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What Is The Insurance Value Of Medicare?

November 19, 2012
inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

 

Healthcare insurance is
great if you do not need it.

The wonderful thing
about Medicare is private insurance is not available to seniors.  

Healthcare insurance companies
are not interested in covering consumers with health risks or preexisting
illnesses.

In fact private
individual healthcare insurance policies are not available to an unemployed 55
year old person with mild obesity and hypertension.

If you are employed and
over 65 years old with mild obesity and hypertension the healthcare insurance
industry is required to insure you under your employer healthcare plan.

The employed person
receives healthcare coverage with pre-tax dollars.

 A person who might be
eligible to purchase individual healthcare insurance must pay with after-tax
dollars.

This is unfair but
easily corrected.

The pre-tax/post tax
issue could be solved if the state insurance boards required the healthcare
insurance companies, wanting to sell private insurance in that state, cover
everyone applying for insurance. The insurance company should be required to
set the premiums based on community rating.

Everyone should pay
premiums with pre-tax dollars.

Medicare, through
government inefficiency, has become very expensive. If it were efficient
insurance it would be less expensive to both consumers and the government.

Most working people have
no idea of Medicare’s cost to them during their working years.

Medicare’s yearly tax
withholding is 1.45% of salary. A worker earning
$100,000 a year pays $1450 yearly to the Medicare Trust Fund. In 40 years that
person would pay $58,000 into the Trust Fund.

When they became eligible
for;

 Medicare Part B the yearly premium in 2012 was
means tested.

 

If your yearly income in 2010 was

You pay (in 2012)

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

$99.90

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$139.90

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$199.80

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$259.70

 

 

 

In
2013 the Medicare Part B premiums are going to increase.

 

 

 

 

 

 

 

 

 

 

 

 

 
   

 

 

 

 

 

If your yearly income in 2011 was

You pay (in 2013)

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

$104.90

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$146.90

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$209.80

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$272.70

above
$214,000

above
$428,000

$335.70

 

Income is defined as
income from all sources such as capital gains, interest, pension annuities,
social security and all earned income.

Further premium increases have been announced for 2014 but
have not been published.

Medicare premiums are
taken out of each Social Security check.

The Medicare Part B
insurance has deductible and co-pay rules. Medicare Part B deductibles apply
for each hospital stay, ER visits and physician office visits.

For each benefit period
you pay:

  • A total of $1,156 for each hospital admission of
    1-60 days.
  • $289 per day for days 61-90 of a hospital stay.
  • $578 per day for days 91-150 of a hospital stay
    (Lifetime Reserve Days).
  • All costs for each day beyond 150 days.
  •  

Skilled Nursing Facility
Coinsurance

  • $144.50 per day for days 21 through 100 each
    benefit period. Days 1-20 are free.
  •  

Part B: (covers Medicare eligible physician services, outpatient
hospital services, certain home health services, durable medical equipment)

  • $140.00 per year. (Note: You pay 20% of the
    Medicare-approved amount for services after you meet the $140.00 deductible.)

 

The deductible for the
first $140 dollars worth of services plus 20% of any physicians and hospital
bill can add up as one gets older. It becomes unaffordable for many seniors.

 

Medicare Part B’s deductibles
and copays’ costs makes Medicare gap coverage   essential.

Premiums For Medicare Part
F   

Policy Summary

Monthly Premium:
$84 – $302  depending on age and benefits

Estimated Annual
Cost: $6,050.00

Benefits

  • Basic Benefits Medigap
    Basic Benefits definition[?] – Opens in a
    new window
  • Skilled Nursing Facilities Skilled
    Nursing Facility definition[?] – Opens in a
    new window
  • Part A Deductible Part
    A (Hospital Insurance) definition[?] – Opens
    in a new window
  • Part B Deductible Part
    B (Medical Insurance) definition[?] – Opens
    in a new window
  • Part B Excess Charges (100%)
  • Foreign Travel Emergency
  • Preventive Services

 Medicare
Part D is the drug benefit plan. Medicare Part D helps reduce the cost of
medications.

Medicare
Part D is also means tested. There are multiple plans to pick. Some include
complete payment for brand named drugs and some cover the donut. The price can
range from $40 to $120 per month per senior depending on the coverage a senior
picks. The additional means tested fees are below.

The
brand named drugs are expensive. Most drug chains have followed Wal-Mart’s lead
and charge $4.00 for generic drugs. This forces seniors to purchase generic
drugs

Medicare
Part D is expensive and unfair for seniors needing brand named drugs.

The Means Testing Formula For Medicare
Part D 2012

 If your yearly income in 2010 was

You pay

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

Your
plan premium

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$11.60
+ your plan premium

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$29.90
+ your plan premium

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$48.10+
your plan premium

above
$214,000

above
$428,000

$66.40
+ your plan premium

 http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

 Medigap
fees and Medicare Part D fees are paid with post tax dollars.

These
costs are in addition to seniors having contributed $58,000 to the Medicare
Trust Fund during their working years.

“The reason we have
health insurance at all is not that health care is expensive, but rather that
there is great uncertainty about who will need very expensive and potentially
lifesaving care and when they will need it. Medicare should give beneficiaries
not just access to medical care, but also protection from the risk of
catastrophic spending.” 

Medicare
coverage is not cheap. President Obama’s Obamacare is going to make it more
expensive with less access to care.

 Why
is Medicare Part B,F,D  so expensive when
the average person on Medicare spends only $6,600 dollar per year?

This
is the major question. The government should focus on the answer. It should not
be spending time and money on a system that is punitive to patients and
physicians and has little chance of being successful.

The
money creating the Medicare deficit is going somewhere. Where?

The cost to Medicare beneficiaries is high.
The protection against economic ruin is limited. The basic benefit lacks a cap
on out-of-pocket spending, so beneficiaries are exposed to the risk of
open-ended cost sharing that can generate substantial financial strain (or
deplete assets for surviving spouses).1 

Moreover,
the odds of facing a catastrophic expense mount over time. Almost 50% of
beneficiaries are hospitalized at least once over a 4-year period.2 

If
we are going protect our seniors from financial strain or ruin Medicare must
reassess it premises and reduce its administrative waste. It must be completely
transparent. If the government did it correctly it would provide an affordable
healthcare insurance plan for seniors.

“Everyone knows the dice is loaded.”
Leonard Cohen.

  

http://youtu.be/GUfS8LyeUyM

 

At
the moment seniors do not have another choice. It is the only game in town.

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

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  • Julie Anderson • November 20, 2012

    Healthcare policies must even beneficial to the seniors but they shows the less interest and they concentrate on the other categories.\They show the less interest because these are already with the problem and with them we will have no benefit!!!
    Medicare

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It Is Time To Re-examine Our Premises

November 14, 2012
inConsumer Driven Health Care, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

About once a week I have an in-depth conversation with my
son Brad. In my view his perception of the world is more accurate than most. In
his younger days I did most of the teaching and he did most of the listening.

Today, I do most of the listening and he does most of the
teaching. This morning he said something profound. We were talking about large
corporations business models. He said most corporations do not know what
business they are in.

He is right. As technologies change business model must
change. If the business model does not change the corporation cannot survive.

The healthcare industry and the medical care industry
(physicians and hospital systems) must re-examine their premises and change
their business model.

President Obama is trying to change the business model
with Obamacare. In reality he is not changing the old business model at all. He
is expanding the old business model that has failed.

He is also making the business model more complicated. He
is building an elaborate and expensive structure whose goal is to decrease
costs. It will cause the system to fail faster.

Obamacare is adding a more punitive and restrictive
element to healthcare delivery rather that a more innovative and rewarding
element to both the patients and physicians.

It is not designed to promote health; it is designed to
cut costs by limiting access to care, rationing care and decreasing freedom of
choice.

Obamacare pays lip service to preventive care. Preventive
care will be largely ineffective because of the reimbursement metrics and lack
of incentives provided to consumers. 
Consumers must be incentive driven.

There are many examples of long time successful
corporations that could not change their business model fast enough. These
companies were muscle bound either because of a lack of vision, a lack of
leadership, multiple committee meetings and too much decentralization of an
ever-expanding bureaucracy.

Eastman Kodak is a perfect example. It was the premier film,
film processing and photography paper manufacturer in the world.

 Kodak did not
recognize that it was  in the imaging
business. The technology of digital photography put Kodak out of business
because Kodak could not change its business model fast enough.

Royal Typewriter Company viewed itself as a typewriter
manufacturer. As soon as IBM developed the innovative Selectric typewriter
Royal should have figured it out.

Royal should have developed a faster and more innovative
typewriter. Royal also should have jumped on the development of a typewriter
that would store the typed data.  Instead
it was more of the same old.

It did not take long for consumers to drive the
typewriter companies out of business.  Word
processing on computers made typing documents  easier and more useful.

The railroad business did not have the vision to understand
it was in the transportation business. Airplanes, eighteen-wheelers and
Greyhound buses almost drove the railroads out of business. Railroads did not realize
that consumers wanted a better product. A product that is faster and cheaper.

Railroads have only partially recovered.  

Consumers drive innovation. If a new great product is
introduced to consumers, the new product can take off at the expense of the
legacy product.

Just think about ITunes and the music industry, the
IPHONE and the legacy landline telephone industry and the IPAD and the desktop
computer industry.

Amazon has dis-intermediated the Book Publishing industry
with its Kindle and wireless downloading of books.

The opportunity in healthcare is similar. However
Obamacare is driving the country in the opposite direction away from a consumer
driven industry into a government controlled, bureaucratically dictated
decision making industry.

The business model
of 2020 should look like this.

Slide14
Instead it is going to look like the slide below under Obamacare. The
healthcare industry is going to collapse under its own structure.

 
Slide11

The
effective future business model will put consumers in charge of their
healthcare dollars and provide consumers with financial incentives to stay
healthy.

It
will decrease the healthcare industry’s control of the healthcare system.
Consumers will have control of their own first dollar coverage.

Consumers
will drive the healthcare system to produce the best medical product. They will
seek high quality care at the lowest price.

Physicians
and hospital systems will want to produce the best product at the lowest prices
so they can attract patients.

Only
a consumer driven healthcare system will drive the technologies of efficiency
into the healthcare system.

Remember,
without patients or physicians there would not be a healthcare system.

My
2020 business model of the future can be studied in detail on the following
links.

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

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Eyes Wide Shut

November 11, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Physician's Problems
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Stanley Feld M.D.,FACP,MACE

 

I cannot believe the results
of the Presidential election.

All of President Obama’s
policies have failed so far. All have served to inhibit economic growth or make
it worse.

Yet the majority of
Americans voted for President Obama. Why could this occur when many of the
structural ideas and ideals representative of the United States are being dismantled?

This is a great county.
Americans accept the winner and move on.  They continue to speak to their neighbors who
had the other guy’s sign in their front yard.

On the other hand it amazes
me to see that the electorate ignores the real issues and votes for the  personality. Marshall McLuhan was correct. The media is the message. Why the media
is ignoring the facts is beyond me.   

It is disappointing because
Americans are also ignoring the obvious coming unintended consequences that are
going to be the result of their voting decision.

The devil is always in the
details. I have presented my views of how the medical care system is going to
be destroyed by Obamacare. It is only a matter of time.

The healthcare system is
becoming too expensive, unsustainable, impersonal, rationed. The result will be
a denial of access to medical care for many Americans. 

Obamacare’s effect will become
the opposite of what President Obama intended and  promised.

I have also stated that his
strategies for change have been misguided.  

President Obama’s advisors
are all ivory tower professors and bureaucrats. They have no understanding of
what is happening in the street at the interface between patients and
physicians.

Ideologically they want to
make medical care better for all. President Obama does not understand the
pressures and the reality of the real practice interactions between physicians
and patients or physicians and their communities.

President Obama believes
that healthcare should be an entitlement and not an individual responsibility. Healthcare
entitlements will never solve America’s problems with obesity and chronic
diseases.

In the process of making
healthcare an entitlement, President Obama is devaluing the skills of those
practicing medicine.

Many physicians have quit
practice because of adverse conditions. The result will be a decreasing
physician workforce in an increasing covered population. This is not a good equation.

Most physicians do not
accept Medicaid and many have stopped accepting Medicare.

This will shift the burden of
higher cost of medical care to seniors and poor people.  

Bob
Doherty is Senior Vice President of Governmental Affairs and Public Policy,
American College of Physicians. His blog at The ACP Advocate Blog is reprinted below.
It deserves a wide audience.

Bob
Doherty has dealt with the socioeconomic concerns of Internists and Internal
Medicine Sub Specialists for at least 30 years both at the American Society for
Internal Medicine and later after ASIM merged with American College of
Physicians.

Bob
Doherty wrote this article discussing the effects of Obamacare on the practicing
physician. He presents practicing physicians’ complaints about  Obamacare.

This
article should be read carefully. President Obama should pay attention to
physicians’ complaints.

 “The
micro level of health reform cannot be ignored”

by BOB DOHERTY on November 5th,
2012in POLICY

 

Much of what passes for debate on
health care during this election year is focused on the macro side, on big
issues like how do we cover the uninsured or restructure Medicare and Medicaid
financing.  But for all of the talk about vouchers and block grants and
insurance mandates, the candidates are missing the micro issues that really
matter most to doctors and their patients, which is how health care policy
directly affects the quality of the patient-physician encounter.

Talk to physicians around the
country, as I regularly do, and these are some of the issues that have them
most concerned:

1. Will anyone do
anything about the oppressive burden of paperwork and red tape?
2. Will the candidates’ “macro” proposals for reforming healthcare and
entitlements result in more or less paperwork and red tape?
3. I already don’t have enough time to spend with patients but now I am
expected to counsel them on preventive care, lifestyle choices, and the
effectiveness of different treatments?   How is this possible?
4. Electronic health records, great concept, but they don’t really streamline
the process as advertised, if anything, they just make things more difficult,
and besides, they still don’t communicate with other systems.
5. Everyone wants to measure me, but the measures don’t agree with other, they
measure the wrong things and they are difficult to report on.   And
who is measuring the value and effectiveness of the measures themselves?
6. Okay, I am supposed to practice cost conscious care, but who is going to
stop a lawyer from suing me if I don’t give a patient the test they asked for?
7. Why is my cognitive care paid so little while procedures and drugs are paid
exorbitant rates?
8. Payers and government keep imposing more penalties, for not e-prescribing,
for not converting to ICD-10, for not meaningfully using my electronic health
record, for not complying with their pay for performance schemes.  By the
time they get done fining me for noncompliance, I will have had to shut my
office. Then who will take care of my patients?
9. And who has the time to keep track of all of these mandates, incentives,
rules, and penalties?  I would have to hire a full-time person keep on top
of everything. Who is going to pay for that?
10. So I am supposed to transform my practice?  Well, we all want to do
our part, but who is going to pay for that?  Besides, my patients seem to
think my practice is just fine as it is

Now, I don’t really expect Obama
and Romney to come out with plans to address these micro health policies. 
But it is reasonable to hold their macro proposals to a standard of whether
they will make all of these aggravations and intrusions better or worse. 
And at some point, policymakers–no matter their political leanings and plans to
reform healthcare at the macro level, need to pay attention to what is
happening at the micro patient-doctor encounter level.  After all, the
boldest of big ideas won’t make healthcare better if it makes it harder for
physicians to give their patients the care they need.

Physician advocacy
organizations also need to pay attention to the micro issues.  ACP prides
itself on taking on the big issues like controlling health care costs and allocating health care resources rationally.  
But the College puts at least as much effort into the micro issues, from objecting to the latest EHR mandates to offering alternatives to ICD 10 coding to advocating for higher payments.

The goal must be to fashion
public policies that improve care at the macro level — universal access to
coverage, spending health care dollars more wisely, and improving healthcare
delivery systems — while also removing barriers at the micro level that intrude
on the patient-doctor relationship.  Both are equally important.

Bob Doherty is Senior Vice President of Governmental Affairs and
Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.”

 

Bob
Doherty has been an advocate of Obamacare in the past. He has highlighted the
idealist principles of Obamacare. I am happy that he is starting to realize the
unintended consequences that will occur as a result of  Obamacare.

Healthcare
is only one area of life that President Obama is affecting adversely. I believe
the majority of the population will start realizing soon that re-electing
President Obama was a mistake.

Hopefully
it does not become an irreversible disaster.

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

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It Is All About Trust

November 4, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP,MACE

I
voted for President Obama in 2008 because he promised us hope and change. I
knew little of his past or present ideology. He was an attractive candidate and
promised hope.  The New York Times never
went into depth about his past, past interests or past performances.

Americans
trusted him and voted for him. He looked like and acted like the candidate of
hope. I trusted him to lead America on the right path.

President
Obama has done so many things wrong in the last 4 years that it is amazing to
me that anyone trusts him today.

Yet
he even said in one of his stump speeches “you
know me and you know you can trust me.”

Immediately
after his inauguration America was confronted with an $800 billion dollar
stimulus package that promised to produce millions of shovel ready jobs. 

There
weren’t many shovel ready jobs. He baled out some companies and not others. All
the bale outs were at taxpayer expense.

This
stimulus package provided lots of money to increase the size of government. In
fact, President Obama used a sizable about of this money to build a government
bureaucracy for a healthcare bill that was yet to be written.

A
few things developed that made me suspicious of President Obama’s ideology.  President Obama is dedicated to big
government and big spending even though it is inefficient and not directed
toward its original goal.

I
have not been a fan of John Maynard Keynes since I read Fredrick Hayek ‘s “Road to
Serfdom.” 

FDR
did not spend his way out of the depression. World War II got us out of the
depression.

Keynesian
economic has not worked. President Obama was clearly putting us on a “Road to
Serfdom” with his out of control spending and increased national debt by over
$4 trillion dollars.

President
Obama has made many annoying moves in the last four years to fake out the
American public.

Common
denominators have been a lack of transparency, a disregard for the legislative
branch of government and an overuse of executive orders.

Recent
lack of transparency is illustrated by Fast and Furious and the tragic Benghazi
tragedy.

The
mainstream media’s coverage has been disgraceful.  http://query.nytimes.com/search/sitesearch/#/Bengasi%2C+Libya+consulate/

Other
annoying actions have been the transfer of power from the congress to the
executive branch and the intimidation of the Supreme Court.

It
seems that he either ignores the constitution or gets around its meaning in
some way. The notion that the constitution is an antiquated document is
offensive and appalling.

The
media as been manipulated by the way events and facts are presented.  November 2nd unemployment results are an
outstanding example.

Americans
have been conditioned over the years to get their news from sound bites and not
detailed facts. Whichever sound bite is present the most times becomes the
fact.

The
economy is not doing well. It is growing at a very slow pace. Job growth is
slow. The presentation of the monthly data is confusing.

The November 2 unemployment
headline was; “Latest Jobs Report Shows Persistent Economic
Growth.”

 The first sentence was there were 171,000 new
jobs in October. The economy needs 500,000 new jobs per month for a normal recovery.

Consumers
still cannot get jobs, credit or loans from banks.

The
last sentence in the press release stated that unemployment rate rose from 7.8%
to 7.9%. No one remembers the last sentence

Since
the media is the message and 171,000 new jobs sounds like a big number that is
better than expected. It gives the illusion that the economy is improving on
President Obama’s watch.

Americans are not
stupid. The New York Times is trying much too hard to get President Obama re-elected.

President
Obama has generated mistrust by Americans for the promises he made about Medicare
and Obamacare. The amount of money spent, so far, by the President Obama on
Obamacare is not available to the public.

The
analysis of the increase in middle class taxes already in place as a result of
Obamacare are not discussed by the main stream media nor by President Obama.  

There
are 10 hidden taxes on citizens making less than $250,000 a year i.e. the
Medicare payroll tax. This tax is going up from 2.9 percent to 3.8 percent. There is an additional 3.8
percent Medicare tax added to investment income. Together, this will cost
taxpayers $318 billion from 2013 to 2022. These taxes were not obvious to the
great majority.

The
impact of future Obamacare taxes on the middle class is going to be
overwhelming. The new taxes were written into Obamacare but not presented to
the public. This serves to increase the mistrust for President Obama and his
promise for transparency.

The
one thing I learned from Hayek is that you cannot manipulate the economy by
edict or force without limiting freedom. In a “free” society “ the unintended
consequences and costs are certain to get out of control.

Costs
can be controlled in a level playing field competitive free market. The
consumer driven market is non-existent. Consumers must start to understand
their power in society.

Government
should make rules that level the paying field for all and then get out of the
way. No spinning the facts and no non-transparent activities. No favoritism to
lobbyists, associations or unions.

Rules
should be made for the benefit of the people in a competitive environment.

Medicare
premiums and deductible expenses for senior will raise not decrease as promised
by President Obama. Out of pocket expenses will rise.

Seniors’ standard Medicare
Part B monthly premiums will jump from $99.90 to $128.20 at the low end of the
means testing while their Part B deductibles will rise from $140 to $180. Seniors’ Medicare hospital deductible on admission will
increase from $1,156 to $1,336, while their daily hospital
coinsurance will climb from $289 to $334 in out of pocket expenses.

I
have pointed out that Obama care’s main feature, ACO’s, will be impossible to
execute and will subsequently fail. This will lead to greater distortions of
the healthcare system.

The
result will be a decrease in choice, a decrease in the freedom to choose your
physicians or recommended care, a decrease in access to care and rationing of
care once the government has total control.

This
does not included increases in costs to seniors and the middle class that has
been scheduled by Obamacare.   

All
the stakeholders have taken advantage of the healthcare system in its present
form. The stakeholders are the healthcare insurance industry, the hospital
systems, the government, the patients and the physicians.

The
healthcare system needs a new business model in order to survive. President
Obama’s business model is not the one. The public does not trust it.

The
actions of the stakeholders are natural as these stakeholders try to survive.

 It is government’s job to make the rules so
these dysfunctional survival methods cannot flourish.  

President
Obama cannot be an effective leader in the future. The public does not trust
him any more.

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

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Big Data Is A Major Problem For The Healthcare System.

October 31, 2012
inChronic Disese Management, Consumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

President
Obama is blinded by his ideology. His healthcare policy goal is to eventually
have a single party payer system. Medical care will be commoditized with
treatment decisions made by the central government.

It
is a charade that his health insurance exchanges will lead to affordable
private insurance. It is misguided to believe that a non-elected central
committee (IPAB) will be tolerated to make treatment decisions for the
population.

The
larger pretense is that President Obama is building an inexpensive bureaucracy.
Last week he again stated that government overhead for Medicare and Medicaid is
very low. He again declared that the overhead expense is only 2½ percent.

It
cost two and one half percent for the central government to outsource administrative
services to the healthcare insurance industry. The healthcare insurance
industry, in turn, charges the government 18-40% to administer the programs.

Everyone
knows most everything government run is inefficient. President Obama is
enlarging the scope of government in all areas at a time when government is too
large and inefficient. The government’s income is $1 trillion dollars less than
its expenses per year since he has been President.

President
Obama thinks if he spends enough money he will spend his way out off the jam.

President
Obama believes one way to become more efficient is to gather more data. He can
then figure out which hospital systems and physicians are inefficient and
penalize them.

This
philosophy has two potential pitfalls. If the data is faulty the conclusions
are wrong. The second pitfall is that penalties do not encourage cooperation
and meaningful improvements. 

“Decision-making in
healthcare can be painfully slow, as any physician will tell you. Hospital systems and
physicians are being spurred on in part because healthcare is beginning to deal
with a shift in reimbursement toward one that rewards quality and disincentives
inefficiency and waste.

One problem is that quality is not clearly
defined and is sometime false. The government must reexamine its premises.

Most hospitals and health systems have lots of
data that might improve outcomes and cut waste.

The
problem is getting that data, which is often unstructured, into a format that
allows clinicians to make decisions faster and in a more coordinated fashion.

All
of the innovation is happening without input from physicians. It is being done
to decrease the cost of the hospitals. One thought would be to get rid of a few
excess salaried, $750,000 a year hospital administrators and $2,000,0000 plus
healthcare insurance company administrators which would go a long way to reduce
the cost of healthcare coverage.

Instead
the government is looking to penalize physicians. Physicians are the providers
that deliver medical care.

There
is software being developed that deals with real time processing of clinical
data. The software can communicate those data to networked physicians instantly
and help physicians deliver more timely care.

Many
hospital systems are trying to install these real time systems. Unfortunately,
many hospital administrators do not understand its power as a teaching tool to
increase the efficiency and effectiveness of medical care.

 The hospital systems’ only interest is in the
financial result and the question of whether the huge investment is worth the
capital expenditure.

Some
physician group practices, independent of hospital systems, are incorporating
these software systems into their electronic medical records. These groups recognize the potential
importance of having instantaneous predictive data.

Most
physicians do not have an EMR and only 7% of physicians have a fully
functioning EMR.

In
the monograph from “Pathways to Data Analytics” two things were very apparent. It
looks like the healthcare insurance industry controls the committee and its
plans is to continue to control the healthcare dollars and hope to control the
healthcare data.

Increasingly, a
data-driven approach to healthcare is necessary.

The complexity of clinical care requires it, says Glenn Crotty
Jr., MD, FACP, executive vice president and chief operating officer at CaMC.

 “We’re moving from an
individual practitioner cottage industry to a team-based process now . . .. [Medical
care] is beyond the capacity of any one individual to be expert enough to do
that. So we have to do it in a team.”

A team requires information. The changing dynamics of healthcare
spending and reimbursements also require data to navigate.

“Our analytics are not just for finance, which traditionally is
what hospitals invested in,” says St. Luke’s Chief Quality Officer Donna Sabol
, MSN, RN. “When you look at how [hospital] payment is changing [to] a value-based
equation, you have to have good analytics for finance and for quality.”

Absent from the report is the patient and his/her responsibility
to the therapeutic unit. Until some policy maker understands the role of
patients to the therapeutic unit they will get nowhere in improving the
healthcare system.

A glaring example is the money spent by hospital systems to
improve the discharge process to avoid re-hospitalization within the 30 days
post discharge.

Obamacare has instituted the rule November1,2012 that if a
patient is re-hospitalized within 30 days of the initial hospitalization the
hospital system will not get paid.

I can think of 5 ways hospital systems can get around this rule
without suffering the penalty. 

None-the-less the hospital systems are buying software to study
and automate the process to avoid re-hospitalization using its clinical data in
real time.

 The Seton Hospital System in Austin Texas
might have figured it partially out.

It started what it calls an extensivist
program. It is acting as an extension of its physicians care to help avoid re-hospitalization
and use the best data it can collect.

Its is helping clinicians identify patients who
would benefit most from extra attention following discharge. The program
started with congestive heart failure patient


"A
lot of it is about enabling decision-making," Ryan Leslie says

"It's taking the whole universe of
information we have and cutting out what's extraneous and giving clinicians the
information they need to make decisions."

Ryan Leslie is vice
president of analytics and health economics at Seton Healthcare system.  He is taking
unstructured clinical information and connecting that with billing or
administrative information and social demographic information.

He says,  "you start connecting all those things
together and you get a more complete picture of the patient as a person, rather
than as a recipient of a bill," he says. "That's been the exciting
thing recently. You realize that a patients' success or failure may not have to
do with the care plan details or the clinical attributes of the patient as much
as the social attributes."

Physicians
outside the hospital work with a team of social workers, nurses, and others to
visit patient homes and figure out what's keeping a patient from effectively
following treatment protocols that will likely keep them out of the hospital.

The software
helps determine, based on a host of combined data, which patients are most
likely to be re-hospitalized within 30 days. Targeting the patients is like
looking into a crystal ball. The hospital system cannot afford to service all
the patients with congestive heart failure. The program is in its early stages.
If successful the plan is to expand it to diabetes and other chronic diseases.

This will
happen well beyond November 2012 and January 1,2014. This hospital system
finally realized that it can and must be an extension of its physicians’ care
and not a competitor for patient care.

Missing is the
patients responsibility and incentive in not being readmitted to the hospital.
This can only be accomplished when consumers not only have a desire to be
healthy they have a financial interest to stay healthy.

This can be
accomplished in a consumer driven healthcare system where the patients are responsible
for their health and own their healthcare dollars. The easiest way to get there
is using my ideal medical savings accounts.

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

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Business Model For Medical Care 2020. The Ideal Future State

October 28, 2012
inEMR, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Information Technology in Healthcare, Innovations in Healthcare, Medicine: Healthcare System, Summary Blogs
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 

Please click on all the links to study
the references to each spoke. It will help you visualize the power of the business
model.

The ideal future state business
model for the healthcare system must include the execution of ideas in the specific spokes outlined below.. These spokes
will serve to align all of the stakeholders’ interests.

Slide16
The business model must
contain appropriate rules for a consumer driven healthcare system, an ideal
electronic medial record, and an ideal medical savings account.

The ideal medical saving
accounts can work optimally when there is significant tort reform and patients
take full responsibility for their health and healthcare dollars.

Consumer education is critical to the business
model of the future. Educational modules can be available to consumers 24/7 via
the Internet. These educational modules must be an extension of consumers
physicians’ care in order to be effective. The education can become available
using a series of social networks.

Chronic disease self-management education can
be achieved by the use of interactive online teaching programs. Patients can be
linked to share their disease experience through private social networks.

Most believe that the healthcare system must
have greater integration of care. This integration of care can be done
virtually through a series of private integrated networks.

Effective integration can be achieved without
disruption of the entire healthcare system. Obamacare has been disruptive to
the entire healthcare system.

Obamacare is forced integration by the
government will be slow, costly and unsuccessful.

Physicians must be compensated for the presently
uncompensated time necessary to execute each one of the spokes of the wheel.

Each spoke is necessary to convert the
healthcare system into a system that once more makes the physician patient
relationship paramount.

The future business plan removes control of the
healthcare system from the government. It permits the patient to have the freedom
to choose his own healthcare course.   

Tort reform is vital to the 2020 business model.
It will decrease costly over-testing to avoid frivolous malpractice suits.
There are many ways to set up a tort reform system that truly protects patients
from real harm while eliminating over-testing. It limits the malpractice
litigation system. Punitive damages must be lowered. Losers in lawsuits must
pay all fees. These two provisions will decrease lawyers’ incentive to sue.

 
Slide24

Consumer driven healthcare will create a system
that promotes personal responsibility by the consumers’ for their health and
health care dollars.

 
Slide19

The major spoke necessary to successfully
accomplish a consumer driven healthcare system is my ideal medical saving
accounts.

 
Slide18

 

The ideal medical savings accounts would
provide the financial incentive for consumers to drive the healthcare system.
It would dis-intermediate the healthcare insurance industry’s grasp on first
dollar coverage and profits. The insurance industry would realize that its
profit margin would increase under this system.

In order for consumers to be in a position to
lower the cost of healthcare they must be taught to understand how to self
manage their disease and be responsible for the decisions they make in their
choices for medical care.

Slide20

In order to decrease patients’ dependency on
the government and increase  being
responsible for themselves, a system of education using information technology
as an extension of their physicians’ care has to be developed and put into
place.

Social networking is in its infancy at present.
It must be developed and used as an educational tool between physicians, patients
and physicians, and patients and patients.

All the social networking must be an extension of
the physicians’ medical care to their patients. Social networking must be
developed to enhance and promote the physician/patient relationship because
this relationship is critical, at its core, to successful medical treatment.

Social networking and information technology
can extend physician educational resources for patient care.

Slide21

Systems of care for the self-management of chronic
disease as an extension of their physicians care have already been developed.
The unsuccessful chronic disease self-management systems are the programs that
are not an extension of physicians’ care. The reason these third party systems
are unsuccessful is because they undermine the patient physician relationship.

President Obama has done pilot studies using
those third party self-management companies to prove that chronic disease
self-management systems work. They have all failed to reduce the cost of care.

Therefore the administration has reached the
conclusions that self-management of chronic disease does not work. Nothing
could be further from the truth. The government simply does not understand the
magic of the physician-patient relationship.

Slide22

In order to decrease the cost of medical care,
medical care must be integrated. At present, primary care physicians recommend
specialists. The primary care physicians know whether the specialists are doing
a good job by the specialists’ treatment results with their patients.

Most of the time physicians do not know their
specialists’ fees. These fees must be totally transparent to primary care
physicians and their patients. The primary care physicians can then be in a
position to help their patients choose appropriate specialists.

It will also reduce the specialists’ prices
because they will be forced to become competitive by the patients in a consumer
driven system.

Hospital fees must also be transparent. One of
the reasons I am opposed to hospital systems hiring physicians and paying them
a salary is the hospital systems would then be able to develop a monopoly in a
town or area of town. This would permit the hospital system to raise prices
without informing patients or physicians.

Hospital systems could erase physicians’ choices
and hindered patients from having the freedom to choose a hospital or
specialist of their choice with their primary care physicians. It devalues the
patient physician relationship.  

 
Slide23

The way President Obama is going about
developing a universally functioning electronic medical record is foolish and
costly. Most physicians cannot afford a fully functional electronic medical
record. This fact is being used to drive physicians into being employees of
hospital systems. The problem is hospital systems are paying hundreds of
millions of dollars for electronic medical records that are not fully
functional.

Many of these records are hard to use and
provide inflexible data. The inflexible data leads to healthcare policy
decisions that are wrong. The data is also used to commoditize medical care.

Commoditized medical care is not the best quality
of medical care.  

If the government is so smart it should develop
a fully functional electronic medical record and provide it to all hospital
systems and practices for free.

The EMR should be put in the cloud. Providers
should be charged by the click. The government can service and upgrade the EMR
in one place and improve the quality of data collected. The data should be used
for educational purposes only and be owned by the patients and physicians. It
should not be used for punitive purposes. The inaccurate data is now used for
punitive purposes. The result has been a lack of physician cooperation.

 
Slide17

The healthcare journey to an ideal future state
must begin in an orderly way. The principle goal is to be consumer centric. It
must be consumer driven and force the secondary stakeholders to be transparent
and competitive.

This journey will wring the excess costs out of the healthcare
system. It will create a democratic system affordable to all.

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

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Permalink:

Twisting the Facts About Health Care

October 24, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

I have been a New York Times reader since 7th grade. At
that time I delivered the New York Times to all the classrooms in my Junior
High School.

The New York Times has become pretty shabby in recent
years. It has stopped printing unbiased news. It does not print,  “All
The News Fit To Print.”

It has been publishing biased news, news leaks as well as
opinions that have contained innuendo and not based on facts.

A glaring example is the healthcare editorial on Sunday October
21,2012.

The New York Times is trying very hard to help defeat
Mitt Romney and push President Obama over the finish line.

I hope intelligent readers can see through the Times’
smokescreen of no facts and evaluate the candidates objectively.

The editorial’s first sentence is absolutely correct.

“The outcome of the presidential election will determine which of
two opposing paths the nation will follow on health care for all Americans.”

One
path represented by Obamacare is a path of government takeover of healthcare.
It will convert the healthcare system totally to an entitlement system.  The government will make the rules and create regulations.
Many will be difficult to follow and impossible to enforce.

This
path leads to restriction of freedom of choice, rationing and a decrease in
access to healthcare.

Americans
did not expect this option when they elected President Obama.

It
is easy to remember the sound-bite, “ If you like your present
insurance you can keep it. If you like your physicians you can keep them.”

His
campaign principles were vague. His promises were broad brushstrokes of
policies and not a specific outline of policies. At the end of these vague
promises was the appealing promise of affordable healthcare insurance coverage
for all.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/09/is-medicare-an-effective-bureaucracy-part-1.html

It
turns out that after four years healthcare insurance coverage has become more
expensive. There is no relief in sight. All Americans are subjected to 10
hidden taxes that in effect increases the cost of healthcare insurance
coverage.

America
has passed a 2400 page bill that few read and fewer understand. The bill has
generated over 44,000 new regulations so far and massive new government
bureaucracies.

The
bill was supposed to decrease the cost of healthcare by over $125 billion
dollars during the next ten years.

It
is now estimated to cost taxpayers an additional $1 trillion dollars over ten
years.

The
New York Times editorial goes on to say:

“If voters re-elect President Obama, he will
protect the health care reforms that are his signature domestic achievement.”

It
sounds like the New York Times believes this is a good thing. My guess is the
Times is not a very good judge of sound business practices because it is itself
on the verge of bankruptcy.  Obamacare is
unsustainable and destined to drive America into bankruptcy.

So
far President Obama has done nothing to decrease the number of uninsured and
nothing to decrease the cost of care. In fact the cost of care has escalated as
patient deductibles have increased, premiums have increased and the quality of
employer coverage has decreased. Employer sponsored healthcare insurance
coverage is expected to decrease further in the next two years.

The
New York Times editorial goes on to state:

“If they elect Mitt
Romney, they will be choosing a man who has pledged to repeal the reform law
and replace it with — who knows what?”

The biggest defects in today’s healthcare system are ;

1. It does not encourage individuals to be responsible for the
maintenance for their own health

2, it does not give consumers control of their healthcare dollars
or incentives to preserve those dollars.

3. It does not discourage the practice of defensive medicine with
effective tort reform.

4. It does not create a competitive healthcare market that must
become consumer driven in order to control costs.

The New York Times invites us to visit Mitt Romney’s web site
after this biased preamble:

“The competing visions are often difficult to evaluate because the
Republican candidates — Mr. Romney and his running mate, Paul Ryan — have
become so artful about obfuscating their plans for Medicare, Medicaid and what
they will do to reform the whole system.”

I went to the web site to see what Mitt Romney’s plan is. He has
very specific proposals in his healthcare plan. The proposals could Repair the
Healthcare System if implemented correctly.

I imagine the New York Times did not pay attention to any of the
words in the plan because they are drinking President Obama/Mr. David Axelrod’s
"Kool Aid."

The Times tells us in the very next sentence;

“Almost nothing the Republican candidates say on these or other
health care issues can be taken at face value.”

I would say this is not objective reporting.

What is Mitt Romney’s healthcare plan? I would like readers to
read it carefully and judge for themselves.

He first explains the Obamacare failures. The failures are
important to keep in mind because Obamacare has been shoved down the mouth of
Americans.

OBAMA'S FAILURE

Unfortunately,
the transformation in American health care set in motion by Obamacare will take
us in precisely the wrong direction. The bill, itself more than 2,400 pages
long, relies on a dense web of regulations, fees, subsidies, excise taxes,
exchanges, and rule-setting boards to give the federal government extraordinary
control over every corner of the health care system. The costs are
commensurate: Obamacare added a trillion dollars in new health care spending.
To pay for it, the law raised taxes by $500 billion on everyone from
middle-class families to innovative medical device makers, and then slashed
$500 billion from Medicare.

Obamacare
was unpopular when passed, and remains unpopular today, because the American
people recognize that a government takeover is the wrong approach. While
Obamacare may create a new health insurance entitlement, it will only worsen
the system’s existing problems. When was the last time a massive government
program lowered cost, improved efficiency, or raised the consistency of
service? Obamacare will violate that crucial first principle of medicine: “do
no harm.” It will make America a less attractive place to practice medicine,
discourage innovators from investing in life-saving technology, and restrict
consumer choice.

In short,
President Obama’s trillion dollar federal takeover of the U.S. health care
system is a disaster for the federal budget, a disaster for the constitutional
principles of federalism, and a disaster for the American people.

MITT'S PLAN

On his
first day in office, Mitt Romney will issue an executive order that paves the
way for the federal government to issue Obamacare waivers to all fifty states.
He will then work with Congress to repeal the full legislation as quickly as
possible.

In place
of Obamacare, Mitt will pursue policies that give each state the power to craft
a health care reform plan that is best for its own citizens. The federal
government’s role will be to help markets work by creating a level playing
field for competition. 

Restore
State Leadership and Flexibility

Mitt will
begin by returning states to their proper place in charge of regulating local
insurance markets and caring for the poor, uninsured, and chronically ill.
States will have both the incentive and the flexibility to experiment, learn
from one another, and craft the approaches best suited to their own citizens.

  • Block grant Medicaid and other payments to
    states
  • Limit federal standards and requirements on
    both private insurance and Medicaid coverage
  • Ensure flexibility to help the uninsured,
    including public-private partnerships, exchanges, and subsidies
  • Ensure flexibility to help the chronically
    ill, including high-risk pools, reinsurance, and risk adjustment
  • Offer innovation grants to explore
    non-litigation alternatives to dispute resolution

Promote
Free Markets and Fair Competition

Competition
drives improvements in efficiency and effectiveness, offering consumers’ higher
quality goods and services at lower cost.  It can have the same effect in
the health care system, if given the chance to work.

  • Cap non-economic damages in medical
    malpractice lawsuits
  • Empower individuals and small businesses to
    form purchasing pools
  • Prevent discrimination against individuals
    with pre-existing conditions who maintain continuous coverage
  • Facilitate IT interoperability

Empower
Consumer Choice

For
markets to work, consumers must have the information and the power to make
decisions about their own care.  Placing the patient at the center of the
process will drive quality up and cost down while ensuring that services are
designed to provide what Americans actually want.

  • End tax discrimination against the individual
    purchase of insurance
  • Allow consumers to purchase insurance across
    state lines
  • Unshackle HSAs by allowing funds to be used
    for insurance premiums
  • Promote "co-insurance" products
  • Promote alternatives to "fee for
    service"
  • Encourage "Consumer Reports"-type
    ratings of alternative insurance plans

 

Mitt Romney’s plan is an outline of his healthcare plan that
corrects all of the defects in our healthcare system. Obamacare has amplified
the healthcare system’s defects.

By giving states the opportunity to select a waiver from Obamacare,
Governor Romney is eradicating all the new taxes, regulations, bureaucracy, and
impingement on individual choice, individual freedoms and access to care
issues. He is also opening the door for subsidized healthcare coverage for
those in need.

It is much more specific than the plan President Obama presented before
his election in 2008. I have reviewed my articles on his proposals. President
Obama disguised his real intentions. He made it sound much better than he
intended. If one reads between the lines it is clear President Obama wanted the
federal government to control the healthcare system.

The blog post from 2008 make interest reading. Please click on
them.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-1.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-3.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-4.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-5.html

President Obama is the pot calling the kettle black.

Government Romney puts the consumer first, not the government. His
plan also strengthens states rights which have been severely discounted during
his term in office. The states can be a little more efficient that the central
government.

President Obama has presented nothing about his healthcare plan
during his reelection cycle,

Many of the regulations have not been written yet. President Obama
is waiting until after the election when “he
will have more flexibility. ”

Please remember I voted for him in 2008. President Obama has been a
tremendous disappointment to me. He does not understand the American psyche and
is ignoring Americans’ wishes.

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

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The Future State Business Model For Repairing the Healthcare System

October 21, 2012
inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

Obamacare is going to lead to the demise of both the healthcare system and the medical care system in the United States. America is at a critical turn in 2012.  The evidence for the collapse is presented in the following links.

The business model for a successful repair of both the healthcre system and the medical care system are outline on the next slide.


Slide14

A consumer driven healthcare system is critcal to a successful repair of the healthcare system. Read this link to understand the full meaning and implications of a consumer driven healthcare system.

Consumers must drive the systems by being responsible for their own healthcare decisions and own their healthcare dollars even if they are subsidized by the government.

Another critcal element in business model for the future state is effective tort reform. Ideally defensive medical testing  has to be eliminated completely. Defensive medical costs the healthcare system between $300-500 billion dollars a year

A summary of the misalign insentives must be understood and examine . There is a way to align all the primary and secondary stakeholders incentives. It must be agreed too that consumers are the primary stakeholders and physicians are next. Most of the control and power in the system has shifted to the secondary stakeholder namely the government, the hospital systems and mostly the healthcare insurance industry.

The government must understand that the only way to reduce cost is to shift the responsibility of controlling costs from the government to consumers.

Consumer must be the leader of their healthcare team.

Consumers must be responsible for health and healthcare dollars.

Consumers must have effective financial incentives to become medically responsible to themselves. It is clear with the incidence of obesity, the increases in smoking and drug addictions, hearth attacks, and strokes from high blood pressure that the need to attain good health is not enough incentive.

My ideal Medical Saving Accounts are an excellent way of providing financial incentives to achieve good health in a consumer driven system. The achievement of good health will drive down the costs to the healthcare system. The incidence of costly complications of disease will be reduced.

My ideal Electronic Medical Record is an important innovation. It is inexpensive to physicians. The data belongs to patients and their physicians and set up in a way that it is not punitive to physicians. It should be a fully functional EMR.

All physicians know that medical care decisions making and judging the quality of medical care by electronic data is faulty. All the EMR's are expensive. They also put physicians in a vulnerable position to be judged by faulty data. My Ideal EMR helps physicians track their patients and improve their medical communications and care. 

It is important that consumer become responsible for their own Personal Medical Record. The ideal EMR permits patients to download their records with their tests to their own computer or flash drive. Consumers should carry their medical records at all times in case of emergency. 

Social Networking is the key to a consumer driven healthcare system. The possibilities are compelling.

Improved communication between patients and physicians will be driven by a consumer driven healthcare system connected to social networking. The motivations is financial when consumers own their healthcare dollars.

Education via the Internet must be an extension of physician care.

Government's Educational Responsibility:

Teach consumers to become intelligent healthcare consumers

Government must develop a program to effectively combat obesity. There must be a change in the food industry and farm policy.

Price Transparency

Price Controls Do Not Work.

Eliminate Medical Monopolies

Patient must learn to be and educated and responsible healthcare consumer.

There must be a decrease in medical entitlement programs. Consumers must have skin in the game in order to be educated and responsible consumers. Consumers need to be a financial risk.

This is the outline of the future state business model. The readers should click on each link to read the details of each bullet point.

This business model will enable America to have an affordable healthcare system for all which will become sustainable.

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

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Permalink:

Evidence For Impending Healthcare System Failure

October 17, 2012
inMedicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

The following are the links that is the evidence for the impending failure of the healthcare system in its present form and in the form that Obamacare is adopting.

Obamacare is piling on more regulations and restrictions to the present healthcare system. The present system is a failed system.The regulation will be impossible to comply with and impossible to enforce. They will create more opportunity for secondary stakeholder to extract more funds from monies needed for direct patient care creating a greater decrease in access to care for all .

The links follow the slides I presented in my last blog. Those links could not be opened because they were jpegs.

My hope is the links serve as an excellent reference to Repair The Healthcare System presently or when it collapses under it unsubstainable costs and the present system's inability to be executed.

The Etiology of Accelerated
Collapse

Slide03

Medicare 1965-1980 Fee for
service

Nixon
authorized HMO’s

Medicare Price Fixing Begins In 1980

Cost shifting Penalizes Private
insurance

HMO Fail Because Of Faulty Assumptions In 1990.

 Reasons for Hillarycare’s
Failure To Pass.

Distrust of Government
Increases.

Healthcare Insurance Companies
Raise Premiums.

Birth of Managed  Care: Another Compicated Mistake  

Managed Cares Fails. 

Managed Care Pricing And
Premiums Remain  High

2009 Obamacare And The Threat
Of Government Takeover To Freedom, Liberty and Choice.

Rationing Of Healthcare

ACOs Are HMO's On Steroids Combined With Managed Care Is Obamacare's Complicated Mistake. 

ACOs Will Fail At Great Costs To Everyone.

 Tort Reform And Defensive Medicine Are Ignored By Obamacare.

Medical Cost Escalate Out Of
Control And Then The Healthcare System Will Collapse.

The other major slide in the last blog was the barriers to the
Physician/Patient Relationship. This relationship is critical to the
theraputic index. It is almost destroyed and will be totally dstroyed in
Obamacare. Both physicians and patients will become commodities in a
bureaucratic healthcare system. Patients will not win.

 

Physician/ Patient Barriers to the Physicians/Patient Relationship

Slide08

 

The Physician/Patient
Relationship.

 The
physician/patient relationship.

 The Magic  of the Patient Physician Relationship  

 Patient and
Physician responsibility contract

 Patient should be the leader of the team

 Barriers for physicians in the Physician/Patient
Relationship

 

1. Tort
Reform/Defensive Medicine.

2. Restriction
of Physicians Clinical Judgment.

3. Medicine
is a calling not a business 

  4.  Constant
lowering physicians’ reimbursement.

 5. Physicians
are driven to decrease time spent with patients.

6. Government
rations care through panel of experts

7. Physician’s
treatments are driven by government regulations.

8. The
traditional media undermining physician credibility

9. Government
is attempting to commoditize medical treatment.

 

Patient Barriers To the Patient/Physicians Relationship

1. Patients are not in control of their own medical decisions.

2. Patients are not in control of their own healthcare
dollars.

3. Patients
do not have to be responsible for their treatment because they

receive
first dollar coverage.

4.  Education about chronic disease must be extension of
physician’s care  

5.  Internet can undermine the Physician/Patient
relationship..

6. Method of choosing a physician is random and must be
made clearer.

7. Portability of information about previous treatment
is difficult.

8. Patient must be responsible and in control of their
medical record.

9. Patient must endure poor communication by their
physician.

10.
Government and the healthcare insurance industry limit choice with

network
restrictions.

11. Patients should be responsible for their treatment
Management

America's healthcare system is at a critical turn in 2012.

Obamacare must be repeal.

Effective healthcare reform is essential. Both the primary and secondary stakeholders have abused a system. A system that is punitive.

Consumers must drive the system by being responsible to themselve and their healthcare dollars.

Obamacare is building a system of government dependency by all stakeholders (patients,physicians,hospital and healthcare insurance companies).

The healthcare system should be developed to create innovation and competions among stakeholders for the benefit of consumers and their indepent choice.

The government's inefficiency will create a healthcare system destined to doom at the expense of all of us taxpayers.

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

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