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A New York Times Article Misleads Americans Part 1

Stanley Feld M.D.,FACP ,MACE

On 12/7/2019 the Times published an article by Anu Partanen and Trevor Corson

 entitled “Finland is a Capitalist Paradise.”

The media is the message. The article will resonate with many young couples trying to live a happy life in New York City.

The article also resonates with Bernie Sanders’ primary message.

Bernie: “Take a look at what Finland, the happiest country in the world, is doing. If Finland can provide everyone with health care, send everyone to college for free and provide affordable childcare, why can’t the US?”

The problem is the message is false.  

 “Two years ago, we were living in a pleasant neighborhood in Brooklyn. We were experienced professionals, enjoying a privileged life.

 We’d just had a baby. She was our first, and much wanted. We were United States citizens and our future as a family should have seemed bright. But we felt deeply insecure and anxious.”

There is no dispute with that statement. The college debt burden could be added to that feeling of insecurity.

“Our income was trickling in unreliably from temporary gigs as independent contractors. Our access to health insurance was a constant source of anxiety, as we scrambled year after year among private employer plans, exorbitant plans for freelancers, and complicated and expensive Obamacare plans.

Obamacare was supposed to solve the healthcare insurance problem for this young couple. Obamacare hasn’t solved the problem because of its faulty construction, its top-heavy government bureaucracy and its inefficient administration.

 “With a child, we’d soon face overwhelming day-care costs. Never mind the bankruptcy-sized bills for education ahead, whether for housing in a good public-school district or for private-school tuition. And then there’d be college. In other words, we suffered from the same stressors that are swamping more and more of Americans, even the relatively privileged.

“As we contemplated all this, one of us, Anu, was offered a job back in her hometown: Helsinki, Finland.”

As usual, the New York Times could not help taking a shot at President Trump’s philosophy when they said,

“Finland, of course, is one of those Nordic countries that we hear some Americans, including President Trump, describe as unsustainable and oppressive — “socialist nanny states.”

It turns out President Trump is right.

The couple moved to Finland from Brooklyn. The evidence they used to make their decision was all hearsay from friends and family living in the United States.

Their impression, after living in Helsinki for over a year, sounds like Utopia.

“We’ve now been living in Finland for more than a year. The difference between our lives here and in the States has been tremendous, but perhaps not in the way many Americans might imagine.” 

“What we’ve experienced is an increase in personal freedom. Our lives are just much more manageable. To be sure, our days are still full of challenges — raising a child, helping elderly parents, juggling the demands of daily logistics and work.”

The authors do not describe the meaning of personal freedom.

“But in Finland, we are automatically covered, no matter what, by taxpayer-funded universal health care that equals the United States’ in quality (despite the misleading claims you hear to the contrary), all without piles of confusing paperwork or haggling over huge bills.

This assertion has been disputed by many physicians and people living in Finland. https://www.ess.fi/uutiset/kotimaa/2015/07/30/terveyskeskuslaakarille-voi-paasta-nyt-tai-kuukauden-kuluttua—katso-oman-kuntasi-tilanne

https://legalinsurrection.com/2019/11/finlands-healthcare-system-still-flounders-bernie-and-warren-hardest-hit/

Is this true? What is really happening in Finland?

If you are not sick and do not need the Finnish healthcare system, you will feel very secure. However, if you need to use the healthcare system it is not so good.

Why the New York Times, along with Bernie Sanders and Elizabeth Warren, does not tell us the truth about Finland is obvious. The truth does not fit their agenda.

Finland has more doctors per capita than the UK but, at the level of primary care, a far higher proportion of these physicians are in private practice than is the case in Britain.

Seventeen percent (17%) of Finnish doctors work solely in the private sector. Most of these physicians are general practitioners. This is twice the percentage of physicians that were in the private sector twenty years ago.

An additional twenty percent of physicians work in both the private sector as well as the public sector. 

The bizarre thing is most employers in Finland pay for their workers to have private primary healthcare. Employers do not pay for their employees’ families. The families remain in the public sector.

The public sector is far from free. A visit to a family practitioner cost 16.10 euros. However, patients only pay for the first three visits and then it is free.

According to a Dr. Saarinen of Ula “the more experienced and “better” doctors end up in the private sector, leaving the “inexperienced” and “inefficient” doctors running the health centers.”

 Private practitioners are better paid and work under less pressure than public practitioners.

“A hospital consultation in the public sector costs patients about €38, and you pay for each night that you spend in hospital, up to a maximum of €679.”

The free healthcare service in Finland is not really free. Municipalities pay for the free service. The result is service in poorer areas of the country tend to have bad health service and limited access to medical care.

Private GPs usually set up practices in more affluent areas where they are more likely to get paid.

It looks like a grim socialized medical system. No wonder Finns deny the finding they are the happiest people in the world.

In Helsinki there are reports of huge queues at health centres (GP surgeries), waits for appointments of many weeks, and greater and greater demands with less and less funding. In south-eastern Finland it takes about a month to see a GP. Back in December 2013, it was reported that Finns were increasingly using private doctors in neighbouring Estonia to save time and money.”

Dr. Saarinen explains that the system essentially forces people to go private or rely on friends who are doctors.

Finland’s healthcare system has been a mess for at least two decades.

The couple writing this article are ignoring the facts. They said:

“Our child attends a fabulous, highly professional and ethnically diverse public day-care center that amazes us with its enrichment activities and professionalism. The price? About $300 a month — the maximum for public daycare, because in Finland day-care fees are subsidized for all families. 

And if we stay here, our daughter will be able to attend one of the world’s best K-12 education systems at no cost to us, regardless of the neighborhood we live in. The college would also be tuition-free. If we have another child, we will automatically get paid parental leave, funded largely through taxes, for nearly a year, which can be shared between parents. Annual paid vacations here of four, five or even six weeks are also the norm.”

Nothing is free!

The New York Times reported on a UN study proving Finland is the happiest country in the world. The problem is the Finns do not think the study is accurate. The Finns claim that the study was poorly designed and inaccurate.

https://blogs.scientificamerican.com/observations/finland-is-the-happiest-country-in-the-world-and-finns-arent-happy-about-it/

The New York Times has once again printed fake news story to influence readers to believe in the wisdom of “Medicare for All.”

Bernie Sanders, has long been touting Finland, Sweden, Denmark and Norway as the shining examples of socialism and socialized medicine.

Bernie says:

“Take a look at what Finland, the happiest country in the world, is doing. If Finland can provide everyone with health care, send everyone to college for free and provide affordable child care, why can’t the US?”

Carl Sandberg said, in “The Prairie Years”, “If you tell a lie enough times it becomes the truth.

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



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Healthcare Policy in The Post Truth Era

Healthcare Policy in The Post Truth Era

Stanley Feld M.D.,FACP, MACE

 The government has been deficient in trying to do anything to Repair the Healthcare System.

Unfortunately, John McCain’s vote blocked the repeal of Obamacare which froze any progress.  His reason was feeble and politically naïve.

John McCain wanted congress to work together and have bipartisan agreement on healthcare reform. The entire majority of the present House of Representatives has no desire to be bipartisan or help President Trump create or pass any bipartisan legislation.

Democrats in the house only want to impeach the president. They have no time for positive legislation to repair the healthcare system.

I believe the Trump administration has the right idea. 

President Trump and his administration have decided to make structural changes to the healthcare system by executive order until it can make big legislative changes. Their hope is they win a more cooperative Congress in 2020.

We are living in a Post-Truth era.

Post-truthpolitics(also called post-factual politics[1]and post-reality politics)[2]is a political culturein which debate is framed largely by appeals to emotion disconnected from the details of policy, and by the repeated assertion of talking pointsto which factual rebuttals are ignored.

Post-truthdiffers from traditional contesting and falsifyingof facts by relegating facts and expert opinions to be of secondary importance relative to appeal to emotion. While this has been described as a contemporary problem, some observers have described it as a long-standing part of political life that was less notable before the advent of the Internetand related social changes.”

https://en.wikipedia.org/wiki/Post-truth_politics

 The media is the message. Donald Trump threatens the Democratic Party, the bureaucracy and the traditional mainstream media.  He also threatens some of the Republicans.

He is a crude speaking person from Queens, New York. He has been called a brawler by some. He says he never starts a fight. He fights back. Many say he fights back in an unappealing way.

He says his goal is to drain the swamp. We have all gotten a glimpse of the inefficient and at times corrupt bureaucracy within our government. We can see the swamp’s depth only because of the Internet and the availability of alternate news opinions.

President Trump is working hard to streamline and increase the efficiency of the ever-expanding bureaucracy. He is a direct threat to their well-being. This is their justification for hating him.

The traditional mainstream media has promoted the Democrats’ agenda. They have helped obstruct President Trump’s agenda. The media has ignored or criticized the continual successes of President Trump.

It has either published disinformation or misinformation, ignored critical thinking on issues, or simply published non-truths.

President Trump has had no choice. Obamacare remained the law. It has been expensive and unsuccessful. It is impossible to know its yearly cost to the federal government. It is self-imploding and will disappear shortly.

Obamacare has just completed its open enrollment period for 2020. The enrollment period is supposed to end on December 15th. The Obama administration extended it to March 31 during some enrollment years. The Trump administration has extended the 2020 open enrollment period until December 31, 2019 this year.

85% of people who enrolled in Obamacare have a preexisting illness. The Obama administration has subsidized most of the premiums. It did not subsidize the deductibles. Obamacare participants still could not afford to pay the deductible. In essence, participants have no healthcare insurance because they could not afford to use it.

Open enrollment as of December 7, 2019, was awful.

2020 enrollment
http://acasignups.net/blogs/charles-gaba

There are only 6,134,477 who have enrolled in 2020 compared to 16.1 million enrollees in 2014. Medicaid was expanded by 9.3 million in 2014. With the Medicaid expansion, a total of 25 million people received insurance in 2014. 

Medicaid is a single party payor. It is inefficient. It has a problem getting physicians to participate because reimbursement does not cover most physician’s overhead.

President Obama decided to have the federal government pay over 90% of the state-run Medicaid programs for a few years.  The states, which signed up for the Medicaid expansion, did not have an increase in costs.

When states have to start paying more for the Medicaid expansion, they will have to raise taxes because by law they cannot have a budget deficit. At the moment most of those states have unauthorized budget deficits. Those deficits will become worse when they have to fund expanded Medicaid.

The mainstream media and Democratic congress continually publish the figure that Obamacare has decreased the uninsured by 20 million. However, eleven million were that result of the expanded Medicaid program.

2014

2014 graph

The numbers do not match. The government graphs are complex and confusing. However, they are very informative. The graphs tend to confuse us with estimates and actual enrollees.

 In 2016 the numbers decreased to 9.3 million with open enrollment extended to February 1, 2016

 2016

2016 enrollment

 Medicaid enrollment increased in 2016 to 15.3 million.  The Medicaid increase is included in the total number of previously uninsured, Obamacare provided healthcare insurance. Obamacare’s increase in previously uninsured is, in fact, an expansion of Medicaid.  The mainstream media use the number 20 million newly insured patients which is a misleading justification for fixing Obamacare. Some of Medicaid’s increase enrollment could represent the illegal immigrants who are now entitled to healthcare coverage.

2016 increase Medicaid

The net Medicaid increase since March 2010 in 2016 was 16.3 million. It looks like Obamacare’s goal was to increase Medicaid. The next step is to have “Medicaid/Medicare for All.”

2018 remained the same as in 2016, with many more dropouts because people realized Obamacare’s unaffordability. Since it was unaffordable, they realized they could not afford care event thought they paid their premium. Therefore, they dropped out and stopped paying their premiums.

2018 enrollment

2020 has been the expected disaster. Consumers needed relief from the Obamacare disaster. Obamacare has caused a further increase in dysfunction in an already dysfunctional healthcare system for people insured by Medicare, Medicaid and Private Healthcare insurance. 

Everyone is dissatisfied.

2020 enrollment

Only 6.1 million consumers have enrolled in Obamacare for 2020.

President Trump is hoping that after the 2020 election, he will have a friendlier Congress. Obamacare will be repealed. Congress will want to do something to help him repair the healthcare system. Meanwhile, he can only do some structural changes to lead us on the path toward an affordable healthcare system.

I predicted Obamacare would eventually fail when it was passed in 2010. Obamacare did not align stakeholders’ incentives!

Obamacare was destined to become unaffordable to consumers, the states and the federal government.

Bernie Sanders’ and Elizabeth Warren’s “Medicare for All” will suffer the same fate as Obamacare.

Most of all the taxpayers in the nation will suffer the most.

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



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Slowly But Surely :Trump Is Quietly Reforming Healthcare


Stanley Feld M.D.,FACP, MACE

Since congress did not want to help President Trump repeal Obamacare and fix the healthcare system, he decided to quietly repair the healthcare system by himself. He has no choice. Obamacare will self-implode and disappear.

President Trump has kept his steps toward healthcare reform under the radar. It is all published and there for everyone to see.   

President Trump is hoping that after the 2020 election he will have a friendlier congress. A congress that wants to do something to help him help American consumers of healthcare obtain affordable healthcare.

Consumers need relief from the Obamacare disaster. Obamacare has caused increased dysfunction on top of an already dysfunctional healthcare system.

Obamacare has caused a previously unaffordable healthcare system to become more unaffordable.

I hate to say it. I predicted Obamacare would fail in 2010. Basically Obamacare did not align stakeholders’ incentives.

I explained why Obamacare was failing in each subsequent year of its passage.

http://stanfeld.com/?s=Obamacare+will+fail

 I also offered my concept of repair of the healthcare system with my ideal medical savings accounts.

President Trump has taken important steps to repair the healthcare system. He has brought back the power of “Associations.”  Associations now have the ability to negotiate with healthcare insurance companies and sell healthcare insurance to its members.

In addition, Associations now have the ability to offer its members healthcare insurance at pre-tax dollars. This is a very big deal. Previously individuals seeking individual insurance had to pay for that healthcare insurance with post-tax dollars.

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

Instantly, healthcare premiums are effectively reduced to consumers by 20-40% using pre-tax dollars. This make present premiums more affordable.

Associations are growing very rapidly as final rules are being created to make their healthcare insurance available. The significance of Associations has been largely ignored by the mainstream media. 

Associations will create competitiveness among healthcare insurers and help individuals, small business and even giant corporations eliminate the need to negotiate and provide healthcare insurance to their employees. It might even help the government’s unsustainable programs such as Medicare, Medicaid and the VA rid itself of these unsustainable programs.

The traditional mainstream media has been busy publicizing the socialist concept of “Medicare for All.”

I have pointed out that “Medicare for All” doesn’t work. It has never worked in a financially sustainable way for many countries. In countries that have socialized medicine consumers are dissatisfied because there are long waiting times and a shortage of the access to medical and surgical care.

Our leftist politicians say socialist medicine has worked beautifully in countries like Sweden, Denmark, Canada, and England to name a few.

I have published the difficulties consumers have had in these socialized medicine countries.

Unfortunately, our leftist politicians are either ignoring the truth or do not know what they are talking about. The traditional mainstream media are simply acting as puppets for our leftist Democratic politicians who want to control the healthcare system.

Everyone knows the larger the bureaucracy the more inefficient the system. The VA healthcare system is a perfect example of this statement.     

“Last week, the executive order was initiated that will empower consumers in the individual healthcare insurance market and those consumers in the small corporations to purchase healthcare insurance through associations. It will allow the employers in small corporations to pay for their employees the healthcare insurance through the Associations with pre-tax dollars.”

“It will level the playing field to enable individuals in both groups to negotiate healthcare insurance premium prices through their associations with the same purchasing power that large corporations have.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

It could also work for consumers working for large corporations. Those employees who are displeased with their corporate provided healthcare insurance coverage can change to association provided insurance.

The new rules can potentially get employers out of the healthcare insurance providing business.

These new regulation has had little coverage in the New York Times, network television or any other mainstream media.

The traditional main stream media have been pushing the Democratic Socialists’ idea of “Medicare for All.”  “Medicare for All” cannot work.

“On Thursday June 20th 2019, the Department of Health and Human Services announced a final regulation that allows businesses to fund employees who buy health insurance on the individual market–something that until now has been illegal.”

 “The U.S. Departments of Health and Human Services, Labor, and the Treasury issued a new policy that will provide hundreds of thousands of employers, including small businesses, a better way to provide health insurance coverage, and millions of American workers more options for health insurance coverage.”

Since this new policy is a President Trump initiative, the elites in the media must have concluded that is a silly policy and it cannot work.

“ The Departments issued a final regulation that will expand the use of health reimbursement arrangements (HRAs). When employers have fully adjusted to the rule, it is estimated this expansion of HRAs will benefit approximately 800,000 employers, including small businesses, and more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.”

A close study of Health Reimbursement Arrangements (Associations) will make it clear that these numbers are correct. In fact, these estimates might be a gross underestimation of increased number of consumers with healthcare coverage.“Under the rule, starting in January 2020, employers will be able to use what are referred to as individual coverage HRAs to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market, subject to certain conditions. … Individual coverage HRAs are designed to give working Americans and their families greater control over their healthcare by providing an additional way for employers to finance health insurance.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

Associations allow everyone to be participants in the large corporation negotiating healthcare market. It allows consumers to avoid the trap of large, bureaucratic and by definition inefficient government control healthcare.

“The HRA rule also increases workers’ choice of coverage, increases the portability of coverage, and will generally improve worker economic well-being. This rule will also allow workers to shop for plans in the individual market and select coverage that best meets their needs. … [T]he final rule should spur a more competitive individual market that drives health insurers to deliver better coverage options to consumers.”

 The new policy empowers individual consumers to shop the market and select the healthcare coverage that best meets the needs of their family.

The insurance industry will not have to comply with the burdens of Obamacare’s regulations for healthcare coverage. They can create new products including medical savings accounts without restriction.

This will create an extremely competitive healthcare insurance environment.

“This is a good example of how the Trump administration is moving forward in practical ways on important issues, empowering consumers and freeing up markets. The Democrats don’t like it, of course. But the new HRA system will be popular with millions of Americans whose ability to access the individual market and exercise consumer choice will be enhanced.”

https://www.modernhealthcare.com/article/20181110/NEWS/181109905/early-association-health-plans-defy-fears-offer-comprehensive-benefits

The only big barrier is that it will make consumers become responsible for choosing their healthcare coverage and be responsible for their healthcare dollars.

I believe most Americans are up for the challenge.

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



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Mechanism Design and the Repairing the Healthcare System


Stanley Feld M.D., FACP, MACE.      

On November 11, 2007, I published the following blog: “Incentives and Mechanism Design.” The authors Leoid Hurwicz, Roger Meyerson and Eric Maskin were awarded the Nobel Prize in Economics for the concept in 2007.

http://stanfeld.com/?s=mechanism+design

 I suspect few politicians know about Mechanism Design in 2019. I am certain Bernie Sanders and the “Medicare for All” crowd do not know anything about Mechanical Design.

In my last blog, I described how politicians and the mainstream media use Confirmation Bias to try to put the government in control of healthcare against the will and welfare of the public.  

https://en.wikipedia.org/wiki/Confirmation_bias

I think Donald Trump either studied the use of Mechanism Design and its mechanics or he intuitively uses its principles in his thinking.

Mechanism Design is a concept that tries to put science into social science. It mathematically evaluates vested interests of stakeholders in order to eliminate confirmation bias and line up all the stakeholders’ vested interests for the greatest good. It assumes all the stakeholders have expressed their vested interests truthfully.

The Democrats want to hold onto (fix) Obamacare. However, the Democrats understand Obamacare is not viable in its present form. I believe “Medicare for All” with central government control of healthcare will be a disaster as it has been in most single party payer systems.

I do not believe Obamacare is fixable. I believe President Obama and the Democrats believed that Obamacare would fail. Then the nation would beg either his public option or Medicare for All.

I think President Obama believes “Medicare for All” and the total government control of healthcare is the ideological solution to the problems in our healthcare system.

His confirmation bias overrules all of the examples of “Medicare for All” failed examples at home (Vermont California and Colorado), as well as Denmark, Sweden, England, and France.  

In 2017, the Republicans with a slim majority in the Senate refused to repeal Obamacare. Whether the Republican failure to repeal Obamacare was because of intramural revenge or ideology is best to question is which system is best for the common good.

If our politicians understood the principles of Mechanism Design and were diligently working for the people who elected them benefit, America would be on the way to “Repairing the Healthcare System.”

Against this backdrop of a hostile Democratic Party, in control of the House of Representatives, Donald Trump and his administration is slowing working its way to “Repairing the Healthcare System” using the principals of Mechanism Design.

In November 2007, pre the Obama administration, I wrote:

Last month the Nobel Prize in economics was awarded to Leoid Hurwicz, Roger Meyerson and Eric Maskin. They were awarded the Nobel Prize for developing the economic theory of “Mechanism Design.” My first reaction was “what is that?”

https://en.wikipedia.org/wiki/Mechanism_design

After some research, I discovered the power of Mechanism Design. It is a brilliant economic theory that could solve many economic problems. Mechanism Design applied to our healthcare system could solve the healthcare systems problems.

What is it? “In economics, mechanism design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested. This is done by setting up a structure in which each player has an incentive to behave as the designer intends. The game is then said to implement the desired outcome. The strength of such a result depends on the solution concept used in the game. It is related to metagame theory, which is the theory of games the play of which consists of developing the rules of another game.

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare. However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers [1], thus significant research in mechanism design involves making trade-offs between these qualities. Other desirable criteria that may be achieved include fairness (minimizing variance between participants’ utilities), maximizing the auction holder’s revenue, and Pareto efficiency. More advanced mechanisms sometimes attempt to resist harmful coalitions of players.”

Lodi Hurwitz contributed to the idea of incentive compatibility. His point is the way to get as close to the most efficient economic outcomes is to design a mechanism in which everyone does best for themselves. He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying.

If everyone’s incentives are aligned, you have a much more efficient economic system. An example is defense contracting. If you agree to pay on a cost-plus basis you have created an incentive for the contractor to be inefficient. If you agree to pay a fixed price you can come close to an efficient price if you have all the truthful information. If you do not you have incentives aligned and truthful information you create the incentive to be overcharged. Most people can do better by not sharing truthful information. If the rules of the game require truthful information you can get close to an efficient market-driven solution.

The concept of Pareto efficiency means no one can be made better off without someone becoming worse off. Therefore, the incentive is to maintain your dominance by not being truthful at the expense of others. Hurwicz observed as others had that the dispersion of information was at the heart of the failure of a planned economy. He observed that there was a lack of incentive for people to share their information with the government truthfullyThe free market mechanism was far less afflicted than central planning bureaucracy by such incentive problems. The free market economy was by no means immune to this defect. He observed that the free market economy can get us closer than central planning to incentive compatibility because the end consumer can drive the discovery of truthful information.

The customer creating rules of engagement in a market-driven economy can get you closer to the ideal of Mechanism Design. Since the customer determines success of an enterprise by creating demand in a transparent environment, they can get closer to incentive efficiency. They create the rules of the game for compatible incentive.

Roger Meyerson contributed the revelation principle, a mathematical model that simplifies the calculation to create the most efficient rules of the game. The mathematical model gets people to reveal their truthful private information leading to aligned incentives.

Eric Maskin’s breakthrough was in perfecting Mechanism Design with his “implementation theory.” His theory clarifies how to design mechanisms that heighten incentive alignment and efficiency.

How does Mechanism Design relate to the Repair of The Healthcare System? We have to set the rules of the games so that we align all the stakeholders’ incentives without one stakeholder takes advantage of another. The insurance industry is taking advantage of the patients, doctors and hospital systems. The hospital systems are taking advantage of the patients, doctors and insurance companies. Doctors are taking advantage of the insurance companies, hospital systems, patients and the government. The government is taking advantage of the hospital systems, the doctors and the patients. Employers who pay the insurance bills for their employees are taken advantage of by the insurance companies. The drug companies are taking advantage of patients and unduly influencing physicians.

In our healthcare system, everyone is pursuing his vested interest in a game that has rules that do not lead to “incentive compatibility.”

Some politicians think central planning will straighten out the rules. Historically, central planning has not worked. The winners of this year’s Nobel Prize in economics have proven this fact.

I believe consumers can fix the rules of the game so that all the incentives are compatible. Consumers have to have incentives to force politicians to fix the rules of the healthcare game. Consumer-driven healthcare system will achieve the alignment (incentive compatibility) using the ideal medical saving account.

Twelve years have passed since 2007. America has not gotten closer to the solution to Repair the Healthcare System even though the solution is staring us in our eyes.

www. stanfeld.com

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



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Swedes Are Frustrated Over Their Socialized Healthcare System

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

As an example of the frustration of the Swedes:

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

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

Credit: George Hodan/public domain

https://medicalxpress.com/news/2018-09-swedes-world-class-healthcarewhen.html

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

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

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

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

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

 Dental appointments can take a wait of 6 months.

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

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

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

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

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

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

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

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

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

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

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

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Bernie Sanders’ Proposed Tax Hikes To Pay For “Medicare for All”


Stanley Feld M.D.,FACP, MACE

Nothing is free despite Bernie Sanders and other socialists’ promises. “Medicare for All”is proposed to replace private insurance with government insurance as the single party payer.

The government controls of several parts of our healthcare system. All these parts, Medicare, Medicaid and the VA Healthcare System, are financially unsustainable. All, except Medicare for seniors, are unsatisfying for patients.

Each year the Medicare premiums and deductibles for seniors have been increased, services have decreased and reimbursement to providers have decreased. It is past the point of being unaffordable for many patients although it has been invaluable for sick patients who could not possibly afford the cost of care without Medicare.

In reality the government owns these healthcare services, but it does not run these healthcare services. The administrative services are outsourced to the healthcare insurance industry. The healthcare insurance industry, in turn, has figured out how to game the system and take advantage of the government and citizens involved in the system.

Additionally, the inefficiency of government bureaucracy intensifies waste and cost. The estimated cost of Bernie Sanders’ “Medicare for All” is thirty -trillion dollars of ten years. Many believe thirty-two trillion dollars over ten years is a low number. It is also over 90% of the United States’ total ten- year budget at present spending.  

 Bernie Sanders has released a set of tax hike options in order to get some of the money to pay for his fiasco.

These tax hikes would hit American families at every income level and businesses large and small. The proposal increases taxes by $16.2 trillion over the next decade, according to an estimate of Americans for Tax Reform.”

This proposal will cover only half of the thirty-two trillion-dollar estimate.

  1. A 4% increase in payroll tax to employees.

“According to Sen. Sanders’ estimates, this increases taxes on American families and individuals by $3.9 trillion over ten years.”

  1. A new 7% increase in payroll tax for employers.

This tax will hinder business growth. It will decrease employment because it will decrease business spending on employees. It will also increase government spending for entitlements. This tax increase will only provide an estimated 3.5 trillion dollars over 10 years. It will probably result in less than 3.5 trillion because there will be less payroll tax to collect.

Please note Bernie’s numbers between employee and employer payroll taxes do not add up. It is pure fiction.

  1. The proposal would ban employer-provided healthcare insurance and repeal the employer deductions for health care insurance. The net result will be increasing taxes on businesses by over $3 trillion over a decade.

     This adds up to an additional 3 trillion-dollar cost to business not necessarily a three trillion-dollar savings.

  1. Bernie Sanders’ proposal would also repeal Health Savings Accounts, which are utilized by an estimated 25 million American families. Health Savings Accounts are a good deal for middle class families earning between $60,000 to $200,000 a year. Health Savings Accounts would even be more attractive if they were changed to Medical Savings Accounts.  

At present roughly half of the Health Savings Accounts are owned by middle class families.

A key element in a successful reform of the healthcare system is to provide health and financial incentives to citizens. Citizens must become responsible for their health and healthcare dollar in order for healthcare reform to succeed.

Bernie’s plan helps people be less responsible for themselves and more dependent on the government.

Isn’t this exactly what the socialists want? Historically socialism always fails.

  1. The tax deduction for cafeteria plans and the medical expense deduction is also eliminated.
  2. Eliminating Health Tax “Expenditures”

n all, Sanders estimates this will increase taxes on families and businesses by $4.2 trillion.

  1. 70 percent Top Tax Bracket for Ordinary Income and Capital Gains Income


This would give America the highest income tax rate in the world.

“ According to the Tax Foundation, a top 70 percent rate for ordinary income and capital gains income above $10 million will raise $51.4 billion over a decade. After accounting for macroeconomic effects, the proposal would actually cost the government $63.5 billion because of the proposal suppresses investment and economic growth.” In reality the income and negative effect to the government are a small number and insignificant to paying for the cost of “Medicare for All.”

  1. 77 Percent Death Tax

“Sanders proposes raising the death tax rate to 77 percent for inheritances.  

     Currently, the death tax applies to estates over $11 million or 22 million per couple. Over 22 million dollars is taxed at a rate of 40%.

      The death tax is, in reality, a double tax. People have paid tax on the money they have saved already. At the time of death, the government taxes them again on post-tax dollars. The tax should really be called a confiscation tax.

      Bernie Sander’s death tax proposal will increase taxes by $2.2 trillion over ten years. This is an insignificant amount compared to what “Medicare for All” will cost.

  1. Wealth Tax
    “Bernie Sanders proposes an annual wealth tax of 1 percent kicking in above $21 million in assets. Sanders estimates the proposal will increase taxes by $1.3 trillion over ten years.”

      10. Bank Tax

         “ Sanders proposes a tax on financial institutions totaling $800 billion over ten years.”

      11.Broaden the Self Employment Tax
Sanders would require business owners to report more of their business income as salary, increasing the amount of self-employment tax owed. This would increase taxes by $247 billion over ten years.

The total increase in taxes would only result in a $16.5 trillion-dollar payment on a thirty-two trillion-dollar bill. Where will Bernie get the rest of the money? He probably figures the government could print the other $16 trillion dollars. If it does it will decrease the value of the tax increases and an overall cost will be higher than 32 trillion dollars.

There is something seriously wrong with socialistic thinking. I do not believe the majority of American will fall for this serious defect in thinking.

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



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Do Finland’s and Britain’s Healthcare System Work


Stanley Feld M.D.FACP,MACE

 The Finn’s have been frustrated with their highly praised and publicized socialistic healthcare system. Finland’s free healthcare system has received excellent press in Britain. Now citizens in the U.S. are being brainwashed about the success of this system by Bernie Sanders.

Why? Britain’s socialized medicine system is collapsing. The system lost 200,000 nurses since 2010.  

In 2017/18, more than 26,000 nurses left the health service.  Voluntary resignations from the NHS is up 55 per cent.

The number of NHS staff quitting over long hours has tripled in six years. Voluntary resignations citing chronic staff shortages resulting in long hours and poor work-life balance were the largest reason for such nurses quitting the NHS. Primary care physicians are quitting for the same reasons and low reimbursement.

Royal College of Nursing (RCN) acting chief executive, Dame Donna Kinnair, said: “Health and care services are losing thousands of experienced, dedicated nursing staff who feel as if no-one is sufficiently listening to their concerns and patient care is routinely compromised by chronic staff shortages.

The National Health Service is about to lose more nurses and physicians because the National Health Service is about to have to reduce nurses’ pay once again while increasing weekly work hours.

“Finland’s health service has been in a parlous state for decades and it is getting worse.”

Bernie Sanders should not be telling us how great “Medicare for All” will be.

Last year former Social Security and Medicare Trustee Charles Blahous exposed the $32.6 trillion price tag.

“As massive as BernieCare’s estimated $32.6 trillion ten-year price tag is, it would be even more massive if it didn’t assume that U.S. doctors and nurses will simply accept the low pay and poor working conditions that Mr. Sanders has in mind.”

“The 32.6 trillion assumes doctors and nurses in the United States continue to willingly practice medicine if the job comes with lower pay and even more bureaucracy than the current highly regulated system?”

it will create a deficit of more than three trillion dollars a year and not save the 600 billion dollars over ten years promised. Bernie Sanders should know Britain’s and Finland’s free healthcare systems have failed. He should stop lying to the American public.

https://www.zerohedge.com/news/2019-03-12/finlands-government-collapsed-under-weight-socialized-healthcare

Back to Finland and the big Bernie lie. 

Finland has more doctors per capita than the UK but, at the level of primary care, a far higher proportion of these physicians are in private practice that is the case in Britain.

Seventeen percent (17%) of Finnish doctors work solely in the private sector. Most of these physicians are general practitioners. This is twice the percentage of physicians that were in the private sector twenty years ago.

An additional twenty percent of physicians work in the private sector as well and the public sector.  

The bizarre thing is most employers in Finland pay for their workers to have private primary healthcare. Employers do not pay for their employees’ families. The families remain in the public sector.

The public sector is far from free. A family practitioner visit cost 16.10 euros. However, patients only pay for the first three visits and then it is free.

According to Dr. Saarinen of Ula “the more experienced and “better” doctors end up in the private sector, leaving the “inexperienced” and “inefficient” doctors running the health centers.”

 Private practitioners are better paid and work under less pressure than public practitioners.

“A hospital consultation in the public sector costs about €38, and you pay for each night that you spend in the hospital, up to a maximum of €679.”

The free healthcare service in Finland is not national. Municipalities pay for the free service. The result is service in poorer areas of the country tend to have bad health service and limited access to medical care.

Private GPs usually set up practices in more affluent areas where they are more likely to get paid.

It looks like a grim socialized medicine system. No wonder Finns deny the finding they are the happiest people in the world.

In Helsinki there are reports of huge queues at health centres (GP surgeries), waits for appointments of many weeks, and greater and greater demands with less and less funding. In south-eastern Finland, it takes about a month to see a GP. Back in December 2013, it was reported that Finns were increasingly using private doctors in neighboring Estonia to save time and money.”

Dr. Saarinen explains that the system essentially forces people to go private or rely on friends who are doctors.

Finland’s healthcare system has been a mess for at least two decades.

The big question is why in the U.S. do we permit politicians such as Bernie Sanders, OA Cortez, and a complicit mass media get away with the lies about the glory of socialized medicine?

How do we permit our media and our politicians get away with this disinformation?

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



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The Concept of “Medicare for All” is Misguided

The Concept of “Medicare for All” is Misguided

Stanley Feld M.D.FACP,MACE

Bernie Sanders (I-VT), has long been touting Finland, Sweden, Denmark and Norway as the shining examples of socialism and socialized medicine. 

 The New York Times reported on a UN study proving Finland is the happiest country in the world. The problem is the Finns do not think the study is accurate.

The New York Times has once again printed fake news to influence readers to believe in the wisdom of “Medicare for All.”

Carl Sandberg said in “The Prairie Years”, “If you tell a lie enough times it becomes the truth.”

https://blogs.scientificamerican.com/observations/finland-is-the-happiest-country-in-the-world-and-finns-arent-happy-about-it/

Bernie Sanders (I-VT) has been hanging his socialistic rhetoric on the success of Finland’s socialist society and especially Finland’s healthcare system which is free healthcare for all. 

Last week Finland’s government collapsed over universal healthcare costs.                                                                                                                                                  

 Similar problems are bedeviling Sweden and Denmark, two other countries frequently held up as models to follow on health care. Finland’s crisis in particular comes as calls for universal health care have grown louder among Democrats in the United States.”

Americans have not heard from the mainstream media about the collapse of Finland’s government or the reasons for that collapse.

Norway is excused from this discussion because Norway has become a very rich country from its North Sea oil income and its restrictive immigration policies. It is the citizen’s sugar daddy along with a 50% tax rat

The Kaiser Family Foundation found that 58 percent of Americans oppose “Medicare for all” if told it would eliminate private health insurance plans, and 60 percent oppose it if it requires higher taxes.

Reuters reported that soaring treatment costs and longer life spans have particularly affected the Nordic countries financial problems.

“Nordic countries, where comprehensive welfare is the cornerstone of the social model, have been among the most affected,” according to Reuters. “But reform has been controversial and, in Finland, plans to cut costs and boost efficiency have stalled for years.”

..Just a few days before Finland’s government collapsed over its inability to foot the bill for its expansive socialist experiment, Sanders took to Twitter in an attempt to shame America.

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“In the United States it costs, on average, $12,000 to have a baby. In Finland it costs $60. We’ve got to end the disgrace of our profit-driven health care system and pass Medicare for all.”

With the collapse of Finland’s government over its inability to financially support its massive socialist agenda, Bernie will undoubtedly do the same thing he always does when socialism (or communism) fails: ignore, obfuscate, and deflect.”

 We only have to remember Vermont’s “Medicare for All” failure.

Bernie Sanders and AOC should read Finland and Sweden’s newspapers to understand that the people are unhappy with free but unavailable medical care. The unhappiness of the citizens historically happens in every socialist state.

If Democrats are successful in getting “Medicare for All” into law, we will face the same dilemma in America’s future.

Finland has been held up as a model welfare state. The distribution of the resulting high taxes is spent on the social issues the politicians think are most important and not what the citizens think are most important.  The majority of the high taxes are spent on education and childcare, not on health care.

The experience of a patient in Finland is very educational. This article appeared in Britain’s Guardian newspaper as Britain struggles with its National Health Services system.

“Why is Finland’s healthcare system failing my family?”

This reporter moved to Finland from the U.K. to experience this highly rated welfare state. Finland receives an extremely positive press in Britain. The British welfare state systems are failing.

“I have moved to from Britain to Finland because it is lauded as the shining example of a successful welfare state.”

https://www.theguardian.com/society/2016/feb/23/finland-health-system-failing-welfare-state-high-taxes

“Imagine going to your nearest doctors’ surgery at 9am on a weekday with your sick six-year-old daughter because you cannot make an appointment over the phone. After your drive to another part of the city, you can’t simply book a time with the receptionist.”

 There is no receptionist. You have to swipe your daughter’s national insurance card through a machine, which gives you a number.

“Then you and your feverish child simply sit and wait. Or rather, you stand, because the room is so crowded that people are sitting on the floor, on steps, or leaning against walls. The numbers come up on a screen every 10 minutes or so, in no particular order so you’ve no idea how long your wait will be as your daughter complains of feeling cold then hot and then cold again.”

Patients get sicker and frustrated waiting for care.

“By 10.45, another patient’s dad exclaims he’s been there since 8.15, he’s had enough, and he’s going to go to a private GP. “You used to just be able to make an appointment with a doctor!” he says angrily.”

You are not waiting to see a physician you are waiting to see a nurse that will determine whether you see a physician assistant or General Practitioner.

At 11.30, you give up and take your daughter to see a private doctor as well, forking out £50 for the privilege.”

Finland’s schools always have the best ranked international student assessment results in the western world; there’s high social equality; all its teachers have master’s degrees.

But unknown to Bernie Sanders, Finland has one of the worst health services records in Europe.

According to an OECD report published in 2013, the Finnish health system is chronically underfunded. The Nordic nation of five million people spent only 7% of GDP on its public health system in 2012, compared with 8% in the UK. In 2012, the report found, 80% of the Finnish population had to wait more than two weeks to see a GP.

America’s healthcare system is becoming unaffordable. When politicians like Bernie Sanders, AOC, and all the announced Democrat candidates for president support “Medicare for All” it sounds easy and appealing. The fact is socialized medicine doesn’t work.

The only system that can work is a system that creates incentives for consumers to be financially and medically responsible for themselves and the creation of rules by the government forcing insurance companies and hospital systems to become competitive in favor of consumers.

Donald Trump knows this. If only our elected officials in Washington wanted to act for the benefit of the citizens who elected them.

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



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 Changing The Rules: It Is Just The Beginning

 Stanley Feld M.D.,FACP, MACE

A proposal to cut Medicaid payments to some insurers with excessive reserves stirs concern from healthcare insurers.

Progressive politicians refuse to believe that entitlement programs like Medicaid are not viable. Politicians should be looking at creative ways to structure the Medicaid form of insurance for both physicians and patients.

https://www.politico.com/states/new-york/albany/story/2018/01/22/proposal-to-cut-medicaid-payments-to-some-insurers-with-excessive-reserves-stirs-concern-206875

I have not written a blog lately because both the Democrats and the establishment Republicans in both the house and the senate disillusion me. Neither house or senate members are interested in being creative.

Neither body knows how medicine works.

These politicians have no interest in doing what is best for the people who elected them. They are only interested in maintaining power and extending their power over the people they govern.

The result will be to decrease to quality of care to patients forever.

In the meantime there have been news stories on how different corporate organization and big businesses are trying to take over medicine.

Many readers have noticed that emergency clinics are popping up in every city and town.

I believe these emergency clinics centers are in reality real estate plays waiting for so that big corporations, like Aetna; to buy them out in order to expand their plans to take over medical care.

It feels similar to the proliferation of small banks in the 1980’s. These new small banks’ plan was to grow and be bought out at a premium by larger banks in order to enlarge the sale premium.

When the defective program (Medicaid) is a failure one should learn from that failure. One should not continue to try fixes to the program (Medicaid) when each fix creates greater dysfunction.

One should institute another plan that might work. However, government officials continuously apply an additional patch that leads to more unintentional consequences.

This week New York State governor Andrew Cuomo put another patch on its failed Medicaid system. I predict this patch will lead to more unintended consequences. The result will be to make Medicaid coverage worse for its New York State’s Medicaid recipients.

Governor’s Cuomo’s initial mistake was expanding Medicaid at President Obama’s request. He then compounded the mistake by subsequently allowing illegal immigrants in the state to receive Medicaid coverage.

It is not wise to take a financially failed system and expand it. It is much better to change the system.

Now Governor Andrew Cuomo’s budget is proposing to cut Medicaid payments to certain health insurance companies with excess reserves, a move that is alarming insurers because of its intent and its ambiguity.

“The proposal, part of the $168.2 billion executive budget released last week, says that any Medicaid managed care or long-term care Health Maintenance Organization that has excess reserves across all lines of business would be subject to a prospective cut in Medicaid rates.”

 Why would an insurance company want to participate in these programs?

The immediate unintended consequence is that the insurance company that found a defect in the payment schedule for HMO’s and managed care would leave the Medicaid market.

The second unintended consequence is it would discourage companies from having incentive to make a profit.

“Under current law, all Health Maintenance Organizations are subject to minimum reserve requirements,” said Erin Silk, a spokeswoman for the Department of Health. “This policy will provide the commissioner with the discretion to make rate adjustments to plans holding reserves in excess of the statutory requirements for reasons that cannot be explained or justified.”

The state did not project any savings from this proposal.”

The state cannot run Medicaid without insurance companies being the administrative service providers. It is the same old story. This comes on top of a proposed fourteen percent tax on for-profit insurers as well as the state receiving a cut of the proceeds when a nonprofit insurer converts to a for-profit insurer as a result of the new tax law.

Governor Coumo wants this additional money because he thinks the insurance industry is going to have a windfall from President Trump’s new tax law. He figures the state will collect $640 million dollars more as a result of this move.

“There were 3 million New Yorkers enrolled in these types of plans in 2014, according to a report from the United Hospital Fund.”

The insurance industry gave the usual illogical reason for opposing Cuomo’s proposals.

These insurance companies are there to make money. They are not going to let Coumo out of his commitment. I believe they will walk away from providing administrative services for the states Medicaid insurance coverage.

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

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