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Public Option vs. Ideal Medical Savings Account: Part 4

September 8, 2009
inMedicine: 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

Politicians and healthcare policy makers have not included consumer driven healthcare in the healthcare reform debate. They have not included tort reform in the debate either.

The debate is about a public option. President Obama is going to redefine his meaning of the public option in his message to congress. He will make it sound benign. It will not sound like a government takeover of healthcare. He will omit the details and consequences of the bill.

President Obama must know the government cannot afford a public option. He knows he must control costs somehow. His policy makers believe the only way to control cost is by total government control over the healthcare system. Ultimately the goal is a single party payer system.

This way of thinking about the problem is wrong. Government control does not reduce costs in most projects. It usually increases costs. The President is focused on reducing physicians’ and hospitals’ reimbursement. He believes they are the reason for increasing costs. Medicare has continually decreased reimbursement to physicians and hospitals. Yet costs have increased.

To some extent decreased reimbursement leads to increased utilization but it is not the principle reason for the increase in utilization. A principle reason is an increase in the need to practice defensive medicine. Plaintiff attorneys deny it. The Massachusetts study confirms that defensive medicine leads to a large increase in utilization and costs.

Physicians are an easy target because they are not well organized. The Democrat controlled government is timid about attacking the plaintiff attorneys and tackling tort reform. Defensive medicine results in about a $700 billion dollar a year cost to the healthcare system. 

Howard Dean said it a few weeks ago. “Congress will not face the issue of tort reform because it does not want to take on plaintiff attorneys.” Consumers can solve this for congress by signing a valid limited liability waiver. Patients can put their own cap on damages. It would not require any courage on the part of congress or the President to face this difficult political issue. All congress and the President have to do is declare the waiver valid.

Texas and California have had the courage to place caps on damages. It has been very successful. If there were caps on damages and they were effective the need for defensive medicine practices would decrease.

The public does not trust congress or the President with control over its healthcare coverage. The public experience with unintended consequences of government control is obvious to all.

Recent examples are the unintended consequences of the bank bailouts, Goldman Sachs bailout, the economic stimulus package promise, the auto bailout, and the war in Afghanistan. All these bailouts are increasing the deficit at the expense of the taxpayers and future generations.

The public mistrusts the healthcare insurance industry as much as it mistrusts the government to control healthcare. The healthcare insurance industry has restricted access to care and rationed care. It has not reimbursed physicians and hospitals in a timely fashion. It has found it is cheaper to pay the negotiated settlement rather the medical bills for its insured.

Nancy Pelosi is right about one thing and only one thing. The real villain is the healthcare insurance industry. However, she does not understand with a public option she is not controlling the healthcare insurance industry fees for administrative services. The government outsources administrative services to the healthcare industry and will still be subject to grotesque administrative services fees.

The healthcare insurance industry has lobbied to change the law to increase co pays to 35-40% of bills so it can lower premiums to affordable levels. Increasing deductibles and lowering premiums would satisfy President Obama’s goal of affordable premiums. At the same time, it will increase the out of pocket cost of medical care for consumers who might need to use their “affordable healthcare insurance.”

The healthcare insurance industry will be forced to offer insurance to consumers with preexisting illness at an affordable cost. Some states have a high risk pool. The premiums in the high risk pools are at least 11/2 times higher than normal premiums and have higher deductibles. High risk patients must be put into the general insurance pool.

There has not been a word in the healthcare reform discussion about patient responsibility for their health. We are in the middle of the worst Obesity epidemic in American history. President Obama should declare a War on Obesity. He should promote legislation that could help eradicate obesity. He should provide patients with financial incentives to eliminate obesity and adhere to prescribed therapy. Obesity is a leading driver of increasing healthcare costs. The costs will only become grater as the obesity epidemic continues.

It is time consumers took control of their own health care dollars and their own health and well being. The defensive medicine/tort reform issue can be solved by consumers. Obesity can be solved with the government rewriting farm subsidies and a substantial public service health campaign to change our eating habits.

A consumer driven healthcare system along with the ideal medical savings accounts could solve many of the healthcare system’s problems without total government control. The government’s job should be to help with educating the public, negotiating prices that are transparent and fair and enforcing regulations to create a level playing field for consumers among the other stakeholders.

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

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How To Neutralize The Healthcare Insurance Industry’s Attack. Part 1

May 27, 2009
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Yesterday Blue Cross and Blue Shield of North Carolina started rolling out the healthcare insurance industry’s attack on President Obama’s National Health Insurance Exchange. The 1993 Harry and Louise attack campaign will not work in 2009. Consumers do not trust the healthcare insurance industry to look after their needs. President Obama is playing off this mistrust and counter attacking. He sent an email to 20 million consumers asking them to join his call. He wants us ask congress to pass real healthcare reform in 2009. He asked us to join and donate money. After we join his cause we could then tell our story about the dysfunction in the healthcare system. He said your voice will make a difference. He says nothing in specific terms about how he will Repair the Healthcare System.

“Stanley –

You will note every email is personalized.


“The chance to finally reform our nation’s health care system is here. While Congress moves rapidly to produce a detailed plan, I have made it clear that real reform must uphold three core principles — it must reduce costs, guarantee choice, and ensure quality care for every American.”

Healthcare insurance premiums are constantly increasing while coverage is decreasing. Most healthcare insurance policies do not have a choice of physicians (physician networks). Quality healthcare (undefined) is not available for every American (universal healthcare). The healthcare insurance industry’s control of the healthcare system is responsible for most of these defects.

“As we know, challenging the status quo will not be easy. Its defenders will claim our goals are too big, that we should once again settle for half measures and empty talk. Left unanswered, these voices of doubt might yet again derail the comprehensive reform we so badly need. That’s where you come in.”

President Obama invites us to fight those who would derail the comprehensive reform we so badly need. He does not define the reform (Hillary Clinton’s 1993 reform?). He does not describe the route to reform. It sounds good is meaningless.

When our opponents spread fear and confusion about the changes we seek, your support for these core principles will show clarity and resolve. When the lobbyists for the status quo tell Congress to hold back, your personal story will give them the courage to press forward.

President Obama’s message is clear. The call to action is to neutralize the healthcare insurance industry’s attack.

Join my call: Ask Congress to pass real health care reform in 2009.

“After adding your name, please consider sharing your personal story about the importance of health care reform in your life and the lives of those you love.”
“I will be personally reviewing many of these signatures and stories. If you speak up now, your voice will make a difference.”


http://my.barackobama.com/HealthCareOrganizing

When I tried to tell my story there was only one place to tell my story to President Obama. The space was to donate and join the call to action. He promises to personally review my story yet he has not listened to my call for a system of patient responsibility or patient reward. He has not listened to the plea for major tort reform. He has not listened to the need for a free electronic medical record in the cloud paid for by physicians by the click. President Obama does not have a clear the way to achieve his goals. He is going to get a bill passed that is worse than the Massachusetts plan.

In our sound bite society one, he wins using the new media. The healthcare insurance industry does not get it.

http://my.barackobama.com/HealthCareOrganizing

“Last November, the American people sent Washington a clear mandate for change. But when the polls close, the true work of citizenship begins. That’s what Organizing for America is all about. Now, in these crucial moments, your voice once again has extraordinary power. I’m counting on you to use it.”

Thank you,
President Barack Obama

clip_image001

President Obama followed up with another email call to action. He is organizing People Power, one block at a time, one neighborhood at a time and one city at a time. His costs are minimal.

President Obama, using the new media, has the healthcare insurance industry on its heels. He used the old media to declare that the healthcare insurance industry made a commitment to reduce healthcare costs by 2 trillion dollars in the next 10 years. His sound bite is “ you’ve made a commitment; we expect you to keep it.” Now the healthcare insurance industry has backed down. Implied is how can it be trusted?

Patient power and the new media will not let this happen. “When our opponents spread fear and confusion about the changes we seek, your support for these core principles will show clarity and resolve.”

“On June 6th, in thousands of homes across the country, we’ll gather to launch our grassroots campaign for health care. We’ll watch a special message from the President. We’ll build the teams and draw up the plans for winning health care reform the same way we won the election: Building support one block, one neighbor, one conversation at a time. And we’ll put those plans into action.” “Please sign up today to host or attend a kickoff near you.”
http://my.barackobama.com/HCkickoff

This time the healthcare insurance industry must do better than Harry and Louise.

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

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President Obama’s Healthcare Reform Trick Play

May 17, 2009
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Healthcare policy definitions are easy to confuse. I am an advocate for universal healthcare coverage. I am not an advocate for a single party payer. I believe the only way to be successful in repairing the healthcare system is to remove control of the healthcare dollar from the healthcare insurance industry. Consumers must be in control of their health care dollars. The ideal Medical Savings account can motivate patients to be responsible for their health.

Patients with chronic disease must be motivated to control their chronic disease. If they are motivated to control their disease healthcare costs would decrease. Using the ideal medical savings account a patient with diabetes for example would be expected to spend $4000 dollars a year. It they controlled their disease well and avoided hospitalization their employer or the government could afford to provide a bonus. If they controlled their disease and avoided hospitalization they would have $2000 to put in a retirement account. They could be eligible for an additional $2000 bonus. The result is a savings of $4000 into their retirement account. Patient responsibility and motivation are the only way we have a chance to Repair the Healthcare System.

President Obama healthcare plan is going to make patients more dependent on government and less responsible for their care and choices. In fact choice will be rationed. His allies in the single party payer camp are complaining that he has “caved” in to hospitals and healthcare insurance companies.

They claim he was elected to install a single party payer system. They ignore the point that the government cannot afford to pay for the Medicare single party payer system much less universal coverage for the entire population as the single party payer.

The function of the government should be to make appropriate rules to align the incentives of all the stakeholders in the healthcare system. President Obama is confusing everyone with his position on healthcare reform in order to decrease resistance to his plan. My guess is he is doing it intentionally.

“Although Barack Obama was elected on a health care reform platform, his version ignores single payer. Nor is single payer advocated by his allies in the well-funded coalition called Health Care for America Now, composed of MoveOn, USAction, ACORN, Americans United for Change, the unions SEIU and UFCW and other liberal heavy hitters.”

President Obama is a clever politician. He understands that it would be political suicide to directly advocate a single party payer system. The American public wants choice. They do not want to have healthcare rationed. The American public understands the government cannot afford a single party payer system for all. The public outrage would dominate the debate. His healthcare plan is designed to arrive at a single party payer system by default.

The advocates of a single party payer do not understand the subtlety of President Obama’s positioning in the healthcare reform debate. .

“Journalist Russell Mokhiber, founder of the new group Single Payer Action, notes that no advocate of a single payer system was invited to the recent White House summit on health care reform. Only protests by Progressive Democrats of America and others won an invitation for Congressman John Conyers, sponsor of the United States National Health Care Act: H.R.676.”

The advocates of single party payer system are now attacking President Obama. They are accusing him of caving in to the demand of powerful vested interests.

“Mokhiber quotes Dr. David Himmelstein of Physicians for a National Health Program: “The President once acknowledged that single payer reform was the best option, but now he’s caving in to corporate health care interests and completely shutting out advocates of single payer reform," even though "the majority of Americans favor single payer, and it’s the most popular reform option among doctors and health economists."

This is political spin. President Obama is not caving into anyone. The majority of Americans are do not want rationing of health care that usually follows the high cost of a single party payer by government that exists in other western countries.

The President knows the best way to achieve a single party payer system. His plan is to get there by default.

The Obama healthcare reform plan is create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

I believe his National Health Insurance Exchange will drive the private insurance companies out of the healthcare insurance business. This might not be a half bad idea since the healthcare insurance industry controls healthcare cost and earns a grotesque amount of money.

It could change the healthcare insurance industry but I doubt it. It should become a 6% broker as the administrative service organization instead of 15% broker in a private insurance system. However there is no price transparency. In reality the government pays 18% for Medicare administrative services. President Obama healthcare reform proposals will not repair this abuse. Nothing will change. The government will restrict access and ration healthcare.

Watch out.

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

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The Electronic Medical Record (EMR) Stimulus Fiasco: Part 3

May 10, 2009
inEMR, Information Technology in Healthcare, Medicine: Healthcare System, Pay for Performance (P4P), Physician's Problems
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Stanley Feld M.D.,FACP,MACE

 

President Obama’s goal for healthcare reform is to increase the quality of medical care, increase efficiency of medical care and decrease the cost of care. The goal is admirable. The route he is taking is wrong. In the process he might destroy the medical workforce.

The route the electronic medical record (EMR) stimulus package should take should be flexible and educational for patients and physicians. It should use modern software technology instead of subsidizing old inflexible technology that is set up to be punitive to physicians and patients to the advantage of the government and the healthcare insurance industry.

The term "quality medical care’ is used loosely. It has not been appropriately defined. The practice of evidence based medicine has been used to define quality medical care. The problem is evidence based medicine is changing daily.

A better definition should be the best clinical outcome with the most efficient financial outcome. It is assumed that practicing evidence based medicine will lead to the best clinical outcome at the most efficient cost.

Clinical guidelines are defined by “experts” interpreting evidence based medicine. I am/was one of those experts and appreciate its short comings.

Some guidelines are essential and should be inflexible. Others are ever changing and must be flexible. In bureaurocratic systems it is difficult to create flexible rules. Also, all patients are different. Clinical judgment plays an important role in treatment.

Physicians should not be penalized for using clinical judgment. Nonetheless, physicians are penalized in a pay for performance evaluation for deviating from inflexible clinical guidelines. Since some clinical guidelines are always changing the weakness of the approach is obvious.

An example of an inflexible clinical guideline is the need for rules to have a sterile operating room with sterile gowns and tools to avoid surgical infection.

An example of a need for a flexible clinical guideline should be a physician’s approach to a patient with hypertension. The goal should be to normalize the blood pressure. The goal for lowering the blood pressure to normal is to avoid heart attacks and stroke. However, if the patient’s blood pressure was elevated for a long period of time and was severe enough to compromise the renal (kidney)) blood flow, lowering the blood pressure too quickly could result in the patient having a stroke from a relatively low blood pressure. This is an example of the value of clinical judgment.

Physician performance should not be evaluated on static measurements. It must be evaluated on physicians’ medical judgment. Clinical judgment is a function of a physician’s ability to relate to his or her patients. (patient physician relationship)

On the other hand, if a patient felt poorly as a physician tried to lower the blood pressure to normal the patient might stop his medication without telling the physician. The physician’s workup might have been perfect and his choice of medication may have been excellent. This physician might get an excellent mark on his performance but the patient had a stroke because the patient did not comply with treatment. The patient might not have complied because he was not taught to be a professor of his disease. Healthcare is a team sport. The patient physician relationship failed but was not measured. .

The poor performance was missed by the static digital healthcare evaluation imposed by an inflexible EMR. The importance of the patient physician relationship and not including patient responsibility in the clinical outcome should be part of any performance measurement. A performance measurement should be a measurement of both the patients’ and physicians’ performance.

Now that the federal government plans to spend $50 billion to spur the use of computerized patient records, the challenge of adopting the technology widely and wisely is becoming increasingly apparent.

There is no question we should have universal electronic medical records. It should be a teaching tool for patients and physicians. The EMR should be inexpensive and flexible. It should not a tool to judge and penalize clinical performance. President Obama is being ill advised. His EMR stimulus program is going to result in a waste of $50 billion dollars.

“In a “perspective,” Dr. Kenneth D. Mandl and Dr. Isaac S. Kohane portray the current health record suppliers as offering pre-Internet era software — costly and wedded to proprietary technology standards that make it difficult for customers to switch vendors and for outside programmers to make upgrades and improvements.”

The software the government is going to spend $50 billion dollars on is going to be too expensive, inflexible and not widely distributed.

“Instead of stimulating use of such software, they say, the government should be a rule-setting referee to encourage the development of an open software platform on which innovators could write electronic health record applications”.

EMR software platforms in the cloud should be developed. This link by Christopher Barnatt  is an excellent utube explanation of cloud computing. I suggest all watch it.Amazon uses the cloud to sell books. www.Salesforce.com’s business model tracks sales force activity at a minimal cost to the company. It is flexible and maintenance free.

“Such an approach, they say, would open the door to competition, flexibility and lower costs — and thus, better health care in the long run. “If the government’s money goes to cement the current technology in place,” Dr. Mandl said in an interview, “we will have a very hard time innovating in health care reform.”

The rules can be immediately changed. The cost to a medical practice could be minimal. Its effectiveness is maximal. The cost to the government using modern software technology could be between 1-10 % of what the stimulus is proposing to spend. If it is fashioned as an educational tool to patients and physicians the payback will be maximal, quality of care will improve and the cost of care will decrease.

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

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Consumer Driven Healthcare Plans Trickle

March 11, 2009
inMedicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust, Universal Healthcare
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Stanley Feld M.D.,FACP,MACE

 

As the healthcare debate heats up the meaning of consumer driven healthcare (CDHC) needs repeating. The true meaning of CDHC has been bastardized by the healthcare insurance industry as represented by Health Savings Accounts (HSA).

The healthcare insurance industry feared that if Medical Savings Accounts dominated it would lose control of the initial healthcare premium dollars. The result would be a decrease in profit and an increase in price competition and real price transparency.

The reality would be America would have universal healthcare in a more efficient healthcare system. The system would be more efficient because it would be driven by the consumer for their benefit and not a third party payer. A more efficient system will maintain healthcare insurance industry’s profit while permitting a decrease in healthcare system costs.

“A lack of consumer understanding has contributed to the glacial growth of consumer-driven plans. Can better information from health plans help CDHPs take hold?”

HSAs place limits on consumers’ incentives. All of the healthcare premium dollars are eventually paid to the healthcare insurance industry.

Our economic recession along with increasing unemployment have set the stage for consumers to accept any help government will provide. Enter a single party payer and all its problems. Since Medicare and Medicaid have proven to be unsustainable, it is foolish to throw money at a failing system. It is time to revitalize the system.

Just the opposite should be occurring. CDHC should be promoted and not be marginalized. President Obama’s universal healthcare with a single party payer system marginalizes CDHPs. The route he is taking to achieve everyone’s goals and will not repair the healthcare system.

“The idea behind consumer-driven health plans is to transform members into healthcare consumers through education and place more responsibility on the individual.”

Health Saving Accounts (HSA) do little to encourage patient responsibility or make patients informed consumers. HSA were a political compromise designed by the healthcare insurance industry. The resulting plan gutted the intent and effect of the CDHC movement.

“ Studies show that the percentage of Americans insured in CDHPs is still in the single digits, largely for two reasons: Consumers simply don’t understand the tax-free savings accounts that are connected to CDHPs, and few health plans are providing cost and quality information to allow consumers to compare doctors, hospitals, and treatment options.”

Wrong!

Consumers do not see a financial advantage of the HSA because there are none. The money has to be used to pay present deductibles and future deductibles. There is no reason the future deductable will not be increased reducing the present value of the money in their health savings account. The healthcare insurance industry wants health savings accounts to fail. It feels its margins are presently excellent and does not need a change.

“More than one-quarter those respondents said that HSAs are difficult to open/manage, or too complicated, or they simply didn’t understand the accounts.”

Consumer driven healthcare is the only thing that can repair the healthcare system. It would take control out of the healthcare insurance industry’s hands. The route to take is the ideal medical saving accounts.

Healthcare insurance would convert to real at risk insurance. Consumer would own and control their healthcare dollar. The government could teach the consumer to use the healthcare dollar wisely. The government could provide clear price and quality transparency. It would force all the secondary stakeholders to compete for the consumers’ healthcare dollar. This competition would force an increase in efficiency and decrease in administrative waste.

The government should act as the facilitator for the competition. The time has come for politicians to do something for consumers and not for secondary stakeholders.

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President Obama Will Ration Healthcare. Wake Up America! : Part 1

January 14, 2009
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Universal Healthcare
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Stanley Feld M.D.,FACP,MACE

I spent a glorious weekend with Brad and Daniel in Las Vegas at the Consumer Electronic Show (CES). I thought there were some phenomenal electronics exhibited which will be coming to Main Street soon.

Brad introduced me to many young entrepreneurs who are very concerned about providing healthcare insurance for their employees. They are having trouble finding affordable healthcare insurance. My suggestion is for them to consider my ideal medical savings account.

Most of these young entrepreneurs realize they do not understand the issues that have resulted in the exorbitant healthcare insurance premiums.

I told them to not listen to the sound bytes of Tom Daschle and his team. They do not understand the issues either. If they did, they would be pursuing a different course. Tom Daschle is going to try to force the Democratic Party’s healthcare agenda of the last forty five years down the country’s throat. .

I have described most of the issues. I like President-elect Obama very much. Many voted for him because of the promise of renewal, new thinking and hope for the future.

David Remnick of the New Yorker summarized Barack Obama’s appeal.

“Barack Obama was not elected the forty-fourth President based on the depth of his legislative achievements or on the length of his public service. John McCain and Hillary Clinton were the “experience” candidates. Rather, Obama projected an inspiring message, a “narrative,” of change at a moment when so much in American life––the economy, the environment, national security, health care––is in such parlous condition that, for many voters, political familiarity seemed less a source of solace than a form of despair.

Barack Obama has hired “experienced people” to run his healthcare team( Daschle, et al). His “team” has the same old tired ineffective story that Hillary Clinton and others have had for healthcare reform. It is a story the American public does not want to hear.

“

During the campaign, Obama embodied novelty and a broader American coalition, and everything we heard about his temperament—as a community organizer in Chicago, as a president of the Harvard Law Review, as a legislator, as a campaigner—spoke of someone who, in contrast to the outgoing, faith-based President, possessed a gift for rational judgment and principled compromise. “

His healthcare advisors are old school. They do not understand the importance of the physician patient relationship. They refuse to understand the problems in the healthcare system. They ignore the importance of patient responsibility for their own health and healthcare. They do not seem to believe in the importance of the role of incentives and self reliance as an engine of America’s greatness. They believe government can fix everything.

President Barack Obama’s healthcare team is going to be successful in passing healthcare legislation. Healthcare system reform they will propose and pass will fail. It will bankrupt America as it is bankrupting Massachusetts.

The Congressional budget office estimated a 100 trillion dollar a year healthcare deficit in forty years without an improvement in the health of seniors alone. Adding the entire population to the Medicare roles will make this deficit unimaginable.

Tom Daschle’s plan is similar to the Massachusetts universal healthcare plan. We must understand the cause for the failure of the Massachusetts plan in order to comprehend the impending failure of Tom Daschle’s plan. There is nothing innovative about his plan. It is the same plan Hillary Clinton advocated in 1993 and others in the Democratic Party advocated for many years.

The plan will probably pass in a congressional vote because Americans are frightened by a huge economic recession. They have little idea what is being advocated by the Daschle healthcare team.

When a population is frightened all politicians have to promise is hope. People will give unprecedented power to politicians even if they do not understand the results of those promises.

Many are claiming Ayn Rand was right 52 years ago when “Atlas Shrugged” was published. The names of the new controlling bureaucracy are different but the methodology is the same.

Where are you John Galt?

Mr. Obama is taking a dangerous chance by advocating these old, and proven to be ineffective ideas. The Congressional Budget Office (CBO) noted in its report the failure to reduce the cost of healthcare significantly or increase the quality of care. The CBO’s report was published just before Christmas when everyone’s thoughts were on the holiday.

Wake up America!! Please !!

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

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Is Barack Obama Any Different Than Other Politicians? Part 3

August 21, 2008
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

Barack Obama’s healthcare policy calls for subsidies.

Subsidies

“Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.”

Barack Obama should do some arithmetic. A minimum wage worker without a healthcare insurance benefit does not qualify for Medicaid coverage in most states.

Presently in Texas a family can not earn more than $800 a month in order to receive Medicaid. A family of four can not live on $10,000 a year and think of buying health insurance. Moises has a very difficult time supporting his family earning $22,000 a year. He worries about getting sick every day of his life but can not spare a penny of his income for healthcare coverage. .

Poverty today is defined by a 1955 definition. It is not adequate. President Bush rejected the SCHIP program twice because he sees the deficit writing on the wall. Republicans want to eliminate entitlement programs not add them. An additional entitlement will bankrupt the country at a faster rate than our present Medicare and Medicaid programs.

Maybe we could help the needy with a healthcare insurance program that would create incentives to be responsible for their health (exercise, lack of obesity and adherence to medication), and medical care? Maybe we could create programs to stimulate corporate America to promote wellness and exercise social responsibility to combat obesity? This would be a worthwhile investment for our government. It might even be a better investment that protecting corporations in search of increasing markets in the name of globalization.

Obesity, addiction, non-compliance with recommended medical treatment is a huge cost to our system. It must be dealt with. Only the consumer can deal with these issues on a personal level.

Some states like Indiana and New Jersey have tried to increase the income level for the eligibility for Medicaid. The federal government has refused to fund these new definitions because it does not have the money to pay for it.

States that are in worse shape financially than the federal government need to fund the difference. The only way it can be done is by raising taxes.

Michael Bloomberg seems to be the only politician with constructive ideas.

The “bipartisan Romney plan” of universal healthcare coverage in Massachusetts is shaping up to be another disaster of fuzzy thinking. The intention was good. The cost overrun this year is in the range of over $400 million dollars. The present Massachusetts administrators are hailing their universal healthcare plan as a success because more people are insured. The problem is the administrators have left the pricing and control of the healthcare insurance coverage in the hands of the healthcare insurance companies. The plan has not eliminated any of the administrative inefficiencies of the healthcare insurance industry or encourages medical practice efficiencies. It does not encourage patient responsibility nor chronic disease management incentives.

The Massachusetts plan is certainly going to result in an increase in state tax is Massachusetts.

Barack Obama’s policy statement on Subsides is naive. It presents a false hope without a plan. All government subsides so far have gone to the wrong stakeholder. The result of a policy executed with this open ended philosophy will result in increased government cost. In effect the government is providing an entitlement for the healthcare insurance industry. They are leaving control of pricing and administration in the healthcare insurance industry’s hands. An increase in government spending will result in a decrease in healthcare coverage for the average person as well.

How can I say that? Recent past history has demonstrated it. As long as the healthcare insurance industry is in control of the pricing, government bureaucracy is suppose to oversee that pricing. Historically the price has increased and healthcare coverage has decreased.

To paraphrase Yogi Berra “it is the $600 toilet seats all over again”.

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Can You Believe This? Health Savings Account Threatened By The “Taxpayer Assistance and Simplification Act

April 22, 2008
inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

The House of Representatives passed a bill called the “Taxpayer Assistance and Simplification Act” last week that will essential destroy Health Savings Accounts and the quest for consumer independence from the government’s control of the healthcare system. I have criticized HSAs in the past because they only give consumers partial control and not full control of their healthcare dollar. If you do not use the money you lose it. In my opinion this creates a perverse incentive that does not stimulate wellness. It stimulates potential abuse. Patients keep the money they do not spend with my Ideal Medical Savings Account. The MSA would increase incentives for wellness and decrease abuse, because if patients abused the system they losing their own money.

“Democrats have made affordable health care a mainstay of their election agenda, but apparently only if you’re willing to get insurance through the government. Witness their stealthy assault on Americans who prefer the private-sector option of Health Savings Accounts.”

No one in the Democratic Party dominated House of Representative nor the Democratic Party’s presidential candidates seem to understand the government can not afford to have a government dominated system. It is also clear they do not trust patients to pursue their vested interest.

“The House passed legislation on Tuesday, the mis-named “Taxpayer Assistance and Simplification Act,” that contained the awful provision that would throw a mountain of paperwork at Health Savings Accounts.”

<President Bush sent a note to congress stating that he would veto the bill if it contained the anti HSA provision. I do not think the Senate will accept the provision either. The frightening thing is the lack of understanding by the Democratic Party of what is necessary to Repair the Healthcare System.

“A key player here is Ways and Means Health Subcommittee Chairman Pete Stark, whose main purpose in politics is to give the U.S. a government-run health-care system. He is a known opponent of HSAs – once comparing them to “weapons of mass destruction” – because they introduce more individual choice into the health-care marketplace.”

“Mr. Stark and his friends want to impose the same bureaucratic overhead even on spending that consumers do with their own money. The Senate should stop this one dead in its tracks.”

I thought Pete Stark finally understood the folly of his thinking. He trusts neither physicians nor patients. I was misled by his comments in Forbes magazine when he admitted he made a mistake with his Stark Laws.

“This week, the House passed legislation that included a provision to require every HSA transaction be reviewed and verified as a legitimate medical expense. Democrats say this is to ensure that consumers are using their tax-free withdrawals for a knee replacement, rather than a new iPod. In reality it adds a layer of bureaucracy that could sharply reduce the appeal and cost savings of HSAs.”

Presently the healthcare insurance industry administers these health savings accounts and does not permit misuse to occur. Maybe the only way the Democratic Party can reach its goal of government controlled single party payer healthcare system is to destroy HSAs?

“Pushing for the provision was a company called Evolution Benefits, which has patented a system for the substantiation of health-care expenses. Evolution’s lobbyist, John McManus, was the former staff director of the Health Subcommittee under Republican Bill Thomas.”

Unfortunately, this is how the government works. It is influenced by vested interested other than the people it is suppose to represent. Republicans are furious at John McManus, a former Republican congressman’s staff director now a lobbyist.

“Liberals claim HSAs are insurance for the “healthy and wealthy,” but there’s little evidence this is true. “

There is no evidence that HSAs are only for the healthy and wealthy. It is a potential mechanism for the government to subsidize insurance for the poor and not so poor to promote patient responsibility and stimulate a substantial reduction in cost and increase incentive for citizens to improve healthcare habits. All congress has to do is pass a law saying everyone automatically will be insured using a community rating system and pre tax dollars.

“The high deductable insurance permits the insured to open an HSA and make an annual contribution up to $2,900 for an individual in 2008, which he can use to pay for ordinary health needs. Savings not spent in any given year can build up tax-free for medical expenses. HSAs also give consumers more reason to care about prices, bringing much-needed market discipline.”

A family contribution is over $5,000 in 2008.

“ In any case if people cheat on their HSAs, they are only cheating themselves.”

I wonder how many congresspersons really understand the problems in the healthcare system and what will motivate the people they represent?

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

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Costs Soar For Mass. Health Care Law

April 20, 2008
inMedicine: Healthcare System, Universal Healthcare
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Stanley Feld M.D.,FACP,MACE

I hesitate to spend more time on the impending failure of the new Massachusetts healthcare law. However, the results of this experiment have consequences for the up coming presidential election. I have previous stated that Hillary Clinton healthcare plan is similar to the Massachusetts plan. The difference is Ms. Clinton would have the government plan competing with the insurance companies plan. It is destined to fail. The outcome will be the complete government take over of the healthcare system, an entitlement plan America can ill afford.

America can not afford the future value of our present entitlements. The debt will be compounded by adding the entire population to the healthcare insurance rolls. Politicians at all levels have ignored the debt problem of 100 trillion dollars.

Hopefully, someone will wake up and realize the present healthcare insurance system must change. .

“Two years after the state’s landmark health law was signed, the cracks are starting to show.”
“Costs are soaring and Massachusetts lawmakers are weighing a dollar-a-pack hike in the state’s cigarette tax to help pay for a larger-than-expected enrollment in the law’s subsidized insurance plans”.

I believe the cracks were present before the law was passed. Governor Romney was going to run for President and needed an innovative and heroic accomplishment. A bipartisan healthcare law with mandated universal coverage was politically driven and foolishly passed.

“But that hasn’t dampened enthusiasm at the Statehouse. Leaders there boast that in the two years since former Gov. Mitt Romney signed the law with a choreographed flourish at historic Faneuil Hall, the number of insured residents has soared by nearly 350,000.”

The lawmakers in Massachusetts are living in a dream world denying the problem of the program’s cost and the increased state spending deficit. The state is raising the healthcare premium, decreasing the healthcare coverage and increasing taxes. Nonetheless, the state can not afford the entitlement.

“Along the way the law has been scrutinized by other states, sparked the ire of critics on the right and left, and drawn the attention of presidential candidates.”

The blind are leading the blind. One state develops a healthcare system that does not work and all the others try to jump in with slight modifications of the same plan with its mistakes.

“It’s the very first question I get when I’m with other governors,” said Massachusetts Gov. Deval Patrick. “I don’t think anybody is prepared to say that what we have done here in Massachusetts is necessarily the formula for the rest of the country or for a national reform, but at least we are trying.”

Massachusetts has tried to maintain the private healthcare insurance system without reforming the private healthcare insurance system. It has to fail because the basic problem is the incentives for the private healthcare insurance industry have not been changed.

“The Massachusetts reform law remains the focal point for other states and the nation in trying to figure out if state-based reform is possible,” said Alan Weil, head of the Maine-based National Academy for State Health Policy. “It’s the biggest game in town.”

“One of the most radical fixtures of the law is the so-called “individual mandate” — the requirement that virtually everyone have health insurance or face tax penalties.”

Policy makers are always thinking in punitive terms toward patients and physicians rather than creating incentives for people. I believe people should get a tax credit for losing weight, controlling their chronic disease and not over utilizing the healthcare system. They should be rewarded for good health and not a penalized for not wanting to pay an inflated healthcare insurance premium.

“Anyone deemed able to afford health insurance but who refused to buy it during 2007 already faces the loss of a $219 personal tax exemption. New monthly fines that kicked in this year could total as much as $912 for individuals and $1,824 for couples by December.”

How can a government determine the reward? It could be difficult. It is easier for the government to collect a penalty for a person not having insurance. The reward should be contributed to the person is tax free retirement fund. Patients should own their healthcare dollar. They would be motivated to shop for the best price. The more they saved the more they would have added to their retirement fund. If someone had a chronic disease and controlled the disease with proper treatment they should receive a reward. The payer could afford to give that person a bonus because of the money saved on the treatment of complications of that disease. My plan would in effect shift responsibility and motivation to control cost to the patients. It would motivate patients to fight the War on Obesity.

“Michael Tanner, a senior fellow at the libertarian-leaning Cato Institute, said the law has been an unqualified failure. He also noted the vast majority of the newly insured are receiving subsidized care.”

“They said it would get us universal coverage and reduce costs and it’s done neither,” Tanner said. “

The biggest problem is the rising costs of healthcare. Neither the Massachusetts plan nor any of the other state plans have done anything to change the motivation of the drivers of the old healthcare system.

“The law — and its individual mandate — has become a key talking point in the presidential race.”

None of the presidential candidates have even spoken of the importance of patient responsibility. If the government set the appropriate rules it could eliminate all the administrative waste in the system and decrease the complications of chronic disease. We would then have an affordable healthcare system. This can be accomplished by motivating and not punishing the patients and physicians.

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