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And you think we have problems ?

June 6, 2006

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Stanley Feld M.D. FACP, MACE

Canada has been very proud of its government directed single party payer Healthcare System. Everyone in Canada automatically has health care coverage. The system in Canada has been compared to the American Healthcare System. The impression through the media has been that Canada’s System is what an effective healthcare system should be However, last year, the Canadian Supreme Court ruled that people of Canada should be entitled to buy private health insurance. Prior to the Supreme Court decision, a choice of private insurance was forbidden.

The headline in The National Post of Canada on Saturday June 3, 2006 read,

“51% say private care OK”.

The Supreme Court decision has brought the argument about the purchase of private healthcare insurance into public debate. A percentage of the population has been dissatisfied with the Medicare system for a long time. However, no one talked about it. In theChaoulli decision, the Supreme Court declared Quebec’s ban on private health insurance is unconstitutional.

A survey of 3,000 Canadians brought out some incredible opposing opinions. Fifty-one per cent of respondents identify with the statement “If we are unhappy with the service we receive from Medicare, we should have the right to spend our
own money to buy health care outside the public Medicare system.”

49% believe that “when it comes to health care, everyone should be equal and no one should be allowed to spend their own money to get better services.”

An overwhelming majority of respondents believe the government should focus on making the public system better so no
one feels any need to pay for private health care. This is a clear indication that there are endogenous defects in the single party payer government directed healthcare system in Canada.

The identical sentiments are prevalent in England. The Hillary Clinton “Healthcare Reform initiative”
advocated a single party payer system similar to the Canadian system. The advantages of both the Canadian system and British system were widely quoted at that time.

Why is our system and their system creating such discomfort among patients and physicians? One is supposedly a private system (United States Healthcare System) and one is a government run system (Canada). The answer is obvious to me. Each of them limits access to care.

A system that is truly market driven, and lets the patients exercise control over their choice of care would be a system that would work. If the patients were responsible for their care and had control of their own healthcare dollars the defects in the system would be their responsibility.

The answer is found in examples in the retail arena. Wal-Mart and Target have done so well because they sell quality products at a transparently affordable price. If the quality decreases or the price is too high, people will switch to a different vendor. Why has Target done better in the clothing area than Wal-Mart? Target has better quality and style at about the same price! Target figured out how to get a competitive advantage. Wal-Mart is presently redoing the clothing section of its business to compete.

People are not stupid. They know when their freedom of choice and access is restricted. When freedom is restricted the people react; hopefully our politicians respond. If things get bad enough, people will elect different representatives.

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Healthcare Policy in The Post Truth Era

January 4, 2020

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Healthcare Policy in The Post Truth Era

Stanley Feld M.D.,FACP, MACE

The government has been deficient in trying to do anything to Repair the Healthcare System.

Unfortunately, John McCain’s vote blocked the repeal of Obamacare which froze any progress. His reason was feeble and politically naïve.

John McCain wanted congress to work together and have bipartisan agreement on healthcare reform. The entire majority of the present House of Representatives has no desire to be bipartisan or help President Trump create or pass any bipartisan legislation.

Democrats in the house only want to impeach the president. They have no time for positive legislation to repair the healthcare system.

I believe the Trump administration has the right idea.

President Trump and his administration have decided to make structural changes to the healthcare system by executive order until it can make big legislative changes. Their hope is they win a more cooperative Congress in 2020.

We are living in a Post-Truth era.

“Post-truthpolitics(also called post-factual politics^[1]and post-reality politics)^[2]is a political culturein which debate is framed largely by appeals to emotion disconnected from the details of policy, and by the repeated assertion of talking pointsto which factual rebuttals are ignored.

Post-truthdiffers from traditional contesting and falsifyingof facts by relegating facts and expert opinions to be of secondary importance relative to appeal to emotion. While this has been described as a contemporary problem, some observers have described it as a long-standing part of political life that was less notable before the advent of the Internetand related social changes.”

https://en.wikipedia.org/wiki/Post-truth_politics

The media is the message. Donald Trump threatens the Democratic Party, the bureaucracy and the traditional mainstream media. He also threatens some of the Republicans.

He is a crude speaking person from Queens, New York. He has been called a brawler by some. He says he never starts a fight. He fights back. Many say he fights back in an unappealing way.

He says his goal is to drain the swamp. We have all gotten a glimpse of the inefficient and at times corrupt bureaucracy within our government. We can see the swamp’s depth only because of the Internet and the availability of alternate news opinions.

President Trump is working hard to streamline and increase the efficiency of the ever-expanding bureaucracy. He is a direct threat to their well-being. This is their justification for hating him.

The traditional mainstream media has promoted the Democrats’ agenda. They have helped obstruct President Trump’s agenda. The media has ignored or criticized the continual successes of President Trump.

It has either published disinformation or misinformation, ignored critical thinking on issues, or simply published non-truths.

President Trump has had no choice. Obamacare remained the law. It has been expensive and unsuccessful. It is impossible to know its yearly cost to the federal government. It is self-imploding and will disappear shortly.

Obamacare has just completed its open enrollment period for 2020. The enrollment period is supposed to end on December 15^th. The Obama administration extended it to March 31 during some enrollment years. The Trump administration has extended the 2020 open enrollment period until December 31, 2019 this year.

85% of people who enrolled in Obamacare have a preexisting illness. The Obama administration has subsidized most of the premiums. It did not subsidize the deductibles. Obamacare participants still could not afford to pay the deductible. In essence, participants have no healthcare insurance because they could not afford to use it.

Open enrollment as of December 7, 2019, was awful.

http://acasignups.net/blogs/charles-gaba

There are only 6,134,477 who have enrolled in 2020 compared to 16.1 million enrollees in 2014. Medicaid was expanded by 9.3 million in 2014. With the Medicaid expansion, a total of 25 million people received insurance in 2014.

Medicaid is a single party payor. It is inefficient. It has a problem getting physicians to participate because reimbursement does not cover most physician’s overhead.

President Obama decided to have the federal government pay over 90% of the state-run Medicaid programs for a few years. The states, which signed up for the Medicaid expansion, did not have an increase in costs.

When states have to start paying more for the Medicaid expansion, they will have to raise taxes because by law they cannot have a budget deficit. At the moment most of those states have unauthorized budget deficits. Those deficits will become worse when they have to fund expanded Medicaid.

The mainstream media and Democratic congress continually publish the figure that Obamacare has decreased the uninsured by 20 million. However, eleven million were that result of the expanded Medicaid program.

2014

The numbers do not match. The government graphs are complex and confusing. However, they are very informative. The graphs tend to confuse us with estimates and actual enrollees.

In 2016 the numbers decreased to 9.3 million with open enrollment extended to February 1, 2016

2016

Medicaid enrollment increased in 2016 to 15.3 million. The Medicaid increase is included in the total number of previously uninsured, Obamacare provided healthcare insurance. Obamacare’s increase in previously uninsured is, in fact, an expansion of Medicaid. The mainstream media use the number 20 million newly insured patients which is a misleading justification for fixing Obamacare. Some of Medicaid’s increase enrollment could represent the illegal immigrants who are now entitled to healthcare coverage.

The net Medicaid increase since March 2010 in 2016 was 16.3 million. It looks like Obamacare’s goal was to increase Medicaid. The next step is to have “Medicaid/Medicare for All.”

2018 remained the same as in 2016, with many more dropouts because people realized Obamacare’s unaffordability. Since it was unaffordable, they realized they could not afford care event thought they paid their premium. Therefore, they dropped out and stopped paying their premiums.

2020 has been the expected disaster. Consumers needed relief from the Obamacare disaster. Obamacare has caused a further increase in dysfunction in an already dysfunctional healthcare system for people insured by Medicare, Medicaid and Private Healthcare insurance.

Everyone is dissatisfied.

Only 6.1 million consumers have enrolled in Obamacare for 2020.

President Trump is hoping that after the 2020 election, he will have a friendlier Congress. Obamacare will be repealed. Congress will want to do something to help him repair the healthcare system. Meanwhile, he can only do some structural changes to lead us on the path toward an affordable healthcare system.

I predicted Obamacare would eventually fail when it was passed in 2010. Obamacare did not align stakeholders’ incentives!

Obamacare was destined to become unaffordable to consumers, the states and the federal government.

Bernie Sanders’ and Elizabeth Warren’s “Medicare for All” will suffer the same fate as Obamacare.

Most of all the taxpayers in the nation will suffer the most.

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

Copywrite 2006-2020

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People Are Not Stupid

February 22, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System

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Stanley Feld M.D.,FACP, MACE

The next time I hear that people are stupid I am going to scream.

The next time I hear Bernie Sanders saying college education should be free, and medical care should be free I am going to scream.

The next time I here that the healthcare insurance industry is losing money I am going to scream.

How can the healthcare insurance industry be losing money when insurance executives receive these salaries?

Does the healthcare insurance industry think we are stupid?

The healthcare insurance industry loads premiums with all kinds of expenses.

There are hundreds of insurance executives making a million dollars or more a year reporting to each one of the above chief executives in each company.

There are hundreds of empty office buildings owned by the healthcare insurance industry. These buildings pay rent to the subsidiaries of each insurance company.

Those rents are an expense and are used to justify to state and federal regulators the reason for increasing insurance premiums yearly. Claims adjustors who previously occupied those buildings have been replaced by computer software.

Those buildings are empty but are still considered an expense by state and federal regulators.

The more money the taxpayers are forced to pay for healthcare premiums the more the healthcare system uses in its inefficient bureaucracy.

It is estimated that the healthcare insurance industry takes 40% out of every healthcare premium dollar for expenses. Many expenses are paid to subsidiaries of each company. Each subsidiary generates a profit that helps pay the executives’ inflated salaries.

The insurance company’s actual profit is not the 3% that is claimed.

This behavior by the healthcare insurance industry and state and federal regulators is enough to make a guy like Bernie Sander mad as hell.

In turn he has made all of his Democratic followers mad as hell. Something should to be done about this healthcare insurance industry rip off.

What is Bernie Sanders going to replace the present system with? Bernie Sanders will tell us healthcare coverage is going to be free as he replaces the present healthcare system with a healthcare system that will provide more money to insurance companies in order to provide the administrative services.

He is propagating a lie and he knows it.

Healthcare coverage will never be free.

Nothing is free. Taxes will increase to unbearable levels as beauracratic inefficiencies increase.

The taxpayers get it. All they have to do is look at the VA healthcare System.

The government cannot provide the administrative services in a universal healthcare system. The government will have to outsource the administrative services to the healthcare insurance industry.

The government will provide an increased opportunity for these companies to abuse the taxpayer even further.

I always hear that Medicare for all is the answer. That it is a single party system that works. Yes, it works for the beneficiaries. However, it is unsustainable. Most experts agree that is unsustainable for the government and the taxpayer.

It is an irrational thought that Medicare work for all at an affordable cost for everyone. Bernie Sanders should be smart enough to know it. The taxpayers are smart enough to know it.

Taxpayers are demanding that our politicians stop trying to feed us Kool-Aid.

The only way to fix the system is to replace it with a system that demands that the people are responsible for their health and their healthcare dollars.

On the other side, big governments entitlement programs are out of control. People can play our entitlement system so hard that it does not pay to look for work. The article below is unbelievable.

America has come to an interesting juncture. Both the right and the left take advantage of the systems provided by big government.

There is massive abuse on both the right and the left. The abuse is so great that it has proliferated so that the ethic of everyone working hard at a job is evaporating.

The loser is the middle class hard working taxpayer who is paying for all the abuse in the unsustainable systems that have been created.

The Obama administration either does not know what to do or doesn’t want to do anything. Once we experience economic collapse the government can take over.

I believe it knows exactly what it is doing. The Obama administration is changing America as promised. The administration is pushing us on to the Road to Serfdom.

For this reason alone we have to throw the bums out and elect new people who will help us get back to economic growth and the American hard work ethic.

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

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President Obama’s “Noble Lie”

November 20, 2013

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The Obama administration has been riddled with multiple scandals such as Fast and Furious, IRS, Benghazi, the red line on Syria, saying he is protecting Israel’s back, NSA and now the Obamacare roll out.

Bob Woodward on the Chris Wallace Show on November 18^th said he was not impressed with President Obama’s lie about Americans keeping their own insurance and their doctor if they like him.

To paraphrase Bob Woodward’s comment he said President Obama’s goal was to do something Noble for the American people. He wanted to provide insurance for the 30 million uninsured Americans.

My impression is Bob Woodward was forgiving President Obama’s “Noble Lie.” He moved on to the disastrous rollout of the Obamacare web site.

http://youtu.be/gVp54E18NFU

I was floored.

I thought about Bob Woodward’s statement for a long time. His statement reminded me of Plato’s Philosopher King.

My humanities teacher at Columbia College, Gilbert Highet ,was obsessed with Plato’s concept of the “Noble Lie.”

Gilbert Highet believed it is the duty of the intellectual to support freedom and defend pluralism.

He emphasized that the concept of the “Noble Lie” was exactly what the American founders rejected in the Declaration of Independence, the Constitution and the Bill of Rights.

The very next day one of my readers sent me an article by historian and author Arthur Herman ("The Cave and the Light: Plato Versus Aristotle, and the Struggle for the Soul of Western Civilization) concerning Plato’s “Noble Lie.”

He wrote,

“Thomas Jefferson once confessed to John Adams that he had been rereading Plato’s "Republic" and “laid it down often to ask myself how it could have been that the world should have so long consented to give reputation to such nonsense as this,” including the notion of the Noble Lie.

They knew rulers, no matter how well educated or experienced, actually have no superior knowledge to ordinary people, because they all understand and judge reality at the same level.

That’s why Noble Lies aren’t just wrong. They also don’t work very long because citizens can see what’s real and true just as clearly as any of Plato’s Philosopher Kings, and sooner or later will catch them out.

President Obama has a knack of moving the traditional media quickly off one “Noble Lie” on to another before the first lie and its consequences can be fully appreciated by the people.

George Will had a wonderful statement about this ability. He called it

Clunker progressivism.

“Barack Obama’s presidency has become a feast of failures whose proliferation protects their author from close scrutiny of any one of them.

Now, however, we can revisit one of the first and see it as a harbinger of progressivism’s downward stumble to HealthCare.gov.”

The following quote of Plato by Arthur Herman sounds a little bit like Bob Woodward’s statement last Sunday.

“It is the business of the rulers of the city,” Plato wrote in his "Republic," “to tell lies, deceiving both its enemies and its own citizens for the benefit of the city…”

In fact, the wise ruler — Plato’s Philosopher King — must be prepared to “administer a great many liesand falsehoods,” Plato went on, for the benefit of the masses.

Plato goes on to justify the “Noble Lie.”

“The Philosopher King knows that they are too ignorant to ever see the truth about their city’s problems and how to fix them.”

“And at times it’s only through telling what Plato called “a noble lie” that he or she can get the people’s cooperation in achieving it.”

Mr. Obama, you are not Plato!

The traditional media and the Democratic Party promote these Noble Lies.

Arthur Herman goes on to say,

“And every lie is planted for a single end: to justify increasing the power of the federal government, and with it the clout of its Number One champion, the Democrat Party.”

The Democrats who voted for Obamacare either knew or understood its provisions. If they did not understand the provisions because they did not read the bill before they voted for Obamacare they were not doing their job.

It was predictable that Obamacare would be a disaster for ten of millions of Americans already holding health insurance policies.

“Above all, they knew their president had deceived the American public into accepting this financial and moral disaster, in order to clear the way for a single payer, completely government-run health system”

In either case they should all be thrown out of office.

Americans have not seen anything yet!

Wait until they try to see a doctor or receive access to needed medical care once Obamacare get further on down the implementation road.

It is going to get worse!

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

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Additional Defects In Obamacare

October 23, 2013

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I have been saying Obamacare is going to fail long before
the bill was passed into law. Obamacare will fail because of multiple system
design defects.

I would hate to believe these defects were built into the
system purposefully.

It was done to prove that free market forces do not work.
The Obama administration created a “not so free market”. These not so free
markets have been proven to fail over and over again.

It seems logical that given the $1 trillion dollar a year
deficits of the Obama administration, someone, somewhere would be interested in
decreasing the deficit spending.

None of the increased government spending has improved the
economy, decreased unemployment or decreased uncertainty.

The computer system defects in the health insurance
exchanges are much deeper than the sound bite treatment they getting from the
Obama administration.

The task of integrating 40-50 year old legacy computer
systems is an extremely difficult task using 50-year-old software.

Information technology experts have told me that the
health insurance exchange computer sign up system (healthcare.org) is months to
years away from getting the health insurance exchange information system fixed.

It should be destroyed after spending $634 million dollars
and redone using modern technology.

The verification of people who qualify for government
subsidies is being dropped. The patient’s word about need is being accepted in
lieu of verification.

This is a tremendous glitch in the system, opening the
system to tremendous fraud and abuse. It is not a way to run a business.

John McAfee former CEO and founder of McAfee antivirus
said the health insurance exchange web site is a hacker's wet dream. The You
Tube explains why he came to this conclusion.

http://youtu.be/5TCtLtzSe6I

Poor patients who might qualify for the Obamacare tax
credits do not pay income tax. Therefore they have no income to apply a tax
credit against.

The administration has dropped word tax credit. It is now called
a subsidy. The law’s tax credit will be given to the healthcare insurance
company selling the insurance.

This is a “glitch.” The law was written to pay the states
for those who qualify for a tax credit. A Washington D.C. ruled that the case
by states against Obamacare has merit.

The states contend that persons’ insured through the
federal government exchanges do not qualify for federal tax credits. Only
states can receive and distribute the tax credits.

The law was reinterpreted by the Obama administration
without the consent of congress.

Another “glitch” is that the healthcare insurance industry
is given limitless power to collect money from the Treasury. The mechanics are not
transparent.

“The
Affordable Care Act may give health insurance companies a virtually limitless
power to tap the U.S. Treasury, thereby lifting insurers' profits to
undreamt-of heights. This power derives from the mathematical formula for
calculating individual subsidies.”

The mathematical formula for calculating the subsidies
will cause America’s deficit to skyrocket further each year.

President Obama told America that Obamacare would bend the
cost curve downward and provide an efficient cost effective healthcare system
for all.

Let us look at the payment formula. A family of four
earning $30,000 year will not pay more than 2% a year for healthcare insurance
($600/year). This makes the Accountable Care Act (Obamacare) affordable for the
poor (maybe).

If the premium of the healthcare insurance policy obtained
by this poor family costs $10,000 a year through the health insurance exchange the
federal government will pay the remaining $9,400 in the form of a tax credit to
the insurance company.

Originally, it sounded like the family would get a tax
credit after the family paid $10,000. A family making up to $40,000 a year does
not pay any taxes and therefore a tax credit is worthless.

The wording was changed from a tax credit to a
subsidy. The tax credit now goes to the
healthcare insurance company providing the insurance policy.

The tricky thing about all this is the insurance
industry’s tax credits reduce the
governments tax receipts and increases the insurance companies net profit.

The net effect is an increase in tax-free income from the
federal treasury.

The government collects less income tax from the insurance
company.

The Obama
administration has given the healthcare insurance industry a huge tax break.
The tax break will increase the industry’s bottom line profits.

Obamacare has permitted the insurance company to have a
Medical/Loss ratio of 80/20. The Medical/Loss ratio means that the healthcare
industry must spend at least 80% of the insurance premiums collected on direct
medical care.

If it only spends 75% on direct medical care, the healthcare
company must give provide a 5% rebate.

Here in lies the rub. The Obama administration has let the
healthcare insurance industry define direct medical care.

These are some of the services the Obama administration
has permitted the healthcare insurance industry to categorize as direct medical
care.

The cost of verifying the credentials
of doctors in its networks.
The cost of ferreting out fraud such as
catching physicians over testing patients or doing unnecessary operations.
The cost of programs such as help desks
that keep people who have diabetes
out of emergency rooms.
Some insurers have insisted that
typical business expenses are included — such as sales commissions for
insurance agents and taxes paid on healthcare insurance companies investments

Each one of these "direct medical care expenses"
has an added on profit included in the direct medical care expense category.

This is the way the healthcare insurance industry takes
40-60% of each premium off the top and leaves only 40-60% of healthcare dollars
for direct medical care.

Next year the healthcare insurance company will be
permitted to raise the healthcare insurance premium of a poor family to
$12,000. Its excuse will be that it is losing money.

If the premium is not raised the healthcare insurer will
quit providing the insurance. The government is totally dependent on the
insurer whether the insurer provides insurance as it does in the health
insurance exchanges or for administrative services as it does for Medicare (a single
party payer).

The poor family still makes $30,000 dollars a year and
still pays $600 dollar a year for the now $12,000 dollar premium.

The insurance company now keeps $2,400 vs. $2,000 for
overhead and profit plus all the profit they can get from the direct care
dollars that should really be overhead.

The federal government gives the healthcare insurer a tax
credit of $11,400 vs. $9,400.

The poor insurance
enrollee doesn't pay a penny more for his healthcare insurance.

The only loser is the American taxpayer who will pay the
subsidy in the form of increased taxes.

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

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Significance Of IBM Retiree Decision

September 18, 2013

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System

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Stanley
Feld M.D.,FACP,MACE

IBM’s dropping of retirees’ healthcare plans will be the cause of a
continuing avalanche of companies dropping healthcare insurance for its non-retired
employees. These companies are doing it
in two ways. They are decreasing work hours from 40 to 30 hours per week. They
are hiring part time employees. The are also outsourcing work to avoid paying
an “Obamacare penalty.”

Companies are contracting with “Private Health Exchanges” to service the
rest of their employees. The companies provide a stipend for healthcare
coverage and send employees to the “Private Health Exchange” to buy coverage.
If employees cannot afford the coverage, employees would be able to buy
insurance from the government health insurance exchange.

In February 2011 I wrote about the McKinsey study that estimated the
percent of employers that would stop providing healthcare insurance for their
employees in 2014.

None of the Obamacare fans wanted to believe this study.

Senator John Kerry and Representative Barney Frank said a public option was
essential in order for Obamacare to work.

President Obama told them not to worry. Obamacare will work without a
public option.

I called Obamacare’s health insurance exchanges essentially Obamacare’s Public
Option. Consumers will be forced into the health insurance exchanges in 2014.

The Congressional Budget Office provides congress estimates of the effects
of legislation. The CBO is not required to think.

The CBO crunches numbers provided
to it by the administration. The administration has been less than candid with
everyone including the American public

“The
Congressional Budget Office estimated that only 7 percent of employees
currently covered by employer-sponsored insurance (ESI) will have to switch to
government subsidized-exchange policies (Public Option) in 2014.”

The McKinsey study concluded; Feb 2011

Overall, 30 percent of employers will definitely
or probably stop offering ESI in the years after 2014.
Many
Human Resources officers and CFOs do not know the implications of Obama care.
Among employers having a high understanding of
President Obama’s Healthcare Reform Act more than 50% will stop offering
employee healthcare benefit and more than 60% will make some kind of change.
At least 30 percent of employers feel they would
gain economically from dropping coverage and paying the penalty. They would
even gain if they increase their employees’ salary or other benefits.
The
insurance coverage is in excess of $15,000 per year per employee. The
government penalty is $2,000 per employee.
The
difference in cost will force employers to drop ESI and force employees into
the Public Option. This was President Obama’s plan all along.
The survey also showed that more than 85 percent
of employees would remain at their jobs even if their employer stopped offering
ESI.
Sixty (60) percent of employees would expect an
increase in compensation from their employers.
Who
are these rules in favor of? They are not in favor of the employee.”

“Health care reform fundamentally alters the
social contract inherent in employer-sponsored medical benefits and how
employees value health insurance as a form of compensation.”

“Obamacare” guarantees the right to health
insurance regardless of an individual’s medical status or ability to pay. In
doing so, it minimizes the moral obligation employers may feel to cover the
sickest employees, who would otherwise be denied coverage in today’s individual
health insurance market.

The logical result is healthcare insurance
premiums would increase for the individual and benefits would decrease to keep
the premium cost down.

In 2014, people who are not offered affordable
health insurance coverage by their employers will receive income-indexed
premium and out-of-pocket cost-sharing subsidies from the government through public
health insurance exchanges.

The highest subsidies will be offered to the
lowest-income workers. It enables these low paid workers to obtain coverage
they could not afford in today’s individual healthcare insurance market.

It will force people into the dysfunctional
individual insurance market under public supervision of public health insurance
exchange.

The government will pay the subsidies for the resulting
increased premiums that will result from expanded coverage in this “Public
Option.” The government would then pass the increased premium cost on to the
taxpayer on a means tested basis and with higher taxes.

This is what Don Berwick and President Obama meant by
redistributing wealth.

The next step is government’s complete control of
a single party healthcare system.

Employers will no longer be able to offer better
healthcare insurance benefits to their highly compensated executives either.
Companies will be forced to discontinue employee healthcare coverage. We see
that happening in the Fall of 2013.

The penalty is set low to further encourage
companies to discontinue coverage. President Obama’s goal is to have most people
in the “Public Option.”

This will lead to government control of the
healthcare system and all the inefficiencies that will result. These
inefficiencies will increase the cost of care and result in a decrease in
access to care as well as rationing of care.

State insurance exchanges will be paid for
by the states with a federal subsidy. These exchanges will offer individual and
family policies of set benefit levels (bronze, silver, gold, and platinum) from
a variety of insurance companies.

The effect on the federal deficit will be much
greater than the original CBO’s estimated. The number of people who will loss
their company insurance was estimated by the CBO at 10 million, or about 7
percent of employees, currently covered by ESI.

Seventy (70) million people was McKinsey’s estimate in 2011.

“ A July study by Craig Garthwaite of Northwestern
University’s Kellogg School of Management predicts as many as 940,000. That
number is an estimate of how many adults without children are working because
of what the researchers call “employment lock.”

This
increased number of participants will add to the federal deficit. The increased
federal deficit will result in higher taxes for everyone, including the middle
class.

“The taxpayers are going to get
hammered,” says Douglas Holtz-Eakin, a former Congressional Budget Office
director who is now president of American Action Forum, a Washington-based
advocacy group that opposes the health law. “It’s going to be extraordinarily
expensive.”

President Obama wins his ideological goal.
Consumers will have less control over their own healthcare decisions and
choices.

The healthcare insurance industry will gain more
control over pricing. This will increase profits because they will administer
government health insurance exchange services. President Obama will continue to
outsource the administrative services to the healthcare insurance industry.

The losers will be consumers and
physicians.

The impending results are all totally
predictable. Obamacare fans refuse to listen.

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

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Where I Am Coming From

November 26, 2012

inMedicine: Healthcare System

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Stanley

Feld M.D.,FACP,MACE

I realize that many people
read my blog by just glancing at it. It is difficult for a casual reader to
grasp my hypothesis.

The devil is always in the
details. The details expose defects and unintended consequences.

Yogi Berra once said, "You've got to be very careful if you don't know where you are going because you might not get there."

Many readers believe I am
very critical of President Obama’s plan to reform the healthcare system. This impression
is correct.

To my chagrin many of my
non-physician friends, who are President Obama lovers, hold it against me.

The basic goals of President
Obama’s healthcare reform plan are correct.

In my view his philosophy and
methods are wrong. I have pointed out the faults with his philosophy and
methods and why they cannot work.

President Obama wants
universal access to healthcare that is affordable and is delivered using best medical
practices.

I have the same goals.

I have outlined a consumer
driven healthcare system which emphasizes freedom of choice, individual independence
and personal responsibility.

President Obama is imposing a
government driven healthcare system emphasizing a lack of freedom of choice,
mandates, penalties, dependence and entitlements.

I appreciate that President
Obama can only visualize accomplishing his goals by government decree,
regulations and enforcement.

I believe Americans are smart,
want freedom of choice, personal dignity and can assume responsibility for
their choices.

I believe government control
will result in increased waste, inefficiency and corruption at the expense of
effective medical care for consumers.

President Obama thinks government
control is the only way to control costs. I believe the more government control
is imposed on consumers the greater the costs.

President Obama wants bureaucrats
to make medical decisions for consumers and physicians. If physicians do not
cooperated he is willing to substitute “healthcare providers” for physicians.

President Obama does not
respect consumers’ ability to make the right choices.

I believe in consumers’
intelligence. The government’s responsibility is to provide tools for consumers
to make intelligent choices.

It is difficult to find an
effectively functioning, centrally controlled healthcare system. The statistics
are questionable. I recently described
the Canadian healthcare system.

Consumers and physicians can get
used to centrally controlled healthcare systems. They learn to tolerate it.
However, these healthcare systems are not as affordable as many contend.

Innovation and vibrancy comes
from a healthcare system in which the major stakeholders have the incentives to
be innovative.

Obamacare has caused
secondary stakeholders (healthcare insurance industry, hospitals and hospital
administrators, drug companies, medical device companies and information
technology companies) to position themselves to take advantage of the centrally
controlled healthcare system.

Obamacare is not aligning all
the stakeholders’ incentives. It is further misaligning incentives. Obamacare
will cause a rapid demise of the healthcare system.

A more centralized government
controlled healthcare system will result in greater dysfunction of the
healthcare system, increasing cost and less effective medical care for the
majority of consumers.

If America evolves to a
single party payer healthcare system, which I believe is President Obama’s goal,
the achievement of his goals for affordable care for all using best practices
will become more elusive.

On May 11, 2006 I published my first blog. This was
pre President Obama. President Obama wasn’t the first president who has
contributed to the dysfunction and ultimate demise of the healthcare system.

I thought it would be fun to see “What I Was About” on
May 11, 2006.

"Repairing The Healthcare System.

Stanley Feld M.D.,FACP,MACE

Preamble

This blog is
about Stanley Feld M.D., FACP, MACE’s studied view for repairing the health
care system.

There is been
much written daily about the defects in the health care system. All
stakeholders are to blame for the severe distortion in today’s healthcare
system including consumers (patients).

Unfortunately,
few healthcare policy wonks have asked practicing physicians what they think
the healthcare systems’ problem are. Neither has anyone asked the practicing
physician what an acceptable solutions would be.

Persons not
affected by the distortions and dysfunction in the health care system pay
little attention to the broken system. Fortunately 80% of the population are
not sick. They are not in need of an effective and functional healthcare system.

People not immediately affected by any system
do not pay attention to the defects in those systems.

However,
the healthcare system is vital to every citizen both in the short term or long
term.

Our broken
health care system cannot be ignored any longer. Our personal health and the
health of our citizens is the most precious asset we have as individuals, and
vital to the country’s success and well being in the future.

In my view, we
are going through a process similar to the slow boiling of a frog. We are
noticing the rise in temperature little by little, but are too lethargic to
take action and jump out of the pot. The effort is much too difficult.

However, we
must take action now!! Soon, we will all
be cooked.

What
is the solution to America’s dysfunctional healthcare system?

Americans live
in a free consumer driven economic environment for most goods and services.

The only way
to get us out of this increasing hot water is for consumers to understand the
structural defects in the broken healthcare system. Then they must act.

Someone must
outline an effective and easy plan of action that aligns all the stakeholders
incentives.

In reality,
all of the stakeholders are to blame for the distortions in the system. The
stakeholders need to be answerable to consumers. Consumer (patients) can exert
power only after understanding the structural defects in the healthcare system.

The goal of
this blog is to explain reasons for these defects, as well as the potential
solutions. In my view the solutions I will propose will ultimately fix the
system.

Presently most
of the stakeholders’ incentives are misaligned. The proposed solutions are
aimed at aligning all the stakeholders’ incentives. All previous solutions have
served to misalign incentives even further resulting in our present
dysfunctional system.

The previous
governmental adjustments have resulted in a system that is much too expensive,
has much too much waste, is inefficient, and almost unworkable.

The result is
that all of the stakeholders are very stressed and unhappy.

Over the next
weeks or months, I will outline the problems in the healthcare system and the
solutions to creating a functional healthcare system."

I said the above in May 2006.I am continuing to
point out the increasing problems as well as my solutions. The key to the
solution is a healthcare system in which consumers’ drive the healthcare system and
have responsibility for their health and healthcare dollars.

As the incidence of obesity continues to
increase and as the baby boomers continue to retire, a system must be developed
to create independence and responsibility and not entitlement and irresponsibility.

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

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My Impression Of The Canadian Healthcare System

September 19, 2012

inMedicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

Cecelia ad I just returned from a trip to
Halifax, Cape Breton Island and Prince Edward Island. It was a phenomenal trip.

It was too early in the fall season for the
trees to turn color but the weather was great and the countryside was glorious.

We had planed to go there 49 years ago on our
honeymoon.

We did not have time to get all the way to
Halifax, Cape Breton or Prince Edward Island. We had to drive back to New York
City to start my medical internship on July 1^st. 1963.

Cecelia and I decided it was time to go for it.

We stayed in Port Hood on Cape Breton for five
days, enjoyed the singing and dancing and had a wonderful drive around the
Cabot Trail.

I am a friendly guy and I was curious about how
the folks on the street like the Canadian healthcare system. I was tired of
listening to the Democratic Party’s propaganda.

The propaganda contradicts Canadian and former
Canadian physicians feeling about the system.

I spoke to a lot of people in the town we visited
about their feelings about the Canadian healthcare system.

I came away with several impressions.

Dr. Kurisko practiced surgery in Canada before coming to the
United States to practice surgery.

Dr. Kurisko description
of the Canadian Healthcare System is very accurate. It reflects the feeling of
the people who have need to use the system.

http://youtu.be/At9q6uFR3gU

Canadians are comfortable
with their medical entitlement. Everyone said they like the fact that if they get sick
they will not get “wiped out” by the costs as Americans might be.

I found a You Tube about the
Canadian system with responses of the common man. It clearly expresses this
sentiment.

http://youtu.be/VQFX32Ed7ZQ

This is the impression of a
group of people. The question is the possibility of a bias in selection of the
people interviewed.

Upon deeper questioning of
the people I spoke to, my conclusion is that once people get used to a medical
entitlement they are very hesitant to give it up even if it restricts their
freedom of choice. Only 20% of the population uses the healthcare system at any one time.

The second conclusion is
that this is the way the healthcare system is in Canada. Canadian feel they must
live with it and get over complaining about it.

The things they did not like
about their healthcare single payer system is the very high sales tax in
addition to federal and provincial taxes.

The income tax baseline is lowe than
the U.S. and the income earned at the top rate of tax is lower than in the U.S. If you combine all taxes paid the rate is above 50% for some income brackets and at least 30% for
the lowest income bracket.

I was not aware of the fact
that the sales tax on everything in Canada is 15% in addition to business taxes
and personal income taxes. There is both
a province tax and a central tax on purchases.

Federal Tax Rates

Up to $41,544 15.00%

41,545–83,088 22.00 %

83,089–128,800 26.00 %

128,801 and over 29.00 %

Everyone pays federal
income tax in Canada. Fifty percent of U.S. citizens do not pay Federal income
tax

In addition to federal
income tax each province tax is slightly different Below are a few examples.

British Columbia

Up to $36,146 5.06%

36,147–72,293 7.70 %

$72,294–83,001 10.50%

$83,002–100,787 12.29%

$100,788 and over 14.70%

Alberta

10.00% All income

Saskatchewan

Up to $40,919 11.00%

$40,920–116,911 13.00%

$116,912 and over 15.00%

Ontario

Up to $37,774 5.05%

$37,775–75,550 9.15%

$75,551 and over 20%

New Brunswick

Up to $37,150 9.10%

$37,151–74,300 12.10%

$74,301–120,796 12.40 %

$120,797 and over 14.30%

Nova Scotia

Up to $29,590 8.79%

$29,591–59,180 14.95%

$59,181–93,000 16.67%

$93,001–150,000 17.50%

$150,001 and over 21.00%

We visited Halifax, Nova
Scotia and Charlottetown, Prince Edward Island but spent most of our time in
the countryside.

The long waiting times to
see a physician in the office and in the ER was a constant complaint.

The people complained about
the shortage of physicians. Their impression was that a lot of physicians fled
to the U.S. causing the physician shortage.

There were few small towns
with physicians. Bigger towns had small hospitals and physician shortages.
Larger towns had tertiary hospitals. These hospitals were full service hospitals.
These hospitals rationed care

The emergency rooms of any
size hospitals are always jammed. Sometimes you can wait for 6 hours and not
see a physician taking care of anyone.

One lady told me she had a
tremendous stomachache. She went to the ER waited more than 6 hours without
anyone in the ER seeing a physician. After 6 hours the pain started to subside.
She was so fatigued she went home.

I guess that is one way to
cure a patient. It took her 4 days before the pain to subside.

Another complaint was
follow-up visits by a patient with her own physician. The patient was a 65-year-old
diabetic female. Her physician was diligent. He wanted to see her every three
months. She could only get an appointment in 5 months.

One 55-year-old male with
heart disease said the healthcare system has been fine for him. He calls his
cardiologist at home. He is an interesting case and the cardiologist will see
him the next day.

Many complained about the
waiting time for special test such as CAT scans and MRIs, hip and knee
replacements and cardiac catherizations.

Waiting times for hip and
knee replacements can be more than one year.

The Fraser Institute released
a report outlining the government financial difficulties with the Canadian healthcare system.

“A 2011 report by the Fraser Institute concluded that
Canada’s health care system is spending at an unsustainable rate. Six of ten
Canadian provinces are on track to spend half of their revenues on health care,
according to the institute.”

“We conclude
that Canada’s health system produces rates of growth in health spending that
are not sustainable solely through redistributive public financing,” the report
concluded.

I think it is about time Americans paid attention to
Obamacare. It will be worse for all.

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

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Some of Obamacare’s Complicated Mistakes

August 10, 2011

inEMR, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama appointed Dr. Donald Berwick as head of CMS during the congressional recess last August. It was my impression it was a one-year appointment. He does not seem to be leaving anytime soon.

President Obama made this appointment to avoid congressional hearings and the publicity of disapproval.

Dr. Berwick’s goal for healthcare reform is a single party payer. He also believes in redistribution of wealth. I believe Obamacare will be repealed either by the Supreme Court or the next election.

CMS’s execution of their initiatives is poor.

Dr. Berwick believes in increasing bureaucratic structures to administer central control over physicians and their patients by regulations and penalties.

Accountable Care Organizations are not a bad idea if they could work. They would increase the measurability of good care. There are too many organizational barriers in the way of execution of ACOs.

Physicians and hospital systems will be fighting with each other over distribution of reimbursement and quality care judgments. Family practitioners and internists will be fighting with specialist over the distribution of reimbursement. I do not believe physicians will be satisfied with a salary determined by hospital systems.

Patients will suffer as access to care decreases. Federal funds will be wasted and the federal deficit will increase further.

ACO’s are in really HMO’s on steroids. Patients were dissatisfied with HMOs in the late 1980s to early 19990s.

The Pay4Performance formula creates penalties and not incentives for physicians and hospital systems. There are no incentives or penalties for patients’ performance.

Health Insurance Exchanges are supposed to be a way to increase insurance availability for patients who are uninsured. It is in really the “Public Option” in disguise. The Exchanges will turn out to be very costly. They will increase the federal deficit as well as state budget deficits.

The states are objecting to the Health Insurance Exchanges for two reasons. The federal government is trying to shift the economic burden to the states while decreasing state control over of their insurance policies. HHS has even threatened to take total control of the Health Insurance Exchanges.

Electronic Medical Records remain too costly for physicians. EMRs are not completely functional despite President Obama’s $100 billion dollar subsidy. Most hospitals and physician offices are trying to comply with the government mandate. The subsidy is not enough to purchase the best EMR.

No one has acted on my suggestion to put the ideal EMR software in the cloud and charge hospitals and physicians by the click. A fully functional universal Electronic Medical Record would be available instantly at an affordable cost.

These are some of the layers of complexity. I predict these initiatives will not be fulfilled by 2013. There are too many new things to adjust too all at once. All the initiatives need a reason for total cooperation.

Making things worse is the requirement to use ICD-10 to file claims.

ICD is a claims coding formula going into its tenth iteration in 2013. It is much more complex than ICD-9.

“The differences between the two versions are significant. Whereas ICD-9 CM provides approximately 13,000 diagnosis and 3,000 procedure codes, the version of ICD-10 diagnosis and procedure codes to be deployed in the United States are roughly 68,000 diagnostic codes and 87,000 procedure codes.”

In January 2009, HHS and CMS mandated ICD-10 codes be used by all healthcare plans, providers, and clearing houses for all diagnosis and inpatient procedures effective October 2013. It seems like there would be enough time to adjust. However, healthcare system adjustment will be huge.

“ICD-10 is one key piece to the overall success of the larger puzzle. More granular

Data will better reflect the patients’ condition and help us manage their care better. At least, that’s the idea.”

I do not think ICD-10 will happen in 2013. These initiatives are federal mandates. They have two things in common. They rely heavily on IT, both for transactions and analytics, and they impose significant changes on organizational workflows, specifically those of clinicians.

Any workload changes are difficult to adjust to. Too many changes at once are lethal to an initiative. Dr. Berwick’s timing introducing the changes will be lethal to the changes. When this change comes at physicians from so many different angles they become passively aggressive and resist change.

ACOs, Electronic Medical Records and Health Insurance Exchanges fulfillment is behind schedule. ICD-10 will also be behind schedule.

CMS has declared the ICD-10 compliance date will not be moved.

• The vast majority of respondents (72%) believe ICD-10 will have a positive impact on quality in the long term.

• While they see the long-term benefit, many respondents (41%) also believe ICD-10 will strain physician relationships.

• Most (60%) expect short-term cash flow to be negatively impacted both in terms of project resources and lost revenue.

• Only a third of the respondents believe payers will be ready by October 2013 and most believe physician cooperation will be their biggest barrier.

Although the knowledge that ICD-10 is coming has sparked action by healthcare leaders—most (84%) have started their ICD-10 projects—as a group, less than a third (29%) have moved beyond the assessment phase into implementation.

ICD-10 is creating many levels of complexity to coding. It will require an increased office staff along the care continuum. The staff must learn and use the new diagnostic and procedure codes. It will also require someone to assign appropriate codes that reflect physicians’ notes. Someone will be needed to create an appropriate claim for the medical encounter. ICD-10 will increase overhead as reimbursement decreases. It is naïve to believe the EMR will automatically accomplish this

Unquestionably, ICD-10 introduces an added layer of complexity to the multitude of challenges for physicians and hospital systems that are already at hand as a result of Obamacare.

ICD-10 puts revenue at risk for the sake of data the government might use misuse.

I predict physicians will not participate fully. The physician shortage will intensify as more people enter the healthcare system and fewer physicians are available to treat Medicare patients.

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

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