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The Plan To Empower Consumers Of Healthcare

October 16, 2017

inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System

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Stanley Feld M.D., FACP,MACE

The only way to empower consumers of healthcare is to allow them be responsible for their health and healthcare dollars.

The delivery of medical and surgical care has progressed markedly in the last sixty years. Life expectancy has also increased.

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. The percentage is rising yearly.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well but the treatment of these complications comes at a high cost.

How do you decrease obesity in America?

How do you get people to be responsible for their health and healthcare dollars?

One of the key elements in decreasing obesity is to give consumers financial incentives to use the healthcare system efficiently.

“ObamaCare went in the wrong direction. Its regulations—including required “essential benefits”—raised prices on these plans and limited their availability.”

The only incentive Obamacare provided was the incentive to overuse the system. This was especially true for patients on Medicaid. They had zero premiums and deductibles.

A second tool for motivating patients to consider price is large liberalized health savings accounts. These tax-sheltered accounts are generally used to pay for the noncatastrophic expenses that form the bulk of medical care.

First, equip consumers to consider prices.”

“ Critics always claim this is unrealistic: Are you supposed to shop around from the back of the ambulance?

The critics use the ambulance excuse argument to eliminate the possibility of consumers using their own judgment to make price decisions.

“But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

http://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. The many articles about my ideal medical saving accounts are attached to this link.

“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”

Medicaid patients also overuse the healthcare system.

“ 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.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and delivers it to consumers.

Both HSA’s and MSAs have the unique advantage of providing and financial incentive to save.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health.

The financial incentive decreases 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.”

My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ HSAs 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.”

Scott Atlas has publicized the obvious. This would apply to Medicaid recipient also. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to a MSAs should be raised to $6000 or $7000 dollars. If a consumer get sick and experiences a cost of $6000 he should receive 100% (first dollar) coverage through a reinsurance policy that would cost less than $6000.

There can be many variations on this theme for the consumers benefit.

When a person with an HSA dies, the funds should be allowed to roll over tax-free to surviving family members.

This financial incentive should be added to My ideal Medical Savings Account.

“The information that patients require to assess value must be made radically more visible. A 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.

“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 his 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 younger and healthier the corporate employees are the lower the premiums.

This is where the formation of associations with larger memberships of all ages fits in to lowering the price of healthcare. Large associations would have great leverage in negotiating price with insurance companies. They would also spread the risk.

If financial incentive with my ideal medical saving account was added to the price the association negotiated and the consumer paid for the premium, usage would fall and the cost of insurance would decrease.

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 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

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What Is Patient-Centered Healthcare?

March 1, 2017

inChronic Disese Management, Consumer Driven Health Care, Medicine: Healthcare System

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Stanley Feld M.D.,FACP, MACE

Patient-Centered Healthcare is a new buzz phrase. It has become popular among Republicans in the last few years.

I have a feeling most people do not know what physicians mean by patient-centered healthcare.

The true definition is that patients are in the center of the medical care interaction. Patients determine their needs and their physicians. Patients drive the medical encounter. Neither the government nor the insurance industries drive the medical encounter.

A fatal floor in Obamacare was that President Obama wanted the federal government to control the healthcare system.

President Trump’s goal is to have patients in control of their own health and healthcare dollars. It is not a problem if the government or employers provide those healthcare dollars.

I believe Tom Price M.D. understands that the only system that will work is a system in which the consumers (patients) are responsible for their own health and healthcare dollars.

The government’s job is to provide incentives in the healthcare system for consumers to become responsible for their health and healthcare dollars.

I am not at all sure the Republican congressional leadership understands the definition or value of patient- centered care.

Obamacare provided just the opposite. Obamacare provided incentives for consumers/patients to be dependent of government.

This fundamental tenet of patient-centered care was tested by Stewart, et.al. in 2000.

Experts studied audio taped doctor-patient interactions while patients also rated these same interactions.

Expert opinion could not be correlated with positive results, but patient-perceived patient-centered care correlated with “better recovery from their discomfort and concern, better emotional health.

A Wikipedia definition of “Patient centered healthcare” does not exist. There are many consumer-driven healthcare definitions.

Most of the Republicans are talking about patient centered healthcare. However, they start and end with Health Savings Accounts and Consumer Driven Healthcare.

The American Association of Clinical Endocrinologist defined patient-centered healthcare in its diabetes guidelines of 1996 and 2002. (on request)

The guidelines were a System of Intensive Self-Management of Type 2 Diabetes Mellitus.

The Type 2 Diabetic was taught to become a “professor of his/her diabetes.”

The goal was to get the diabetic blood sugar as close to normal as possible. It was shown that normalizing the blood sugar helped avoided the vascular complication of diabetes. The treatment of the vascular complications of diabetes absorbed 80% of the money spent on diabetes.

Patients live with their disease 24/7. Blood sugars are very variable. Patients need to learn how to adjust to these variables by managing their medications and lifestyle.

Patients taking a pill or a shot will not control their blood sugar unless they understand the medication and how to adjust it to have the greatest affect on the blood sugar.

The only way a patient can understand how to control their blood sugar is for them to understand how their blood sugar affects the effectiveness of the medication and how their medications and lifestyle affects their blood sugar.

This same phenomenon applies to most chronic diseases.

The only way to decrease the complications of chronic diseases is for patient to drive the treatment of their disease.

This in turn will be the only way to control healthcare costs. This is what I mean when I say patients should be in control of their health.

As an added incentive to control costs, patients should be in control of their healthcare dollars so they figure out how to use medication most affectively.

In the February 2017 Endocrine News published by the Endocrine Society there was an article interviewing four endocrinologists for their definition of patient centered care.

“In 2001, The Institute of Medicine published a book called Crossing the Quality Chasm: A New Health System for the 21^st Century.”

“In it, the institute identified six aims for improvement of healthcare delivery, one of which was “patient-centered care,” defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”

The Institute of Medicine’s definition moves patients’ needs and attitudes toward patients being in the center of care. It does not place them as responsible for the management of their care. It does not include patients’ responsibility for their care.

All four of the endocrinologists got close to the definition of patient centered care. Only Carol Greenlee, MD, FACE, FACP, of Western Slope Endocrinology in Grand Junction, Colorado nailed the definition. Dr. Greenlee is the only physician in private practice.

She said:

“One of the most important things is partnership with the patient and what is called “contextualized” care, which means taking into account a patient’s needs and circumstances, goals and values.

It is also called developing a physician/patient relationship.

Another aspect is moving from the physician being at the center of the care model, with staff working to help the physician (doing tasks for the physician or other clinician such as “rooming” the patient or “scheduling” the patient for the clinician) to the staff also “taking care of the patient” as their job, with different roles on the patient-centered care team (getting the patient in for a needed appointment).

It is doing what is best for the patient (not giving the patient what they want, e.g. pain meds, MRI, antibiotics) or ask for (those things are not often best for the patient, but takes time to discuss through).

It’s taking our best science and knowledge and technology and then adapting it to meet the patient’s unique needs, circumstances, values, and goals.

It requires clearing up misconceptions (such as asking what the patient currently understands about a condition or a test or treatment), helping discuss risks and benefits in the context of that individual patient.

It requires asking not just telling, but it is not dumping everything back on to the patient.

It is taking into account the “work” (the job) of care (self-care that the patient or family need to do) on top of the illness and the rest of life that the patient and their family have to deal with and do (i.e. consideration)

Most clinicians think that they are already patient-centered because they care about their patients.

But that does not mean they provide patient-centered care or practice in a patient-centered approach.

I thought I was patient-centered because I cared but then I had to uproot my mental model to really become patient-centered.”

Republicans and their advisors do not understand the meaning of the concept of patient centered care.

Tom Price M.D. understands the concept of patient centered care.

Without the patient being in the center of the management of his/her care, the healthcare system can never be repaired and will never be financially sustainable.

I hope President Trump gets the concept in spite of the advice from congressional Republican and Democrats. Congress is trying to satisfy all the secondary vested interests. Healthcare is a big business with many secondary stakeholders. They do not want to lose this important profit center.

These stakeholders are better organized than patients or physicians to influence healthcare policy makers.

The primary stakeholders are patients with their head coaches and assistant coaches being physicians and their healthcare team.

Patients must be in the center of the healthcare team because they are the only ones that can influences the cost of medical care.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Donald Trump on Healthcare Reform

September 16, 2016

inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D. FACP, MACE

Donald Trump’s healthcare proposals are totally different from Hillary Clinton’s. His proposals are a step in the right direction to Repair the Healthcare System.

His advisors tried to create a market based healthcare system. However, they have omitted the most important elements necessary to align all the stakeholders’ incentives.

Unfortunately, their approach is the usual healthcare policy wonks market based policy approach. They do not focus on the most important stakeholder in the healthcare system.

The consumer is the most important stakeholder in the healthcare system. The consumer should be the driver of the healthcare system.

A market based system should:

Promote of consumer driven healthcare system.
Promote consumers’ responsibility for their health and healthcare dollars.
Promote the physician/patient relationships.
Promote a respect for consumers’ intelligence. Consumers can judge what is best for their healthcare needs.
Promotion of accurate education about a consumers’ disease and provide resources to help consumers make the best choices to treat their diseases and use their and healthcare dollars.

Donald Trump’s web site starts by pointing out the defects in Obamacare. The Obama administration and Hillary Clinton’s spin machine uses the traditional media to promote the erroneous concept that all that is needed to fix Obamacare’s small defects are small modifications and more money.

This is a wild fantasy. The real goal is to completely control the healthcare system.

Donald Trump’s web site starts by declaring that Obamacare must be repealed.

“Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act—(Obamacare.”

The average Americans are starting to understand Obamacare economic burden on the economy in general and them individually

“ The Affordable Care Act, (Obamacare), legislation, passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history must be repealed.”

President Obama and majorities in the House and Senate tightly controlled the debate in congress and the traditional media.

Nancy Pelosi said it all when she said “you will not know what is in Obamacare until it has passed.”

“Obamacare has tragically but predictably resulted in runaway costs.”

The runaway costs for the government and individuals were the result of:

“Websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.”

“Obamacare has raised the economic uncertainty of every single person residing in this country.”

This has resulted from the 10 hidden taxes, along the inhibiting effect on the economy and the uncertainty of the potential mandates, that resulted in and from job losses.

“As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.”

Donald Trump concludes that Obamacare cannot be fixed. It must be repealed.

“But none of these positive reforms can be accomplished without Obamacare repeal. On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

Donald Trump recognizes that simply repealing Obamacare will not fix the healthcare system.

He also recognizes that he must work with Congress to have a series of reforms ready for implementation.

“We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country.”

It is refreshing to know that a potential president is willing to work with congress rather than issue executive orders and see if he can get away with them.

“By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.

Any reform effort must begin with Congress.”

Donald Trump says;

Several reforms will be offered that should be considered by Congress so that on the first day of the Trump Administration, we can start the process of restoring faith in government and economic liberty to the people.

This is the correct process according to the constitution.

It is imperative that Republicans maintain their majorities in the House and Senate in order for Donald Trump to lead legislation to repeal and replace Obamacare.

The following are the suggestions a Trump administration will offer the congress according to his website.

Completely repeal Obamacare.
Our elected representatives must eliminate the individual mandate (tax according to the Supreme Court). No person should be required to buy insurance unless he or she wants to.
Modify existing law that inhibits the sale of health insurance across state lines.

Donald Trump assumes eliminating state line restrictions will allow full competition in the healthcare insurance market place. He assumes insurance premium costs will go down and consumer satisfaction will go up. The healthcare insurance companies will try to keep the insurance premiums equally high in all states.

It can only work if consumers can buy insurance they believe they need. Costs of unnecessary insurance should not be piled into one insurance plan fits all. i.e. A post menopausal woman does not need to pay a birth control premium.

4. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.

Individuals should be allowed to take the same tax deductions as group insurance plans are allowed.

5. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

This is where Donald Trump’s proposal weakens. The Medicaid program must be modified. Medicaid recipients should be incorporated into my ideal Medical Saving Account program. The government should act as the funding agent for the eligible poor.

This will put the poor on the same payment footing as everyone else.

The Medicaid eligible poor should be given financial incentives to take charge of their health and healthcare dollars.

Our healthcare system must be moved from a system that fixes you when you are sick or broken into a system that rewards people financially for remaining healthy and controlling their healthcare spending.

It is much cheaper to avoid the cost of emergency care than it is to get sick and have to go to the emergency room.

6. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate.

Health Savings Accounts (HSAs) should be changed to Medical Savings Accounts (MSAs) to provide better financial incentives for people who choose this form of insurance. The Medical Savings Accounts can easily be customized so that consumers can choose the level of insurance they desire.

The contribution to the MSA can be flexible to provide adequate amounts of money to be put into the savings accounts to incentivize consumers to remain healthy.

Obesity is a huge program that must be consumer driven. Obesity must be cure by the patient and his family, not surgery.

Obese children are becoming diabetic and also hypertensive at a young age. This must be stopped because of the potential explosive effect of complications of both diabetes and hypertension on individual and overall costs of medical care.

7. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.

Price transparency is an essential provision for individuals, businesses and groups. It provides leverage for consumers to be responsible for their healthcare dollars. It is also necessary to require insurance companies to provide verifiable price transparency for their administrative costs and their direct patient care costs

Consumers must be empowered to be responsible and shop for the most value and best prices for procedures, exams or any other medical related procedure.

This is the way to decrease the cost of healthcare services and medical care services.

Social networking should be used as the backbone for the establishment of consumer empowerment.

The success of Angie’s list, Trip Advisor and Open Table are a result of social networking. Local communities have their individual social networks that empower people in their neighborhood to know which vendors provide the best value in their community.

This simple step can be used to decrease the cost of healthcare and medical care.

This could be a place where government can lead the way in establishing this accurate educational resources.

8. Block-grant Medicaid to the states.

These block grants can be used by the states to fund MSAs without a threat of increasing state budget deficits or giving states rights to the control of the federal government.

Block grants for social networking should be used to provide incentives to help individuals to seek out and eliminate fraud, waste and abuse of some of its local providers. It would eliminate expensive big data collections that many times are inaccurate in decision making by central federal control.

9. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

Federal and state governments should help its citizen choose safe, reliable and cheaper products for the treatment of their diseases.

It would help with compliance and adherence to recommended treatment and decrease the cost of care.

It would promote consumers taking responsibility for their own health and healthcare dollars.

10. Congressss will need the courage to step away from the special interests and do what is right for America.

One example is allowing consumers access to imported, safe and dependable drugs from overseas. It will provide more options to consumers. This is only one example of many that ways to decrease the cost of drugs in this country.

Donald Trump is proposing a lot of important changes.

However, he is missing the important element of consumer power, consumer initiative, and consumer incentives.

His healthcare changes must include a consumer driven system with an ideal medical saving account otherwise the healthcare system will remain an unmanageable, expensive and abused mess.

Donald Trump admits this is simply a start. His start is much more powerful than Hillary Clinton’s proposal to continue and build on Obamacare.

Obamacare has been a disaster that is unsustainable. It is weekly increasing the cost of care while rationing care and decreasing access to care.

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

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Why Vermont’s Single Party Payer Healthcare Plan Failed

August 19, 2016

inConsumer Driven Health Care, Defective scientific studies, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP,MACE

Vermont’s single party payer healthcare plan was doomed to fail from the onset for several reasons.

Healthcare policy consultants do not understand the medical care system. The healthcare policy consultants for the Vermont healthcare system were the same consulting architects President Obama used for Obamacare.

The consultants were Harvard’s William Hsiao and MIT’s Jonathan Gruber.

William Hsiao has spent most of his academic career helping governments install healthcare systems. William Hsiao is the K.T. Li Research Professor of Economics in Department of Health Policy and Management and Department of Global Health and Population, at Harvard T.H. Chan School of Public Health.

Jonathan Gruber is a professor of economics at the Massachusetts Institute of Technology, where he has taught since 1992.^[1]

He is also the director of the Health Care Program at the National Bureau of Economic Research, where he is a research associate.

Jonathan Gruber has been heavily involved in crafting public health policy.

He has been described as a key architect^[2] of both the 2006 Massachusetts health care reform, sometimes referred to as “Romneycare”, and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as the “ACA” and “Obamacare”.

There is little evidence that the systems he and Dr. Hsaio have built are overwhelming successful, cost effective or preserve consumer freedom of choice.

In fact, a study by NPR and Harvard’s T.Chan School of Public Health concluded that Obamacare is a complete failure.

Dr. Hsaio is on the faculty the Harvard T.Chan School of Public Health.

“NPR AND HARVARD T.H. Chan School of public Health SAY: OBAMACARE IS A COMPLETE FAILURE”

In a New York Times interview in 2009 Dr. Hsiao discussed the system of healthcare Reform he installed in Taiwan.

The question was:

What’s the most important lesson that Americans can learn from the Taiwanese example?

Dr. Hsiao.

You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.

The Taiwan government managed to insure 98 percent of the population with a premium cost of 4.6 percent of wages.

Has your system of healthcare in Tiawan translated into better life expectancy or lower complication rates from major diseases?

Dr. Hsiao.

“There is evidence of positive health results for select diseases, like cardiovascular disease and kidney failure.”

There is no medical or financial data available to prove outcomes have improved.

“Overall, it’s really difficult to say that national health insurance has improved the aggregate health status, because mortality and life expectancy are crude measurements, not precise enough to pick up the impact of more health care.”

“That said, life expectancy is improving, and mortality is dropping. And everyone now has access to good health care”.

This is not good science. It is not even good social science. This is a biased opinion.

What are the system’s weaknesses?

Dr. Hsaio

“In the legislative process, compromises had to be made. First, the president yielded on payment reform, so Taiwan kept its fee-for-service payment system. Unfortunately, that encourages doctors and hospitals to give more treatment in order to boost their income.

“Second, the Taiwanese system doesn’t have a systematic way to monitor and improve quality of care.”

“Third, in the legislative process, they rejected a provision to adjust the premium automatically when the national health system depletes its reserves.”

“In every country, health care costs are increasing faster than wages. When that happens, the premium has to go up. But that provision wasn’t incorporated into the law. As a result, the system is running a deficit.”

“National health insurance tries to cut the fees for hospital and physician services. But eventually these fee reductions will adversely affect the quality of health care.”

President Obama was so anxious to change the healthcare system in the United States to fit his socialist ideology that he picked two professors, Dr. Hsaio of Harvard and Jonathan Gruber of MIT to be the architects of Obamacare.

Jonathan Gruber has been introduced as the ‘architect’ of the Massachusetts law and/or Obamacare”.^[52]

Neither professor had scientific evidence that a single party payer system would work efficiently.

Obamacare was not working efficiently yet the progressives in Vermont hired Dr. Hsaio and Dr. Guber to be the architects for Vermont’s single party payer system.

Jonathon Gruber has turned out to be a honest about the Obama administration’s lies.

Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or “stupid”.

In October 2013, Gruber we said: “the bill was deliberately written “in a tortured way” to disguise the fact that it creates a system by which “healthy people pay in and sick people get money”.

Some of Americans are waking up to the fact that they cannot trust President Obama and his administration to be our surrogate. This is true not only in healthcare but in his decision making in every area of the economy and our live.

Gruber said this obfuscation was needed due to “the stupidity of the American voter” in ensuring the bill’s passage. Gruber said the bill’s inherent “lack of transparency is a huge political advantage” in selling it .^[31]

In 2010, Jonathan Gruber expressed doubts that the ACA would significantly reduce health care costs. He thought lowering costs played a major part in the way the bill was promoted by the Obama administration.^[36]

President Obama said he never met Jonathan Gruber and did not think he came to the White House. President Obama forgot he hired him and paid him a $400,000 consultation fee.

In 2014, the Obama administration claimed that Gruber did not have a major role in creating the PPACA.^[50]

President Obama acted irresponsibly to the public by hiring healthcare policy wonks to change America’s healthcare system without evidence for the success because their thoughts fit his ideology.

I don’t think President Obama understands he has changed the way hospitals and physicians have changed their approach to healthcare and medical care.

In my opinion, healthcare and medical care has changed for the worse.

Rich Lowry said that the videos were emblematic of “the progressive mind, which values complexity over simplicity, favors indirect taxes and impositions on the American public so their costs can be hidden, and has a dim view of the average American”.^[41]

The American public eventually figures it out.

Commentator Charles Krauthammer called the first Gruber video “the ultimate vindication of the charge that Obamacare was sold on a pack of lies.”^[42]

The Vermont governor hired Dr. Hsaio and Dr. Gruber to create a single party payer system in Vermont figuring,the system would be easier in one small state than in the nation.

Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state.

“In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

Watch out Colorado!

Why doesn’t a single party payer system work?

All of the healthcare policy wonks, especial Dr. Hsaio and Dr. Gruber, leave out the most important ingredients in a successful healthcare system.

Consumers cannot be treated as a commodity. Consumers cannot be forced to take what is given to them. The healthcare system must have a viable physician patient relationship provision.

The physician patient relationship is a big part of the therapeutic index. If treatment is to be successful patients must participate in their care.

Consumers of the healthcare system must drive the healthcare system. It must not be government or the healthcare insurance industry.

Consumers must be a the center of the healthcare system.

A system needs to be developed that puts patients in charge, not the government. Consumers must be responsible for their healthcare and their healthcare dollars.

This will motivate doctors and hospitals to compete for patients’ business.

My Ideal Medical Savings Account will provide incentives for the consumers to have a consumer driven healthcare system. This system will in turn drive hospital systems and physicians to compete for their care.

The end result will be to decrease the cost of the healthcare system and improve medical care and consumer satisfaction with the healthcare system.

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

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Managing Points Of View and Healthcare

May 27, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems

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Stanley Feld M.D.,FACE, MACE

Finally, it is official. Ben Rhodes, the deputy national security adviser for strategic communications, admitted that the Obama administration lied about the Iranian Nuclear deal to the press, public and congress.

His interview with David Samuels in a New York Times Magazine typified the approach to manipulating the truth by the Obama administration in all areas of the administration’s activities.

The administration has been trying to walk back Ben Rhodes’ statements for a week. The traditional media is trying to bury his statements even though the king of the mainstream media (the New York Times) published the interview.

The justification for this behavior is that it has been used by all-previous administrations including that of George Bush. It is therefore an insignificant objection.

Ben Rhodes explained to David Samuels, in the New York Times profile that, “it was first necessary to lie to a corrupted and inexperienced American media about all sorts of things, beginning with the nature and intentions of the enemy in this case the Iranian regime.”

Subsequent lies were added, as the White House took advantage of a dangerous mix of journalists’ ignorance, their ideological and partisan commitment to the administration, and finally, their career aspirations.

It reminds me of Jonathan Gruber’s attitude toward the press and President Obama’s pretense that he hardly knew Jonathan Gruber.

http://stanfeld.com/?s=Jonathan+Gruber

https://www.google.com/search?q=Ben+Rhodes+Iran+nuclar+deal&ie=utf-8&oe=utf-8

Rhodes went on to say, “The average reporter we talk to is 27 years old, and their only reporting experience consists of being around political campaigns… They literally know nothing.”

This implies the lack of respect the Obama administration has for the press, Americans and for the virtue of honesty. It is not a good example for our youth’s future behavior and the way to mange a Point of View.

Thus they (the press) will believe what he tells them. He also tells friendly non-governmental organizations and think tanks what he is telling the journalists. Those outlets produce “experts” whose expert opinion is just what Rhodes wants it to be. These ignorant young journalists thus have quotes that look like independent confirmation of the White House’s lies. :

Ben Rhodes admitted, when David Samuels asked, “We created an echo chamber of freshly minted experts cheerleading for the deal. ‘They were saying things that validated what we had given them to say.’

This is the apparent attitude of President Obama and his administration. It is applied to every lie they have told to the American people.

Ben Rhodes described a tactic that is an extension of Sol Alinsky’s playbook. I believe the American people are catching on.

The defendants of the Obama administration marginalize the people who expose the lies with additional lies.

The Obama administration and its defendants are usually effective in marginalizing their opponents.

The defendants of the lie have the power of the pulpit and a friendly mainstream media.

The same tactics are used in defending Obamacare as I have described many times in my blog.

I find it difficult to believe that so many smart people believe these lies.

Carl Sandberg said “if you tell I lie enough times its eventually becomes the truth.” This is especially true when people start adjusting and investing in the lie.

Marilyn Travenner, now that she is CEO of the healthcare insurance industry lobbying group, has a different point of view than when she was the head of CMS. Someone else other than government is paying her.

I have said that the dysfunction in the healthcare system is the fault of all the stakeholders, namely the government, the healthcare insurance companies, the drug companies, the physicians and the patients.

Each group adjusts to a dysfunctional element making the healthcare system more dysfunctional. The growing dysfunction is driven by the multiple points of view.

President Obama’s ideology has accelerated the dysfunction.

Marilyn Travenner is now diverting blame for the dysfunction away from the healthcare insurance industry. Many do not realize that the government run healthcare system is totally dependent on the healthcare insurance industry. The healthcare insurance industry does the administrative services for the government.

The administration brags that CMS’ overhead is only 2.5-5% of Medicare’s cost. This is an illusion; It is false.

The percentage of overhead published does not include the cost paid by the government to outsource the administrative services to the healthcare insurance industry.

The administrative services overhead is added into the cost of healthcare. Insurance premiums are calculated using the Medical Loss Ratio calculation. Many insurance company expenses are considered direct medical care expenses. Direct medical care expenses should only be for direct medical care.

The government programs set payments to the healthcare insurance industry for administrative service according to the Medical Loss Ratio.

Insurance administrative expenses, like a help desk or network selection expenses, should not be included in direct medical cost. Presently, it is the method used by the healthcare insurance industry to ultimately take 30-40% of the healthcare dollars off the top.

President Obama and his administration brag that Obamacare is bending the healthcare cost curve for Medicare and Medicaid. The only reason this was true in 2012 and 2013 was because Obamacare’s hidden taxes from citizens at every income level were being collected while there were no Obamacare medical care expenditures until 2014. The 2014 and 2015 cost curve was bent upward contributing to the 19 trillion dollar deficit.

In my last blog I mistakenly left out the word contributing to the 19 trillion dollar deficit. Obamacare is not budget neutral. It is not presently bending the healthcare cost curve.

Some smart people believe Obamacare is bending the healthcare curve because they uncritically believe all the administration’s press releases.

In the last few weeks we have been warned not to believe everything President Obama and his administration tell us.

I am sure the judge in Texas who was lied to by the Department of Justice about immigration reform is not very happy.

The cost of physician services might be increasing on a retail level. However, government and insurance reimbursement to physicians is decreasing.

Travenner, in her previous life blamed the rising cost of medical care on physicians. In order to divert attention from the healthcare insurance industry she continues to blame physicians.

“The cost for everything from office visits to complex surgeries is on the rise, so there’s not much that can be done here to ebb this common cause of premium inflation.”

This is an incorrect premise. It is true that hospital costs are rising. If the premise is incorrect the solution is usually incorrect.

Next, Ms. Travenner explains additional reasons for increasing premiums.

“Prescription drug price inflation is a far bigger problem. A lack of a universal health plan, long periods of patent exclusivity, high demand for pharmaceutical products in the U.S., and the speed with which approved drugs can be brought to pharmacy shelves are all reasons why prescription drug costs could continue soaring in 2017 and future years.”

She omits the most important reasons for the increase in drug prices to the public.

President Bush’s deal with congress to pass Medicare Part D was to eliminate government’s ability to negotiate drug prices with the drug companies. The government negotiates drug prices for the military and VA. It gets negotiated prices that are comparable to all other countries on the globe.

At the same time the government restricts consumers from buying prescription drugs in Canada, suppressing competition.

The Obama administration keeps blaming the drug rules on President Bush’s administration. Why hasn’t President Obama renegotiated a better deal in the last seven years, or just change the rules by executive order as he usually does?

Tavenner also hit on “the point that restructuring the insurance market hasn’t paid benefits as expected.”

New regulations requiring Obamacare insurers to provide plans with a host of minimum benefits, as well as being unable to deny benefits to people with pre-existing conditions, has left insurers exposed to adverse selection.

In plainer terms, it means sicker people who’d been shut out of the insurance system previously have flooded in, and not enough healthier individuals have enrolled.

This last point is valid. The claim that the insurance industry is losing money is not true. It is losing money on adverse selection but they are making up that loss by increasing premium prices to the government and the corporate market.

If they did not make money how could they pay CEOs of some healthcare insurance industry companies 100 million dollars a year?

Finally, Tavenner cautioned that the turbulence can be expected because insurers “sit in the three-R world.”

What Tavenner is alluding to are two programs that are set to end in 2017: the reinsurance program that provided payments to plans that enroll higher-cost members, and the risk corridor, which acted like a modern day Robin Hood by taking excessive profits from top-performing insurers and giving them to Obamacare insurers losing excessive amounts of money.

Without the risk corridor, new insurance entrants could be discouraged, since they’d be responsible for covering the entirety of their losses. The third “r,” risk adjustment, will remain in place to distribute capital from plans with low-risk enrollees to those with high-risk.

The reinsurance aspect of Obamacare was probably illegal. The government guaranteed the insurance companies that it would make up whatever loss they claimed. The Obama administration paid the healthcare insurance industry only 12% of the promised amount. This deception by the government has led to some of the reasons UnitedHealthcare and now Aetna are pulling out of Obamacare’s health exchanges.

However, the government is totally dependent on the healthcare industry for it administrative services.

The devil is always in the details.

There is an ever-growing need to lie to manage the public’s point of view in favor of Obamacare.

The public is becoming aware of the Obama administration’s attempt to mange the public’s point of view. Ordinary citizens are madder than hell at the Obama administration and the establishment in both the Democratic and Republican parties.

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

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Destroying The Healthcare System

January 6, 2016

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D, FACP,MACE

I believe President Obama’s goal is to destroy the healthcare system. The people will then beg the Obama administration to institute a single party payer system with the government being in full control.

The fact is Obamacare is not working despite the Obama administration’s convincing the mainstream media to advertise that it is very successful.

I was shocked at a December 9^th New York Times article stating:

“ A million new customers have signed up for health insurance during the Affordable Care Act’s third open-enrollment season, Obama administration officials said on Wednesday, and call centers have been deluged.”

This statement is an optimistic statement and a distraction from the true. A readers impression would be Obamacare is doing great.

The Obama administration simply ignored last year’s enrollment numbers. Ten million people were supposed to have signed up for healthcare coverage through the Federal Health Insurance Exchanges. Only seven million of those who signed up paid their premiums for the entire year.

The premiums and deductibles were too high even for the poor who received federal subsidies.

Most of the people remaining in the Obamacare in the federal exchanges were people with a pre-existing illness. One diabetic told me her individual premium for Obamacare was $12,500 dollars with a $6,000 dollar deductible. Her bill for last year, being hospitalized one time, was almost $100,000. She felt Obamacare was a very good deal for her.

The insurance company covering these kinds of patients with a pre-existing illness cannot make money for the insurance coverage they are required to provide.

If all the patients have pre-existing illnesses, the only thing the insurance companies can do is raise the premiums or stop selling insurance in this Federal Health Exchange market.

The Obama administration promised it would limit the insurance industry’s loss with its reinsurance program. The Obama administration reneged on its word and only paid 12% of what was due for 2014. The administration did not have the money to pay for it.

In 2014, the first year of coverage, we were told 13 million signed up, but only 7 million had coverage at the end of the year.

The administration provided data to the CBO to predict the number of enrollees Obamacare will have in 2016. The CBO predicted 21 million would be signed up for 2016. The CBO used data provided by the Obama administration to make this calculation.

What happened to the remaining 7 million enrollees for 2015? We are not told how many enrollees automatically re-enrolled.

We only hear that, ‘ A million new customers have signed up for health insurance.”

We can now understand the concerns expressed by UnitedHealth Group and other insurers that say they are losing money in the Obamacare Federal Health Insurance Exchanges.

Open enrollment is due to end January 1, 2015. In mid December CMS announced,

‘We are now seeing a surge of interest as we get closer to the deadline,” “Each day has been bigger than the day before.”

The last two weeks in December had less that 100,000 people sign up. Yet the government published these numbers. Many wonder how real these numbers are. If they are real there has been no increase in enrollment in the last year.

Confirmed 2016 Exchange QHPs: 9,584,850 as of 12/30/15
Projected Exchange QHPs: 11.32M by 01/02/15 (8.60M via HC.Gov)
In the last week in December only 80,000 people signed up compared to 96,000 the same week last year.

The coverage is poor and too expensive for most people.

Open enrollment has now been extended to January 31 for enrollment March 1^st.

“People who go without insurance next year may be subject to tax penalties of $695 a person or more, although some may be able to qualify for hardship exemptions.”

This is a joke. However, the joke is on the consumers and taxpayers.

So far, Obamacare has created a 10% increase in federal taxes middle-class taxpayers.

It has increased coverage for the Medicaid eligible poor. However, these people cannot find a doctor who will treat them.

The healthcare system is costing over three trillion dollars a year and increasing our deficit more than $1.5 trillion dollar a year. There are still 34 million people uninsured. How many people are under insured because their jobs have been changed to part time jobs? They cannot afford to buy Obamacare’s insurance?

2017 is the year the healthcare insurance markets are supposed to stabilize. These markets have not stabilized. Healthcare insurance companies, and business groups can not understand how the new CMS’ proposals will regulate and expand provider networks and standardize plan options let alone have insurance markets result in lower premiums.
“We remain deeply concerned that this proposed rule will not stabilize the individual market,” Steven Kelmar, Aetna’s executive vice president for corporate affairs, wrote in a letter to the CMS. “Unless some fundamental flaws are corrected, we believe there is a grave risk that the federal exchange will not operate as a viable, competitive market in 2017.”

One of the more significant and controversial provisions in the proposed rules involves the adequacy of provider networks. The CMS proposal demands that ACA-compliant health plans sold on the federal exchanges in 2017 would have to abide by new network standards.

All plan networks would have to include hospitals and doctors within certain travel times or distances from members. There would also be minimum provider-to-member ratios for some medical specialties.

CMS proposed that all health plans in each metal tier on the federal exchange have the same benefits. For example, all 2017 bronze options would have a $6,650 deductible, and all plans would have no more than one provider tier.

This proposal practically guarantees that the healthcare insurance industry selling insurance under Obamacare’s exchanges would lose money. Therefore, the industry would choose not to participate.

The big losers would be patients with preexisting illnesses. They would lose their insurance.

The traditional mainstream media is already cranking up the Obama administration spin machine to promote a single party payer system as the best and simplest option to provide insurance for all Americans.

Nobody is thinking about who will pay for a single party payer system after the administration emotionally conditions the public to beg for a single party payer system.

The hardest by increased costs in the system are consumers at every income level.

As the cost rises to unaffordable levels all consumers are starting to take think about taking responsibility for their health and healthcare dollars.

“The new research also finds that as a result of the increase in health care costs, focus group participants are changing how they operate within the health care system.

They are questioning their doctors recommendations more frequently, comparing cost and quality information for local providers, and even putting off seeking care altogether.”

Despite the low of enrollment in 2016 (that the Obama administration denies), CMS is about to publish new 2017 rules for the insurance industry. These rules are guaranteed to make the healthcare system more dysfunctional.

The fact is the structure of Obamacare is failing and about to collapse.

All of the Obama administration’s tinkering to stop the free fall is creating greater momentum for total collapse of the healthcare system.

The answer to fixing the healthcare system is not a single party payer system.

The answer is a consumer driven healthcare system with the aid of smart phones and the Internet and Medical Savings Accounts.

Progressives have a tendency to forget the math. They have more interest in satisfying an emotional response. The resulting entitlement policies lead to the unintended consequences and only make things worse.

Neil Cavuto demonstrated this logic recently in an interview with a student campaigning for free student loans.

https://youtu.be/Zmji36q8E4o

Progressives’ logic is faulty. It demonstrates a lack of understanding of the affects of entitlements and their unintended consequences.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

January 4, 2016

inSummary Blogs

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Scott Becker of Becker’s Healthcare asked me to write an article on Element needed to Repair The Healthcare System. Becker’s Healthcare is the leading source of cutting-edge business and legal information for healthcare industry leaders.

His portfolio includes five industry-leading trade publications:

Becker’s ASC Review
Becker’s Infection Control & Clinical Quality
Becker’s Spine Review
Becker’s Hospital Review
Becker’s Dental Review

My article appeared in the latest addition and with permission from Scott Becker. I am reprinting it on my site. Becker’s Healthcare is a valuable information site.

Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

Patients, physicians, hospital executives, healthcare insurance executive and government all believe the healthcare system is dysfunctional and unsustainable in future years.

All the stakeholders are unhappy with Obamacare.

Clinical Endocrinologist, Stanley Feld, MD, FACP, MACE, is a physician who believes Obamacare’s business model is seriously flawed. He also believes that Obamacare has accelerated the dysfunction in the healthcare system.

Dr. Feld believes Obamacare has increased the healthcare system’s unsustainability by causing an increase in bureaucracy, a decrease in efficiency and encouraging the gaming of the healthcare system by all stakeholders.

The Obamacare business model must be changed to a consumer driven healthcare business model with the consumer in charge and in the center of the healthcare system, not the government or other secondary stakeholders.

Consumers must be taught and incentivized to use all the 21^st century technology tools available including smart phones. The goal must be to improve medical care and treatment outcomes, not improve the measurement of medical process outcomes.

Dr. Feld became interested in the causes of the healthcare system’s dysfunction in 1991 while he was on the steering committee of a nascent medical organization, the American Association of Clinical Endocrinologists (AACE).

He became AACE’s third President and was chairman of the Type 2 Diabetes Guideline committee. He was the chief author of “A System of Intensive Self-Management of Type 2 Diabetes Mellitus.”

In 1991 there was little government and healthcare insurance industry support for the concept of teaching the Type 2 Diabetics how to be the “Professor of Their Disease” even though there was a Type 2 Diabetes epidemic.

The epidemic was the result of lack of understanding by consumers (patients) of how to prevent and treat Type 2 Diabetes Mellitus. Uncontrolled Type 2 Diabetes causes complications that are coronary heart disease, kidney failure, blindness and amputations. Quality of life of is decreased. The complications are costly to the patients and the healthcare system.

America was in the midst of an obesity epidemic. The epidemic continues today. Obesity predisposes consumers to Type 2 Diabetes Mellitus and its subsequent complications.

Dr. Feld said everyones goal for the healthcare system is to have a healthier population at an affordable price. The goal can be accomplished by putting consumers in control of their health and healthcare dollars. Consumers must also be given financial incentives to control their health. No one is focused on the consumer’s responsibility to lower cost in the Obamacare business model.

Dr. Feld believes Obamacare’s business model has too many faults to repair. Each time President Obama alters the business model to fix a fault, the healthcare system becomes more costly, dysfunctional and unsustainable.

Dr. Feld developed a business model that would accomplish the goal of providing a functional and efficient healthcare system at an affordable cost to consumers, employers, healthcare insurance companies and the government.

Dr. Feld’s business model would eliminate most of the government’s inefficiency that absorbs 40% of the healthcare dollars. The inefficiencies must be eliminated or at least significantly decreased.

Here are Dr. Feld’s five key elements necessary to Repair the Healthcare System.

All the key elements listed are explained in detail in Dr. Feld’s blog “Repairing the Healthcare System”. Each link will have a full list of my blog posts on the topic.

The Ideal Medical Savings Accounts (MSAs).

Dr. Feld’s Ideal Medical Savings Account is the insurance model in his business plan.

Medical Saving Accounts are different than Health Savings Accounts. Health Saving Accounts are the fastest growing healthcare insurance plans. Medical Saving Accounts provide consumers with more financial incentive.

The Ideal Medical Saving Account transfers the premium dollars saved by consumers into a tax-free retirement trust that is not restricted to medical care. The financial incentive will cause consumers to be responsible for the control of their health and wisely spend their healthcare dollars.

The Ideal Medical Savings Accounts are democratic. The employer, the individual or the government could fund the Medical Savings Account. The deductible must be high enough to provide enough financial incentive for consumers to be motivated to become responsible for their health and their healthcare dollars. Once the deductible is reached the consumer receives with first dollar coverage for an illness.

If the deductible is not spent the consumer gets it tax-free in their retirement trust.

Ideal Medical Savings Accounts provide consumers the choice of physician. The environment is created where consumers decide on who will provide the best value for their healthcare dollars rather than the government, the healthcare insurance industry or the government.

MSAs would create a Consumer Driven Healthcare System with the benefit of consumers creating competition among the stakeholders in the healthcare system rather than stakeholders deciding for consumers. For greater details go to this link.

The Importance of Tort Reform

Most politicians have ignored the importance of Tort Reform. They have been led to believe that Tort Reform is an insignificant cost to the healthcare system.

Dr. Feld points to study by the Massachusetts Medical Society. Every practicing physician believes the data of this study. The resulting data is an excellent and truthful indicator of the huge cost of over-testing to prevent malpractice claims.

The lack of Tort Reform costs the healthcare system $200 billion to $750 billion dollars a year as a result of over testing by physicians to avoid malpractice suits.

Physicians who order a test usually do not receive the profit built into the test he/she has ordered.

The Importance of Self-Management of Chronic Disease

The unsuccessful management of chronic diseases results in 80% of the cost of care for those diseases. Most important is to prevent the chronic disease from occurring in the first place. Diseases with the highest costs are Diabetes Mellitus, Heart Disease, Hypertension and Cancer. Obesity and consumer’s genetic makeup are responsible for most of these chronic and costly diseases.

Consumers are in control of the development of obesity. They must be responsible for preventing it. However all of our cultural stimulation encourages obesity. Consumers must make a choice. Government can provide public education programs to help consumers make the correct choice. When consumers are educated and are at financial risk for developing obesity, they will become responsible and avoid becoming obese.

The reformed healthcare system could prevent the onset of complications of these chronic diseases. The cost of the complications of chronic disease is 80% of the cost of treating that disease.

These teams must be an extension of their physicians care and responsible to their physician.

The Magic of the Patient/Physician Relationship.

Obamacare tries to quantify patient care. Twenty thousand rules and regulations have been produced so far to measure the care delivered by physicians to patients.

Maybe the measurement criteria for quality care are wrong? Maybe the government is measuring the wrong thing.

There is no quality measurements made about patients’ compliance or adherence. There are no rules to measure the patient/physician relationship.

These would be important measurements for bureaucrats to measure in order to quantitate the effectiveness of care.

If one wanted to commoditize the delivery of quality medical care, consumer responsibility for compliance with their treatment is an important measurement.

The patient/physician relationship is magical. It can result in improved patient compliance and self-management of both acute illness and avoidance of the complications of chronic diseases. The end result is that it can decrease the cost of healthcare by at least 50 percent. The healthcare system would then be affordable.

As the government and healthcare insurance companies try to decrease their cost they have decreased reimbursement and increased regulations and paperwork for physicians

A physicians work product is intelligence, skill and time. Physicians do not have enough time to develop a patient/physician relationship today.

The patient/physician relationship is difficult to measure. It cannot be commoditized into a universal report that a computer program can generate.

The Rule of Information Technology

Physicians are not opposed to information technology. They are against information technology generating data that is being used as a tool to judge their clinical competence and reimbursement by bureaucrats. Many times the “big data” is inaccurate.

Information technology should be used as a tool to extend a physician’s ability to patients. It should be used as a tool to improve physicians’ care.

In order to reduce the cost of medical care and increase the patient’s ability to be a “Professor of Their Disease”, medical care must be delivered by a team approach.

Information technology must be a part the team with the consumer being in the center. Physicians must be the coach; the other members of the team must be physician extenders (assistant coaches).

There are many websites generating both good and bad information. As the manager of the team the physician and his assistant managers should pick the websites for his/her patients to use.

Physicians and his/her healthcare management teams should develop social networks so his/her patients can relate to each other and learn the subtleties of their chronic disease from each other. Physicians and his patient extenders would monitor and correct any false information generated through the social network.

These social networks would be very effective in motivating consumers to be responsible for their care and their healthcare dollars.

These are five elements that would decrease the cost of America’s healthcare system. They would avoid the trap and unintended consequences of a single party payer system.

The real cost curve has not been bent downward. It has been bent upward in the actual cost to taxpayers. The government is not measuring all the costs, including new taxes, as payment for Obamacare.

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

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Healthcare Spending Increases To 18.2% of GDP

October 27, 2015

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP, MACE

Healthcare spending has increased each year. Healthcare spending is now 18.2% of the GDP up from 17.7% in 2014.

In 2000 it was 14% of the GDP.

The data presented in the following charts are partially correct. They are derived from clams data which are also partially correct. The charts can give an idea on how the healthcare money is

spent. and wasted.

Wasted Money

Drivers of increased Healthcare Spending

Distribution of Healthcare Spending

There are many reasons for this increase. The Obama administration prefers to blame the increasing spending on his most popular reasons.

His reasons might not be completely true.

The traditional media then publicizes the President Obama’s popular reasons. The reasons get translated into public understanding and public opinion.

President Obama’s reasons for the increased healthcare spending are hospitals’ and physicians’ prices are increasing. Hospital and physician retail prices are increases. However, their insurance reimbursement has decreased. Public opinion then demands that physicians decrease their prices.

The reality is physician reimbursement has been steadily declining in recent years as spending has been increasing.

I have continually pointed this out.

Medicare, Medicaid and private insurance have forced physicians to accept lower reimbursement. Patients are increasingly discovering that “my doctor doesn’t take my insurance or my Medicare or my Medicaid.”

Consumers without insurance coverage are charged retail price by hospitals and physicians rather than the discounted prices hospitals and physicians accept.

These consumers can try to negotiate the prices. They are usually more successful with physicians than hospitals.

Decreasing reimbursement is one of the main reasons physicians are driven to see more and more patients in less and less time.

Physicians must continue to pay overhead and salaries.

This phenomenon of increased patient volume disrupts the magic of the physician/patient relationship. It is also the driving force behind the massive increase in concierge medicine.

If it is not the rise in physician reimbursement, what is the reason for the increase in healthcare spending?

There are several possibilities.

GDP is increasing at a lower rate than healthcare spending.
Consumers are sicker. They need more medical and surgical care than previously.
Healthcare insurance premiums are increasing at a greater rate than the GDP.
Bureaucratic support of the healthcare system is growing at a greater rate than the GDP.
Pharmaceutical use is increasing because a sicker population needs more drugs.
RNA Technology has lead to the discovery of more potent therapies that are costly to the healthcare system.

Statistics published by the Altarum Institute in July suggest that President Obama and his fans in the traditional media reevaluate their premises about the rising healthcare spending.

“Out-of-control spending on prescriptions drugs and the soaring cost of health insurance administration continue to be the two major drivers behind rising healthcare costs.”

Healthcare spending grew to $3.3 trillion in this year.

Prescription drug spending increased by 9.2% from the previous year. Part of that increase was the introduction of new drugs.

The Obama administration ignores the fact that more people are becoming sick because of an increase in obesity, diabetes and hypertension. These people now have to take medicine, see doctors, and buy medical devices.

Administration services costs and net costs of health insurance (after paying medical bills) have increased 9.4% from a year ago.

These costs included government bureaucratic costs, insurance bureaucratic costs, out of pocket expenses and insurance premium costs.

How much waste is in all these administrative services costs.

3. Hospital spending rose 6.1% from a year ago. Hospital bureaucracy has been try how to decrease spending by decreasing waste and personal. However, bureaucracy and unnecessary administrators and outrageous hospital executive salaries continue to increase.

Physician and outpatient clinical expenditures rose 5.0%.

Physician investment in medical structures and equipment rose only 1.7%. Physicians are reluctant to make investments in a failing healthcare system.

Each category in the various graphs above reveals opportunities to decrease the cost of medical care.

It cannot be done by the government’s complete take over of healthcare.

The government is the problem as we have seen and still are seeing with the VA Healthcare system.

Socialism does not work. In leads to unintended consequences as consumers adjust to the rules and regulations of an attempt to manage society.

Consumers must demand rule changes and permit the market place to sort things out.

Repair of the healthcare system can only occur in a consumer driven healthcare system with consumers in control of their healthcare and their healthcare dollars.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Why Republicans Need A Viable Healthcare Plan NOW

November 12, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

I have been asked by many of my conservative friends why so many of my liberal friends believe Obamacare is great.

My liberal friends think conservatives are are illogical, callous, spiteful, partisan and soulless. Some even believe conservatives are ignorant.

Obamacare provides coverage for people who cannot get coverage or afford healthcare coverage in the pre Obamacare era. Insurance options and county healthcare system were inadequate for servicing these people.

It turns out that people who need to buy healthcare insurance coverage through Obamacare cannot afford the coverage either.

Even with the illegal subsidies they cannot afford the deductibles.

Obamacare is not the solution to our healthcare system problems. Obamacare is an inefficient bureaucracy that was pasted onto a pre-existing dysfunction and unsustainable healthcare system.

The costs overall are increasing despite the Obama administration and progressives telling us the costs are decreasing. Healthcare taxes have increased the overall federal tax rate to 50%.

Americans have not been provided with the real tax rate increases or unemployed or partially employed statistics since 2009. Yet progressive quote the figures the administration provides as absolute facts.

Americans know something funny is going on because they have less money to spend.

Progressives do not want to understand these consequences. The acceleration of unintended consequences of Obamacare will lead to the economic collapse of the healthcare system as well as the economic collapse of the country.

Progressives want to ignore the effects Obamacare is having on the economy even though only 15 of the 350 million of us are in the individual market and less that 7 million are insured under Obamacare.

Progressives ignore the facts and revert to name calling aimed at conservatives.

Conservatives do not know how to respond. Progressives continue to call conservatives tax adverse, callus, ignorant and for the vested interest of big business.

I try reading and listening both the progressive and conservative media. Progressives play the same theme continuously.

Progressives continuously use emotionally charged examples that anyone would be sympathetic to. At the same time they belittle their “conservative opponents.”

A New York Magazine article by Jonathan Chait entitled, “Yes, the Republican Obamacare Strategy Will Kill People” illustrates my point.

“There is a famous thought experiment called the trolley problem, and it goes like this: A runaway trolley is headed toward five people bound on the tracks. You are standing before the switch that could divert it onto another track, where it would kill only one person. Do you pull the switch?

The problem is a way of grappling with the moral responsibility of actively killing a person for some larger end, a problem that lurks behind much of the role of the state, from policing to Harry Truman dropping the atomic bomb on Japan.”

The reader should not be confused by where this story is going. It is a distraction from the real problems of Obamacare’s healthcare policy and implementation.

“The trolley problem is the most flattering possible way to think about the conservative movement’s fanatical commitment to repealing Obamacare.”

“ That is, if you ignore the obvious elements of partisan spite, callousness, and self-deception, one can posit a commitment to abstract moral principles about the role of the state.”

This sentence serves as an invective against the conservative enemy.

“Conservatives’ abstract principles, like most people, can come attached to specific costs. If they pull the switch and repeal Obamacare, or if they persuade five Republican Supreme Court justices to cripple it, they will spare America from the evils of mandates, taxes, regulation, and what they imagine being European socialist horrors. They will also kill what are now identifiable human beings”.

This sums up progressives’ attack against conservatives. The reader will be convinced that the conservatives are evil, use corrupt tactics and act immorally.

Mr. Chiat ignores the unworkable healthcare policy and economically unsustainable facts.

It is all about character assassination of an opponent. It is a typical Saul Alinsky tactic.

Mr. Chiat then goes on to describe a Washington Post report of a patient (Mr. Tedrow) who without the benefit of Obamacare’s health insurance exchange coverage plus subsidy could not have had a liver transplant. Obamacare saved the patient’s life.

There have been many stories like this published in the traditional progressive media in defense of Obamacare.

The article states that all the Republican Party wants to do is repeal Obamacare and go back the pre-Obamacare dysfunctional healthcare system.

“Republican health-care plan is no better than the pre-reform status quo. Conservatives are within their rights to prefer freedom from taxes and regulation even at the cost of David Tedrow’s well being.”

The New York Magazine article presupposes that a Republican Healthcare Plan will ignore patients like David Tedrow.

“But any morally serious position has to account for the brutal realities embedded in this trade-off. Truman’s war strategy involved killing a lot of Japanese civilians.”

“The Republican health-care strategy is to flip a switch whose immediate effect will be to impoverish and kill a lot of people. Is there a single conservative who will admit this?”

The article also presupposes that Republicans will just flip the switch on the people that need help and kill them.

Republicans must immediately present an understandable healthcare plan to the public that is sustainable and will preserve our freedoms to make our own our healthcare decisions rather than the government choosing for us.

Republican cannot propose tweaks around the edges of Obamacare such as repealing the medical device tax. This proposal will have little effect on repairing the healthcare system.

A reader responding to by last post wrote that describe the writing of a sustainable plan,

“I think you could more simply say this to rally America:

“We must change our healthcare system because its current costs are unsustainable. The only two choices we have is to freely change it by taking more responsibility for ourselves (The American Way) or be forced to do what the Government tells us to do (The Obamacare way).”

“After that, everything else is tactics. Obamacare must be seen for what is it, Government force. It is not healthcare.”

I think the majority of voting Americans, who take the time to think about these things, are aware of the limitations on our freedom to choose and the financial unsustainability of Obamacare.

Americans are aware of the fact that they have been lied to by the Obama administration over and over again. Americans do not trust the Obama administration to make serious healthcare decisions for them.

They do not understand what they can do about it. The President and the congress are supposed to work for us. It is imperative to express your opinion to them.

They understand the progressive spin masters whose only tool is to discredit conservative integrity, thought and intentions.

Republicans must immediately develop and publicize a logical plan will provide universal healthcare for all Americans while maintaining their freedoms.

Americans must be in control of their health and their healthcare dollars even if the government has to supply the needy with healthcare dollars.

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

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