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They Are Getting There

July 27, 2017

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Stanley Feld M.D.,FACP, MACE

As Obamacare implodes, President Trump is trying to get a Republican congress to repeal and replace Obamacare in an orderly fashion with a minimum of disruption to the present healthcare system.

The Republican establishment in congress is trying to disrupt his goal. All the Democrats are going to stonewall him.

Republicans won both houses of congress because they promised to repeal and replace Obamacare. They had seven years to create a plan. They have failed to achieve a consensus in the Republican caucus.

Democrats are starting to talk about making it easy. They are suggesting congress replacing Obamacare with a government run single party payer healthcare system.

You may recall President Obama told John Kerry and Barney Frank that America would get to a single party healthcare system via Obamacare. He told them not to worry.

The reality of the situation is America is inching its way to a universal single party payer healthcare system.

Medicaid, Medicare and the VA system are already single party payer systems. Each one of these programs has been declared unsustainable.

It is incomprehensible to me that the Republican politicians who the American people elected in good faith are not hearing their complaints

Presently 41.5% of the population is in one of these single party payer healthcare plans. 49% of Americans pay no taxes. This means that 51% of Americans are paying the healthcare bill for 49% who do not pay taxes.

This is the redistribution of wealth that Dr. Donald Berwick said was essential in America.

If fact many of the 49% receive additional monies from the government such as food stamps, free mobile telephone service and free housing.

America is on its way to European socialism, This ideological system has failed in Europe.

The following calculation is how I came up with the percentage of Americans that are in an entitlement healthcare system. I use U.S. agency census data.

“The current population of the United States of America is 326,613,397 as of Monday, July 24, 2017, based on the latest United Nations estimates.”

9 %of the population is urban (270,683,202 people in 2017)
The median agein the United States is 1 years.

hfo/world-population/us-population/

The chart below displays the total number of individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in the current month (April 2017) and the period prior to the start of first Marketplace open enrollment period or “baseline” period (July – Sept. 2013).

The current enrollment is obviously post Obamacare.

*Month*	*Expansion States*	*Non-Expansion States*	*Total*
Baseline July-Sept 2013 (Monthly Average) (49 states)	37,069,415	19,733,676	56,803,091
Apr 2017 (preliminary) (51 states)	52,058,495	22,472,507	74,531,002

Medicaid and Chip increased by 22,472,507 since the onset September 2013.

74,531,002/326,613,397 equals 22.81% of the population is on Medicaid so far.

Medicare enrollment is lower than present Medicaid enrollment. As of May 2017, 37,976,052 are on original Medicare and 20,089,220 are on Medicare Advantage or others Medicare plans for a total of 58,065,272 on this single party payer entitlement.

Medicare is an entitlement program with high premiums. The premiums are means tested. People in the upper tax brackets pay over $18,000 a year in after tax dollars premiums for Part B, Part D and Part F.

The people in lower tax brackets pay less. The premium deduction for Part B is taken out of their monthly Social Security check. This creates a burden on their standard of living.

The additional 58,065,272 to the 74,531,002 bring the total percentage of the population on a single payer healthcare system to 40.6%.

(132,596,274/326,613,397= 40.6%)

If the VA healthcare system enrollees are added to the analysis of the number enrollees to a government run single party payer healthcare system the percentages increase.

In Fiscal Year 2014 the total veteran population was 21,619,731. 9,111,955 veterans were enrolled. 6,616,963 veterans used the VA Hospital System. The VA System brings the total number enrollees in a single party payer system to 133,508,229 or 40.9%

9,111,955 + 132,596,274= 133,508,229

133,508,229/326,613,397= 40.87%

https://fas.org/sgp/crs/misc/R43579.pdf

The IHS provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who belong to 567 federally recognized tribes in 36 states.

https://www.ihs.gov/aboutihs/

133,508,229+2,200,000= 135,708,229

135,708,229/326,613,397= 41.5%

41.5% of the American population is already in a government controlled single party payer healthcare system. President Obama was right. He promised he would get there

Barney Frank and John Kerry did not have to worry. The only problem is that Obamacare is collapsing because it is unsustainable.

It is a pity is Republicans cannot agree to an innovative plan to repeal and replace Obamacare. Maybe the Republican want to have control over the healthcare system and deny Americans their freedoms.

The Democrats don’t care about the welfare and freedoms of Americans or the fiscal health of the nation.

Something needs to be done about this madness now.

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

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The Republican Establishment’s Failure

July 20, 2017

inChronic Disese Management, Consumer Driven Health Care, Medicaid, Medicine: Healthcare System

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Stanley Feld M.D.,FACP, MACE

I am coming to the conclusion that the Republican establishment does not want to Repair the Healthcare System.

The Republican establishment has the same goal as the Democratic establishment.

Recently the mainstream media is saying that a single party payer system is looking good.

Neither party has any interest is having consumers control their healthcare dollars. It looks as if both parties want the government to control the consumer’s healthcare dollars.

All the politicians ignore the fact that government control is unaffordable. It also ends up not working.

The best example is the bureaucratic VA Hospital System and its system wide corruption.

A reader wrote:

“I have read your last blog post carefully and agree with many of the points put forward but there is a glaring omission.”

“How are patients supposed to be responsible for their healthcare dollars when there is absolutely no transparency and no consistency in pricing.”

The lack of transparency is a major defect in our present healthcare system.

Only 20% of consumers use the healthcare system at any one time. Eighty percent of the consumers have not run into the lack of transparency problem in the healthcare system.

Most consumers do not care about transparency because they have first dollar coverage provided by their employer. They think their medical care is free. They believe they have excellent healthcare insurance.

President Obama took care of that notion with Obamacare. The defective structure of Obamacare caused healthcare insurance premiums and deductibles to skyrocket. First dollar healthcare insurance became too expensive for most employers.

Employers stopped providing first dollar coverage. Middle class employees are now noticing that out of pocket expenses have made their healthcare insurance unaffordable. Consumers have tried to compare prices of competitive providers. They have discovered that it is impossible!

Consumers are becoming aware of the lack of transparency. They have been astonished by this lack of transparency.

There is nothing in the new Republican bill that addresses Republican politicians’ awareness that the lack of transparency is a major defect in the healthcare system.

The lack of transparency is only one of the major defects in our healthcare system.

There is nothing in the Republican bill that speaks to the consumers’ responsibility for their health and healthcare dollars. Consumer driven healthcare is completely ignored.

There is nothing in the bill that addresses effective tort reform. The Massachusetts Medical Society survey showed that defensive testing to avoid lawsuits costs the healthcare system between $250 billion to $700 billion dollars a year.

The lack of the development of systems of care for chronic diseases cost another $700 billion dollars a year that our healthcare system does not address. There is nothing in the bill that emphasizes this very important defect in the healthcare system.

The Republican establishment thinks consumers are too stupid to take care of themselves.

The mainstream media likes to tell us that people love entitlements. The public does not want to give up these entitlements.

My question is how come less than 9 million people signed up for Obamacare’s individual healthcare plans last year if they love entitlements?

It is because they cannot afford to buy the health exchange insurance even though 85% of the premiums of those 9 million consumers are subsided by the government. Their high deductibles are not subsidized.

The Republicans are going claim they are promoting health savings accounts. The public is not told the amount of money they can put into a health savings account or whether it will provide first dollar coverage over that amount if they get sick.

There is no financial incentive for consumers to be responsible for their healthcare or their healthcare dollars.

My Ideal Medical Saving Account is a much better idea.

These are only a few of the major defects in the Republican establishment’s concept to fix the healthcare system.

President Obama did some of the awful things to Obamacare through rules and regulations after certain vested interests complained about the law. Obamacare’s rules and regulations have to be eliminated

There were crony waivers that would make one’s blood boil. In fact, elected congressional members got the best exemptions.

It is becoming apparent that congress doesn’t want to fix the healthcare system for the majority of Americans. The congressional establishment wants to control consumers.

Socialism does not work!

Our political establishment does not tell us about the economic result in other countrys’ single party payer universal healthcare systems.

We don’t have to go to other countries. We only have to go to the indigent areas in California were everyone is covered by Medicaid.

The Republican establishment needs to get off the stick before all of them are kicked out of congress.

Just imagine the healthcare systems savings if every consumer were empowered to shop for the best healthcare at the best price.

The result would be a free market healthcare system in which competition would cleanse the system and make it affordable to everyone.

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

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How Can I Be So Misinterpreted?

July 13, 2017

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

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Stanley Feld M.D., FACP, MACE

A reader sent me the following comments.

“Sorry Doc,

I like and Highly respect you, but You are Wrong:

 My Ideal Medical Savings Account is essential. OK BUT WHAT ABOUT THOSE THAT LITERALLY LIVE PAYCHECK TO PAYCHECK??? How are these Americans going to start and contribute to MEDICAL SAVING ACCT?

Patients must be responsible for their care and healthcare dollars. WHAT ABOUT THOSE CHILDREN AND SENIORS DISABLED—-HOW WILL THEY DO SUCH?”

This reader has misinterpreted my post entitled “My Ideal Medical Savings Account Is Democratic!”

There are many problems with the healthcare system. It has become unaffordable and inaccessible. The expansion of entitlement programs usually makes the problems in the healthcare system worse.

Healthcare policies should be introduced to solve problems in the healthcare system and not expand them.

Innovative systems and software need to be developed to fix the problems. Just think of the revolutionary way the IPhone changed the way we communicate in the last ten years.

Our healthcare system can be changed in a way that promotes free choice, improves the quality of care and reduces costs.

Our healthcare system has become unaffordable and unworkable for many of its stakeholders. The most important stakeholder is the patient.

This reader has misinterpreted my arguments in favor of My Ideal Medical Savings Account.

The expansions of entitlements has proven to be unaffordable and ineffective in the past.

In the present Republican healthcare bill to repeal and replace Obamacare people who live from paycheck to paycheck will be eligible for a tax credit that is paid to them in advance. This will allow them to have money to pay for their Medical Saving Account.

If the government subsidizes consumers in this way consumers will not only have the money to pay for their medical care they will also have first dollar coverage above the deductible amount provided by the tax credit.

My Ideal Medical Saving Account convert indigent patients from a complete entitlement program (Medicaid) toward a system where patients would be responsible for their care. Patients would try to conserve their healthcare dollars.

If indigent patients save money on their healthcare coverage they will receive the unspent money in a retirement trust account.

Consumers will have the incentive to stay healthy or be treated appropriately and not overuse the healthcare system. This is the way to My Ideal Medical Savings Account can apply to the indigent and consumers of all income levels.

Essential to Medical Savings Accounts are all prices must be transparent. This is where effective software comes in.

The definition of a tax credit in this context is different than applying a tax credit to income earned. If a consumer is eligible to receive a tax credit he receives the money directly from the government to pay for his Medical Saving Account.

The positive effect to the healthcare system is that if the individuals take good care of themselves and are responsible for their health and healthcare and their healthcare dollars they will not end up in the Emergency Room or hospital and spend a lot of their deductible money.

They will have money left from the tax credit given to them by the government. The money is their money and will go directly into a retirement trust fund. The leftover money is not saved to be spent on future healthcare needs.

This financial incentive will keep the cost down for consumers and the healthcare system.

Please read my blog “My Ideal Medical Saving Accounts Are Democratic” carefully.

In the Medicaid entitlement program for the indigent and disabled consumers do not have a financial incentive to be responsible for their health and healthcare dollars. With Medical Savings Accounts there is a financial incentive for consumers to be responsible for their health and healthcare dollars.

“The Ideal Electronic Medical Record is essential. YES BUT SOME CAN BE HACKED SO HOW EFFECTIVE WOULD IT BE?”

When going to a Clinic or hospital consumers automatically sign a consent form for the release of medical records. When buying a healthcare insurance policy consumer sign a similar release of medical records form.

Medical records are not as private as we all would like them to be.

It is the Ideal Electronic Medical Record’s software developer who is responsible for developing medical records that cannot be hacked. Americans have been cautioned about computer privacy since 1980. The problem has not been solved yet.

Most of the electronic medical records that are bought by physician offices and hospital systems are from private vendors. The software is expensive and cannot do everything it is supposed to do including protecting the patient’s privacy rights.

The ideal medical record should provide an educational experience to physicians. Presently the software available does not do this.

The EMRs provide a surveillance tool for the government and the insurance companies to judge patient care.

The government should build an un-hackable software system that resides the cloud. Physicians and hospitals should pay for it by the click. It should provide an educational experience for physicians in order to improve patient care. It should not be used as a punitive tool

We have been told over the years that the VA Hospital System has an excellent EMR. Why is the VA Hospital System switching to Cerner’s EMR? Cerner’s EMR has all the defects of commercial EMRs

Cerner’s EMR is not an Ideal Electronic Medical Record. The company probably obtained the government contract because of its political connections.

“Patient education must be an extension of their physicians’ care. ABSOLUTELY BUT IN ENGLISH NOT MED TERMS!”

This is the reason the healthcare system must be consumer driven with community social networking.

If a physician does not satisfy the community he practices in, consumers will know about it quickly through community social networking. They will then have the choice not to use that physician.

If the government, healthcare insurance companies and physicians will not provide the necessary transparency in the system, consumers must.

“A team approach to chronic disease management must be adopted with the patients becoming the professor of their disease.”

AHH But When a patient Tries to Educate themselves on Such—THE INTERNET HONESTLY HAS CONTRADICTING INFO!

I KNOW THIS ONE PERSONALLY AS I HAVE BEEN RESEARCHING FOODS AND INFO ON HIGH CREATININE LEVELS!

MY CREATININE LEVELS ARE HIGHER THAN NORMAL, but there is so much Contradictory Info out there—

-I.E. Should I EAT UNSALTED NUTS OR NOT EAT NUTS> SHOULD I EAT BLAND WHITE BREADS OR THE MORE HEALTHFUL MULTI GRAIN AND WHEAT BREADS!!! And Should I consume Lean Meats and Poultry or NOT! Some say yes, others say No!

Patients’ cannot educate themselves by solely using the Internet. The educational process has to be through their physician and his healthcare team’s selected Internet sites.

The team should pick the Internet resources it wants the patient to use. The appropriately chosen Internet sites should be used as an extension of the physician’s care. Consumers should be confident of the information source picked by their physician and his healthcare team. It will also enhance the physician patient relationship

“Hence on some of the issues you wrote I slightly agree with, but over all you fail to consider the Poorer Americans and that not all Americans have intelligence to research or are too disabled to RESEARCH!”

I believe that everyone should be responsible for his or her medical care and medical education. Ever the poorest people can be responsible for their care and can be educate.

Many social agencies exist to help poor people be responsible for themselves.

Individual responsibility and initiative is the principle that has made America great. If a person is not capable of being responsible for himself, artificial intelligence systems could be developed to help this very small percentage of the population survive and thrive.

Entitlements and dependence on the central government by all is what President Obama wanted. It simply results in more debt and a weaker society.

There are many problems in our society. We have to start somewhere with good ideas to invigorate all levels of society.

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

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Better Care Reconciliation Act (BCRA)

June 29, 2017

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

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Stanley Feld M.D.,FACP,MACE

It looks like the Senate is making a mess out of its version (BCRA) of repeal and replace Obamacare.

My first reaction was that Better Care Reconciliation Act is a stupid name for a bill to repeal and replace Obamacare.

I have not heard a single specific criticism of BCRA by the Democratic leadership.

Nancy Pelosi said the bill will kill hundred of thousands of people. Hillary Clinton said it was a death bill. Chuck Schumer told the American people it is a terrible bill and leave millions uninsured. They all said it is going to make the rich richer and the poor poorer.

The evidence for these statements has not been presented.

Democrats have used these scare tactics so often that no one believes them anymore.

Americans are smarter than that.

Republicans have not explained the strategy behind BCRA in making the healthcare system better than Obamacare either.

All I have heard from President Trump is that it is a beautiful bill. It will make our healthcare system great.

If no one understands BCRA how can a media driven public poll with a 17% approval rate have any meaning?

The survey of public opinion is meaningless.

At present Obamacare has left 26 million uninsured and rising. It has only insured less than ten million people in the individual market.

Obamacare is also unaffordable. The deductibles are as high as $6500 before any insurance kicks in. People who buy the insurance have no insurance until they spend more than $6500.

I don’t understand the Senate Republicans who want a perfect conservative bill. They are not going to get it. They will yield the floor to the minority Democrats.

The turkey buzzards are circling the corpse already. The corpse being Obamacare and the Republican replacement

Elizabeth Warren said we must go to the next steps which is a single party payer system now.

I believe Obamacare is going to self-destruct in 2018 if nothing is passed immediately.

The choice for the Republicans who are oppose compromise and the passing of BCRA is clear to me.

Either the Republicans pass this bill and have a chance for a free market healthcare system or reject it and end up with a failed Obamacare healthcare system.

Everyone knows the replacement for a failed Obamacare system is a single party payer system just like the VA Healthcare System.

A single party payer system will be an unaffordable disaster.

I will not comment on the specifics of the Better Care Reconciliation Act (BCRA) except to say it is not perfect.

Let us see if it passes and what form takes. I will make some comments at that time.

President Trump needs BCRA to pass in order to make significant inroads in reforming the tax code.

I would be a pity if his fellow Republicans tied his hand on significant tax reform to simplify the tax code.

My hope is that Tom Price knows how to fix the healthcare system once the house and senate agree on specifics of the bill in conference.

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

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It Is All about How You Look At Things

June 22, 2017

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System

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Stanley Feld M.D.,FACP,MACE

Brad Feld responded to my blog “How Software Innovation Can Cause Creative Transformation Of The Dysfunctional

Healthcare System”.

“Brad Feld”

www.feld.com

“Brad Feld has been an early stage investor and entrepreneur since 1987. Prior to co-founding Foundry Group, he co-founded Mobius Venture Capital and, prior to that, founded Intensity Ventures. Brad is also a co-founder of Techstars.

In addition to his investing efforts, Brad is active with several non-profit organizations. He currently is chair of the National Center for Women & Information Technology and the Global EIR Coalition and is on the boards of Path Forward, the Kauffman Fellows, and Defy Ventures.

Brad is a writer and speaker on the topics of venture capital investing and entrepreneurship. He’s written a number of books as part of the Startup Revolution series and writes the blogs Feld Thoughts and Venture Deals.

Brad holds Bachelor of Science and Master of Science degrees in Management Science from the Massachusetts Institute of Technology. Brad is also an art collector and long-distance runner. He has completed 24 marathons as part of his mission to finish a marathon in each of the 50 states.”

Brad is an innovative thinker.

This is what he wrote;

“Outstanding blog post dad.

And I think your punch line is completely correct – the healthcare software

innovators should focus 100% of their energy on the patient and the

physician (their customer). That would quickly transform everything in the

healthcare supply chain.

Can you imagine what would happen if the government subsidized Borders

and Barnes and Noble?

Yup – pretty easy to see that they would be doing fine. Bookstores would be classified as a public good.

What nonsense.”

I think common sense, clear thinking and innovative software can solve a lot of the healthcare system’s problems. I don’t think the Senate Republicans are thinking clearly or using common sense in attempting to revise the house healthcare bill.

Healthcare policy makers are trying to reform healthcare by using a business model destined to fail.

The healthcare business model of 1945 to 1965 was a model that put patients and physicians at the center of care. It worked.

In 1965 government policy makers were trying to do a good deed. Their policies started the healthcare system on the slippery slope to destruction.

The government poured money into the healthcare system and patients and physician were no longer at the center of the healthcare system. The secondary stakeholders began to devise ways of taking a large percentage of that government money out to the healthcare system.

They learned to take money that was supposed to be paid for direct patient care out of the healthcare system. In the name of patient care they were permitted by the government to take business expenses off the top.

The relationship between patients and physicians has been destroyed in the process.

The vested interests of secondary stakeholders have taken over and direct healthcare policy. The patients and the physicians are no longer the primary stakeholders in the healthcare system.

The primary customer in the healthcare system should be the patient. Patients’ physicians’ are their primary surrogates.

Well-intended policy makers have tried to fix the system by making revisions and updates to the broken business model.

Their revisions only made the healthcare system more expensive and less effective for the care of patients.

The 2011 Obama business model is a jumble. The secondary stakeholders control the healthcare system. The secondary stakeholders destroyed the patient/physician relationship.

President Obama’s healthcare reform law has made the healthcare system worse than it was pre-Obamacare. Obamacare is a failed business model.

Obamacare does not consider a way to get back to the patient/physician relationship.

It reminds me of the Microsoft operating system. Microsoft has patched upgrades on top of the DOS operating system of the 1980s rather than revising the operating system.

Obamacare has added complexity to the system. It introduced many ideas that have turned out to be bad ideas for the culture that was in place. The execution of these ideas were worse.

One is Accountable Care Organizations. Another is pay for performance rules.

Obamacare does not deal with tort reform. It does not deal with patient responsibility for their own care and their own healthcare dollars.

Obamacare creates a healthcare system that makes consumers more dependent on the government.

Obamacare gives secondary stakeholders (government, the healthcare insurance industry and pharmaceutical companies) increased control over consumers and their freedom to make their own healthcare decisions.

The critical turn in healthcare policy thinking is essential.

The 2020 business model of Obamacare will result in an increase in the velocity of the healthcare system’s collapse.

The result will be an increased budget deficit. Healthcare spending can escalate to 100% of the GDP in less than 20 years.

*At this critical point we must turn to a sustainable state for the healthcare system.

The business model must be changed. The new business model must be unrestrained by the present business model.

This is where software innovation comes in.

Software must be developed that redirects the model to a consumer driven healthcare system.

It must be controlled by consumer choice, responsibility and actions. Consumers must also control their healthcare dollars. Legislation must be written to provide consumers with choice, responsibility, and incentives to be responsible for their care.

Consumers are the only ones that can demand this option.

Consumers must change the course of the healthcare system.

The secondary stakeholders will not give up their power easily. The release of their power will only come as a result of the Internet and innovative software development that teaches consumers how to utilize their power.

Steve Jobs did it with iTunes, iPods, iPhones and iPad. He transformed the music publishing industry through the use of iTunes.

Jeff Bezo did it with Amazon and the book publishing industry. He has extended his software model to the retailing industry. He is about to extend it to the food distribution industry.

To transform the healthcare system, medicine needs software developers and healthcare policy innovators who understand the practice of medicine.

CEO’s of large corporations and small businesses must think about the future state without government restrictions.

The 2020 medical business model in the future state must have the following components:.

My Ideal Medical Savings Account is essential.

The Ideal Electronic Medical Record is essential.

Patients must be responsible for their care and healthcare dollars.

Patient education must be an extension of their physicians’ care.

A team approach to chronic disease management must be adopted with the patients becoming the professor of their disease.

Patients must become the team leader. Physicians must be coaches with their healthcare team as assistant coaches,

Tort Reform must eliminate defensive medicine,

Specialty care must be integrated with primary care.

All of these components must be attributes of a reformed healthcare system. These attributes must be executed and included in the healthcare system at the same time.

Consumers must be taught to drive the healthcare system.

Skeptics who are trying to hold on to power and protect the validity of past policies will fight hard just as the music industry and the publishing industry did.

All of the secondary stakeholders in the healthcare industry will thrive, as the patient/ physician relationships will once again will be revitalized.

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

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Senate Republicans Are Making Repeal and Replace Harder Than It Should Be

June 14, 2017

inDisinformation and the healthcare system, EMR, Health Savings Accounts vs Medical Savings Accounts, Innovations in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.

It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.

Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.

People like entitlements because they are free. Someone else is paying for them.

Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.

“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.

Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”

The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.

The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.

Congress needs the healthcare insurance industry’s ability to provide administrative services whether it is for Medicare, Medicaid, health insurance exchange coverage (Obamacare) or private insurance.

The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.

President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..

Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.

The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.

Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.

Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.

It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.

They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.

“Canada’s health-care wait times costing patients many millions in lost time, wages”

“Ontarians wait longer for health care than citizens of other universal health-care countries”

The fact is single party payer systems do not work for all the stakeholders.Both Democrats and Republicans are missing the essential point about what would work to provide an affordable healthcare system that aligns the incentives of all stakeholders.An essential element is to develop a system that encourages consumers of healthcare to be responsible for their health and have control over their healthcare dollars.

The Senate’s present revision does not consider this. The Senate is considering the needs of the healthcare insurance industry and not the needs of consumers.

The Senate should be considering the following in order to repeal and replace Obamacare.

My Ideal Medical Savings Account should be instituted immediately. It will provide financial incentives for consumers as well and incentives to maintain health.

Self-management of chronic disease is essential for a healthcare system to become affordable. My Ideal Medical Saving Account provides that financial incentive.

1. The Ideal Medical Saving Account will provide instant adjudication of medical care claims.

The ideal Medical Savings Accounts will encourage patient responsibility for their health, the care of their disease and their healthcare dollars.
The Republican Party should establish an organized system of disease management education for persons with chronic disease. The education system should be designed to be an extension of physicians’ care. It should not be a free-standing education system. Physicians should be provided with incentives to set up these educational systems.

http://stanfeld.com/chronic-disease-management-and-education-as-an-extension-of-physicians-care/

A system of social networking with physicians and their patients should be developed. The government could provide the template for physicians and their team.

http://stanfeld.com/social-networks-patient-education-and-the-healthcare-system/

The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.

Social networking between physicians should also be developed.
Integrated care systems with generalists to specialists must be developed for both treatment and cost transparency for the physicians and patients.

There must be instant communication between physicians and patient via an effective electronic medical record. The EMR must be a teaching tool for physicians. It must not be a tool to judge physicians’ care and penalize them. The EMR should be cloud based. Maintenance and upgrades should be free and seamless. Physicians should be charged by the click.

http://stanfeld.com/?s=EMRs

Tort Reform is an essential element in a healthcare system that would work and be affordable. It would decrease the cost of over testing. It would also decrease the cost of malpractice insurance and legal fees. These cost are built into the cost of care. The cost of care would be reduced significantly. http://stanfeld.com/?s=tort+reform

The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.

Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.

The house bill to repeal and replace Obamacare touches on some alignment.

The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.

The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.

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

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It Looks Like The Dice Are Loaded

June 7, 2017

inPoliticians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

Everyone is probably familiar with Leonard Cohen’s song “Everybody Knows.” If you are not you should read the words and /or listen to it.

https://www.google.com/#q=leonard+cohen+song+everybody+knows

The first paragraph says it all.

“Everybody knows that the dice are loaded
Everybody rolls with their fingers crossed
Everybody knows the war is over
Everybody knows the good guys lost
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
That’s how it goes
Everybody knows”

Leonard Cohen nailed it.

That is what is going on with the repeal and replacement of Obamacare in the congress.

“Everybody knows” the Republicans have shown little enthusiasm in repealing and replacing Obamacare. House Republicans barely got it passed. They had seven years to develop a replacement plan.

I think Republicans do not want replace Obamacare. They have used repeal and replace as a calling card to get a majority in both the house and the senate.

It looks like the American public has been used as a pawn for Republican to gain control of congress.

The Republicans talked a good game for the seven years that Obamacare has been the law of the land.

Obamacare has been a disaster. The majority of people have seen large increases in their healthcare insurance premiums and deductibles along with poor access to care.

Obamacare has cost our treasury trillions of dollars because of it poor business model design and mismanagement.

Obamacare claims it has provided healthcare coverage for twenty million Americans. It is not true. Thirteen million of those twenty million have been added to the enrollees in Medicaid.

Medicaid is a single party payer system that does not provide effective insurance coverage. It does not provide easy access to care in most parts of the country. There is also built in rationing of care.

“Everybody knows”

The healthcare insurance industry insurers are dropping out of Obamacare’s health insurance exchanges. Almost all the state insurance exchanges have gone bankrupt and are out of business.

Americans heard over and over again from Republicans that Obamacare is going to die from it own weight. It is true.

There will continue to be insurance to coverage for the nine million insured with preexisting illness. The government mostly subsidizes these nine million patients. However they have unaffordable deductibles.

“Everybody knows that the dice are loaded.”

This week both Mitch McConnell and other Republican senators were publicly pessimistic about their prospects of repealing and replacing Obamacare this year.

“Senate Republicans remain publicly pessimistic about their prospects of repealing and replacing Obamacare this year with several raising concerns this week about the party’s central campaign promise even as one of their leaders vowed to pass such a bill this summer.”

The fix is in. The dice are loaded! Everybody knows.

Russ Limbaugh blew his top when he heard this.

“Rush Limbaugh said during his show that Republicans are road blocking the President’s agenda to a greater extent than Democrats are.

Limbaugh specifically pointed to remarks by Senate Majority Leader Mitch McConnell (R-KY), specifically about the Obamacare repeal bill.

Check it out:”

“I don’t understand how people don’t get that it’s not just the Democrats in Washington that are road blocking Trump. I mentioned it earlier.”

“Mitch McConnell says he can’t see a way to getting 50 votes for the House Obamacare repeal bill?

Now, stop and think here, folks. Back when the only element that we had was the House of Representatives and Republican voters were constantly saying, “Why aren’t you doing more to stop Obama? Why aren’t you trying to do something to stop Obamacare?”

The answer was always, “Well, all we’ve got is the House. W-w-we can’t get anything through the Senate because the Democrats own the Senate. Obama’s in the White House! He’ll veto anything if it did make it there.”

Limbaugh continued that prior to this year, “Republicans always blamed failed policy attempts on a lack of majority in the Senate.

“Then, when we won the Senate, they blamed failed agendas on President Obama.”

“So we’ve given Washington a Republican House, Republican Senate, and a Republican president in the White House, and it still feels as though nothing is getting done.”

How come?

“It’s the Republicans standing up and saying, “I just don’t see how we’re — there’s no room here.

“ I don’t know how we’re goanna lower rates when you have this exemption over here and you have this exemption there.”

Mitch McConnell is giving hollow excuses. The Republican establishment’s motives and method are becoming very transparent.

Everybody knows the dice are loaded.

Rush Limbaugh continues,

“ And I just read this stuff and I shake my head. They don’t want to cut taxes.

Either they don’t want to cut taxes institutionally, they don’t want to cut taxes economically, or they just don’t want to do the heavy lifting.”

The Republican and Democratic establishment has built a very successful swamp for themselves. It is both socially and economically rewarding. It is a strong powerbase that neither is willing to relinquish.

“ I don’t know what it is. My guess is they don’t want to help Trump.”

President Trump has pledged to drain the swamp. He has pledged to put power back into the hands of the people. He represents a real threat to the power the establishment in both parties has over the people and their freedoms.

Neither party anticipated his victory and neither party understands his popularity. The Democrats are trying to hobble him directly with fake scandals. The mainstream media are trying to hobble him with fake news.

“They just don’t see how they can do it,” Limbaugh said, remarking how especially incredible it is:”

Because, of course, there’s a way.

They just don’t want to do it.

I think it’s all establishment, all the time anti-Trump, throw the media in there as well.

But even in the middle of this I can tell you almost assuredly that Trump is not off his game. He’s not despondent. He’s not sitting there worried about why all these people hate him.

He’s not worried about all that. He’s just head down and moving ahead full speed as he can…

Rush Limbaugh should not be confused. Republicans are defending the swamp they built. These guys are not going to let President Trump disrupt the powerbase that is in the swamp.

While the Republican establishment is stonewalling President Trump, the Democratic establishment is rolling out a single party payer option again. The Democratic establishment is going to try to sneak it in.

The Democrats argue that it is obvious the Republican establishment does not have a plan. The Democrats proclaim they have a replacement for Obamacare. They claim that a single party payer is easy to understand. Their proclamation is, “Doesn’t Medicare work for seniors?”

“At rallies and in town hall meetings, and in a collection of blue-state legislatures, liberal Democrats have pressed lawmakers, with growing impatience, to support the creation of a single-payer system, in which the state or federal government would supplant private health insurance with a program of public coverage

Medicare does work for seniors. The problem is the premiums and co-payment is becoming higher each year. Supplemental insurance increases each year. Healthcare insurance coverage for seniors is unaffordable to many.

Medicare is also unsustainable for the federal government. The premiums do not cover the costs of coverage.

The Democrat-controlled California State Senate approved a preliminary plan for enacting single-payer system.

This is a joke. California has a huge budget deficit presently. Where are they going to pay for its proposal?

When are Democrats going to realize the importance of fiscal responsibility?

They don’t now. The expansion of Obamacare to a Medicare model is unsustainable and will bankrupt the state.

This kind of thinking by liberals and Democrats is not going to repair the healthcare system. It will result in collapse of the healthcare system as politicians try to increase their power over the people.

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

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Trump Is Not the Real Target – You Are

May 31, 2017

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACP

Many of my readers have been upset by the slowness and the lack of progress from the Republican senate in repealing and replacing Obamacare.

The country is approaching enrollment time for 2018. Insurance companies need to submit available healthcare plans to the health insurance exchanges soon.

Maybe there will be no healthcare plans available for people in the individual healthcare market with pre-existing illness. This will signify total collapse of Obamacare.

Maybe the Republicans are hanging around waiting for the public to realize that there will be insufficient healthcare plans submitted.

Then the Republicans could blame the Democrats for Obamacare’s failure.

Obamacare has failed for all the reasons I have already written about. There is no reason to debate if it has failed. There is also no reason to debate that President Obama’s vision for Obamacare failed.

President Obama and the Democrats are responsible for its failure. Obamacare was an ill conceived healthcare plan that could not be sustainable.

There are plenty of reasons to support the people who might lose insurance. Those people do not include the 12 million new enrollees in Medicaid.

President Trump is not going to touch their insurance.

The 9 million people enrolled with pre-existing illnesses that have signed up for Obamacare on the individual market must be covered with affordable insurance in some way.

There are many more people in this category who do not have insurance under Obamacare because it is unaffordable.

Within the House Republican plan there are provisions for these people.

It is clear that the liberal mainstream media is on the Democrats’ side.

It’s goal is to do everything it can to obstruct President Trump’s agenda and what he promised the American people.

President Trump won the election on his agenda, not on his personality.

It is clear that the mainstream media is against President Trump. A recent study showed that over 80% of articles written in our daily newspapers are negative articles about the Trump administration.

Many of the 20% positive articles have a negative subtext. Many of these negative articles have no basis in fact and have been proven to be untrue.

President Trump uses the words “fake news” because it angers the press and excites his base.

The Democrats are trying to make as many issues as possible treasonous without any basis for the use of the word treason.

In fact they roll out Maxine Waters every day saying President Trump should be impeached without her presenting a single piece of evidence for impeachment.

It should be clear that is a Saul Alinsky tactic. I have not heard one conservative or Republican accuse the Democrats of using Alinsky tactics.

President Obama did many things that were unconstitutional. He was never called out for them with congressional investigation. When the issues were investigated they were all given a pass. I can think of the IRS and Lois Lerner investigation, the attorney general issue, the CIA issue, and most of all the Hilliary Clinton hearing in which she said nothing for nine hours. The press, the congress and the President let her get away with it without at least an indictment.

James Comey of the FBI said she was careless and unindictable.

The other day I received the following article from a reader declaring the target of these attacks is not President Trump.

The target is the voters who want constructive legislation in Washington for the people. The country cannot survive with the corruption and unconstitutional behavior much longer.

Tim Daughtry is a conservative speaker and co-author of Waking the Sleeping Giant: How Mainstream Americans Can Beat Liberals at Their Own Game wrote a beautiful article explaining what is going on.

I have never thought of the establishment game in these terms. I have reprinted Mr. Daughtry’s entire article so that all of us will take a moment “to reexamine out premises” as Ayn Ryan suggested 70 years ago in Atlas Shrugged.

Trump Is Not the Real Target; You Are

Tim Daughtry

“As we watch the daily barrage of accusations and innuendo directed against President Trump by the far left, the liberal media, and even some in his own party, those of us who voted to put him in the Oval Office need to remember one crucial point: President Trump is not the real target. You are.

Even considering his outsized persona and the stunning phenomenon of an outsider who has never held political office winning the presidency against one of the most powerful political machines in American history, the new movement that elected Donald Trump has never been about Trump. In the 2016 election, the “forgotten men and women of America” were hell-bent to send a message to the powerful elites of both parties.

The message was that the Washington elites are serving themselves and their own agenda and ignoring the rest of the nation. The message was that Washington has become a swamp of corruption and self-serving collusion among powerful interests and that Main Street America is ready to see that swamp drained.

Donald Trump was our messenger.

Because his candidacy was not about Trump the man but Trump the messenger, he was able to withstand the smears and assaults of the Clinton Machine that would have sunk any other candidate. They siphoned all the way to the bottom of their slime barrel, and still the message prevailed.

That message was simple and grounded in common sense. No country can survive unless it has control over its borders. People coming into American should be vetted to make sure that they pose no danger to us. After eight years of stifling taxes and regulations, we should once again make America a healthy place in which to do business, make products, and create jobs. Political correctness may seem silly and laughable, but in reality it poses a serious threat to free expression and open exchange of ideas. If it’s terrorism, call it that. Say what is obvious to our common sense even if it offends the delicate sensibilities of the elite.

Now the denizens of the Washington swamp are sending a message back to the forgotten men and women who voted for Trump and his reforms: “Forget you.”

The leftists who worked to radically transform the nation under Barack Obama are telling us that they hold the reins of power and that we the people don’t run anything. They are telling us that their agenda will prevail regardless of how we vote or what we want. They are telling us that they can subvert, attack, and destroy any messenger that we send into their territory. And feckless leaders in the GOP seem, at best, more afraid of displeasing the Democrats than betraying their own voters, and, at worst, in cozy collusion with the opposition.

What is at stake in the barrage of innuendo, twisted news, and “investigations” is not just the future of the Trump presidency, but the future of the very idea that governmental power rests ultimately on the consent of the governed.

Of course there is much at stake in the actual policy questions facing the country. But underneath the debates about border security, court appointees, tax and regulatory policy, and so on lies a deeper question that is at the very heart of our system of government: Can the American people still change the direction of the country if we believe that the country is headed in the wrong direction? Or will the powerful and self-serving elites impose their agenda even when we don’t consent to it?

When the voters put leftists in power, as they did with the election of Barack Obama in 2008, the country moves left. But when voters try to change course, as we did in the elections of 2010 and 2014, the country still careened towards open borders, government control of healthcare, rule by rogue judges, and lawless license for those in the power elite.

And so we went outside the traditional path and elected Donald Trump in 2016. The liberal news anchors had barely dried their tears after Election Day when the left began to cloud the real meaning of Trump’s election by pushing the bizarre claim that the Russians had somehow hacked the election.

In their gaslighting version of reality, you didn’t really vote to drain the swamp. You didn’t really vote to secure our borders. You didn’t vote to repeal and replace Obamacare and put doctors and patients back in charge instead of Washington bureaucrats. You didn’t vote to restore rule of law and common sense to Washington. The Russians somehow threw the election to Trump. You can go back home now and let the experts run things.

It’s swamp gas. Don’t breathe it.

There is plenty in Washington that merits investigation, from foreign influence through the Clinton Foundation to Obama’s use of intelligence data for political purposes. Congress has the power to do just that, but we need to give them the will.

Let’s remind our representatives that they might forget us, but we won’t forget them.”

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

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What Are The Republicans in the Senate Doing?

May 24, 2017

inChronic Disese Management, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I am rapidly coming to the conclusion that the Republican establishment in both houses of congress are trying to torpedo Donald Trump’s agenda.

Republicans had seven years to coordinate a bill to repeal and replace Obamacare.

The House of Representative’s bill has finally past. Senate committees are stalling progress of the bill.

Both houses should have had all the debates and consensus reached to during the last seven years.

Why would congressmen try to stall the passage of the bill? President Trump has stated that passage of the budget bill is dependent on passage of the healthcare bill.

The reason is obvious to me.

President Trump has pledge to those who voted for him that he is going to drain the swamp in Washington. He is going to eliminate corruption and streamline the bloated bureaucracy.

The Republican establishment is a big part of the swamp. They are thriving in the swamp they helped create.

President Trump represents a direct threat to their power. The Republican establishment does not realize that the only reason they have a majority in both houses is because of the rebellion within the party against the Republican establishment.

Tea partyers and independents voted for unknown candidates and defeated many establishment Republicans in the primaries.

The goal of the Republican establishment is to weaken President Trump’s agenda.

They don’t understand that they are destroying the Republican Party while they are trying to save their own swamp.

It is time the Republicans in the Senate passed the bill.

Regulations that should be eliminated are any regulations that increase bureaucratic control over the healthcare system and the practice of medicine.

The healthcare community knows how to control the costs of chronic diseases. It is by decreasing the onset of complications. Patients have to participate in controlling their chronic disease.

If a healthcare system was developed to control the costs of these chronic diseases, the United States would not only have the best healthcare system in the world we would have the most cost effective healthcare system in the world.

“In the case of diabetes, for example, the American Diabetes Association r eports that the total cost of that debilitating disease amounted to $245 billion in 2012. This includes $176 billion in direct medical costs, and $69 billion in lost productivity.”

The key to diabetes control and the avoidance of diabetes complications is to control blood sugar to a close to normal as possible. This takes a lot of work on the patient’s part. Patients need the education and the motivation to become the professor of their disease and control their blood sugar.

“ As Rep. Tom Price (R-Ga.), a physician, recently noted, diabetic seniors enrolled in traditional Medicare still do not have access to continuous glucose monitors (CGMs), a medical technology today covered by 95 percent of private health plans. ’’

It is bizarre. Yet, Republican Senators who should have figured this out over the last seven years are debating small points that will have little effect on the clinical outcomes. The Republican Party has an opportunity of a lifetime to fix the healthcare system for the American people.

Republicans are going to waste this opportunity to serve the people in order to preserve their swamp that has gotten the people into this horrible position.

I am afraid we are going to see this behavior of perpetuating waste when it comes to education, the environment and energy.

The Democratic Party is worse. They are not acting in the peoples’ interest. They are trying to obstruct everything President Trump is trying to accomplish.

They criticize every initiative saying it is bad without providing reasons for why it is bad.

I believe it is time for the members of both parties to get off the stick. They must stop thinking about themselves and start thinking about the welfare of Americans.

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

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