Stanley Feld M.D., FACP,MACE

President Obama has manipulated both the traditional media and the new media. He has been a likable fellow. His discusses issues in generalities. The devil is always in the details.

President Obama’s healthcare reform sounds great. He is going to provide affordable care to everyone and an increase in quality. He does not discuss the hidden cost to the government or who is going to pay for it.

It would be fine if the health reform plan would work. It won’t. It will increase government control over individual decision making. I predict healthcare reform will fail under the weight of its own bureaucracy

We have already seen signs of its failure with healthcare insurance premiums rising. The McDonald’s incident showed that the Obama administration is willing to show favoritism.

President Obama just launched a new consumer website www.healthcare.gov . On it he explains how you can take control of your healthcare. He explains how the Affordable Care Act will benefit you, your family or your business. He also explains how to find healthcare insurance coverage.

It is worth looking at. The media is the message but not necessarily the truth.

http://www.youtube.com/watch?v=DCQSGnZ0lTg&feature=related

John R. Graham, Director of Health Care Studies, Pacific Research Institute adds some of the missing facts from President Obama’s statements on HealthCare.gov.

“The mission of the Pacific Research Institute (PRI) is to champion freedom, opportunity, and personal responsibility for all individuals by advancing free-market policy solutions.”

Since its founding in 1979, PRI has remained steadfast to the vision of a free and civil society where individuals can achieve their full potential.
Put simply, public policy is too important to be left just to the experts. Individuals are the real decision makers when it comes to their schools, health care, and environment.”

http://www.youtube.com/watch?v=m1lxwQ1XauE

The contrast between President Obama’s explanation and John Graham’s interpretation is eye opening. It is consistent with Charles Krauthammer’s statement, “Don’t listen to what President Obama says, Pay attention to what he does and what he is doing.”

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

Stanley Feld M.D.,FACP,MACE

President Obama should listen to individual physicians and physician groups. They can tell him how to make Medicare more efficient.

President Obama is ignoring the power of innovation in competition. Government control leads to increased inefficiency.

Medicare wastes millions of dollars. The government should be focused on identifying and eliminating this waste.

It should not be concentrating on developing a bureaucratic infrastructure that will increase waste.

Taylorism of the early 20th century must yield to disintermediation of the 21st century.

President Obama is not listening to practicing physicians. Republicans and their leaders should be listening to practicing physicians. Republicans should be developing policies to fix the inefficiencies in the healthcare system right now.

I received this note from a group of physician leaders of large group practices throughout the country expressing some major concerns. These are a consensus of their top five concerns. Most practicing physicians and physician groups would agree. All have been frustrated by these issues.

“Stan, we polled a few of my colleagues about what would be our top issues/concerns as it relates to our current involvement with Medicare and Medicaid (CMS). We have summarized our discussions in a "5 top list".

1. “There is an inconsistency and difficulty in administration of local coverage policies versus national coverage policies and the costs associated with the variances.”

The administrative services for Medicare are outsourced to the healthcare insurance industry. Vendors in each state are autonomous. They have the ability to interpret and institute Medicare policy as they wish.

This inconsistency causes problems in tourist states for physicians and patients. There should be national policies and specific guidelines for policy implementation by carriers.

This simple fix would streamline the payment process for seniors and reduce physicians’ costs associated with claims payments. Complex payment appeals by both physicians and seniors would be reduced. The healthcare insurance industry’s staff costs and physicians’ staff costs for processing, reprocessing and adjudicating claims would be reduced. The wasteful administrative cost passed to Medicare would be saved.

2. “Oversight and management of Medicare Advantage Plans must be improved.”

There is a lack of appropriate oversight of management for the Medicare Advantage program. This defect impacts the cost of senior citizens’ medical care. Medicare Advantage does not implement the ever changing policies rapidly. There is no source for adjudication of complaints. Reimburse is delayed in some cases for a year.

Traditional Medicare carriers have no power to offer help. There needs to be more consistency and transparency on coverage policies for Medicare Advantage plans.

Medicare Advantage was created as a step to relieve the government of responsibility for Medicare. It shifts the entire responsibility from the government to the healthcare insurance industry.

The healthcare insurance industry charges the government a $3,000 premium above the cost of traditional Medicare to assume this responsibility. Seniors pay a lower premium for Medicare Advantage also. The healthcare insurance industry profit on Medicare Advantage is greater than traditional Medicare.

It is much easier for physicians to deal with traditional Medicare carriers than Medicare Advantage carriers. The amount of time spent by both providers and carriers in correcting payment problems would be reduced. This reduction in administrative waste would reduce the cost of medical care quickly.

3. “All stakeholders; physicians, hospital systems, insurance carriers and government should be held accountable for fraud and abuse.”

There is no mechanism to measure fraud and abuse by CMS. Physicians’ challenges to carriers are expensive, time consuming and minimally rewarding.

Reimbursement challenges will only increase when future rationing and control of medical care decisions are made by the new powerful commission boards and advisory panels. There is no government accountability or defense by physicians or patients for these new agencys’ decisions.

The government claims CMS saved $900 million by hiring external contractors to review provider compliance. Is this report published and validated?

Does CMS undergo similar audits of best business practices, administration staffing and other benchmarks to test its bureaucratic efficiency of operations?

4. “Operational impact of government policy on physician practices must be considered. “

An example of this comment is e-prescribing. The government should make it as easy as possible for physicians to e-prescribe. Instead, e-prescribing is mandated for 2012. The government is creating punitive rules for physicians not in compliance with this mandate.

The government should understand that mandates do not work. Usually, the cost of enforcing mandates is greater than the cost of not having a mandate .

The government should make it voluntary, easy and profitable comply with a rule that should be part of every practice. E-prescribing will make practice more efficient.

More that 90% of physicians have a smartphone. Many physicians have IPADS. All have computers with internet connectivity.

If the government promoted an application like ScriptPad, the e-prescribing problem would be solved instantly at no cost to the government or the physicians.

Monetary incentives for compliance should be provided to physicians participating. There should be no penalty for non participation.

What does ScriptPad do?

ScriptPad allows physician to write e-prescriptions faster and safer than their current paper process. ScriptPad will eliminates prescription writing mistakes. It sends prescriptions directly to the patient’s pharmacy.

This I minute video demonstrates how it works.

The same can be done in the cloud for a fully functional electronic medical record. Instead the government is setting up a complicated subsidy program that falls short of the cost of an EHR. The government should provide a fully functional web based electronic medical record to physicians.

5. “ Medicare Part B fee schedule administration”

CMS changes Part B fee schedules several times a year. Physicians are not compensated for updating their billing systems. Physicians’ reimbursement is often delayed by the changes. Patients and physicians are irritated by these fee changes. The explanations of benefits are always changing for the same services.

"Has someone at CMS kept tabs on how much it costs CMS and the taxpayers for each fee schedule implementation/delay?"

This group of physician leaders estimated the government would save $108,984,375 million dollars a years if fee schedules were not changed so often. The calculation does not include cost savings for the physicians or any overhead for the healthcare insurance carrier the government has outsourced administrative services to.

Small changes such as those suggested above would save Medicare at least one half a billion dollars a year in waste.

I hope someone is listening.

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

Stanley Feld M.D.,FACP,MACE

In order to gain support for Democratic candidates during the midterm elections , President Obama is on the campaign trail. During his campaigning he is telling Americans to be patient. His healthcare reform bill is going to be great for seniors and all other citizens.

Democratic candidates running for reelection are avoiding his support. They are not campaigning on the healthcare reform act many were forced to vote for.

Americans are not buying President Obama’s rhetoric.

The healthcare reform law is extremely complicated. Many people do not understand the consequences.

At this time, I feel it is important to repeat what is known about the law. The subtext is the government cannot afford to continue spending at the present level for the Medicare and Medicare entitlements .

None the less President Obama plans to expand the Medicaid entitlement in order to insure the uninsured. The logic to expand the entitlement is irrational within the framework of the present healthcare system. President Obama is attempting to change the framework. Budget deficits will increase, taxes will increase, access to care will decrease and rationing of care will increase.

Americans are not interested In President Obama’s plan to pay for the health care law by cutting Medicare services many seniors depend on. Below are just some of the Medicare cuts outlined in the law. There are many other unfavorable consequences of the law that I have discussed previously.

These cuts have been largely denied by the President on his present campaign trail.

· Medicare will cut reimbursements to inpatient psychiatric hospitals. It is not clear to me what profit margins these psychiatric hospitals enjoy. It would be important to know if these hospitals could remain viable. If the hospitals stop accepting Medicare patients the entire economic burden will be on the seniors.

In 2011: 

• Wealthier seniors ($85K/$170K) begin paying higher Part D premiums. Presently Medicare Part B is means tested and pay high premiums. Wealthier seniors pay up to $250 per month per person for traditional Medicare coverage. It is anticipated these premiums will increase. the total cost for Medicare coverage can rise for full coverage to over $18,000 in after tax dollars for a husband and wife.

• There will be Medicare cuts to home healthcare agencies. I always thought the fees paid for home healthcare by Medicare were high. However, if the home healthcare agency refuses to accept Medicare, the burden of payment will be on the patient. Patients might have no choice but to go to the hospital. Hospitalization will increase the cost of care unless Medicare refuses to pay the hospital.

• Medicare payments for ambulance services will be reduced. I always thought that a $1000 plus fee for ambulance services was high. I could never understand how this fee was negotiated. I believe a study of the actual cost of ambulance services would be important before the fees are cut.

• Medicare payments to ambulatory surgery centers will be cut. Ambulatory surgery centers cost less than hospital surgery centers. It is not wise economically to drive ambulatory surgical centers out of business.

• Medicare will cut payments for diagnostic labs and durable medical equipment companies. The government should be stimulating competition and innovation. If should be negotiating prices. It should not be dictating prices.

• New Medicare will decrease payment to long term care hospitals. Long term care hospitals charge less than acute care hospitals. However, these hospitals are charging excessive fees. The government should be discovering where the inefficiency and overcharging is occurring and negotiate fees to increase competition among long term care hospitals. The government’s action will cut prices. The cost of the price cuts will be shifted to seniors.

• Medicare Advantage premiums will be increased and benefits will be decreased. There is no mention in the law of controlling the healthcare insurance industry effectively. Massachusetts’ healthcare insurance exchange has not be successful in controlling costs.

• Seniors will be prohibited from purchasing power wheelchairs. Seniors must first rent wheelchairs for 13 months before Medicare will pay for a wheelchair. I imagine the government figures the senior will die before the 13 months are up.

In 2012:               

• Medicare reimbursements for dialysis treatments will be drastically reduced. This is a clear indication of rationing of care.

• Medicare will decrease the fees paid for hospice care. Hospice care is a great service. It keeps dying patients out of the hospital. It supposedly results in a tremendous reduction in the cost paid for a dying patient. In my opinion hospice care is one of the most innovative developments in the last two decades. I do not understand why President Obama wants to destroy one of the most cost effective services of Medicare.

• Medicare will continue to reduce payment for hospital services and nursing home services. Seniors will bear the direct economic burden of these reductions.

The government is at fault for the rising Medicare costs. Rather than setting up a system of competition and empowering patients to spend their healthcare dollar wisely it has dictated rules and regulations that have served to increase the cost of delivering healthcare. The government regulations have caused an increase in abuse and administrative waste by the healthcare insurance industry.

The only way to repair the healthcare system is to permit consumers to own their healthcare dollars. Only then will consumers be motivated to be responsible for their health.

President Obama’s healthcare reform law is accomplishing the opposite. He is making consumers dependent on the government.

It will not work in America.

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

Stanley Feld M.D.,FACP,MACE

An interesting debate occurred in the Washington Post between Michael Leavitt was the former secretary of Health and Human Services, and a member of the Medicare Board of Trustees from 2005 to 2009, and Dr. Don Berwick, the director of CMS.

Michael Leavitt wrote a scathing article criticizing President Obama’s Medicare Reform Act calling it an illusion. Don Berwick wrote a rebuttal to Michael Leavitt’s article.

Michael Leavitt starts off his article by stating, “Despite the report from Medicare’s trustees this month that the hospital insurance trust fund will not be depleted until 2029, 12 years later than was predicted just last year, Medicare is no better off than it was a year ago. “

The Medicare Trustees Report was strange. Nothing was done to change anything and all of a sudden, the hospital insurance fund was extended 12 years. I thought it was funny arithmetic.

Medicare Trustees is supposed to be an organization independent of the administration. Shortly afterward Richard Foster, Chief Actuary for Medicare, who is independent of both the Medicare Trustees and the administration, wrote an “Alternative Report.” He report received little coverage in the traditional media.

I wrote an article about Mr. Fosters report.

“The Medicare Chief Actuary Alternative Report: Richard Foster

After the Medicare Trustees Report was published, Richard Foster the Chief Actuary for Medicare warned “the projections in a Medicare Trustees Report “unreasonable” and “implausible.”

He encouraged everyone to ignore the report and view instead an “Illustrative Alternative” report. He said, “The projections shown in the report do not represent the “best estimate” of actual future Medicare expenditures.”

“Noting that the formal Trustees report assumes Medicare physician fees will be reduced by 30% over the next three years, Chief Actuary Richard Foster says that’s “implausible.” In addition, the Trustees report assumes Medicare fees will fall below Medicaid rates by 2019 and fall further and further behind private payment rates in future years, as the following chart shows:”

In his April 22 report, Richard Foster laid out the implausible aspects of the math. President Obama has used funny arithmetic to get his healthcare reform bill passed with a promise of budget neutrality. Foster said;

• Cuts in Medicare spending of $575 billion over the next decade.

• 7½ million members of Medicare Advantage plans to lose their coverage and cause another 7½ million to face higher premiums and benefit cuts.

• About one in seven facilities — hospitals, skilled nursing facilities, home health agencies, and hospices — to become unprofitable and possibly drop out of Medicare altogether.

• Many doctors to quit seeing Medicare patients entirely.

The public no longer believes President Obama and his projections. They understand his motives.”

President Obama constantly claims his healthcare reform law will “Bend the Cost curve” According the Chief Medicare actuary report it will bend the curve in the wrong directions.

In his rebuttal, Dr. Don Berwick uses the Medicare Trustees Report as a given truth to defend President Obama’s healthcare reform law.

“The Medicare Board of Trustees estimated last month that the Affordable Care Act produces savings that extend the life of the Medicare Hospital Insurance Trust Fund for 12 years, to 2029. The actuary of the Centers for Medicare and Medicaid Services (CMS), an independent office, reached the same conclusion.”

Dr. Berwick has misquoted Richard Forster, the chief actuary of the Centers for Medicare and Medicaid Services.

Dr. Berwick goes on to say, the Congressional Budget Office has estimated that the law will reduce the federal deficit by more than $100 billion over the next 10 years and more than $1 trillion in the following decade.

Those real savings help today’s and tomorrow’s Medicare beneficiaries.

The problem with that statement is that is what the CBO said before the bill was passed. The CBO was given assumptions by Nancy Pelosi, Harry Reid, and President Obama.

After the bill was passed in May 2010, the CBO revised the estimate. Rather than decreasing the deficit, it will increase the deficit by $115 billion dollars over ten years.

The problem begins with double counting. The Congressional Budget Office estimates that the health law will reduce Medicare spending by about $450 billion over 10 years. But all of those savings, plus massive tax increases, are used in the new law to pay for an expansion of Medicaid and a new entitlement program to subsidize insurance premiums for low-income households.

Dr. Berwick explained the double counting away by pointing out that Medicare cuts can be used to improve the government’s capacity to finance benefits in the future or to pay for another entitlement.

If there are cuts to Medicare payments of $450 billion dollars over 10 years how are Medicare benefits going to improve. The CBO and Medicare’s actuary said the $450 billion dollars could not be used for both Medicaid and Medicare. More importantly, congress has already committed those funds to other projects.

Dr. Berwick says this is not double counting. It sounds like double counting to me.

“Some, including Leavitt, claim these savings are "double counted." This argument is inaccurate and oversimplifies what is really going on.”

The government accounting rules opaquely cook the books and increase the deficit. Medicare’s estimated saving is credited to the Medicare Trust Fund. The Medicare Trust Fund buys treasury bonds. The government uses the bond proceeds to fund other projects. When Medicare needs the money, they sell the treasury bonds. The government prints more money without congressional approval. The increased funds will then pay for Medicaid expansion.

It is double counting.

Many Americans have a hard time following these manipulations.

I must warn President Obama and Dr. B
erwick that Americans’ are interested now. There is a developing mistrust for the administration and the increasing budget deficits. The mistrust is growing especially since nothing is being accomplished except bigger government control over the healthcare system.

This is all smoke and mirrors with patients and physicians being the victims

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

Stanley Feld M.D.,FACP MACE

I have pointed out the many trick plays President Obama used to pass his healthcare reform plan. These trick plays are now obvious to the majority of Americans. The tactics have led to profound mistrust for President Obama.

Democrats running in this falls midterm election are avoiding talking about their vote for the healthcare reform law. Twenty-one states believe the bill is unconstitutional.

Two weeks ago, Politico broke the news that a major coalition of liberal supporters of the health care overhaul was telling activists not to mention deficit or cost reductions when attempting to sell people on the bill. Now, Politico reports, another major liberal health care activist group, Health Care for America Now, has an even better strategy for helping out the politicians who voted for the bill: Maybe just avoid talking about the law entirely! 

Over the next couple of weeks President Obama is going to campaign to persuade voters of the benefits and constitutionality of the Patient Protection and Affordable Care Act (Obamacare).

I think President Obama will be shooting Democrats running for re-election in the foot.

The majority of Americans is not buying anything President Obama has promised.

Remember Nancy Pelosi telling us not to worry because we will understand the bill after it is passed?

Americans are now finding out what is in the bill. It is not pretty.

If you like your plan, you can keep your plan.

Americans are realizing that President Obama couches his words with double meanings.

“What I’m saying is, the government is not going to make you change plans under health reform,”

Everyone knows employers change plans each year. These new plans do not qualify under President Obama’s statement. In a draft document laying out grandfathering rules it states that most plans will relinquish their grandfathered status if the plan is unchanged after a period of time.

Healthcare Reform will cost around $900 billion.

President Obama told a joint session of Congress that his health care plan would cost “around $900 billion over ten years.” He even said it would save tax payers money.

It will be paid for “mostly” by shifting around money that we are already spending.

Actually, the majority of the money from the bill’s official scored cost comes from new taxes. According to the CBO, “the two pieces of legislation [that make up the health care law] were estimated to increase mandatory outlays by $401 billion and raise revenues by $525 billion.”

The original CBO’s report said the final cost estimate for the law came in at about $950 billion. After the bill was law the CBO report stated the law will actually require about $115 billion in additional discretionary spending, putting the official price tag well over $1 trillion. http://cboblog.cbo.gov/?p=835

My guess is this estimate is still low.

President Obama said healthcare reform law will not cut Medicare benefits.

He said, “Nobody’s talking about reducing Medicare benefits.” But according to the head of the Congressional Budget Office, “thanks to $130 billion in planned cuts to companies that offer Medicare Advantage plans, the health care law will “reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans.”

President Obama’s statement again represents another misdirection of reality.

President Obama declares that his healthcare reform law will put Medicare on better fiscal footing.

In August 2010, the Obama administration’s Department of Health and Human Services released a report claiming that the PPACA would “extend the life of the Medicare TrustFund by 12 years.”

Affordable Care Act Update: Implementing Medicare Costs Savings

“This new law recognizes that Medicare isn’t just something that you’re entitled to when you reach 65; it’s something that you’ve earned. It’s something that you’ve worked a lifetime for, having the security of knowing that Medicare will be there when you need it. It’s a sacred and inviolable trust between you and your country. And those of us in elected office have a commitment to uphold that trust – and as long as I’m President, I will.And that’s why this new law gives seniors and their families greater savings, better benefits and higher-quality health care. That’s why it ensures accountability throughout the system so that eniors have greater control over the care that they receive. And that’s why it keeps Medicare strong and solvent – today and tomorrow.”

– President Barack Obama, June 8, 2010

The Director of CBO Douglas Elmendorf said that “to describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings.”

Medicare’s top actuary agreed. He said “in practice the improved (Medicare hospital insurance) financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions) and to extend the trust fund.”

President Obama’s Healthcare Reform act will give consumers more access and greater choice.

I do not think so. It will generate many unintended consequences.
Organizing for America, the successor to Obama’s campaign organization, claims that the new health care law will result in “more choices…for millions of Americans.”

Most experts expect that the health care overhaul will result in a serious doctor shortage, particularly amongst primary care physicians, meaning many individuals will have to wait longer for care, and may not get to see the doctor they want to see. Meanwhile, insurers in some states are already cutting back on insurance options. Healthcare insurance premiums will increase dramatically.

It will bring down the price of insurance.

President Obama, Nancy Pelosi and Harry Reid promise their healthcare reform bill would provide affordable healthcare insurance. The even called the bill the Patient Protection and Affordable Care Act.

The healthcare insurance industry is raising the cost of insurance between 10% and 29% next year. Insurance deductibles are increasing. Consumers’ out of pocket expenses are increasing.

“The CBO predicted that the law will cause average health insurance premium prices to rise by 10-13 percent in the individual market. And a recent survey indicates that most businesses expect insurance prices to rise as a result of the PPACA.”

I wonder what President Obama meant when he said the law would “bend the cost curve”? The implication is it would reduce the cost of healthcare coverage. I think it is bending the curve in the opposite direction.

CBO Director Douglas Elmendorf said in presentation at the Institute of Medicine; “the health legislation e
nacted earlier this year does not substantially diminish [the] pressure” of rising health costs.”

The big question should be where is all the money going? It is not physicians. Reimbursement is continuously being reduced.

The money is going to the additional government bureaucracy, and the healthcare insurance industry.

I think the American people get it. I wanted to repeat it

Lest We Forget.

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

Stanley Feld M.D.,FACP,MACE

President Obama cannot understand why the American people are frightened about his healthcare reform act. The reasons are obvious.

The new healthcare reform law is increasing government bureaucracy and increasing regulations. Americans believe this is shorthand for increasing cost of care, decreasing access to care, rationing care, and increasing deficits.

President Obama has not demonstrated respect for Americans’ fear or wisdom.

President Obama’s healthcare reform act is on a collision course toward complete government control of the healthcare system. America’s destiny is a single party payer system. Why would President Obama want America to have single party payer system? The single party payer systems are failing in Canada and England. Those two countries are in the process of switching to a decentralized healthcare system.

Disintermediation of the healthcare system could solve many of the problems in our healthcare system. Presently, the healthcare insurance industry controls private insurance as well as public insurance by its administrative service fees. The federal government outsources its administrative services to the healthcare insurance industry.

Harry Reid and Nancy Pelosi are going to finance this debacle by increasing taxes.

Two of the most successful innovative entrepreneurs of our time, Jeff Bezos of Amazon.com and Michael Dell of Dell Computing have invested in Qliance Medical Management.

Qliance Medical Management is a company that disintermediates healthcare insurance. Its plan is to deliver real market-based solutions for healthcare by eliminating the middleman.

“According to Qliance, 40 cents of every dollar spent on health care goes toward dealing with insurance companies and paying for overhead.”

I have calculated the administrative services cost to be closer to sixty cents of every dollar spent.

“Qliance plans bet is that by getting rid of insurance companies and associated administrative fat, such as elaborate customer billing and reporting, they can deliver cheap, quality health care.”

Qliance is like a health club membership for healthcare. Membership includes unrestricted access to a Qliance clinician and clinic services for one monthly fee.

“Instead of dealing with costly overhead, we reinvest that 40¢ in our clinics, electronic medical records and in patient services. You experience shorter wait times, longer appointments and lower costs.”

Jeff Bezos and Michael Dell are on the right track but the plan has several defects.

“ Qliance customers pay a flat monthly fee of $44 to $84 dollars – depending on age and level of care you choose – to become a member.  For this, they get health care in clinics that are open seven days a week, covering 90% of the problems that we see doctors for, such as “check-ups…minor fractures…as well as ongoing care for chronic illnesses.”

Qliance customers must purchase catastrophic coverage for all other illnesses not covered. Qliance Medical Management is an attempt to deliver real market-based solutions for health care. This model is one of the first attempts to disintermediate the healthcare insurance industry.

Qliance is not the answer. It has too many defects. The most significant defect in the model is it depends on the population that joins, and the use or overuse of the system. Most importantly, the model is lacking patients’ incentives to remain healthy and live a healthy life style. If patients have a chronic disease, the model does not include motivation for patients to self-manage their disease.

Today, medical payments of insured patients are paid by the government or the healthcare insurance companies. The healthcare insurance companies also provide the administrative services for the government. There is a 40 to 60 cent burden on every healthcare dollar. This is the largest source of waste.

As government controls and regulations displace consumer power and choice, our health care costs and expenditures increase, not decreased. The Massachusetts healthcare reform experiment has proved this point.

“When you buy a car, a computer, purchase a cell phone plan, you shop.  Vendors compete for customers by finding innovative ways to make and distribute their products so they can deliver higher quality and lower costs than the competition.”

Our highly regulated health care reform act has none of these characteristics. 

President Obama believes more government regulations rather than innovation and freedom of choice is the answer. He is wrong.

Mike Tanner of the Cato Institute in his paper entitled “Bad Medicine.” points out that President Obama’s healthcare reform law will fail in all three goals. He estimates that the bill will cost three times the estimate and fail to provide healthcare insurance for all Americans, reduce insurance costs for, businesses, and government, and increase the quality of health care and the value for each dollar of health care spending.”

“The Reid Pelosi Obama plan that we’re now stuck with builds on what has already failed.  More government, more spending, and less freedom.  Unleashing entrepreneurs like Bezos and Dell is what we need to address health care.”

Qliance is a first step in the march to consumer driven healthcare. It must be combined with an ideal medical savings account to disintermediate the healthcare insurance industry.

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

Stanley Feld M.D.,FACP,MACE

Director of CMS, Dr. Don Berwick, has the same central government control philosophy as President Obama. They have different reasons for central control.

Dr. Berwick is going to feel disappointed and deceived when he fails to effect meaningful change or reduce medical costs. President Obama’s healthcare reform law is going to increase the cost of Medicare and Medicaid, restrict access to care and result in rationing of care.

President Obama wants to increase quality and decrease cost of healthcare with more efficiency. Everyone has the same goal. President Obama is going about it the wrong way

Dr. Berwick has stated that he loves the British National Healthcare System. He was hired as a consultant to that system by Tony Blair. The goal was to modernize Britian’s centralized system. He failed to reduce their costs. Britain is now decentralizing its healthcare system.

Dr. Berwick thinks in systems terms using the concepts of Fredrick Taylor. In a 2009 speech Dr. Berwick said,

“The idea of a system is neither a frill nor a fine point if we are to get reform right,” “System of healthcare lies at the very center of the scientific and political challenges that stand between us and the care we seek. With a proper understanding of systems, authentic health care redesign is feasible and socially productive. Without that understanding, ‘reform’ will likely do more harm than good.”

Our healthcare system does not coordinate care using teams. If they did the patient must be at the center of the team not the government.

All the stakeholders must be members of the team. They all must be accountable to each other. Members include patients, physicians, hospitals, healthcare insurers, and the government. Dr. Berwick is only considering physicians and other healthcare providers. He is giving the healthcare insurance industry a pass. The healthcare insurance industry is the biggest villain in our dysfunctional healthcare system..

Patients and physicians are the most important members of the team. Physicians are the managers, patient are the workers.

In order for a system to work, team members first have to know the elements of the system. The team members should then be provided with incentives so they are motivated to make the system work.

Dr. Berwick is not considering incentives for patients and physicians. He does not believe in the value of the free market. I believe his attitude will be a huge problem in his attempt to convert medical care to Taylor’s principles of scientific management..

I do not doubt his ability to create systems of care. I disagree with his punitive system of fulfilling systems of care. It will not work.

“Health care reform without attention to the nature and nurture of health care as a system is doomed,” Berwick said. “It will at best simply feed the beast, pouring precious resources into the overdevelopment of parts and never attending to the whole — that is care as our patients, their families and their communities .”

Dr. Berwick has criticized physicians care. He does not criticize patients lack of adherence to recommended care or their lack of compliance to healthy lifestyles. There has been little discussion on where money is wasted in the healthcare system. The healthcare insurance industry, hospitals’ or government’s role in the dysfunction of the healthcare system is not being discussed.

His has focused on waste created by the deficiencies in safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. There is no doubt the healthcare system’s needs the scientific management approach in each area. However, this is not where the bulk of the waste is.

“The improvement of health and health care depends on systems thinking and systems redesign,” Berwick said. “ ‘Reform’ without systems thinking isn’t reform at all.”

I agree we need systems of care. This philosophy is expressed in AACE’s System of Intensive Self-Management for Type 2 Diabetes Mellitus. I was the chairman of the task force for these guidelines. I ask develop of system of care for the diagnosis and treatment of osteoporosis.

President Obama favors a single-payer system with central control. Central control does not increase efficiency.

Dr. Don Berwick believes that the only efficient way to develop a process of scientific management in healthcare is central control with a single-payer system.

There are multiple defects in his notion.

1. Medical care should not be a set of algorithms that are centrally dictated. Algorithms should be a guide to care. Physicians must use clinical judgment.

2. The patient physician relationship must be nurtured. A large part of the therapeutic effect is that relationship. Medical care is not a commodity.

3. Clinical judgment is vital to successful patient outcomes.

4. Systems of care, with an interdisciplinary team approach, should be taught in medical schools and post graduate courses.. Presently, all disciplines are taught in isolation. When physicians go into practice, they realize the importance of interdisciplinary relationships. Models for interdisciplinary treatment approaches must be promoted and incentivized.

5. Dr. Berwick’s approach assumes that politicians and politics do not play a role in forming healthcare policy. Few believe this notion. Politics plays a big role in dictating agency policies.

6. In 1945, Friedrich Hayek pointed out that the command approach to dictating work flow is doomed to failure. Commanders do not receive accurate information about what is happening on the ground. This results in faulty central decisions.

7. Technocrats, like Dr. Berwick, may believe they can marshal statistics to optimize the health-care system. Statistics on outcomes and treatment plans have been misleading..

8. Statistical analyses rely on too many assumptions and too much unreliable data. These are the reasons government programs often result in colossal amounts of waste, fraud, and abuse.

9. The interaction of all the stakeholders must be considered. If the abuses of all the stakeholders are not considered and eliminated, the decision reached by the technocrats could be incorrect.

President Obama believes technocrats (Dr. Berwick) can solve the problems in the healthcare system. Dr. Berwick sees the problems in the healthcare system from 30,000 feet.

Our healthcare problems will only be solved by consumers at ground level along with disintermediation of the middlemen in favor of consumers.

Repair of the healthcare system can be achieved with consumer driven healthcare and ideal medical saving accounts. Consumers must be empowered by the government to take care of their health and their medical care individually with the appropriate incentive.

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

Stanley Feld M.D.,FACP,MACE

President Obama has to understand the differences between Taylorism and Disintermediation. He would then understand the difficulties Americans are having with his healthcare reform law.

President Obama must combine the advantages of Taylorism with the advantages of Disintermediation in order to Repair the Healthcare System. The system must be for the benefit of consumers.

The disadvantages of Taylorism combined with central government bureaucracy will destroy healthcare in America.

President Obama’s only concern is to increase centralized government even if America cannot afford it.

Dr. Berwick is the right technocrat for President Obama. Dr. Berwick’s only concern is to convert the practice of medicine and the delivery of medical care to Frederick Taylor’s Principles of Scientific Management.

Taylorism

Frederick Taylor published his monograph The Principles of Scientific Management in 1911. Henry Ford utilized Taylor’s concepts in mass producing the automobile.

Taylor believed that decisions based upon tradition and rules of thumb should be replaced by precise procedures developed after careful study of an individual work process. Its application is contingent on a high level of managerial control of the worker.

He stated that central authority must provide detailed instruction and rules to each worker. Managers have to supervise and grade workers in the performance of their tasks. The managers plan the work. The workers actually perform the tasks.

Taylor was convinced that productivity efficiency lies in scientific management, rather than in searching for extraordinary creative workers to perform the work. .

Scientific management commoditizes products and lower cost of production. Medical care should not be a set of algorithms and rules that are centrally dictated. Algorithms should be a guide to help physicians’ with clinical decisions.

The problem with President Obama and Dr. Berwick’s plan is it disregards the role the healthcare industry plays in the inefficiency and cost for healthcare. It disregards the cost and inefficiency created by 160 new bureaucratic agencies to create new rules and regulations. It disregards the waste created by defensive medicine.

Disintermediation

Disintermediation is a term used in the “science of economics.” It is the elimination of the intermediaries in a supply chain. Simply put it cuts out the middlemen.

President Obama and Dr. Berwick are not eliminating the biggest middleman with their plan, the healthcare insurance industry.

Michael Dell of Dell Computing and Jeff Bezo of Amazon.com are the masters of disintermediation. They have eliminated the middlemen and revolutionized the computer industry and the publishing industry. Steve Jobs did the same to the music industry with the IPOD and ITUNES.

Consumers are empowered by market transparency. The middlemen were bypassed. Disintermediation has liberated consumers and reduced costs.

Wal-Mart uses the same disintermediation principle with its effective use of information technology. Wal-Mart passes the saving produced by eliminating the middlemen on to consumers. Wall-Mart has revolutionized retailing.

Healthcare reform should include systems of care. It should also include a disintermediation system to bypass the healthcare care insurance industry. Disintermediation in the healthcare system can empower patients to control of their health and healthcare dollars.

President Obama wants to increase quality and decrease the cost of healthcare by increasing the efficiency of healthcare delivery.

Everyone has the same goal. President Obama’s route is wrong.

Our healthcare systems problems can be solved by combining Taylorism with Disintermediation.

This can be achieved with consumer driven healthcare and ideal medical saving accounts.

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

President Obama has asked us to change to green. We should listen to him..

http://online.wsj.com/article/SB10001424052748703579804575441330559553568.html?mod=djemEditorialPage_h

Another reader sent this video expressing the frustration of the people.

“Mr. Rasmussen has a partial answer for Mr. Emanuel’s confusion, and it lies in a significant division among the American public that he has tracked for the past few years—a division between what he calls the Mainstream Public and the Political Class.”

Mr. Rasmussen did a survey asking three questions.

1.
Whose judgment do you trust more: that of the American people or America’s political leaders?

2. Has the federal government become its own special interest group?

3. Do government and big business often work together in ways that hurt consumers and investors?

Those who identify with the government on two or more questions are defined as the political class.

“ A majority of Democrats, Republicans and independents all agree with the mainstream view on Mr. Rasmussen’s three questions. "The major division in this country is no longer between parties but between political elites and the people," Mr. Rasmussen says.

The political class overwhelmingly supported the bailouts of the financial and auto industries, the health-care bill, and the Justice Department’s decision to sue Arizona over its new immigration law. Those in the mainstream public just as intensely opposed those moves.

President Obama insists he is doing what is right for America. The statement has a similar sound to Nancy Pelosi’s statement that “we will understand the healthcare reform bill after it is passed.”

One last reader comment.

to be signed by a president who also smokes,

with funding administered by a treasury chief who didn’t pay his taxes, to be overseen by a surgeon general who is obese,

and financed by a country that’s broke.

There you have it. I suggest President Obama start listening to the people and stop ignoring the expression of their feelings.

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