Stanley Feld M.D., FACP, MACE Menu


Our Government Knows What to Do. It Just Does Not Do It!

Stanley Feld M.D.,FACP,MACE

Insurance companies are in the business of providing insurance. Insurance is for unforeseen occurrences. It seems pretty sensible to me. However, as the health insurance industry has evolved, coverage is not as straight forward as is should be.

The individual patient buying insurance is not treated as fairly as the group buying insurance coverage. If you have hypertension and work for a large company that provides employee health insurance you are automatically covered in your company’s group health insurance policy. If you hate you job and quit, you would not be able to buy health insurance. The insurance company would deny you insurance coverage because of the hypertension. If you could get insurance hypertension and the complications of hypertension would be excluded from your coverage.

If you as an individual had any preexisting illness, the insurance company would make that illness a cause for denial or exclusion of health insurance coverage for that illness. The preexisting illness is not an exclusion or denial if the person is in an employer group health insurance plan. If you are a young individual with no preexisting illness and a healthy family you could obtain coverage with after tax dollars, while the company group health insurance coverage is pre tax dollars and a deductible expense to the employer.

Some of the exclusions are perverse. They include a history of migraine headaches, gallstones, pelvic inflammatory disease, back pain and back disorders, asthma, allergies, hemorrhoids, varicose veins and even sinusitis.

The reasons for outright denials of individuals seeking health insurance are even more perverse. The illnesses include ulcerative colitis, cirrhosis of the liver, diabetes mellitus, schizophrenia, coronary artery disease, epilepsy, and even obesity. Diseases with the chance for immediate emergency such as AIDS, uncontrolled hypertension, previous stroke and leukemia to name a few, are automatic policy with no questions asked. It is paid for by the employer with pre tax dollars and denials.

All of the illnesses above receive coverage in an employer group is a deductible expense.

If anyone in a family got any one of these diseases there would be no option for the employee to leave his job and become self-employed for fear of not being able to obtain medical insurance. This data is available at the U.S. Office of Technology Assessment. The person with the group insurance from an employer is imprisoned. He can not change jobs.

Insurance companies are in business to make money. They do everything in their power not to lose money by avoiding risk if they can. The government has not closed this loop hole in favor of the insurance industry.

Grace-Marie Turner of the Galen Institute ( an innovative research organization focusing on health and tax policy) found a remarkable op-ed piece written by Dick Armey (R-Texas) and Pete Stark(D-California) in the Washington Post in 1999. Pete Stark is the incoming chairman of the House Ways and Means Health Subcommittee. Dick Armey was house Majority Leader at that time. The title of the article was “The ultimate congressional odd coupe weighs in.”

The two seldom agreed on anything. However the agreed that “Congress should act now to help the 43 million Americans who have no health insurance”. Remember folks the date of the article was June 1999. It seems congress is a little slow. We are have 46.7 million people uninsured.

“For individuals, being uninsured is a problem because too often it means health care forgone, small warning signs ignored and minor illnesses allowed to become costly crises. It’s a problem for families because unpaid medical bills are a leading cause of personal bankruptcy. And it’s a problem for the nation because uncompensated care is an unfair burden on doctors, hospitals and taxpayers.”

“Indeed, today’s tax code discriminates against not only insurance purchased outside the workplace but also lower-paid, part-time and small-business workers. The highly paid CEO gets a more lavish health-care tax break than the waitress earning the minimum wage.”

“Properly designed, such a tax credit could bring about near-universal coverage without new mandates or bureaucracy. It would eliminate barriers the uninsured face in today’s system, enabling them to shop for basic coverage that suits their individual needs and is portable from job to job.”

To be successful, the credit would need to be sufficiently generous to buy a decent policy; available to those who owe no tax liability; and, to prevent fraud, paid directly to insurers or other entities, not to individuals.”

You notice there is no mention of the need for price transparency and a way to set up competitition between insurance companies to decrease the premium charges.

“ We do want to permit a gradual transition to a world in which individuals are free to obtain the kind of insurance they want, regardless of where it’s purchased.”

Admittedly, a tax credit can’t help people who are too sick to insure at any price. Although we differ, fairly strongly, about the best way to help such people, we agree a reasonable way can be found to do so, and we’ll keep looking for it. (Rep. Stark would prefer to get insurers to take all customers at a common price, regardless of health status. Rep. Armey would set up “high-risk pools” to subsidize sick people’s coverage in the 22 states that haven’t already done so.)”

Pete Stark is right on the money here although I hardly ever agree with him. The common price, regardless of health status is what group policy holders enjoy and this common price should be a community rated price. Community rated price is the average usage a particular community has and a calculation of the price of insurance on the basis of that community usage in a price transparent environment based on cost of the provider and not charges.

Dick Armey is wrong! High risk pools have not worked. The insurance industry has managed to price the cost of insurance in high risk pools out of the reach of those who need it.

“Too often, when Congress turns to health issues, it ends up applying legislative Band-Aids. It’s time to address underlying causes. The biggest health problem facing the country is the uninsured. The tax code can be used to help them. We urge a bipartisan consensus to do so.”

Even when they know what to do they do not do it. It is up to us to demand that it be done. Congress has not done anything since these two leaders said it must be done in 1999. June,1999 was six and one half years ago. Who do you think blocked it? The facilitator stakeholders block it because their vested interest was threatened. It is our turn.

  • Jay Draiman, Energy Consultant

    Energy Independence begins with Energy efficiency – It’s cheaper to save energy than to make energy.
    By Jay Draiman, Energy Consultant
    In order to insure energy and economic independence as well as better economic growth without being blackmailed by foreign countries, our country, the United States of America’s Utilization of Energy Sources must change.
    “Energy drives our entire economy.” We must protect it. “Let’s face it, without energy the whole economy and economic society we have set up would come to a halt. So you want to have control over such an important resource that you need for your society and your economy.” The American way of life is not negotiable.
    Our continued dependence on fossil fuels could and will lead to catastrophic consequences.
    The federal, state and local government should implement a mandatory renewable energy installation program for residential and commercial property on new construction and remodeling projects, replacement of appliances, motors, HVAC with the use of energy efficient materials-products, mechanical systems, appliances, lighting, insulation, retrofits etc. The source of energy must be by renewable energy such as Solar-Photovoltaic, Geothermal, Wind, Biofuels, Ocean-Tidal, Hydrogen-Fuel Cell etc. This includes the utilizing of water from lakes, rivers and oceans to circulate in cooling towers to produce air conditioning and the utilization of proper landscaping to reduce energy consumption. (Sales tax on renewable energy products and energy efficiency should be reduced or eliminated)
    The implementation of mandatory renewable energy could be done on a gradual scale over the next 10 years. At the end of the 10 year period all construction and energy use in the structures throughout the United States must be 100% powered by renewable energy. (This can be done by amending building code)
    In addition, the governments must impose laws, rules and regulations whereby the utility companies must comply with a fair “NET METERING” (the buying of excess generation from the consumer at market price), including the promotion of research and production of “renewable energy technology” with various long term incentives and grants. The various foundations in existence should be used to contribute to this cause.
    A mandatory time table should also be established for the automobile industry to gradually produce an automobile powered by renewable energy. The American automobile industry is surely capable of accomplishing this task. As an inducement to buy hybrid automobiles (sales tax should be reduced or eliminated on American manufactured automobiles).
    This is a way to expedite our energy independence and economic growth. (This will also create a substantial amount of new jobs). It will take maximum effort and a relentless pursuit of the private, commercial and industrial government sectors’ commitment to renewable energy – energy generation (wind, solar, hydro, biofuels, geothermal, energy storage (fuel cells, advance batteries), energy infrastructure (management, transmission) and energy efficiency (lighting, sensors, automation, conservation) (rainwater harvesting, water conservation) (energy and natural resources conservation) in order to achieve our energy independence.
    “To succeed, you have to believe in something with such a passion that it becomes a reality.”
    Jay Draiman, Energy Consultant
    Northridge, CA. 91325
    May 31, 2007
    P.S. I have a very deep belief in America’s capabilities. Within the next 10 years we can accomplish our energy independence, if we as a nation truly set our goals to accomplish this.
    I happen to believe that we can do it. In another crisis–the one in 1942–President Franklin D. Roosevelt said this country would build 60,000 [50,000] military aircraft. By 1943, production in that program had reached 125,000 aircraft annually. They did it then. We can do it now.
    “the way we produce and use energy must fundamentally change.”
    The American people resilience and determination to retain the way of life is unconquerable and we as a nation will succeed in this endeavor of Energy Independence.
    The Oil Companies should be required to invest a substantial percentage of their profit in renewable energy R&D and implementation. Those who do not will be panelized by the public at large by boy cutting their products.
    Solar energy is the source of all energy on the earth (excepting volcanic geothermal). Wind, wave and fossil fuels all get their energy from the sun. Fossil fuels are only a battery which will eventually run out. The sooner we can exploit all forms of Solar energy (cost effectively or not against dubiously cheap FFs) the better off we will all be. If the battery runs out first, the survivors will all be living like in the 18th century again.
    Every new home built should come with a solar package. A 1.5 kW per bedroom is a good rule of thumb. The formula 1.5 X’s 5 hrs per day X’s 30 days will produce about 225 kWh per bedroom monthly. This peak production period will offset 17 to 2
    4 cents per kWh with a potential of $160 per month or about $60,000 over the 30-year mortgage period for a three-bedroom home. It is economically feasible at the current energy price and the interest portion of the loan is deductible. Why not?
    Title 24 has been mandated forcing developers to build energy efficient homes. Their bull-headedness put them in that position and now they see that Title 24 works with little added cost. Solar should also be mandated and if the developer designs a home that solar is impossible to do then they should pay an equivalent mitigation fee allowing others to put solar on in place of their negligence. (Installation should be paid “performance based”).
    Installation of renewable energy and its performance should be paid to the installer and manufacturer based on “performance based” (that means they are held accountable for the performance of the product – that includes the automobile industry). This will gain the trust and confidence of the end-user to proceed with such a project; it will also prove to the public that it is a viable avenue of energy conservation.
    Installing a renewable energy system on your home or business increases the value of the property and provides a marketing advantage. It also decreases our trade deficit.
    Nations of the world should unite and join together in a cohesive effort to develop and implement MANDATORY RENEWABLE ENERGY for the sake of humankind and future generations.
    The head of the U.S. government’s renewable energy lab said Monday (Feb. 5) that the federal government is doing “embarrassingly few things” to foster renewable energy, leaving leadership to the states at a time of opportunity to change the nation’s energy future. “I see little happening at the federal level. Much more needs to happen.” What’s needed, he said, is a change of our national mind set. Instead of viewing the hurdles that still face renewable sources and setting national energy goals with those hurdles in mind, we should set ambitious national renewable energy goals and set about overcoming the hurdles to meet them. We have an opportunity, an opportunity we can take advantage of or an opportunity we can squander and let go,”
    solar energy – the direct conversion of sunlight with solar cells, either into electricity or hydrogen, faces cost hurdles independent of their intrinsic efficiency. Ways must be found to lower production costs and design better conversion and storage systems.
    Disenco Energy of the UK has announced it has reached important
    milestones leading to full commercialization, such as the completion of
    field trials for its home, micro combined heat and power plant (m-CHP).
    The company expects to begin a product roll out in the second quarter of
    Operating at over 90 percent efficiency, the m-CHP will be able to
    provide 15 kilowatts of thermal energy (about 50,000 Btu’s) for heat and
    hot water and generate 3 kilowatts of electricity. The m-CHP uses a
    Stirling engine generator and would be a direct replacement for a home’s
    Running on piped-in natural gas the unit would create some independence
    from the power grid, but still remain connected to the gas supply
    Whereas heat is supplied only when the generator is running (or
    conversely electricity is generated only when heat is needed) a back-up
    battery system and heavily insulated hot water storage tank seem
    eventual options for more complete energy independence.
    All government buildings, Federal, State, County, City etc. should be mandated to be energy efficient and must use renewable energy on all new structures and structures that are been remodeled/upgraded.
    “The government should serve as an example to its citizens”
    A new innovative renewable energy generating technology is in development. The idea behind Promethean Power came from Matthew Orosz, an MIT graduate student who has worked as a Peace Corps volunteer in the African nation of Lesotho. Orosz wanted to provide electric power, refrigeration, and hot water to people without electricity. He and some MIT colleagues designed a set of mirrors that focus sunlight onto tubes filled with coolant. The hot coolant turns to pressurized vapor, which turns a turbine to make electricity. The leftover heat can be used to warm a tank of water and to run a refrigerator or an air conditioner, using a gas-absorption process that chills liquid ammonia by first heating it.
    New Solar Electric Cells – 80% efficient
    Mr. Marks says solar panels made with Lepcon or Lumeloid, the materials he patented, … Most photovoltaic cells are only about 15 percent efficient. …
    A major increase in daily petroleum output is deemed essential to meet U.S. and international oil requirements in 2020, and so we should expect recurring oil shortages and price increases. Only by expediting the diminishing our day-to-day consumption of petroleum and implementing of efficiency and renewable energy policy can we hope to reduce our exposure to costly oil-supply disruptions and lower the risk of economic strangulation.
    Jay Draiman, Energy Consultant
    Northridge, CA 91325
    Posted on: 06/26/2007

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