Stanley Feld M.D.,FACP,MACE

President Obama has used one trick after another to get his healthcare reform bill passed. He has also used many tricks to put control of the healthcare system in the hands of the executive branch of government. The Secretary of Health and Human Service has the power to make healthcare policy without congressional oversight.

The Secretary of Health and Human Services can delegate her powers to whomever she chooses. I was astonished that neither congress nor the Republicans made a fuss about President Obama usurping congressional power.

President Obama is moving further away from respecting the will of the people. It is clear that the majority of Americans oppose most aspects of President Obama’s healthcare plan. They do not like the implications of government control over the entire healthcare system, the specter of a public option, a single party payer,or rationing of healthcare.

Americans despise the implication of the loss of freedom to choose. They feel deceived by President Obama’s statements that if you like your physician or your healthcare plan you may keep it. In reality, this was a false promise.

President Obama nominated Dr. Donald Berwick to be Director of Center of Medicare and Medicaid Services (CMS). Dr. Berwick dedicated his life to healthcare policy. His ideas are “progressive” ideas. I disagree with many of his ideas. I also believe the congress and the American public should have been exposed to these ideas through the usual Senate confirmation process.

The Senate did not schedule the confirmation hearings because the nomination paperwork had not been completed.

During the July 4^th recess, President Obama simply appointed Dr. Berwick as Director of CMS. I believe President Obama made this recess appointment to avoid a Senate debate on his choice.

“Circumventing Senate confirmation to appoint the new Medicare chief is part of the same political willfulness that inflicted ObamaCare on the country despite the objections of most voters.”

Democrat Max Baucus, the Senate Finance Chairman, issued a statement critical of this end-around. Finally, an important Democratic Senator has reacted to President Obama’s usurping congressional power.

“Mr. Baucus hadn’t scheduled hearings because the nomination paperwork wasn’t even finished 11 weeks after Dr. Berwick was named.”

The obvious question is was the administration stalling to make the appointment without proper debate and vetting during the July 4^th recess?

President Obama claims that the Republicans were impeding the appointment "for political purposes."

It is obvious that President Obama wanted to avoid restarting the healthcare debate in an election season.

Dr. Berwick’s opinions agree with President Obama’s philosophy on healthcare reform. The direct appointment avoids reigniting the philosophical disagreements with Republicans.

Dr. Berwick’s philosophy is expressed in his 1996 book “New Rules” and in position papers of the Institute of Healthcare Improvement.

A primary function of health regulation is to “constrain decentralized, individual decision making and to weigh public welfare against the choices of private consumers.”

This sounds like socialized medicine to me. It sounds like a restriction of freedom of physicians to use clinical judgment and consumers freedom of choice.

He believes that "protocols, guidelines, and algorithms for care," with the common underlying notion that someone knows or can discover the ‘best way’ to carry out a task to reach a decision, and that improvement in medical care can come from standardizing processes and behaviors and demanding conformity.

It sounds like government control of the practice of medicine and patient choice. Sometimes there is not a single way to treat patients. Rationing should be determined by freedom of the individual to choose and not a central authority.

“In a now-notorious interview last year Dr. Berwick said, "The decision is not whether or not we will ration care—the decision is whether we will ration with our eyes open."

Since the federal government is running out of money, the bureaucracy will determine what is the best treatment at the cheapest price.

“Dr. Berwick personal view is the "public welfare" should have the power to trump the mere "choices of private consumers."

Dr. Berwick is also a believer in the value of the defective Dartmouth Atlas conclusions.

“Dr. Donald Berwick, nominated by President Obama to run Medicare, called it the most important research of its kind in the last quarter-century.”

Dr. Donald Berwick deserves a proper vetting because of the power he will wield. President Obama has pulled another t
rick play on the American public. He should not be permitted to get away with it.

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

Stanley Feld M.D.,FACP,MACE

Here we go again. On Friday June 11, 2010 at 4.30 pm internal administration documents were leaked. The documents reveal that up to 51% of employers may have to relinquish their current health care coverage because of ObamaCare. President Obama promised us that if we like our insurance we can keep. (See 3.46 minutes of the following You Tube.}

This is getting to be a habit with this administration.

Late in the afternoon on Fridays is a convenient time to leak information. No one will notice the information. The leaks’ impact will be old news by Monday morning.

The administration claims it did not know how it leaked. It is only a draft of the regulations created by Kathleen Sebalius Secretary of HHS. President Obama’s healthcare bill gives her the authority to write the regulations.

“The "midrange estimate is that 66% of small employer plans and 45% of large employer plans will relinquish their grandfathered status by the end of 2013," according to the document.

In the worst-case scenario, 69% of employers — 80% of smaller firms — would lose that status, exposing them to far more provisions under the new health law.”

The report was part of a joint project of the Departments of Health and Human Services, Labor and the IRS. The final report will be 118 pages. The report examined the effects ObamaCare’s regulations will have on existing, or "grandfathered," employer-based health care plans.

President Obama pledged it would have no effect on the healthcare insurance you have now. He did not say anything about modifications to present plans.

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This is another trick play by President Obama. The Republicans have been caught flatfooted once again. The healthcare reform bill allows President Obama and the Secretary of Health and Human Services to interpret broad provisions in the bill any way they want.

The President has said that a single party payer system works in other countries. It can work in America. His goal is to work his way toward a single party payer.

People have accused President Obama of wanting to eliminate private insurance. He said “we can keep our insurance if we like our present insurance.”

It turns out with these new regulations that we cannot keep our healthcare insurance plan if our employers modify the provisions in our plan. Americans will be forced to buy healthcare insurance from President Obama’s health insurance exchanges.

The health insurance exchange is supposed to provide affordable healthcare insurance. The healthcare insurance will be purchased with after-tax dollars.

The problem is cost controls will be regulated by the government. The program will fail to control costs just it has failed to control cost and improve service in Massachusetts.

President Obama has also said if something does not work we will adjust the system. Here comes the Public Option. However, the government and the states cannot afford to pay for healthcare insurance.

What are the conditions that eliminate your retaining your present healthcare insurance?

* The plan eliminates benefits related to diagnosis or treatment of a particular condition.

* The plan increases the percentage of a cost-sharing requirement (such as co-insurance) above the level at which it was on March 23, 2010.

* The plan increases the fixed amount of cost sharing such as deductibles or out-of-pocket limits by a total percentage measured from March 23, 2010, that is more than the sum of medical inflation plus 15 percentage points.

* The plan increases co-payments as a total percentage measured from March 23, 2010, that is more than the sum of medical inflation plus 15 percentage points or medical inflation plus $5.

* The employer’s share of the premium decreases more than 5 percentage points below what the share was on March 23, 2010.

The regulations are a done deal. Employers modify healthcare insurance plans every year. It is cheaper to pay a $2,000 per employee penalty than $15,000 a year per employee healthcare insurance premium.

“A White House official said, “This is a draft document, and we will be releasing the final regulation when it is complete. The president made a promise to the American people that if they liked their health care plan, they can keep it. The regulation, when finalized, will uphold that promise."

Jonathan Alter in his book “The Promise” which is about President Obama’s first year in office quotes him on healthcare. “President Obama said to a group of Single Party Payer advocates that “they had to deal with the world as it is and not wanted it to be.”

President Obama is dealing with the world as he is working his way toward how he wants it to be. A government controlled world.

The next step is a single party payer.

Consumers will not have freedom of choice or free access to care.

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

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform bill was rammed through congress over a month ago. He has been first to point out that the world has not fallen apart yet. He is being disingenuous since he healthcare reform plan does not influence medical care until 2014.

The strategy is to not do anything drastic until after he wins the November 2010 elections for the Democratic Party and the Presidential election in November 2012.

He is disregarding American’s anger toward him for ignoring their wishes. He is hoping they forget their anger.

The traditional media is helping America forget the tactics used to pass the healthcare reform bill. They are not evaluating the long term consequences on medical care and the budget deficit. It is not economically feasible to enlarge failed entitlement programs.

The public opposes the healthcare bill yet Wellpoint, who has been making billions of dollars a year, raises insurance premiums by 39%.

Immediately, President Obama, Harry Reid and Nancy Pelosi demonized the healthcare insurance industry. The choice given the public was to keep the present system along with healthcare insurance company abuse or adopt President Obama’s healthcare reform plan. The Republican Party did not present an alternative loud enough.

President Obama’s healthcare reform plan won the day by a partisan vote and a frustrated electorate. It led to Nancy Pelosi’s comment that Americans will understand the bill after it is passed.

The reality is the healthcare reform bill will lead to a single party payer system with increasing deficits, increased taxes and decreased access to care.

The healthcare insurance industry and Big Pharma are supporting President Obama’s healthcare reform plan because they will continue to control the healthcare dollars. Now the government will subsidize their business.

After passage of the healthcare reform plan, President Obama went on to his financial reform bill. There was much opposition to his plan. The plan does not go far enough to repair structural defects in the financial system. It also increases government control of the financial system without preventing abuse. Fannie Mae and Freddie Mac are not restructured.

In the midst of the financial system reform debate the Democrats started a congressional hearing on alleged abuses by Goldman Sachs. Congress has demonized Goldman Sachs. The public has another choice. America can either support President Obama’s financial reform or the old structure.

President Obama’s environment and energy bill was going nowhere. Cap and trade looked dead. President Obama agreed to permit offshore drilling for oil as a compromise.

The catastrophic oil spill occurred. The traditional media obsessed over the leak. In order to be a “good guy” President Obama announced that off shore drilling is too risky and discontinues his plan to let federal leases for off shore drilling.

We now have an environment and energy bill without off shore drilling. There is no consideration about this decision’s effect on a fragile economy.

The immigration bill is going nowhere also. It has large structural defects. The federal government is not enforcing laws that already exist. Arizona passed a law duplicating the federal laws. Arizona gets demonized by the White House and the traditional media.

President Obama has condemned Arizona. Arizona is only doing what the federal government should be doing. There is now public sympathy for President Obama’s defective immigration bill.

I suspect President Obama will use this opportunity to push through his immigration bill rather than do it right. Where are the Republicans?

President Obama wants illegal immigrants to be legalized citizens. He wants them to have the right to vote. His plan is to get enough new voters to neutralize the independent voter who have defected since he was elected President.

The pattern is clear. You demonize the opposition and then pass your alternative as if it is the only alternative. President Obama’s method has legs with the traditional media. Experts in each area will tell you most of this legislation will not solve any of our problems. It will be ineffective legislation. It will increase the federal deficit and lead to more taxation. It will decrease economic growth by decreasing incentives. It will increase government power over States and suppress individual freedoms. Many unintended negative consequences will occur after government has operational control.

I am afraid the public is growing weary of protest. They will forget the tricks used to produce terrible legislation. We will have many costly unintended consequences for many years to come.

The most frightening consequence is government control over our lives and freedom and a never ending need to raise taxes. It will suppress America innovative spirit.

President Obama is moving ahead with his healthcare pilot studies. In my view all of the approved pilot studies have little chance of success.

A potential pilot study with the biggest chance of success is not being considered. The five models to be studied are Accountable Care Organizations, Primary Care Medical Homes, Bundled Payments, Partial Capitation, and Full Capitation.

All five have problems. The chance of succeeding to reduce cost is marginal. The Ideal Medical Savings Account is ignored as an option. The MSA should be compared to each model tested. The Ideal Medical Savings Account model is the only model with a chance for success. The MSA is a consumer driven model. It puts patients in control of their healthcare dollars. It rewards consumer when they use their healthcare dollars wisely and maintain their health. It promotes self responsibility and self respect.

I will evaluate each model and point out the problems in each model.

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

Stanley Feld M.D.,FACP,MACE

President Obama’s goal might be for his healthcare reform plan to fail. Once it fails the default plan will be a public option with a single party payer system.

Everyone will be forced to opt into the public option. There will not be a private option.

The cost of healthcare will not decrease. The government will be paying the private healthcare insurance industry to administer the public option. Hospitals and physicians will figure out how to game the new system. The increasing costs will force a restriction to access to care.

President Obama must re-examine his premises. The medical care crisis is neither a Democratic nor Republican problem. It is an American problem. Americans need to be motivated to live a healthier existence. Only then will the cost of care diminish.

Consumers must be provided with education to live a healthier existence. The culture must be changed to emphasize better nuitrition and exercise.

Brad Feld pointed me to a fascinating paper by Carliss Y. Baldwin (Harvard) and (Brad’s mentor) Eric von Hippel (MIT). The paper suggests that some of the most basic theories on which the patent system is based are wrong. The thesis is our present patent system might hinder innovation.

The same logic can apply to the premises President Obama and his healthcare policy wonks apply to medical care. President Obama’s healthcare reform plan is punitive to both patients and physicians. It does not promote patient responsibility. It penalizes physicians for poor patient care outcomes.

Effective healthcare reform should promote patient responsibility and physician innovation. Inappropriate patient incentives and punitive regulations for physicians encourage patients and physicians to get around the healthcare reform system. President Obama’s healthcare reform plan does not achieve its goal of saving money and building efficient medical care systems.

A way to develop efficient medical care systems is through a consumer driven healthcare system with patients being in control of their healthcare dollars.

Nevertheless, President Obama’s healthcare plan is law. He won the election and forced through a partisan vote for a healthcare reform plan the overwhelming majority of the public and the physician community oppose. Only time will demonstrate the impending disaster in the healthcare system.

“Mindful that the new health care law’s ability to slow rising medical costs will depend to a great extent on how it is put in effect, President Obama is assembling a high-level team to carry out key elements of the overhaul and is considering moving faster than the law requires to put them into action. “

Kathleen Sebelius, the secretary of health and human services is reorganizing the Centers for Medicare and Medicaid Services. She is developing an innovation center whose goal is to test ways to reduce reimbursing providers.

She can enforce ideas she deems important nationwide without Congressional approval. The power of the secretary of health and human services has been expanded greatly without checks and balances.

She has started working on new regulations in an attempt control Medicare, Medicaid costs. She is also working on regulations to control independent private health care providers. President Obama wants an Independent Payment Advisory Board for controlling Medicare spending before 2014.

The problem with the Independent Payment Advisory Board is its total independence of congressional oversight. In the past Congress has ignored the Medicare Trustees’ recommendations to reduce costs. President Obama’s healthcare reform bill eliminates congressional oversight. Congress has not exercised its responsibility. However congress is accountable to the public and the Independent Payment Advisory Board is not.

The new board’s responsibilities will be in the hands of a 15 member board nominated by President Obama and confirmed by the Senate for the six-year term. The memberships will be full-time positions.

“Each year that Medicare spending exceeds annual targets, as most analysts expect it will, the board must propose ways to reduce payments to care providers.”

The Independent Payment Advisory Board provides Congress with an excellent opportunity to shirk its responsibility. The executive branch will have a firm grasp on control of the healthcare system.

“With the federal debt projected to rise to levels that many economists consider unsustainable, mainly due to growing health costs and an aging population, Congress might have little choice in coming years but to accede to unpopular limits on payments for doctors, hospitals and other health care providers of the kind that lawmakers have ignored in the past. The board would give them political cover to do so. “

“It’s a very promising structure,” said Peter R. Orszag, Mr. Obama’s budget director. “But like anything else in life, it’s what you make of it. So whether it realizes its potential depends on how it’s implemented.”

Tom Daschle, wants the board to be expanded to deal with not only Medicare but also all healthcare insurance.

“ Otherwise, he said, doctors will shift their costs that Medicare does not fully reimburse to patients with private insurance, “which really exacerbates the problem.”

Tom Daschle said it. It is all about the government takeover of the healthcare system. It is about government regulating the healthcare system at the expense of all the stakeholders including patients. It is not about healthcare reform to produce efficient and safe systems of care through patients influencing physicians to develop innovative systems of medical care.

When was the last time a government controlled system was efficient and cost effective? Government should make the rules and then get out of the way.

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

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.

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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

The Canadian Healthcare system does not offer us a better option. We are told Canadians are happy with their system. However, only 20% of the potential patients use the system at one time. When Canadians need Immediate care they often come to the U.S. and pay cash for their treatment rather than face the lines resulting from rationed care.

“*Canada has one-third fewer doctors per capita than the OECD average. "The doctor shortage is a direct result of government rationing, since provinces intervened to restrict class sizes in major Canadian medical schools in the 1990s," Dr. David Gratzer, a Canadian physician and Manhattan Institute scholar, told the U.S. House Ways & Means Committee on June 24.”

Many Canadian physicians have come to the United States to practice medicine in the last 20 years.

“ Some towns address the doctor dearth with lotteries in which citizens compete for rare medical appointments”.

Massachusetts’ universal healthcare system has failed. In Massachusetts there is an overwhelming shortage of Primary Care Physicians. Patients are trading or selling physician appointments in many small towns.

Canada has the same horror stories. Eighty percent of Canadians are not sick. They feel their healthcare system is fine.

There are many deficiencies in Canada’s single party payer system that are not advertised by politicians in the U.S. that want a single party payer.

"In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment," Pacific Research Institute president Sally Pipes, a Canadian native, wrote in the July 2 Investor’s Business Daily. "That’s 86 percent longer than the wait in 1993, when the [Fraser] Institute first started quantifying the problem."

* This includes a median 9.7-week wait for an MRI exam, 31.7 weeks to see a neurosurgeon, and 36.7 weeks – nearly nine months – to visit an orthopedic surgeon.”

These waiting times are rationing of care. Patients have sued the government and the Supreme Court ruled in favor of patients.

“ The Canadian supreme court justice Marie Deschamps wrote in her 2005 majority opinion in Chaoulli v. Quebec, "This case shows that delays in the public health care system are widespread, and that, in some cases, patients die as a result of waiting lists for public health care.”

The healthcare debate in the U.S. is not about improving the health of Americans. It is about shifting the control over the healthcare system to the government from the private sector.

If healthcare reform was about improving the health of Americans, our politicians would be focusing on how to decrease our mortality and morbidity rate due to the major chronic illnesses, how to decrease the abuse of the healthcare insurance industry, how to decrease the waste of defensive medicine, how to get people insured that are refused insurance with pre existing illness and how to give people incentives to keep themselves healthy.

These are the major issues. There is no need to have to take over the healthcare system. The government should make the rules, level the playing field in favor o the consumer, let the consumer drive healthcare and then get out of the way.

“The public option – for which Democrats lust – would fuel an elephantine $1.5 trillion overhaul of this life-and-death industry. Guess who goes home with the goodies?”

It is not the consumer. It will be the government bureaucracy, the healthcare insurance industry, and the pharmaceutical companies.

It will be the government having control over the public and its ability to choose its healthcare. It will increase government’s dominance over our lives and our freedoms.

Is this what Americans’ want?

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

Stanley Feld M.D.,FACP,MACE

The single party payer system in Great Britain and Canada is not as good as Democrats and the mass media have led us to believe. The United States pays more of our gross national product for its healthcare than Great Britain and Canada do but they do not get the same or better outcomes than we do.

The healthcare system in the U.S. could be repaired. The cost can be reduced significantly if the U.S adopted the changes I and others have advocated

The changes are significant malpractice reform, reduction in waste and abuse by the healthcare insurance industry, consumer driven healthcare through a medical savings account and the institution of a universal electronic medical record funded by the government and paid for by physicians and hospital systems by.usage

The sound bite of effective care given in Great Britain and Canada for less money is false. Here are just a few outcome comparisons between our healthcare system and theirs. You be the judge;.

• “Breast cancer kills 25 percent of its American victims; in Great Britain, the Vatican of single-payer medicine, breast cancer extinguishes 46 percent of its targets.”

Why? Early diagnosis with timely mammography and immediate and intensive treatment at the time of diagnosis.

“ Prostate cancer is fatal to 19 percent of its American patients. The National Center for Policy Analysis reports that it kills 57 percent of Britons it strikes.”

It is fatal in 19 percent of American males because of delayed diagnosis and treatment in some males. Males are not good about routine checkups. They go to the physician when they hurt. Some without insurance cannot afford to get a routine PSA screening test..

“ Organization for Economic Cooperation and Development data show that the U.K.’s 2005 heart-attack fatality rate was 19.5 percent higher than America’s. This may correspond to angioplasties, which were only 21.3 percent as common there as here.”

Why? The difference is caused by a delay in access to care.

“The U.K.’s National Institute of Health and Clinical Excellence (NICE) just announced plans to cut its 60,000 annual steroid injections for severe back-pain sufferers to just 3,000. This should save the government 33 million pounds (about $55 million). "The consequences of the NICE decision will be devastating for thousands of patients," Dr. Jonathan Richardson of Bradford Hospitals Trust told London’s Daily Telegraph. "It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

It is not very smart or efficient to restrict access to care to end up with patients being addicted to narcotics and/or needing surgery that will be delayed because of restrictions on access to care.

"Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets," Daniel Martin wrote last year in London’s Daily Mail. "Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour [party] pledge. The hold-ups mean ambulances are not available to answer fresh 911 calls. Doctors warned last night that the practice of ‘patient-stacking’ was putting patients’ health at risk."

Unintended consequences are usually the result of bureaucratic mandates. It is similar to the airlines leaving the gate to leave on time and then keeping us waiting on the tarmac for takeoff so that it looks good for on time takeoff statistics. It is not about service. It becomes about statistical targets to cover defects.

There are many more examples of defects in the National Health Service of Great Britain that we never hear about. The average person is not sick and does not complain about the healthcare system. Many are passive about the abuse they experience in the healthcare system.

President Obama’s healthcare team is going to create a Federal Healthcare Board similar to the NICE and have a panel of experts decide on best practices for Americans in order to improve our healthcare system.

When has a consensus committee ever improved anything? A consensus panel will eliminate individual freedom to make healthcare choices.

Is this what Americans’ want?

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