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All items for June, 2009


Medicare Coverage Is Not Cheap For Either Seniors Or The Government : Part 1; Seniors


Stanley Feld M.D.,FACP,MACE

Many people believe Medicare works well. Many people have said all we need to do to repair the healthcare system is lower the eligibility age from 65 to newborns.

America would then achieve a. universal care, b. affordable costs c. improved quality care. The healthcare system would be fixed. The statement is simplistic but popular.

Medicare coverage does work well for seniors if they have both adequate supplemental coverage and Medicare Part D to cover the Medicare gaps in coverage and drugs.

Medicare Part D( drug coverage) was poorly constructed. It was built to the advantage of the healthcare insurance industry not seniors. If seniors do not have supplemental Medicare insurance (Medigap) they could be bankrupted because of the Medicare deductibles and co-pays. .

Medicare does protect the senior from the retail price of medical care. It does guarantee insurability at a price not determined by pre-existing illness. It does permit choice of provider providing the provider sees Medicare patients.

Fewer and fewer physicians are accepting Medicare patients. Medicare reimbursement and coverage decline with each passing year. In many cases physician reimbursement is lower than the physician’s cost to provide the service.

This has been a constant battle for physicians since the government cost savings program was mandated in the 1980’s. Another 20% reduction in reimbursement is scheduled for 2010.

Seniors can still go to physicians who do not accept Medicare. However, seniors will be responsible to pay the retail price for the service. Seniors will collect directly from Medicare 80% of Medicare’s acceptable fee after they submit the bill to Medicare.

For example, if a medical bill is $200 and Medicare’s allowable fee is $80, Medicare will pay you 80% of the allowable fee or $64. The senior has already paid the physician $200. The senior’s out of pocket expense is $135 . If the physician honors Medicare $120 of his $200 fee is disallowed.

Medicare will pay the physician $64. The senior is liable for $16. If the senior has supplemental insurance (Medigap) the supplemental insurance will pay the remaining $16. .

The Medicare premium paid by seniors monthly is not cheap. The base assessment is $99 per month per senior. This assessment might not be affordable to many who are on a fixed income.

The Medicare Part D helped pay for prescription drugs. Many seniors cannot afford to buy the medication they need. Medication needed to stay well and out of the hospital.

1. Medicare has recently imposed an added assessment to the basic Medicare premium. It is called the Modified Adjusted Income Calculation. The IRS supplies Medicare with a senior’s previous year income tax returns. Capital gains, dividends, tax free dividends, and salaries are including in the Modified Adjusted Income calculation.

2. A married couple with a joint return and income from all sources is going to have an additional assessment of between $51.60 and $284 dollars per person per month depending on their combined Modified Adjusted Income calculation assessment.

3. The assessment starts at $160,000/yr and ends at $410,000 per year. A widow with dividends, capital gains, an annuity and rental income of $164,000 per year is assessed an additional $103.30 per month or $1239.60 per year.

4. This assessment is paid with pre tax dollars. It gets deducted from the Social Security payment. If a person has earned income in addition to passive income the person is also paying additional tax on his Social Security check.

5. The deductible of 20% of the allowable fee and the initial $992.00 deductible for a hospital admission becomes expensive quickly.

6. In order for the Medicare recipient to have full coverage for the deductibles they have to buy Medigap insurance. There are seven Medigap insurance policies. The best and most complete is the Medigap Part F. Several private healthcare insurance companies sell this coverage. For persons under 70 years the cost of the policy is $140 dollars per person per month in after tax dollars. The effective post tax cost per month is $200 per person or $400 per couple. The yearly after tax dollar cost is $4800 per year.

7. If you add Medicare Part D for prescription drug coverage, it adds another $24 per person or $34.28 dollars in after tax dollars per month per person or $822 dollars per couple per year. This cost does not consider the extra cost of the infamous doughnut hole.

8. The total premium for adequate Medicare insurance is $2244 plus $4800 plus $822 or $7866 per year. This calculation excludes the modified adjusted gross income. The modified adjusted income can add $619.20 to $3408 per couple per year to the premium. The MAGI creates a means adjusted premium. The maximum means adjusted premium is $11,274. per year per couple in 2008.

It should be clear that Medicare has its benefits. However it also has limitations because despite these premiums and deductibles the government’s unfunded liabilities for Medicare is escalating to unsustainable levels.

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

  • Shared Decision Making

    This is quite a comprehensive posting on medical coverage. It gives us some interesting insight and information no doubt. 🙂

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Are The Wheels Coming Off?


Stanley Feld M.D.,FACP,MACE

During the past week the healthcare debate has increased in intensity. President Obama has drawn a line in the sand. He wants a bill on his desk by August 1, 2009.

It also looks as if his healthcare reform plan is being derailed not by Republicans but by his own party.

President Obama has also given the AMA a glimpse of where he stands on malpractice reform. He received boos from members of the AMA.

He has set out the fundament principles of his healthcare reform.

1. Universal coverage

2. Affordable cost

3. Increase in quality of care.

President Obama then asked key committees in both houses to craft a bill compatible with his goals. He is very smart.

“What the president wisely assessed, looking at what did not happen in the early ’90s, was that unless there was some real ownership, unless members of Congress owned drafting and crafting and did some heavy lifting and then owned the final work product, it wasn’t going to work.”

This is clever but it could be the down fall of any healthcare reform. Max Bacchus has presented Tom Daschle’s plan. Ted Kennedy has presented a plan that is fiscally irresponsible according to the congressional budget office. His healthcare reform plan completely ignores the warning of the congressional budget office. The House of Representatives released the Conyer healthcare reform plan that would create an even larger deficit than Ted Kennedy’s plan.

None of the plans from either side of the aisle are focused on the real problems in the healthcare system.

Kathleen Sebelius, secretary of health and human services, summarized the mood that is motivating the country to move forward. The country feels government needs to do something. She disregards the fact that what is done needs to be constructive and must repair the healthcare system.

“ I think the underlying factor is that the status quo is not sustainable and it’s not acceptable. And in many ways the economic downturn has shaken the status quo.”

Economically, emotionally, and morally the status quo is not sustainable. Everyone agrees. The debate is getting very confusing while focusing on the wrong issues.

In the early ’90s, there was a sense that doing nothing was an O.K. alternative. For some people it was better than doing something that they felt would lead us in a wrong direction. I really don’t know of a single stakeholder group or party in this discussion who is willing to say out loud doing nothing is O.K.

Everyone agrees something must be done. The momentum for healthcare reform is compatible with Heidi Klein’s “Shock Doctrine.”

If people are frightened enough about an issue they will accept any policy. She says this is the method politicians use to gain power over the people.

All the healthcare reform proposals are confusing and difficult to follow. At this point citizens are so frightened and disgusted that they relinquish their power to elected officials who they hope understand the problem. They assume these politicians will look after their vested interests.

I think the weight of inertia is always more powerful often than the forces of change. But in this case there’s an underlying turmoil, whether it’s people looking at the moral imperative, people looking at the financial imperative, and people frankly looking at what’s happening to our country in terms of health outcomes. Nobody feels this is acceptable

Kathleen Sebelius explained the legislative confusion away by saying this is how legislation works. The people want a bill.

President Obama is going to prove to congress that the people are demanding a change through his house parties and blogs calling for support of his healthcare plan. The Democrat controlled congress will have no choice but to give them a bill. The problem is the plan will make things worse as proven in Massachusetts.

When Secretary Sebelius was asked the question;So are you not concerned about the Congressional Budget Office release on the HELP bill? Do you think it doesn’t really pose problems? (The office “scored” the bill produced by Sen. Edward M. Kennedy’s committee as costing at least $1 trillion over 10 years, while leaving 36 million people uninsured).”

She said don’t worry. Whenever you see a big price tag and the notion that lots of people are not covered it will raise questions.

“ What I’ve been told is that we shouldn’t spend a lot of time and energy on that because it( Kennedy’s plan) is a partial hit on a partial bill.

I think the American people are tired of these general responses to some positive data by impartial sources. The administration believes all it has to be do is to respond by repeating President Obama’s generally accepted idealistic principles. The people will believe everything will be alright.

I’m still optimistic at the end of the day that a bill that meets what the president said all along, some fundamental principles — cover every American who lacks health insurance right now, build on what is working in the health system, so people who have coverage and a health provider that they like and they feel is good for their family keep it, that we have a new system in place to really lower costs over all for everybody and that we begin to drive quality, which is now available to some Americans some of the time depending on where you enter the system. So around those principles I’m convinced we’re going to have a proposal.

What are the details of President Obama’s program? What is the cost to the tax payers going be? Is the congressional budget office wrong about the 1 trillion dollars over ten years? Is Senator Kennedy wrong about 36 million uninsured because the government cannot afford it? How is the quality of care going to improve with the bills on the table when quality medical care is not defined properly? Is a board of experts’ going to be able to define and enforce its definition of quality medical care?

This is not the time to give in or give up!

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Summary Blogs to Repair the Healthcare System


Stanley Feld M.D.,FACP,MACE

I am posting what I consider summary blogs. It would be difficult to read all the summaries in one sitting. I compiled this list for people who have just started following “Repairing the Healthcare System.” The links are intended to get you started and to be used as a reference.

The links below are my view of the policies that must be adopted to Repair the Healthcare System. The letters written to President-elect Obama and then President Obama were written when he promised that everything was on the table and he was open to all ideas. It is now clear to me that nothing was on the table. He will expand a government entitlement the country cannot afford and most people would not want. President Obama should be concentrating on the real problems in the healthcare system.

If you follow the links in each article you will understand my views on the policies needed to repair the healthcare system. I believe it can be repaired without enlarging unaffordable entitlements and the resultant increase in public debt. I have proposed specific policy changes that will enhance quality, improve coverage and decrease costs.

The Healthcare System’s Problems Part 1

The Healthcare System’s Problems Part 2

The Ideal Medical Savings Account

The Ideal Electronic Medical Record Part 1

The Ideal Electronic Medical Record Part 2

E prescriptions

Real Price transparency

The Definition Of The Physician Patient Relationship Part 1

The Definition Of The Physician Patient Relationship Part 2

Dear President Obama Part 1

Dear President Obama Part 2

Dear President Obama Part 3

Dear President Obama Part 4

Dear President Obama Part 5–elect-barack-obama-part-5.html

Dear President Obama Part 6

Rationale for Effective Malpractice Reform Part 1

Rationale for Effective Malpractice Reform Part 2

Electronic Medical Record Stimulus Fiasco Part 1

Electronic Medical Record Stimulus Fiasco Part 2

Electronic Medical Record Stimulus Fiasco Part 3

Call to Action


Republican Healthcare Proposal Executive Summary : Part 2


Stanley Feld M.D.,FACP,MACE

Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice

The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important improvements to both programs without limiting eligibility or benefits by:

• Integrating low‐income families with dependent children into higher‐quality private plans through direct assistance

What is the definition of higher-quality private plans? Who is going to judge quality? How is government going to fund these “higher quality private plans?”

Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans

How will this be accomplished when Medicaid reimburses so poorly. There is a shortage of Medicaid physicians already. These physicians must do a volume business (Medicaid Mills) to make ends meet. These volume practices (Medicaid Mills) are being investigated for fraud.

Realigning responsibility between federal and state governments in order to better coordinate benefits by requiring the Medicare program to assume Medicaid responsibility of premiums, cost‐sharing, and deductibles for low‐income seniors

The above is just words. It almost sounds as if the federal and state government are going to be responsible for increased funding for private enterprise.

Rebalancing long‐term care services to ensure choice between institutionalized and home‐based care

Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage

Medicare Advantage is recognized as an insurance product designed to rid the government of the Medicare entitlement . The government under the Republican administration paid an extra $3,000.00 per person to outsource the responsibility for Medicaid from the state to the healthcare insurance industry. The cost is unsustainable. Excess profits flow to the healthcare insurance industry.

Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to

physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction while reducing costs

This is a “pay for performance a system” that ultimately cannot work because of intrinsic defects in the pay for performance concept. Quality medical care has not been defined appropriately. Is it defined as medical outcomes, financial outcomes, number of test performed or disease discovery?

Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D

Medicare Part D is a poorly constructed in the present form. It is written to the advantage of the healthcare insurance industry, the pharmacies and the pharmachuetical companies. It is not a patient centric plan.

Ensuring Compensation for Injured Patients

Our current legal system does a poor job at compensating patients for medical mistakes in a fair and efficient manner. Instead of nurturing an environment where medical professionals can openly learn from their mistakes, our legal system often forces doctors and patients into contentious courtroom disputes. The Patients’ Choice Act would reform this broken system that helps drive health care costs out of control by:

• Encouraging states to adopt a number of legal alternatives entirely run by the state that would include the establishment of expert medical panels to resolve disputes, creation of health courts, or a combination of both

This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.

Establishing Transparency in Health Care Price and Quality

For a vibrant health care market to function properly, patients must know what services cost and who provides the best service. Uniform and reliable measures of reporting quality and price information should be designed by the stakeholders in health care rather than the heavy‐hand of government. The Patients’ Choice Act would bring this much needed transparency into the health care market by:

Creating a Healthcare Services Commission that relies on a public/private partnership to enhance the quality, appropriateness and effectiveness of health care services through the publication and enforcement of quality and price information

Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality with the input from all major stakeholders in health care, as well as the general public

Ensuring that measures of effectiveness keep pace with innovation

This is the most logical proposal in the plan. It also contains specific action points. However it keeps the power in the healthcare insurance industry’s hands. It should put the power in the consumers’ hands. If the private sector (healthcare insurance industry) does not cooperate, it should be restricted from selling insurance by the state board of insurers.

There is the entire proposal. There is nothing new and no outline of action to accomplish any part of the proposal.

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

  • sasha2008

    Where is CBO’s calculation for Fraud?
    Healthcare Fraud- SEC Fraud – Bankruptcy Fraud and Financial Fraud – a trail that just ended in December 2008 where Leo Wise, not at ethics CBO stated?
    ‘Ladies and gentlemen, this is a case of staggering fraud,’ Leo Wise said. ‘It is one of the largest frauds the FBI has ever investigated.
    RICK SCOTT – Chairman of Conservatives for Patients’ Rights
    July 26, 1997, Los Angeles Times article:
    A controversial deal maker whose hard-nosed business tactics have reshaped the medical industry resigned Friday as scandal engulfed the vast hospital empire he had assembled over the last decade.
    Richard Scott — sometimes called “the Bill Gates of health care” – was chairman of Columbia/HCA Healthcare Corp. –
    Columbia/HCA was a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott. Scott was recently terminated by Darla Moore, the wife of Richard Rainwater amid a massive federal investigation into the Medicare billing, physician recruiting and home-care practices of the nation’s largest for-profit health care company.
    Columbia was the nation’s largest provider of healthcare services, with facilities in 36 states, England, Switzerland and Spain. Columbia’s networks include 342 hospitals, 148 surgery centers, more than 570 home health locations, and a nationwide pharmacy benefit management; A Pharmacy Benefit Manager (PBM) is a third party administrator of prescription drug programs.
    Medicare Part D? Is this government subsidized program profitable for your company- whatever the name is today- 2009?
    2009-The Wall Street Journal reported that Richard Scott, “the former chief executive of HCA Inc,” had formed the non-profit organization Conservatives for Patients’ Rights as part of a “lobbying campaign to derail or modify” President Obama’s health care proposals, but failed to note that Scott’s departure from HCA in 1997 amid a federal investigation into the company’s Medicare billing, physician recruiting, and home-care practices.
    While Senator Frist was the majority leader in Congress this is what was settled on the massive fraud- at his family’s empire:
    2003- http://WWW.USDOJ.GOV
    HCA Inc. (formerly known as Columbia/HCA and HCA – The Healthcare Company)
    Healthcare Fraud-SEC Fraud-Bankruptcy Fraud-Financial Fraud—–Some of the LARGEST FRAUD CASES in our country all stem from the Balanced Budget Act of 1997.
    On Sept 8, 1998 Standard and Poors downgraded the bonds of Charter/HCA to negative bases on poor earnings.
    Rainwater also owned a large stake in Magellan Health Care which controls Charter Medical.
    Magellan, run by Darla Moore, is the largest network of psychiatric hospitals in the country. They are becoming more and more involved in obtaining government money for services formerly not covered as health care, according to Fortune Magazine.
    Columbia/HCA Healthcare Corp. – the nation’s largest for-profit health care company decided to sell its home health-care business
    Home health – was struggling under the Balanced Budget Act of 1997- about 1,400 agencies closed nationwide in 1998.
    On July 29, 1999 Medshares filed the largest corporate bankruptcy filed in the state of Tennessee.
    The court utilized the DIP Finance tool. Darla Moore, the wife of Richard Rainwater and according to Fortune Magazine, was the creator of DIP Finance while at Chase Bank in late 80’s.
    At Medshares, consolidation is key to its strategy of being one of the survivors of the home health shakeout. Its management company, TBN of Tennessee Inc., swallowed up the home health units of Columbia/ HCA Healthcare Corp. and Integrated Health Services in late 1998 and early 1999, only to file for bankruptcy protection for Medshares and Soleus Healthcare Services, formerly IHS Home Care, a few months later.
    2002 FBI raids National Century Financial Enterprises
    “This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.
    ‘Ladies and gentlemen, this is a case of staggering fraud,’ Leo Wise said. ‘It is one of the largest frauds the FBI has ever investigated.
    All of Columbia Homecare Group units were at National Century Financial Enterprises.
    ONE month before GW Bush left office- All other execs at National Century Financial Enterprises were found guilty and convicted.
    December 2008 – the largest fraud case FBI has ever investigated-ONE ACQUITTAL-

  • Chiropractic EMR

    I would like to Thanks for the informative post. I really appreciate it. The health security for low‐income families and American seniors are threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers.
    The above is just words. It almost sounds as if the federal and state government is going to be responsible for increased funding for private enterprise.
    This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.
    Chiropractic EMR

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Republican Healthcare Proposal Executive Summary : Part 1


Stanley Feld M.D.,FACE,MACE

It is not fair to criticize the Republican Party’s healthcare proposal without providing the reader with the source material. The source material comes from Senator Tom Coburn’s web site. My negative comments should be judged in light of the original proposal. The executive summary follows.

Preventing Disease and Promoting Healthier Lifestyles

· Critical investments in public health and disease prevention will go a long way in restraining

health care costs and improving the quality of Americans’ lives. The Patient’s Choice Act of 2009 would:

Encourage increased coordination of federal prevention efforts and bring long‐overdue accountability to these programs

Require CDC to undertake a national campaign highlighting science‐based health promotion strategies

Equip recipients of Supplemental Nutritional Benefits with easily understandable information about nutritious food options and target the use of food stamps to healthy food choices

Invest $50 million annually for increased vaccine availability and bonus grants to states that achieve 90 percent or greater coverage of CDC‐recommended vaccines

Provide incentives for states to reduce rates of chronic disease like heart disease and diabetes

All of the above proposals should be executed. How will they be implemented? The Republicans do not have a plan but not having a plan does not make the Democrat’s plan a good one.

Creating Affordable and Accessible Health Insurance Options

Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant market for health insurance that is consistent and fair will allow all Americans access to health coverage.

How will Republicans make a vibrant market for healthcare insurance? How will people who cannot afford healthcare insurance pay for it? The tax credits might help a little. However, if you do not have the cash you cannot pay for the insurance.

The Patient’s Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the following:

Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different health insurance policies and select the one that meets their unique needs

Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range of choices

Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating Exchange insurers based on age or health

What will the premium be for those with preexisting illnesses? Will the premiums be higher for patients with preexisting illnesses? The high risk pool premiums have been very expensive.

Creates a non‐profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre‐existing conditions.

Expands coverage through auto‐enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year

This is an empty statement. How will this be administered? The devil is in the details and there are no details presented.

Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’

Risk pooling has been tried and has been unsuccessful. It has been an excuse to allow the insurance industry to spread the risk. The proposal also implies variable premiums.

Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage

Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get their health coverage through their employers, discriminating against the self‐employed, the unemployed, and small businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by:

Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family

Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid with HSAs without a tax penalty

Allowing preventative services to be covered by High Deductible Health Plans

Increasing the amount of money an HSA owner may annually contribute to their account

Healthcare insurance premiums are $14,000.00 a year for a family. A $5,700.00 tax credit does not cover it. It also assumes the consumer has enough income to have a $5,700.00 be tax liability. Citizens are not subject to income tax if they make up to $38,000.00 year. HSA’s retain the healthcare dollar to be used for future spending on healthcare. The healthcare insurance industry retains control over the premium and the healthcare dollars. It is not a pro consumer proposal. It does not offer financial incentives to consumers .

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

  • Matt

    Aren’t refundable tax credits for situations in which an individual might NOT have a tax liability? For example, if one makes under $38,000, as you say, they would not be liable for federal income tax. In this situation, then, the “refundable” tax credit as the Republicans propose would be administered to our hypothetical individual without respect to their income. Would he not simply get a check for $2,300 (as an individual)?

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Republican Healthcare Plan Unveiled.


Stanley Feld M.D.,FACP.MACE


Republicans in Congress have introduced their health care reform plan. "The Patients’ Choice Act of 2009," has been introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA).

The proposal that relies heavily on private mechanisms does not contain an individual mandate to have healthcare insurance, It offers insufficient tax credits for families and individuals previously insured and not in a group insurance plan. It must be noted that people who make less than $38,000 per year pay no income tax. A tax credit is meaningless to them. These are the people who are uninsured.

Individuals not in a group insurance plan pay retail for healthcare insurance premiums with after tax dollars. Employers that have group healthcare insurance for employees, pay the insurance premiums with pretax dollars.

The new Republican healthcare plan would eliminate employers tax deductible benefit. This would discourage employers from providing healthcare insurance to employees. The plan is not dissimilar to the proposal championed by John McCain during the presidential campaign. His proposal was considered inadequate.

“The focus of the proposal is to push for a "guaranteed choice of coverage" in the private market through federal-state partnerships know as State Health Insurance Exchanges.

Individuals will have a "one-stop marketplace" to choose plans in the exchange, including the option of keeping their employer coverage and/or existing insurer.

The plan eliminates pre-tax dollar deduction for employers who provide health coverage to their employees. It provides a $5,710 tax credit to families and a $2,290 tax credit to individuals toward the purchase of health insurance coverage.

This is not enough of a tax credit to be effective for those who can afford to buy healthcare insurance. In reality it will save the government money. It would eliminate employer tax deduction. An unintended consequence will be an increase in thenumber of uninsured.

Healthcare insurance premiums average $14,000 per family and $7,000 per individual. The healthcare insurance industry cherry picks patients. It eliminates the sick and over 55 year olds with a high potential for illness. If its ability to cherry pick is eliminated the healthcare insurance premiums will be even higher.

The Republican healthcare plan does not state if the non insurable sick will be subject to the same or higher premiums.

"Participating insurers," meanwhile, would be required to "offer coverage to any individual — regardless of patient age or health history" though there is no mandate for an individual to purchase that insurance”.

Many things are wrong with the Republican party’s proposal. I am disappointed in Senator Tom Coburn. He is a “practicing M.D” he should know the real problems in the healthcare system..” The proposal has some good ideas but no suggestions on how to implement those ideas.

His plan ignores the real problems. The uninsured cannot afford to purchase healthcare insurance. Some young healthy people do not want spend the money for healthcare insurance. Many people are underinsured. Illegal immigrants are uninsured. They show up for care in our safety net hospitals. Our safety net hospitals are underfunded. The plan does not contain incentives for patients to work hard to remain healthy.

The reasons healthcare costs are so high are many. Price Waterhouse has calculated 1.1 trillion dollars is wasted dollars between defensive medicine and unnecessary administrative cost.

Medical care for the complications of chronic diseases absorbs 80% of the healthcare dollars. The complication rate can be reduced by at least 50% if patients became “professors of their disease” and they themselves prevented the complications. This can only be accomplished through education and financial incentives.

The proposal does not repair any of the abuses of the healthcare insurance industry, the government, the hospital systems or physicians.

The proposal gives employers a perfect excuse to drop insuring employees by the removal of their tax exemption for premiums. President Bush tried very hard to accomplish this and failed. .

The Republican plan would leave a greater number of Americans uninsured with no improvement in the health of the nation.

The Patients’ Choice Act contains many of the popular sound bites. It does not have a plan to achieve change. The only way change will occur is by leveling the playing field and providing incentives for patients. The plan keeps the healthcare insurance industry in control of the healthcare dollars.

It states; “ the Act transforms health care in America: strengthening the relationship between the

patient and the doctor; using the forces of choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans.”

I am disappointed in the Republican proposal. It is a proposal of empty words. The public will not be fooled. The public wants change. I will publish the executive summary so readers can judge for themselves.

Under the Republican plan, instead of a competitive marketplace for healthcare coverage I can visualize a market place dominated by a few healthcare insurance companies. The result will be further increase in cost of premiums. The healthcare insurance industry would continue to own the healthcare dollar and be non transparent.

The healthcare insurance industry would continue to abuse patients, physicians, hospitals and the government.

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

  • Doc DeVore

    This is disappointing news, but not surprising. Obama’s plans have many problems, but the Republic proposal does nothing to actually fix the problems we have.

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“Rope A Dope”


Stanley Feld M.D.,FACP,MACE


There are many issues involved in healthcare reform. The major issues to decrease defensive medicine with malpractice reform, rapid affordable installation of electronic health records, control of the obesity epidemic, effective chronic disease management and a change in the healthcare insurance model are not on the radar screen of the President or Congress.

The issue with effective healthcare reform is about money. In order to save a significant amount of money the above problems must be solved. As President Obama plan progresses in the congress the battle is all about political tactics and positioning for the midterm elections in 201

On the one hand, President Obama and his party say they’re hoping to strike a good-faith compromise on health care. On the other, they’re threatening this "budget reconciliation" maneuver to coerce Republicans into rubber-stamping liberal policy.”

The Democrats want to get a handful of GOP Senators to support the bill before in gets to the floor. The goal is to short circuit a bloody debate before it begins. The Democrats are to join their fold. Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe voted for expanding the state children’s insurance program (Schip).

SCHIP was a compassionate bill and logical. However it is a bill that does not create patient incentives. It is difficult to imagine Republicans defecting to the poorly constructed bill that will created greater costs and more dysfunction to the healthcare system.

“This new entitlement — like Medicare but open to all ages and all incomes — would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise.”

All the the Democrat’s rhetoric in nonsense. Without a change healthcare insurance healthcare costs will continue to rise . We need only to look at the Massachusetts experience.

The administration is prepared to make promises to Republican such as the government healthcare plan would only be sold to the uninsured and small businesses that can not afford to provide employees with healthcare insurance because of the costs. Once the Republicans on on board and the bill is past the administration could modify this proposal and make it all inclusive.

“ The White House strategy is to dilute the healthcare plans proposal just enough to win over credulous Republicans. That is what has always happened with government health programs:”

President Obama is playing a game of got uh. Some one wrote to me and called it Rope A Dope.

“When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers”.

Medicare’s cost to seniors has also risen with a base month cost of $99 per month per person or $2400 per year per couple. The catch is the deductible are $999 for hospital admission and and 80/20 deductible. The monthly payment per person is means tested and can go to $275 per month per person with after tax dollars. The a senior has to by Medicare Part F for deductible coverage. Its cost is 170 per month per person. Medicare Part D at it least expensive is $47 per month per person with high deductible.

In order to get full coverage the cost can be as high as $15,000 per year in after tax dollars.

Congressional actuaries expected Medicare to cost $3.1 billion by 1970. Medicare today costs $455 billion and rising.

Medicaid was intended as a last resort for the poor. It now covers one-third of all long-term care expenses in the U.S.. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.

Over time end stage renal disease and disabled person have been added to the Medicaid roles Other person also have been included.

“SCHIP was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.”

A common denominator to all of this unsustainable increases is the way the healthcare insurance industry controls the healthcare dollars. This leads to abuse by other stakeholders. Incentives must be aligned with the consumer controlling their healthcare dollars.

The Lewin group estimates that 119 million more persons with private insurance could be added to the 90 million already on Medicare and Medicaid. Health habits must be changed to combat obesity. The only way it will be changed is a change in farm policy and the consumers owning their healthcare dollars. Otherwise we are doomed to every increasing premiums and overuse of the healthcare system.

Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they’ve guaranteed otherwise.

President Obama is going to mount a public opinion campaign for his plan. The Republicans are going to cave in. They are trapped

Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.

President Obama will have successfully “Roped A Dope” Who is the Dope? All of us unless we get wise quickly.

The only way to Repair the Healthcare System is to enable consumers to own their healthcare dollars and to provide incentives to consumers to be responsible for their health. The government should make the rules to level the playing field and empower consumers to drive the healthcare system to their benefit.

These actions allow healthcare affordable to all including the government.

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

  • Nari Kannan

    You raise a very important point that has in fact proven success stories around the world. Singapore makes healthcare consumers directly responsible for their healthcare dollars, although the Government and Employers chip in also. But eventually YOU are responsible for your own healthcare dollars there and it seems to be successful.
    Read “The Singapore Model”

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What Is Reality?: America Is Heading Toward Financial Disaster

Stanley Feld M.D.,FACP,MACE

The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare.

“Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi schemes? The new Obama-Democrat budget deficit is $1.8 trillion, four times larger than it was only last year. The national public debt has increased by more than 10 percent since Inauguration Day.”

Social Security and Medicare are underfunded entitlement programs. Medicare for the entire country is not viable.

These are the published numbers for 2008.

  • Social Security’s unfunded liabilities stood at $13.6 trillion.
  • Medicare’s unfunded liabilities are more than $30 trillion.
  • Medicaid, another severely underfunded and politically untouchable entitlement program, only adds to the total.
  • The federal government’s current entitlement bill, including future obligations-based only on promises it has made in the past — is greater than $57 trillion.”

The first Baby Boomers started drawing early retirement benefits from Social Security last year.”

78 million people are going to stop working, stop paying taxes, stop paying into retirement programs and start drawing Social Security and Medicare benefits. The federal government has made explicit and implicit promises to millions of retiring citizens. It does not have the funds to keep those promises without a big hike in taxes.

“According to a recent forecast by the Congressional Budget Office shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century”

In order to get close to funding our current obligations it is estimated that the income tax rate will have to increase to 66%. With all the bailouts and economic stimulus packages the federal government’s debt can only get worse.

Yet the game of who can have better sound bites and who can win is the only thing that is important to President Obama, the healthcare insurance industry, and the Democratic congress.

Healthcare reform should not be about a National Healthcare Insurance Exchange or universal healthcare with a single party payer. This is not going to fix the healthcare system. It will make our financial problems worse. Our government officials should face reality. It should do what all physicians know needs to be done.

It should be passing legislation to create a less polluted environment. It should revise the Farm Bill. It should eliminate the use of corn syrup. It should fight obesity with public service educational campaigns. It should create an insurance product that provides consumers with financial incentives to stay healthy. It should eliminate the causes of administrative waste and defensive medicine. These should be the areas of discussion in order to repair the healthcare system. These bold topics threaten powerful vested interests and are politically explosive.

America should set up a healthcare insurance system that provides incentives consumers to demand better foodstuff and a healthier environment. Consumers should own their healthcare dollars and be able to save what they do not use. (ideal medical savings account).

The federal government should make the conversion to functional electronic medical records easier and less costly to physicians (ideal electronic medical record). We should have major tort reform to decrease the intolerable cost of defensive medical.

These are areas in which the healthcare reform debate should be focused. If the Republican Party wants to seize the initiative from the Democratic Party and excite the citizens of our country they need to act .

Instead, we have a silly debate pitting the new media (Democratic Party) against the old media (Republican Party) over systems we cannot afford. The new media will win. Americans lose no matter which side wins.

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

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Consumers’ Anger Toward The Healthcare Insurance Industry Mounts


Stanley Feld M.D.,FACP,MACE

President Obama is utilizing the well earned anger consumers have for the healthcare industry in order to promote his healthcare reform plan. Eighty percent of consumers are not sick. Those 80% think their healthcare insurance policy is great. The 20% of the population that is sick is very unhappy with the healthcare insurance industry.

The internet and the blogosphere have enabled those 20% to express their anger. In less than 5 hours there were 177 negative comments to the article describing how the healthcare insurance industry double crossed President Obama. This anger has been ignored in the past. The new media has created an environment in which the anger cannot be ignored. The healthcare insurance industry has killed the goose that laid its golden eggs.

President Obama has made the internet his town hall to permit consumers to express their discontent for the healthcare system. I suspect President Obama will receive more than 5 million complaints in his campaign to expose the abuse of patients by the healthcare insurance industry.

It will not bring us closer to having an affordable healthcare system. If the complications of chronic diseases were prevented, defensive medicine eliminated by effective malpractice reform, and healthcare insurance companies’ administrative waste stopped, America would have an affordable healthcare system.

Consumers need to control their healthcare dollars, receive incentives and be responsible for their own health and healthcare. ( ideal medical savings accounts).

The following are a few consumer comments

“Not surprised at all by this. The health insurance companies have had an unbelievable advantage, they can do anything they want. The only thing they need to do is keep Congress happy with lobbyists because Congress is not their customer, they have their own insurance paid by you and I. It’s gloves off time on health reform. These guys will pull no punches, they are fighting for their yachts. While we lose insurance if we file a claim.”

A consumer terminated from his job.

“I am a 56 year old professional with master degrees and many years of experience in my industry & for 19 years plus I worked for the same large corporation that just terminated me from employment because I was diagnosed with a blood cancer.
My family and I have lost medical coverage because of this and at a time when I need it the most. I would like to continue buying the same insurance even with the termination but I can not do so because I am excluded from group employment. I have lost all my rights to buy insurance like everyone else and with pre-existing medical problems nobody will insure me (or my family which depended on me).
At the very least, because I worked all my life and have never been unemployed, I should have been allowed to keep my insurance that I had while I was healthy. When I tell my friends overseas what my employer, Sun Chemical Corporation has done with me, they all say it is illegal in their country and it is a total horror that our society has chosen to discriminate so savagely against the sick and those unfortunate to lose their employment.
It is a travesty that corporations and health insurance companies collude to cleanse their ranks of those that are sick and those that are getting old as it has happened at Sun Chemical Corporation a multinational division of Dainippon Ink & Chemicals a Japanese conglomerate. “
An abused person”

This man’s corporation dropped him. He should be able to get COBRA insurance but the COBRA premium is at least 150% more than the employer paid premium. The premiums must be paid with after tax dollars. This increases the real cost of the COBRA premiums by an additional 35%.Corporate self insured plan’s can avoid the COBRA coverage requirement.

This consumer is 9 years away from being eligible for Medicare coverage. He cannot qualify for private insurance because of his age and his preexisting illness. The rest of his family might not qualify for more expensive individual healthcare insurance policies.

A byproduct of the new media is others can be made aware of the healthcare systems inequities.

“I am so sorry and hope there is some sort of alternative for you found very soon – for you and your family’s sake. This is why we have to hang solidly behind healthcare reform. Personally, I would prefer single payer because these guys do not want to reform, they want to continue holding everyone’s health hostage. What you’re going through is awful. Please take care…so sorry.”

+ I’m a fan of this user

There are pleas for people to exercise our People Power.

Dear J,

“It’s exactly stories like you that need to get out in front of this thing and bury Blue Cross in their hypocritical "we provide better service" grave.
Just like so many scare-tactic politicking, these ads are nothing more than a mirror aimed outward. The private insurance industry is broken because there are really no better options.
If they want to survive, they’re just going to have to do better…

As far as I’m concerned, no one will be upset if they don’t survive.”

There are even comments containing color words.

Blue Cross Blue Shield s@#%&–they have raised my rates every year for the past three years, even though they have not had to pay ANY medical charges for me. What do you expect these insurance guys to do? They don’t want to lower costs. No doubt, if there were a cure found for cancer, there would be some idiots, like insurance companies and republicans, rushing to undermine the cure and bury it because it hurt the chemotherapy industry. That’s the way they think. They have NO interest in making health care more affordable, more efficient, and less necessary. Don’t threaten the system that helps the fat cats.

The negative comments are endless. President Obama will receive lots of documentation. Documentation he will use against the healthcare insurance industry. He will win. Unfortunately, he will not solve any of the problems in the healthcare system.

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

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