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Obamacare’s Games For Stakeholders And The Unintended Consequences

July 21, 2013

inConsumer Driven Health Care, Medicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley
Feld M.D.,FACP,MACP

I can’t help remembering
Nancy Pelosi’s famous statement, “We have to pass the bill to find out what is
in it.”

http://youtu.be/lAt54NKsRRk

The public didn’t like
Obamacare to begin with.

Each day “we are finding out what is in it.”

Each day it gets worse
despite the fact the President Obama keeps saying Obamacare is great and will save us
money. Americans do not believe him.

If you are a big
government control advocate, the ideology of Obamacare could be applauded.

Practically, Obamacare is
naïve and an impending “train wreck.”
Unintended consequences keep appearing because of defects in the theory and poor
design.

Patients, the healthcare
care insurance industry, physicians, hospital systems, and drug companies could
have predicated these unintended consequence if they knew what was it the bill
at its passage. Those who did understand the Accountable Care Act (Obamacare)
hated the act at its passage.

Many of my progressive
friends blame the problems Obamacare is having on Republicans.

I think they are getting
that idea because the New York Times and its editorial op-ed writers that are making
that claim. However, the New York Times offers no concrete proof.

Obamacare is failing on it
own. Its implementation gets harder and more expensive each day.

The unions were President
Obama biggest ally. All of a sudden Obamacare’s unintended consequences has
angered the unions. The unions realize what Obamacare is doing to them.

On July 12, James Hoffa of the Teamsters (1.4
million members), Joseph Hansen of the Food and Commercial Workers (1.3 million
members) and D. Taylor of UNITE-HERE (200,000 members, mostly culinary and
hotel workers) wrote to complain about the president's Affordable Care Act.

Obamacare is destroying
the 40-hour workweek unions worked many years to achieve. Employers are hiring part time employees to replace full
time employees that had been laid off because of the recession.

Employers are doing this
to avoid a $2,000 penalty for not providing healthcare insurance for each employee.

The majority of the job
growth figure of 195,000 for June consisted of part time job growth.

Union
leaders are correct. Obamacare "creates
an incentive to keep employees’ work hours below 30
hours a week."

After
all, employers can avoid a $2,000-per-worker penalty if they don't provide mandated insurance as long as employees
work fewer than 30 hours a week.

" Union leaders have realized—too late—that
ObamaCare will affect the livelihood of millions of workers who wait tables,
wash dishes, clean hotels, man registers, stock shelves and perform other tasks
that can be limited to shifts of less than 30 hours a week."

White
house Press Secretary Jay Carney said it "is
belied by the facts."

Once
again he was lying. He used 2010 Bureau of Labor Statistics numbers to answer
the complaint.

“So far
this year, as ObamaCare is being implemented, full-time employment has grown at
an average monthly rate of 21,700 while part-time employment has increased an average
of 93,000 a month.”

These
are terrible numbers that belie Jay Carney’s “facts.”

Three big unions
worry that the health law will hurt their members' benefits and paychecks.

The letter to Nancy
Pelosi and Harry Reid was unusually harsh.

The letter was not from
Mr. Obama's GOP adversaries but from the president’s allies, the big three most
powerful unions. A fourth union joined the group a few days later.

The unions finally
realized that Obamacare was going to cut unions out of some government
subsidies. Obamacare makes a unionized workforce more expensive for employers. It makes it less attractive for workers to
join unions.

"Millions of union workers, the
letter notes, are covered by nonprofit health plans jointly administered by
employers and unions, and won't qualify for ObamaCare's generous taxpayer
subsidies."

This will drive union
members out of their unions.

Further, the unions
nonprofit insurance plans are subject to "Obamacare’s new 2-3% tax on each
insurance policy they place."

The union wants their members
exempt from this tax because the union will be forced to pass it on to their
members. Members will be forced to use the health insurance exchanges to buy
their healthcare insurance.

Unions are starting to
realize the goal of Obamacare is to force everyone into his “Public Option”
that will default to a single party payer. The result will be complete
government control of the healthcare system.

There are three insurance
options in the health insurance exchanges. Citizens will buy the cheapest
“affordable option.” The deductibles
will be high. Citizens will have to pay deductibles out of pocket decreasing
their purchasing power.

Republicans are enjoying
this meltdown. They want Obamacare
repealed.

“House Republicans say their goal is to repeal President Obama's
health care law, not to present an alternative plan.”

This is a big mistake on
the part of the Republicans. Republicans do not have a viable substitute to
repair the dysfunctional healthcare system.

"Every voter knows what Republicans are against. They don't
know what they're for" on health care, said Rep. Steve Israel of New York,
who heads House Democrats' campaign committee.”

“He said the strategy would haunt Republicans next year among
moderate and independent voters who want changes, not outright repeal.”

Republicans need an
innovative alternative to Obamacare that will work and excite the public. They need a plan that will put consumers in
charge of their health and healthcare dollar. Consumers do not want a healthcare
system that puts the government in charge of their health.

Consumer driven
healthcare with my democratic ideal medical savings account should be adopted
by the Republican Party to replace Obamacare.

Republicans must take a
stand and help Americans avoid Obamacare’s impending disaster to our economy,
job growth and financial viability.

Republicans must show Americans
that they care about them and have a viable solution to our healthcare systems problems.

Otherwise as President
Obama said this week, “he will blow right
through it” as he
has done in the past.

Now that Americans are waking up it is time
for the Republican leadership to start waking up and fight back effectively.

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

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Romneycare 2012 vs. Obamacare

August 12, 2012

inConsumer Driven Health Care, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

Recently President Obama said his Healthcare Reform Act at its core is the same as Romneycare.

Romneycare is different. Romneycare gives a tax credit to people who purchase insurance. Obamacare penalizes those who do not purchase insurance.

Governor Romney wanted to incentivize people to be responsible and buy insurance while President Obama wants to expand an entitlement and increase public dependency on government.

When Romneycare (Massachusetts) was passed I predicted it would result in cost overruns, restrictions of access to care and rationing of care.

Mitt Romney admits the bill was not ideal. There were things he wanted in the bill but the Democrat controlled Massachusetts legislature refused to let him put them in.

This You Tube represents a recent defense of his bill. He has pledged to repeal Obamacare if elected President.

http://youtu.be/6d4raK3QJmQ

I predicted that cost overruns would get to a point where the state of Massachusetts would have to force physicians to participate in Romneycare as a condition for state licensure.

“The New Romneycare” is going to penalize the good hospitals that keep people alive and reward hospitals where those people would die. The good hospitals’ readmission rates would be higher than the hospitals where patients died. If a patient died in the hospital the overall readmission rate would fall.

This example illustrates one problem with the interpretation of remote claims data.

President Obama’s Healthcare Reform Act (Obamacare) will end in failure just as Romneycare has only on a grander scale with greater deficits and less access to medical care.

Both Romneycare and Obamacare have the same defects. Neither gets to the core of the problems in the healthcare system.

A core problem is the unnecessary testing resulting from defensive medicine and the need for effective tort reform.

Another core problem with the healthcare system is the financial abuse of healthcare insurance. Both the state of Massachusetts and Obamacare are dependent on the healthcare industry to provide administrative services for government run plans.

The insurance companies take 40% of the healthcare dollar and blame physicians and hospitals for the rising costs. The 40% is disguised under direct patient care in its financial statements.

An important factor in rising costs is the increasing administrative paperwork for hospitals and physicians for government information gathering. It leaves less time for patient care.

Policy wonks make up rules resulting in the increased documentation in the name of increased quality care. No one has defined quality care precisely.

In 2009 President Obama bailed out Romneycare to the tune of 8 billion dollars.

The mainstream media constantly reports that over ninety plus percent of the population is insured. Reportedly the patients are happy.

No one reports the appointment and emergency waiting times.

There is very little negativity in our press about the Canadian healthcare system. This You Tube presents a former Canadian physician’s experience.

http://youtu.be/At9q6uFR3gU

Governor Romney must stop defending RomneyCare. It is a hollow defense.

http://youtu.be/4DW6IKG9d_8

I could not find any negative press in the Boston Globe about the Massachusetts plan in a long while. The August 3, 2012 Wall Street Journal has a devastating article about the Massachusetts Plan.

The headline was, “With costs rising fast, Massachusetts moves to dictate medical care.”

My inevitable postscript for Romneycare is cost containment with price controls and the increased bureaucratic dictating how medicine should be practiced.

Rather than Democratic Governor Deval Patrick trying to patch the law and make things worse he should repeal the law and deal with the underlying problems.

“The claim then, as with the Affordable Care Act, was that health care would be less expensive if everyone had insurance.”

The claim seems naïve to me if there is no cure for the healthcare insurance industry taking 40-60% off the top and defensive medicine is not reduced through tort reform.

Unless the healthcare industry is consumer driven “bending the cost curve” will not happen.

So what in happening in Massachusetts?

1. 79% of the newly insured are on public programs.

2. Health costs—Medicaid, Romneycare's subsidies, public-employee compensation—will consume some 54% of the state budget in 2012 up from about 24% in 2001.

3. Health spending in real terms has jumped by 59%.

4. Spending for education has fallen 15%, police and firemen by 11% and roads and bridges by 23%.

5. Massachusetts spends more per capita on health care than any other state.

6. Costs are 27% higher than the U.S. average.

Healthcare premiums and taxes are rising and the physicians are the target instead of the health-care insurance industry.

1. Under the plan, all Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure—that is, permission to practice.

2. They'll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics.

3. An 11-member board known as the Health Policy Commission will use the data to set and enforce rules to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017, and 0.5 percentage points lower thereafter.

4. The data collected will be claims data and it will stink. If past results are a predictor of future results price control do not work.

5. No registered provider is allowed to make "any material change to its operations or governance structure," the bill says, without the commission's approval.

6. The commission can also rewrite the terms of provider contracts with insurers and payment levels and methods if they are "deemed to be excessive."

7. The commission can decide to supervise the behavior of any provider that exceeds some to-be-specified individual benchmark.

8. These delinquents must submit a "performance improvement plan" that the commission must endorse.

9.The commission is empowered to control the practice and organization of medicine.

10. Some complain this government control is too weak because the delinquents can only be fined $500,000 for disobeying the commission's dictates.

What ever happened to individual freedom of choice and other freedoms?

It is obvious that Romneycare is a bust and getting worse.

However in my view Romneycare is a pretty tame failure compared to what is going to happen down the road with Obamacare.

Everyone agrees that the healthcare system needs to deliver medicine more efficiently and be more accountable.

But.

Accountable to whom?

The healthcare system must become more accountable to consumers. The only system that will work is a consumer driven healthcare system with the consumers responsible for their healthcare dollars.

I believe is important for our elected officials to do well.

However it is more important to do well doing the right things.

Our government is not doing the right thing for the people with Obamacare.

It is only going to make things worse as government tries to exercise more control.

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

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With Obamacare Patients Lose

July 15, 2012

inMedicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

President Obama, in his attempt to create a healthcare system that is more efficient, affordable and democratic does not attack the basic dysfunctions in the healthcare system.

Obamacare does nothing to disintermediate the healthcare insurance industry.

It does not provide incentives for consumers to be responsible for their health or their healthcare dollar.

It creates another entitlement and increased consumer dependency on government rather than consumer independence.

It does nothing to alleviate the practice of defensive medicine and the waste of $750 billion dollars for unnecessary tests that would be eliminated if effective Tort Reform were enacted.

President Obama and his advisors believe that defensive medicine accounts for only 2-3 billion dollars a year.

They conclude the cost is insignificant. They are ignoring reality proven by well-done studies. Their premise is incorrect. Ignoring the facts will continue the dysfunction in the healthcare system.

I have stated repeatedly that I believe President Obama’s goal is complete government control of the healthcare system.

The rules in Obamacare will destroy the patient physician relationship and private healthcare.

The only system left will be the government’s Public Option through Health Insurance Exchanges. Everyone will be on Medicare or Medicaid.

Both Medicare and Medicaid are presently unsustainable. Expanding both will accelerate the demise of both Medicare and Medicaid.

The resulting socialized Medicine will be an unsustainable disaster as it has become in England and Canada.

The public knows Obamacare will fail. They also know we need to do something. The public needs to hear about a viable alternative.

With Obamacare premiums will increase along with taxes. Access to care and rationing of treatment will occur.

The path America is on is “The Road To Serfdom” as described by Fredrick Hayak. Serfdom is occurring slowly but steadily. President Obama has told us in his own words how we will get there.

He sounds great because he is charming and seductive. His only problem is he is not truthful about his goal and its cost to society.

http://youtu.be/i2e-86eOIT0

Consumers will be the biggest losers.

The more than 250 million consumers who already have health insurance will see their healthcare insurance change, the cost increase, and the quality of care diminish.

How will Americans feel when they hear about a brand new cure only to find out that their government’s controlled insurance won’t cover it? The decisions to cover care will be made by a non-elected committee that sends its recommendation to another not elected committee who then sends it to a third committee to decide on whether the treatment is affordable or valid for the age of the patient.

“Patients will have to get used to less access to real health care solutions, fewer approvals for the very latest, personalized, genetic-based cancer treatment or surgical technology that could save your life.”

Who loses? The consumer.

The Doctor Patient Medical Association released survey of doctors showing that 90% believe that Obamacare is on the wrong track.

The same survey revealed that 83% of practicing physicians are contemplating quitting the practice of medicine.

The physicians remaining in practice will see more patients per hour and have care of their patients dictated to them by the government bureaucrats. Obamacare will turn personalized patient care into commodity care.

There will be no patient physician relationship. There will be rationing of care and decreased access to care. Patient’s will not have freedom of choice for care or treatment.

A recent article in Britain’s Daily Mail described the use of the “Liverpool Pathway. A British Professor claims the NHS kills off 130,000 elderly patients every year using the Liverpool Pathway.

The Liverpool Pathway is a set of rules that decide who should receive treatment and who should not receive treatment.

“Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway.”

Under Obamacare physicians will bear the brunt of explaining how come ever rising premiums are buying you fewer and fewer benefits.

Consumers who can afford to pay physicians directly will not receive a tax break unless their medical care expenses are more than 10% of their gross income.

The popular Health Savings Accounts will perish because of the barriers against them as written into the healthcare law.

The Healthcare System’s savior “My Ideal Medical Savings Accounts” will vanish from consideration.

Obamacare also restricts physicians’ clinical judgment. Sometimes physicians will sense a patient is really sick with a serious disease. An example is a disease called a fever of unknown origin. Many tests would have to be performed to make the diagnosis. The sooner the diagnosis is made the better the chance for patients to survive.

Physicians might fear the Independent Medicare Advisory Board would deny the workup and penalize the physician. It could be that the Independent Medicare Advisory Board members and the other committees did not factor in the difficulties in the diagnosis.

In time the diagnosis would become obvious but it might be too late to save the patients life.

We have already seen healthcare premiums soar under Obamacare. I have shown that Medicare premiums are schedule to escalate in 2014. Medicare and Medicaid is healthcare insurance.

Healthcare insurance will be less affordable not more affordable even though government subsides will be greater. The budget deficit will grow increase.

Access to care will decrease because of the increased number of patients. Physicians will have less time to spend with patients. A growing number of patients will have increased difficulty finding a physician.

There is a current physician shortage. The physician shortage will become compounded when some physicians stop practicing medicine. Other physicians will either restrict the healthcare insurance plans they accept or stop accepting healthcare insurance completely.

The delivery of healthcare is getting worse and more expensive not better and less expensive.

Obamacare is creating an escalating mess.

Patients are going to be the biggest losers on every level of interaction with the President Obama’s Healthcare Reform Act.

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

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Obamacare Tax Increases That Have Been Forgotten

July 8, 2012

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens making 250,000 dollars a year or less. These taxes contradicts President Obama’s promise.

Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

These taxes and Mr. Norquist’s summary is ignored by the traditional media.

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said citizens earning under $250,000 would not pay one single dime more in taxes.

http://youtu.be/56c1fSdTAWI

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organizes the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my last blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in taxes.

“Obamacare contains 20 new or higher taxes on American families and small businesses.

Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.

	Capital Gains	Dividends	Other*
2012	15%	15%	35%
2013+	23.8%	43.4%	43.4%

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

	First $200,000 ($250,000 Married) Employer/Employee	All Remaining Wages Employer/Employee
Current Law	1.45%/1.45% 2.9% self-employed	1.45%/1.45% 2.9% self-employed
Obamacare Tax Hike	1.45%/1.45% 2.9% self-employed	1.45%/2.35% 3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that take effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

	1 Adult	2 Adults	3+ Adults
2014	1% AGI/$95	1% AGI/$190	1% AGI/$285
2015	2% AGI/$325	2% AGI/$650	2% AGI/$975
2016 +	2.5% AGI/$695	2.5% AGI/$1390	2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

Mr. Norquist left out the worse tax of all. This “tax” is under everyone’s radar. It has never been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present
Monthly Fee of $96.40, rising to:

$104.20 in 2012

$120.20 in 2013

And

$247.00 in 2014."

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.

These are provisions incorporated in the Obamacare legislation, purposely

delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus. Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare must be repealed.

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.

It is time for everyone to get angry and vote him out of office in November.

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

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The Government’s Role In A Free Society

June 27, 2012

inMedicaid, Medicare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

U.S. Congressman Paul Ryan gave a speech in January 2010 at Hillsdale College's Allan P. Kirby, Jr. Center for Constitutional Studies and Citizenship defining the role of government in a free society with particular reference to healthcare.

Paul Ryan understands the constitution and uses a lot of common sense.

Mr. Ryan traces the history of the progressive movement of the Democratic Party in America.

“The social and political programs of the Democratic Party’s progressive movement came in on two great waves: the New Deal of the 1930s and the Great Society of the 1960s”.

“Today, President Obama often invokes progressivism and hopes to generate its third great wave of public policy.”

This desire by President Obama leads him to believe he will be judged as one of the greatest Presidents in American history.

President Obama believes his ideology will save the healthcare system, the financial system, and the country.

There is no question the healthcare system needs to be reformed. It has become unaffordable and inaccessible to people who need healthcare insurance coverage.

The need for reform leads Dr. Don Berwick former Director of CMS to conclude that by definition effective healthcare system means the redistribution of wealth.

The debate in healthcare is not whether we need healthcare reform but what form that reform should take.

“Under the terms of our Constitution, every individual has a right to care for their health, just as they have a right to eat.”

“These rights are integral to our natural right to life. It is the government's chief purpose to secure our natural rights.”

But the right to care for one's health does not imply that government must provide health care, any more than our right to eat, in order to live, requires government to own the farms and raise the crops.

The government's chief purpose is to secure our natural rights. It is a critical sentence defining the role of government by our constitution.

It is not the role of government to provide healthcare any more than it is our right that the government feed us. It is the individual’s responsibility to do both.

It is the government’s obligation to protect our rights. The government’s obligation is to establish free market conditions so providers and vendors cannot take advantage of us and abuse our rights. We should not be entitled to food or healthcare.

Paul Ryan goes on to say,

“ With good reason, the Constitution left the administration of public health—like that of most public goods—decentralized.

If there is any doubt that control of health care services should not have been placed in the federal government, we need only look at the history of Medicare and Medicaid—a history in which fraud has proliferated despite all efforts to stop it and failure to control costs has become a national nightmare.”

All the stakeholders are experiencing this nightmare after 47 years of the government making adjustments to the Medicare and Medicare rules.

No one predicted the adjustments made by both the government and the stakeholders would result in unsustainable costs for the government, private sectors and the people.

This national nightmare is going to expand with the passage of Obamacare, the funding of the multiple agencies formed and the proposed 32 million more uninsured people to be added to Medicaid along with the increasing number of baby boomer going on Medicare.

Democrats, Republicans and Independents believe in fairness to all. Americans are very charitable people and are frequently mobilized to help the needy.

However, President Obama has tried to appeal to our sympathy for him by painting a contrast between himself and his opponents. He is trying to persuade us that he is the good guy and the rest are bad guys.

“If you believe this economy grows best when everybody gets a fair shot and everybody does their fair share and everybody plays by the same set of rules, then I ask you to stand with me for a second term as president.”

On closer examination his actions have gotten us deeper into our fiscal dilemma. He has not leveled the playing field; he has wasted money and increased our deficit. The U.S. is at the point where it cannot borrow itself out of its jam.

If the U.S. continues to try to print (money) itself out of the jam the economy will implode.

President Obama’s ideology has created uncertainty and decreased the private sector willingness to create jobs and stimulate the economy. He has not created enough jobs with his massive stimulus packages.

A reader wrote,

We ran out of money a long time ago. Every dollar we spend is 40% borrowed money and healthcare in our country is comprised of 50% taxpayer money. What else do we need to see in terms of the math to believe we are on an unsustainable path?

Paul Ryan argues,

“President Obama urges us today—out of compassion—to support the progressive model; but placing control of health care in the hands of government bureaucrats is not compassionate."

Bureaucrats don't make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus.

Dr. Ezekiel Emanuel, one of the administration's point people on health care, advocates what he calls a “whole life system”—a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.”

“ In keeping with this, the plans that recently emerged from Congress have a Medicare board of unelected specialists whose job it would be to determine the program's treatment protocols as a method of limiting costs.” (USPTF and IPAB)

I believe there are very few Americans who would be satisfied with this kind of halthcare system once they understand what is happening.

Ryan goes on to say:

"The good news is that we have a choice.

There are three basic models for health care delivery that are available to us:

(1) Today's business-government partnership or “crony capitalism” model, in which bureaucratized insurance companies monopolize the field in most states."

Medicare and Medicaid’s administrative services are outsourced to the healthcare insurance industry by the government. The healthcare insurance companies charge the government 40% of the Medicare and Medicaid healthcare dollars for overhead.

President Obama claims that the medical loss ratio will limit the overhead to 20% and 80% will go to direct medical care. Wrong!

The overhead is disguised in direct medical care costs.

How do you think top healthcare insurance executives can receive many millions of dollars in compensation each year?

"(2) The progressive model promoted by the Obama administration and congressional leaders, in which federal bureaucrats tell us which services they will allow."

We have seen over and over again unintended consequences, excessive waste created by cumbersome rules and regulations, and stakeholders adjustment to take advantage of the rules and regulations, all of which lead to intolerable costs, taxes and the erosion of the value of the dollar. Obamacare is going to result in greater administrative waste plus rationing of care.

" (3) The model consistent with our Constitution, in which health care providers compete in a free and transparent market, and in which individual consumers are in control."

The government's chief purpose is to secure our natural rights by leveling the playing field for all the stakeholders and enforcing the rules. It is essential that the rules are transparent and simple.

The patients must be empowered to be responsible for their healthcare dollars and their health. Entitlements do not promote personal responsibility

One of Paul Ryan’s concluding points is,

“The answer is that the current health care debate is not really about how we can most effectively bring down costs.”

It is a debate less about policy than about ideology. It is a debate over whether we should reform health care in a way compatible with our Constitution and our free society, or whether we should abandon our free market economic model for a full-fledged European-style social welfare state.

This, I believe, is the true goal of those promoting government-run health care."

My Ideal Medical Saving Account can be an extremely democratic and fair model. By changing a couple of existing healthcare insurance rules the administration would create a truly free competitive free market for healthcare consumption.

The government should also educate patients to assess the value of the medical care they freely choose. It should be the consumer’s decision, not the government’s decision.

These actions would reduce the cost of healthcare and create a sustainable healthcare system.

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

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A Genius Wrote

June 16, 2012

inConsumer Driven Health Care, Disinformation and the healthcare system, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

Todd Siler is a famous artist and scientist. He is much more that. He is a genius. He has written many books about visualizing and solving problems. The most famous is “Thinks Like A Genius”.

For many years he created “Truizms” for the Rocky Mountain News. These Truizms deserve a publication of their own. His Truizms’ are insightful and inspiring. Todd sent me some Truizms to help me illustrate the points I am trying to make.

It is an honor to have Todd become a great friend. He is extremely perceptive and a phenomenal teacher, in addition to being a wonderful human being.

Todd wrote a great response to my last blog “Lets (Not) Do Physicals.”

Stanley, the frustrating situation you've accurately described here invokes Joseph Heller's classic novel Catch-22:

"There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he were sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to. Yossarian was moved very deeply by the absolute simplicity of this clause of Catch-22 and let out a respectful whistle. (p. 56, ch. 5)…."Catch-22 says they have a right to do anything we can't stop them from doing."

Quoting my blog , Todd wrote,

“It is not enough for the Obama administration to say it is interested in prevention of disease when it restricts access to prevention measures.

It is not right to restrict access to steps needed to prevent the debilitating or deadly complications of hip fracture.

“The USPSTF concludes that, for men, evidence of the benefits of screening for osteoporosis is lacking and the balance of benefits and harms cannot be determined.”

To me the trend to reduce physical examinations and lab screening is a ridiculous trend. The present spending on physicals probably should be modified some but not discontinued.”

I agree!

Todd

One of Todd’s insightful Truisms’’ follws

Our bureaucratic society with its multiple and conflicting rules does not permit us to honestly do the right thing for Americans, especially when money is involved.

President Obama says the right things, but he does not do the right things.

The Healthcare System’s policies should let consumers decide on what is logical for them after listening to the advice of their physicians.

Consumers should control their healthcare dollars with financial incentives provided for them to stay healthy, become educated about their diseases, and control their chronic diseases.

The evidence medicine debate should be between the medical community and the USPTF without creating a media circus.

Healthcare insurance should be a high deductible first dollar coverage plan that would cover everyone.

I covered how this would work in my blog “The Ideal Medical Saving Account is Democratic.

America’s healthcare system is at the home in a “Catch 22”.

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

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Medicine Is A Calling: Not A Business

January 29, 2012

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I am pleased that I am able to stimulate comments from physicians in various parts of the country. Please keep the comments coming.

Many of these physicians feel trapped by the bureaucracy and medical care policies that are restricting them from developing a real physician patient relationship. The physician patient relationship is precious to the practice of medicine.

The positive physician patient relationship enables an enhanced therapeutic effect.

As stated by a previous physician writer in my last blog,

The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”

Physicians have been trapped into this behavior as John Goodman pointed out. The patient physician relationship has been destroyed by the dysfunctional healthcare system. Obamacare is accelerating the dysfunction in the healthcare system.

Many tests are done for defensive medicine purposes. In fact the extrapolated cost of defensive medicine is $700 billion dollars a year.

Physicians might even give the patient a shot of something for good measure to prevent a malpractice suit.

The government, hospitals systems, and healthcare insurance industry control the healthcare system.

These secondary stakeholders have made physicians commodities. Physicians are trapped into going through the motions. Medicine is a calling not a business. Physicians have been forced into making it a business.

Physicians are so frustrated with the system that they are joining hospital systems to rid themselves of the bureaucracy and avoid practice responsibility and malpractice suits.

The hope is that it will lead to a “happier life.” Not true.

The privileged hospital employed physicians become the designated spokesperson by the hospital administrator for the staff physicians. They deny there is any anger or frustration toward the government, the hospital system or the healthcare insurance industry.

The rest of the physicians keep their mouth shut and trudge along angry and frustrated.

There is a mountain of pent up anger and frustration toward hospital systems by these physicians.

I received this note from another physician writer,

“Dr. Feld:

When I read your post last week “It’s All About Patients and Physicians”, I thought you were writing to me directly. I have been thinking about this for years. It is not only that software innovation in Medicine lags behind every other industry, but also the focus has not been in the correct area. As with everything else, the medical profession has given control to others.”

This physician is absolutely correct. In a country whose administration and congress is run by lobbyists who are not interested in patients or physicians but are more interested in protecting and furthering their clients’ vested interests the problems will not be solved. Medicine and Surgery do not have adequate representation or resources to make their case to the public.

Perhaps it is because the AMA is too democratic or too civil. The AMA’s customers are physicians. Physicians have deserted the AMA because of lack of representation.

I think the AMA might still have a chance with some bold leadership. After all without patients or physicians you wouldn’t have need for a “healthcare system.”

He goes on,

“Current software tools allow the development of disruptive systems that can put patients and physicians on the same side of the equation, develop networks to allow much better communications, and integrate the future of mobile devices that will transform healthcare. It should be possible to produce change in current relationships.”

It is not only possible it is probable. I need a Posse of consumers to step out and force the secondary stakeholders to not take advantage of them. This must be a consumer driven effort.

Consumers can be organized through social networking just as Internet companies, venture capitalists and citizen expressed their voice on the Internet and stopped the two Censorship Acts (SOPA and PIPA) that were being railroaded through congress. The traditional media did not cover these two bills until the organized effort was working.

President Obama backed these bills until it was obvious to all that the anti-censorship effort expressed the will of the American people.

Patients (consumers) need leadership and innovative software to demand that they own their healthcare dollars and healthcare care decisions.

I believe many physicians yearn for the ability to spend more time with their patients. Patients must demand it also and pressure the government to relinquish control over our healthcare system.

This writer/ physician’s note to me expresses this desire. It is an important story about the physician patient relationship’s key role in patient care.

“Let me begin with a story. I take care of an elderly man who lives in Brooklyn and suffered a stroke one year ago. At the time the patient was visiting with his son, who is a Rabbi in Chicago. The patient made an excellent recovery following high-quality rehabilitation at a Chicago hospital.

He is a survivor of the Holocaust who lives with his wife and is generally independent. Although his walking is slow, he is able to walk utilizing a cane to a nearby synagogue for services every morning. As I was interviewing him last week, he mentioned that most of his day is spent at home with very little to do.

He does not have television, and is not that interested in reading newspapers.

After hearing this, I excused myself to go to my office and bring back an iPad to show him. I placed it in front of him, and logged on to a website sponsored by Yeshiva University (yutorah.org).

I showed him that he would have access to literally thousands of lectures by leading rabbis that he could listen to on demand. His eyes widened and he looked at me with amazement. He asked me if that device needed a computer, and whether it would work in his home. He inquired about the cost.

His wife immediately told me that she wanted one (iPad) for him, and that their daughter would be calling me for the information about setting things up.”

Ninety percent of physicians would like to have time to relate to patients this way. The dysfunctional system has forced physicians to act differently.

This patient recovered from his depression. He is thriving with the use of his innovative device (iPad).

He goes on further to say,

I cannot finish my career in Medicine without finding a way to integrate experienced people with great ideas and insight with young people who know how to create the tools to bring innovative approaches to actuality.

I will describe the future state next. Innovative software can be built in the future state that provides patients with the tools to express their needs and for patients to accept responsibility for their care.

Consumer driven healthcare with the ideal medical savings account will be the foundation of this transformative healthcare system.

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

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Paul Ryan on Medicare

October 26, 2011

inConsumer Driven Health Care, Medicine: Healthcare System, Quality medical care measures, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Paul Ryan and the Republican House passed the 2012 budget that has been ignored by Harry Reid and the Senate. Harry Reid gets his orders from President Obama. He chose not to consider the Republican House budget. Instead Democrat chose to demonize Paul Ryan.

President Obama seems to be ignoring America’s debt and deficit spending crisis. The Senate has not produced a budget in over 900 days. President Obama has presented numbers to the CBO that would result in decreasing the budget deficit. The numbers presented to the CBO are phony. The Healthcare Reform Act will result in a huge increase in our deficit. It will result in higher taxes.

The traditional media has been very effective in demonizing Paul Ryan’s budget proposal.. The TV ad implying that Paul Ryan is pushing grandma off the cliff is a total lie. The media should fact check before accepting an inaccurate advertisement .

If anything, President Obama’s Healthcare Reform Act will push grandma off the cliff.

Paul Ryan’s explanation of our debt crisis and deficit spending is clear. His budget proposal is also clear.

Paul Ryan questions the reasons President Obama and the Democratic Senate are ignoring the coming disaster.

The healthcare system is inundated with waste, fraud, abuse, a lack of competition and well-directed incentives for the healthcare system to function efficiently.

President Obama’s healthcare reform law is awash with penalties, punishment and rationing as well as waste in the form of more bureaucracy, committees, studies and pilots. Medicare is unsustainable.

The healthcare insurance industry has figured out how to profit from the proposed ACO (Accountable Care Organizations). It means more bureaucracy resulting in higher fees to charge the government for providing administrative services. The result will be higher unsustainable costs for both the government and seniors.

Hospital systems know are not prepared for ACOs. ACO’s are too costly to set up. Most hospital systems information systems are not good enough to provide the data the government wants to evaluation the care given. Administrators managing hospital systems intuitively know that the government will make decisions that will be counter to hospital systems’ vested interests.

Physicians know that hospital systems are going to try to capture as much of their intellectual property as possible and restrict their freedom to make medical judgments. It will be very difficult to create physician hospital alignment under an ACO.

This is a must watch You Tube

Patients know ACO’s are going to restrict access to care, increase their out of pocket expenses, ration care and result in higher taxes and higher deductible. Partial implementation of President Obama’s healthcare act already has resulted in all of the above.

Hospital systems and physicians have not signed up for ACO’s. That resulted in Dr. Don Berwick and CMS revising their ACO final rules. Dr. Berwick is trying to entice hospital systems and physician groups to sign up and form ACO’s.

Dr. Berwick says he is for patients, hospital systems and physicians delivering better care to patients. I believe him. However, he is doing it the wrong way.

The only thing the new rules accomplish is to make forming an ACO more affordable at the front end. Medicare ACO’s continue to be a government controlled system with penalties and punishments to providers.

Patients’ treatments will be determined by a non-elected committee and not their physicians. The committee might make the wrong decision by examining the wrong data.

The most recent example was the United States Preventive Services Task Force (USPSTF) on prostatic specific antigen (PSA).

There was not one urologist on the committee. Another example was the USPSTF task force studying osteoporosis and the use of bone mineral density in men over 70. There was not one Clinical Endocrinologist on the committee.

All anyone has to do is go into any Wal-Mart on a Monday morning. At least 50% of males over 70 years old look like they have lost several inches of height. Each of these men has osteoporosis. They are at risk for hip fractures. Hip fractures at the least with decrease quality of life. At most, long hospitalization and death. Hip fractures can be prevented if treated properly.

Medicare will not pay for these men to have a bone density for the diagnosis of osteoporosis. This leads me to the definition of quality medical care.

The next step would be to study the number of hip fractures in men over 70 years old and the cost of treatment of these fractures. An evaluation of the quality of life after fracture must be evaluated to get an accurate assessment of the cost effectiveness of doing bone mineral density testing.

Medical care systems must be a patient centered and controlled. It must not be a government centered and controlled system. This is the only way to develop a cost efficient system. Dr. Berwick’s way will only increase the cost to the government. He will spend money the government does not have.

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

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Economic Incentives Motivate!

June 22, 2011

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The use of economic incentives to motivate behavior is neither a Democratic or Republican idea. It is human nature to be motivated by economic incentives. The concept of individual responsibility is an American idea. It has been tarnished in recent years.

There is no question in my mind that government has the responsibility to be compassionate and help the needy. It is my view that government should help individuals help themselves.

The costs associated with Medicare and traditional healthcare insurance are rising. Every stakeholder points a finger at the other stakeholders as the cause.

President Obama’s Healthcare Reform Act is raising costs higher in anticipation of cuts in the future. He is in the process of forcing individuals to be more dependent on the government rather than promoting individual responsibility.

Obamacare will fail to control costs.

All anyone has to do is look at a Rand Corp. study of 29 years ago to see what works and what doesn’t work. After all that is said what matters are results in decreasing costs, not your political ideology.

The Rand Corp’s political leanings are more left of center than right of center. The Rand Corp tries not to be biased by these leanings in its scientific studies. Its conclusions from its own data are sometimes skewed to the left ignoring its own evidence.

The Rand Health Insurance Experiment looked at consumers’ healthcare consumption in healthcare plans with different deductibles as well as an HMO. It monitored the results and reported its findings in 1982.

The findings were:

Patients are responsive to out-of-pocket costs (the more they have to pay, the less health care they buy).
Changes in the amount of spending have no apparent impact on health care outcomes in most cases.
Judging from the difference in behavior between HMO doctors and fee-for-service doctors, physicians are also very responsive to economic incentives.
Consumers with high deductibles were as likely to cut back on useful health services, as they were to cut back on unnecessary care.
The critics of the consumer driven model have used this last point as proof that consumer driven healthcare doesn’t work. They claim that these consumers will not get appropriate care if they have a high deductible and try to save money.

If health care was free, spending soared with no improvement in health status. In the government controlled model government has to limit individual choice of care and access to care in order to keep consumption of care down.

The 1982 RAND study proved to me that consumer driven healthcare can work. Healthcare consumption is driven by the economic incentives the healthcare system offers consumers, physicians, hospital systems, pharmaceutical companies and healthcare insurers. Consumer driven healthcare patients used services they felt were essential to them and did not spend money on services they felt were not essential.

A consumer driven healthcare system would stimulate the growth of full-service diabetes centers that would force physicians into competing for diabetic patients because patients would be managing their own healthcare dollars. CDHC could energize the chronic disease healthcare market. It would create specialized centers competing for the care of patients with chronic diseases. Preventing the complications of chronic disease with education about self-management is in the interest of patients with the disease as well as society. The medical care of the complications of chronic diseases consume 80% of all healthcare dollars. Consumers and physicians respond to economic incentives. The healthcare social contract is really between consumers and physicians not government and hospital systems.

A 2011 Rand study of more than 800,000 families from across the United States found when people shifted into health insurance plans with high deductibles their healthcare spending dropped an average of 14 percent compared to families in health plans with lower deductibles.

In October 2010 Cigna released a report covering 5 years of real-world experience with 897,000 plan members, about half in “traditional” coverage plan and the rest in consumer-driven plans.

All of the results show that CDHPs are working beyond anyone’s expectations.

CDHPs save 15 percent in the first year, 18 percent in year two, 21 percent in year three, 24 percent in year four, and 26 percent in year five.
All this while individual out-of-pocket exposure is about the same (17 percent) in both types of plans.
Using Cigna’s quality measurements (which are wrong), there is 8 percent to 10 percent higher use of preventive services in the CDHPs.
CDHP enrollees are 9 percent more likely to get evidence-based treatment in the first year and 14 percent more likely in the second year of enrollment.
CDHP enrollees are five times more likely to complete a health risk assessment.
CDHP enrollees are19 percent more likely to work with a health advocate.
CDHP enrollees are 40 percent more likely to use on-line cost and quality tools when making decisions.
CDHP enrollees have a 13 percent decrease in the use of emergency rooms.
CDHP enrollees are 9 percent more likely to switch to generic drugs.
CDHP enrollees have a 14 percent lower prescription costs.
CDHP enrollees are 21 percent more likely to participate in a disease management program.
CDHP reduce their costs by 21 percent for joint disease, 8 percent for diabetes, and 7 percent for hypertension.
CDHP enrollees are slightly more satisfied with their plans than people in traditional approaches (83 percent versus 82 percent).

Finally according to the Employee Benefit Research Institute(EBRI), 22 million people are enrolled in consumer-driven and high-deductible health plans.

In 2010 EBRI conducted “Consumer Engagement in Health Care Survey” (CEHCS) analyzing the behavior and attitudes of 4,509 adults ages 21–64 with private health insurance coverage.

The findings were;

People who enroll in these plans are more cost-conscious than those who have traditional health insurance policies.
53 percent routinely check to see whether their plan would cover specific care, compared with 47 percent of traditional policyholders.
More than 50 percent check if a generic drug is available, compared with 44 percent in traditional plans.
CDHP enrollees were more likely than traditional plan enrollees to choose doctors based on their use of health information technology.
CDHPs enrollees also were more likely to exercise and less likely to be obese compared with traditional health plan enrollees.

President Obama’s Healthcare Reform Act will eliminate consumer driven health care plans. I believe this is ill advised. CDHPs have decreased the cost of healthcare by motivating consumers to drive their healthcare decisions. A government directed system will not achieve this goal.

The results above were gotten with Health Savings Accounts. The use of my Ideal Medical Savings Account increases the economic incentives for consumers.

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