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President-elect Trump Part 9

Stanley Feld M.D., FACP, MACE

I am extending my discussion on the importance of malpractice reform because politicians ignore the potential costs and decreased access of care resulting from the present system.

In 2003, Texas Governor Rick Perry and the Texas legislature unenthusiastically changed tort reform laws in Texas.

I thought it was inadequate tort reform. It turned out that the meager reform has had great results.

Rick Perry and the Texas legislature ended plaintiff attorneys’ practice of venue shopping for friendly judges.

They also put a cap of $250,000 on noneconomic damages like pain and suffering.

These reforms have changed the malpractice climate in Texas. The reforms limited plaintiff’s attorneys’ profitability on frivolous liability claims.

Texans believe that because of these reforms and the lack of a state income tax, Texas has become the country’s best state for economic growth and job creation.

A Perryman group report concluded,

“Perhaps the most visible economic impact of lawsuit reforms is the benefits experienced by Texans who have better access to high-quality healthcare.”

 

“Doctors and hospitals are using their liability insurance savings to expand services and initiate innovative programs; those savings have allowed Texas hospitals to expand charity care by 24%.”

The medical malpractice business for plaintiff’’s attorneys has dried up in Texas. plaintiff’s attorneys are moving to other states.

Physicians are applying for licenses to move to Texas from other states.

“In 2001, according to the American Medical Association, Texas’ ranking in physicians per capita was a dismal 48th out of 50.”

“Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years.”

 “Dr. Perryman, subsequent to the issuance of his Report, informed TLR Foundation that at least 1,887 of those physicians are specifically the result of lawsuit reform.”

 The Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.

Medical liability insurance rates declined. Many doctors saw average rates drop 20% to 50%.

The American Medical Association removed Texas from its list of states experiencing a liability crisis; marking the first time it has removed any state from the list.

A survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures during the Texas malpractice crisis.

Two simple changes in the tort laws made malpractice suits unprofitable for plaintiff attorneys.

Rick Perry has been so impressed with the results of his tort reforms that he wanted to extend his state’s impressive tort reform record.

Mr. Perry is proposing a British-style “loser pays” rule, which would require plaintiffs to pick up the legal costs of their targets if they lose their suits.

The Wall Street Journal showed that Ezekiel Emanuel malpractice cost estimate was wrong. It is not $25 billion year.

According to the Pacific Research Institutes estimate it is at least $242 billion dollars a year. I think the cost is closer to $750 billion dollars.

 

President-elect Trump, there are other consequences of the present malpractice liability system in the U.S. that cannot be measured in dollars.

One is alawsuits emotional wear and tear on both patients and physicians,

In order to avoid potential lawsuits physicians are avoiding high-risk patients and high-risk patient procedures. The result is a decrease in patient access to necessary care.

The details of the Massachusetts Medical Society Defensive Medicine 2008 survey is profoundly important in explaining trends in the healthcare costs due to the lack of malpractice reform.

Unfortunately, the mainstream media has published only meaningless sound bites about malpractice reform significance.

The survey’s significance has not had the impact on policy it should.

The authors state that the dollar estimates do not include the diagnostic procedures, hospital admissions, specialty referrals and consultations, or unnecessary prescriptions by physicians in specialties not included in the study.

The eight specialties surveyed represent only 46% of the physicians in the Massachusetts. The real costs to the healthcare system from the practice defensive medicine in the state of Massachusetts are much higher.

I believe the costs of defensive medicine in many other states are also much higher because in many states malpractice awards are higher. This encourages litigation.

President-elect Trump, defensive medicine is a huge burden nationally to the healthcare system. Its costs will undermine any attempt at healthcare reform. You must take medical malpractice liability reform seriously. There has to be a fundamental change in the structure of adjudication.

The survey’s findings must be studied carefully. The physicians surveyed estimated their percentages for defensive medicine testing to avoid lawsuits.

The real percentages can be studied objectively using big data. . Nonetheless the current estimates reveal unsustainable waste in our dysfunctional healthcare system.

Radiological imaging is one tool overused by physicians defensively to avoid litigation. Physicians feel they must test everything even if the probability of a positive result is insignificant.

“Plain Film X-Rays: An average of 22% of X-rays were ordered for defensive reasons.”

“CT Scans: An average of 28% of CT scans were motivated by liability concerns, with major differences among specialties.”

About 33% of scans ordered by obstetricians/ gynecologists, emergency physicians, and family practitioners were done for defensive reasons.

The total number of unnecessary CT scans needs to be calculated along with its costs in order to understand the significance of the percentage presented.

The health policy solution should not be to lower the reimbursement for CT scans. The solution is to fix the medical malpractice liability system.

MRI Studies: An average of 27% of MRIs were ordered for defensive reasons, with significant differences by specialty.

Obstetricians/ gynecologists, general surgeons, and family practitioners reported the highest rates, with the lowest rates by neurosurgeons and emergency physicians.

Ultrasound Studies: An average of 24% of Ultrasounds were ordered for defensive reasons. Orthopedic surgeons (33%) and obstetricians/gynecologists (28%) reported the highest rates, with neurosurgeons (6%) and anesthesiologists (9%) the lowest.

I believe neurosurgeons are underestimating their use of radiologic procedures in order to look good. Neurosurgery is one of the specialties with the highest malpractice rates.

Please note that obstetricians/gynecologists take no chances and order the most procedures for defensive purposes.

Laboratory Testing:

An average of 18% of laboratory tests were ordered for defensive reasons, with emergency physicians (25%) reporting the highest rates and neurosurgeons (7%) the lowest.

Specialty referrals, consultations and hospitalizations are overused the most for defensive reasons. No one wants to take a chance and send the patient home even if the indication for hospitalization is small.

Specialty Referrals and Consultations:

“An average of 28% of specialty referrals and consultations were motivated by liability concerns, with significant differences by specialty.

 Obstetricians/gynecologists reported that 40% of their referrals and consultations were done for defensive reasons, and anesthesiologists and family practitioners said that 33% of their referrals and consultations were done for the same reasons.”

Hospital Admissions:

An average of 13% of hospital admissions were motivated by liability concerns, with surgical specialties reporting lower rates than the other specialties.

The cost of defensive medicine is very high and extremely wasteful.

The repair of the dysfunctional malpractice system is simple. The system must decrease financial incentives for plaintiff’s attorneys to file frivolous lawsuits.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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President-elect Trump: Part 6

Stanley Feld M.D.FACP, MACE

There has been no mention of the importance of tort reform in your proposal to replace Obamacare. President Obama made no mention of tort reform either.

Without medical malpractice reform your administration will not be able to reduce the cost of healthcare and increase the quality of medical care.

It is very difficult to institute malpractice reform. It is in direct opposition to the vested interest of plaintiffs’ malpractice attorneys and malpractice insurance companies. These two group have very powerful lobbies.

I have estimated that there is at least one trillion dollars of waste in our healthcare system because of over-testing, over-treating and over diagnosing as a result of the threat of malpractice lawsuits.

Malpractice insurance and the time and money spent in litigation has to be include in the one trillion dollar estimate. Ezekiel Emanual M.D., Obamacare architect, proposed an artificial threshold of significant cost savings in order to form a policy.

“ A useful threshold for savings is 1 percent of costs of healthcare, which comes to $26 billion a year. Anything less is simply not meaningful.”

One percent is arbitrary. It permits Dr. Emanuel to dismiss problems that cost the healthcare system less than $26 billion a year.

The validity of the data collection is of no concern to Dr. Emanuel. He says only $1.3 billion results in malpractice costs. He ignores over testing, and lawsuit costs.

He said,

“Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable and meaningless.

 In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

Dr. Emanuel has no difficulty in producing fake data to make his point to the unknowing.

 A study, closer to truth than just an opinion, disclosed:

The truth is a full accounting reveals that more than 10 percent of America’s health expenditures per year are spend on tort liability and defensive medicine.

This study concludes that $242 billion a year extra is spent because of the lack of tort reform.

The $242 billion is well above Dr. Emanuel’s fictitious threshold.

“Much of this waste is generated or justified by the fear of legal consequences that infects almost every health care encounter. The legal system terrorizes doctors. Fear of possible claims leads medical professionals to squander billions in unnecessary tests and procedures.

Physicians and nurses are afraid to speak candidly to patients about errors. They try to explain the risk reward ratio of treatments for fear of assuming legal liability. The result is the practice of defensive medicine and over testing to cover every possible contingency.

This legal anxiety is also corrosive to the therapeutic magic of the physician patient relationship.

It would be relatively easy to create new rules that would provide a reliable system of justice for patients harmed by medical treatments and procedures without encouraging costly litigation.

A new and effective tort reform system would decrease the costs of defensive medicine significantly. It would encourage physicians to use of clinical judgment rather than expensive tests. It would improve physician/patient relationships.

“ The good news is that it would be relatively easy to create a new system of reliable justice, one that could support broader reforms to contain costs.”

Everyone makes mistakes in every walk of life. The medical legal liability threat could result in further unnecessary errors. Physicians, nurses and hospitals are advised not to offer explanations about mistakes. Sometimes errors are concealed to avoid a legal ordeal. The hidden error could be compounded by additional mistakes.

“Even in ordinary daily encounters, an invisible wall separates doctors from their patients. As one pediatrician told me, “You wouldn’t want to say something off the cuff that might be used against you.”

There are cost multipliers created as mistrust accelerates between the patients and physicians. You would like physicians to adopt electronic medical records. Some physicians avoid using EMRs because the information could be misinterpreted and used against them.

The Electronic Medical Record available through hospitals systems or standalone physician practices is used by the government and the insurance industry to verify the treatment in order to guarantee treatment is best practice treatment.

Physicians are producing cut and paste reports to cover best practice observation by a third party rather than the actual encounter with the patient in order to avoid reimbursement penalty or possible liability.

There is an increasing use of second opinions. Every medical problem is requiring multiple unnecessary laboratory tests to rule out something that might have been missed in the evaluation of patients in order to avoid malpractice suits.

An example is a CAT scan done in Emergency Rooms for the slightest head trauma.

“Medical cases are now decided jury by jury, without consistent application of medical standards.

 According to a 2006 study in the New England Journal of Medicine, around 25 percent of cases where there was no identifiable error resulted in malpractice payments.

 The malpractice insurance companies want to settle the malpractice claims before the court charges mount.

“Nor is the system effective for injured patients — according to the same studies, 54 cents of every dollar paid in malpractice cases goes to administrative expenses like lawyers, experts and courts.”

These are some of the major tort reform issues that must be addressed in effectively.

They must be addressed to decrease wasteful expenditures in the healthcare system.

Malpractice lawsuits have been a growth industry for defense attorneys. The malpractice suits have also been a tremendous psychological and economic burden for physicians who have to defend themselves.

Politically is has been a tremendous economical burden to the healthcare system. In the past politicians have refused to acknowledge the economic burden to the healthcare system.

Malpractice reform is a threat to the vested interests of the defense attorneys and malpractice insurance companies.

Malpractice reform is essential to any meaningful healthcare reform.

President-elect Trump the big question is.

“Do you have the will and the courage to take on the plaintiff attorneys and the malpractice insurance industry in order to correct the medical tort reform system?”

 Effective Malpractice reform must treat both injured patients and physicians fairly.

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Dear President-elect Trump: Part 5

Stanley Feld M.D. FACP,MACE

Dear President-elect Trump,

A blog from a medical student appeared in www.KevinMD.com

The medical student, Jacob Chevlen, got it right.

Don’t call me a provider.”

President-elect Trump, if you really want to repair the healthcare system and I believe you do, you must listen to this medical student carefully.

You must realized that patients are not commodities. They are living human beings with emotions as well as concrete illnesses.

Many illnesses and their complications can be avoided if the way to maintain good health is understood by consumers. Cultural changes must occur to decrease the external stimuli that lead to these illnesses including obesity and drug abuse.

It must be recognized that the most important stakeholders in the healthcare system are patients (consumers). A viable healthcare system must be built around patients who have incentives to remain healthy.

Consumers of healthcare depend on physicians. Physicians are the second most important stakeholders in the healthcare system.

Patients depend on physicians to use their expertise and judgment to help them maintain health and to fix them when they get sick. This skill is developed over 6 to 10 years of post-graduate education.

The government, the healthcare insurance companies, the hospital systems, and the pharmaceutical companies are all secondary stakeholders.

Both patients (consumers) and physicians have been devalued by the government’s desire to simply reduce healthcare costs.

Government bureaucracies believe that they can reduce costs by regulating physicians’ “decision making” and “second guess” their clinical judgment.

The federal government is trying to control the healthcare system. The harder the government tries to control the healthcare system the more dysfunctional it becomes.

Some day the federal government is going to realize it costs more in the long run to try to control the two most important stakeholders. (consumers and physicians) than it is to provide financial incentives to consumers to maintain their health.

Society has been programed by government and other secondary stakeholders to consider physicians as healthcare providers.

We are not healthcare providers. We are physicians! Medical student Jacob Chevlen expresses this sentiment perfectly.

“I am a medical school student. Like many of you reading this, my life is spent between the walls of the library and the walls of the clinic.”

I remember being told as a first year medical student that I would have to learn a new language and live a different life than my college friends not going into medicine.

“I was told at the beginning of this journey that it was fair; that it was an “equivalent exchange.”

“You want to relieve suffering — great — you’re going to suffer.”

“You want to extend lives — fantastic — you’ll trade years of your own.”

“You want to lead your patients to healthier relationships — beautiful — I promise you’ll be distanced from your family, friends, and other loved ones.”

One of these statements with its consequences has been true for many physicians I have known through the years.

“We accepted this trade because we are driven to be physicians.”

“Ultimately, it’s a small price to pay to join that sacred society of men and women who devote their lives to healing.”

It is truly a fulfilling emotional experience to have practiced clinical endocrinology for 30 years. I have developed so many wonderful physicians/patient relationships. I know these relationships that I had added to my therapy. These relationships had immensely improved my patients’ treatment outcomes and well-being.

“However, none of us made these sacrifices to be a “provider,” and this is the culture we must fight.”

As President of AACE and subsequent author of Repairing the Healthcare System, I have tried to fight for a cultural change.

Obamacare has devalued physicians and downgraded the physician/patient relationship.

Some of these sick human beings have no interest in listening to a provider when the government or the health insurance company will take care of them when they get sicker.

Consumers who desire to develop a patient/physician relationship are finding they have access. So many physicians have given up on developing physician/patient relationships.

Consumers are now gravitating to concierge physicians in their quest to find a physician that cares and will develop a physician /patient relationship with them.

“Recently, the director of the Governor’s Office of Health Transformation spoke at my medical school.”

It sounds like an agency in Atlas Shrugged to me. The “GOHT” is a mind programing agency whose goal is to manipulate physicians’ minds.

“To enroll in that will give them enhanced reimbursement for reducing costs to Medicaid.”

“Not once during his entire lecture did he use the word “doctor”, when referring to physicians, or advanced practice nurses; he only referred to them as “healthcare providers.”

The “experts” believe that social engineering works. President-elect, you surprised the government, the media and the experts and showed them social engineering does not work. You won the election, didn’t you?

Jacob Chevlan goes on to say;

“Stop.

Have you ever considered what a “provider” is or does?”

“Well, that’s obvious: A provider provides! A provider is the source of a good or service. They disseminate it freely and happily, expecting nothing in return.”

Unimportant is the many years of schooling to develop an understanding of the subtleties of disease, its presentation and treatments.

Physicians’ judgment and patient physician relationships should not be discounted.

“That is how government, insurance companies, and hospitals look at physicians. We are obliging tools, conduits along the path of the flow of money from patients to insurance companies, and insurance companies to hospital systems.”

Medical Student Jacob Chevlan has nailed it President-elect Trump. If you have any chance of Repairing the Healthcare System you should listen to this medical student who has not been involved in the present disillusionment of the practice of medicine.

I have outline simple fixes that can cure this dysfunction rapidly.

“Our feelings, and our goal of providing top-level care, are fundamentally irrelevant.”

“ Why else would prior-authorizations exist?”

The government and the healthcare insurance industry’s data supersede physicians’judgment.

“Or electronic health records whose only real function is to facilitate billing?”

EMR’s as crafted can easily provide irrelevant false “big data.” EMR’s should be used as a continuing education tool to enhance physicians’ judgment rather than a punishment tool for physicians’ reimbursement.

“ Or the fact that it is illegal to provide pro-bono care to Medicaid or Medicare patients?”

“These and other “innovations” burden physicians and patients, slowing or even completely halting the delivery of care.”

This medical student goes on to say;

I do not know when physicians allowed themselves to be called “providers,” but I do know that no positive change will happen to our toxic and unsustainable health care system until we stop accepting it.

I can only hope Mr. President-elect that you take heed and listen to this medical student as your surrogates formulate your replacement for the disaster called Obamacare.

“I am not a “provider school” student. When I graduate, my diploma will not say “provider” on it. It will say “doctor,” and we should accept nothing less.”

Bravo Jacob Chevlan !!!

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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  • Naina Katyal

    Such a very useful article. Very interesting to read this article.I would like to thank you for the efforts you had made for writing this awesome article.
    Desi chhokri

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Dear President–elect Trump Part 4

Stanley Feld M.D.,FACP, MACE

In 2008 I thought President Obama was the real deal.

I thought he cared about Americans and cared about repairing the healthcare system. I wrote six letters to him giving him suggestions on how to repair the healthcare system.

Then, I realized he was not interested in the improved delivery of healthcare to all Americans. He was interested in the central government controlling the healthcare system in order to control the people and limit their freedoms.

Obamacare was the answer to his goal. Most physicians did not agree with his plan. Many felt powerless to object. Many felt they should go along to get along.

Many in the healthcare industry figured that greater government involvement in healthcare financing would lead to its economic benefit.

Everyone has been deceived. Everyone is starting to believe that government managed healthcare leading to a better healthcare for all and a better healthcare system is a myth.

In my letters I tried to explain this to President-elect Obama. My explanation fell on deaf ears.

Dear President Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president–elect-barack-obama-part-5.html

Dear President Obama Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Over the last seven and a half years I have developed a simple but effective consumer driven healthcare system that should replace Obamacare after it is repealed.

Obamacare is missing the major ingredient necessary to create creating a successful healthcare system.

The healthcare system must be market driven, with consumers being responsible for their healthcare and healthcare dollars. The tool that will accomplish this is my Ideal Medical Saving Account. Please include reading the article  My Ideal Medical Savings Account Is Democratic! among all the articles in the group explaining My Ideal Medical Savings Accounts.

The Republicans in the House got many things right in its legislation to replace Obamacare. However they have left out the three most important elements necessary to Repair the Healthcare System.

The first is the revival of the physician/patients relationship.

Consumers must control their health and their healthcare dollars. America must have a consumer driven healthcare system.

Consumers can be taught to drive the healthcare system though public service education.

Consumers must be taught through public service education to change their eating and exercising habits. The emphasis must be on the health dangers of obesity and its development.

Secondly, consumers must be given financial incentives as outlined by my Ideal Medical Savings Accounts to control their own health and have access to available care available in necessary.

Third, there must be significant tort reform included in the replacement of Obamacare.

If the Republicans simply send you the bill they have passed in the house and you sign it you will have an impending disaster as large as Obamacare.

If you include my suggestions in your bill, you would excite consumers and physicians. All the people who have been hurt by the failures of Obamacare will cheer you.

The repeal of Obamacare is vital. It should only be replaced with a consumer driven healthcare system that I have outlined. It will be economically sustainable. It would win over all conservatives and independents. It would even make progressives rethink their ideology.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Naina Katyal

    Really impressed! Everything is very open and very clear clarification of issues. It contains truly facts. Your website is very valuable.
    Desi chhokri kurtis

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Dear President-elect Trump Part 3

Stanley Feld M.D.,FACP, MACE

The following is Part 3 of my review of your healthcare reform platform. You have a viable alternative to Obamacare. Your alternative needs some vital additions.

In my last blog I omitted the link proving that only 1 million people signed up for Obamacare health insurance exchanges.

I apologize for the oversight. Today enrollment is only 2.3 million. I also noticed that the enrollment date was extended to January 30 from December 31 without fanfare. The site I omitted that follows daily enrollment is acasignups.net.

Obamacare is still a long way from the 20 million claimed and the actual 10 million enrolled for 12 months.

The Obama “experts” still believe that Obamacare is viable. They refuse to believe it has been a healthcare disaster as well as a disaster for America’s economy.

Your next proposal is;

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

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

The cost of first dollar reinsurance for coverage after the deductible is met plus the MSA contribution is much cheaper than the first dollar coverage Medicaid coverage. The insurance vendor will still make a sizable profit by providing first dollar coverage reinsurance.

The contribution to the MSA should be flexible to provide an adequate amount of money to be put into the savings accounts to provide financial incentivizes to consumers to maintain their health.

Obesity is a huge problem to health maintenance of health. Obesity can be effectively cured behavioral change of consumers.

The incidence of chronic diseases in obese people is five times that of normal weight people. Financial incentives must be provided. The is also the area that social engineering might be helpful.

Obese children are becoming diabetic and hypertensive at a young age. This must be prevented because of the potential explosive cost effect of complications of both diabetes and hypertension on individuals. The overall costs to patients, Medicaid and society will be devastating.

Medicaid must be converted to a system where the recipients are responsible for their health with financial incentives. Only then Medicaid patients will not be treated as a commodity. Service will improve. .

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

Price transparency is an essential provision for individuals, businesses and groups in order to produce smart consumers of healthcare.

It is also necessary to require insurance companies to provide verifiable price transparency for their administrative costs and their direct patient care costs.

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

The only way to decrease the cost of healthcare services is to produce smart and motivated consumers of healthcare.

The Healthcare System must be converted to a Consumer Driven Healthcare System.

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

The success of Angie’s list, Trip Advisor and Open Table are a result of social networking.

All medical care is local. Local communities have their individual social networks that empower people in their neighborhood to know which vendors provide the best value in their community.

Healthcare consumers can use this simple procedure to decrease the cost of healthcare and medical care.

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

  1. Block-grant Medicaid to the states.

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

Block grants for social networking should be used to provide incentives to help individual Medicaid patients seek out and eliminate fraud, waste and abuse of some of its local providers.

It would eliminate expensive big data collections that often times are inaccurate for policy making by central federal control.

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

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

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

It would provide consumers with information to take responsibility for their own health and healthcare dollars.

  1. Encourage Congress to step away from the special interests and do what is right for America.

One example is allowing consumers access to imported, safe and dependable drugs from overseas. It will stimulate competition for consumer dollars in the U.S. and lower the cost of brand and generic drugs sold here. Drug prices are artificially high in the U.S.

This is only one example of many ways to decrease the cost of drugs in this country.

You have made many proposals to make a lot of important changes to the healthcare system.

Some are good proposals. Some are not very well thought out by your advisors.

You left out Tort Reform, which is one of the most important proposals. Effective Tort Reform will result in a precipitous decrease in the cost of medical care.

It is absurd to let Obamacare “experts” like Ezekiel Emanuel and Jonathan Gruber heckle your “non viable” healthcare reform plan.

However, you are missing the other important elements in reforming the healthcare system. Those elements are the elements of the use of consumer power, consumer initiatives, and consumer incentives.

 By utilizing these elements you will begin to “Drain the Healthcare Swamp.”

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

You have admitted these proposals are simply a start. You can easily fall into the trap of listening to academicians who have never practiced medicine in a private setting. You need people who understand patients’ needs.

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

You must repeal and replace Obamacare. No one wants it. You have outlined a viable proposal even if the progressives don’t like it.

It is a good start.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Dear President-elect Trump Part 3

 

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Dear President-elect Donald Trump: Part 1

Dear President-elect Donald Trump: Part 1

Stanley Feld M.D.,FACP,MACE

Repairing the Healthcare System

Dear President-elect Donald Trump: Part 1

In 2008 I wrote to President-elect Obama and told him what has to be done to repair the healthcare system from a practicing physician’s point of view.

He did not listen to one suggestion.

I am going to try to help you out also. You are correct to want to repeal and replace Obamacare. It is a failure. It is also a disaster to both America’s healthcare system and economy.

The healthcare reforms you propose on you website are good so far. However they are incomplete and inadequate if your goal is to achieve a viable market driven healthcare system.

I will list the others elements with links to the documentation in future letters to you.

Patients and physicians are the two most important stakeholders in any market-driven healthcare system. They are the only stakeholders that can drive the market in an affordable way.

The insurance industry, the government, hospital systems and the pharmaceutical industry are all secondary stakeholders.

You have told a biased media that you will repeal and replace Obamacare.

They are now trying to make fun of you because of your threat to the establishment. Please ignore them.

The progressive spin machine using Ezekeil Emanuel and other surrogates are wrong when they keep repeating that neither you nor the Republican Party have not offered a viable replacement plan.

You might remind them that their plan was not very viable. What makes Ezekiel Emanuel an expert when he has never practiced medicine in a private office setting?

You and the Republican house have some very viable suggestions. Democrats refuse to read them or recognize them. They have not analyzed their economic effect on the healthcare system.

However, you do not go far enough in including the patients who are essential to drive the healthcare system. Patients must assume the responsibility for their health and care of their diseases.

Patients must be provided with treatment options and potential outcomes in order to be responsible for their health. They must also be provided with financial incentives to take care of their health.

Consumers must be in control of their health and healthcare dollars to achieve an efficient market driven healthcare system.

Obamacare treats the two most important stakeholders as economic commodities. It disregards patients’ feelings.

Healthcare policy should be built around patients’ needs and not the needs of secondary stakeholders.

The key to Repairing the Healthcare System is the promotion of individual consumer responsibility for their care. Patients must feel physicians and their healthcare team care about them.

The physician patient relationship is the most important healing element in a therapeutic equation. It can lead to patients understand and adhering to recommended treatment.

Patients must be the captains of their therapeutic team. Physicians must be the head coaches with their nurses and physician assistants being the assistant coaches.

Only then will we have an efficient and affordable healthcare system. I have written in detail about the mechanisms necessary to achieve an affordable healthcare system.

A successful and affordable healthcare system must be a consumer driven healthcare system using my ideal medical saving accounts .

Medical Savings Accounts are different than Health Savings Accounts.

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

All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Atlanta Weekend With Daniel

Stanley Feld M.D.,FACP,MACE

I love spending a weekend each year with each of my sons.

I have done that with Daniel and Brad once a year for at least the last decade.

Daniel picked L.A. this year then, he changed his mind. He wanted to go to Atlanta. He had Tech Stars business in Atlanta on Monday and Tuesday and his 25th Emory homecoming on Saturday.

He figured he would kill three birds with one stone. I would love mingling with young people (47 year olds) at the 25th college reunion.

The plan was to meet up on Friday afternoon at 2:30 pm at the Atlanta airport.

I would go to Atlanta Thursday morning and spend twenty-four hours with one of my best friends Dr. Albert Padwa, Professor Emeritus at Emory University, now an accomplished artist/sculptor.

Al and I have been buddies since the second grade at P.S.70 in the Bronx. We both went to Wade Jr. High School and Taft High School in the Bronx.

We competed with each other in a very friendly way. We were considered the smartest kids in the class.

We both went to Columbia College and graduated in the Class of 59. I went on to Medical School. Al got a PhD in Chemistry. He did that instead of medicine because he could not tolerate the sight of blood.

He became a famous free radical organic chemist at Emory University.

We have been pals for 73 years.

When Daniel went to Emory as an undergraduate Al and his wife looked after him.

Al and I spent a great day together going over old times and some old adventures.

First, we went to Emory’s chemistry building to see his mobiles. He has mobiles all over the new chemistry building. They are truly excellent.

Chem building Al
picture

Next, we went to his house to see his mobiles and stabiles. I fell in love with two of them. I think he will give me one of his stabiles for my backyard.

My sculpure

I showed Brad my pictures of Al’s work. He wants to buy one.

 

Brads sculpture

On Friday morning we went to Piedmont Park. Piedmont Park is one of the great botanical gardens in the world.

Piedmont 1
Piedmont 3
Piedmont 2

The next morning we went to the Atlanta version of the New York City’s High Line, the Atlanta Beltline Eastside Trail.

Beltline 2
Beltline 1

Large Cities are finally figuring out how to make themselves livable.

On the trail we had lunch in an old reconditioned factory. I had a delicious shrimp roll.

Then, we then drove out to the airport to pick up Daniel. Al wanted to hang out with Daniel in the afternoon. We had a great time finding an ice cream parlor in Al’s neighborhood the Virginia Highlands.

As soon as we walked into the lobby we saw a bunch of Daniel’s fraternity brothers. I knew most of them. We shot the bull for a while (2 hours) before we ever got to our room.

We went downstairs immediately because we were now late in getting to Kenny and Lisa Feld’s house.

Kenny is my brother Charlie Feld’s son. Daniel is one year older than Kenny. I love Kenny and Lisa.

Brad is one year older than Jon, Charlie’s other son.

The boys spent many weekends together when Cecelia and I left town for a date weekend. Charlie and his wife took care of my kids. Each couple watched the other couple’s kids for date weekends.

We have a wonderful evening with them and their two kids, Sidney and Dillon.

Kenny then drove us to some bar near Virginia Highlands for the first official homecoming event. Daniel’s class had a bigger representation than most of the other reunion years.

The opening event was much different than my 25th Reunion at Columbia. I had fun at the Emory Reunion opening night. The noise was deafening.

We went back to the hotel via Uber. The Uber driver convinced me to download Waze. It is an excellent GPS. Waze is one hundred times better than the GPS in both my Lexus’. Lexus needs to learn something from them.

At ten am Saturday morning we were on the way to the World of Coca Cola. I have been to Atlanta several times but have never been to the World of Coca-Cola.

Coke 2

Coke 1

My visits have always been for business. I never made time to visit Atlanta for fun. Daniel and I had a great time tasting all the Coca Cola products produced all over the world. Frankly, some of them were awful. However, I am sure they fit the taste of that individual country.

The most precious time was just talking to each other about life goals and our philosophy of life.

Next stop was a Mexican fast food place in downtown Atlanta. It was better than I had expected.

After lunch we walked across the park to the National Collegiate Hall of Fame. I did not know it existed. I enjoyed that very much.

I picked out the Columbia College helmet. We always had the worst team in the Ivy League. The museum had all the helmets of all the collegiate leagues and biographies of all the college stars in the Hall of Fame.

Columbia helmet

It was over 90 degrees when we went to the Emory Reunion Lawn Party. I was so hot I lasted only about an hour. The instructions I got to get back to the hotel were terrible. After a two-hour hike I stopped a woman to ask how far the hotel was from here. We got into a nice conversation as she started walking me to the hotel.

We passed her car on the way to the hotel. She said “why don’t I drive you to the hotel?”

I guess she saw how overheated I was and how horrible I looked. I accepted with great relief.

In the hotel room I took a cold shower. I remembered my days at Parkland Memorial Hospital in Dallas when someone would come into the ER with heat stroke and we put them in an ice cube filled bathtub.

I feel much better in ten minutes.

Daniel came home just before the next event. He needed a cold shower too.

Down to the lobby and off to Turner Field for the next event. It is all about reuniting will friends, some of whom you haven’t seen in 25 years.

The barbeque was good but not as good as Sonny Bryan’s or Dickey’s in Dallas.

The conversations were wonderful. Daniel’s classmates (men and women) were as dressed up as you can be in 2016.

I had a great time that weekend. In the hotel room Daniel and I talked for a while. I was off to the airport relatively early on Sunday having once again spending a wonderful weekend with one of my sons.

 

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

All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Pre-Election Obama Administration Lies

Stanley Feld M.D.,FACP,MACE

The Obama administration is out in force telling pre-election lies so that the Democrat’s base that loves entitlements stays calm.

New data from Joint Commission on Taxation led the TPC to cut the number of people paying federal income taxes by 3.9 million. In total, 77.5 million individuals and married couples — or tax units. as they are defined by the TPC — won’t pay income tax this year out of a total of 171.3 million. The previous estimate was for 66.2 million out of 163.8 million tax units not paying income tax in 2015.

In 2015, this represented 45.2% of the taxpayer units.  In 2013, 40.4% of taxpayer units paid no taxes. With the influx of illegal immigrants paying no taxes the percentage of non taxpaying units will increase.

The illegal immigrants will receive Medicaid and other entitlements.

Hillary Clinton has pledged to increase illegal immigration with open borders and increase Medicaid enrollment.

Taxes will have to be increased. The middle class will be crushed. Hillary Clinton will hide some of these taxes as President Obama has done for Obamacare..

President Obama is trying desperately to save Obamacare from self-destruction.

I have recently reviewed the phony enrollment figures for 2014, 2015 and 2016 published by the Obama administration. There has not been a significant increase in enrollment in the last three years.

The claim that there are 20 million enrollees as a result of Obamacare is not even a half-truth. There are only 10 million enrollees from the Health Insurance Exchanges.

The failed Medicaid entitlement program has an added 10 million enrollees and insufficient physician coverage.

The first pre-election day lie was HHS Secretary Sylvia Burwell telling a group that the 2017 Open Enrollment period was going to sign up an additional 1 million enrollees. She said the Federal Health Insurance Exchange marketplace was strong.

The Marketplace is strong – and will continue to be strong – because it is offering a product people want and need.

This year, we know the Marketplace is strong, but we think it will grow even more.”

“As we look to this next open enrollment period, we project that the Marketplace will grow by another million people. By the end of open enrollment for 2017, we expect 13.8 million people to have selected a plan.”

Obamacare enrollment through the Health Insurance Exchanges was supposed to grow to 21 million last year according to the CBO estimate. At best, 11 million people are enrolled not 12.8 as claimed. Eighty-five percent of the enrollees receive subsidies.

President Obama’s goal is to have a single party payer in control, namely the government.

Secretary Burwell goes on to conclude;

“In closing, as the President said during the debate over the law, “we did not come to fear the future. We came here to shape it.”

It looks like President Obama is shaping the future in a way Americans did not anticipate or want.

The next big pre-election lie was President Obama’s lie admitting that Health Insurance Exchange premiums will go up 22% in 2017. He also said that the government would cover the premium increases for those receiving subsidies.

He did not discuss the government’s position on the increases in deductibles. Is President Obama also covering the deductible increases?

Where is President Obama getting the money? I think the money for the increased subsidies was built into the budget by telling the CBO that there were supposed to be 21 million enrollees in the Federal Health Insurance Exchanges. Only 10 million enrollees showed up.

The reason for these continuing lies is to calm the public. President Obama and Hillary Clinton want us to believe that Obamacare is good and is working well.

The obvious message of these lies is that the public should vote for Hillary Clinton to continue this good work.

 

https://youtu.be/ziVfvWO8oUE

This You Tube is an excellent summary of all the lies President Obama and the Obama administration have told the America public since the Affordable Care Act (Obamacare) was passed.

It is worth ten minutes of your time to review this deception.

This week he tried to dodge the responsibility for the Health Insurance Exchanges demise and also claimed he should not be blamed for the rise in premiums in the private group insurance market.

Of these major cities, the places with the largest increases in the unsubsidized second-lowest silver plan were Phoenix, AZ (up 145% from $207 to $507 per month for a 40-year-old non-smoker),

Three hundred dollars a month or $3,600 dollars a year is a lot of money for a person making between $40,000 and $50,000 per year.

 The premium increases in Birmingham, AL (up 71% from $288 to $492) and Oklahoma City, OK (up 67% from $295 to $493).

 “ Meanwhile, unsubsidized premiums for the second-lowest silver premiums will decrease in Indianapolis, IN (down -4% from $298 to $286 for a 40-year-old non-smoker), Cleveland, OH (down -2% from $234 to $229), and Providence, RI (down -1% from $263 to $261) and increase just 1% in Little Rock, AR (from $310 to $314).”

 In many states there isn’t any competition in healthcare insurance for consumers business.

“Marketplace insurer participation in states using Healthcare.gov in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin.”

Hillary Clinton bragged that healthcare reform was called Hillarycare long before it was called Obamacare.

I would not be very proud of that statement, if I were her.

I do not believe the American public is not going to be fooled again by progressive rhetoric and lies.

Obamacare is a disaster. I have described the disaster and its potential consequences for since its passage in 2010.

It has caused both the public and private healthcare markets to escalate insurance premiums to unaffordable levels for all Americans. The cost to the federal government is unsustainable.

The present awareness of the Obamacare disaster is the straw that is going to break the back of Hillary Clinton’s campaign.

All Americans deserve a better healthcare system than Obamacare.

My ideal medical saving account is the solution to the healthcare problem.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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