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Did Your Representatives Read The House of Representatives Healthcare Bill HR3200?

July 30, 2009
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D., FACP, MACE

The House of Representatives Healthcare Bill is 1018 pages long. Many Representatives and Senators did not read the entire economic stimulus bill because “we did not have time” before we experienced a severe economic recession. They claimed to be saving us from another great depression.

I have read a good portion of HR3200. The provisions are unacceptable and sinister. It represents a complete government takeover of our healthcare system. It is not in the interest of the consumer. It is not in the interest of our precious freedom of choice.

A reader of my blog sent me a summary of HR 3200 written by Larry Schweikart. The reviewer FamilySecurityMatters.org Contributing Editor Larry Schweikart is the author o 48 Liberal Lies About American History: (That You Probably Learned in School) and A Patriot’s History of the United States: From Columbus’s Great Discovery to the War on Terror.   He blogs at patriotshistoryusa.blogspot.com. Mr. Schweikart is not the most liberal person on the planet. However, his analysis is about 80% accurate by my reading of the sections Mr. Schweikart summaries.

Every Americans, especially our Senators and Representative must know what is actually in the bill before it is passed. President Obama’s generalities do not cover the details of HR 3200.

It feels like Ayn Rand’s Atlas Shrugged all over again.

The mainstream media is not covering the real story.

Below are few video clips that try to tell the real story

http://online.wsj.com/video/can-americans-keep-their-current-health-care/6043F8F9-0BEB-4E36-8589-7AEEE4C7AB9E.html

http://online.wsj.com/video/can-americans-keep-their-current-health-care/6043F8F9-0BEB-4E36-8589-7AEEE4C7AB9E.html

Mr. Schweikart evaluated 498 of the 1107 page bill. The summary of one half HR3200 is frightening. His summary is a good reference guide to the appreciation of the harshness of the bill. It also explains President Obama’s urgency in getting a bill passed before anyone realizes the implications of the bills contents.

Representatives who vote for this bill should not be reelected. They are not representing their constituents’ rights or protecting their freedoms. Your healthcare, health and freedoms are at stake.

You can check the reviewer’s summary against the actual bill at the link below.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

“Take a look at what actually is in the Health Care bill. Obama makes disingenuous comments like "You’ll still keep your doctor" or "You’ll keep your existing health care."

Pg 22 of the HC Bill mandates the Government will audit books of all employers that self insured. Can you imagine what that will do to small businesses? Everyone will abandon “self insurance” and go on Government insurance. So when Obama says that there will still be private health care, it’s simply a lie: this mandate will force employers to abandon their private plans.

Pg 30 Sec 123 of HC bill – a Government committee will decide what treatments/benefits a person may receive.

Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE WILL BE RATIONED! President Obama has been saying healthcare is to be rationed all along in code.

Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You will have no choice!

Pg 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise.

Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Healthcard will be issued! Government has real-time access to your tax return presently and means test Medicare recipients’ premiums

Pg 59 HC Bill lines 21-24 Government will have direct access to your bank accts for election funds transfer. A further impingement on freedom and privacy.

Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (read: ACORN).

Pg 72 Lines 8-14 Government will create an HC Exchange to bring private HC plans under Government control.

Pg 84 Sec 203 HC bill – Government mandates ALL benefit packages for private HC plans in the Exchange.

Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans = The Government will ration your Healthcare!

Pg 91 Lines 4-7 HC Bill – Government mandates linguistic appropriate services. Example – Translation for illegal aliens.

Pg 95 HC Bill Lines 8-18 The Government will use groups, i.e. ACORN & AmeriCorps, to sign up individuals for Government HC plan.

Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans. AARP members – your Health care WILL be rationed.

Pg 102 Lines 12-18 HC Bill – Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.

Pg 124 lines 24-25 HC No company can sue Government on price fixing. No "judicial review" against Government Monopoly.

Pg 127 Lines 1-16 HC Bill – Doctors/ AMA – The Government will tell YOU what you can earn.

Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.

Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.

Pg 149 Lines 16-24 ANY Employer with payroll $400k & above who does not provide public option pays 8% tax on all payroll.

Pg 150 Lines 9-13 Businesses with payroll between $251k & $400k who don’t provide public option will pay 2-6% tax on all payroll.

Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Government will be taxed 2.5% of income.

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)

Pg 195 HC Bill -officers & employees of HC Admin (the GOVERNMENT) will have access to ALL Americans’ finances and personal records. Big brother will be watching your every move.

Pg 203 Line 14-15 HC – "The tax imposed under this section shall not be treated as tax" Yes, it says that.

Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid. Seniors, low income, poor affected. Kill off the poor and elderly.

Pg 241 Line 6-8 HC Bill – Doctors – doesn’t matter what specialty – will all be paid the same.

Pg 253 Line 10-18 Government sets value of Doctor’s time, professional judgment, etc. Literally, value of humans.

Pg 265 Se
c 1131Government mandates & controls productivity for private HC industries.

Pg 268 Sec 1141 Federal Government regulates rental & purchase of power driven wheelchairs.

Pg 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!

Pg 280 Sec 1151 The Government will penalize hospitals for what Government deems preventable readmissions.

Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission – Government will penalize you.

Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.

Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion – Government will mandate hospitals cannot expand.

Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!

Pg 335 L 16-25 Pg 336-339 – Government mandates establishment of outcome-based measures which of course forces health care rationing.

Pg 341 Lines 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc., forcing people into Government plan.

Pg 354 Sec 1177 – Government will RESTRICT enrollment of Special needs people!

Pg 379 Sec 1191 Government creates more bureaucracy – Telehealth Advisory Committee. Healthcare by phone.

Pg 425 Lines 4-12 Government mandates Advance Care Planning Consultations. Think Senior Citizens end of life prodding.

Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of attorney. Mandatory!

Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in how to die. EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (and your life). Health care will be denied based on age. 500 Billion will be cut from Seniors healthcare. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.

Pg 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.

Pg 429 Lines 1-9 An "advanced care planning consultant" will be used frequently as patients’ health deteriorates.

Pg 429 Lines 10-12 "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from the Government to end a life!

Pg 429 Lines 13-25 – The Government will specify which Doctors can write an end of life order.

Pg 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.

Pg 469 – Community Based Home Medical Services/Non profit orgs. (ACORN Medical Services here?)

Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATION. 1 monthly payment to a community-based organization. (Like ACORN)

Pg 489 Sec 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into our marriages.

Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services. You’d better speak up now before you are on the "advanced care consultation" list.

It gets worse: the Health Care Reform bill that is now about to come up for a vote will absolutely eliminate private health care options. Do not kid yourself: They are going to say that they aren’t going to interfere with your right to go to your "own doctor" or have your own "private health insurance." But there won’t be non-government doctors or private health insurance if the government mandates them out of existence.

Even still, I hear people who want to "get past all this partisanship." Sorry, but GROW UP.

Our system from the beginning has pitted one group against another out of fear of the very giant government that is metastasizing before our eyes. James Madison didn’t like "parties" or "factions," but he finally admitted that they were absolutely necessary to fragment power.

For our system to work there has to be a clear choice, not a mushy middle, because the mushy middle always, always, always gravitates left. There is a "presumption of power" on the left –conservatives, by nature, do not like government, don’t trust it, and do not want to use it to advance their ends, which they see as advanced through liberty, individual achievement, and entrepreneurship.

FamilySecurityMatters.org Contributing Editor Larry Schweikart is the author o 48 Liberal Lies About American History: (That You Probably Learned in School) and A Patriot’s History of the United States: From Columbus’s Great Discovery to the War on Terror.   He blogs at patriotshistoryusa.blogspot.com.

It is hard to read H3200 and comprehend its implications. However, a careful reading leads me to similar conclusions to those of Mr. Schweikart.

Do you think your representatives have studied the bill? If they have and vote for it they should lose your vote. If they have not read it and vote on party lines they should lose your vote.

This bill is not going to Repair the Healthcare System. It will make the healthcare system more complex, restrict access to care, restrict the delivery of care, ration care, limit freedom of choice, and increase the deficit.

Americans have to demand that congress tackle the real problems in the healthcare system. Have you contacted your Representative and Senators? If you have, good for you. If not , what are you waiting for?

Let your Senators and Representatives know the proposals are unacceptable.  Write, fax, call, email, twitter. Tell them:

“We do not want the government to control our lives. We want affordable, universal healthcare coverage that does not limit access to care. We want control over our healthcare dollars. We do not want government to control our lives and our money.”

https://writerep.house.gov/writerep/welcome.shtml

http://www.senate.gov/general/contact_information/senators_cfm.cfm

 

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

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Medicare is Not Cheap For Either Seniors Or The Government: Part 3: The Real Issues Needed To Be Solved To Reform The Healthcare System Reform

July 5, 2009
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama is pushing a healthcare reform plan that will fail. However something has to happen and he is creating a populous uprising.

The reason it will fail if his healthcare reform plan is passed is the government cannot afford to pay for Medicare coverage for all. . Expanding coverage to the entire population will create bigger unsustainable defects in addition to the present unsustainable defects for seniors.

Private corporations and small businesses cannot afford to pay for private healthcare insurance coverage either. It is looking for a way to unload their private insurance obligation. The public option will be a way to do it.

This is the dilemma. The present public debate is not discussing the real issues. Healthcare coverage should be universally available at an affordable cost and be high quality. There is no argument with President Obama’s goals. The route he is taking will increase bureaucracy, decrease efficiency of medical care, restrict access to care, decrease quality of care and increase the cost of care. It will also increase government control over healthcare delivery and decrease patient choice.

What are President Obama’s options for reducing the cost of healthcare coverage if he gets his proposal passed?

a. Reduce the medical care coverage to patients

b. Ration care

c. Increase the patient deductible costs

d. Increase patients premiums

e. Decrease payment to physicians and hospitals

f. Decrease administrative waste

g. Decrease profits of healthcare insurance companies who will be the government’s administrative service provider. .

h. Decrease unnecessary medical treatments. Who decides what is unnecessary?

Other options not on the table

i. Develop a plan for end of life ethical decisions. Politicians are not interested in discussing this issue.

I wonder what Ted Kennedy’s bill will be and who will be paying it?

j. Decrease defensive medicine practices by instituting effective tort reform. President Obama said he is not considering this and received boo’s at the AMA meeting. He believes the lawyer claim that the cost is insignificant.

k. Decrease physicians’ overhead by decreasing rent, paperwork, committee meetings and needed full time employees for the excessive administrative work.

The government should develop an ideal electronic record and charge users by the click. Upgrades and maintenance would be free. It would create a completely functional EMR. President Obama 50 billion dollar plan will make vendors rich and have little impact on electronic medical record development.

l. Decrease Healthcare insurance industry’s administrative waste. It will not occur in a non price transparent and cost transparent environment.

m. Decrease patient abuse or the healthcare system.

n. Fund effective chronic disease management program.

There is no plan for re-teaching physicians how to run chronic disease management programs. A few poorly designed studies outsourced chronic disease management to proprietary disease management companies. The failed to report improvement in outcomes because they were not extensions of the primary physicians care.

o. Define responsibilities in the therapeutic unit (physician and patient). Patient physician contracts for chronic disease.

Who is responsible for the defects in the healthcare system leading to increased costs?

I believe these are the key questions to ask. Once answered, systems can be set up to correct the defects. The easiest group to blame is physicians. They are the least organized, the least effective lobbying group and the least generous to politicians.

1. Who is responsible for obesity?

Patients become obese by overeating and under exercising. Food industry by producing cheap high caloric value processed food. Government through subsides encourages food industry and farm industry to produce these food. There is little public service campaign to discourage obesity.

2. Who is responsible for AID’s infection?

Patients by sexual habits and behavior. Government has conducted public service education campaign that has encouraged effective prevention but has not been intense enough.

3. Who is responsible for drug and alcohol addiction?

Patients are responsible for their behavior. There are no public service campaigns that discourage this behavior. Many of our entertainment icons encourage the masses misbehavior.

4. Who is responsible for smoking?

Patients are responsible for this behavior. Government has been effective in promoting a non smoking policy. The tobacco companies have gotten around government efforts. Agricultural policy has not discouraged tobacco growth.

5. Who is responsible for air pollution leading to chronic lung disease, asthma and lung cancer?

The government is with its lack of a coherent environmental policy. The bill passed by the House of Representatives does not decrease pollution. It increases the cost to pollute. It is defective in have many negative exceptions.

6. Who is responsible for the epidemic of Diabetes Mellitus, lung disease, end stage renal disease, and osteoporosis?

All the stakeholders with the government most responsible for not having a positive health policy

6. Who is responsible for the high cost of insurance?

The healthcare insurance industry with the nature of its price structure, the practice of defensive medicine by physicians, the patients with first dollar coverage, the government by not enforcing regulations.

The Obama administration is focused on the wrong reforms. It is talking about expanding a broken non functioning system. All the actions by the various stakeholders are driven by perverse incentives. All of these perverse incentives are driven by economics. The economic morass has evolved since the introduction of Medicare in 1965. Most political decisions are driven by vested interests protecting their economic interests.

In order to create an affordable and functioning healthcare system for all, President Obama and his team should be discussing how to align all the stakeholders’ vested interests so all are satisfied with the economic outcomes. The consumers are the primary stakeholder. The systems should be built to empower the consumers. President Obama should be focused on decreasing these factors and issues that stimulating our excessively expensive and dysfunctional healthcare system.

With his stimulus program for electronic medical records and his proposed healthcare plan he is throwing good money after bad. The money will be wasted and the healthcare system will not be improved. More people will be covered by healthcare insurance. The healthcare insurance coverage will be restricted by the government as a third party and not by the patients. Less medical care will be available and that will be bad.

I discuss most of these issues and the solutions in my blog http://stan.feld.com. The summary blogs are at   http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/06/summary-blogs-to-repair-the-healthcare-system.html

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

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How To Neutralize The Healthcare Insurance Industry’s Attack. Part 2

May 31, 2009
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Stanley Feld M.D.,FACP,MACE

Move On.org ability to social network is legend. MoveOn.org acted immediately with a call to action as soon as it was obvious that the healthcare insurance industry was going to attack President Obama’s healthcare plan. Its plan is to attack the healthcare insurance industry

Blue Cross Blue Shield is trying to kill "a key plank in Obama’s reform platform." So we’re trying to raise $150,000 in two days to fight back. Can you chip in $35 right now?

clip_image001Click Here

“Dear MoveOn member, “

Breaking news on health care: The Washington Post is now reporting that insurance giant Blue Cross Blue Shield "is putting the finishing touches on a public message campaign aimed at killing a key plank in Obama’s reform platform."1

The Huffington Post sums it up as "Insurers Planning on Double-Crossing Obama."2

MoveOn.org drew the line in the sand before the healthcare insurance industry using old media tactics finished its storyboard.

“We knew the insurance companies would eventually turn on the president, but this is much sooner than expected. And they’re targeting the public health insurance option—the crucial piece that will help cover everyone. So we’re immediately launching a rapid-response campaign to go toe-to-toe with Blue Cross Blue Shield and win quality health care for all Americans.”

MoveOn.org makes the point that the insurance companies turned on the President. It has prepared a rapid-response to help the President get his healthcare reform package passed in 2009.

“We need to raise $150,000 in the next two days. It’s a lot, but we’ll need every penny to take on Goliath. We’ll run ads, hold events, and work like crazy to get the real truth out to voters. AND we’ll keep the pressure on Congress to make sure they don’t get bullied into gutting the president’s plan to guarantee health care coverage for everyone. Can you chip in $35 right now to make it happen?”

https://pol.moveon.org/donate/blueshield.html?id=16165-7180088-yqI_hAx&t=3

MoveOn.org’s message is clear. It is asking people to send money to prevent the healthcare insurance industry from destroying a key provision, (“National Insurance Exchange”) in the President’s healthcare reform plan. President Obama’s healthcare reform plan claims it will provide a public health insurance plan option that will not subsidize neither healthcare Insurance companies CEO’s salaries nor stockholders profits therefore reducing healthcare costs.

MoveOn.org ignores the fact that our country presently cannot afford the costs of Medicare . Expanding Medicare will be a disaster.

“If we had the choice of a public plan, private insurers would have to lower rates and improve quality to compete, so they’re dead set against it. Today’s news just confirms that fact.”

You bet the healthcare insurance industry is dead set against his plan. However the healthcare insurance industry is the administrative service provider for government operated healthcare plans. Everyone will move to the public plan. The healthcare insurance industry will make a greater profit because everyone will be insured. The process of setting price will be in the hands of the healthcare insurance industry.

There will be not improvement in access to care or quality of care because the incentives in the healthcare system will not be changed.

“In the past, Blue Cross Blue Shield has been sued for underpaying doctors and fined for refusing to cover necessary medical treatments for their customers.3 Now, with what watchdog group Media Matters calls a "desperate attempt to deceive,"4 they’ve gone one step too far.”

The healthcare insurance industry has killed the goose that laid its golden egg. It is impossible for consumers or physicians to sue the government. The government will be forced to underpay physicians as well as restrict access to necessary medical treatment.

The debate is not a debate on Repairing the Healthcare System. It is a debate between the government and the healthcare insurance industry about who controls the healthcare dollar

MoveOn raised $270,000 in 24 hours surpassing the goal of $150,000. The message is loud and clear. Consumers are mad as hell and they do not want to take it any more.

“Dear MoveOn member,

Amazing! After news broke of Blue Cross Blue Shield’s new campaign to defeat Obama’s health care plan, MoveOn members responded in a huge way. Together, we smashed our goal and raised $270,000 in just one day. (Thanks!)”

Move on.org will not stop there and set a new goal of $350,000 for the next 24 hours.

“If we can hit this mark, we’ll send a strong message to the entire industry that if they start trying to block Obama’s key health care proposal to cover everyone, we’ll be ready to fight back—hard.”

This is too much for Harry and Louise to take on. When consumers realize that President Obama’s plan will not work they will demand control of their healthcare dollars.

There are three take home points.

1. The old media will not work.

2. People power using the new media is very powerful

3. Healthcare will become consumer driven.

4. The debate is focused on the wrong issues

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President Obama: Massachusetts Healthcare Reform Is The Wrong Model

March 18, 2009
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Stanley Feld M.D.,FACP,MACE

After I wrote the article about consumer driven healthcare a Washington lobbyist said to me; “ many people in Washington do not think that the Massachusetts healthcare plan has failed. In fact President Obama and many congressmen think the Massachusetts plan should be the model for the federal government’s healthcare reform plan.”

This is difficult for me to believe. The Massachusetts healthcare reform plan fails all five criteria the Institute of Medicine’s use to define an effective healthcare plan. The plan not only fails all five criteria for healthcare reform, it has encountered obscene cost overruns.

 

“ The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.”

The Massachusetts healthcare reform plan flunks by all five criteria.

    1. Universal healthcare coverage : The state still has more than 200,000 citizens without coverage. The number is rising as a result of increasing unemployment.

    2 . Continuous coverage: Coverage is not continuous if individuals lose their jobs. The healthcare insurance premiums have risen. Small businesses can not afford to cover employees. It is less expensive to pay the state imposed penalty tax.

   3. Affordable for individuals and families: Individuals and families cannot afford coverage.

“For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications. “

   4.Affordable to Society : The original budget for the Commonwealth Care subsidized program was $387 million dollars. It almost doubled in the first year to $630 million dollars. The estimated cost in 2009 is $1.3 billion dollars. Massachusetts has already received a federal government bailout of $2 billion dollars for healthcare. These cost increases are not sustainable nor affordable to society.

   5.Access to high-quality care for everyone : High deductible plans are cheaper but the deductibles are so high many consumers can not afford care when they are sick. Much of the population is under insured. The goal is to assure affordable healthcare insurance while providing quality care.

If the plan flunks all five Institute of Medicine criteria how can policy makers in Washington think it is a success? They are deceiving themselves and the public. Why bother study the effectiveness of the plan when you can believe in the buzz?

There are other issues that compound the failure. They include local political issues of power.

1. “Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals.

2. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world.

3. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.”

President Obama , please be aware of the unintended consequences of Tom Daschle’s healthcare plan. Throwing money at defective and unsustainable systems will not work. It will fail no matter how much plan is intellectualized by healthcare policy wonks at thirty thousand feet above reality.

Some think the Medicare model meets the Institute of Medicine’s five criteria for healthcare reform. They are convinced Medicare for all is the answer.

They argue;“Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country.

Medicare does satisfy the first three criteria. It insures everyone over 65 regardless of preexisting illness. It provides access to care and not tied to a job.

However, it has not be affordable to every senior. High deductibles, massive copayments and services approved and therefore billable but not covered must be taken into account when deciding on Medicare’s affordability for seniors on a fixed income. Medicare Part D (drug coverage) has failed to be affordable from the onset. The premiums have tripled in the last 2 years.

The cost of Medicare is not affordable to society. If fact bureauocrats have tried to decrease its costs, limit its coverage and limit reimbursement. The Bush administration tried to eliminate Medicare as an entitlement. The increasing cost of Medicare is unsustainable to society. According to the CBO the cost per year will reach 100 trillion dollars in 50 years. Adding the entire population to Medicare will be folly.

The only system that will repair the healthcare system is a system in which consumers control their initial healthcare dollars and is taught to be responsible for their health maintenance. .

President Obama, you should take a hard look at the ideal Medical Savings Account option to control costs and improve the health of America.

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

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The Role Of Government In Healthcare

October 5, 2008
inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

I believe in the power of the free market if the rules are fair to all.  Logic and common sense should determine healthcare policy. I am suspicious of the validity of pilot studies designed to test healthcare policy initiatives. The studies usually are defective in their design. 

The rules of the free market in healthcare should be in favor of the consumer driven healthcare model . Physicians will listen to patients if the patients control the healthcare dollar. The primary stakeholders (patients) should own their healthcare dollar and their employer should continue to pay for the healthcare benefit. The healthcare insurance industry should not be in control of the healthcare dollar.

The proposed healthcare reforms of both presidential candidates cannot work because the healthcare insurance industry  controls the healthcare dollar and therefore the healthcare system.

Neither Presidential candidate has a chance at constructive healthcare reform.

In order for America’s economy to grow and prosper, America must promote the growth of a strong working middle class. A nation without a strong middle class having an opportunity to enjoy upward mobility is a nation that is stagnating and on the way to bankruptcy. The middle class has experienced a lack of growth lately because they have been disadvantaged to the benefit of the wealthy. They have been disadvantaged in healthcare, housing, finance, education and other social systems that have been declared broken.  Our artificial free market economies have rules that promotes the growth of narrow vested interests and stimulates greed.

The middle class must have the opportunity be educated. It must be provided with incentives to be innovative. It must have affordable healthcare and housing. These incentives must be available for all Americans. Education and health are our most valuable assets. America must develop a cultural atmosphere to encouraged citizens to practice civic and self responsibility. The environment must be free of pollution to protect citizens from disease and illness. The air that we breathe and the food that we eat must not be influenced by the greed of special vested interests.

In recent weeks we have experienced bailout proposals for our financial system.  The proposal initially ignored the protection of the middle class. In my view the first draft of the Bush bailout proposal was an insult to America’s intelligence. It favored special vested interests and furthered citizen mistrust of the federal government. The terms of the initial bailout were for the protection of Wall Street and not the protection of Main Street. The protection of Wall Street was supposed to trickle down to Main Street. The final agreement will hopefully have protections for Main Street  as well as Wall Street with no pork. These dual protections should have been embodied in the initial proposal. We should not reward corporate executives’ failure.

I have written to both John McCain and Barack Obama about my thoughts on Repairing the Healthcare System. All I have gotten back is pleas from both campaigns requesting donations. My input has as many other citizens’ input been ignored by both campaigns.

The media has characterized the presidential campaign and debates as a boxing match. The media count who outscored who on points. I hear platitudes but no specific proposals on how to protect the middle class.

I hear John McCain say he is going to fight and fight hard for the middle class as he has done for 28 years. The few specific proposals he has presented protect wealthy vested interests.

Barack Obama says he is going to look after the middle class at the expense of the vested interested  high wage earners and investors. He does not tell us how he is going to go about it.

John McCain says he is opposed to regulations yet deregulation has gotten us in the position we are in. He reversed himself at twhen it was obvious our economy was about to collapse. A few days earlier he said our economy was basically sound. He did not project the perception of knowledge of economics to America. 

It sounds like Barack Obama wants to fix everything with regulations.  We have seen historically that regulating everything does not work. A simple example is the failure and perverse effects of price controls. A true market economy works if the correct rules are in place for the benefit of all. I am against government regulations that are oppressive to incentives and innovation.

Our legal system is also broken. It is not easy to enforce the law. Corporations, organizations, and citizens get around the law if they can afford the legal expense at the expense of the middle class. There is little penalty for misrepresentation. Congress is controlled by lobbying groups. Who are the peoples’ lobbying groups? The congress should be the lobbying group for the all citizens. Instead, Congress is lobbied and influenced by vested interests.

Government should make and enforce appropriate and fair rules. It should get out of the way and let consumers drive the system. Americans are smart enough to purchase the best products for themselves given the appropriate information. 

I have criticized the healthcare insurance industry. John McCain wants to give the control of the institutions of Medicare and Medicaid to the healthcare insurance industry in order to eliminate this entitlement. The healthcare insurance industry does nothing for the middle class and small businesses and everything for its own bottom line. Obscene healthcare insurance executives’ salaries and corrupt payoffs occur at the expense of ordinary people.

Once again, it is healthcare insurance contract time for hospital systems and employers paying for healthcare insurance. Again, there have been examples of difficulty between the healthcare insurance industry, hospitals physicians and employers. Once again Unitedhealthcare  is using the same tactics they used in the Denver market last year. Neither Congress nor the State Insurance Boards have taken action to protect the middle class.

 

The headline in the Kansas City Star reported that ”

“St. Luke’s Hospital system in Kansas City and UnitedHealthcare go their separate ways as the price of healthcare insurance goes up and the coverage goes down.”

“In July, after a year and a half of trying to come to agreement, the nonprofit St. Luke’s — which encompasses 11 hospitals and several physician practices in the region — said it was done negotiating and would stop accepting United benefits after Feb. 28, 2009”

“St. Luke’s perspective, negotiations had been going on for a year and a half without significant progress. It announced a firm split with United in July so patients and businesses would have ample time to find new coverage if they wanted to stay in St. Luke’s network

“Bonner, who is senior vice president of business development for St. Luke’s, said the increase the hospital asked for would have brought reimbursement rates from United in line with other insurance carriers.”

I suspect both are wrong. I suspect the negotiating tactic UnitedHealthcare uses is the same used in Denver. They yield when they start losing subscribers.

United, which has 504,000 “members” in northwest Missouri and all of Kansas, would continue negotiating if St. Luke’s came back to the table, Tracy said, but he admitted reconciliation is highly unlikely.”

“United’s insurance-carrier competitors said they are seeing a windfall. Since St. Luke’s announcement this summer, Humana has been writing about 40 policies a month for companies leaving United, said David Miller, president of Humana in Kansas and Missouri.”

The losers are the middle class who would buy insurance if they could afford the premiums. The State Insurance boards must develop and enforce real  transparency rules for the healthcare insurance industry. If the rules are not followed the healthcare insurance company should lose its license to sell insurance in the state.  The rules must be made and enforced by the insurance board and state hospital boards before negotiation comes to this point. Presently, there is no simple mechanism for adjudications. State boards of insurance and hospital systems’ mandates must have effective consumer protection.

Patients are not included in the free market determination of price. They are the victims of a market price controlled by the healthcare insurance industry (secondary stakeholders).

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Dr. Feld. Why Only Pick On The Healthcare Insurance Industry?: Part 2

May 28, 2008
inMedicine: Healthcare System, Summary Blogs
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Stanley Feld M.D.,FACP,MACE

This post continues my reply to Matt Modleski’s comment. If one views the dysfunction in the healthcare system as a gradually evolving process is it clear that all the stakeholders have contributed to its dysfunction. As each stakeholder adjusted to the changes, the healthcare system became more dysfunctional.

“ The number of scans, tests and procedures that are done each year unnecessarily because the facilities that are built (many Physician owned) are put to use is also a big part of the problem. This has been documented in study after study (some of them conducted by physicians).”

In the studies Matt refers to patients going to these testing clinics could be getting better care than the non physician owned clinics? Remember quality of care has not been clearly defined by policy makers or the healthcare insurance industry.

Physicians in academic medicine have not precisely defined quality medical care. However, everyone talks about it. I do not believe you can assume physicians are doing the test simply to make a profit.

I do think there are a lot of unnecessary procedures done in many hospital outpatient facilities and physician owned facilities. Many of the procedures are done because physicians are forced to practice defensive medicine. There are many law suits in the pipeline presently because of missed diagnosis.

Patients with vague symptoms at the time of physician visits need to be tested to detect possible disease. Almost everyone experiencing automobile accidents with the slightest head trauma automatically undergoes a CAT scan to rule out a cerebral bleed. President Reagan did not get an automatic MRI or CAT scan when he had his subdural hematoma.

Diagnoses that would not otherwise be made are made early through testing using new technology. Clinical judgment has lost its place in the defense of malpractice suits. The costs of using new technologies has an enormous impact on the cost of medical care. Yet no one has precisely defined quality medical care . Nonetheless, physicians have been accused of over testing when they control their intellectual property.

A significant number of malpractice suits would disappear if the government changed some liability rules. The rule change would make malpractice claims less attractive to malpractice attorneys. Malpractice attorneys receive one third to one half of any settlement. A change in the contingency rule would decrease lawyers’ incentives and frivolous malpractice claims. The government has to put limits on damages for certain claims and change the adjudication process. Plaintiffs attorneys’ have resisted these changes.

The state of Texas has made these changes. there has been a marked reduction in malpractice claims as well as malpractice premiums.

The reasons for the overuse of the healthcare system have not been publicized in the media or by organized medicine. Overuse of the healthcare system makes a sensational story for the media and it is easy to blame physicians. I am not interested in defending physicians. However, one should give physicians the benefit of the doubt since you trust them to deliver the best medical care possible. If you do not like what they suggest pick another physician. I would not rely on a healthcare insurance company’s employee looking at the computer screen to make a medical treatment judgment about my health.

There are also lots of unnecessary tests done because of increasing patient demand. Patients learn from the media and online what needs to be tested. Cholesterol testing and bone density testing are increasing. When the compliance rate is analyzed only 30%- 50% of people who should be tested are tested. When they were tested only 30-50% treated stayed on the medication after 1 year. Think about it. If everyone was tested and treated appropriately the cost of testing and treatment would increase while the cost of the complications of these chronic diseases would fall precipitously. The greatest cost is the cost of treating the complications of chronic diseases.

Matt complains about physicians owning the facilities to test patients. Why should physicians give their intellectual property away to hospitals when they can do the test more conveniently and cheaper in their office?

Physicians detect, treat and teach patients how to become professor of their chronic disease so patients can be knowledgeable in managing their disease. This is the definition of cognitive therapy. Cognitive therapy is not reward by the government or the healthcare insurance industry. Isn’t this a perverse circumstance since 90% of the healthcare dollar is spent of the complications of chronic disease?

“The system is broken and commoditized reimbursement, regardless of the quality of care, is a key component, but so is the overtreatment of patients by financially driven providers. Every now and then you hint as much, but you would be helping everyone by giving it equal airtime with your perspective on the woes created by the insurance companies.

Physicians’ intellectual property has been discredited and devalued. Physicians are intelligent people who have accepted the fact that their credibility is challenged. They are trying to figure out way to make a living taking caring for patients in the best possible way. They also want to figure out how to protect their intellectual property. They try not to react to a healthcare system that has challenged their skills and integrity.

Patients are at fault by believing medical care is a right. Obesity is an epidemic and generates chronic disease and the complication of chronic disease. The adherence to hypertension therapy is less than 50% leading to strokes and myocardial infarction. The adherence to diabetes treatment is less than 40%. Shouldn’t society be putting energy and money into solving this problem?

The question is where did the dysfunctional behavior start? It started when the healthcare insurance industry started gaming and controlling the healthcare system for profit after the government instituted price controls.

My solution is my ideal medical savings account putting the patient in control under the appropriate set of rules. The consumer is the only stakeholder that can force the government to make the correct rules!

"Keep doing what you do, I read your stuff every day".

"Cheers,

Matt"

Matt, thanks for your comment.

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

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Clinton, Obama Clashing On Healthcare – Part 1: Democrats Debate Requiring People To Buy Coverage

January 16, 2008
inMedicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Universal Healthcare
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Stanley Feld M.D.,FACP,MACE

“ Sen. Hillary Rodham Clinton is on the attack against her main rival, charging that Sen. Barack Obama’s health plan would leave millions of Americans without medical protection while hers provides coverage to all.”

The real issue should be that everyone should be the able to purchase healthcare insurance if they want to. It should not be mandated with a penalty. There should be no restriction on eligibility. Everyone should be able to purchase healthcare insurance with pre-tax dollars. The government should subsidize the less fortunate on a means tested basis. Everyone should own their healthcare dollar. Everyone should have financial incentives to use their healthcare dollar wisely.

Patient education is critical for the prevention of the complications of chronic disease.Patient education should be adequately compensated. Patient education programs to teach patients to use their healthcare dollar wisely should be available on the internet.

Consumers can force the healthcare insurance industry to compete for their healthcare dollar. If real price transparency was required for hospital systems and physicians, both would be forced to compete for the consumers’ healthcare dollar.

With consumer driven healthcare, the market economy would force the healthcare insurance industry to become more efficient. It would decrease its 150 billion dollars in administrative costs.
Consumer driven healthcare would also stimulate hospital systems and physician groups to deliver more efficient medical care. Both groups would be interested in eliminating administrative waste through the use of information technology. The consumer must be the primary driver of the healthcare system, not the government nor the healthcare insurance industry.

Consumer driven healthcare would create a more orderly evolution toward the adoption of information technology rather than the punitive administrative rules and bureaucratic inefficiency advocated by Gingrich and Kerry in their E-prescriptions article.

I have mentioned that it costs a physician $7 to pull a chart from his filing racks. It costs another $15 to complete the chart. The use of the ideal electronic medical record would decrease this cost to pennies. In turn, it will decrease the physicians costs to deliver medical care which would reduce fees.

If an innovative software company provided universal software to physicians and hospital systems and charged physicians and hospital systems by the click, we could eliminate the burden of start up costs and capital expenditure.

Hospital systems’ pharmaceutical charges and bed charges should be based on its cost plus a reasonable profit.

Healthcare premiums must be community rated and available to all with pre-tax dollars and subsidies if necessary. Consumers electing not to purchase healthcare insurance would be responsible for the retail charges. This might create incentives for those would choose not to take advantage of the universal coverage opportunity.

Incentives should be given to physicians to develop patient education services to prevent the complications of chronic diseases. All the presidential candidates are ignoring the fact that 80-90% of the healthcare dollars are spent on the complications of chronic disease.

“ Hillary Clinton’s assertion, flatly rejected by the Obama campaign, rests on a pivotal difference between the two Democratic presidential candidates’ health proposals. Clinton says she wants the government to require all citizens to buy insurance or face a penalty. Obama relies on a mandate for children only, and instead emphasizes ways to make coverage more affordable.”

I believe the basic difference between Hillary and Obama is Hillary thinks you have to force people to do things and Obama thinks you have to provide the environment and incentives to get people to do things. Obama has more respect for our intellect than Hillary does. However, both candidates are advocating systems that will fail. After they fail the next step is universal coverage by a single party payer. The single party payer will be a disaster for America.

“ The seemingly technical distinction has launched an impassioned debate among economists, health care analysts and politicians, and has fueled a key campaign argument in early-voting states such as Iowa. It will likely receive more attention as the election season grinds ahead.”

Here we go again. The media seeks openings to make the election a spectator sport. Americans want serious discussion of the issues and well thought out solutions.

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Retirement Center’s Partnership With Insurer Eases Healthcare Concerns

December 9, 2007
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

It is my belief that innovative entrepreneurs are going to develop systems that will provide consumers with control over their healthcare dollar. These systems will provide the infrastructure to help patients prevent the complications of chronic disease and also result in decrease in cost to the healthcare system.

If patients have control of their healthcare dollar the decrease in cost will be an extra dividend to patients. Other innovations will be stimulated by a consumer driven system. We are starting to see some good ideas.

Here is an example of a good idea: Dallas retirees J.T. and Phyllis Dunkin, both 78 years old, are paying more for their health insurance (MediGap insurance) but enjoying life more. They live in a retirement community in North Dallas. Like many seniors, the Dunkins have supplemented their basic Medicare coverage by purchasing a Medigap insurance policy. Medigap reduces their sizable potential out-of-pocket health care expenses not covered by Medicare. Mr. and Mrs. Dunkin pay $250 per month each in premiums for the added coverage. Medicare has deductibles and co-pays that can be a great burden. I will provide more details on these deductibles and co-pays in the future. The Dunkins pay about $90 a month more than the typical Plan F Medigap insurance but the added benefits of chronic disease management more than compensate for the increased price.

“ Dr. Mary Norman, Highland Springs’ medical director is instantly available to patients in the retirement community for acute medical illness. “

“When Mr. Dunkin underwent bypass surgery in March, the health plan provided transportation to the hospital, sent a nurse to his bedside to check on his care and then, when he was about to be discharged, arranged for a home health aide.”

“Afterward, Mrs. Dunkin didn’t have to make sense of the bills by herself or spend hours on the phone with a customer service representative. Instead, she sat down with the health plan’s benefits counselor, who answered her questions right then and there. “

Interpreting bills and figuring out liability on the ocean of hospitals’ and physicians’ charges is a stress that many elderly patients cannot handle. The stress often leads to depression.

“Best of all, the couple live just a three-minute walk down the hall from their doctor’s clinic in the Highland Springs senior-living community”

“When we tell our friends, they don’t believe us,” Mrs. Dunkin said. “Medicare isn’t supposed to be this easy.”

It is common knowledge among seniors that Medicare is an extremely confusing system.

“Medicare is usually not so easy. The Dunkins, who are in their 70s, are part of a pilot project in which their senior-living company has teamed up with a health insurance company, with Medicare’s approval, to provide supplemental coverage.”

Their supplemental insurance is not the garden variety supplemental insurance.(Medigap) The goal of their supplemental insurance is to teach patients how to manage their chronic disease. It also provides instant physician availability. The idea is that they will avoid costly hospitalization. Ninety percent of the Medicare costs for seniors are spent on the complications of chronic disease. With this goal in mind this entrepreneurial system is already working to decrease complications of chronic disease.

Experts say the project may become a national model for improving the care of chronically ill Medicare beneficiaries while holding down costs. Early cost savings have been promising.

It is obvious to me that one of the keys to the Repair of the Healthcare System is to effectively teach patients how to manage their chronic disease. The result will be a decrease in the complications of chronic disease and a decrease the cost of care enabling the seniors to live a happier and healthier life.

This innovation can easily be incorporated into my ideal medical savings account plan. The cost savings must be shared with the patient to make them even happier and stimulate further compliance with treatment

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Mechanism Design and the Healthcare System

November 11, 2007
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

Last month the Nobel Prize in economics was awarded to Leoid Hurwicz, Roger Meyerson and Eric Maskin . They were awarded the Nobel Prize for developing the economic theory of “Mechanism Design.” My first reaction was “what is that?”

After some research I discovered the power of Mechanism Design. It is a brilliant economic theory that could solve many economic problems. Mechanism Design applied to our healthcare system could solve many of the problems.

What is it? “ In economics, mechanism design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested. This is done by setting up a structure in which each player has an incentive to behave as the designer intends. The game is then said to implement the desired outcome. The strength of such a result depends on the solution concept used in the game. It is related to metagame theory, which is the theory of games the play of which consists of developing the rules of another game.

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare. However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers[1], thus significant research in mechanism design involves making trade-offs between these qualities. Other desirable criteria that may be achieved include fairness (minimizing variance between participants’ utilities), maximizing the auction holder’s revenue, and Pareto efficiency. More advanced mechanisms sometimes attempt to resist harmful coalitions of players.”

Lodi Hurwicz contributed the idea of incentive compatibility. His point is the way to get as close to the most efficient economic outcomes is to design mechanism in which everyone does best for themselves. He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying.

If everyone’s incentives are aligned you have a much more efficient economic system. An example is defense contracting. If you agree to pay on a cost plus basis you have created incentive for the contractor to be inefficient. I you agree to pay a fixed price you can come close to an efficient price if you have all the truthful information. If you do not you have incentives aligned and truthful information you create the incentive to be overcharged. Most people can do better by not sharing truthful information. If the rules of the game require truthful information you can get close to an efficient market driven solution.

The concept of Pareto efficiency means no one can be made better off without someone becoming worse off. Therefore the incentive is to maintain your dominance by not being truthful at the expense of others. Hurwicz observed as others had that the dispersion of information was at the heart of the failure of a planned economy. He observed that there was a lack of incentive for people to share their information with the government truthfully. The free market mechanism was far less afflicted than central planning bureaucracy by such incentive problems. The free market economy was by no mean immune to this defect. He observed that the free market economy can get us closer than central planning to incentive compatibility because the end consumer can drive the discovery of truthful information.

The customer creating rules of engagement in a market driven economy can get you closer to the ideal of Mechanism Design. Since the customer determines success of an enterprise by creating demand in a transparent environment they can get closer to incentive efficiency. They create the rules of the game for compatible incentive.

Roger Meyerson contributed the revelation principle, a mathematical model that simplifies the calculation to create the most efficient rules of the game. The mathematical model gets people to reveal their truthful private information leading to aligned incentives.

Eric Maskin’s breakthrough was in perfecting Mechanism Design with his “implementation theory.” His theory clarifies how to design mechanisms that heighten incentive alignment and efficiency.

How does Mechanism Design relate to the Repair Of The Healthcare System? We have to set the rules of the games so that we align all the stakeholders’ incentives without one stakeholder takes advantage of another. The insurance industry is taking advantage of the patients, doctors and hospital systems. The hospital systems are taking advantage of the patients, doctors and insurance companies. Doctors are taking advantage of the insurance companies, hospital systems, patients and the government. The government is taking advantage of the hospital systems, the doctors and the patients. Employers who pay the insurance bills for their employees are taken advantage of by the insurance companies. The drug companies are taking advantage of patients and unduly influencing physicians.

In our healthcare system everyone is pursuing his vested interest in a game that has rules that does not lead to “incentive compatibility.”

Some politicians think central planning will straighten out the rules. Historically, central planning has not worked. The winners of this year’s Nobel Prize in economics have proven this fact.

I believe the consumers can fix the rules of the game so that all the incentives are compatible. Consumers have to have incentives to force politicians to fix the rules of the healthcare game. Consumer driven healthcare system will achieve the alignment (incentive compatibility) using the ideal medical saving account.