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All items for October, 2012


Big Data Is A Major Problem For The Healthcare System.

Stanley Feld M.D.,FACP,MACE

Obama is blinded by his ideology. His healthcare policy goal is to eventually
have a single party payer system. Medical care will be commoditized with
treatment decisions made by the central government.

is a charade that his health insurance exchanges will lead to affordable
private insurance. It is misguided to believe that a non-elected central
committee (IPAB) will be tolerated to make treatment decisions for the

larger pretense is that President Obama is building an inexpensive bureaucracy.
Last week he again stated that government overhead for Medicare and Medicaid is
very low. He again declared that the overhead expense is only 2½ percent.

cost two and one half percent for the central government to outsource administrative
services to the healthcare insurance industry. The healthcare insurance
industry, in turn, charges the government 18-40% to administer the programs.

knows most everything government run is inefficient. President Obama is
enlarging the scope of government in all areas at a time when government is too
large and inefficient. The government’s income is $1 trillion dollars less than
its expenses per year since he has been President.

Obama thinks if he spends enough money he will spend his way out off the jam.

Obama believes one way to become more efficient is to gather more data. He can
then figure out which hospital systems and physicians are inefficient and
penalize them.

philosophy has two potential pitfalls. If the data is faulty the conclusions
are wrong. The second pitfall is that penalties do not encourage cooperation
and meaningful improvements. 

Decision-making in
healthcare can be painfully slow, as any physician will tell you
Hospital systems and
physicians are being spurred on in part because healthcare is beginning to deal
with a shift in reimbursement toward one that rewards quality and disincentives
inefficiency and waste.

One problem is that quality is not clearly
defined and is sometime false. The government must reexamine its premises.

Most hospitals and health systems have lots of
data that might improve outcomes and cut waste.

problem is getting that data, which is often unstructured, into a format that
allows clinicians to make decisions faster and in a more coordinated fashion.

of the innovation is happening without input from physicians. It is being done
to decrease the cost of the hospitals. One thought would be to get rid of a few
excess salaried, $750,000 a year hospital administrators and $2,000,0000 plus
healthcare insurance company administrators which would go a long way to reduce
the cost of healthcare coverage.

the government is looking to penalize physicians
. Physicians are the providers
that deliver medical care.

is software being developed that deals with real time processing of clinical
data. The software can communicate those data to networked physicians instantly
and help physicians deliver more timely care.

hospital systems are trying to install these real time systems. Unfortunately,
many hospital administrators do not understand its power as a teaching tool to
increase the efficiency and effectiveness of medical care.

 The hospital systems’ only interest is in the
financial result and the question of whether the huge investment is worth the
capital expenditure.

physician group practices, independent of hospital systems, are incorporating
these software systems into their electronic medical records. These groups recognize the potential
importance of having instantaneous predictive data.

physicians do not have an EMR and only 7% of physicians have a fully
functioning EMR.

the monograph from “Pathways to Data Analytics” two things were very apparent. It
looks like the healthcare insurance industry controls the committee and its
plans is to continue to control the healthcare dollars and hope to control the
healthcare data.

Increasingly, a
data-driven approach to healthcare is necessary.

The complexity of clinical care requires it, says Glenn Crotty
Jr., MD, FACP, executive vice president and chief operating officer at CaMC.

 “We’re moving from an
individual practitioner cottage industry to a team-based process now . . .. [Medical
care] is beyond the capacity of any one individual to be expert enough to do
that. So we have to do it in a team.”

A team requires information. The changing dynamics of healthcare
spending and reimbursements also require data to navigate.

“Our analytics are not just for finance, which traditionally is
what hospitals invested in,” says St. Luke’s Chief Quality Officer Donna Sabol
, MSN, RN. “When you look at how [hospital] payment is changing [to] a value-based
equation, you have to have good analytics for finance and for quality.”

Absent from the report is the patient and his/her responsibility
to the therapeutic unit. Until some policy maker understands the role of
patients to the therapeutic unit they will get nowhere in improving the
healthcare system.

A glaring example is the money spent by hospital systems to
improve the discharge process to avoid re-hospitalization within the 30 days
post discharge.

Obamacare has instituted the rule November1,2012 that if a
patient is re-hospitalized within 30 days of the initial hospitalization the
hospital system will not get paid.

I can think of 5 ways hospital systems can get around this rule
without suffering the penalty. 

None-the-less the hospital systems are buying software to study
and automate the process to avoid re-hospitalization using its clinical data in
real time.

 The Seton Hospital System in Austin Texas
might have figured it partially out.

It started what it calls an extensivist
program. It is acting as an extension of its physicians care to help avoid re-hospitalization
and use the best data it can collect.

Its is helping clinicians identify patients who
would benefit most from extra attention following discharge. The program
started with congestive heart failure patient

lot of it is about enabling decision-making," Ryan Leslie says

"It's taking the whole universe of
information we have and cutting out what's extraneous and giving clinicians the
information they need to make decisions."

Ryan Leslie is vice
president of analytics and health economics at Seton Healthcare system.  He is taking
unstructured clinical information and connecting that with billing or
administrative information and social demographic information.

He says,  "you start connecting all those things
together and you get a more complete picture of the patient as a person, rather
than as a recipient of a bill," he says. "That's been the exciting
thing recently. You realize that a patients' success or failure may not have to
do with the care plan details or the clinical attributes of the patient as much
as the social attributes

outside the hospital work with a team of social workers, nurses, and others to
visit patient homes and figure out what's keeping a patient from effectively
following treatment protocols that will likely keep them out of the hospital.

The software
helps determine, based on a host of combined data, which patients are most
likely to be re-hospitalized within 30 days. Targeting the patients is like
looking into a crystal ball. The hospital system cannot afford to service all
the patients with congestive heart failure. The program is in its early stages.
If successful the plan is to expand it to diabetes and other chronic diseases.

This will
happen well beyond November 2012 and January 1,2014. This hospital system
finally realized that it can and must be an extension of its physicians’ care
and not a competitor for patient care.

Missing is the
patients responsibility and incentive in not being readmitted to the hospital.
This can only be accomplished when consumers not only have a desire to be
healthy they have a financial interest to stay healthy.

This can be
accomplished in a consumer driven healthcare system where the patients are responsible
for their health and own their healthcare dollars. The easiest way to get there
is using my ideal medical savings accounts.

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

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Business Model For Medical Care 2020. The Ideal Future State

Stanley Feld M.D.,FACP,MACE


Please click on all the links to study
the references to each spoke. It will help you visualize the power of the business

The ideal future state business
model for the healthcare system must include the execution of ideas in the specific spokes outlined below.. These spokes
will serve to align all of the stakeholders’ interests.

The business model must
contain appropriate rules for a consumer driven healthcare system, an ideal
electronic medial record, and an ideal medical savings account.

The ideal medical saving
accounts can work optimally when there is significant tort reform and patients
take full responsibility for their health and healthcare dollars.

Consumer education is critical to the business
model of the future. Educational modules can be available to consumers 24/7 via
the Internet. These educational modules must be an extension of consumers
physicians’ care in order to be effective. The education can become available
using a series of social networks.

Chronic disease self-management education can
be achieved by the use of interactive online teaching programs. Patients can be
linked to share their disease experience through private social networks.

Most believe that the healthcare system must
have greater integration of care. This integration of care can be done
virtually through a series of private integrated networks.

Effective integration can be achieved without
disruption of the entire healthcare system. Obamacare has been disruptive to
the entire healthcare system.

Obamacare is forced integration by the
government will be slow, costly and unsuccessful.

Physicians must be compensated for the presently
uncompensated time necessary to execute each one of the spokes of the wheel.

Each spoke is necessary to convert the
healthcare system into a system that once more makes the physician patient
relationship paramount.

The future business plan removes control of the
healthcare system from the government. It permits the patient to have the freedom
to choose his own healthcare course.   

Tort reform is vital to the 2020 business model.
It will decrease costly over-testing to avoid frivolous malpractice suits.
There are many ways to set up a tort reform system that truly protects patients
from real harm while eliminating over-testing. It limits the malpractice
litigation system. Punitive damages must be lowered. Losers in lawsuits must
pay all fees. These two provisions will decrease lawyers’ incentive to sue.


Consumer driven healthcare will create a system
that promotes personal responsibility by the consumers’ for their health and
health care dollars.


The major spoke necessary to successfully
accomplish a consumer driven healthcare system is my ideal medical saving



The ideal medical savings accounts would
provide the financial incentive for consumers to drive the healthcare system.
It would dis-intermediate the healthcare insurance industry’s grasp on first
dollar coverage and profits. The insurance industry would realize that its
profit margin would increase under this system.

In order for consumers to be in a position to
lower the cost of healthcare they must be taught to understand how to self
manage their disease and be responsible for the decisions they make in their
choices for medical care.


In order to decrease patients’ dependency on
the government and increase  being
responsible for themselves, a system of education using information technology
as an extension of their physicians’ care has to be developed and put into

Social networking is in its infancy at present.
It must be developed and used as an educational tool between physicians, patients
and physicians, and patients and patients.

All the social networking must be an extension of
the physicians’ medical care
to their patients. Social networking must be
developed to enhance and promote the physician/patient relationship because
this relationship is critical, at its core, to successful medical treatment.

Social networking and information technology
can extend physician educational resources for patient care.


Systems of care for the self-management of chronic
disease as an extension of their physicians care
have already been developed.
The unsuccessful chronic disease self-management systems are the programs that
are not an extension of physicians’ care. The reason these third party systems
are unsuccessful is because they undermine the patient physician relationship.

President Obama has done pilot studies using
those third party self-management companies to prove that chronic disease
self-management systems work. They have all failed to reduce the cost of care.

Therefore the administration has reached the
conclusions that self-management of chronic disease does not work. Nothing
could be further from the truth. The government simply does not understand the
magic of the physician-patient relationship.


In order to decrease the cost of medical care,
medical care must be integrated. At present, primary care physicians recommend
specialists. The primary care physicians know whether the specialists are doing
a good job by the specialists’ treatment results with their patients.

Most of the time physicians do not know their
specialists’ fees. These fees must be totally transparent to primary care
physicians and their patients. The primary care physicians can then be in a
position to help their patients choose appropriate specialists.

It will also reduce the specialists’ prices
because they will be forced to become competitive by the patients in a consumer
driven system.

Hospital fees must also be transparent. One of
the reasons I am opposed to hospital systems hiring physicians and paying them
a salary is the hospital systems would then be able to develop a monopoly in a
town or area of town. This would permit the hospital system to raise prices
without informing patients or physicians.

Hospital systems could erase physicians’ choices
and hindered patients from having the freedom to choose a hospital or
specialist of their choice with their primary care physicians. It devalues the
patient physician relationship.  


The way President Obama is going about
developing a universally functioning electronic medical record is foolish and
Most physicians cannot afford a fully functional electronic medical
record. This fact is being used to drive physicians into being employees of
hospital systems. The problem is hospital systems are paying hundreds of
millions of dollars for electronic medical records that are not fully

Many of these records are hard to use and
provide inflexible data. The inflexible data leads to healthcare policy
decisions that are wrong. The data is also used to commoditize medical care.

Commoditized medical care is not the best quality
of medical care.  

If the government is so smart it should develop
a fully functional electronic medical record and provide it to all hospital
systems and practices for free.

The EMR should be put in the cloud. Providers
should be charged by the click. The government can service and upgrade the EMR
in one place and improve the quality of data collected. The data should be used
for educational purposes only and be owned by the patients and physicians. It
should not be used for punitive purposes. The inaccurate data is now used for
punitive purposes. The result has been a lack of physician cooperation.


The healthcare journey to an ideal future state
must begin in an orderly way. The principle goal is to be consumer centric. It
must be consumer driven and force the secondary stakeholders to be transparent
and competitive.

This journey will wring the excess costs out of the healthcare
system. It will create a democratic system affordable to all.

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

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Twisting the Facts About Health Care

Stanley Feld M.D.,FACP,MACE

I have been a New York Times reader since 7th grade. At
that time I delivered the New York Times to all the classrooms in my Junior
High School.

The New York Times has become pretty shabby in recent
years. It has stopped printing unbiased news. It does not print,  “All
The News Fit To Print.”

It has been publishing biased news, news leaks as well as
opinions that have contained innuendo and not based on facts.

A glaring example is the healthcare editorial on Sunday October

The New York Times is trying very hard to help defeat
Mitt Romney and push President Obama over the finish line.

I hope intelligent readers can see through the Times’
smokescreen of no facts and evaluate the candidates objectively.

The editorial’s first sentence is absolutely correct.

“The outcome of the presidential election will determine which of
two opposing paths the nation will follow on health care for all Americans.”

path represented by Obamacare is a path of government takeover of healthcare.
It will convert the healthcare system totally to an entitlement system.  The government will make the rules and create regulations.
Many will be difficult to follow and impossible to enforce.

path leads to restriction of freedom of choice, rationing and a decrease in
access to healthcare.

did not expect this option when they elected President Obama.

is easy to remember the sound-bite, “ If you like your present
insurance you can keep it. If you like your physicians you can keep them.”

campaign principles were vague. His promises were broad brushstrokes of
policies and not a specific outline of policies. At the end of these vague
promises was the appealing promise of affordable healthcare insurance coverage
for all.

turns out that after four years healthcare insurance coverage has become more
expensive. There is no relief in sight. All Americans are subjected to 10
hidden taxes that in effect increases the cost of healthcare insurance

has passed a 2400 page bill that few read and fewer understand. The bill has
generated over 44,000 new regulations so far and massive new government

bill was supposed to decrease the cost of healthcare by over $125 billion
dollars during the next ten years.

is now estimated to cost taxpayers an additional $1 trillion dollars over ten

New York Times editorial goes on to say:

“If voters re-elect President Obama, he will
protect the health care reforms that are his signature domestic achievement.”

sounds like the New York Times believes this is a good thing. My guess is the
Times is not a very good judge of sound business practices because it is itself
on the verge of bankruptcy.  Obamacare is
unsustainable and destined to drive America into bankruptcy.

far President Obama has done nothing to decrease the number of uninsured and
nothing to decrease the cost of care. In fact the cost of care has escalated as
patient deductibles have increased, premiums have increased and the quality of
employer coverage has decreased. Employer sponsored healthcare insurance
coverage is expected to decrease further in the next two years.

New York Times editorial goes on to state:

“If they elect Mitt
Romney, they will be choosing a man who has pledged to repeal the reform law
and replace it with — who knows what?”

The biggest defects in today’s healthcare system are ;

1. It does not encourage individuals to be responsible for the
maintenance for their own health

2, it does not give consumers control of their healthcare dollars
or incentives to preserve those dollars.

3. It does not discourage the practice of defensive medicine with
effective tort reform.

4. It does not create a competitive healthcare market that must
become consumer driven in order to control costs.

The New York Times invites us to visit Mitt Romney’s web site
after this biased preamble:

“The competing visions are often difficult to evaluate because the
Republican candidates — Mr. Romney and his running mate, Paul Ryan — have
become so artful about obfuscating their plans for Medicare, Medicaid and what
they will do to reform the whole system.”

I went to the web site to see what Mitt Romney’s plan is. He has
very specific proposals in his healthcare plan. The proposals could Repair the
Healthcare System if implemented correctly.

I imagine the New York Times did not pay attention to any of the
words in the plan because they are drinking President Obama/Mr. David Axelrod’s
"Kool Aid."

The Times tells us in the very next sentence;

“Almost nothing the Republican candidates say on these or other
health care issues can be taken at face value.”

I would say this is not objective reporting.

What is Mitt Romney’s healthcare plan? I would like readers to
read it carefully and judge for themselves.

He first explains the Obamacare failures. The failures are
important to keep in mind because Obamacare has been shoved down the mouth of


the transformation in American health care set in motion by Obamacare will take
us in precisely the wrong direction. The bill, itself more than 2,400 pages
long, relies on a dense web of regulations, fees, subsidies, excise taxes,
exchanges, and rule-setting boards to give the federal government extraordinary
control over every corner of the health care system. The costs are
commensurate: Obamacare added a trillion dollars in new health care spending.
To pay for it, the law raised taxes by $500 billion on everyone from
middle-class families to innovative medical device makers, and then slashed
$500 billion from Medicare.

was unpopular when passed, and remains unpopular today, because the American
people recognize that a government takeover is the wrong approach. While
Obamacare may create a new health insurance entitlement, it will only worsen
the system’s existing problems. When was the last time a massive government
program lowered cost, improved efficiency, or raised the consistency of
service? Obamacare will violate that crucial first principle of medicine: “do
no harm.” It will make America a less attractive place to practice medicine,
discourage innovators from investing in life-saving technology, and restrict
consumer choice.

In short,
President Obama’s trillion dollar federal takeover of the U.S. health care
system is a disaster for the federal budget, a disaster for the constitutional
principles of federalism, and a disaster for the American people.


On his
first day in office, Mitt Romney will issue an executive order that paves the
way for the federal government to issue Obamacare waivers to all fifty states.
He will then work with Congress to repeal the full legislation as quickly as

In place
of Obamacare, Mitt will pursue policies that give each state the power to craft
a health care reform plan that is best for its own citizens. The federal
government’s role will be to help markets work by creating a level playing
field for competition. 

State Leadership and Flexibility

Mitt will
begin by returning states to their proper place in charge of regulating local
insurance markets and caring for the poor, uninsured, and chronically ill.
States will have both the incentive and the flexibility to experiment, learn
from one another, and craft the approaches best suited to their own citizens.

  • Block grant Medicaid and other payments to
  • Limit federal standards and requirements on
    both private insurance and Medicaid coverage
  • Ensure flexibility to help the uninsured,
    including public-private partnerships, exchanges, and subsidies
  • Ensure flexibility to help the chronically
    ill, including high-risk pools, reinsurance, and risk adjustment
  • Offer innovation grants to explore
    non-litigation alternatives to dispute resolution

Free Markets and Fair Competition

drives improvements in efficiency and effectiveness, offering consumers’ higher
quality goods and services at lower cost.  It can have the same effect in
the health care system, if given the chance to work.

  • Cap non-economic damages in medical
    malpractice lawsuits
  • Empower individuals and small businesses to
    form purchasing pools
  • Prevent discrimination against individuals
    with pre-existing conditions who maintain continuous coverage
  • Facilitate IT interoperability

Consumer Choice

markets to work, consumers must have the information and the power to make
decisions about their own care.  Placing the patient at the center of the
process will drive quality up and cost down while ensuring that services are
designed to provide what Americans actually want.

  • End tax discrimination against the individual
    purchase of insurance
  • Allow consumers to purchase insurance across
    state lines
  • Unshackle HSAs by allowing funds to be used
    for insurance premiums
  • Promote "co-insurance" products
  • Promote alternatives to "fee for
  • Encourage "Consumer Reports"-type
    ratings of alternative insurance plans


Mitt Romney’s plan is an outline of his healthcare plan that
corrects all of the defects in our healthcare system. Obamacare has amplified
the healthcare system’s defects.

By giving states the opportunity to select a waiver from Obamacare,
Governor Romney is eradicating all the new taxes, regulations, bureaucracy, and
impingement on individual choice, individual freedoms and access to care
issues. He is also opening the door for subsidized healthcare coverage for
those in need.

It is much more specific than the plan President Obama presented before
his election in 2008. I have reviewed my articles on his proposals. President
Obama disguised his real intentions. He made it sound much better than he
intended. If one reads between the lines it is clear President Obama wanted the
federal government to control the healthcare system.

The blog post from 2008 make interest reading. Please click on

President Obama is the pot calling the kettle black.

Government Romney puts the consumer first, not the government. His
plan also strengthens states rights which have been severely discounted during
his term in office. The states can be a little more efficient that the central

President Obama has presented nothing about his healthcare plan
during his reelection cycle,

Many of the regulations have not been written yet. President Obama
is waiting until after the election when “he
will have more flexibility. ”

Please remember I voted for him in 2008. President Obama has been a
tremendous disappointment to me. He does not understand the American psyche and
is ignoring Americans’ wishes.

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

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The Future State Business Model For Repairing the Healthcare System

Stanley Feld M.D.,FACP,MACE

Obamacare is going to lead to the demise of both the healthcare system and the medical care system in the United States. America is at a critical turn in 2012.  The evidence for the collapse is presented in the following links.

The business model for a successful repair of both the healthcre system and the medical care system are outline on the next slide.


A consumer driven healthcare system is critcal to a successful repair of the healthcare system. Read this link to understand the full meaning and implications of a consumer driven healthcare system.

Consumers must drive the systems by being responsible for their own healthcare decisions and own their healthcare dollars even if they are subsidized by the government.

Another critcal element in business model for the future state is effective tort reform. Ideally defensive medical testing  has to be eliminated completely. Defensive medical costs the healthcare system between $300-500 billion dollars a year

A summary of the misalign insentives must be understood and examine . There is a way to align all the primary and secondary stakeholders incentives. It must be agreed too that consumers are the primary stakeholders and physicians are next. Most of the control and power in the system has shifted to the secondary stakeholder namely the government, the hospital systems and mostly the healthcare insurance industry.

The government must understand that the only way to reduce cost is to shift the responsibility of controlling costs from the government to consumers.

Consumer must be the leader of their healthcare team.

Consumers must be responsible for health and healthcare dollars.

Consumers must have effective financial incentives to become medically responsible to themselves. It is clear with the incidence of obesity, the increases in smoking and drug addictions, hearth attacks, and strokes from high blood pressure that the need to attain good health is not enough incentive.

My ideal Medical Saving Accounts are an excellent way of providing financial incentives to achieve good health in a consumer driven system. The achievement of good health will drive down the costs to the healthcare system. The incidence of costly complications of disease will be reduced.

My ideal Electronic Medical Record is an important innovation. It is inexpensive to physicians. The data belongs to patients and their physicians and set up in a way that it is not punitive to physicians. It should be a fully functional EMR.

All physicians know that medical care decisions making and judging the quality of medical care by electronic data is faulty. All the EMR's are expensive. They also put physicians in a vulnerable position to be judged by faulty data. My Ideal EMR helps physicians track their patients and improve their medical communications and care. 

It is important that consumer become responsible for their own Personal Medical Record. The ideal EMR permits patients to download their records with their tests to their own computer or flash drive. Consumers should carry their medical records at all times in case of emergency. 

Social Networking is the key to a consumer driven healthcare system. The possibilities are compelling.

Improved communication between patients and physicians will be driven by a consumer driven healthcare system connected to social networking. The motivations is financial when consumers own their healthcare dollars.

Education via the Internet must be an extension of physician care.

Government's Educational Responsibility:

Teach consumers to become intelligent healthcare consumers

Government must develop a program to effectively combat obesity. There must be a change in the food industry and farm policy.

Price Transparency

Price Controls Do Not Work.

Eliminate Medical Monopolies

Patient must learn to be and educated and responsible healthcare consumer.

There must be a decrease in medical entitlement programs. Consumers must have skin in the game in order to be educated and responsible consumers. Consumers need to be a financial risk.

This is the outline of the future state business model. The readers should click on each link to read the details of each bullet point.

This business model will enable America to have an affordable healthcare system for all which will become sustainable.

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

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Evidence For Impending Healthcare System Failure

Stanley Feld M.D.,FACP,MACE

The following are the links that is the evidence for the impending failure of the healthcare system in its present form and in the form that Obamacare is adopting.

Obamacare is piling on more regulations and restrictions to the present healthcare system. The present system is a failed system.The regulation will be impossible to comply with and impossible to enforce. They will create more opportunity for secondary stakeholder to extract more funds from monies needed for direct patient care creating a greater decrease in access to care for all .

The links follow the slides I presented in my last blog. Those links could not be opened because they were jpegs.

My hope is the links serve as an excellent reference to Repair The Healthcare System presently or when it collapses under it unsubstainable costs and the present system's inability to be executed.

The Etiology of Accelerated


Medicare 1965-1980 Fee for

authorized HMO’s

Medicare Price Fixing Begins In 1980

Cost shifting Penalizes Private

HMO Fail Because Of Faulty Assumptions In 1990.

 Reasons for Hillarycare’s
Failure To Pass.

Distrust of Government

Healthcare Insurance Companies
Raise Premiums.

Birth of Managed  Care: Another Compicated Mistake  

Managed Cares Fails. 

Managed Care Pricing And
Premiums Remain

2009 Obamacare And The Threat
Of Government Takeover To Freedom, Liberty and Choice.

Rationing Of Healthcare

ACOs Are HMO's On Steroids Combined With Managed Care Is Obamacare's Complicated Mistake. 

ACOs Will Fail At Great Costs To Everyone.

 Tort Reform And Defensive Medicine Are Ignored By Obamacare.

Medical Cost Escalate Out Of
Control And Then The Healthcare System Will Collapse.

The other major slide in the last blog was the barriers to the
Physician/Patient Relationship. This relationship is critical to the
theraputic index. It is almost destroyed and will be totally dstroyed in
Obamacare. Both physicians and patients will become commodities in a
bureaucratic healthcare system. Patients will not win.


Physician/ Patient Barriers to the Physicians/Patient Relationship



The Physician/Patient

physician/patient relationship

 The Magic  of the Patient Physician Relationship  

 Patient and
Physician responsibility contract

 Patient should be the leader of the team

 Barriers for physicians in the Physician/Patient


1. Tort
Reform/Defensive Medicine.

2. Restriction
of Physicians Clinical Judgment

3. Medicine
is a calling not a business

  4.  Constant
lowering physicians’ reimbursement

 5. Physicians
are driven to decrease time spent with patients

6. Government
rations care through panel of experts

7. Physician’s
treatments are driven by government regulations

8. The
traditional media undermining physician credibility

9. Government
is attempting to commoditize medical treatment


Patient Barriers To the Patient/Physicians Relationship

1. Patients are not in control of their own medical decisions.

2. Patients are not in control of their own healthcare

3. Patients
do not have to be responsible for their treatment because they

first dollar coverage.

4.  Education about chronic disease must be extension of
physician’s care

5.  Internet can undermine the Physician/Patient

6. Method of choosing a physician is random and must be
made clearer

7. Portability of information about previous treatment
is difficult

8. Patient must be responsible and in control of their
medical record.

9. Patient must endure poor communication by their

Government and the healthcare insurance industry limit choice with


11. Patients should be responsible for their treatment

America's healthcare system is at a critical turn in 2012.

Obamacare must be repeal.

Effective healthcare reform is essential. Both the primary and secondary stakeholders have abused a system. A system that is punitive.

Consumers must drive the system by being responsible to themselve and their healthcare dollars.

Obamacare is building a system of government dependency by all stakeholders (patients,physicians,hospital and healthcare insurance companies).

The healthcare system should be developed to create innovation and competions among stakeholders for the benefit of consumers and their indepent choice.

The government's inefficiency will create a healthcare system destined to doom at the expense of all of us taxpayers.

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

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There Is A Way To Fix The Healthcare System!!

Stanley Feld M.D.,FACP,MACE

The healthcare system cannot be fixed using a
broken business model.

It can only be fixed by changing the business
model to a consumer driven business model that would include personal
responsibility and individual freedom of choice.

President Obama believes the healthcare system
can be fixed by a single party payer system run by the government.

I do not believe the government has run things
very well. Many examples come to mind in many areas. Two recent examples are
the Fast and Furious scandal and the lack of security for the murdered ambassador
in Benghsi Lybia.

When things go bad with government policy it is
difficult to discover the reasons. I believe consumers are very hesitant to
trust the government to make their healthcare decisions for them. On the other
hand consumers would be happy to allow the government and taxpayers to pay for
their medical costs.

A cultural shift in the healthcare system must
occur.  The shift must be toward
individual responsibility. Consumers must be responsible for their health and
their healthcare dollars if Americans are to be healthier and the cost of
healthcare decreased. The government must allow and encourage the introduction
of innovative forms of healthcare insurance.

The role of government must be to educate
consumers maintain health and to be smart purchasers of healthcare insurance.
Government should make the rules so secondary stakeholder cannot take advantage
of the primary stakeholders  (consumers)
and then get out of the way.

Government should help those who are less well
off with subsidies and equal access to medical care. Consumers must be
financially incentivized to take responsibility for their health or healthcare
dollars. They must not be penalized if they do not take responsibility for
their health and healthcare dollars.

I presented a new healthcare business model a
few months ago. It deserves to be restated.


This is the way the healthcare system looks


Since 1965, as a result of government intervention,
healthcare costs have escalated. This escalation has been the resulted of
increasing government intervention over the years. The path to accelerated
collapse of the healthcare system has started.

The result has been destruction of the patient-physicians
relationship. Effective medical care has been disrupted along with the
impersonal fragmentation of care.


All of the underlined headings represent links
to articles that explain these problems. I will publish functional links in the
next blog.

President Obama’s goal is to have a single
party payer healthcare system. He believes this is the only way to an efficient

He realizes he cannot achieve this goal immediately.
He must do it one step at a time.

The methodology he is using will not work.  He is imposing an accountable care
organizations model onto hospital systems and large physician practices. He
plans to pay one fee for certain diseases based on financial outcomes.

The fee is to be divided between the
stakeholders. President Obama wants to collect data to evaluate and direct
physicians and hospital systems care.

It sounds good but it will not work because he
will encounter physician resistance.

He wants to make cost effective judgments about
patients care without giving patients the right to make their own decisions.

It is going to very difficult to divide the
shrinking pot of money between physicians and hospital systems.

President Obama refuses to admit that the
government outsources the administrative services to the healthcare insurance
industry. The healthcare insurance industry’s fee for this service is about 40%
of the healthcare dollar.

In a recent debate he again stated that CMS’s
overhead is very low at 2.5%

President Obama’s ACA (Obamacare) is proceeding
with the same business model that has failed except he wants complete control
and no competition. If the U.S. continues with the same business model the total
collapse of the healthcare system will accelerate.


The healthcare system is at a critical turn.
The disadvantages of President Obama’s healthcare reform act are obvious. The present
healthcare systems model has lead to all of the disadvantages on the above list.

It is going to take many years to get an
accountable care organization to effectively function if at all. It will take
many years to have a fully functional EMR installed in every hospital system
and physician’s office. If something is not done to correct the business model
we will experience total collapse of the healthcare system.



Two things have to happen to change course. The
business model has to change to transfer power from the government to the


The healthcare system is good at curing
infectious disease and replacing kidneys, lungs, livers or hearts.

The big question is, “how does the healthcare
system prevent disease from occurring?”

The greatest expense is diseases that can be
prevented such as diabetes mellitus and heart disease. The root causes are not
preventable yet because they are genetic. The expression of the diseases and
its resultant and costly complications can be prevented.

Obesity causes the expression of these diseases.
The avoidance of obesity requires a drastic change in society’s food industry
and culture.

Americans have been programed over time to eat
more calories and do less activity. There is no quick fix for obesity. People
must eat less and be more active in order to lose weight.

The government has not devoted adequate
resources for education and innovation to change this culture.

Mayor Bloomberg had the right idea by
decreasing the size of the soda pop being sold in N.Y.C. but his approach is

He must use education and provide real incentives.
He is trying to legislate behavior. It has never worked in the past.

Americans’ attitude toward food must change by creating
hype for decreasing intake and increasing exercise tied to financial
incentives. Penalties do not work. Incentives and freedom to choose does work.

This is the main problem with President Obama’s
business plan for the healthcare system. He is imposing his will on the
consumers, hospital systems and physicians.

It will not work. It must stop now because it
is unsustainable for taxpayers.

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

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It Is Time To Listen To Physicians

Stanley Feld M.D.,FACP,MACE

Physicians are getting tired of being blamed for the
rising healthcare costs. There are starting to realize that they have to take
action to preserve their professional integrity. In fact, six out of ten
physicians said they would quit medicine in a recent study by the Physicians

I believe physicians will have a hard time quitting
because they love practicing medicine. I do believe physicians in their early
60’s are contemplating quitting. Many physicians are looking for viable exit
strategies to avoid quitting.

The Physicians Foundation commissioned an extensive survey of nearly 13,575 physicians.
Meritt Hawkins, the physician search and consulting firm, conducted the survey.

 “The survey found that 60% of physicians would retire today, if given the
opportunity—an increase from 45% in 2008. And it's not just disgruntled and
tired Baby Boomers who want to abandon their healing work. At least 47% of
physicians under 40 also said they would retire today, if given the

The survey pointed out many major problem areas.

Two specific issues consistently agreed
to were malpractice concerns and the need for tort reform as well as the lack
of cohesive leadership among all physician groups to represent the vested
interests of physicians and their patients.

This is an excellent and detailed
survey that has heightened the awareness of physicians’ practice problems.

The Massachusetts Medical Society
survey pointed out the scope of defensive medicine
. I extrapolated findings of
the society’s survey to the nation.

My conclusion was that $500 billion to $700
billion dollars a year is spent on defensive medicine testing in the nation.  Tort reform would serve to decrease this
defensive testing.

President Obama and his advisors have
ignored tort reform and defensive medicine as an insignificant cost. Ezekiel Emanuel
M.D. one of President Obama’s advisors thinks defensive medicine only raises
the cost of the healthcare system between $26 billion dollars a year.
Dr. Emanuel feel this is an insignificant number to deal with in a 2.7 trillion dolloar healthcare system. His metrics are wrong. This
is a misguided bias.

The Physician Foundation survey notes
that many policy makers, academics, and others identify fee-for-service
reimbursement as a key driver of health care costs. Physicians believe that "defensive medicine is a far more
important cost driver."

40.3% of the physicians surveyed said "liability/defensive
medicine pressures" was the least satisfying aspect of medical practice.

The survey also reveals that doctors
see as a major cost driver of healthcare liability/defensive medicine.

69.1% of physicians said defensive
medicine is the "number one ranked factor" driving up healthcare
costs. The survey described the ordering of tests, prescribing of drugs, and
conducting of procedures done "partly or solely to drive a wedge against
potential malpractice lawsuits."  

"Medical malpractice lawsuits are common,
adding an additional layer of paperwork, expense, and stress in virtually every
physician's work day," the report adds

The government ought to be listening to physicians practicing medicine every
day rather than ivory tower professors who have never practice a day in their

"Physicians understand to some degree
that's the cost of doing business, but the defensive medicine goes deeper than
that, in the ordering of extra tests, doing the extra procedures, and extra
scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of
overspending in American healthcare. President Obama and Obamacare have ignored
it. Some states have addressed it and the cost of care has been decreasing
slowly. I believe it will take time in those states.  If anyone was sincere about bending the
healthcare cost curve they have to take defensive medicine seriously. 

According to the survey physicians felt that there is a lack of a
forceful cohesive voice representing them.

"There is a systematic, endemic series
of problems," Walter Ray M.D. vice president of the Physicians Foundation
, says. "Everywhere their defensive medicine,
regulation issues, reimbursement issues. We are all in the same boat. But
physician representation is balkaniz
ed. There is not a national organization
that represents a majority of physicians."

When the survey asked which best describes
their feelings about the current state of the medical profession, only 3.9
percent of physicians used the words “very positive,” while 23.4 percent of
physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent —
described their feelings as either somewhat negative” or “very negative,” while
only 31.8 percent of physicians described their feelings as “somewhat positive”
or “very positive”.

A "least satisfying" aspect of
practicing medicine included dealing with Medicare/Medicaid/government
regulations (27.4%) and reimbursement issues (27.3%).


The American Medical Association (AMA) represents only
15% of physicians, according to the Physician Foundation report. One of the
reasons for the low enrollment is that physicians feel the AMA does not
represent their vested interests.

 Sermo is another
physician organization. It is an Internet social network. In less than 2 years
Sermo had as many members as the AMA.

Sermo originally concentrated on
socioeconomic issues. It also discussed difficult clinical cases.  

The socioeconomic activity has recently
faded. Sermo’s power was using the social network to do instant surveys
expressing physician’s opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to
the public as media stories of physicians’ opinions. It was done through public
service announcements and daily press releases.

Physicians were able to let the public know
how they felt about an issue instantly. It was very attractive. Somehow the
initial vigor stalled. Physicians are now left without a vehicle or
organization to express to express their feelings.

Government, the healthcare insurance industry
and the hospital systems have little desire to listen to the concerns of
practicing physicians. It is more important to tell physicians what to do. It
will not work long term.

The Physicians Foundation Biennial Survey is
valid and accurate
. However it is not dynamic or evolving. Neither has it gotten
much attention. It is a must read along with the Massachusetts Medical Society survey
for those interested in physician concerns and behavior.

Patients’ problem with the healthcare system
gets less attention. The government and insurance companies tell patients what
they can and cannot do

Repair of the healthcare system will only
happen when the American healthcare system evolves to a consumer driven
healthcare system with individual responsibility and individual control by the
patients of their healthcare dollars.

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


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Medical Costs Outrun President Obama’s Projections

Stanley Feld M.D.,FACP,MACE

No one should be surprised that the cost of
healthcare and medical prices are overrunning projections by the Obama
administration. It was self-evident with the passage of Obamacare. Now it is

President Obama has done all the wrong things to
lower costs and all the right things to raise costs.

Health Care Cost Institute analyzes claims data from UnitedHealth Group Inc.,
Aetna Inc. and Humana Inc.
The Institute said the cost for consumers with
employer-sponsored healthcare insurance plans increased 4.6 percent in 2011.
The government estimated a 3.9% increase for 2011.

A recently published study
by the U.S. Centers for Disease Control and Prevention found the number of
people without insurance climbed 1.7 percent in the first quarter of 2012.

Both numbers are the
opposite of the numbers President Obama promised in 2009 when he was forcing
congress to pass Obamacare.

CDC reported that 47.3 million people lacked insurance, and the health
institute said hospitals and doctors raised prices at a clip that outstripped

Why is President Obama not bending the cost
curve as he promised? I would say he either doesn’t know what he is doing or he
knows precisely what he is doing.

My guess is he is trying to force consumers into
a "Public Option" that will be created by the health insurance exchanges. He is
also trying to stick the cost of this “Public Option” onto state governments.
The state governments are required to balance their budget.

Even before states institute the health
insurance exchanges most states are suffering from large budget deficits when
they are supposed to have a balanced budget.

The health insurance exchanges will make it
worse.  The federal government will have
to bail states out as the payer of last resort. This will increase the federal
deficit even further. The federal government will have to print more money.

Printing more money will devalue savings,
salaries and purchasing power. The result will be further inflation. Somewhere someone like a China will not continue to buy the United State's depth and it will default on payment.

America is currently suffering from inflation.
It is being disguised because the government has eliminated fuel costs and food
costs from inflation calculation.

I believe Americans understand this. Governor
Romney must emphasize this in no uncertain terms.

Affordable Care Act, which
promises to expand coverage to 30 million Americans starting in 2014 and trim
health costs.


 “If you don’t bend the cost curve, ultimately
insurance gets more expensive,” said Douglas Holtz-Eakin, the president of the
American Action Forum, a Washington-based advocacy group that opposes the health
law. “It’s a big problem for the Affordable Care Act.”

Obamacare tries to limit insurers’
administrative expenses and profits. The Healthcare insurance industry is
supposed to pay at least 80% of premiums for direct patient care. (Medical Loss
Ratio of 80

However, President Obama
has permitted the healthcare insurance industry to continue to count expenses
for administrative services into the direct medical services column. The result
is a decrease in the amount of money available for direct patient care.

The Health Care Cost
Institute published the direct cost per person under employer- sponsored plans
increased from $4,349.00 in 2010 to $4,547.00 per person in 2011. United, Cigna
and Humana cover 40 million people.

I have previously published
that the cost per Medicare senior is $6,600 a year.

The obvious question is why
should an employer pay $15,000 to $20,000 dollars a person a year when the cost
is $4,547?

Why should I be paying a
premium of over $15,000 a year in after tax dollars for my Medicare premium and
supplements for my wife and me when it costs $6,600 per person? The $6,600 per
year average includes the sickest seniors. 

Each year the government
increases the Medicare premiums on a means tested basis because it spends money
above my premium cost. 

Keep in mind I have been
paying into the Medicare Trust since 1965. Now I am paying an additional
$15,000 a year for direct services that cost $6,600 per year per person.

Any salary earned by a
senior results in them paying into the Medicare trust.

Someone is ripping off the
system. The likely candidates are the healthcare insurance industry and the ever-increasing
government bureaucracy.

institute created last year to analyze claims data from major insurers, found
that charges for hospital emergency rooms rose 9.1 percent in 2011, after
adjusting for a reduction in the intensity of care they delivered.”

This statistic is a
distraction from the real issue. The real issue is to explain the difference in
direct cost compared to premium costs. 

President Obama believes
that hospitals owning and managing physicians practices will result in best
practices using evidence- based medicine.

I believe a system can be
built to teach independent physicians best practices combined with their use of
clinical judgment.

Holtz-Eakin, former CBO
head, believes that Obamacare encourages consolidation among hospitals and
doctors. The consolidation of hospitals and physicians is leading to greater
pricing power by the hospital system.

The problem with the
consolidation of hospital systems and physician practices, is that physicians
are not receiving an increase in reimbursement for their intellectual property
or technical skills.

The hospital system owns physicians’
intellectual property and technical skills. Its staff does the collecting and
financials. The hospital system enjoys the increase in revenues. The salaries
for its administrators have skyrocketed into an average of 1 million to 5
million dollars a year.

It is clear that the price
of adding 30 million people to the healthcare insurance rolls will increase
costs. The increasing price spiral will not be to the advantage of patients and

The costs will become
unsustainable and the government controlled healthcare system will collapse.

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

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Individual Freedom – Stand for it now or lose it forever.

 Stanley Feld M.D.,FACP,MACE

I have spoken to and corresponded with many practicing physicians about
Obamacare. A universal sense among physicians is Obamacare is closing in on
their freedom to make clinical judgments and care for their patients in the
best way.

President Obama claims to be promoting best practices but the sense is
the results of Obamacare will be bad for them and their patients.

Some physicians have taken a defensive position and sold their
practices to hospital systems. They are willing to let the access to care and
the rationing of care become a problem the hospital systems will deal with.

Many of those physicians have forgotten the mistrust they have had for
the hospital systems in the past.  

Intuitively, physicians understand that hospital systems will take
advantage of their intellectual property and technical skills for the hospital
system’s benefit and profit.

The physicians who have joined hospital systems are hoping they will
make an adequate living and have less aggravation. They will be sheltered from the
government, the healthcare insurance industry and patients.

I believe those physicians will be surprised when they realize they
will be serfs of the government, the healthcare insurance industry and the hospital systems.

I have read some awful contracts physicians have signed with hospital

Physicians know the winner under Obamacare will be the government and
its quest for control over the healthcare system.

They also know that the healthcare insurance industry knows how to
control the government and its spending thereby increasing its profits. The
government is totally dependent on the healthcare insurance industry for its
administrative services.

Hospital systems are afraid they will not receive what they consider
their corporate share of the government largess.

Many physicians feel Obamacare is a government ploy claiming to reduce the cost
of medical care to the detriment of patients and physicians under the guise of
improving the quality of healthcare. President Obama is ignoring the underlying

Most physicians are not political activists. They also do not
understand their enormous political power. Patients, government, hospital
systems and the healthcare insurance industry desperately need physicians as
their workforce. 

If one physician has 2,000 patients in his practice he has 2,000 that
like him and approve of his care. These patients will listen to him.

Few physicians explain the coming threat of Obamacare to the practice
of medicine to their patients.

David McKalip, M.D., Neurological
Surgeon, wrote the following letter to his physician friends for them to distribute
it to their patients. The distribution does not take much of physicians’ office

The threat to patient care is discussed

Every physician and his patients
should distribute the letter to their entire email list.

President Obama is trying hard to
distract both physicians and patients from the effects of his horrible law. He and
the press do not want to talk about it with only 6 weeks to his possible re-election.

All that has to be done is to copy and paste the letter and email or give it to
your patients and friends.

Feel free to copy and paste the entire blog to include my comments. I believe this letter is appropriate one day before the first debate.

Hello all,

This is a
letter I will be sending out to my physician colleagues. I will then be placing
fliers in my waiting room supporting Romney and a large sign on my property.

The time is
now or never. Please take this letter and send it to your entire
referring list. The cost of the mailing will be worth it so you know you did
what you could….



I write you
at a critical time in American History as a dangerous threat faces the future
of our medical profession and our patients.

am asking for your help to save medicine by reaching out to the only people
that can save it: your patients.
  For most of my career I have
been working to protect our profession from control by the self-serving
interests of the government and insurance companies.

I have
greatly appreciated the often-quiet support of so many of you who could be
confident that I was working with many other medical leaders on your
behalf.  However, now I ask you to do something more:  to stand
up with me
 and so many others to ensure that American Medicine is
protected by electing Mitt Romney as President and stop President
Obama’s government and corporate takeover of medicine

It is
certain that a President Romney won’t be perfect, but at least he is someone we
can hold accountable.  President Obama and his administration have been
granted extraordinary powers by Congress to implement Obamacare in any way they
see fit through rule-making authority – they will keep coming after doctors.

Obamacare is
a bridge too far for medicine and must be stopped now so we can implement
better reform that drives down costs, and truly improves access and quality (as
offered by the Florida Medical Association).

So I will
ask you to speak directly to your patients and do something that is rarely
warranted – advocate that they elect Mitt Romney President
Such dramatic actions should only occur in historic times like these; but we
must take action now while we still can.

Here are the
messages I would ask you to give to your patients.

Obamacare will ration the health care you deserve.

will occur through a panel of 15 unelected bureaucrats called the Independent
Payment Advisory Board (IPAB) set a budget for patients doctors
cannot go over when you need it (
working through tens of thousands of
pages of Obamacare rules).

will occur by greatly strengthened private and government-run HMO’s that will
also place your doctors on a budget.


that provide the best care you expect will be penalized financially and

Doctors will
be forced to report your private medical data to the government and then forced
into spending valuable patient care time on social behavior counseling such as
smoking, alcohol cessation and weight loss.

will be intimidated into working for less, while spending more on complying
with regulations, until they finally have to leave practice. They will be
replaced by doctors that serve the government and insurance companies more than
patients.  Doctors you can’t trust.

bureaucrats will have the power to assign you to a new doctor with a history of
spending less money on their patients.

siphons $700 billion from Medicare through such rationing tactics
a program that is running out of money in the Medicare Trust Fund since
Congress spent it on their pet projects.  Medicare will not be
changed for any patient over the age of 55 by Mitt Romney
 or Paul
Ryan. You will still have the benefits you expect.

will be saved for future generations by Mitt Romney
by transforming it into a model that our children and
grandchildren can afford and that they own – not one that is owned by the
government that would ration their care and take their money from the Trust

I know I am
asking a lot to ask your patients to vote for a particular candidate by using
your first amendment right of Free Speech. 

You can do
this by wearing a Romney button, putting up a campaign sign in your office,
printing out the bullet points from this flier and putting them in your waiting
room and asking them to vote for Romney.

If you do not take this action now you will not have a chance to
do so again
.  Will
you join me and help elect Mitt Romney?  Then I will go back to work
holding him accountable through organized medicine.





McKalip, M.D., Neurological Surgeon

Individual Freedom – Stand for
it now or lose it forever.

 Replace David's name with your name if you like

Obama has lied about Obamacare and bullied everyone in his path including the Supreme

Don’t let
him do it to patients and physicians. It is up to both physicians and patients
to make Dr.David McKalip’s letter viral by copying and pasting it and sending
it to your entire email list.

If you are a patient or potential patient please distribute this letter as well.

Thank you.


Individual Freedom – Stand for
it now or lose it forever.

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

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