Stanley Feld M.D.,FACP,MACE

After I wrote the article about consumer driven healthcare a Washington lobbyist said to me; “ many people in Washington do not think that the Massachusetts healthcare plan has failed. In fact President Obama and many congressmen think the Massachusetts plan should be the model for the federal government’s healthcare reform plan.”

This is difficult for me to believe. The Massachusetts healthcare reform plan fails all five criteria the Institute of Medicine’s use to define an effective healthcare plan. The plan not only fails all five criteria for healthcare reform, it has encountered obscene cost overruns.

“ The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.”

The Massachusetts healthcare reform plan flunks by all five criteria.

1. Universal healthcare coverage : The state still has more than 200,000 citizens without coverage. The number is rising as a result of increasing unemployment.

    2 . Continuous coverage: Coverage is not continuous if individuals lose their jobs. The healthcare insurance premiums have risen. Small businesses can not afford to cover employees. It is less expensive to pay the state imposed penalty tax.

   3. Affordable for individuals and families: Individuals and families cannot afford coverage.

“For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications. “

   4.Affordable to Society : The original budget for the Commonwealth Care subsidized program was $387 million dollars. It almost doubled in the first year to $630 million dollars. The estimated cost in 2009 is $1.3 billion dollars. Massachusetts has already received a federal government bailout of $2 billion dollars for healthcare. These cost increases are not sustainable nor affordable to society.

   5.Access to high-quality care for everyone : High deductible plans are cheaper but the deductibles are so high many consumers can not afford care when they are sick. Much of the population is under insured. The goal is to assure affordable healthcare insurance while providing quality care.

If the plan flunks all five Institute of Medicine criteria how can policy makers in Washington think it is a success? They are deceiving themselves and the public. Why bother study the effectiveness of the plan when you can believe in the buzz?

There are other issues that compound the failure. They include local political issues of power.

1. “Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals.

2. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world.

3. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.”

President Obama , please be aware of the unintended consequences of Tom Daschle’s healthcare plan. Throwing money at defective and unsustainable systems will not work. It will fail no matter how much plan is intellectualized by healthcare policy wonks at thirty thousand feet above reality.

Some think the Medicare model meets the Institute of Medicine’s five criteria for healthcare reform. They are convinced Medicare for all is the answer.

They argue;“Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country.

Medicare does satisfy the first three criteria. It insures everyone over 65 regardless of preexisting illness. It provides access to care and not tied to a job.

However, it has not be affordable to every senior. High deductibles, massive copayments and services approved and therefore billable but not covered must be taken into account when deciding on Medicare’s affordability for seniors on a fixed income. Medicare Part D (drug coverage) has failed to be affordable from the onset. The premiums have tripled in the last 2 years.

The cost of Medicare is not affordable to society. If fact bureauocrats have tried to decrease its costs, limit its coverage and limit reimbursement. The Bush administration tried to eliminate Medicare as an entitlement. The increasing cost of Medicare is unsustainable to society. According to the CBO the cost per year will reach 100 trillion dollars in 50 years. Adding the entire population to Medicare will be folly.

The only system that will repair the healthcare system is a system in which consumers control their initial healthcare dollars and is taught to be responsible for their health maintenance. .

President Obama, you should take a hard look at the ideal Medical Savings Account option to control costs and improve the health of America.

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

Stanley Feld M.D.,FACP,MACE

President Obama, here we go down the road of unintended consequences and wasting taxpayers’ money.

“Baylor Health Care System plans to ask for some of the state’s federal economic stimulus money for two of its multimillion-dollar projects.”

You have given states economic stimulus money without control over how it is to be spent. Is a grant to Baylor Health Care System going to stimulate the economy? Is this going to repair the healthcare system?

Baylor’s request reminds me of a story about the University of Texas, Southwestern Medical Center’s legendary former chief of medicine Donald Seldin M.D., MACE.

In 1952, at the age of 33, was named chief of medicine at Southwestern Medical School. He came to Dallas from Yale as an accomplished nephrologist. Southwestern Medical School’s physical facilities at the time were a group of Quonset huts.

At that time Dr. Seldin was invited to attend a meeting on how to cure arthritis in the indigent community. The committee for the cure of arthritis had already decided on it plan for cure.

The plan was presented by a retired army general. He said the city fathers had to fund twenty fully equipped ambulances at $20,000 each. The ambulances would bring indigent people to Parkland Memorial Hospital for treatment.

As the story goes, Dr. Seldin had one of his now famous outbursts. He told them it was totally illogical and a grand waste of 1952 dollars. He said city fathers should grant Southwestern Medical School $200,000 for him to establish an annuity. With this annuity he would bring one of the most famous arthritis researchers in the country to Dallas to find the cure for arthritis. Somehow he convinced the city fathers of his logic. He had an endowment to bring Dr. Morris Ziff to Dallas to head a new form Department of Rheumatology. In his lifetime Dr. Ziff almost found the cure for rheumatoid arthritis. He trained hundreds of Rheumatologists. They will find the cure.

“Baylor is seeking money for a cancer center to be built near downtown Dallas and a diabetes center in South Dallas. Baylor would not say how much it intends to request.”

President Obama, your stimulus money should be going to finding a cure for the dysfunctional healthcare system, not throwing money at an old system.

“A request for stimulus money could raise eyebrows because Baylor has said it has enough money for the projects. The stimulus money, if granted, would be used to hire more people from within the community, said Kristi Sherrill, Baylor’s vice president of government affairs.”

Isn’t that a sweet answer? The money will be used by Baylor to build a facility. In turn Baylor will charge the government for care of the patients that come to the clinics.

"Any additional funding granted to these two projects, both already under way, would be used to directly help patients fight two of the biggest health issues affecting North Texans," cancer and diabetes, said Sherrill.”

Doesn’t this sound like the rheumatoid arthritis story? It seems like someone in the state of Texas gets it. It is not clear whether Governor Perry gets it.

“Talmadge Heflin, director of the Center for Fiscal Policy at the Texas Public Policy Foundation in Austin, said his organization believes that stimulus money should be used for one-time projects.”

"We believe they should not use the money in a way that would create an ongoing obligation for the state," Heflin said. "And we don’t believe the money should be spent just because you can get it."

Think about it President Obama. You gave the money to the states. The states are going to spend it as they wish. It might not comply with your good intentions to repair the healthcare system or stimulate the economy. Your goals are good. The route you are taking neither repairs the healthcare system nor stimulates the economy.

The most pointed statement was made by a comment at the end of Jason Roberson in the Dallas Morning News article revealing Baylor’s intentions

“Watch all the little piggys run to the big, fat Federal teat.
I got a hog pen that needs finishing. Could I get some stimulus funds for that? It would be the compassionate thing to do.”

Enlightened Rogue

Baylor does not need the money. They have plenty of funding and creditworthiness. Nonprofit hospitals already receives 32 billion dollars in subsidies from the federal government to service the indigent. The nonprofit hospital only spend 5 billion retail dollars in service.

“Regardless of what economic stimulus money it receives, Baylor appears to have the money and creditworthiness to complete its projects.”

President Obama, a request of this sort has plenty of destructive unintended consequences. I suggest you hire people to figure out the cure of the healthcare system and not throw taxpayers money out the window for worthless ambulances that will neither cure the problems nor stimulate the economy.

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

Stanley Feld M.D.,FACP,MACE

America’s present healthcare crisis is neither a Democratic nor a Republican issue. It is an American issue. It can be solved logically and swiftly using common sense. Let the American consumers control their healthcare dollars. Provide consumers with financial incentives for wise healthcare purchases and education for good health maintenance to prevent the onset of a chronic disease.

President Obama’s healthcare team is setting up a healthcare system where the government will make the healthcare choices for Americans. Ultimately government will ration care.

Daily, Americans are overwhelmed by bad news sound bites. For years we have heard that our healthcare system is broken. It is broken because the government has broken it. Only 20% of the people are sick at any one time. The other 80% do not think there is a problem with the healthcare system. In the last 25 years most Americans have heard of or experience horror stories about the dysfunctional healthcare system. The goal should be to repair the problems and not impose another dysfunctional healthcare system on us.

First, it was HMO’s and the restrictions of access to care. Then, it was Managed Care. Managed Care turned out to be managed costs and restrictions on access to care. Then, it was the ever increasing healthcare insurance premiums. Now, it will be the government‘s experiment with a single party payer system. An experiment that is destined to fail.

The Bush administration did nothing about repairing the healthcare system. Correction. Everything President Bush tried to do the congress rejected. The healthcare insurance industry and its executives made grotesques profits while restricting access to medical care and decreasing physician reimbursement.

Medicare and Medicaid’s costs have continued to rise. The healthcare insurance industry controls Medicare’s dollars. The Bush administration did nothing to stop it. The Bush administration recognized that bureaucratic entitlements would destroy our economy. The administration tried to get rid of the Medicare entitlement by providing a bonus to the healthcare insurance industry for the takeover of Medicare with Medicare Advantage and Medicare Part D. The cost to seniors and the profit to the healthcare insurance industry has been huge.

Neither Republicans nor Democrats in congress have done anything logical to fix the healthcare system. The executive and legislative branches have only generated greater mistrust among all the stakeholders in the healthcare system.

Congress knows the increasing Medicare costs are unsustainable. The Congressional Budget Office predicts a 100 TRILLION dollars per year deficit for Medicare alone in 50 years.

Why would a responsible member of congress or the executive branch want to increase an entitlement that does not work to included the entire population?

Today’s sound bites have frightened most of the population. Americans are anxious to be rescued by anything that sounds good. All that is needed is a well crafted public relations campaign of sound bites promising salvation.

Liberal Democrats have put together such a public relations campaign. President Obama has captured the lead to be society’s savior. It does not matter whether his proposals are logical or if they will work. It sounds good. America is ready to go for it.

Republicans are feeling overwhelmed. They intuitively understand that a government controlled single party payer system will not work. Massive government programs have not worked effectively in the past. Why should they work now? Consumers should be empowered to make their own decisions. Government should not make decisions for them.

An organization call the “Leadership Conference for Guaranteed Healthcare , the national single pay alliance” has crafted such a public relationship program. They have cobbled together a group of social networks to express the anger and fears felt by the American public. Their sound bites are compelling.

President Obama will play off these social networks to force his change in the name of goodness and justice for all. It is Tom Daschle’s doctrine. Most of the proposals will fail. They will fail not because they are unjust. They will fail because the route to achieve them is wrong. The costs will be unmanageable as we have seen in the Massachusetts experiment..

The sound bites are indeed compelling:

1. Everybody In, Nobody Out. Universal means access to health care for everyone, period.
2. Portability. If you are unemployed, or lose or change jobs, your health coverage stays with you.
3. Uniform Benefits. No Cadillac plans for the wealthy and Pinto plans for everyone else, with high deductibles, limited services, caps on payments for care, and no protection in the event of a catastrophe. One level of comprehensive care for everyone, regardless of the size of your wallet.
4. Prevention. By removing financial roadblocks, a universal health system encourages preventive care that lowers an individual’s ultimate cost and pain and suffering when problems are neglected and societal cost in the over-utilization of emergency rooms or the spread of communicable diseases.
5. Choice. Most private insurance restricts your choice of providers and hospitals. Under the U.S. National Health Insurance Act, patients have a choice, and the provider is assured a fair payment.
6. No Interference with Care. Caregivers and patients regain their autonomy to decide what’s best for a patient’s health, not what’s dictated by the billing department. No denial of coverage for pre-existing conditions or cancellation of policies for "unreported" minor health problems.
7. Reducing Waste. One third of every private health insurance dollar goes for paperwork and profits, compared to about 3% under Medicare, the federal government’s universal system for senior citizen healthcare.
8. Cost Savings. A guaranteed health care system can produce the cost savings needed to cover everyone, largely by using existing resources without the waste. Taiwan, shifting from a U.S. private health care model, adopted a similar system in 1995, boosting health coverage from 57% to 97% with little increase in overall health care spending.
9. Common Sense Budgeting. The public system sets fair reimbursements applied equally to all providers, private and public, while assuring that appropriate health care is delivered, and uses its
   clout to negotiate volume discounts for prescription drugs and medical
   equipment.
10. Public Oversight. The public sets the policies and administers the system, not high priced CEOs meeting in private and making decisions based on their company’s stock performance needs.

Who can argue with any of these points? The major question is can a government bureaucracy administer this system effectively without impinging on citizens’ choices, rights and freedoms.

Is this the solution to the high incidence of chronic disease and the dysfunctional healthcare system?

My answer is no. Americans are being duped once more by cool sound bites.

The Alliance has put together interesting groups. They have used the internet to leverage the Alliance. They have used the same technique that President Obama used to become President. They have formed giant social networks and put them together. President Obama can easily play off this coalition as evidence for the need by the public for a single party payer system.

The social networks and President Obama have outflanked common sense. They have created a false hope and it will fail to repair the healthcare system. .

Leadership is needed to formulate a common sense strategy to solve the healthcare system’s dysfunction for all American at every socioeconomic level. Neither the Democrats or the Republicans have such a plan.

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