Stanley Feld M.D., FACP, MACE Menu

Permalink:

What Happened to the “Physician/ Patient Relationship?”

April 17, 2013
inConsumer Driven Health Care, EMR, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

The only way America’s healthcare system will be repaired is by
revitalizing the Physician/ Patient Relationship.

Veterans complaining about the VA Hospital System in my last
blog brought on a flurry of negative comments about practicing physicians not
connecting with their  Medicare and
commercial insurance patients in the private sector.

The chief complaint is that physicians are not connecting to
their patients or their patients’ illness. I have heard enough stories to
believe it is true.

A 44-year-old male with
private healthcare insurance sent one such complaint to me.

His acute illnesses history was compatible with acute prostatitis.

He needed a new physician because his previous primary care physician
had taken a sabbatical leave.

He called for help in finding a physician to his friends on
Facebook, Twitter and Link In. The consensus was the physician he describes
below.

The physician did multiple tests, several of which I did not
think were necessary, along with a cursory physical examination. The physician
thought the patient had prostatitis and prescribed Cipro for one month. A
follow-up examination was not scheduled.

The last paragraph in the patient’s note to me was,.

By the way, my doctor's office called to let me know the
lab results are in and they are mailing them to me. The doctor told the front
desk person to send me a letter, which I'll get in a day or two. According to
the front desk person, in the letter he says that my labs look good, and that I
need to work on getting my lipids up. Apparently he included a link to a
website that I can learn more about lipids. Pretty great patient care, eh…

This is horrifying to me. The patient will probably do well.
However there is no contact or concern about the patient’s outcome in this
interaction. There was no physician patient relationship formed for a patient
who is looking for a primary care physician.

I would be very upset if this interaction happened to me.  I would be more upset if I then receive a bill
for $800 for the visit.

This patient does not know what the bill will be because the
office said it will bill his insurance company.

The evidence of the loss of the Patient-Physician Relationship of delivering medical care did not happen overnight.

A reader Dr. Dale Fuller sent me this commentary. He walks us through the
evolution of the destruction of the Doctor- Patient relationship.

Dr. Fuller’s view is similar to the view I have discussed in this
blog on multiple occasions. I believe it is important to publish his thought in
its entirety.

 

 "Whatever Happened to
the “Doctor- Patient Relationship?”

 

Dale Fuller M.D.

Lately, I
find myself thinking about this question more and more.  I think the first time I heard the term,
“doctor-patient relationship” was back during Harry Truman’s administration,
when there was an effort led by the Democrats to create a National Health
Insurance Program.

“Socialized
Medicine” the opposition cried, and “The end of the doctor patient
relationship!   I wasn‘t even a student
in college back then, and in the absence of more information, I saw the
doctor-patient relationship in the context of my experience with the doctor who
looked after me on those rare occasions when I needed to see him,

Dr. T.D.
Jones, who was a very kind man.  He was a
small town doctor, and the only doctor in my hometown as well as a good many
other towns around it during World War II.

I kind of
understood the term “socialized medicine” in the context of the then-new
National Health Service being launched in Great Britain. 

Truman and
company lost the battle for NHI back then.

The next big
“Socialized Medicine initiative arrived in 1960 
“Socialized   during the Republican administration of Dwight
Eisenhower.

Senator
Robert Kerr, of Oklahoma and Rep. Wilbur Mills of Arkansas, both Democrats
introduced the Kerr-Mills act, the “Medical Assistance for Aged Act 1960-1965”
(benefiting primarily the elderly on Old Age and Survivors’ Assistance).

Kerr-Mills
was passed in 1960, again over cries that it would destroy the doctor-patient
relationship.  But this time the cries
were neither so loud, nor as successful. 
By this time I am a newly minted MD, and my awareness of the total
meaning of the term is still mostly intuitive.

During the
administration of Lyndon Johnson, came the Social Security Amendments of 1965,
which brought us Medicare and Medicaid. 

When I
entered practice in 1968, Medicare and Medicaid were just getting under way, so
I never experienced what it was like to practice in the absence of the law.

In March of
2010, President Obama signed into law The Patient Protection and Affordable
Care Act, and we are now living through the incremental steps preceding that
law becoming fully in effect in 2014.

The various
legislative initiatives have, to be sure, impacted the doctor-patient
relationship in many ways, as the opponents predicted, but it appears to me
that we have been hearing less and less about that relationship as the years
have passed. 

I think it
might just be that the relationship we are discussing may be threatened by a
number of other forces other than the laws described above, but before I
attempt to list those forces, I want to spend a little time setting the stage
to describe just what the doctor-patient might and might not mean.

Goold and
Lipkin, in an article published in 1999 (1) called the doctor-patient
relationship “a keystone of care: the medium in which data are gathered,
diagnoses and plans are made compliance is accomplished, and healing, patient
activation, and support are provided.”

They say that
the medical interview is the major medium of health care, and that more than
82% of diagnoses are made by history alone.

The three
functions of a medical interview are the gathering of information (both through
history and physical examination) developing and maintaining a therapeutic
relationship, and communicating information.

In the eyes
of the law, physicians also have a fiduciary responsibility toward their
patients. Physicians are bound to act in their patients’ interests even when
those interests may conflict with their own.

In that
physicians are often directly involved with events and conditions that are
life-altering for their patients and families, at birth, during severe illness,
healing or death, it can also be said that in being a physician, and providing
health care, doctors are engaging in a moral enterprise.

There was a
time when the unwritten social contract laid out above, simply existed as an
understanding between patients and doctors.

In the early
1940’s the arrival on the scene of what became the Blue Cross and Blue Shield
program, initially serving the employees of the Dallas, Texas Independent
School District began to interpose a third party, the insurance company,
working through the employers, in the social contract that was the Doctor-Patient relationship.

Initially
that interposition was pretty innocuous, with the insurance plan simply paying
the bills of the doctor as they were presented. The phrase, “usual and
customary” arose to define the fees involved that the insurance company paid.
Unusual fees or fees exceeding customary levels became subject to challenge,
requiring justification if they were to be paid.

Over time, a
database of fees that really were usual and customary began to become a better
and better tool to define where the usual kind of fee stopped and the unusual
kind of fee was recognized.

Kerr-Mills,
when it came along, introduced the federal government as a payer, and
relatively soon thereafter, the health care bureaucracy began to grow and
insert itself between doctors and patients to an increasing degree.

Since this
was in the “Pre-Medicare era” the number of patients involved was relatively
small, and so the impact on the doctor patient relationship was still somewhat
limited.

The arrival of Medicare and Medicaid served to
illustrate that the old “camel entering the tent” analogy was beginning to come
true.

Initially,
while the organizations were formed to administer the programs, “usual and
customary” was still the order of the day where payments were concerned, and
the social contract still functioned much as it had always done.

At the
request of the Department of Defense, organized medicine (AMA) created a set of
relative value scales in an attempt to standardize professional fees. The set
of codes was called “Current Procedural Terminology (CPT codes)” (first
introduced in 1966).

The charges
were to be based upon a blend of time required, professional skill involved,
and liability risk.

The compendium
of procedures have grown over the years, the principles remain essentially the
same.

In a fit of
zeal, the Federal Trade Commission inserted itself and accused professional
societies of “price fixing” via the CPT codes.

Settlements
eventually ensued, and money passed from the societies that were sued to the
FTC, and life, after the “nolo contendere pleas’ went on as usual.

The reason
for this was that the societies were not well enough funded to defend their
position vs. the FTC, even though they might have won their cases.

Increasingly
though, as might be expected, the government began to insert itself more and
more into the transaction between doctors and patients, generally, drawing upon
the reality that it was paying, directly or indirectly, for more than 50% of
the care given in the US.

Regulations
and rules have proliferated, respecting what can and cannot be done for
patients who are beneficiaries of federal programs. 

Another force
was also becoming more vocal in making statements and policy regarding what
could and could not be done for patients.

This force
began with the passage of the Health Maintenance Act of 1973.  This act enabled a vast acceleration of the
whole concept of managed care. 

Healthcare
Insurance Companies citing the growing demand for, and cost of medical care to
employers, found a ready market among employers for their “products” to serve
as “benefits” for their employees. 

Physicians
and hospitals, fearing that they might be left out of the managed care programs,
made haste to “join” this program or that program, seeking access to the
populations of patients enrolled in the programs by the insurance companies
selling coverage to employers. 

The fear was
that exclusive arrangement with insurance companies would eliminate whole
populations of patients from providers who had not “signed up”.

This meant
that the traditional bilateral social contract between doctors and patients
essentially had come to an end of sorts.

Patients’ expectations
were that service and behavior of the doctor they were allowed to see remained
pretty much the same except for a small by important fact.

Those
employees covered by managed care were required to see the doctors who
participated in the program, and to use the hospitals the programs had
agreements with.

Financial
penalties awaited those patients who sought their care “out of plan”, for
whatever reason. 

Now patients
and doctors both have someone else “calling the tune” when it comes to the
delivery of healthcare.

Each time the
“plan” purchased by the employer changed, for whatever reason, there could be a
change in the physicians and hospitals available to the patient. 

This brings
us to a key element of the doctor-patient relationship. A key element is
continuity of care.

Continuity of
care brings with it an opportunity develop relationships in which doctors and
patients really know and trust one another. This relationship allows physicians
to recognize changes in patients and recognize the early onset of disease.

Neither the physicians’ understanding nor the
patients’ trust cannot be rebuilt immediately between two individuals each year
who are basically strangers to one another.

 Doctor of days past, the trusted counselor, often
friend and confidant, is no longer exists. 
Now, patients are simply seeing another person in an office. Both
parties are at sea when it comes to knowing what they need to know about one
another to allow the encounter to produce the necessary result within the time
allowed.

Time, like
continuity, is also a vanishing element in the doctor-patient
relationship.  Fewer and fewer
practitioners have the time, amidst the pressures of “patient throughput” to
really engage in patients’ needs.

Physicians
must gather and record data, establish a diagnosis, and create a treatment plan
of quality.

The
documentation has to be complete in order to get paid by the government or the
healthcare insurance carrier.

Doctors must also
explain his treatment plan in such a way that they are assured of patients’
compliance with the treatment proposed in the time available to doctors.

As a result
of decreasing reimbursement and increasing overhead the time necessary for
patient education is insufficient. Patients do not understand the significance
of the therapy. The result is a lack of compliance.

Another
problem is that the “third party payers” rather than the patients approves of any
tests and procedures that doctors believe are needed to strengthen the
diagnosis.

The result is
a further erosion of patients trust in the doctor.

The time for
a consultation is short. Tests and procedures are now increasingly used to
substitute for the gathering of data to make the diagnosis.

Tests and
procedure escalate the costs of medical care.

Data
gathering by history and physical examination is time consuming. If a history
and physical examination is properly done it can yield the diagnosis of patients’
problems about 80% of the time.

The
doctor-patient relationship is indeed fading into the past. The third party carriers
and the federal government have, in their zeal to contain cost, pretty much
seen to that.

The reality
is that the destruction of the doctor-patient relationship costs more in the
long run.

The federal government, in its enthusiasm to
make a positive impact on the quality of care patients receive, has mandated
the use of electronic medical records.

The EMR in
its own way have also served to diminish the doctor-patient relationship.

In many
doctors’ offices, the focal point in the room is a computer with data entry.
The keyboard and the screen have almost the full attention of the doctor, who,
without looking at the patient, asks the questions and types the responses.

The patient is lucky if the doctor makes eye
contact with him/her for a brief interval a couple of times during the visit,
thus further diminishing the possibility that trust can be built in the
encounter. 

The quality
of the encounter can, in the opinion of various policy makers and consultants,
be measured and changed in the same way that manufacturing processes can be
impacted by applying the principles taught by Deming and others.

Maybe it can,
but it has yet to be demonstrated. 
Processes peripheral to the interaction of patient and doctor, may be
made better, but there is little evidence that the same approach can bring back
anything like the doctor patient relationship we used to know."

The three basic goals of Obamacare are
to create an affordable healthcare system with access to care of high quality.

A complicated and complex
bureaucracy that is over regulation will be very difficult to enforce.

It will penalize physicians’
judgment as it tries to decrease reimbursement. It will restrict patients’
access to medical care. It will reduce freedom choice.

Obamacare will not enhance the
Patient Physician Relationships that are so vital to a successful therapeutic
effect. 

A healthcare system that places
consumers in control of their healthcare dollars and provides incentives to
consumers to be responsible for their health and healthcare will encourage
physicians to save money and rejuvenate the Physician Patient Relationship for
improved therapeutic outcome at an affordable cost.

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

Please have a friend subscribe

  • Emo Fisting • October 25, 2013

    I need to to thank you for this excellent read!! I definitely enjoyed every bit of it. I’ve got you saved as a favorite to check out new stuff you post…

  • www.freegreenconcepts.com • October 30, 2013

    I was suggested this web site by my cousin. I am not sure whether this post is written by him as no one else know such detailed about my difficulty. You’re wonderful! Thanks!

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Perception Is Reality

April 15, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System
• Leave a comment

Stanley
Feld M.D.,FACP,MACE

I mentioned Joe Klein’s criticism of the VA
healthcare system in my last blog. I promised to cover some of the problems veterans
are having in the VA healthcare system.

I cannot believe the VA healthcare system is as
bad as illustrated by the following examples.

However, perception is
reality.

I believe if the government completely takes
over the healthcare systems and creates a single party payer system, Americans
will have the same perceptions that these veterans have had about the VA
healthcare system.

I have read some of the government’s official reviews
of complaints by veterans. The VA Office of Inspector General Office of
Healthcare Inspections writes the government’s official reviews.


The typical conclusion of the Inspection General
for the VA was that the overwhelming majority of the complaints in various VA
hospitals are unwarranted or insignificant.

“The VA Office of Inspector General Office of
Healthcare Inspections conducted an inspection in response to allegations of
misdiagnosis and other care issues at the Atlanta VA Medical Center (the
facility) in Atlanta, GA, and two community based outpatient clinics (CBOCs) in
Veterans Integrated Service Network 7.”

 

"The purpose of this
inspection was to determine the validity of the allegations. We did not
substantiate that a facility emergency department physician misdiagnosed a
stroke as vertigo (a feeling of motion while one is stationary) in September
2010. We determined that the facility emergency department physician’s evaluation
and management of the patient’s complaints and hyperglycemia were appropriate."

"We did not substantiate that the patient received
deficient care or that facility and CBOC providers failed to appropriately meet
the patient’s vision, hearing, and stroke rehabilitation needs."

This is the typical
verbage of many reports written by the VA’s Inspector General. Unfortunately,
these conclusions do not foot with veterans’ complaints.

The
general characteristics of most of the complaints fall into specific
categories.

One universal
characteristic of each complaint is the lack of development of a positive doctor patient relationship. 

An Army
Major with a combat brain injury felt he had never been treated so poorly in
his life. A VA physician reviewing his condition did not even look at his
record. The physicians showed no compassion when the patient needed compassion the
most.

“I have such a low regard for the
VA. I have never been treated in my life as poorly as I had with the VA.”

His
perception was that “everyone
in the system blames others or passes the buck to someone else.”

 The
physician simply wrote a prescription for some medication.”

The physician
showed no interest in the patient or his disease. He showed no empathy for the
patient.

Another
former Marine, Mike Ligurri, who has written the book, The
Sandbox. He was
diagnosed with Post Traumatic Stress Disorder.

Mike
Ligurri also expressed the lack of personal contact with him by the VA physician.
He was given medication to take without explanation of the medication.

 “My attitude was I don’t want to take pills
just because you tell me I will feel better.’  

He felt
the physician he dealt with was cold hearted and not involved.  

There is
no incentive for VA physicians to become involved with patients in the VA
system. The patients are not their patients. At
each clinic patients usually see a different physician.

The
perception of patients is that the VA physicians and the VA system do not
connect with them.

Patients are treated as commodities.  

I can
relate to that feeling. When I was in training at a charity hospital I was
never able to form a relationship with patients. I did not even see the
patients I admitted to and discharged from the hospital.

There was
little continuation of care or follow-up by me.

When I went
into practice the patient was my patient and I was his doctor. The positive
patient physician relationship made the visit more satisfying to me and more
therapeutic for the patient.

If I
didn’t relate to my patient while in private practice, my patient had the
option of leaving my practice and finding another physician.

I, as
other physicians in private practice, made it my business to relate to my patients.
My incentive was to build my practice and reputation. I was a consultant to
other physicians as a clinical endocrinologist.

In order
words, I had incentive to treat my patients well and my patients and referring
physicians had freedom of choice of any other physician.

The
experience patients have at the VA is reflected in the following comment,

“They made
me feel like they had no time for me. All they did was to take notes, never
engaging with me, and after ten minutes decided to write me a pill
prescription. I was never told about alternate forms of therapy.”

Patients
want to know about their disease. They want to learn the reasoning for their
treatment. They are not stupid. They want to know what to expect from their
disease and their treatment.

They want
to have a caring and comforting physician because they are frightened about
their disease.

Patient
education and a positive patient physician relationship are essential for good
therapeutic outcomes.

A few
weeks ago at medical grand rounds I sat next to a fellow physician and good
friend who was cured of testicular cancer 30 years ago at age 32.

At that
time he was frightened out of his mind because he had no experience with
testicular cancer. He was sent to a radiation oncologist who explained his
disease, his prognosis and what to expect throughout the course of therapy.
This relationship was a total comfort to him.

He
mentioned this to me during our conversation. He said that he felt very bad
because he had not appropriately thanked the radiation oncologist for the
fantastic physician patient relationship. The relationship permitted him to
tolerate his therapy well. He said he been given hope of surviving and a
positive feeling about his outcome.

I told
this physician I was going to have lunch with that radiation oncologist the next
week. He asked me to be sure to tell the oncologist that he thinks of him all
the time.

He has
been so thankful for his help. He added that post testicular cancer therapy he
enjoyed a fantastic marriage and has been blessed with two wonderful sons.

Now that defines a wonderful physician patient relationship! 

Another complaint of
VA system patients is the long wait time for appointments and the mountain of
paper work that has to be completed in order to make each appointment.

If a patient misses
an appointment because of bad weather or unforeseen circumstances you have to
start the process all over again.

It must be maddening
for VA patients. A Veterans’ study committee has reported an average wait time
has been quoted as 50 day to 273 days.

Recently an older
veteran told me that he had a cataract that was progressing yearly. He was at
the point that he needed cataract surgery to be able to see.

He was told that the
wait and backup was one year.

He made enough of a
stink about the delay in his surgery that the VA healthcare system sent him to
a private practicing ophthalmologist. The private ophthalmologist did the cataract
surgery in one week.

He was thrilled
because he could see clearly again.

I am compelled to
tell some of these stories not to point out the solutions to the problems with
the VA system.

The VA system is run by
long term employees entrenched in their jobs without a threat of either losing
their patients or their jobs.

These employees have
little accountability; they create reports and publish meaningless evaluations.
These reports are of little value in fixing a healthcare system that works
poorly for patients but looks good on paper.

 “Even Jon Stewart is blasting the
handling of Veterans’ benefits, “That is f—- criminal. The VA has a backlog
of 900,000 people. McDonalds handles ten times that many customers in an hour,
and may I remind you they are run by a clown.”

The point is that Obamacare with its ever increasing
bureaucracy, agencies, and regulations is going to lead the entire population
into this trap by decreasing incentives and limiting choice.   

It Is “Coming Our Way with Obamacare.”

 

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

Please have a friend subscribe
 

 

 

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

The Traditional Mainstream Media Is Waking Up To Obamacare’s Defects

April 11, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

 Stanley Feld M.D.,FACP,MACE

 

Joe
Klein is TIME's political columnist and author of six books, most recently “Politics
Lost.” His weekly TIME column, "In the Arena," covers national
and international affairs. In 2004 he won the National Headliner Award for best
magazine column.

He
is a Democrat and a big supporter of President Obama.

Joe
Klein is a major liberal leaning reporter within the traditional mainstream media.
His last two articles in TIME magazine are finally starting to show
understanding of the problem with Obamacare. Here are some of these articles
more important statements.

He
starts one article with,

 “Let
me try to understand this: the key incentive for small businesses to support
Obamacare was that they would be able to shop for the best deals in health care
superstores — called exchanges.

 "The Administration has had three years to set
up these exchanges. It has failed to do so."

 "This is a really bad sign.”

The
administration continuously claims it is not its fault programs are failing. It
is always the other guy’s fault.

The
other “guys fault” was the main
strategy of President Obama’s reelection campaign. He needs more time to make
things work.

“There will be those who argue that
it’s not the Administration’s fault. It’s the fault of the 33 states that have
refused to set up their own exchanges. Nonsense. Where was the contingency
planning?” 

The
Obama administration just announced it couldn’t have the health insurance
exchanges program ready by January 2014.

It
is refreshing to read a liberal mainstream media writer saying what I have said
all along.

The
Obama administration’s trick here was to stick the states with the costs of the
exchanges.

The
states that have thought out the consequences have refused to accept
responsibility for the health insurance exchange.

The
Obama administration has also demanded that states follow the administration’s
conditions and rules. The states have viewed this as a threat to states rights.

The
Supreme Court sided with the states’ rights argument.

 

"The Obama Administration has announced
that it won’t have the exchanges ready in time, that small businesses will be
offered one choice for the
time being — for a year, at least."

A hidden story is the administration does not have the funding
to pay the states for the health insurance exchanges for three years.

This is one of the reasons President Obama is again demanding
the ability to raise taxes in a budget agreement. Republicans are saying he has
received his tax increases January 1, 2013.

“No doubt, small-business owners will be skeptical of the Obama
Administration’s belief in the efficacy of the market system to produce lower
prices through competition. That was supposed to be the point of this plan.”

Joe Klein goes on to say,

“We are now seeing weekly examples of this Administration’s
inability to govern. Just a few weeks ago, I reported on the failure of the Department of Defense and Veterans
Affairs to come up with a unified electronic health care records system.”

We have been told that the VA had an excellent electronic health
record. The VA advertises that every physician can download it and use it free.
I downloaded it.

The VA EHR is very difficult to use.

 Joe Klein had sharp
criticism for the “Head Start Program”,

 "There have been the
oblique and belated efforts to reform Head Start, a $7 billion program that a
study conducted by its own bureaucracy — the Department of Health and Human
Services — has found nearly worthless." 

 The
list of Obama administration failures is indeed endless. It is the work of a
community organizer trying to run a big business.

 “Barack
Obama is not a “how” President. Oh, he pays lip service to government reform.
His people can tell you the number of unnecessary regulations they’ve
eliminated.”

 “
It barely scratches the surface of what needs to be done—there is no creative
destruction in government, regulations pile up on top of each other like silt,
generation after generation.”

 The
next statements confirm Joe Klein’s liberal leanings.

 “One thing is clear:
Obamacare will fail if he doesn’t start paying more attention to the details of
implementation.”

 “But, as a Democrat — as
someone who believes in activist government — he has a vested interest in
seeing that federal programs actually work efficiently. I don’t see much
evidence that this is anywhere near the top of his priorities.”

 “And, in a larger sense,
the notion of activist government will be in peril — “  

“The problem is not, as the Republicans
claim, big government. It’s bad government.”


At
last the traditional mainstream media is starting to get it. There is starting
to be recognition of the problem with government controlled and operated
systems.

I
have explained many times that the mess in the healthcare system is not a
liberal or conservative problem.

It
is a problem in creating a healthcare system that aligns all the stakeholder
incentives and works for every consumer of healthcare.

A
consumer driven healthcare system with appropriate tort reform will have to be developed
by the government.

A
healthcare system must be constructed that allows consumers to own their
healthcare dollars and be responsible for their health and healthcare.

The
government could provide the subsidy to the needy. The result would be a
healthcare system that would be more efficient and less costly.

Individual
responsibility and freedom to choose is essential for a successful healthcare
system.

 

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

Please have a friend subscribe
 

 

 

 

 

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Reality Vs. Fantasy

April 8, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System
• Leave a comment

Stanley
Feld M.D., FACP, MACE.

“I’m Busted” ,my last blog, generated
several interesting comments.  

The comment below was a
standout. It represents a total disregard for historical understanding of what
made the healthcare system totally dysfunctional.

It is obvious from the
comment that this individual has not gone to any of my links in the blog nor
has he been a long time reader. I suggest he read the letters I sent to
President Obama at the time after his first election.

“We’ve been through
this before Dr. Feld.  While your generation was/is in charge of the U.S.
Healthcare System our Quality has Sunk and the Costs have Risen
Dramatically.  (www.ifhp.com/documents/2012iFHPPriceReportFINSALMarch25.pdf )” 

Physicians are not in charge of the healthcare
system.The government and the healthcare insurance industry is in charge.

I could not open the link this reader sent. He goes on to say,

 “ Take Some Responsibility for this Healthcare
Mess.  Stop Crying and Placing Blame on those searching for Workable
Options to Fix What You Proudly Created.  Please share this with your
readers.  Stop being so one-sided. 

Thank
you. 

XY

I have stated innumerable times that all stakeholders including
physicians are responsible for the dysfunction in the healthcare system.

Key to the understanding of the healthcare system's dysfunction
is the need to understand the evolution of the dysfunction. I cover the history
in my summary blogs. 

The dysfunction in the healthcare system started in 1965 with
the passage of Medicare.

Every subsequent government regulation was followed by a more
expensive reaction to the regulation by the stakeholders.

Life was simple pre
1965. The healthcare social contract was between the patient and the physician.

 

  •  Personal Care – The Physician Knew Me And
    My Family
  •  The Healthcare System Was Efficient – Consumer
    Driven
  •   It Was Adequate for 90% of Medical Problems
  •   It Was Democratic
    – Rich & Poor

Disadvantages

  •  Lifespan / Expectancy – Short
  • Lived
    Unhealthy Lives
  • Misdiagnosed
    Many Illnesses- Lack of Technology
  • Limited
    Body of Knowledge- Limited Treatments And Drugs

 

Patients made their own healthcare decisions. Patients and
physicians had positive relationships.

This positive patient/physicians relationship is 50% of the therapeutic
outcome.

As the medical knowledge base increased more money was pumped
into the healthcare system thanks to Medicare. Secondary stakeholders were
needed to deal with the increase in money and complexity. Soon these secondary
stakeholders began to dominate the healthcare system.

 Secondary stakeholders have disrupted Patient/physician
relationships. These stakeholders have created large barriers between
physicians and patients.

 
Slide09

 

Both patients and physicians have become commodities. In its
present form, the healthcare system, as it has grown in complexity and expense
has precipitously diminished physicians’ control over his medical care and his
ability to apply his medical judgment.

Obamacare is adding more layers of complexity to the healthcare system
to an already dysfunctional healthcare system.

Obamacare will be difficult to execute and impossible to
enforce.

When the reader says, “Stop Crying and
Placing Blame on those searching for Workable Options to Fix What You Proudly
Created.”

 I am not crying. I am sad for patients and their
future medical care within the Obamacare healthcare system.

I am trying to get consumers to see the inevitable.

Past evidence has proven that when government
controls and operates any systems the actions proposed are unworkable and unenforceable.
The result is great costs and more inefficiency.

 The healthcare system’s incentives will only be aligned
when the system is consumer driven. The government must support but not control
the healthcare system.

The government should set the rules to align
incentives and then get out of the way.

I have made a strong case for consumer driven
healthcare.

The healthcare system model the government brags
about is the VA Hospital System model.

Recently the VA has received bad press in the traditional
mainstream media.  VA public relations
department has tried to marginalize the criticism.

It has also tried to compensate for the criticism
by outsourcing medical and surgical care to the private sector with success.

 Elise Cooper’s article in the American Thinker:
“The
VA: a Culture of Disconnect” says it all. I will add to her title “Coming Our
Way” with Obamacare.

 

  • "Many veterans feel disconnected with the VA.
    They regard it as a huge bureaucracy that is very impersonal
    and unhelpful. The vets get frustrated because they do not know where to
    turn for help.”

“American
Thinker interviewed
veterans and others involved with the VA to reveal some personal examples and
to see if the complaints are justified.”

I will discuss in detail these interviews shortly.
I will say the complaints are justified.  

America is running out of time to repeal Obamacare.
Consumers have to wake up now and see what it is doing to their healthcare
system, their taxes and their economy.

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

Please have a friend subscribe

 

 

 

`

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

I’m Busted

April 2, 2013
inMedicine: Healthcare System
• Leave a comment

 Stanley Feld M.D., FACP, MACE.

 

 

 

 

As
we get closer to 2014 and the scheduled full implementation of Obamacare
conditions in the practice of medicine are getting worse.

I
have described how most of the major programs initiated by Obamacare,

(such
as the Accountable Care Organizations, the Electronic Health Record
initiatives and the Health Insurance Exchanges development), are failing or off
to a slow start.

 A detailed critique of the Obama
administrations’ Obamacare can be found using the search engine in my blog.

If
you receive my blog by email (RSS) double click on the blog title or go to the
web site http//:stan.feld.com.

Search
for the topic in the search engine in the top right corner of the blog post.

The
shortcomings of Obamacare are becoming obvious to many citizens. Most physicians
and hospital systems are finding Obamacare’s new programs difficult to execute.

A
reader wrote

"Dear Dr. Feld,

Once it becomes so painful for the
average voter, Obama will simply say, “a single payer system is the only way to
fix this insurance company mess.”  He’s doing exactly what he planned to
do, he’s just not telling the truth about it.

X"

It
is becoming more apparent that President Obama’s goal has been to destroy the public
and private sector healthcare systems. In reality the money in both the public and
private healthcare system has been controlled by the healthcare insurance
industry and not by the government.

The
Obama administration is building the infrastructure to easily convert the
healthcare system to a single party payer system. The majority of Americans are
opposed to a single party payer system. It eliminates choice.

The
expense of Obamacare has been and will be enormous to all stakeholders with 300
new agencies and 20,000 new regulations.

The
new healthcare taxes are scheduled to take effect almost monthly.

At
present at least 40% of the healthcare system is a single party payer system
when considering the government healthcare plans in place.

The
Obama administration will have two major problems converting America totally to
a single party payer.

The
public will be outraged when it becomes aware of that the direct costs to them,
the lack of availability of medical care and restriction to access to care
caused by Obamacare.

There
are two possible solutions. Either repeal Obamacare and start from square one
or let the government control the entire system.  

The
government will not be able to afford a single party payer system. It will have
no choice but to increase taxes further to support the healthcare system.

The
other major problem Obamacare will have with a universal single party payer system is the
healthcare insurance industry will continue to control the money in the system.

The
government does not have the infrastructure to provide the administrative
services and to adjudication claims. There are many hidden cost in the movement
of money that most are unaware of.

 

The entire situation reminds
me of Ray Charles’ song “I’m busted.”

  

 

http://youtu.be/D_Ew-768xmk

In 2008, after President
Obama was elected I wrote him six letters explaining how he could reduce the
costs of medical care in America by introducing cost savings initiatives.

Dear President Obama Part 1

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

Dear President Obama Part 2

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

Dear President Obama Part 3

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

Dear President Obama Part 4

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

Dear President Obama Part 5

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

Dear President Obama Part 6

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

I took a Willie Sutton
approach. “ Go where the money is.” 

If the government provided incentives to decrease
wasteful spending, the healthcare system would self correct without the myriad rules
and regulations    that
will not work and cannot be enforce.

Simple things such as:

  1. Incentivize individual responsibility with Medical
    Savings Accounts,
  2. Encourage the use of a Universal Electron Health
    Record with a fully functional EHR in the cloud. Physicians and hospitals would
    pay for its use inexpensively by the click. It would be sort of like a toll way
    fee without capital expense. The EHR could be upgraded and serviced at no
    expense.
  3. Create a healthcare system that is consumer driven
    with consumer owning their healthcare dollars and being responsible for their
    healthcare choices.
  4. A Tort Reform System that eliminates the need for
    defensive medicine that over tests patients to avoid law suits.
  5. Chronic Disease Management Systems to teach patients
    to be the professor of their disease in order to avoid costly complications of
    their disease.
  6. Develop patient educational systems available on the
    Internet 24/7 as an extension of their physicians’ care.
  7. Help develop disease specific Social Networks. The development
    of a disease specific community can serve to solve some problems patients have.
  8. Eliminate secondary stakeholder waste, fraud and
    abuse.
  9. Eliminate the purchase of first dollar healthcare coverage
    from the healthcare insurance industry  

I believe if all of the
above was done correctly it would save $750 billion to $1 trillion dollars a
year for the healthcare system.

President Obama has ignored
every point I have tried to make. Obamacare has not included any of the real
cost drivers in a non-punitive way.

He has simply added a huge
bureaucracy with rules and regulations that are expensive, difficult to execute
and more difficult to enforce.

If my recommendations were initiated
and executed properly America would have a sustainable healthcare system.

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

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Obamacare’s Deception

March 27, 2013
inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System
• Leave a comment

 Stanley Feld M.D.,FACP,MACE

We
all remember Nancy Pelosi’s famous declaration when she said “we will not know
what is in the bill until we pass it.”

I
could remember asking to myself how stupid can Americans be to listen to this
lady?”

Americans
are going to be shocked to learn the extent to which they have been deceived by
Obamacare. The legislation neither protects patients nor makes  the Health Insurance Exchange plans affordable.

The
details of Obamacare have been anything but transparent. New details are
appearing every day in the form of new regulations by new agencies.

I
believe it would be impossible for someone without an intense interest in
Obamacare to understand it.

There
have been over 20,000 new regulations from 300 new agencies so far. Mass
confusion has been generated as regulations from one agency contradict  regulations from other agencies.

The
Obama administrated has said recently that the public should not expect cost
saving from Obamacare.

 The Obama administration has also asked for an
additional $1 trillion dollars over the next ten years in order to fulfill
Obamacare’s promise to the American people.

It
looks as if none of the administration’s advisors or the administration had
considered the unintended consequences.

“Obamacare
works for the insurance companies but not for Americans.”

The
slogans such as “shared responsibility,” “no free riders” and “ownership
society.” dress the insurance industry’s raid on public resources in the cloak
of a “free market” health care system.

Obamacare neither protects patients nor are the healthcare
insurance plans to be offered by the health insurance exchanges affordable.

Americans with incomes between 133% and 400% of the Federal
Poverty Level (Income above 133% of the federal poverty level = $31,322/yr. or $2,610/mo.
Income above 400% of the federal poverty level= $94,200/yr. or $7850/mo.) will
pay for the least expensive   subsidized policies from 2% to 9.5% of Modified
Adjusted Gross Income (MAGI) from their IRS reported income.

Americans with the least income are faced with a substantial yearly
and monthly after tax salary reductions even though their healthcare insurance
policy is subsidized by the government.

On January 1,2014 they are mandated to have healthcare coverage.

A person with a Modified Adjusted Gross Income receiving $27,925
from all sources of revenue will pay $187.33 per family member per month.

The total price for a family of four is ($2,247.96 per year times
4)  $8991.84 in after tax dollars. This
pays for a Silver level plan that is next to the least expensive plan to be
offered by the health insurance exchanges.

If a person who has this plan goes to a physician or a hospital  the patient’s deductible will be sizable
despite the government subsidy.

Even if the family has subsidized healthcare insurance these
families might not be able to afford to use the insurance.

The quality of life of a low earner will be compromised. He must
buy the subsided healthcare insurance. The result will be he will have to make
cuts in buying food and adequate housing in order to pay for the healthcare
coverage.

We have not heard much about this problem from the Obama
administration.

As the insurance industry raises premiums on private insurance
they are also going to raise the prices in the Health Insurance Exchanges.

If the family opts out of buying the insurance they will have to
pay a penalty.

It is actually better to pay the penalty and then sign up for
insurance if you or a member of your family gets sick.

 The fee paid for
insurance in 2014 will varying according to 2012 income. If a family income
rose in 2012 and the breadwinners lost their jobs in 2013 and 2014 the family
could not afford the MAGI healthcare insurance premium they would be required
to pay.

If income increased in 2013 they would be liable for the
increase the next year.

“The
stress alone from such a regressive scheme is, without a doubt, not conducive
to good health and well-being.”

On January 1, 2014 everyone is required to buy healthcare
insurance or else pay a penalty. Even with the government’s subsidy a low income
earner could be forced out of the market.

In the meantime, states such as California are decreasing
reimbursement for physicians. Physicians are choosing not to participate in
both Medicare and Medicaid. This will increase the physician shortage.

The only choice states have left is to tie medical license
renewal to physicians accepting Medicare and Medicaid.

At the same time states and the federal government are
decreasing funding to already financially stressed charity safety net hospital
systems. Many of these institutions have closed. Most of them are failing.

The decrease in safety net hospital systems will further
decrease the options for low-income earners to receive medical care.

Obamacare is turning out to be a not well thought out plan. It
is a series of Catch 22s.

The only winner is the healthcare insurance industry which will
provide the administrative services to the government to adjudicate claims. It
will receive both the government subsidy and the payment made by the low-income
earner. 

Obamacare has deceived the public.  As I have stated in the past Obamacare has
some good ideas but the structure, regulations and execution are terrible.

Obamacare sounds good when President Obama talks about it but it
is an impending disaster medically and financially for Americans.

Only a consumer driven healthcare system with the bullet-proof
ideal medical savings account will align all the stakeholders’ incentives.

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



If you have enjoyed it please have a friend subscribe
 

 

 

 

 

 

 

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

St. Patrick’s Day 2013

March 24, 2013
inLife's Experiences
• Leave a comment

Stanley Feld M.D.,FACP,MACE

St. Patrick’s Day is my birthday. This St. Patricks’s day was my 75th
birthday.

A little background has to be presented before I talk about the
phenomenal birthday party my wife Cecelia threw for me in the Eilan Hotel Resort and
Spa in San Antonio.

When I was three years old my mother took me to the New York City Fifth
Avenue St. Patrick’s Day Parade. She sewed a kelly green jump suit for me to
wear.

When we got to the Parade she told me all those people were marching to
celebrate my birthday. This happened every year until I was six. I finally
caught on.

She celebrated St. Patrick’s Day with me  the rest of her life. After I
moved out of the house she would call at 6.30 am every St. Patrick’s Day and
sing Happy Birthday to me.

My sister-in-law took over after my mother’s death. I get a chill up my
spine every time Cindy does it. She never misses a beat.

Cecelia sent me this as a little extra birthday present.

"Stan,

I helped fund Doug and Telisha's new CD with a donation through
Kickstarter.

Here it
is, FOR YOU, their personal video. HAPPY BIRTHDAY! "

"Hi Cecelia,



Here is a link to Stanley's special video telegram:

 

 
http://youtu.be/oVpj4_mODnY

Sincerely,

Telisha"

I started my practice of Clinical Endocrinology in the summer of 1970.
At the beginning of March 1971 I bought a kelly green wool blazer to wear while
seeing patients on my birthday. If March 17th landed on a Sunday I
carried out the ritual on Monday. If it landed on Saturday I wore my jacket on
Friday.

It was lots of fun. After a few years the same patients made an appointment
to see me on my birthday.

After a while more people than I could see in one day wanted an
appointment on that day. Some of the people made appointment a year in advance
so they would have the slot.

I think they had more fun than I had. Patients started bringing me St.
Patrick’s Day clothing. They brought in green ties, sweaters, vests, leprechaun
shoes and hats of all shapes and sizes.

I had so much stuff and so many patients that wanted to have an
appointment on my birthday that I extended the celebration to two days and
started wearing a different costume each day.

My birthday has been a glorious day. This year Cecelia wrote to her
entire email list and asked them to say something about me. She has not given the album to me yet because she has not finished it and the notes keep coming in.

She said many of the notes made her cry and she
is sure they will make me cry.

Brad put his note to me in his blog. It made me cry. I remember all
of it.

Cecelia and I drove down to San Antonio on Wednesday March 13th. We thought it would be fun to drive. It was a mistake. I-35 is still a mess between Waco and San Antonio after all these years.

I would be remiss if I did not put some of my outfits into this blog.


IMG_2455 copy 2
Arriving at Eilan Hotel Resort and Spa

IMG_2460 copy
 I wore this soccer shirt to dinner at La Fonda with Brad and Amy.

 Thursday Daniel, Laura and Sabrina arrived. We explored the new end of the Riverwalk before dinner. 

 
IMG_2465 copy
IMG_2465 copy
IMG_2465 copy
IMG_2465 copy

Doesn't Daniel look great? 

 

IMG_2477 copy
Dinner was wonderful at Il Sogno Tratoria at the Pearl Brewery 

 

IMG_2478 copy

Friday's Outfit

 
IMG_2484 copy

 Charlie and Cindy arrive.

 

IMG_2495 copy
 

Dinner at Boudros on the Riverwalk

IMG_2500 copy
 

All dessed up for Saturday  

 

IMG_2506 copy

They dyed the San Antonio River green for my birthday.


800px-Chicago_River_dyed_green,_focus_on_river copy

They did it in Chicago,too. My birthday is a great day.

2013-03-16 18.51.14 copy

My fabulous and beautiful wife and I before dinner at Sustenio at the Eilan Hotel


2013-03-16 19.55.46 copy

Brad, Amy and I before the birthday dinner.


2013-03-16 21.02.53 copy

My cake. Do not let the green fool you. It is solid chocolate


2013-03-16 19.57.27 copy

Brad, Stan and Dan with the most wonderful person in my world, Cecelia.

 

I wish to thank Cecelia publicly for creating this fabulous weekend. 

I love you

 

Stan

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



If you have enjoyed it please have a friend subscribe


  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

I Can Hear The Train A Comin’

March 20, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP MACE

  

http://youtu.be/v7gV5C5mB7A

It is almost past the time for physicians to
listen to that train whistle coming down the line.

A reader wrote

 

"Great
blog Dr. Feld.

 Ask
your Physician friends this question:

 “What
and how will you feel when your license to practice medicine is no longer
sanctioned at the state level, rather it is issued by the Federal Government
and tied directly to your willingness to see a certain percentage of
Medicare/Medicaid patients?”

 That’s
where this train is headed, most physicians are simply too blind it to see it or too deaf the hear it.

M "

 

M., I have tried to warn my physician
friends that the train is coming. Physicians’ freedoms and the patient-physician
relationship are circling the drain.

The only option they will have will be
to practice medicine without a license. This is a ridiculous thought.

Where is the silent physician majority?
I have only heard from Dr. Ben Carson. I have a feeling the press is going to
start calling him a lunatic very shortly. The goal will be to marginalize and silence
him.

 

 

http://youtu.be/hNvIfCZWCtQ

 

Where are the organizations that are
supposed to represent physicians and their patients?

If you ignore the pain you do not know
the cancer is growing. If you do not feel the pain you do not know if it is
growing either.

The cancer cannot be cured if it is
ignored.

Physicians cannot ignore this problem
any longer. Neither can consumers. Entitlement spending run wild will drive
America into bankruptcy.

Cancer is comparable to the national debt.
It will not be cured if it is recklessly ignored. The end result will be
bankruptcy.

President Obama has
demonstrated an apparent disregard for the literal interpretation of the constitution’s
First, Second, Fourth and Twelfth Amendments during his term in office.

States rights seem
meaningless. The Democratic congress has empowered President Obama to do anything
he wants to do to the healthcare system.

Congress has transferred all
decision making to the executive branch of government.

Congress is supposed to
represent the people. Most consumers do not know what is going on. The
information is not readily available.  If
they do not know what is going on will not mount a protest.

Consumers who enjoy the
benefits of the entitlements are not likely to be willing to give them up. It
is not as much a matter of entitlements as it is a matter of waste and
inefficiency resulting from complex government bureaucracies.

President Obama has told us
that Medicare and Medicaid are very efficient. Yet he has not provided proof.
The administrations claim is the waste is the result of fraud and abuse. My
question is by whom?

Public opinion cannot be
expressed if the public does not understand the issues.

The traditional media has
ignored most of the important issues; it has not published the possible
consequences of the administrations rules, regulations and actions.

If congressmen express an
opinion contrary to the party line of the establishment they are called a Wacko
Birds.

The press will jump all over
this because it might sell newspapers or magazines. The public accepts the
catchy phrase as the truth.

I have outlined and
described in detail the logical solutions to Repairing The Healthcare System.

With the 20,000 new
regulations and 300 new agencies the Obama administration has tightened the box.
They have disabled the physicians’ ability to practice medicine unless they
comply with government dictates.

This is called government
control and takeover of the healthcare system.

Many physicians think they
can finesse this imprisonment. These physicians are wrong. Many think they will
be able to stop accepting Medicare and Medicaid and continue to practice
medicine. They are wrong.

Physicians’ ability to use their
medical judgment is being taken away.

The Obama administration’s
response would obviously be that is silly. They are not trying to control
medical judgment.

However the government
continues to proceed in commoditizing medical care. 

Physicians are going to
scream when they wake up and realize what is happening to medicine and medical
care.

Some physicians say they are
powerless to do anything. These physicians are wrong.

All they have to do is learn
the details of the real issues. Then they have to explain it to every patient.
Patients are not going to like what is happening.

Physicians can provide their
patients with talking points or an already written letter to send to congress
and President Obama.

Remember this is a
government by the people for the people. We hire these guys. Our vote provides
these politicians with their job. Congress and the President are scared stiff
to have our disapproval.

The government runs like
Franz Kafka’s bureaucracy in his book “the Castle.” No one has authority to
make a decision and no one takes responsibility for the consequences.

Who took responsibility for
the Benghazi disaster? The press ignored it. The facts were not forthcoming and
no one took responsibility.

Americans’ health is too
precious to ignore the impending disaster.

Who is going to take
responsibility for the disaster?

 

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



If you have enjoyed it please have a friend subscribe

 

 

 

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Obamacare’s Actions To Destroy The Healthcare System

March 16, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System
• Leave a comment

Stanley
Feld M.D., FACP, MACE

The Obama administration is doing
everything it can to destroy the healthcare system. President Obama continues
to campaign that he is going to save Medicare and Medicaid and provide
universal care while saving $4.25 trillion dollars.

It does not add up.  The Obama administration keeps raising taxes,
decreasing benefits and increasing deductibles on Medicare and Medicaid
premiums. The administration is decreasing the work force by regulation and
executive order.

Everything that is being done increases
the burden on seniors and insured workers.

To my amazement no one in organized
medicine except the American Association of Physicians and Surgeons (AAPS) has
protested.

I applaud Jane Orient M.D. executive
director of AAPS and her Board of Directors for stepping forward and trying to
defend the rights of patients and their physicians.

At stake are patients’ ability to
choose their physicians and physicians’ ability to practice medicine as they
choose.

Where are the AMA and all the specialty
organizations in the federation medical organizations?  It is little wonder these organizations are
losing members.

All medical organizations should join
with Jane Orient M.D. and her Board of Directors lawsuit against the government.

AAPS filed suit
against PPACA three days after it was signed into law, but the National
Federation of Independent Business (NFIB) and 26 states stayed the case pending
a Supreme Court decision in the case brought.

All of us know that the Supreme Court
upheld the Obamacare law. It was deemed by Chief Justice Robert that the
executive branch has the power to levy a tax. It is not within the power of the
executive branch to create a mandate. President Obama insisted throughout the
legal process that this was a mandate and not a tax.

 

In my opinion this decision by Justice
Roberts was a big mistake. Obamacare is a terrible law that will not create
universal healthcare. It will be ineffective and inefficient. It will destroy
the healthcare system. Obamacare cannot possible work.

I think this is President Obama’s goal.

The Supreme Court in its decision acknowledged,
"any tax must still comply with other requirements in the
Constitution."

No one except the AAPS has challenge
this point.

“The motion filed by AAPS is the first to ask an appellate
court to rule on whether PPACA violated the Origination Clause of the U.S.
Constitution, which requires that all "bills for raising revenue"
originate in the House of Representatives.”

More and more physicians are not participating
in Medicare. Physicians still have the ability to choose to participate in
Medicare and Medicaid.

At the beginning of 2013 a new
regulation went into effect. Previously, if a physician did not participate in
Medicare the patient had to pay the physician his fee. The patient could then
bill Medicare and collect 70% of Medicare’s allowable fee.  Medicare does not pay the patient after
January 1st,2013.

Non-participating physicians may use
laboratory, x-ray departments or consultants that participate in Medicare. The
participating consultants, labs and x-ray departments can bill Medicare
directly and receive their usual and customary fee from Medicare. 

Effective May 1, 2013 (a new regulation
issued March 1, 2013 by HHS) the Department of Health and Human Services will
deprive patients of benefits for blood tests, x-rays, and specialist
consultations—benefits for which they were forced to pay all their working
lives, and which would be covered if ordered or referred by a non participating
Medicare physician.

I believe the Obama administration’s
goal is to force physicians to participate in Medicare.

"Because of Medicare's increasingly costly and
restrictive rules placed on doctors, many Medicare-eligible patients are
receiving medical care from physicians not enrolled in the program,"
states Jane M. Orient, M.D., executive director of the Association of American
Physicians and Surgeons (AAPS).

AAPS filed an
emergency motion for injunctive relief  in the U.S. Court of
Appeals for the District of Columbia Circuit.

The
Founding Fathers fought for independence largely because of excessive taxation
without representation. When the Constitution was drafted, the founders
insisted that taxes originate in the House, the legislative body closest to the
people, both in representation and in election cycles.

“ObamaCare
originated in Senator Reid's 2000-page amendment to a 6-page House bill about
tax credits for members of the armed forces who are called into overseas
assignments. AAPS has raised several arguments why ObamaCare constitutes an
illegal tax, including violation
of the constitutions Origination Clause.”

This new executive order disregards the
constitution’s “Origination Clause” to try to stop physicians from not
participating in Medicare

Only
the AAPS had the guts to speech out against this executive branch breech of its
power and defend patients and physicians rights as granted by the constitution.

Hooray
for the AAPS.

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



If you have enjoyed it please have a friend subscribe

 

 

  • cell phone glass repair • October 27, 2013

    I was suggested this blog by way of my cousin. I’m no longer certain whether this put up is written by means of him as nobody else recognise such particular about my trouble. You are wonderful! Thank you!

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.