Stanley Feld M.D.,FACP,MACE

There is good reason for the negative approval rating polls of the congress and the President. They have proven over and over again what they tell us is not what they mean. The public does not trust the Congress or Senate. The public is starting to mistrust President Obama. I suggest he not say trust me anymore. He needs to give the public reason to trust him.

The healthcare insurance industry has little desire to repair the healthcare system. It wants want the healthcare system to generate increased revenue and profits.

“In the first half of 2009, the health service and HMO sector spent nearly $35 million lobbying Congress, the White House and federal healthcare offices, according to data from the Center for Responsive Politics.”

The healthcare lobbying effort has been extremely profitable for healthcare lobbyists. President Obama had promised to decrease the influence of lobbyists.

 
“With more than 900 lobbyists, that sector — whose top spenders are insurance giants UnitedHealth, Blue Cross Blue Shield and Aetna — was poised to spend more than in 2008, a record lobbying year.”

President Obama promised America a change. The president’s directives against lobbyists were among his first official acts. His stated goal was to make government more open and accountable to the public.

“We are here as public servants, and public service is a privilege,” Obama said, addressing his White House staff and Cabinet on his first full day in office. “It’s not about advancing yourself or your corporate clients.”

Tom Daschle is an unregistered and highly paid lobbyist. He is President Obama’s go to man for healthcare reform. Yet he is a consultant for a lobbying firm Alston & Bird whose clients are the healthcare insurance giants like UnitedHealth and hospital associations.

President Obama said; “We need to close the revolving door that lets lobbyists come into government freely and lets them use their time in public service” to promote their own interests when they leave.”

The public does not forget Presidential candidate’s promises. They have recognized the contradictions in President Obama’s actions. His actions only lead to the public’s increasing cynicism and mistrust in him and his administration. There is great public hesitation to trust the government to take care of their healthcare needs.

“The LA Times article that the "change" being supported by the White House is going to make the for-profit companies fatter and wealthier at the expense of a healthcare system bloated by the excessive administrative, profits, and grossly high salaries of the health insurance and drug companies.”

The public protests are not only about the public option. They are about the government offering “affordable” public insurance to all. An entitlement the government cannot afford. The protests are about the control over our freedom of choice.

The healthcare insurance industry will make more money when the insurance pool is increased. The government will subsidize all policies to keep the price “affordable”. The healthcare insurance industry’s profit will increase. President Obama will raise taxes and inflate the economy.

“Undermining support for the public option wasn’t the only gain scored by insurance lobbyists.

Public option was a diversion by the healthcare insurance industry. Its purpose was to frighten and distract the public from the healthcare industry’s other goals. The healthcare lobbyists have made deals with congress and the President. The deals are not transparent.

“In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders’ medical costs under their most affordable plans. Now the committee is considering setting that rate as low as 65%, meaning insurers would be required to cover just about two-thirds of patients’ healthcare bills. According to a committee aide, the change was being considered so that companies could hold down premiums for the policies.”

You bet. President Obama promised to provide affordable premiums. He also promised to regulate the healthcare insurance industry. The terms are favorable to the healthcare insurance industry and not favorable to consumers. President Obama has said nothing about the increase in out of pocket expenses.

“Most group health plans cover 80% to 90% or more of a policyholder’s medical bills, according to a report by the Congressional Research Service. Industry officials urged that the government set the floor lower so insurers could provide flexible, more affordable plans.”

The healthcare insurance industry is going to get its wishes. Healthcare insurance premiums might be more affordable but out of pocket expenses will be higher.

 
"It is vital that individuals, families and small-business owners have the flexibility to choose an affordable coverage option that best meets their needs," said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying shop.”

Isn’t that disingenuous? The greater tragedy is our representatives are going to approve the change in the deductibles. President Obama will call it a victory for healthcare reform. The Democratic party’s goal is to ultimately have a single party payer system.

Who is roping which dope? Who is the dope? The government thinks it is manipulating the healthcare insurance industry. The healthcare insurance industry thinks it is manipulating the government.

The net result is they are both manipulating consumers of healthcare. Consumers will get less healthcare coverage at greater out of pocket expense and higher taxes. The American consumer is the dope.

“Consumer advocates argue that a lower government minimum might quickly become the industry standard, placing a greater financial burden on patients and their families.”

"These are a bad deal for consumers," said J. Robert Hunter, a former Texas insurance commissioner who works with the Consumer Federation of America.”

Consumer advocates have seen through the charade. However they do not have enough money and consumer support to make others aware of what is going on behind the scenes. AARP is not providing awareness. Consumers know they have been promised transparency by President Obama but they have seen little transparency.

"They have beaten us six ways to Sunday," said Gerald Shea of the AFL-CIO. "Any time we want to make a small change to provide cost relief, they find a way to make it more profitable."

Meanwhile, companies would probably see a benefit by providing less insurance "per premium dollar," Hunter said.
Taxpayers do not want more government control over their lives and freedoms. They do not trust government to do things efficiently. Recent experience has confirmed consumer distrust. One only has to look at the inefficiencies in the bank bailouts, the economic stimulus package, the two wars, and the mounting deficits. All theses inefficiencies are at the taxpayers’ expense.

It is time for consumers to take over and demand control of their healthca
re dollars and their own healthcare decisions no matter what socioeconomic level they are in.

The government’s role should be to encourage and incentivize consumers to pursue a path toward better health without permitting them to be taken advantage of by the other stakeholders. This will be the only way to control healthcare costs.

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

Stanley Feld M.D.,FACP,MACE

The healthcare debate is becoming more confusing daily. President Obama has promised change. Fifty-three percent of Americans voted for change. We are not going to get change. It turns out President Obama represents status quo except at a greater expense to the taxpayer.

The healthcare insurance industry controls the healthcare dollars across all insurance lines. These insurance lines are private insurance for small companies, corporations that are self insured, Medicare, Medicaid and self insured local and state governments.

This broad control of the health care dollar comes about because all these healthcare insurance providers outsource their administrative services to the healthcare insurance industry. The major healthcare insurance companies disguise this control by creating differently named subsidiaries that “win the administrative services contracts.”

Fifteen to twenty percent (15-20%) of the healthcare dollar goes to administrative services fees. This is a very high fee. Medicare claims it only pays 2.5% for administrative services. This is probably true for its in-house administrative services but not for outsourced administrative services.

The healthcare industry has also had a stranglehold on all providers of healthcare insurance by increasing premiums and decreasing reimbursement to physicians and hospitals while maintaining its outrageous administrative services fees.

All the stakeholders are captives of the healthcare insurance industry. This stranglehold has caused an increase in the uninsured and destroyed the ill conceived Massachusetts universal healthcare plan.

President Obama’s healthcare reform plan is not focused on eliminating this stranglehold. The Obama healthcare reform plan will still outsource the administrative services to the healthcare insurance industry while increasing the government’s bureaucracy to try contain costs.

When are our politicians going to figure out the only way to repair the healthcare system is to eliminate the middlemen and let the transactions be between patients and physicians?

“This year alone, the healthcare industry has spent over $34 million to hire 923 lobbyists to influence Congress, according to the Center for Responsive Politics.”

Why? Because the healthcare insurance industry has positioned itself so it cannot lose no matter which modified healthcare reform plan is adopted.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama’s massive healthcare initiative. I believe this is an act. Do not let it fool you. Patient welfare is not the healthcare insurance industry’s concern.

“The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers — many of whom would get government subsidies to help pay the companies’ premiums.”

"It’s a bonanza," said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc”.

The healthcare insurance industry hired the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group to do a study opposing the “public option”. The healthcare insurance companies contended that a government-run plan would put the healthcare insurance companies out of business.

I believe this is a diversion. The healthcare industry will make out like a bandit either with or without a public option. The consumer will not be so fortunate. .

Laszewski said the industry’s reaction to early negotiations boiled down to a single word: "Hallelujah!"

"The insurers are going to do quite well," said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. "They are going to have this very stable pool, they’re going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide — plus their administrative costs."

Tom Daschle has emerged, according to the mainstream press, as Obama’s key go-to guy. It is as though he never left. He has the ear of the President as well as the healthcare insurance industry and the pharmaceutical.

“He still speaks frequently to the president, who met with him as recently as Friday morning in the Oval Office.”

Tom Daschle declared after meeting with President Obama that the President is becoming impatient with the debate and might force his healthcare reform bill through the Senate with a 51 vote majority.

“He remains a highly paid policy adviser to hospital, drug, pharmaceutical and other health care industry clients of Alston & Bird, the law and lobbying firm.”

It seemed strange that UnitedHealth and other healthcare insurers would hire Alston and Bird to represent them by a “liberal” Democrat (Tom Daschle) until it became clear that with or without a public option the healthcare industry would experience a bonaza.

“UnitedHealth spent the most, $2.5 million in the first half of 2009, and hired some of Washington’s most prominent political players, including Tom Daschle.”

With the public now opposed to a public option the White House and Senate Democratic leaders have introduced the concept of a on nonprofit insurance cooperatives.

“Mr. Daschle began promoting a cooperative two months ago as a politically feasible alternative to a more muscular government-run insurance plan. It is an idea that happens to dovetail with the interests of many Alston & Bird clients, like the insurance giant UnitedHealth and the Tennessee Hospital Association.”

Liberal democrats are opposed to the nonprofit insurance cooperatives. They fear it will take longer to evolve into a single party payer system than the public option would. Liberal Democrats believe the only way to repair the healthcare system is to have total government control over the healthcare system.

They do not realize that as long as the healthcare insurance industry controls the healthcare dollar the healthcare system will not be repaired. As long as consumers do not have financial incentives to control their health and their healthcare dollar the healthcare system will not be repaired

The healthcare insurance industry does not want the healthcare system repaired. They want the healthcare system to generate more income for them rather than better health for consumers.

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

Stanley Feld M.D.,FACP,MACE

In response to my last post I received this note.

“Stan

This is interesting.  You may like this but it is very obvious that it is just another stall tactic.  If the current bill, with reconciliation, passes, we still have to address these points.  So where are this fellow’s solutions?”

I watched President Obama’s town hall meeting in Grand Junction on Saturday evening. He is a compelling and seductive speaker. If I thought his plan would work and at the same time be budget neutral I might be seduced.

It will not work for the consumer and it will not be budget neutral. He needs a better plan.

What is missing?

President Obama’s generalities are correct. The country needs a system that provides universal care at an affordable cost and an increase in quality. I believe his strategy is wrong. His strategy is reflected in his healthcare reform bill.

He is correct in pointing out that the healthcare insurance industry controls the healthcare dollar. His prescription to destroy the healthcare insurance industry is wrong because it will penalize patients. President Obama’s healthcare reform bill is not doing anything to limit the healthcare insurance industry 20% gross administrative fee whether we have a single party payer or a private insurance system.

He promises to get rid of the waste in the system. He claims eliminating the waste will pay for two thirds of the 1.1 trillion dollars his healthcare billion will cost in the next ten years. The remainder will be paid for by taxing people making over $250,000 a year. He needs to redo the math.

President Obama’s system sounds pretty simple. However, it seems the government hardly ever does anything efficiently. The costs are always underestimated. There are always uncontrolled abuses or unintended consequences.

President Obama is ready to create a massive new bureaucracy and employ approximately 110,000 new employees. Bureaucracy is always a prescription for inefficiency.

President Obama is ignoring the waste created by defensive medicine. The total cost of unnecessary testing is about $750 billion dollars a year. Nonetheless, tort reform is off the table. Defensive medicine is blamed on physicians wanting to generate more money for themselves. I think defensive medicine came first, and then physicians figured out how to generate more income in response to decreasing reimbursements for their services and an increase in malpractice lawsuits. Placing a cap on malpractice awards destroyed the malpractice business in Texas and California.

Where is the role of patients’ responsibility for their own health and healthcare. Patients with adequate healthcare insurance are satisfied. The healthcare inflation problem is the result of medical care costing little for the patient with insurance except for the deductibles.

Our healthcare system is a fix the sick system. The healthcare system is not geared to prevent an illness. The administration’s healthcare reform plan speaks of prevention but does not provide incentives to patients or physicians to prevent illness or even deal with the obesity epidemic..

“Consumers are receiving quality medical care at little direct cost to themselves. This creates runaway costs that have to be addressed. But ill-advised reforms can make things much worse.”

The public has no great love for the healthcare insurance industry. Their protests about the healthcare reform bill are not to protect the healthcare insurance industry. It is to protect their freedom of choice. The public does not trust the government to make choices for them.

Both political parties have extremely low approval ratings. President Obama’s approval rating is sinking because of the perception of his half truths and a mounting distrust by independent voters.

“An effective cure begins with an accurate diagnosis, which is sorely lacking in most policy circles. The proposals currently on offer fail to address the fundamental driver of health-care costs.”

President Obama’s public option and increase in bureaucratic decision making is not going to solve our healthcare systems problems. He is not focusing on repairing the perverse incentives that are presently in the dysfunctional healthcare system.

Consumers must solve the healthcare system problems just like they solved the auto industries problems. Government role should be to provide the appropriate regulations to level the playing field.

“The health-care wedge is an economic term that reflects the difference between what health-care costs the specific provider and what the patient actually pays. When health care is subsidized, no one should be surprised that people demand more of it and that the costs to produce it increase.”

The solution is not a public option or a single party payer system. Consumer driven healthcare is the solution through the use of the ideal medical savings account.

“To pay for the subsidy that the administration and Congress propose, revenues have to come from somewhere. The Obama team has come to the conclusion that we should tax small businesses, large employers and the rich.”

President Obama’s plan will not work because the health-care recipients will lose their jobs as businesses can no longer afford their employees. The economy will get worse and the wealthy will flee to tax havens.

General anxiety will increase, patients will get sicker and the healthcare system will be overused creating more debt and more taxes.

A few economic self evident truths are:

1. A free marketplace with appropriate rules encourages innovation and productivity.
2. In the United States profitability is a strong market driver. If inappropriate rules are set up entities will try to figure out how to benefit from the rules to the disadvantage of others.
3. The higher the taxes the lower the productivity. The lower the taxes the higher the productivity.
4. The greater the bureaucracy the lower the added value productivity.
5. Consumers will try to maximize their purchasing power.

“According to research I performed for the Texas Public Policy Foundation, a $1 trillion increase in federal government health subsidies will accelerate health-care inflation, lead to continued growth in health-care expenditures, and diminish our economic growth even further. Despite these costs, some 30 million people will remain uninsured.”

Rather than expanding the role of government in the health-care market, Congress should implement a consumer driven approach to health-care reform. A consumer driven approach focuses on the consumers being the policemen for their own healthcare dollar. If would focus on the doctor relationship and empower the patients and their physicians to make effective and economical choices.

The patients would be proactive rather
than passive. The result will be an increase in efficiency in the healthcare system rather than a further decrease.

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