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The Future State Business Model For Repairing the Healthcare System

October 21, 2012
inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

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

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


Slide14

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

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

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

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

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

Consumer must be the leader of their healthcare team.

Consumers must be responsible for health and healthcare dollars.

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

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

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

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

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

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

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

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

Government's Educational Responsibility:

Teach consumers to become intelligent healthcare consumers

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

Price Transparency

Price Controls Do Not Work.

Eliminate Medical Monopolies

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

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

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

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

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

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Evidence For Impending Healthcare System Failure

October 17, 2012
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

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

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

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

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

The Etiology of Accelerated
Collapse

Slide03

Medicare 1965-1980 Fee for
service

Nixon
authorized HMO’s

Medicare Price Fixing Begins In 1980

Cost shifting Penalizes Private
insurance

HMO Fail Because Of Faulty Assumptions In 1990.

 Reasons for Hillarycare’s
Failure To Pass.

Distrust of Government
Increases.

Healthcare Insurance Companies
Raise Premiums.

Birth of Managed  Care: Another Compicated Mistake  

Managed Cares Fails. 

Managed Care Pricing And
Premiums Remain  High

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

Rationing Of Healthcare

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

ACOs Will Fail At Great Costs To Everyone.

 Tort Reform And Defensive Medicine Are Ignored By Obamacare.

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

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

 

Physician/ Patient Barriers to the Physicians/Patient Relationship

Slide08

 

The Physician/Patient
Relationship.

 The
physician/patient relationship.

 The Magic  of the Patient Physician Relationship  

 Patient and
Physician responsibility contract

 Patient should be the leader of the team

 Barriers for physicians in the Physician/Patient
Relationship

 

1. Tort
Reform/Defensive Medicine.

2. Restriction
of Physicians Clinical Judgment.

3. Medicine
is a calling not a business 

  4.  Constant
lowering physicians’ reimbursement.

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

6. Government
rations care through panel of experts

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

8. The
traditional media undermining physician credibility

9. Government
is attempting to commoditize medical treatment.

 

Patient Barriers To the Patient/Physicians Relationship

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

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

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

receive
first dollar coverage.

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

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

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

7. Portability of information about previous treatment
is difficult.

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

9. Patient must endure poor communication by their
physician.

10.
Government and the healthcare insurance industry limit choice with

network
restrictions.

11. Patients should be responsible for their treatment
Management

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

Obamacare must be repeal.

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

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

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

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

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

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

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It Is Time To Listen To Physicians

October 10, 2012
inConsumer Driven Health Care, Medicine: Healthcare System, Physician's Problems
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Stanley Feld M.D.,FACP,MACE

Physicians are getting tired of being blamed for the
rising healthcare costs. There are starting to realize that they have to take
action to preserve their professional integrity. In fact, six out of ten
physicians said they would quit medicine in a recent study by the Physicians
Foundation.

I believe physicians will have a hard time quitting
because they love practicing medicine. I do believe physicians in their early
60’s are contemplating quitting. Many physicians are looking for viable exit
strategies to avoid quitting.

The Physicians Foundation commissioned an extensive survey of nearly 13,575 physicians.
Meritt Hawkins, the physician search and consulting firm, conducted the survey.

 “The survey found that 60% of physicians would retire today, if given the
opportunity—an increase from 45% in 2008. And it's not just disgruntled and
tired Baby Boomers who want to abandon their healing work. At least 47% of
physicians under 40 also said they would retire today, if given the
opportunity.”

The survey pointed out many major problem areas.

Two specific issues consistently agreed
to were malpractice concerns and the need for tort reform as well as the lack
of cohesive leadership among all physician groups to represent the vested
interests of physicians and their patients.

This is an excellent and detailed
survey that has heightened the awareness of physicians’ practice problems.

The Massachusetts Medical Society
survey pointed out the scope of defensive medicine. I extrapolated findings of
the society’s survey to the nation.

My conclusion was that $500 billion to $700
billion dollars a year is spent on defensive medicine testing in the nation.  Tort reform would serve to decrease this
defensive testing.

President Obama and his advisors have
ignored tort reform and defensive medicine as an insignificant cost. Ezekiel Emanuel
M.D. one of President Obama’s advisors thinks defensive medicine only raises
the cost of the healthcare system between $26 billion dollars a year. Dr. Emanuel feel this is an insignificant number to deal with in a 2.7 trillion dolloar healthcare system. His metrics are wrong. This
is a misguided bias.

The Physician Foundation survey notes
that many policy makers, academics, and others identify fee-for-service
reimbursement as a key driver of health care costs. Physicians believe that "defensive medicine is a far more
important cost driver."
 
40.3% of the physicians surveyed said "liability/defensive
medicine pressures" was the least satisfying aspect of medical practice.

The survey also reveals that doctors
see as a major cost driver of healthcare liability/defensive medicine.

69.1% of physicians said defensive
medicine is the "number one ranked factor" driving up healthcare
costs. The survey described the ordering of tests, prescribing of drugs, and
conducting of procedures done "partly or solely to drive a wedge against
potential malpractice lawsuits."  

"Medical malpractice lawsuits are common,
adding an additional layer of paperwork, expense, and stress in virtually every
physician's work day," the report adds.


The government ought to be listening to physicians practicing medicine every
day rather than ivory tower professors who have never practice a day in their
lives.

"Physicians understand to some degree
that's the cost of doing business, but the defensive medicine goes deeper than
that, in the ordering of extra tests, doing the extra procedures, and extra
scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of
overspending in American healthcare. President Obama and Obamacare have ignored
it. Some states have addressed it and the cost of care has been decreasing
slowly. I believe it will take time in those states.  If anyone was sincere about bending the
healthcare cost curve they have to take defensive medicine seriously. 

According to the survey physicians felt that there is a lack of a
forceful cohesive voice representing them.

"There is a systematic, endemic series
of problems," Walter Ray M.D. vice president of the Physicians Foundation, says. "Everywhere their defensive medicine,
regulation issues, reimbursement issues. We are all in the same boat. But
physician representation is balkanized. There is not a national organization
that represents a majority of physicians."

When the survey asked which best describes
their feelings about the current state of the medical profession, only 3.9
percent of physicians used the words “very positive,” while 23.4 percent of
physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent —
described their feelings as either somewhat negative” or “very negative,” while
only 31.8 percent of physicians described their feelings as “somewhat positive”
or “very positive”.

A "least satisfying" aspect of
practicing medicine included dealing with Medicare/Medicaid/government
regulations (27.4%) and reimbursement issues (27.3%).

 

The American Medical Association (AMA) represents only
15% of physicians, according to the Physician Foundation report. One of the
reasons for the low enrollment is that physicians feel the AMA does not
represent their vested interests.

 Sermo is another
physician organization. It is an Internet social network. In less than 2 years
Sermo had as many members as the AMA.

Sermo originally concentrated on
socioeconomic issues. It also discussed difficult clinical cases.  

The socioeconomic activity has recently
faded. Sermo’s power was using the social network to do instant surveys
expressing physician’s opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to
the public as media stories of physicians’ opinions. It was done through public
service announcements and daily press releases.

Physicians were able to let the public know
how they felt about an issue instantly. It was very attractive. Somehow the
initial vigor stalled. Physicians are now left without a vehicle or
organization to express to express their feelings.

Government, the healthcare insurance industry
and the hospital systems have little desire to listen to the concerns of
practicing physicians. It is more important to tell physicians what to do. It
will not work long term.

The Physicians Foundation Biennial Survey is
valid and accurate. However it is not dynamic or evolving. Neither has it gotten
much attention. It is a must read along with the Massachusetts Medical Society survey
for those interested in physician concerns and behavior.

Patients’ problem with the healthcare system
gets less attention. The government and insurance companies tell patients what
they can and cannot do

Repair of the healthcare system will only
happen when the American healthcare system evolves to a consumer driven
healthcare system with individual responsibility and individual control by the
patients of their healthcare dollars.

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

 

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The Healthcare System in Switzerland Works

September 28, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld
M.D.,FACP,MACE

Paul
Krugman is starting to drive me crazy with all his fact free declarations about
the healthcare system.

He recently declared that consumer driven healthcare has
been a bust everywhere it has been tried. Paul Krugman as an “expert” has once
again made a declaration that contradicts the facts. He is clearly not
interested in being confused by facts.

Paul Krugman is against putting consumers in
control of the healthcare system. He feels,
as President Obama feels, that a central committee (IPAB) should be in charge
of deciding what to do with limited health care resources. 

He has said,

 "Consumer-based" medicine has been a
bust everywhere it has been tried. Medicare Advantage was supposed to save
money; it ended up costing substantially more than traditional Medicare.

Medicare Advantage costs the government more
money because the government gave the private insurance companies a $3,000 bonus
per senior to get Medicare out of the government’s hands.

This is one of the principle reasons I am not a fan of
Medicare Advantage.

In reality Medicare Advantage provides more
services at lower premiums and deductibles for seniors. Seniors with Medicare Advantage use
fewer services resulting in a lower cost of total services and more profit for the
healthcare insurance industry.

“America has the most "consumer-driven" health care
system in the advanced world. It also has by far the highest costs yet provides
a quality of care no better than far cheaper systems in other countries.”

Paul
Krugman is wrong.  Switzerland has the
most consumer driven healthcare system in the world and the Swiss government
pays far less than most countries while the Swiss get a high quality of care.

His ideology
blinds his mind. The healthcare system in Switzerland is a consumer driven
healthcare system that works for the Swiss. The Swiss government makes the
rules and then gets out of the way.

The
Swiss healthcare system can be used to start a constructive conversation about
healthcare reform in America that can satisfy both conservatives and liberals
and save the U.S. from bankruptcy resulting from expanding entitlements.

The
healthcare system in Switzerland is a consumer driven healthcare system in
which consumers have choice. It has resulted in a low income tax rate,
universal healthcare, and satisfied stakeholders

The
Swiss system could not be totally transformed into an American system because
of America’s embedded ideology and prejudices as well as stakeholder vested interests.
However it outlines the government’s role in a healthcare system and highlights
the power of a consumer driven system.

America’s
healthcare system must undergo significant changes. Most of these significant
changes have been ignored by President Obama in Obamacare. It empowers
government and not the consumer.

Paul Krugman has stated flatly, "Patients
are not consumers"

“Patients get illness that others (government) should decide on
whether it is cost effective to treat.”

This
attitude toward patients points out the disrespect for the intelligence and
judgment of consumers.

The elements
critical to meaningful reform of America’s healthcare system must include the
following changes.

1.
There must be significant and meaningful Tort Reform to decrease the practice
of defensive medicine.

2.
There must be significant reform of the healthcare insurance industry’s
financial rules to stop the industry from listing non-direct care expenses as
direct patient care.

3.
There must be regulations to cause the healthcare industry to be competitive
for consumers’ business. Government should not be the consumer of healthcare.

4.
There must be legislation to change the healthcare insurance industry’s incentives
for profitability in order to create innovative healthcare insurance products
that will reduce healthcare costs.

5.
There must be significant financial incentives for consumers to be motivated to
save healthcare dollars.

6.
Consumer must responsible for their health and healthcare dollars. The
entitlement mentality must be eliminated.

7.
Hospital systems should be competing for patients’ healthcare dollars and not
government healthcare dollars.

8.
Physicians must be responsible to consumers and not hospital systems or the
government.

9.
Insurance costs must be community rated.

The
healthcare system must be a consumer driven system just as purchasing
groceries, automobiles, computers and televisions are. If the product is poor
the company will go out of business.

America’s goals should be universal healthcare
coverage with freedom of choice, and reduction of healthcare costs.

It is worth understanding the Swiss healthcare
system as a starting point to meaningful reform of the American healthcare
system. 

These are the major features
of the Swiss Healthcare System:

1.Swiss citizens
buy insurance for themselves.

2.There are no
employer-sponsored or government-run insurance programs.

3.Insurance
prices are transparent to the beneficiary and community rated.

4. The
government defines the minimum insurance benefit packages that must be offered.
 Everyone must have the minimum
healthcare insurance coverage.

5. All
packages require beneficiaries to pick up a portion of the costs of their care
(deductibles and coinsurance) in order to incentivize citizens to be
responsible for their health and the control of healthcare dollars spent.

6. My ideal
medical savings account would provide a positive incentive by rewarding
citizens who did not spend the first $6,000 dollar to keep that money in a
retirement account.

7. Patient
incentive is a critical element in healthcare reform because incentives provide
consumers with a reason to take care of their health and healthcare
dollars 

8.The Swiss government
subsidizes health care for the poor on a graduated basis, with the goal of
preventing individuals from spending more than 10 percent of their income on healthcare
insurance.

9. Citizens
can be responsible for a significant component of healthcare costs in Switzerland.

10. Consumers
often opt for the cheaper healthcare insurance packages. They have freedom of
choice.  Many Swiss consumers choice chose
minimal insurance plans combined with high-deductible insurance plans.

11. Citizens
are free to choose comprehensive insurance coverage or some form of
supplemental coverage. It is not a one size fits all system.

12. Ninety-nine
percent (99.5%) of Swiss citizens have health insurance.

13.There are
about 100 different private insurance companies in Switzerland with multiple
healthcare insurance plans.

14. It is clear
that the government has made the rules and then has gotten out of the way. The
rules have set up a market driven competitive healthcare system.

15. The result
has been that healthcare insurers are competing for consumers’ business on
price and service. Consumers gravitate to the best price and service that fits
their needs.

16. The Swiss
healthcare system not only helps to curb health care inflation but most
beneficiaries have complete freedom to choose their doctor.

17. The setup
of the system has resulted is low waiting times for physician and hospital
services with a minimum of bureaucratic slow downs. 

18. The Swiss healthcare
system aligns all the stakeholder incentives by empowering the consumer while
helping less fortunate consumers.

19. Government
spending on health care in Switzerland is only 2.7 percent of GDP, by far the
lowest in the developed world.

U.S.
government spending on health care was 7.4 percent of GDP in 2008 and will
exponentially grow under Obamacare.

 “ If the U.S. could move its state health spending to Swiss
levels, it would save more than $700 billion a year.”

Dr. Regina Hertzlinger has an excellent description of the
Swiss healthcare system in the following You Tube.


 

http://youtu.be/E5bsz_oewDA

Switzerland’s
healthcare system cannot be superimposed on the U.S. healthcare system. It can
be used as a starting point to empower consumers to drive the healthcare system
and be part of the solution. 

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

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Permalink:

What Is The Ryan Plan All About?

August 22, 2012
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP,MACE

The need for effective Medicare reform is becoming
increasingly apparent. Both the public and providers do not like Obamacare.

The cost overruns for Obamacare are hidden
from the public but are becoming evident.

There is an ideological divide between policies
that work and policies that don’t work.

President Obama believes the only policies
that work are government policies that control providers, insurers, and
consumers.

There are multiple examples that have shown
that these policies have never worked. Government has never controlled spending
for any projects for myriads of reasons.

What makes President Obama think his
government can force the healthcare system to become more efficient and control
healthcare costs?

Price controls and restriction of access to
medical care will not work.  

Entitlement programs have been fertile
grounds for fraud and abuse by all the vested interests including government
agencies.

Government should be of the people for the
people.

Government should level the playing field so
secondary stakeholders compete for primary stakeholders’ business.

I voted for President Obama because I thought
he offered this hope. He fooled me as he has fooled millions of other Americans.

President Obama has a cool, seductive
speaking delivery. He is general enough to make one think he believes in what
you believe but his agenda is central government control over all areas of life.

The agenda is the opposite of the individual
freedoms our country stands for.

None of President Obama’s policies have
worked in the last 3.5 years.   

He has snuck in higher taxes on the middle
class for his healthcare bill and has not lowered healthcare costs.  Healthcare costs have increased.

Americans are not dumb. They are beginning to
realize they are on the road to serfdom.

President Obama is using every dirty trick
known in American politics to attack Governor Romney and now Representative
Ryan in order to keep  from talking about
his record on jobs, the economy, healthcare costs, the deficit and its meaning,
our National Security, foreign policy, energy, and immigration.

For some reason the traditional media is on
President Obama side. The result has been a loss of their audience by newspapers,
magazines, and network television.  

America is in a fiscal crunch. Entitlement
spending is at the center of the fiscal crunch and must be reformed effectively.

 “Medicare
is at the center of our fiscal crunch, with outlays that have grown about twice
as fast as the economy over the past decade, according to the Congressional
Budget Office (CBO)”.

 The fiscal crunch is only going to get worse
as 76 million baby boomers retire in the next two decades.

“Medicare
will consume an ever-increasing share of the federal budget unless policies are
adopted to bend Medicare's cost curve.”

The Medicare trust fund has been depleted by the
federal government borrowing from the trust fund. Over time and as unemployment
rises less Americans are paying into the fund. The government’s depletion of
the fund has occurred since the beginning of Medicare.

The Medicare premiums paid by seniors for
Medicare Part B is going to double in the next two years. This is a tax on
seniors on fixed incomes that no one is talking about and few can afford.  

President Obama is expanding an entitlement
with Obamacare.  It will accelerate the
consequences of the fiscal crunch.

“Even
if the substantial reductions in payments to health care providers included in
the Affordable Care Act (ACA) are fully implemented and Congress allows the
27.4% reduction in physician payments required under current law to go through,
Medicare spending will continue to grow at unsustainable rates.”

 The Ryan
plan can change the direction of Medicare and save it.

         What does
the Ryan Plan do?

  • No one over 55 years old is affected.
  • People younger than 55 will have the option to choose
    between traditional Medicare or premium support from government to pay for
    competing private healthcare insurance plans.
  • Traditional Medicare is a defined benefit plan. The
    government decides on the price
    it will pay for medical services.
  • Ryan’s plan is a "defined contribution" plan. The
    government decides on an amount of money ("premium
    support") to provide to individuals to buy private insurance of
    their choice.
  • Consumers will choose from an approved set of competing
    private insurance plans along with traditional
    Medicare.
  • There is an open enrollment period each year, allowing
    people to choose either of the
    plans.

 

The goal is to force the healthcare
insurance industry to compete for patients
as well as give seniors the right to choose the most appropriate plan for
their needs.

 The Ryan plan allows competition among
in the private sector which will increase efficiency and drive down
costs.

President
Obama is scorning this system as a “voucher system.” 

Nonsense!

Once
again President Obama is obfuscating the truth with a sound bite.

Americans
55 years old and younger have paid into the system all their working life jus
as senior 55 years and older have. The “premium support” is not a free give
away as are food stamps.

Premium support is determined each year by the government
calling for competitive bidding by the healthcare insurance industry.

“ The government would then provide seniors
in each region of the country with a "premium support" equal to the
second-lowest bid in that region, or one equal to the bid of the federal
fee-for-service Medicare program — whichever is lower”.

Seniors could choose the traditional Medicare, since the
government would still contain a package of required benefits that would
constitute its comprehensive insurance coverage, just as Medicare does today.

Seniors would be guaranteed freedom of choice. A private
healthcare insurance option would equal the “premium support” payment.  

The premium of the private insurance might even become
cheaper than the Medicare premium seniors would have to pay.

The Ryan plan would allow the healthcare insurance
industry to compete with Medicare.  

The healthcare insurance industry could be forced to
lower its net profit by the competition just like it has occurred in other
industries. The competition could also force increase efficiency and quality of
product.

Tort Reform and fraud and abuse are not addressed in the
Ryan Plan yet.

The Ryan Plan is a good start to change from central
control to individual choice. It I not there yet.

 Presidential candidate
Romney’s pick of Paul Ryan as running mate has made Romney the good guy in the
Medicare issue.

“ It's
President Obama who has put Democrats in the position of being the party that
is cutting current seniors' benefits, rationing care (thanks to the IPABs), and
letting the program collapse as it becomes unsustainable.”

If
you're a senior now or in the future, Democrats are offering you nothing except
a grim, mean, rationed future when it comes to medical care.

It's the
Republicans who are offering hope for a sustainable Medicare future with
freedom of choice.

“Given
the serious fiscal problems facing this country, slowing the growth of Medicare
spending is no longer optional. The only question is how to do it.

The
Wyden–Ryan proposal outlines a strategy for Medicare reform that harnesses
market forces to control costs. It provides a real alternative to the top-down
controls favored in the Obamcare.

 Paul Ryan and Ron Wyden have defined the
policy parameters that could be the basis for real Medicare reform in 2013.

   Amazingly,
the Washington Post and liberal healthcare policy wonks are starting to think
the Ryan Plan might be a good idea.

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

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Permalink:

The Ryan Medicare Plan And President Obama’s Criticism

August 19, 2012
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama has said over and over again that Paul Ryan’s budget is going to end Medicare coverage as WE KNOW IT and leave seniors without healthcare coverage. The first part is TRUE and the second part is FALSE.

President Obama’s spin miesters (David Axelrod et al)  have a knack for distorting facts with lies.  The Obama team couples the distortions of the truth together with powerful visual distortions in the media. If the visual distortion is seen enough times it is interpreted as the truth no matter what the facts are.

As an example, President Obama’s grandma ad has appeared over and over again. The grandma ad is totally false. However “the media is the message. ” 

This false message has become part of the American psyche.

Who needs facts or the truth when the media presents such a vivid image?

  

http://youtu.be/OGnE83A1Z4U

Paul Ryan’s plan will change Medicare as we know it.  The simple truth is Medicare is going broke. If nothing is done the Medicare program will be bankrupt and disappear.  Then seniors will not have any healthcare insurance coverage.

Paul Ryan’s Medicare change is the way to save the Medicare insurance coverage for senior of future generations.

IT WILL NOT CHANGE MEDICARE COVERAGE FOR ANYONE PRESENTLY 55 YEARS OLD OR OLDER.

Obamacare will hasten the bankruptcy of Medicare and balloon our debt and deficit. Medicare coverage will be forced to disappear.

In order to convince the American public that he is going to reduce spending President Obama played an accounting trick play on the American public.

It goes by the name of "double counting."

It is clear to me that neither Democrats nor some Republicans understand President Obama’s double counting. Double counting will hasten the demise of Medicare.

Paul Ryan is trying to explain double counting once more to seniors. He is calling out President Obama and David Axelrod as they try to obfuscate the truth about double counting and the Paul Ryan’s plan to save Medicare.

American seniors are starting to catch on slowly but surely. The public is getting tired of the Obama/Axelrod false hope, half-truths and outright lies.

“In short, the Medicare scoring convention is not widely understood and thus obscures the double-counting.”

Putting the Medicare payroll tax hikes and spending constraints on the "pay-as-you-go" ledger was instrumental in getting the health law through Congress, because doing so fostered a widespread misperception that the law would reduce future deficits.

“No such prohibition exists in the budget process against committing Medicare savings simultaneously to Medicare and to pay for a new federal program (Obamacare).”

“It's this budget loophole, unique to Medicare, that gives the health law's spending constraints and payroll tax hikes the appearance of reducing federal deficits.

But it is appearance, not reality. If you have only $1 of income and are obliged to pay a dollar each to two different recipients, then you will have to borrow another $1. This is effectively what the health law does. It authorizes far more in spending than it creates in savings.

It is one of President Obama’s many trick plays on the American public.

The cartoon presents a simple explanation of double counting. Paul Ryan should use this simple explanation of double counting.

  

http://youtu.be/q8x20P4RpgQ

It is important to listen carefully with our eyes wide open and hear President Obama’s lies about Medicare spending and Obamacare in the next two months.

Now President Obama says he is going to reduce fraud and abuse in Medicare by $731 billion dollars.

Who is he kidding?

His plan is to reduce payment to physicians and hospitals. He will be forced to play favorates with certain hospital systems.

A reduction in Medicare cost will not will not happen as long as President Obama permits the healthcare insurance industry to do the administrative services for Medicare and not address the issue of Tort Reform.

The Accountable Care Organizations and its payment changes will not save money. In fact it might cost more if ACOs can be organized at all.

Medicare’s administrative services have been outsourced to the healthcare insurance industry since 1965. Medicare has never had a chance of being fiscally viable and sustainable. The healthcare insurance industry takes 40-60% of every healthcare dollar spent of the top.

Obamacare does not change this procedure one bit.

President Obama continues to say that Mitt Romney and Paul Ryan allegedly are going to end Medicare and leave seniors without coverage. 

The exact opposite is true. However, Romney and Ryan have not explained this simply enough to be understood by all. They must explain in detail and sound bites why President Obama’s assertion is false.

In fact, Obamacare is going to change Medicare as we now know it. Actually it already is causing the rationing of cancer drugs and a de facto rationing of care.

“It is ObamaCare that was specifically designed to destroy Medicare, and to herd seniors into a one-size-fits-all plan where care to them can be rationed with impunity.”

“ And even Dr. Donald Berwick, President Obama's personal choice to run Medicare and Medicaid, admitted that this rationing is one of ObamaCare's ultimate aims, as did Dr. Ezekiel Emanuel, one of the president's chief health care advisers.”

Under Obamacare, Medicare has already changed as we know it. In 2014 it will change drastically.

In view of this fact for President Obama to say that the Ryan plan will change Medicare as we know it is arrogant and disingenuios.

There are many differences in both plans. I will try to explain the differences in simple terms in future blogs.

The huge difference is Obamacare is an entitlement that promotes dependence on the central government where the Ryan plan promotes self-responsibility and independence from government and government controls over our freedoms of choice and decision-making.

President Obama is taking a dangerous chance with his criticisms of the Ryan plan.

Hopefully the Romney/Ryan ticket will be able to explain away President Obama’s criticisms in simple, understandable terms.

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

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Romneycare 2012 vs. Obamacare

August 12, 2012
inConsumer Driven Health Care, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

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

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

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

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

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

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

  

http://youtu.be/6d4raK3QJmQ

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

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

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

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

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

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

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

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

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

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

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

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

No one reports the appointment and emergency waiting times.

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

 

http://youtu.be/At9q6uFR3gU

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

  

http://youtu.be/4DW6IKG9d_8

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

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

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

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

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

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

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

So what in happening in Massachusetts?                                          

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But.

Accountable to whom?  

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

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

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

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

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

 

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

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With Obamacare Patients Lose

July 15, 2012
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

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

Obamacare does nothing to disintermediate the healthcare insurance industry.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

Consumers will be the biggest losers.

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

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

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

Who loses? The consumer.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Obamacare is creating an escalating mess.

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

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

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Supreme Court and Healthcare

June 24, 2012
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

This week the Supreme Court is going to rule on whether President Obama’s Healthcare Reform Act is constitutional or not.

The traditional media and blogosphere has spent many hours speculating on the Supreme Court’s decision.

The Supreme Court probably recognizes the many strange issues involved in the passage of Obamacare and the many tricks President Obama played in its passage. It also recognizes than only 32% of the population approves of the plan.

The Supreme Court has cleverly picked the two most important issues dealing with the constitutionality of President Obama’s Healthcare Reform Act. These two issues are intermingled with the multitude of issues that are wrong with the law.

There are two key issues.

One key issue is whether it is constitutional for the central government to mandate that Americans and American companies must purchase healthcare insurance from a private healthcare insurance company. If Americans do not purchase the healthcare insurance, can the federal government fine them?

The second key issue is whether it is constitutional for the federal government to force states to increase the number of people eligible for Medicaid or do the states have the right to determine who they can and should cover at their expense.

 The two core issues are freedom of individual choice and central government control over states rights. Does the federal government have the power under the constitution to limit these constitutional rights?

Once the constitutionality of these two issues are decided by the Supreme Court, Obamacare still has the healthcare system’s original dysfunctional problems.

Obamacare institutes none of the necessary rules or regulations to repair the healthcare system. It adds a patch onto a dysfunction healthcare system.

Effective repair of the healthcare system must be incentive driven with alignment of all of the stakeholders. The primary stakeholders are the patients and physicians.  It must not be a system that is punitive to stakeholders.

The healthcare system must not be an entitlement program. It can be a subsidized program that is consumer owned and driven. Consumers must have financial incentive to be responsible for their health and healthcare dollars.

Any system that promotes government dependency will fail.

The list of initiatives that could repair the healthcare system is large. Obamacare does not include any of them.  

Obamacare omits the need for patients’ responsibility, expands entitlements and promotes government dependency.

These are the initiatives that must be included in a healthcare system that will work:

  1. Eliminate defensive medicine by effective Tort Reform.
  2. Individual patients’ responsibility for their healthcare dollars using the Medical Saving Accounts.
  3. Individual patients must become responsible for their health.  Obesity and the avoidance and control of chronic diseases and complications are in large measure the patient’s responsibility. Financial incentives for effective health along with educational programs to avoid chronic diseases and the complications of chronic diseases should be available.
  4. Dis-intermediate the healthcare insurance industry’s ability to extract 40% of every healthcare dollar for both public and private healthcare insurance sectors: Medical Savings Accounts.
  5. Eliminate the vague regulations and confusing regulations restricting innovative direct medical care programs.
  6. Make all healthcare insurance programs, corporate, small business and individual programs, tax deductible. 
  7. Administrative waste is expanded in Obamacare. Over 250 new agencies have been created already.  
  8. Effective system to implement Electronic Medical Records. The present stimulus is inadequate and will not achieve its goal. It can be done much less expensively.
  9. The hospital reimbursement system must be revised.  The government should institute regulations that monitor transparent real costs of a service and transparent negotiated charges. This should be available to patients and physicians in order to make educated choices.
  10. The government should provide on-line information to patients and physicians about reimbursement for services and need for services based on evidence based medicine recommendations.
  11. The government should help patients save their own money by helping patients decide what are necessary diagnostic tests and treatment.
  12. It should be the patient’s decision and not the government’s decision on necessary treatment.  
  13. Patient should be a Pro-sumer ( Productive Consumer). Patients must learn to be responsible for their care and healthcare decisions.
  14. The central government should stop trying to control the healthcare system and forcing consumers to be dependent on government. This is the Road To Serfdom.  
  15. The government should streamline regulations, eliminate paperwork, and make the healthcare system interaction a pleasant one.
  16. The government should eliminate bureaucracy. The government must approach healthcare reform from the patients’ and physicians’ point of view.

 

 There are many more initiatives I could list that are needed to the repair of the healthcare system. All the initiatives are based on maintaining individual freedoms and promoting individual responsibilities. The initiatives are not based on forcing everyone to be dependent on government.

These are exactly the problems the Supreme Court is considering.

As a society we have been acculturated to accept an entitlement society and central government dependency.

We are also noticing that entitlement societies do not work as witnessed by European socialism.  

America is in a Catch 22 situation. If you want to be fiscally responsible you cannot live beyond your means. America cannot maintain the entitlements any longer because the central government cannot afford them.  

After a finite time a nation runs out of other peoples’ money.

 

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

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