obama repeatedly claimed that the annual healthcare premium per family would decrease by $2,500 per year before the end of his first term. We are almost at the end of his first term and the average cost of a yearly premium has increased $2,200 according to a Kaiser Family Foundation report.

President Obama claims seniors enjoy their Medicare coverage. I believe it is great to provide guaranteed insurance for seniors despite pre-existing illness.

However, the costs of Medicare premiums and Medicare’s initial deductibles have increased since 2009 while the covered services have decreased.  

President Obama has also told seniors that their Medicare Part D benefits have improved under his watch. However, the cost of Part D, the deductibles and the costs of the different tier drugs have all increased.

“The CBO's initial estimate in March 2010 of ObamaCare's budget impact showed it saving money, reducing the federal deficit by $143 billion in the first 10 years. But that positive estimate was largely the product of gimmicks inserted into the bill by Democratic leaders to hide the law's true cost.”

Last month President Obama’s proposed fiscal 2013 budget included $111 billion in additional spending for the premium subsidies in the health law's insurance exchanges. Many states are refusing to sign up for health Insurance exchanges even though President Obama said he would pay 90% of the cost of these exchange in the first couple of years.

The states are broke and in the red. They have a constitutional obligation to have a balance budget.

The healthcare insurance exchanges are a President Obama ploy to get states to sell insurance to the uninsured increasing the state’s deficit. President Obama and congressional leaders said it would only affect one million Americans who would lose their employer-sponsored healthcare coverage.

This did not seem like an accurate number to me. The healthcare insurance premiums were $13,000 per family. If the employer did not provide healthcare coverage the penalty to an employer would be $2,000 per employee per year.  The numbers given to the CBO clearly was a misrepresentation.

According to the CBO, 154 million Americans are covered under employer-sponsored plans. The cost to taxpayers would be huge and further increase the deficit if 50% of those individuals lost their coverage and became eligible for the $10,000 per year subsidy.

A McKinsey & Co. study in June 2011 showed that 30%-50% of employers plan to stop offering health insurance to their employees once the health law is implemented in 2014.

Employers dropping employer sponsored healthcare coverage will expose their employees to large financial risk even with the proposed government subsidy.

Employers would be making most employees eligible for huge subsidies in the new health-care exchanges. The government paid subsidy would be up to $10,000 for a household income of $64,000 per year.

This was another trick play by President Obama to get everyone into a public option and government run socialized medicine.

 “In recent testimony before the Senate Appropriations Committee, Health and Human Services Secretary Kathleen Sebelius told me that America's health insurance system is in a "death spiral." She failed to acknowledge that implementation of ObamaCare will be the cause of that death spiral, and American taxpayers will be left to pick up the tab.”

We have also learned that President Obama gave 1400 corporations exemptions from Obamacare. These corporations provided “Minimed healthcare insurance” to their low wage earning employees. Minimed healthcare insurance provides little coverage to low wage earning employees. Hundreds of thousands of these people are essentially uninsured.

On the data given to the CBO, the premiums collected by the Community Living Assistance Services and Support Act (CLASS Act) were estimated to reduce the budget deficit by $70 billion dollars per year.

The new CLASS Act program is voluntary. Premiums are estimated to be $123 per month for workers who choose to participate. It covers home care for those who become disabled at any age, not just those over age 65.

This is a pretty low premium. It seemed too cheap to be true. Congress had to impose a secret tax on all taxpayers to cover the cost of CLASS.

 

All taxpayers will all be taxed $150-$250 PER MONTH beginning in 2011 for the NEW Community Living Assistance Services and Support Act (CLASS Act) that was added to the Reconciliation Bill on Friday night, Mar 19, 2010, before Congress voted on Sunday, Mar. 21, 2010. It will help pay for long-term home-care for the elderly. Isn’t that nice?”

 

These are only a few examples of President Obama’s disinformation provided to the American taxpayer before and after his healthcare reform act was passed.

If the American taxpayer only listened and knew these facts and unintended consequences beforehand this bill would have never passed. If the Democrats in congress studied the bill beforehand they would have never passed it.

America had President Obama’s healthcare pulled over its eyes. This is the reason Vice President Biden said on an open mike, “This is a big f—–g deal”

  

 

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

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Healthcare Insurance Industry’s’ New Business Model Is Wrong.

Stanley Feld M.D.,FACP,MACE

One percent of the people spend 25% of the healthcare dollars. Twenty percent of the people spend 80% of the healthcare dollars.

It would be important to know why this is true. Then figure out what could be done about it Stakeholders need to agree on a course of action.

It would be a good idea to understand what physicians think should be done. 

“One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.”

The 1% and the 20% are suffering from complications of a chronic disease.

The incidence of chronic diseases is on the rise in the United States. A major precipitating factor for this is obesity.

The incidence of Type 2 Diabetes Mellitus is increasing in both adults and young children, as the incidence of obesity is increasing.

The incidence of complications of Diabetes Mellitus will increase in the future. The result will be an increase in the cost of medical care.

President Obama’s healthcare reform act will expand healthcare coverage to 32 million uninsured in 2014. Obamacare is forcing the healthcare insurance industry to change its business model in order in order to remain profitable.

Premiums are out of the reach of most businesses and individuals. Premium increases are not an option.

High-risk individuals are denied healthcare insurance coverage. High-risk patients automatically get coverage in corporate healthcare plans. The healthcare insurance industry simply raises premiums on corporate groups in order to maintain its profits.

Something must be done to decrease the increase in chronic disease and its complications. 

The government cannot afford to insure its present patient obligations much less the 32 million uninsured.

“As the new federal health care law aims to expand care and control costs, the people in the medical 1 percent are getting more attention from the nation’s health insurers.”

Twenty percent of the population not 1% should be getting the attention of the healthcare insurance industry.

“Studies have already shown that Medicare spending is concentrated on a small group of individuals who are seriously ill.

An analysis by the IMS Institute for Healthcare Informatics, the research arm of IMS Health, a health information company in Danbury, Conn., provides a rare glimpse into the medical problems of people with private health insurance that are under 65.

About three-quarters of them suffer from at least one chronic condition that could spiral out of control without proper care.”

Most of these people were obese.

The healthcare insurance industry cannot avoid these patients after 2014.

“Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent.”

The healthcare insurance industry realizes it must fundamentally change its business model.

The healthcare insurance industry has a problem developing a new business model that would work. The industry does not want to lose control over patients, their physicians and the monies paid into the healthcare system.

The healthcare industry does not have a clue about how to actually repair the healthcare system. It is focused on its own bottom line rather than looking at business models that will be beneficial to everyone and align all the stakeholders’ incentives.

The healthcare insurance industry is planning on instituting programs that will tinker with the edges. It will not fix the problems.

The new business models will increase the percentage of money the insurance industry receives for direct patient care maintaining a Medical-Loss ratio of 15%. There is no interest in providing patients with financial incentives and a choice.

The net result will be higher costs and system failure. The weird thing is most of the healthcare insurance industry executives know it.

“The reality is if we don’t figure out how to get to the patients, we’re not going to get where they need to be,” said Dr. Lonny Reisman, the chief medical officer for Aetna.

The reality is that the system must be consumer driven with consumers in charge of their healthcare and their healthcare dollars.

At the moment patients have no incentive to decrease the cost of care. Hundreds of patients have told me that they go to the doctor to fix their illness. Medicare or their insurance pays. The patients have no idea of the costs they incur nor do they care. They have no interest in controlling their disease.

My ideal medical saving accounts would give the patients incentive to learn about their disease. They would be interested in self-managing their disease with the physician and his medical care team being the coach.

“The next challenge, say insurers, is to figure out how best to work with a person’s doctor. Because many of these patients seem to be seeing many doctors and taking many medications, there may be no one who is accountable for the patients’ overall health.” 

Physicians have figured out what services get paid by the healthcare insurance industry. They do not get paid for educating patients about their disease.

The healthcare insurance industry and the government have developed a punitive bureaucracy.   

An attempt is being made to penalize or reward physicians for medical outcomes. Pay for Performance (P4P) is a punitive payment system. It will fail. 

Patients are responsible in large part for the onset of their medical problems and in controlling their medical outcomes. Physicians cannot be responsible for patients’ outcomes. It is the responsibility of the patient.

“Insurers are also still grappling with their understanding of human nature — why some people simply don’t take care of themselves or take their medicine or go to the doctor, even when it is clear that they should.”

Patient outcomes have nothing to do with human nature. It has everything to do with financial incentive and effective education.

Spokes 5 and 6 of my future state business model has everything to do with patients’ responsibility for caring for their disease and the physicians’ responsibility to the patients. It has nothing to do with physicians’ and patients’ responsibility to the healthcare insurance industry or government.

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

Please send the blog to a friend

 

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