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ObamaCare Is Not A Cost Savings Act

Stanley Feld M.D., FACP,MACE

The evidence is mounting that President Obama’s healthcare reform act will not make healthcare more efficient or more affordable.

I have pointed out that Obamacare will create a healthcare system that will limit innovation, lead to healthcare rationing, and lower the quality of care.  All this is coming our way.

The theoretical cost savings proposed and confirmed by the CBO on data given to it by President Obama has not worked out as promised.

It couldn’t work out as I predicted with the creation of a massive bureaucracy and its generation of massive rules and regulations to enable the government to control the healthcare system.

I would have loved to see President Obama create a system of affordable healthcare that is accessible to everyone. President Obama’s did not. He has created a financial and healthcare delivery mess.

He has the wrong business model.

He was able to pass his healthcare reform act by faking out the congress and the CBO using unrealistic numbers about cost saving.

President Obama repeatedly claimed that the annual healthcare premium per family would decrease by $2,500 per year before the end of his first term. We are almost at the end of his first term and the average cost of a yearly premium has increased $2,200 according to a Kaiser Family Foundation report.

President Obama claims seniors enjoy their Medicare coverage. I believe it is great to provide guaranteed insurance for seniors despite pre-existing illness.

However, the costs of Medicare premiums and Medicare’s initial deductibles have increased since 2009 while the covered services have decreased.  

President Obama has also told seniors that their Medicare Part D benefits have improved under his watch. However, the cost of Part D, the deductibles and the costs of the different tier drugs have all increased.

“The CBO's initial estimate in March 2010 of ObamaCare's budget impact showed it saving money, reducing the federal deficit by $143 billion in the first 10 years. But that positive estimate was largely the product of gimmicks inserted into the bill by Democratic leaders to hide the law's true cost.”

Last month President Obama’s proposed fiscal 2013 budget included $111 billion in additional spending for the premium subsidies in the health law's insurance exchanges. Many states are refusing to sign up for health Insurance exchanges even though President Obama said he would pay 90% of the cost of these exchange in the first couple of years.

The states are broke and in the red. They have a constitutional obligation to have a balance budget.

The healthcare insurance exchanges are a President Obama ploy to get states to sell insurance to the uninsured increasing the state’s deficit. President Obama and congressional leaders said it would only affect one million Americans who would lose their employer-sponsored healthcare coverage.

This did not seem like an accurate number to me. The healthcare insurance premiums were $13,000 per family. If the employer did not provide healthcare coverage the penalty to an employer would be $2,000 per employee per year.  The numbers given to the CBO clearly was a misrepresentation.

According to the CBO, 154 million Americans are covered under employer-sponsored plans. The cost to taxpayers would be huge and further increase the deficit if 50% of those individuals lost their coverage and became eligible for the $10,000 per year subsidy.

A McKinsey & Co. study in June 2011 showed that 30%-50% of employers plan to stop offering health insurance to their employees once the health law is implemented in 2014.

Employers dropping employer sponsored healthcare coverage will expose their employees to large financial risk even with the proposed government subsidy.

Employers would be making most employees eligible for huge subsidies in the new health-care exchanges. The government paid subsidy would be up to $10,000 for a household income of $64,000 per year.

This was another trick play by President Obama to get everyone into a public option and government run socialized medicine.

 “In recent testimony before the Senate Appropriations Committee, Health and Human Services Secretary Kathleen Sebelius told me that America's health insurance system is in a "death spiral." She failed to acknowledge that implementation of ObamaCare will be the cause of that death spiral, and American taxpayers will be left to pick up the tab.”

We have also learned that President Obama gave 1400 corporations exemptions from Obamacare. These corporations provided “Minimed healthcare insurance” to their low wage earning employees. Minimed healthcare insurance provides little coverage to low wage earning employees. Hundreds of thousands of these people are essentially uninsured.

On the data given to the CBO, the premiums collected by the Community Living Assistance Services and Support Act (CLASS Act) were estimated to reduce the budget deficit by $70 billion dollars per year.

The new CLASS Act program is voluntary. Premiums are estimated to be $123 per month for workers who choose to participate. It covers home care for those who become disabled at any age, not just those over age 65.

This is a pretty low premium. It seemed too cheap to be true. Congress had to impose a secret tax on all taxpayers to cover the cost of CLASS.


All taxpayers will all be taxed $150-$250 PER MONTH beginning in 2011 for the NEW Community Living Assistance Services and Support Act (CLASS Act) that was added to the Reconciliation Bill on Friday night, Mar 19, 2010, before Congress voted on Sunday, Mar. 21, 2010. It will help pay for long-term home-care for the elderly. Isn’t that nice?”


These are only a few examples of President Obama’s disinformation provided to the American taxpayer before and after his healthcare reform act was passed.

If the American taxpayer only listened and knew these facts and unintended consequences beforehand this bill would have never passed. If the Democrats in congress studied the bill beforehand they would have never passed it.

America had President Obama’s healthcare pulled over its eyes. This is the reason Vice President Biden said on an open mike, “This is a big f—–g deal”



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

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Medicare Coding Is Becoming More Complicated Under Obamacare

Stanley Feld M.D.,FACP,MACE

Physicians make coding errors. These errors result in decreased reimbursement.   The denied claims might not be noticed for months by the physicians’ office.

In a busy practice the details of all the changes in coding rules are sometimes impossible to understand.

An entire coding industry with coding professionals taking certification examinations has developed with a great increase in the cost to the healthcare system.  

President Obama’s healthcare reform act is trying to institute a completely new electronic claims system. It is called 5010. It will replace claims system 4010.

As far as I can tell the goal is to obtain more data on physicians’ practice patterns. The goal of the new system is to determine the “quality” of physicians care. If the quality is poor, reimbursement will be reduced. Claims will be denied. Its execution looks confusing and expensive.

5010 was suppose to be in place and required for all to use by January 1, 2012. Apparently, it was not fully installed or tested by enough healthcare organizations to be validated. The date of full implementation was moved to March 31, 2012. Last week full implementation was moved to June 30, 2012.

The other complicated “innovation” of Obamacare is ICD 10 coding system.  This new coding system replaces ICD-9. It has increased the number of codes from 18,000 to 68,000 for coding in-patient and out-patient care. Effective implementation of these codes will be very difficult.

The implementation of these two “innovations” will add billions of dollars to the cost of healthcare.

 It will increase physicians’ paperwork. It will result in more mistakes. It is questionable whether the new systems will increase the quality of care.

It is adding more complexity to an already dysfunctional system.

It is impossible for physicians to keep up with all the new regulations the Centers for Medicare and Medicaid Services is about to impose on them.

Most physicians do not have the time to study the new regulations and their implications. They hope their professional organizations will pick up the important ones and point out the problems in plain English.

Many times one regulation contradicts another regulation. The administrative service providers (healthcare insurance industry) for CMS interpret the regulations the way they want. There is often a lack of consistency from state to state.

The Texas Medical Association recently informed us of an error related to submission of measure No.235, Hypertension: Plan of Care for the 2012 Physician Quality Reporting System.

 The Texas Medical Association sent the following message to all Texas physicians. I challenge anyone to understand this message.

The Centers for Medicare & Medicaid Services (CMS) has identified an error related to the submission of measure No. 235, Hypertension: Plan of Care, for the 2012 Physician Quality Reporting System (PQRS). Hypertension: Plan of Care is a claims/registry measure with G-codes that are inactive due to an error. Consequently, Medicare carrier TrailBlazer has rejected or denied claims containing the G-codes associated with the measure.

The following is a note I received from a physician.

“I thought I went to medical school to learn how to take care of sick patients?”

“I did not go to medical school to deal with complicated and impossible rules and regulations daily. These regulations interfere with my ability to help sick patients”

Physicians are faced with these confusing rules daily. I do not believe that these rules promote quality care for patients. These rules serve to irritate physicians. The rule changes result in a non-user friendly Medicare system.  I predict it will ultimately result in non-cooperation by physicians.

The TMA goes on to tell us what CMS is going to do and what we can do to obtain reimbursement for treatment given using CMS’ rules.

 CMS will reactivate the codes G8675, G8676, G8677, G8678, G8679, G8680, and 4050F with its next update of the HCPCS code data in April 2012. For 2012 claims-based reporting, PQRS requires at least three measures be reported at a 50-percent reporting rate.

In the interim, if you had intended to report this measure via claims for the 2012 PQRS, consider doing the following:

  • Report additional measures to substitute for measure No. 235, Hypertension: Plan of Care.
  • Hypertension: Plan of Care is a per-visit measure, which requires reporting for 50 percent of eligible patient visits. Therefore, you could report the measure on more than 50 percent of eligible visits from April through December 2012 to increase the likelihood for successful reporting of the measure.

As an alternative to reporting PQRS quality measures via claims, physicians can report using a qualified registry (PDF). TMA endorses two such vendors. Or, practices can submit measures using a qualified electronic health record (PDF).

Published March 16, 2012

Is it any wonder the Medicare and Medicaid System have tremendous bureaucratic cost overruns?

There has to be a better way?

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

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  • Brandon

    Interesting… thank you for the blog. In regards to the medical coding, you said they added some 50,000 new codes. Was the purpose to dilute the system, or to just make sure there is a code for every imaginable situation? Is there like a database or something that you just search keywords and you find the correct code? I have to be honest, I find this fascinating, I had no idea this was how medical billing worked.. or didn’t work I should say.

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The Relationship Between Type 2 Diabetes Mellitus And Statin Therapy

Stanley Feld M.D. FACP, MACE

Readers have continuously reminded me that consumers are not smart enough to purchase the right kind of healthcare.

"Hello Dr. Feld,

What is your solution for patients who simply aren’t educated enough to make these decisions on their own? In “Redefining Healthcare” Michael Porter advocates a role for insurers to help in this regard and I’m wondering what your thoughts are given that the fastest growing demographic in America is poor, uneducated, and potentially (as a result) unhealthy folks."

I refuse to believe that consumers are too stupid to be educated if properly motivated.

I welcome insurance companies trying to educate consumers but they are doing it for their benefit and not the patients’ benefit. The education offered is not an extension of the physician’s care and will therefore be ineffective.

I respect the intelligence of all consumers. They will want to become educated consumers as soon as there is a financial benefit.

Any educational system built will have no effect on about 10% of the population. These people will be a burden to society.

The government and the healthcare insurance companies had their day trying to fix the healthcare system.

It is now the consumers’ turn to use their consumer power to fix the healthcare system. Consumers are starting to realize they need to be responsible for their care. They are also realizing they must control their healthcare dollars.

In order to be a wise healthcare consumer, they must understand their chronic disease.

The recent FDA statement about statins causing Type 2 Diabetes has been confusing to patients. Statins can be expensive. Patients will not spend the money for the statin nor adhere to a treatment plan if they think they will be harmed by the medication.

An understanding of the pathophysiology of Type 2 Diabetes and hypercholesterolemia will make it clear that there is no relationship between statin therapy and its causing diabetes.

At least 20% of the population has genetic insulin resistance. There is a slight difference between ethnic groups with the incidence being 30% in Hispanics and Native Americans.

This genetic defect results in a rising insulin level as the patient becomes obese, older and/or stressed.

The increase in childhood obesity in genetic insulin resistance children is causing an increase in childhood Type 2 Diabetes.

The underlying genetic defect can express itself before the blood sugar rises out of the “normal range.”

Insulin Resistance Syndrome has had several names over the past 30 years. One name was the Deadly Quartet. The quartet consists of obesity, hypertension, hypercholesterolemia, and diabetes.

Insulin Resistance Syndrome’s new name is Metabolic Syndrome. Each disease can present independently at different times. Hypertension, hyperlipidemia and diabetes are usually precipitated by obesity, stress or steroid therapy.

If patients understood the pathophysiology of metabolic syndrome they would try hard to lose weight and adhere to medication prescribed.

Patients must be taught to become the professor of their disease.

It is insufficient to say “doc, my cholesterol is high, fix me”. The only people who can “fix” patients with chronic diseases are patients themselves.

What do we know about Type 2 Diabetes Mellitus and insulin resistance?

1. The incidence of Clinical Type 2 Diabetes Mellitus is high in patients who are obese.

2. Clinical Type 2 Diabetes (high blood sugar) can disappear with weight loss and exercise in early onset diabetes. These patients still have insulin resistance but the resistance is decreased and the blood sugars become normal.

3. Obesity must be decreased in order to eliminate overt diabetes. If not, the medical cost of treating diabetes and its complications will continue to rise.

4. High LDL cholesterol is a frequent complication of Type 2 Diabetes.

5. High LDL levels cause coronary artery plaques. The result can be myocardial infarction (heart attack).

6. Diabetes Mellitus is frequently first discovered at the time of a myocardial infarction (heart attack). Mildly elevated blood sugars could remain asymptomatic for an average 8 years and discovered after a complication of diabetes (heart attack) occurs.

7. Treating high LDL cholesterol with statins in Type 2 Diabetics decreases the incidence of myocardial infarction.

8. Statins decrease the production of LDL in the liver by inhibiting an enzyme that produces LDL.

9. High blood sugar and high insulin levels also decrease nitric oxide levels in the lining of blood vessels (endothelium). The result is a narrowing of the coronary arteries.

10. Statins stimulate an increased endothelial nitric oxide production. Statins dilate the coronary arteries.

11. The dilatation of the coronary arteries along with the decrease in LDL production decreases plaque formation and the risk of a myocardial infarction.

12. High insulin levels in early Metabolic Syndrome inhibits LDL receptors ability in the liver to attach to circulating LDL. This inability to attach to the liver cells decreases the liver’s ability to sense there is enough cholesterol in the blood stream. The liver then increases the production of LDL.

13. Statins inhibit the liver from producing more LDL. Lowering the LDL produced decreases LDL in the blood stream.

14. Logically, by lowering LDL cholesterol production with a statin the effect of insulin resistance to increase cholesterol production is neutralized. The use of statins in Insulin Resistance Syndrome does not cause diabetes.

15. Therefore data for the FDA’s black box warning is wrong.

Education is the key to chronic disease management.

Physicians must teach patients in terms they can understand. Education will only be effective if patients are motivated to learn.

Physicians must be motivated by consumers to teach. Consumers controlling their healthcare dollars could motivate physicians to teach them at their level. Physicians could use their own social networks to provide customized instruction.

Obesity is the core-precipitating problem in Metabolic Syndrome. My ideal Medical Saving Account with its financial incentive could help change the obesity problem in America.

The ideal MSA might even compel the experts to not throw misinformation around lightly and frighten the public.

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

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  • Pietr

    Those who restrain desire do so because theirs is weak enough to be restrained.”
    ― William Blake
    >It is insufficient to say “doc, my cholesterol is high, fix me”. The only people who can “fix” patients with chronic diseases are patients themselves.
    Dr. Feld, this statement is a copout. You throw the responsibility back at the patient and your hands in the air. Since you recognize that obesity is an refractory to treatment, it is easier to blame the patient to sloth and gluttony and absolve yourself.
    The treatment of obesity was available 20 years ago with the combined agonists fenfluramine and phentermine. Unfortunately, these drugs were off patent and Dr. Weintraub and his colleagues didn’t see the danger. When the cardiac and pulmonary problems occurred, FEN/PHEN had no advocate and its promise disappeared.
    Treatments for OCD and addiction using dopamine and serotonin agonists/precursor have been described. The current protocol uses the immediate precursors levodopa and serotonin. Another duo taken together increases cerebral acetylcholine and crushes nicotine craving. Lecithin and pantothenate (vit B5) are dirt cheap and have absolutely no risk.
    These simple treatments do not make money for PHARMA, in fact they are a threat to its very existence. PHARMA would be foolish not to fight against their use. In my case, they destroyed my career, reputation and life.
    Tell your alcoholics, cocaine addicts and fatties that the system has failed them rather than blaming them.
    I hope you enjoy the Blake quotation.
    We seem to differ not only on the price of nude tennis balls (Spaldeens) in 1950 but also the solution for medical management. I hope we can converse civilly in the future for I respect the quality of your writing and the degree of intellect and trust in your motivations.
    Pietr Hitzig

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New Statin Therapy Warnings and Its Science

Stanley Feld M.D.,FACP,MACE

I have said repeatedly that patients have to become the Professors of Their Disease. A reader recently wrote, “ The average consumers are not smart enough to evaluat complicated clinical data.”

My answer is that it is the responsibility for their physicians to teach them how to evaluate the data used to decide on their cause of therapy.

Physicians’ goals are to their treat patients with the best possible evidence based medicine. It is the patient’s responsibility to understand the reasons for the treatment and be responsible for adhering to the treatment.

In my opinion, during the last decade, arriving at the best evidence based medical care has become very difficult. The design of clinical research studies has become sloppy. The statistical results of the studies have frequently been misrepresented. Statistical trends have been interpreted as being statistical truths.

However, once a statistical trend has been reported and accepted as evidence the non- statically significant data have resulted in producing defective healthcare policy and decreasing the quality of medical treatment.

One prime example has been my opinion of the effect of the Women’s Health Initiative on women’s health. Another is the conclusion of the FDA to put a black box treatment warning in the labeling of statins.

The conclusions drawn from the clinical data for the recent black box warning are wrong. The studies are wrong because the clinical studies were designed poorly or the conclusions were not statistically significant.

There are a few simple statistical rules that must be followed for a study to prove that the conclusions are correct and a medication has a certain statistically significant effect.

The p value must be less than .05, the confidence interval must not cross 1 and the hazard ratio must be 2 or greater. It must also be a well designed study to be able to show a valid effect.

  The women’s health initiative was poorly designed. In my opinion the study design alone disqualifies the study results. 

  1.  TNT (Treating to New Targets) trial,[4] 351 of 3798 patients randomized to 80 mg of atorvastatin and 308 of 3797 randomized to 10 mg developed new-onset type 2 diabetes mellitus (T2DM) (9.24% vs 8.11%, adjusted hazard ratio [HR]: 1.10, less than 2, 95% confidence interval [CI]: 0.94-1.29, crosses 1 P = .226). Not significant.
  2.  In the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial,[5] 239 of 3737 patients randomized to atorvastatin 80 mg/day and 208 of 3724 patients randomized to simvastatin 20 mg/day developed new-onset T2DM (6.40% vs 5.59%, adjusted HR: 1.19, 95% CI: 0.98-1.43, P = .072). Not Significant.
  3. Across the 3 trials, there was no difference in the major cardiovascular events, which were 11.3% in patients with and 10.8% in patients without new-onset T2DM (adjusted HR: 1.02, 95% CI: 0.77-1.35, P = .69) including the SPARCL trial were not significant.  
  4. In a meta-analysis of 13 clinical trials with 91,140 participants showed no significant difference. It is my opinion that meta-analysis is worthless because of variation in each study’s design.  

I understand that the first reaction of a reader would be that it is impossible for the average person to understand the significance of this science.

There is no reason this information could not be explained to people in various formats from very advanced to cartoon simple. The explanations could be available on an Internet social network 24/7 chosen by their physicians.

I believe patients could understand the information once they were motivated to be responsible for their medical care.

I am astonished that “experts” would propagate this disinformation on topics as important as the health and well being of the population.

Hopefully a consumer driven healthcare system would compel everyone to be more careful in examining data from clinical research studies. 


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

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Let’s Talk About Statins

Stanley Feld M.D.,FACP,MACE

The New York Times did it again. Once again we are experiencing media hyperbole. The first sentence tells it all.

We’re overdosing on cholesterol-lowering statins, and the consequence could be a sharp increase in the incidence of Type 2 diabetes.

Bingo.  For years teaching physicians have worked hard trying to convince practicing physicians the virtues of statin therapy to lower the incidence of coronary artery disease by lowering LDL cholesterol (bad cholesterol).

Finally, it took hold. Practicing physicians tried for years to convince their patients to take statins to decrease the risk of heart attacks.

Over the years evidence mounted proving that normal total cholesterol value should be lower than 200 mgs% from a previous normal of 240 mg%.  The normal LDL cholesterol should be lowered to 100 mgs% from 150% mgs%.

This was not a pharmaceutical industry’s conspiracy. It was arrived at with actual statistically significant clinical data.

The New York Times goes on to say;

This past week, the Food and Drug Administration raised questions about the side effects of these drugs and developed new labels for these medications that will now warn of the risk of diabetes and memory loss. The announcement said the risk was “small” and should not materially affect the use of these medications.”

As soon as the first sentence was read it immediately put the safety of statins in question. There was no discussion of the flawed data used to reach this conclusion.

I predict the warning that resulted from flawed data will result in the unwarranted  decrease in physicians prescribing statins and patients refusing to take statins.

“ The data are somewhat ambiguous for memory loss. But the magnitude of the problem for diabetes becomes much more apparent with careful examination of the data from large clinical trials.”

I believe the data is shabby for both increasing the incidence of diabetes and the decrease in cognitive function.

I also believe the scientists at the FDA also believe the data is shabby.

FDA’s statements include;

"1. However, because statins are so widely used, there is a heightened awareness by the public when we make any safety-related labeling changes to this class of drugs."

"These changes do not in any way alter the risk-benefit calculus for this class of drugs. We continue to believe that the benefits of statins far outweigh their risks, but we do want clinicians and patients to be aware of their side effects so that they can be used in the most safe and effective manner possible."

The media has emphasized the safety label change warning patients of the possibility of getting diabetes as a result of taking statins. The fact is there are so many flaws in the studies sited that initiated the label change that the changes are unwarranted.

The FDA goes on to state,

“ We are not recommending that patients be discontinued from their statin therapy based on a small increase in blood sugar levels.”

“Rather, elevations in blood sugar levels should be treated with dietary and lifestyle management and/or adjustment or initiation of antidiabetic therapies. We do not consider this a reason to not continue or not initiate statins, particularly in the diabetic population where patients are at increased risk for major adverse cardiovascular events and statin therapy has been shown to reduce that risk.”

This disclaimer had not been emphasized in the traditional media. The Women’s Health Initiative (WHI) another flawed study did not have one statistically significant leg to the study. Yet it’s handling in the traditional media changed the course of women’s health forever. Evidence from the WHI was used as study material. The statement below assumes the conclusion of harmful effects of statins is real.

“Despite the higher hazard ratios observed in the WHI study, we do not have strong evidence suggesting that there is a gender effect for the development of this adverse effect.”

The FDA looked at the effect of statins on neurocognitive function.

“We looked at those study results; there was no difference in neurocognitive functioning observed between patients exposed to statin therapy vs those unexposed, including in executive function (attention and speed) and memory, both immediate and delayed.”

There is no evidence here.

"There were trials conducted with statins to see if they could improve cognitive functioning in patients with mild to moderate Alzheimer disease. We reviewed the results of one such study, which showed neither evidence of benefit nor harm in cognitive functioning associated with statin therapy.”

My fear is the misleading warnings being publicized in the press will change the course of therapy for patients at risk for coronary artery disease.

The science used to arrive at these warnings is shabby. It is important to understand the defects in the evidence so that society does not do to statins what it did to hormone replacement therapy for women's health.


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

Please send the blog to a friend




Chronic Disease Management And Education As An Extension of Physicians’ Care.

Stanley Feld M.D.,FACP,MACE

All the Spokes in my Future State healthcare business model should be attended to simultaneously to be effective.  

My vision ignores the barriers of the journey to implementing the changes in this discussion. There will be many barriers.  Legacy vested interests find it difficult to see a better way when those interests are struggling to survive in the present system.

The healthcare system must be consumer driven. Consumers must be put in control of their healthcare dollars. The other stakeholders will then be forced to cater to the consumer.

When this happens all the stakeholders’ vested interests will become aligned. It will result in a decrease in healthcare costs and an increase in stakeholders’ satisfaction.

Patients will accept responsibility for the management of their health. Physicians will become more efficient in their delivery of care..

The music industry fought Apple after ITunes dis-intermediated its legacy business model only to find its profit increased.

Consumers must have a way to obtain adequate chronic disease management education.  They must have transparent healthcare costs and understand treatment choices. Physicians must be actively involved in their patients’ education.

Chronic disease management education must be an extension of the physicians’ care. It is part of patients’ medical care. Physicians must be motivated to provide this care.








Effective chronic disease management is dependent on patients managing their chronic disease. Patients will take control only after appropriate incentives and educational methods are in place.

The goal is to decrease the onset of complications of a chronic disease. Patients can control their disease and decrease the occurrence of chronic complications. Eighty percent of the cost of medical care is spent on treating these complications.

Physicians must teach patients to become the professor of their chronic disease. The educational vehicle must be available 24/7 for patients to be able to review concepts they did not understand completely.

Physicians must have knowledge of current evidence based medical care to teach patients properly.

Much of the infrastructure is in place. It tends to be provided by secondary stakeholder and undermines the patient physician relationship. The infrastructure is not utilized properly.

Patients need to be responsible for controlling their disease. Chronic disease management is not an entitlement. It is a patient responsibility.

Patients are dependent of the government or the healthcare insurance industry to pay their bills. They have first dollar healthcare coverage

My ideal medical saving account would solve this issue. It would probably cost the government and the healthcare insurance industry less if they provided patients with $7,500 in a trust fund, provided the incentives for keeping money not spent and provided first dollar coverage after the patient spends $7,500 dollars.

Patients will then be converted to Prosumers (Productive consumers) and become intelligent consumers of healthcare.

Consumers would then encourage or force their physicians to provide appropriate chronic disease management education.

The formation of social networking on multiple levels could enable physicians to provide this education inexpensively and effectively.

For example, all of a physician’s diabetics patients can be members of his social network for diabetics. The information to learn about diabetes can be provided by his social network. Testing of patients’ understanding of core principles of diabetes can be done with direct feedback to the physician. This would provide the physician with insight to emphasize topics the patient did not understand.

The core information could also default to a more detailed explanation of the topics misunderstood.

It could be done for many chronic diseases such as asthma, COPD, heart disease, GI diseases, and joint diseases.

This education would promote the physician patient relationship. It would demonstrate than their physicians care about their care.

If there is a contradiction in the education between the physician’s thinking and the core information, a separate social network connected to the core information for physicians only can serve as a platform for debate between physicians. Continuing medical education could even be provided to give physician incentive to participate.

There are many innovative mechanisms to use to promote the patient-physician relationship, educate patients to be professors of their disease, and to be responsible for their own disease management.

The utilization of information technology through social networking will repair the healthcare system. It will enable access to education and affordable care.


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

Please send the blog to a friend




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It’s Baseball Time

Stanley Feld M.D.,FACP,MACE

Every year my brother (Charlie) and I go to Baseball’s Spring Training Cactus League with our boys.


Brad and Daniel are my boys. Jon and Kenny are Charlie’s boys. Their ages are one-year apart. They are each in their 40’s.

We have always enjoyed our time together on long weekends. It is bonding time.

We catch up with our lives, watch baseball games and philosophize.


Brad, Charlie, Daniel

I always come away invigorated.

This year Kenny could not come. Last year Jon brought his son Jack. He was 10. We put Jack on our Junior Varsity.  This year we promoted Jack to the varsity. He knows baseball better than all of us.

The first game was the Oakland A’s vs. The Seattle Mariners. It was not a great game. The games never are. The great thing about the games is the smell of the grass, the pop of the mitt, the crack of the bat and being with our boys.


Oakland A's Field 


Gaylord Perry       Bert Campaneris  Fergie Jenkins


Saturday’s game was the Colorado Rockies vs. the Arizona Diamond Backs at the new Salt Lake Fields At Talking Stick.

Salt River Fields at Talking Stick is a stadium complex located in the Salt River Pima-Maricopa Indian Community near Scottsdale, Arizona.

It is the newest Major League Baseball spring training facility. It is the shared home for the Arizona Diamondbacks and the Colorado Rockies.


It is a beautiful ball field. The Cactus League is growing each year. Arizona weather is wonderful in March. It is much better than Florida’s March weather. The humidity is high in Florida’s Grapefruit League.

The Cactus League has figured out the right price point for the tickets to the games. Tickets in Florida can be five to ten times higher.



Daniel and the DiamondBacks


Stan and Daniel

Publicity is great and the baseball experience is user friendly.

On Sunday we saw the opening Spring Training game for the Texas Rangers and Kansas City Royals. They share a relative new training facility (10 years old) in Surprise Arizona. Surprise is a new town about 30 miles northwest of Scottsdale.

Every year the roads to Surprise get better and the trip shorter. Surprise is growing by leaps ad bounds. A person would never think America is in a Recession/Depression.

There are more new restaurants and shopping centers popping each year than can be imagined.


Josh Hamilton 

We had a treat. Ron Washington kept the first team in the game for five innings. It didn’t matter to any of us that the American League Champs were really lousy on Sunday.

The only thing that matters to the six of us was being together and the smell of ice cold beer, peanuts, popcorn and Cracker Jacks. 

Next weekend my brother and I are going to hit some baseballs.

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

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