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The Folly of Obamacare

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If Something Works, Destroy It!

Stanley Feld M.D.,FACP,MACE

If a program is working well the Obama administration starts regulating the program out of existence. In a very quiet and deceptive way the Obama administration is destroying Health Savings Accounts.

The fastest growing health insurance plan in the private healthcare market is Health Saving Accounts (HSAs). HSAs are also available in Health Insurance Exchanges.

Consumers love HSA’s because the money not spent for their yearly deductible expenses go into a personal trust fund, which goes to pay future medical expenses. Consumers, employers or government can fund the deductible. Healthcare coverage starts after the deductible is reached. The trust fund can grow tax-free until funds are withdrawn.

HSAs are not ideal but they do act to provide a mild financial incentive to consumers to be responsible for their health and healthcare dollars. Consumers decrease their overuse of the healthcare system.

Health Savings Accounts are not as powerful as my ideal Medical Savings Accounts. Medical Savings Accounts provide greater financial incentive for consumers to be responsible for their healthcare and healthcare dollars.

Consumers seem to lack the desire to prevent obesity, which is responsible for many chronic diseases and their complications. These diseases are responsible for 80% of the healthcare dollars spent.

With my ideal Medical Savings Account consumers or the consumer’s sponsors (government or employers) pay a high deductible. The sponsor then buys first dollar reinsurance for healthcare coverage. The unspent deductible goes into a Medical Saving Account tax-free retirement fund. It does not stay in the healthcare system.

The Medical Saving Account provides greater financial incentive for consumers to become more responsible for their health care and healthcare dollars.

Why and how does Obamacare want to regulate Health Savings Accounts out of existence?

In case you missed it, final regulations published on March 8 will make it impossible to offer HSA-qualified plans in the future.

 The health insurance industry has been opposed to HSAs and MSAs because the premiums the healthcare insurance industry receives is lower than regular healthcare insurance premiums.

Once the premiums are put into a trust it does not belong to the healthcare insurance industry to invest.

The healthcare industry has tried to influence HHS to dissuade consumers from buying HSAs through Health Insurance Exchanges since the exchanges began.

However HSS has done nothing (a) to help consumers identify HSA-qualified plans on the exchanges or (b) provide information to individuals that choose HSA-qualified plans about where to get more information about opening and contributing to an HSA.”

Last year’s proposed standardization of healthcare plan design rule gave no hint that the proposal would eliminate the possibility of HSAs surviving.

This year’s rule change made it clear that this was President Obama’s goal.

1)” Plans must apply specific deductibles and out-of-pocket limits that are outside the requirements for HSA-qualified plans.”

2) “Plans must cover services below the deductible that are not considered “preventive care.”

“ Regarding the deductibles and out-of-pocket limits, no Bronze, Silver, or Gold plans adhering to the standardized benefit designs will likely be HSA-qualified for 2017.”

The first step was for HHS to change the definition of a qualified plan. The next step was to force the plan design to be incompatible with HSAs.

HHS and CMS have given the healthcare insurance industry another gift. Maybe it is a payback for CMS short changing the insurance industry on its reinsurance payback promise.

In any event HSAs look doomed. The Obama administration has succeeded in destroying the development of a viable healthcare system that the free market, not the central government controls.

John Dunn M.D.,J.D. wrote a wonderful summary of Obamacare’s failed attempts to control the healthcare system to his chat group followers.

He has summarized all the policies that have failed in the Obama administration’s goal to destroy the private healthcare market and eliminate the free market system.

 “ Subject: HSAs being eliminated?

Yep, Obamacare strikes again to accomplish the real goal, elimination of private capitalist free market healthcare.

 Now let’s tally up the failures of Obamacare in its attempt to destroy the healthcare system—

  1. more expensive, less accessible,
  2. restrictions on hospitals and care givers,
  3. promotion of mid level practitioners, extraordinary inefficiencies created by computer mandates,
  4. penalties for hospitals and physicians that are created by apparatchiks,
  5. no decline in the uninsured,
  6. in fact there might be an increase in the uninsured because of the cost of premiums and deductible,
  7. more movement of people to Medicaid where coverage is free,
  8. bankruptcies of COOP insurance programs,
  9. exchanges failing with insurers leaving the market for taking big economic hits from adverse selection,
  10. and most of all—the death spiral of private market insurance—with the goal being to destroy the private market ????  
  11. Why of course, Medicaid for all. 

 The goal of government bureaucrats is control and power, achieved in this case by the growth of single payer government controlled medicine—Medicaid on steroids—

The result will be mediocrity as far as the eye can see, and destruction of innovative and creative health care,

but also the loss of the ethics and patient consideration that comes from physician guided health care,

 instead a trade for mandarins with frowns and red pencils,

 Checking the data banks that aren’t secure from hacking.

 It leaves one almost breathless, but it started a long time ago.

Good intentions and unanticipated results—Bastiat von Mises, Fredrick Hayek warned us about the fatal conceit and the problem of government actions to protect certain interests or promote a cause—ignorant of the realities of markets and the benefits of free markets. 

Socialism and statism will produce mediocre, expensive healthcare run by bureaucrats and apparatchiks who aren’t interested in good patient care,

They are only interested in control.

Looks like I am not the only one who has figured it out.

I do not understand why the political establishment cannot understand why Americans are getting ready to cast a protest vote against them.
 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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Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

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

His portfolio includes five industry-leading trade publications:

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

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

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

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

All the stakeholders are unhappy with Obamacare.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  1. The Ideal Medical Savings Accounts (MSAs).

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

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

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

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

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

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

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

  1. The Importance of Tort Reform

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

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

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

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

  1. The Importance of Self-Management of Chronic Disease

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

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

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

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

  1. The Magic of the Patient/Physician Relationship.

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

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

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

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

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

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

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

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

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

  1. The Rule of Information Technology

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

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

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

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

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

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

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

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

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

 

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

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

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Single Party Payer Will Fail

Stanley Feld MD, FACP, MACE

Socialism does not work!

Intellectually, socialism is attractive and easy to understand.

 

Simple Definition of Socialism

 

Full Definition of socialism

  • 1
:  any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

  • 2
a :  a system of society or group living in which there is no private property
b :  a system or condition of society in which the means of production are owned and controlled by the state

  • 3
:  a stage of society in Marxist theory transitional between capitalism and communism and distinguished by unequal distribution of goods and pay according to work done.”


It would be nice to have the government tend to all our needs equally.

Everything would be free to the public.

  • Not one would need to “get ahead.”
  • No one would have special privilege.
  • Everyone would live the same housing.
  • No one would have to have responsibility for anything.
  • No one would have incentive to be creative or inventive.
  • No one would need to take the initiative to be innovative and create new good and services.

The government would then run out of money because people would have little to be innovative about or have any incentive to work hard to provide for their family.

People would have little incentive to produce income that would generate taxes for government to spend on goods and services to support the benefits offered the people in a socialistic system.

The government would have to borrow more money from others because the people would not produce enough income to tax.

What lender would be inclined to lend money to a country that could not pay it back?

The socialistic system would then become unsustainable and collapse.

This explanation might be considered by some to be a fifth grade explanation of socialism. It is simple to understand but direct and to the point.

America is headed in that direction. The present healthcare system as is unsustainable.

Government cannot spend other peoples’ money when the money is not there.

In America the federal government and state governments keep making the same mistakes over and over again.

Obamacare’s regulations caused 335,000 healthcare insurance policies to be cancelled in Colorado. In 2010 Obamacare made these Coloradan healthcare insurance policies illegal.

Obamacare has failed for the citizens of Colorado.

The state’s politicians tried to fix Obamacare by borrowing hundreds of millions of dollars from the federal government to set up Colorado HealthOP the state’s co-op health insurance plan.

The goal was to stimulate competition among insurance companies by providing lower priced insurance. The co-op is in debt to the federal government for hundreds of millions of dollars.

Colorado HealthOP became the largest insurer on a state health insurance exchange in Colorado.

Colorado HealthOp lost so much money that it could not borrow any more. The Colorado HealthOp had to shut down in October 2015 leaving the federal government to absorb its loan to the state of Colorado.

The closure of Colorado HealthOP left 80,000 Coloradans without health insurance coverage for 2016.

The other state insurance plans are increasing premiums an average of 11.7% to stay above water according to state calculations.

It has made premiums and deductibles too expensive for many of these uninsured 80,000 people.

Coloradans are tired of all the insurance changes, increasing prices and uncertainty. They want something new.

The knee jerk reaction is to change to something easy to understand. A socialistic single party payer system (SPPS) is the easiest to understand. Let the state provide healthcare insurance to everyone. Healthcare would be universal and free to the public.

The problem is nothing is free. The advocates in Colorado (progressives and liberals) are mobilizing to replace Obamacare with either the Canadian or United Kingdom healthcare system.

However, both of these nations healthcare systems are unsustainable. They are failing because of the cost, inefficiency, long wait times for diagnosis and treatment and lack of services despite the governments claims and some of the consumers’ perceptions.

The progressive advocates accumulated 100,000 Coloradans’ signatures. These progressive democrats have gotten a single party payer (SPPS) proposal on the 2016 ballot.

“ColoradoCare,” as it is being called, would replace private insurance with health care funded completely by the government, substituting higher taxes for premiums.

The conservatives in Colorado do not have a proposal to replace Obamacare to put on the ballot in 2016. They have been asleep at the switch.

Conservatives and libertarians have been sleeping at the switch in every state except Vermont.

Conservatives and libertarians did nothing in Vermont. Peter Shumlin was elected governor to institute a SPPS.

The Vermont experiment with a single party payer system has been a disaster already.

“In 2010 Vermont voters elected Democratic Gov. Peter Shumlin, who promised to institute single payer in lieu of ObamaCare.”

Jonathan Gruber, who designed Obamacare, and thinks Americans are stupid, along with William Hsiao, who thinks price controls work designed the system for Vermont.

“Helping design the system was advisers such as Jonathan Gruber, the MIT economist often described as the architect of Obamacare, and William Hsiao, the Harvard economist who developed the Medicare price controls that are driving up prices around the country.”

Vermont played right into President Obama’s goal of creating a single party payer system (SPPS). Colorado is trying to follow the same path to disaster.

The Obama administration provided Vermont with many millions of dollars in federal grants in order to accomplish President Obama’s dream of a single party payer healthcare system.

In order to pay for Vermont’s SPPS the state proposed an 11.5% payroll tax on businesses, which would have taken the total payroll-tax burden to nearly 20%.

Vermont contemplated a new state income tax of 9.5% to pay for the SPPS on top of the existing 3.55-8.95% individual state tax.

The state budget would need to be doubled with the SPPS, therefore taxes would need to be doubled.

Even with these increases in taxes the plan would be deep in the red in three to five years.

Gov. Shumlin (Vermont) was elected to create a SPPS. In 2014 he abandoned single payer system he was about to create because of its effect on the state economy.

Gov. Peter Shumlin woke up to the impending disaster, “The potential economic disruption and risks,” he remarked, “would be too great to small businesses, working families and the state’s economy.”

Ben and Jerry might even flee the state and move to Texas because of the high taxes and economic disruption.

The people of Colorado should look carefully at Vermont’s mistake. The Denver Post has already predicted tax increases that would drive business and job growth out of the state.

Colorado also has a large VA Hospital System. In April 2015 the Colorado Springs Gazette reported that four of Colorado’s VA facilities were among the 10-worst in terms of wait times of all VA hospitals.

The Veterans Affairs hospital system is a pure a single-payer system.

A September report by the agency’s inspector general supports the conclusion that thousands of veterans may have died while waiting for the care they needed, although shoddy record-keeping made it impossible to know for sure.”

All Coloradans have to look at is their state’s VA SPPS that cannot take care of the 400,000 veterans in the state. Why should Coloradans expect a SPPS would work for five (5) million residents it their state?

What have conservatives and liberations offered as a substitute for the failed Obamacare experiment?

Nothing!

Leaders should start looking at My Ideal Medical Savings Account system that would put consumers in charge of their health and healthcare dollars.

Please send my summary blogs about an alternative to Obamacare and my Ideal Medical savings accounts to your elected representatives.

Spread the word about My Ideal Medical Savings Account as an alternative to Obamacare.

I wish everyone a HAPPY AND HEALTHY HOLIDAY SEASON

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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I Told You What To Do 8 Years Ago: Part 2

Stanley Feld M.D. FACP,MACE

There are so many little changes that can have a big affect on repairing the healthcare system.

These changes would go a long way in putting consumers in control of their own health and healthcare dollars.

President Obama and the Democrats want to make consumers dependent on government. Most Republican politicians do not understand the healthcare system’s problems.

Republican senators and congressmen have not been able to come up with a viable solution because they are influenced by vested interests other than the consumers’ vested interests. .

Republicans cannot understand that consumers are smart. Most know how to spend their money wisely. Consumers can solve problems if they are given the right tools and incentives.

In last week’s Republican debate Mike Huckabee got close when he said we have to solve four chronic diseases and the costs to the healthcare system would plummet. He mentioned diabetes, heart disease, cancer and lung disease. He was almost correct.

The care of chronic diseases that are manageable consume 80% our healthcare dollars. Most of the 80% is spent on the complications of these chronic diseases.

Motivating patients to become the “Professor of Their Disease” can prevent at least 50% of the complications of these diseases.

Mike Huckabee missed that part. Patients must be provided with financial incentives to prevent a chronic disease from occurring in the first place and then learn how to prevent complications from occurring.

I am publishing the spring of 2007 blog summaries to demonstrate that none of the obvious fixes have been executed to put consumers in a position to make wise choices and be responsible for them.

What Have I Said So Far? Part 2 Spring 2007

April 3,2007

Stanley Feld M.D.,FACP,MACE

 

The solutions I have proposed are all directed to a patient centered, patient driven, and patient advantaged system. I will review the proposed solutions in the next two blogs.

 Price transparency is an essential beginningNot only must the retail price be published but all of the discounted prices must be transparent as well.

The government must enact legislation so that the providers and the insurance companies post their range of prices. The government has to empower the patient with negotiating power to get the best price.

There are many different prices paid for a service depending on the negotiating power of the purchaser. The net effect of this total price transparency will be lower the prices and decrease cost of health insurance.

Consumer must demand real price transparency. Aetna’s declaration of price transparency last year was a rouse. The hospital associations of Wisconsin and now Texas have developed web sites to provide hospital retail prices.

We have little idea how much the government or insurance companies pay for these services. I assure you the discount is very deep and the hospitals are satisfied with the payments. 

The automobile industry has figured out how to deal with total price transparency and the Internet publication of the MSRP, the invoice prices and the average prices paid for an individual automobile. 

We should demand that the healthcare system does the same. The system should be set up where patients can negotiate price pre or post treatment. Sometimes the patients need a care emergently and are not in a position to negotiate in an emergency room.

Yet an oncologist is not permitted to administer the drug in his office for one and one half times the cost of the drug. It is estimated that $150 billion dollars are wasted on administrative costs in the hospital and in the insurance industry. These costs add not value to the treatment of patients. Increased executive salaries and increasing construction of enlarging hospital facilities absorb the administrative waste. The brick and motor expansion of hospitals should be over since much can be done on an outpatient basis.

 These are some of the solutions necessary to repair the healthcare system. The solutions have to be instituted as a total plan and not introduced piecemeal. Each of the pieces of the solution is dependent on each other in order to have a positive effect on repairing the healthcare system. Next time I will review the other elements of my plan needed to Repair the Healthcare System.

April 03, 2007  

There are two more parts to go. If only our elected officials would listen. The only way that will occur is if consumers start making demands. If the politicians do not listen them kick them out of office.

The most profound thing said at the Republican debate last week was by Marco Rubio. He said the traditional media is the Democrats largest and most powerful special interest group.

I suggest people start reading between the lines of the New York Times articles for a start.

Wake up, America.

 

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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Simple, Viable Republican Alternatives To Obamacare

Stanley Feld M.D., FACP, MACE

There are many simple and viable alternatives to Obamacare which Republicans should start considering.

Republicans should seriously consider My Ideal Medical Savings Account as an alterative to Obamacare. It is logical, simple, does not require a large complicated infrastructure and aligns all the stakeholders’ incentives.

It is easy for consumers to understand.

Consumers want to have choices. The dysfunction of our healthcare system has gotten to the point where most consumers don’t have a choice. Consumers simply do not know they lost their freedom of choice and access to care until they get sick.

Consumers think they have adequate healthcare coverage until they get sick. Only 20% of the population gets sick.

The other 80% of the population refuses to think about the problem.

When they do experience illness, the dysfunction in the healthcare system makes them furious. They want to blame someone. Physicians are usually the targets of their frustration.  

Most physicians are trapped in a situation that causes them to fight for their own survival for all the reasons I have previously enumerated. This creates a more dysfunctional healthcare system.

All the stakeholders fight for their own vested interests. These vested interests have become misaligned. The vested interest of the government is to control of the system and decrease its costs.  

Costs cannot be controlled by regulations without consumer involvement.   Consumers of healthcare must understand the effectiveness of their care is dependent on their involvement in their own medical care.

Consumers’ adherence to treatment is a key component in the effectiveness of medical care.

Medical costs cannot be controlled by government price fixing.

Medical costs cannot be controlled by government restrictions to access of care. Consumers will become sicker resulting in a higher cost illness.

Consumers must be empowered to be intelligent, motivated and responsible consumers of medical care. Only then can healthcare costs be controlled.

A functional healthcare system must provide financial incentives to consumers in order for them to want to be empowered to control costs. Consumers should not be dependent on the government to control costs.

The government must repair the actuary and accounting rules of the healthcare insurance industry. Insurance reserves should not be scored as a loss to justify premium increases.

The healthcare insurance industry takes 40 cents off the top of every insurance dollar that is spent. Consumers with both private insurance and government insurance are only getting 60 cents value for every healthcare dollar spent. The healthcare industry is allowed to do some strange accounting with their required reserves.

If this accounting method were repaired, premium costs would decrease.

Effective malpractice reform would result in a significant decrease in healthcare costs. The Obama administration refuses to believe tort reform is needed.  

Many of the rules written into Obamacare, Medicare, and Medicaid are so screwy they defy common sense and penalize consumers. One glaring rule is Medicare permitting hospitals to admit Medicare patients to the hospital for observation for 48 hours.

Medicare does not pay for Observation admissions. Patients have to pay out of pocket for these admissions.

Consumers must become aware of these screwy rules and protest them. These rules have been written by the Obama administration to save the government money. These rules penalize patients the government professes to help.

Consumers are the only stakeholders that can motivate President Obama and congress to fix the significant points of waste in the healthcare system. Consumers have the power to vote.

I do not believe that President Obama has an interest in repairing the healthcare system. All of his actions signify that he wants the healthcare system to fail. After it fails people will beg the government to completely take over and have a single party payer.

Does anyone trust the government to take over our most valuable asset, our healthcare?

The government take over will also fail because dependent consumers will figure out how to game the system just as food stamp recipient have figured out how to game that inefficient system.

The goal of a sincere administration and congress is to figure out how to motivate consumers to be “PROSUMERS” (productive consumer) with an economic interest in the healthcare system.

Airlines, banks, bookstores, entertainment venues have all figured it out. Why can’t the government help consumers figure it out?

My blog entitled “My Ideal Medical Saving Account Is Democratic” presents a consumer driven healthcare formula. It gives every socioeconomic group the opportunity to be an effective “Prosumer”.

It gives all Prosumers the incentive to be responsible for their health and healthcare dollars.

Below is the blog My Ideal Medical Savings Account Is Democratic!

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) “was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrict freedom of choice and decrease in access to care.

The excellent example of increasing costs, decreasing choice, and decreasing access to care is Medicaid.

The fact that someone is covered by healthcare coverage does not mean they have access to medical care.

 I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health.  Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self- insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk is low. 

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust.  If they spent over $6,000 they would receive first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes Mellitus, or heart disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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Republicans who really want to repair the healthcare system should take notice of these suggestions. They should stop proposing complicated alternatives to Obamacare that will not work.

Republicans should start trying to understand the real problems in the healthcare system.

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

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Permalink:

The Obamacare Alternative That Would Work!

Stanley Feld M.D.,FACP,MACE

Some have complained that "My Ideal Medical Savings Account" cannot work. I have communicated with some of these people who made this and similar comments. I discovered two common themes to their comments.

The first theme was that people are too dumb to take care of themselves and make their own medical decisions.

The government must make the healthcare decisions for them.

The second was people would not handle their healthcare dollars appropriately if they were given the money.

These people might be talking about 5% per of the population who will be a burden to society no matter what healthcare system is put into place.

Why burden the other 95% of the population who want to be responsible for their health and healthcare dollars if they were given the chance?

The chance given has to include complete transparency, equal tax treatment, and adequate education to use their healthcare dollars wisely to made wise medical care decisions.

The week Tammy Bruce wrote an article in the Washington Times entitled, “Obamacare Isn’t A Train Wreck, It’s A Cancer.”

She explains how it is metastasizing throughout our economy and culture. It will destroy our society.

It is clear me that people commenting did not read my blog “My Ideal Medical Savings Account Is Democratic” carefully.

I decided to republish that blog at this time when it appears that Obamacare is failing on every level as I had predicted.

My hope is people will read the blog more carefully this time and understand it as an alternative to the impending disaster of Obamacare. 

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrictions on freedom of choice and a decrease in access to care.

I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health.  Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self-insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk of spending $6,000 for most people is low. 

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust.  If they spent over $6,000 they would have first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes, or health disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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Permalink:

I Gave You A Better Plan In 2008

Stanley Feld M.D., FACP, MACE

“The hardest thing to explain is the glaringly evident, which everybody has decided not to see.”

Any Rand, The Fountainhead

 

                                                                        December 7,2013

Dear President Obama;

Last week you said no one has showed you a better plan for healthcare than Obamacare.

You were the dysfunctional healthcare system’s great hope in 2008. Your problem is you listened to the wrong people when you wanted to repair the healthcare system.

 Unfortunately, these people believe as you believe. Their ideology believes in central government control and the redistribution of wealth. This ideology has only led to the failure of national economies in the past.

There are better plans than Obamacare.

In fact, I sent you six letters right after you were elected President explaining how the healthcare system had gotten into the mess it was in and what must be done to repair the mess.

You ignored me completely. I understand why. Your ideology is to increase central government control and redistribute wealth.

I believe in giving individuals the ability to control their own destiny, make free choices, and have incentives to improve and become innovative.

Increasing incentives promotes innovation. You believe in decisions by committee. I have never seen that work in business.

There are several key elements needed to Repair the Healthcare System.

The first is consumers must be responsible for their own healthcare dollars and their own health. Government should not be responsible for consumers’ healthcare dollars.

Consumers must be given positive financial incentives and education to use their healthcare dollars wisely and take care of their health.

A system of financial incentives can be set up so that people who are sick with a chronic disease such as diabetes, heart disease or lung disease can be rewarded if they keep themselves from getting a complication of their chronic disease.

Eighty percent of the healthcare dollars are spent on the complications of chronic diseases. Clinical research studies have shown that appropriate medical care and appropriate self-management can decrease the complications of chronic disease by at least 50%.

People are not dumb. If they had control of their money and freedom to choose they would choose to keep themselves healthy.

Past government attempts at redistributing wealth have never worked. Redistribution of wealth by increasing taxes on “the wealthy” has never historically increased efficiency or productivity.

What makes you think total government control and the redistribution of wealth will work now?

I appreciate your desire to have all Americans covered with healthcare insurance.

What makes you think healthcare coverage will make Americans healthy?

If you would provide incentives to American consumers to practice healthy habits and save money you would better serve us.

The healthcare insurance industry takes at least 40% of the healthcare dollars off the top of both private and public insurance.

You have done nothing with Obamacare to decrease the insurance industry’s incentives except try to penalize them. Obamacare has been unsuccessful.

The reason is clear. Obamacare is totally dependent on the administrative services of the insurance industry.

If fact, because of your disastrous web site you have asked the insurance industry to tell you how much the government owes them. This is the fox in the hen house.

What have you done about Tort Reform?

You have done nothing. Why?

Your healthcare policy advisors know little about medical care and the problems in the practice of medicine.  They believe that the practice of defensive medicine has a minor effect on the cost of medical care.

An estimate is that defensive medicine costs the medical care system $300 billion to $750 billion dollars a year in unnecessary testing.

Obamacare’s solution is to pay less money for those tests, not to eliminate the need to do those tests.

At the same time Obamacare lets secondary stakeholders take advantage of the system. It costs the government $1700 dollars for a fifteen minute ambulance drive to a hospital. Why? What are the basic costs and a reasonable profit to the ambulance company?

Physicians who treat those Medicaid patients brought in by the ambulance receive $24 dollars in reimbursement for his care. Does that make any sense to you?

Your government bureaucrats say we need to save money somewhere.

Hospital systems also receive special deals from the government.

Every hospital has a least two sets of books. One set for the government to see how much the hospital system is losing and the other set to show the hospital administration and board of trustees how much they are making.

Why are hospital administrator salaries increasing as physician salaries are decreasing?

Physicians are smart people. They will figure out how to get around the distortions being created by Obamacare. The result will be a more costly healthcare system and a further increase in the redistribution of wealth.

Who approved of the $640 million dollars contract to CGI for www.healthcare.gov  only to receive a system that doesn’t function and is probably about half built using an antiquated software program that should not be used?

Is it cronyism or stupidity? I know you are not stupid.

We have seen many examples of cronyism. In healthcare the multiple waivers from Obamacare are egregious. Two of the most agregious waivers were the waivers to congress and the unions.

What should the role of government be in healthcare?  Government should work to align everyone’s vested interests. It should set conditions to give all stakeholders real incentives to improve the healthcare system efficiently.

Consumers should be given the most incentive. Consumers are the only one that will be able to lower the costs. Consumers and physicians generate those costs. You do not impose restrictions by penalty. You increase incentives to get consumers to save money.

Try my ideal medical savings accounts.

Below are the links to the letters I had written to you when you were President-elect in case someone in your administration misplaced them.

In those letters is the course you should have followed to have a legacy to be proud of.

I have also provided a host of summary blogs that have explained repairs in detail.

Dear President-elect Obama Part 1

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

Dear President Obama-elect Part 2

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

Dear President Obama-elect Part 3

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

Dear President Obama-elect Part 4

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

Dear President Obama-elect Part 5

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

Dear President Obama-elect 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

Summary Blogs

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/summary-blogs/

You are the one who asked to “show me a better plan.”

I hope you pay attention to my letters this time.

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

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Permalink:

What Is Going On With Obamacare?

Stanley Feld M.D.,FACP,MACE

President Obama’s implementation of Obamacare is right on course to destroy the healthcare system and replace it with the federal government being the single party payer.

He is out to prove that the free market system does not work.

President Obama uses the strategies of Cloward and Pivan as well as Saul Alinsky to overwhelm the healthcare system. The goal is to create chaos in the system.

At the same time he attacks his enemies personally.

Cloward and Pivan said full enrollment of those eligible for welfare (entitlement/Obamacare) “would produce bureaucratic disruption in welfare agencies and fiscal disruption in local and state governments” that would “deepen existing divisions among elements in the big-city political parties and party coalitions.

The remaining white middle class, the working-class ethnic groups and the growing minority poor would be polarized. This would further weaken democratic institutions and existing political parties.

"In order to avoid the continuation of the chaos the federal government would step in and be obligated to advance a federal solution to poverty that would override local welfare failures, local class and racial conflicts and local revenue dilemmas.”[3]

Doesn’t this sound familiar? This week President Obama presented a non-fix to fix the problem of over five million people losing their insurance coverage. His move will only accelerate the chaos in the healthcare system he has already created.

Saul Alinsky said “do not let the enemy attack with a constructive solution. The enemy must be neutralized before its solution takes hold.”

The way to neutralize the enemy is by focusing on an individual you are going to attack. “Do not attack the constructive solution or the institution.”

Freeze the criticism on the individual; personalize the individual criticism and then polarize the populous against the individual and the constructive solution that individual represents. 

This is exactly what President Obama and the Democrats did to Mitt Romney and Paul Ryan. President Obama ignores the opposition’s constructive solutions.

An unidentified source sent me this comment. I am in total agreement

“Obamacare was designed to fail so that the unwashed masses, at the mercy of a cumbersome and unworkable system would look to Obama and the Feds for salvation in the form of single-payer medical care”. 

The only "incompetent and unknowledgeable" aspect of the situation is that Obama never, ever considered that the sycophantic Mainstream Media would ever call him out on this.

President Obama has never considered the wisdom of the American people.

In reality, government interference with the free market and its bureaucratic structure, inefficiencies and ill informed advisors have been the major cause of all the chaos.

Ben Carson quote

Barney Frank and John Kerry told President Obama that the only way Obamacare would work is with a strong public option and a single party payer system. President Obama’s response was don’t worry just pass the Affordable Care Act.

The creation of chaos in the healthcare system is the first step. Obamacare has succeed is creating chaos for people having their healthcare insurance coverage cancelled.

President Obama promised them that they could keep their insurance if they like their insurance. They could also keep their doctor if they liked their doctor.

He knew that this was not true in 2010. Nevertheless he promised it 23 more times since.

The New York Times reported,” A Contrite Obama Unveils a Health Fix

President Obama announced a fix to his signature health care law that will allow existing customers to keep their insurance plans.”

President Obama was far from contrite in my view. His non-fix fix will serve to accelerate the chaos in the marketplace.

His pronouncement is unconstitutional.

The insurance industry is not inclined to do things obviously against the “law of the land”. The main reason is the insurance industry has already purged the old insurance policies from their systems.

It will be impossible to reactivate them again in four weeks.

Increasing chaos is an important step in accelerating President Obama’s endgame to collapse the entire healthcare system.

Let us look at what he said during his “contrite” press conference.

"His announced fix is aimed at remedying the mass cancellation of individually purchased insurance plans by letting insurance companies re-offer non-compliant policies."

President Obama let slip that this is one big blame-shifting exercise. He announced that no one would be able to say Obamacare caused him or her to lose insurance.  

This is a Saul Alinsky tactic. The insurance industry has no inclination or ability to change its policies this late in the game. The industry can only lose money doing this.

President Obama has thus set up the healthcare insurance industry to take the blame for the before and after crisis in the healthcare system.

The fix undermines the essential premise of Obamacare. The young healthy people need to be forced into buying insurance through the health insurance exchanges. Insurance they do not want or need.

The President’s new fix will explicitly encourage many people to stay out of the exchange. The signal is clear that no one should sign up now because the entire program is in flux.  Young people do not trust President Obama anymore.

There were a series of incredible statements and lies made at the fix press conference.  Those paying close attention could hear them.

We fumbled the rollout on this health-care law.”

No kidding. Where is the lie about the promise you made after you knew this would happen with both the web site and the ability to keep your insurance.

“I completely get how upsetting this can be for a lot of Americans.”

Thank you Mr. President.

“It is a complex process.”

Therefore, no one in the administration is to be blamed for anything that went wrong because it is a complex process.

“I was not informed directly [How about indirectly?], that the Web site would not be working. . . .

I don’t think I’m stupid enough to go around saying this is going to be like shopping on Amazon or Travelocity, a week before the Web site opens, if I thought that it wasn’t going to work.”

This is either an intentional lie or he did not listen to people who were telling him the web site was not ready.

People were telling him for months that the web site was not ready, not secure and not tested.

It is time for President Obama take some personal responsibility.

“With respect to the pledge I made that if you like your plan you can keep it. . . that there is no doubt that the way I put that forward unequivocally ended up not being accurate.”

President Obama didn’t lie. He was just inaccurate. Hah!

“The Affordable Care Act is not going to be the reason why insurers have to cancel your plans.”

President Obama must be kidding. His administration’s regulations made the old insurance policies against the law of the land.

“The federal government does a lot of things really well. One of those things it does not do well is information technology procurement.”

Is it the federal government’s fault when President Obama awarded the non-bid contract to build the web site to Michelle Obama’s girlfriend?

“In terms of what happens on Nov. 30th or Dec. 1st, I think it’s fair to say that the improvement will be marked and noticeable.”

I thought we were promised that the web site would be fixed by November 30.

“What we are also discovering is insurance is complicated to buy.”

 Why make it more complicated with Obamacare? The process could and should be simplified.

“There is no doubt that our failure to roll out the ACA smoothly has put a burden on Democrats, whether they’re running or not.”

The burden is on the Democrats. They were fools to pass this un-executable law without reading it or understanding it.

Didn’t Nancy Pelosi tell fellow Democrats that they have to pass the bill in order to see what is in it?

Democrats were the only ones that voted yes for the bill. They are responsible for what is in it.

They all deserve to be kicked out of office in 2014.

“There have been times where I thought we were … slapped around a little bit unjustly. This one’s deserved, all right?”

Again Saul Alinsky comes up. In the last few days I have once again seen the race card come up in the traditional media and among celebrities. Alinsky said attack your enemy personally.

There is beginning to be outrage and fear among the people of all socioeconomic groups. Everyone is now getting President Obama number. No one trusts him anymore.

 Obamacare must be repealed. America must start all over again to reform the healthcare system.

A good place to start is with My Ideal Medical Savings Accounts and Tort Reform.

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

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 .[3]