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Here It Comes!

February 3, 2016
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

The mainstream media has been very quiet about Obamacare lately as the defects in its execution keep rolling along.

You may recall President Obama telling Senator John Kerry and Representative Barney Frank not to worry about including a Public Option in the bill. He told them they would not have to include the Public Option in the Affordable Care Act.

Barney Frank said we would never get a single party payer system unless we have a Public Option in the bill.

President Obama was right. He didn’t need a Public Option because the single party payer system was already embedded in the bill without anyone knowing it.

Medi-Cal is California’s name for its Medicaid program. California is one of the states that have expanded the Medicaid program under Obamacare.

Twenty states have not expanded their Medicaid program for fear of the federal government impinging on states rights while sticking their state with the bill.

The states also feared increases in their budget deficit. States are required to balance their budget. The result would be an increase in state taxes.

The increase in state taxes would render the state unattractive to companies and their business. Less company growth would mean an increase in unemployment and a decrease in state tax revenue. A decrease in tax revenue would result in a decrease in state services.

President Obama said, “Don’t worry.” He promised to fund Medicaid expansion fully for the first 3 years. Federal funding would decrease after the first three years to 50%. The funding percent has changed a few times since that promise. One could not know the present decrease unless one read the Federal Register daily.

Expanding Medicaid was a key part of the Affordable Care Act (Obamacare). It was also a hidden trap set by President Obama to slip the healthcare system into a single party payer system by default. That is why President Obama insisted we did not need a Public Option.

Obamacare required nearly all Americans, under penalty of law, to have insurance starting in 2014.

“Though a surprise, the high Medi-Cal enrollment is generally hailed as a success. California’s uninsured population has been cut in half since Obamacare, in large part because so many Californians signed up for Medi-Cal, which is free for beneficiaries.

Medi-Cal was opened to all low-income Californians starting two years ago, with the federal government paying for those new enrollments.”

In 2016 one third (1 in 3) or 12.7 million Californians are covered by Medi-Cal.

The total cost of the Medi-Cal explosion is $91 billion dollars, up from $54 billion dollars in 2012. California is responsible for $12 billion dollars. It will increase California’s budget deficit and may result in another tax increase.

The cost per insured is $7,165.35.

“The Medi-Cal program continues to grow at a very substantial rate, which is great. We are very happy that we’re able to provide healthcare to getting close to 13 million Californians,” said Mari Cantwell, chief deputy director at the state Department of Health Care Services, at a hearing in downtown L.A. this month. But, Cantwell added: “Obviously with that comes cost.”

The Medi-Cal is viewed by many state officials as being underfunded.

Medi-Cal patients are struggling to find doctors.

Many patients are receiving low quality of care by government standards.

A psychiatrist in Los Angeles told me that all the private practice internists in L.A. require an upfront concierge fee of at least $2,000 a year at the beginning of the year to be in their panel. If this is true, Internists in L.A. are insulating themselves against the low reimbursement of Medi-Cal. This concierge fee increases the California physician shortage.

The result has been that groups of activists have filed a federal civil rights complaint alleging that Latinos are being denied access to healthcare because the program does not pay doctors enough.

“The Affordable Care Act allowed states to open up Medicaid to anyone making less than 138% of the federal poverty level.”

Twenty states did not sign up for the expanded Medicaid because of the fear of federal takeover and the further impingement of state rights.

Pre-Obamacare, states were required to pay 43% of Medicaid’s cost and the federal government paid 57% of the costs. States ran the program and determined reimbursement.

As costs increased reimbursement was decreased and physician participation decreased because of the decreased reimbursement.

As a result of the 20 states resisting Medicaid expansion the federal government will pay 100% of the cost of new expansion enrollees and 93 percent off the cost of expanding Medicaid over the next nine (9) years instead of the next two (2) years.

The present rule looks like a great deal for the states. However with the federal government paying most of the Medicaid bill for the next nine (9) years the federal government will want to control Medicare.

Who needs a Public Option to get to a single party payer?

Who is going to stop the federal government from changing the eligibility for Medicaid to 200 or 400% of the poverty level?

Who is going to force doctors to participate in Medicaid if they want to practice medicine with a federal license?

Where is the government going to get the money without having skyrocketing increases in taxes?

Tax laws and lack of pro-growth tax reforms are inhibiting America’s economic growth.

America has been set up to have the future state of healthcare be a single party payer system. President Obama has done it in a clever way. He has had no regard for being fiscally responsible in the face of a 19 trillion dollar, and rising, debt.

Single party payer systems have failed in England and Canada.

Why should America create another failure?

Can Americans have a future state healthcare system that is not destined to fail?

Yes we can!

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Accelerating The Destruction Of The Healthcare System

January 18, 2016
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Most of you are familiar with my slide of the demise of the healthcare system.

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Obamacare is accelerating the total collapse of the healthcare system. Once total collapse has occurred Americans might beg for a complete government taken over of the healthcare system with a single party payer system.

I have pointed out most of Obamacare’s new rules causing the unintended consequences and accelerating the healthcare system’s demise.

An unintended consequence in the Accountable Care Organization leads to a new rule to correct the consequence. Unelected officials then create another rule. The new rule results in other unintended consequences. All of these consequences accelerate the healthcare system’s demise.

Obamacare’s first year in operation was 2014. The Obama administration started taxing everyone in 2010 to support the added expenses Obamacare would generate.

Only the individual insurance portion of Obamacare was initiated.

The following are examples of unintended consequences.

Fourteen million people lost their individual healthcare insurance coverage in 2012 because of Obamacare’s new rules. Insurance coverage premiums increased because of the ACA’s required coverage.

Many workers lost their full time jobs. They were put on part-time employment in order for employers to avoid Obamacare penalties.

CMS reported that 13 million signed up for Obamacare in 2014 despite the healthcare.gov website disaster. The number of enrollees was revised a few of times down to 6.6 million because of counting errors.

The direct and indirect costs of Obamacare were never reported to the public.

Obamacare activated a reinsurance program that was built into the Affordable Care Act. The reinsurance program was a bailout to entice the healthcare insurance industry to participate in the Federal Health Insurance Exchanges without experiencing any loses.

The insurance industry has claims the Obama administration owed it 2.5 billion dollars in 2014. The Obama administration was able to pay only 12%. The law restricted the government’s reinsurance payment to a certain percentage of the premiums paid. The amount owed as promised to the healthcare insurance industry for their participation in Obamacare was $2.2 billion short.

I believe the healthcare insurance industry will be loath to participate in the Federal Health Insurance Exchanges in 2017. UnitedHealth has already threatened to quit participating.

This year (2016) during open enrollment only 8.1 million enrolled in the Federal Health Insurance Exchanges.

It has been difficult to trust CMS’s overall claims for the number of enrollees. It has nothing to do with how many people have paid first premium or the anticipated number who will continue to pay premiums throughout the year.

President Obama stated in his state of the union speech that 18 million previously uninsured have received insurance under Obamacare. This is not true.

For argument’s sake let say his number is correct.

More than half the enrollees received Medicaid. President Obama is urging states to expand Medicaid.

What is going to happen when Medicaid is expanded? More people will get free government supplied healthcare insurance but will not be able to find physicians. Medicaid reimbursement is so poor that few physicians participate.

The healthcare system’s demise is rapidly accelerating. Obamacare’s claiming to increase people being covered but these people cannot obtain healthcare services.

Obamacare does not incentivize these people to be responsible consumers. Obesity continues to increase and the dollars spent for healthcare continues to increase.

The truth is enrollment has been terrible for 2016. President Obama is expanding the enrollment period again this year to try to increase enrollment.

“Eager to maximize coverage under the Affordable Care Act, the Obama administration has allowed large numbers of people to sign up for insurance after the deadlines in the last two years, destabilizing insurance markets and driving up premiums, health insurance companies say.”

“The administration has created more than 30 “special enrollment” categories and sent emails to millions of Americans last year urging them to see if they might be able to sign up after the annual open enrollment deadline.

The Obama administration has done nothing to verify whether these late arrivals are eligible for insurance. They just sign up and are insured.

People have figured out they can wait until they become ill or need medical services to sign up. They then sign up and pay their premiums a few months’ premiums. They stop paying their premiums after they have received their medical services. They figure they do not need insurance any more.

“Individuals enrolled through special enrollment periods are utilizing up to 55 percent more services than their open enrollment counterparts” who sign up in the regular period, the Blue Cross and Blue Shield Association, whose local member companies operate in every state, told the administration.

The Obama administration has told the healthcare insurance industry that it has heard their concerns. The problem is that CMS has not done anything about the insurance industry’s concerns.

“Many individuals have no incentive to enroll in coverage during open enrollment, but can wait until they are sick or need services before enrolling and drop coverage immediately after receiving services, making the annual open enrollment period meaningless,” Steven B. Kelmar, an executive vice president of Aetna.”

Twenty five percent of Aetna enrollees have signed up during the special extended enrollment periods. It has been reported that last year 950,000 people enrolled during the special enrollment period between February and July 2015.

“Kevin J. Moynihan, the chief executive of the federal insurance marketplace, said it shows the marketplace is working to meet people’s needs. He said certain life changes like losing your coverage, having a child, turning 26, moving or getting married may qualify you for a special enrollment period.”

People who are qualified for insurance do not get verified for insurance. It is easy to understand that this leads to unstable insurance markets and subsequent increases in premium prices.

It is o.k. for progressives if healthcare insurance is considered a right under a single party payer system with the losses taken by the government even if the deficit increases.

It is not o.k. if the Obamacare healthcare system pretends to be developing an efficient free enterprise system with the healthcare insurance industry experiencing the loss under the weight of unidentified risks created by the federal government.

The number of people not continuing to pay their insurance premiums their entire year is enormous. The healthcare insurance industry had no way of anticipating this occurrence.

“On average,” Aetna said, “special enrollment period enrollees stay with us for less than four months, while enrollees who come to us during the annual open enrollment period maintain their coverage on average for eight to nine months.”

The same turnover rate has happened to UnitedHealth. It is one of the many reasons UnitedHealth has threatened to quit participating in Obamacare in 2017.

The result will be even higher insurance premiums next year. Most of the Obamacare insurance rates are unaffordable this year.

“Enroll America, a nonprofit group with close ties to the Obama administration, said the government “should not tighten eligibility or verification standards in ways that could place an undue burden on consumers.”

There is no verification for late enrollment. The last statement by “Enroll America” reflects President Obama’s progressive and irresponsible attitude toward fiscal responsibility.

It is no wonder the national debt has grown to $19.2 trillion dollars.

It is another way to accelerate the collapse of the healthcare system.

I believe President Obama knows exactly what he is doing. His problem is he does not understand or care about the significance of the effect the deficit increase will have on America’s financial stability.

Middle class Americans are getting slaughtered.

Additionally he does not understand that Americans will not accept a government controlled single party payer system.

The Republican Party must get on the stick right now. They must offer a viable alternative to President Obama’s goal of a single party payer system. They should not wait until after the election.

The alternative should work in an efficient way. It should put consumers in charge of their health and healthcare dollars.

It would be a good idea for Republicans to understand and offer as an alternative My Ideal Medical Saving Accounts.

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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$3 Trillion And Rising

January 11, 2016
inConsumer Driven Health Care, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

The Obama administration is spending money on Obamacare like a drunken sailor. It has no respite for the budget deficit. Paul Krugman even said deficit spending is not a problem.

The deficit could almost be justified if there was a possibility that Obamacare could work.

If Obamacare could provide universal healthcare at an affordable price, increase the efficiency and quality of care, and align all the stakeholders’ interests the increasing deficit caused could almost be justified.

Obamacare can’t work. Its business model is just accelerating the path to the total collapse of the healthcare system.

The dysfunction and inefficiencies didn’t happen overnight. It started when the government set up its bureaucracy for Medicare in 1965 and has gotten worse as progressives tried to adjust to the unintended consequences and rising costs.

Obamacare has accelerated the path toward total collapse of the healthcare system. It has caused more rules and regulations. The increase in bureaucracy leads to more inefficiency and increasing adjustments by providers to make the defective business model work for their vested interests rather than the patients’ vested interests..

Little tweaks to fix the healthcare system have lead to unintended consequences, greater dysfunction and higher costs.

In 2010 with the passage of Obamacare, bureaucracy increased. Businesses have invested great deals of money to adjust to new regulations imposed by Obamacare.

David Brooks said on the PBS News Hour on January 8, 2016 that Obamacare cannot be repealed because it was embedded in the business model of too many healthcare businesses.

I thought healthcare reform was dedicated to the proposition of providing universal healthcare and improved healthcare at an affordable price to patients.

In the last two years there has not been an increase in the number of new patients insured in the Federal Health Exchanges.

There has been an increase in the number of Medicaid patients insured. However, Medicaid provides such poor insurance reimbursement that few physicians participate.

The few physicians who do participate have to see many patients a day using many physician assistants. “These Medicaid Physicians” are frequently accused of running “Medicaid Mills.”

The physicians are accused of corruption and gaming the system. Then they come under federal investigation. Some of these physicians are corrupt but most aren’t.

David Brooks is drinking the Kool Add of the progressives and President Obama. He stated that Obamacare is now embedded in the fabric of our culture.

None of the stakeholders are having any fun. I believe everyone would jump at being given a viable alternative. The viable alterative is not a single party payer system.

Countries which have a single party payer system are working hard to avoid bankruptcy.

All one has to do is read Canada’s Fraser Institute Report.

Obamacare is an entitlement. It does not promote consumer responsibility for their care or healthcare dollars.

There is a better way. The Republican political establishment just refuses to listen. The Democratic establishment continues to make fun of the Republican establishment for not having an alternative.

Meanwhile all of the stakeholders, including the government, are experiencing increased pain.

Last month government officials announce that healthcare spending in the United States was 3 trillion dollars or an average of $9,500 a person.

A soon as the figure was announced the Obama administration’s spin machine got started with disinformation about the 3 trillion dollars.

The New York Times continues to report that Obamacare is working. The logic used is America has had a lower growth in healthcare spending in the last five years.

The New York Times completely ignores the fact that healthcare taxes have increased yearly over the last five years while Obamacare healthcare coverage has only been in effect for two years since 2014.

The spending curve for every aspect of healthcare experienced a sharp upturn in 2014.

The Obama administration is trying to blame the upturn on drug prices. Drug prices are partly to blame increase in cost. If one digs deeper it will be seen as a small part of the cost increase.

The increase cost is due to the accelerated dysfunction caused by Obamacare.

“Health spending in the United States last year topped $3 trillion — an average of $9,500 a person — as five years of exceptionally slow growth gave way to the Affordable Care Act’s expansion of Medicaid and private insurance coverage, and as prescription drug prices resumed their sharp climbs, the government said Wednesday.”

Only a few of the major provisions in the Affordable Care Act (Obamacare) took effect in 2014.

What is going to happen when all of the major provisions of Obamacare take effect?

“Total spending on health care increased 5.3 percent last year(2014), the biggest jump since 2007, and accounted for 17.5 percent of the nation’s economic output, up from 17.3 percent in 2013, the Department of Health and Human Services said in its annual report on spending trends.”

 “By contrast, health spending grew 2.9 percent in 2013, the lowest rate of increase since the federal government began tracking it in 1960.”

2013 was three years into increased Obamacare healthcare taxes that affect all taxpayers including those that make less than $250,000,000 per year.

The people making less than $250,000/year were promised they would not spend one dime more for Obamacare.

I believe many American are aware of the mind games the Obama administration has played on them and are ready for an alternative that is a consumer centered and consumer driven system with them being in control of their health and healthcare dollars.

Republicans should at least offer the public a choice of My Ideal Medical Saving Account.

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

All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

 

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Destroying The Healthcare System

January 6, 2016
inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D, FACP,MACE

I believe President Obama’s goal is to destroy the healthcare system. The people will then beg the Obama administration to institute a single party payer system with the government being in full control.

The fact is Obamacare is not working despite the Obama administration’s convincing the mainstream media to advertise that it is very successful.

I was shocked at a December 9th New York Times article stating:

“ A million new customers have signed up for health insurance during the Affordable Care Act’s third open-enrollment season, Obama administration officials said on Wednesday, and call centers have been deluged.”

This statement is an optimistic statement and a distraction from the true. A readers impression would be Obamacare is doing great.

The Obama administration simply ignored last year’s enrollment numbers. Ten million people were supposed to have signed up for healthcare coverage through the Federal Health Insurance Exchanges. Only seven million of those who signed up paid their premiums for the entire year.

The premiums and deductibles were too high even for the poor who received federal subsidies.

Most of the people remaining in the Obamacare in the federal exchanges were people with a pre-existing illness. One diabetic told me her individual premium for Obamacare was $12,500 dollars with a $6,000 dollar deductible. Her bill for last year, being hospitalized one time, was almost $100,000. She felt Obamacare was a very good deal for her.

The insurance company covering these kinds of patients with a pre-existing illness cannot make money for the insurance coverage they are required to provide.

If all the patients have pre-existing illnesses, the only thing the insurance companies can do is raise the premiums or stop selling insurance in this Federal Health Exchange market.

The Obama administration promised it would limit the insurance industry’s loss with its reinsurance program. The Obama administration reneged on its word and only paid 12% of what was due for 2014. The administration did not have the money to pay for it.

In 2014, the first year of coverage, we were told 13 million signed up, but only 7 million had coverage at the end of the year.

The administration provided data to the CBO to predict the number of enrollees Obamacare will have in 2016. The CBO predicted 21 million would be signed up for 2016. The CBO used data provided by the Obama administration to make this calculation.

What happened to the remaining 7 million enrollees for 2015? We are not told how many enrollees automatically re-enrolled.

We only hear that, ‘ A million new customers have signed up for health insurance.”

We can now understand the concerns expressed by UnitedHealth Group and other insurers that say they are losing money in the Obamacare Federal Health Insurance Exchanges.

Open enrollment is due to end January 1, 2015. In mid December CMS announced,

‘We are now seeing a surge of interest as we get closer to the deadline,”   “Each day has been bigger than the day before.”

The last two weeks in December had less that 100,000 people sign up. Yet the government published these numbers. Many wonder how real these numbers are. If they are real there has been no increase in enrollment in the last year.

Confirmed 2016 Exchange QHPs: 9,584,850 as of 12/30/15
Projected Exchange QHPs: 11.32M by 01/02/15 (8.60M via HC.Gov)
In the last week in December only 80,000 people signed up compared to 96,000 the same week last year.

The coverage is poor and too expensive for most people.

Open enrollment has now been extended to January 31 for enrollment March 1st.

“People who go without insurance next year may be subject to tax penalties of $695 a person or more, although some may be able to qualify for hardship exemptions.”

This is a joke. However, the joke is on the consumers and taxpayers.

So far, Obamacare has created a 10% increase in federal taxes middle-class taxpayers.

It has increased coverage for the Medicaid eligible poor. However, these people cannot find a doctor who will treat them.

The healthcare system is costing over three trillion dollars a year and increasing our deficit more than $1.5 trillion dollar a year. There are still 34 million people uninsured. How many people are under insured because their jobs have been changed to part time jobs? They cannot afford to buy Obamacare’s insurance?

2017 is the year the healthcare insurance markets are supposed to stabilize. These markets have not stabilized. Healthcare insurance companies, and business groups can not understand how the new CMS’ proposals will regulate and expand provider networks and standardize plan options let alone have insurance markets result in lower premiums.
“We remain deeply concerned that this proposed rule will not stabilize the individual market,” Steven Kelmar, Aetna’s executive vice president for corporate affairs, wrote in a letter to the CMS. “Unless some fundamental flaws are corrected, we believe there is a grave risk that the federal exchange will not operate as a viable, competitive market in 2017.” 

One of the more significant and controversial provisions in the proposed rules involves the adequacy of provider networks. The CMS proposal demands that ACA-compliant health plans sold on the federal exchanges in 2017 would have to abide by new network standards.

All plan networks would have to include hospitals and doctors within certain travel times or distances from members. There would also be minimum provider-to-member ratios for some medical specialties.

CMS proposed that all health plans in each metal tier on the federal exchange have the same benefits. For example, all 2017 bronze options would have a $6,650 deductible, and all plans would have no more than one provider tier.

This proposal practically guarantees that the healthcare insurance industry selling insurance under Obamacare’s exchanges would lose money. Therefore, the industry would choose not to participate.

The big losers would be patients with preexisting illnesses. They would lose their insurance.

The traditional mainstream media is already cranking up the Obama administration spin machine to promote a single party payer system as the best and simplest option to provide insurance for all Americans.

Nobody is thinking about who will pay for a single party payer system after the administration emotionally conditions the public to beg for a single party payer system.

The hardest by increased costs in the system are consumers at every income level.

As the cost rises to unaffordable levels all consumers are starting to take think about taking responsibility for their health and healthcare dollars.

“The new research also finds that as a result of the increase in health care costs, focus group participants are changing how they operate within the health care system.

They are questioning their doctors recommendations more frequently, comparing cost and quality information for local providers, and even putting off seeking care altogether.”

Despite the low of enrollment in 2016 (that the Obama administration denies), CMS is about to publish new 2017 rules for the insurance industry. These rules are guaranteed to make the healthcare system more dysfunctional.

The fact is the structure of Obamacare is failing and about to collapse.

All of the Obama administration’s tinkering to stop the free fall is creating greater momentum for total collapse of the healthcare system.

The answer to fixing the healthcare system is not a single party payer system.

The answer is a consumer driven healthcare system with the aid of smart phones and the Internet and Medical Savings Accounts.

Progressives have a tendency to forget the math. They have more interest in satisfying an emotional response. The resulting entitlement policies lead to the unintended consequences and only make things worse.

Neil Cavuto demonstrated this logic recently in an interview with a student campaigning for free student loans.

https://youtu.be/Zmji36q8E4o

Progressives’ logic is faulty. It demonstrates a lack of understanding of the affects of entitlements and their unintended consequences.
 The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

January 4, 2016
inSummary Blogs
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Scott Becker of Becker’s Healthcare asked me to write an article on Element needed to Repair The Healthcare System. Becker’s Healthcare is the leading source of cutting-edge business and legal information for healthcare industry leaders.

His portfolio includes five industry-leading trade publications:

  • Becker’s ASC Review
  • Becker’s Infection Control & Clinical Quality
  • Becker’s Spine Review
  • Becker’s Hospital Review
  • Becker’s Dental Review

My article appeared in the latest addition and with permission from Scott Becker. I am reprinting it on my site. Becker’s Healthcare is a valuable information site.

Making Medicine Function: Five (5) Key Elements From Stanley Feld M.D.,FACP,MACE : Repairing the Healthcare System

Patients, physicians, hospital executives, healthcare insurance executive and government all believe the healthcare system is dysfunctional and unsustainable in future years.

All the stakeholders are unhappy with Obamacare.

Clinical Endocrinologist, Stanley Feld, MD, FACP, MACE, is a physician who believes Obamacare’s business model is seriously flawed. He also believes that Obamacare has accelerated the dysfunction in the healthcare system.

Dr. Feld believes Obamacare has increased the healthcare system’s unsustainability by causing an increase in bureaucracy, a decrease in efficiency and encouraging the gaming of the healthcare system by all stakeholders.

The Obamacare business model must be changed to a consumer driven healthcare business model with the consumer in charge and in the center of the healthcare system, not the government or other secondary stakeholders.

Consumers must be taught and incentivized to use all the 21st century technology tools available including smart phones. The goal must be to improve medical care and treatment outcomes, not improve the measurement of medical process outcomes.

Dr. Feld became interested in the causes of the healthcare system’s dysfunction in 1991 while he was on the steering committee of a nascent medical organization, the American Association of Clinical Endocrinologists (AACE).

He became AACE’s third President and was chairman of the Type 2 Diabetes Guideline committee. He was the chief author of “A System of Intensive Self-Management of Type 2 Diabetes Mellitus.”

In 1991 there was little government and healthcare insurance industry support for the concept of teaching the Type 2 Diabetics how to be the “Professor of Their Disease” even though there was a Type 2 Diabetes epidemic.

The epidemic was the result of lack of understanding by consumers (patients) of how to prevent and treat Type 2 Diabetes Mellitus. Uncontrolled Type 2 Diabetes causes complications that are coronary heart disease, kidney failure, blindness and amputations. Quality of life of is decreased. The complications are costly to the patients and the healthcare system.

America was in the midst of an obesity epidemic. The epidemic continues today. Obesity predisposes consumers to Type 2 Diabetes Mellitus and its subsequent complications.

Dr. Feld said everyones goal for the healthcare system is to have a healthier population at an affordable price. The goal can be accomplished by putting consumers in control of their health and healthcare dollars. Consumers must also be given financial incentives to control their health. No one is focused on the consumer’s responsibility to lower cost in the Obamacare business model.

Dr. Feld believes Obamacare’s business model has too many faults to repair. Each time President Obama alters the business model to fix a fault, the healthcare system becomes more costly, dysfunctional and unsustainable.

Dr. Feld developed a business model that would accomplish the goal of providing a functional and efficient healthcare system at an affordable cost to consumers, employers, healthcare insurance companies and the government.

Dr. Feld’s business model would eliminate most of the government’s inefficiency that absorbs 40% of the healthcare dollars. The inefficiencies must be eliminated or at least significantly decreased.

Here are Dr. Feld’s five key elements necessary to Repair the Healthcare System.

All the key elements listed are explained in detail in Dr. Feld’s blog “Repairing the Healthcare System”. Each link will have a full list of my blog posts on the topic.

  1. The Ideal Medical Savings Accounts (MSAs).

Dr. Feld’s Ideal Medical Savings Account is the insurance model in his business plan.

Medical Saving Accounts are different than Health Savings Accounts. Health Saving Accounts are the fastest growing healthcare insurance plans. Medical Saving Accounts provide consumers with more financial incentive.

The Ideal Medical Saving Account transfers the premium dollars saved by consumers into a tax-free retirement trust that is not restricted to medical care. The financial incentive will cause consumers to be responsible for the control of their health and wisely spend their healthcare dollars.

The Ideal Medical Savings Accounts are democratic. The employer, the individual or the government could fund the Medical Savings Account. The deductible must be high enough to provide enough financial incentive for consumers to be motivated to become responsible for their health and their healthcare dollars. Once the deductible is reached the consumer receives with first dollar coverage for an illness.

If the deductible is not spent the consumer gets it tax-free in their retirement trust.

Ideal Medical Savings Accounts provide consumers the choice of physician. The environment is created where consumers decide on who will provide the best value for their healthcare dollars rather than the government, the healthcare insurance industry or the government.

MSAs would create a Consumer Driven Healthcare System with the benefit of consumers creating competition among the stakeholders in the healthcare system rather than stakeholders deciding for consumers. For greater details go to this link.

  1. The Importance of Tort Reform

Most politicians have ignored the importance of Tort Reform. They have been led to believe that Tort Reform is an insignificant cost to the healthcare system.

Dr. Feld points to study by the Massachusetts Medical Society. Every practicing physician believes the data of this study. The resulting data is an excellent and truthful indicator of the huge cost of over-testing to prevent malpractice claims.

The lack of Tort Reform costs the healthcare system $200 billion to $750 billion dollars a year as a result of over testing by physicians to avoid malpractice suits.

Physicians who order a test usually do not receive the profit built into the test he/she has ordered.

  1. The Importance of Self-Management of Chronic Disease

The unsuccessful management of chronic diseases results in 80% of the cost of care for those diseases. Most important is to prevent the chronic disease from occurring in the first place. Diseases with the highest costs are Diabetes Mellitus, Heart Disease, Hypertension and Cancer. Obesity and consumer’s genetic makeup are responsible for most of these chronic and costly diseases.

Consumers are in control of the development of obesity. They must be responsible for preventing it. However all of our cultural stimulation encourages obesity. Consumers must make a choice. Government can provide public education programs to help consumers make the correct choice. When consumers are educated and are at financial risk for developing obesity, they will become responsible and avoid becoming obese.

The reformed healthcare system could prevent the onset of complications of these chronic diseases. The cost of the complications of chronic disease is 80% of the cost of treating that disease.

These teams must be an extension of their physicians care and responsible to their physician.

  1. The Magic of the Patient/Physician Relationship.

Obamacare tries to quantify patient care. Twenty thousand rules and regulations have been produced so far to measure the care delivered by physicians to patients.

Maybe the measurement criteria for quality care are wrong? Maybe the government is measuring the wrong thing.

There is no quality measurements made about patients’ compliance or adherence. There are no rules to measure the patient/physician relationship.

These would be important measurements for bureaucrats to measure in order to quantitate the effectiveness of care.

If one wanted to commoditize the delivery of quality medical care, consumer responsibility for compliance with their treatment is an important measurement.

The patient/physician relationship is magical. It can result in improved patient compliance and self-management of both acute illness and avoidance of the complications of chronic diseases. The end result is that it can decrease the cost of healthcare by at least 50 percent. The healthcare system would then be affordable.

As the government and healthcare insurance companies try to decrease their cost they have decreased reimbursement and increased regulations and paperwork for physicians

A physicians work product is intelligence, skill and time. Physicians do not have enough time to develop a patient/physician relationship today.

The patient/physician relationship is difficult to measure. It cannot be commoditized into a universal report that a computer program can generate.

  1. The Rule of Information Technology

Physicians are not opposed to information technology. They are against information technology generating data that is being used as a tool to judge their clinical competence and reimbursement by bureaucrats. Many times the “big data” is inaccurate.

Information technology should be used as a tool to extend a physician’s ability to patients. It should be used as a tool to improve physicians’ care.

In order to reduce the cost of medical care and increase the patient’s ability to be a “Professor of Their Disease”, medical care must be delivered by a team approach.

Information technology must be a part the team with the consumer being in the center. Physicians must be the coach; the other members of the team must be physician extenders (assistant coaches).

There are many websites generating both good and bad information. As the manager of the team the physician and his assistant managers should pick the websites for his/her patients to use.

Physicians and his/her healthcare management teams should develop social networks so his/her patients can relate to each other and learn the subtleties of their chronic disease from each other. Physicians and his patient extenders would monitor and correct any false information generated through the social network.

These social networks would be very effective in motivating consumers to be responsible for their care and their healthcare dollars.

These are five elements that would decrease the cost of America’s healthcare system. They would avoid the trap and unintended consequences of a single party payer system.

The real cost curve has not been bent downward. It has been bent upward in the actual cost to taxpayers. The government is not measuring all the costs, including new taxes, as payment for Obamacare.

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Breaking The Law Again

December 9, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D, FACP,MACE

The mainstream media is biased. It usually supports the Obama administration blindly. Many intelligent liberals believe everything in the New York Times and what Paul Krugman says as if both were source material.

The New York Times and the TV networks ignored the initial press release by United Healthcare potentially withdrawing from the 38 federal health insurance exchanges in 2017. Fox news was the only cable network that covered the story.

The potential withdrawal is a very big deal. It is an indication that Obamacare is failing. Paul Krugman continually declares Obamacare is a success.

In order to induce United Healthcare’s participation in Obamacare’s health insurance exchanges the Obama administration guaranteed the healthcare insurance industry stop loss protection.

Then the Obama administration only paid 12.6% of the $2.8 billion dollars due the healthcare insurance industry under the stop loss agreement.

“Health insurance stocks took a nasty tumble last week, and maybe the markets are realizing that ObamaCare isn’t performing as well as the political class pretends.”

“The immediate cause of the selloff was UnitedHealth Group ’s shock $425 million downgrade to its earnings forecast for 2015, almost entirely driven by losses on the Affordable Care Act exchanges. “

United Healthcare did not sign up to sell insurance in the federal health insurance exchanges originally because it was afraid it would suffer large losses. It signed up only after President Obama activated the stop loss provision embedded in the reinsurance program of Obamacare legislation.

The United Healthcare announcement comes only a few weeks after 12 of 23 smaller, nonprofit insurance cooperatives failed and stopped selling insurance to Obamacare subscribers. These co-ops received billions of dollars in federal loans that will never be paid back to the nations taxpayers.

These cooperatives were given federal loans by the Obama administration in order to be competitive with the big insurance companies.

The federal health insurance exchanges attracted people with pre-existing illness. President Obama’s legacy law guarantees people with pre-existing illness availability to healthcare insurance at the same price as people without pre-existing illness.

People with pre-existing illnesses cost more than people without existing illness.

The resultant premiums are high and the deductibles are higher. Consumers who qualify for subsidies do not receive subsidies for the $6000 deductibles.

Young healthy consumers are not buying insurance from the federal health exchanges. They have figured out that they are not getting insurance coverage until they spend the $6,000 deductible.

These young consumers did not earn enough money to afford the high premiums and higher deductibles. The poor cannot afford the deductibles either. No one at low risk is signing up for Obamacare.

In order to keep Obamacare going the Obama administration needs the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for the government.

United Healthcare is not interested in selling insurance on the health insurance exchanges because the government has not been trustworthy and has not paid them what was promised.

The stop loss insurance should not have been promised to the healthcare insurance industry in the first place. However, President Obama jumped in and essentially gave the healthcare insurance industry the ability to sell insurance at no risk.

United healthcare did not sign up for 2013 but jumped into the Health Insurance Exchanges in 2015 because of the government’s stop loss guarantee.

Obamacare now owes the healthcare insurance industry 2.5 billion dollars. The budget contained an amendment that does not permit the government to reimburse more than it collected in premiums. Both houses of congress and President Obama signed the amendment into law.

At present President Obama has pledged to pay out the risk corridors payments despite the massive shortfall in the near term.

All President Obama has to do is ignore the law he signed in order pay the $2.5 billion dollars illegally. If he pays United Healthcare the money due it might continue to participate in Obamacare’s federal healthcare insurance exchanges.

HHS “will explore other sources of funding for risk corridors payments, subject to the availability of appropriations. This includes working with Congress on the necessary funding for outstanding risk corridors payments.”

“The risk corridors program, one of three health insurance risk programs established by the Obamacare, essentially helps mitigate insurers’ losses in the early years of the new insurance marketplaces. The risk corridors program expires after 2016.”


United Healthcare is in business to maximize profits and not to lose money on good deeds.

Obamacare’s business model is a terrible model destined to lose trillions of taxpayers’ dollars. United is not interested in losing billions of dollars doing the government a favor.

Paul Krugman continues to tell his readers Obamacare is working wonderfully despite fact that it is failing. Major media networks have hardly described the problem.

It will be worse if we go to a single party payer system. Socialism has never worked.

It should be all about consumer driven healthcare and market forces driving healthcare with consumers being responsible for their health and healthcare dollars.

Government only function should be to create simple regulations that none of the stakeholders should abuse. The government must execute the enforcement of these simple regulations.

My ideal medical savings account will work. It will permit universal healthcare coverage and eliminate the development of the massive, inefficient and dysfunctional healthcare system called Obamacare.

Obamacare is unsustainable. It is being proven every day even if it is ignored by the traditional media, President Obama and his administration and Paul Krugman.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Where Is The Missing Money?

November 30, 2015
inUncategorized
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Stanley Feld M.D.,FACP,MACE

Does anyone know how much Obamacare cost each year? Does anyone know if Obamacare is the cause of America’s more than one trillion-dollar deficit each year despite the Obamacare tax increases that are supposed to pay for it ?

If someone knows they sure are not telling taxpayers. A good friend who is a liberal and a big fan of President Obama said to me he is not worried about the federal deficit. Neither is President Obama. President Obama has convinced his base that the budget deficit and America’s escalating debt is an insignificant problem.

It follows that he can spend money as he wishes and waste money with impunity. I was taught that is not the way to run a business. Especially when the waste fullness gets negative results that leads to more deficit spending.

The problem is the waste of money is reported in dribs and drabs and usually on a Friday afternoon.

We have seen that happen in the VA system. After one year and billions of dollars spent the waiting times have decreased slightly. The medical service to veterans has not improved. No one in the bureaucracy has been held responsible. Veterans have been complaining more loudly since nothing has improved.

Missing Money

“The federal government awarded over $5 billion to help states set up Obamacare exchanges, with the vast majority – $4.6 billion – going to 16 states and Washington, D.C.” 

The Government Accountability Office (GAO) recently reported that most of the money has not been accounted for. Several of those State Health Insurance exchanges have gone out of business this year.

$1.4 billion of that has been spent on IT projects. This sounds very high for 16 different web sites. Why couldn’t everyone use the same website?

Three ($3 billion) has been “spent or drawn down.” Only some of the drawn down spending has been detailed.

At least $1.6 billion is unaccounted for. Only three states returned any portion of the money. The federal government has only received back $1 million.

It sounds like government bureaucracy inefficiency at best and fraud and abuse at worst with no one being held accountable.

Can Americans trust the government to run our healthcare system?

Where did those taxpayer dollars go?

More Missing Money

Obamacare created the co-ops to encourage State Health Insurance Exchanges to increase competition in state insurance markets.

The intent was to offer consumers choices with the hope of holding down premiums.

Co-ops were snuck into Obamacare to replace the public option. No one has spoken about this being a substitute for the “public option.” The public option is an obvious ploy to convert the healthcare system quickly to a single party payer system.

The public option was designed to compete with private insurers on the state level by offering lower premiums in order to force the insurance industry to lower its premiums. The co-ops were designed to do the same thing.

President Obama offered state co-ops $6 billion dollars for start-up costs. Since there were only 23 states co-op formed instead of 50 Congress decreased the total payment to $2.4 billion to the 23 start-up co-ops.

All 23 co-ops received their proportional federal loans to meet solvency requirements as well as start-up costs.

President Obama now claims the Republican house denied Obamacare enough money for the co-op to be successful.

Twelve (12) of the 23 nonprofit insurance co-ops announced they will not offer coverage to consumers who bought healthcare coverage in 2015 in 2016. They are bankrupt. Where did the money go?

Somewhere between 300,000 and 600,000 people will be shopping for more expensive healthcare coverage for 2016.

The remaining 11 standing co-ops are $500 million dollar in the hole.

There is no accounting available to explain why these co-ops have failed

Does anyone think these $2.4 billion dollar loans will be paid back to the federal government? I do not. It will simply be added to the federal deficit.

  • “CMS said the government would “use every tool available to recover taxpayer dollars” from the co-ops going out of business, but it declined to say how much she expected to recoup.”

There are many reasons these co-ops have failed. Republicans not giving the co-ops more money, as progressives and Democrats have claimed, is not one of the reasons.

Another area of missing taxpayers’ dollars.

The Senate Finance Committee is looking into the millions of taxpayer dollars being spent on ads to promote Obamacare enrollment.

The total federal government budget for ads and PR was nearly $1 billion in fiscal 2013. How much was spent on Obamacare?

The Health and Human Services budget for “paid media” is about $35 million for the current enrollment period. The $35 million dollars will be spent in the 38 states using HealthCare.gov in the 2016 enrollment period.

Chairman Orrin Hatch, R-Utah, raised concerns about agency ad spending and sent a letter to the acting head of the Centers for Medicare and Medicaid Services (CMS) asking for a full accounting of agency ad spending.

“Increased transparency on government spending on advertising will improve accountability and help ensure that the taxes from hardworking Americans are not squandered and wasted on ineffective or misguided government programs,” he wrote to Acting Administrator Andrew M. Slavitt.

Senator Hatch demanded the accounting by November 25th. Does anyone think he received it?

In 2010, the nonpartisan Government Accountability Office (GAO) reported the Obama administration spent nearly $20 million on a Medicare brochure that contained “instances in which HHS presented abbreviated information and a positive view of Patient Protection and Affordable Care Act (PPACA) that is not universally shared.”

The GAO papered over the ridiculous expenditure.

GAO concluded that “nothing in the brochure constitutes communications that are purely partisan, self-aggrandizing, or covert.” 

CRS reported HHS was second only to the Department of Defense, spending $197.4 million on advertising in fiscal 2013.

“The total federal government budget for ads and PR was nearly $1 billion in fiscal 2013.”

Would healthcare be so expensive if the government was transparent and congress was really on top of everything?

Physicians only receive 20% of the healthcare dollars spent.

President Obama and his administration spend taxpayer’s money at will.

Americans have to demand “more efficiency and much more transparency.”

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Obamacare Is In Big Trouble!

November 18, 2015
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

There are so many parts of Obamacare that are failing it would be impossible to describe each failure in a single blog..

President Obama and his administration keeps telling the American people that Obamacare is working great. It is here to stay.

I cannot believe Americans believe him. I cannot believe he thinks Obamacare is doing great.

It could be true that everything is going great for him if he wants Obamacare to fail and cause hardship for millions of Americans.

At that point Americans would beg President Obama or another progressive president loke Hillary Clinton to institute a single party payer system.

A single party payer system has been Hillary’s dream since Hillarycare 1993. Now she is saying she wants a private insurance based system. The purpose of this statement is to neutralize (freeze) her free market system critics.

Once more America is being exposed to Hillary Clinton’s use of a typical Saul Alinsky tactic. The tactic in his “Rules for Radicals” is to freeze your opponent by stating his position as yours even if it is a lie.

Hillary wrote her senior Wellesley College thesis on Saul Alinsky and “Rules for Radicals”. She also became a big fan and good friend of his.

Hillary Clinton and President Obama know Obamacare is failing. They are just waiting for the tipping point. The tipping point will be when the American people say please help us and give us a single party payer system.

At that point we will hear the typical gee shucks, I guess we will have to try a single party payer system.

A single party payer system will be a bigger financial and patient care disaster than what we have now.

The data on the first week of applications for Obamacare’s healthcare.gov was announced to the rave reviews by the Obama administration.

Since few pay attention to the actual numbers President Obama can get away with the lie.

The CBO predicts 19 to 21 million will sign up for Obamacare for 2016. The administration estimates they are going to have 9.1 to 11 million enrollees for 2016.

The Obama administrations estimate is 30% lower than the announce 13 million enrollees in 2015. In reality only 9.7 million enrollee paid for healthcare insurance through healthcare.gov 2015. Of those 9 million only 6.5 million kept their insurance premiums current for the entire year.

The www.acasignup.net quoted the Obama administrations claim that 595,590 filled out applications to get price insurance quotes. Only 8% of the reported applicants or 47,243 paid their first month’s premium for 2016.

These numbers are not a cause for celebration unless you want to misinform the public by claiming a successful first week enrollment.

Let’s do the math. The enrollment period for 2016 is from November 1st until December 31st 2015 or eight and one have weeks with four major holidays, Veterans Day, Thanksgiving, Christmas and New Years.

Let us the assume all 600,000 that filled out applications will pass the application requirements and pay their assigned premium for each month. Let us also assume the average weekly application rate is 600,000 per week for the 81/2 weeks. The grand total enrollees would be 5.1 million enrollees for 2016. This is 4.5 million less paid enrollees than in 2015.

There was an attrition rate 2% a month in 2015. President Obama extended the enrollment period several times to get more people to sign up.

2015 FULL YEAR ENROLLMENT/ATTRITION RATE TABLE PROJECTION:

2015_full_year_projection_effectuated

2014 FULL YEAR ENROLLMENT/ATTRITION RATE TABLE (FINAL):

  Microsoft ExcelScreenSnapz 2014 458

It is clear that President Obama’s victory laps celebrating the success of Obamacare is unwarranted.

However the media is the message. He controls and manipulates the media. It would have been much easier to provide Medicaid and CHIP coverage to the poor outright than destroying the healthcare system with changes that are not working.

The final enrollment for 2014 was 6,338,622 not over 13 million. The final enrollment for 2015 was 9,736,350 and not over 13 million. This is a net gain of 3.5 million new paying enrollees in 2015.

This year the Obama administration estimates that 9 million will purchase insurance through the health insurance exchanges. At the present rate only 5.1 million will purchase insurance for 2016 at the end of the enrollment period December 31, 2015.

The CBO’s estimate was 19-21 million paid enrollees.

It does not represent a very successful net gain when the government publishes that there are 34 million uninsured Americans. No one knows if the 90 million unemployed Americans are counted in the number uninsured.

Unaffordable care act

All anyone hears is the Obama administration’s reasons our taxes, and insurance premiums are going up, while our insurance coverage is going down. The Obama administration is blaming the healthcare insurance industry and Republicans.

President Obama has used, with the help of the mainstream media, the Saul Alinsky tactic to freeze opponents by shocking them with unsustainable factoids.

 The Avalere Health consultancy’s analysis of 2015 signup data showed surprisingly weak ObamaCare enrollment at modest income levels. At between 150% and 200% of the poverty level, just 41% of those eligible signed up for coverage. The number falls to 30% among those between 200% and 250% of the poverty level.

 In 2016 President Obama is going to penalize people that do not have healthcare insurance.

It’s now clear that the actual impact of ObamaCare’s individual mandate tax penalty will be far worse than the benign intent that the Obama administration claimed.

“What we’re talking about is a penalty for the few people who will refuse to buy health insurance — even though they can afford it — and who expect the rest of us to pick up the tab for their care,” a September 2009 White House defense of the individual mandate states.”

Reality should be coming into focus by now for the average American taxpayer and the poor. Obamacare is ripping everyone off.

“The mandate’s primary impact will be to compel low-income households to buy bronze coverage with deductibles of up to $6,850 per adult that are well beyond their capacity to afford. “

Even after these poor people pay the $6,850 deductible they have a 40% deductible on the rest of the billing.

Who said poor people are too stupid to handle their own money and be responsible for their healthcare dollars?

They are smart enough to know the government is ripping them off.

George  Shore101 • 3 months ago

“If the Obama administration and Democrats love the poor why did they force the poor to purchase something they can not afford and then penalize them for not being able to afford it?”

It is a horrible thought to think President Obama is working to make the poor poorer and make the healthcare system fail the American people.

It looks like he is. His plan to replace it with a single party payer system will result in a bigger failure.

Why are Republicans just standing around doing nothing? Why don’t they publicize my Ideal Medical Saving Accounts?

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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I Told You What To Do 8 Years Ago: Part 3

November 4, 2015
inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

I told you about all my ideas necessary to repair the healthcare system 8 years ago. None of the ideas have changed

Politicians and their healthcare policy wonks have not implement or supported any of theses ideas. The adoption of Obamacare has made the healthcare system worse.

“The hardest thing to explain is the glaringly evident, which everybody has decided not to see.”

Any Rand, The Fountainhead

It is a pity that the public votes for people who hold their vested interest and their quest for power above the needs of the people.

It is worse that the traditional media works as a special interest group to support the politicians’ quest for power over the people.

Our government is getting further from the solution to the problems of our healthcare system in order to force consumers to be more dependent on big government and less responsible for themselves.

The end game will be a disaster for Americans, our freedoms and our financial well-being.

My ideas do not support the vested interests of secondary stakeholders. I support consumers’ interest. Many of these secondary stakeholders are abusing the healthcare system. They take advantage of consumers.

The government is one of those secondary stakeholders that cause dysfunction in the healthcare system with its endless regulations.

The government regulations are written to control physicians and patients..

Consumers’ health and their healthcare dollars must be the responsibility of the consumers. A consumer driven healthcare system is the only way to stop the evolving medical care and financial disaster.

This week the progressives in Colorado blew my mind. They want to eliminate Obamacare because it has failed and replace it with a state run single party payer system.

This group has 200,000 signatures to petition that its proposal be put on the 2016 ballot.

In the small print they are proposing a $25 billion dollar tax increase to pay for the proposal.

Obamacare has resulted in increasing the cost and dysfunction of the healthcare care system. The adoption of this single party payer system will make it worse.

I am sure many people in Colorado are unaware of the progressives’ stinking thinking.

However, the petition is the first step in President Obama’s scheme to make thing so bad that the people beg the government to take over the entire healthcare system.

This tactic is right out of Saul Alinsky’s playbook and right up Hillary Clinton’s alley.

Meanwhile, “What Have I Said So Far? Spring 2007 Part 3 is republished below.

Maybe people will start paying attention to what is happening in our healthcare system before it is too late.

For more details on each proposal please click on the links.

“What Have I Said So Far? Spring 2007 Part 3

Stanley Feld M.D.,FACP, MACE

 

The following are additional solutions necessary for the Repair of the Healthcare System

Disease management systems can be developed in primary care physicians’ offices because there are not enough specialists to take care of all the patients with chronic disease.

 Treating chronic diseases this way should lower the complication rate for chronic diseases. The result should be a reduction in the cost of healthcare by at least 45%.

 

Measurement of quality should be all of the above. However, the key measurement of quality is the medical outcome as it relates to the financial outcome. If you prevent a $50,000 complication utilizing $1,000 of treatment you have a leveraged financial outcome as well as an excellent medical outcome.

The main question is, “was the complication of the chronic disease avoided?” We are misguided when we start believing that measuring the percentage of our patients we measure cholesterol on, or the percentage of patients on whom we do colonoscopies or bone densities is a measure of quality of care.

It is simply one element of quality medical care and it should not be rewarded as the Pay 4 Performance advocates are suggesting. This thinking makes us vulnerable to another false hope of reducing complications of chronic diseases.

 

  • Increasing obesity in our population is a huge health risk.The government should declare war on obesity. It should strive to eliminate the many stimuli we are exposed to. It should institute a gigantic public media campaign to explain the health risks and the stimuli in society to overeat.

    The most important need is to put the patient in charge of his disease management. The patient must be responsible for his care and in control of his health care dollar. We do not need more schemes destined to fail such as;

the California and Massachusetts mandates. We do not need the Pay 4 Performance scheme that will distort the healthcare system even further.

We need some common sense infused into the development of a healthcare system that is driven by the patients and not the facilitator stakeholder for the purpose of the facilitator stakeholders’ bottom line.

If patients do not want to take care of themselves they will suffer medically and financially.


These are some of the solutions I have proposed. We need the political will and leadership to institute and execute these solutions.

Responsibility for follow up care and compliance must be the patient. The physicians are the teachers educating patients to be experts in their disease self- management.

In the present system the penalty to the patient is bad health. The new system should have a clear message of good health and financial reward. It is much cheaper for all the stakeholders in the long run.

The patient has to;
• Be responsible for the purchase of care.
• Have ready access to care.
• Be responsible for the appropriate adherence to care and medication regime given by the physicians.
• Be rewarded for excellent lifestyle changes and avoidance of complications of disease.

If this is accomplished, and it can be with appropriate leadership and the demand by the consumer, we can repair the healthcare system.”

It is almost past time to start listening and demanding a “consumer driven healthcare system.”

Consumers have Patient Power and do not even know it.

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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