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The Bipartisan Romney’s Massachusetts Plan Is Going To Fail !

October 15, 2008
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Stanley Feld M.D., FACP,MACE

A reader asked why I am spending so much time on the Massachusetts universal healthcare plan?

It is because many states are trying to install a similar plan. There must be some deal where the government will support states that adopt such a plan. Massachusetts just collected 10.2 billion dollars extra from the Bush administration for the plans’ failure.

I believe it was a bipartisan bill because the Republicans thought they would get a political advantage over the Democrats from the bill, and the Democrats thought they would get a political advantage over the Republicans.

The Bush administration wants to shift the responsibility of universal coverage from the federal government to the states and avoid another entitlement program.

Romney was running for president at the time and wanted to do something big. The Massachusetts Democrats did not want to be against something that might make a big difference.

However, the Massachusetts healthcare plan was not thought out. Massachusetts did not control the premiums costs they promised to subsidize while putting a ceiling and floor on premiums to the consumers. They did not set appropriate incentives for employers to continue to provide healthcare to employees.

The number of enrollees was underestimated. The premiums the healthcare insurance industry was demanding increased and is inflated. Rather than the normal laws of insurance cost prevailing (the more lives insured the lower the premium cost) the opposite is happening. The cost of the healthcare system is rising in Massachusetts at a more rapid rate than in other parts of the country.

Emergency Room charges are higher than physician office visit charges for the same illness. However, in the new system family practitioners and internists are overbooked. The waiting list is at least three months.

Thousand of newly insured patients have figured out that the fastest way to see a physician is to go to the Emergency Room.

“Thousands of newly insured Massachusetts residents are relying on emergency rooms for routine medical care, an expensive habit that drives up healthcare costs and thwarts a major goal of the state’s first-in-the-nation health insurance law.”

Citizens in Massachusetts are going to the emergency room at a 40% higher rate than the national average and a 20% higher rate than before  the present universal healthcare system.

 

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The 2006 law is a mandated universal healthcare law. It requires nearly everyone to have health insurance coverage. The policy wonks hoped would ease overuse of ERs as the newly insured went instead to primary care doctors for non-urgent health needs. They cannot see their primary care doctor for months because of overuse of the system.

“Routine care in ERs is considerably more expensive than at a doctor’s office or community health center. The average charge for treating a non-emergency illness in the ER is $976, according to a 2007 report by the state Division of Health Care Finance and Policy, which estimated that the total bill for non-urgent ER care in Massachusetts exceeded $1 billion in 2005. In comparison, it costs between $84 and $164 to treat a typical ailment such as strep throat in a primary care doctor’s office, according to Blue Cross Blue Shield of Massachusetts, the state’s largest private insurer. “

What happened? No state official thought out the perverse outcomes. No one thought to  motivate patients to save money. No one thought of teaching physicians to change their practice patterns to make room for acute medical illness. No one thought of setting up a system of education to teach patients to take care of illnesses that do not need to be seen.

What is the reason no one thought of these things? It is because no one asked practicing physicians what they thought the problems were.

John McCain doesn’t address the issue. Barack Obama’s plan for universal coverage will follow the Romney plan except it will be a federal government entitlement program. Neither the Massachusetts plan nor the presidential candidates’ healthcare plans create incentives for patients to be responsible for how they spend their healthcare dollar.

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Is Medical Care a Right or a Responsibility?

October 12, 2008
inPoliticians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust, Universal Healthcare
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Stanley Feld M.D., FACP, MACE

During the debate on October 7 the presidential candidates were asked if healthcare was a right or a responsibility. In my view neither candidate answered correctly. It demonstrated each candidate’s lack of understanding of the issue.

McCain said:

“I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. … But government mandates I — I’m always a little nervous about. But it is certainly my responsibility.”

John McCain’s answer is  incomprehensible. He is desperately trying to stay on message. He wants to transfer all entitlements including Medicare, and Social Security to the private sector. One has the think of the disaster the privatization of Social Society would have been during this economic meltdown. I think John McCain understands the weakness of his position on entitlements. He weakened himself even further with unconnected gibberish.

Obama said:

“I think it should be a right for every American. … for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that”

Barack Obama’s answer does not prove it should be a right. It shows the power and callousness of the healthcare insurance industry. I have said over and over again that the healthcare insurance industry is not the solution, it is the problem

Both candidates’ get a poor grade for their answer. Their answers indicate neither one has an understanding of the healthcare problem. If you do not understand a problem you can not develop a viable solution to fix the problem. The solution has to be fair to all stakeholders.

The correct answer is the individual’s healthcare should be both a right and a responsibility. Healthcare coverage should be the right of every citizen regardless of age, preexisting illness or income. If citizens choose not to be responsible for their health they should suffer a penalty. If a person is ill he should be responsible for adhering to the medical treatment and follow up or suffer a penalty.

If a citizen suffers a random non-curable illness it is an actuarial hazard that insurance should protect against. If a citizen takes care of his chronic disease to avoid complications he should receive a reward. The process will stimulate responsible behavior for the person’s well being.

Obesity should be discouraged. It is a self inflicted major risk for chronic disease. Nothing is being done to reduce its’ incidence.

Affordable availability of healthcare should be a right of every citizen. At the far end we have  viable safety net hospitals. It seem the present administration is doing everything in it power to eliminate these facilities. John McCain’s thinking implies he will do the same.

Citizens should own their healthcare dollar as outlined in my ideal medical savings account. Employer based healthcare insurance has been the foundation of our healthcare system. In recent years employers have been ripped off by the healthcare industry. If the first $6000 of healthcare coverage was the responsibility of the employee and the employee could keep any money not spent for retirement, the employee would have the incentive to shop for the best medical care at the best price. A communications system could be set up to direct patients to this best care model. This system would provide incentives for caregivers to provide better care.

If a person was self employed or unemployed, means testing would determine the subsidy or payment on a fair basis.

Educational programs for avoiding chronic diseases must be set up or supported through grants by the government to encourage citizens to be responsible for their right.

The government must be responsible for passing legislation to promote environment reforms. Dirty coal plans should be banned. We could prevent at least 21,850 hospital admissions per year nationally. There were 26,000 Emergency room visits for asthma alone last year. Asthma is the No. 1 cause of kids ending up in the Emergency Room. Dirty coal burning power plants cause 554,000 asthmatic attacks, 16,200 attacks of chronic bronchitis, 38,200 heart attacks and 23,600 deaths per year.

I have emphasized that preventing chronic disease and its complications is the key to reducing our healthcare costs. Eighty percent of our healthcare dollar is spent on the complications of chronic disease. Ninety percent of the Medicare dollars are spent on the complication of chronic disease.

 

The narcotics industry is another big problem ”The cost to society of illicit drug abuse alone is $181 billion annually.”

Societal costs combined with alcohol and tobacco costs, exceed $500 billion including healthcare, criminal justice, and lost productivity.

The cost of drug addiction is a tremendous burden to the healthcare system. Yet we are supporting a government in Afghanistan where both the enemy and the government profit from narcotics without the United States doing anything about it. There is no sign that the next administration will do differently.

Americans must wake up. The Presidential candidates must wake up. We need universal healthcare. It is a right and responsibility of every citizen. It is the responsibility of the government to promote a healthy environment so we can exercise our responsibility to remain healthy.

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

  • Sarah • March 17, 2009

    I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
    Sarah
    http://www.lyricsdigs.com

  • rocky • June 2, 2009

    this is a nice post

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Everyone Wants To Be Bailed Out: Part 1

October 8, 2008
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

 

Massachusetts will receive $10.6 billion dollars over three years from the federal government to help fund its mandated universal healthcare insurance debacle. President Bush’s goal is to move government entitlement programs to the private sector. Medicare and Medicaid would be moved to the domain of the private healthcare insurance industry if he gets his way.

From the onset Mitt Romney’s ill conceived bipartisan universal healthcare legislation in Massachusetts was destined to fail. It was destined to fail because it would be financed by the state but run by the private sector without changing the structure of the healthcare system. It was clear to me the universal healthcare plan would go through a series of modifications at taxpayers’ expense while the healthcare insurance industry profited and access to and coverage for healthcare decreased. The Massachusetts’s universal healthcare plan is failing despite the disinformation and misinformation of Massachusetts officials.

“At a time when many states are facing substantial cuts in federal financing, Massachusetts will be able to expand its first-in-the-nation healthcare law because of a federal promise of $10.6 billion dollars over the next three years, Governor Deval Patrick said yesterday.”

The federal government is bailing out the universal healthcare coverage program because of increased premiums demanded by the healthcare insurance industry.

Making things worse is new state legislation raising taxes on employers not offering enough employees healthcare insurance.

“Under Massachusetts’ landmark health care law, employers who did not enroll at least a quarter of their workers in an insurance plan or contribute a third of the premium costs faced a $295 annual fee per worker.”

The reasoning is faulty after the state’s promise to guarantee universal care at no penalty to employers. The error made by the state was to provide universal care with the healthcare insurance industry being in control of the healthcare dollars rather than the consumers being in control of their healthcare dollars.

If patients were in control of their healthcare dollars and had the right to save for retirement the healthcare insurance dollars not spent for retirement two things would happen. Consumers would be motivated to carefully spend their own healthcare dollars and the administrative costs in first dollar coverage would be eliminated.

“Sarah Iselin, commissioner of the Massachusetts Division of Health Care Finance and Policy, said the new regulations would help ensure that all businesses are making a fair contribution to support the new insurance law.”

In addition to the $10.6 billion dollar bailout the division of healthcare finance is taxing employers. Employers are first, consumers are next and then providers. The state and federal government are presumably finished contributing.

“The long-term success of health care reform requires the continued shared commitment of consumers, employers, providers and government to achieve near-universal coverage in Massachusetts,” Iselin said.

Businesses said the changes run counter to the original intent of the so-called “fair share contribution” portion of the original law, which was designed to encourage employers to offer insurance to workers — but stop short of a mandate.

Businesses should not be surprised at this turn of events. Romney’s universal healthcare plan used the wrong formula in the wrong state.

“The deal, struck after months of delicate negotiations, gives Massachusetts about $2.1 billion more than it received from the government in its last round of negotiations three years ago for its Medicaid waiver package. The waiver allows Massachusetts to provide subsidized health insurance to some residents with incomes higher than would typically be allowed under traditional Medicaid rules.”

People who cannot afford healthcare insurance should be subsided. However, they have to be motivated to take care of their health and be concerned about spending their healthcare dollars. This connection is not made by anyone in government.

“Several state leaders characterized the agreement as a federal stamp of approval for Massachusetts’ historic healthcare law, which was enacted in 2006 and requires nearly every resident to have coverage.”

State leaders are living in a fantasy world. Citizen of the state will pay the price for state leaders inability to think clearly about this issue.

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

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The Role Of Government In Healthcare

October 5, 2008
inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

I believe in the power of the free market if the rules are fair to all.  Logic and common sense should determine healthcare policy. I am suspicious of the validity of pilot studies designed to test healthcare policy initiatives. The studies usually are defective in their design. 

The rules of the free market in healthcare should be in favor of the consumer driven healthcare model . Physicians will listen to patients if the patients control the healthcare dollar. The primary stakeholders (patients) should own their healthcare dollar and their employer should continue to pay for the healthcare benefit. The healthcare insurance industry should not be in control of the healthcare dollar.

The proposed healthcare reforms of both presidential candidates cannot work because the healthcare insurance industry  controls the healthcare dollar and therefore the healthcare system.

Neither Presidential candidate has a chance at constructive healthcare reform.

In order for America’s economy to grow and prosper, America must promote the growth of a strong working middle class. A nation without a strong middle class having an opportunity to enjoy upward mobility is a nation that is stagnating and on the way to bankruptcy. The middle class has experienced a lack of growth lately because they have been disadvantaged to the benefit of the wealthy. They have been disadvantaged in healthcare, housing, finance, education and other social systems that have been declared broken.  Our artificial free market economies have rules that promotes the growth of narrow vested interests and stimulates greed.

The middle class must have the opportunity be educated. It must be provided with incentives to be innovative. It must have affordable healthcare and housing. These incentives must be available for all Americans. Education and health are our most valuable assets. America must develop a cultural atmosphere to encouraged citizens to practice civic and self responsibility. The environment must be free of pollution to protect citizens from disease and illness. The air that we breathe and the food that we eat must not be influenced by the greed of special vested interests.

In recent weeks we have experienced bailout proposals for our financial system.  The proposal initially ignored the protection of the middle class. In my view the first draft of the Bush bailout proposal was an insult to America’s intelligence. It favored special vested interests and furthered citizen mistrust of the federal government. The terms of the initial bailout were for the protection of Wall Street and not the protection of Main Street. The protection of Wall Street was supposed to trickle down to Main Street. The final agreement will hopefully have protections for Main Street  as well as Wall Street with no pork. These dual protections should have been embodied in the initial proposal. We should not reward corporate executives’ failure.

I have written to both John McCain and Barack Obama about my thoughts on Repairing the Healthcare System. All I have gotten back is pleas from both campaigns requesting donations. My input has as many other citizens’ input been ignored by both campaigns.

The media has characterized the presidential campaign and debates as a boxing match. The media count who outscored who on points. I hear platitudes but no specific proposals on how to protect the middle class.

I hear John McCain say he is going to fight and fight hard for the middle class as he has done for 28 years. The few specific proposals he has presented protect wealthy vested interests.

Barack Obama says he is going to look after the middle class at the expense of the vested interested  high wage earners and investors. He does not tell us how he is going to go about it.

John McCain says he is opposed to regulations yet deregulation has gotten us in the position we are in. He reversed himself at twhen it was obvious our economy was about to collapse. A few days earlier he said our economy was basically sound. He did not project the perception of knowledge of economics to America. 

It sounds like Barack Obama wants to fix everything with regulations.  We have seen historically that regulating everything does not work. A simple example is the failure and perverse effects of price controls. A true market economy works if the correct rules are in place for the benefit of all. I am against government regulations that are oppressive to incentives and innovation.

Our legal system is also broken. It is not easy to enforce the law. Corporations, organizations, and citizens get around the law if they can afford the legal expense at the expense of the middle class. There is little penalty for misrepresentation. Congress is controlled by lobbying groups. Who are the peoples’ lobbying groups? The congress should be the lobbying group for the all citizens. Instead, Congress is lobbied and influenced by vested interests.

Government should make and enforce appropriate and fair rules. It should get out of the way and let consumers drive the system. Americans are smart enough to purchase the best products for themselves given the appropriate information. 

I have criticized the healthcare insurance industry. John McCain wants to give the control of the institutions of Medicare and Medicaid to the healthcare insurance industry in order to eliminate this entitlement. The healthcare insurance industry does nothing for the middle class and small businesses and everything for its own bottom line. Obscene healthcare insurance executives’ salaries and corrupt payoffs occur at the expense of ordinary people.

Once again, it is healthcare insurance contract time for hospital systems and employers paying for healthcare insurance. Again, there have been examples of difficulty between the healthcare insurance industry, hospitals physicians and employers. Once again Unitedhealthcare  is using the same tactics they used in the Denver market last year. Neither Congress nor the State Insurance Boards have taken action to protect the middle class.

 

The headline in the Kansas City Star reported that ”

“St. Luke’s Hospital system in Kansas City and UnitedHealthcare go their separate ways as the price of healthcare insurance goes up and the coverage goes down.”

“In July, after a year and a half of trying to come to agreement, the nonprofit St. Luke’s — which encompasses 11 hospitals and several physician practices in the region — said it was done negotiating and would stop accepting United benefits after Feb. 28, 2009”

“St. Luke’s perspective, negotiations had been going on for a year and a half without significant progress. It announced a firm split with United in July so patients and businesses would have ample time to find new coverage if they wanted to stay in St. Luke’s network

“Bonner, who is senior vice president of business development for St. Luke’s, said the increase the hospital asked for would have brought reimbursement rates from United in line with other insurance carriers.”

I suspect both are wrong. I suspect the negotiating tactic UnitedHealthcare uses is the same used in Denver. They yield when they start losing subscribers.

United, which has 504,000 “members” in northwest Missouri and all of Kansas, would continue negotiating if St. Luke’s came back to the table, Tracy said, but he admitted reconciliation is highly unlikely.”

“United’s insurance-carrier competitors said they are seeing a windfall. Since St. Luke’s announcement this summer, Humana has been writing about 40 policies a month for companies leaving United, said David Miller, president of Humana in Kansas and Missouri.”

The losers are the middle class who would buy insurance if they could afford the premiums. The State Insurance boards must develop and enforce real  transparency rules for the healthcare insurance industry. If the rules are not followed the healthcare insurance company should lose its license to sell insurance in the state.  The rules must be made and enforced by the insurance board and state hospital boards before negotiation comes to this point. Presently, there is no simple mechanism for adjudications. State boards of insurance and hospital systems’ mandates must have effective consumer protection.

Patients are not included in the free market determination of price. They are the victims of a market price controlled by the healthcare insurance industry (secondary stakeholders).

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Stinkin Thinkin Part 3 President Bush Does It Again!

September 30, 2008
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Stanley Feld M.D.,FACP,MACE

 

In the waning hours of his administration President George W Bush is trying to sneak in legislation to weaken a woman’s right to choose. It took Hillary Clinton and Cecile Richards writing an op ed in the New York Times on September 19th to expose his scheme.

“ a proposed rule from the Department of Health and Human Services that would govern family planning. It would require that any health care entity that receives federal financing — whether it’s a physician in private practice, a hospital or a state government — certify in writing that none of its employees are required to assist in any way with medical services they find objectionable.”

President Bush’s proposed rule is another attempt to attack Roe v. Wade. The larger issue is an attack on our constitutional freedom as described in Roe v. Wade’s decision. His proposed rule is another way to undermine the Supreme Court decision.

“Laws that have been on the books for some 30 years already allow doctors to refuse to perform abortions. The new rule would go further, ensuring that all employees and volunteers for health care entities can refuse to aid in providing any treatment they object to, which could include not only abortion and sterilization but also contraception.”

The government is threatening to remove federal financing from any entity providing healthcare or medical care, if the federal government found that entity in noncompliance with the proposed rule.

“Health and Human Services estimates that the rule, which would affect nearly 600,000 hospitals, clinics and other health care providers, would cost $44.5 million a year to administer.”

I thought Republicans and the Republican administration opposed unnecessary spending. This proposal has not been highlighted until Hillary Clinton’s op ed. The fourteenth amendment defines the constitutional right to privacy. America was built on the premise of separation between church and state as stated in the first amendment.

Religious beliefs should not be translated into federal law. Larry Tribe makes that clear in his book “The Invisible Constitution”.

Roe v. Wade, 410 U.S. 113 (1973) is a controversial United States Supreme Court case that resulted in a landmark decision regarding abortion.

According to the Roe decision, most laws against abortion in the United States violated a constitutional right to privacy under the Due Process Clause of the Fourteenth Amendment. The decision overturned all state and federal laws outlawing or restricting abortion that were inconsistent with its holdings. Roe v. Wade is one of the most controversial and politically significant cases in U.S. Supreme Court history. Its lesser-known companion case, Doe v. Bolton, was decided at the same time.[2]

Roe v. Wade centrally held that a mother may abort her pregnancy for any reason, up until the “point at which the fetus becomes ‘viable.’ The Court defined viable as being potentially able to live outside the mother’s womb, albeit with artificial aid. Viability usually occurs at about seven months (28 weeks) but may occur earlier, even at 24 weeks.”[1] The Court also held that abortion after viability must be available when needed to protect a woman’s health, which the Court defined broadly in the companion case of Doe v. Bolton. These rulings affected laws in 46 states.[3]

Abortion is a religious issue and not a state issue. It is not an emotional issue that can be debated into law. It is an constitutional individual rights issue about freedom. The Supreme Court made this very clear in 1973. Citizens of the United States should have the right to their religious beliefs but the government  should not impose religious beliefs on the rights of others.

President George W. Bush in his proposed new rule left open the interpretation of abortion.

“The definition of abortion in the proposed rule is left open to interpretation. An earlier draft included a medically inaccurate definition that included commonly prescribed forms of contraception like birth control pills, IUD’s and emergency contraception. That language has been removed, but because the current version includes no definition at all, individual health care providers (and the federal government) could decide on their own that birth control is the same as abortion.”

The Bush administration always tries to justify its many attacks on freedoms granted by our constitution by hiding behind protecting our rights and freedoms. He is attacking a basic freedom with this rule.  I believe the American people are too smart to buy into his thinking.

“The Bush administration argues that the rule is designed to protect a provider’s conscience. But where are the protections for patients?” (and patient’s freedoms)

I read about this proposed rule on September 28th. The comment period ended Sept 25th. The goal of the administration was to sneak the proposal past the public. Why didn’t our presidential candidates publicize the proposed rule?

“The 30-day comment period on the proposed rule runs until Sept. 25. Everyone who believes that women should have full access to medical care should make their voices heard. Basic, quality care for millions of women is at stake.”

Even though the 30 day comment period has ended, it is never too late to contact our legislators, They must listen! We elect them!  I believe everyone opposed to this proposal should write their representatives in congress as well as their local newspapers. They should send their objections to both John McCain and B
arack Obama. 

The Republican Party declares it is against government regulations. Yet it wants to impose regulations on one of our basic freedoms. The right to privacy. 

Does anyone want four more years of Stinkin Thinkin?

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

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Healthcare Disappears As An Election Issue

September 28, 2008
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

 

We have not heard much about the healthcare issue in the last three weeks. The 47 million uninsured have been ignored by both candidates. The upcoming 100 trillion dollar Medicare deficit has been ignored. I guess if politicians ignore a problem it goes away.

The present administration and congress is ignoring the middle class during this financial crisis. In Naomi Klein’s Shock Doctrine the basis premise is only a crisis actual or perceived produces a real changes. Klein credits the theory to Milton Friedman. This You Tube link is worth seeing.  She provides numerous examples of recent applications of the premise to advantage the rich at the expense of the middle class.

A crises permits unimagined change. It produces increased citizen dependency on government. The government officials can imposes policies to the advantage of the few in the guises of helping the many. These changes must be imposed before society recovers from the shock. The Republican administrations has declared goal is the elimination of entitlements and regulations. President Bush and potential President John McCain want to privatize Social Security and Medicare. The only way to do this is to create a crisis on Main street and shift the costs to Main Street for the advantage of a few. 

I believe this is what is happening right now with Secretary Paulsen’s proposal to bailout the financial system. His bailout package does not offer assistance  to people with mortgage problems that resulted from the banking systems irresponsible but profitable actions.

The financial community will get relief. The taxpayer will not get relief with his proposal. The taxpayer will foot the bill without any hope for payback or profit. This present crisis has not happened overnight. Yet neither Presidential candidate took the lead in exposing the problems. The problems have been common knowledge for a long time. Neither has either candidate taken the leadership to articulate the unfairness of the proposed bail out to the American people.

The healthcare systems problem have not happened over night either. The Shock Doctrine principles will rear its ugly head. When the healthcare system collapses the Shock Doctrine will result in a disaster in either direction. Either the new Republican administration will hand unregulated total control of the healthcare system to the healthcare insurance industry. or we will have socialized medicine with the Democratic administration.

Yet, “No one is speaking about healthcare any more. The economy, price of gas, war in Iraq have surpassed the uninsured and healthcare insurance premiums as top election issue for candidates”

“Public opinion polls have shown that among the top issues of concern to Americans, health care is languishing far behind the economy, the war and the price of gas. One CBS poll from July put voter interest in health care at just 3 percent. In August, it was at 8 percent.”

How can this happen? It can happen very easily. The media is the message. Only 20% of the population uses the healthcare system at any one time. Healthcare is not the concern of 80% of the population at any one time. The bigger issue of Repairing the Healthcare System so Americans can receive the best care on the planet is not a vital issue to either candidate when Americans are preoccupied with the present shock. Barack Obama has tried to generate a conversation about healthcare but John McCain has no new healthcare plan or the interest in a  discussion about healthcare. He knows the Shock Doctrine will prevail when the healthcare system collapses. He will then be able to eliminate the entitlement he hates.

American’s most precious asset is health. A functional healthcare system is vital to our health as a nation.

“For a lot of people who have health insurance, they are paying more for health care, but it may not show up as concretely as paying $70 to fill their gas tank,” said Anna Greenberg, a Democratic pollster.”

The candidates do not seem to have an interest in healthcare because the majority of Americans are not affected. When we have a severe economic downturn the majority of Americans will be affected. However it will be after the election. It will be too late to deal with the healthcare issue rationally. Also the candidates must realize how shallow and uninformed their concepts of the problems of the healthcare system are.

“There were no conference calls to talk about health care. There were no television ads about health care”

Barack Obama’s campaign claims healthcare is a top issue but does not force it to be a top issue. His solution to the healthcare system is not a viable solution.

 

“Obama’s spokesman, Bill Burton, said the problem is the press, not the campaign.” 

“The issue of health care may be getting less attention than it deserves from the media, but it’s still a top concern for voters and among the top issues that Sen. Obama talks about on the campaign trail,” said Burton.

Tucker Bounds, a spokesman for McCain, acknowledged that the issue has not been prominent so far but when pressed with why the conversation is not a priority he says,

“However,” he said, “There is a stark contrast in the way both candidates would address the issue. Because the views on providing affordability, accessibility and portability of health care are so divergent, it could hardly escape the conversation each candidate will have with voters.”

As usual Tucker Bounds  is making a  meaningless statement.

I believe more and more Americans are waking up to the existence of these  non-specific answers to specific problems. Americans will express themselves at the polls next month. The traditional politicians better wake up. They had better start expressing the will of Main Street and not the will of Wall Street or else they will be out of power.

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

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Stinkin’ Thinkin’ Part 2 Health Costs: More Cost Burden on the Employee

September 24, 2008
inConsumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D., FACP, MACE  

Sound Bytes are deceiving. The Republican Party’s Presidential candidate, Republican Party politicians, and Republican policy wonks have often quoted reports that health care costs are expected to ease slightly for employers in 2009. There is deception in this fact. The overall decrease in healthcare costs for businesses is the result of its shifting the burden of costs to their employees. The result is a decrease in cost for the employers nationally. Therefore the sound byte is inaccurate. The cost of healthcare actually will rise 5.7% for the employers. This represents a decrease from last years rise of 6.1%. The direct costs to the consumer increases 29% next year. Once again, the devil is in the details. We can not rely on sound bytes.  The healthcare insurance industry triumphs again.  The result will be an increase in healthcare insurance industry net profits.   

 

 

What does all this mean in the present Presidential campaign?  Why are healthcare insurance premiums increasing when the provider reimbursement is decreasing? Why is the burden of the cost of healthcare insurance shifting to patients away from the government and the employers? President Bush and a McCain presidency’s goal is to shift the burden of healthcare costs to the employee. Is this going to improve the uninsured problem? No! It will make it worse.

It looks like the healthcare insurance industry is killing the goose that lays its golden egg. It looks like John McCain wants to help the healthcare insurance industry accomplish this feat without either of them realizing it.  It will happen at the expense of the consumer until the consumer cannot tolerate it any more.

It also looks like John McCain’s policy of more of the same is helping Barack Obama and the Democratic Party justify universal healthcare coverage by a single party payer. An equally disasterous strategy. Where are the principles that have made America great? All politicians should be forced to read Adam Smith’s “Wealth of Nations“.

Dick Swersy’s comment on my blog about the Nobel Prize winning technique to repair the healthcare system is noteworthy.   Mechanism Design to Repair the Healthcare  is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may be self-interested. This is done by setting up a structure in which each player has an incentive to behave as the designer intends. The game will then implement the desired outcome. The strength of such a result depends on the solution concepts used in the game. 

Mechanism designers commonly try to achieve the following basic outcomes: truthfulness, individual rationality, budget balance, and social welfare. However, it is impossible to guarantee optimal results for all four outcomes simultaneously in many situations, particularly in markets where buyers can also be sellers. Significant research in mechanism design must decide on making trade-offs between these qualities and vested interests. The most desirable outcome in the healthcare system should be sustaining patients’ welfare and physicians’ incentives for innovations in care. These goals will strengthen our healthcare system not weaken it.

Our Presidential candidates are not thinking of these goal as they formulate programs to sustain the goals of the secondary stakeholders. How can you create affordable insurance when coverage decreases, deductibles increase, and the price decreases are defined by increasing the price 5.7% vs. 6.1% a year. It is a charade designed to fool Americans. The charade works because Americans are not paying attention to what is going on. We will complain when it is too late.

“America is at its most powerful and most influential when it is combing innovation and inspiration, wealth building and dignity building, the quest for big profits and the tackling of big problems. When we do just one, we are less than the sum of our parts. When we do both, we are greater than the sum of our parts- much greater” Thomas Friedman

  Our Presidential candidate are way off base. It is up to the people to pay attention and force  politicians to stop their Stinkin Thinkin.

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

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Stinkin Thinkin! Part 1

September 21, 2008
inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
• Leave a comment

 

Stanley Feld M.D.,FACP,MACE

 

Unfortunately John McCain has misrepresented Barack Obama’s positions on many issues. John McCain has changed his own position on many issues. He seems to have a meager or shallow grasp of most issues. He claims he is going to fight for the middle class but he has not defined what he is going to fight or a strategy to fight it. He has chosen a Vice Presidential running mate who is being sold to the public as a champion of the middle class. I believe this has been her appeal. However, I have not hear her define any substantive issues or strategies. He is running a campaign of symbolism rather than substance.

He has not spoken substantially about most issues. He does not seem to understand the needs of the middle class. He said on many occasions that the economy is basically sound. On September 17 he said he is going to clean up the financial mess. His plan is to appoint a committee like the 9/11 committee. He has also has stated he does not understand the economy. His campaign chairwoman says he would not make a good corporate CEO.

John McCain’s sound bytes are not even good. He is an embarrassment to the Republican Party. Nevertheless the “polls’ say almost 50% of us will vote for him. How can this be? How is it possible that he can be pulling the wool over the eyes of the American public?

On the issue of healthcare he is way off the mark. His major proposal is his tax credit to consumers.

“Senator John McCain’s top domestic policy adviser, former Congressional Budget Office director Douglas J. Holtz-Eakin, recently said in a conference call with reporters that Mr. McCain’s health care proposal would “put 25 to 30 million individuals out of the ranks of the uninsured, into the ranks of the insured.”

In an article released Tuesday, a panel of prominent health economists concludes that Mr. Holtz-Eakin’s projection is off by, well, 25 to 30 million.

Simple logic tells us there is no way to decrease the number of uninsured by 25 to 30 million by creating a tax credit of $2,500 per individual and $5,000 per family to buy healthcare insurance. The tax credit is insufficient to have very much impact. It is not even a good sound byte because healthcare insurance costs $6,000 per individual and $12,000 per family. The families will still not be able to afford healthcare insurance.

However, the sound byte represents a major tenet of his healthcare plan. Even if he was correct the common man would still be at the mercy of the abusive healthcare insurance industry. He has said nothing about correcting healthcare insurance industry abuse and inefficiency. The abuse is directly related to how the healthcare insurance industry calculates the healthcare premiums.

“The article, published in the journal Health Affairs, argues that “initially there would be no real change in the number of people covered as a result of the McCain plan.” After a short-term reduction of 1 million in the number of people without coverage, the number of uninsured would increase by 5 million after five years, the authors predict. There are currently 45 million people without insurance, or 15 percent of the population, according to the Census Bureau.”


This misrepresentation of the true effect of his policy is pervasive in all of John McCain’s campaign assertions. His healthcare policy will not create more competition among insurance companies. It will give the healthcare insurance industry more control of the premiums charged and an opportunity for great net profits. Have media sound bytes become more influential in decision making than logic and facts? I believe Americans are smarter than that.

“That, the McCain campaign asserts, would drive more people into the individual market, fomenting competition, reducing premiums and discouraging consumers from buying more coverage than they need or can afford. The economists wrote that many “people are likely to have far less generous policies than those they have today.”

The economists are from the University of Michigan, Columbia, Indiana University and Harvard. Their estimates of the effect of McCain’s healthcare tax credits are comparable to those made in July by the Urban Institute and Brookings Institution. The Urban Institute and Brookings Institute projected that 1 million people would gain coverage after one year under Mr. McCain’s plan, that almost 5 million people would gain coverage after four years, and that the number of uninsured would then creep upward.

John McCain is obsessed with the growth of entitlements like Medicare, Medicaid and Social Security. He is correct. They have gotten out of hand because of their defective structure. His goal is to shift these entitlements over to the private sector. The private sector loves his goal because it is an opportunity to increase profits.

John McCain should be asking why the entitlements are failing rather than giving them away to institutions that have abused systems such as the healthcare industry and the financial industry. These entitlements are failing because of their structure. These institutions will have to be restructured to correct their defects and inefficiencies. The current bureaucracies are incapable of creating initiatives linked to innovation and change.

Privatizing these institutions is not going to make things better for our middle class. John McCain’s plans will drive the middle class toward poverty for the benefit of big business. The pity is John McCain does not know the effect his plan is destined to have.

The strength of America is in a vibrant middle class with incentives to advance through education. It is in the creation of the desire and capability for upward mobility for the lower and middle class that will make us stronger. Government has to set rules that are fair to all and permit the lower class to rise to the middle class. People must have hope, security and goals. The middle class should not be conditioned to live in fear of war, economic collapse, and lack of adequate healthcare.

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

  • Elliott Klug • September 22, 2008

    Dr. Feld – I commend you and thank you for such a frank analysis. Sound Byte policy is scary and Mr. McCain’s fighter pilot approach is scarier.
    Will your fellow republicans take heed?
    An Independent.

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