Results found: 99

Permalink:

Has A Government Entitlement Program Ever Come In Under Budget?

October 27, 2009

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

• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform plan will not repair the healthcare system. It will not provide universal coverage, it will not provide affordable coverage and it will not increase the quality of care.

Not repairing the healthcare system is unacceptable. I have proposed an ideal medical saving accounts that will align all the stakeholder’s interests while not letting any stakeholder take advantage of the other. It is dependent on appropriate, enforceable state and federal rules and regulations that permit the market system to flourish and maintain freedom of choice.

Government should make rules to level the playing field for all stakeholders and then get out of the way. An efficient healthcare system can be created by permitting the consumer to drive the healthcare system.

Many employers have adjusted to the present healthcare rules and regulations. The result has been greater dysfunction in the healthcare system .

As healthcare insurance premiums increased employers could not afford full coverage for their employees. They changed to providing partial insurance coverage. Employees are required to pay for a significant portion of their insurance policy. The money comes out of the employee’s salary with pretax dollars. .

Other employers have provided high deductible insurance for their employees. The initial deductible costs are paid for with after tax dollars and have been an unaffordable burden to employees. Some cannot afford to pay the deductible and avoid care.

This scheme has the same effect on employees’ purchasing power as a federal tax increase. It should be viewed as a hidden tax increase.

There are many ways to fix the inequities to consumers in the present healthcare insurance system. .

“Substantial improvements to private insurance markets can be much more targeted and straightforward.

These include changes to HIPAA and COBRA provisions to ensure portability between employer insurance plans,

Measures to prevent higher premium upticks for customers moving from group to individual insurance markets,

Ensuring that market entrants only face a single risk evaluation,

Opportunities for the uninsured to opt back in to the system under new protections.”

Correct accounting standard for incurred claim and Medical-Loss ratio.

Instituting ideal medical savings accounts with patients owning and controlling their healthcare dollars would result in consumers being educated purchasers of healthcare services. Permitting consumers to retain the unused portion of the deductible in a tax retirement trust account would motivate the consumer to have a healthy lifestyle.

Developing rules and regulations that calculate healthcare insurance premiums for the entire population and not rates determined by age or pre-existing illness.

Taxing employers appropriately so that they provide adequate healthcare insurance for their employees with tax deductible dollars.

9. Creating malpractice reform that has caps on liability. It will decrease defensive medicine and over testing by physicians in order to avoid malpractice suits. This simple rule could decrease healthcare costs by $750 billion dollars a year.

“STEPHANOPOULOS: The president has drawn one other very red line in the sand, that he won’t sign any health care bill that increases the deficit.”

“OBAMA: I will not sign a healthcare reform plan that adds one dime to our deficits, either now or in the future.”

However the history of government entitlement programs estimates has consistently contradicted President Obama’s statement. With the CBO’s estimates changing weekly and a large bureaucracy being set up, President Obama’s estimates are certain to be underestimates.

Next let’s examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing.

In many states a person living in poverty but earn more than the poverty level defined in 1955, does not qualify for Medicaid coverage.

Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that’s before the health-care bill covers millions of new beneficiaries.

The bureaucratic process for Medicaid coverage requires reapplication every six months. Moises’ reapplication was rejected by bureaucratic error without explanation. He and his wife do not have coverage. Now his children are uncovered. So much for bureaucratic efficiency in Medicaid.

Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren’t small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion.

Even if one gave President Obama the benefit of the doubt on his budget estimates his plan will not repair the real defects in the healthcare system.

There is strong historical precedent that his new entitlement program will create large deficits no matter what tricks he plays with the numbers.

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

Permalink:

Consumers’ Anger Toward The Healthcare Insurance Industry Mounts

June 3, 2009

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama is utilizing the well earned anger consumers have for the healthcare industry in order to promote his healthcare reform plan. Eighty percent of consumers are not sick. Those 80% think their healthcare insurance policy is great. The 20% of the population that is sick is very unhappy with the healthcare insurance industry.

The internet and the blogosphere have enabled those 20% to express their anger. In less than 5 hours there were 177 negative comments to the article describing how the healthcare insurance industry double crossed President Obama. This anger has been ignored in the past. The new media has created an environment in which the anger cannot be ignored. The healthcare insurance industry has killed the goose that laid its golden eggs.

President Obama has made the internet his town hall to permit consumers to express their discontent for the healthcare system. I suspect President Obama will receive more than 5 million complaints in his campaign to expose the abuse of patients by the healthcare insurance industry.

It will not bring us closer to having an affordable healthcare system. If the complications of chronic diseases were prevented, defensive medicine eliminated by effective malpractice reform, and healthcare insurance companies’ administrative waste stopped, America would have an affordable healthcare system.

Consumers need to control their healthcare dollars, receive incentives and be responsible for their own health and healthcare. ( ideal medical savings accounts).

The following are a few consumer comments

“Not surprised at all by this. The health insurance companies have had an unbelievable advantage, they can do anything they want. The only thing they need to do is keep Congress happy with lobbyists because Congress is not their customer, they have their own insurance paid by you and I. It’s gloves off time on health reform. These guys will pull no punches, they are fighting for their yachts. While we lose insurance if we file a claim.”

A consumer terminated from his job.

“I am a 56 year old professional with master degrees and many years of experience in my industry & for 19 years plus I worked for the same large corporation that just terminated me from employment because I was diagnosed with a blood cancer.
My family and I have lost medical coverage because of this and at a time when I need it the most. I would like to continue buying the same insurance even with the termination but I can not do so because I am excluded from group employment. I have lost all my rights to buy insurance like everyone else and with pre-existing medical problems nobody will insure me (or my family which depended on me).
At the very least, because I worked all my life and have never been unemployed, I should have been allowed to keep my insurance that I had while I was healthy. When I tell my friends overseas what my employer, Sun Chemical Corporation has done with me, they all say it is illegal in their country and it is a total horror that our society has chosen to discriminate so savagely against the sick and those unfortunate to lose their employment.
It is a travesty that corporations and health insurance companies collude to cleanse their ranks of those that are sick and those that are getting old as it has happened at Sun Chemical Corporation a multinational division of Dainippon Ink & Chemicals a Japanese conglomerate. “
An abused person”

This man’s corporation dropped him. He should be able to get COBRA insurance but the COBRA premium is at least 150% more than the employer paid premium. The premiums must be paid with after tax dollars. This increases the real cost of the COBRA premiums by an additional 35%.Corporate self insured plan’s can avoid the COBRA coverage requirement.

This consumer is 9 years away from being eligible for Medicare coverage. He cannot qualify for private insurance because of his age and his preexisting illness. The rest of his family might not qualify for more expensive individual healthcare insurance policies.

A byproduct of the new media is others can be made aware of the healthcare systems inequities.

“I am so sorry and hope there is some sort of alternative for you found very soon – for you and your family’s sake. This is why we have to hang solidly behind healthcare reform. Personally, I would prefer single payer because these guys do not want to reform, they want to continue holding everyone’s health hostage. What you’re going through is awful. Please take care…so sorry.”

+ I’m a fan of this user

There are pleas for people to exercise our People Power.

Dear J,

“It’s exactly stories like you that need to get out in front of this thing and bury Blue Cross in their hypocritical "we provide better service" grave.
Just like so many scare-tactic politicking, these ads are nothing more than a mirror aimed outward. The private insurance industry is broken because there are really no better options.
If they want to survive, they’re just going to have to do better…

As far as I’m concerned, no one will be upset if they don’t survive.”

There are even comments containing color words.

Blue Cross Blue Shield s@#%&–they have raised my rates every year for the past three years, even though they have not had to pay ANY medical charges for me. What do you expect these insurance guys to do? They don’t want to lower costs. No doubt, if there were a cure found for cancer, there would be some idiots, like insurance companies and republicans, rushing to undermine the cure and bury it because it hurt the chemotherapy industry. That’s the way they think. They have NO interest in making health care more affordable, more efficient, and less necessary. Don’t threaten the system that helps the fat cats.

The negative comments are endless. President Obama will receive lots of documentation. Documentation he will use against the healthcare insurance industry. He will win. Unfortunately, he will not solve any of the problems in the healthcare system.

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

Permalink:

Consumers’ Must Control Their Healthcare Dollars

March 15, 2009

inMedicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

• Leave a comment

Stanley Feld M.D.,FACP,MACE

I. Consumer Control of their healthcare dollars:

A. How would a medical savings account work to reduce cost, while encouraging physicians, hospitals and the healthcare insurance industry to become more competitive and efficient?

1. By creating a system in which consumer’s demands drive competition and efficiency because they are spending their own money.

2. The government’s role should to support assets designed to teach consumers to drive the healthcare system’s efficiency so that consumers could save their own money for retirement.

B. The cost of healthcare insurance for a family of four is presently over $12,000 per year. Who should be the payers for healthcare?

1. Both consumers and employers should be able to pay for healthcare insurance with pre tax dollars.

2. Medicare and Medicaid should be abolished. Both Medicare and Medicaid are unsustainable entitlement programs that must be restructured to create a sustainable system. They should replaced by The Ideal Medical Savings Account. Medicare recipients should pay a means tested premium directly from their monthly Social Security check. It should be paid with pre-tax dollars.

3. The government should subsidize the uninsured using economic means testing methodology similar to the economic means testing used to determine Medicare premiums. The premium should be paid monthly rather than yearly. The more you earn the more you pay.

4. Consumers who were Medicaid would not pay a premium. They would be totally subsidized by the government as they are presently. They would get the identical healthcare insurance that other consumers have.

The physicians’ and hospital systems’ fees have already been negotiated or imposed by the healthcare insurance industry or government. There are many reimbursement overpayments and underpayments in the system that can be corrected. There are many prices for healthcare services. There are retail and multiple discounted prices.

Presently, uninsured consumers are charged retail price for healthcare services. Under appropriate rules with real price transparency, consumers can negotiate an affordable price acceptable to all. If a consumer elects to overpay it reduces the money in the consumer’s Medical Savings Account. The government’s role should be to support a variety of assets to provide consumers with education. The government should enforce appropriate rules and regulations to protect consumers. The Ideal Medical Savings Account will create incentives for consumers to save their money and maintain their health.

II. Healthcare System Errors

A. The healthcare system does not provide payment for prevention care.

B. There are no good criteria defining preventive care.

C. There is no payment for systems of medical care that will prevent the complications of chronic diseases.

D. There are duplications of testing and costs in the system due to perverse incentives and lack of appropriate information technology.

E. There is overpayment for some procedures and tests and underpayment for others.

This can be fixed by a system of both government and consumer education. Government must educate consumers to be wise purchasers of medical care. It can be done with effective websites. .

III. Mechanics Of The Ideal Medical Savings Account:

A. Goal: Provide consumers with incentives to become wise purchasers of medical care and maintain good health.

1. Employers are willing to pay $12,000 per year for healthcare premiums. Presently it costs $15,000

2. $6,000 of the $12,000 should be put into a medical saving trust account. The second $6,000 is for first dollar insurance coverage beyond the initial $6,000.

3. At the end of each year the unused portion should be transferred to a retirement account.

4. All consumers would be motivated to have healthcare insurance. They benefit from money saved, if they remained healthy.

5. Government subsidies should be available to self employed and uninsured consumers who could not afford healthcare insurance. Universal coverage would be instantaneous. Consumers would maintain free choice. Each consumer would be his own deterrent to abuse of his health and overuse of the healthcare system

6. It is to society’s benefit to maintain a healthy and fit population.

7. Consumers with a chronic disease should be motivated to learn to avoid acute or chronic complications of the disease.

a. For example: A diabetic could be motivated to learned how to avoid acute complications eliminating costly emergency room visit. Continuous control of blood sugars would reduce complications by at least 50%.

b. Diabetics need maintenance with follow up care. If they maintain perfect control he would spend part of the $6,000.

c. If they spent $4,000 but avoided hospitalization or a complication of his disease his employer or the government could afford to give him a $2,000 bonus. Their total retirement account deposit at the end of the year would be $4,000 rather than $2,000. They would have avoided hospitalizations and ER visits . Diabetics would be on the way to avoiding the costly complications of their chronic disease.

d. They would enjoy good health and increase their retirement account. The government or their employers would save money decreasing their premium costs.

Simply providing healthcare insurance (private insurance or public insurance) will not solve the problem of the ever increasing cost of care.

Motivating and teaching consumers to take care of their health short term and long term will decrease healthcare costs.

8. Ideal Medical Savings Accounts would make actuarial sense to the healthcare insurance industry if it could get past its desire to control the first healthcare dollars. It would be able to reduce premiums because fewer people would get sick.

If the Ideal Medical Saving Account would come to pass America would have a positive impact on our epidemic of obesity, environmental pollution and lung disease.

America let us force our politicians to finally do something that makes sense.

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

Permalink:

Dear President-Elect Obama: Part 4

December 7, 2008

inUncategorized

• Leave a comment

Stanley Feld M.D.,FACP,MACE

You made a promise to the American people. You would listen to everyone and choose the best plan. If it did not work you would change the plan. You campaigned on a platform of universal healthcare without mandates. It has recently been reported that a consensus is emerging on universal healthcare.

“The prospect of bold government action appears to be accepted among players across the ideological and political spectrum, including those who opposed the idea in the 1990s”.

I see no evidence that this consensus includes the opinions of practicing physicians. There is some evidence that you have included large well known universities, clinics and hospital systems. However they do not represent the majority of the practicing physicians in the country. The practicing physicians are your workforce and they are the people whose opinion you should seek.

“The answer says leading groups of businesses, hospitals, doctors, labor unions and insurance companies — as well as senior lawmakers on Capitol Hill and members of the new Obama administration — is unprecedented government intervention to create a system of universal protection.”

This sounds like the typical government way of doing things. The consensus crafts the laws and regulations. When the programs fail the law makers are confused. The programs fail because the laws and regulations do not get to the basic problems. This leads to more regulations leading to more failure.

I am afraid you are going to rely heavily on Tom Daschle. He is a nice man and an effective legislator. He is also a self appointed healthcare expert. I have written an extensive review of Mr. Daschle’s book and plan. His plan is dead wrong. His policies do not solve the basic problems of the healthcare system.

I beg you. Please do not rely on his plan to solve the healthcare problems. It will only increase the cost, decrease compliance and drive the country into healthcare bankruptcy more quickly.

There are some good ideas in his plan but they are poorly crafted. The recession and rising unemployment will certainly increase the uninsured to well over 250,000. I believe universal healthcare is a concept that has come of age.

“Mr. Daschle wants to open to all Americans the Federal Employee Health Benefits Plan–a menu of private-insurance options now accessible only to government workers.”

He suggests there would also be some form of means-tested premium support (or tax benefits) for Americans who couldn’t afford one of the presently available plans. This could solve the uninsured problem. It would at least put the uninsured premium payment on a pretax dollar schedule and level the playing field. Private health plan contributions made by employers enjoy pre tax status.

However, by making the Federal Employee Health Benefits Plan available to all citizens you are providing a perfect excuse for employers to drop the health benefit.

Providing a healthcare benefit to employees has become too costly. The Bush administration, by distorting the goals of my ideal Medical Savings Accounts, with Health Savings Accounts tried to provide an excuse for employers to drop the healthcare benefit

Employers have had to decrease healthcare coverage to keep the premium prices within reach. Many citizens are under insured. Employers would rather pay the government and let you be the provider of healthcare insurance for their employees. Universal healthcare with a single party payer then becomes socialized medicine with restriction of freedom of choice by the patients and restrictions on practice of physicians.

Your administration would have to continue to outsource the administrative services to the private healthcare insurance industry. This would thrill the healthcare insurance industry as I have described previously.

Your expanded government program would experience the same financial debacle the state of Massachusetts is experiencing with its universal healthcare plan. In fact the state of Massachusetts has applied for an addition 8 billion dollar bailout after receiving 2 billion dollars from the federal government already.

The Federal Health Board is an example of a bad idea with potential for terrible results. Rather than being a board that creates educational programs for physicians to improve the quality of care (an attribute that has not been clearly defined) it is punitive to physicians and restrictive to patients’ access to care. Remember ,when the CEO of Winn-Dixie was asked what his secret to success was. He said, “Don’t get the A&P mad”.

“The health board would manage the pricing, and use, of tens of thousands of medical products and procedures. How can a single board (instead of, say, the market) make so many decisions, and wisely? Mr. Daschle proposes a dozen or so “experts” who would be “chosen based on their stature, knowledge, and experience, ensuring that the decisions they make have credibility across the health-care spectrum.”

Mr. Daschle admits that the board is loosely based on the National Institute for Clinical Excellence in Britain and the Federal Joint Committee in Germany. Both are charged with managing the public’s access to higher-cost drugs, medical devices and procedures. “But both are growing increasingly unpopular in their home countries–precisely because they’ve become a triumph of cost-containment over patient access and choice.”

“Despite the fresh enthusiasm Mr. Daschle shows for his federal health-board proposal, it’s not exactly a new idea. Mr. Daschle himself proposed it as part of the failed American Health Security Act of 1993.”

This is not the way reform the U.S. healthcare system. The healthcare system needs to be reformed using common sense. I am hoping you will use common sense and get to the core of the healthcare systems problems. I will discuss common sense reforms in my next letter to you.

Permalink:

Can Employers And Patients Trust Healthcare Insurance Companies Part 1

August 29, 2007

inUncategorized

• Leave a comment

Stanley Feld M.D.,FACP,MACE

I received several comments in recent weeks highlighting the hardships employers face trying to provide healthcare insurance to their employees. Employers, and individuals who want to buy individual insurance have been deceived by the healthcare insurance industry. Many associations subcontract healthcare insurance companies to provide healthcare insurance for the association membership. However, the healthcare insurance is expensive and deceptively limited. People think they are covered until they get sick and discover they are not.

The simple answer is the ideal medical savings accounts with high deductible insurance available to all after all the conditions for the ideal healthcare systems are met.

The healthcare insurance industry and congress have blocked the ideal medical savings account concept for years. Why has congress been so stubborn? MSAs were introduced by the Golden Rule insurance company at least a decade ago. Congress has been influenced by healthcare insurance industry lobbying to block the concept of individuals owning their healthcare dollar and also receive a pretax dollar tax exemption for buying their own healthcare insurance policy. I also do not believe that many of the members of congress want to understand the power and intelligence of the consumer.

In my naïve younger days, I simply could not understand why congress would be opposed to such a logical plan. It would eliminate 150 billion dollars of administrative waste in the healthcare system. My problem was I was not aware of the excessive influence the healthcare insurance industries lobbying groups have on congress.

Lobbying groups in general wield more influence than the will of the people in the daily activities of government simply because they have more money and are more focused than the individual. Previously, I spent a lot of time on TXU’s desired to pollute Texas even further with “Dirty Coal Plants”
and the subsequent acquisition of TXU by KKR with KKR’s promise to discontinue the pursuit of dirty coal plant permits.

This past week it was published that TXU and KKR spent $17 million dollars just to get its merger passed and work its way toward building dirty coal plants in Texas. Imagine how much the healthcare insurance industry pays lobbyists.

It is a true goliath against a weak and divided foe, namely patients (the consumer). Consumers do not get activated unless they are affected. Only then to they want to do something to solve the problem. The problem is only 20% of consumers are sick at any one time. We do not anticipate that we could be affected any day now.

It took the healthcare insurance industry four years and many millions of dollars to have firms like Cooper Lybrand and Price Waterhouse develop schemes that would counter the potential effectiveness of the Ideal Medical Savings Account. They developed the concept of the Health Savings Account. The HSA kept the premium dollar in the control of the healthcare insurance companies. The healthcare dollar does not belong to the patient. The healthcare insurance industry robbed patients, physicians and hospitals of incentives to be innovative in order to repair the healthcare system by being competitive.

United Healthcare bought the Golden Rule Insurance Company. It immediately destroyed Golden Rule’s medical saving account product. UnitedHealthcare has converted Golden Rule’s MSA to an HSA. I cannot understand why the health policy experts who advocated MSAs are satisfied for the now. Their argument is this is compromise. It is a step in the right direction.

To paraphrase the great German philosopher Fredrick Hegel “An ineffective step in the right direction is worse than no step at all. If the ineffective step fails then you will never created the correct concept.”

I will add, especially if the step in the right direction is a purposeful step in the wrong direction. HSAs are destined to fail, in my view, because they do not put the consumer in charge of his healthcare dollar.

Permalink:

What Does Chronic Disease Management Mean? Part 1

July 5, 2007

inChronic Disese Management, Medicine: Healthcare System, Patients Problems, Physician's Problems, Quality medical care measures

• Leave a comment

Stanley Feld M.D.,FACP,MACE

Ninety percent (90%) of the Medicare dollar is spent on the complications of chronic diseases according to CMS. Eighty percent (80%) of the healthcare dollars for all age groups is spent on the complications of chronic diseases.

I have stated that our medical care system is great at fixing things that are broken. Our healthcare system has not been good at preventing things from breaking. The medical care system has not been good at preventing the complications of chronic diseases once the patient is afflicted with the disease.

There are two reasons for our inability to prevent things from breaking. One, is that most of the abuse to the human body is a result of the patient’s behavior and lifestyle. An additional factor is the genetic predisposition patients have for a particular chronic disease. Physicians can do little to control genetic predisposition presently. Genomics represents a great hope for preventing the onset of chronic disease in the future. Inhibiting stem cell research seems foolish in the face of its potential benefit. Prohibiting the use of embryonic material that is going to be destroyed anyway to me is illogical. The controversy is a result of the science wars presently going on between theology and science. It is my belief once the public understands the potential of genomics and the illogical nature of the controversy, public opinion with turn on the foolishness of the argument and the controversy will evaporate. This is for the future and the prevention of the onset of chronic disease.

Once the patient has a chronic disease, there is much that can be done for each disease to slow or halt its progression and slow or halt the onset of devastating complications. If we were effective in preventing the complications of chronic disease after its onset, this would result in an improved quality of life for patients and a marked reduction in cost to the healthcare system. The present costs of the healthcare system are leading to an increasing number of uninsured as well as bankrupting the nation.

Presently, most studies demonstrate that, with adequate treatment, we can reduce the complication rate of most chronic diseases by 50%. The reduction to the cost of the healthcare system would be 800 million dollars. Theoretically, with perfect control of the chronic disease and perfect medical therapy we could reduce the complication rate by 100%. The result would be a 100% reduction of the 90% of the money spent by the healthcare system on the complications of the diseases.

Most healthcare economists, “healthcare policy experts” and politicians are starting to understand the math. What I have discovered is that they do not understand the process of chronic disease management and the importance of the patient physician relationship. They do not understand the pathophysiology of the chronic diseases or the origin of the complication of the diseases.

The chronic diseases we are talking about are cardiovascular disease and hypertension, diabetes mellitus, osteoporosis and muscular skeletal disease (arthritis and collagen vascular diseases, lung disease, AIDs, and cancer. We have a $2 trillion dollar annual healthcare system. The total cost of all chronic disease complications to the healthcare system is $1.6 trillion dollars per year.

A lot of brain power is going into trying to do something to reduce the healthcare system costs because we simply can not go on with ever increasing costs and ever increasing opportunities for facilitator stakeholders to increase there profitability while there are ever increasing number of uninsured persons.

We must have a universal healthcare system. However, universal healthcare does not mean a single party payer. I believe a single party payer system will add bureaucracy and impose rules that will stifle and inhibit innovation. The result will be increased inefficiency and increased cost. We all agree that what has made America is innovation by entrepreneurs and not rules by bureaucrats. I know that the physicians are not the problem. They are part of the problem. There is no reason to create a healthcare system that will methodically inhibit physician innovation. Even worse, drive a skilled labor force (physicians) out of business whose education we as a society subsidized.

Who is responsible for the complications of chronic diseases? It is the patient who lives with his disease and lifestyle 24 hours a day. The patient must learn how to control his disease to avoid the complications of the disease. The physicians can only be the coach or manager of the patients and modify their treatment plan through his experience and clinical judgment. Physicians must teach patients how to adjust to changes in the course of their disease. Physicians have to do this with their healthcare team with the patient being the most important person on the team.

Patients must be provided with education, incentive and financial reward for their successful adherence to treatment regimes. The promise of good health does not seem to be enough of a reward. Once patients understand that they are responsible for their self-management and the management of their health care dollar adherence to treatment will improve and outcomes of chronic diseases will improve. Physicians also have to be compensated for their effort. To help make the patients the professors of their disease is a very hard process. It is much easier for a physician to set a broken arm, fix a hernia, or even do bypass heart surgery. Yet the insurance industry does not value or reward this effort.

If patients owned their healthcare dollar and needed to spend their money wisely, they would become intelligent consumers of healthcare. This would force innovation by physicians and hospitals. They would force and increase the quality of chronic disease management at decrease the cost. This would also create a competitive environment for hospitals to control prices. They would produce a market driven economy as occurs in other areas of commerce. Healthcare is a not marketplace presently. Hospital prices presently have nothing to do with hospital costs. This is why we need the ideal medical saving account owned by patients and not the insurance industry. The Ideal Medical Savings Accounts would align all the stakeholders incentives to enable the best product at the best price in a truly consumer driven healthcare system.

In order to understand its complexity I will discuss the disease management concept of several diseases. Obesity is the worse epidemic we are experiencing at the moment. It leads to diabetes, heart disease and hypertension, each of which has devastating and costly complications. In my “War on Obesity” I have discussed some of its problems. I will integrate obesity into the disease management process.

Permalink:

What Have I Said So Far? Part 2 Spring 2007

April 3, 2007

inMedicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP,MACE

The solutions I have proposed are all directed to a patient centered, patient driven, and patient advantaged system. I will review the proposed solutions in the next two blogs.

• Price transparency is an essential beginning. No only must the retail price be published but all of the discounted prices must be transparent as well. Somehow, the government has to enact legislation so that the providers and the insurance companies post their range of prices. The government has to empower the patient with negotiating power to get the best price. There are many different prices paid for a service depending on the negotiating power of the purchaser. The net effect of this total price transparency will be lower the prices and decrease cost of health insurance. The consumer must demand real price transparency. Aetna’s declaration of price transparency last year was a rouse. The hospital associations of Wisconsin and now Texas have developed web sites to provide hospital retail prices. We have little idea how much the government or insurance companies pay for these services. I assure you the discount is very deep and the hospitals are satisfied with the payments. The automobile industry has figured out how to deal with total price transparency and the internet publication of the MSRP, the invoice prices and the average prices paid for an individual automobile. We should demand that the healthcare system does the same. The system should be set up where the patient can negotiate price pre or post treatment. Sometimes the patients need a care emergently and are not in a position to negotiate in an emergency room.

• Elimination of a two tier payment system with hospital clinics receiving more money for procedures than outpatient physician clinics for the same procedures. Eliminate the restricting of payment to the physicians’ office clinics as long as there is proof of equal quality and qualifications to do the procedures in the physicians’ office. This can serve to increase price competition for services. Price competition is a vital element on the repair of the healthcare system.

•Expand consumer driven healthcare using the ideal Medical Savings Accounts and not the present Health Savings Accounts. I have made clear the difference between the two. The ideal Medical Savings Account would be to the patients’ advantage and not the insurance industries advantage. The ideal MSA would serve to motivate the patient to shop price and quality because they are spending their own money. It would also encourage adherence to treatment for the same reason.

• Create a level tax exempt playing field for the self employed and uninsured
so they can buy insurance with pretax dollars. Provide those who qualify for subsidy with a subsidy to pay for their Medical Saving Account. If they use the healthcare system appropriately or they do not have to use the system they should be rewarded with a lifetime tax exempt saving account. Incentives on all levels drive our system of free enterprise.

• Administrative waste in hospitals should be penalized and not rewarded. The system of payment presently is very opaque. For example payment for some chemotherapy is 10 time the cost of the drug. Yet the oncologist is not permitted to administer the drug in his office for one and one half times the cost. It is estimated that $150 billion dollar are wasted on administrative costs in the hospital and in the insurance industry. These costs add not value to the treatment of patients. The administrative waste is absorbed by increased executive salaries and increasing construction of enlarging hospital facilities. The brick and motor expansion of hospitals should be over since much can be done on an outpatient basis.

These are some of the solutions necessary to repair the healthcare system. The solutions have to be instituted as a total plan and not introduced piecemeal. Each of the pieces of the solution is dependent on each other in order to have a positive effect on repairing the healthcare system. Next time I will review the other elements of a plan I have proposed that will solve the dilemma expressed by the questions that need to be addressed to Repair the Healthcare System.

Permalink:

What Healthcare System Could Work? A Universal Healthcare System Will Not Work!

February 2, 2007

inMedicine: Healthcare System

• Leave a comment

Stanley Feld M.D., FACP, MACE

The solution should be pretty clear to all following my blog. I advocate the American way! I believe a consumer market driven system with government making rules for the benefit of all members of the society. When one stakeholder takes advantage of another stakeholder to the harm of the other stakeholder the government has to intercede.

Richard Swersey Columbia College Class of 1959 has a college degree in the ability to think! He also has a post graduate mining degree and masters of business administration. He wrote “You referenced Adam Smith in your blog on dirty coal plants. People need to be reminded that: (1) there is a large section of “Wealth of Nations” entitled “The Role of the Sovereign”. Even Adam Smith recognized that the market can’t do everything; and (2) there has never been a time in recorded history where commerce (or markets, or industry) was totally free of government intervention.”

I made the same point in the blog on the TXU proposed dirty coal plants. Adam Smith’s treatise also applies to the healthcare system. The function of government is to promote civility (civil right) for the benefit of all and not to build bureaucracies that can not possibly work effectively.

Dick is absolutely correct. The function of government in a democracy should be to function for the people by the people. The operative words are for the people and not to the disadvantage of the people.

Entrepreneurship and obtaining a competitive advantage is the engine that drives innovation in America. Our problem in medicine right now is some the facilitator stakeholders have large vested interests they need to protect. They are very busy protecting their vested interest by various political means. Unfortunately government is not acting for the benefit of the people. The advantaged stakeholders are so short sighted that they can not see that the system they are protecting is falling apart right in front of their eyes. In fact, it is about to blow up. We, the primary stakeholders (patients and physicians) can not see what does not hurt us. We are waiting for the Katrina effect. The mentality of what we can not see can not hurt us has to stop. We have to act know and demand change.

In my view price transparency and the consumer (patient) being in control of their own healthcare dollar can go a long way to transform medical services into a competitive market place.
Some of the insurance companies are talking a good game. Aetna has feigned price transparency in Cincinnati. They published only the price of the top thirty procedures for customers that bought HSAs. This is good start but never expanded to my knowledge. I called this blog Another Smoke Screen.

Wal-Mart made an innovative advance with its generic drug initiative. They are charging $4 for a thirty day supply of generic drugs. They have 340 drugs in the formulary. Physicians feel comfortable using some generic drugs. They also want to help their patients. Patients can also demand generic drugs. Most physicians will use generic drugs if there is not a clear cut difference between the generic and brand name medication.

Wal-Mart can not keep the drugs in stock. They also can not keep people out of the store. Wal-Mart is not losing money on the drugs either. The result will be an increase in net profit to Wal-Mart and a consumer driven market benefit for the patient. It will also force brand name drugs to come down in price. Wal-Mat’s initiative will created a clear market driven economy for buying drugs.

Who needs Medicare Part D and its $10 co pay along with its ominous $2200 doughnut? Wal-Mart is also setting up competitive price wars among CVS, Walgreens Rite Aid. Wal-Mart has good chance of winning because it has the mentality to engage in these kinds of innovative programs. The CVSs will get there as it works its way through their hierarchical bureaucracy. The end result will probably be too little too late for CVS.

The most of the uninsured who could buy insurance have had no choice but to not buy insurance.
They have chosen take their chances. When they get sick someone has to pay or not get paid. This is the point. It gets painful and costly for all the stakeholders. The Canadian model of Universal Health Care with a single party payer does not work. The costs rise, access to care is restricted and patients die.

The main question is how do we fix the problems. We have to exercise some common sense. We need to be equitable. The vested interest empires (facilitator stakeholders) have to start to understand that our most precious possession is our health and not their profit. A healthy nation is a strong the nation. They have to stop fight the Repair of the Healthcare System.

Price transparency, reform DRG on cost and not charges are very important. We must stop the bonus to hospitals or insurance companies for supposed cost overruns at the end of the year. We must provide incentive for disease management training to all patients with chronic disease. We must make the patient responsible for their healthcare and healthcare dollar in a price transparent environment. We must motivate the patient to care for their chronic disease by rewarding prevention of complications of disease.

We must eliminate hospital and insurance company administrative waste. We must neutralize defensive medical practice by malpractice reform. We must revolutionize the adjudication of claims system to a system of instant payment.

We must provide and institute an EHR universally that can measure outcomes. The outcomes we must measure are the medical outcomes. The medical outcomes must be relational to the financial outcomes and patient and physician input as to the value of the outcome.

We need to start getting serious about all of these issues in unison. We have to concentrate on the cost of complications of chronic disease. We must create financial incentives for preventative services. We have to teach the patient the “Professor of their Chronic Disease”.
http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2006/06/do_complication.html

We must motivate the patients to be responsible for their chronic care. If they are not they will have a financial loss as well as a medical loss. We must put the patients in control of their healthcare dollar. I believe if we did all of this our healthcare system would not be in trouble. All of this can be accomplished with the Ideal Medical Savings Account. The structure of the current HSA system will not accomplish all of these key initiatives

If the government wanted to subsidize something it would be the purchase of the ideal medical savings accounts for all the uninsured who could not afford to buy insurance. This would eliminate all the waste in Medicaid. The concept of universal healthcare with the government as a single party payer is a sham because it does not address any of these important initiatives.

Permalink:

Is Anyone Confused Or Convinced?

December 6, 2017

inDisinformation and the healthcare system, Medicine: Healthcare System

• Leave a comment

Stanley Feld M.D.,FACP, MACE

Obamacare has failed. You wouldn’t know it by the massive misrepresentation by the mainstream media.

The mainstream impression is that registration during the open enrollment period for 2018 ending December 15,2017 is doing well.

I have not written a blog in about a month because there has been nothing to write about.

I have laid out my ideas about what is necessary to repair the healthcare system. It is all about personal responsibility and physician/patient relationships for both acute and chronic diseases.

It is the only way to control costs and decrease waste in the healthcare system.

Frankly, I am saddened that our representatives in congress don’t give a damn about the costs to the American people.

They simply want Americans to be dependent on government. The government wants to control Americans rather than Americans controlling the government.

Both the Republican and Democratic establishment have been brain dead on how to effectively repair our healthcare system.

Republicans had seven years to figure out an efficient system. The have controlled the house for two terms. They have controlled the senate for one term.

Then they failed. Almost 100 bills passed the house. any passed both houses and were vetoed by President Obama.

Why couldn’t they send one of those bills to President Trump?

Tom Price M.D. had some ideas on how to repair the healthcare system. However he was disposed of by claims of misuse of government funds.

There has been little published since the Republican establishment failed it its effort to repeal and replace Obamacare in November 2017.

It is unclear to me whether the Republican effort failed because it was a step in the wrong direction or the Republican establishment hates Donald Trump.

In any case the Democratic establishment is trying to blame Donald Trump for the Obamacare failure.

They claim it is Donald Trump’s fault the healthcare insurance industry is not being paid the unauthorized supplement President Obama promised but could not pay. He could not find the money.

It is the House of Representative that authorizes expenditures. The cost of those promised subsidies that were unauthorized was 88% short of the healthcare insurance industry’s claims.

The Obamacare cost overruns were gigantic. It must be remembered that the Health Insurance Exchanges only provided insurance for less than 10 million people in the individual healthcare market.

Many factors added to the cost overruns including subsidizes of over $15,000 dollars a year for these premiums in the individual market. The 2018 subsides will be over $20,000.

The healthcare system has become such a partisan issue that the truth about Obamacare’s failure is not the point anymore.

It seems that the Republican establishment is not any smarter than the Democrat establishment in trying to repair the system.

The end of the open enrollment period for 2018 is supposed to be December 15, 2017.

I posted two graphs in this post. One represents enrollment until 11/25/2017 and the second represents enrollment until 12/2/2017.

They bring out several points about Obamacare’s failure.

Seven states of the 39 states have already extended their open enrollment period. California has extended open enrollment until 1/31/2018.

On 11/25/2017 confirmed but not paid enrollment was only 2,660,938 with only 2,277,079 through Healthcare.gov and 383,859 for Medicaid.

Open enrollment projected for 11/25/2017 was 4.2 million with 2.6 million through Healtcare.gov. and 1.6 million through Medicaid.

These projected numbers were revised upward during the summer of 2017 to 4.6 million with 2.8 million through Healthcare.gov and1.8 million through Medicaid.

This represents a 500,000 person enrollment short fall for healthcare.gov. It also must be remember that 85% of the people enrolling through healthcare.gov have preexisting illnesses and are subsidized by the government.

The open enrollment numbers look worse on December 2, 2017 although there is not a word of it in the mainstream media.

On 12/2/2017 confirmed but not paid enrollment was 3,491,164 with only 2,751,260 through Healthcare.gov and 709,904 for Medicaid.

Open enrollment projected for 12/2/2017 was 5.1 million with 3.5 million through Healtcare.gov. and 1.6 million through Medicaid.

These projected numbers were revised upward during the summer of 2017 to 5.8 million with 4 million through Healthcare.gov and1.8 million through Medicaid.

This represents a 1,248,840 (4,000,000-2,751,260= 1,248,840) person short fall for healthcare.gov with 13 days to go for the open enrollment period.

It is difficult seeing these numbers by casually studying these charts.

Obamacare is an unmitigated failure. Democrats want to throw more money at it.

Republicans do not know what to do.

I suggest they lo ok at my blog entitled The Ideal Medical Saving Accounts are democratic.

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

Please have a friend subscribe

3
4
5
6
7
8
9
6/11