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
Never the less, President Obama’s healthcare team is modeling his universal healthcare plan after the Massachusetts plan. It is possible the President’s healthcare team knows this plan will fail. They will then conclude the only remaining option will be a single party payer system run by the government.
However, the government presently outsources Medicare’s administrative services to the healthcare insurance industry. The healthcare insurance industry controls the healthcare dollars and therefore controls the costs and the coverage. A single party payer system will also fail just as Medicare is failing unless the structure of the Medicare system is changed.
The solution is to change the control of the healthcare dollar from the healthcare insurance industry to the consumer.
In the meantime President Obama’s healthcare team will destroy the healthcare system piece by piece.
“The $28 billion spending plan also freezes Medicaid reimbursement rates for doctors and hospitals who care for poor patients, after steep cuts made in October.”
Massachusetts’ physicians seem to be the most tolerant physicians in the nation. They tolerate continued reimbursement freezes and cuts even though their overhead rises but they are losing their tolerance rapidly.
"We have a state that has been visionary in pioneering health reform and universal coverage," said Dr. Bruce Auerbach, president of the Massachusetts Medical Society and head of emergency care at Sturdy Memorial Hospital in Attleboro. "Anything we do that reduces the ability of physicians to care for Medicaid patients is going to negatively impact our pursuit of true healthcare reform."
You bet it will. Politicians will conclude, as they have in California, is the only way to pull this out of the ditch is to increase taxes. They do not realize that if they increase taxes they could drive business out of the state. The result would ultimately be the reduction of state tax revenue.
The governor’s tax proposal also touched on public health: He is seeking new levies on alcohol, candy, and sweetened beverages among other increases in taxes.
This tax idea is not a bad idea. It could encourage lifestyle change and even decrease obesity and alcoholism. The result could be to decrease chronic disease and its complications thereby decreasing healthcare costs.
According to administration estimates, those new tariffs would generate $121.5 million for public health initiatives, if the Legislature goes along with them.
In order to save face the mandated universal healthcare plan was not cut except for one critical element. Eliminating a program that helps the insured enroll will generate more uninsured citizens as unemployment rises during this recession.
“The state’s closely observed health insurance initiative, which requires most adults to have coverage, emerged largely, but not entirely, untouched in the budget blueprint. A program that helps the uninsured enroll for health coverage was eliminated, just as thousands of Bay State residents are losing their jobs.”
This is occurring after the federal government has provided Massachusetts with 8 billion dollars in state bailout money. Someday a healthcare plan that aligns all the stakeholder incentives and solves the problem of the complications of chronic disease will be proposed by a governmental body. It would help to ask patients and practicing physicians what they think the solution is. That day does not seem to be on the horizon.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Stanley Feld M.D.,FACP,MACE
https://apps.who.int/iris/bitstream/handle/10665/327538/18176127-eng.pdf?sequence=1&isAllowed=y
The healthcare system is not rosy for the people in Finland. It has been getting worse since March 2019 despite the New York Times’ glorification of it nine months later in December 2019.
Bernie Sanders continually ignores Finland’s healthcare system’s reality as he tries to convince people that “Medicare for All” will fix our health care system.
Finland’s healthcare system’s problems are multiple. Finland’s government collapsed due its massive socialized medicine program even though the healthcare system is not completely free.
Finland has struggled to keep its promises to its people.
What are the principle reasons for the failure? `
Governments cannot provide quality healthcare to the masses in a fiscally sustainable way. Period.
In March, just after Juha Sipila’s Finish government resigned, the governor of the Bank of Finland, Ollie Rehn, warned that reform remained urgent “from the point of view of fiscal sustainability.”
The Finish population is aging, and birth rates are falling. The number of taxpayers paying into the system is decreasing. The overall population is living longer. All three reasons are putting a greater strain on medical resources.
In 2018, the average single Finn faced a net average tax rate of 30%. With President Trump’s tax cut the average U.S. rate is 23.8%. If a U.S.tax payer is earning $250,000 a year or more in the U.S. there is an additional 3.8% supplemental Medicare tax increase despite President Trump’s tax cut from 38% to 23.8%. Our Medicare and Medicaid programs are unsustainable and presently require more tax revenue or severe service cuts.
“Finns are having less and less children. People are getting older. So we need more people here because we need taxpayers,” says Juha Tuominen, the CEO of the largest hospital in Finland, which provides one in four Finns with specialized care.”
The solutions are to have more tax-paying people, increase the tax rate on tax-paying workers or cut services. With the government being in control it could try to do all three. Bernie Sanders’ $60 baby is a pipe dream.
In Finland, there have to be effective reforms. Right now, the system is unequal. The poor and people who live in remote areas are not being served.
Bernie, Elizbeth Warren, and the U.S. traditional media are glorifying the Finish system for unsuspecting Americans.
“People outside of Finland tend to see only the good sides of the system,” says Hiilamo.
“Normally, we show people the sunny side of the street, but there is a dark side of the street. And health care is on the dark side, and for many years we have had a problem.”
Long wait times are one of the most predictable consequences of anything that is government-run, including health care.
In addition to long wait times, the government’s efforts to cut costs and be more efficient have resulted in ill people, including at emergency care facilities, not getting to see a physician until they can “justify” the need to see a physician to a nurse.
A Finnish patient gave the newspaper The Guardian this case history.
“Imagine going to your nearest doctors’ office at 9 am on a weekday with your sick six-year-old daughter because you cannot make an appointment over the phone.
After your drive to the doctor’s office in another part of the city, you can’t simply book a time with the receptionist. There isn’t one.
Instead, you must 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.
By 10.45 a.m., 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 see, you are not even waiting to see a GP. You’re waiting to see a nurse in order to justify to her how quickly your child needs to see a GP or whether she needs to see one at all.
At 11.30, you give up and take your daughter to see a private doctor as well, forking out £50 for the privilege.
This isn’t some nightmare vision of the NHS after 10 years of Tory cuts. This happened to me recently in a country I have moved to from Britain that is normally lauded as the shining example of a successful welfare state.”
Finland has one of the worst health services in Europe according to The Guardian. Its health service has been in a perilous state for decades and it is getting worse. Nothing has been done since its government collapsed in March 2019.
Bernie is leading America down the garden path with a misrepresentation.
http://www.oecd.org/els/health-systems/Country-Note-FINLAND-OECD-Health-Statistics-2015.pdf
A publicly run and funded health care system — known as “Medicare for All” — is now the senator’s big ideas!
Doctors and patients who can leave Finland’s centralized health care system are doing so in droves. Only the well off can afford to buy healthcare insurance.
According to [Samuli] Saarni, the President of the Finnish Medical Association, the number of doctors has not increased on a par with the larger workload – for example, in the last 15 years 4,200 new doctors have entered the workforce but only 330 of them have gone to work in healthcare centres.
Doctors are now responsible for extra paperwork, including renewing electronic prescriptions. These time-consuming tasks take away from the time they can spend with patients.
“The current set-up doesn’t support doctors spending as much time as possible with patients,” Saarni told HS.
The shortage of physicians and extra scut work has resulted in long waiting times for medical appointments. Over 1.1 million of the 5 million people living in Finland have now opted for private medical insurance.
Every second child born has private medical insurance. Only fifty percent of child deliveries are done by the health service.
Despite this, the public healthcare sector is still under great strain.
Public healthcare centres have lost experienced physicians to the private sector.
The public sector physicians’ patient loads have resulted in an increasing percentage of physician burnout by young doctors at healthcare centres according to Dr. Saarni.
Minister of Family Affairs and Social Services Krista Kiuru announced on Tuesday that each and every citizen should be guaranteed a doctor’s appointment within seven days of asking for one. This is easier said than done.
Tampere’s Daily Aamulehti reported that the challenge is great. In the city’s municipal clinic at Hatanpää, patients waited for an appointment for a median of 42 days.
The Tammela health centre reported average waiting periods of 11 days, while private Mehiläinen clinics in the city saw patients in just two days.
“The situation simply cannot continue,” Kiuru said.
The Finnish government is pouring more of its taxpayers’ money into the flailing system, but it’s not clear that throwing money at the myriad problems is the answer.
Finland is planning to plow some 200 million euros into municipal healthcare services in the next four years to try to reduce waiting times for non-urgent appointments.
In 2020, an initial 70 million euros will be available as part of the new government’s drive for reform of health and social care reform, as stated by the Minister of Family Affairs and Social Services Krista Kiuru.
Long waiting times, few physicians, ill-equipped and poorly maintained hospitals, and a long list of other failures have resulted in broad discontent with the extremely expensive Finnish healthcare system.
All socialistic healthcare systems are constructed incorrectly. A viable healthcare system can be constructed so that consumers are responsible for their care and not the government.
There are no government-run healthcare systems that are viable anywhere on the planet. Norway is the only country whose free healthcare system is surviving in. It survives only through the massive infusions of cash from an oil-rich government.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Copywrite 2006-2020
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Stanley Feld M.D.,FACP,MACE
The EMR project that President Obama forced on the medical profession in 2009 has not yet produced any evidence that EMR will save the country $350 billion in inpatient care and $150 billion dollars in outpatient care over a 15 year period of time.
The RAND EMR study was wrong. The study sounded good to President Obama because he thought EMRs would enable the federal government to control medical and surgical practices in America.
Unfortunately, data from three other studies, a cardiology group, a Harvard group and Canadian group showed there is no savings difference between paper records and electronic records.
The project has been a $38 billion dollar failure. I predicted the EMR project would fail in 2011. EMRs are a great idea. The EMR projects goals were wrong.
Wall Street Journal article in 2012 stated, “The electronic medical record (EMR) is touted as the key to containing costs, reducing errors, improving quality, and simplifying administration: an “elegant exercise in wishful thinking.
The RAND Corporation study was paid for by all the vested interests stakeholders involved in medical care except physicians and patients.
Allscripts Healthcare Solutions, the Cerner Corporation and Epic Systems of Verona, Wis. are the major EMR software companies who paid for the study.
GE and the healthcare insurance industry were also major funders of the RAND Study. The Obama administration funded the implementation of the EMR project to the detriment of the healthcare system.
The healthcare system has not contained costs, reduced errors, improved quality or simplified administration. Each category has gotten worse.
I do not think the Obama administration’s primary interest was to fix the existing healthcare system. If the EMR project hobbled the healthcare system, the population would beg the government to completely take over institute his “Public Option” and subsequently “Medicare for All.” There was no consideration of the fact that that Medicare and Medicaid are unsustainable.
The complete control of the VA Healthcare System has not worked out very well for the government. One important reason for the VA Healthcare System’s failure is the bloated government bureaucracy. Effective medical care takes instantaneous judgement and rapid execution. Government regulations inhibit the process leading to long waiting times and ineffective and costly treatment.
Medicare and Medicaid costs have been unsustainable and are getting worse. Why would a politician think complete government control over 20% of the GDP, the healthcare system, would be any better than a free market system where patients would take responsibility for their healthcare and healthcare dollars?
The government could provide the dollars to the needy with financial incentives attached for all in the system.
Ideal EMR should be for the benefit of physicians and their patients. The EMR should not be only for the financial benefit of healthcare insurance companies, the government, the pharmacy benefit managers and the software companies.
The EMR project places the secondary stakeholder in the position to judge physicians’ behavior and subsequently penalize them if they do not comply with government regulations and expected results.
The EMR should be a tool to continually educate physicians to help them become better. It should educate patients so they can become professors of their disease and help them avoid the complications of their chronic diseases.
The EMR should not be a tool used by secondary stakeholders to penalize physicians and patients. This will not decrease the ever-increasing cost of healthcare.
At the moment EMRs are relatively useless. A lot of money has been spent by all the stakeholders with very limited benefit. There have been hundreds of examples published by all stakeholders about the defects in the present EMRs that do not allow for an increase in the quality of care and a decrease in the cost of care.
My ideal EMR along with my ideal medical saving accounts can go a long way toward repairing the healthcare system. http://stanfeld.com/is_an_ideal_ele/
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Copywrite 2006-2019
Please have a friend subscribe
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Copywrite 2006-2018
Please have a friend subscribe
Stanley Feld M.D.,FACP,MACE
Last year the Great British single party payer system, The National Health Service, backfired.
It occurred just at the time Americans were being suckered into instituting a single party payer system by its progressive politicians..
Winston Churchill was right when he said,“You can always count on Americans to do the right thing—after they’ve tried everything else.”
I hope some of our leaders are listening.
Dr. Don Berwick touted Britain’s National Health Serviceas the America’s ultimate healthcare role model.
Dr. Berwick had some good ideas and many very bad ideas.
President Obama had other ideas. His ideas were not about repairing the healthcare system. His goal for healthcare reform was having the federal government control the entire healthcare system.
President Obama and Dr. Berwick portrayed physicians and patients as the villains in healthcare dysfunction. It is easy to blame the physicians and the patients because both have some blame in the dysfunction.
In 2009 the new British coalition government declared the National Health Service a fiscal failure.
After 62 years, the British government’s present goal is to decentralize its healthcare system. The goal does not include decentralizing medical decision making. The system continues to put restraints on consumers’ medical spending. The government believes consumers are not smart enough to make their own medical decisions.
Baroness Hale had previously written the following for the British High Court, the U.K.’s equivalent of the U.S. Supreme Court:
“Decision-makers must look at [the patient’s] welfare … the nature of the medical treatment in question, … they [decision makers] must try and put themselves in the place of the individual patient.”
“The patient is not the decision-maker.”
The British Healthcare Service has an organization called NICE. Nice is a perfect bureaucratic name for “the National Institute for Clinical Excellence.” NICE sounds nice. Its function is not very nice.
According to the NHS Constitution, “You have the right to drugs and treatments that have been recommended by NICE.”The National Institute for Clinical Excellence is an agency that “advises” the government whether to authorize payments or withhold them for treatments deemed “not cost effective.”
Britain’s National Health Servicehas continually changed over the 62 years. Various British administrations have searched for the formula to deliver high quality care at an affordable price.
Unfortunately,Britain is making another complicated mistake.
The United States is making the same mistake as it marches toward a single party payer system. The mistake is the lack of respect for the intelligence and will of consumers. The mistake is not permitting consumers to be financially and emotionally responsible for their own medical care decisions.
The British incident is chilling. The British High Court recently ruled against parents’ wishes in defense of the National Health Services.
The high court’s decision is the result of British consumers giving total control of the healthcare system to its central government.
The British government believes that the people are not smart enough or responsible enough to figure out how to take care of themselves.
The British thinking is not dissimilar to the thinking of the Obama administration and Dr. Donald Berwick.
The basic conflict is over who is ultimately in charge of medical decision making. Government control of medical decision making is not limited to Great Britain’s single-payer structure.
In all government run health-care systems, whether in Australia, Canada, or even here in the United States under Obamacare, government increasingly makes final medical decisions, not patients in consultation with their doctors.
NICE is an agency that “advises” the government whether to authorize payments or withhold them for treatments deemed “not cost effective.”
“Consumers have the right to do what they or their doctor thinks best medically as long as your decision does not override the decision NICE decides is cost effective for the government.”
What is missing from the British system?
All government has to do is make the right rules, empower consumers with their own money, level the playing field among stakeholders and get out of the way.
Americans did not fully understand two recent single party payer events that occurred in Britain. This was partly because the American media did not cover the story’s significance adequately.
Perhaps the American media did not understand the story’s significance to the American debate in reference to a single party payer healthcare system.
“ First Charlie Gard and now Alfie Evans. These are two 23 month old babies who, though verbally silent, still gave clarion warnings to proponents of single-payer health care: The government — not my parents — is in charge of my life.”
Charlie Gard was born in August 2015 with a rare genetic disorder that carried a poor long-term prognosis.
“In July 2017, little Charlie was just 23 months of age and on a ventilator. Over the objections of his parents, British doctors decided to withdraw life-sustaining care.”
“According to British Courts, the National Health Service (NHS), the country’s single-payer system, is the ultimate medical decision maker — not the family. Ventilator support was withdrawn and Charlie died.”
Less than a year later another 23 month old child hit the British headlines. Alfie Evans was a comatose child whose NHS doctors said his condition was hopeless. His physicians felt he could not survive without ventilating life support. They wanted to terminate his life support.
His parents wanted to transfer their child to Rome’s Bambino Gesu Pediatric Hospital for further care. The Italian Hospital was willing to take him.
The British High Court ruled against the parents’ wishes, leaving Alfie’s fate to the NHS. As Justice-Baroness Hale wrote in Aintree v James: “we [referring to patients] cannot always have what we want.” On April 28, 2018,Alfie’s ventilatory support withdrawn.
Alfie did not die when artifical ventilation was withdrawn. He died because of inadaquate I.V. nutrition.He was able to breath on his own. His physicians were wrong.
NICE is the model on which the Independent Payment Advisory Board (IPAB) was created under the Affordable Care Act.The Independent Payment Advisory Board, or IPAB, was to be a fifteen member agency which was to have the explicit task of achieving specified savings in Medicare without affecting coverage or quality. The system creating IPAB granted IPAB the authority to make changes to the Medicare program with the Congress being given the power to overrule the agency’s decisions through supermajority vote.
The Bipartisan Budget Act of 2018repealed IPAB before it could take effect.[1
In my opinion it should not be the government or the court that decides about who should live or die. It should be the patient or the patient’s family who decides with the advice of the patient’s physicians and clergy.
The institution the patient is being cared in should not be responsible for the bill.
Consider the question “who’s in charge?” from two perspectives: that of the American public and that of physicians.
Americans prize their freedom above all else. When the government makes medical decisions against the patient’s wishes, it directly infringes on personal freedom. It is doubtful that Americans would support a single-payer system if they understood what they have to give up in exchange for the promise of government supplied health care. Americans would be giving up freedom of choice.
http://stanfeld.com/?s=single+party+payer+system
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
Stanley Feld M.D., FACP,MACE
Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.
Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.
The economics of these single party payer systems are seldom discussed in a coherent way. Americans have no idea of the economic burden a single party payer system places on the budget of countries that have such a system.
The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.
In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.
The Canadian healthcare system is unsustainable.
“Canada spends 50% of its GNP on healthcare. All of the provinces are experiencing massive deficits due to additional healthcare costs.”
“Canadians who are healthy and do not need to interact with the system are happy and feel secure that their healthcare needs will be serviced without cost. Nothing is free.”
“The United States consumes only 18.5% of our GDP on healthcare. This percentage is rising as access to care is decreasing.”
The Frazer Reportis very specific on the cost of healthcare in Canada although the government is not very transparent.
Each province is having a difficult time figuring out how to fix its healthcare system. Many Canadians are convinced that a single party payer system is not the answer but cannot politically eliminate it.
The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time. People who are not sick think the single party payer system in great. They are happy they have no anxiety about the cost of healthcare if they get sick.
In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.
The private healthcare market is flourishing in Britain for those who can afford it.
The British healthcare system is unsustainable. The British government has not been able to fix the expensive National Health Service.
America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.
Seniors love Medicare. Most seniors could not afford to get medical treatment if there was not the Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. Most economist agree, as a result of Medicare, the cost of healthcare in America has continued to increase yearly for all Americans.
Congress has ignored the basic defects in the Medicare system that has caused this explosion. Over the years a few brave congressmen have made attempts to correct these structural defects.
The Democrat and Republican establishment have ignored these congressmen.
The political establishment has made feeble attempts to control costs through ineffective regulations. The bureaucracy has grown and the healthcare system has become more costly and inefficient.
The reduction in reimbursement to physicians has resulted in the tremendous increase in concierge medicine. This explosion in concierge medicine has decreased access to medical care in many cities in the U.S.
The result is an increase in cost and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers. The government has imposed more control over the individual’s ability to make his or her own healthcare decisions.
Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.
President Obama’s law (Obamacare) increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from government investigations and penalties in the long run.
The VA system is the purest example of sheer failure. Not only are the patients unhappy but also the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.
The inefficiency, corruption and waste have not been able to be fixed by many notable private sector executives the government has hired to fix it. They have all ultimately resigned or were fired.
The VA system’s single party payer system remains an incurable failure.
These examples are proof that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.
Are these mistakes intentional? Perhaps.
The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.
What is happening now?
The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.
The article, “Back to the Health Policy Drawing Board” may be intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.
After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exist. The New York Times article is promoting Medicare for all.
Medicare currently is a single party payer system whosecost is out of control. America cannot continue to print money forever.
America’s politicians are ignoring this fact in order to gain more power.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Copywrite 2006-2018
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Stanley Feld MD,FACP, MACE
I have wondered why either house of congress has not done anything about healthcare reform in the past 6 months.
The reason is that both the Democrat and Republican leadership in both houses of congress do not want to do anything about Repairing the Healthcare System.
“Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market.
Reports show individual market erosion and increasing taxpayer liability.”
The CMS conclusions for 2017 were obvious in 2016. Obamacare is on a downward spiral.
In 2017 87% of enrollees were subsidized as opposed to 83% in 2016.
There was an alarming 20% drop nationwide in enrollees in Obamacare’s individual healthcare market without federal premium subsidies.
223,000 subsidized enrollees dropped their subsidized insurance.
These Obamacare enrollees dropped their insurance because even with subsidies their premiums became too expensive. Their average monthly premiums of the subsided and unsubsidized groups spiked by 21%.
Unsubsidized Obamacare enrollment dropped an average of 33% nationally. It dropped an astonishing 73% in Arizona. It is a wonder that neither Arizona senator wants to do anything about Repairing the Healthcare System. It is also a wonder that Arizona citizens continue to support these senators.
Obamacare is dead!
The Democrats are naturally blaming its death on President Trump. President Trump does not want to pour more money into this failed concept while forcing a greater payment liability on taxpaying Americans. He wants congress to do something to repair the healthcare system.
President Obama’s plan all along was for Obamacare to fail and be replaced by a single party payer system.
I have written about 20 articles on why a single party payer system is unsustainable and will fail.
http://stanfeld.com/?s=single+party+payer
The British National Health Services System is a failure. Single party payer systems close to home are a failure.
For example The VA Health System is a failure. Medicaid is an unsustainable failure. It is unsustainable while offering inefficient care.
http://stanfeld.com/?s=Medicaid+failure
Medicare is a failure because it is unsustainable by the government. Seniors like it because they can get care that they could not afford otherwise.
However, seniors are getting wise. Medicare is becoming unaffordable to seniors. The government construction of Medicare premiums for Part B, Part D and Part F are costing seniors somewhere north of $16,000 a year in post tax dollars.
Medicare used to pay 80% of its approved fee. The approved fee is about 50% of the physicians’ fees. In 2018 Medicare is only paying around 50% of its approved fee. Seniors have to pay the difference.
This will drive seniors out of the Medicare marketplace.
There is a better way. I have gone into excruciating detail describing the better way.
http://stanfeld.com/?s=My+Ideal+Medical+Savings+Account
Newt Gingrich, when he was house leader, said my idea was a BIG IDEA. However nothing ever came of the big idea. The “big idea” empowers the people not the government.
“Unlike many other politicians who have promised to take on the establishment and “drain the swamp,” Representative Thomas Massie (R-Ky.) 2012 is actually trying to do just that, and is taking some serious flak for his exposure of the Deep State and its agents on Capitol Hill.”
In a video series entitled The Swamp, Massie, along with Representatives Dave Brat and Tom Garrett of Virginia, Ken Buck of Colorado, Rod Blum of Iowa, and Ted Yoho of Florida, are showing people “what happens behind the scenes in Congress.”
To date, there are four episodes, each running about 10 minutes.
Besides pulling back the curtain to reveal the names and tactics of those who really pull the legislative levers in Congress, The Swamp videos make it very obvious that, although there are 435 members of the House of Representatives, the key decisions are made by a handful of very powerful leaders bent on controlling the country and that the betrayal is bipartisan.
The first video introduces these non establishment representatives’ chief complaint.
https://www.facebook.com/TheSwamp/videos/1794302460864573/
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An average of 4,500,000 people have viewed these videos.
“Representative Blum responded, “Most all the decisions around here are made by a few people at the very top, without the input of any other congressional members or U.S. senators. That’s not good representative government, wouldn’t you say?”
“I think both parties are engaged in a quiet deal that we will support our base, and if it leads to bankruptcy, okay, and you will support your base, and if it leads to bankruptcy, okay,” Representative Buck says in Episode 1.
In Episode 2, the perception of a two-party system where the two parties oppose each other and want to achieve different ends is shattered as leaders of Democrats work with their Republican counterparts to shove a bloated, unconstitutional omnibus spending bill through the House without giving members time to read the text of the measure.
https://www.facebook.com/TheSwamp/videos/1807501746211311/
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“One of the most shocking revelations comes in Episode 3, when Rep. Massie details how the party forces members to pay “rent” for their committee assignments and chairmanships. If a congressman wants to sit on a committee, he is expected to raise a certain amount of money for the National Republican Congressional Committee, the body that works to elect House Republicans. There is an identical system on the Democrat side. In an interview, Rep. Buck told me this system has been in place for Republicans since the days of Newt Gingrich, and even longer for Democrats.”
https://www.facebook.com/TheSwamp/videos/1816800768614742/
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Episode 4 of The Swamp was released just a few days ago and covers the consequences faced by those lawmakers brave enough to buck the system and call out the conspirators.
https://www.facebook.com/TheSwamp/videos/1831877993773686/
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There you have it. This is the complex definition of The Swamp.
The structure has been created whereby our representatives and senators do not represent the will of the people.
Congress represents the will of the vested interests. Anyone that understands this has to play ball or move out.
It will be very difficult for America to get a sensible healthcare reform bill for the benefit of the American people when this pyramid of power exists.
It looks like legislation is driven by money, not the will of the people. These four videos are essential to understanding the process. They must be watched.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Copywrite 2006-2018
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Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.
Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.
The economics of these single party payer systems are seldom discussed in a coherent way. The American public has no idea of its economic burden to its countries.
The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.
In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.
The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time.
In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They also suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.
The private healthcare system is flourishing in Britain for those who can afford it.
The British healthcare system is unsustainable. The British government cannot figure out how to make it more efficient.
America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.
Seniors love Medicare. They could not afford to get treatment if there was not a Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. The price of healthcare has continued to explode yearly.
Congress has ignored the basic defects that have caused this explosion. A few congressmen are making feeble attempts to correct this continuing price explosion.
The political establishment largely ignores these congressmen.
As attempts are made to try to control costs through regulations the bureaucracy grows and the system becomes more inefficient. The reduction of reimbursement to physicians has resulted in the explosion of concierge medicine.
The result is an increase in costs and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers and government.
Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.
President Obama’s law increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from investigations and government penalties in the long run.
The VA system is the purest example of sheer failure. Not only are the patients unhappy but the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.
The inefficiency, corruption and waste have not been able to be fixed but many notable private sector executives. They have all ultimately resigned or were fired.
The VA system’s single party payer system remains an incurable failure.
These examples have proven to me that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.
Are these mistakes intentional?
The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.
What is happening now?
The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.
The article, “Back to the Health Policy Drawing Board” is intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.
After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exists.
However, the cost of the Medicare system is out of control. America cannot continue to print money forever. America’s political class is ignoring this fact.
It is so out of control political wonks are starting to talk about having another Debt Jubilee.
https://en.wikipedia.org/wiki/Jubilee_Debt_Coalition
The New York Times article starts by saying:
The Affordable Care Act needs help.
It sure does. The problem is there are too many defects in the structure of Obamacare that led to the increases in costs to the government and consumers. Obamacare is beyond repair.
After scores of failed repeal attempts, Congress enacted legislation late last year that eliminated one of the law’s central features, the mandate requiring people to buy insurance.
There was only one failed repeal attempt not scores of repeal attempts. The one repeal attempt failed by one vote. It seemed to me to be a vindictive vote. It was not on the bills lack of merit. It seemed to me to be on John McCain’s personal animosity toward President Donald Trump.
There has been a total lack of bipartisanship in trying to repair Obamacare. The have been no ideas offered by Democrats. Its goal was to stymie the Republican administration.
Many establishment Republicans’ goal was to also stymie the Republican administration.
Obamacare had three principal features:
President Trump slipped the elimination of the mandate into the tax bill to bring a speedier death to Obamacare.
Each feature represented a death bell from the onset
A June 2017 poll showed that 60 percent of Americans said the government should provide universal coverage, and support for single-payer insurance rose more than one-third since 2014.
Americans are frustrated with the dysfunction in the healthcare system. Premiums have increased tremendously since Obamacare. Its regulations and defective principles increased dysfunction.
Enormous deductibles have resulted in individual buying defective insurance policies. Consumers have ended up with essentially no insurance coverage except for catastrophic illness. Only people at risk for high cost treatment have bought these policies.
I cannot imagine what the 60% who want a single party payer were thinking. Can a government run system improve the inherent inefficiency, waste, abuse and unsustainability of Obamacare or a VA like healthcare system?
A government run single party payer system can only make things worse.
The healthcare system will not improve until congress acts to level the playing field and fix the defects inherent in our present healthcare system.
I believe a universal consumer driven healthcare system, available to all, can “Repair the Healthcare System” at a much lower cost to society and individual consumers than a single party payer system.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
Jeff Bezos, Warren Buffett and Jamie Diamond should try this disruptive approach in their venture into healthcare reform.
All the other approaches that have been tried have not worked or have become unsustainable. Most of the approaches have been unfair to consumers and the majority of taxpaying Americans.
The only way to empower all the consumers in a healthcare system is to encourage them to become responsible for their health and healthcare dollars.
I believe it can only be accomplished by providing easily understandable financial incentives for consumers to save money for themselves.
Providing financial incentives to consumers to save money for themselves can be disruptive to the present models used to pay for medical services just as Amazon has been disruptive to retail sales.
The delivery of medical and surgical care has advanced tremendously in the last sixty years.
At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.
The incidence of obesity has risen every year. Over fifty percent of Americans are obese.
Obesity begets many chronic diseases and subsequently the complications of these diseases.
Physicians can treat these complications fairly well. However the treatment of chronic disease complications are costly.
How do you decrease the incidence of obesity in America?
Physicians must attack the core causes of obesity.
Among those causes are excess food intake, lack of daily exercise, mental depression, cultural milieu and/or a combination of all of the above.
The cure of obesity depends on the ability to eliminate these core drivers. Financial incentives can get patients involved in eliminating the core drivers of obesity.
The responsibility for obese patients’ healthcare depends on patients’ lifestyle, popular cultural milieu, and patient education.
In America, it is almost impossible to buy a meal in any level restaurant without excess calories.
How do you get people to be responsible for their health and healthcare dollars?
The one key element ignored by policy makers to decrease obesity is to give obese consumers of healthcare financial incentives to concentrate on trying to lose weight.
“Obamacare went in the wrong direction. It limits personal liability for their obesity. It does not promote personal responsibility
The only incentive Obamacare provided was the incentive to overuse the healthcare system.
This was especially true for patients on Medicaid. They had zero premiums and deductibles. The only deterrent to accessing medical care was physician availability.
Physicians refused to participate in Medicaid because of low professional reimbursement. Low reimbursement by the government was necessary because of the decreases in funding and participant overuse of the system.
Obamacare planned to cure the shortage of “medical providers” by increasing the number of “valid medical providers” who could bill on their own, such as nurse practitioners and certified physician assistants.
However, the defect there is that patients were not under the supervision of physicians engaged in their care. It ignores the patient physician relationship that is so important to effective medical care.
If Jeff Bezo, Warren Buffet and Jamie Diamond (BBD group) are serious about Repairing the Healthcare System for their employees as a nonprofit organization, they should consider my Ideal Medical Savings Account.
http://stanfeld.com/?s=My+Ideal+Medical+Savings+Account
The Ideal Medical Savings Accounts (MSA) are tax-sheltered accounts used to pay for non-catastrophic medical expenses. These non catastrophic medical expenses account for the bulk of the cost of medical care.
Money left from the Medical Savings Account at the end of the year is put into a consumer’s retirement account.
The MSA provides the financial incentive to not overuse the healthcare system.
Warren Buffet understands the money making potential of re-insurance. He is heavily invested in re-insurance companies.
If one of the BBD Groups employee’s gets sick and spends of all of his MSA money, reinsurance provides first dollar coverage for the illness.
The BBD Group could teach employees how to shop for price and value. Insurance companies are supposed to shop for value. However the shopping is never to the patient’s advantage. It is to the advantage of the insurance company.
“ Critics always claim this is unrealistic:
The critics’ use the ambulance argument to eliminate the possibility of consumers using their own judgment to make price decisions.
Patients are smart enough to figure out which hospital they want to go to before they get into the ambulance.
Emergency care represents only 6% of health care expenditures.
“But emergency care represents only 6% of health expenditures.”
“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “
ttps://www.wsj.com/articles/the-health-reform-that-hasnt-been-tried-1507071808
ttp://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/
“My Ideal Medical Saving Account provides that financial incentive to not overuse the healthcare system. All the articles about my ideal medical saving accounts are attached to this link.
http://stanfeld.com/?s=My+ideal+Medical+Savings+Accounts
“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”
Medicaid patients also overuse the healthcare system.
Most Medicaid patients can understand the MSA’s financial incentive.
“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”
These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system. It would save the re-insurance company a great deal of money.
Both HSA’s and MSAs have the unique advantage of providing the financial incentive to for consumers to save money for themselves.
When people have savings to protect in HSAs, the cost of care drops without harmful effects on health.
The financial incentives decrease the overuse of the healthcare system.
“ According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”
https://www.healthaffairs.org/do/10.1377/hpb20160204.950878/full/
My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.
“ MSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”
MSAs should also apply to Medicaid recipients. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “
The maximum contribution to MSAs should be raised to $6000 or $7000 dollars. If a consumer gets sick and experiences a cost of more that $6000 he should receive 100% (first dollar) coverage through the BBD group’s provided reinsurance policy. A reinsurance policy would cost the BBD Group less than $6000 a year.
The total insurance package to BBG Group employees should cost the BBD Group $12,000 rather than the present cost of $18,000.
BBD is a self insured association. The association has elimated the multiple middlemen in the present healthcare system.
When a person with an MSA dies, the funds should be allowed to roll over tax-free to surviving family members.
This financial incentive should be included in My Ideal Medical Savings Account.
“The information that patients require to assess value must be made more transparent.
2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”
A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.
At present healthcare prices are not transparent. Consumers are not motivated to shop prices. The BBD Groups leverage with its employees would force transparency.
“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”
In this age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines. It would supply instant access to expertize at an affordable cost.
Everything possible should be done to encourage consumer responsibility and provider competition.
The present tax code does the opposite. Consumers in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.
The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.
The BBD Groups volume of consumers would have tremendous leverage with providers.
The younger and healthier the corporate employees are the lower the premiums.
The formation of associations with large memberships of all ages would lower the cost of healthcare. Large associations would have great leverage in negotiating price with providers. They would also spread the risk.
Self- insured associations such as the BBD Group would also spread the risk and lower the cost.
Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars the same as the corporate group plan policy holders.
These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE