The core problem has developed over the last 40 years. The government and the healthcare insurance industry have created a huge payment hairball between patients and physicians.
ICD and CPT coding has created complications beyond belief for patients and physicians. The ICD 10 is more confusing that ICD 9.
The writer is a retired physician with 40 years of private practice experience. He has lived through the development of the dysfunction in the healthcare system.
“Stan
This observation has been on my mind for a long time. The health issues in the 4th section of the WSJ today January
23,2011 caused me to put the ideas down on paper.
D”
“In doctors’ offices all across the country, a scenario like this is being played out as I write these comments.
The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”
“What happens next is where I’d like to spend a little time in this essay.
The written prescription/s may be hand-carried to the pharmacy, the doctor may telephone the prescription/s to the pharmacy, or more commonly these days, the prescriptions may be sent on line or by fax, with the doctor’s assistant doing the sending.
“Now here is where the situation can get dicey. Up to 20% of all those prescriptions are never picked up by the patient. After an interval, they are returned to stock in the pharmacy. It is unlikely that the doctor will be made aware that this has happened.”
The e-prescription must be a two way street. The physician should be notified electronically by the pharmacy if a patient does not pick up a prescription.
The physician’s office should automatically contact the patient and explain the importance of the medication.
Other results can also happen. The patient picks up some, but not all of the prescriptions because of the cost versus what he/she can afford.
In the fully functioning EMR software can be included to enable the pharmacy to inform the physician.
Or the patient picks up all of the medications ordered. Once at home, the patient may or may not take the medications as prescribed.
The instructions from the doctor may be recalled incompletely or inaccurately.
The healthcare team can electronically reinforce instructions and goals for the medication using the Internet sites picked by the physician.
Freestanding organizations will fail if they are not an extension of physicians’ care.
The CBO recently revealed that President Obama’s pilot studies using freestanding chronic disease management organizations have failed to lower the cost of care.
Effective chronic disease management of diabetes can lower the complication rate by at least 50%. Decreasing complications can lower the cost of care by 80%
The medications may not be tolerated by the patient, and as a consequence, he/she may elect to discontinue one or more of them, or may elect to take them in some manner other than as directed by the doctor.
The patient may not notify his physician of his difficulty taking the medication.
Social networking between physicians and patients and patients in that physicians practice could solve this problem.
Patients understand that most cognitive physicians are reimbursed for coded procedures. Advice over the telephone or email is not reimbursed. A mechanism for reimbursement must be developed for using social networking.
The medications may prove effective in alleviating the problem that caused the patient to see their physician in the first place, or they may not.
Most of the events described will not be known to the patient’s physician until the patient is next seen in the office, and maybe not even then.
E-mail could have malpractice liability in the current malpractice environment. This is one more reason Tort reform is essential.
In a perfect world, a lot of the issues raised above could be made better by a few simple moves. The pharmacy could make the physician’s office aware that the prescriptions were never picked up.
Someone in the physician’s office could call or email the patient 3-4 days after the visit, and inquire whether the patient is taking the medication,
Reinforcing the physician’s instructions, and inquiring whether the medications are helping the patient, asking if there have been any problems arising from the use of the medication, and passing what is learned back to the physician.
The reinforcement of the instructions can be very helpful, and the awareness of issues relating to the medication can lead to more timely resolution of problems the patient is experiencing.
It has always seemed to this writer that the doctor-patient relationship would be well served if we all started to use what I call “The Doctor Phil Question”, which goes like this: “How’s that working out for you?”
It is all about patients’ responsibility for their healthcare and their healthcare dollar. It is about consumer driven healthcare and the patient physician relationship.
As long as the government and the healthcare insurance industry continues to drive a wedge between the patient and physician the cost of healthcare will continue to rise.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
Last week I flew to New York City to speak to a group of venture capitalists about my ideas on how to Repair the Healthcare System from a physicians point of view.
My son, Brad Feld, was in Boston involved in a project at his alumni MIT. He decided to come down to New York and sit in on my meeting.
I love hanging out with Brad. It is always a learning experience for me. My readers have guessed by now that I love to learn and especially from my son. I especially love to learn about the potential of the future. It stimulates me to think.
Two months ago Brad sent me a MakerBot Thing-O-Matic. MakerBot is a company in which he and his venture capital firm Foundry Group invested. The MakerBot Cave is in Brooklyn, N.Y.
My MakerBot Thing-O-Matic came in five boxes weighing 25 pounds. I opened the boxes and it looked like at least a million pieces (o.k. at least a half million).
It took us months to finish. When we finished the HealthKit I thought it was going to explode when we plugged it in. It worked to our joy!!.
A MakerBot Thing-O-Matic is a 3D printer. I saw it with Brad at CES in 2011. He invested in it then.
I told Brad I thought he lost his mind. I thought the MakerBot was just a toy making little kids’ toys.
Construction of my MakerBot Thing-O-Matic looks like a 10-12 hour project with a lot of software interaction.
After our N.Y.C meeting he took me to the Bot Cave in Brooklyn. Manufacturing things in Brooklyn has a nice ring to it.
As soon as I walked into the Cave I decided Brad once again made a brilliant decision.
The first thing that impressed me was the number of young (25-40) people working in the Cave (about 100).
If President Obama wants to create jobs he should visit the Bot Cave in Brooklyn. He would learn a thing or two.
I was told the next iteration of the MakerBot would be pre-built.
After watching these kids build them I got pumped to get home and build my MakerBot. I was also promised a personal assistant if I got stuck.
3 dimensional printing is beyond toys. There is a web site called Thing-O-Matic that lets users post their creations for other users. The MakerBot community has become an organic social network.
For example, someone designed a wall coat hook that is being reproduced all over the country. The Bot Cave had coats hanging on them everywhere.
I have been looking for flat electric outlet covers without curves. They have been impossible to find. All I have to do is scan my design into the computer, size it and print out a very sturdy electric outlet plate.
Three weeks ago I needed a replacement plastic gear. I had to buy all the parts for the machine just to get one part. Now (after I put my MakerBot Thing-O-Matic together) I will be able to reproduce any plastic part I want. The practical potential for 3D dimensional printing is infinite.
How does it work? It is all about software innovation. Your smartphone takes multiple pictures of an item. You import the pictures to the computer software. Maker Bot recommends multiple pictures at many angles to get the proportions perfect. The pictures are transformed into 3 dimensional co-ordinates. You hit go button and the machine melts the right amount of plastic at the weight you specify and extrudes your part or model in 3 dimensions.
Who would have thought there were people that smart to create an appliance like this machine for consumers.
The more intriguing thing is I could not understand the MakerBot’s potential until now. Brad understood it as soon as he saw it.
The reason is clear. He could visualize MakerBot’s potential. I predict everyone will have a MakerBot Thing-O-Matic in 10 years just like everyone has a smartphone after 4 years.
I have a gut feeling “we ain’t seen nothin yet.”
Everything will be consumer driven. Even healthcare will be consumer driven.
The MakerBot people gave me an iridescent expandable plastic bracelet for my wife.
It reminded me of the bracelet Hank Rearden in Atlas Shrugged. Hank Rearden gave to his wife a bracelet made out of Reardon steel after it was invented.
She did not understand its significance. His wife traded it with Dagny Taggatt, the heroine, for a diamond bracelet.
The future is in 3 D printing.
Brad thanks for taking me to the Brooklyn Maker Bot Cave and opening my eyes again.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
I love Costco. Its prices are great and its selection is abundant. Last week I was dazzled by the display of megavitamins as soon as I walked into the store.
Americans want to be healthy. Few have a death wish but many (60%) are obese. Megavitamins have been touted as the instant route to healthy living. The megavitamin business has grown into a $30 billion dollar a year business.
Megavitamins have been successfully oversold.
There is no evidence that megavitamins are the route to health and healthy living.
There is little good evidence to support the widespread use of dietary supplements.
The US Preventative Health Services Task Forces reviewed some of the literature on megavitamins and dietary supplements. The group stated there was insufficient evidence for or against the use of multivitamins with folic acid or antioxidants. It also stated that the use of Vitamin A, C or E did not have sufficient evidence for or against its use.
I think these supplements could be helpful if the requisite dosage was known. There is no evidence that these dietary supplements are helpful at the present dosage. There are no scientific studies about which doses would work. There are only testimonials attesting to usefulness.
”Beware of the man with one case.”
A friend of mine worked for thirty years proving the existence of Vitamin D deficiencies in 50% of the elderly population. It took him half that time to convince the medical population that he proved something.
The dosage necessary ended up being 6 times the dosage in multivitamins. Therefore USPHTF conclusions are correct with the present data. However they might have drawn their conclusions from the wrong data.
This is not an unusual occurrence in clinical medicine as I have pointed out previously.
The American Medical Association hedged its bet by stating,
Chances are people who are starving or dying from cancer will have a multivitamin and mineral deficiency.
The American Dietetic Association advises,
“low-dose multivitamin and mineral supplements depending on individualized dietary assessment.”
The ADA’s statement is obviously self-serving.
The American Heart Association made the only logical statement in the whole bunch.
“The AHA emphasized healthy eating patterns rather than supplementation with specific nutrients. “
The recommendations against the routine use of supplements are grounded in fairly good evidence if one believes in a methodology used by the Cochrane intervention review.
A Cochrane intervention review of 77 randomized controlled trials with 232,550 participants found no evidence to recommend antioxidant supplementation for primary or secondary prevention of mortality.[7].
There is shabby evidence that cannot be generalized regarding possible harm related to the use of some supplements.
“For example, the Alpha-Tocopherol Beta-Carotene Cancer Prevention Trial demonstrated that beta-carotene supplements increased the risk for lung cancer among male smokers.[8]”
At this point there is no good scientific evidence for the use of megavitamins. “People believe what they want to believe.” The placebo phenomenon is extremely important.
The media is the message. Somehow the power of advertising has convinced the public that it is good to take megavitamins.
Costco is trying to take advantage of the hype. Consumers are driving this healthcare choice. The result is a $30 billion dollar a year business. The money is coming directly out of the consumer’s pocket. It is not included in healthcare costs.
Consumers are trying to be responsible for their health on the basis of hype. It is much easier in the mind of most to stay healthy taking a pill than do the heavy lifting required for healthy living.
Why can’t someone create an anti-obesity hype that works as well as the megavitamin hype?
Increases in obesity lead to increased Type 2 Diabetes, hypertension, hyperlipidemia and the resulting Diabetic complications of stroke, heart attack, blindness, amputations, chronic renal disease and cancer.
Many schemes have been devised to decrease the increasing obesity rate. None have worked except eating less and doing more.
With the increasing obesity in children there is an increased incidence of Type 2 Diabetes in kids, teenagers and young adults.
Gastric bypass has become the rage for these young super obese people. To my dismay more and more insurance plans are paying for gastric bypass procedures. Even Medicaid is paying for the procedures.
Is the world going nuts? I guess Medicaid’s logic is if the people become thinner it will decrease the incidence of Diabetes, decrease the complications of Diabetes and therefore decrease the cost of healthcare for these people.
To me it is like painting over rust. The rust will bleed through and the money for the paint will be spent already.
Americans do not get any help from society norms. We are flooded by manufactured foods with tons of calories and tons of salt. Mayor Bloomberg passed an educational law that fast food stores must publish calorie counts on foods.
This is helpful is the calorie count is accurate and people pay attention.
Home cooking served in small portions is essential. The fat, calories and salt can be controlled. There is no need to have a home cooked meal anymore.
All you have to do is go to Costco or Sam’s and buy any precooked meal you want. Dinner is a 3 to 10 minute microwave pop away. Why would any busy person bother to prepare a home cooked meal? The harmful consequences prepared meals are in the distant future.
If you have dinner at a restaurant an average meal contains more calories than the average person burns in a day. My wife and I have been sharing for years.
Consumers want to be responsible but it is very difficult in the cultural milieu of our society.
Ken Cooper M.D. created an exercise craze in the 1970’s. It has lasted until the present. He did not figure out how to get people to sustain their exercise program. He also did not figure out how to get people to decrease their intake in our sea of manufactured food and pre-cooked food.
The incidence of obesity is growing.
Most consumers are not stupid. They seek to be responsible in the easiest way possible.
Someone will come along and initiate a legitimate health craze.
The Ideal medical savings account (by providing financial incentives along with intense public education through appropriate advertising) can be as successful as the Dietary Supplement industry.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
“If any innovations and innovative activities are excluded you end with a “stationary state.”
Schumpeter's theory is that “the success of capitalism will lead to a form of corporatism. In turn corporatism will foster values hostile to capitalism. He contends this is especially true among “intellectuals.”
The intellectuals and the social climate must allow entrepreneurship to thrive. If not capitalism will be replaced by socialism in some form.”
The hero of his story is the entrepreneur.
We are seeing this now as corporations are trying desperately to hold on to their power using obsolete technology and suppressing entrepreneurship with the government’s help.
The Internet has provided people with information, a choice and a voice. It has stimulated entrepreneurship and the current software revolution.
The government is making a big mistake in attacking freedom. I do not think it will get away with it because of the power of the Internet.
The hero of my story about "Repairing the Healthcare System" will be the software entrepreneur.
Technology has caused legacy business models to be replaced by innovative software models. These innovative software models have reduced costs and provided more choice for consumers at a cheaper price.
America cannot afford socialized medicine. A paradigm shift must take place. This shift will occur as a result of innovative software. The challenge is who will get there first.
Britain, Canada and Europe’s socialized medical systems are failing financially. These countries are changing their healthcare systems from government controlled socialized systems to private systems.
Entitlement healthcare systems do not work because patients are not responsible for their healthcare dollars. Patients overuse the system because they are not responsible for payment.
When governments are overextended financially they restrict access to medical care.
Secondary healthcare stakeholders are fighting to maintain the “stationary state” because they receive 90% of the healthcare dollars.
Secondary stakeholders use a hollow excuse for maintaining control over the healthcare dollars. They maintain that consumers are too stupid and too powerless to take care of themselves.
Software companies are trying to improve the healthcare system. They have failed because they are focused on the wrong customers.
Secondary stakeholders are a giant hairball between the patient/ physician relationship. This hairball must be disrupted.
Much of the software necessary to disrupt the hairball is available. It is not focused for the benefit of patients and physicians.
An innovator is going to come along and disrupt this hairball just as Steve Jobs disrupted the music industry.
Dis-intermediating software can only become viral and effective if it enhances the patient physician relationship.
Consumers are starting to realize that they must become responsible for their own medical care and control their healthcare dollars. The government is too unreliable.
Patients are the customers/consumers of heaslthcare. Consumers must learn to manage their health and medical care dollars wisely. They must be provided with education and financial incentives to become responsible for their own health and healthcare choices.
What are the areas in which innovative software can dis-intermediate the failing structures in the healthcare system?
Ideal Electronic Medical Record.
Ideal Medical Saving Account.
Chronic Disease Management.
Tort Reform
Patient Education as an Extension of Physicians Care.
Integrated Care Between Family Practitioners and Specialists.
Patient Responsibility: Health and Healthcare Dollars.
Consumer Driven Healthcare.
No one likes to be forced to do anything. President Obama’s Healthcare Reform Act is forcing patients and physicians to do things they do not understand or do not approve of. Americans are refusing to buy into his system.
In the words of the great singer/philosopher Leonard Cohen, ”Everybody knows.”
A software innovator with a prepared mind between the age of 20-50 years old is going to come along and initiate a software revolution in healthcare. It will improve medical care for all. It will decrease healthcare costs and increase patient satisfaction. It will restore the patient physician relationship.
I will be happy to help anyone who will listen.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
It is clear to me why the healthcare industry has not experienced the same transformation resulting from software innovation that the publishing industry, the music industry and the movie industry have experienced.
I have formed these opinions by dealing with local and national hospital administrators, healthcare insurance executives, pharmaceutical executives, healthcare policy wonks and government bureaucrats.
Most of these executives are focused on the wrong customer. Most are too busy trying to solidify their perceived position of power in the healthcare system.
Those executives who understand who the customer is have kept quiet in order to maintain or advance their position in various organizations.
The result is software innovators have been chasing the wrong customer. The result has been greater dysfunction in the healthcare system.
There are also many healthcare system issues making it very difficult to stay focused on the main problem.
I have been fascinated by my son Brad Feld’s insight into the software industry. His tutoring has helped me learn how to critically think about software development and its transformational potential.
My brother, Charlie Feld, has also helped me through his insight into pattern recognition and the use of information technology to solve the problems of various industries.
I have followed the progress of medical software innovation for the last three decades. I am still far from expert but believe I have a better grasp on the problem than most.
I have a good feel for the potential offered by this software revolution for the practice of medicine and how to use it.
If the software industry understood the physician mentality and understood the real customer, the needed breakthrough could occur.
The result would be a large decrease in the cost of healthcare.
Waste, abuse and overuse would be decreased and the therapeutic effect of the patient physician relationship would be restored.
Brad is not interested in healthcare system software innovation. He dealt with physicians and dentists when he ran Feld Technologies in 1985 while a student at MIT.
He built an interoffice and intra-office network for my practice Endocrine Associates of Dallas P.A. in 1985. He hired MIT students to write software with him and Dave Jilk.
The network these kids built was the sturdiest Medical Systems network in Dallas. The network lasted from 1985 until 2002. There are still remnants of this software in the practice today.
When he finished my software project he pledged to himself he would never deal with physicians again. He concluded that they are all a pain.
Not true. Physicians know what they want and need. They have an awesome responsibility for their patients’ lives and privacy.
Secondary stakeholders have frequently taken advantage of the medical profession and its intellectual property. Physician mistrust of secondary stakeholders is monumental.
Much of the “data collected” from information systems has been used against them even if the data is incorrect or incorrectly interpreted.
Healthcare policy has been formulated on inaccurate data and inaccurate conclusions.
Healthcare software companies are paid by secondary stakeholder to create innovative software. The software companies do not realize that the real customers are patients and physicians. These companies do not understand why they cannot get patients and physicians to cooperate.
When data collected is wrong, incomplete or misunderstood physicians protest. They are ignored. The typical response is that this is the only data available.
Healthcare policy should not be formulated on the bases of false data.
Is it any wonder that physicians are not interested in cooperating with the powers that be in the healthcare system’s use of inaccurate data?
The medical transaction must be between the patients and physicians. All of the secondary stakeholders have jumped into the center of this transaction to control the healthcare system. The secondary stakeholders only add value at the edges of the patient physician transaction.
Our health is our most precious asset. Americans are willing to pay as much as necessary for medical care. They want everything done especially if they are not responsible for paying for it.
If physicians do not think something should be done they can get sued. The knee jerk reaction is to do everything.
Physicians only receive between 5-10% of the healthcare dollars.
Third parties have taken control of the healthcare system. They have assumed responsibility for the healthcare of patients. They are also in the process of dictating access to care. The present increased healthcare costs are unsustainable.
Innovative software used properly can disassemble the elements of the hairball and drive them to the edges of the healthcare system where they belong.
Proper software innovation can accomplish the goal of decreasing costs and increasing the quality of care by restoring the patient physician relationship.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Society is in the midst of an electronic revolution. Innovations in hardware and software have created greater shifts in our economy than the assembly line, mass transportation and electricity. We ain’t seen nothing yet.
The potential for economic growth as of result of this revolution is unimaginable.
Current business models have crumbled and have been replaced by software driven companies. Software driven companies are cheaper to run and have created innovative and easy to use products and services for consumers.
My hope is Congress will be unsuccessful in restricting these freedoms. There will be many more industries that will be disrupted by innovative software in the coming decade.
Marc Andreessen expects, “at least five billion people worldwide own smartphones, giving every individual with such a phone instant access to the full power of the Internet, every moment of every day.
Amazon.com is a dramatic example of a company that has used innovative software to transform an industry. Twelve years ago Borders was the king of stick and brick booksellers. Borders had an effective software book distribution system for its increasing number of bookstores.
Amazon, with software that distributed books directly to the customers ate Borders’ lunch. Borders thought on-line book sales was non strategic. “People like to touch books before they buy them.”
How wrong can one be? Using the same software Amazon now sells everything at a lower price than most retail stores and on-line companies. Its software decreases overhead and in turn consumer prices.
Consumers are not stupid. They want the best product at the lowest price. Amazon produced and consumers responded.
Big box stick and brick retail stores that took over the local mom and pop businesses will fail unless they became hybrids.
The old business model bankrupted Borders.
Amazon didn’t stop there. Its Kindle digitized books and delivered them instantly at half the price to consumers with a greater margin for Amazon.
This demonstrates the genius of innovation. The creative uses of innovative software are staring us in the face daily. Most industries have a Blind Spot.
The existence of those people who want to touch the pages of books is fading fast. Jeff Bezo saw this Blind Spot.
Netflix copied Amazon with DVD movies. It destroyed Blockbuster. Netflix then switched from physically delivering DVDs by mail to both delivering DVDs and on-line downloads.
It would have worked if they put the consumer first. Netflix infuriated consumers with its pricing. It almost immolated itself. I do not think Netflix will recover unless consumers perceive that they are first.
Amazon, using a more sensible model, is going to take over the on-line movie business. Blockbuster, now owned by Dish network, doesn’t have a clue about the needs of consumers.
Dish, Direct TV and Cable are trying to adjust to the rapid pace of software innovation. I do not think they can because they are bogged down in bureaucracy.
They are simply not entrepreneurial.
This brings us to Apple, Steve Jobs and the entrepreneurial spirit. Steve Jobs turned the music industry on its ear with ITunes, the smart phone industry on its ear with the IPhone and the computer industry on its ear with the IPad and the Mac Book Air.
His method was to use innovative software that made the appliance work for the consumer. He does not make the consumer suffer as Microsoft does with constant software freezes.
He kept his eye on the consumers. He put the consumer first. It served his vested interest well.
Before is died he made a statement in which he said he finally figured out television.
Google is a close second to Apple but Google is hampered by a growing bureaucracy.
“The great incumbent software companies like Oracle and Microsoft are increasingly threatened with irrelevance by new software offerings like Salesforce.com and Android (especially in a world where Google now owns a major handset maker).”
I could mention many more companies that have served as disinter mediators of incumbent businesses by software innovation. These innovations have resulted in vast improvements in value to consumers, decreased costs and economic growth.
Why hasn’t healthcare in the U.S. been the beneficiary of this software revolution?
The reasons are clear to me having practiced Clinical Endocrinology for 30 years.
Software developers in the medical space do not know who their customers are. Their customers are patients and physicians and the patient/physician relationship. The customer is not the government, the healthcare insurance industry or hospitals.
Once this is understood the software revolution in medicine will begin.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
I have been speaking to many people about the hazards of Obamacare.
Many well-educated people do not understand the defects in President Obama’s Healthcare Reform law and its potential unintended consequences.
Unfortunately, many congressmen and senators do not understand the consequences of the law either.
Rather than President Obama’s Healthcare Reform law making the medical care system better it is destined to make it worse.
I have explained the reasons for these unintended consequences in past blogs.
Most people have difficulty understanding details of the law because it is poorly covered in the press in our sound bite society.
Only a small percentage of people need medical care at any one time. To those not needing medical care the healthcare system under President Obama’s law has changed little except for higher healthcare premiums and deductibles.
The 35-55 year olds are the group that must become aware of the changes that will result from the law. When they will need medical care our healthcare system will likely be decimated.
Everyone is in agreement that our federal, state and local governments are bankrupt. Everyone understands our federal government has borrowed and spent the money we should have saved to fund our future healthcare needs.
President Obama’s conclusions also demonstrate his lack of understanding of the complicated defects that have accumulated over many years of adjusting to defective healthcare policy.
Increasing bureaucratic structure and government control is at the root of the problems in the healthcare system. Increasing this structure is not the solution to the healthcare system.
President Obama is now backing off some of the draconian aspects of contaminating the theoretical basis of his Healthcare Reform Act.
Obamacare mandates what must be covered under the Federal Health Care Law
• Ambulatory patient services, like doctor’s visits
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance abuse services
• Prescription drugs
• Rehabilitative and habilitative services, and specialized social and medical services for people with conditions like autism and cerebral palsy
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care
President Obama is choosing to avoid some crucial choices until well after the 2012 elections. Critics accuse the administration of political expediency. The Obama administration insists the decisions have been based on sound policy judgments.
I hope the public is not stupid enough to believe President Obama’s ploy. The public has been duped in the past. I think it is waking up.
In passing a good deal of the decision-making to states, the administration has guaranteed that Americans will continue to face a patchwork of state regulations that make coverage uneven and inefficient.
People in Utah and Wyoming, for example, are likely to have more limited access to expensive services now mandated in states like Massachusetts and Maryland. And consumer advocates worry that some states will limit benefits too strictly.
President Obama has taken the guts out of his law just as he previously discontinued the insurance mandate to large organizations in 2011.
Newspapers, TV and the movies are the traditional media. It is not surprising that these two media would work hard to protect their vested interests. The Internet is a threat to their vested interest. They are trying to put restrictions on the Internet that is a threat to our freedom of expression. It also represents a threat to our economy.
I think some members of the Judicial Committee of the House of Representatives do not understand the implication of the bill and the unintended consequences. If they do they are doing an evil thing to our freedom of speech and freedom of the press.
The Internet has provided the individual a voice. It is the freedom of choice to listen to that voice.
These bills are consistent with President Obama’s apparent quest to increase governmental control over our freedoms. Both bills have had minimal coverage by the press.
Brad said,
“There are two very disturbing bills making their way through Congress: Protect IP Act (PIPA - S.968) and Stop Online Piracy Act (SOPA – H.R.3261).These bills are coated in rhetoric that I find disgusting since at their core they are online censorship bills. It’s incredible to me that Congress would take seriously anything that censors the Internet and the American public but in the last few weeks PIPA and SOPA have burst forth with incredibly momentum, largely being underwritten by large media companies and their lobbyists.”
“ I’ve been incredibly agitated the last few days by SOPA after watching three hours of the House Judicial Committee hearing on Friday. SOPA is such an evil thing at so many levels and the people in the House that want it to happen appear to refuse to listen to facts or logic, and – when they talk about what they are confronted with – claim the facts and logic aren’t actually factual or logical. “
The Judicial committee of the House of Representative was going to vote for the bill and send it to the entire house for passage on December 16th. By some miracle at a last minute the decision was made to delay the bill until the committee could learn more about the unintended consequences
President Obama said he would sign the bill. My sense is most of the congressmen on the committee did not understand the bill. Testimony has been heard so far only from advocates for the bills passage. It almost looks rigged.
My fear is the facts are immaterial to the committee membership.
Brad went on.
“In addition to being censorship bills, these are anti-entrepreneurship bills. They are a classic example of industry incumbents trying to use the law to stifle disruptive innovation, or at least innovation that they view as disruptive to their established business.
To date, the Internet has been an incredible force for entrepreneurship and positive change throughout the world (did anyone notice what recently happened in Egypt?) It’s beyond comprehension why some people in Congress would want to slow this down in any way.”
Wake up America. We must speak up using the tool that lets our voice be heard. The Internet.
STOP CENSORSHIP.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
President Obama and congress have made major progress in increasing central power over individual freedoms during President Obama’s tenure in office. Congress has done it by passing unpopular laws; President Obama has done it issuing unpopular by executive orders.
Two prominent examples are working their way through the governmental system right now.
The first is Obamacare with its many defects. The next congress and President will probably repeal Obamacare. President Obama’s Healthcare Reform Act has already damaged the economy, increased the budget deficit and is destroying the healthcare system.
The Supreme Court will not overturn Obamacare completely. The court is only judging the law on limited issues. The Supreme Court’s decision is going to take at least two years fro the time the bill was passed.
The real issue at stake with President Obama’s Healthcare Reform Act is should the central government have the power to control our lives and our choices.
The states are protesting that the federal government is taking power away from the states.
Citizens are complaining that the federal government is limiting their rights and freedom of choice.
This conflict has existed throughout American history. America has struggled with the challenge of the balance of power between federal control, states rights and individual rights.
President Obama is a strong advocate of central control. In the process he is trampling states rights and individual freedoms. He has bypassed congress and by executive order conferred absolute power to administrative appointees.
If the federal government can require people to purchase health insurance, what else can the government force Americans to do? The government will be able to compel citizens to do any number of things by decree.
President Obama has ignored this basic issue. Has congress and the executive branch overstepped their constitutional authority?
His administrations’ lawyers have had a difficult time providing a coherent response to the question in court appearances around the country.
“What limiting principle do you articulate?” If Congress may require people to purchase health insurance, what else can it force them to buy? Where do you draw the line?
Would it be unconstitutional, to require people to buy broccoli?
Beth S. Brinkmann, the administration’s lawyer said, “No,” then “It depends.”
Beth Brinkman’s response was “I would have to know much more about the empirical findings,”
Judge Brett M. Kavanaugh asked,
“How about mandatory retirement accounts replacing Social Security?”
Ms. Brinkmann replied. “It would depend.”
None of these ridiculous responses were published in the traditional media at the time of the testimony. The administration’s lawyers are trying to define its views of the limits of government power. The have not provided constitutional justification for their views.
“They have said, for instance, that laws authorized by the Constitution’s commerce clause must be economic in nature, must concern interstate commerce and must address national problems.”
I do not think this should be done at the expense of states’ rights and individual freedoms.
The reason President Obama’s Healthcare law requires an individual mandate to purchase healthcare insurance is because Obamacare is not actuarially sound. It might work if everyone pays into the premium pool.
Rather than repairing the healthcare system and its inefficiencies President Obama is adding more revenue to a failing system by mandating everyone to pay into something they do not want.
In reality, Medicare has failed economically even though seniors are satisfied with the insurance.
Medicare Part A mandates everyone to pay into the system through payroll taxes. The reason the government had gotten away with the Part A mandate is because Americans had the right to opt out of Medicare Part B.
Another hollow argument President Obama’s lawyers have used is that the health care market is unique.
The administration’s lawyers have suggested,
“Questions about constitutional limits can miss the point. The only question actually before the courts, they said, is whether the particular law under review was within Congress’s authority. Other cases, they said, can be decided as they arise.”
There are many unintended consequence of Obamacare already. Hopefully, the Supreme Court judges will understand these implications of these unintended consequences. Most important is the precedent the law set for other cases.
In 1995, when the court struck down a federal law that prohibited people from carrying firearms in school zones, Chief Justice William H. Rehnquist wrote that “we pause to consider the implications of the government’s arguments” in defending the law — that stopping activities that could lead to violent crime relates to interstate commerce because it affects “national productivity.”
Under that reasoning, Chief Justice Rehnquist wrote, “It is difficult to perceive any limitation on federal power,” adding that “if we were to accept the government’s arguments, we are hard pressed to posit any activity by an individual that Congress is without power to regulate.”
Many judges are reluctant to issue rulings without some sense of what their consequences will be in other cases.
The outcry about Obamacare has been loud and clear. Our constitutional government should be government for the people by the people.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Government, hospital systems, pharmaceutical companies, pharmacies, pharmacy middlemen, and healthcare insurance companies are secondary stakeholders in the healthcare system.
The primary stakeholders are patients and physicians. They also comprise the medical care system. Without the primary stakeholders there would be no need for a healthcare system.
The secondary stakeholders have long ago taken over the healthcare system. All businesses and the government deal with the hand they are dealt using their best judgment. The people running the business or government pursue their vested interest. The difference between businesses and government is businesses work to make as big a profit as possible. Government, depending on the political party in power, pursues fulfillment of its ideology.
Since 1942 and the Economic Stabilization Act of President Roosevelt the market place for medical care has been distorted. In 1946 healthcare insurance was introduced. At that time the interaction between the primary stakeholders, physicians and patients, started to be destroyed by secondary stakeholders.
The cost of healthcare has progressively increased since the government passed the Medicare and Medicaid in 1965. Costs increased further in 1980 when the government said we couldn’t keep paying these increasing costs and instituted price controls for Medicare and Medicaid.
This led to cost shifting of the difference to the private healthcare insurance sector. Businesses providing healthcare insurance for their employees accepted the resulting premiums associated with cost shifting until 1985. At that time they said, “stop.”
The healthcare insurance industry asked corporations what percentage of your gross revenue could you afford for healthcare insurance benefits. The healthcare premiums were 18% of gross revenue.
The corporate answer was they could afford up to 12% of gross revenue. The healthcare insurance industry’s response was, no problem.
HMO pricing became the most economical option for corporate employers. HMO fixed healthcare cost for corporations and healthcare insurers.
HMOs shifted the risk to physicians and hospitals. HMOs failed because physicians and hospital did not know how to assess risk. They accepted risk initially because they were afraid to lose patients.
Hillarycare failed to become law because of the potential for patient abuse, restrictions of access to care, rationing of care and loss of freedom of choice. Patients did not want the government to dictate their medical decisions.
Obamacare was passed by a Democrat controlled congress with a very liberal ideology.
Many congressmen did not read the entire document or debate the potential unintended consequences.
The difference in ideology between liberal and conservative is easy to understand.
The healthcare system is not a true marketplace. The healthcare marketplace has been continuously distorted by government regulations and adjusted regulations since Medicare passage in 1965.
All the stakeholders have distorted the market even further by adjusting to government regulations in order to purse their vested interest.
If real repair of the healthcare system is to occur a real marketplace has to be created. Obamacare is another adjustment in an already distorted marketplace. Obamacare is accelerating the dysfunction in the healthcare system until it implodes and results in increasing costs not savings.
The healthcare insurance industry controls costs. Many Democratic healthcare policy experts have ignored the facts. The healthcare insurance industry’s goal is to maximize its profit. It takes 30% of the healthcare dollars off the top.
The healthcare insurance industry should not be in control of the economics of the healthcare system.
Personal medical care decisions should not be left to the munificence of the government. The government has never done anything efficiently.
Private and Medicare insurance has kept control of medical decisions out of consumers’ hands. Consumers purchase healthcare insurance individually or from Medicare. Consumers also can receive healthcare insurance from their employers as a job benefit.
The healthcare insurer directs consumers to use physicians and hospital in its network. The insurer negotiates reimbursement rates for the insured with hospitals and physicians.
Consumers are given little or no information about the comparative cost or quality of any particular doctor or hospital. Consumers go to a doctor in their network.
Physicians do a history and physical exam and order tests and procedures on patients’ behalf. When the test and procedures come back physicians prescribe the appropriate medication after a follow-up visit.
The healthcare insurance company reimburses physicians.
Patients receive a copy of the bill from the insurer with patient portion of the co-pay. The explanations of benefits are impossible to interpret.
This is not a marketplace transaction. Patients have no control over the reimbursement. Patients and physicians have little incentive to restrain overuse of the healthcare system. They have no incentive to even scrutinize the bill. Patients’ have no incentive to control costs.
The use of healthcare services is divorced from marketplace forces that constantly assess cost benefit ratios. Neither physicians nor patients have incentive to get the best care at the lowest price with the best quality.
As healthcare costs increase each year the source of the increase remains opaque. The increasing costs are made to appear to be the result of patients’ and physicians’ overuse of the healthcare system.
The increase in cost could be the result of the healthcare insurance industry and the pharmaceutical industry’s increased profits.
All stakeholders pursue their vested interests. The only way to align vested interests is to have consumers be responsible for thei health and healthcare dollars.
Only then will a true market place exist. Entitlements and price controls do not work. The cost of healthcare will skyrocket with Obamacare and create a larger budget deficit.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Pharmaceutical companies have been merging for years. Pharmacies have also been merging for years. The excuse for mergers has been efficient production, distribution and sale of drugs.
The commission has not done a very good job in protecting consumers of healthcare for years.
The next wave of monopolies which will hurt consumers is the merging of pharmacy benefit management companies. Their executives are using the same excuse to both the FTC and the congress.
“Senior executives say the merger will significantly reduce the nation’s health care costs and deliver drugs in a safer, more efficient fashion. “
I have finally figured it out.
First, I must explain this attempt to create another healthcare monopoly that will result in increased cost to the healthcare system.
If past behavior is a predictor of future behavior, whoever is paying for the drugs will pay more.
Express Scripts’ has offered to pay $29 billion for the acquisition of Medco Health Solutions. Both pharmacy benefit manager are among the biggest in the business.
Combined they will handle prescription drug benefits for more than 115 million people. The two companies now control 33% of the prescriptionsfilled in the United States. Their combined revenue is $110 billion dollars a year and growing.
The Federal Trade Commission wants more details before it approves the merger. The antitrust subcommittee of the Senate Judiciary Committee wants to examine the antitrust implications of the merger.
It is pretty obvious that the merger will decrease competition leaving only two major pharmacy benefit managers Express Scripts/Medco and CVS Caremark.
A Morgan Stanley Research indicated that the 50 largest companies in the United States rely heavily on the services of Medco, Express Scripts and the third major benefit manager, CVS Caremark.
"Dan Gustafson, an antitrust lawyer who recently helped write a letter to the F.T.C. objecting to the merger on behalf of the American Antitrust Institute, a Washington organization. “These are customers who require a broad spectrum of services on a national level,” he said."
The smaller pharmacy benefit managers (40) typically do not have the geographic reach, bargaining power or data-handling capabilities of Express Scripts, Medco and CVS Caremark.
“When benefit managers steer health plans to their own pharmacy fulfillment services, employers may have little choice but to agree, said Edward A. Kaplan, a benefits consultant at Segal, which advises employers and others about health insurance. “They have very little leverage,” he said.
The Senate subcommittee and FTC regulators want to study the implications of the merger on the individuals, large companies that provide drug insurance to their employees, the mail order pharmacy and specialty drug markets.
The merged company would control a third of the specialty drug market. This market produces a high net profit. By controlling the market Express Scripts/Medco would not only increase the price it would increase their net profit.
Robert Seidman, a former pharmacy executive at WellPoint who is now a health care consultant in Los Angeles said,
Express Scripts/Medco retort is pretty lame. It asserts there is plenty of competition including companies like UnitedHealth Group, the powerful insurance company. The obvious reply should be that there is not enough competition.
A number of consumer groups including Consumers Union, along with associations representing community pharmacists, chain drugstores and supermarkets, have sent letters to regulators and legislators arguing that the combined company would create a drug benefit giant with unrivaled power.
The fear is Express Scripts/Medco would have the power to steer patients to its own mail order and specialty pharmacy businesses.
DeAnn Friedholm, the director for health care reform at Consumers Union, said her group was particularly concerned that the merger could reduce consumer choice.
“We like the idea of having good choices for consumers that meet their needs, not just the need of these huge P.B.M.’s,” Ms. Friedholm said.
Just as President Obama and previous administrations has encouraged hospital systems to become monopolies in the name of efficiency, President Obama is going to believe Express Scripts/Medco’s promise of efficiency and lower costs and have the FTC push through the merger.
I would guess President Obama thinks he can control Express Scripts/Medco or he is playing favorites again or he wants the healthcare system to implode.
This is one more step toward the implosion of the healthcare system.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
I have been a constant critic of Accountable Care Organizations. I have said they cannot work to the benefit of patients and physicians because of the difficulty of organizing them and the subsequent unintended consequences. ACOs will increase the costs to the government and healthcare insurance industry to provide the administrative services.
Additionally the government outsources administrative services to the healthcare insurance industry. Administrative services fees are constantly increasing because of waste, inefficiency, and mark-ups.
Hospitals are brick and mortar structures. They are not the future of medical care. Hospitals, now hospital systems, had to change their business plan because more and more patients are being treated out of the hospital.
Outpatient clinics, diagnostic imaging centers, chemistry laboratories and ambulatory surgical centers have shifted income from hospitals to physician owned outpatient clinics.
Hospital systems goal has been to buy physicians’ practices and ancillary care facilities. Hospital systems’ consultants have concluded that they would be in a better position to negotiate price if they owned the physicians infrastructure regardless of the cost and pay physicians a salary.
The published reason given for this action is to provide better and integrated medical care within their hospital system. The real reason is to capture the revenue lost to outpatient facilities and profit from physicians’ productivity. Physicians are realizing they are being taken advantage of and are demanding their fair share of their own productivity.
The Federal Trade Commission is supposed to have the authority to challenge monopolistic hospital mergers to protect consumers.
In 1996, the FTC amended its policies on health care mergers. The new policy encouraged hospital systems to merge by providing safe harbor to competing hospital systems when the hospital system could prove their hospital could achieve sufficient clinical integration.
The definition of sufficient integration was very loose and ill defined. The government thought it could save money by having all the fees under one roof. The FTC encouraged healthcare system monopolies in order to achieve more efficient and integrated care. It did not realize it would bite them in the leg someday.
It has always been a mystery to me how the government came to this conclusion. Suddenly the government has realized that the monopolies have turned on it and are in a position to demand more reimbursement.
“I thought that the 1996 amendments…were the biggest loophole in the antitrust laws I had seen,”
“Subsequent Advisory Opinions issued by Commission staff…were about as clear as mud.”
Dr. Donald Berwick and President Obama claim that Accountable Care Organizations are the cure to our rising healthcare costs. A gigantic and expensive bureaucratic system has been constructed by CMS to regulate these new ACOs. ACO’s promote further consolidation and mergers of physicians and hospital systems.
Remember the government outsources all of the administrative services to the healthcare insurance industry. I have shown how the healthcare insurance industry has taken 30 to 50% of every Medicare healthcare dollar to the disadvantage of the taxpayer and seniors.
Large merged hospital systems have in turn taken advantage of their size to take advantage of the healthcare insurance industry.
The healthcare insurance industry has taken advantage of the government in pricing administrative services.
Finally, the government has taken advantage of seniors by increasing Medicare premiums, increasing deductibles and decreasing benefits..
“ The final ACO guidelines, says Rosch, are “extraordinarily generous to providers,” and will constrain the FTC’s ability to block exploitative provider mergers.”
“In other words,” Rosch points out, “the savings to Medicare from the ACO program are no more than a rounding error. Yet even the CBO’s modest cost savings projections are likely overstated.”
Middle-class Americans are already struggling with the burdens of the rising cost of health insurance. The potential ACO policy blunder is not to be taken lightly.
Obamacare’s failure will skyrocket our federal debt. The lack of consideration of the dysfunctional dynamics of the healthcare system will result in unintended consequences that will create greater dysfunction and higher costs.
Obamacare and ACOs will end up making health care even less affordable and accessible.
Maybe that is President Obama’s goal.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Somehow, large hospital systems have been able to stay under the radar. They have been able to avoid the responsibility of the rising costs of healthcare.
Large hospital systems and large hospital chains know that insurers need them to service their network of patients. The healthcare insurance companies know that the hospital systems can hold them hostage to increased reimbursement.
When a large hospital system demands an increase in reimbursement the healthcare insurance industry simply increases premiums.
An example is the increasing premiums and costs that resulted from Romneycare in Massachusetts. Romneycare’s structure is one large driver of rising costs in Massachusetts.
Hospitals in Boston were extremely competitive before 1990.
The race in the late1980’s was to build the best hospital/physician network in town. The goal was to attract patients, overwhelm the competitors and get the best reimbursement from insurers.
The merger between two eminent Harvard-affiliated hospitals, Massachusetts General Hospital and Brigham and Women’s Hospital developed a hospital system (Partners) that would control the marketplace.
The two most prestigious hospitals in the state forced the healthcare insurance industry to increase their reimbursement for providing care. Meanwhile, the Tufts hospital system offered a lower reimbursement rate but patients wanted to go to Partners.
Many hospitals are merging throughout the country to take advantage of this market leverage and increase reimbursement from the healthcare insurer.
Hospital systems are frantically trying to buy primary care physicians’ private practices to enjoy this leverage. The statistics claim that from 30% to 70% of practices have been bought by hospital systems.
The fiction is that medical schools are producing a different breed of physicians. The fiction is all the present day physicians want is a salary. I do not think this is true.
The barrier of entry to opening a private practice is cost. Physicians completing medical school have already incurred large debt.
The problem with being employed by hospital systems is the hospital system controls the overhead expenses. These expenses are inflated. Many salaried physicians do not realize the unfair overhead expenses because the expenses are opaque.
It takes a while for physicians in the system to figure out that they are not getting their fair share of the reimbursement for their productivity. At that point physicians start fighting with the hospital system. Some physicians quit en mass and open their own practice.
Partners’ physicians figured it out. Partners is still intact but the physicians are now getting their fair share.
Physicians are starting to realize they have leverage over their hospital employee and that they must have control of their overhead.
“But the long history of hospital mergers shows no evidence that consolidation leads to either. Indeed, according to FTC lawyer Matthew J. Reilly, the merged Toledo hospitals immediately went to work jacking up rates:”
“Soon after the acquisition was consummated,” Mr. Reilly said, “ProMedica approached certain health plans to obtain higher reimbursement rates.”
“The higher rates, he said, are typically passed on to consumers in the form of higher premiums, co-payments and other costs.”
Businesses act in the pursuit of their vested interests. Government sets the rules and businesses seek to take advantage of those rules.
Somehow, secondary stakeholders must be controlled. It will take a consumer driven healthcare system to control it.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
It will take educated, motivated and incentivized consumers to reduce the costs of Medicare in order for the program to be sustainable in the future.
It is likely that central government control over individual healthcare and medical care choices will create a bigger mess. It will also impinge on individual freedoms.
Ensuring that Medicare provides quality health care coverage to millions of older and disabled Americans is essential in a compassionate society. How this can be accomplished is the question.
Seniors have been deceived into believing that they have prepaid their retirement healthcare insurance during their working years. They are realizing that they have been deceived by many administrations.
“It is also hugely costly. The federal government spent about $477 billion in net Medicare outlays in fiscal year 2011 — 13 percent of its total federal spending. By 2021, it is projected to spend $864 billion — or 16 percent of the total budget — according to figures derived by the Kaiser Family Foundation. That rate of growth is not sustainable indefinitely.”
Where did the Social Security and Medicare taxes paid by Americans disappear to? The government collected those taxes and then lent them to the government treasury to maintain U.S. solvency. Now the government is insolvent. It cannot pay back the trust funds as Social Security and Medicare payments decrease and the number of eligible Social Security and Medicare recipients increase.
President Obama’s administration and its bureaucrats are ignoring the real problems in Medicare.
They think consumers are too stupid to look after themselves and their own money. It is essential to President Obama’s ideology that the central government control consumers’ choice, consumers’ medical decisions and the money consumers paid into the Medicare system.
The federal government has not done a very good job of managing the money consumers, now seniors, have paid into Social Security and Medicare all these years.
Politicians refuse to understand the sources of waste in the healthcare system. This was made painfully obvious as expressed by Dr. Emanuel. All the stakeholders (patients, physicians, hospital systems, healthcare insurance companies, pharmaceutical companies and the government) have contributed to the waste in the healthcare system.
The biggest villain has been the healthcare insurance industry. The next biggest villain has been the federal and state governments for letting the healthcare insurance industry get away with what they are getting away with.
Healthcare policy experts refuse to understand that the government is not the administrative services provider for the Medicare program. The government outsources all the administrative services to the healthcare insurance industry.
The government pays over 20% of each healthcare dollar plus a bid price to the healthcare insurance industry’s regional vendor.
Most of the vendors that administer Medicare and Medicaid are subsidiaries of the major healthcare insurers. They change their name to the disguised subsidiaries because some of the state government exposed the major companies for the abuses the healthcare insurance companies imposed on patients and physicians.
The politicians’ and bureaucrats’ goal is to maintain power. Their decisions are based on maintaining their power or leveraging their ideology to maintain or obtain that power through the next election cycle.
They are not concerned with the health and welfare of citizens.
President Obama proves this daily by running for reelection rather than running the country
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
In reviewing Ezekiel Emanuel’s New York Times article I thought of an interesting question. In Dr. Emanuel’s view it is not worth having tort reform or healthcare care insurance reform. He claims these reforms are an insignificant burden to the cost of the healthcare system.
The question then is where is the $2.5 trillion dollars the U.S. healthcare system spends going?
President Obama and Dr. Emanuel think it is going to physicians. President Obama’s idea to control healthcare costs is to reduce physician reimbursement.
The Sustainable Growth Rate (SGR) is a complicated and defective formula intended to contain the overall growth of Medicare spending for physicians’ services. The intent was to keep physicians’ reimbursement in line with the nation’s ability to pay for that medical care. The SGR formula uses the gross domestic product per capita in a complicated and inaccurate way.
Let us assume that 161,400 of the 661,400 physicians in the U.S. work in private medical related industries such as the healthcare insurance industry, the pharmaceutical industry, the physician executive industry and government services. These physicians are not involved in direct patient care and do not generate direct patient costs to the healthcare system.
The number of non direct patient care physicians is probably higher (185,192 in other non practice positions and 476,208 in direct patient care). My assumption uses 500,000 physicians involved in direct patient care for all types of insurance to inflate physicians’ reimbursement.
Let us also assume that physicians’ overhead is 50% of total collections. Therefore physicians’ take home salary is 50% of collections. Fifty percent is a fairly accurate assessment whether the physicians are self employed or hospital system employed.
If we round off the salaries to $190,000 for Primary Care Physicians and $340,000 for Specialists and round off the number of Primary Care Physicians to 300,000 (actually 375,000) and 200,000 in Specialties (actually 125,000) and do the math, physicians’ salary comprise only 5% of the total $2.5 trillion dollars spent in the healthcare system.
The Math:
$190,000 per year per primary care physician x 300,000 physicians= $57,000,000,000 ($57 billion dollars for primary care physicians).
340,000 per year per specialists x 200,000 specialists= $68,000,000,000 ( $68 billions dollars a year for specialists).
$57 billion + $68 billion= $125 billion per year for the costs of physicians salary for direct patient care.
$125 billion (125,000,000,000)/ $2.5 ($2,500,000,000,000) trillion per year = 5%
If you double the physicians’ collections to include physicians’ overhead costs , physicians receive 10% of total dollars spent on healthcare system.
Improvements can be achieved in decreasing physicians’ overhead by having more integrated healthcare systems. Presently, most communities do a fair job.
Integrated electronic medical records could achieve a further decrease in the 5% of the total healthcare cost spend by physicians for overhead.
The government is spending billions of dollars on building bureaucracies, creating regulations, developing a IRS physicians fraud squad and creating committees trying to reduce 5% of the healthcare costs.
President Obama is approaching the problem of escalating healthcare system costs using the wrong premises. It will result in increasing healthcare system costs. Obamacare already has increased the costs of the healthcare system even though it is not fully implemented.
“According to many on the left, health insurance companies are sleazy and unethical, making obscene profits by charging high prices to sick people, giving physicians and patients the runaround to avoid paying bills, and rescinding policies just when people who paid in good faith get cancer, while their executives often walk away with millions in compensation.”
The individual state’s Board of Insurance is in charge of regulating the healthcare insurance industry. The stated goal is to protect consumers.
All state boards issue licenses to sell healthcare insurance yearly to healthcare insurers.
Few of the state Boards of Insurance have enforced their own regulations. The state insurance boards could easily refuse to issue a license to a company that doesn’t follow the regulations
Dr. Emanuel takes the healthcare insurance industry’s bottom line literally, while ignoring the financial facts.
“Last year, health insurance companies did rack up big profits, but it turns out that the combined profits of the country’s five largest for-profit health insurance companies —United, WellPoint, Aetna, Humana and Cigna — were $11.7 billion, only 0.5 percent of total health care spending.”
“Even confiscating every penny of those profits would add up to less than half of the cost-saving threshold. And even not-for-profit insurance companies need to have an operating margin — a profit by another name. There just isn’t enough money there to make a dent in health care spending.
The bottom line figure after expenses might be published as only $11.7 billion dollars but the real profits are buried into the profit built into the administrative expenses that do not get added into the bottom line.
An additional 25 percent of consumers in this market are in plans that spend between 25 and 30 cents of every premium dollar on administrative costs.
And in some extreme cases, insurance plans spend more than 50 percent of every premium dollar on administrative costs.
President Obama thinks his law will decrease these expenses. The public has also been lead to believe that Medicare’s administrative overhead is 2.5%. The 2.5% is the overhead to maintain a CMS department outsourcing administration services to the healthcare insurance industry and generating new regulations.
The percentage of overhead has to be higher much higher now with the development of Dr. Berwick’s bloated bureaucracy.
CMS outsources its administrative services to the healthcare insurance industry. The healthcare insurance industry adds an additional 20-30% to the bid price for services claims.
The healthcare insurance industry is required to maintain the Medical-Loss Ratio at 80-85%. Medical Loss Ratio means it has to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement rather than on administrative costs.
Healthcare insurance companies have been permitted, by the government, through the influence of its lobbyists, to shift certain expenses from administrative expenses into the patient care expenses. The result is less money spent on direct patient care.
These expenses are designated as direct patient care expenses. Each expense is a profit center. This profit is not reflected in the healthcare insurance company’s bottom line. These are the reasons the net income figures are bogus.
Aetna made $4.8 billion dollars in profit on Medicare Advantage and Medicare Part D alone two years ago.
A reader wrote in response to my blog Disinformation Compliments Of The New York Times.
His comment fits in perfectly with today’s protest American Censorship Day.
“2500 years ago the Father of Strategy said:
“Today’s battles are information battles because information shapes both perception and opinion. Those who use it to both attack and defend will win, those who do not will lose.” Sun Tzu
"With the media’s help (and others who supported this man without doing their homework) we are at a strategic disadvantage. It’s why I wrote my book in mathematical terms not political terms. There is no arguing math. It is objective."
"Have a good day Dr. Feld.”
Occasionally I look at the Daily Kos. Today, November 16, I looked at the Internet newspaper because I wanted to see what they had to say about American Censorship Day.
The Daily Kos nailed it. They also included a You Tube of Joe Biden defending the freedoms and the need for not censoring the Internet.
“There are a couple of bills (like PROTECT IP) coursing through Congress that if enacted threaten the entire Internet only to protect outmoded business models of the movie and music industries.
One particularly pernicious example is the Stop Online Piracy Actwhich would require the US government to do their or any supposed "rightsholder's" bidding to shut down foreign "rogue" sites. The truth is that it would also shut down US sites like Twitter and YouTube and including the DailyKos - (that means you, too) if found in violation of Hollywood's whims the SOPA provisions. It even threatens to shut down and blacklist ISPs who don't cooperate.”
If this is intentional it is a neat way to keep the public confused.
The Daily Kos goes on to say,
“The bills are opposed by big Internet companies like Google, Facebook, Yahoo!, eBay, Twitter, LinkedIn, Zynga and others. Even VP Joe Biden has spoken out against it (although not directly and only until he is for it - coming soon!):”
Joe Bidden statement on censorship of the Internet.
I became aware of two bills flying through the Senate and the House by reading my son Brad Feld’s blog. The bills are Protect IP Act (PIPA - S.968) and Stop Online Privacy Act (SOPA – H.R.3261).
I searched the New York Times to see what the newspaper that (Prints all the news fit to Print”) had to say about the bills. My search produced this reply.
I have tried to get Brad excited about the lunacy of Obamacare. He has not been interested in how Obamacare will ration care, restrict access to medical care, and restrict our freedom to choose and make our own healthcare decisions.
These two bills restricting the Internet lit his wick. It also lit Fred Wilson’s wick. I hope is it wakes everyone up. We must get past this centralized government manipulation and fight for our freedoms.
Congress restricting the freedoms of the Internet is just another example in President Obama’s goal to have government control all of our decisions and actions. It will serve to restrict our freedoms.
The most vital part of our economy and job growth at the moment is the Internet. These two bills will destroy this monumental jobs creating machine.
It is another piece of lunacy brought to you by our federal government. I wonder how many Representatives and Senators have read the bills.
Let me remind everyone that large media companies offer huge support to President Obama and the Democrats in congress. These bills are congruent with the large antiquated medias’ vested interest and President Obama’s goal of central control over our lives.
This Video video does a great job in explaining the two bills potential primary and secondary impact. I do not believe our congressional representatives understand the impact of the bills.
Someone is trying to railroad passage through congress.
If you run a website, have a blog, or are interested in protecting our freedom go to the American Censorship site to see how you can participate on 11/16/11.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
He defines the divide between conservatives’ and liberals’ opinions.
He states that conservatives are concerned about the cost of tort reform. Liberals are concerned about the profits of the healthcare insurance industry and drug industry. Using the wrong data to prove his point he concludes that these issues are simply a distraction from the real efforts of controlling healthcare costs.
Nothing could be further from the truth.
Today, I will concentrate on examining his evidence against the need for tort reform.
“ Conservatives favorite fix is to reform medical malpractice by limiting noneconomic damages, statutes of limitation and lawyers’ fees. In its favor is the fact that doctors’ fear of medical malpractice lawsuits is legitimate.
According to a recent study in the New England Journal of Medicine, about 7.4 percent of doctors get sued each year. By age 65, even those in “low risk specialties” like pediatrics and dermatology face a 75 percent chance of being sued.
His argument continues by saying,
It’s no wonder doctors order M.R.I.’s for routine headaches and monthly ultrasounds for normal pregnancies, despite these procedures not being required or recommended by professional guidelines.
His second argument against tort reform is the Congressional Budget Office 2009 scoring of the cost impact of tort reform.
“In 2009, the Congressional Budget Office did a comprehensive assessment of the potential cost savings from medical malpractice reforms.
Its conclusions: A package that included a $250,000 cap on noneconomic damages, a $500,000 cap on punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year — 40 percent from reduced malpractice premiums and the rest in the form of fewer defensive procedures like M.R.I.’s.
Dr. Emanuel concluded that $11 billion dollars a year savings is insignificant because it is a cost saving below $26 billion dollars a year. He contends tort reform is a distraction from real efforts to control healthcare costs and should be ignored. The CBO scoring information has lead Dr. Emanuel to an inaccurate opinion.
The percentage of healthcare costs is even greater when the Massachusetts Medical Society survey is taken into account. The amount spent for defensive medicine can be extrapolated to actual costs from this survey.
I have written a series of blogs analyzing the impact Massachusetts Medical Society’s survey. The extrapolated costs turn out to be about $700 billion dollars a year. The real cost of defensive medicine is somewhere between $242 and $700 billion dollars a year.
In 2008 damage awards alone for medical malpractice claims reached $5.9 billion dollars. The total of medical tort costs was $16 billion for legal costs, underwriting costs and administrative expenses. From 1986 the average jury award was $100,000. In 2006 the average award increased to $637,000. No one knows what the award value is for cases settled out of court.
Each year, 25% of practicing physicians are sued. 90% of physician sued are found innocent. The average defense cost is $100,000. This cost is not included in the CBO scoring
The fear of lawsuits causes most doctors to practice "defensive medicine" as the interviews of Massachusetts physicians points out. The result is unnecessary testing, referrals, and procedures to protect themselves from allegations of medical negligence.
A recent survey of doctors published in the Journal of the American Medical Association found that 93% of physicians admit to practicing defensive medicine. A 2008 survey by the Massachusetts Medical Society found that about 25 % of medical procedures are defensive in nature.
This waste results in increased healthcare insurance premiums. The premium increases result in an increase of at least 3 million uninsured people per year. When these uninsured people get sick they avoid going to a physician. This results in a decrease in work productivity. It is estimated that the annual decrease in productivity is more than $40 billion dollars a year.
In states where tort reform has been instituted by placing caps on so-called non-economic damages, the malpractice costs have decreased 39%. This drop in costs is a result of decreased malpractice suits. The decrease is economically bad for the plaintiff attorneys. Annual malpractice premiums have gone down at least 13%. In fact, the medical malpractice business for plaintiff attorneys has about dried up in Texas.
As a result of tort reform in Texas, more than 16,500 physicians have moved to the state from non-tort reform states. More than 430,000 additional Texas have healthcare insurance as a result of the tort reforms according to the Perryman group.
Senate Majority Leader Harry Reid, a Nevada Democrat, claims: "The whole premise of a medical malpractice 'crisis' is unfounded." Harry Reid listens to Dr. Ezekiel Emanuel’s opinion.
The influence of the disinformation is terrifying. Inaccurate opinions by influential people will never lead to a functional, affordable healthcare system.
The disinformation concerning healthcare insurance company profits and drug company profits will be discussed shortly.
The New York Times needs a fact checker.
In my view it is irresponsible of President Obama and his advisors to distort the truth with disinformation.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
All I have heard from President Obama’s special joint session of congress speech is you must pass this jobs bill right away. I did not hear any solutions to America’s complicated structural problems.
There is little mention that his American Jobs Act is a $450 billion dollar stimulus package adding to the previous one trillion dollar stimulus package that did not work. President Obama also said it will not cost the American public a dime.
On the other hand, Herman Cain and Newt Gingrich had a riveting 81 minutes debate discussing in detail what should be done about Medicare, Social Security, Medicaid, and jobs.
It was a truly remarkable debate. The three minutes response limitation on the candidates was suspended in the first three minutes.
Clear, concise and detailed explanations of each candidate’s positions were given. Both candidates were entertaining and serious. They treated Americans as intelligent humans who can make decisions for themselves once they understand the issues.
Their goal was to educate the people.
This Internet video is very worthwhile watching. It explains, why in their opinion, central government solutions have not worked. They explain what has worked in the past and what needs to be done to solve America’s problems.
I suggest those of you who enjoy reading the Federal Register to read the proposed rule: “ Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment, Volume 76, page 41930.Proposed rule docket ID is HHS-OS-2011-0022”
President Obama’s healthcare reform act is proposing to collect healthcare claims data on all Americans. The federal government already owns the claims data on Medicare and Medicaid recipients.
Now President Obama wants the claims data on all private insured and non-insured consumers. His reason is to stratify risk for the healthcare insurance industry.
Every consumer would pay the same healthcare insurance premium through the state exchanges whether he was a high risk or low risk patient.
If patients incurred high healthcare costs because they were a high-risk patients, the government would subsidize the healthcare insurance company if the cost was greater than the fixed premium.
Presumably the government would subsidize the healthcare insurance company so it would not lose money. It would also tighten the government’s control over the healthcare insurance industry and its profits. These regulations have not been written yet.
What is wrong with that? Consumers are again left out of the loop. An unelected bureaucrat is making our healthcare decisions. If the potential consequences were followed to the end, private insurance and a freedom of choice to have no insurance coverage would be eliminated.
Everyone would be required to have to have healthcare insurance through the state healthcare insurance exchanges. In reality it is a backdoor mandate.
The healthcare insurance industry is being asked to provide proprietary information to government. The healthcare industry claims that providing this information will undermine its competitiveness.
It forces the healthcare insurance industry to become more transparent while the proposal claims to protect the healthcare insurance industry from risk.
There are several obvious dangers of this action. The first danger is from the healthcare insurance industry’s point of view. Another danger is from the healthcare system’s point of view. The third danger is from the consumer’s point of view.
The federal government is not capable of providing the administrative services necessary for healthcare coverage. The government outsources the administrative services for Medicare and Medicaid.
If the government tried to lower those fees, the healthcare insurance industry would walk away from the healthcare system. The healthcare system would collapse.
A “centralized approach” wherein insurers’ data go directly to Washington.
An “intermediate state-level approach” in which insurers give the information to the 50 states.
A “distributed approach” in which health insurance companies crunch the numbers according to federal bureaucrat edict.
“ There are major problems with any one of these three “options.” First is the obvious breach of patient confidentiality. The federal government does not exactly have a stellar track record when it comes to managing private information about its citizens.”
“Why should we trust that the federal government would somehow keep all patient records confidential?”
Each option provides government bureaucrats access to the health records of every American.
President Obama’s trap for consumers is obvious. If a business loses or gives up or sells confidential data a victim can fire or sue a health insurance company. The power of the market can also punish a private sector provider.
If a government bureaucrat losses or gives up your confidential information to another federal agency or other private individuals, the individuals affected could not get the unionized bureaucrat fired even if they could find out who was responsible bureaucrat providing the information.
Providing the federal government the ability to spy on, review, and approve individuals’ private patient-doctor interactions is an abuse of power and a challenge to every American’s liberty Where is the ACLU on this issue?
In an attempt to do the right thing, President Obama and HHS ends up restricting our freedoms, individual rights and liberty.
I hate to be cynical. Perhaps President Obama’s goal is the have centralized control over Americans and restrict our freedoms, individual rights and liberty. .
Obamacare is looking more and more like this is the goal.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
The CLASS Act was another ill-conceived part of President Obama’s healthcare reform act. President Obama and HHS (Health and Human Services) realized that this social entitlement program was going to be another entitlement disaster. CLASS would have cost the taxpayers an additional $75 billion per year when it was passed on the condition of being budget neutral.
CLASS was discontinued before it could join other entrenched government entitlement programs that are unsustainable.
CLASS quietly became an amendment to President Obama’s healthcare reform act. There was little discussion about CLASS when the Democrats in congress passed President Obama’s healthcare reform act. There was little discussion until Kathleen Sibelius’ announcement to discontinue CLASS.
It was to pay a cash benefit that each recipient could decide how to use.
It could not disqualify participants with pre-existing disabilities or charge them more.
It had to pay for itself without relying on taxpayer dollars.
It was to provide long-term care for the elderly and disabled.
The program is not meant to shoulder the whole cost of long-term care, for either the elderly or younger people with disabilities, but it could make a great difference to strapped families.
It would typically cover home care, assisted living, adult daycare, nursing home, and Alzheimer’s facilities for those who needed it,
There would have been no apparent age or time limits for benefits.
No underwriting in the selection of beneficiaries.
CLASS was designed to collect “premiums” during employees’ working years and spend the money immediately.
When the obligations came due, the program would have been forced to seek a taxpayer bailout. “This is called redistribution of wealth.”
Medicare benefits typically pay for nursing home and home care coverage typically only for relatively short -term recovery (21 days) from an acute illness.
Medicare beneficiaries who need long term care beyond their benefits but don’t have private supplemental long term care insurance must pay out of pocket.
CLASS would pay recipients $50 a day for in-home care assistant to help with cooking, cleaning, and bathing. This sounds cheap. However it would cost the government over $18,000 a year per person.
There are no signup restrictions and no increased premiums based on overall health and age at the time of signup.
The vast majority of the voluntary participants would be the sickest and most in need of long term care. There is no way that a voluntary program could be budget neutral.
CLASS like Medicare would have few restrictions on the amount and types of care that beneficiaries receive.
Advocates for “health care is a right” are stuck with the dilemma what to do with a severely demented 99 year old nursing home patient with terminal cancer. Should that patient receive the same life extending care as a 65 year old with no medical problems?
This is a moral and legal dilemma that society must face. Patients and their family should make that decision.
It is immoral for a group of bureaucrats to decide on treatment for the individual. It is equally questionable to have physicians decide to withhold treatment
It is one of the reasons patients should own their healthcare dollars and be responsible for how they spend them. Patients and their families should have some skin in the game.
The government could provide some of the healthcare dollars for those who qualify.
If those dollars are not spent at the end of the year, patients and their family would keep them. This would provide incentive to make logical decisions about the consumption of medical care.
There is no evidence that nursing home care or home assistance care or assisted living or adult day care increase life expectancy. These services provide comfort for the elderly and their children.
Rather than providing complete medical care for the elderly in the hope of extending life, less expensive ways can be devised to provide comfort other than warehouseing the elderly in nursing homes.
CLASS would have provided minimal financial assistance in providing comfort to the infirmed elderly. With mounting budget deficits America cannot even afford minimal help.
Basically CLASS was an insurance plan without any of the rational limits and restrictions that real insurance companies use to prevent themselves from going bankrupt. President Obama’s CLASS Act could never work. After the government spent $75 billion dollars a year on a tax neutral plan, he would say “OOPS”. America would enjoy the luxury of another money draining entitlement program.
The “healthcare insurance” paradigm for providing healthcare to the elderly must be changed. Patients must be motivated to be responsible for their own care.
President Obama has tried to keep the conversation about discontinuing CLASS, another entitlement program, to a minimum.
The realization of the failure of CLASS should be used to think about healthcare coverage from a different perspective rather than letting our politicians making the same mistakes over and over again.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Economic downturns and upswings occur over and over again. Economists believe both downturns and upswings can be managed. However, economists continue to make the same policy mistakes. The mistakes result in an increase in depth and frequency of the economic swings.
Businesses both large and small and consumers are frustrated and angry about the present economic downturn and its prolonged continuation.
President Obama thinks his ideology is correct. However, his philosophy is flaming the fires of racial and economic divisions and unrest. His ideology is prolonging and increasing the depth of this economic downturn.
Before I present a systemized solution to the dysfunction of the healthcare system, I feel compelled to put the economic, political and social crisis in into a systems error perspective.
The national deficit is exploding because of excessive government spending. None of President Obama’s economic stimuli have worked.
Economic uncertainty is increasing as a result of the unintended consequences created by the thousands of new regulations produced by the Obama administration’s bureaucracies. The regulations are written at the discretion of non-elected government officials.
American businesses and the American people mistrust government more and more. Powerful vested interests influence government policy to their advantage.
Congress and the President were elected “by the people for the people.” The government has gotten too large. The government does not seem to be working in the interest of the people who voted for them.
In 1957 Ayn Rand having experienced a totalitarian government in her native Russia was upset by the trend in America. This resulted in her writing Atlas Shrugged.
Right now President Obama’s ever-increasing bureaucracy and government control over every aspect of our lives is reminiscent of “Atlas Shrugged.”
Milton Freidman pointed out that Keynsian economics does not work. All the World’s societies run on greed. The trick is to harness greed for the common good.
Big government generates large bureaucratic structures. Large bureaucratic structures do not fix anything. They make systems more complex and more difficult to manage.
This is what is happening with the bureaucratic structures being formed by Obamacare. More departments are created. People running these departments have independent power. Multiple independent departments lead to multiple contradictions. The contradictions lead to greater costs to the system and added dysfunction.
The Department of Human Services and CMS is such a system. It has become a monster bureaucracy with the enactment of Obamacare.
Look at the names of some of the agencies created. They are right out of "Atlas Shrugged."
I recall President Reagan’s famous statement, “I am from the government and I am here to help.”
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Paul Ryan and the Republican House passed the 2012 budget that has been ignored by Harry Reid and the Senate. Harry Reid gets his orders from President Obama. He chose not to consider the Republican House budget. Instead Democrat chose to demonize Paul Ryan.
President Obama seems to be ignoring America’s debt and deficit spending crisis. The Senate has not produced a budget in over 900 days. President Obama has presented numbers to the CBO that would result in decreasing the budget deficit. The numbers presented to the CBO are phony. The Healthcare Reform Act will result in a huge increase in our deficit. It will result in higher taxes.
The traditional media has been very effective in demonizing Paul Ryan’s budget proposal.. The TV ad implying that Paul Ryan is pushing grandma off the cliff is a total lie. The media should fact check before accepting an inaccurate advertisement .
If anything, President Obama’s Healthcare Reform Act will push grandma off the cliff.
Paul Ryan’s explanation of our debt crisis and deficit spending is clear. His budget proposal is also clear.
Paul Ryan questions the reasons President Obama and the Democratic Senate are ignoring the coming disaster.
The healthcare system is inundated with waste, fraud, abuse, a lack of competition and well-directed incentives for the healthcare system to function efficiently.
President Obama’s healthcare reform law is awash with penalties, punishment and rationing as well as waste in the form of more bureaucracy, committees, studies and pilots. Medicare is unsustainable.
The healthcare insurance industry has figured out how to profit from the proposed ACO (Accountable Care Organizations). It means more bureaucracy resulting in higher fees to charge the government for providing administrative services. The result will be higher unsustainable costs for both the government and seniors.
Hospital systems know are not prepared for ACOs. ACO’s are too costly to set up. Most hospital systems information systems are not good enough to provide the data the government wants to evaluation the care given. Administrators managing hospital systems intuitively know that the government will make decisions that will be counter to hospital systems’ vested interests.
Physicians know that hospital systems are going to try to capture as much of their intellectual property as possible and restrict their freedom to make medical judgments. It will be very difficult to create physician hospital alignment under an ACO.
This is a must watch You Tube
Patients know ACO’s are going to restrict access to care, increase their out of pocket expenses, ration care and result in higher taxes and higher deductible. Partial implementation of President Obama’s healthcare act already has resulted in all of the above.
Hospital systems and physicians have not signed up for ACO’s. That resulted in Dr. Don Berwick and CMS revising their ACO final rules. Dr. Berwick is trying to entice hospital systems and physician groups to sign up and form ACO’s.
Dr. Berwick says he is for patients, hospital systems and physicians delivering better care to patients. I believe him. However, he is doing it the wrong way.
The only thing the new rules accomplish is to make forming an ACO more affordable at the front end. Medicare ACO’s continue to be a government controlled system with penalties and punishments to providers.
Patients’ treatments will be determined by a non-elected committee and not their physicians. The committee might make the wrong decision by examining the wrong data.
There was not one urologist on the committee. Another example was the USPSTF task force studying osteoporosis and the use of bone mineral density in men over 70. There was not one Clinical Endocrinologist on the committee.
All anyone has to do is go into any Wal-Mart on a Monday morning. At least 50% of males over 70 years old look like they have lost several inches of height. Each of these men has osteoporosis. They are at risk for hip fractures. Hip fractures at the least with decrease quality of life. At most, long hospitalization and death. Hip fractures can be prevented if treated properly.
The next step would be to study the number of hip fractures in men over 70 years old and the cost of treatment of these fractures. An evaluation of the quality of life after fracture must be evaluated to get an accurate assessment of the cost effectiveness of doing bone mineral density testing.
Medical care systems must be a patient centered and controlled. It must not be a government centered and controlled system. This is the only way to develop a cost efficient system. Dr. Berwick’s way will only increase the cost to the government. He will spend money the government does not have.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
I wonder how many Congressional Representatives and Senators read HR3200. It is amazing that our representatives would permit the federal government to restrict our freedoms so severely.
This morning I received this You Tube from a reader. It describes the restrictions on our freedoms created by President Obama’s healthcare reform plan. The restrictions have not be publicized by the traditional media.
I was reminded of the blog I wrote on July 30,2009. Below is the link to the original bill and a copy of my 2009 blog.
It is easy to forget all the restrictions imposed on Americans’ freedoms by this piece of legislation.
On Thursday, Oct 20, 2011 at 8:52 AM a reader sent this You Tube and comment
"This has to be one of the scariest pieces I've seen. If you have the stomach, take the few minutes to review. Maybe even compare the statements with the actual bill." Here's the link to HR3200:
I have compared the You Tube to the original bill. Obamacare is defective. Americans will not tolerate centralized control over our lives and choices once they understand the concepts in the bill.
President Obama has been effective in manipulating the media to keep Americans in the dark.
The House of Representatives Healthcare Bill is 1018 pages long. Many Representatives and Senators did not read the entire economic stimulus bill because “we did not have time” before we experienced a severe economic recession. They claimed to be saving us from another great depression.
I have read a good portion of HR3200. The provisions are unacceptable and sinister. It represents a complete government takeover of our healthcare system. It is not in the interest of the consumer. It is not in the interest of our precious freedom of choice.
Every Americans, especially our Senators and Representative must know what is actually in the bill before it is passed. President Obama’s generalities do not cover the details of HR 3200.
Mr. Schweikart evaluated 498 of the 1107 page bill. The summary of one half HR3200 is frightening. His summary is a good reference guide to the appreciation of the harshness of the bill. It also explains President Obama’s urgency in getting a bill passed before anyone realizes the implications of the bills contents.
Representatives who vote for this bill should not be reelected. They are not representing their constituents’ rights or protecting their freedoms. Your healthcare, health and freedoms are at stake.
You can check the reviewer’s summary against the actual bill at the link below.
“Take a look at what actually is in the Health Care bill. Obama makes disingenuous comments like "You'll still keep your doctor" or "You'll keep your existing health care."
Pg 22 of the HC Bill mandates the Government will audit books of all employers that self insured. Can you imagine what that will do to small businesses? Everyone will abandon “self insurance” and go on Government insurance. So when Obama says that there will still be private health care, it’s simply a lie: this mandate will force employers to abandon their private plans.
Pg 30 Sec 123 of HC bill – a Government committee will decide what treatments/benefits a person may receive.
Pg 29 lines 4-16 in the HC bill - YOUR HEALTHCARE WILL BE RATIONED!President Obama has been saying healthcare is to be rationed all along in code.
Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You will have no choice!
Pg 50 Section 152 in HC bill - HC will be provided to ALL non US citizens, illegal or otherwise.
Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Healthcard will be issued! Government has real-time access to your tax return presently and means test Medicare recipients’ premiums
Pg 59 HC Bill lines 21-24 Government will have direct access to your bank accts for election funds transfer. A further impingement on freedom and privacy.
Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (read: ACORN).
Pg 72 Lines 8-14 Government will create an HC Exchange to bring private HC plans under Government control.
Pg 84 Sec 203 HC bill - Government mandates ALL benefit packages for private HC plans in the Exchange.
Pg 85 Line 7 HC Bill - Specifics of Benefit Levels for Plans = The Government will ration your Healthcare!
Pg 91 Lines 4-7 HC Bill - Government mandates linguistic appropriate services. Example - Translation for illegal aliens.
Pg 95 HC Bill Lines 8-18 The Government will use groups, i.e. ACORN & AmeriCorps, to sign up individuals for Government HC plan.
Pg 85 Line 7 HC Bill - Specifics of Benefit Levels for Plans. AARP members - your Health care WILL be rationed.
Pg 102 Lines 12-18 HC Bill - Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.
Pg 124 lines 24-25 HC No company can sue Government on price fixing. No "judicial review" against Government Monopoly.
Pg 127 Lines 1-16 HC Bill - Doctors/ AMA - The Government will tell YOU what you can earn.
Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.
Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.
Pg 149 Lines 16-24 ANY Employer with payroll $400k & above who does not provide public option pays 8% tax on all payroll.
Pg 150 Lines 9-13 Businesses with payroll between $251k & $400k who don’t provide public option will pay 2-6% tax on all payroll.
Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Government will be taxed 2.5% of income.
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)
Pg 195 HC Bill -officers & employees of HC Admin (the GOVERNMENT) will have access to ALL Americans’ finances and personal records. Big brother will be watching your every move.
Pg 203 Line 14-15 HC - "The tax imposed under this section shall not be treated as tax" Yes, it says that.
Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid. Seniors, low income, poor affected. Kill off the poor and elderly.
Pg 241 Line 6-8 HC Bill – Doctors – doesn’t matter what specialty – will all be paid the same.
Pg 253 Line 10-18 Government sets value of Doctor’s time, professional judgment, etc. Literally, value of humans.
Pg 265 Sec 1131Government mandates & controls productivity for private HC industries.
Pg 268 Sec 1141 Federal Government regulates rental & purchase of power driven wheelchairs.
Pg 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!
Pg 280 Sec 1151 The Government will penalize hospitals for what Government deems preventable readmissions.
Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission - Government will penalize you.
Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion - Government will mandate hospitals cannot expand.
Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!
Pg 335 L 16-25 Pg 336-339 - Government mandates establishment of outcome-based measures which of course forces health care rationing.
Pg 341 Lines 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc., forcing people into Government plan.
Pg 354 Sec 1177 - Government will RESTRICT enrollment of Special needs people!
Pg 379 Sec 1191 Government creates more bureaucracy - Telehealth Advisory Committee. Healthcare by phone.
Pg 425 Lines 4-12 Government mandates Advance Care Planning Consultations. Think Senior Citizens end of life prodding.
Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of attorney. Mandatory!
Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in how to die. EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (and your life). Health care will be denied based on age. 500 Billion will be cut from Seniors healthcare. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.
Pg 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.
Pg 429 Lines 1-9 An "advanced care planning consultant" will be used frequently as patients’ health deteriorates.
Pg 429 Lines 10-12 "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from the Government to end a life!
Pg 429 Lines 13-25 - The Government will specify which Doctors can write an end of life order.
Pg 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.
Pg 469 - Community Based Home Medical Services/Non profit orgs. (ACORN Medical Services here?)
Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATION. 1 monthly payment to a community-based organization. (Like ACORN)
Pg 489 Sec 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into our marriages.
Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services. You’d better speak up now before you are on the "advanced care consultation" list.
It gets worse: the Health Care Reform bill that is now about to come up for a vote will absolutely eliminate private health care options. Do not kid yourself: They are going to say that they aren't going to interfere with your right to go to your "own doctor" or have your own "private health insurance." But there won't be non-government doctors or private health insurance if the government mandates them out of existence.
Even still, I hear people who want to "get past all this partisanship." Sorry, but GROW UP.
Our system from the beginning has pitted one group against another out of fear of the very giant government that is metastasizing before our eyes. James Madison didn't like "parties" or "factions," but he finally admitted that they were absolutely necessary to fragment power.
For our system to work there has to be a clear choice, not a mushy middle, because the mushy middle always, always, always gravitates left. There is a "presumption of power" on the left –conservatives, by nature, do not like government, don't trust it, and do not want to use it to advance their ends, which they see as advanced through liberty, individual achievement, and entrepreneurship.
It is hard to read H3200 and comprehend its implications. However, a careful reading leads me to similar conclusions to those of Mr. Schweikart.
Do you think your representatives have studied the bill? If they have and vote for it they should lose your vote. If they have not read it and vote on party lines they should lose your vote.
This bill is not going to Repair the Healthcare System. It will make the healthcare system more complex, restrict access to care, restrict the delivery of care, ration care, limit freedom of choice, and increase the deficit.
Let your Senators and Representatives know the proposals are unacceptable. Write, fax, call, email, twitter. Tell them:
“We do not want the government to control our lives. We want affordable, universal healthcare coverage that does not limit access to care. We want control over our healthcare dollars. We do not want government to control our lives and our money.”
We all agree the healthcare system is dysfunctional. As Obamacare works its way toward full implementation the dysfunction has intensified and healthcare costs have increased. It is important for all of us to recognize why Obamacare is a disaster.
Obamacare will not only destroy our healthcare system. More importantly It will destroy our freedoms.
On October 19th 2011, President Obama said his administration has done everything correctly. It just hasn’t worked out yet.
Does anyone believe him?
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
