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My Impression Of The Canadian Healthcare System

Stanley Feld M.D.,FACP,MACE

 

Cecelia ad I just returned from a trip to
Halifax, Cape Breton Island and Prince Edward Island. It was a phenomenal trip.

 
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It was too early in the fall season for the
trees to turn color but the weather was great and the countryside was glorious.

 
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We had planed to go there 49 years ago on our
honeymoon.

We did not have time to get all the way to
Halifax, Cape Breton or Prince Edward Island. We had to drive back to New York
City to start my medical internship on July 1st. 1963.

 Cecelia and I decided it was time to go for it.

 We stayed in Port Hood on Cape Breton for five
days, enjoyed the singing and dancing and had a wonderful drive around the
Cabot Trail.

 
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I am a friendly guy and I was curious about how
the folks on the street like the Canadian healthcare system. I was tired of
listening to the Democratic Party’s propaganda.

The propaganda contradicts Canadian and former
Canadian physicians feeling about the system.

I spoke to a lot of people in the town we visited
about their feelings about the Canadian healthcare system.

 I came away with several impressions.  

 Dr. Kurisko practiced surgery in Canada before coming to the
United States to practice surgery.

Dr. Kurisko description
of the Canadian Healthcare System is very accurate. It reflects the feeling of
the people who have need to use the system.

  

 http://youtu.be/At9q6uFR3gU

Canadians are comfortable
with their medical entitlement. Everyone said they like the fact that if they get sick
they will not get “wiped out” by the costs as Americans might be.

I found a You Tube about the
Canadian system with responses of the common man. It clearly expresses this
sentiment.

  

http://youtu.be/VQFX32Ed7ZQ

This is the impression of a
group of people. The question is the possibility of a bias in selection of the
people interviewed.

Upon deeper questioning of
the people I spoke to, my conclusion is that once people get used to a medical
entitlement they are very hesitant to give it up even if it restricts their
freedom of choice. Only 20% of the population uses the healthcare system at any one time.

The second conclusion is
that this is the way the healthcare system is in Canada.   Canadian feel they must
live with it and get over complaining about it.

The things they did not like
about their healthcare single payer system is the very high sales tax in
addition to federal and provincial taxes.

The income tax baseline is lowe than
the U.S. and the income earned at the top rate of tax is lower than in the U.S. If you combine all taxes paid the rate is above 50%  for some income brackets and at least 30% for
the lowest income bracket.

I was not aware of the fact
that the sales tax on everything in Canada is 15% in addition to business taxes
and personal income taxes.  There is both
a province tax and a central tax on purchases.

 

Federal Tax Rates

Up to $41,544                                        15.00%

41,545–83,088                                      22.00 %

83,089–128,800                                    26.00 %

128,801 and over                                  29.00 %

 

Everyone pays federal
income tax in Canada. Fifty percent of U.S. citizens do not pay Federal income
tax

In addition to federal
income tax each province tax is slightly different Below are a few examples
.

 

British Columbia       

Up to $36,146           5.06%

36,147–72,293         7.70 %

$72,294–83,001          10.50%

$83,002–100,787        12.29%

$100,788 and over      14.70%

 

Alberta

10.00% All income

Saskatchewan

Up to $40,919     11.00%

$40,920–116,911   13.00%

$116,912 and over 15.00%

 

Ontario

 Up to $37,774      5.05%

$37,775–75,550      9.15%

$75,551 and over    20%

 

New Brunswick

 

Up to $37,150        9.10%

$37,151–74,300     12.10%

$74,301–120,796    12.40 %

$120,797 and over  14.30%

 

Nova Scotia

 Up to $29,590         8.79%

$29,591–59,180        14.95%

$59,181–93,000        16.67%

$93,001–150,000      17.50%

$150,001 and over     21.00%

 

We visited Halifax, Nova
Scotia and Charlottetown, Prince Edward Island but spent most of our time in
the countryside.

The long waiting times to
see a physician in the office and in the ER was a constant complaint.

The people complained about
the shortage of physicians. Their impression was that a lot of physicians fled
to the U.S. causing the physician shortage.

There were few small towns
with physicians. Bigger towns had small hospitals and physician shortages.
Larger towns had tertiary hospitals. These hospitals were full service hospitals.
These hospitals rationed care

The emergency rooms of any
size hospitals are always jammed. Sometimes you can wait for 6 hours and not
see a physician taking care of anyone.

One lady told me she had a
tremendous stomachache. She went to the ER waited more than 6 hours without
anyone in the ER seeing a physician. After 6 hours the pain started to subside.
She was so fatigued she went home.

I guess that is one way to
cure a patient. It took her 4 days before the pain to subside.

Another complaint was
follow-up visits by a patient with her own physician. The patient was a 65-year-old
diabetic female. Her physician was diligent. He wanted to see her every three
months. She could only get an appointment in 5 months.

One 55-year-old male with
heart disease said the healthcare system has been fine for him. He calls his
cardiologist at home. He is an interesting case and the cardiologist will see
him the next day.  

Many complained about the
waiting time for special test such as CAT scans and MRIs, hip and knee
replacements and cardiac catherizations.

Waiting times for hip and
knee replacements can be more than one year.

The Fraser Institute released
a report outlining the government financial difficulties with the Canadian healthcare system.

A 2011 report by the Fraser Institute concluded that
Canada’s health care system is spending at an unsustainable rate. Six of ten
Canadian provinces are on track to spend half of their revenues on health care,
according to the institute.”

“We conclude
that Canada’s health system produces rates of growth in health spending that
are not sustainable solely through redistributive public financing,” the report
concluded
.

I think it is about time Americans paid attention to
Obamacare. It will be worse for all.

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

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Canada Has Big Single Party Healthcare System Problems

Stanley Feld M.D., FACP, MACE

There are big problems in Canada that have been undisclosed by Democrats to the public in the United States.

There were two articles in American newspapers in 2011 that applaud the Canadian system.

 Article 1. Debunking Canadian health care myths – The Denver Post .

Article 2. Everything you ever wanted to know about Canadian health care in one post. Washington Post.

Both articles are opinion articles and lack concrete evidence. The articles contain both misinformation and disinformation.  The articles are in essence  fake news designed to mislead the American public into believing that a single party payer system is the answer to America’s healthcare systems problem.

The articles are precisely why the American public should not and does not trust politicians and the traditional mass media.

The Fraser Institute is a well-respected Canadian think tank. Its research is considered accurate, with a libertarian slant.

Its 2011 report contradicts the statistics in both the Washington Post’s and the Denver Post’s articles about the Canadian government healthcare costs.

 Article 1. “Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s.”

Article 2.  “In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries.”

This is not true according to the Fraser report. Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the Frazer Institute. To be specific, in 2011, health care spending consumed 50% GDP in Canada’s two largest provinces, Ontario and Quebec.

“Total federal, provincial and territorial government health spending has grown by 8.1 percent annually, while the national GDP in Canada rose by only 6.7 percent during the same period.”

 The provincial governments have raised taxes and rationed care, while increasing patient wait times.  

“Provincial drug plans have also more often refused to pay for most of the drugs that are certified as “safe and effective” by Health Canada.”

“Unsustainable rates of growth in health care spending crowd out the resources available for other purposes including education, public safety, and economic growth-enhancing tax relief.”

One has only to think about the Obama administration’s initial propaganda and the stunning reality we are facing presently. 

The VA is now asking for additional funding to clear up its disaster.

The problem is entitlements are too expensive for governments.  Entitlements do not work because governments cannot legislate behavior by directives. Individuals must be responsible for their health and healthcare dollars.

The other problem is government entitlement programs generate a large bureaucracy. The bureaucracy stimulates the development of inefficiencies and corruption. The new bureaucracy practically guarantees the failure of the entitlement.

The government never gets to the core problems that must be repaired when they try to construct a healthcare system that is efficient, cost effective and will benefit consumers. 

The primary stakeholders are consumers of healthcare. Physicians are a close second. Secondary stakeholders are hospital systems, healthcare insurance companies, drug companies, malpractice insurance companies, and the government.

In order to Repair America’s Healthcare System, the government must focus on the primary stakeholders’ (patients’) needs and ways to satisfy those needs. The key is to set up a system that provides the primary stakeholders (consumers of healthcare) with incentives to maintain their health and conserve their healthcare dollars. This applies to healthy consumers as well as patients with chronic diseases.

Patients with chronic diseases must become professors of their disease. They must understand the latest techniques and use the latest tools to prevent the progression of their disease.  

The healthcare system must help consumers be prosumers (productive consumers) of their own healthcare.

The Canadian system is not the answer to our healthcare system’s problems. The United States has a much larger population than Canada. The Canadian government cannot support its universal healthcare system.

 How will we? Bernie Sander’s state of Vermont has abandoned its “Medicare for All” program.

The only way the portion of our population in favor of Medicare for All is going to believe it is unsustainable and destined for failure is going to experience its failure. It seems Bernie and his followers have little interest in learning from previous experience.

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

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Does It Work For The Canadian Government?

Stanley Feld M.D.,FACP,MACE

In the last blog post I have discussed how a former Canadian
physician (now a U.S. physician) felt about the Canadian system.

The next question is does the Canadian Healthcare System work for the
Canadian government? 

The answer is No!

The Canadian deficit resulting from the Canadian healthcare system is mounting at a unsustainable rate in a country that is already overtaxed. The problem is
the government is not admitting it and the U.S. government and media are
ignoring it.  

I have discussed how patients I interviewed in Canada feel about
their healthcare system. Some of Canadians are bitter about Canadian physicians
immigrating to the U.S. because the practice conditions are better in the U.S. than
in Canada.

The Canadians complained that physicians coming to Canada from
India and China are not being licensed to practice medicine despite the severe
physician shortage. Most of these physicians are driving taxicabs.  

 I included a You Tube of Canada patients raving about the Canada
Healthcare system.

 The people interviewed looked healthy and probably did little
interacting with the healthcare system.

Is the Canadian healthcare system good or a least better than the
U.S. healthcare system?

There have been two recent articles in American newspapers that
applaud the Canadian system.

  1. Debunking Canadian health care myths
    – The Denver Post
                                                                                                                             http://www.denverpost.com/opinion/ci_12523427#ixzz25y9kuiVG

 2. Everything you ever wanted to know about Canadian
health care in one post. Washington Post

http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/01/everything-you-ever-wanted-to-know-about-canadian-health-care-in-one-post/

Both articles are opinion articles and lack concrete evidence. The
articles contain both misinformation and disinformation.  

 It reminded me of a Justice Scalia’s recent comment on 60 minutes.

“You should not believe what you read about the
court in the newspapers,” Scalia said. “Because the information has either been
made up or given to the newspapers by somebody who is violating a confidence,
which means that person is not reliable.”

Scalia

The Fraser Institute is a well-respected Canadian think tank. Its
research is accurate with a libertarian slant.

Its 2011 report contradicts the statistics in these articles
concerning the Canadian government healthcare costs.

 Article 1. “Ten percent of Canada's GDP is
spent on health care for 100 percent of the population. The U.S. spends 17
percent of its GDP but 15 percent of its population has no coverage whatsoever
and millions of others have inadequate coverage. In essence, the U.S. system is
considerably more expensive than Canada's.”

Article
2.
 “In 2009, Canada spent 11.4 percent
of its Gross Domestic Product on health care, which puts it on the slightly
higher end of OECD countries.”

This is not true
according to the Fraser report.
Six of ten Canadian provinces are on track to
spend half of their revenues on health care, according to the institute. To be
specific, in 2011, health care spending consumed 50 percent of revenues in
Canada’s two largest provinces, Ontario and Quebec.

According to the
institute,

“By 2017,
four more provinces — Saskatchewan, Alberta, British Columbia and New Brunswick
— will spend half of their revenues on health care.

These two articles are
either copying other inaccurate articles or copying each other. It could be
they are just reporting provincial (states) spending and not total costs.
Healthcare costs in Canada are rising faster than the GDP.

“Total
federal, provincial and territorial government health spending has grown by 8.1
percent annually, while the national GDP in Canada rose by only 6.7 percent
during the same period.”

Article 1 states that
the decision making for treatment and tests needed are made exclusively by the
patients’ physicians. We know this is not true because of the rationing of care
and the long wait times to see a physician.

“In Canada, the government has absolutely no say in who gets care or how
they get it. Medical decisions are left entirely up to doctors, as they should
be.”

There are no requirements for pre-authorization whatsoever. If your
family doctor says you need an MRI, you get one.”

Article 2. states the opposite.  “The Canadian health care system was
built around the principle that all citizens will receive all “
medically
necessary and hospital physician services
.” To that end, each of Canada’s 10
provinces and three territories finance and run a statewide health insurance
program with federal aid. There is no cost-sharing for the health care services
guaranteed under federal law.”

The Fraser report
describes the actions the provincial governments have taken in response to the
rapidly rising costs.

The provincial
governments have raised taxes and rationed care, increasing patient wait times.
This agrees with the reactions of the people I interviewed

“Provincial
drug plans have also more often refused to pay for most of the drugs that are
certified as “safe and effective” by Health Canada.”

“Unsustainable
rates of growth in health care spending crowd out the resources available for
other purposes including education, public safety, and economic
growth-enhancing tax relief,”

Despite Canada’s
increase in federal funding and rationing of care the cost of care increases.
The federal government has encouraged the individual provinces to make the
necessary reforms to increase their efficiency and decrease bureaucratic waste.
The low overhead figures quoted by the two U.S. newspaper articles are wrong.

We conclude
that Canada’s health system produces rates of growth in health spending that
are not sustainable solely through redistributive public financing,” the report
concluded.

“In 2011,
health care spending consumed 50 percent of revenues in Canada’s two largest
provinces, Ontario and Quebec.

By 2017,
four more provinces — Saskatchewan, Alberta, British Columbia and New Brunswick
— will spend half of their revenues on health care, according to the institute.”

“Federal
funding is not a solution: the federal government has already transferred
billions more in health funding to the provinces than the amounts needed to
keep up with general price inflation or population growth.  

The study added that none of the government’s rationing efforts
have made the growth of government spending on health care sustainable.

“The Fraser Institute concluded that Canada’s
health care system is spending at an unsustainable rate. Six of ten Canadian
provinces are on track to spend half of their revenues on health care
,
according to the institute.”

We conclude that Canada’s health system
produces rates of growth in health spending that are not sustainable solely
through redistributive public financing.”

The media is the message. The message sent controls behavior.

All Canadians want a comfortable entitlement for healthcare. I do
not blame them.

The problem is entitlements are too expensive for the government.  They don’t work because governments cannot
legislate behavior by directives. Individuals must be responsible for their
health and healthcare dollars. Using incentive programs government can help
people be responsible to and for them.

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

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John McCain’s Plan For Healthcare System Reform Is Much Worse Than Barack Obama’s Healthcare Plan. Part 3

Stanley Feld M.D., FACP, MACE

John McCain’s healthcare plan goes on to have “specific” proposals. His specifics are in reality generalities. He does not describing a plan to execute any of his “specific” proposals.I believe the American people deserve more than John McCain is offering.

“A Specific Plan of Action: Lowering Health Care Costs”

“John McCain Proposes A Number Of Initiatives That Can Lower Health Care Costs. If we act today, we can lower health care costs for families through common-sense initiatives.”

How can we lower healthcare costs if we act today with common sense initiatives ?

“Within a decade, health spending will comprise twenty percent of our economy. This is taking an increasing toll on America’s families and small businesses. Even Senators Clinton and Obama recognize the pressure skyrocketing health costs place on small business when they exempt small businesses from their employer mandate plans.”

Amer ica is being bankrupted by many dysfunctional policies. Medicare alone will cost 100 trillion dollars a year in 60 years. It is essential that politicians understand the basic problems with the healthcare system before making specific proposals without having a mechanism for executing the proposals. One basic problem with the healthcare system is the healthcare industry’s control of the healthcare dollar. John McCain plans to keep the healthcare insurance industry in control of the money. He should give patients control of their healthcare dollar.

CHEAPER DRUGS:

“Lowering Drug Prices. John McCain will look to bring greater competition to our drug markets through safe re-importation of drugs and faster introduction of generic drugs.”

Did anyone ever consider why brand name drugs cost less in Canada than in the United States? It is because the Canadian government can not and will not pay a higher price. The pharmaceutical companies want Canada’s drug market. They simply cost shift the difference for the same drug to the United States market. If the Food and Drug Administration is doing its duty correctly generic drugs should be no different that brand name drugs.

Drug patents protect the pharmaceutical companies’ return on investment. When the patent expires the drug can be sold generically. In order to maintain a return on investment the pharmaceutical industry needs to discourage patients and physicians from using generic drugs and re-importing brand name drugs. At the same time the government wants the pharmaceutical industry to have incentives to produce new drugs.

There is clearly a conflict of interests that is not resolved. It will not be easy for John McCain to fulfill the statement to lower drug prices without a program to lower prices that is fair to all. How is he going to do this? Is he going to create another entitlement program for drugs? It is easy to make a promise. It is hard to fulfill poorly thought out promises.

CHRONIC DISEASE:

“Providing Quality, Cheaper Care For Chronic Disease. Chronic conditions account for three-quarters of the nation’s annual health care bill. By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure and the use of information technology, we can reduce health care costs. We should dedicate more federal research to caring and curing chronic disease.”

What programs are going to be created for “prevention, early intervention, healthy habits, new treatment model, ect”. Is his government going to reward physicians and patients for preventing the complications of chronic diseases? How is he going to encourage cognitive physicians to create infrastructure to practice chronic disease management? Decreasing reimbursement for cognitive physicians will not encourage chronic disease management.  So far there has been little or no payment for prevention of the complications of chronic disease.

How is he going to fight the war on obesity? Is he going to penalize baseball teams that sell baseball tickets offering all you can eat? Is he going to restrict restaurants from serving larger portions in order to raise prices and attract customers as well? Is he going to reward patients for healthy lifestyle changes? John McCain has to present solutions and not sound bites? He has no solutions.

COORDINATED CARE:

Promoting Coordinated Care. Coordinated care – with providers collaborating to produce the best health care – offers better outcomes at lower cost. We should pay a single bill for high-quality disease care which will make every single provider accountable and responsive to the patients’ needs.

This is a good idea. How is he going to do this? Does he mean making the patient the center of the team and the team an extension of the physicians care? Does he mean making the patients the professor of their chronic disease and equally responsible for the outcome as the physician and his chronic disease team? 

GREATER ACCESS AND CONVENIENCE:

Expanding Access To Health Care. Families place a high value on quickly getting simple care. Government should promote greater access through walk-in clinics in retail outlets.

This is a bad idea. One the one hand John McCain calls for co-coordinated care and on the other hand he promotes fragmented care. Disease management and effective medical care work when there is a strong physician-patient relationship. The team approach can promote the physician-patient relationship if the team is an extension of the physician’s care. The government should train or retrain physicians’ practices to provide greater access to quick simple care rather than encourage a new entity in the healthcare industry that could potentially abuse and overcharge the healthcare system. Uncoordinated home healthcare and nursing home care absorb a large portion of the healthcare dollar. If the care was coordinated it could add value to the medical care system. 

 

John McCain’s  healthcare plan outlines specific proposals. He does not offer specific solutions for his proposals. His proposals also highlight his lack of understanding of the healthcare system’s basic problems.   

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

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What Healthcare System Could Work? A Universal Healthcare System Will Not Work!

Stanley Feld M.D., FACP, MACE

The solution should be pretty clear to all following my blog. I advocate the American way! I believe a consumer market driven system with government making rules for the benefit of all members of the society. When one stakeholder takes advantage of another stakeholder to the harm of the other stakeholder the government has to intercede.

Richard Swersey Columbia College Class of 1959 has a college degree in the ability to think! He also has a post graduate mining degree and masters of business administration. He wrote “You referenced Adam Smith in your blog on dirty coal plants. People need to be reminded that: (1) there is a large section of “Wealth of Nations” entitled “The Role of the Sovereign”. Even Adam Smith recognized that the market can’t do everything; and (2) there has never been a time in recorded history where commerce (or markets, or industry) was totally free of government intervention.”

I made the same point in the blog on the TXU proposed dirty coal plants. Adam Smith’s treatise also applies to the healthcare system. The function of government is to promote civility (civil right) for the benefit of all and not to build bureaucracies that can not possibly work effectively.

Dick is absolutely correct. The function of government in a democracy should be to function for the people by the people. The operative words are for the people and not to the disadvantage of the people.

Entrepreneurship and obtaining a competitive advantage is the engine that drives innovation in America. Our problem in medicine right now is some the facilitator stakeholders have large vested interests they need to protect. They are very busy protecting their vested interest by various political means. Unfortunately government is not acting for the benefit of the people. The advantaged stakeholders are so short sighted that they can not see that the system they are protecting is falling apart right in front of their eyes. In fact, it is about to blow up. We, the primary stakeholders (patients and physicians) can not see what does not hurt us. We are waiting for the Katrina effect. The mentality of what we can not see can not hurt us has to stop. We have to act know and demand change.

In my view price transparency and the consumer (patient) being in control of their own healthcare dollar can go a long way to transform medical services into a competitive market place.
Some of the insurance companies are talking a good game. Aetna has feigned price transparency in Cincinnati. They published only the price of the top thirty procedures for customers that bought HSAs. This is good start but never expanded to my knowledge. I called this blog Another Smoke Screen.

Wal-Mart made an innovative advance with its generic drug initiative. They are charging $4 for a thirty day supply of generic drugs. They have 340 drugs in the formulary. Physicians feel comfortable using some generic drugs. They also want to help their patients. Patients can also demand generic drugs. Most physicians will use generic drugs if there is not a clear cut difference between the generic and brand name medication.

Wal-Mart can not keep the drugs in stock. They also can not keep people out of the store. Wal-Mart is not losing money on the drugs either. The result will be an increase in net profit to Wal-Mart and a consumer driven market benefit for the patient. It will also force brand name drugs to come down in price. Wal-Mat’s initiative will created a clear market driven economy for buying drugs.

Who needs Medicare Part D and its $10 co pay along with its ominous $2200 doughnut? Wal-Mart is also setting up competitive price wars among CVS, Walgreens Rite Aid. Wal-Mart has good chance of winning because it has the mentality to engage in these kinds of innovative programs. The CVSs will get there as it works its way through their hierarchical bureaucracy. The end result will probably be too little too late for CVS.

The most of the uninsured who could buy insurance have had no choice but to not buy insurance.
They have chosen take their chances. When they get sick someone has to pay or not get paid. This is the point. It gets painful and costly for all the stakeholders. The Canadian model of Universal Health Care with a single party payer does not work. The costs rise, access to care is restricted and patients die.

The main question is how do we fix the problems. We have to exercise some common sense. We need to be equitable. The vested interest empires (facilitator stakeholders) have to start to understand that our most precious possession is our health and not their profit. A healthy nation is a strong the nation. They have to stop fight the Repair of the Healthcare System.

Price transparency, reform DRG on cost and not charges are very important. We must stop the bonus to hospitals or insurance companies for supposed cost overruns at the end of the year. We must provide incentive for disease management training to all patients with chronic disease. We must make the patient responsible for their healthcare and healthcare dollar in a price transparent environment. We must motivate the patient to care for their chronic disease by rewarding prevention of complications of disease.

We must eliminate hospital and insurance company administrative waste. We must neutralize defensive medical practice by malpractice reform. We must revolutionize the adjudication of claims system to a system of instant payment.

We must provide and institute an EHR universally that can measure outcomes. The outcomes we must measure are the medical outcomes. The medical outcomes must be relational to the financial outcomes and patient and physician input as to the value of the outcome.

We need to start getting serious about all of these issues in unison. We have to concentrate on the cost of complications of chronic disease. We must create financial incentives for preventative services. We have to teach the patient the “Professor of their Chronic Disease”.
http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2006/06/do_complication.html

We must motivate the patients to be responsible for their chronic care. If they are not they will have a financial loss as well as a medical loss. We must put the patients in control of their healthcare dollar. I believe if we did all of this our healthcare system would not be in trouble. All of this can be accomplished with the Ideal Medical Savings Account. The structure of the current HSA system will not accomplish all of these key initiatives

If the government wanted to subsidize something it would be the purchase of the ideal medical savings accounts for all the uninsured who could not afford to buy insurance. This would eliminate all the waste in Medicaid. The concept of universal healthcare with the government as a single party payer is a sham because it does not address any of these important initiatives.

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More Single Party Payer Noise

Stanley Feld M.D., FACP,MACE

Democrats have tried to pass a single party payer healthcare system since 1935. Slowly, but surely, the American population has been indoctrinated into believing that a single party payer system run by the government is the best healthcare system to have.

Americans have been filled with disinformation about the wild successes of single party payer systems in the rest of the world.

The economics of these single party payer systems are seldom discussed in a coherent way. Americans have no idea of the economic burden a single party payer system places on the budget of countries that have such a system.

The fact that these governments continue to raise taxes to pay for their single party payer system while decreasing their citizens’ access to care is hardly ever discussed. Only the favorable statistics that fit the progressive narrative are published.

In Norway the income tax rate is 50%. This is mostly because of its universal single party payer healthcare system. Norwegians seem happy with the system. If they get sick they have nothing to worry about. Their health care is free.

The Canadian healthcare system is unsustainable.

Canada spends 50% of its GNP on healthcare. All of the provinces are experiencing massive deficits due to additional healthcare costs.”

“Canadians who are healthy and do not need to interact with the system are happy and feel secure that their healthcare needs will be serviced without cost. Nothing is free.”

“The United States consumes only 18.5% of our GDP on healthcare. This percentage is rising as access to care is decreasing.”

The Frazer Reportis very specific on the cost of healthcare in Canada although the government is not very transparent.

Each province is having a difficult time figuring out how to fix its healthcare system. Many Canadians are convinced that a single party payer system is not the answer but cannot politically eliminate it.

The fact is nothing is free and only 20% of the population interacts with the healthcare system at any one time. People who are not sick think the single party payer system in great. They are happy they have no anxiety about the cost of healthcare if they get sick.

In Britain taxpayers are unhappy with the National Health Services. Consumers recognize the bureaucratic waste in their healthcare system. They suffer from decreased access to care. Wait times for health care and surgery are ridiculously long.

The private healthcare market is flourishing in Britain for those who can afford it. 

The British healthcare system is unsustainable. The British government has not been able to fix the expensive National Health Service.

America has a single party payer system for Medicare, Medicaid, SCHIP and the VA system.

Seniors love Medicare. Most seniors could not afford to get medical treatment if there was not the Medicare System. Policy wonks and Democrats refuse to recognize that in 1965 after Medicare was enacted, healthcare prices exploded. Most economist agree, as a result of Medicare, the cost of healthcare in America has continued to increase yearly for all Americans.

Congress has ignored the basic defects in the Medicare system that has caused this explosion. Over the years a few brave congressmen have made attempts to correct these structural defects.

The Democrat and Republican establishment have ignored these congressmen.

The political establishment has made feeble attempts to control costs through ineffective regulations. The bureaucracy has grown and the healthcare system has become more costly and inefficient.

The reduction in reimbursement to physicians has resulted in the tremendous increase in concierge medicine. This explosion in concierge medicine has decreased access to medical care in many cities in the U.S.

The result is an increase in cost and greater opportunity for abuse by the insurance industry, the pharmaceutical industry, hospitals and healthcare providers. The government has imposed more control over the individual’s ability to make his or her own healthcare decisions.

Medicaid has experienced the same increasing costs. It also created a shortage of physicians because of low reimbursement. Obamacare has expanded Medicaid. This has decreased the availability of medical care for Medicaid patients.

President Obama’s law (Obamacare) increased the number of Medicaid recipients but did not cure the reasons for the lack of providers. Many clever Medicaid providers have figured out how to exploit Medicaid rules only to suffer from government investigations and penalties in the long run.

The VA system is the purest example of sheer failure. Not only are the patients unhappy but also the providing administrative bureaucracy is riddled with inefficiency, corruption and waste.

The inefficiency, corruption and waste have not been able to be fixed by many notable private sector executives the government has hired to fix it. They have all ultimately resigned or were fired.

The VA system’s single party payer system remains an incurable failure.

These examples are proof that a single party payer system is unsustainable and not economically feasible. The government continues to make the same mistakes over and over again.

Are these mistakes intentional? Perhaps.

The government’s goals are to gain power and have control over the population. If its goals were to have an efficient and effective healthcare system, it would provide the resources to permit all consumers to drive the healthcare system. It would create a system that would motivate consumers to be responsible for their healthcare.

What is happening now?

The healthcare policy ideologists are using the New York Times as their propaganda vehicle to promote a single party payer system.

The article, Back to the Health Policy Drawing Board” may be intellectually simulating to readers of the Sunday Times. However, many of its details are untrue.

After one casually reads the article on a pleasant Sunday morning it would seem much simpler to have a single party healthcare system controlled by the government than the chaotic system that presently exist. The New York Times article is promoting Medicare for all.

Medicare currently is a single party payer system whosecost is out of control. America cannot continue to print money forever.

America’s politicians are ignoring this fact in order to gain more power.

 

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



Copywrite 2006-2018

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Permalink:

Public Option: Another Catch 22

Stanley Feld M.D.,FACP,MACE

Obamacare is in crisis. The public does not realize it because the media is keeping the impending disaster out of the public’s view.

The Obama administration and media is also shielding the public from the past history of Obamacare and its failures at each step.

At this moment, the Obama administration, the traditional mass media and Hillary Clinton think the magic bullet to save Obamacare is a “Public Option.”

All progressives are obsessed with the idea that a single party payer system will magically convert Obamacare into an affordable healthcare system. They also think the Public Option is a direct route to a single party payer system.

https://youtu.be/f3BS4C9el98

 

It is unfortunate that the progressives’ base believes a single party payer system is the answer to our dysfunction healthcare system despite the failures experienced in Vermont, New Hampshire, Canada and England.

My wife and I were touring the Canadian Rockies a few weeks ago with a tour group.

I got into a discussion with a couple of lawyers on the tour about the healthcare system.

I told them Canada spends 50% of its GNP on healthcare. All of the provinces are experiencing massive deficits.

Canadians who are healthy and do not need to interact with the system are happy and feel secure that their healthcare needs will be serviced without cost. Nothing is free.

Canadians who need the healthcare system are unhappy. They experience long waits and poor service.

The lawyers’ immediate reaction was healthcare consuming 50% of Canada’s gross national product was impossible.

The United States consumes only 18.5% of our GDP on healthcare.

They checked their IPhones. Their iPhones said Canada only spends 11.4% of their GNP on healthcare. They clearly did not believe me.

I told them to read my blog and the Frazer Report.

The Washington Post published: in 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries:

This is not true according to the Fraser report.

 “Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the Frazer Institute. To be specific, 

By 2017, four more provinces — Saskatchewan, Alberta, British Columbia and New Brunswick — will spend half of their revenues on health care, according to the institute.”

I decided to reinvestigate the discrepancy between the two numbers when I got home.

Why would the Washington Post publish one number (11.4 percent of its Gross Domestic Product on healthcare) and the Fraser Report publish a 50% number?

In 2012, I figured the Washington Post just got it wrong. The reporter probably copied a number from some report that did not include all the funding for healthcare.

The Fraser Report added up all of contributions various Canadian agencies made to the government funding of the Canadian single party payer healthcare system.

The August 2016 Fraser Report made the discrepancy clear between the 11.4% and 50% number.

“Canadians often misunderstand the true cost of our public health care system.”

 “This occurs partly because Canadians do not incur direct expenses for their use of health care, and partly because Canadians cannot readily determine the value of their contribution to public health care insurance.”

The August 2016 Fraser Research Bulletin explains the discrepancy. It starts off by saying;

Health care in Canada is not “free.” While Canadians may not be billed directly when they use medical services, they pay a substantial amount of money for health care through the country’s tax system. Unfortunately, the size of these tax payments is hard to determine because there is no “dedicated” health insurance tax.

“As a result, individuals and families often cannot fully appreciate the true cost they pay towards the public health care system.”

The Canadian Government has figured out how to hide the true cost of healthcare from the press and the public.

The Obama administration is also hiding many costs from the American public as the insurance premiums are skyrocketing.

The purpose of this research bulletin is to help individuals Canadians and their families better understand how much healthcare actuallt dosts them personally so they can determine whether they are receiving good value for their tax dollars.”

 The problem is the Canadian public is only interested in what their individual healthcare coverage insurance costs.

Their coverage is “free” at the point of service. Free is good but nothing is free. Their complaint is the difficulty with access to care and the time it takes to get care.

Canadians are not thinking about the total healthcare costs to society. Canadians are not thinking about the source of revenue for that cost.

In Canada general revenue taxes are increased gradually.

Somehow these increases are not recognized.

Yet, people earning $48,456 a year have a tax rate of 43.1% and pay $11,439 dollars for healthcare coverage.

The healthcare coverage comes off the top of the tax bill similar to our social security payment pays for our Medicare Part B insurance.

Someone making $281,359 pays $158,255 in taxes or q tax rate of 56% of which $37,361 is paid for healthcare insurance coverage.

When people speak of “free” healthcare in Canada, they are entirely ignoring the substantial taxpayer-funded cost of the system.

The healthcare insurance premiums paid by Canadians only covers a fraction of the costs of the Canadian Healthcare System.

Some Canadians might assume that in those provinces that assess them, health care premiums cover the cost of health care.

 “However, the reality is that these premiums cover just a fraction of the cost of health care and are paid into general revenues from which health care is funded.”

 This is precisely what President Obama is doing with our healthcare system. The true cost is totally opaque.

In the U.S. it is impossible to figure out from which taxpayer fund President Obama take the revenue for the $2.5 billion dollar loans lost for the failed Co-Ops experiment, the $650 million dollar website fiasco, or the insurance subsides for 85% o the consumers who signed up for Obamacare.

 Congress is not helping us find out where the money is coming from either.

Indeed, Canadians cannot easily work out precisely what they pay to government each year for health care because there are many different sources of government revenues that may contribute to funding health care, including income taxes, Employment Insurance (EI) and Canada Pension

Plan (CPP) premiums, property taxes, profit taxes, sales taxes, taxes on the consumption of alcohol and tobacco, and import duties, among

others.”

 President Obama is not telling the American public the truth about the cost of Obamacare with its tiny participation.

If Americans knew where all the money is coming from they would demand immediate real of Obamacare.

There is a growing mistrust for our elected officials. The increase in public awareness is a result of the spread of social media and Internet communication.

It is difficult for the Obama administration and media to hide thing from the American people anymore. The catch is Americans have to more pay attention.

An excellent example is Hillary Clinton’s cancellation of a noon fund raising event is North Carolina. The cancellation was announced at 9 a.m. It went viral on the Internet at 10 a.m.

The cancellations aroused suspicion that Hillary was sick again, especially when her campaign announced that it had not comment.

Five hours later it announce that she had to cancel her events for the week to study for the debate.

With the many lies Americans have experienced from President Obama from Obamacare to the Iran Nuclear Treaty and Hillary from her emails and the Clinton Foundation, Americans are starting to become aware of their need to pay more attention to the day’s events and not rely on elected surrogates to look after us.

Healthcare, taxes, our economic growth and personal safety are important issues to most Americans. Many Americans are wondering if we can trust our surrogates.

Americans are starting to demand the truth.

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

Permalink:

President Obama – Do Something That Could Work!

Stanley Feld M.D.,FACP,MACE

The solution to repairing the healthcare system is simple. The
healthcare system must be consumer driven. If consumers were in control of their
healthcare dollars and were responsible for their health and their healthcare
choices the cost of the healthcare system would decrease to manageable levels.

My ideal Medical Savings Account puts the consumer in charge. Its
success is totally dependent on real transparency by all stakeholders including
healthcare insurance companies, hospital systems and physicians. 

A Health Savings Account does not give consumers enough of an
incentive
to shop for price and quality with the present lack of transparency.
In a transparent healthcare system Medical Saving Accounts would provide more
incentive than Health Savings Accounts.  

Presently President Obama is trying to eliminate Health Savings
Accounts. HSAs are the single greatest threat to his goal for a single party
payer system. They are also the fastest growing healthcare insurance product.

The lack of transparency for hospitals, healthcare insurance
companies, drug companies and physicians must be eliminated. The public must
demand that the healthcare insurance industry make their expenses transparent
so that its exorbitant salaries and profits can be clearly understood.   

There is no reason that this one stakeholder receives 40% of
every premium dollar
spent either by private corporations or the government.
The medical loss ratio as it is presently constructed by the Obama
administration provides 20% for expenses. The other 20% of the $40% is in the
direct patient care column.

The government should help consumers understand these prices and
understand the measurement of quality. Consumers of healthcare must be turned
into Prosumers of healthcare (Productive Consumers.)

When this happens the consumers can become independent
intelligent consumers. Consumers will become independent of government and its
bureaucracy.

The Obama administration wants consumers to be more dependent on
government not less dependent.

Intelligent independent Consumers will force the other
stakeholders to be competitive. Competition will drive healthcare costs down.

Government cost controls will not drive prices down. They will
simply distort prices and cause more spending.

Private sources such as Angie’s list help consumers decide on
which plumber to hire. It is important and creates competition and price
lowering. However the defect in Angie’s list is that it is based on other
consumers’ opinions.

It is not based on specific costs or origins of the cost to the
plumber or the measurement of the plumber’s skill. It only deals with price and
consumer satisfaction. Angie’s list does make plumbers competitive.

Competition for consumers will bring down the cost of healthcare.
 By forcing consolidation of doctors and
hospitals Obamacare will decrease competition and increase prices.

 Healthcare
policy wonks dismiss this concept because they believe consumers are not smart
enough or interested enough in learning to be intelligent healthcare consumers.
They are wrong.

Their thnking is correct if a system exists where consumers are
spending other people’s money. Obamacare is such a system. It will drive costs
up just as the private first dollar coverage system has driven healthcare
prices up.

There is no financial incentive for healthcare consumers to try
to save money and preserve their health.

Obamacare is a huge entitlement with an overwhelming budget that
will be impossible to execute. We have seen that to be true with ever increasing
waivers and the most recent delay in the mandate until 2015.  There will be delays in other critical
portions of Obamacare in the near future. It could be delayed forever because
it cannot be executed.

In my last blog I forgot to mention the delay in forming and
activating the Independent Physician Advisory Board.

Last year I wrote about the Obama administration’s infatuation
with the Canadian Healthcare System. I reviewed the 2011 Fraser report
explaining that the Canadian Healthcare System is unsustainable.


I also wrote about Canadian consumers’ healthcare experiences in
two provinces I visited.  The fact is the
system doesn’t work well and is unsustainable.

The Fraser Institute in a
2011 report concluded that Canada’s health care
system is spending money at an unsustainable rate
. Six of ten Canadian
provinces are on track to spend half of their revenues on health care,
according to the institute.

“In 2011, health care
spending consumed 50 percent of revenues in Canada’s two largest provinces,
Ontario and Quebec.

By 2017, four more
provinces — Saskatchewan, Alberta, British Columbia and New Brunswick — will
spend half of their revenues on health care, according to the institute.

Total federal, provincial
and territorial government health spending has grown by 8.1 percent annually.
Canada’s GDP increased by 6.7 percent during the same period. The math is
obvious. The Canadian healthcare entitlement system is not working.

“In response to the rapidly
rising costs, provincial governments have raised taxes and rationed care,
increasing patient wait times. Provincial drug plans have also more often refused
to pay for most of the drugs that are certified as “safe and effective” by
Health Canada.

“Unsustainable rates of
growth in health care spending crowd out the resources available for other
purposes including education, public safety, and economic growth-enhancing tax
relief,” Fraser Institute Senior Fellow Nadeem Esmail told The Daily Caller
News Foundation in an email.”

Only 20% of the people utilize the healthcare system at any on
time. If consumers know they are entitled to healthcare and the healthcare
system will fix them if they get sick, consumers of healthcare feel protected. The
feelings of eighty percent of consumers who are not sick believe the system is
great until they have to interact with the system. In this system of
entitlement consumers have a tendency to not take care of their health.  This makes them more likely to interact with
the system in the future when they are very sick. The result is increasing
healthcare costs.

Once an entitlement is created it is almost impossible to
eliminate it even though it has proved ineffective and costly.

England’s NHS has shown this to be true. The NHS is struggling
right now to modify the NHS so it works
better for physicians and patients.
However, the new reform rules have been contaminated with so many amendments
that I suspect no progress will be made
.

Consumers are realizing that Obamacare is much too complicated
and impossible to execute. Rather than demanding repeal and eliminating the
concept of instituting an entitlement program, the New York Times is publishing
letters from readers that are demanding a single party payer system to simplify
the system.

Let us stop making the same mistakes over and over again.

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

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Permalink:

Where I Am Coming From

Stanley

Feld M.D.,FACP,MACE

I realize that many people
read my blog by just glancing at it. It is difficult for a casual reader to
grasp my hypothesis.

The devil is always in the
details. The details expose defects and unintended consequences.

Yogi Berra once said, "You've got to be very careful if you don't know where you are going because you might not get there."

Many readers believe I am
very critical of President Obama’s plan to reform the healthcare system. This impression
is correct.

To my chagrin many of my
non-physician friends, who are President Obama lovers, hold it against me.

The basic goals of President
Obama’s healthcare reform plan are correct.

In my view his philosophy and
methods are wrong. I have pointed out the faults with his philosophy and
methods and why they cannot work.

President Obama wants
universal access to healthcare that is affordable and is delivered using best medical
practices.

I have the same goals.  

I have outlined a consumer
driven healthcare system which emphasizes freedom of choice, individual independence
and personal responsibility.

President Obama is imposing a
government driven healthcare system
emphasizing a lack of freedom of choice,
mandates, penalties, dependence and entitlements.

I appreciate that President
Obama can only visualize accomplishing his goals by government decree,
regulations and enforcement.

I believe Americans are smart,
want freedom of choice, personal dignity and can assume responsibility for
their choices.

I believe government control
will result in increased waste, inefficiency and corruption at the expense of
effective medical care for consumers.

President Obama thinks government
control is the only way to control costs. I believe the more government control
is imposed on consumers the greater the costs.  

President Obama wants bureaucrats
to make medical decisions for consumers and physicians. If physicians do not
cooperated he is willing to substitute “healthcare providers” for physicians.

President Obama does not
respect consumers’ ability to make the right choices.

I believe in consumers’
intelligence. The government’s responsibility is to provide tools for consumers
to make intelligent choices.

It is difficult to find an
effectively functioning, centrally controlled healthcare system. The statistics
are questionable. I recently   described
the Canadian healthcare system.  

Consumers and physicians can get
used to centrally controlled healthcare systems. They learn to tolerate it.
However, these healthcare systems are not as affordable as many contend. 

Innovation and vibrancy comes
from a healthcare system
in which the major stakeholders have the incentives to
be innovative.

Obamacare has caused
secondary stakeholders (healthcare insurance industry, hospitals and hospital
administrators, drug companies, medical device companies and information
technology companies) to position themselves to take advantage of the centrally
controlled healthcare system.

Obamacare is not aligning all
the stakeholders’ incentives.
It is further misaligning incentives. Obamacare
will cause a rapid demise of the healthcare system. 

A more centralized government
controlled healthcare system will result in greater dysfunction of the
healthcare system, increasing cost and less effective medical care for the
majority of consumers.

If America evolves to a
single party payer healthcare system, which I believe is President Obama’s goal,
the achievement of his goals for affordable care for all using best practices
will become more elusive.

On May 11, 2006 I published my first blog. This was
pre President Obama. President Obama wasn’t the first president who has
contributed to the dysfunction and ultimate demise of the healthcare system.

I thought it would be fun to see “What I Was About” on
May 11, 2006. 

 

"Repairing The Healthcare System.

Stanley Feld M.D.,FACP,MACE

Preamble

This blog is
about Stanley Feld M.D., FACP, MACE’s studied view for repairing the health
care system.

There is been
much written daily about the defects in the health care system. All
stakeholders are to blame for the severe distortion in today’s healthcare
system including consumers (patients).

Unfortunately,
few healthcare policy wonks have asked practicing physicians what they think
the healthcare systems’ problem are. Neither has anyone asked the practicing
physician what an acceptable solutions would be.

Persons not
affected by the distortions and dysfunction in the health care system pay
little attention to the broken system. Fortunately 80% of the population are
not sick. They are not in need of an effective and functional healthcare system.

People not immediately affected by any system
do not pay attention to the defects in those systems.

However,
the healthcare system is vital to every citizen both in the short term or long
term.

Our broken
health care system cannot be ignored any longer. Our personal health and the
health of our citizens is the most precious asset we have as individuals, and
vital to the country’s success and well being in the future.

In my view, we
are going through a process similar to the slow boiling of a frog. We are
noticing the rise in temperature little by little, but are too lethargic to
take action and jump out of the pot. The effort is much too difficult.

However, we
must take action now!!  Soon, we will all
be cooked.

What
is the solution to America’s dysfunctional healthcare system?

Americans live
in a free consumer driven economic environment for most goods and services.

The only way
to get us out of this increasing hot water is for consumers to understand the
structural defects in the broken healthcare system. Then they must act.

Someone must
outline an effective and easy plan of action that aligns all the stakeholders
incentives.

In reality,
all of the stakeholders are to blame for the distortions in the system. The
stakeholders need to be answerable to consumers. Consumer (patients) can exert
power only after understanding the structural defects in the healthcare system.

The goal of
this blog is to explain reasons for these defects, as well as the potential
solutions. In my view the solutions I will propose will ultimately fix the
system.

Presently most
of the stakeholders’ incentives are misaligned. The proposed solutions are
aimed at aligning all the stakeholders’ incentives. All previous solutions have
served to misalign incentives even further resulting in our present
dysfunctional system.

The previous
governmental adjustments have resulted in a system that is much too expensive,
has much too much waste, is inefficient, and almost unworkable.

The result is
that all of the stakeholders are very stressed and unhappy.

Over the next
weeks or months, I will outline the problems in the healthcare system and the
solutions to creating a functional healthcare system."

I said the above in May 2006.I am continuing to
point out the increasing problems as well as my solutions. The key to the
solution is a healthcare system in which  consumers’ drive the healthcare system and
have responsibility for their health and healthcare dollars.

As the incidence of obesity continues to
increase and as the baby boomers continue to retire, a system must be developed
to create independence and responsibility and not entitlement and irresponsibility. 

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

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