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Hospital System Monopolies And ACOs

December 7, 2011

inHealthcare Insurance Industry, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I have been a constant critic of Accountable Care Organizations. I have said they cannot work to the benefit of patients and physicians because of the difficulty of organizing them and the subsequent unintended consequences. ACOs will increase the costs to the government and healthcare insurance industry to provide the administrative services.

Government has proven over and over again its ability to make complicated mistakes. These mistakes result from bloated bureaucracies and conflicting bureaucratic missions.

Additionally the government outsources administrative services to the healthcare insurance industry. Administrative services fees are constantly increasing because of waste, inefficiency, and mark-ups.

Hospital systems have been merging for 15 years. In the process they are attempting to buy physicians practice and provide a salary for physicians.

Hospitals are brick and mortar structures. They are not the future of medical care. Hospitals, now hospital systems, had to change their business plan because more and more patients are being treated out of the hospital.

Outpatient clinics, diagnostic imaging centers, chemistry laboratories and ambulatory surgical centers have shifted income from hospitals to physician owned outpatient clinics.

Hospital systems goal has been to buy physicians’ practices and ancillary care facilities. Hospital systems’ consultants have concluded that they would be in a better position to negotiate price if they owned the physicians infrastructure regardless of the cost and pay physicians a salary.

The published reason given for this action is to provide better and integrated medical care within their hospital system. The real reason is to capture the revenue lost to outpatient facilities and profit from physicians’ productivity. Physicians are realizing they are being taken advantage of and are demanding their fair share of their own productivity.

The Federal Trade Commission is supposed to have the authority to challenge monopolistic hospital mergers to protect consumers.

In 1996, the FTC amended its policies on health care mergers. The new policy encouraged hospital systems to merge by providing safe harbor to competing hospital systems when the hospital system could prove their hospital could achieve sufficient clinical integration.

The definition of sufficient integration was very loose and ill defined. The government thought it could save money by having all the fees under one roof. The FTC encouraged healthcare system monopolies in order to achieve more efficient and integrated care. It did not realize it would bite them in the leg someday.

It has always been a mystery to me how the government came to this conclusion. Suddenly the government has realized that the monopolies have turned on it and are in a position to demand more reimbursement.

J. Frank Rosch the FTC Commissioner said,

“I thought that the 1996 amendments…were the biggest loophole in the antitrust laws I had seen,”

“Subsequent Advisory Opinions issued by Commission staff…were about as clear as mud.”

Dr. Donald Berwick and President Obama claim that Accountable Care Organizations are the cure to our rising healthcare costs. A gigantic and expensive bureaucratic system has been constructed by CMS to regulate these new ACOs. ACO’s promote further consolidation and mergers of physicians and hospital systems.

“The net result” of ACOs, says Rosch, “may therefore be higher costs and lower quality health care—precisely the opposite of its goal.”

Remember the government outsources all of the administrative services to the healthcare insurance industry. I have shown how the healthcare insurance industry has taken 30 to 50% of every Medicare healthcare dollar to the disadvantage of the taxpayer and seniors.

Large merged hospital systems have in turn taken advantage of their size to take advantage of the healthcare insurance industry.

The healthcare insurance industry has taken advantage of the government in pricing administrative services.

Finally, the government has taken advantage of seniors by increasing Medicare premiums, increasing deductibles and decreasing benefits..

“ The final ACO guidelines, says Rosch, are “extraordinarily generous to providers,” and will constrain the FTC’s ability to block exploitative provider mergers.”

The Congressional Budget Office, much to the dismay of Obamacare’s advocates, did not think ACO’s would save much money in ten years.

The CBO projected that the Medicare ACO initiative would save $5.3 billion over ten years.

“In other words,” Rosch points out, “the savings to Medicare from the ACO program are no more than a rounding error. Yet even the CBO’s modest cost savings projections are likely overstated.”

This supposed savings amounts to eight-hundredths of one percent of Medicare’s spending over the projected ten years.

People have a tendency not to do the arithmetic when present with what sounds like a big number.

“Against the very meager prospects for cost savings,” Rosch concludes, “there is a very real risk that some ACOs will be formed with an eye toward creating or exercising market power.

Middle-class Americans are already struggling with the burdens of the rising cost of health insurance. The potential ACO policy blunder is not to be taken lightly.

Obamacare’s failure will skyrocket our federal debt. The lack of consideration of the dysfunctional dynamics of the healthcare system will result in unintended consequences that will create greater dysfunction and higher costs.

Obamacare and ACOs will end up making health care even less affordable and accessible.

Maybe that is President Obama’s goal.

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

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physical therapist salary • December 13, 2011

By some weird arithmetic, the more life stuffs itself into the valley, the more spaces it creates for further life.
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Hospital Systems Are Creating Local Monopolies.

December 4, 2011

inConsumer Driven Health Care, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The primary stakeholders in the healthcare system are patients and physicians. Without patients or physicians there would not be a healthcare system.

Patients should be the drivers of the healthcare system. They are not. The primary drivers are the government and the healthcare insurance companies.

Hospital systems play the next largest role in driving up the costs of the healthcare system. Large hospital systems are constantly playing a game of chicken with the government and the healthcare care insurance industry.

Somehow, large hospital systems have been able to stay under the radar. They have been able to avoid the responsibility of the rising costs of healthcare.

Large hospital systems and large hospital chains know that insurers need them to service their network of patients. The healthcare insurance companies know that the hospital systems can hold them hostage to increased reimbursement.

When a large hospital system demands an increase in reimbursement the healthcare insurance industry simply increases premiums.

An example is the increasing premiums and costs that resulted from Romneycare in Massachusetts. Romneycare’s structure is one large driver of rising costs in Massachusetts.

Hospitals in Boston were extremely competitive before 1990.

The race in the late1980’s was to build the best hospital/physician network in town. The goal was to attract patients, overwhelm the competitors and get the best reimbursement from insurers.

In 1993 the model changed from a competitive model to a monopolistic model.

The merger between two eminent Harvard-affiliated hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital developed a hospital system (Partners) that would control the marketplace.

The two most prestigious hospitals in the state forced the healthcare insurance industry to increase their reimbursement for providing care. Meanwhile, the Tufts hospital system offered a lower reimbursement rate but patients wanted to go to Partners.

Partners HealthCare created a monopoly. It could deny access to the patients of any insurer who dared not accept whatever Partners wanted to charge.

What patient would want to be on an insurance plan that didn’t have access to the two most prestigious hospitals in Boston?

“Partners’ secret agreement in 2000 with Blue Cross Blue Shield of Massachusetts, in which Blue Cross would give Partners more money, in exchange for Partners’ promise that they would demand the same rate increases from everyone else. The growth rate of individual insurance premiums in the state doubled.”

Many executives at Blue Cross/ Blue Shield wanted to fight Partners’ demands. However discretion was the better part of valor.

An executive of Blue Cross/Blue Shield said,

“We are a successful business up against a hospital system that save people’s lives. It’s not a fair fight…”

Many hospitals are merging throughout the country to take advantage of this market leverage and increase reimbursement from the healthcare insurer.

Hospital systems are frantically trying to buy primary care physicians’ private practices to enjoy this leverage. The statistics claim that from 30% to 70% of practices have been bought by hospital systems.

The fiction is that medical schools are producing a different breed of physicians. The fiction is all the present day physicians want is a salary. I do not think this is true.

The barrier of entry to opening a private practice is cost. Physicians completing medical school have already incurred large debt.

The problem with being employed by hospital systems is the hospital system controls the overhead expenses. These expenses are inflated. Many salaried physicians do not realize the unfair overhead expenses because the expenses are opaque.

It takes a while for physicians in the system to figure out that they are not getting their fair share of the reimbursement for their productivity. At that point physicians start fighting with the hospital system. Some physicians quit en mass and open their own practice.

Partners’ physicians figured it out. Partners is still intact but the physicians are now getting their fair share.

Physicians are starting to realize they have leverage over their hospital employee and that they must have control of their overhead.

The Department of Justice is opening an investigation of hospital systems engaged in anticompetitive behavior. It is also challenging mergers in various parts of the country. Hospital systems have offered the defense that mergers will lead to “more efficient and cost-effective care.”

“But the long history of hospital mergers shows no evidence that consolidation leads to either. Indeed, according to FTC lawyer Matthew J. Reilly, the merged Toledo hospitals immediately went to work jacking up rates:”

“Soon after the acquisition was consummated,” Mr. Reilly said, “ProMedica approached certain health plans to obtain higher reimbursement rates.”

“The higher rates, he said, are typically passed on to consumers in the form of higher premiums, co-payments and other costs.”

Businesses act in the pursuit of their vested interests. Government sets the rules and businesses seek to take advantage of those rules.

Somehow, secondary stakeholders must be controlled. It will take a consumer driven healthcare system to control it.

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

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Fixing Medicare

November 30, 2011

inConsumer Driven Health Care, Medicare

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Stanley Feld M.D.,FACP, MACE

As we have seen, Dr. Ezekiel Emanuel’s misconceptions of the true drivers of medical costs are not fact based. President Obama and his administration do not have a clue about how to fix Medicare.

Dr. Emanuel and Dr. Berwick have created a system that Americans did not want and do not like. Dr. Berwick’s replacement was his assistant. She, in all probability, thinks the same way he does. It is likely there will be no improvement in fixing Medicare.

Accountable Care Organizations are a long way from being organized effectively and efficiently. Organizations which would be most likely to develop ACO’s are not signing on. The reasons are obvious. Obamacare provides inadequate incentives to join with great risks.

I believe the only way to fix Medicare is by developing a healthcare system that permits consumers, not the government, to drive their own medical care choices. Consumers must be responsible for their health and choice of medical care. They must also have control of their healthcare dollars and be educated and incentivized to use those healthcare dollars wisely.

To quote Milton Friedman, “There ain't not such thing as a free lunch.”

It will take educated, motivated and incentivized consumers to reduce the costs of Medicare in order for the program to be sustainable in the future.

It is likely that central government control over individual healthcare and medical care choices will create a bigger mess. It will also impinge on individual freedoms.

Ensuring that Medicare provides quality health care coverage to millions of older and disabled Americans is essential in a compassionate society. How this can be accomplished is the question.

Seniors have been deceived into believing that they have prepaid their retirement healthcare insurance during their working years. They are realizing that they have been deceived by many administrations.

“Medicare is nothing less than a lifeline for 49 million older and disabled Americans.”

“It is also hugely costly. The federal government spent about $477 billion in net Medicare outlays in fiscal year 2011 — 13 percent of its total federal spending. By 2021, it is projected to spend $864 billion — or 16 percent of the total budget — according to figures derived by the Kaiser Family Foundation. That rate of growth is not sustainable indefinitely.”

Where did the Social Security and Medicare taxes paid by Americans disappear to? The government collected those taxes and then lent them to the government treasury to maintain U.S. solvency. Now the government is insolvent. It cannot pay back the trust funds as Social Security and Medicare payments decrease and the number of eligible Social Security and Medicare recipients increase.

President Obama’s administration and its bureaucrats are ignoring the real problems in Medicare.

They think consumers are too stupid to look after themselves and their own money. It is essential to President Obama’s ideology that the central government control consumers’ choice, consumers’ medical decisions and the money consumers paid into the Medicare system.

The federal government has not done a very good job of managing the money consumers, now seniors, have paid into Social Security and Medicare all these years.

Politicians refuse to understand the sources of waste in the healthcare system. This was made painfully obvious as expressed by Dr. Emanuel. All the stakeholders (patients, physicians, hospital systems, healthcare insurance companies, pharmaceutical companies and the government) have contributed to the waste in the healthcare system.

The biggest villain has been the healthcare insurance industry. The next biggest villain has been the federal and state governments for letting the healthcare insurance industry get away with what they are getting away with.

Healthcare policy experts refuse to understand that the government is not the administrative services provider for the Medicare program. The government outsources all the administrative services to the healthcare insurance industry.

The government pays over 20% of each healthcare dollar plus a bid price to the healthcare insurance industry’s regional vendor.

Most of the vendors that administer Medicare and Medicaid are subsidiaries of the major healthcare insurers. They change their name to the disguised subsidiaries because some of the state government exposed the major companies for the abuses the healthcare insurance companies imposed on patients and physicians.

The politicians’ and bureaucrats’ goal is to maintain power. Their decisions are based on maintaining their power or leveraging their ideology to maintain or obtain that power through the next election cycle.

They are not concerned with the health and welfare of citizens.

President Obama proves this daily by running for reelection rather than running the country

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

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Medicare America • March 19, 2012

Thanks for this article. Quite sensible.
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Where Is The Healthcare Money Going?

November 27, 2011

inDisinformation and the healthcare system, Physician's Problems, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP, MACE

In reviewing Ezekiel Emanuel’s New York Times article I thought of an interesting question. In Dr. Emanuel’s view it is not worth having tort reform or healthcare care insurance reform. He claims these reforms are an insignificant burden to the cost of the healthcare system.

I have demonstrated that the evidence for tort reform and reform of the healthcare insurance industry proves him wrong.

The question then is where is the $2.5 trillion dollars the U.S. healthcare system spends going?

President Obama and Dr. Emanuel think it is going to physicians. President Obama’s idea to control healthcare costs is to reduce physician reimbursement.

Physicians have the weakest expression of its vested interests among all the stakeholders because of lack of effective leadership.

Simple arithmetic reveals that reducing physician reimbursement will yield an insignificant reduction in healthcare costs.

Never the less on January 1^st Medicare is going to decrease physicians’ reimbursement by 27%. This decrease is the result of the application of the government’s Sustainable Growth Rate (SGR).

The Sustainable Growth Rate (SGR) is a complicated and defective formula intended to contain the overall growth of Medicare spending for physicians’ services. The intent was to keep physicians’ reimbursement in line with the nation’s ability to pay for that medical care. The SGR formula uses the gross domestic product per capita in a complicated and inaccurate way.

In 2008 the Bureau of Labor statistics published a report that there were 661,400 physicians in the United States.

The report’s findings are summarized in the table below.

Projections data from the National Employment Matrix
Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Change, 2008-18		Detailed Statistics
Occupational Title	SOC Code	Employment, 2008	Projected Employment, 2018	Number	Percent	Detailed Statistics
Physicians and surgeons	29-1060	661,400	805,500	144,100	22	[PDF]	[XLS]
NOTE: Data in this table are rounded. See the discussion of the employment projections table in the Handbook introductory chapter onOccupational Information Included in the Handbook.

Let us assume that 161,400 of the 661,400 physicians in the U.S. work in private medical related industries such as the healthcare insurance industry, the pharmaceutical industry, the physician executive industry and government services. These physicians are not involved in direct patient care and do not generate direct patient costs to the healthcare system.

The number of non direct patient care physicians is probably higher (185,192 in other non practice positions and 476,208 in direct patient care). My assumption uses 500,000 physicians involved in direct patient care for all types of insurance to inflate physicians’ reimbursement.

The Bureau of Labor report states,

Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wage–and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. .

Let us also assume that physicians’ overhead is 50% of total collections. Therefore physicians’ take home salary is 50% of collections. Fifty percent is a fairly accurate assessment whether the physicians are self employed or hospital system employed.

“According to the Medical Group Management Association's Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in specialties earned total median annual compensation of $339,738.”

If we round off the salaries to $190,000 for Primary Care Physicians and $340,000 for Specialists and round off the number of Primary Care Physicians to 300,000 (actually 375,000) and 200,000 in Specialties (actually 125,000) and do the math, physicians’ salary comprise only 5% of the total $2.5 trillion dollars spent in the healthcare system.

The Math:

$190,000 per year per primary care physician x 300,000 physicians= $57,000,000,000 ($57 billion dollars for primary care physicians).

340,000 per year per specialists x 200,000 specialists= $68,000,000,000 ( $68 billions dollars a year for specialists).

$57 billion + $68 billion= $125 billion per year for the costs of physicians salary for direct patient care.

$125 billion (125,000,000,000)/ $2.5 ($2,500,000,000,000) trillion per year = 5%

If you double the physicians’ collections to include physicians’ overhead costs , physicians receive 10% of total dollars spent on healthcare system.

Improvements can be achieved in decreasing physicians’ overhead by having more integrated healthcare systems. Presently, most communities do a fair job.

Integrated electronic medical records could achieve a further decrease in the 5% of the total healthcare cost spend by physicians for overhead.

The government is spending billions of dollars on building bureaucracies, creating regulations, developing a IRS physicians fraud squad and creating committees trying to reduce 5% of the healthcare costs.

President Obama is approaching the problem of escalating healthcare system costs using the wrong premises. It will result in increasing healthcare system costs. Obamacare already has increased the costs of the healthcare system even though it is not fully implemented.

"IF REALITY DOESN'T match your expectations, perhaps it's time to re-examine your premises."

Where is the other 90% of the healthcare system costs going?

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

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physical therapist salary • December 13, 2011

By some weird arithmetic, the more life stuffs itself into the valley, the more spaces it creates for further life.
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A Little More Disinformation From The New York Times

November 20, 2011

inUncategorized

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Stanley Feld M.D.,FACP,MACE

It is getting harder and harder for me to read the New York Times. The half-truths are glaring. The bias is becoming more and more transparent.

Dr. Ezkiel Emanuel’s article in the New York Times on November 3^rd continues with these half-truths and bias.

“According to many on the left, health insurance companies are sleazy and unethical, making obscene profits by charging high prices to sick people, giving physicians and patients the runaround to avoid paying bills, and rescinding policies just when people who paid in good faith get cancer, while their executives often walk away with millions in compensation.”

All of the above is true. The main issue is how the healthcare industry can continue to get away with it.

Dr. Emanuel has not bothered to learn how to read the healthcare insurance industry’s financial statements.

The individual state’s Board of Insurance is in charge of regulating the healthcare insurance industry. The stated goal is to protect consumers.

All state boards issue licenses to sell healthcare insurance yearly to healthcare insurers.

Few of the state Boards of Insurance have enforced their own regulations. The state insurance boards could easily refuse to issue a license to a company that doesn’t follow the regulations

Dr. Emanuel takes the healthcare insurance industry’s bottom line literally, while ignoring the financial facts.

“Last year, health insurance companies did rack up big profits, but it turns out that the combined profits of the country’s five largest for-profit health insurance companies — United, WellPoint, Aetna, Humana and Cigna — were $11.7 billion, only 0.5 percent of total health care spending.”

“Even confiscating every penny of those profits would add up to less than half of the cost-saving threshold. And even not-for-profit insurance companies need to have an operating margin — a profit by another name. There just isn’t enough money there to make a dent in health care spending.

Dr. Emanuel’s obvious conclusion is $11.7 billion profit is not meaningful. It should not be considered to influence the total cost of healthcare or future healthcare policy.

“ A useful threshold for savings is 1 percent of costs, which comes to $26 billion a year. Anything less is simply not meaningful.”

He says .

Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable is meaningless. In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

The bottom line figure after expenses might be published as only $11.7 billion dollars but the real profits are buried into the profit built into the administrative expenses that do not get added into the bottom line.

The truth is,

Over 20 percent of consumers who purchase coverage in the individual market today are in plans that spend more than 30 cents of every premium dollar on administrative costs.

An additional 25 percent of consumers in this market are in plans that spend between 25 and 30 cents of every premium dollar on administrative costs.

And in some extreme cases, insurance plans spend more than 50 percent of every premium dollar on administrative costs.

President Obama thinks his law will decrease these expenses. The public has also been lead to believe that Medicare’s administrative overhead is 2.5%. The 2.5% is the overhead to maintain a CMS department outsourcing administration services to the healthcare insurance industry and generating new regulations.

The percentage of overhead has to be higher much higher now with the development of Dr. Berwick’s bloated bureaucracy.

CMS outsources its administrative services to the healthcare insurance industry. The healthcare insurance industry adds an additional 20-30% to the bid price for services claims.

A large administrative service provider (Trailblazers) in Texas was just outbid for its administrative services by an east coast administrative service provider (Highmark) confirming the bid pricing mechanism.

Strangely, both Trailblazers and Highmark are subsidiaries of Blue Cross/ Blue Shield. This is the place that 20-30% is taken off the top of the Medicaid and Medicare budget and is not included in the bottom line.

The healthcare insurance industry is required to maintain the Medical-Loss Ratio at 80-85%. Medical Loss Ratio means it has to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement rather than on administrative costs.

Healthcare insurance companies have been permitted, by the government, through the influence of its lobbyists, to shift certain expenses from administrative expenses into the patient care expenses. The result is less money spent on direct patient care.

The cost of verifying the credentials of doctors in its networks.

These expenses are designated as direct patient care expenses. Each expense is a profit center. This profit is not reflected in the healthcare insurance company’s bottom line. These are the reasons the net income figures are bogus.

Aetna made $4.8 billion dollars in profit on Medicare Advantage and Medicare Part D alone two years ago.

“Citigroup research group estimates that presently the overall healthcare insurance industry’s net profit is about $56.5 billion per year. The addition of 16 million enrollees will add $40 billion dollars in net profit to the healthcare insurance industry’s bottom line.”

“Gail Boudreaux, UnitedHealth's executive vice president, told investors last month that: "The Medicaid space is a significant long-term growth opportunity for us. It's a big market that's getting even bigger." UnitedHealth pegs the value of new bids or expansions over the next three years at $40 billion.”

The net profit of $11.9 billion dollars is a bogus figure. Dr. Emanuel has to know this. The healthcare insurance industry is cooking its books.

President Obama and his administrative advisors are pretending to believe the numbers produced by the healthcare industry.

The administration in turn is using the media and its power of the pulpit to convince the public to believe it.

The bizarre thing is that the scheme is working as reflected in the comments to Dr. Emanuel’s article.

This is disinformation are its best.

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

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EMR • November 22, 2011

I think they are always going to try and find way to go aroudn the system or the law and create loopholes to make it legal for them to do this to us. That figure is insane. If they were less greedy we wouldn’t have the economical problems we have now.
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American Censorship Day: Administration’s Double Speak

November 16, 2011

inStakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

A reader wrote in response to my blog Disinformation Compliments Of The New York Times.

His comment fits in perfectly with today’s protest American Censorship Day.

“2500 years ago the Father of Strategy said:

“Today’s battles are information battles because information shapes both perception and opinion. Those who use it to both attack and defend will win, those who do not will lose.” Sun Tzu

"With the media’s help (and others who supported this man without doing their homework) we are at a strategic disadvantage. It’s why I wrote my book in mathematical terms not political terms. There is no arguing math. It is objective."

"Have a good day Dr. Feld.”

Occasionally I look at the Daily Kos. Today, November 16, I looked at the Internet newspaper because I wanted to see what they had to say about American Censorship Day.

The Daily Kos nailed it. They also included a You Tube of Joe Biden defending the freedoms and the need for not censoring the Internet.

“There are a couple of bills (like PROTECT IP) coursing through Congress that if enacted threaten the entire Internet only to protect outmoded business models of the movie and music industries.

One particularly pernicious example is the Stop Online Piracy Act which would require the US government to do their or any supposed "rightsholder's" bidding to shut down foreign "rogue" sites. The truth is that it would also shut down US sites like Twitter and YouTube and including the DailyKos – (that means you, too) if found in violation of Hollywood's whims the SOPA provisions. It even threatens to shut down and blacklist ISPs who don't cooperate.”

These two bills play right into President Obama’s goal to control information. At the same time V.P. Joe Biden is talking about maintain the Internet free from censorship.

If this is intentional it is a neat way to keep the public confused.

The Daily Kos goes on to say,

“The bills are opposed by big Internet companies like Google, Facebook, Yahoo!, eBay, Twitter, LinkedIn, Zynga and others. Even VP Joe Biden has spoken out against it (although not directly and only until he is for it – coming soon!):”

Joe Bidden statement on censorship of the Internet.

http://www.youtube.com/watch?feature=player_embedded&v=55mKLcWhr9E

The New York Times finally published an editorial opposing the bill with politically correct qualifications.

“The intention is not the same as China’s Great Firewall, a nationwide system of Web censorship, but the practical effect could be similar.”

Let us see how long it takes to get Joe Biden in sync with the administration’s goal.

Why doesn’t President Obama weigh in on the issue?

Where is the outrage from the Republican Party leadership in the House and the Senate about these bills?

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

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The Government and American Censorship: 1984 In 2011.

November 15, 2011

inStakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I was going to continue to describe how the New York Times, through Ezekiel Emanuel, has fed the American public disinformation about the healthcare system to manipulate their opinions.

I decided that talking about American Censorship Day November 16^th is more important.

I became aware of two bills flying through the Senate and the House by reading my son Brad Feld’s blog. The bills are Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261).

I searched the New York Times to see what the newspaper that (Prints all the news fit to Print”) had to say about the bills. My search produced this reply.

Your search – Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261). – did not match any documents under All Results Since 1851.

I have tried to get Brad excited about the lunacy of Obamacare. He has not been interested in how Obamacare will ration care, restrict access to medical care, and restrict our freedom to choose and make our own healthcare decisions.

These two bills restricting the Internet lit his wick. It also lit Fred Wilson’s wick. I hope is it wakes everyone up. We must get past this centralized government manipulation and fight for our freedoms.

Congress restricting the freedoms of the Internet is just another example in President Obama’s goal to have government control all of our decisions and actions. It will serve to restrict our freedoms.

The most vital part of our economy and job growth at the moment is the Internet. These two bills will destroy this monumental jobs creating machine.

It is another piece of lunacy brought to you by our federal government. I wonder how many Representatives and Senators have read the bills.

“There are two very disturbing bills making their way through Congress: These bills are coated in rhetoric that I find disgusting since at their core they are online censorship bills. It’s incredible to me that Congress would take seriously anything that censors the Internet and the American public but in the last few weeks PIPA and SOPA have burst forth with incredibly momentum, largely being underwritten by large media companies and their lobbyists.”

Let me remind everyone that large media companies offer huge support to President Obama and the Democrats in congress. These bills are congruent with the large antiquated medias’ vested interest and President Obama’s goal of central control over our lives.

EFF, Free Software Foundation, Public Knowledge, Progress, Fight, Participatory Politics Foundation, and Creative Commons in support of free speech and a free and open Internet are opposing the bills and have organized American Censorship Day for tomorrow (11/16/11). The goal is to make every American aware of this new trick play and stop this lunacy.

This Video video does a great job in explaining the two bills potential primary and secondary impact. I do not believe our congressional representatives understand the impact of the bills.

Someone is trying to railroad passage through congress.

PROTECT IP Act Breaks The Internet from Fight for the Future on Vimeo.

If you run a website, have a blog, or are interested in protecting our freedom go to the American Censorship site to see how you can participate on 11/16/11.

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

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Florence Hill • December 26, 2012

The bill that stops online privacy could never be a bill that protects us. Instead, it hinders our freedom of expression and the privacy given to us when we were born is now taken back from us just because of the crimes happening on the internet. The government should think of something that is more appropriate than stopping us from expressing ourselves.
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Disinformation Compliments Of The New York Times

November 13, 2011

inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

If you want to have an accurate opinion you should have accurate facts.

Lately, the New York Times has been publishing opinion articles, in the name of truth, by experts who give opinions based on inaccurate facts.

The danger is that government policy based on those opinions is wrong and will lead to unintended consequences.

Ezekiel Emanuel M.D. published such an article in his weekly opinionator blog on November 3^rd,2011.

I will review the facts used by Dr. Emanuel to form his opinion.

“Everyone — conservative and liberal — agrees that $2.6 trillion a year is too much to spend on health care, and that we have to cut costs. But they don’t agree on who is to blame or what is to be done.”

I agree.

He proposes an artificial threshold of significant costs saving in order to form a policy.

“ A useful threshold for savings is 1 percent of costs, which comes to $26 billion a year. Anything less is simply not meaningful.”

This number is random. It permits him to dismiss problems that cost the healthcare system less than $26 billion dollars a year.

He defines the divide between conservatives’ and liberals’ opinions.

He states that conservatives are concerned about the cost of tort reform. Liberals are concerned about the profits of the healthcare insurance industry and drug industry. Using the wrong data to prove his point he concludes that these issues are simply a distraction from the real efforts of controlling healthcare costs.

Nothing could be further from the truth.

Today, I will concentrate on examining his evidence against the need for tort reform.

“ Conservatives favorite fix is to reform medical malpractice by limiting noneconomic damages, statutes of limitation and lawyers’ fees. In its favor is the fact that doctors’ fear of medical malpractice lawsuits is legitimate.

According to a recent study in the New England Journal of Medicine, about 7.4 percent of doctors get sued each year. By age 65, even those in “low risk specialties” like pediatrics and dermatology face a 75 percent chance of being sued.

His argument continues by saying,

It’s no wonder doctors order M.R.I.’s for routine headaches and monthly ultrasounds for normal pregnancies, despite these procedures not being required or recommended by professional guidelines.

His second argument against tort reform is the Congressional Budget Office 2009 scoring of the cost impact of tort reform.

“In 2009, the Congressional Budget Office did a comprehensive assessment of the potential cost savings from medical malpractice reforms.

Its conclusions: A package that included a $250,000 cap on noneconomic damages, a $500,000 cap on punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year — 40 percent from reduced malpractice premiums and the rest in the form of fewer defensive procedures like M.R.I.’s.

Dr. Emanuel concluded that $11 billion dollars a year savings is insignificant because it is a cost saving below $26 billion dollars a year. He contends tort reform is a distraction from real efforts to control healthcare costs and should be ignored. The CBO scoring information has lead Dr. Emanuel to an inaccurate opinion.

The CBO did not score all the necessary data to arrive at the accurate cost savings from tort reform.

“A full accounting of medical malpractice reforms shows the benefits would be $242 billion a year.”

The CBO assessment is a gross underestimate of the potential cost savings. President Obama and the Democrats provided the CBO with scoring data. The data given was intended to give cover to congressional Democrats who say malpractice-liability costs are trifling.

The truth is a full accounting reveals that more than 10 percent of America's health expenditures per year are spend on tort liability and defensive medicine.

The percentage of healthcare costs is even greater when the Massachusetts Medical Society survey is taken into account. The amount spent for defensive medicine can be extrapolated to actual costs from this survey.

I have written a series of blogs analyzing the impact Massachusetts Medical Society’s survey. The extrapolated costs turn out to be about $700 billion dollars a year. The real cost of defensive medicine is somewhere between $242 and $700 billion dollars a year.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

In 2008 damage awards alone for medical malpractice claims reached $5.9 billion dollars. The total of medical tort costs was $16 billion for legal costs, underwriting costs and administrative expenses. From 1986 the average jury award was $100,000. In 2006 the average award increased to $637,000. No one knows what the award value is for cases settled out of court.

Each year, 25% of practicing physicians are sued. 90% of physician sued are found innocent. The average defense cost is $100,000. This cost is not included in the CBO scoring

The fear of lawsuits causes most doctors to practice "defensive medicine" as the interviews of Massachusetts physicians points out. The result is unnecessary testing, referrals, and procedures to protect themselves from allegations of medical negligence.

A recent survey of doctors published in the Journal of the American Medical Association found that 93% of physicians admit to practicing defensive medicine. A 2008 survey by the Massachusetts Medical Society found that about 25 % of medical procedures are defensive in nature.

This waste results in increased healthcare insurance premiums. The premium increases result in an increase of at least 3 million uninsured people per year. When these uninsured people get sick they avoid going to a physician. This results in a decrease in work productivity. It is estimated that the annual decrease in productivity is more than $40 billion dollars a year.

In states where tort reform has been instituted by placing caps on so-called non-economic damages, the malpractice costs have decreased 39%. This drop in costs is a result of decreased malpractice suits. The decrease is economically bad for the plaintiff attorneys. Annual malpractice premiums have gone down at least 13%. In fact, the medical malpractice business for plaintiff attorneys has about dried up in Texas.

As a result of tort reform in Texas, more than 16,500 physicians have moved to the state from non-tort reform states. More than 430,000 additional Texas have healthcare insurance as a result of the tort reforms according to the Perryman group.

Senate Majority Leader Harry Reid, a Nevada Democrat, claims: "The whole premise of a medical malpractice 'crisis' is unfounded." Harry Reid listens to Dr. Ezekiel Emanuel’s opinion.

The influence of the disinformation is terrifying. Inaccurate opinions by influential people will never lead to a functional, affordable healthcare system.

The disinformation concerning healthcare insurance company profits and drug company profits will be discussed shortly.

The New York Times needs a fact checker.

In my view it is irresponsible of President Obama and his advisors to distort the truth with disinformation.

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

Please send the blog to a friend

Private Investigator NYC • November 22, 2011

Reading a long and full of information article like this one are still one of the best way to improve knowledge.
EMR • November 27, 2011

I dont think anyone really knows all of the information, bills, side notes and loop holes in these bills. No one really knows the whole story.
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Our Sound Bite Society. Cain vs. Gingrich Debate

November 9, 2011

inInformation Technology in Healthcare, Innovations in Healthcare, Medicaid, Medicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

I missed the Cain vs. Gingrich debate on November 5^th because it was not well publicized by the traditional media. I watched the debate on the Internet on November 9^th.

All I have heard from President Obama’s special joint session of congress speech is you must pass this jobs bill right away. I did not hear any solutions to America’s complicated structural problems.

There is little mention that his American Jobs Act is a $450 billion dollar stimulus package adding to the previous one trillion dollar stimulus package that did not work. President Obama also said it will not cost the American public a dime.

On the other hand, Herman Cain and Newt Gingrich had a riveting 81 minutes debate discussing in detail what should be done about Medicare, Social Security, Medicaid, and jobs.

It was a truly remarkable debate. The three minutes response limitation on the candidates was suspended in the first three minutes.

Clear, concise and detailed explanations of each candidate’s positions were given. Both candidates were entertaining and serious. They treated Americans as intelligent humans who can make decisions for themselves once they understand the issues.

Their goal was to educate the people.

This Internet video is very worthwhile watching. It explains, why in their opinion, central government solutions have not worked. They explain what has worked in the past and what needs to be done to solve America’s problems.

All the traditional media said about the debate in the press is Gingrich won. There was no discussion of the details of the debate.

There was not one “got ya” question or response during the debate.

In my opinion neither candidate won the debate. The viewing American public won. Please watch this debate. It will not be a waste of time.

Our nation needs more of these frank discussions to educate the public about the problems we have and potential solutions to the problems.

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

EMR • November 22, 2011

the new bill is huge and a lot of factors need to be considered before anyone can make an intelligent decision. Too bad noone fully knows the whole bill
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