Repairing the Healthcare System

The Whiz Kids: The 1950 Philadelphia Phillies

Stanley Feld M.D.,FACP,MACE

Some of my readers may have guessed I am a baseball nut. I played lots of baseball as a kid. I was also an avid baseball fan. Early on I developed an understanding of the beauty of the game.

Unlike politics and political maneuvering, baseball was an honest sport. Each baseball game has a beginning, middle and an end. The official baseball rule book provides a level playing field for all the stakeholders.

This is in total contrast to the healthcare system. President Obama’s proposed healthcare plan is going to destroy the delivery of medical care..

I grew up 14 blocks from the Yankee Stadium on the corner of Mt. Eden Avenue and Topping Avenue across the street from Claremont Park. I had a special rock in the stone wall that I used to climb into the park to play ball every day.

I went to a lot of Yankee and New York Giant games in the summers of the late 40’s and early 50’s for free as described in an earlier blog.

Kids on our baseball team always rooted for the Yankees. We also picked a National League team to root for at the beginning of each season. Most of my teammates picked the Brooklyn Dodgers. Jackie Robinson was everyone’s hero.

In 1950 I decided to root for the Philadelphia Phillies. My personal scouting report indicated they were going to win the National League title. I thought they had a great chance to beat the Brooklyn Dodgers.

I also knew all my friends would be rooting for the Brooklyn Dodgers. I was 11 years old growing up in the Bronx. At that age we were all interested in arguing about everything with one another.

The Phillies changed their uniforms to Red Pinstripes with a P on the front just like the Yankees blue pinstripes. Previously their uniforms were dumpy and ordinary like the Brooklyn Dodgers uniforms. This excited me.

The Phillies were a young team (average age 26) and became the youngest team ever to play in a World Series. People started calling them the Whiz Kids in July of 1950 when they started to win.

Two games separated the top four teams (Phillies, Cardinals, Dodgers and Boston Braves) on July 1. Suddenly the Whiz Kids began to win. In July the Phillies were 21-13 and in August they were 20-8. At the beginning of September the Whiz Kids were seven games ahead of the Brooklyn Dodgers. It looked like they were in.

Richie Ashburn was 22 years old and caught everyone’s fancy. Curt Simmons was an early bonus baby at 21 who was a fantastic pitcher. Robin Roberts age 22 had a great sounding name, a tremendous pitching arm and a wonderful personality.

Jim Konstanty was unhittable with a palm ball. He was a great relief pitcher. He was named MVP in 1950. The Yankees traded for him in his later years as a closer. He did a great job for the Yanks.

Dick Sisler was a star hitter and outfielder. Del Ennis was their best hitter and outfielder. He batted .311 with a slugging average of .551.

I loved Andy Seminick, the catcher. He batted only .288 but had a .524 slugging average which was great for a catcher in those days.

Completing my list of hero’s were Granny Hammer at short, Eddie Waitkus at first and “Pudd’n Head” Jones at third.

I was in heaven because of the Whiz Kids great play on the field. I was the talk of the neighborhood kids for picking the Phillies. I had a marvelous time following the Phillies and Yankees. Suddenly, in September, the Phillies hit the wall with a streak of bad luck.

Curt Simmons’ (17-8, 3.40 ERA) National Guard Group was called to active duty for the Korean conflict on September 10. Bubba Church (8-6, 2.73 ERA) was struck in the face by a wicked line drive. Bob Miller (11-6, 3.57 ERA) injured his arm during a pitching duel.after hurting his back two weeks earlier. The Phillies lost three starting pitchers.

The Whiz Kids lost 12 out of 16 games in September. The Dodger won 11 of 13 and forced a two game playoff. Eddie Waitkus then singled to put runners on first and second. Richie Ashburn, a great bunter, bunted into a force play for the first out.

That brought up Dick Sisler (13 Hr, 83 RBI, .296 avg.) who belted a three run homer. Robin Roberts then got out the next three Dodger batters to win the pennant for the Phillies for the first time in 35 years.

Naturally I was rooting for the Yankees in the World Series. I would have been beaten up by one of the gangs in the neighborhood if I didn’t root for the Yankees. The Yankees won the World Series in four close games.

I hope the Yankee do as well against the Phillies this year.

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

Has A Government Entitlement Program Ever Come In Under Budget?

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform plan will not repair the healthcare system. It will not provide universal coverage, it will not provide affordable coverage and it will not increase the quality of care.

Not repairing the healthcare system is unacceptable. I have proposed an ideal medical saving accounts that will align all the stakeholder’s interests while not letting any stakeholder take advantage of the other. It is dependent on appropriate, enforceable state and federal rules and regulations that permit the market system to flourish and maintain freedom of choice.

Government should make rules to level the playing field for all stakeholders and then get out of the way. An efficient healthcare system can be created by permitting the consumer to drive the healthcare system.

Many employers have adjusted to the present healthcare rules and regulations. The result has been greater dysfunction in the healthcare system .

As healthcare insurance premiums increased employers could not afford full coverage for their employees. They changed to providing partial insurance coverage. Employees are required to pay for a significant portion of their insurance policy. The money comes out of the employee’s salary with pretax dollars. .

Other employers have provided high deductible insurance for their employees. The initial deductible costs are paid for with after tax dollars and have been an unaffordable burden to employees. Some cannot afford to pay the deductible and avoid care.

This scheme has the same effect on employees’ purchasing power as a federal tax increase. It should be viewed as a hidden tax increase.

There are many ways to fix the inequities to consumers in the present healthcare insurance system. .

“Substantial improvements to private insurance markets can be much more targeted and straightforward.

1. These include changes to HIPAA and COBRA provisions to ensure portability between employer insurance plans,

1. Measures to prevent higher premium upticks for customers moving from group to individual insurance markets,

1. Ensuring that market entrants only face a single risk evaluation,

1. Opportunities for the uninsured to opt back in to the system under new protections.”

1. Correct accounting standard for incurred claim and Medical-Loss ratio.

1. Instituting ideal medical savings accounts with patients owning and controlling their healthcare dollars would result in consumers being educated purchasers of healthcare services. Permitting consumers to retain the unused portion of the deductible in a tax retirement trust account would motivate the consumer to have a healthy lifestyle.

1. Developing rules and regulations that calculate healthcare insurance premiums for the entire population and not rates determined by age or pre-existing illness.

1. Taxing employers appropriately so that they provide adequate healthcare insurance for their employees with tax deductible dollars.

    9. Creating malpractice reform that has caps on liability. It will decrease defensive medicine and over testing by physicians in order to avoid malpractice suits. This simple rule could decrease healthcare costs by $750 billion dollars a year.

“STEPHANOPOULOS: The president has drawn one other very red line in the sand, that he won't sign any health care bill that increases the deficit.”

“OBAMA: I will not sign a healthcare reform plan that adds one dime to our deficits, either now or in the future.”

However the history of government entitlement programs estimates has consistently contradicted President Obama’s statement. With the CBO’s estimates changing weekly and a large bureaucracy being set up, President Obama’s estimates are certain to be underestimates.

Next let's examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing.

In many states a person living in poverty but earn more than the poverty level defined in 1955, does not qualify for Medicaid coverage.

Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that's before the health-care bill covers millions of new beneficiaries.

The bureaucratic process for Medicaid coverage requires reapplication every six months. Moises’ reapplication was rejected by bureaucratic error without explanation. He and his wife do not have coverage. Now his children are uncovered. So much for bureaucratic efficiency in Medicaid.

Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren't small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion.

Even if one gave President Obama the benefit of the doubt on his budget estimates his plan will not repair the real defects in the healthcare system.

There is strong historical precedent that his new entitlement program will create large deficits no matter what tricks he plays with the numbers.

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

President Obama’s Trick Plays Are Blind-sided By Healthcare Insurance Industry

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform plan will not repair the healthcare system. It will not provide universal coverage. It will not provide affordable coverage and it will not increase the quality of care.

The main reasons are:

1. It does not deal with malpractice reform.

2. It does not deal with the administrative services fees charged by the healthcare insurance industry to the private sector and Medicare and Medicaid.

George Stephanopoulos spoke with David Axelrod on the This Week program on October 18,2009. The interview revealed an administration blind spot as President Obama pulls tricks to sneak through a healthcare reform bill that the public does not want and the government cannot afford.

STEPHANOPOULOS: So -- so you reject this argument that he has to draw more lines in the sand, twist the arms of his opponents, now tell people what he wants and expect it to get it done?

AXELROD: Let's take the issue of health care, because that's, obviously, one of the things that people are referring to. We are farther along than we've ever been in passing a comprehensive health insurance reform in this country. It's something we've discussed for 100 years. We are on the doorstep of getting that done, and that's because of the approach this president has taken.

President Obama has been ramming a healthcare bill through congress. Rahm Emanuel has been having meetings behind closed doors without Republican participation. He is even trying to sneak in the Public Option in the Senate bill the Democrats plan to bring to the floor.

This is not the definition of bipartisan agreement on legislation. David Axelrod’s remarks to prove his point is incomprehensible.

STEPHANOPOULOS: And yesterday, the president in his radio address suggested that he might be willing to take away their antitrust exemption.

Why would the healthcare insurance industry have an antitrust exemption to start with? The healthcare insurance industry’s pricing is non transparent to both the government and the private sector. Actuary calculations are a mystery, an inaccurate estimate and an easy way to cook the books.

STEPHANOPOULOS: Was he saying that he would sign a bill that would take that away and open the door to premium caps by the Congress?

David Axelrod avoided the question because it was a threat to the healthcare insurance industry. I think he knows the healthcare insurance industry wins no matter what kind of healthcare reform bill passes and the public loses.

AXELROD: Let's talk about the insurance industry for a second, because most of the stakeholders in this health care debate are at the table, they're trying to produce real reform, because everyone knows the current system is unsustainable.

Everyone is at the table because they want their pet dog to be included in the enormous injection of money into the healthcare system.

David Axelrod is also perpetuating the myth that Health Insurance = Health Care. Health Care really is medical care. We have excellent medical care in our country when you are sick. We have few systems at all levels of society to deal with prevention of disease.

Two prominent examples are the food industry and obesity and air pollution and chronic lung disease.

Health Care (Medical Care) is what your Doctor does for you.
Health Insurance is a third party's promise to pay Doctors out of that third party's own funds.

The healthcare market is unsustainable because of the pricing in the healthcare insurance industry. This is very different than medical care.

AXELROD: “The insurance industry has decided now at the 11th hour that they don't want to go along with this. One of the problems we have is we have a health care system now that functions very well for the insurance industry but not well for the customers. In the last 10 years, healthcare premiums have doubled.”

David Axelrod is correct here. He fails to say that Medicare and Medicaid is outsourced to the healthcare insurance industry.

STEPHANOPOULOS: President Obama is saying, if they don't play ball, they're going to lose their antitrust exemption?

AXELROD: 10 years ago, 15 years ago, the healthcare insurance industry spent 95 percent of their premiums on health care. Now it spends 80 percent with a 20% profit. More of the money is going to bonuses, salaries, administrative costs.

George Axelrod got the numbers wrong. The healthcare insurance industry keeps more than 20% of every healthcare dollar. It buries its fees in the Medical Loss Ratio calculations.

AXELROD: One thing we ought to do, the House bill has in it provisions that -- that says that if they fall below a certain level of return of these medical loss ratios -- in other words, the amount of money that they spend on actual health care, that they -- they need to rebate some of that money to consumers. That seems like a good idea.

If anyone believes that the healthcare insurance industry will refund premiums I have a bridge to sell you.

Medical Loss Ratio = Incurred Claims / Earned Premiums

The Medical Loss Ratio reflects what Insurers spend on Doctors and Hospitals, ignoring the accounting standards that direct inclusion of all claims against the entire insurance company ( including its shopping centers, blimps, skating rinks, billboards, management salaries "and so on") in the category called "Incurred Claims" - not just medical claims.
This is accounting slight of hand - including non-medical expenditures in a calculated value called "Medical Loss Ratio". President Obama is not fixing the accounting standards that generate enormous profits for the healthcare insurance industry at consumers’ expense.

The greater the incurred expenses, the less money there is available to cover medical expenses. The result is greater than the Medical Loss ratio. The artificial Medical Loss Ratio justifies increases in premiums by the healthcare insurance industry even as physician and hospital reimbursement decrease.

 

http://www.state.mn.us/mn/externalDocs/Commerce/Hospital_Medical_Dental__Indemnity_Corp_Non_Profit__111403105213_HMDI.pdf

President Obama should be focused on the Medical Loss Ratio accounting standard. If he did the fair thing there would be no need for this disastrous healthcare reform legislation.

President Obama’s healthcare reform plan is not for the people by the people. It is for special interests. The special interests are government and its control as well as the profit of the healthcare insurance industry. If is not for patients and affordable costs and improvement in the quality of medical care.

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

Everyone Is Getting Sick Of President Obama’s Trick Plays. Part 1

 

Stanley Feld M.D.,FACP,MACE

President Obama is doing exactly what a good lawyer does. He wears you down with trick plays. Voters are getting sick of hearing all about the benefits of his healthcare reform plan while not being told about the downside of healthcare reform. The administration and the Democratic congress are not listening to voter objections and voter mistrust.

Senator Baucus has gotten his bill out of committee. President Obama has hailed it as a bipartisan victory since one Republic Senator, Olympia Snow, voted for it. Most voters would say President Obama’s statement is a joke. It sounds as if he thinks voters are stupid.

The polls show that the Democrat congresspersons approval rating is less than 30%. President Obama’s approval rate is under 50%. Voters see massive tax increases coming down the pike. They feel powerless to stop them until they vote in November 2010.

Voters also know that newly formed bureaucratic agencies and entitlements are difficult to reverse. These new bureaucratic agencies and entitlements are about to be rammed through Congress. The public is frustrated.

Americans are witnessing a rapid recovery in the stock market. However, the country is facing larger deficits, increasing failures in the commercial real estate industry and an impending credit card debt crisis.

Bailed out banks defy President Obama’s plea to decrease bonuses using taxpayers’ dollars. These banks are getting ready to come to the government once more for more federal bailout money. Just change the rules so a person can only get paid on performance instead of bonus by contract. If someone receives a bonus by contract it should be a non tax deductible expense to the company.

The congress and President Obama are ignoring the basic systemic problems as promised. Most problems can be fixed by changing regulations with simple logical regulations.

The stimulus package is not stimulating the economy. President Obama is bragging about the stimulus package creating 30,000 jobs so far while the unemployment rate increases weekly. America is experiencing a jobless economic recovery. Where are the jobs? The only job growth is related to government job growth.

Locally real estate taxes are rising as out housing values are declining. However, cities and state are running large deficits and cannot afford to assess taxes on actual housing values.

We were told America is a government by the people for the people. However, our surrogate representatives are acting in the interest of special interests and not the people.

President Obama’s healthcare reform is not going to provide universal care as promised. His healthcare reform plan is going to increase our taxes and the deficit by at least 1.5 trillion dollars in ten years. President Obama has said he will not sign a bill that would increase the federal deficit.

“The problem for Mr. Obama is that the Baucus bill is being sold on the strength of accounting tricks that make it appear that it won't add to the deficit. If fiscally conservative Democrats sign on to the bill now after publicly saying they are doing so because it doesn't add to the deficit, they may end up bailing once the tricks are revealed to the public.”

The trick play is he is going to collect increased taxes and cut benefits (ration care to seniors) in the first five years before instituting reform. Meanwhile he will create a massive government bureaucracy.

President Obama healthcare reform plan will fail because the plan he is proposing escalates costs of healthcare not decreases it. The costs will be shifted from the government to the consumer by non transparent increases in taxes and increased out of pocket expenses.

 

“One trick is easily explained. The bill imposes tax hikes and benefit cuts right away, including $121 billion of Medicare reductions between 2011 and 2015. But new spending really doesn't start until five years out (2015) and isn't fully operational until 2017. The bill uses 10 years worth of tax hikes and benefit cuts to fund a few years worth of benefits.”

Shouldn’t voters have a say in this folly?

The Democrats and President Obama will see what will happen when the voter figure out what they are doing to us. I think the independent voters have figured it out already and will not vote Democratic in the next election.

“The Congressional Budget Office (CBO) released a report last week claiming the bill won't add to the deficit.”

“But this assumes that employers who dump employee coverage under the Baucus bill will then increase worker paychecks by an amount equal to what they had spent on health care. This replaces a nontaxable event (providing health insurance) with a taxable one (increasing worker paychecks), magically producing $83 billion in revenues. Without this windfall, the Baucus bill adds billions of dollars to the federal deficit in the first decade.

Of course, why would a company drop employee coverage just so it could pay more (in fines, taxes and wages) than it did before?”

How we are going to pay for this ineffective plan that is destined to fail. Voters have only to look at what has and is happening in Massachusetts. Massachusetts is having massive cost overruns. It has been forced to decrease coverage and ask for increased federal funds.

Nonetheless, President Obama states that Congress has taken a massive step toward the passage of a healthcare reform package that will provide universal care, affordable insurance and improve quality.

Does anyone believe President Obama and his trick plays anymore?

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

Confusion About The Ideal Medical Saving Account: Part 2

Stanley Feld M.D.,FACP,MACE

Why will President Obama’s Healthcare Reform Plan fail? Medicare and Medicaid have unrelenting increases in its yearly deficits. Both programs as well as the available private health insurance do not provide incentives to consumers or physicians to improve the healthcare system.

Consumers, who have healthcare insurance have been passive until now. “If I get sick my insurance will take care of me.”

As more people get sick they realize they are uninsured.

Therein lies the problem with President Obama’s Healthcare Reform Plan. It forces the consumer to be dependent on the government rather than to be responsible for health and healthcare.

Sometimes patients cannot help it if they get sick. Some illnesses are genetic. Some illnesses are environmental. Many illnesses are preventable.

Healthcare reform should put an emphasis on disease prevention. It should provide incentives for consumers to prevent disease and incentives for physicians to teach patients to avoid complications once they have a chronic disease.

Prevention of the onset of chronic disease and the complications of chronic disease require motivated consumers. It also requires the elimination of environmental hazard that precipitate chronic disease. There are many examples of environmental hazards (air pollution, toxic wastes, cigarette smoking, and obesity to name a few).

Let us take obesity as an example.

Is there any language provided in any of the bills before congress addressing the obesity epidemic?  No, yet obesity predisposes consumers to Type 2 Diabetes and coronary artery disease. Medical care of these two problems cost the nation $400 billion dollars a year.

 

In a March 26, 2008 article in the New York Times, New York City was declared Fat City? Ten (10) million pounds were gained in 2 years according to the April issue of Preventing Chronic Disease, a medical journal published by the Centers for Disease Control and Prevention.

“About 173,500 adult New Yorkers became obese and more than 73,000 received new diagnoses of diabetes from 2002 to 2004, according to a new study by the New York City Department of Health and Mental Hygiene. Put another way, “the citywide weight gain totaled more than 10 million pounds in just two years,” the city noted in a news release summarizing the study.”

President Obama should be concentrating his efforts on how to motive people to lose weight in order to avoid the onset of Diabetes Mellitus and Heart Disease. He and his healthcare reform team should study my “War on Obesity.”

None of the necessary steps are being taken by the administration to solve Obesity in America. Without a solution to the obesity epidemic, the Type 2 Diabetes Mellitus epidemic will continue and the cost of President Obama’s new entitlement plan will escalate.

How should President Obama motivate people to be responsible for their own care? He should provide incentives. He should propose and enforce regulations that provide consumers with a healthier food environment.

A first step would be to deal with farm subsides that encourage obesity. It can be done. He must also provide effective education to the public to combat obesity. He must provide economic incentives to consumers to exercise and lose weight. This can be accomplished by the ideal medical savings account.

President Obama should become serious about dealing with malpractice reform. The cost of defensive medicine is $750 billion /year. Consumers must be educated to demand tort reform. Defensive medicine would affect the remaining balance in their medical savings accounts. Consumers should be taught to demand an explanation for the tests from their physicians. Consumers could be taught to waive physicians’ liability if there is no good reason for a test. Physicians have not been sued for tests they have done. They have been sued for tested they have not done.

President Obama should be spending money on a system that encourages innovation (the ideal medical savings account) rather than spending and wasting money on a new entitlement for a healthcare system that is broken.

I will repeat my answer to your question. Your employer or the government pays for your ideal medical savings account.  The entire policy (the $6,000 deductible and the $6,000 high deductible policy) remains tax deductible to your employer.

You have the responsibility to use the first $6,000 wisely and remain healthy. If you do not spend it you keep it in a trust account tax free for retirement and not for future healthcare needs. If you use it before you retire you pay ordinary income tax plus a penalty. If you spend more than $6,000 you receive first dollar healthcare coverage.

If you are self employed and qualify for government aid or a subsidy the government pays for healthcare premium. If you are on Medicaid the government remains the payor.

All citizens would have the same healthcare coverage. Everyone would be responsible for their choice of lifestyle. President Obama would instantly have 300 million consumers repairing the healthcare system. It would take major control of the healthcare system out of the healthcare insurance industry’s hands.

Stimulating innovation would decrease the cost of healthcare while insuring everyone. It would improve wellness and quality care.

Expanding an entitlement is not the answer to Repairing the Healthcare System.

 

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

Confusion About Ideal Medical Saving Accounts: Part 1

Stanley Feld M.D.,FACP,MACE

I agree with the general goals of healthcare reform as outlined by President Obama. They are universal healthcare, affordable healthcare, and quality healthcare. The problem is the route he is taking will not achieve his goals.

His route will increase bureaucracy, decrease freedoms of individuals to choose, decrease quality and increase the cost of care.

A reader question highlights the confusion about the ideal medical saving account.

“ Do I understand you expect me to pay $500 per month toward tax free trust account and also budget $500/month for medical expenses toward my deductible?

How does a person making under $28,000 year do this!

The answer to the question is no.

The government or your employer would pay the $500 per month for you into a trust account. This would put the first dollar coverage in consumers’ hands rather than the healthcare insurance industry’s hands. The trust account would serve as an economic incentive for consumers to become wise shoppers for medical care and for them to be responsible for their own wellness. What was not spent of the first $6,000 would be in consumers’ retirement account rather than in an account for future healthcare expenditures.

Consumers would force providers to be innovative and compete for the consumers’ healthcare dollars just as Wal-Mart, Target, and Amazon do. Government’s position should be to provide appropriate consumer education to protect them and become informed shoppers for their healthcare needs.

There are several new innovative practice and healthcare insurance systems being developed by physicians that will reduce the cost of care by marginalizing the healthcare insurance industry’s influence and control over the healthcare system while reducing physician overhead.

I will discuss some of these innovative practice and healthcare insurance systems in the near future.

President Obama is willing to spend 1 trillion dollars over the next ten years to repair the healthcare system in addition to the many billions President Obama has secured in the hastily prepared “economic stimulus package.” It is money that will be wasted because his healthcare reform package can only increase healthcare complexity and decrease access to care. It will also increase the healthcare industry’s profit at the expense of medical care to consumers.

Consumers should be motivated to be in charge of their healthcare needs and expenditures. President Obama’s healthcare team thinks a large and inefficient bureaucracy will do it. He has only to look at the failed system in Massachusetts.

Everyone agrees that Medicare and Medicaid have failed. Seniors, in general, are satisfied with Medicare coverage until they have to pay all the deductible costs.

Some are able to cover the deductible costs with additional insurance (Medigap or Medicare Advantage) coverage. The premiums for Medicare are high with the upper limit for full coverage being $15,000 a year. The cost of the Medicare premium is not noticed because it is taken out of their social security payment.

The premiums with coverage for deductibles and drugs can vary from $3,000 per persons to $7,500 per person with after tax dollars. Seniors are all means tested by direct communication between the IRS (tax returns) and Medicare.

Despite high premiums the government has to subsidize healthcare costs at an unsustainable rate. New innovative delivery of healthcare is essential in order to deliver healthcare at an affordable cost, universally, and with increased quality.

Expanding the Medicare system to all citizens will simply make the deficit worse. The CBO estimates that in 40 years the yearly deficit will increase by 100 trillion dollars with the present healthcare system.

There are ways to accomplish President Obama’s goals. The system has to be simplified. Consumers have to be in control of their healthcare dollars and be responsible for their health. President Obama’s healthcare reform plan will make consumers more dependent on government and healthcare more expensive.

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

Where Are The Facts?

Stanley Feld M.D.,FACP,MACE

 

The New York Times wrote an editorial “Medicare Scare-Mongering.” The editorial contained no facts proving its proposition.

“It has been frustrating to watch Republican leaders posture as the vigilant protectors of Medicare against health care reforms designed to make the system better and more equitable.”

Both Democrats and Republicans know that Medicare is unsustainable in its present form. Both parties are posturing for the public and political power. Neither are attacking the problems in the healthcare system to make the system sustainable.

Why? Repairing the healthcare system threatens the vested interests of secondary stakeholders that fund politicians’ election.

“ This is the same party “Republicans” that in the past tried to pare back Medicare and has repeatedly denounced the kind of single-payer system that is at the heart of Medicare and its popularity.”

Both parties are trying to pare back Medicare because Medicare is unsustainable. Each party’s methodology is different.

“For all of the cynicism and hypocrisy, it seems to be working. The Republicans have scared many older Americans into believing that their medical treatment will suffer under pending reform bills.”

Seniors have evaluated the Democrat’s proposals. They understand the implications of the various proposals. Seniors are convinced that the implications are going to have a negative impact on their present level of care. They mistrust the political rhetoric and understand bureaucratic inefficiency. .

“The general public believes that, too. The latest New York Times/CBS News poll of 1,042 adults found that only 15 percent believe changes under consideration would make the Medicare program better, while 30 percent think they would make it worse.”

It would be very simple for the New York Times editorial board to explain how the Democratic proposals would improve Medicare coverage. The editorial does not do this. It is more rhetoric.

“The Obama administration and Congressional leaders are hoping to save hundreds of billions of dollars by slowing the growth of spending in the vast and inefficient Medicare system that serves 45 million older and disabled Americans.

If Medicare is inefficient, how is the administration going to do to make it efficient? It cannot do it by increasing bureaucracy. 

The Obama proposals are ignoring the two most wasteful aspects of Medicare, defensive medicine and the healthcare insurance industry’s abuse of outsourced administrative services.

The inefficiency in Medicare will only increase when the government controls healthcare coverage of an additional 45 million people.

There is only one logical way for the government to reduce costs. It must ration care. Reducing Medicare payments by $500 billion dollars over the next few years is not going to decrease bureaucratic inefficiency.

The editorial also complains about Medicare Part D and Medicare Advantage. Both programs were terribly constructed. They rip off both patients and the government. Complaining about them and throwing money at them will not make them more efficient. Medicare Advantage must be eliminated and Medicare Part D must be redone in a logical way and not to the advantage of the healthcare insurance industry.

“by enhancing their drug coverage, reducing the premiums they pay for drugs and medical care, eliminating co-payments for preventive services and helping keep Medicare solvent, among other benefits.”

Why isn’t the editorial board attacking the healthcare insurance industry that is making billions of dollars from Medicare Part D at the government’s expense? Why isn’t the NYT editorial board demanding that the government negotiate the same drug price it pays for military and veterans administration drugs?

The House legislation, the only bills in near-final form, would reduce and ultimately eliminate a gap — the so-called doughnut hole — in Medicare drug coverage that currently forces more than three million beneficiaries to pay for drugs entirely out of their own pockets once they hit specified spending levels.

It will create a great government deficit.

Republicans are not the villain. The current proposals are the villain. The proposals will restrict access to care, ration care, and waste $1.1 trillion dollars on top of the yearly loss presently.

But the Republicans have done far too good a job at obscuring and twisting the facts and spreading unwarranted fear. It is time to call them to account.

The New York Times editorial board does not present a stitch of evidence for the statement below. I think liberals are so tired of the senseless debate that they will accept any declaration.

What the Republicans aren’t saying — and what the Democrats clearly aren’t saying enough — is that in important ways, coverage for a vast majority of Medicare recipients, those in traditional Medicare, should actually improve under health care reform.

The New York Times editorial board is clearly pro Obama and has done a poor job analyzing the content of the proposals.

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

GOVERNMENT MEDICINE SHOULD HORRIFY AMERICANS: Part 3

 

Stanley Feld M.D.,FACP,MACE

The Canadian Healthcare system does not offer us a better option. We are told Canadians are happy with their system. However, only 20% of the potential patients use the system at one time. When Canadians need Immediate care they often come to the U.S. and pay cash for their treatment rather than face the lines resulting from rationed care.

“*Canada has one-third fewer doctors per capita than the OECD average. "The doctor shortage is a direct result of government rationing, since provinces intervened to restrict class sizes in major Canadian medical schools in the 1990s," Dr. David Gratzer, a Canadian physician and Manhattan Institute scholar, told the U.S. House Ways & Means Committee on June 24.”

Many Canadian physicians have come to the United States to practice medicine in the last 20 years.

“ Some towns address the doctor dearth with lotteries in which citizens compete for rare medical appointments”.

Massachusetts’ universal healthcare system has failed. In Massachusetts there is an overwhelming shortage of Primary Care Physicians. Patients are trading or selling physician appointments in many small towns.

Canada has the same horror stories. Eighty percent of Canadians are not sick. They feel their healthcare system is fine.

There are many deficiencies in Canada’s single party payer system that are not advertised by politicians in the U.S. that want a single party payer.

"In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment," Pacific Research Institute president Sally Pipes, a Canadian native, wrote in the July 2 Investor's Business Daily. "That's 86 percent longer than the wait in 1993, when the [Fraser] Institute first started quantifying the problem."

* This includes a median 9.7-week wait for an MRI exam, 31.7 weeks to see a neurosurgeon, and 36.7 weeks - nearly nine months - to visit an orthopedic surgeon.”

These waiting times are rationing of care. Patients have sued the government and the Supreme Court ruled in favor of patients.

“ The Canadian supreme court justice Marie Deschamps wrote in her 2005 majority opinion in Chaoulli v. Quebec, "This case shows that delays in the public health care system are widespread, and that, in some cases, patients die as a result of waiting lists for public health care.”

The healthcare debate in the U.S. is not about improving the health of Americans. It is about shifting the control over the healthcare system to the government from the private sector.

If healthcare reform was about improving the health of Americans, our politicians would be focusing on how to decrease our mortality and morbidity rate due to the major chronic illnesses, how to decrease the abuse of the healthcare insurance industry, how to decrease the waste of defensive medicine, how to get people insured that are refused insurance with pre existing illness and how to give people incentives to keep themselves healthy.

These are the major issues. There is no need to have to take over the healthcare system. The government should make the rules, level the playing field in favor o the consumer, let the consumer drive healthcare and then get out of the way.

“The public option - for which Democrats lust - would fuel an elephantine $1.5 trillion overhaul of this life-and-death industry. Guess who goes home with the goodies?”

It is not the consumer. It will be the government bureaucracy, the healthcare insurance industry, and the pharmaceutical companies.

It will be the government having control over the public and its ability to choose its healthcare. It will increase government’s dominance over our lives and our freedoms.

Is this what Americans’ want?

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

GOVERNMENT MEDICINE SHOULD HORRIFY AMERICANS: Part 2

Stanley Feld M.D.,FACP,MACE

The single party payer system in Great Britain and Canada is not as good as Democrats and the mass media have led us to believe. The United States pays more of our gross national product for its healthcare than Great Britain and Canada do but they do not get the same or better outcomes than we do.

The healthcare system in the U.S. could be repaired. The cost can be reduced significantly if the U.S adopted the changes I and others have advocated

The changes are significant malpractice reform, reduction in waste and abuse by the healthcare insurance industry, consumer driven healthcare through a medical savings account and the institution of a universal electronic medical record funded by the government and paid for by physicians and hospital systems by.usage

The sound bite of effective care given in Great Britain and Canada for less money is false. Here are just a few outcome comparisons between our healthcare system and theirs. You be the judge;.

• “Breast cancer kills 25 percent of its American victims; in Great Britain, the Vatican of single-payer medicine, breast cancer extinguishes 46 percent of its targets.”

Why? Early diagnosis with timely mammography and immediate and intensive treatment at the time of diagnosis.

“ Prostate cancer is fatal to 19 percent of its American patients. The National Center for Policy Analysis reports that it kills 57 percent of Britons it strikes.”

It is fatal in 19 percent of American males because of delayed diagnosis and treatment in some males. Males are not good about routine checkups. They go to the physician when they hurt. Some without insurance cannot afford to get a routine PSA screening test..

“ Organization for Economic Cooperation and Development data show that the U.K.'s 2005 heart-attack fatality rate was 19.5 percent higher than America's. This may correspond to angioplasties, which were only 21.3 percent as common there as here.”

Why? The difference is caused by a delay in access to care.

“The U.K.'s National Institute of Health and Clinical Excellence (NICE) just announced plans to cut its 60,000 annual steroid injections for severe back-pain sufferers to just 3,000. This should save the government 33 million pounds (about $55 million). "The consequences of the NICE decision will be devastating for thousands of patients," Dr. Jonathan Richardson of Bradford Hospitals Trust told London's Daily Telegraph. "It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

It is not very smart or efficient to restrict access to care to end up with patients being addicted to narcotics and/or needing surgery that will be delayed because of restrictions on access to care.

"Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets," Daniel Martin wrote last year in London's Daily Mail. "Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour [party] pledge. The hold-ups mean ambulances are not available to answer fresh 911 calls. Doctors warned last night that the practice of ‘patient-stacking' was putting patients' health at risk."

Unintended consequences are usually the result of bureaucratic mandates. It is similar to the airlines leaving the gate to leave on time and then keeping us waiting on the tarmac for takeoff so that it looks good for on time takeoff statistics. It is not about service. It becomes about statistical targets to cover defects.

There are many more examples of defects in the National Health Service of Great Britain that we never hear about. The average person is not sick and does not complain about the healthcare system. Many are passive about the abuse they experience in the healthcare system.

President Obama’s healthcare team is going to create a Federal Healthcare Board similar to the NICE and have a panel of experts decide on best practices for Americans in order to improve our healthcare system.

When has a consensus committee ever improved anything? A consensus panel will eliminate individual freedom to make healthcare choices.

Is this what Americans’ want?

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