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Review: What Have I Said Recently ?

December 26, 2006

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Stanley Feld M.D.,FACP,MACE

I have been distracted from my main theme, the ideal Medical Saving Account as the vehicle needed to repair the healthcare system. I have been building the case for this system of self responsibility as the mechanism to repair the best medical care system in the world. The theme is patients’ must control their healthcare dollar to repair the healthcare system.

We must develop a system of incentives where provider prices are transparent and providers compete for the patient’s healthcare dollar. We must create a system where providers (hospitals, physicians, and other healthcare providers) are forced to become efficient to compete for the patient’s healthcare dollar on quality of care and cost of care. The result will be that healthcare costs will decrease and the quality of care will increase. This is the meaning of consumer driven healthcare.

The last few weeks have been spent on the “Dirty Coal Plants” TXU is proposing for Texas. These “Dirty Coal Plants” are being proposed all over the country because of the abundance of cheap dirty strip mined coal. Presently $34 billion dollars are wasted healthcare costs to treat illnesses resulting from the present levels of pollution. The healthcare costs resulting from the proposed “Dirty Coal Plants” in Texas and around the country could easily double and perhaps triple.

The point is that Dirty Coal Plants polluting the environment result in large avoidable costs to the healthcare system. These costs can not be controlled by the patient exercising patient responsibility.

Patients will be afflicted with unavoidable environmentally caused diseases once these Dirty Coal Plants are built and operational. The Dirty Coal Plants will be operational for the next fifty years. The illnesses and costs of medical care for these illnesses could be avoided if we do not pollute our environment.

One could look at building these Dirty Coal Plants as “man’s inhumanity to man in pursuit of the mighty dollar.” I have been amazed by how many people believe that the EPA standards are the state of the art, that the present EPA rules will protect us from pollution. If the levels were a concern the EPA would change the rules. Therefore, we do not have to become pollution experts. The EPA’s mission is to protect us from any environmental toxin that might be dangerous. We have delegated the EPA as our surrogate to protect us from pollutants that could harm us.

Unfortunately, this has proven not to be true. Two court judgments have gone against the EPA rules in recent months. The EPA has for some reason loosened standards of pollution since 2000. One should question why. Our advances in technology have given us the ability to decrease coal burning pollution markedly by building IGCC Coal Plants. Our advances in understanding the medical effects of pollution have demanded that we decrease our exposure to these pollutants.

I understand our need to reduce our dependence on foreign oil as an energy source. If the new Dirty Coal Plants result in an additional $68 billion burden to our healthcare system by avoidable disease healthcare costs, shouldn’t a prudent government be investing in creating incentives for renewable sources of clean energy such as wind and solar energy? At the same time shouldn’t we be investing in creating incentives for energy conservation? We could use the extra $68 billion saved to promote these efforts.

TXU claims there are other sources of pollution such as our automobiles. Shouldn’t we create incentives for automobile companies to decrease the pollution and increase conservation of fuel for our automobiles more than they have? Look at the impact of the Toyota Prius, without incentives. Toyota is not even an American company. Toyota has created a competitive advantage for their product. Other companies have been slow to follow with as efficient a product. In fact it seems they are trying to undermine the efficiency of the product.

America is a brilliantly creative marketing country. America has created many “hypes” in my lifetime. My first recollection was promoting cigarette sales even though the cigarette companies knew they were not good for us. I could not wait to be old enough to smoke a cigarette. Recently, it is flat screen high definition television. Congress has even taken time out from their busy work to set a deadline for digital HDTV.

Why can’t Congress create incentives for us to stop harming ourselves with environmental pollution? Perhaps there is not enough lobbying money in the effort.

Why can’t Congress get smart and use its creative energy to promote the health of our citizens, rather than bending to the vested interest pursuit of the almighty dollar resulting in more pollution and more medical costs to society.

It can only be done if the politicians, the government officials, and the government agencies are challenged by the citizens they are supposed to be serving. It is clear to me the evolution of the rules in our legal system and the institution of lobbying has removed citizen input for demanding what is in the citizens best interest.

The time has come to express ourselves. The citizens of Texas are trying to do that right now. However, we have a very refractory Governor Rick Perry and a very powerful corporation in TXU. TXU has not demonstrated any corporate community responsibility to date. I hope our legislative officials in Austin will be able to respond to the cries of the citizens and force this folly to stop!!

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Did I Solve Denise’s Problem? Not yet!

July 11, 2006

inMedicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

My last few blogs dealt with Price Transparency. These posts were meant to describe the problem as well as offer a solution to the problem.

Denise, as an uninsured patient, was thrown into a situation where she was at a tremendous price disadvantage. The solution presented would provide her with price ranges that she could negotiate. However, when you are ill, you do not want to be forced to negotiate the price of your own care. If there was a Universal Medical Saving Account available to everyone, sold by insurance companies without eligibility or tax restrictions, the fees would have already been negotiated for Denise. Her decision making would be simplified. She would decide whether the insurance company was allowing too little or too much to be paid for a service with her MSA money. She should have the opportunity to express her impression of the quality of the service. If she was displeased with the service, she should be able to choose another insurance company, physician or hospital.

These simple principles would create a competitive marketplace in favor of the patient. The impartial web site would permit other patients to judge the quality of their care. The provider could defend the quality of his care to others in this transparent marketplace. One can begin to see that a Consumer Driven Healthcare System (CDHCS) could be effective by market forces determining cost and price. It could also be a good deal for the patient. An effective CDHCS could encourage a system of patient responsibility for his care. In turn, it could increase adherence rates to treatment and reduce complication rates of chronic illness. The result would be a decreasing cost of care to the healthcare system. I will, in future blogs, discuss the system of Consumer Driven Healthcare that would work.

I mentioned that Dr David Westbrock was correct when he stated that the insurance industry has subverted the Medical Saving Account product which is key to the Consumer Driven Healthcare movement. They have substituted an alteration in the original system called the Health Saving Account. This alteration serves the insurance industries’ vested interest and not the patients’. In the long run, the HSA will serve as a false hope to the Repair of the Healthcare System.

Next, I will return to the evolution of steps that have distorted the Healthcare System. They are a threat to destroy our medical care system.

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Politics of Electronic Medical Records

March 25, 2019

inEMR, Medicine: Healthcare System

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Politics of Electronic Medical Records

Stanley Feld M.D.,FACP,MACE

The EMR project that President Obama forced on the medical profession in 2009 has not yet produced any evidence that EMR will save the country $350 billion in inpatient care and $150 billion dollars in outpatient care over a 15 year period of time.

The RAND analysts claim that more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care over a 15-year period of time.

The RAND EMR study was wrong. The study sounded good to President Obama because he thought EMRs would enable the federal government to control medical and surgical practices in America.

Unfortunately, data from three other studies, a cardiology group, a Harvard group and Canadian group showed there is no savings difference between paper records and electronic records.

The project has been a $38 billion dollar failure. I predicted the EMR project would fail in 2011. EMRs are a great idea. The EMR projects goals were wrong.

Wall Street Journal article in 2012 stated, “The electronic medical record (EMR) is touted as the key to containing costs, reducing errors, improving quality, and simplifying administration: an “elegant exercise in wishful thinking.

The RAND Corporation study was paid for by all the vested interests stakeholders involved in medical care except physicians and patients.

Allscripts Healthcare Solutions, the Cerner Corporation and Epic Systems of Verona, Wis. are the major EMR software companies who paid for the study.

“In February 2009, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill.

GE and the healthcare insurance industry were also major funders of the RAND Study. The Obama administration funded the implementation of the EMR project to the detriment of the healthcare system.

The healthcare system has not contained costs, reduced errors, improved quality or simplified administration. Each category has gotten worse.

I do not think the Obama administration’s primary interest was to fix the existing healthcare system. If the EMR project hobbled the healthcare system, the population would beg the government to completely take over institute his “Public Option” and subsequently “Medicare for All.” There was no consideration of the fact that that Medicare and Medicaid are unsustainable.

The complete control of the VA Healthcare System has not worked out very well for the government. One important reason for the VA Healthcare System’s failure is the bloated government bureaucracy. Effective medical care takes instantaneous judgement and rapid execution. Government regulations inhibit the process leading to long waiting times and ineffective and costly treatment.

Medicare and Medicaid costs have been unsustainable and are getting worse. Why would a politician think complete government control over 20% of the GDP, the healthcare system, would be any better than a free market system where patients would take responsibility for their healthcare and healthcare dollars?

The government could provide the dollars to the needy with financial incentives attached for all in the system.

Ideal EMR should be for the benefit of physicians and their patients. The EMR should not be only for the financial benefit of healthcare insurance companies, the government, the pharmacy benefit managers and the software companies.

The EMR project places the secondary stakeholder in the position to judge physicians’ behavior and subsequently penalize them if they do not comply with government regulations and expected results.

The EMR should be a tool to continually educate physicians to help them become better. It should educate patients so they can become professors of their disease and help them avoid the complications of their chronic diseases.

The EMR should not be a tool used by secondary stakeholders to penalize physicians and patients. This will not decrease the ever-increasing cost of healthcare.

At the moment EMRs are relatively useless. A lot of money has been spent by all the stakeholders with very limited benefit. There have been hundreds of examples published by all stakeholders about the defects in the present EMRs that do not allow for an increase in the quality of care and a decrease in the cost of care.

My ideal EMR along with my ideal medical saving accounts can go a long way toward repairing the healthcare system. http://stanfeld.com/is_an_ideal_ele/

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

Copywrite 2006-2019

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Did Obamacare Cause The Increase In Private Healthcare Insurance Premiums?

February 2, 2019

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

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Stanley Feld M.D.,FACP, MACE

A reader of my blog received this question from one of his friends.

The reader asked me his friend’s question “I have a question and I don’t want it to be political (as I stay away from that for many reasons).
Health insurance is so expensive and it does not cover hardly anything. We had to get the worst plan with the worst coverage. But it was not this way 6 years ago. We could afford good coverage.

The question is: Did Obamacare cause this change in healthcare insurance and these problems in access to care?

A reader asked:

Which of your blogs would be the best one to show him to answer his question?

The answer to the question is YES!! I will try to explain.

If I sent all the links to your friend would be overwhelmed. There are too many to count. I will summarize some of the major reasons Obamacare is to blame for some of the increases in private healthcare insurance premiums and the decrease in the access to care. Obamacare has led us into a financial disaster. “Medicare for All” is not the answer.

I believe the goal of Obamacare was to create greater dysfunction in the healthcare system which would lead to huge premium increases for private healthcare coverage. The public would then beg the government to adopt a single party payer system with “Medicare for all.” This has been the progressives” goal since 1935. Do you remember Barney Frank and John Kerry saying we cannot have a single party payer system yet because we do not have the votes?

https://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2018/10/the-main-reason-behind-rising-medical-costs.html

The government has not had a very successful single party payer systems record. The VA Health Administration, the Indian Health Service, Medicare and Medicaid are all inefficient and financially unsustainable.

“Our federal government already runs three single-payer systems—Medicare, the Veterans Health Administration, and the Indian Health Service—each of which is in a shambles, noted for fraud, waste, and corruption.”

“Why would we want to turn over all of the American medicine to those who have proved themselves incompetent to run large parts of it?”

https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

The federal government depends on healthcare insurance companies to do the administrative services for Medicare, Medicaid and Obamacare. Administrative services include negotiating payments to hospitals, nursing homes, physicians and providers on all levels.

The various healthcare insurance companies are supposed to bid for these service contracts. The insurance companies receive one global fee. The healthcare insurance company with the contract must pay providers on a fee for service basis. The healthcare insurance companies do not have good enough data to make an accurate bid estimate. Actuary science is not rocket science. The healthcare insurance company builds in a twenty percent cushion to the bid. If the bid was low and the healthcare insurance company that lost money Obamacare guaranteed through a complicated reinsurance formula reimbursement to the company for its loss.

Recently the government audit discovered an overpayment of $10 billion dollars to the healthcare insurance industry for Medicare Part D.

I believe there is much more overpayment in Medicare Part A, B and D because of the government bureaucracy. The government only had the money to pay 12% of the reinsurance claims of the healthcare insurance company one year. The insurance industry simply raised the premium in the private sector.

http://stanfeld.com/president-obama-somehow-finds-the-money/

http://stanfeld.com/accelerating-the-destruction-of-the-healthcare-system/

http://stanfeld.com/the-deception-and-disinformation-continues/

Nationwide, the Obama administration made $7.3 billion in reinsurance payments to health insurers. The reinsurance program, funded by taxes on health insurers and self-funded employer health plans, has been criticized by Republicans as a “bailout” for insurers.

https://www.ibj.com/blogs/12-the-dose-jk-wall/post/53906-obamacare-shovels-another-122m-to-indiana-insurers

The healthcare insurance industry then once again raised premiums on the private healthcare sector to make up for its losses. to

The government reinsurance payments weren’t enough in all cases. New York-based Assurant Inc. asked for a 26 percent hike in private premiums for 2016, due to high claims in Indiana, before that company decided to exit the Obamacare markets in all states.

This was typical price shifting.

http://stanfeld.com/?s=price+shifting

Healthcare insurance companies projected that Obamacare would result in them losing money because of adverse selection. Obamacare’s increase required benefits for both public and private insurance. Obamacare’s rules included coverage for oral contraceptives for all and coverage of pre-existing illnesses among others. A sixty-year-old male does not need an insurance policy the receives oral contraceptives.

The healthcare insurance industry asked for double-digit increases in private healthcare insurance in every state. The logic was that these enrollees would pay for the loses that would occur from the Obamacare enrollees.

http://stanfeld.com/managing-points-of-view-and-healthcare/

The government’s argument is all should pay for everyone ’s healthcare needs. These healthcare needs have increased as the population has gotten more obese and has had a rise in drug addiction. These increased healthcare risks resulted in increased actuary estimates of healthcare cost. It does not put a burden on consumers who do not act responsibly.

The increased healthcare premiums caused many employers to drop healthcare coverage for their employees. The decrease in healthcare insurance coverage added to the pressure of healthcare premium increases.

The healthcare insurance industry also plays games with the Medical Loss ratio. The result is an increase in healthcare premiums and deductibles while decreasing services. The Obamacare issued regulations that the insurance industry must dedicate 80% of the healthcare premium to direct medical care and 20 % can be used for administrative expenses for both the public government insurance and private insurance. It is the state insurance regulators responsibility to enforce the regulation.

The expenses the industry wanted to be included are;

Expenses to be included in direct medical care are:

The cost of verifying the credentials of doctors in its networks.
The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.
The cost of programs that keep people who have diabetes out of emergency rooms.
The sales commissions paid to insurance agents.
Taxes paid on investments.
Taxes paid on premium income.

All these expenses are administrative expenses in my view and not medical expenses. If these expenses are permitted as benefit expenses, premium money available for direct medical care would decrease. The eighty percent required for direct medical care would be markedly reduced. The result would be an increase in healthcare insurance premiums.

http://stanfeld.com/medical-loss-ratio-how-did-the-healthcare-insurance-industry-do/

http://stanfeld.com/what-is-the-medical-loss-ratio/

The calculation for direct medical care helps the healthcare insurance company prove it lost money. The insurance company then applies to state regulators for a premium increase. The state regulators permit the premium increases. If the premium increase is refused by the regulators the insurance company threatens to leave the state. The other option the healthcare insurance company uses is to decrease the insurance services and/or increase the insurance deductibles.

Another problem has developed in the healthcare insurance industry that is causing it to raise premiums and reduce services and access to care as a result of Obamacare.

Hospital systems are buying out physicians’ practices. Obamacare has put many restrictions on physician practices. It has increased practices overhead. Obamacare has decreased the ability for physicians to use their medical or surgical judgment that they have become happy to sell their practices to hospital systems. The hospital systems now have to deal with the problems of medical practice. The cost of electronic medical records, which have not added to the quality of medical care, increased many physicians’ willingness to sell their practices to hospital systems. At the moment the percentages of hospital-owned practices are up to 65% from only 17% ten years ago.

http://stanfeld.com/physicians-barriers-to-practice-their-profession/

https://www.wsj.com/articles/SB10001424052748704122904575315213525018390

As premiums have gone up physicians have not experienced an increase in reimbursement. They have been forced to see more patients quickly to earn almost as much as before Obamacare. Obamacare has destroyed the patient-physician relationship which in my view is essential in medical care. Physicians simply do not have time to talk to patients.

Hospital systems have taken over physician populations in many communities. This gives the hospital leverage over the healthcare insurance industry. The hospital system can demand higher reimbursement because it provides all the physicians.

The large hospital systems can demand that the insurance company only use the physicians in its hospital system even if there are lower cost of care options in a community.

The result is an increase in healthcare premiums and decreased the quality of care.

All of this is the result of Obamacare. There are about ten more reasons why Obamacare has increased premiums and decreased access to care. I have left link exposed. You are encouraged to look at them to see the full explanation for some of the point I have made.

I hope this blog answers your friend’s question. : Did Obamacare cause this change in healthcare insurance and these problems in access to care?

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

Copywrite 2006-2019

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How Jeff Bezos, Warren Buffett and Jamie Diamond Can Disrupt The Healthcare System

February 19, 2018

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicaid, Medicare

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Stanley Feld M.D., FACP,MACE

Jeff Bezos, Warren Buffett and Jamie Diamond should try this disruptive approach in their venture into healthcare reform.

All the other approaches that have been tried have not worked or have become unsustainable. Most of the approaches have been unfair to consumers and the majority of taxpaying Americans.

The only way to empower all the consumers in a healthcare system is to encourage them to become responsible for their health and healthcare dollars.

I believe it can only be accomplished by providing easily understandable financial incentives for consumers to save money for themselves.

Providing financial incentives to consumers to save money for themselves can be disruptive to the present models used to pay for medical services just as Amazon has been disruptive to retail sales.

The delivery of medical and surgical care has advanced tremendously in the last sixty years.

At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.

The incidence of obesity has risen every year. Over fifty percent of Americans are obese.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well. However the treatment of chronic disease complications are costly.

How do you decrease the incidence of obesity in America?

Physicians must attack the core causes of obesity.

Among those causes are excess food intake, lack of daily exercise, mental depression, cultural milieu and/or a combination of all of the above.

The cure of obesity depends on the ability to eliminate these core drivers. Financial incentives can get patients involved in eliminating the core drivers of obesity.

The responsibility for obese patients’ healthcare depends on patients’ lifestyle, popular cultural milieu, and patient education.

In America, it is almost impossible to buy a meal in any level restaurant without excess calories.

How do you get people to be responsible for their health and healthcare dollars?

The one key element ignored by policy makers to decrease obesity is to give obese consumers of healthcare financial incentives to concentrate on trying to lose weight.

“Obamacare went in the wrong direction. It limits personal liability for their obesity. It does not promote personal responsibility

The only incentive Obamacare provided was the incentive to overuse the healthcare system.

This was especially true for patients on Medicaid. They had zero premiums and deductibles. The only deterrent to accessing medical care was physician availability.

Physicians refused to participate in Medicaid because of low professional reimbursement. Low reimbursement by the government was necessary because of the decreases in funding and participant overuse of the system.

Obamacare planned to cure the shortage of “medical providers” by increasing the number of “valid medical providers” who could bill on their own, such as nurse practitioners and certified physician assistants.

However, the defect there is that patients were not under the supervision of physicians engaged in their care. It ignores the patient physician relationship that is so important to effective medical care.

If Jeff Bezo, Warren Buffet and Jamie Diamond (BBD group) are serious about Repairing the Healthcare System for their employees as a nonprofit organization, they should consider my Ideal Medical Savings Account.

http://stanfeld.com/?s=My+Ideal+Medical+Savings+Account

The Ideal Medical Savings Accounts (MSA) are tax-sheltered accounts used to pay for non-catastrophic medical expenses. These non catastrophic medical expenses account for the bulk of the cost of medical care.

Money left from the Medical Savings Account at the end of the year is put into a consumer’s retirement account.

The MSA provides the financial incentive to not overuse the healthcare system.

Warren Buffet understands the money making potential of re-insurance. He is heavily invested in re-insurance companies.

If one of the BBD Groups employee’s gets sick and spends of all of his MSA money, reinsurance provides first dollar coverage for the illness.

The BBD Group could teach employees how to shop for price and value. Insurance companies are supposed to shop for value. However the shopping is never to the patient’s advantage. It is to the advantage of the insurance company.

“ Critics always claim this is unrealistic:

The claim is that patients are not smart enough to shop for price and value. 2. Are you supposed to shop around from the back of the ambulance?

The critics’ use the ambulance argument to eliminate the possibility of consumers using their own judgment to make price decisions.

Patients are smart enough to figure out which hospital they want to go to before they get into the ambulance.

Emergency care represents only 6% of health care expenditures.

“But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

ttps://www.wsj.com/articles/the-health-reform-that-hasnt-been-tried-1507071808

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

ttp://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/

“My Ideal Medical Saving Account provides that financial incentive to not overuse the healthcare system. All the articles about my ideal medical saving accounts are attached to this link.

http://stanfeld.com/?s=My+ideal+Medical+Savings+Accounts

“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”

Medicaid patients also overuse the healthcare system.

Most Medicaid patients can understand the MSA’s financial incentive.

“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”

These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system. It would save the re-insurance company a great deal of money.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and deliver it to consumers retirement accounts.

Both HSA’s and MSAs have the unique advantage of providing the financial incentive to for consumers to save money for themselves.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health.

The financial incentives decrease the overuse of the healthcare system.

“ According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”

https://www.healthaffairs.org/do/10.1377/hpb20160204.950878/full/

My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ MSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”

MSAs should also apply to Medicaid recipients. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to MSAs should be raised to $6000 or $7000 dollars. If a consumer gets sick and experiences a cost of more that $6000 he should receive 100% (first dollar) coverage through the BBD group’s provided reinsurance policy. A reinsurance policy would cost the BBD Group less than $6000 a year.

The total insurance package to BBG Group employees should cost the BBD Group $12,000 rather than the present cost of $18,000.

BBD is a self insured association. The association has elimated the multiple middlemen in the present healthcare system.

When a person with an MSA dies, the funds should be allowed to roll over tax-free to surviving family members.

This financial incentive should be included in My Ideal Medical Savings Account.

“The information that patients require to assess value must be made more transparent.

2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”

A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.

At present healthcare prices are not transparent. Consumers are not motivated to shop prices. The BBD Groups leverage with its employees would force transparency.

“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”

In this age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines. It would supply instant access to expertize at an affordable cost.

Everything possible should be done to encourage consumer responsibility and provider competition.

The present tax code does the opposite. Consumers in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.

The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.

The BBD Groups volume of consumers would have tremendous leverage with providers.

The younger and healthier the corporate employees are the lower the premiums.

The formation of associations with large memberships of all ages would lower the cost of healthcare. Large associations would have great leverage in negotiating price with providers. They would also spread the risk.

Self- insured associations such as the BBD Group would also spread the risk and lower the cost.

Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars the same as the corporate group plan policy holders.

These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.

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

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Is Anyone Confused Or Convinced?

December 6, 2017

inDisinformation and the healthcare system, Medicine: Healthcare System

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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

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The Plan To Empower Consumers Of Healthcare

October 16, 2017

inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System

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Stanley Feld M.D., FACP,MACE

The only way to empower consumers of healthcare is to allow them be responsible for their health and healthcare dollars.

The delivery of medical and surgical care has progressed markedly in the last sixty years. Life expectancy has also increased.

At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.

The incidence of obesity has risen every year. Over fifty percent of Americans are obese. The percentage is rising yearly.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well but the treatment of these complications comes at a high cost.

How do you decrease obesity in America?

How do you get people to be responsible for their health and healthcare dollars?

One of the key elements in decreasing obesity is to give consumers financial incentives to use the healthcare system efficiently.

“ObamaCare went in the wrong direction. Its regulations—including required “essential benefits”—raised prices on these plans and limited their availability.”

The only incentive Obamacare provided was the incentive to overuse the system. This was especially true for patients on Medicaid. They had zero premiums and deductibles.

A second tool for motivating patients to consider price is large liberalized health savings accounts. These tax-sheltered accounts are generally used to pay for the noncatastrophic expenses that form the bulk of medical care.

First, equip consumers to consider prices.”

“ Critics always claim this is unrealistic: Are you supposed to shop around from the back of the ambulance?

The critics use the ambulance excuse argument to eliminate the possibility of consumers using their own judgment to make price decisions.

“But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

http://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/

“My ideal medical saving account provides that financial incentive to not overuse the healthcare system. The many articles about my ideal medical saving accounts are attached to this link.

“ Likewise, nearly 60% of Medicaid money goes to outpatient care.”

Medicaid patients also overuse the healthcare system.

“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”

These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and delivers it to consumers.

Both HSA’s and MSAs have the unique advantage of providing and financial incentive to save.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health.

The financial incentive decreases the overuse of the healthcare system.

My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ HSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”

Scott Atlas has publicized the obvious. This would apply to Medicaid recipient also. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to a MSAs should be raised to $6000 or $7000 dollars. If a consumer get sick and experiences a cost of $6000 he should receive 100% (first dollar) coverage through a reinsurance policy that would cost less than $6000.

There can be many variations on this theme for the consumers benefit.

When a person with an HSA dies, the funds should be allowed to roll over tax-free to surviving family members.

This financial incentive should be added to My ideal Medical Savings Account.

“The information that patients require to assess value must be made radically more visible. A 2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”

A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.

“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”

In his age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines.

It would supply instant access to expertize at an affordable cost.

Everything possible should be done to encourage consumer responsibility and provider competition.

The present tax code does the opposite. Consumers’ in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.

The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.

The younger and healthier the corporate employees are the lower the premiums.

This is where the formation of associations with larger memberships of all ages fits in to lowering the price of healthcare. Large associations would have great leverage in negotiating price with insurance companies. They would also spread the risk.

If financial incentive with my ideal medical saving account was added to the price the association negotiated and the consumer paid for the premium, usage would fall and the cost of insurance would decrease.

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

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The Republican Establishment’s Failure

July 20, 2017

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

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Stanley Feld M.D.,FACP, MACE

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

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

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

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

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

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

A reader wrote:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My Ideal Medical Saving Account is a much better idea.

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

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

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

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

Socialism does not work!

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

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

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

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

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

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

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How Can I Be So Misinterpreted?

July 13, 2017

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

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Stanley Feld M.D., FACP, MACE

A reader sent me the following comments.

“Sorry Doc,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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