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What Is Net Neutrality?

May 21, 2014

inDisinformation and the healthcare system, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Net neutrality is the idea that broadband operators shouldn't be allowed to block or degrade Internet content and services–or charge content providers an extra fee for speedier delivery or more favorable placement.

In November 2011 I wrote about the government attempt to control the Internet Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261).

The title of the article was “The Government and American Censorship: 1984 in 2011.”

I searched the New York Times to see what the newspaper that (“Prints all the news fit to Print”) had to say about the bills. My search produced this reply.

Your search – Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261). – did not match any documents under All Results Since 1851.

The most vital part of our economy and job growth at the moment is the Internet. These two bills will destroy this monumental jobs creating machine.

It is another piece of lunacy brought to you by our federal government. I wonder how many Representatives and Senators have read the bills.

“There are two very disturbing bills making their way through Congress: These bills are coated in rhetoric that I find disgusting since at their core they are online censorship bills. It’s incredible to me that Congress would take seriously anything that censors the Internet and the American public but in the last few weeks PIPA and SOPA have burst forth with incredibly momentum, largely being underwritten by large media companies and their lobbyists.”

Let me remind everyone that large media companies offered huge support to President Obama and the Democrats in congress. These bills are congruent with the large antiquated media”s vested interest and President Obama’s goal of central control over our lives.

EFF, Free Software Foundation, Public Knowledge, Progress, Fight, Participatory Politics Foundation, and Creative Commons in support of free speech and a free and open Internet are opposing the bills and have organized American Censorship Day for tomorrow (11/16/11). The goal is to make every American aware of this new trick play and stop this lunacy.

This video does a great job of explaining the two bills’ potential primary and secondary impact. I do not believe our congressional representatives understand the impact of the bills.

Someone is trying to railroad passage through congress.

PROTECT IP Act Breaks The Internet from Fight for the Future on Vimeo.

Both failed to pass in congress because of the overwhelming outcry by the technology community.

President Obama promised the American public he would issue regulations through executive orders and agency powers to enact laws that congress failed to enact.

When President Obama was running for president in 2007 and 2008 he was a strong proponent of Net Neutrality.

At that time President Obama was asked: "Would you make it a priority in your first year of office to reinstate Net neutrality as the law of the land? And would you pledge to only appoint FCC commissioners that support open Internet principles like Net neutrality?"

"The answer is yes," Obama replied. "I am a strong supporter of Net neutrality."

The White House announced: President Obama is strongly committed to Net Neutrality in order to keep an open Internet that fosters investment, innovation, consumer choice, and free speech. The announced action by FCC Chairman Genachowski, building on the work of Chairman Waxman's collaborative effort to craft legislation in this area, advances this important policy priority.

http://youtu.be/-Lz-bPHojVE

http://youtu.be/mP01t0Z4Hr8

In 2014 President Obama hires a lobbyist Tom Wheeler who is a former telecommunication lobbyist. Mr. Wheeler is opposed to Net Neutrality. The president has the FCC issuing regulations that oppose Net Neutrality and transfer great power and a complex bureaucracy to the federal government.

It represents another broken promise by President Obama.

“Federal Communications Commission Chairman Tom Wheeler went ahead with his proposal on Thursday to give his agency the power to decide whether the terms and prices of broadband Internet services are "reasonable."

http://youtu.be/km1AhFkt4Dk

This is another power grab by the central government to have control of the Internet. The concept is once again not covered by the traditional media in an understandable way.

As a reaction to satisfy the “Net Neutral” community Mr. Wheeler said the goal is not to have a fast and slow speed Internet no matter how much broadband they consume.

Mr. Wheeler said he prefers the "reasonable" pricing standard. But he also suggested another, even worse option to regulate broadband prices: reclassifying Internet connections as "telecommunications services."

A reader of my blog wrote, "Can you think of anything that the U.S. government does really, really well?"

“For two decades Congress has wisely refused to give the FCC the same power over the Internet that it holds over the telephone system. And for two decades the Internet has enabled a gusher of creativity that was unimaginable over a century of regulated telephony. “

Regulators from every state will also be able to get into the act. I cannot imagine it will be regulated for the benefit of consumers. There is something strange about all the telecoms companies merging with each other in the past few months.

“Mr. Wheeler's brainstorm to change all this is simply to pretend the Internet is a phone network.”

Since this designation would automatically impose myriad obligations that have nothing to do with current customer needs—and that many modern firms could not possibly fulfill—the commission would then have to issue a flurry of exemptions ("forbearance" in FCC parlance) to prevent chaos in the market for Internet connections.

The FCC is inventing an Obamacare for the Internet. It is enacting an unworkable system upon a system (the Internet). Then the FCC will have to get busy issuing waivers which will prevent the new system from operating as it was theoretically designed to operate.

The telecommunication industry will have a field day at the expense of the public.

“GOP Commissioner Michael O'Rielly, who also dissented, notes that the FCC's net-neutrality campaign "rests on a faulty foundation of make-believe statutory authority."

Imagine all the costs, confusion, lawsuits, legal fees, and regulations that will occur to restrict the freedom of the internet and all the innovations in commerce the Internet has created.

The elimination of Net Neutrality is all about increasing government power, restricting individual freedoms and shifting the costs of government’s inefficient control on to consumers.

Anna Eshoe is the ranking Democrat on the Communications and Technology Subcommittee. She has pointed out that the new FCC wording has not fooled Silicon Valley entrepreneurs.

“Like many Internet users, I fear that the latest round of proposed Net Neutrality rules from the FCC will not do enough to curtail discrimination of Internet traffic, but rather leave the door open to discrimination under more ambiguous terms.”

The new regulations diminish Net Neutrality while empowering government bureaucracy. The online gatekeepers threaten free speech, harm competition and diminish the continued openness of the Internet. The proposed regulations do not protect the freedoms and available to consumers and businesses in a Net Neutral environment.

Barack Obama promised in the 2008 and 2012 campaigns that he would enforce Net Neutrality. He has not kept that promise.

The affect on Americans’ freedoms will be as bad or worse than Obamacare.

Please write to your congressmen and President Obama and ask them to preserve Net Neutrality.

Thank you

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

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Another Obamacare Trick Exposed And Backfiring

May 18, 2014

inMedicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

The drug industry has been quiet during the Obamacare debate. However, the industry’s lobbying group worked with the Obama administration to get Obamacare.

Why would PhRMA do that when President Obama encouraged everyone to buy generic drugs in order to get full coverage for their drug costs?

It is because President Obama promised PhRMA huge concessions and windfall profits after the health insurance exchanges were successful.

PhRMA is not going to make those windfall profits. When Americans see that the health insurance exchanges are more expensive than the private plans. Only those who cannot buy private insurance because they have pre-existing illnesses will sign up for Obamacare.

This will drive the health insurance exchange premiums higher,cover less, restrict access to care and drugs and ration care.

President Obama provided waivers from the implementation of Obamacare to many special groups except the individual market. Those waivers delayed implementation of Obamacare for one to two years.

The administration was concerned that implementation of Obamacare to everyone would cause a storm of protest that the administration could not contain.

These special groups will lobby for the continuation of those waivers as they realize that premiums and deductibles will be higher in the health insurance exchange market than the private market.

The profits PhRMA expected will evaporate.

Consumers not subsidized by Obamacare who bought Silver plans in the individual market through the health insurance exchanges are cooked.

They will pay one and one half to two times the price for drugs next year than they are paying this year.

The government will be paying drug companies for the increased price of drugs for people whose Silver plans are subsidized.

The result will be an increased cost of Obamacare to the public as President Obama redistributes wealth on the backs of the middle class making $50,000.01 or more

How did PhRMA help President Obama get Obamacare passed?

PhRMA paid for the multimillion dollar Harry and Louise ad campaign on TV during the debate for passage of Obamacare.

It financed a false message that was in support of Obamacare as opposed to its original Harry and Louise message that sunk the passage of Hillarycare in 1993.

http://youtu.be/fOr17a4ZOIU

“A new report by Milliman, Inc. finds that Silver plans with combined deductibles offered through the Health Insurance Exchanges may require patients to pay more than twice as much out of pocket for prescription medicines overall as they would under a typical employer plan.”

“This is a far larger increase in out-of-pocket costs than was found for other medical care.”

The cost of drugs to consumers buying a Silver plan through the Health Insurance exchange without government subsidy and high deductibles will cost twice as much as employer sponsored plans.

“Americans participating in the Exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” said John Castellani, President and CEO of PhRMA.

Patients’ with high deductible Silver plans will have difficulty affording medicines necessary to manage their illnesses. Paying for medications will be especially difficult for consumers earning more than $50,000.00 who are not subsidized and have chronic diseases. These people need multiple medications to control their chronic disease in order to avoid complications of their disease.

Eighty percent of the healthcare dollars are spent on treating the complications of chronic disease.

The unaffordability of medication to prevent acute and chronic complications of chronic diseases such as Diabetes Mellitus results in an increase in hospitalizations and higher health care costs overall.

Conversely, programs that encourage better adherence have been shown to reduce emergency department visits, hospitalizations, and other preventable, costly care.

The Obamacare rules and regulations are going to encourage an increase, not a decrease, in healthcare costs for non-subsidized Americans.

This contradicts President Obama’s pledge to encourage prevention of illness.

However, it fulfills President Obama’s goal of redistribution of wealth. It could also be interpreted as increasing the tax on the middle class.

If the public realized this would happen with Obamacare it would have protested the passage of Obamacare.

A house panel uncovered the secret deal in an email between PhRMA and the Obama administration in 2012. It was not revealed to the public until recently.

Nancy Pelosi’s statement about not knowing what is in Obamacare until it is passed was an ominous signal that the public would be taken advantage of. No one picked up the signal.

President Obama’s signal legislation is leaving hard working Americans no option but to demand that Obamacare be repealed.

It must be replaced by a healthcare plan that will work.

It must be replaced by a plan that gives consumers the opportunity to be responsible for their health and their healthcare dollars.

It must be replaced by a plan where common sense prevails.

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

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Seniors Should Be Madder Than Hell About Obamacare And Not Take It Anymore

May 14, 2014

inMedicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama promised seniors on Medicare that Medicare would not be affected by Obamacare. He has also told us Obamacare is a success.

President Obama lied to seniors.

One way to stop the lies is to vote against all the Democrats up for reelection in both houses of congress. The Democrats were the only ones who voted for Obamacare. Both representatives and senators rely on the senior vote to be elected or re-elected. Democrats in congress are terrified by the threat of losing the senior vote.

Many of my friends read the New York Times and listen to network news. These people believe they are well informed. They are constantly arguing with me about what they think President Obama has accomplished with Obamacare.

They believe President Obama’s sound bites about Obamacare.

Many seniors trust President Obama. They believe he would not deceive them about Medicare. Seniors have held on to their beliefs about Obamacare until it affects them personally.

In November 2013 I wrote a blog entitled “Medicare’s Perverse Incentive Against Seniors.”

Many seniors did not believe my post until they or a friend personally experienced the perverse incentive Obamacare had on Medicare.

A senior named Evelyn, who sometimes publishes my blog, received a letter about Medicare from a gentleman and sent it to her contacts.

This letter was about the perverse incentives Obamacare has imposed on hospitals. Seniors are being penalized by not receiving Medicare coverage and having to pay out of pocket expenses.

The new Medicare rules were intended to decrease the number of re-hospitalizations within 30 days of discharge. Many seniors are admitted to the hospital in congestive heart failure. Many of those seniors have difficulty staying out of congestive heart failure. They have to be readmitted in 30 days.

If a senior is readmitted in 30 days after discharge from the hospital, Medicare does not cover the hospital bill. The senior is not responsible for the bill. The hospital system takes the financial hit.

The implication of the readmission is the hospital system did not do a good job in treating the patient.

It could be that the patient did not do a good job taking care of himself and staying out of congestive heart failure. It could also be that the patient is too sick to stay out of congestive heart failure.

Hospitals can avoid being penalized by admitting seniors for outpatient observation.

This is a glaring defect in government rules created by bureaucrats who have little clinic experience.

Hospitals can admit patients to observation and send them home in less than 48 hours. If they are readmitted within 30 days it does not count as a re-hospitalization. Medicare would cover the bill for the seniors’ readmission. The hospital will get paid.

Medicare will not cover the outpatient observation admission bill.

I wrote:

“It is all about money. It is about the government spending less, the hospital collecting more and the patients getting stuck with the bill.

Government officials realize that Medicare costs are unsustainable. CMS creates rules and regulations to expose Medicare to less liability.

Unfortunately the unintended consequence is that CMS exposes Medicare patients to more liability in the process.”

Once more President Obama lied to us.

“People are shocked when they receive the bill. Nobody is required to tell them they’re outpatients.”

Those patients who have been outpatient observation admissions do not qualify for the rehabilitation benefits. Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services.

Evelyn’s friend writes about his experience with a recurring urinary tract infection that has been easily treated of the years:

“I just found myself in the middle of a medical situation that made it very clear that "the affordable care act" is neither affordable, nor do they care.”

This is where Evelyn’s friend’s story gets interesting.

He said he was diagnosed as having of prostate cancer diagnosed by needle biopsy in 2007. He had a “radical prostatectomy.” The final pathology report of the tumor turned out to be benign.

Since surgery he has had numerous “urinary tract infections (UTIs).” He assumed the UTIs were a side effect of the surgery since he never had a UTI pre surgery. His Family Physician confirmed his assumption.

In March 2014 he developed a UTI. He went to an Urgent Care Center (Doc In The Box) to get his usual urine culture and an appropriate antibiotic.

After a forty-five minute wait for a physician he had to urinate. He also became nauseous and light headed. The receptionist told him he should not to go to the bathroom until after he saw the doctor and he (the patient) provided a urine specimen.

He then passed out. This can happen with a full, irritated and distended bladder. Hypotension (low blood pressure) can occur and cause a patient to faint.

He woke up with dry heaves and was confused. He tried to stand but was still hypotensive.

He was told by the Urgent Care Center that an ambulance was called to bring him to the nearest hospital emergency room for evaluation.

The cause of the hypotensive episode was clear. However because of malpractice concerns the Urgent Care Center staff was required to send him to the nearest hospital emergency room for complete evaluation.

If an emergency room physician could have used his clinical judgment (not the dictated care rules) the physician would have concluded, after work-up, past history, and clinical evaluation of the work-up, that the patient could get necessary treatment as an outpatient at home.

The patient wrote;

“Now, "the rest of the story", and the reason for sending this to so many of you.”

“I finally got to see a Doctor. I asked "what is going on." I'm just having a UTI, just get me the proper medication and let me go home.”

The Emergency Room Physician told him;

“That his symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.”

The appropriate studies were done over the next three hours. At about 7:30 pm the nurse came back to his room to tell him that one of the tests takes 1- 2 days to complete.

He asked if the hospital could email the (the results) to him. I assume the missing test were a urine culture and a blood culture.

The nurse informed him that he wouldn't need the tests emailed because he wasn't going anywhere.

He told her he had no intention of staying overnight. He wanted to see the doctor. He asked the physician if he was going to be admitted for treatment or admitted for outpatient observation.

“He told me that I would be admitted for observation. I said Doctor, correct me if I'm wrong, but if you admit me for observation Medicare will not pay anything. The non Medicare coverage was due to the affordable care act ( An Obamacare regulation). The doctor said that's right, it won't.”

Another physician came into the room as he was getting dressed to leave the hospital ER against doctor’s orders. The next physician confirmed the patient’s interpretation of Medicare rules.

After the last physician prepared his discharge papers, the discharge nurse came into the room for him to sign the papers in order to relieve the hospital of any liability.

The patient told her; “ I wasn't trying to be obstinate, but I wasn't going to be burdened with the full (financial) responsibility for my hospital stay.”

After making sure the door was closed, she said, "I don't blame you at all, I would do the same thing."

She went on to say, "You wouldn't believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney."

She further said, "The 'Affordable Care Act' is going to be a disaster for seniors.

Yet, if you are in this country illegally, and have no coverage, you will be covered in full."

The patient went for a follow up appointment with to his Family Practitioner since his white blood count was pretty high.

“During the visit I shared the experience at emergency, and that I had refused to be admitted. “

“His response was "I don't blame you at all, I would have done the same thing".

“He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.”

“I told him that I had heard that the affordable care act (Obamacare) would no longer pay for cancer treatment for those 76 and older, is that true?

“His understanding is that it is true.”

“The more I hear, and experience the Affordable Care Act (Obamacare), the more I'm beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they'll be.”

Evelyn is doing a great service by publishing this man’s letter. I hope it makes seniors aware of what is happening to Medicare coverage.

I am repeating a lot of this letter to re-emphasize, to followers of my blog, much of what I have said in the past. It is important to point out that all of Obamacare’s defects are becoming a reality to patients.

The defects are directly affecting seniors and their access to healthcare coverage.

Seniors must become “professors of their diseases” and control their health and healthcare dollars.

Remember, politicians are supposed to be working for seniors, not controlling them.

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

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Physicians Have To Wake Up!

May 11, 2014

inMedicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

It is time for physicians to wake up and take an active part in Repairing the Healthcare System.

Physician job satisfaction is at an all time low. Physicians are uncertain about staying in private practice. Others who have joined hospital systems as salaried physicians are uncertain about the wisdom of that decision.

Patient satisfaction is even lower as medical care is becoming less personalized. The patient/physician relationship has all but disappeared.

None of the secondary stakeholders (hospital systems, insurance companies, pharmaceutical companies and even government) are having a good time. The government is unable to sustain the costs without raising taxes and restricting access to care.

Today, I want to concentrate on the problems as physicians are feeling them.

A reader sent me this commentary a few weeks ago.

"Have you ever been to Sea World?"

"Last evening I was at a staff meeting at my community hospital. The hospital had recently rolled out “Computerized Physician Order Entry” software that was supposed to enable improvements in the orders and delivering of pharmaceuticals to the patients in the hospital.

Apparently, it did not go well. One of the speakers at the meeting was an articulate physician from the “world headquarters” who came to offer encouragement and reassurance. He cited the benefits: instant transmittal of the doctors’ orders to the pharmacy.

Orders were legible, reducing the risk for misreading of the doctor’s handwriting. Quicker delivery of medication to the patient was also cited.

After the doctor’s presentation, questions rained down upon his head from the physicians in the audience.

They cited a wide range of problems, and the speaker attempted to answer them with patience and courtesy.

Finally one physician asked, “Why are we doing this at all, when there are so many problems?” Another added, “Why is the company using an antiquated platform for the new software, since the platform is 20 years old, and so obsolete?”

And so it went lots of problems, and no solutions except a request for patience as the problems are addressed, with remedies apparently months away.

That set me to thinking:

If we go back to the formulation of the >2000 pages that evolved to become “Obamacare”, we would be hard pressed to find evidence of the input from working doctors as the legislation and the resulting regulations were formulated and decreed.

We can, if we want to feel really good, go back to Medicare itself and the rules that came along as to what could and could not be done without pre-approval.

Medicare part D added another layer of similar rules that seemed to appear de novo from sources other than working doctors.

Managed care, in its various ramifications showed a similar tendency to be created by people who didn’t have patients as their first concern, but rather the cost of services.

So, how, you ask, does all this relate to “Sea World”?

Think about the trained seals act. The seals do their thing on command from trainers who are not seals.

The seals bark loudly, the crowd applauds, and if the seals perform well, they each get a fish.

Doctors are much like that, in that they do their thing the best way they can, but they are abiding by rules they had little input in their creation, reporting their charges using codes they did not write, accepting payments that have no relation to the charges they report, using a system they did not create and one that gets sillier by the year.

So, fellow physicians, welcome to Sea World, as long as we continue to act like the seals, we’ll be able to get a fish now and then, I suppose."

Ladies and gentlemen, we are highly trained professionals. Our job is to solve and fix medical illness using clinical judgment gained through clinical experience and life long learning.

We are not trained seals.

It is time for physicians to wake up and take an active part in Repairing the Healthcare System.

The medical profession got itself into this position because it did not step up and fix the dysfunction itself.

There would not be a healthcare system with consumers and physicians.

Neither consumers nor physicians know how powerful they are. Consumers must exercise their power and drive the healthcare system by owning their healthcare dollars and be responsible for their health and their medical care

Physicians must teach consumers how to drive the healthcare system.

The politicians, businessmen and bureaucrats think they can fix it.

They can’t.

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

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Bureaucratic Barriers To Medical Care

May 7, 2014

inDefective scientific studies, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The greatness of America lies in the freedoms provided by the constitution and the bill of rights.

These freedoms have stimulated Americans to be innovative, creative and inventive.

The constitution promotes individual freedoms with the federal government being held in check by the states.

Many feel that over the last 50 years as society has become more complex the power of Federal government has increased. The central government has increased its power, limited individual freedoms and increased control over the people.

The usurping of power by the Federal government seems to have accelerated over the last 5 years. President Obama has even usurped power over the congress and might have intimidated the Supreme Court. He has decreased the effectiveness of the checks and balance system.

It could be argued that congress has given President Obama and his administration the power and control in the checks and balances system that congress is supposed to have.

Obamacare is the best example of this. When Sarah Palin screamed about the Independent Physician Advisory Board (IPAB) being a “Death Panel” she was ridiculed as being ignorant.

Sarah Palin’s fear was that government bureaucrats, opposed to individuals making that decision, would usurp the individuals’ right to make their own life-and-death medical decisions.

The argument for the formation of the IPAB is that this board will make rational and cost effective medical treatment decisions that individuals are incapable of making.

The IPAB will take the freedom of treatment choice out of the individual’s hands.

I contend that the ultimate goal of Obamacare is to work toward a single party payer system. The government will be the single party payer.

Since the government is the payer, the government will say it is entitled to make the best and most cost efficient treatment decisions for patients.

I have heard cries from Democrats that this is not President Obama’s intention.

The irony is that it is happening right now. CMS is issuing regulations to restrict care even before the IPAB has been formed.

“The introduction of a powerful and largely unaccountable board into health care merits special scrutiny.”

In the Affordable Care Act unfettered power to make policy decisions has been given to the Secretary of Health and Human Services by a partisan Democratic congressional vote.

Last year (2013) government bureaucrats had already usurped a life-and-death medical decision. Health and Human Services Secretary Kathleen Sebelius refused to waive the bureaucratic rules barring access to the adult lung-transplant list by 10-year old Sarah Murnaghan.

A judge ultimately intervened and Sarah received a lifesaving transplant June 12,2013.

There will not be recourse for patients to any IPAB decision once the IPAB is formed. Obamacare also stipulates that there "shall be no administrative or judicial review" of the board's decisions. Its members will be nearly untouchable, too.

“But the grip of the bureaucracy will clamp much harder once the Independent Payment Advisory Board gets going in the next two years.”

“An Obamacare Board Answerable to No One.”

The IPAB is directed to:

Develop detailed and specific proposals related to the Medicare program.
Include proposals cutting Medicare spending below a statutorily prescribed level.
Encourage to make rules "related to" Medicare.

The IPAB will control more than a half-trillion dollars of federal spending annually. After the health insurance exchanges failure the IPAB will control the 2.7 trillion dollar healthcare industry.

Once the board acts, its decisions can be overruled only by a three-fifths supermajority in Congress. If the IPAB fails to implement cuts in spending, all of its powers are to be exercised by the HHS Secretary.

None of the Republican congressmen have made a stink about this board since Democrats shot down Sarah Palin for being so ignorant as to call the IPAB “Death Panels.”

The Obama administration is feeling its oats even before the IPAB has been formed.

CMS created its own panel to restrict access to care. The panel is called Medicare Evidence Development and Coverage Advisory Committee.

A Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers. The nine-member panel is against Medicare paying for the screening tool.

A December 2013 recommendation by the U.S. Preventive Services Task Force said current or past heavy smokers ages 55 to 80 should get the scans. The two government agencies have contradicted each other.

I wonder if there was a pulmonologist or lung cancer special on either panel. Is this what we are to look forward to with the IPAB?

Under Obamacare, the U.S. Preventative Services Task Force's recommendation means that private insurers are required to cover the screening with no out-of-pocket obligation for their non-Medicare members.

The reason is Obamacare offers better insurance policies through the health insurance exchanges than insurance coverage pre Obamacare. The increased cost is passed on to the consumer in higher premiums.

This is called redistribution of wealth.

The CAT scan should typically cost $300 to $400. If the patients were responsible for the bill under present law, it might cost $1,000- $2,000 dollars.

The Medicare Evidence Development and Coverage Advisory Committee advises CMS on coverage determinations. The committee gave a lame explanation for the reason to discontinue coverage.

The committee members said they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.

The USPSTF made their decision based on the National Lung Screening Trial, which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays.

The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease.

The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented.”

Which government agency is right?

It is not enough for the Medicare panel to say, “they agreed the study was impressive in its implementation and results, they concluded it was not enough to recommend a new coverage policy to the CMS.”

Is the makeup of the committee qualified to make that judgment that will affect 20,000 patients’ lives? Unknown.

Please note that patients (consumers) had no input on the decision. We are told that President Obama is an advocate of disease prevention.

This recommendation contradicts President Obama’s pledge to prevent the onset of disease or to catch disease early in order to cure the disease.

The two agencies even contradict each other. Which one is right? Where is the scientific discussion?

Should Americans give up their freedom of choice to inconsistent government bureaucrats who might not be qualified to make the personal decisions for them?

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

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Who Can You Trust?

May 4, 2014

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

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Stanley Feld M.D.,FACP,MACE

On April 16^th President Obama declared that Obamacare is a success. He said over 8 million people had enrolled through the health insurance exchanges.

He did not know how many had paid the first month’s premium or how many enrollees would be subsidized by the government.

He did not know how many had a chronic illness or pre-existing conditions. He said that 35% of the enrollees were under 34 years of age. This is short of the 37% needed to make Obamacare financially viable but he said it was close enough.

It turns out that only 66% of the enrollees paid their first month’s premium by the April 15^th.This was the deadline set by the administration. Republican lawmakers issued a report last week using healthcare insurers data.

If the insurers knew the numbers the Obama administration and President Obama certainly knew the numbers.

My guess is less than 2 million people who were previously uninsured obtained insurance. The administration is withholding the figures to avoid protest about its failure to provide insurance for the uninsured.

In his press conference he declared Obamacare is a success and Republicans and the media should stop talking about Obamacare’s failure

“Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.”

"The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working and I know the American people don't want us spending the next 2½ years refighting the settled political battles of the last five years."

It turns out President Obama’s success numbers of 8 million enrollees contradicts all the healthcare insurance companies’ tallies of insurance holders.

Why did President Obama lie? President Obama’s goal is to manipulate the media and fulfill his agenda.

The mainstream media does not believe him or his administration any more. This mistrust has been accentuated by the recent Benghazi information that the administration had tried so desperately to withhold.

I do not want to talk about these lies.

I want to talk about other promises about Obamacare that are turning out to be lies and deceptions.

In a recent report a New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan.

She suffers from a disease known as Arnold Chiara Malformation and Syringomyelia.

This 49-year-old woman said, "I've been vomiting. I lost 22 pounds. The pain is unbearable.” "My medication helps me function during the day."

The Obamacare plan she purchased assured her that she was covered for her medications and her disease.

Nevertheless her insurance card was denied when she went to fill her prescriptions. None of her doctors have accepted her Obamacare plan.

In all of Staten Island there are only six doctors who accept her plan. She has been unable to get an appointment with any of them.

This is one of many complaints that patients are making to their congressmen who face the same problem with Obamacare’s narrow networks and the extreme restrictions of Obamacare to physicians and hospitals.

"Even though the insurance company cashed your check, it doesn't mean it (the policy) has been implemented."

These stories are just beginning since most of the people who have signed up have pre-existing illnesses. Obamacare is already making people furious. The fury might be disguised by the traditional media’s ignoring the fury or downplaying it. The complaints might be further diluted by the fact that President Obama has given waivers to the majority of people covered by their employers or unions.

This strategy is clever. After people in the individual market get tired of complaining Obamacare will be so rooted that the rest of the populations will find it unproductive to complain.

I think President Obama is miscalculating the American peoples’ resolve. The strategy will not work.

Obamacare’s narrow networks are limiting specialty centers. The Associated Press says just 4 of 19 nationally recognized comprehensive cancer centers offer Obamacare access through all insurance plans in their state Obamacare exchanges.

President Obama’s promise of access to care and the lack of rationing of care is turning out not to be true.

All one has to remember is that President Obama ridiculed the Republican’s suggestions that Obamacare was going to create “death panels.”

He said it would never happen. It looks like it is happening.

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

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President Obama Tries To Shut Up Media

April 30, 2014

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

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Stanley Feld M.D.,FACP,MACE

On April 16^th President Obama tried to shut up the media’s criticism of Obamacare with his announcement that 8 million people have enrolled in Obamacare. The administrations had reached its goal. Obamacare is a success

Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.

One month earlier we heard from the same administration that the 6.6 million people who had lost their healthcare insurance because of Obamacare was an insignificant sliver of the population.

President Obama’s announcement contained few new details about enrollment.

The entire point of Obamacare was supposed to be to insure people who were uninsured previously.

It turns out (from insurance company data) that as many as 80% of the 8 million enrollees were replacing extremely expensive healthcare insurance policies with Obamacare healthcare policies.

Individual healthcare insurance for older people with a pre-existing disease is unobtainable or extremely expensive.

These people were in the individual healthcare market only. Many had pre-existing diseases and chronic diseases.

Their risk is much higher than low risk patients. Many of these people received government subsidies because they made less than $50,000 dollars a year.

The administration has still not published the number of people who did not have insurance before Obamacare went into effect and have signed up and paid their premium.

President Obama claims he does not know that number. If the healthcare insurance companies know the exact number the Obama administration has to know that number.

President Obama’s declaration of success is ludicrous.

Patients who enrolled and paid their premium are going to realize the negative impact it will have on their medical care shortly.

There is no class of American professionals who will be more negatively impacted by Obamacare than physicians.

Obamacare reinforces the worst features of third-party payment arrangements for payment of medical care. The third party payment system of healthcare insurance has already compromised the independence and integrity of the medical profession.

“With Obamacare physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. “

These are some of the difficulties physicians will face with Obamacare.

The Medicare Payment Formula is flawed. Physicians continue to face the threat of deep payment cuts under Medicare’s sustainable growth rate (SGR) formula.

The SGR governs the annual growth of Medicare physician payments. Congress has kicked the can down the road since 2003. Physicians have incurred a potential reduction of 30% from the present payments if congress does not provide a permanent fix.

Medicaid will be expanded in states that agree to do so to cover any individual earning up to 138 percent of the federal poverty level—$15,856 for an individual in 2013. Many states have refused to expand Medicaid.

The Congressional Budget Office (CBO) projects that this expansion will add 12 million individuals to Medicaid by 2015.

The physician reimbursement rates for Medicaid patients is 58% lower than the reimbursement physicians receive in the private sector.

Thirty three percent of physicians do not participate in Medicaid. Patients’ access to physicians is decreased. The result is Emergency room overcrowding. ER overcrowding was the very thing the President Obama’s healthcare policy wizards wanted to decrease.

Obamacare is imposing more bureaucracy, rules, regulations, and restrictions on physicians.

Since 2010, with few exceptions, the law prohibited physicians from referring Medicare patients to hospitals in which they have ownership.

Thus, a whole class of physician-owned, specialty hospitals has been removed from competition, even though they enjoyed an undisputed record of providing high-quality patient care.
This regulation has driven a large number of physicians to stop accepting Medicare even thought their service is of high quality and less expensive than hospital systems.
There have been mountains of new regulations that are impossible to keep up with. These regulations have driven physicians away from accepting Medicare reimbursement.
Obamacare has created multiple federal agencies, boards and commissions to regulate the practice of medicine.
These creations are partly the fault of physician groups not effectively regulating their peers.

a. Obamacare created a “nonprofit” Patient-Centered Outcomes Research Institute. The institute will determine clinical effectiveness of medical treatments, procedures, drugs, and medical devices.

The result will be an administrative implementation nightmare. All medicine is local. Only financial incentive can work. Penalties and regulatory requirements will not work. It will simply generate an atmosphere of mistrust and non-cooperation.

The Patient-Centered Outcomes Research Institute could be a teaching tool for physicians and patients.

However, the likelihood of the government dictating cookbook care guidelines and regulations, and interfering with physicians’ clinical judgment and the further destruction of the patient-physician relationship is high. The Institute will also retard clinical innovation in the delivery of care.

b. President Obama’s Independent Payment Advisory Board (IPAB) is comprised of 15 unelected bureaucrats. It will be composed of non-practicing physicians, lawyer, laypersons and government bureaucrat.

The goal is to reduce the growth rate of Medicare spending and non-federal spending through health insurance exchanges.

“IPAB’s recommendations would go into effect unless Congress enacts an alternative proposal of equivalent savings.”

The chance of congress presenting an alternative equivalent saving is small. President Obama has stated in the past that the IPAB has little power except to make recommendations. This is not true!

Former Vermont Democratic Governor Howard Dean (D) has said,

"IPABs are essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."

This is the only thing that Dr. Dean has ever said that I have ever been able to agree with.

The IPAB will control spending through reimbursement cuts. It can enable limited or no payment for selected services and medical procedures or for Medicare physician payment.

It looks as if it could drive physicians out of practice and hospital out of business. This is especially true in the absence of tort reform.

c. Pay-for-performance programs are another terrible idea. Physicians can only control some of the outcomes. Patients’ compliance/adherence is the key to most outcomes.

Payment will be adjusted to reflect performance. The measurement will be based on data from the Physician Quality Reporting System and cost data from Medicare fee-for-service claims.

I have previously demonstrated the ineffectiveness of using claims data to make outcomes decisions.

These programs can be used to create powerful economic incentive by complying with standardized guidelines at the expense of individual patient care.

All you have to do is “check the box” to achieve a high and financially beneficial score as a condition of participating in the government’s health programs.

It is aa attempt created by bureaucrats that will not work in the real world.

Most physicians hate Obamacare. Forty-three percent of physicians are considering retiring in the face of the need for an additional 91,500 physicians by 2020.

“Obamacare neglects physicians’ most pressing concerns, such as tort reform, and significantly worsens the already painful problems that come with third-party payment and government red tape.”

Obamacare misses all the keys necessary for Repairing the Healthcare System. Obamacare steers out of the skid (wrong direction). It makes things worse.

Consumers must drive the healthcare system. The physician/patient relationship must be restored. Physicians must help patients make treatment decisions not government, insurance executives and other bureaucrats.

Repairing the Healthcare System will not be achieved until patients, not the government, control their health care dollars and decisions at the advice of their physicians in a viable physician patient relationship.

My Ideal Medial Savings accounts steer into the skid and repairs the healthcare system.

The Obamacare debate is hardly over as President Obama has declared.

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

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Different Views Of The Elephant

April 27, 2014

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

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Stanley Feld M.D.,FACP,MACE

There are many different ways of looking at a large elephant. The cost of the healthcare system is similar to the large elephant in the room.

There are so many ways one could look at healthcare costs. A person can become crazy trying to solve the ever increasing cost through the prism of one’s view.

The information available can be dizzying. There are so many ways of looking at the problem. Much of the information is untrue or incomplete.

I have provided examples previously in which patients tried to find out fees from hospital systems for certain procedures. The fees have been totally opaque. Hospital systems should not be allowed to withhold fee information.

Price transparency is important because it has the potential to set up a system of competition.

The healthcare insurance companies could be a good source of this information because they are billed by the hospital systems.

The big data they publish is essentially worthless because they pay only the contracted price the hospitals and physicians negotiate with each insurance company.

A few weeks ago an article in the Wall Street Journal published the billings from different hospital systems for certain diseases in the same location.

Prices for the same diseases are differ all over the place in hospitals close to each other in California.

However these retail prices are meaningless. This is not price transparency.

The hospital is only going to receive the contracted price from that particular insurance company.

The variation in “retail price” only reflects a variation of service that hospital system performed in each particular disease category.

How much of that service needed to be done for the hospitals population is an important question. The comparison is not necessarily apples to apples.

What was the hopital system’s actual cost for that services?

How did they arrive at its billing?

How much is waste and bloated administration costs and how much is actual medical care?

How did that hospital system calculate the profit for that service?

If this was real price transparency we should be told how much the hospital system paid was for that actual service.

The WSJ article states “It's a simple idea, but a radical one. Let people know in advance how much health care will cost them—and whether they can find a better deal somewhere else.”

This is almost as foolish a question as the chart of the varying hospital prices for various diseases.

If consumers have sudden onset of chest pain they need medical care immediately. The consumer does not have the luxury of shopping for the best price in the area. Those consumers need to be treated at the closest hospital.

Medical bills are outrageous. They are also incomprehensible. In many cases the negotiated reimbursement varies within various healthcare insurance companies.

Hospital systems submit these high prices simply to get the most money from the various negotiated reimbursement deals they have accepted. They do not individualize the prices negotiated with each insurance company because their computer systems can’t handle it.

Physicians do the same thing. They accept the negotiated price for reimbursement by the various insurance companies even though their retail prices are higher.

Occasionally they bill an uninsured consumer. Then the hospital system and physician can collect their retail fee from an uninsured consumer. There is seldom any negotiating to benefit the consumer.

This is absurd but true.

“Unlike other industries, prices for health care can vary dramatically depending on who's paying. The list prices for hospital stays and doctor visits are often just opening bids that insurers negotiate down.”

“ The deals insurers and providers strike are often proprietary, making comparisons difficult. Even doctors are generally clueless about what the tests, drugs and specialists they recommend will cost patients.”

The primary stakeholders in the healthcare system are consumers and their physicians. If consumers and physicians cannot get the prices of the services they are about to use they should demand them or use another vendor.

The declaration of proprietary prices sounds very official and mysterious.

Price transparency is common in most industries. Price transparency stimulates competition with lower cost and better quality.

Price transparency is rare in health care. The "charges," "prices," "rates" and "payments" are all opaque. They bear little relation to actual costs.

It is essential that consumers drive the requirement of providers to publish their prices in order to get customers. The government has no interest in doing it.

If consumers were spending their own money, most consumers would demand price transparency.

If a third party is paying the bill for healthcare, consumers would have no interest in the price of care or controlling the price of care.

“Last year, 38% of Americans with employer-sponsored insurance had a deductible of $1,000 or more—up from 10% in 2006, according to the Kaiser Family Foundation.”

Obamacare is expanding the services required for insurance policies. The services include unnecessary coverage for a lot of potential participants. Both health insurance premiums and private insurance require coverage of unnecessary services. President Obama is also taxing the insurance companies for every insurance policy they sell.

These additional costs are passed on to consumers without consumers’ knowledge in this price opaque world of healthcare.

Premium prices are skyrocketing; deductibles and copays are also increasing.

Obamacare mandates people to buy these healthcare insurance policies.

At the same time the silver and bronze plans created by the Obamacare (Affordable Care Act) carry average family deductibles of $6,000 and $10,386 respectively as opposed to $1,000 pre Obamacare.

More than half of bronze plans also require patients to pay 30% of doctors' fees, according to health-information site HealthPocket.com.

Obamacare and all its regulations are not so affordable to anyone making over $50,000.

Everyone earning under $50,000 receives a subsidy from the government. Over 50% of the people earn under $50,000 dollars. These consumers do not have incentive to shop for cheaper medical care.

People making over $50,000 are trapped. The middle classes’ discretionary income is being reduced by the very program President Obama (Obamacare) promised to protect.

My ideal Medical Savings Account solves all of these problems.

President Obama doesn’t want a solution to the healthcare system. He wants control of the healthcare system. He wants the government to be in control of the entire system.

Only then can he tell consumers what medical care they can and cannot have.

When the present Obamacare system implodes people will beg the government (payer of last resort) to bail them out even at the price of freedom and independence.

The next step will be to control all of the freedoms that Americans have left.

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

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The Wrong View Of The Right Problem

April 23, 2014

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

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Stanley Feld M.D.,FACP, MACE

Most of the stakeholders in the healthcare industry are not stupid. Most understand the issues very well.

The problem is they all look at the same problem from the prism of their own vested interest. Each government action causes these stakeholders to react in their vested interest.

Each reaction causes a compensatory reaction from the other stakeholders, which in turn causes another chain of reactions.

The healthcare system becomes further twisted into a tighter non-functioning hairball that is more expensive than previously.

Aetna CEO Mark Bertolini was the keynote speaker at HIMSS14. His analysis was correct He said,

“Antiquated systems and out-of-control healthcare costs in the United States are not sustainable.”

He went on to say the healthcare system is plagued by inefficiency and waste.

“ We can’t afford it. It’s unsustainable.”

Employees are now paying 41 percent of their healthcare dollars to the healthcare insurance industry. It includes premium costs, deductibles, and copays.

These costs consume much of employees’ disposable income. Mark Bertolini predicts that employees will be paying 50% in 5 years as insurance premiums increase.

Mark Bertolini is really saying consumers will stop buying insurance soon. The result will be a decrease in Aetna’s profit.

Who is at fault?

All the stakeholders are at fault. Consumers are at fault for not taking care of themselves. The incidence of the onset of all chronic diseases increases with the incidence of obesity.

When there is an increase in chronic disease there is an increase in the complications of chronic diseases.

Eighty percent of the money spent on treating that chronic disease is spent on treating the complications of that chronic disease.

Patients must manage their chronic diseases under their physicians’ direction. The patient lives with that disease 24/7.

Patients must be taught to be the “Professor of Their Disease” so that they do not get a complication of that disease.

Patients must also be given financial incentives to become the manager of their disease. This incentive can be developed in many ways.

Reimbursement for education is not routine. There is little financial incentive for physicians to set up educational systems.

Hospitals at one time set up educational systems for chronic disease. They found them a financial burden and discontinued them. The educational systems did not distinguish one hospital from another.

The educational systems were not set up correctly. They should have been set up as an extension of the patient’s physician’s care.

I believe the healthcare insurance industry really wants to lower costs while retaining the profit margins enjoyed in the pre and post Obamacare era.

Aetna’s Bertolini got it right. “We can’t afford it.”

“If we really want to take care of people, we should align incentives around keeping them healthy.”

He is right. His problem is he thinks he controls patients and patient care.

The government thinks it controls patients.

Physicians know they do not control their patients’ behavior.

Neither the healthcare industry and government nor physicians controls patients.

Patients control themselves.

Bertolini said. "Recent data compiled by Aetna found that the top 5 percent of Medicare patients consumed 43 percent of Medicare dollars. They spent on average $108,000 a year per person."

The demographics of these patients disease including past and present lifestyle are not discussed in the data mining survey. This information would be helpful to know the true meaning of this data.

He then concludes, “Let’s not keep sending these people around with 25 different prescription and all these different doctors and hospitals.”

Who is the stakeholder sending patients to all the different hospitals and giving all the different prescriptions.

Physicians, of course!

Therefore, let us penalize physicians for spending all this money on our patients.

This is the wrong way to look at the problem.

If there was meaningful Tort Reform, physicians wouldn’t be doing so much unnecessary testing and treating to avoid missing something that could result in a malpractice suit.

If there were meaningful incentives for patients to be responsible for themselves people would stay healthy.

Patients should be responsible for their healthcare dollars not the government or the insurance industry.

People should also be rewarded if they stay healthy just as the auto insurance industry rewards drivers who do not have an accident.

If the government made a meaningful effort to change our eating habits through meaningful education much illness and medical costs would be reduced.

The center of the new healthcare system should be the patients. It should be a consumer driven system.

As soon as all the secondary stakeholders focus on that fact and start helping instead of penalizing patients and their physicians, the cost of the healthcare system will come down.

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

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