Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform act is about to be repealed by Republicans in the House of Representatives. Democrat’s say this is a meaningless gesture. I do not think so. The House of Representatives is expressing the will of the people. The Harry Reid and President Obama will be exposed as ignoring the will of the people.

President Obama’s healthcare reform act will not Repair the Healthcare System. His new entitlement for 32 million people will not save money or reduce the deficit.

President Obama promised his healthcare reform act would provide universal access to care to all Americans, be affordable to both the government and its citizens, and increase the quality of medical care

“Of all the claims deployed in favor of Obama Care, and there are many, the most preposterous is that a new open-ended entitlement will somehow reduce the budget deficit, insure 32 million more people, and save money too!”

Americans have experience with open ended entitlements. They never save money. Most Americans understand that government cannot subsidize coverage for tens of millions of people and simultaneously reduce the deficit

The Democrats’ spin machine started working immediately as the Republicans prepare to repeal ObamaCare.

“Health and Human Services Secretary Kathleen Sebelius chimed in that "we can’t afford repeal,"

ObamaCare will cost at least $2.6 trillion over the next 10 years. Is this a bargain for taxpayers? Presient Obama’s healthcare reform act does little to Repair the Healthcare System.

ObamaCare is setting up Accountable Care Organizations (ACOs). In my opinion, ACOs have little chance of being effective. ACOs will create a system of salaried physicians owned by hospital systems. All physicians have to be integrated into the system in order for the ACO to have a chance. Physicians’ productivity will decrease. ACO will create incentives for secondary stakeholders. There will be few incentives for primary stakeholders. .ACOs will generate regulations that will increase “paperwork” and decrease direct patient care. It will increase government control over the lives of patients. It will not reduce costs.

President Obama released a statement saying repeal will “explode the deficit.”

Meanwhile, other Democrats have taken up arms about House procedure. The GOP adopted a budget rule that says repeal doesn’t have to be "paid for," and the press corps is treating this exemption as a scandal against Washington decency.

The CBO was manipulated by the numbers given to it by the Democratic House of Representatives to score ObamaCare. I would not be surprised if the numbers change if Republicans request a rescore with different numbers. The Democratic controlled congress has gamed the CBO’s budget conventions.

The CBO is required to "score" the numbers presented to them by congress no matter how unrealistic.

The party in power at the time (Democratic Party) makes believe that the CBO’s forecasts are carved in stone. All the score really shows is that politicians have rigged the budget rules to hide the true cost of entitlements.

Americans now understand the congressional process. The congressional disrespect is the reason the polls are unfavorable toward congress. Americans want the truth.

President Obama managed to pass his bill despite the opposition of the majority of the American people. Americans continue to oppose the bill today even though the facts in the bill have become a blur.

“Gallup reported yesterday that Americans favor repeal, 46% to 40%.”

How did gaming the CBO budget scores make President Obama’s healthcare act seem to save money?

1. President Obama’s healthcare law uses 10 years of taxes to fund six years of subsidies.

2. Social Security and Medicare revenues are double-counted to the tune of $398 billion.

3. A new program funding long-term care frontloads taxes but backloads spending.

4. The law pretends that Congress will spend less on Medicare than it really will, in particular, through an automatic 25% cut to physician payments that Democrats have already voted not to allow for this year.

5. President Obama had the law shift the government doctor fix out of the healthcare budget

These are just a few of the tricks used by President Obama to get the CBO to score his healthcare reform budget neutral.

Richard Foster, the chief Medicare actuary separately published analyses of the Medicare and Medicaid spending that would have be devastating to President Obama’s healthcare law. He revealed the true cost. His report was not widely covered by the traditional media.

Doug Holtz-Eakin, a former CBO director and an economist has pointed out that ObamaCare creates an incentive for businesses to drop employee coverage. Employees will be forced into the private insurance market using after tax dollars or Medicaid. This was obvious to me from the start. The results will explode the federal and state deficits far more than the CBO projects. It will also result in a decrease in access to care as well as rationing of healthcare.

“ Entitlements are always sold as modest and "paid for," then years later everyone suddenly discovers that they are "unaffordable" without digging deeper into the pockets of the middle class. How do you think Medicare and Medicaid got to their current pass?”

When will our government ever learn? President Obama should be fixing the core problems in the healthcare system. Instead, he is creating an opportunity for increased government control over healthcare and greater healthcare insurance industry profit at the expense of consumers (taxpayers).

President Obama should try a consumer driven healthcare system and the ideal medical savings account.

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

Stanley Feld M.D.,FACP,MACE

President Obama removed the provision in his healthcare reform bill last year dealing with reimbursing physicians for end of life counseling. There was great citizen uproar about this provision. It was viewed by many as a first step toward rationing of medical care.

“When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system.”

Sarah Palin call the provision the creation of “death panels.” A government “panel of experts” would decide whether Medicare would pay for treatment of patients deemed hopeless. The panel of experts would decide regardless of the patient’s wishes.

Sarah Palin’s term was criticized as “sensationalistic.” The criticism is correct. However, in a sound bite society you have to use effective sound bites to get attention. The eliminated provision illustrates the truth about a world of finite resources and infinite entitlements.

Entitlements are ever expanding as our population expands. The government cannot afford expanding our entitlement programs. Yet President Obama’s healthcare reform act is going to expand the Medicare and Medicaid entitlements to cover 32 million uninsured.

One way out is to decrease benefits. This is the administration’s plan.

Another way out of the mess is to attack the root of the problems. America could create a consumer driven healthcare model. America could also develop of system of logical tort reform. Government could subsidize those consumers that qualify for subsidies. Consumers should own their healthcare dollars as outlined in the ideal medical savings account.

I have objected to President Obama’s healthcare reform act. It puts all the power of medical decision making in the hands of the executive branch. HMS and CMS create rules and regulations without congressional oversight. The most recent revelation portends provisions to come.

President Obama’s administration has achieved the same end of life goal by regulations produced by Dr. Donald Berwick chief of CMS, starting Jan. 1.

“At a stroke, Medicare chief Donald Berwick has revived the "death panel" debate from two summers ago.”

Medicare will enact the same policy removed from the bill through the power of regulation. Congress has had no input. This is the first step in a never ending series of future steps President Obama will take to control our freedom to make healthcare choices. The regulations seem benign on the surface.

“The office of Oregon Democrat Earl Blumenauer, the author of the original rider who then lobbied Medicare to cover the service, sent an email to supporters cheering this "victory" but asked that they not tell anyone for fear of perpetuating "the ‘death panel’ myth." The email added that "Thus far, it seems that no press or blogs have discovered it, but we will be keeping a close watch."

President Obama has used a number of trick plays on congress and Americans to further his agenda. One trick President Obama pulled was his appointment of Dr. Berwick during congressional recess without congressional hearing after withholding the request for congressional hearings for 3 months.

Dr. Berwick now slips through a regulation about reimbursement that Congress explicitly rejected. Unfortunately for Dr. Berwick an email was leaked illustrating scheming with his political patrons to duck any public scrutiny.

“Expect many more such nontransparent improvisations under the vast powers ObamaCare handed the executive branch.”

An administrative representative immediately stepped in and declared the rule-making is not coercive. He claimed the rule gives seniors more autonomy, not less.

“The facts are that if the medical experts in Congress haven’t decided that some treatment or service is worthy of the fee schedule, then the program won’t pay for it even if it is in the best interests of patients.”

The two most expensive occurrences are the birth of premature infants and the last 30 days of life. As a society, we will have to learn how to deal with these facts. Society must be innovative in dealing with these tragedies to the satisfaction of all. As a society, we also have to conquer obesity and the onset and management of chronic diseases.

Unfortunately, President Obama’s methodology is wrong. He has demonstrated an arrogance and disrespect for the American people. The American people now understand his methodology. They have experienced his multiple trick plays and have lost trust in him and his administration. There is a perception that he disrespects the will of the people he has been elected to serve. President Obama will not achieve his goals as long as the perception exists.

The Democratic Party has experienced this mistrust during the midterm elections. Nonetheless, President Obama and the Democratic Party continued to show their disrespect for the will of the American people during the lame duck congressional session.

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

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform bill was rammed through congress over a month ago. He has been first to point out that the world has not fallen apart yet. He is being disingenuous since he healthcare reform plan does not influence medical care until 2014.

The strategy is to not do anything drastic until after he wins the November 2010 elections for the Democratic Party and the Presidential election in November 2012.

He is disregarding American’s anger toward him for ignoring their wishes. He is hoping they forget their anger.

The traditional media is helping America forget the tactics used to pass the healthcare reform bill. They are not evaluating the long term consequences on medical care and the budget deficit. It is not economically feasible to enlarge failed entitlement programs.

The public opposes the healthcare bill yet Wellpoint, who has been making billions of dollars a year, raises insurance premiums by 39%.

Immediately, President Obama, Harry Reid and Nancy Pelosi demonized the healthcare insurance industry. The choice given the public was to keep the present system along with healthcare insurance company abuse or adopt President Obama’s healthcare reform plan. The Republican Party did not present an alternative loud enough.

President Obama’s healthcare reform plan won the day by a partisan vote and a frustrated electorate. It led to Nancy Pelosi’s comment that Americans will understand the bill after it is passed.

The reality is the healthcare reform bill will lead to a single party payer system with increasing deficits, increased taxes and decreased access to care.

The healthcare insurance industry and Big Pharma are supporting President Obama’s healthcare reform plan because they will continue to control the healthcare dollars. Now the government will subsidize their business.

After passage of the healthcare reform plan, President Obama went on to his financial reform bill. There was much opposition to his plan. The plan does not go far enough to repair structural defects in the financial system. It also increases government control of the financial system without preventing abuse. Fannie Mae and Freddie Mac are not restructured.

In the midst of the financial system reform debate the Democrats started a congressional hearing on alleged abuses by Goldman Sachs. Congress has demonized Goldman Sachs. The public has another choice. America can either support President Obama’s financial reform or the old structure.

President Obama’s environment and energy bill was going nowhere. Cap and trade looked dead. President Obama agreed to permit offshore drilling for oil as a compromise.

The catastrophic oil spill occurred. The traditional media obsessed over the leak. In order to be a “good guy” President Obama announced that off shore drilling is too risky and discontinues his plan to let federal leases for off shore drilling.

We now have an environment and energy bill without off shore drilling. There is no consideration about this decision’s effect on a fragile economy.

The immigration bill is going nowhere also. It has large structural defects. The federal government is not enforcing laws that already exist. Arizona passed a law duplicating the federal laws. Arizona gets demonized by the White House and the traditional media.

President Obama has condemned Arizona. Arizona is only doing what the federal government should be doing. There is now public sympathy for President Obama’s defective immigration bill.

I suspect President Obama will use this opportunity to push through his immigration bill rather than do it right. Where are the Republicans?

President Obama wants illegal immigrants to be legalized citizens. He wants them to have the right to vote. His plan is to get enough new voters to neutralize the independent voter who have defected since he was elected President.

The pattern is clear. You demonize the opposition and then pass your alternative as if it is the only alternative. President Obama’s method has legs with the traditional media. Experts in each area will tell you most of this legislation will not solve any of our problems. It will be ineffective legislation. It will increase the federal deficit and lead to more taxation. It will decrease economic growth by decreasing incentives. It will increase government power over States and suppress individual freedoms. Many unintended negative consequences will occur after government has operational control.

I am afraid the public is growing weary of protest. They will forget the tricks used to produce terrible legislation. We will have many costly unintended consequences for many years to come.

The most frightening consequence is government control over our lives and freedom and a never ending need to raise taxes. It will suppress America innovative spirit.

President Obama is moving ahead with his healthcare pilot studies. In my view all of the approved pilot studies have little chance of success.

A potential pilot study with the biggest chance of success is not being considered. The five models to be studied are Accountable Care Organizations, Primary Care Medical Homes, Bundled Payments, Partial Capitation, and Full Capitation.

All five have problems. The chance of succeeding to reduce cost is marginal. The Ideal Medical Savings Account is ignored as an option. The MSA should be compared to each model tested. The Ideal Medical Savings Account model is the only model with a chance for success. The MSA is a consumer driven model. It puts patients in control of their healthcare dollars. It rewards consumer when they use their healthcare dollars wisely and maintain their health. It promotes self responsibility and self respect.

I will evaluate each model and point out the problems in each model.

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

Stanley Feld M.D.,FACP,MACE

President Obama and the Democratic Party controlled congress have used multiple procedural tricks to pass a terrible healthcare reform bill. In the opinion of many constitutional lawyers they have passed legislations that are unconstitutional.

The majority of the public has felt President Obama and the Democrats have ignored the will of the people. President Obama does not think so. He has stated Americans will decide in his favor in the November midterm elections.

President Obama has been disingenuous and arrogant in his selling his healthcare reform bill. His attitude was made clear during his speech in Maine on April 1^st. (Go to you tube below and start at 7.47 minutes).

President Obama’s goal is default to the public option. The public will have no other choice.

The public option will socialize medicine, increase taxes, increase healthcare insurance premiums (subsidized by the government, ration care, decrease access to care, eliminate freedom of choice, decrease the quality of care and bankrupt the nation.

Federal deficit spending has increased to over 2 trillion dollars this past year. The federal deficit ceiling has been increased from $11 trillion to almost $14 trillion dollars. Despite all the deficit spending unemployment is almost 10% and not falling. The only new jobs are government jobs or government related jobs.

The legislative and executive branches of government have totally disregarded the will of the American people. The only option left for the public is to appeal to the judicial branch of government.

Legal action does not add value to the healthcare system. However, when people feel abused they take legal action. The winners are always the lawyers.

The losers will be the taxpayers. Taxpayers will be paying both the plaintiff and defendant fees to lawyers.

There is no question the healthcare system is dysfunctional. President Obama’s healthcare reform bill will make the healthcare system worse.

I have demonstrated that the healthcare reform bill can only increase the deficit. The bill might appear to have the potential to reduce the deficit because of the disinformation the administration feeds to the traditional media.

There has been much criticism of the AMA and its President because of the position they have taken to support the healthcare reform bill. The AMA is losing membership. Other physician organizations such as Sermo and the Association of American Physicians and Surgeons have an equal number of members

The Association of American Physicians and Surgeons (AAPS) became the first medical organization to sue the government to overturn the newly enacted health care bill, the Patient Protection and Affordable Care Act (PPACA). AAPS v. Sebelius et al.).

“If the PPACA goes unchallenged, then it spells the end of freedom in medicine as we know it,” observed Jane Orient, M.D., the Executive Director of AAPS. “Courts should not allow this massive intrusion into the practice of medicine and the rights of patients.”

The law suit makes many compelling arguments. These arguments represent the vested interest of patients first. Physician leadership and input is required to educate the public and the courts.

1. “There will be a dire shortage of physicians if the PPACA becomes effective and is not overturned by the courts.
2. The PPACA requires most Americans to buy government-approved insurance starting in 2014, or face stiff penalties.
3. This violates the Fifth Amendment protection against the government forcing one person to pay cash to another. AAPS is the first to assert this important constitutional claim.

Insurance company executives will be enriched by this requirement. Federal and State government will be forced to subsidize the unaffordable healthcare insurance premiums. Ultimately taxes will be increased. The result will be a slowing of the economic recovery.

1. The PPACA also violates the Tenth Amendment, the Commerce Clause, and the provisions authorizing taxation.

Taxing and spending power are unconstitutional when payments go to private healthcare insurance companies. President Obama and Congress recognized that PPACA cannot be funded without the insurance mandates.

5. The traditional sovereignty of the States over the practice of medicine is destroyed by the PPACA.

6. AAPS asks the Court to enjoin the government from promulgating or enforcing insurance mandates.

7. AAPS asks HHS Secretary Kathleen Sebelius and Social Security Commissioner Michael Astrue to provide the Court with an accounting of Medicare and Social Security solvency.

8. Court action is necessary “to preserve individual liberty” and “to prevent PPACA from bankrupting the United States generally and Medicare and Social Security specifically,”

AAPS contends Congress imposed assumptions on the Congressional Budget Office resulting in the PPACA reducing the budget deficit. These include assumptions leading to a $500 billion savings in Medicare. The savings was accomplished by moving the Doctor Fix out of the Healthcare Reform Bill budget. Moving the Doctor Fix out of the healthcare budget still increases the federal deficit.

AAPS contends that Congress and President Obama know the opposite to be true. They know the CBO’s assumptions are unrealistic.

This law suit is the first of a long list of law suits to come. The states are lining up to defend their state sovereignty and protect their state budgets.

President Obama’s view is that everyone is playing into his hands. He has many legal tricks up his sleeves. The public is sick of his trick plays.

A fear is the American public will get tired of the healthcare debate before it is too late to repeal.

The education of the public must continue.

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

Stanley Feld M.D., FACP,MACE

The tale of two States demonstrates the difference between doing healthcare reform incorrectly and correctly.

Obamacare is fashioned after the Massachusetts healthcare reform plan. It leaves the administrative services in the hands of the healthcare insurance industry.

Indiana empowers consumers to control their healthcare dollars.

Therein lies the difference between ineffective and effective healthcare reform.

President Obama has even given the State of Massachusetts $8 billion dollars in bailout money to support the failed healthcare reform plan.

“MASSACHUSETTS HAS been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.”

President Obama’s healthcare reform plans goals mimic the goals of the Institute of Medicine. His goals are 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.

No one would disagree with these goals. Massachusetts’ healthcare reform plan had these goals

“The state’s plan flunks on all counts.”

“First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.

Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.

Third, the program is not affordable for many individuals and families. 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.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care.”

The Governor of Massachusetts in now threatening to institute price controls. Price controls never work.

There is little hope it will work now. Former Governor Mitt Romney sold this plan as a way to control spending. The new entitlement has failed to control costs. For fiscal 2010 the cost over budget is $47 million and in fiscal 2011 the cost is estimated at $913 million. The original estimated cost was two thirds less.

The plan could never work because the health insurance industry had control over the healthcare dollars and kept raising premium prices.

“Last month, Democratic Governor Deval Patrick landed a neutron bomb, proposing hard price controls across almost all Massachusetts health care. State regulators already have the power to cap insurance premiums, which Mr. Patrick is activating. He also filed a bill that would give state regulators the power to review the rates of hospitals, physician groups and some specialty providers. Those that are deemed too high "shall be presumptively disapproved."

The Massachusetts healthcare reform plan is not beyond price controls.

On the other hand the State of Indiana has conducted a different experiment. They have instituted a system using Healthcare Savings Accounts (HSA). It has been very successful.

The healthcare reform was set up as a healthcare insurance option for State s. In the first year only 4 percent of State employees signed up for the HSA option.

In the second year over 70 percent of Indiana’s 30,000 state workers chose the HSA option.

“The HSA option has proven highly popular, says Mitch Daniels, Indiana’s governor, by far the highest in public-sector America.”

This is how it works;

• In Indiana’s HSA, the state deposits $2,750 per year into an account controlled by the employee. The employee pays all his health bills controlling his first healthcare dollars. The State of Indiana pays the premium for the plan.
• The intent is that participants will become more cost-conscious and careful about overpayment or overutilization.
• It turned out that a very small number of employees (about 6 percent last year) used their entire $2,750 account balance.
• The unused funds in the account (to date some $30 million or about $2,000 per employee) are the State employee’s permanent property.
• The State shares further health costs up to an out-of-pocket maximum of $8,000, after which the employee is completely protected.

The State found that individually owned and directed health-care coverage has a startlingly positive effect on costs for both employees and the state.” State employees enrolled in the consumer-driven plan will save more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative.

Mitch Daniels says the state is saving, too.

“In a time of severe budgetary stress, Indiana will save at least $20 million in 2010 because of high HSA enrollment.”

“Mercer, a healthcare consultant calculates the state’s total costs are being reduced by 11 percent due solely to the HSA option.” 

The contrasts between the financial results of the two states are obvious. Obamacare is similar to the Massachusetts plan with added infringements on freedom to choose. It will fail.

The Indiana healthcare reform plan can be improved upon using the ideal Medical Savings Account.

There is no reason not to try a plan similar to the Indiana plan in most States. States are required to have a balanced budget. The Senate bill has marginalized health savings accounts. President Obama has refused to understand the merits of giving consumers the freedom to be responsible for their healthcare dollars.

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

Stanley Feld M.D.,FACP,MACE

President Obama’s speech on healthcare reform to a joint session of congress added nothing new to the healthcare reform debate.. It was just spun differently.

He did give a tepid nod to tort reform. Defensive medicine results from a defective tort system. The defective tort system generates between $300 and $700 billion dollars a year in excessive diagnostic testing. Lawyers and insurance companies make large sums of money from the malpractice system. The tort system adds little value to the health of citizens.

President Obama said he will set up a few demonstration projects. Government demonstration projects have not worked in the past. His tort reform projects are too few and will have little effect. Everyone knows the problem as well as the solution. Our healthcare system needs significant tort reform immediately. The President is protecting the plaintiff attorneys because he doesn’t want to take them on. They have been large contributors to Democratic Party member election campaigns.

President Obama said the “Public Option” is the best way to control costs. However, he will not have a Public Option if he gets a bill passed. He is going to try to sneak a single party payer system through the back door as Barney Frank has stated.

The President said no one will have to spend more than $5,000.00 a year in out of pocket expenses.

Who is going to pick up the costs after consumers spend $5,000.00? I assume the government will. Consumers have to buy government mandated and approved healthcare plans.

Consumers will have to pay for policies that have a 40% deductible with after tax dollars as opposed to the 20% deductible with pre-tax dollars. The Obama administration has been convinced by the healthcare insurance industry that it needs the increase in deductible percentage in order to produce a lower “affordable” premium.

Consumers, by paying with after tax dollars, will be paying 35% more for their healthcare policies and 20% more in deductibles expenses. If the tax rate goes up to 40% they will pay 40% more for both. This is a hidden increase in consumers’ taxes and a government increase in revenue.

The big winner is the healthcare insurance industry, not consumers. The healthcare insurance industry will have a greater number of people insured on its roles because of a presidential mandate that he had promised to avoid.

President Obama said he will subsidize businesses and individuals who cannot afford healthcare insurance.

Who is going to make that judgment? The government will make that judgment. He asks us to stop being skeptical and trust his administration. He will take care of consumers in the spirit that made our country great.

President Obama, how can we trust your administration with our healthcare needs when we have had experience with so much false hope from your administration in the last 8 months?

He is leaving the control of the healthcare dollars in the healthcare insurance industry’s hands. The healthcare insurance industry provides administrative services. Can we trust the healthcare insurance industry to be fair and look out for the well being of consumers? No!!

President Obama said there are almost 400 insurance companies in the nation. He claims his plan will force them to be competitive. There are only five major healthcare insurance companies (Unitedhealthcare, Aetna Blue Cross/Blue Shield, Cigna, and Humana). Most of the other healthcare insurance companies are subsidiaries of those five major companies.

There will be no competition. The administration says a “Public Option” is the only effective way to lower the costs of healthcare. It will make healthcare insurance companies compete. However the insurance industry will define the costs and the price of the government’s public option. It has done so for Medicare Part D at the expense of taxpayers and it will do it again.

Medicare Part D is another failed government entitlement whose monthly premium has gone from $14 to $37 in three years. The patient deductibles have increase and the onerous donut still exists.

In addition to increasing the premium price the government subsidizes Medicare Part D with of billions of dollars a year. I predict the premiums for the “Public Option” will slowly escalate at tax payers’ expense.

The only creative way to break this healthcare insurance industry stranglehold is to institute a system with Medical Savings Accounts. The government or employers, as providers, should give consumers first $6,000 for their healthcare needs and teach them how to spend it wisely. What consumers do not spend they keep. The second $6,000 would be used to buy high deductible first dollar healthcare coverage.

This is the only way to reduce the healthcare insurance industry’s influence and grasp on healthcare spending. Medical Savings Accounts will provide consumers with incentives to use their healthcare dollar wisely. It will also provide incentives for patients to comply with medication and treatment prescribed. America might even make serious progress combating our obesity epidemic.

Stanley Feld M.D.,FACP,MACE

The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare.

“Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi schemes? The new Obama-Democrat budget deficit is $1.8 trillion, four times larger than it was only last year. The national public debt has increased by more than 10 percent since Inauguration Day.”

Social Security and Medicare are underfunded entitlement programs. Medicare for the entire country is not viable.

These are the published numbers for 2008.

• Social Security’s unfunded liabilities stood at $13.6 trillion.
• Medicare’s unfunded liabilities are more than $30 trillion.
• Medicaid, another severely underfunded and politically untouchable entitlement program, only adds to the total.
• The federal government’s current entitlement bill, including future obligations-based only on promises it has made in the past — is greater than $57 trillion.”

The first Baby Boomers started drawing early retirement benefits from Social Security last year.”

78 million people are going to stop working, stop paying taxes, stop paying into retirement programs and start drawing Social Security and Medicare benefits. The federal government has made explicit and implicit promises to millions of retiring citizens. It does not have the funds to keep those promises without a big hike in taxes.

“According to a recent forecast by the Congressional Budget Office shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century”

In order to get close to funding our current obligations it is estimated that the income tax rate will have to increase to 66%. With all the bailouts and economic stimulus packages the federal government’s debt can only get worse.

Yet the game of who can have better sound bites and who can win is the only thing that is important to President Obama, the healthcare insurance industry, and the Democratic congress.

Healthcare reform should not be about a National Healthcare Insurance Exchange or universal healthcare with a single party payer. This is not going to fix the healthcare system. It will make our financial problems worse. Our government officials should face reality. It should do what all physicians know needs to be done.

It should be passing legislation to create a less polluted environment. It should revise the Farm Bill. It should eliminate the use of corn syrup. It should fight obesity with public service educational campaigns. It should create an insurance product that provides consumers with financial incentives to stay healthy. It should eliminate the causes of administrative waste and defensive medicine. These should be the areas of discussion in order to repair the healthcare system. These bold topics threaten powerful vested interests and are politically explosive.

America should set up a healthcare insurance system that provides incentives consumers to demand better foodstuff and a healthier environment. Consumers should own their healthcare dollars and be able to save what they do not use. (ideal medical savings account).

The federal government should make the conversion to functional electronic medical records easier and less costly to physicians (ideal electronic medical record). We should have major tort reform to decrease the intolerable cost of defensive medical.

These are areas in which the healthcare reform debate should be focused. If the Republican Party wants to seize the initiative from the Democratic Party and excite the citizens of our country they need to act .

Instead, we have a silly debate pitting the new media (Democratic Party) against the old media (Republican Party) over systems we cannot afford. The new media will win. Americans lose no matter which side wins.

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