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From My Perspective: The Power of Play

April 21, 2009
inLife's Experiences
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Cecelia Feld

www.studio7310.com

I’ve had many requests for guest blogs, so I thought I’d start with one by someone who has not asked, my wife, Cecelia. (A little nepotism goes a long way). Stanley Feld M.D.,FACP,MACE

Do you play? Or, because you’re all grown up, have you forgotten how?

I recently had the opportunity to stay with my granddaughter for a few days while her parents took a mini vacation. The wonderful thing about being a grandparent is being able to step back and reflect on the experience, something difficult to do as a parent (lack of time, energy). Fun for an almost five year old (or four and 11/12’s as Sabrina will tell you) comes in many guises, often free or at little cost. Fun = play; play = fun. Learning is fun. Is there anything she is not interested in? No. Is there anything she won’t try? No.

During the time she wasn’t in pre-school we went from classes in tap, gymnastics, swimming, and tennis (thank you Laura for the thorough schedule) to bike riding around the lake, playing dress up at the Boulder History Museum, and hands on activities at NCAR (National Center for Atmospheric Research), a terrific place for a budding astronaut to explore the effects of gravity. Becoming an astronaut is her passion right now. I promised her she could dance, too, which she wants to do when she’s not in space.

Art projects are part of the game when Grandma is an artist. Even Grandpa Stan got involved with crayons and paper. Cuddles on the couch reading or talking about dinosaurs made quality quiet time. Remember Shel Silverstein’s poems? Laughter all around. Fun!

Time with Sabrina always involves learning new things and improving skills while having fun playing. Did you love to dance as a kid? Do you go dancing now? Take a class or rent a video. Grab a partner or not. It will put a smile on your face. Might even make you laugh. Is dancing not your thing? How about yoga? Get away from your “work” and try something completely different. Read fiction if you always read non-fiction and vice versa. Get in touch with your inner five year old at an art gallery or museum. You’ll see the art differently. Mess around with art materials like you did as a child. I promise I won’t mind the competition.

Grab a child (adult children qualify), grandchild, niece, nephew, brother, sister, spouse, partner, friend, or anyone and share something you’re good at. Right now, Sabrina “helps” me knit. I promised I would teach her how when she’s six, maybe sooner. Grandpa Stan is good with clocks and telling time, also sun, moon and planets. Learn from an almost five year old; be active and inquisitive. Walk the dog, even if you don’t have one. “Live, laugh, love and be happy.”

And, play!

Make your life a work of art.

  • Daniel Feld • April 23, 2009

    Well done. Like the guest columnist. She’s a good writer! Made me smile.

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President Obama; If You Really Want To Reduce Healthcare Costs, Effectively Reform The Medical Malpractice Tort System: Part 4

April 19, 2009
inMedicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

 

President Obama, there are other consequences of the present malpractice liability system that cannot measured in dollars or impact. In order to avoid potential law suits physicians are avoiding high risk patients and high risk patient procedures. The result is a decrease in patient access to necessary care.

The measured costs of defensive medicine can be calculated from the Massachusetts Medical Society survey.

“Physicians practice defensive medicine because they don’t trust the medical liability system. This survey should provide a strong impetus for legislative, business, and health care industry initiatives promoting fundamental liability reform.”

It is essential to introduce effective and fundamental liability reform to reduce the practice of defensive medicine, decrease costs and improve access to care.

The Massachusetts Medical Society’s survey of physician concerning defensive medicine also point out the restriction of access to care as a result of the malpractice environment.

“The survey found that 38 percent of responding physicians reported they reduced the number of high-risk services they performed, with orthopedic surgeons (55%), obstetrician/ gynecologists (54%), and general surgeons (48%) reporting the highest frequencies.”

These actions by physicians’ specialties are a natural reaction to the malpractice environment. It also reduces the healthcare system’s capacity to care for sick patients.

“28 percent of physicians in the sample reported reducing the number of high-risk patients they saw, with obstetrician/gynecologists (44%) and the surgical specialties (37–42%) much more likely to reduce their number of high-risk patients.”

In many small or medium sized communities there is little or no access to medical or surgical specialists to take care of high risk patients. President Obama, rather than increase the quality of care, as you have promised, the quality of care in some communities will decrease.

Other surveys by the Massachusetts Medical Society confirm their survey.

“In its annual Physician Workforce Study over the last five years, the Society has found that an average of 44%-48% of physicians in the state reported that they are altering or limiting their practices because of the fear of being sued.”

The 2008 workforce study’s results were worse than the Massachusetts Defensive Medicine survey. More than half of physicians in seven specialties said they have progressively limited their practices, the fear of a frivolous malpractice suit being the primary reason. It is natural for people to adjust to their environment.

“Neurosurgery practices (76%), urology (75%), emergency medicine (66%), obstetrics/gynecology (57%), family medicine (53%), general surgery (51%), and orthopedics (51%).”

President Obama, what should you do to neutralize the negative impact of defensive medicine?

First, do not believe the arguments of the trial lawyers. The claim that malpractice reform will harm patients "by limiting their ability to seek compensation through the courts" is a smoke screen to protect their profitability in law suits.

The medical liability system is inefficient. It does not compensate patients experiencing medical errors very fairly. In fact more than 50 cents on every compensated dollar goes to pay lawyers and the courts. Patients may wait year to receive a single penny. The wear and tear of a malpractice suit on patients experiencing medical errors and physicians being sued is enormous.

The answer is not to leave it up to congress to work it out. Congress has a 30% approval rating. Congress is also composed mostly of lawyers. You are our leader. You are the one who must outline the change that is fair to patients, the government, and physicians.

The fundamentals of change should include the following:

  1. Decrease the profitability of malpractice suits for attorneys.
  2. Invest in a culture of patients’ safety at every healthcare enterprise.
  3. Promote full disclosure to patients about adverse events quickly without legal consequences.
  4. Promote apology to patients without legal consequences.
  5. Provide fair compensation to patients for medical errors.
  6. Professional mediation and arbitration to resolve disputes quickly and dismiss frivolous claims abruptly.
  7. Create a body of judges immune from liability to adjudicate malpractice suits. The body should be composed of physicians and lay leaders. The best judge of physicians medical errors are other physicians if they were freed of adverse countersuit
  8. Create a system of no fault malpractice insurance.
  9. Place limits on patient compensation and expedient rate of compensation.
  10. Eliminate the adversarial nature of the claims.
  11. Build trust between patients and physicians.

Defense attorneys will hate most elements of this proposal because it threatens their vested interest and profitability. I suspect they will fight them with tooth and nail.

President Obama, if you implement these proposals to fundamentally change the medical liability system you would go a long way to reduce the practice of defensive medicine and a yearly wasted cost of $700 billion dollars to the healthcare system.

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

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President Obama; If You Really Want To Reduce Healthcare Costs, Effectively Reform The Medical Malpractice Tort System: Part 3

April 15, 2009
inMedicine: Healthcare System, Patients Problems, Physician's Problems, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama, the details of the Massachusetts Medical Society Defensive Medicine survey have profound importance in explaining trends in the delivery of medical care. Unfortunately, only meaningless sound bites have been given by the media. The survey’s significance has not had the impact on policy it should.

The authors state that the dollar estimates do not include the diagnostic procedures, hospital admissions, specialty referrals and consultations or unnecessary prescription by physicians in specialties not included in the study.

The eight specialties surveyed represent only 46% of the physicians in the Massachusetts. The real costs to the healthcare system from the practice defensive medicine in the state of Massachusetts are much higher. The authors estimate the real costs could be twice the $1.4 billion dollars per year they estimated.

I believe the costs of defensive medicine in many other states are much higher because the cost of litigation in many states is lower and the malpractice awards are higher encouraging litigation.

“This survey clearly shows that the fear of medical liability is a serious burden on health care,” said Dr. Sethi. “The fear of being sued is driving physicians to defensive medicine and dramatically increasing health care costs. This poses a critical issue, as soaring costs are the biggest threat to the success of Massachusetts health reform efforts.”

Defensive medicine is definitely a threat to the success of the Massachusetts healthcare reform efforts. President Obama, defensive medicine is a big burden nationally to the healthcare system. Its costs will undermine any attempt at healthcare reform unless you take medical malpractice liability reform seriously. There has to be a fundamental change in the structure of adjudication.

The survey’s findings must be studied carefully. The physicians surveyed estimated their percentages for defensive medicine testing to avoid law suit. I think their estimates are low. The real percentages must be studied objectively using data mining techniques. Nonetheless the current estimates reveal unsustainable waste in our dysfunctional healthcare system.

Radiological imaging is one tool overused by physicians defensively to avoid litigation. Physicians feel they must test everything even if the probability of a positive result is insignificant.

“Plain Film X-Rays: An average of 22% of X-rays were ordered for defensive reasons.”

“CT Scans: An average of 28% of CT scans were motivated by liability concerns, with major differences among specialties.”

About 33% of scans ordered by obstetricians/ gynecologists, emergency physicians, and family practitioners were done for defensive reasons.

The total number of unnecessary CT scans needs to be calculated along with its costs in order to understand the significance of the percentage presented. The health policy solution should not be to lower the reimbursement for CT scans. The solution is to fix the medical malpractice liability system.

MRI Studies: An average of 27% of MRIs were ordered for defensive reasons, with significant differences by specialty.

The highest rates were reported by obstetricians/ gynecologists, general surgeons, and family practitioners, with the lowest rates by neurosurgeons and emergency physicians.

Ultrasound Studies: An average of 24% of Ultrasounds were ordered for defensive reasons. Orthopedic surgeons (33%) and obstetricians/gynecologists (28%) reported the highest rates, with neurosurgeons (6%) and anesthesiologists (9%) the lowest.

I believe neurosurgeons are underestimating their use of radiologic procedures in order to look good. Neurosurgery is one of the specialties with the highest malpractice rates. Please note that obstetricians/gynecologists take no chances and order the most procedures for defensive purposes.

Laboratory Testing:

An average of 18% of laboratory tests were ordered for defensive reasons, with emergency physicians (25%) reporting the highest rates and neurosurgeons (7%) the lowest.

Specialty referrals, consultations and hospitalizations are overused the most for defensive reasons. No one wants to take a chance and send the patient home even if the indication for hospitalization is small. Hospitalization is also the most costly overused element in defensive medicine.

Specialty Referrals and Consultations:

“An average of 28% of specialty referrals and consultations were motivated by liability concerns, with significant differences by specialty. Obstetricians/gynecologists reported that 40% of their referrals and consultations were done for defensive reasons, and anesthesiologists and family practitioners said that 33% of their referrals and consultations were done for the same reasons.”

Hospital Admissions:

An average of 13% of hospital admissions were motivated by liability concerns, with surgical specialties reporting lower rates than the other specialties.

The percentages of defensive procedures are admitted by practicing physicians. The cost of defensive medicine is high and wasteful. President Obama, defensive medicine is not the minor problem that the malpractice attorneys want you to believe it is. It is time for definitive action now.

 

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

  • Medical Negligence  • January 24, 2011

    The doctor’s actions have caused or contributed to the plaintiff’s personal injury, his actions may not be deemed negligent if it can be shown that they were the ‘reasonable’ actions of a medical professional given the information the doctor had and the specific circumstances.

  • Tyler grey • July 11, 2012

    I just stumbled upon your informative blog and wanted to say that I have really enjoyed reading your blog posts. I will be your frequent visitor.

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President Obama; If You Really Want To Reduce Healthcare Costs, Effectively Reform The Medical Malpractice Tort System: Part 2

April 12, 2009
inPatients Problems, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

     
     

President Obama, as you know the real truth is elusive. Every vested interest has an agenda to protect. My agenda as a long time practicing Clinical Endocrinologist, now retired from active practice, has been to preserve the value of the profession of medicine and permit the delivery of the best clinical care possible to patients. Society has strayed from these goals. There are multiple problems with the healthcare system. They are interrelated and must be solved simultaneously.

The present malpractice liability problem leading to the practice of defensive medicine is a huge problem for the healthcare system. It is essential that this problem be solved before meaningful cost savings and increased quality of care are realized

Malpractice attorneys dismiss the system of adjudicating malpractice liability as the cause of significant defensive medicine costs. They claim that they are the protectors of mistreated patients. You will soon receive a 29 page document defending their claim and dismissing the significance of defensive medicine.

“Trial lawyers are preparing for a fight, starting with a 29-page research document they will send to Capitol Hill in an attempt to convince lawmakers that lawsuits have very little to do with healthcare costs.”

The malpractice attorneys will attempt to make a compelling argument. I suspect they will have little real scientific evidence to prove their point in the 29 page document.

Donald Berwick Professor in the Department of Health Policy and Management Department of Health Policy and Management has never been a friend of practicing physicians. He has frequently pointed out the defects in the practice of medicine. Recently Don Berwick made the following off the cuff comment in response to a question after he addressed the American Medical Association (AMA) meeting.

"What about malpractice reform?" the first questioner asked when Berwick opened up the discussion to attendees. He was a physician, and murmurs of approval rippled through the crowd.”

Berwick’s answer didn’t please the questioner and many of his colleagues. “The data just doesn’t back up the claim that malpractice lawsuits are one of the top drivers of healthcare costs, he replied.”

No one was brave enough to ask Dr. Berwick to show them the data for this conclusion. I have read Fooled By Randomness twice. I am starting to understand that all expert opinions are noise unless they are confirmed scientifically. Even then conclusions can change as the knowledge base changes.

In November 2008, the Massachusetts Medical Society published a survey of practicing physicians. The purpose of the survey was to get a sense of what practicing physicians (the generators of defensive medicine) thought the incidence of defensive medicine was in their practice. I was surprised it was not published in the New England Journal of Medicine.

“A first-of-its-kind survey of physicians by the Massachusetts Medical Society on the practice of “defensive medicine” – tests, procedures, referrals, hospitalizations, or prescriptions ordered by physicians out of the fear of being sued – has shown that the practice is widespread and adds billions of dollars to the cost of health care in the Commonwealth.”

The devil is usually in the details. The details found were the details at ground level. It was not speculations by experts or secondary measurement. The defect in the survey was the fact that was a survey (surveys have its scientific defects) even though 900 practicing physicians in eight specialties in Massachusetts completed the survey. Its strength is the survey links practice to costs.

“The Investigation of Defensive Medicine in Massachusetts” is the first study of its kind to specifically quantify defensive practices across a wide spectrum and among a number of specialties. The study is also the first of its kind to link such data directly with Medicare cost data.”

Physicians self reported on seven tests that might be used in defensive medicine. They were plain film X-rays, CT Scans, Magnetic Resonance Imaging (MRIs), ultrasounds, laboratory testing, specialty referrals and consultations.

Based on Medicare reimbursements rates in Massachusetts for 2005-2006 the eight specialties surveyed generated 281 million dollars in defensive medicine costs in outpatient clinics. Their practice of defensive medicine also generated $1.1 billion in unnecessary costs for hospital admissions. The big winner here was the hospitals. Hospitals might not be motivated to fight as hard as physicians to eliminate defensive medicine because defensive medicine serves its revenue generating agenda well.

The estimate of a total of $1.4 billion only includes 7 tests and 8 specialties in a 900 physician sample. Massachusetts is a small state. If we assume all the states are the same size and multiple by 50 states we are talking about $70 billion dollars wasted on defensive medicine.

If the survey included all specialties, all physicians, and all costs including the cost of malpractice premiums and physician practice time lost in litigation in all states, my guess would be the cost of defensive medicine would be ten times the 70 billion dollars. A $700 billion dollar cost for defensive medicine is an unnecessary cost to the healthcare system. This cost can be dismissed lightly or yield to unscientific expert opinion. The result does not include the emotional toll on physicians being sued and the lawsuits effect on their ability to practice medicine.

The legal system for handling malpractice claim is very costly. A more logical and cost effective system for adjudicating patients harmed by medical error needs to be instituted.

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

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President Obama; If You Really Want To Reduce Healthcare Costs, Effectively Reform The Medical Malpractice Tort System ?: Part 1

April 7, 2009
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama, you have not discussed the need for medical malpractice reform. Without medical malpractice reform you will not be able to reduce the cost of healthcare and increase the quality of medical care. It will be difficult because malpractice reform goes against the vested interest of some of your major supporters, plaintiffs’ malpractice attorneys.

There is at least one trillion dollars of waste in our $2.3 trillion dollar healthcare system. One hundred fifty million dollars ($150 million dollars) is wasted on excessive administrative costs by the healthcare insurance industry. The remainder is generated by the practice of defensive medicine and cost of malpractice insurance.

“Much of this waste is generated or justified by the fear of legal consequences that infects almost every health care encounter. The legal system terrorizes doctors. Fear of possible claims leads medical professionals to squander billions in unnecessary tests and procedures.

Physicians and nurses are afraid to speak candidly to patients about errors. They try to explain the risk reward ratio of treatments for fear of assuming legal liability. The result is the practice of defensive medicine and over testing to cover every possible contingency. This legal anxiety is also corrosive to the therapeutic magic of the physician patient relationship.

It would be relatively easy to create new rules that would provide a reliable system of justice for patients harmed by medical treatments and procedures without encouraging costly litigation. If a new system was in place it would decrease the costs of defensive medicine significantly. It would encourage physicians use of clinical judgment rather than expensive tests and improve the physician patient relationship.

“ The good news is that it would be relatively easy to create a new system of reliable justice, one that could support broader reforms to contain costs.”

Everyone makes mistakes in every walk of life. The legal liability threat could generate further unnecessary errors. Physicians, nurses and hospitals are advised not to offer explanations about a mistake. Sometimes errors are concealed to avoid a legal ordeal. The hidden error could be compounded by additional mistakes.

“Even in ordinary daily encounters, an invisible wall separates doctors from their patients. As one pediatrician told me, “You wouldn’t want to say something off the cuff that might be used against you.”

There are cost multipliers created as mistrust accelerates between the patients and physicians. You would like physicians to adopt electronic medical records. Some physicians avoid using EMRs because the information could be misinterpreted and used against them. There is an increasing use of second opinions. Every examination requires an observer for the examination to avoid legal liability. Every problem requires multiple laboratory tests to rule out something that might have been missed. An example is a CAT in the Emergency Room for even the slightest head trauma.

“Medical cases are now decided jury by jury, without consistent application of medical standards. According to a 2006 study in the New England Journal of Medicine, around 25 percent of cases where there was no identifiable error resulted in malpractice payments.

“Nor is the system effective for injured patients — according to the same study, 54 cents of every dollar paid in malpractice cases goes to administrative expenses like lawyers, experts and courts.”

These are the major tort reform issues. They must be addressed to decrease wasteful expenditures in the healthcare system. Malpractice lawsuits are a growth industry for defense attorneys, a burden to physicians having to defend themselves and a significant cost to the healthcare system. Malpractice reform is essential to any meaningful healthcare reform. President Obama, I think you know it. The question again is will to take the correct route to reform the malpractice tort system.

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

  • Ted Howard • April 7, 2009

    My girlfriend is a first year ER resident. She recently did her cardiology rotation. She admitted the same homeless crack addict three times in one week because his chest hurt and his triponin was elevated. Those are symptoms of his crack smoking, not an MI. They had to admit three times before they could start telling the ER that they refused to admit him. The hospital was his hotel. He paid his bills with unspoken threats of malpractice claims, threats he didn’t even know he was making.
    Seen this? http://seattletimes.nwsource.com/html/jerrylarge/2008969201_jdl02.html

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Father-Son Weekend Part 2

April 4, 2009
inLife's Experiences
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Stanley Feld M.D.,FACP,MACE

This is about two pals, a father and son, hanging out for a weekend, bonding, learning from each other and eating stuff we would never eat at home.

Brad flew from Los Angeles to San Francisco Friday morning to visit one of his companies. He left L.A. at 7 am and was back at 2 pm. We met for lunch at Carney’s ,a famous Hamburger/Hot Dog joint on Sunset Strip. The yellow train on Sunset Blvd is cool but the hot dogs and hamburgers are overrated.

After lunch we were both sleepy. We went to our room at the Mondrian Hotel and took the now famous Feld nap. My father invented it. My brother, Charlie, and I perfected it. Brad, his brother, and two cousins are taking it to the next level. It is as things should progress.

We blew off a scheduled dinner downtown at Water Grill. The guys we were to meet got sick and cancelled. Brad and I walked along Sunset Strip to observe the beautiful people. There are also plenty of beautiful people at the Mondrian Sky Bar and the Pool Deck. It is a happening place.

During our walk we stopped at “Ketchup” for dinner. Its sign was cool. We were lucky to get a table after promising to eat fast. “Ketcup” was funky and unusual. They have a great menu for 20 to 35 year olds. The mac and cheese with five different flavors of ketchup was up there with the best. We talked two girls sitting at the next table into ordering it.

We had chocolate gelato at Café Pisano. After gelato Brad and I started to walk. We had a deep philosophical discussion. I love talking philosophy with Brad. These days I learn much more than I teach.

We continued down Sunset Set Strip until we got tired mentally and physically. A great kind of tired. Before retiring we needed a little more Mondrian Pool Deck.

The next morning I ran 3 miles. I was back without quadriceps pain. We had a breakfast meeting scheduled with Dov Seidman. I referred to Dov in a blog last week. Brad and Dov are good friends. Dov is one smart guy. He is a humanist. One of his views is the economic crisis is going to change society for the better. We will once again become human beings rather than human doers.

The healthcare industry needs some humanization.

The amazing thing to me is Brad and Dov’s generation have a broader view of the world and human potential than most of the group running the country. We sat and talked for two hours. Both of them ended up teaching me a lot.

Jason Mendelsohn and Ryan McIntyre told Brad that Pizzeria Mozza was the best pizza in the world. We took a cab to Pizzeria Mozza. The crazy thing about L.A. is that every cab ride is $30 or more. Traffic is everywhere. Brad’s IPhone has a link to calling a cab by email. His Iphone GPS tells us where the traffic jams are. Since the jams are everywhere it didn’t help much.

We got to Pizzeria Mozza at 11 am. They do not open until 12 pm. So we walked about 3 miles down Melrose just talking. The conversation was invigorating. Jason was correct. It is great pizza. I remember my first date with Cecelia 50 years ago. We had pizza is a hole in the wall on Boston Post Road and Gunhill Road in the Bronx run by an Italian family. Today’s pizza is the only one that matched that pizza. My recollection could be clouded by love at first sight.

I wanted to see the Contemporary Museum of Art and the L.A. Symphony Hall. Another $30 cab ride without air conditioning. The museum’s permanent collect was fabulous. It has a Rothko room that is as good as the Rothko Chapel in Houston. I thought the Dan Bradberry exhibit was mediocre.

Frank Gehry’s Symphony Hall was cool but not his best work. Bilbao is better.

There were no cabs in downtown L.A. on Saturday afternoon. We walked two miles to Oblong’s office for a demonstration from John Offenkopper. He and Kevin Parent (cofounders) were Brad’s fraternity brothers at MIT. So many kids in that fraternity were so smart.

John was Stephen Spielberg’s technical adviser in “The Minority Report”. He converted the fantasy into reality. Children born in 2010 will not have heard of a keyboard and a mouse is just as my granddaughter has not heard of a typewriter. They will be replaced by finger and hand motions.

Marty drove downtown to see the Oblong demonstration. He drove brad and me to the Mondrian. (I appreciate the fact that it was out of his way). The Feld guys needed a nap but we had cancelled our reservation for 7pm at Asiadecuba. We figured we ought to try to get a table at the pool at 6 pm. What a scene! The meal was also good. We were so sleepy after dinner. We slept from 8 pm to 7 am Sunday. I haven’t slept 11 hours straight in 40 years. .

Mark Suster twittered Brad on Saturday and asked if he could meet us for breakfast on Sunday. Brad did not know Mark. Brad googled him on his Iphone. He then twittered him a yes at the Mondrian Asia Cuba at 8.30 a.m. It is an instant world out there folks.

The breakfast meeting was wonderful. Again I learned how things are done in the New World. I got on the airplane again invigorated by a wonderful weekend of just hanging out with my son.

Next is a weekend with Daniel. We are just waiting for him to pick the weekend.

 

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

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Father Son Weekend: First Two Days With My Medical School Roomate

April 1, 2009
inUncategorized
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Stanley Feld M.D.,FACP,MACE

My father –son weekend this year with Brad was in Los Angeles.

We picked Los Angeles because L.A. is warm in March and Brad has invested in Oblong Inc. an L.A. company co-founded by John Underkofflerer and Kevin Parent. They are two great guys I met when Brad was at MIT. 

My 50th Columbia College reunion is coming up in June . I volunteered to be on the Jubilee Reunion committee. As a member of the reunion committee I developed a social network for Columbia College CC’59 using Ning. I like Ning’s founder Marc Andreesen’s mind. I was curious to see if a social network would work with 70 year old Columbia College graduates. We all need social networks because we are all social beings whether we admit it or not. .

The network works. I have reconnected with college friends I have not seen in 50 years. One connection was with one of my medical school roommates.

He invited me to visit him when I was in L.A.(Santa Monica) . I went to Los Angeles two days before my weekend with Brad to renew our friendship. The first challenge was getting to his house and then getting into his house. The taxi dropped me off a block from his house because a gate closed off his street. I snuck through the gate

Marty is a psychiatrist. He sees patients in his house. He office layout is the same as HBO’s program “In Treatment”. I arrived early and figured he would be busy with a patient. I was sure he would leave a window open to climb in just as he did in our basement apartment in medical school. Lucky for me I arrived during his lunch break . He has two Great Danes. Each one is bigger and heavier that I am. If I climbed through the window I would have been the Great Danes’ lunch.

Marty and I had a simple lunch and talked non-stop. He cancelled his patients for the rest of the day. We were off to his gym. I jog daily. I never used an elliptical machine although Cecelia has tried to convince me to try it. Marty insisted I use it because then we could talk side by side. After 15 minutes my quadriceps were on fire. When I got off the machine (after 35 minutes), I could hardly stand up. It felt seasick for the next hour.

In our gym clothes we went galley hopping at Bergamot Station in Santa Monica. When we got back to his home he asked me to help him walk his Great Danes.

I am not a dog lover. The dog I was walking almost dislocated my shoulder. It was less than an enjoyable experience.

Marty has not changed one bit in 50 years. I would bet most of us haven’t changed much.

Dinner and an investment meeting in the fancy Shutter Hotel on Santa Monica beach. The meeting confirmed my impression of economic market predictions. Everyone should read “Fooled by Randomness”.

With my thighs still hurting I ended up running 4 miles to the Santa Monica Pier by myself the next morning. My run to the Pier was too much. My thighs were really hurting now. I had to run walk or crawl to get back since I had no money.

Marty and Francine took me for a surprise lunch of Hebrew National Hot Dogs at Costco I love Costco. The three of us went shopping and spent an hour buying things they did not need.

Next, L.A. Louver Art Gallery in Venice. It was wonderful. The David Hockney prints on exhibit were a mind blowing experience.

Brad and John were to meet us at 7 pm at Cholada Thai cusine on Malibu Beach.

They do not take reservations. However, Marty using his best psychiatric skills and charm talked them into giving us a reservation for 7 pm. Brad and John were stuck in traffic. Brad twittered me their problem. We gave up our table and walked on the beach until they showed up. Welcome to L.A.The meal was great and the look of the place was authentic hippy.

On Friday morning we went to the L.A . Museum of Art . The museum architecture is hodge podge. I think L.A. county should have blown up the original build before adding on. The exhibits were fair.

Norman Cousins said laughing is good for your health. I had two day of reminiscing and continuous laughing or smiling. Marty dropped me off at the Mondrian Hotel to meet up with Brad.

Thank you Marty and Francine for showing me the Los Angeles I had never seen before. And finally thank you Marc Andreesen for Ning and reconnecting me to Marty.

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

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President Obama, We Are Looking For Inspirational Leadership Not More Spending and More Taxes

March 24, 2009
inHealthcare Insurance Industry, Innovations in Healthcare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Universal Healthcare
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Stanley Feld M.D.,FACP,MACE

 

President Obama, you won the election because you are articulate, confident, logical and inspirational. You projected a vision for the country that included fairness and opportunity for all. You promised to return to America’s ethical and moral base. The country was tired of congressional bickering, gridlock, threats to constitutional freedoms, gamesmanship, and unproven or hidden corruption. Americans were tired of corporate privilege and abuse.

In early 2008 America was told the economy was doing great. America was winning the war in Iraq. America was winning the war on terrorism. There was no inflation in the U.S. Housing prices were rising. No of these declarations made any sense to the average American.

All an average American had to do was wake up in the morning and experience rising prices, housing foreclosures, and a bombs exploding in Iraq to know there was something wrong with these declarations.

In January 2009 the government told us we had been in a recession since October 2007. Is the individual’s testing of reality better than the government’s. The government has all those fancy, incomprehensible indices. Indices that happen to be derivatives of derivatives such as gross national product, housing starts and the consumer price index

America has a generalized mistrust of government and its agencies,politicians, banks, corporations and other commercial entities. The United States has had an ethical and moral deficiency leading to our economic collapse.

To me, the A.I.G. bonuses simply highlight this deficiency. Congress’s action to remedy A.I.G. bonuses highlights congressional impotence and showboating. It underlines its inability to act to cure our ethical and moral problems. Its actions also highlights congress’s inability to problem solve for the peoples benefit. It problems solves for its own benefit and desire to increase power over our lives.

America elected you, President Obama, in the hope that you would restore us to our ethical and moral center. Please do it quickly. Please abandon outmoded systems that you are preparing to reregulate. It will only hinder Americans ability to be innovative and it will surpress worthy incentives. Please let us develop and promote fresh new ideas that will put us on a stronger footing for economic growth in the future.

Tom Freidman expressed it beautifully last Sunday.

“President Obama missed a huge teaching opportunity with A.I.G. Those bonuses were an outrage. The public’s anger was justified. But rather than fanning those flames and letting Congress run riot, the president should have said: “I’ll handle this.”

He should have gone on national TV and had the fireside chat with the country that is long overdue. That’s a talk where he lays out exactly how deep the crisis we are in is, exactly how much sacrifice we’re all going to have to make to get out of it, and then calls on those A.I.G. brokers — and everyone else who, in our rush to heal our banking system, may have gotten bonuses they did not deserve — and tells them that their president is asking them to return their bonuses “for the sake of the country.”

I bet they would be compelled by public sentiment to return their bonuses for the sake of the nation. It would be better for them and the country to return their bonuses voluntarily than return them through unconstitutional taxation. This tax moves America further from its ethical and moral base. President Obama ,you should inspire, not coerce ethical and moral behavior.

President Obama, I am sure you know inspiring conduct has a greater impact that trying to enforce conduct. The government bureaucracy is usually poor at enforcing regulations. There are usually loopholes in new regulations. Rich vested interests have a way of wiggling through these loopholes at citizens’ expense. You were elected because of your populist notions and the promise to return America to our ethical and moral base. You have expressed the notion that you cannot legislate ethics and morality. You must inspire Americans to do what they should do and not force them to do it. Regulations and increased taxation have a way of precipitating unintended negative consequences.

“There is nothing more powerful than inspirational leadership that unleashes principled behavior for a great cause,” said Dov Seidman, the C.E.O. of LRN, which helps companies build ethical cultures, and the author of the book “How.”

Dov Seidman’s principles hold true in healthcare. Loopholes in healthcare regulations have permitted stakeholders to adjust. Further regulations to close loopholes resulted. These adjustments to regulations have permitted the healthcare insurance industry to capture the greatest share of the money at the expense of the primary stakeholders (consumers).

Your healthcare team is doing nothing other than expanding failed programs (Medicare and Medicaid). Congress has given you the money to repair the healthcare system by the force of your personality and oratory. Your team is in the process of handing the appropriation over to the healthcare insurance companies. Think about it. Why do you think the healthcare insurance industry is in favor of universal care extension of Medicare and Medicaid ? Look at the profit they are generating in Massachusetts.

It is time to be inspirational and innovative. You promised if something did not work you would try something else. You have the money for healthcare, put it in the hands of the consumer with rules and regulations that protect consumers. I believe you and the country will be pleased with the results.

America needs inspiration and innovation, not false hope from failed systems in order to repair the healthcare system.

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

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President Obama Don’t Confuse Us With Illogical Thinking.

March 22, 2009
inMedicaid, Medicare, Medicine: Healthcare System, Pay for Performance (P4P), Politicians,Healthcare and Vested Interests, Universal Healthcare
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Stanley Feld M.D.,FACP,MACE

Medicare and Medicaid flunk the Institute of Medicine’s criteria defining an effective healthcare plan.

“The President’s $634 billion "down payment" on health care reform in his proposed budget depends on raising taxes and saving money largely through administrative payment changes in existing entitlement programs. That is not exactly fundamental reform.”

John Goodman’s analysis of Nicholas Kristof New York Times editorial is perfect. He starts off by saying: “I have observed before that when people start talking about health care their I.Q. tends to fall about 15 points.”

“The same error in reasoning appears in almost every speech on health care given by Barack Obama and by just about everybody else on the political left as well.”

I am not interested in partisanship. I am only interested in logical problem solving. If a plan for medical treatment makes sense and has good clinical evidence to prove a positive outcome, I am for it. The same applies to solving social and economic problems.

President Obama’s healthcare team is in the process of formulating a plan that is not logical . The healthcare plan has not succeeded in the past and will fail at a greater cost to taxpayers and society.

John Goodman has outlined the logic used by Nicholas Kristof and the administration to justify the validity of the administration’s healthcare reform plan.

Classic syllogisms are taught to every high school student ;

All men are mortal

Socrates is a man

Therefore Socrates is mortal

John Goodman points out the syllogism used about by Nicolas Kristoff and the administration:

“Major Premise:

The United States spends twice as much per person on health care as Canada and most European countries and has worse outcomes.

Minor Premise:

Spending twice as much in return for less is bad.

Conclusion:

We should tax the rich and spend even more on health care.

Whoa! Something’s wrong here.”

You bet there is something wrong. It is not logical. The proposed solution of taxing the rich does not follow expanding failed programs (Medicare and Medicaid).

President Obama’s healthcare reform proposal;

1. Down Payment or Unknown Costs

President Barack Obama’s budget sets aside $634 billion over 10 years in a health care reserve fund, which is earmarked for the enactment of unspecified policies intended to bring down costs and expand coverage but its true costs are still unknown..

The congressional budget office’s estimates are much higher.

2. Key Provisions in the Health Care Budget

Higher Taxes. The President is proposing tax increases on those making over $250,000 annually. This revenue is projected to finance approximately half of the projected health care spending, an estimated $318 billion.

The President’s healthcare team is proposing to throw money at a broken system and use the tax increases to pay for it. The result will be a further increases in future taxes. President Obama should be developing a healthcare system that will provide incentives to the primary stakeholder (consumers) and promote innovative thinking and behavior by the other primary stakeholder (physicians) to promote efficiency and decrease costs.

His plan does not initiate real change in the healthcare system. The government will still outsource administrative services to the healthcare insurance industry. The healthcare insurance industry will still control the healthcare dollar.

3. Medicare Private Plan Payment Changes.

4. Medicare Prescription Drug Premiums.

Under this proposal, higher-income seniors would pay higher premiums than lower-income seniors for Medicare Part D prescription drug coverage.

Medicare Part D is presently too expensive. Its premiums have tripled in the last two years. Medicare Part D has benefited the healthcare insurance industry. The healthcare insurance industry’s net profit is $5 billion dollars per  year. Only 20% of Medicare patients participate.

5. Medicaid Prescription Drug Payment.

6. Medicare Payment Changes.

“Systemic delivery reforms, such as "pay for performance" (where physician and hospital reimbursement are tied to compliance with government practice guidelines), are intended to result in securing better value for dollars.”

Similar “reforms” have lead to providers adjusting by gaming the system. Centralized medical decision making in Washington will lead to political manipulation of the system by healthcare lobbyists. It does not repair the healthcare system.

 

7. Medicaid Family Planning.

8. Prescription Drug Re-Importation.

President Obama’s healthcare plan does little to empower the patient. It does little to change our healthcare system’s flawed public and private payment system. The power to manipulate the system’s payment remains in the healthcare insurance industry’s hands. Its appeal is to the populist notion to “soak the rich” to help the poor. It does not add value to individual freedom of choice and ability to secure valuable healthcare. It does not repair the healthcare system.

If President Obama really wanted to repair the healthcare system he would place control and decision making for healthcare needs in the hands of the consumers and their families.

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

  • jacksmith • March 23, 2009

    Finally, the time has arrived to fix Americas Healthcare crisis, and Americas healthcare nightmare. Hundreds of thousands of you are killed needlessly every year by your healthcare delivery system in a rush to profit. And because of a rush to profit Hundreds of thousands more of you are needlessly dying from treatable illness that people in other developed and civilized countries don’t DIE! from. Rich, middle class, and poor alike. Insured, and uninsured. Men, women, children, and babies.
    Additionally, thousands more of you are driven into financial ruin, and bankruptcy just because you, or one of your loved ones got sick or injured. And all of this is happening at a time when America spends twice as much of it’s GDP (Gross Domestic Productivity) on health care than any other country in the developed world. Individual Americans spend about ten times as much on health care as any other people in the developed world. This is a CRIME AGAINST HUMANITY. AND IT MUST END!
    But before we can truly fix this healthcare crisis and disgrace, everyone needs to clearly understand what the problem is. And everyone needs to clearly understand the real enormity of the problem. The problem is that HEALTHCARE AND MEDICAL DELIVERY IN AMERICA IS SEVERELY CORRUPTED AND COMPROMISED BY GREED! AND THE PRIVATE FOR PROFIT MOTIVE. And it is corrupted, and compromised IN EVERY ASPECT, AND EVERY PLACE OF HEALTHCARE AND MEDICAL DELIVERY. Unfortunately for all Americans, compromised healthcare ALWAYS results in needless suffering, injury, disability, and or death. Which is exactly what is happening now in America in shocking numbers.
    Health care is NOT! a private for profit business. Healthcare is an essential public service. Like police, and fire. And healthcare is also a human right! PRIVATE FOR PROFIT HEALTHCARE IS AN OXYMORON, AND AN IMMORAL AND UNETHICAL PERVERSION OF HEALTHCARE AND HUMAN RIGHTS.
    So how do we fix this healthcare disgrace? I believe the fix for Americas healthcare disaster is essentially the same thing that every other developed country in the World has essentially done. “NOT FOR PROFIT, TAX PAYER SUPPORTED, SINGLE PAYER, AUTOMATIC, FREE UNIVERSAL HEALTHCARE FOR ALL. Essentially HR676 (enhanced, and expanded medicare for all). Just like every other CIVILIZED! country in the developed World has. There is no other way to truly fix and reform our current disastrous healthcare delivery system.
    All Universal health care systems work best when everyone participates. But I know that the healthcare lobby, and some politicians will try and undermine “Not For Profit, Tax payer supported, Single payer, Automatic, Free Universal Healthcare for all” by falsely claiming that it will limit your choice, and require you to participate.
    So, I propose that everyone be included in the national plan unless they choose to opt out. If you opt out and need medical care the national plan will insure your provider that they will be reimbursed under the rules for members in the national plan. But those who opted out, and their insurer will be responsible for the FULL! cost to the national plan for providing your care if you or your private insurer fails to reimburse the provider or the national plan in a timely manor to at least the standards of the national plan.
    Including reporting you to credit agencies, withholding of taxes, leans, and garnishment of wages for unpaid medical bills. Just like you have now under private for profit healthcare, and private for profit health insurance.
    Further, people who opted out will be required to provide proof of financial responsibility for future illness or be required to participate in the national plan. And everyone with children will be required to participate in the national plan. Or provide proof of insurance coverage on each child to the standards of the national plan. It will be against the law to report anyone in the national plan to a credit agency for unpaid medical bills.
    Frankly, only a dope would want to opt out of the national plan and opt to keep our current disastrous private for profit medical, and insurance plans. But they will be free to choose. The most important thing is that the vast majority of Americans that want the protection, benefits, and higher quality of a universal national plan have that choice.
    You see, one of the most important aspects of a universal healthcare system is easy access, and patient protection. This is accomplished by having a single payer without a conflict of interest in patient care. And by having a payer who has the power to enforce minimum standards of excellence in healthcare delivery for everyone in the plan. This is much of what Medicare does now for senors. “Aeger Primo” (The patient comes first). Unfortunately in our healthcare system the patient comes last. We are just a peace of meat to them. Cash cows to be slaughtered for profit.
    So this is IT! my fellow Americans, My fellow human beings, My fellow World Citizens. And my fellow Cyber Warriors. 🙂 The time has come. D day. H hour. HEALTHCARE REFORM THIS YEAR! Let no one stand in our way. Contact your representative and tell them you want “Not For Profit, Tax Payer Supported, Single Payer, Automatic, Free Universal healthcare for all. And tell them you want that choice now. Tell them you want President Obama’s budget passed without delay. President Obama’s budget is brilliant. And exactly what is needed now.
    President Obama, and his allies will need all the support you can give them. The healthcare lobby will try to take out his people if they can, like they did with Tom Daschle and Nancy Killefer. And they will try to neutralize President Obama’s popularity, and political power. Or they will try to take him down someway. Don’t stand for it. If they attack him. Go after them ten times harder and remove them from office. We had an election. And you the people chose President Obama’s leadership, and change agenda. Let no one in government disrespect the will of the American people and remain in office.
    Let’s get this healthcare reform done now my fellow Americans. This year. Take no prisoners.
    God Bless All Of You
    Jack Smith — Working Class 🙂
    http://jacksmithworkingclass.blogspot.com/
    (http://jacksmithworkingclass.blogspot.com/)

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