Stanley Feld M.D.,FACP,MACE

Several readers commented they were thankful that the healthcare bill passed in the Senate on Christmas eve.

I was curious to know their reason for being thankful when the bill is so flawed. Universally, their reply was “we need healthcare reform and this bill represents a good first step.”

I asked each commenter if the bill makes the healthcare system worse than it is now does that represent a good first step?

Their reply was if we do not take this step now there will be nothing done about healthcare reform again for another 40 years. I believe this is untrue. This is the view of the administrations propaganda machine to get a bill passed. .

The propaganda is flawed for several reasons:

1. The step taken 40 years ago was to enact Medicare. However Medicare has evolved into an unsustainable federal entitlement. Changes in Medicare over the last 40 years have resulted in an unaffordable but necessary program for seniors also.

2. The continuous band-aid fixes to the structurally flawed entitlement program has not solved the economically unsustainable problem.

3. Expanding enrollment in both Medicare and Medicaid is going to make both programs more economically unsustainable.

4. Medicaid is a failed program. Expanding Medicaid for a renewed definition of poverty is not going to fix Medicaid’s failure. Medicaid reimbursement is so low that it is difficult to get providers to service Medicaid patients.

It takes creative physicians practices’ to generate more revenue than expenses seeing Medicaid patients. These practices have initiated cries of fraud by many government officials and healthcare policy wonks.

It might be fraud in some cases but the fraud was initiated by the reimbursement structure.

Medicaid physicians are reacting by asking the question “why bother seeing these patients?”

This attitude has produced a physician shortage for Medicaid patient services.

Why would Senators and congressmen believe suddenly expanding Medicaid eligibility will alleviate this physician shortage?

The Urgent Care Clinics staffed by nurse practitioners and physician assistants and owned by private corporations are cash for profit businesses.

Medicaid does not reimburse for 30 to 60 days. Its reimbursement is less than the Urgent Care Clinics’ and physicians’ offices cost of doing business. Medicaid patients cannot afford to pay cash. The Urgent Care Clinics and physicians offices cannot afford to see these patients.

States are responsible for part of the Medicaid coverage. Most States are on the verge of bankruptcy. President Obama’s Healthcare Reform Bill will not provide increased funding for the increased Medicaid spending. Senator Ben Nelson of Nebraska held his vote out until Harry Reid gave Nebraska 100% Medicaid supplement.

“Many other members of Congress are eager to follow the Nelson example, including one from South Carolina: Representative James Clyburn, a Democrat. Mr. Clyburn told The A.P. that he wanted to get more money for his state when the Senate and House begin negotiating a final health care bill.

Mr. Clyburn said he hoped to increase the federal portion of Medicaid payments to his state to 95 percent. That would be up from the 90 percent that most states get — most except Nebraska, which will now get 100 percent of its Medicaid expansion picked up by the federal government, in perpetuity, thanks to Senator Nelson.”

President Obama pledged he will not tolerate earmarks (pork barreling) to gain legislative approval.

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Harry Reid also gave Massachusetts a supplement for Medicaid. The rest of the States are screaming how about me. Arnold Schwartzenegger has been most vocal for California.

Governors across the country have voiced concerns about the national efforts to expand eligibility for health coverage through Medicaid, a federal-state partnership that covers the expense of health care for the poor and disabled.

The net result will be an increased in federal deficit spending.

What is wrong with each version of the bill? Neither bill solves the basic problems within the healthcare system.

“The fundamental problem with the 2,074-page Senate health-care bill (as with its 2,014-page House counterpart) is that it wildly compounds the complexity by adding hundreds of new provisions, regulations, mandates, committees and other arbitrary bureaucratic inventions. “

Overlooked is the fact is that all these bureaucratic interventions, provisions, regulations, mandates, committees are going to increase expenses. All President Obama has to do is ask any practicing physician. This is going to make President Obama’s healthcare reform bill more unsustainable and increase the federal deficit without an increase patient care.

“Worse, all of this bureaucracy is packed into a monstrous package without any regard to each other. The only thing linking these changes — such as the 118 new boards, commissions and programs — is political expediency. Each must be able to garner just enough votes to pass. There is not even a pretense of a unifying vision or conceptual harmony”

It is obvious that the bill is irredeemable. Howard Dean said Kill the Bill.

"This is essentially the collapse of health care reform in the United States Senate," Dean told Vermont Public Radio. "Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill."

Democrats should make a serious deal with the Republicans. The deal should be made to fix the structural defects in the healthcare system and focus on helping the people who elected them. Otherwise members of both parties should lose their job.

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

Stanley Feld M.D.,FACP,MACE

It is easy to introduce bias into poll results and surveys. Most people are cynical about polling results

However, when every one of the major polling services’ come up with the same answer, one must believe the results represent unified public opinion. The Democrats in the House of Representative, the Democrats in the Senate and President Obama are ignoring the fact that the American public is against President Obama’s healthcare reform plan.

There is no question that America needs healthcare reform. It does not need President Obama’s version of healthcare reform as I have discussed in the past. Most importantly President Obama’s healthcare reform system will not work. It ignores the basic problems and defects in the present healthcare system.

President Obama continues to say his healthcare reform bill will provide universal coverage, affordable coverage and increasing quality of care. None of those results will be achieved with his healthcare reform plan. The American people know this and are afraid of the increased taxes and the restrictions on our freedom.

The composite polling data express the sentiment of the American public. The progression of these polling data can be seen by clicking See All Obama and Democrats’ Health Care Plan Polling Data

Polling Data

The Democratic controlled Senate version of the bill also contains some sinister amendments. Many organizations are lining up to challenge the constitutionality of the bill.

Buried in Harry Reid’s massive amendment to the Senate version of Obamacare is Reid’s is Section 3403 designed to prevent any future Congress from repealing a central feature of this monstrous legislation.

“Section 3403 reads in part: "… it shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment or conference report that would repeal or otherwise change this subsection."

Do you think all the Democratic Senators understand the implications of this maneuver? If section 3403 remains in the bill and President Obama signs this measure into law, Harry Reid intends that no future Senate or House will be able to change a single word of Section 3403, regardless whether future Americans or their representatives in Congress want to change it.

The subsection at issue is the regulatory power of the non elected Medicare Advisory Board to "reduce the per capita rate of growth in Medicare spending." It is an open ended grant to a regulatory agency granting power to control costs, quality and quantity of healthcare coverage.

“And Reid wants the decisions of this group of unelected federal bureaucrats to be untouchable for all time”.

Harry Reid makes compounds the problems of Section 3403 by ignoring two centuries of Senate rules. He passed the measure in the dead of night in less than 48 hours. I suspect few Democratic Senators who voted for this bill have read and understood the implication of Section 3403.

“The final Orwellian touch in this subversion of democratic procedure is found in the ruling of the Reid-controlled Senate parliamentarian that the anti-repeal provision is not a change in Senate rules, but rather of Senate "procedures." Why is that significant?

Becau
se for 200 years, changes in the Senate’s standing rules have required approval by two-thirds of those voting, or 67 votes rather than the 60 Reid’s amendment received.”

Few Democratic Senators have listened to the wishes of the American people. President Obama refuses to listen to the wishes of the American people.

How many points made about the healthcare reform bill by President Obama correct?

Should Americans be angry? Yes. What can we do? Throw the bums out when you go to the polls next November.

After the New Year I will resume twice a week entries. I wish all a happy and healthy New Year.

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