Stanley Feld M.D.,FACP,MACE

Both noise and facts drive decision making in all areas of policy making. The trick is to separate noise from facts. The devil is usually in the details. Americans have been conditioned to sound bites. We do not have the patience to understand the details and their ramifications.

Sound bites can be misinterpreted as being valid. The healthcare debate has made the public more interested in the details and the potential unintended consequences.

A typical example is the cost of care for Type 2 Diabetes Mellitus in Dallas compared to five Texas cities. The claims data is probably noise disguised as valid facts.

The public has become very cynical about the traditional media. Reporters can easily be manipulated by government and special interest groups’ press releases. Policy should be made for the benefit of the people. It should not be made for the benefit of special interest groups or the government.

The public mistrusts the government because of its discoveries of frequent disinformation fed to the media. This disinformation extends to all areas of its daily life including the two wars, the economic meltdown, the bank bailout, and automotive bailouts. All seem to be done at the expense of taxpayers and not to taxpayers’ advantage.

What doesn’t the public know about the healthcare debate? The public does not believe President Obama’s generalities. His plans contain too much bureaucracy, inefficiency, waste, taxes, and too much tax payer dollars. Special interests groups such as the healthcare insurance industry and hospital system will gain at the expense of the taxpayers and their freedoms.

The public is very hesitant to let the government take over the management of its healthcare. It mistrusts the government and its inefficiency. It knows something must be done to repair the healthcare system. However, it does not know what. President Obama’s plan sounds too convoluted, tricky and bureaucratic. His healthcare reform plan has little chance to be efficient and fair to the public.

Americans trusted President Obama during the election campaign. They are having their doubts now especially with the implications of his healthcare reform program.

The public trusts the healthcare insurance industry less than it trusts the government. .

The easiest way to accomplish healthcare reform is to allow consumers to control their healthcare dollar and teach them how to spend it wisely.

Both the public and the physician community are unhappy that 45 million people are uninsured and many more are under insured.

Qualifications for Medicaid depend on the definition of poverty. Most states and the federal government utilize the outdated 1995 definition of poverty. The definition disqualifies people who make more than $12,000 and less than $60,000 a year. If this group is self employed they cannot afford $14,000 a year for a private insurance plan with after tax dollars.

Some states have tried to increase the poverty level to permit more patients to qualify for Medicaid. The federal government has refused to supplement these states with increase Medicaid funding.

Physicians are under reimbursed by Medicaid. Therefore most physicians do not participate in the program. Physicians cannot make a living seeing Medicaid patients unless they create Medicaid mills and see 200 patients a day per physician using lots of patient extenders.

Newt Gingrich calls this Medicaid fraud. He has proposed fining these physicians or putting them in jail. This will only intensify the primary care physician shortage for Medicaid.

Another proposal hidden in the Baucus bill is to require all physicians to participate in all government programs.

Both of these Medicaid problems are easily fixed with correct regulation by the government without a costly bureaucracy resulting in unintended consequences..

Consumers who lose their jobs cannot afford Cobra insurance with after tax dollars. Consumers over 55 years old with a pre-existing illness, even if they wanted to pay with after tax dollars, would not qualify for private insurance.

Simple federal regulations can require insurability without a massive and wasteful bureaucracy.

The enemy is the healthcare insurance industry not patients or physicians. Patients and physicians are partly to blame. However, it is a response to the unlevel playing field created by the government.

The public is convinced that a government directed healthcare system will not protect or adequately insure them. Government healthcare reform will be inefficient. It will shift medical decisions away from patients and physicians.

President Obama does not seem to care about the opinions of the people who elected him. He is convinced that government control with a single party payer is the only system that will repair the healthcare system. He is doing everything he can to evolve the healthcare system into a single party payer system.

“The fact that America is even considering government medicine is equally wacky. The state guides health care for our two closest allies: Great Britain and Canada. Like us, these are prosperous, industrial, Anglophone democracies. Nevertheless, compared to America, they suffer higher death rates for diseases, their patients experience severe pain, and they ration medical services.”

The government and the pundits are telling us that we spend one third more for healthcare than other industrialized countries and do not have better medical outcomes.

I will discuss the myths about healthcare in the near future. President Obama and the Democrats are making healthcare reform decisions on the basis of the validity of these myths. They are convinced the only way to fix the healthcare system is to have the government control the healthcare system.

It makes no sense based on the experiences of others. We need only to review the disaster in Massachusetts as a result of unintended consequences.

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

Stanley Feld M.D.,FACP,MACE

President Obama’s speech on healthcare reform to a joint session of congress added nothing new to the healthcare reform debate.. It was just spun differently.

He did give a tepid nod to tort reform. Defensive medicine results from a defective tort system. The defective tort system generates between $300 and $700 billion dollars a year in excessive diagnostic testing. Lawyers and insurance companies make large sums of money from the malpractice system. The tort system adds little value to the health of citizens.

President Obama said he will set up a few demonstration projects. Government demonstration projects have not worked in the past. His tort reform projects are too few and will have little effect. Everyone knows the problem as well as the solution. Our healthcare system needs significant tort reform immediately. The President is protecting the plaintiff attorneys because he doesn’t want to take them on. They have been large contributors to Democratic Party member election campaigns.

President Obama said the “Public Option” is the best way to control costs. However, he will not have a Public Option if he gets a bill passed. He is going to try to sneak a single party payer system through the back door as Barney Frank has stated.

The President said no one will have to spend more than $5,000.00 a year in out of pocket expenses.

Who is going to pick up the costs after consumers spend $5,000.00? I assume the government will. Consumers have to buy government mandated and approved healthcare plans.

Consumers will have to pay for policies that have a 40% deductible with after tax dollars as opposed to the 20% deductible with pre-tax dollars. The Obama administration has been convinced by the healthcare insurance industry that it needs the increase in deductible percentage in order to produce a lower “affordable” premium.

Consumers, by paying with after tax dollars, will be paying 35% more for their healthcare policies and 20% more in deductibles expenses. If the tax rate goes up to 40% they will pay 40% more for both. This is a hidden increase in consumers’ taxes and a government increase in revenue.

The big winner is the healthcare insurance industry, not consumers. The healthcare insurance industry will have a greater number of people insured on its roles because of a presidential mandate that he had promised to avoid.

President Obama said he will subsidize businesses and individuals who cannot afford healthcare insurance.

Who is going to make that judgment? The government will make that judgment. He asks us to stop being skeptical and trust his administration. He will take care of consumers in the spirit that made our country great.

President Obama, how can we trust your administration with our healthcare needs when we have had experience with so much false hope from your administration in the last 8 months?

He is leaving the control of the healthcare dollars in the healthcare insurance industry’s hands. The healthcare insurance industry provides administrative services. Can we trust the healthcare insurance industry to be fair and look out for the well being of consumers? No!!

President Obama said there are almost 400 insurance companies in the nation. He claims his plan will force them to be competitive. There are only five major healthcare insurance companies (Unitedhealthcare, Aetna Blue Cross/Blue Shield, Cigna, and Humana). Most of the other healthcare insurance companies are subsidiaries of those five major companies.

There will be no competition. The administration says a “Public Option” is the only effective way to lower the costs of healthcare. It will make healthcare insurance companies compete. However the insurance industry will define the costs and the price of the government’s public option. It has done so for Medicare Part D at the expense of taxpayers and it will do it again.

Medicare Part D is another failed government entitlement whose monthly premium has gone from $14 to $37 in three years. The patient deductibles have increase and the onerous donut still exists.

In addition to increasing the premium price the government subsidizes Medicare Part D with of billions of dollars a year. I predict the premiums for the “Public Option” will slowly escalate at tax payers’ expense.

The only creative way to break this healthcare insurance industry stranglehold is to institute a system with Medical Savings Accounts. The government or employers, as providers, should give consumers first $6,000 for their healthcare needs and teach them how to spend it wisely. What consumers do not spend they keep. The second $6,000 would be used to buy high deductible first dollar healthcare coverage.

This is the only way to reduce the healthcare insurance industry’s influence and grasp on healthcare spending. Medical Savings Accounts will provide consumers with incentives to use their healthcare dollar wisely. It will also provide incentives for patients to comply with medication and treatment prescribed. America might even make serious progress combating our obesity epidemic.

Stanley Feld M.D.,FACP,MACE

Politicians and healthcare policy makers have not included consumer driven healthcare in the healthcare reform debate. They have not included tort reform in the debate either.

The debate is about a public option. President Obama is going to redefine his meaning of the public option in his message to congress. He will make it sound benign. It will not sound like a government takeover of healthcare. He will omit the details and consequences of the bill.

President Obama must know the government cannot afford a public option. He knows he must control costs somehow. His policy makers believe the only way to control cost is by total government control over the healthcare system. Ultimately the goal is a single party payer system.

This way of thinking about the problem is wrong. Government control does not reduce costs in most projects. It usually increases costs. The President is focused on reducing physicians’ and hospitals’ reimbursement. He believes they are the reason for increasing costs. Medicare has continually decreased reimbursement to physicians and hospitals. Yet costs have increased.

To some extent decreased reimbursement leads to increased utilization but it is not the principle reason for the increase in utilization. A principle reason is an increase in the need to practice defensive medicine. Plaintiff attorneys deny it. The Massachusetts study confirms that defensive medicine leads to a large increase in utilization and costs.

Physicians are an easy target because they are not well organized. The Democrat controlled government is timid about attacking the plaintiff attorneys and tackling tort reform. Defensive medicine results in about a $700 billion dollar a year cost to the healthcare system. 

Howard Dean said it a few weeks ago. “Congress will not face the issue of tort reform because it does not want to take on plaintiff attorneys.” Consumers can solve this for congress by signing a valid limited liability waiver. Patients can put their own cap on damages. It would not require any courage on the part of congress or the President to face this difficult political issue. All congress and the President have to do is declare the waiver valid.

Texas and California have had the courage to place caps on damages. It has been very successful. If there were caps on damages and they were effective the need for defensive medicine practices would decrease.

The public does not trust congress or the President with control over its healthcare coverage. The public experience with unintended consequences of government control is obvious to all.

Recent examples are the unintended consequences of the bank bailouts, Goldman Sachs bailout, the economic stimulus package promise, the auto bailout, and the war in Afghanistan. All these bailouts are increasing the deficit at the expense of the taxpayers and future generations.

The public mistrusts the healthcare insurance industry as much as it mistrusts the government to control healthcare. The healthcare insurance industry has restricted access to care and rationed care. It has not reimbursed physicians and hospitals in a timely fashion. It has found it is cheaper to pay the negotiated settlement rather the medical bills for its insured.

Nancy Pelosi is right about one thing and only one thing. The real villain is the healthcare insurance industry. However, she does not understand with a public option she is not controlling the healthcare insurance industry fees for administrative services. The government outsources administrative services to the healthcare industry and will still be subject to grotesque administrative services fees.

The healthcare insurance industry has lobbied to change the law to increase co pays to 35-40% of bills so it can lower premiums to affordable levels. Increasing deductibles and lowering premiums would satisfy President Obama’s goal of affordable premiums. At the same time, it will increase the out of pocket cost of medical care for consumers who might need to use their “affordable healthcare insurance.”

The healthcare insurance industry will be forced to offer insurance to consumers with preexisting illness at an affordable cost. Some states have a high risk pool. The premiums in the high risk pools are at least 11/2 times higher than normal premiums and have higher deductibles. High risk patients must be put into the general insurance pool.

There has not been a word in the healthcare reform discussion about patient responsibility for their health. We are in the middle of the worst Obesity epidemic in American history. President Obama should declare a War on Obesity. He should promote legislation that could help eradicate obesity. He should provide patients with financial incentives to eliminate obesity and adhere to prescribed therapy. Obesity is a leading driver of increasing healthcare costs. The costs will only become grater as the obesity epidemic continues.

It is time consumers took control of their own health care dollars and their own health and well being. The defensive medicine/tort reform issue can be solved by consumers. Obesity can be solved with the government rewriting farm subsidies and a substantial public service health campaign to change our eating habits.

A consumer driven healthcare system along with the ideal medical savings accounts could solve many of the healthcare system’s problems without total government control. The government’s job should be to help with educating the public, negotiating prices that are transparent and fair and enforcing regulations to create a level playing field for consumers among the other stakeholders.

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

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stanley Feld M.D.,FACP,MACE

In response to my last post I received this note.

“Stan

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

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

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

What is missing?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A few economic self evident truths are:

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

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

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

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

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

Stanley Feld M.D.,FACP,MACE

The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare.

“Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi schemes? The new Obama-Democrat budget deficit is $1.8 trillion, four times larger than it was only last year. The national public debt has increased by more than 10 percent since Inauguration Day.”

Social Security and Medicare are underfunded entitlement programs. Medicare for the entire country is not viable.

These are the published numbers for 2008.

• Social Security’s unfunded liabilities stood at $13.6 trillion.
• Medicare’s unfunded liabilities are more than $30 trillion.
• Medicaid, another severely underfunded and politically untouchable entitlement program, only adds to the total.
• The federal government’s current entitlement bill, including future obligations-based only on promises it has made in the past — is greater than $57 trillion.”

The first Baby Boomers started drawing early retirement benefits from Social Security last year.”

78 million people are going to stop working, stop paying taxes, stop paying into retirement programs and start drawing Social Security and Medicare benefits. The federal government has made explicit and implicit promises to millions of retiring citizens. It does not have the funds to keep those promises without a big hike in taxes.

“According to a recent forecast by the Congressional Budget Office shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century”

In order to get close to funding our current obligations it is estimated that the income tax rate will have to increase to 66%. With all the bailouts and economic stimulus packages the federal government’s debt can only get worse.

Yet the game of who can have better sound bites and who can win is the only thing that is important to President Obama, the healthcare insurance industry, and the Democratic congress.

Healthcare reform should not be about a National Healthcare Insurance Exchange or universal healthcare with a single party payer. This is not going to fix the healthcare system. It will make our financial problems worse. Our government officials should face reality. It should do what all physicians know needs to be done.

It should be passing legislation to create a less polluted environment. It should revise the Farm Bill. It should eliminate the use of corn syrup. It should fight obesity with public service educational campaigns. It should create an insurance product that provides consumers with financial incentives to stay healthy. It should eliminate the causes of administrative waste and defensive medicine. These should be the areas of discussion in order to repair the healthcare system. These bold topics threaten powerful vested interests and are politically explosive.

America should set up a healthcare insurance system that provides incentives consumers to demand better foodstuff and a healthier environment. Consumers should own their healthcare dollars and be able to save what they do not use. (ideal medical savings account).

The federal government should make the conversion to functional electronic medical records easier and less costly to physicians (ideal electronic medical record). We should have major tort reform to decrease the intolerable cost of defensive medical.

These are areas in which the healthcare reform debate should be focused. If the Republican Party wants to seize the initiative from the Democratic Party and excite the citizens of our country they need to act .

Instead, we have a silly debate pitting the new media (Democratic Party) against the old media (Republican Party) over systems we cannot afford. The new media will win. Americans lose no matter which side wins.

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