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All items for October, 2008


Governor Jindal: Health care should be left to patients, doctors


Stanley Feld M.D.,FACP,MACE


Governor Bobby Jindal of Louisiana is about to unveil an overhauled Medicaid program for his state. It remains to be seen whether he is going to do it correctly and whether the federal government will support him.

He has hinted that he understands the healthcare system’s problems. Governor Jindal is a Republican governor. The Republican Party’s mandate is to transfer all entitlement programs to the private sector. The result will not be favorable to patients or physicians. Total control of Medicaid by the healthcare insurance industry would mean less access to care and greater profits for the healthcare insurance industry.

“Louisiana’s efforts to improve health-care outcomes must put more power in the hands of doctors and patients and should also include broad public health measures, such as improving nutrition and boosting physical education requirements in schools, Gov. Bobby Jindal said Wednesday.”

The social contract of medical care should be between the doctor and the patient. It should not be between a third party such as the government or the healthcare insurance industry and the physicians or patients.

The government should be responsible for broad public health measures such developing a culture of good nutrition and physical activity in the schools and public service campaigns to combat obesity and promote healthy living.

“It really is looking at health, not just health care,” Jindal said, citing Louisiana’s higher rates of diabetes, obesity and asthma as chronic conditions that can be improved through a sharper focus on public health.”

“Without providing specifics, Jindal said he would favor legislation to encourage more physical education in schools and improve nutrition in school vending machines and lunches.”

Governor Jindal’s plan to revise Medicaid is called Louisiana Health First. Early indications are that it will be a sweeping overhaul of the ineffective Medicaid system. Early indications are that it will not support the concept of a social contract between patients and physicians.

“The plan, dubbed Louisiana Health First, would turn over large chunks of the program to privately run managed-care organizations, which would oversee the health care of as many as 380,000 residents, mainly children.”

We have seen that managed care does not work. It is really managed costs. Managed care usually restricts access to care in order to manage costs.

Governor Jindal is right in the public health area but dead wrong with his managed care organization proposal. He will just be providing a money making vehicle for managed care organizations (healthcare insurance industry) while not improving the health of the people of Louisiana.

“Jindal said he hopes to get the changes approved before the Bush administration leaves office Jan. 20, as the change to a new president could delay the state’s plans. “We simply don’t want to start over from scratch,” Jindal said”.

He wants the change before January 20th 2008. He would love to sneak in a plan that would outsource state and federally subsidize Medicaid to managed care organizations. The Republican Party’s goal is to abandon entitlement programs and hand them over to the private sector (healthcare insurance industry).

President Bush tried to privatize social security. If he was successful it would have been a disaster given the present financial crisis. The President is in the process of privatizing Medicare with the Medicare Advantage program. The administration is paying a premium to the healthcare insurance industry to accomplish the transfer at the expense of taxpayers and seniors. Massachusetts is privatizing universal care and experiencing large cost overruns.They will all fail.

Who do you think will lose? Patients and physician will lose. The only reform program that will work will be to provide incentives for consumers to be in control of their healthcare dollar along with a reward system for consumers if they responsibly maintain their health.

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Politicians Give Me A Headache: Part 3


Stanley Feld M.D.,FACP,MACE

As the Presidential campaign comes to a close the important issues of the campaign get blurred or discarded. Healthcare reform is one of those issues.

In the past I enjoyed the clarity of thinking of the Wall Street Journal editorial page. Lately it has adopted a patina of fuzzy thinking and muckraking. It frequently misses the essential issues in the name of free enterprise. Last week Newt Gingrich said something intelligent. He said the Republican party should abandon the notion of anti-government for the notion of government involvement with competent management. Barack Obama has hinted that he gets it. 

John McCain does not have a healthcare plan. His healthcare plan has one tactic but is not a strategy to repair the healthcare system. It is an anti-government tactic. An effective healthcare plan must have many tactics. The tactics must align the agendas of all the stakeholders. The most important agenda is the medical care provided to consumers. John McCain’s tactic keeps control of the healthcare industry in the hands of the healthcare insurance companies. The healthcare insurance industry is the stakeholder that has abused the healthcare system. Its abuse has led to the abuse by other stakeholders.

John McCain’s healthcare tax credit is supposed to permit the self-insured to pay for healthcare insurance with pre-tax dollars as opposed to post tax dollars. Employer provided healthcare insurance presently pays for employee insurance with pretax dollars.

Equal tax treatment for employers and self employed should have been instituted years ago. John McCain’s non healthcare plan has many problems. His tax credit is not large enough compared to the cost of healthcare insurance. His plan will give employers an excuse to abandon providing healthcare insurance for its employees. The result long term will be an increase in the number of uninsured. A worker earning $40,000 cannot afford $12,000 a year for healthcare insurance for his family even if $5,000 is tax free. The problem is the cost of insurance and the cost of care.

The Wall Street Journal editorial spends time criticizing the Obama campaign for John McCain’s deficiency.

“One underreported story of this election is how heavily John McCain has been damaged by Barack Obama’s television ad assault on his health-care plan. A lot of voters seem to believe the Democrat when he says that Mr. McCain wants to deny them coverage or bankrupt them with crushing hospital bills.”

Barack Obama’s television advertisement is correct. The result of Mr. McCain’s “healthcare plan” will be just that because “affordable plans” will be sold that do not provide adequate healthcare coverage. We are seeing it now with higher co-pays, higher deductibles and underinsured. The healthcare insurance industry’s goal is to maintain high profits without regard for other stakeholders’ needs.

The Journal spends most of the article criticizing Jason Furman, who is Mr. Obama’s economic policy director because he agrees with Mr. McCain’s tactic. John McCain’s tactic is a tax credit for the self employed that is long overdue. Jason Furman does not agree with the taxable income portion of employer provided healthcare insurance. John McCain’s tax credit, taxable income proposal would result in the elimination of employer provided healthcare insurance.

The problem is healthcare reform needs more than one tactic. It needs innovative reform of the healthcare system. Effective healthcare reform must put the consumer in control of his healthcare dollar with incentives for rewards if consumers use their healthcare dollar wisely. Government and the healthcare insurance industry’s control of the healthcare dollar has not worked. Government control does not work because the government can not manage effectively and outsources control to the healthcare insurance industry.

I do not agree with Senator Obama’s plan because it is going to head us down the road of government as a single party payer with healthcare insurance company management like the Massachusetts plan.

Neither candidate has a viable plan. The WSJ editorial does not focus on the issue of healthcare reform. It confuses us about a sidebar tactic.

“ But wait, let’s consult another one of Mr. Obama’s advisers. David Cutler, the Otto Eckstein Professor of Applied Economics at Harvard, put it this way: “Health insurance is not something that is made better by tying it to employment. As a result, essentially all economists believe that universal coverage should be done outside of employment.”

That passage comes from Mr. Cutler’s 2004 book, “Your Money or Your Life,” which outlined a strategy for universal health care. Not surprisingly, Professor Cutler’s plan, like Mr. McCain’s, also applied subsidies such as “tax credits — people get a lower tax bill, or a refund from the government, to be used to purchase insurance.” In this he was echoing many other liberal health experts such as MIT’s Jonathan Gruber, another Democratic policy star.

I think the WSJ thinks Americans are stupid. If they throw enough unrelated quotes at us we will be totally confused.

I believe as Colin Powell believes. Barack Obama is potentially a transformational figure. He seems to have a deeper view of issues than most. Hopefully, he is smart enough to see through the folly in his healthcare advisors’ plans. John McCain is not transforming anything.

  • Alan Shimel

    Stan – I agree with you. The WSJ is just not what it used to be. But than again neither is Wall Street itself. Do you think Murdoch owning it has anything to do with it? Will the WSJ become the print version of Fox News “fair and balanced”? I hope not. What a shame to see another American institution watered down.

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War On Obesity: Obesity And The Economy: Part 10

Stanley Feld M.D.,FACP,MACE

Our financial crisis can be an instrument of change in a positive direction. America’s obesity epidemic is a weapon of mass destruction destined to cause another financial crisis. An increase in the complications of chronic disease can cause an economic meltdown if the obesity epidemic is not contained. The complications of chronic diseases result in the expenditure of 90% our healthcare dollars.

The average American burns 1200 to 2000 calories per day with normal activities of daily living. 2.2 lbs. of fat store 9000 calories of energy. In order to gain 2.2 lbs. a person needs to eat 9000 calories more than he burns. In order to lose 2.2 lbs a person needs to burn 9000 calories more than he eats.

It is very easy to gain 9,000 calories and very hard to lose 9,000 calories in America’s cultural environment. The average fast food meal is over 1000 calories while thirty minutes of jogging at an eleven minute mile burns 200 calories.

How can our financial crisis impact our obesity epidemic? Americans are being cautious about spending money. Large amounts of their retirement savings  are being wiped out.

Exercise is cheap. Couples sharing meals at restaurants result in half the caloric intake and half the cost.

Restaurant entrees are at least 1200 calories. TGI Friday’s tried to develop a competitive advantage by offering smaller portion entrees at lower prices. The plan has not gotten any traction. 

America has to be conditioned to a cultural change in eating habits. We have experienced the explosive change in eating habits in the 1950s and 1960s with the introduction of fast food vendors and snack foods. This was the result of Pavlovian conditioning. 

However, a person can feel just as satisfied with half a sandwich as a whole sandwich. In hard economic times sharing a meal cost half as much as two meals. If we eat simple meals at home it can cost much less than buying take out meals or eating in a restaurant.

How can we accomplish this cultural change? I believe it can be done through education and subliminal advertising. Everyone wants to be thin. They do not have the information to accomplish their goal.

Wal-Mart is going to have a nutritional consultant on its web site suggesting inexpensive healthy food planning. 

New York City’s Mayor Michael Bloomberg is a genius. We need more leaders like him. The New York City Department of health has initiated an educational campaign on the NYC Subway.

“The five ads appearing in subway cars are designed to help people see how quickly fast-food calories add up and drive home the message that some foods can have deceptively high calorie counts.”

The best is a poster of a delicious looking apple raisin muffin. The ad states the muffin is 475 calories. Above the muffin it say the average person burns 2000 calories per day. The observer was left to fill in the rest and make his own choice.


“If you’re eating it as a snack, you may want to split it with a friend,” Nonas, a registered dietitian, said in a statement.


The New York City Department of Health has four additional advertisements. The ads are educational and subliminal.



This is a brilliant public service campaign. However, it only tells half the story. In order to lose weight you have to eat less and burn more. NYC has to follow up with exercise posters and a sustained campaign. Any campaign has to be sustained and remain exciting in order to cause the cultural change in eating necessary to stop the growth of obesity.

The federal government should be doing a similar public service campaign all over the United States. The media is the message and this message should constantly be a reminder to all of us. If we are serious about Repairing The Healthcare System we have to be serious about my War On Obesity.

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Perverse Outcomes Resulting From a Distorted Healthcare System.


Stanley Feld M.D.,FACP,MACE

A great comment was sent to me by an Emergency Physician in reference to the increased Emergency Room visits despite the increase in insured people in the state of Massachusetts. He referred me to his blog.

Unfortunately the destined to fail Romney healthcare plan of Massachusetts is being hailed as a breakthrough by healthcare policy wonks all 50 states. They do not understand the healthcare system.

I am very happy that physicians are starting to use the blogosphere to explain the defects in the healthcare system. Politicians and citizens should listen. It is going to take a citizens’ movement to change the frightful direction of the healthcare system.

In the 1970’s,my father drove my brother and me (both Texans by then) through destroyed neighborhoods in New York City. He wanted to show us the degradation of once viable neighborhoods.

I will never forget him telling us politicians cannot see any of this from 30,000 feet above the ground. The reason health policy wonks and politicians do not see the destruction of the healthcare system is because no one is looking at it at street level. The street level physicians could tell politicians what is going on but none of the politicians are asking or listening. The blogosphere has given physicians a voice. I am happy physicians are taking the time to tell people what is going on. Hopefully someone will listen soon.

Charity Doc is an emergency room physician who describes himself as follows;

“ I once had aspirations to make a difference in the world, now I just work at it one guaiac card at a time. The lucky ones come back negative. Blue’s a bad color!”

He states:

“In honesty though, we’re not all heartless, money-grubbing bastards. We’re here to help everyone who truly needs our expertise.”

I believe him because physicians at all levels are feeling as dispirited as Charity Doc.


“Our current health care system here in America cannot continue on its current course for long for all of the reasons above. “

Charity Doc gives multiple examples and abuse of the emergency room system.

“ I fear a slippery slide to socialized health care if we don’t quickly overhaul the system. When ~20% of the GDP (30% depending on which studies you read) of this country is projected to go toward health care expenditures by the end of this decade, our inefficient system cannot be sustained. The breakpoint is about to come. We are headed toward a huge national crisis and our politicians do not seem to care. In fact, we are already in a crisis and it’s about to get worse.”
“The problems that I bitched and moaned about above are not unique to my hospital alone. It is happening at every Emergency Dept. in this country. More and more Americans are uninsured these days. The numbers are expected to continue to rise. And where do they go for their health care? They show up to the ER’s across the country, of course, bogging down the system causing a serious overcrowding.”

Emergency Room abuse is only a fraction of the problem. If patients do not own their healthcare dollar they do not care how they spend healthcare monies. If they do not have insurance or money they know they will be taken care of nonetheless.

“Thus, uninsured patients show up in hoards to the ERs because we don’t and cannot make them pay first to be seen. The Federal EMTALA law (Emergency Medical Treatment and Active Labor Act) requires that every patient who shows up to a hospital ER must receive a medical screening and stabilization if that hospital participates in Medicare. Without Medicare funding, a hospital is certain to go belly up bankrupt and thus EMTALA is pretty much inclusive of all hospitals in the US of A.”

Private clinics, however, are not bound by EMTALA to do the same.

“So in a way, we already have, sort of, universal health care here in the USA. The word is long out. If you have no health insurance and can’t pay for health care, go to the nearest ER. You don’t have to pay up front and we are too scared of law suits not to take care of you. You can make up phony information about yourself, fake who you are, give ’em aliases, fake phone numbers and addresses, phony social security numbers and you’ll never have to see that hospital bill.”

It is inconvienent care but free care none the less.

“ EMTALA is a well-intentioned law meant to prevent patient dumping and abandonment. Too many people, however, take advantage of it and abuse the system.”

How do the hospital systems make a up for the loss? The government and healthcare insurance companies pay the hospital losses through cost shifting and non transparent accounting.

Charity Doc’s blog is  worth reading if you really want to know what is going on at the street level. The silly things our Presidential candidates are saying are not going to solve these problems. The Republican administration methodical destruction of our safety net charity hospital system is going to make things worse.

America! Please wake up.

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

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


Stanley Feld M.D., FACP,MACE

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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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


Is Medical Care a Right or a Responsibility?


Stanley Feld M.D., FACP, MACE

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

McCain said:

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

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

Obama said:

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

  • Sarah

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

  • rocky

    this is a nice post

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Everyone Wants To Be Bailed Out: Part 1


Stanley Feld M.D.,FACP,MACE


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The Role Of Government In Healthcare


Stanley Feld M.D.,FACP,MACE

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

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

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

Neither Presidential candidate has a chance at constructive healthcare reform.

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

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

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

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

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

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

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

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

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

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

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

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

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


The headline in the Kansas City Star reported that

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

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

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

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

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

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

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

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

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

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