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The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Copywrite 2006-2018
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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
Stanley Feld M.D.,FACP, MACE
Obamacare has failed. You wouldn’t know it by the massive misrepresentation by the mainstream media.
The mainstream impression is that registration during the open enrollment period for 2018 ending December 15,2017 is doing well.
I have not written a blog in about a month because there has been nothing to write about.
I have laid out my ideas about what is necessary to repair the healthcare system. It is all about personal responsibility and physician/patient relationships for both acute and chronic diseases.
It is the only way to control costs and decrease waste in the healthcare system.
Frankly, I am saddened that our representatives in congress don’t give a damn about the costs to the American people.
They simply want Americans to be dependent on government. The government wants to control Americans rather than Americans controlling the government.
Both the Republican and Democratic establishment have been brain dead on how to effectively repair our healthcare system.
Republicans had seven years to figure out an efficient system. The have controlled the house for two terms. They have controlled the senate for one term.
Then they failed. Almost 100 bills passed the house. any passed both houses and were vetoed by President Obama.
Why couldn’t they send one of those bills to President Trump?
Tom Price M.D. had some ideas on how to repair the healthcare system. However he was disposed of by claims of misuse of government funds.
There has been little published since the Republican establishment failed it its effort to repeal and replace Obamacare in November 2017.
It is unclear to me whether the Republican effort failed because it was a step in the wrong direction or the Republican establishment hates Donald Trump.
In any case the Democratic establishment is trying to blame Donald Trump for the Obamacare failure.
They claim it is Donald Trump’s fault the healthcare insurance industry is not being paid the unauthorized supplement President Obama promised but could not pay. He could not find the money.
It is the House of Representative that authorizes expenditures. The cost of those promised subsidies that were unauthorized was 88% short of the healthcare insurance industry’s claims.
The Obamacare cost overruns were gigantic. It must be remembered that the Health Insurance Exchanges only provided insurance for less than 10 million people in the individual healthcare market.
Many factors added to the cost overruns including subsidizes of over $15,000 dollars a year for these premiums in the individual market. The 2018 subsides will be over $20,000.
The healthcare system has become such a partisan issue that the truth about Obamacare’s failure is not the point anymore.
It seems that the Republican establishment is not any smarter than the Democrat establishment in trying to repair the system.
The end of the open enrollment period for 2018 is supposed to be December 15, 2017.
I posted two graphs in this post. One represents enrollment until 11/25/2017 and the second represents enrollment until 12/2/2017.
They bring out several points about Obamacare’s failure.
Seven states of the 39 states have already extended their open enrollment period. California has extended open enrollment until 1/31/2018.
On 11/25/2017 confirmed but not paid enrollment was only 2,660,938 with only 2,277,079 through Healthcare.gov and 383,859 for Medicaid.
Open enrollment projected for 11/25/2017 was 4.2 million with 2.6 million through Healtcare.gov. and 1.6 million through Medicaid.
These projected numbers were revised upward during the summer of 2017 to 4.6 million with 2.8 million through Healthcare.gov and1.8 million through Medicaid.
This represents a 500,000 person enrollment short fall for healthcare.gov. It also must be remember that 85% of the people enrolling through healthcare.gov have preexisting illnesses and are subsidized by the government.
The open enrollment numbers look worse on December 2, 2017 although there is not a word of it in the mainstream media.
On 12/2/2017 confirmed but not paid enrollment was 3,491,164 with only 2,751,260 through Healthcare.gov and 709,904 for Medicaid.
Open enrollment projected for 12/2/2017 was 5.1 million with 3.5 million through Healtcare.gov. and 1.6 million through Medicaid.
These projected numbers were revised upward during the summer of 2017 to 5.8 million with 4 million through Healthcare.gov and1.8 million through Medicaid.
This represents a 1,248,840 (4,000,000-2,751,260= 1,248,840) person short fall for healthcare.gov with 13 days to go for the open enrollment period.
It is difficult seeing these numbers by casually studying these charts.
Obamacare is an unmitigated failure. Democrats want to throw more money at it.
Republicans do not know what to do.
I suggest they look at my blog entitled The Ideal Medical Saving Accounts are democratic.
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
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.”
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. “
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.
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.
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
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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It has become clear to me that both the Democrats and the Republican establishment had no intention of repealing and replacing Obamacare.
Democrats had no intention of repealing or replacing Obamacare because. President Obama is their hero. In fact, he has made the most progress in putting America on the road to a European socialist state.
The problem is European socialism has failed. Europe is much closer to bankruptcy than America is.
Democrats also had no intention of offering any suggestion to Donald Trump to fix Obamacare. Why? They want to destroy his presidency.
Donald Trump is a direct threat to the cushy swamp both the Democratic and Republican establishment has built over the last 50 years.
In addition to this neither, the Democrats nor the Republicans understand the medical care system.
Neither party has a clue about the importance of the physician patient relationship.
Donald Trump represents a direct threat to the Republican establishment’s power over consumers. They too want to destroy his presidency. However, it is essential that the Republican establishment’s goals are not obvious to the public.
Neither party wants to empower the consumers. I believe in order for healthcare reform to be successful it must be consumer driven.
The goal of congress is to focus on making consumers dependent on the government through government control of the healthcare system.
It is strange that one or two people have been positioned to control the Republican Party. The tea party members of the senate are slowly replacing the Republican establishment.
I am afraid that in the next six months Obamacare is going to become unraveled to the grief of the public.
According to the Democrats the only solution is to paste it together and pour money into a single party payer system because “it works!!” in Europe and Canada.
A single party payer system really doesn’t work from and financial and quality of care point of view when studied carefully. In all the countries using with a single party payer system the system appears to work as it plunges each country into further debt.
I have tried to encourage a consumer driven health care system to replace the system controlled and dominated by the government. The government has given the healthcare insurance industry the ability to profit as a result of government bureaucratic inefficiency.
Only a market driven system at the expense of the insurance industry’s profit and government control of Americans’ freedom to choose will work.
I have outlined this system in detail in my blog. All one has to do is read the summary category of the blog to understand the system.
He makes very important points that support my ideal medical saving accounts.
His problem is he does not recognize the fact that congress is not interested in creating an efficient system.
It is important to most Democrats and some Republicans that government control the healthcare system.
My view is that with the tremendous increase in obesity and the resulting increase in chronic disease the cost of healthcare is going to increase markedly over the next decades.
In order to reduce the cost of care government should concentrate its energy in lowering the cost of care by reducing obesity in America. This will decrease the onset of chronic diseases and in turn decrease the cost of medical care.
It can be accomplished by giving patients at all income levels financial incentives to become responsible for their health and healthcare dollars.
Scott Atlas’ article in the Wall Street Journal covers most of the points I have made in the past.
I am happy that someone is starting to agree with my solution.
Mr. Atlas is correct when he says;
“But their whole focus (in the healthcare debate) has been wrong. The debate centered, like ObamaCare, on the number of people with health insurance. A more direct path to broadening access would be to reduce the cost of care. This means creating market conditions long proven to bring down prices while improving quality—empowering consumers to seek value, increasing the supply of care, and stimulating competition.”
I have been saying this for years. However congress has refused to listen.
“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 critic’s 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.
An internet site could help like Tire Rack site teaches people how to shop for tires.
At present consumers have no incentive to shop prices.
If they had a financial reward to shop prices they would not overuse the healthcare system.
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.
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.
“ 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 easily be identified as outliers. Their problems can be dealt with separately. The majority of the consumers should not be penalized for the small percentage of outliers.
“Giving consumers an incentive to consider price when seeking such care would make a huge difference in the cost of medical care.”
Obamacare provided no incentives to save money.
“ObamaCare moved in the opposite direction, shielding consumers from having to care about prices. Its broad coverage requirements and misguided subsidies encouraged bloated insurance policies, furthering the misguided idea that the purpose of coverage is to minimize out-of-pocket costs.
When the insurer picks up nearly the entire tab, patients have little reason to consider costs, and doctors don’t need to compete on price.”
Effective healthcare reform would put patients in charge of their own spending. It would provide a way for consumers to concentrate on being well while giving them a financial incentive to pay less for their healthcare coverage.
Finally someone has seen the wisdom of creating a system of having consumers to be in charge of their health and healthcare dollars.
I have provided a system of healthcare that for a consumer driven system.
Mr. Atlas outlined such a system that matches my system of a consumer driven healthcare system using my ideal medical saving account.
It is unfortunate that our elected congressional establishment has no interest in empowering consumers to control the healthcare system even though it would decrease the cost of healthcare markedly.
The establishment is terrified of Donald Trump and his notion for empowering consumers.
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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Stanley Feld M.D.,FACP, MACE
Why am I opposed to a single party payer healthcare system?
I am concerned about America’s $20 trillion dollar deficit and $180 trillion in unfunded liabilities.
I am also concerned about China being a reliable buyer of American debt.
The deficit should be viewed as a house of cards that might crumble at any time.
Our country has suffered a massive increase in the deficit the last eight years under Barack Obama and Obamacare. The public knows the debt has increased at lease 1 trillion dollars a year.
No one has seen a good accounting the deficit increase. Everyone knows we have had massive inflation even though we have been told that inflation is only one percent.
The public knows Obamacare is imploding.
The public knows about the waste incurred during the Obamacare website roll out and the scandalous contracts to venders. The public knows about the massive increasing in insurance premiums and the massive subsides that were not anticipated.
The Democrats that the people have elected to congress do not seem to care about the deficits created. Now, we have finally realized that the Establishment Republicans do not seem to care about Obamacare failures either.
These officials do not care how much money the government wastes on bad deals at all levels of the economy. Obamacare has made terrible deals with the insurance industry, the pharmaceutical industry and hospital systems.
It has not made a good deal for the middle class or their primary providers namely physicians.
I do not think American healthcare policy makers or congress can afford to make another mistake.
Winston Churchill’s famous quote about Americans stands out here.
“You can always count on Americans to do the right thing after they’ve tried everything else.”
America cannot try something that is destined to fail. Socialism, especially in healthcare, does not work. Our government officials refuse to believe this even though it is demonstrated by our own failed entitlements such as the VA Healthcare System, Medicare and Medicaid.
Government officials refuse to believe that the socialistic universal healthcare systems in the rest of the world are unsustainable.
Britain is the perfect example of this as the system is crumbling.
Socialism does work in the long term.
Winston Churchill said it again.
The key to the solution of the healthcare system problem is to provide incentives to all the stakeholders, especially the consumers.I believe “My Ideal Medical Saving Account” will work to provide universal coverage at an affordable cost.
America does not need a healthcare system that makes consumers dependent on government. It needs a system that makes them independent of government.
Butch Mazzuca is a local Vail Valley Resident who wrote this article about socialism and the healthcare system that appeared in the Vail
Valley News on July 9, 2017.
Mr. Mazzuca has given me permission to republish his article.
“When it comes to socialism, will they ever learn?
http://www.vaildaily.com/opinion/vail-daily-column-when-it-comes-to-socialism-will-they-ever-learn/
Editor’s note: Find a cited version of this column at http://www.vaildaily.com.
“Several weeks ago on ABC’s Sunday morning talk show “This Week,” Senate Minority Leader Chuck Schumer told host George Stephanopoulos, “The democrats need a strong, bold, sharp-edged and common-sense economic agenda. … That’s what’s been missing.”
So I find it a bit ironic that seven months after losing the 2016 presidential election, Schumer feels the Democratic Party is still struggling to articulate a coherent message. Meanwhile, the Bernie Sanders-Elizabeth Warren wing of the party delivers a very clear message. Unfortunately for their constituency, it’s about a failed ideology — socialism.
Sanders and Warren are advocates of redistributing wealth; lax immigration rules, governmental intervention into health care, energy and business; and the acceptance that Washington should be the final arbiter of all problems.
SOCIALISM HAS INHERENT DEFECTS
While socialism is antithetical to the ideals of the Founding Fathers, it tends to gain its strongest support among the young and those who are uninformed. On the surface, socialism sounds great; it has always sounded great and will continue to sound great within certain precincts. The only problem with socialism is that history exposes it as a bankrupt ideology.
But rather than describing socialism’s failures tenet by tenet, the following apocryphal story illustrates socialism’s inherent defects in an easy-to-understand way.
An economics professor at a local college made a statement that he had never failed a single student before but had once failed an entire class. The class insisted that wealth redistribution, aka socialism, worked because then no one would be poor and no one would be rich — a great equalizer.
The professor then said, “OK, let’s try an experiment.” Henceforth, all grades would be averaged; everyone would receive the same grade, and no one would fail.
After the first test, the grades were averaged and everyone received a B. The students who studied hard were upset but the students who studied little were happy. As the second test rolled around, the students who had studied little now studied even less and the ones who studied hard decided they wanted a free ride, too, so they too decided to study little. The second test average was a D.
Now no one was happy. When the third test rolled around, the class average was an F; and from that point forward, the scores never increased, as bickering, blame and name-calling all resulted in hard feelings with the result that no one would study for the benefit of anyone else and the students all failed the class.
The professor then told them socialism as a form of government always fails because of human nature, i.e., when the reward is great, the effort to succeed is great, but when government takes the rewards away, no one will try to succeed.
HUMAN NATURE IS PART OF IDEOLOGICAL EQUATIONS
Similar to the aforementioned students, the far left consistently overlooks the fact that human nature is part of any ideological equation. They fail to understand that socialism has never and will never work because it’s based on a premise that’s inconsistent with human behavior.
When people work, they expect to be compensated commensurate with their effort and skill level. And capitalism does that more effectively than any economic system yet devised by man. Capitalism provides an incentive for people to achieve because they know their efforts will be rewarded.
Conversely, socialism is a disincentive to achievement because people also know their work is valued only collectively, rather than being valued individually.
Quote of the day: “The inherent vice of capitalism is the unequal sharing of blessings; the inherent vice of socialism is the equal sharing of miseries.” — Winston Churchill.”
Butch Mazzuca, of Edwards, writes regularly for the Vail Daily. He can be reached at bmazz68@comcast.net.
Our politicians should stop fooling around with America’s healthcare system, our fiscal viability, and the welfare of our citizen.
It is time to try something that will work, and not another thing that is doomed to failure.
Elizabeth Warren and Bernie Sanders, you are both dead wrong.
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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I am coming to the conclusion that the Republican establishment does not want to Repair the Healthcare System.
The Republican establishment has the same goal as the Democratic establishment.
Recently the mainstream media is saying that a single party payer system is looking good.
Neither party has any interest is having consumers control their healthcare dollars. It looks as if both parties want the government to control the consumer’s healthcare dollars.
All the politicians ignore the fact that government control is unaffordable. It also ends up not working.
The best example is the bureaucratic VA Hospital System and its system wide corruption.
A reader wrote:
“I have read your last blog post carefully and agree with many of the points put forward but there is a glaring omission.”
“How are patients supposed to be responsible for their healthcare dollars when there is absolutely no transparency and no consistency in pricing.”
The lack of transparency is a major defect in our present healthcare system.
Only 20% of consumers use the healthcare system at any one time. Eighty percent of the consumers have not run into the lack of transparency problem in the healthcare system.
Most consumers do not care about transparency because they have first dollar coverage provided by their employer. They think their medical care is free. They believe they have excellent healthcare insurance.
President Obama took care of that notion with Obamacare. The defective structure of Obamacare caused healthcare insurance premiums and deductibles to skyrocket. First dollar healthcare insurance became too expensive for most employers.
Employers stopped providing first dollar coverage. Middle class employees are now noticing that out of pocket expenses have made their healthcare insurance unaffordable. Consumers have tried to compare prices of competitive providers. They have discovered that it is impossible!
Consumers are becoming aware of the lack of transparency. They have been astonished by this lack of transparency.
There is nothing in the new Republican bill that addresses Republican politicians’ awareness that the lack of transparency is a major defect in the healthcare system.
The lack of transparency is only one of the major defects in our healthcare system.
There is nothing in the Republican bill that speaks to the consumers’ responsibility for their health and healthcare dollars. Consumer driven healthcare is completely ignored.
There is nothing in the bill that addresses effective tort reform. The Massachusetts Medical Society survey showed that defensive testing to avoid lawsuits costs the healthcare system between $250 billion to $700 billion dollars a year.
The lack of the development of systems of care for chronic diseases cost another $700 billion dollars a year that our healthcare system does not address. There is nothing in the bill that emphasizes this very important defect in the healthcare system.
The Republican establishment thinks consumers are too stupid to take care of themselves.
The mainstream media likes to tell us that people love entitlements. The public does not want to give up these entitlements.
My question is how come less than 9 million people signed up for Obamacare’s individual healthcare plans last year if they love entitlements?
It is because they cannot afford to buy the health exchange insurance even though 85% of the premiums of those 9 million consumers are subsided by the government. Their high deductibles are not subsidized.
The Republicans are going claim they are promoting health savings accounts. The public is not told the amount of money they can put into a health savings account or whether it will provide first dollar coverage over that amount if they get sick.
There is no financial incentive for consumers to be responsible for their healthcare or their healthcare dollars.
My Ideal Medical Saving Account is a much better idea.
These are only a few of the major defects in the Republican establishment’s concept to fix the healthcare system.
President Obama did some of the awful things to Obamacare through rules and regulations after certain vested interests complained about the law. Obamacare’s rules and regulations have to be eliminated
There were crony waivers that would make one’s blood boil. In fact, elected congressional members got the best exemptions.
It is becoming apparent that congress doesn’t want to fix the healthcare system for the majority of Americans. The congressional establishment wants to control consumers.
Socialism does not work!
Our political establishment does not tell us about the economic result in other countrys’ single party payer universal healthcare systems.
We don’t have to go to other countries. We only have to go to the indigent areas in California were everyone is covered by Medicaid.
The Republican establishment needs to get off the stick before all of them are kicked out of congress.
Just imagine the healthcare systems savings if every consumer were empowered to shop for the best healthcare at the best price.
The result would be a free market healthcare system in which competition would cleanse the system and make it affordable to everyone.
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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A reader sent me the following comments.
“Sorry Doc,
I like and Highly respect you, but You are Wrong:
My Ideal Medical Savings Account is essential. OK BUT WHAT ABOUT THOSE THAT LITERALLY LIVE PAYCHECK TO PAYCHECK??? How are these Americans going to start and contribute to MEDICAL SAVING ACCT?
Patients must be responsible for their care and healthcare dollars. WHAT ABOUT THOSE CHILDREN AND SENIORS DISABLED—-HOW WILL THEY DO SUCH?”
There are many problems with the healthcare system. It has become unaffordable and inaccessible. The expansion of entitlement programs usually makes the problems in the healthcare system worse.
Healthcare policies should be introduced to solve problems in the healthcare system and not expand them.
Innovative systems and software need to be developed to fix the problems. Just think of the revolutionary way the IPhone changed the way we communicate in the last ten years.
Our healthcare system can be changed in a way that promotes free choice, improves the quality of care and reduces costs.
Our healthcare system has become unaffordable and unworkable for many of its stakeholders. The most important stakeholder is the patient.
This reader has misinterpreted my arguments in favor of My Ideal Medical Savings Account.
The expansions of entitlements has proven to be unaffordable and ineffective in the past.
In the present Republican healthcare bill to repeal and replace Obamacare people who live from paycheck to paycheck will be eligible for a tax credit that is paid to them in advance. This will allow them to have money to pay for their Medical Saving Account.
If the government subsidizes consumers in this way consumers will not only have the money to pay for their medical care they will also have first dollar coverage above the deductible amount provided by the tax credit.
My Ideal Medical Saving Account convert indigent patients from a complete entitlement program (Medicaid) toward a system where patients would be responsible for their care. Patients would try to conserve their healthcare dollars.
If indigent patients save money on their healthcare coverage they will receive the unspent money in a retirement trust account.
Consumers will have the incentive to stay healthy or be treated appropriately and not overuse the healthcare system. This is the way to My Ideal Medical Savings Account can apply to the indigent and consumers of all income levels.
Essential to Medical Savings Accounts are all prices must be transparent. This is where effective software comes in.
The definition of a tax credit in this context is different than applying a tax credit to income earned. If a consumer is eligible to receive a tax credit he receives the money directly from the government to pay for his Medical Saving Account.
The positive effect to the healthcare system is that if the individuals take good care of themselves and are responsible for their health and healthcare and their healthcare dollars they will not end up in the Emergency Room or hospital and spend a lot of their deductible money.
They will have money left from the tax credit given to them by the government. The money is their money and will go directly into a retirement trust fund. The leftover money is not saved to be spent on future healthcare needs.
This financial incentive will keep the cost down for consumers and the healthcare system.
Please read my blog “My Ideal Medical Saving Accounts Are Democratic” carefully.
In the Medicaid entitlement program for the indigent and disabled consumers do not have a financial incentive to be responsible for their health and healthcare dollars. With Medical Savings Accounts there is a financial incentive for consumers to be responsible for their health and healthcare dollars.
“The Ideal Electronic Medical Record is essential. YES BUT SOME CAN BE HACKED SO HOW EFFECTIVE WOULD IT BE?”
When going to a Clinic or hospital consumers automatically sign a consent form for the release of medical records. When buying a healthcare insurance policy consumer sign a similar release of medical records form.
Medical records are not as private as we all would like them to be.
It is the Ideal Electronic Medical Record’s software developer who is responsible for developing medical records that cannot be hacked. Americans have been cautioned about computer privacy since 1980. The problem has not been solved yet.
Most of the electronic medical records that are bought by physician offices and hospital systems are from private vendors. The software is expensive and cannot do everything it is supposed to do including protecting the patient’s privacy rights.
The ideal medical record should provide an educational experience to physicians. Presently the software available does not do this.
The EMRs provide a surveillance tool for the government and the insurance companies to judge patient care.
The government should build an un-hackable software system that resides the cloud. Physicians and hospitals should pay for it by the click. It should provide an educational experience for physicians in order to improve patient care. It should not be used as a punitive tool
We have been told over the years that the VA Hospital System has an excellent EMR. Why is the VA Hospital System switching to Cerner’s EMR? Cerner’s EMR has all the defects of commercial EMRs
Cerner’s EMR is not an Ideal Electronic Medical Record. The company probably obtained the government contract because of its political connections.
“Patient education must be an extension of their physicians’ care. ABSOLUTELY BUT IN ENGLISH NOT MED TERMS!”
This is the reason the healthcare system must be consumer driven with community social networking.
If a physician does not satisfy the community he practices in, consumers will know about it quickly through community social networking. They will then have the choice not to use that physician.
If the government, healthcare insurance companies and physicians will not provide the necessary transparency in the system, consumers must.
“A team approach to chronic disease management must be adopted with the patients becoming the professor of their disease.”
AHH But When a patient Tries to Educate themselves on Such—THE INTERNET HONESTLY HAS CONTRADICTING INFO!
I KNOW THIS ONE PERSONALLY AS I HAVE BEEN RESEARCHING FOODS AND INFO ON HIGH CREATININE LEVELS!
MY CREATININE LEVELS ARE HIGHER THAN NORMAL, but there is so much Contradictory Info out there—
-I.E. Should I EAT UNSALTED NUTS OR NOT EAT NUTS> SHOULD I EAT BLAND WHITE BREADS OR THE MORE HEALTHFUL MULTI GRAIN AND WHEAT BREADS!!! And Should I consume Lean Meats and Poultry or NOT! Some say yes, others say No!
Patients’ cannot educate themselves by solely using the Internet. The educational process has to be through their physician and his healthcare team’s selected Internet sites.
The team should pick the Internet resources it wants the patient to use. The appropriately chosen Internet sites should be used as an extension of the physician’s care. Consumers should be confident of the information source picked by their physician and his healthcare team. It will also enhance the physician patient relationship
“Hence on some of the issues you wrote I slightly agree with, but over all you fail to consider the Poorer Americans and that not all Americans have intelligence to research or are too disabled to RESEARCH!”
I believe that everyone should be responsible for his or her medical care and medical education. Ever the poorest people can be responsible for their care and can be educate.
Many social agencies exist to help poor people be responsible for themselves.
Individual responsibility and initiative is the principle that has made America great. If a person is not capable of being responsible for himself, artificial intelligence systems could be developed to help this very small percentage of the population survive and thrive.
Entitlements and dependence on the central government by all is what President Obama wanted. It simply results in more debt and a weaker society.
There are many problems in our society. We have to start somewhere with good ideas to invigorate all levels of society.
I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.
It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.
Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.
People like entitlements because they are free. Someone else is paying for them.
Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.
“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.
Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”
The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.
The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.
Congress needs the healthcare insurance industry’s ability to provide administrative services whether it is for Medicare, Medicaid, health insurance exchange coverage (Obamacare) or private insurance.
The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.
President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..
Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.
The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.
Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.
Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.
It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.
They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.
The fact is single party payer systems do not work for all the stakeholders.Both Democrats and Republicans are missing the essential point about what would work to provide an affordable healthcare system that aligns the incentives of all stakeholders.An essential element is to develop a system that encourages consumers of healthcare to be responsible for their health and have control over their healthcare dollars.
The Senate’s present revision does not consider this. The Senate is considering the needs of the healthcare insurance industry and not the needs of consumers.
The Senate should be considering the following in order to repeal and replace Obamacare.
Self-management of chronic disease is essential for a healthcare system to become affordable. My Ideal Medical Saving Account provides that financial incentive.
1. The Ideal Medical Saving Account will provide instant adjudication of medical care claims.
http://stanfeld.com/chronic-disease-management-and-education-as-an-extension-of-physicians-care/
http://stanfeld.com/social-networks-patient-education-and-the-healthcare-system/
The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.
The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.
Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.
The house bill to repeal and replace Obamacare touches on some alignment.
The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.
The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.
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
Please have a friend subscribe