Stanley Feld M.D., FACP, MACE Menu


Congress Needs To Start All Over Again!


Stanley Feld M.D.,FACP,MACE


Several readers commented they were thankful that the healthcare bill passed in the Senate on Christmas eve.

I was curious to know their reason for being thankful when the bill is so flawed. Universally, their reply was “we need healthcare reform and this bill represents a good first step.”

I asked each commenter if the bill makes the healthcare system worse than it is now does that represent a good first step?

Their reply was if we do not take this step now there will be nothing done about healthcare reform again for another 40 years. I believe this is untrue. This is the view of the administrations propaganda machine to get a bill passed. .

The propaganda is flawed for several reasons:

1. The step taken 40 years ago was to enact Medicare. However Medicare has evolved into an unsustainable federal entitlement. Changes in Medicare over the last 40 years have resulted in an unaffordable but necessary program for seniors also.

2. The continuous band-aid fixes to the structurally flawed entitlement program has not solved the economically unsustainable problem.

3. Expanding enrollment in both Medicare and Medicaid is going to make both programs more economically unsustainable.

4. Medicaid is a failed program. Expanding Medicaid for a renewed definition of poverty is not going to fix Medicaid’s failure. Medicaid reimbursement is so low that it is difficult to get providers to service Medicaid patients.

It takes creative physicians practices’ to generate more revenue than expenses seeing Medicaid patients. These practices have initiated cries of fraud by many government officials and healthcare policy wonks.

It might be fraud in some cases but the fraud was initiated by the reimbursement structure.

Medicaid physicians are reacting by asking the question “why bother seeing these patients?”

This attitude has produced a physician shortage for Medicaid patient services.

Why would Senators and congressmen believe suddenly expanding Medicaid eligibility will alleviate this physician shortage?

The Urgent Care Clinics staffed by nurse practitioners and physician assistants and owned by private corporations are cash for profit businesses.

Medicaid does not reimburse for 30 to 60 days. Its reimbursement is less than the Urgent Care Clinics’ and physicians’ offices cost of doing business. Medicaid patients cannot afford to pay cash. The Urgent Care Clinics and physicians offices cannot afford to see these patients.

States are responsible for part of the Medicaid coverage. Most States are on the verge of bankruptcy. President Obama’s Healthcare Reform Bill will not provide increased funding for the increased Medicaid spending. Senator Ben Nelson of Nebraska held his vote out until Harry Reid gave Nebraska 100% Medicaid supplement.

Many other members of Congress are eager to follow the Nelson example, including one from South Carolina: Representative James Clyburn, a Democrat. Mr. Clyburn told The A.P. that he wanted to get more money for his state when the Senate and House begin negotiating a final health care bill.

Mr. Clyburn said he hoped to increase the federal portion of Medicaid payments to his state to 95 percent. That would be up from the 90 percent that most states get — most except Nebraska, which will now get 100 percent of its Medicaid expansion picked up by the federal government, in perpetuity, thanks to Senator Nelson.”


President Obama pledged he will not tolerate earmarks (pork barreling) to gain legislative approval.


Harry Reid also gave Massachusetts a supplement for Medicaid. The rest of the States are screaming how about me. Arnold Schwartzenegger has been most vocal for California.

Governors across the country have voiced concerns about the national efforts to expand eligibility for health coverage through Medicaid, a federal-state partnership that covers the expense of health care for the poor and disabled.

The net result will be an increased in federal deficit spending.

What is wrong with each version of the bill? Neither bill solves the basic problems within the healthcare system.

The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions. “

Overlooked is the fact is that all these bureaucratic interventions, provisions, regulations, mandates, committees are going to increase expenses. All President Obama has to do is ask any practicing physician. This is going to make President Obama’s healthcare reform bill more unsustainable and increase the federal deficit without an increase patient care.

“Worse, all of this bureaucracy is packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony”

It is obvious that the bill is irredeemable. Howard Dean said Kill the Bill.

"This is essentially the collapse of health care reform in the United States Senate," Dean told Vermont Public Radio. "Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill."

Democrats should make a serious deal with the Republicans. The deal should be made to fix the structural defects in the healthcare system and focus on helping the people who elected them. Otherwise members of both parties should lose their job.

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

  • Michael Kirsch, M.D.

    I thank you for this post. I am a combination of a skeptic and a cynic on the pending health care ‘reform’ legislation. My core view is that it will cost much more than they say, and deliver much less than they promise. There is no fundamental cost controls in place. Tort reform is entirely AWOL. Mayo Clinic lauded (they just ditched their Medicare patients in their Arizona clinic). Medicare, the existing ‘public option’ is running out of cash. I think they made strides in access but have fallen short on cost and medical quality.

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