Stanley Feld M.D.,FACP,MACE

Bernie Sanders and the progressive Democrats are not interested in learning from other countries’ mistakes.

Their ideology blinds them to the fact that socialized medicine does not work. I vividly remember John Kerry and Barney Frank telling President Obama that the Affordable Care Act needs a Public Option. The Affordable Care Act would fail if it did not have a Public Option. With a Public Option included they said America would be well on its way to a single party payer system.

They said a single party payer system is the only healthcare system that would work

President Obama told them he had a clandestine “Public Option” built into Obamacare. However, he was never able to bring it about.  

Progressives believe deeply in their ideology. They do not consider past history, present reality or facts. 

Neither does the American College of Physicians. In a position paper it recommended Medicare for All. It was followed up with a letter published in the New York Times with 2,000 signatures out of the 159,000 members advocating Medicare for All.

“In a separate but related move to the ACP’s announcement, more than two thousand physicians on Monday announced an open letter to the American public, prescribing single-payer Medicare for All, in a full-page ad in The New York Times that will run in the print edition on Tuesday, January 21, 2020.”

https://www.nakedcapitalism.com/2020/01/in-historic-shift-second-largest-physicians-group-in-us-has-new-prescription-its-medicare-for-all.html

I wonder how many of these signatories have any idea of what the economic impact of “Medicare for All.” I really wonder how many members out of the 159,000 would support the position. I know I do not support the ACP’s position.  

All progressives have to do is look at what is happening to socialized medicine all over the developed western world and notice it is unsustainable and its citizens are dissatisfied with it.

Healthcare systems in the developed world are failing even as the ideologs believe it is succeeding.

America’s healthcare system is also having many problems. Americans are dissatisfied with our healthcare system. The healthcare system has gotten worse since Obamacare was passed. The government is responsible for making our healthcare system worse. It has not done the things I have suggested to repair our healthcare system.

 The Commonwealth Fund (a private progressive foundation) with a focus on healthcare is certain that a single party payer system is the only viable healthcare system.

The report ranked healthcare systems throughout the developed western world.  In its 2014 published ranking the National Health Service of Great Britain was considered the best medical system among the 11 of the world’s most advanced nations, including Canada, France, Germany, Switzerland and Sweden.

 The United States came in last.

 Few “experts” have the time or patience to read the complete report or pick out the defects in the report.

Most people read the summary. The summary in this report does not reflect the truth about the evidence present in the report.

The Commonwealth Fund’s rankings of countries is contradicted by objective data about access and medical-care quality in these countries in peer-reviewed academic journals.

The Commonwealth Fund’s methodology is defective. Its conclusions relied heavily on subjective surveys about “perceptions and experiences of patients and physicians.”

Kenneth Thorpe made an important point by examining differences in disease prevalence and treatment rates for ten of the most costly diseases between the United States and the ten European countries with a single payer system.

He used surveys of the non-institutionalized population age fifty and older. Disease prevalence and rates of medication and treatment are much higher in the United States than in these European countries.

Why would that be?

There are many reasons for this finding. The main one is the availability of care in the United States compared to the ten socialized western countries.

Another is lifestyle and incidence of obesity in the United States. Both lead to the onset of chronic disease and increased treatment.

 “Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.”

“Americans are diagnosed with and treated for several chronic illnesses more often than their European counterparts are.”

Americans diagnosed with heart disease receive treatment with medications and procedures more frequently than patients in Western Europe.

In the past local peer review was all that was needed along with confidence in the treating physician’s judgment. This confidence in physicians’ judgment has been destroyed by excessive media sensationalism. The real percentage of abuse is small and easily discoverable by peers and the use of social media.

Cancer treatment survival rates in America are far greater than the survival rates in Britain, and countries in western Europe.

The reasons for the higher cure rates is the availability of early detection and treatment.

Cancer treatment costs are high. The government should look into the reasons for this high cost and try to lower the cost.

The Commonwealth Fund’s report does not consider any of these factors.

“Over a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than 36,000 have been in treatment queues for nine months or more.

Long waits for care are endemic to government-run, single-payer systems like the NHS. Yet some U.S. lawmakers want to import that model from across the pond. That would be a massive blunder.”

https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/#d1df33b36b89

The NHS has a waiting list of 3.2 million people for admission to the hospital. In London alone over 500,000 patients are on a waiting list for diagnosis and treatment.

A large percentage of patients triaged as urgent after being diagnosed with suspected cancer have a 62-day wait time to receive therapy.

Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. That’s well below the country’s goal of treating 95% of patients within four hours — a target the NHS hasn’t hit since 2015.

Now, instead of cutting wait times, the NHS is looking to scrap the goal.

Wait times for cancer treatment — where timeliness can be a matter of life and death — are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn’t start treatment on time despite an urgent referral by their primary care doctor. That’s the worst performance since records began in 2009.

Today In: Industry

And keep in mind that “on time” for the NHS is already 62 days after referral.

Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America.

The British Health and Social Care Act 2012 authorized the use of the small private sector of healthcare to help the NHS with its problems.

The share of NHS-funded hip and knee replacements by private doctors increased to 19% in 2011-12, from a negligible amount in 2003-04. Each year there is an increase in NHS funded care by the private sector.

It sounds like the VA Healthcare System’s solution to its problems.

The NHS also routinely denies patients access to treatment. More than half of NHS Clinical Commissioning Groups, which plan and commission health services within their local regions, are rationing cataract surgery. They call it a procedure of “limited clinical value.”

It’s hard to see how a surgery that can prevent blindness is of limited clinical value. Delaying surgery can cause patients’ vision to worsen — and thus put them at risk of falls or being unable to conduct basic daily activities.

“It’s shocking that access to this life-changing surgery is being unnecessarily restricted,” said Helen Lee, a health policy manager at the Royal National Institute of Blind People.

Many Clinical Commissioning Groups are also rationing hip and knee replacements, glucose monitors for diabetes patients, and hernia surgery by placing the same “limited clinical value” label on them.

Patients face long wait times and rationing of care in part because the NHS can’t attract nearly enough medical professionals to meet demand. At the end of 2018, more than 39,000 nursing spots were unfilled. That’s a vacancy rate of more than 10%. Among medical staff, nearly 9,000 posts were unoccupied. Many physicians have left the NHS and have gone into private practice. Many do both NHS service and private practice.

These shortages could explode in the years to come. In 2018, the Royal College of General Practitioners found that more than 750 practices could close within the next five years, largely because heavy workloads are pushing older doctors to retire early.

English people who can afford private care and private healthcare insurance to avoid the NHS are switching to private insurance even though they have to pay $3,500 for each man, woman and child in a family into the NHS.

Physician shortages are the result of inadequate funding. The cost of the NHS with all these restrictions are unsustainable.

The single party payer system (NHS) is struggling with unsustainable costs even though we hear from progressives how great socialized medicine is in England.

The key ingredient missing in all these systems is patient responsibility for their health and their healthcare dollars. Both are powerful motivators for healthy living and detecting disease early.

Copywrite 2006-2020  

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



Please have a friend subscribe

Healthcare Policy in The Post Truth Era

Stanley Feld M.D.,FACP, MACE

 The government has been deficient in trying to do anything to Repair the Healthcare System.

Unfortunately, John McCain’s vote blocked the repeal of Obamacare which froze any progress.  His reason was feeble and politically naïve.

John McCain wanted congress to work together and have bipartisan agreement on healthcare reform. The entire majority of the present House of Representatives has no desire to be bipartisan or help President Trump create or pass any bipartisan legislation.

Democrats in the house only want to impeach the president. They have no time for positive legislation to repair the healthcare system.

I believe the Trump administration has the right idea. 

President Trump and his administration have decided to make structural changes to the healthcare system by executive order until it can make big legislative changes. Their hope is they win a more cooperative Congress in 2020.

We are living in a Post-Truth era.

“Post-truthpolitics(also called post-factual politics^[1]and post-reality politics)^[2]is a political culturein which debate is framed largely by appeals to emotion disconnected from the details of policy, and by the repeated assertion of talking pointsto which factual rebuttals are ignored.

Post-truthdiffers from traditional contesting and falsifyingof facts by relegating facts and expert opinions to be of secondary importance relative to appeal to emotion. While this has been described as a contemporary problem, some observers have described it as a long-standing part of political life that was less notable before the advent of the Internetand related social changes.”

https://en.wikipedia.org/wiki/Post-truth_politics

 The media is the message. Donald Trump threatens the Democratic Party, the bureaucracy and the traditional mainstream media.  He also threatens some of the Republicans.

He is a crude speaking person from Queens, New York. He has been called a brawler by some. He says he never starts a fight. He fights back. Many say he fights back in an unappealing way.

He says his goal is to drain the swamp. We have all gotten a glimpse of the inefficient and at times corrupt bureaucracy within our government. We can see the swamp’s depth only because of the Internet and the availability of alternate news opinions.

President Trump is working hard to streamline and increase the efficiency of the ever-expanding bureaucracy. He is a direct threat to their well-being. This is their justification for hating him.

The traditional mainstream media has promoted the Democrats’ agenda. They have helped obstruct President Trump’s agenda. The media has ignored or criticized the continual successes of President Trump.

It has either published disinformation or misinformation, ignored critical thinking on issues, or simply published non-truths.

President Trump has had no choice. Obamacare remained the law. It has been expensive and unsuccessful. It is impossible to know its yearly cost to the federal government. It is self-imploding and will disappear shortly.

Obamacare has just completed its open enrollment period for 2020. The enrollment period is supposed to end on December 15^th. The Obama administration extended it to March 31 during some enrollment years. The Trump administration has extended the 2020 open enrollment period until December 31, 2019 this year.

85% of people who enrolled in Obamacare have a preexisting illness. The Obama administration has subsidized most of the premiums. It did not subsidize the deductibles. Obamacare participants still could not afford to pay the deductible. In essence, participants have no healthcare insurance because they could not afford to use it.

Open enrollment as of December 7, 2019, was awful.

http://acasignups.net/blogs/charles-gaba

There are only 6,134,477 who have enrolled in 2020 compared to 16.1 million enrollees in 2014. Medicaid was expanded by 9.3 million in 2014. With the Medicaid expansion, a total of 25 million people received insurance in 2014. 

Medicaid is a single party payor. It is inefficient. It has a problem getting physicians to participate because reimbursement does not cover most physician’s overhead.

President Obama decided to have the federal government pay over 90% of the state-run Medicaid programs for a few years.  The states, which signed up for the Medicaid expansion, did not have an increase in costs.

When states have to start paying more for the Medicaid expansion, they will have to raise taxes because by law they cannot have a budget deficit. At the moment most of those states have unauthorized budget deficits. Those deficits will become worse when they have to fund expanded Medicaid.

The mainstream media and Democratic congress continually publish the figure that Obamacare has decreased the uninsured by 20 million. However, eleven million were that result of the expanded Medicaid program.

2014

The numbers do not match. The government graphs are complex and confusing. However, they are very informative. The graphs tend to confuse us with estimates and actual enrollees.

 In 2016 the numbers decreased to 9.3 million with open enrollment extended to February 1, 2016

 2016

 Medicaid enrollment increased in 2016 to 15.3 million.  The Medicaid increase is included in the total number of previously uninsured, Obamacare provided healthcare insurance. Obamacare’s increase in previously uninsured is, in fact, an expansion of Medicaid.  The mainstream media use the number 20 million newly insured patients which is a misleading justification for fixing Obamacare. Some of Medicaid’s increase enrollment could represent the illegal immigrants who are now entitled to healthcare coverage.

The net Medicaid increase since March 2010 in 2016 was 16.3 million. It looks like Obamacare’s goal was to increase Medicaid. The next step is to have “Medicaid/Medicare for All.”

2018 remained the same as in 2016, with many more dropouts because people realized Obamacare’s unaffordability. Since it was unaffordable, they realized they could not afford care event thought they paid their premium. Therefore, they dropped out and stopped paying their premiums.

2020 has been the expected disaster. Consumers needed relief from the Obamacare disaster. Obamacare has caused a further increase in dysfunction in an already dysfunctional healthcare system for people insured by Medicare, Medicaid and Private Healthcare insurance. 

Everyone is dissatisfied.

Only 6.1 million consumers have enrolled in Obamacare for 2020.

President Trump is hoping that after the 2020 election, he will have a friendlier Congress. Obamacare will be repealed. Congress will want to do something to help him repair the healthcare system. Meanwhile, he can only do some structural changes to lead us on the path toward an affordable healthcare system.

I predicted Obamacare would eventually fail when it was passed in 2010. Obamacare did not align stakeholders’ incentives!

Obamacare was destined to become unaffordable to consumers, the states and the federal government.

Bernie Sanders’ and Elizabeth Warren’s “Medicare for All” will suffer the same fate as Obamacare.

Most of all the taxpayers in the nation will suffer the most.

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



Copywrite 2006-2020

Please have a friend subscribe