Stanley Feld M.D., FACP, MACE Menu

Results found: 35

Permalink:

Lest We Forget

September 19, 2010
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

 

Stanley Feld M.D.,FACP MACE

I have pointed out the many trick plays President Obama used to pass his healthcare reform plan. These trick plays are now obvious to the majority of Americans. The tactics have led to profound mistrust for President Obama.

Democrats running in this falls midterm election are avoiding talking about their vote for the healthcare reform law. Twenty-one states believe the bill is unconstitutional.

Two weeks ago, Politico broke the news that a major coalition of liberal supporters of the health care overhaul was telling activists not to mention deficit or cost reductions when attempting to sell people on the bill. Now, Politico reports, another major liberal health care activist group, Health Care for America Now, has an even better strategy for helping out the politicians who voted for the bill: Maybe just avoid talking about the law entirely! 

 

Over the next couple of weeks President Obama is going to campaign to persuade voters of the benefits and constitutionality of the Patient Protection and Affordable Care Act (Obamacare).

I think President Obama will be shooting Democrats running for re-election in the foot.

The majority of Americans is not buying anything President Obama has promised.

Remember Nancy Pelosi telling us not to worry because we will understand the bill after it is passed?

Americans are now finding out what is in the bill. It is not pretty.

If you like your plan, you can keep your plan.

Americans are realizing that President Obama couches his words with double meanings.

“What I’m saying is, the government is not going to make you change plans under health reform,”

Everyone knows employers change plans each year. These new plans do not qualify under President Obama’s statement. In a draft document laying out grandfathering rules it states that most plans will relinquish their grandfathered status if the plan is unchanged after a period of time.

Healthcare Reform will cost around $900 billion.

President Obama told a joint session of Congress that his health care plan would cost “around $900 billion over ten years.” He even said it would save tax payers money.

It will be paid for “mostly” by shifting around money that we are already spending.

Actually, the majority of the money from the bill’s official scored cost comes from new taxes. According to the CBO, “the two pieces of legislation [that make up the health care law] were estimated to increase mandatory outlays by $401 billion and raise revenues by $525 billion.”

The original CBO’s report said the final cost estimate for the law came in at about $950 billion. After the bill was law the CBO report stated the law will actually require about $115 billion in additional discretionary spending, putting the official price tag well over $1 trillion. http://cboblog.cbo.gov/?p=835

My guess is this estimate is still low.

President Obama said healthcare reform law will not cut Medicare benefits.

He said, “Nobody’s talking about reducing Medicare benefits.” But according to the head of the Congressional Budget Office, “thanks to $130 billion in planned cuts to companies that offer Medicare Advantage plans, the health care law will “reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans.”

President Obama’s statement again represents another misdirection of reality.

President Obama declares that his healthcare reform law will put Medicare on better fiscal footing.

In August 2010, the Obama administration’s Department of Health and Human Services released a report claiming that the PPACA would “extend the life of the Medicare TrustFund by 12 years.”

Affordable Care Act Update: Implementing Medicare Costs Savings

“This new law recognizes that Medicare isn’t just something that you’re entitled to when you reach 65; it’s something that you’ve earned. It’s something that you’ve worked a lifetime for, having the security of knowing that Medicare will be there when you need it. It’s a sacred and inviolable trust between you and your country. And those of us in elected office have a commitment to uphold that trust – and as long as I’m President, I will.And that’s why this new law gives seniors and their families greater savings, better benefits and higher-quality health care. That’s why it ensures accountability throughout the system so that eniors have greater control over the care that they receive. And that’s why it keeps Medicare strong and solvent – today and tomorrow.”

– President Barack Obama, June 8, 2010

The Director of CBO Douglas Elmendorf said that “to describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings.”

Medicare’s top actuary agreed. He said “in practice the improved (Medicare hospital insurance) financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions) and to extend the trust fund.”

President Obama’s Healthcare Reform act will give consumers more access and greater choice.

I do not think so. It will generate many unintended consequences.
Organizing for America, the successor to Obama’s campaign organization, claims that the new health care law will result in “more choices…for millions of Americans.”

Most experts expect that the health care overhaul will result in a serious doctor shortage, particularly amongst primary care physicians, meaning many individuals will have to wait longer for care, and may not get to see the doctor they want to see. Meanwhile, insurers in some states are already cutting back on insurance options. Healthcare insurance premiums will increase dramatically.

It will bring down the price of insurance.

President Obama, Nancy Pelosi and Harry Reid promise their healthcare reform bill would provide affordable healthcare insurance. The even called the bill the Patient Protection and Affordable Care Act.

The healthcare insurance industry is raising the cost of insurance between 10% and 29% next year. Insurance deductibles are increasing. Consumers’ out of pocket expenses are increasing.

“The CBO predicted that the law will cause average health insurance premium prices to rise by 10-13 percent in the individual market. And a recent survey indicates that most businesses expect insurance prices to rise as a result of the PPACA.”

I wonder what President Obama meant when he said the law would “bend the cost curve”? The implication is it would reduce the cost of healthcare coverage. I think it is bending the curve in the opposite direction.

CBO Director Douglas Elmendorf said in presentation at the Institute of Medicine; “the health legislation e
nacted earlier this year does not substantially diminish [the] pressure” of rising health costs.”

The big question should be where is all the money going? It is not physicians. Reimbursement is continuously being reduced.

The money is going to the additional government bureaucracy, and the healthcare insurance industry.

I think the American people get it. I wanted to repeat it

Lest We Forget.

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

Permalink:

Small Business Associations And Individuals Joins State Lawsuit Against President Obama’s Healthcare Reform Bill

June 2, 2010
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 

President Obama has tried to marginalize the law suits filed by 20 states concerning the constitutionality of his healthcare reform bill. President Obama has the power of the pulpit. He also has the traditional media helping him.

There are two main issues with these legal challenges:

  1. Is the mandate to force citizens to buy healthcare insurance constitutional?
  2. Is the nationalization of healthcare a constitutional infringement on States rights?

The lawsuits against the Obama administration have come from 20 State Attorney Generals, plus physicians’ groups and constitutional legal centers. An attempt has been made by the administration marginalize each lawsuit without much explanation.

It is difficult for the average citizens to understand the merits of the challenge. President Obama and his staff keep telling us the bill will reduce the cost of healthcare. It will be good for everyone. President Obama says he has been assured by legal counsel that the bill is constitutional.

Two weeks ago the National Federation of Independent Businesses filed an amended complaint to the lawsuit originally filed by 13 states.

“In addition two individuals also joined the litigation. One is the uninsured owner of an automobile repair shop in Panama City, Fla. The other is a man from Washington State who prefers to pay his medical bills out of pocket rather than being compelled to obtain insurance, as will be the case starting in 2014.”

President Obama’s administration claims the lawsuits are a political ploy by Republicans. The administration has stated it will challenge the law suits on their legal standings and authority.

Dan Danner, president and CEO of the National Federation of Independent Business (NFIB), a nonprofit, nonpartisan organization that works to promote and protect the rights of small businesses to own, operate and grow their businesses wrote;

“We also believe the health-care law is unconstitutional.

The centerpiece of this law is an individual mandate requiring virtually all Americans to purchase health insurance or pay a fine.

We strongly believe that the Commerce Clause of the Constitution does not give Congress the power to force individuals to purchase a private product or face a fine.

Requiring individuals to purchase something simply because they are alive is unprecedented.”

President Obama’s lawyers’ response to the constitutional challenge is it is a political ploy to tarnish the healthcare reform bill.

In court filings the administration has claimed that an individual decision to not purchase insurance is, in effect, a decision about how to pay for future medical care. Taken in the aggregate, those decisions substantially affect interstate commerce by shifting the cost of covering the uninsured to policy-holders, health care providers and taxpayers.

This is a lame argument.

Individual businesses have realized that President Obama’s healthcare bill will dramatically raise health-care costs rather than lower costs. This will increase the overall cost of doing business. There is a built in bias against small businesses.

What’s more, the federal mandate requiring that nearly all U.S. residents carry health insurance by 2014 seriously threatens our basic constitutional rights and individual freedoms.

The government cost estimates are already rising.

“According to the Congressional Budget Office (CBO), the overhaul will cost about $115 billion more than first projected, bringing the total to more than $1 trillion.”

One trillion dollars does not even come close to the real and hidden costs of President Obama’s healthcare reform bill. The bill is not a healthcare reform bill. It is a way of centralizing federal power over individual rights.

President Obama has said the law will significantly help small businesses. He continually focuses on the small business tax credit. In reality the tax credit is not real.

“The reality is that the tax credit is complex and very limited because firms qualify based on number of employees and average wages.

The credit, which is only available for a maximum of six years, puts small business owners through a series of complicated "tests" to determine if they qualify and how much they will receive.

Fewer than one-third of small businesses even pass the first three (of four) tests to qualify: have 25 employees or less, provide health insurance, and pay 50% of the cost of that insurance.”

“More importantly, the credit is temporary, but health-care cost increases are permanent. When the credit ends, small businesses will be left paying full price. They’ll also be forced to deal with all sorts of new taxes, fees and mandates buried in this 2,000-page law.”

One hidden tax is the healthcare insurance industry fee of $8 billion (that escalates to $14.3 billion by 2018) on insurance companies based on its market share. The fee will be passed on to employers in high premiums.

This tax will be paid almost exclusively by small businesses and individuals. The law specifically excludes self-insured plans. Most large corporations and labor union are self insured and will avoid this tax.

President Obama said his healthcare reform bill is going to “go after” the healthcare insurance industry’s grotesque profits.

The healthcare insurance industry is lining up to help the government write the new rules and regulations.

The rules they are helping write will permit the healthcare insurance industry to load its expenses as it has done previously.

With the business association and individual plaintiffs joining the lawsuit public perception might shift from the lawsuit being primarily a political device as President Obama has tried to emphasize to this lawsuit being a serious constitutional and states’ rights issue.

America wake up!

President Obama’s healthcare reform bill is a very expensive law. It will not decrease the cost of healthcare or increase the quality of healthcare.

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

Permalink:

Our Sound Bite Society: The Media Is The Message

March 4, 2009
inUncategorized
• Leave a comment

 

Stanley Feld M.D.,FACP,MACE

 

America’s present healthcare crisis is neither a Democratic nor a Republican issue. It is an American issue. It can be solved logically and swiftly using common sense. Let the American consumers control their healthcare dollars. Provide consumers with financial incentives for wise healthcare purchases and education for good health maintenance to prevent the onset of a chronic disease.

President Obama’s healthcare team is setting up a healthcare system where the government will make the healthcare choices for Americans. Ultimately government will ration care.

Daily, Americans are overwhelmed by bad news sound bites. For years we have heard that our healthcare system is broken. It is broken because the government has broken it. Only 20% of the people are sick at any one time. The other 80% do not think there is a problem with the healthcare system. In the last 25 years most Americans have heard of or experience horror stories about the dysfunctional healthcare system. The goal should be to repair the problems and not impose another dysfunctional healthcare system on us.

First, it was HMO’s and the restrictions of access to care. Then, it was Managed Care. Managed Care turned out to be managed costs and restrictions on access to care. Then, it was the ever increasing healthcare insurance premiums. Now, it will be the government‘s experiment with a single party payer system. An experiment that is destined to fail.

The Bush administration did nothing about repairing the healthcare system. Correction. Everything President Bush tried to do the congress rejected. The healthcare insurance industry and its executives made grotesques profits while restricting access to medical care and decreasing physician reimbursement.

Medicare and Medicaid’s costs have continued to rise. The healthcare insurance industry controls Medicare’s dollars. The Bush administration did nothing to stop it. The Bush administration recognized that bureaucratic entitlements would destroy our economy. The administration tried to get rid of the Medicare entitlement by providing a bonus to the healthcare insurance industry for the takeover of Medicare with Medicare Advantage and Medicare Part D. The cost to seniors and the profit to the healthcare insurance industry has been huge.

Neither Republicans nor Democrats in congress have done anything logical to fix the healthcare system. The executive and legislative branches have only generated greater mistrust among all the stakeholders in the healthcare system.

Congress knows the increasing Medicare costs are unsustainable. The Congressional Budget Office predicts a 100 TRILLION dollars per year deficit for Medicare alone in 50 years.

Why would a responsible member of congress or the executive branch want to increase an entitlement that does not work to included the entire population?

Today’s sound bites have frightened most of the population. Americans are anxious to be rescued by anything that sounds good. All that is needed is a well crafted public relations campaign of sound bites promising salvation.

Liberal Democrats have put together such a public relations campaign. President Obama has captured the lead to be society’s savior. It does not matter whether his proposals are logical or if they will work. It sounds good. America is ready to go for it.

Republicans are feeling overwhelmed. They intuitively understand that a government controlled single party payer system will not work. Massive government programs have not worked effectively in the past. Why should they work now? Consumers should be empowered to make their own decisions. Government should not make decisions for them.

An organization call the “Leadership Conference for Guaranteed Healthcare , the national single pay alliance” has crafted such a public relationship program. They have cobbled together a group of social networks to express the anger and fears felt by the American public. Their sound bites are compelling.

President Obama will play off these social networks to force his change in the name of goodness and justice for all. It is Tom Daschle’s doctrine. Most of the proposals will fail. They will fail not because they are unjust. They will fail because the route to achieve them is wrong. The costs will be unmanageable as we have seen in the Massachusetts experiment..

The sound bites are indeed compelling:

  1. Everybody In, Nobody Out. Universal means access to health care for everyone, period.
  2. Portability. If you are unemployed, or lose or change jobs, your health coverage stays with you.
  3. Uniform Benefits. No Cadillac plans for the wealthy and Pinto plans for everyone else, with high deductibles, limited services, caps on payments for care, and no protection in the event of a catastrophe. One level of comprehensive care for everyone, regardless of the size of your wallet.
  4. Prevention. By removing financial roadblocks, a universal health system encourages preventive care that lowers an individual’s ultimate cost and pain and suffering when problems are neglected and societal cost in the over-utilization of emergency rooms or the spread of communicable diseases.
  5. Choice. Most private insurance restricts your choice of providers and hospitals. Under the U.S. National Health Insurance Act, patients have a choice, and the provider is assured a fair payment.
  6. No Interference with Care. Caregivers and patients regain their autonomy to decide what’s best for a patient’s health, not what’s dictated by the billing department. No denial of coverage for pre-existing conditions or cancellation of policies for "unreported" minor health problems.
  7. Reducing Waste. One third of every private health insurance dollar goes for paperwork and profits, compared to about 3% under Medicare, the federal government’s universal system for senior citizen healthcare.
  8. Cost Savings. A guaranteed health care system can produce the cost savings needed to cover everyone, largely by using existing resources without the waste. Taiwan, shifting from a U.S. private health care model, adopted a similar system in 1995, boosting health coverage from 57% to 97% with little increase in overall health care spending.
  9. Common Sense Budgeting. The public system sets fair reimbursements applied equally to all providers, private and public, while assuring that appropriate health care is delivered, and uses its
    clout to negotiate volume discounts for prescription drugs and medical
    equipment.
  10. Public Oversight. The public sets the policies and administers the system, not high priced CEOs meeting in private and making decisions based on their company’s stock performance needs.

Who can argue with any of these points? The major question is can a government bureaucracy administer this system effectively without impinging on citizens’ choices, rights and freedoms.

Is this the solution to the high incidence of chronic disease and the dysfunctional healthcare system?

My answer is no. Americans are being duped once more by cool sound bites.

The Alliance has put together interesting groups. They have used the internet to leverage the Alliance. They have used the same technique that President Obama used to become President. They have formed giant social networks and put them together. President Obama can easily play off this coalition as evidence for the need by the public for a single party payer system.

The social networks and President Obama have outflanked common sense. They have created a false hope and it will fail to repair the healthcare system. .

Leadership is needed to formulate a common sense strategy to solve the healthcare system’s dysfunction for all American at every socioeconomic level. Neither the Democrats or the Republicans have such a plan.

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

Permalink:

Stinkin’ Thinkin’ Part 2 Health Costs: More Cost Burden on the Employee

September 24, 2008
inConsumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Politicians,Healthcare and Vested Interests
• Leave a comment

Stanley Feld M.D., FACP, MACE  

Sound Bytes are deceiving. The Republican Party’s Presidential candidate, Republican Party politicians, and Republican policy wonks have often quoted reports that health care costs are expected to ease slightly for employers in 2009. There is deception in this fact. The overall decrease in healthcare costs for businesses is the result of its shifting the burden of costs to their employees. The result is a decrease in cost for the employers nationally. Therefore the sound byte is inaccurate. The cost of healthcare actually will rise 5.7% for the employers. This represents a decrease from last years rise of 6.1%. The direct costs to the consumer increases 29% next year. Once again, the devil is in the details. We can not rely on sound bytes.  The healthcare insurance industry triumphs again.  The result will be an increase in healthcare insurance industry net profits.   

 

 

What does all this mean in the present Presidential campaign?  Why are healthcare insurance premiums increasing when the provider reimbursement is decreasing? Why is the burden of the cost of healthcare insurance shifting to patients away from the government and the employers? President Bush and a McCain presidency’s goal is to shift the burden of healthcare costs to the employee. Is this going to improve the uninsured problem? No! It will make it worse.

It looks like the healthcare insurance industry is killing the goose that lays its golden egg. It looks like John McCain wants to help the healthcare insurance industry accomplish this feat without either of them realizing it.  It will happen at the expense of the consumer until the consumer cannot tolerate it any more.

It also looks like John McCain’s policy of more of the same is helping Barack Obama and the Democratic Party justify universal healthcare coverage by a single party payer. An equally disasterous strategy. Where are the principles that have made America great? All politicians should be forced to read Adam Smith’s “Wealth of Nations“.

Dick Swersy’s comment on my blog about the Nobel Prize winning technique to repair the healthcare system is noteworthy.   Mechanism Design to Repair the Healthcare  is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested. This is done by setting up a structure in which each player has an incentive to behave as the designer intends. The game will then implement the desired outcome. The strength of such a result depends on the solution concepts used in the game. 

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare. However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers. Significant research in mechanism design must decide on making trade-offs between these qualities and vested interests. The most desirable outcome in the healthcare system should be sustaining patients’ welfare and physicians’ incentives for innovations in care. These goals will strengthen our healthcare system not weaken it.

Our Presidential candidates are not thinking of these goal as they formulate programs to sustain the goals of the secondary stakeholders. How can you create affordable insurance when coverage decreases, deductibles increase, and the price decreases are defined by increasing the price 5.7% vs. 6.1% a year. It is a charade designed to fool Americans. The charade works because Americans are not paying attention to what is going on. We will complain when it is too late.

“America is at its most powerful and most influential when it is combing innovation and inspiration, wealth building and dignity building, the quest for big profits and the tackling of big problems. When we do just one, we are less than the sum of our parts. When we do both, we are greater than the sum of our parts- much greater” Thomas Friedman

  Our Presidential candidate are way off base. It is up to the people to pay attention and force  politicians to stop their Stinkin Thinkin.

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

Permalink:

John McCain Describes His Health Plan; In Reality A Non Health Plan

May 21, 2008
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests
• Leave a comment

Stanley Feld M.D., FACP,MACE

Politicians give me a headache. John McCain revealed his healthcare plan last week. His healthcare plan is just as poor as Hillary Clinton’s and Barach Obama’s. He goes further than President Bush in shifting the healthcare premium payment from the employer to the employee. This action is just what the large corporations want and the employees don’t want.

“Mr. McCain’s health care plan would shift the emphasis from insurance provided by employers to insurance bought by individuals, to foster competition and drive down prices. To do so he is calling for eliminating the tax breaks that currently encourage employers to provide health insurance for their workers, and replacing them with $5,000 tax credits for families to buy their own insurance.”

Five thousand dollars in tax credits will not help people who can not afford the average $12,000 healthcare insurance premiums for a family of four.

Businesses have been trying for years to relieve itself of the obligation to provide healthcare insurance to employees. The defects in the HSA are clear from my last blog entry. HSA’s will do little to Repair The Healthcare System. The healthcare insurance industry still controls and captures the healthcare dollars. It still sets the premiums for healthcare coverage.

Mr. McCain seems to have no idea of the problems in the healthcare system. The government should create new rules to change the incentives of the stakeholders. The rules must create incentives for the consumers and physicians and not be punitive. One hundred and fifty million people presently have some form of healthcare insurance provided by their employers. Nonetheless, those insured employees can not afford the deductible they are required to pay while receiving less coverage at higher costs.

“Mr. McCain had previously described aspects of his health care plan but on Tuesday offered new details on how to cover people with existing health problems, in a nod to the growing concerns about the difficulties that many sick, older and low-income people have getting insurance. ”

Political expediency is the name of the game. It does not matter what the facts are or if the plan will be effective. However, if the facts of any problem are ignored, problems can not be solved. Neither the Democrats nor the Republicans have a clue regarding the problems in the healthcare system. Neither has presented any viable solutions.

“Elizabeth Edwards, the wife of former Senator John Edwards, recently pointed out that both she and Mr. McCain could be left uncovered by Mr. McCain’s plan because she has cancer and he has had melanoma. Stung by such criticism, Mr. McCain is trying to develop a way to cover people with health problems while still taking a generally market-based approach to solving the health care crisis.”

John McCain has the advantage of ignoring the pre-existing illness problem. As a Senator, he is entitled to participate in both Medicare Part C and Medicare Part B without premium penalty for his pre-existing illnesses. Both plans mandate that people with pre-existing illness must be covered at the universal rate.

“I’ll work tirelessly to address the problem,” Mr. McCain said in a speech here at the H. Lee Moffitt Cancer Center & Research Institute. “But I won’t create another entitlement program that Washington will let get out of control. I won’t do it. Nor will I saddle states with another unfunded mandate.”

McCain is pandering to conservatives who see red at the word entitlement. He is also pandering to the healthcare insurance industry and its executives’ multimillion dollar salaries. His plan will preserve the healthcare insurance industry’s dominance over its $150 billion dollar waste.

“For people who currently get health insurance through their jobs, Mr. McCain’s plan would give them a tax credit that they could put toward buying a different, and potentially less expensive, health insurance plan tailored to their needs — and allow them to keep that health plan, and their doctors, even if they switch or lose their jobs.’

These words have no meaning. Presently people with insurance do not have adequate and affordable insurance coverage. Out of pocket expenses increase yearly. People without insurance can not afford the restrictions on the policies they could buy if they were eligible.

“ Mr. McCain’s speech here implicitly acknowledged some of the shortcomings of his free-market approach. But rather than force insurers to stop cherry-picking the healthiest — and least expensive — patients, Mr. McCain proposed that the federal government work with states to cover those who cannot find insurance on the open market. With federal financial assistance, his plan would encourage states to create high-risk pools that would contract with insurers to cover consumers who have been rejected on the open market."

Mr. McCain does not seem to know that high risk pools have been created and are failing. He might have a between the lines agenda in opposition to consumers needs

“Mr. McCain was vague Tuesday about just how his safety net would be structured, and did not specify how much it might cost, leaving the details to negotiations with Congress and the states.”

This is an interesting admission. The reality is he does not have a healthcare plan that will solve any of the healthcare system’s problems.

"Some health care experts question whether those tax credits would offer enough money to pay for new health insurance plans. The average cost of an employer-funded insurance plan is $12,106 for a family, according to the Kaiser Family Foundation, a health policy group. Paul B. Ginsburg, the president of the Center for Studying Health System Change."

Enough said about the McCain healthcare plan. It is a non healthcare plan to the advantage of the secondary stakeholders and to the detriment of patients.

It is clear to me that we can not depend on our presidential candidates for help. We are going to have to organize and demand the necessary reform essential to eliminate the dysfunction in the healthcare system.

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

Permalink:

The Romney Bipartisan Universal Healthcare Plan Is Being Revised Already! Massachusetts panel approves changes to subsidized residents health plan

December 19, 2007
inUncategorized
• Leave a comment

Stanley Feld M.D.,FACP,MACE

It is worth spending some more time on the ill conceived bipartisan mandatory universal healthcare plan of former Governor Romney.

As I pointed out, I believe the original bill was well intended. It was supposed to be universal insurance coverage without a single party payer. The market was supposed to self regulate premiums while giving patients choice. The defect in the plan was clear to many. It catered the wrong stakeholders’ vested interests without reforming the healthcare system. One can not expect real improvement by patching the present healthcare system in favor of the healthcare insurance industry. I suspect Governor Romney pushed this plan to gain national visibility in his planned run for the presidency.

Today the Massachusetts legislature started changing the provisions of the original universal coverage bill. The changes represent another complicated mistake that is destined to fail.

“Striving to hold down costs to taxpayers, a state panel yesterday approved a range of changes for next year for the rapidly growing subsidized health insurance program. The changes will probably cut payments to doctors and hospitals, reduce choices for patients, and possibly increase how much patients have to pay.”

Please note who the victims of the payment cuts are; the physicians and the patients. The healthcare insurance industry is challenged by the state to simply reduce their planned increases from 14% to 9-11% next year.

“The goal “is to make this great healthcare reform effort sustainable,” said Leslie Kirwan, secretary of administration and finance and chairwoman of the Commonwealth Health Insurance Connector Authority, which is overseeing the insurance initiative.”

Leslie Kirwan seems to be the purveyor of political babble for the state of Massachusetts as you can read in my previous discussion of the Romney Plan.

“For the subsidized plan, called Commonwealth Care, the authority’s staff has suggested that costs per member could rise as much as 14 percent next year, if there were no changes.”
“The bid specifications will direct the four insurers that administer Commonwealth Care to cut payments to healthcare providers by 3 to 5 percent.”

Without real price transparency by the healthcare insurance companies effective reductions in premiums will not occur. Competition among insurance companies to become more efficient is not stimulated.

All the stakeholders must participate in real price transparency if we are going to have a chance to repair the healthcare system.

“There’s no justification to be paying more than Medicaid rates,” said Patrick Holland, the authority’s chief financial officer.”

Patrick Holland ignores the fact that the federal government is having problems forcing physicians to see Medicaid patients. Medicaid reimbursement is below physicians’ costs. They can not afford to take care of Medicaid patients at the present level of reimbursement and their present level of inefficiency. The reduction in reimbursement below the cost of production of services without incentives will not solve anything. Real healthcare reform along with decrease in healthcare cost will occur when then is a full court press on preventing complications of chronic disease.

Examples of ineffective chronic disease management appear monthly in the medical literature. All stakeholders are to blame. The incentives for chronic disease management do not exist. A most recent example appeared in the December 2007 issue of the Archives of Internal Medicine. The article is entitled “Inadequate Control of Hypertension in US Adults with Cardiovascular Disease Co morbidities in 2003-2004.” Only 49.3% of patients were within 20 mm Hg of the goal of therapy. Only 69% of patients received any treatment. Patient compliance as well as the ineffective practice of evidence medicine is always at the root of the problem. The lack of reimbursement needed for physicians to develop the necessary systems of care is usually the cause of ineffective care.

“In addition, the board voted to eliminate one part of the program that has been the most expensive per member. That program had allowed patients to pay a higher monthly premium in order to incur lower fees each time they sought care. But the option drew the sickest and oldest patients and was twice as expensive for the state as a plan with lower premiums. The approximately 3,500 patients in that plan will have to shift into an option under which they pay more of the cost per visit.”

By shifting the burden of payment to the patients creating higher deductibles for less coverage will result is forcing patients not to buy insurance. They simply can not afford to buy insurance. The state would be making criminals out of sick patients because the Massachusetts law makes it mandatory to have insurance.
The way to avoid this imbalance and problem is with a subsided Ideal Medical Savings Account.

When are politicians going to see the obvious? Constructive change will occur only when the consumer knows what to demand and how to demand it. Consumers will get results when politicians’ political future is threatened. Only then will the politicians refuse to be influenced by corporate vested interest.

Permalink:

Romney’s Universal Healthcare Plan Anticipates Large Cost Overruns

December 2, 2007
inMedicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACP

Universal Healthcare coverage is an important idea. It is not synonymous with a single party payer as some would like us to believe. When Mitt Romney was governor of Massachusetts he had a bipartisan bill passed for universal healthcare coverage. The coverage was going to be provided by multiple insurance companies. Governor Romney’s goal was to achieve universal healthcare coverage using the private sector. Market forces were supposed to control costs and there would be no need for government single party payer.

I predicted the Romney plan would not work. The reason is simple. The rules of the game were not changed for the insurance industry, the hospital systems and the physicians. The reason this important idea cannot work is because the program was superimposed on the rules of a broken healthcare system.

The patients thought they were going to get a good deal because now they had guaranteed coverage. Mitt Romney was a hero of the people. As soon as the legislation was passed the insurance industry was fighting over the premium price. The premium is expected to rise next year.

“Enrollment in the state’s new subsidized health plan is growing so quickly that the state could face a funding gap as large as $147 million by the end of the fiscal year, according to a state projection.”

“It’s a good problem to have – people are getting insured and hopefully getting care,” said state Senator Richard T. Moore, cochairman of the Legislature’s Health Care Financing Committee. “But any shortfall is a big deal.

The subsidized program is part of the state’s unprecedented initiative requiring nearly all residents to have health insurance. Even if the gap reaches $147 million, there is no indication it would cripple healthcare reform.

“It’s too early to make any departure from the health reform plan,” said Leslie Kirwan, secretary of administration and finance and chairwoman of the Commonwealth Health Insurance Connector. “We will follow the trends and adjust, if needed.”

This is a lame bureaucratic statement preparing the state of Massachusetts for a tax increase.

“Financial pressures will grow for fiscal 2009, which begins July 1, since insurers who participate in the subsidized program are expected to ask for significantly higher payments from the state. In addition, there is uncertainty about how much the federal government will contribute toward the total cost.

The state budgeted $472 million this fiscal year for the subsidized program, based on enrollment estimates made last winter. The program, called Commonwealth Care, provides comprehensive insurance to people without access to work-based coverage who earns less than 300 percent of the federal poverty level, or about $31,000 for an individual. The state money pays the full premium for the lowest-income residents and subsidizes the rest. Members are responsible for small co-payments.

Outreach has resulted in more than 133,000 people signing up. If enrollment reaches the high estimate of 178,280 by June 30, Holland said, the state cost could hit $619 million.

The enrollment booms “is a sign of success, not failure,” said John McDonough, executive director of the advocacy group Health Care for All. “The sky is not falling. There’s a budget challenge.”

Massachusetts has a lot of “budget” challenges.

“McDonough also said the higher enrollment suggests that there are more uninsured people in Massachusetts than state surveys showed.

Commonwealth Care is one part of the state’s effort to cover the uninsured.
The state has some flexibility built into its $27 billion budget to help fill the likely gap. Kirwan can shift money from the $448 million Health Care Safety Net Trust Fund, which pays for care at hospitals and health centers for uninsured patients.

Long-term funding of healthcare reform depends, in part, on shifting more and more of those funds to insurance subsidies over the next few years.

However, this year’s state budget includes significantly less money than last year’s for the safety net, and spending in that account last year did not go down as much as some had expected, according to preliminary figures.

Hospital officials are concerned about getting stuck with unpaid bills.
Boston Medical Center and Cambridge Health Alliance negotiated a special deal in the health reform law that guaranteed them $287 million a year through 2009 in fees and increased Medicaid rates
“This is one of many warning signs, especially in tandem with the projected state budget deficit and the skyrocketing cost of healthcare in the state,” said Alan Sager, professor of health policy and management at the Boston University School of Public Health. “The [healthcare] law is very shaky on the revenue side.”

Mitt Romney’s plan does not include price transparency on the part of all stakeholders. The plan does not provide consumers with ownership of their healthcare dollar. The plan does not encourage competition. The result of the plan has to be failure with cost overruns using the rules of the present healthcare system.

When the plan fails the healthcare wonks who promote a single party payer system will claim the failure of the Romney plan has proven that universal healthcare has to be regulated by the government as the single party payer

The only thing the Romney plan demonstrates is a governments lack of understanding of the problems in the healthcare system. The plan does not speak to the issue that 80% of the healthcare dollar is spent on the complications of chronic disease. This is where the most saving can be achieved.

It does not face the issue that we have to deal with the obesity problem in the country.

It does not deal with the insurance industry’s abuse of its power or the abuse of all the stakeholders.

It does not deal with patients’ responsibility for their care or their need to own and control their healthcare dollar. A Romney like plan will only succeed when we deal with these defects in the healthcare system.

It deals only with the concept of how much money we are going to put in the system and whom we will penalize. If the plan had been constructed correctly and motivated patients to create a competitive healthcare system, the universal healthcare concept of Romney and Schwarzenegger would have a chance to succeed.

Hillary Clinton’s healthcare proposal is similar in that it is also built for failure. Failure proves the concept does not work. The replacement will be a single party payer.

The consumer is the only one who can force politicians to understand the problems in the healthcare system.

Permalink:

The Next Step in Intensifying the Healthcare Systems Problems

June 12, 2006
inEMR
• Leave a comment

Stanley Feld M.D.,MACE

A bizarre circumstance was beginning to occur in hospitals using DRGs (Diagnosis Related Guidelines). Patients with multiple diagnoses were being assigned multiple DRGs. The physician was required to sign the chart indicating multiple diagnoses. Each DRG had a fixed payment assigned to it. The payment for each DRG was unchanged, even if the diagnosis used excessive resources for that particular patient. This bit of irrationality occurred during the attempt to quantitate the value of care. Physicians developed the ability to give better care using more complex procedures. However, the physicians care was being limited due to the restriction of payment from the DRG system unless that cost of care could be compensated for by using multiple diagnoses and multiple DRGs. The DRG coding profession was born. People were trained to extract multiple diagnoses from the documentation in the chart. The more DRGs you had as a patient during a hospital admission, the more the hospital payment the hospital received.

Physicians reacted to the increase in documentation, surveillance, as well as the difficulty in getting pre-approval for care. The pre-approval of care limited the patients’ access to care. The paperwork was overwhelming. The paper work necessary to complete a claim, at times, was longer than the patient-physician encounter. If there was the slightest entry error in the claim, payment was delayed. Hospitals were more organized than physicians. The hospitals already understood the changing systems and processes. As a result, paperwork did not bother hospital nearly as much as it did physicians. They somehow compensated for the increased cost of processing claims. I will get into the compensation for increased cost of claims in more detail in the future.

A spending cap was placed on Medicare. The fees for visits and procedures continued to rise in both the private and Medicare sector. The physician had to learn to document and quantitate outpatient visits and procedures
The cost of delivering care continued to rise due to inflation and technology. The government permitted moderate increases in fees along the way. The phenomenon of cost shifting was becoming intolerable to the employers (Business) who were still providing first dollar coverage medical insurance for their employees.

Despite the price cap and spending cap, the cost to the government was getting further out of hand. The insurance industry was happy. It was the broker and collected 6% of the money spent in the system the more they collected for their fee. The private sector face 10-20% increases in insurance rates each year. The more money the system generated, the more the insurance industry charged the employer. The physicians and hospitals were becoming unhappy. Even though there was more money in the system, collecting the money became more costly and difficult. Their information systems could not keep up with the changes. The result was less profit. Business was becoming extremely unhappy because the cost of insurance for their employees was approaching 18% of their gross revenues.

What happened next served to intensify the healthcare system’s problems even further.