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All items for August, 2008


John McCain’s Healthcare Plan on Health System Reform Is Much Worse Than Barack Obama’s Healthcare Plan. Part 1

Stanley Feld M.D., FACP, MACE

John McCain does not have a healthcare plan to improve the healthcare system. His goal is to eliminate the healthcare entitlement provided by the government for seniors and Corporate America for its employees.

In my view he is not focused on the basic problems with the healthcare system. John McCain is going to leave the control of the healthcare system in the hands of the healthcare insurance industry. He is not going to empower patients to drive the healthcare system by providing appropriate information, education and incentives.

John McCain’s healthcare plan is worse than Barack Obama’s because it is simplistic thinking. He makes the appropriate pronouncements as slogans. However, he simply strengthens the hand of Corporate America and the healthcare insurance industry to the disadvantage of present and future patients. In a search of his healthcare plan for improvement in the healthcare system none exists.

His healthcare plan starts with:

 “A Call to Action”

John McCain believes we can and must provide access to health care for every American. He has proposed a comprehensive vision for achieving that. For too long, our nation’s leaders have talked about reforming health care. Now is the time to act.”

He is saying nothing but the obvious. One can assume he is for universal healthcare when he says “we can and must provide access to health care for every American.” It is important to review his actual words. One then realizes the words lack substance or strategy.

Americans Are Worried About Health Care Costs. The problems with health care are well known: it is too expensive and 47 million people living in the United States lack health insurance.”

John McCain does not list the problems with the healthcare system. He declares that they are well known. He avoids stating the basic problems or the reasons for the basic problems. Why is it too expensive? Why are so many people uninsured?
John McCain’s Vision for Health Care Reform

McCain Believes The Key To Health Care Reform Is To Restore Control To The Patients Themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care. John McCain Will Reform The Tax Code To Offer More Choices Beyond Employer-Based Health Insurance Coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit – effectively cash – of $2,500 for individuals and $5,000 for families to offset the cost of insurance.

I certainly believe that patients should have control of their healthcare dollar. A tax credit of $2500 for low or middle income individuals is not enough to help pay a $6,000 a year healthcare policy. The $5000 tax credit will not help a low income family pay for a $12,000 healthcare policy. What about people at the poverty level or just above the poverty level? How it a tax credit going to help them? How does this solve the abuses of the healthcare insurance industry? Can Moises with $22,000 income afford a $12,000 a year healthcare policy? The answer is obviously no!

Meanwhile the Republican administration (Bush)is methodically destroying America’s safety net hospitals. The Republican administration is not funding these critically important county hospitals. The lack funding will not result in an increase in these hospitals efficiency. It will leading to a lack of modernization of safety net hospitals and an inability to provide adequate healthcare to the underprivileged and uninsured.


Making Health Insurance Innovative, Portable and Affordable

John McCain Will Reform Health Care Making It Easier For Individuals And Families To Obtain Insurance.

How is he going to make it easier to obtain affordable insurance without government intervention? There is no plan or ideas published in his plan. It is just a slogan without a plan to help the middle class and lower class workers obtain healthcare coverage.

“An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people’s needs, lower prices, and portability. Families should be able to purchase health insurance nationwide, across state lines.”

I have changed my mind about consumers being able to by insurance across state lines. It would be good to increase competition among insurance companies. It might force them to lower premium prices and make less profit. It would be bad for the patients because patients would not have a mechanism to stop healthcare insurance company’s abuse of the healthcare system.

Each state is responsible for which companies they issue permits to sell healthcare insurance. Theoretically the individual states have control of the quality of healthcare insurance product sold in their state. Many State Insurance Boards have not functioned exactly how they were intended to function. This has lead to healthcare insurance abuse that has been slow to discover. Once discovered the legal process is tedious. Some State Boards have imposed penalties so weak they have not acted as deterrents to further abuse.

We need leadership to make State Insurance Boards stronger and not federal legislation that will make the State Insurance Boards less powerful. The healthcare insurance industry has not proven itself to be benevolent.

Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.”

If the insurance plans are underinsuring people at high rates now, how is John McCain going to decrease cost of healthcare insurance with this proposal? There is nothing in his healthcare plan to control the healthcare insurance industry’s premium rates.

John McCain Proposes Making Insurance More Portable. Americans need insurance that follows them from job to job. They want insurance that is still there if they retire early and does not change if they take a few years off to raise the kids.

If there are multiple plans available and a new employer does not provide a healthcare plan as good as the person’s previous healthcare plan that is going to pay for the premium for the previous plan?

There it is! John McCain’s goal is to get the employer out of the healthcare insurance plan provider business. He wants to place the responsibility of paying the premium for healthcare insurance in t
he consumers’ hands. The goal is to protect the employer and not the employee (patients). The goal of John McCain’s non existent healthcare plan is not to put the Patient First but to put Corporate America first.

John McCain should devise a plan that gives employees an incentive to take care of themselves and not an excuse for employers to avoid responsibility for their employees. I believe employees should own the first $6,000 of his healthcare plan and should have first dollar healthcare insurance coverage after that $6,000 is spent. If employees keep the portion of the first $6,000 they do not spend they will have incentive to use their healthcare dollar wisely. John McCain’s non healthcare plan is corporate America friendly and not patient friendly.

John McCain does not have a plan to limit the healthcare insurance industry’s profit, increase efficiency or contain abuse of the healthcare system. He might care but he does not get it.

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

  • bozena

    I agree. I work in a large University hospitals in NY
    and I see pts with no insurance occupying 5,000 a day NESICU beds, and the hospital ends up absorbing all the costs.

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Is Barack Obama Any Different Than Other Politicians? Part 6


Stanley Feld M.D.,FACP, MACE


Some of the ideas in Barack Obama’s healthcare plan are good. However, some of the ideas have defects. The defects will render execution of his healthcare plan impossible. The complexity of his bureaucratic machinery will make his plan inefficient and costly.

Quality and efficiency are important bullet points in Barack Obama’s healthcare plan

· Quality and Efficiency.

“ Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology and administration are being met.”

I have stated that measuring quality medical care has not been accurately defined. Quality medical care should be measured by positive medical outcomes at the least cost. Successful medical outcomes have to be linked to successful financial outcomes.

Inaccurate quality measurements are presently being used to judge physician performance. The system is called Pay for Performance (P4P).

Hemoglobin A1c testing is an example of a presently used quality measure. Does the physician do four hemoglobin A1c’s per year in treating his diabetics? HbA1c is a measurement of glucose control over a 3 month period of time. The result is a valid measurement of glucose control.

The four measurements of HbA1c are in itself meaningless. The importance of the measurement is to track patients’ HbA1c improvement over the year? How much of the improvement was due to the physician’s treatment? How much of it was due to the patient’s effort to improve his HbA1c? Did the improvement in HbA1c prevent the patient from developing a complication of Diabetes Mellitus?


Did the improvement keep the patient out of the hospital? The results and cost savings from these results are the parameters that should be measured to make the judgment of the quality of care and not the measurement of HbA1c itself. The dual fulfillment of the responsibility of the physician and patient should be measured. None of these goals are included in the definition of quality measurements at this time. Until they are we do not have an accurate measurement of quality medical care.

Before the government can demand that participating insurance companies in the new public program can ensure that standards of quality are met quality has to be defined. If the healthcare insurance companies are determining quality the government is essentially putting the fox in the hen house to have a feast.

Lowering costs by modernizing the healthcare system is an essential idea. The responsibility for the cost of care should not be a burden of the government. It should not be a burden on the employer who is providing the benefit. It should be a burden of the consumer (patient). It should be the consumer’s responsibility to take care of him. The employer and government should aid the consumer in his ability to fulfill his responsibility for his wellness and effective and efficient care if he is sick.
Lower Costs by Modernizing The U.S. Health Care System
  • Reducing Costs of Catastrophic Illnesses for Employers and Their Employees:

Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers’ premiums.

Many of the chronic diseases are the result of our social behavior and environment. Obesity, pollution, drug addiction, smoking, and public hygiene generate many chronic diseases. Who should be responsible for our social behavior and environment? Should it be the government, our employer, the state, or our neighbors?

I believe the government should be responsible for developing programs to eliminate pollution as it did in the past with smoking. Our government has dropped the ball with its public service campaign against smoking. It can be done if Congress and the President had the courage to do it.

The government could also do much to reduce obesity and drug addiction. However, it must be up to the consumer to be responsible for himself. Obesity and drug addiction are tinder box problems for our healthcare system. Coal burning electricity plants are another problem. It increases our carbon footprint but this impact is not even a required measurement for license. The indiscriminate use of antibiotics in cattle feed lots is another tinder box problem. The problem could be a mutation of an antibiotic resistant infectious disease epidemic. Barack Obama should be talking about solving these problems and not providing a rebate for employers who have employees with catastrophic illness.

  • Helping Patients:
    1. Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.

This is a great idea. Presently these programs are not supported by the government or healthcare insurance companies.

Traditionally the government sets up pilot programs to test every concept. However, when the pilot study for the effect of managing chronic disease failed, it failed not because the concept of chronic disease management was wrong but because the design of the pilot was defective.


· Coordinate and Integrate care.

Over 133 million Americans have at least one chronic disease and these chronic conditions cost a staggering $1.7 trillion yearly. Obama will support implementation of programs and encourage team care that will improve coordination and integration of care of those with chronic conditions.

This is another great idea. The emphasis for reimbursement has to shift from procedural medicine to cognitive medicine. Since cognitive medicine has not been well supported with reimbursement, physician care has migrated to procedural medicine. Diabetes education is an essential element in teaching the patient how to become a “professor of their disease”. It is essential that patients know how to self manage their diabetes. Diabetes education program must be supported so that physicians can afford to develop diabetes education centers in their office. The diabetes education must be an extension of the physicians care. It does not work in a free standing clinic that is uncoordinated with the physician. It has to be a team management effort with the patient in the center of the team and the physician the captain of the team. It must be a team effort so the patient feels connected and cared for.

None of the infrastructure for chronic disease management is in place presently. I am happy that in Barack Obam
a’s healthcare plan there is awareness of this essential element to repair the healthcare system. However legislative regulation must occur for this to become a reality.

· Require full transparency about quality and costs.

“Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.”

Real price transparency is another big idea.

It must occur if there is going to be any improvement in the costs of the healthcare system. However, if all we have is a single party payer (the government) with the administrative services outsourced to the healthcare insurance industry price transparency will not occur. There will be no competition for healthcare insurance coverage. The lack of competition means the lack of innovation.

Barack Obama has some good ideas.The ideas will fail because big government is king. It is big government’s role to control the lives of the people rather than creating programs which promote people to control their own lives? Most people can be trusted. If they can not control their own lives  under proper incentives and supervision they should be penalized. The government should not try to control the lives of the people.

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

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Is Barack Obama Any Different Than Other Politicians? Part 5


Stanley Feld M.D.,FACP, MACE

From a distance everything Barack Obama says sounds great. The events of the last eight years have created cynicism and despair. We are a nation thirsty for hope to solve our many problems.

In healthcare the basic problem is not how we are going to pay for healthcare for all of our citizens but how to change the healthcare delivery system to create a healthier society and less chronic disease. Eighty percent of our healthcare dollars are spent on the treatment of chronic disease.

Barack Obama’s National Health Insurance Exchange does not address the basic problem in a meaningful way. It creates another bureaucracy that will drive competition out of the market place. It will result in socialized medicine with all of its bureaucratic and monetary problems.


“National Health Insurance Exchange:

The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

I believe his National Health Insurance Exchange will drive the private insurance companies out of the healthcare insurance business. This might not be a half bad idea since the healthcare insurance industry controls healthcare cost and earns a grotesque amount of money. Also the government outsources and will continue to outsource its Medicare administrative services to the healthcare insurance industry at an equally large profit.

“ Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.”

The only option remaining would be the new public plan similar to Medicare Part C the coverage that Senator Kennedy has. In recent years Medicare Part B has experienced increasing deficits. The increasing deficits have resulted in increasing costs to seniors and decreasing healthcare benefits. Increasing costs and deficits are inevitable in a single party payer system if the basic problems in the healthcare system are not addressed.

I believe the goal of the Democratic Party is to convert our healthcare system to a system of universal care with a single party payer. Hillary Clinton tried it in 1993 and Barack Obama will try in 2009 if elected.

It has been said that democratic countries in the west with single party payers do just fine. Canada and England have healthcare systems with universal care with a single party payer. All one has to do is look online at newspapers in Canada (National Post) and London ( Evening Star) to see how well these systems are really doing for their citizen. The following articles appeared in the National Post in Canada

1. Millions of Canadians lack family doctor

MD uses lottery to cull patients Not first such case as lack of doctors causes huge caseloads. In the latest jarring illustration of the country’s doctor shortage, a family physician in Northern Ontario has used a lottery to determine which patients would be ejected from his overloaded practice.


2. Let private sector into health care: CMA president Day

“We must not deny any patient access to essential health care based on ability to pay; nor should we deny access based on a shortage of doctors, hospital beds or operating time.

“Competition, consumer choice and market principles barely exist in our health system. The CMA President is asking for the basic principles that stimulate organizations to work properly

“Let’s note that three of the main Olympic values — excellence, universality, sustainability — are similar to our values and aspirations for a truly great health system. “And, of course, an integral part of the Olympics is competition. Without competition we cannot expect improvement, let alone excellence. “I believe that if we are to preserve universal health care for the next generation, we need to embrace similar principles.”

He clearly pointed out the problems with the Canadian system.

“And he bemoaned the fact that more than one million Canadians were on waiting lists for health care and that five million people did not have access to a family doctor. Yet neither the governing Conservatives nor the Liberal opposition seemed to care, he charged.”

This is what I worry about with Barack Obama’s healthcare plan.

“Individually, most [politicians] have a deep understanding of the plight of our health-care system.”Collectively, especially at the federal level, they are reluctant — even afraid — of engaging in a meaningful public policy discussion on health.

Claude Castonguay, a former health minister in Quebec summarized the findings of a report he submitted to the provincial government. He said that public health care system, as it now stood, was not financially sustainable.


The following articles appeared in the London Evening Star


1. Doctors call for ‘rationing’ of NHS services

“Rationing of services in the NHS is a ‘fact of life’, doctors insisted. The British Medical Association said a postcode lottery operates nationwide with some treatments denied to patients simply because of where they live.

It called for a charter that would tell patients exactly what ‘core’ services they are entitled to receive in England.

But in order to make the NHS work successfully, the BMA says the day-to-day running of the service must be wrested from politicians.

James Johnson, chairman of the BMA’s council, said there had to be an end to the ‘constant political dabbling’ and ‘micro-management’. “

2. London’s healthcare is lagging

3. Third of broken hip victims have to wait two days for surgery

“Thousands of elderly people with broken bones caused by falls are being betrayed by a postcode lottery in NHS care. A report says around one in three broken hip victims had to wait more than 48 hours for surgery – a delay that could have put their lives in danger. “

Enough said about the glories of socialized medicine in Canada or England. Is this what the American people want? Some say most people are satisfied with the healthcare service they receive in Canada and England. Only 20% of the population is sick at any one time. Therefore (most) have no idea what is going on in the healthcare system. It is easy to say they are satisfied with the system when they are not sick.

Rather than our next President creating another ineffective bureaucracy and costly entitlement program all he would have to do is

  1. level the tax playing field for the self employed to be able buy insurance with pre tax dollars
  2. permit the purchase of insurance across state lines
  3. produce purchasing power and negotiating power for consumers with hospitals and physicians and insurance companies in a real price transparent environment
  4. impose community rating with universal coverage regardless of pre-existing illness

  5. provide ownership of the first $6000 to the consumer

I would bet consumers would use their healthcare dollar wisely.

Barack Obama’s National Health Insurance Exchange is a bad idea. It will not work if passed. The fact is the plan is not hopeful. It is the opposite of Barack Obama’s message of hope. A message America dearly needs.

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

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Is Barack Obama Any Different Than Other Politicians? Part 4


Stanley Feld M.D.,FACP,MACE

I continue to look at Barack Obama’s statement puny statement on subsidies.


“Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.”

Is this a false hope? Another example of a deficient subsidy is Medicare Part D. Again, the intention was good but the construction of the subsidy resulted in subsidizing the healthcare insurance industry.

UnitedHealthcare paid AARP $4 billion dollars to be the only provider of AARP’s Medicare Part D plan. Would UnitedHealthcare do this if they thought they would lose money? No! Part D is supposed to be a plan subsiding drug benefits for seniors. The government is supposed to fix the premium for all seniors regardless of health risk.

Last year UnitedHealthcare’s net income from Medicare Part D was over $1 billion dollars. UnitedHealthcare expects this net income to increase in the future as more baby boomers qualify for coverage. Despite all the profit from Medicare Part D next year the premium for seniors is going to increase from $25 to $28 per month per senior in post tax dollars.

The government does not negotiate directly with the pharmaceutical companies for drug prices as it does in the VA and Military healthcare systems. The healthcare insurance industry does the negotiating. The prices set are non transparent.

If the government wanted to be effective it would do its own negotiating. However, this does not seem to be the bureaucracy’s way. This is one of the reasons the government should not be a single party payer.

Medicare’s drug plans will cost beneficiaries an average of $28 a month in 2009, about $3 more monthly than this year, according to the U.S. health-care program for the elderly.”

This increase represents an 11.5% increase from the previous year monthly cost of $25. It brings up the question again as to whether we can trust our politicians to look after our welfare and not the welfare of a secondary stakeholder?

Premiums paid by beneficiaries for basic prescription plans cover about one-fourth of the program’s cost, with the government paying the remainder, according to Medicare. Medicare will spend about $36 billion this year to subsidize drug coverage.”

This is ridiculous. A generic drug estradiol cost $4 a month in Wal-Mart outside the Medicare Part D system. Inside the Medicare Part D system the patients benefit (“Doughnut”) is charged $20. The patient’s co-pay is $4 for the generic estradiol. Does anyone think Wal-Mart charged the healthcare insurance company $18 for this prescription? Does anyone think the Healthcare insurance company didn’t charge CMS (Medicare) $18 plus an additional administrative fee for this prescription? All we are told is Medicare will spend about $36 million this year to subsidize drug coverage.  

Who is benefiting from all this money? In reality the government is subsidizing the healthcare insurance industry at a sizable profit. One can blame it on the Republicans. However it was a bipartisan bill with politicians being influenced by the vested interests of the healthcare insurance industry.

I have received many complaints about Medicare Part D. An outstanding complaint of a patient reaching the $2500 drug subsidy limit was a patient with glaucoma. The drops the patient was prescribed was not generic. The patient had a $65 co-pay. She paid this amount without noting the amount charged to her. After she paid $65 a month for 5 months she was out of drug coverage and into her Medicare Part D doughnut hole. She was charged $500 for her sixth month prescription. This was an out of pocket expense.

She complained to her ophthalmologist. Her ophthalmologist discovered that the retail price on the glucoma eyes drops was $90 for a one month supply bottle rather than $500 charged Medicare by the pharmacy. Her Medicare Part D account was charged $500 each month. She tried to complain but got nowhere. She did not receive a response from the healthcare insurance carrier or the government. The pharmacy said this was the price. They could not tell her how much the healthcare insurance company paid the pharmacy.

“The new estimates for Medicare Part D were based on bids submitted by companies that receive government subsidies to offer the plans.” “About 25.4 million Americans have drug coverage through Medicare, 17.7 million of them in standalone plans and 7.7 million in Medicare Advantage plans that provide health care through private insurers.”

My guess is the healthcare insurance companies make a greater net profit from Medicare Advantage than Medicare Part D because the subsidy is greater.

The point of these examples is the government will overpay the healthcare insurance companies and undercover patients for care. It continuously cuts the reimbursement to physicians while a facilitator stakeholder increases its profit.

George Bush recently proposed consumers pay for Medicare Part D on a means tested bases. He did not demand price transparency or cut the profit from the subsidy to the healthcare insurance industry.

“Republican President George W. Bush proposed raising the premiums paid by individuals earning more than $82,000 a year and married couples making more than $164,000. Democrats in Congress have said the government should have to power to negotiate directly with drug makers to hold down prices.”

Barack Obama plan will simply extend the charade. The only way to fix it is to have the consumer control their healthcare dollar and motivate him to use is healthcare dollar wisely.

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

  • MedMan

    I couldn’t agree more with your conclusion. The problem starts with the moral hazards of insurance and government subsidy; so any solution will require consumers to have an increased financial stake in the system. We are trying to help consumers know what healthcare should cost at the Healthcare Blue Book ( Would like to know what you think of this resource. Thanks

  • Tinman

    What changes will occur with Obama’s plans to eliminate subsidies to Insurance Company’s for Medicare coverage? I am concerned because I have a member of our family who has COPD and takes Oxygen on a daily basis. Will the changes he wants to make continue to cover the oxygen he needs? Thank you for your help with this question.

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Is Barack Obama Any Different Than Other Politicians? Part 3


Stanley Feld M.D.,FACP,MACE

Barack Obama’s healthcare policy calls for subsidies.


“Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.”

Barack Obama should do some arithmetic. A minimum wage worker without a healthcare insurance benefit does not qualify for Medicaid coverage in most states.

Presently in Texas a family can not earn more than $800 a month in order to receive Medicaid. A family of four can not live on $10,000 a year and think of buying health insurance. Moises has a very difficult time supporting his family earning $22,000 a year. He worries about getting sick every day of his life but can not spare a penny of his income for healthcare coverage. .

Poverty today is defined by a 1955 definition. It is not adequate. President Bush rejected the SCHIP program twice because he sees the deficit writing on the wall. Republicans want to eliminate entitlement programs not add them. An additional entitlement will bankrupt the country at a faster rate than our present Medicare and Medicaid programs.

Maybe we could help the needy with a healthcare insurance program that would create incentives to be responsible for their health (exercise, lack of obesity and adherence to medication), and medical care? Maybe we could create programs to stimulate corporate America to promote wellness and exercise social responsibility to combat obesity? This would be a worthwhile investment for our government. It might even be a better investment that protecting corporations in search of increasing markets in the name of globalization.

Obesity, addiction, non-compliance with recommended medical treatment is a huge cost to our system. It must be dealt with. Only the consumer can deal with these issues on a personal level.

Some states like Indiana and New Jersey have tried to increase the income level for the eligibility for Medicaid. The federal government has refused to fund these new definitions because it does not have the money to pay for it.

States that are in worse shape financially than the federal government need to fund the difference. The only way it can be done is by raising taxes.

Michael Bloomberg seems to be the only politician with constructive ideas.

The “bipartisan Romney plan” of universal healthcare coverage in Massachusetts is shaping up to be another disaster of fuzzy thinking. The intention was good. The cost overrun this year is in the range of over $400 million dollars. The present Massachusetts administrators are hailing their universal healthcare plan as a success because more people are insured. The problem is the administrators have left the pricing and control of the healthcare insurance coverage in the hands of the healthcare insurance companies. The plan has not eliminated any of the administrative inefficiencies of the healthcare insurance industry or encourages medical practice efficiencies. It does not encourage patient responsibility nor chronic disease management incentives.

The Massachusetts plan is certainly going to result in an increase in state tax is Massachusetts.

Barack Obama’s policy statement on Subsides is naive. It presents a false hope without a plan. All government subsides so far have gone to the wrong stakeholder. The result of a policy executed with this open ended philosophy will result in increased government cost. In effect the government is providing an entitlement for the healthcare insurance industry. They are leaving control of pricing and administration in the healthcare insurance industry’s hands. An increase in government spending will result in a decrease in healthcare coverage for the average person as well.

How can I say that? Recent past history has demonstrated it. As long as the healthcare insurance industry is in control of the pricing, government bureaucracy is suppose to oversee that pricing. Historically the price has increased and healthcare coverage has decreased.

To paraphrase Yogi Berra “it is the $600 toilet seats all over again”.

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Is Barack Obama Any Different Than Other Politicians? Part 2


Stanley Feld M.D.,FACP,MACE

Every week the words used to describe Barack Obama’s healthcare policy change. I am going to review his healthcare platform as described during the week of August 5-11th. Each platform revision has the same bottom line. The bottom line is universal coverage with the government being the single party payer.(socialized medicine with all its regulations and inefficiencies).

However, each week his words are refined to made them more palatable. It gets to the point where one could believe the words are something more significant than they are. Clearly Barack Obama’s platform is not a solution to our dysfunctional healthcare system. I will evaluate each of his heading separately.

Comprehensive benefits. “The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.”

This sounds perfect because 90% of the healthcare dollars is spent on the complications of chronic diseases. However, the restrictions to access to care and the availability of care have to be analyzed to be understood. Does anyone think Senator Kennedy suffered any of these restrictions for the treatment of his brain tumor?


When Senator Edward M. Kennedy disclosed on May 20 that he had brain cancer, three days after suffering a seizure, doctors did not list surgery as a possibility. A news release from Massachusetts General Hospital in Boston left the impression that radiation and chemotherapy were the main options for his pernicious type of cancer.

Precisely why Mr. Kennedy’s treatment course changed is not known; he and his doctors are not talking to reporters.

What is known is that a few days after Mr. Kennedy learned he had a malignant brain tumor in the left parietal lobe, he invited a group of national experts to discuss his case.

The meeting on May 30 was extraordinary in at least two ways.

One was the ability of a powerful patient — in this case, a scion of a legendary political family and the chairman of the Senate’s health committee — to summon noted consultants to learn about the latest therapy and research findings.

The second was his efficiency in quickly convening more than a dozen experts from at least six academic centers. Some flew to Boston. Others participated by telephone after receiving pertinent test results and other medical records.

Is this what Senator Obama means by The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have.” Does anyone believe this policy would produce the care Senator Kennedy received? If it were true it would be great. However, this is an expansion of an entitlement America can not afford without improving the many inefficiencies and loopholes in the present healthcare system.

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Is Barack Obama Any Different Than Other Politicians? Part 1


Stanley Feld M.D.,FACP, MACE

No! He is not.

In the weeks to come I am going to point out the deficiencies in both
candidates thinking about healthcare. It is clear that neither has received
input from practicing physicians. Please click on the highlighted phrases for
more details on each subject.  

I will start with Barack Obama because the Democratic convention is first.

I am astonished by the lack of scholarship and thoughtfulness on the part of
either Presidential candidate. The issues have been reduced to sound bites. The
pronouncements are picture words that generate false hope. Neither political
party is confronting the real issues and the necessary repairs. If any of their
proposals are passed into law it will simply be a patch. In the process the
proposals will destroy the vital and good elements of our entire healthcare

Both the Medicare and the Private Healthcare Insurance system have failed.
They have neither decreased costs nor improved medical outcomes. They have been
both economic and medical care disasters. The United States can no longer afford
the present course. Academically the reasons for the disaster are clear.

1. Price
controls do not work!

2. Price
transparency is essential to create a free market economy!

3. There are too
many monetary incentives in the healthcare system to maintain an inefficient
system for all stakeholders
. (primary and secondary stakeholders)

4. Punitive
directed at the weakest stakeholders (primary stakeholders) to
correct inefficiencies do not work and lead to greater inefficiencies.

5. The healthcare system must be constructed and run
for the benefit of the primary stakeholders

6. The
primary stakeholders must drive the healthcare system for their medical and
financial benefit. (Consumer driven healthcare)

7. Secondary
stakeholders should be facilitators for the primary stakeholders.

8. Profit
derived from the system should be the result of efficiency and not the result of
political influence to protect secondary stakeholder vested interests

9. Consumers
as the primary stakeholders must be responsible for their health, and medical
Appropriate government subsidy must be provided, if warranted.

10. The
government must set up rules to protect the consumer from the healthcare
insurance industry, hospital systems, drug companies and physicians

10. Actions should be taken by government across all areas of society (War
on Obesity
) to educate
consumers to decrease the incidence of chronic disease

The consumer must fix the healthcare system. None of the other stakeholders
has been successful. In fact, in the last 30 years the healthcare system has
been made worse by the insurance industry, government and policy makers.

All their systemic changes have failed because they have, for the most part,
been to the advantage of the facilitator stakeholders and not the primary
stakeholder, the patient. Facilitator stakeholders’ profits have soared,
insurance premiums have skyrocketed while access to care has plummeted.
Patients, physicians, hospital systems and the government have adjusted to
changes to the detriment of patients. The facilitator stakeholder adjustments
have resulted in further dysfunction in the healthcare system.

Presently, employers and all the stakeholders except for the insurance
industry are in pain. However, the stakeholder most at risk is the consumer.
Only 20% of the population is sick and interacts with the healthcare system at
any moment in time. 80% of the population does not interact with the healthcare
system. They think everything is fine. However, the entire populations’ health
and well being is at risk! If we stay on the present course, I predict the
system will break down completely. Access to care will be limited and rationed.
Access to life saving medical advances will vanish. Future advances in medical
care will disappear.

The goal of the healthcare system should be;

1. To provide patients

a. with access to good quality care
b. with
education to judge quality care

c. with incentives
to be motivated to be responsible for their medical care

d. with the freedom
to judge and select the physician of their choice

e. with the information
from their healthcare providers that is truly portable

f. with choice
of healthcare insurance vehicles that are affordable

g. with education
vehicles to become “Professors of their Chronic Disease” and be truly
responsible for their care

h. effective
and affordable drug coverage designed to enhance patient compliance with

2. To provide physicians

a. with a precise definition of the meaning of quality care for various
chronic diseases
b. with incentives to provide quality care for both acute
and chronic disease
c. with the educational opportunity and motivation to
improve the quality of care they deliver.
d. with an actual vehicle developed
by their peers to prove that they are delivering quality care.
e. with a
mechanism for delivering care at a transparent price
f. with the ability to
communicate with patients electronically
g. with the
ability to improve the patient physician relationships

h. with the
ability to enable patients to practice effective self-management techniques to
prevent costly complications of chronic disease
i. with the ability to
improve communication and access to patient information so as to reduce the cost
of redundant evaluation and treatment

3. To decrease the overall cost of the system

4. To eliminate the 47 million uninsured

5. To align stakeholders’ incentives

6. To provide satisfactory profit margins for hospitals, pharmaceutical
companies, insurance companies, and physicians.

These are ambitious goals. Processes must be changed in order for the United
States to deliver effective health care to the population now and in the future.

Consumers can not leave it up to the facilitator stakeholders and policy
wonks to fix the system. Their policies have distorted the healthcare system in
the past to serve their vested interests. Patients today and in the future must
drive the process of change through appropriate demands on our politicians in
order to repair our healthcare system and install an effective consumer driven
healthcare system.

  • Toronto life insurance broker

    I believe Obama offers simple solution for a very complicated problem. And that’s it – there are no easy, painless solutions, no Alexander the Great to cut the Gordic knot…but voters don’t want to see it, in USA, or here in Canada…I think the biggest problem are tremendous costs of your health system. but how to cut those hundreds of billions???

  • Stephen Holland

    Lorne: What are you smoking?
    Steve MD

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Another Perverse Medical Outcome of Government Policy


Stanley Feld M.D.,FACP.MACE

A few weeks ago Thomas Schweich wrote an article in the New York Times magazine section entitled “Is Afghanistan a Narco-State?” This was in the midst of President Bush drawing down troops in Iraq and sending them to Afghanistan to suppress the Taliban and Al Qaeda once more. Senator Obama has said for over a year the real threat is in Afghanistan and not Iraq. This is the fight against our terrorist enemy. Senator McCain has said we need to win both wars.


John Moore/Getty Images

"POPPY FIELDS FOREVER A crop in Helmand Province in 2006. An unlikely coalition of corrupt Afghan officials, timorous Europeans, blinkered Pentagon officers and the Taliban has made poppy cultivation stubbornly resistant to eradication. "

How does Afghanistan’s production of 90% of the world’s heroin relate to Repairing America’s Healthcare System? Both candidates have pledged to reduce the costs of the healthcare system but have ignored this $180 billion dollar a year medical cost to the healthcare system.

“Thomas Schweich was a senior counternarcotics official in 2006 and had recently arrived in Afghanistan the country that supplies 90 percent of the world’s heroin. Hamid Karzia thanked the American people for all they had done for Afghanistan." Mr. Schweich took to heart Karzai’s strong statements against the Afghan drug trade. He now declares that “it was my first mistake” and his NYTimes article brilliantly describes his mistake.

It is an eye opening article because the Karzai government supports the drug trade and the United State Defense department and our European allies have turned their back on eradicating the poppy fields and the heroin trade for “political reasons”. The article is an absolute must read even if it is only 75% accurate.

What is our present administration thinking?

“The Afghan government is involved in protecting the opium trade — by shielding it from American-designed policies. While it is true that Karzai’s Taliban enemies finance themselves from the drug trade, so do many of his supporters. He is not going to let the narco trade disappear”

Our government is putting our soldiers in harms way to support a corrupt narcotic producing government in the name of the “War on Terror”. The present administration does not have a cohesive anti-drug policy nor is it thinking of the problem’s impact on the cost of healthcare.

”The cost to society of illicit drug abuse alone is $181 billion annually.”

This does not include any of the societal costs. When combined with alcohol and tobacco costs, they exceed $500 billion including healthcare, criminal justice, and lost productivity. The administration is not connecting the dots or using common sense. There is no sign that the next administration will do differently. The cost of drug addiction is a tremendous burden to the healthcare system.


“It is not just dollars and cents, but there is a human cost in tragedies across this Nation. There are nearly 1.6 million Americans, in jail because of illegal narcotics crime activities. There have been 15,200-plus deaths, up almost 8 percent over the previous year, drug-induced deaths not to mention lost opportunities for so many Americans.”

The Bush administration’s actions remind me of the “Mole and Grub” story. Moles eat grubs. Our government is killing moles one at a time. In the process we are getting our soldiers killed along with our citizens who become drug addicts. It is a very difficult, costly and unconquerable process. If we killed the grubs the moles would starve to death.

I believe some of the people in our government have the courage to kill the grubs. However, the officials that count (the administration) refuses to see the consequences of their present inaction. It does not look like it is going to get any better during the next administration unless the citizens demand action.

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


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When Is Congress Going to Learn?

Stanley Feld M.D.,FACP,MACE

When is congress going to learn that punitive action is not a wise course to pursue against a vital workforce? Real incentives work. Bogus incentives always fail. My e-prescription plan would provide physicians incentive to use the software because it would be free and driven by their patients demand.

The U.S. Senate on July 9 passed legislation to revise several Medicare provisions and authorize incentive payments for use of electronic prescribing technology.”

Please notice the complexity of the schedule. Physicians have learned that anything incomprehensible is a trick. Therefore they do not participate. If they do not participate the incentive fails. It is similar to the art of war. You simply do not show up to fight.

The bill calls for Medicare incentive payments for e-prescribing of 2% in fiscal 2009 and 2010, 1% in 2011 and 2012, and 0.5% in 2013. Sec. 132. Incentives for electronic prescribing.


The initial question is 2% of what? Will it cover my cost of installing an E-prescription system? What is the trick? Does the government want to develop an easy way of following my prescribing habits so they can reduce reimbursement?

Provides positive incentives for practitioners who use a qualified e-prescribing systems in 2009 through 2013. Requires practitioners to use qualified e-prescribing system in 2011 and beyond. Enforcement of the mandate achieved through a reduction in payments of up to 2% to providers who fail to e-prescribe. Prohibits application of financial incentives and penalties to those who write prescriptions infrequently, and permits the Secretary to establish a hardship exception to providers who are unable to use a qualified e-prescribing system.

Note the legislation also requires more reporting by physicians. The increased reporting consists of any e-prescribing quality measures established under Medicare’s physician reporting system. Beginning in 2012, payments to physicians not electronically prescribing would be reduced by 1%, then 1.5% in 2013 and 2% in subsequent years. I believe congress is mistaken if they think this will work. It will be costly to the healthcare system and someone other than physicians will make some money. The plan will only generate more mistrust among physicians for the government.

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

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