Stanley Feld M.D.,FACP,MACE

The Obama Administration’s call for healthcare reform has changed from providing universal care, affordable healthcare insurance and increasing the quality of care to healthcare reform is a moral imperative.

“President Obama has called it a “core ethical and moral obligation.’’ House Speaker Nancy Pelosi introduced her bill by saying, “We also have a moral responsibility to pass health insurance reform and we will do so this year.’’ And Senate majority leader Harry Reid has opined that “health care is a moral issue.’’

I believe America has a moral obligation to provide affordable healthcare insurance with a guarantee of universal coverage to every American. President Obama has chosen the wrong strategy. His plan will not achieve universal coverage or be affordable to many individuals or to the nation. It does not solve any of the important structural problems in the healthcare system.

The Democrats, by their own admission, are focused on getting a bill, any bill, passed by Christmas that will put the country on a path to a single party payer.

“Extending this successful program to those between 55 and 64 would be the largest expansion of Medicare in 44 years and would perhaps get us on the path to a single-payer model,” said Representative Anthony Weiner, Democrat of New York.

The proposed healthcare insurance exchange creates 20,000 new government jobs that will create a bloated bureaucracy. It will not lower premiums. It will increase government spending on healthcare.

The Congressional Budget Office stated that the cost of healthcare premiums through Health Insurance Exchange would be 10 to 13% higher than the cost of healthcare insurance under the present government rules and regulations.

A family’s annual health premiums will increase by $3,100 over status quo (CBO & JCT). The average American family would pay more than $20,000 per year for healthcare premiums (CBO & JCT).

“People buying health insurance under the "exchange" in Senate Democrats’ health care bill would pay higher premiums than they would under current law for their plans.”

One of President Obama’s goals was to provide affordable healthcare coverage. The CBO and CFO estimate dismiss this goal. President Obama’s Healthcare Reform will provide new subsides paying almost 60% of the premiums for over 50% of the population. He will mandate insurance for people who might not want it at a higher price than they are currently paying. The mandates are going to force Americans to purchase insurance they might want to buy.

The winner is the healthcare insurance industry. It will be the administrative service provider for the healthcare reform bill.

“According to CBO, however, "the majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies . . . would cover nearly two-thirds of the total premium." That means that while premiums cost more, most people required to buy them under the legislation’s mandate to have insurance would actually pay far less than they would otherwise.”

This is another Robin Hood example of the Obama administration’s political philosophy. It will bankrupt the country. Senator Max Baucus turned implications of the CBO report on its head and called it good news.

"The vast majority of Americans will see lower premiums than they would if we don’t pass health reform," Baucus said, citing the estimate. "We also learned that the millions of Americans who are underinsured—who don’t have enough coverage to prevent them from financial ruin—would be able to purchase significantly more coverage for an affordable price."

Who will be paying the subsidies? I assume it will be the government. It will borrow the money, print the money or increase taxes. The question is maybe the people who cannot afford the subsidized premium can afford the subsidized premiums?

"The Democrat bill will actually increase premiums for American families," Senate GOP Leader Mitch McConnell of Kentucky said in a statement Monday. "A bill that’s being sold as a way to reduce costs actually drives them up."

Senate Democrats have provided few details about their latest health care proposal. This much seems clear. Anyone who wants to buy the same health benefits as members of Congress, or to buy coverage through Medicare, should be prepared for premium increases. Medicare premiums are not cheap.

The cost to a family earning $54,000, slightly more than the current median household income, will have a monthly premium costs of more than $825 in post tax dollars.

The Democrats’ proposal would also allow some people ages 55 to 64 to “buy in” to Medicare, starting in 2011. That could cost about $7,600 a year per person or $15,200 in 2011 for a couple with post tax dollars, according to a budget office analysis of an earlier version of the concept. No subsidies would be available until 2014.

It is true that people 55 to 65 years old, with a pre existing illness like hypertension, or high cholesterol levels, cannot buy healthcare insurance as an individual.

“The Medicare buy-in proposal is intended to fill a gap in the social safety net for millions of people nearing retirement who are unable to obtain or afford insurance. In general, the new Medicare option would be available only to people who are uninsured. People 55 to 64 who have employer-sponsored insurance would be expected to keep it.”

Overlooked is the fact that employers are going to opt out buy employee insurance because it is cheaper to pay the penalty than the premium for its workers. Therefore everyone will be forced to buy an individual policy through the health exchange.

The healthcare reform bill does not offer the same benefits or subsidies that members of congress or other federal employee receive.

In order to get 60 votes in the Senate, Harry Reid had to add Medicare for 55 to 65 year olds. Medicare is a terrific but unaffordable program. It is putting the federal government on an insolvency trajectory. The Senate should be focused on fixing Medicare not adding more people to it rolls.

“Republicans denounced the proposal, saying it would add new financial obligations to a program that could not afford its existing commitments.”

Democrats have declared that it is essential to pass a bill before Christmas. After the bill is passed they will fix it later. Nothing ever gets fixed later unless there is a scandal. The only chance to fix it is now.

America needs healthcare reform. The momentum of debate should be used to pass a logical bill that will provide universal and affordable coverage without accounting and taxation tricks that will be regretted later .

Write to the President and congress.

The email address can be found at;

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

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

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

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

.

Stanley Feld M.D.,FACP,MACE

A reader wrote;” I am getting tired of you telling me how bad the healthcare reform bill is.”

I am tired of writing about the bill. I feel compelled to try to clearly explain the harmful potential of the bill to an unsuspecting public.

Most Americans agree the country needs healthcare reform.

Many intelligent people believe President Obama is on the right track. They believe he is going to provide universal healthcare coverage, affordable healthcare cost, and improve the quality of medical care.

Few in the mainstream media are discussing the real impact of President Obama’s Healthcare Reform Plan.

President Obama cannot accomplish his goals with this bill. He is going to increase federal spending and taxes for every American’s not just the wealthy.

His healthcare plan is going to increase the power of the federal government at the expense of States’ rights. He is going to control American freedom of choice.

“In short, while the House bill doesn’t impose a single-payer, It does give federal bureaucrats – in this administration or any future administration – the power to impose precisely such a system without any further congressional action”.

“To add insult to injury, we would pay vastly more for this new system – a system even less responsive to patient preferences and choices than our current system. We would face higher taxes and, according to the Congressional Budget Office, higher premiums. Both the House and Senate bills penalize employers for hiring workers, especially workers from low-income families – the people who need help the most.”

How would the mandates in the bill harm all taxpayers?

The individual and employer mandates use taxes and penalties to punish uninsured Americans not help them. It also punishes small businesses who hire workers from low income families. It is most harsh on single parents whom it is suppose to help.

“If you wanted to punish the poor and kill the job prospects of people who need jobs the most, this bill would be an effective way to do it.”

President Obama opposed healthcare insurance mandates during his presidential campaign. His healthcare reform bill has two critical mandates. There are individual mandates and employer mandates. Both are very explicit and detailed.

The individual mandate has a euphemism called the “individual responsibility provision.”

“First, there is the “individual responsibility” provision in Section 1501 (pages 320-340). This would require anyone who fails to obtain a qualifying health plan – with a benefit package to be defined later by bureaucrats – to pay an annual tax penalty”

The Senate bill requires everyone to have qualified healthcare coverage between 2014 and 2016 as defined by the government. If they do not have a qualified healthcare plan the annual tax penalty will be $750 per adult family member and $375 per child, with a maximum penalty of $2,250 per family. The tax penalty will be indexed to inflation and will be based on family size, not income. The poor might qualify for an exemption.

The individual mandate in the House bill is worse than the Senate bill. The tax is 2.5% of the modified adjusted income. In either case it is a tax on the middle class. Government is mandating people to buy healthcare insurance against their will.

There is a hardship exemption if the bare bones healthcare insurance is greater than 8% of adjusted gross income. The trick play is you have to make less than $28,000 a year to qualify for the exemption.

The employer mandate also has a pleasant sounding name.

“There is the “employer responsibility” provision (Section 1511-1513, pages 346-357). Companies with more than 50 employees are required to offer qualified health plans – with a benefit package to be defined later by bureaucrats – to their full-time employees.”

Notice the tricks:

a. More than 50 full time employees.

b. Benefits defined later by non elected bureaucrats

The effect will be that small businesses will hire only part time employees. The employees will be mandated to buy their own insurance with after tax dollars.

The penalty for the employer will be $750 per full time employee. $750 dollars per employer is a lot cheaper than the $12,000 to $14,000 for healthcare insurance premiums for the employee’s family paid with after tax dollars.

If a full time employee qualifies for a premium subsidy in the “health insurance exchange” the employer will have to pay a tax penalty of $3000 for that employee. It is still cheaper than a full insurance premium. It will discourage employers from hiring full time employees. There are lots of ways this will hurt the poor. It will shift the burden to the employee.

Companies will be motivated to drop their health plans entirely, dumping all employees into the federal exchange at their own expense.

“In other words, employers will have a strong tax incentive to lay off the workers who need the jobs most – people without other sources of income.”

This is not a healthcare reform bill for the people. It is not robbing from the rich to give to the poor. It will make the poor even poorer.

Meanwhile, congress is not debating the essential elements needed to effectively decrease the cost of healthcare. The bill will not decrease the complications of chronic disease, promote early detection of disease or prevent its complications. The bill will increase taxes, decrease job creation, cause consumers to have less discretionary income and decrease American’s standard of living.

Write to the President and congress.

The email address can be found at;

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

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

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

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

.

Stanley Feld M.D.,FACP,MACE

President Obama said he will not sign a healthcare reform bill that was not budget neutral. You can view this statement at 3.50 minutes into this video clip.

The only way that can happen is if the healthcare expenses in both bills are hidden, unrealistic expense estimates are or expenses deflected to other areas in the budget. The Senate and House bill do both.

“ As history has proven, government health care programs end up costing much more than first promised.”

The most obvious gimmick is to delay healthcare benefits while collecting increased taxes. The Senate bill is designed to collect revenue from increased taxes and fees over 10 years but it delays paying any benefits and subsidies until year 5.

“So, the 2010-2019 estimate is not a full cost estimate of all provisions fully implemented and will certainly add significantly to the true cost of the bill.”

President Obama made a deal with the AMA to get its support for his healthcare reform bill. The deal was to eliminate the Medicare reductions for physician reimbursement that were due and deferred each year during the past 5 years. These deferred reimbursements reductions amounted to $200 billion dollars. The $200 billion in deferred fee Medicare reimbursement reductions was going to take place January 1, 2010

Harry Reid claims the elimination of reimbursement reductions to physicians would reduce the deficit. His claim makes no sense to me or the CBO.

“However, in a letter released today, CBO estimates that combining the House bill (H.R. 3961) with the “Dr. Fix” bill (H.R. 3962) would actually “add $89 billion to budget deficits over the 2010–2019 period.”

Mr. Reid thinks he can get away with this claim. The claim of a deficit reduction reveals a profound disrespect for the electorate’s intelligence. It will backfire on the Democratic Party.

The deal with the AMA does not eliminate deep cuts in Medicare that have been proposed for next year. Each year congress has backed off and deferred the cuts to physicians. There is little reason to believe that Congress will not defer reductions next year or in the future.

Reasons for deferring the Medicare cuts in the past were sound. It is unwise to pay your primary vendors (physicians) less than the vendors’ expenses. They might be unwilling to provide services.

The healthcare reform bill should be attacking the abuses of all stakeholders. It should not focus on punishing the most vulnerable stakeholder (physicians).

The House and Senate bill’s budget includes a Medicare inflation rate of 2% per year for 20 years. This is unrealistic.

The calculations include a reduction in Medicare payment of 21%.

“The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time. It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010.”

Historically these estimates have not been valid. It is especially invalid now when the economy is being primed by monetary infusions. America seems to be heading for a strong inflationary period. The CBO stated that the estimates are not meaningful

“However, a detailed year-by-year projection, like those that CBO prepares for the 10-year budget window, would not be meaningful because the uncertainties involved are simply too great. Among other factors, a wide range of changes could occur—in people’s health, in the sources and extent of their insurance coverage, and in the delivery of medical care (such as advances in medical research, technological developments, and changes in physicians’ practice patterns)—that are likely to be significant but are very difficult to predict, both under current law and under any proposal.”

In fact, the CBO’s estimates includes the additional taxes and fees proposed to make up a projected 900 billion dollar deficit. The deficit prediction appears to be a gross underestimation. The estimates of spending reductions are projected at $426 billion dollars. Receipts would be increased by the tax surcharge on high-income individuals plus other provisions by $572 billion dollars making the bill budget neutral. The other provisions are the rub. These other provisions are fees and hidden tax increases on the middle class.

“Over the 2010–2019 period, the net cost of the coverage expansions would be more than offset by the combination of other spending changes, which CBO estimates would save $426 billion, and receipts resulting from the income tax surcharge on high-income individuals and other provisions, which Joint Tax Committee (JCT) and CBO estimate would increase federal revenues by $572 billion over that period.”

The real cost of the House and Senate bills are likely to be more than the estimated $900 billion dollars. Both the CBO and JCT have admitted it is a low estimate. Some have guessed the real costs will be in the $3 trillion dollars range. The purpose of the healthcare reform bill was to provide universal coverage, provide affordable insurance and increase the quality of care. There are serious doubts that it will accomplish any of these goals.

Americans must demand the true facts.

Enough is Enough!!

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

Stanley Feld M.D.,FACP,MACE

President Obama’s administration has been disingenuous. During the Presidential campaign he promised to reach across the aisle. He also promised a totally transparent administration. All we have had is non transparency, partisanship and disinformation.

A reader wrote “the only reason healthcare reform has been partisan is because one of the parties did not show up to negotiate.” I asked which party he is talking about.

Tom Daschle withdrew from the administration because of a brewing lobbying scandal.

On November 19, 2009 the Senate was presented with a 2074 page healthcare reform bill that was crafted behind closed doors to merge the finance and health committee’s healthcare bills.

Senate Majority Leader Harry Reid scheduled the vote to allow debate of the bill 72 hours after it was published. Tom Daschle has been a frequent advisor to the secret Senate Democratic Party committee meetings.

Mr. Reid declared the Senate will pass the bill without any Republican support if necessary. Somehow he intimidated the entire Democratic caucus to vote for debate despite strong objections by some Democratic Senators to the bill. The Republicans and the majority of the public are against the bill. Public support for President Obama’s bill is well below 50%. The latest Rassmussen Poll has approval of the bill at under 40% with 56% disapproving.

The Senate bill is similar to Nancy Pelosi’s House bill with a few additional trick plays and much creative accounting. .

Americans should be furious because they are being ignored. I hope they are not being worn down by repeated promises of transparency and false hope. Carl Sandberg said, “if you tell a lie enough times it becomes the truth.”

President Obama’s Healthcare Reform Plan is unchanged from the plan Tom Daschle outlined in his book published two years ago. The healthcare plan was destined to fail then and it is destined to fail now.

There are many flaws in the Senate healthcare bill. These are just a few.

1. The Public Option remains in the Senate healthcare bill. It would create a new government-run healthcare plan intended to “compete” with private healthcare insurance in a new healthcare insurance plan. We were told by Harry Reid that the Public Option would not be in the Senate bill. The problem is the rule maker cannot be a fair competitor. Since President Obama’s ultimate goal is a single party payer system for healthcare the Public Option is another trick play.

Peter Pitts, President, Center for Medicine in the Public Interest and former associate commissioner, FDA sent me this YouTube production. It is a cynical explanation of the Public Option.

Barney Frank and others have stated “the Public Option is a must” . It is a first step toward a government run single party payer system. The House does not have the votes for going directly to a single party payer system. The Public Option is another entitlement program. The costs of entitlement programs have historically been underestimated.

The Center for Medicare and Medicaid Services has concluded that millions of Americans will lose their existing employer-based private healthcare coverage to a government subsidized plan. Over time private employer based coverage will vanish.

2. Federal Regulation of Health Insurance would result in sweeping and complex federal regulation of health insurance. The healthcare insurance industry needs regulation. The government plan with the administration and enforcement of the regulations will increase not decrease cost of care because of the increased bureaucracy and the system of pricing premiums. Massachusetts’ health plan is the prime example of a poor design failure.

3. Employer Mandates would be imposed on those who do not offer healthcare coverage. If coverage did not meet the government standard the government would impose a penalty on the company.

The employer mandate would inhibit small companies from hiring low income workers. This is the worst thing to do when the country desperately needs incentives for job creation. It also imposes more government rules on small business decision making.

4. Individual Mandates will require people of all ages to buy healthcare insurance. If the
y did not buy health insurance they would be penalized with a tax. In some extreme cases they could be jailed. This is another example of government controlling our lives.

5. Massive Expansion of Medicaid and New Taxpayer-Funded Subsidies are included in the bill. It is the administration’s way of covering more people earning less than $60,000 per year. At least three things are wrong with expanding Medicaid in its present form. The burden of administration and cost will be shifted to the States. Most States except Texas are in straits financial condition or at the brink of bankruptcy.

Medicaid is underfunded by the States and the Federal government. The underfunding will lead to rationing. Medicaid does not provide adequate services or vendor reimbursement.

There is nothing in the bill that has incentives to encourage patients to be responsible for their health and healthcare decisions. One fifth of the economy will be on welfare and subject to the government’s regulations.

President Obama and the Congressional Democrats have not listened to the people. President Obama has not changed anything in the bill since it was first proposed.

President Obama and Congress should remember that the independent voters and thinkers are the people who elected them. He is rapidly losing their support.

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

Stanley Feld M.D.,FACP,MACE

I have asked readers to write to the President and their representatives. I have had several requests asking for an outline of the note. Below is a letter outlining the points to make if you oppose the bills in congress. The note should be sent to the President and your Senators and Representatives. The political party they belong too does not matter. If Congress receives 100,000 letters it might understand the sentiment of the people it is suppose to represent.

All you have to do is copy the text and paste it into an email to the President and your representatives. The email address can be found at;

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

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

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

Dear Representative, Senator, or President Obama

I am asking Congress and the administration to use common sense to repair the healthcare system. Enough is enough. The Democratic dominated Senate and House have constructed bills that will increase spending, increase the deficit, increase bureaucracy, increase government power over our lives and decrease our freedom of choice.

The Democratic controlled Congress continues to use creative bookkeeping to present bills it claims are budget neutral. The claim is fooling no one. Despite all the protests, Congress is ignoring the will of the people.

The universal healthcare strategy in Massachusetts has failed. President Obama’s healthcare strategy (with similar defects as the Massachusetts plan) with fail and cost the nation dearly.

The healthcare policies in both bills will not achieve the goals of universal care, affordable care and increasing the quality of care. It will commoditized medical care and destroyed the patient physician relationship. I am afraid the President and congress are about to compound past errors in healthcare policy at a very high cost to taxpayers and our economy.

Our present problems in the healthcare system are the result faulty regulations piled upon faulty regulations in an attempt to correct the previous defects. Stakeholders have been driven to adjust to these faulty regulations to protect their vested interests. These actions have lead to ever increasing costs and more defects in healthcare policy.

Willie Sutton (bank robber) told us to go where the money is. In healthcare the biggest waste of money is in:

1. Healthcare insurance industry administrative services waste and healthcare insurance industry abuse; The wastes amounts to $200 billion dollars per year. Appropriate rules and regulations could eliminate the problem of administrative services waste. The public option will not eliminate the administrative services waste. It will add to it. http://www.lijit.com/search/stanleyfeld?type=blog&q=administrative+cost+and+the+healthcare+insurance+industry&x=0&y=0

1. Ineffective chronic disease management: 80% of the healthcare dollars spent ($1.6 trillion dollars per year) is spent on treating the complications of chronic disease. These diseases include hypertension, diabetes mellitus, asthma, osteoporosis, and obesity. CMS estimated that the cost is even higher at 90% of the healthcare dollar spent for chronic disease complications. The obesity epidemic across all age groups. It is going to bankrupt us all. There is in the bills to combat the obesity epidemic. http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&view_id=tT5oCgpkPEUAABEzQ0UAAAAh&q=chronic+disease+management&x=0&y=0
2. Defensive medicine: As a result of the malpractice systems in many states the cost of defensive medicine is somewhere between $460 billion and $750 billion dollars a year. Putting a cap on malpractice awards and appropriate education of physicians and consumers could eliminate the $750 billion dollars of unnecessary expense. The is nothing in the bills that addresses the malpractice reform issue. http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&type=blog&q=defensive+medicine+and+malpractice+reform&x=0&y=0

1. A universal electronic medical record is essential to reducing healthcare costs. Lack of a universal EMR costs the healthcare system at least 100 billion dollars a year in medical errors and duplication of testing.

The $30 billion dollar subsidy in the economic subsidy package will not solve the problem. The average physician’s cost for a universal record is $60,000 dollars. A $20,000 dollar subsidy does not help many primary care physicians afford an EMR.

A universal electronic medical record could be distributed by the government free of charge. Physicians would be charged by the click for its use. EMR software and maintenance service fees would be included. Presently less than 10% of physicians and hospital systems have fully functional EMR’s. http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&type=blog&q=ideal+electronic+medical+records&x=21&y=8

The administration should be going to where the money is rather than developing a more complex bureaucracy with increased potential for waste and abuse. Repair of the healthcare system should be consumer directed with the help of the government and not government directed.

Instead the President and Democrats controlled congress will increase taxes and out of pocket expenses for everyone. The taxes will be imposed four years before the benefits are instituted in order to decrease the real deficit spending. During a recession penalties imposed on employers will decrease employment. The only job growth in this recession so far has been government related or government created jobs. The tax increases will lengthen the recession and inhibit job creation and innovation.

The bill will decrease freedom of choice, result in an increase in rationing of care and intensify the doctor shortage.

Please listen to the people who elected you.

Please do everything in your power to fix what is broken and not destroy our innovative spirit and inhibit our freedoms.

Sincerely

Please write to the President, your Representatives, and Senators before it is too late. The Democratic controlled government has decided to ram this bill through without bipartisan participation. You can stop them one vote at a time.

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

.

Stanley Feld M.D.,FACP,MACE

Rationing of healthcare services exists already. Medicare, Medicaid and private healthcare insurance companies ration medical care in many ways. Rationing is done to decrease the economic burden of healthcare.

Some physicians and most patients are not aware that rationing exists. President Obama’s healthcare reform plan will make rationing very obvious especially to the elderly. Americans will not tolerate rationing. Physicians will not tolerate rationing especially when it interferes with their concept of ethical medical care.

Yet 220 representatives voted to impose rationed medical care on the American public.

H.R. 3962 puts this power in the hands of one unelected official, the Secretary of Health and Human Welfare. The Secretary will determine if a treatment can be performed and how much physicians will be reimbursed.

The medical social contract should be between patients and physicians. Patient should have the freedom to choose. The choice of treatment should not be left up to an unelected official.

Should the government, healthcare insurance company or hospital make our medical choices for us? My answer is no. H.R. 3962 says yes.

“Title 1, Section 101, subsection (h)(2), found on pages 25-26 of the bill. The provision applies in a situation of insufficient funds for high risk individuals and reads:

“If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.”

Note “the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.”

This is rationing, restricting access to care and not adhering to the principle of affordable premiums.

Hospital systems are now rationing care to maximize profits. Many are providing generic drugs rather than brand drugs. Many are substituting different medical devices for the device physicians have prescribed for their patients.

The only way a hospital can be profitable since the government has instituted price controls is to provide a less expensive product.

This is the complaint in the second part of the note I received from the practicing obstetrician. It is only one hospital and one experience. However, the experience and frustration is universal among physicians.

Part 2 of the letter I received:

A very expensive cost to the hospital is buying a joint, for a joint replacement surgery. Let’s say a knee joint for argument’s sake. It’s true…it is expensive. The problem? Medicare won’t even pay enough to cover the actual cost of the joint. Hospitals lose money every time a joint is done.

So, our hospital went to the 6 joint companies and said " We will pay you $100.00
per joint" (not a true  number…this is argument’s sake). Only 2 of the
companies accepted the  offer…Stryker and Smith-Nephew. 
So guess what? If you come to our hospital, that is the only joint you will get. Period. End of story.

But what if a different joint is truly better for you?? The  hospital told the Orthopedic doctors, "We would rather lose you, the doctor, to a different hospital than provide the joint you feel is best". " We’ll  just get doctors who will do that joint and not  complain"…….
WOW….Did you catch that?? They would rather lose 
the doctor, than give the better joint……And we all
know, most joint  replacements are for the elderly….hmmm the elderly…..WHO CARES …they  cost us money…Medicare doesn’t even cover costs and is getting cut another 10% this year…..so go somewhere else……but where?

ALL HOSPITALS are doing this…………Rationed care…….Are you scared yet?? This is the
tip of the iceberg……
So are AMERICAN doctors who can speak  English tired…..very.

I am tired of doing the right thing and being threatened for it. I’m tired of taking pay-cuts
while seeing more patients  every year. I’m tired of malpractice premiums of
$58,000 dollars a year. I’m tired of the threat of always being sued, especially since Leapfrog and the  hospital are telling me how to practice medicine.
Be forewarned that 40% of AMERICAN doctors state they will get out of medicine if the 
Healthcare billed is passed…..including this doctor.
I can not and  WILL NOT practice unethical medicine…..and that is
what being asked of  us…….

If you are scared……..write your  congressmen…….vote….  ..if you aren’t scared, God help  you.

What are consumers’ responsibilities in healthcare reform? Consumers elect their representatives. The representatives are not listening to the people. The solution is to elect new officials.

First write to your elected officials and tell them what you object too.

President Obama’s healthcare reform plan is not about improving care, reducing the cost of medical care, and increasing accessibility to care.

It is about increasing central government power over our lives, increasing taxes and will result in decreasing access to care. It will not accomplish universal coverage.

Write to your congressperson and the President NOW!

Enough is enough.

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

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

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

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

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

Dear Family and Friends,

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

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

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

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

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

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

The unintended consequences will destroy medical care in this country.

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

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

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

Enough is enough.

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

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

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

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