Repairing the Healthcare System

President Obama, We Are Looking For Inspirational Leadership Not More Spending and More Taxes

 

Stanley Feld M.D.,FACP,MACE

 

President Obama, you won the election because you are articulate, confident, logical and inspirational. You projected a vision for the country that included fairness and opportunity for all. You promised to return to America’s ethical and moral base. The country was tired of congressional bickering, gridlock, threats to constitutional freedoms, gamesmanship, and unproven or hidden corruption. Americans were tired of corporate privilege and abuse.

In early 2008 America was told the economy was doing great. America was winning the war in Iraq. America was winning the war on terrorism. There was no inflation in the U.S. Housing prices were rising. No of these declarations made any sense to the average American.

All an average American had to do was wake up in the morning and experience rising prices, housing foreclosures, and a bombs exploding in Iraq to know there was something wrong with these declarations.

In January 2009 the government told us we had been in a recession since October 2007. Is the individual’s testing of reality better than the government’s. The government has all those fancy, incomprehensible indices. Indices that happen to be derivatives of derivatives such as gross national product, housing starts and the consumer price index

America has a generalized mistrust of government and its agencies,politicians, banks, corporations and other commercial entities. The United States has had an ethical and moral deficiency leading to our economic collapse.

To me, the A.I.G. bonuses simply highlight this deficiency. Congress’s action to remedy A.I.G. bonuses highlights congressional impotence and showboating. It underlines its inability to act to cure our ethical and moral problems. Its actions also highlights congress’s inability to problem solve for the peoples benefit. It problems solves for its own benefit and desire to increase power over our lives.

America elected you, President Obama, in the hope that you would restore us to our ethical and moral center. Please do it quickly. Please abandon outmoded systems that you are preparing to reregulate. It will only hinder Americans ability to be innovative and it will surpress worthy incentives. Please let us develop and promote fresh new ideas that will put us on a stronger footing for economic growth in the future.

Tom Freidman expressed it beautifully last Sunday.

“President Obama missed a huge teaching opportunity with A.I.G. Those bonuses were an outrage. The public’s anger was justified. But rather than fanning those flames and letting Congress run riot, the president should have said: “I’ll handle this.”

He should have gone on national TV and had the fireside chat with the country that is long overdue. That’s a talk where he lays out exactly how deep the crisis we are in is, exactly how much sacrifice we’re all going to have to make to get out of it, and then calls on those A.I.G. brokers — and everyone else who, in our rush to heal our banking system, may have gotten bonuses they did not deserve — and tells them that their president is asking them to return their bonuses “for the sake of the country.”

I bet they would be compelled by public sentiment to return their bonuses for the sake of the nation. It would be better for them and the country to return their bonuses voluntarily than return them through unconstitutional taxation. This tax moves America further from its ethical and moral base. President Obama ,you should inspire, not coerce ethical and moral behavior.

President Obama, I am sure you know inspiring conduct has a greater impact that trying to enforce conduct. The government bureaucracy is usually poor at enforcing regulations. There are usually loopholes in new regulations. Rich vested interests have a way of wiggling through these loopholes at citizens’ expense. You were elected because of your populist notions and the promise to return America to our ethical and moral base. You have expressed the notion that you cannot legislate ethics and morality. You must inspire Americans to do what they should do and not force them to do it. Regulations and increased taxation have a way of precipitating unintended negative consequences.

“There is nothing more powerful than inspirational leadership that unleashes principled behavior for a great cause,” said Dov Seidman, the C.E.O. of LRN, which helps companies build ethical cultures, and the author of the book “How.”

Dov Seidman’s principles hold true in healthcare. Loopholes in healthcare regulations have permitted stakeholders to adjust. Further regulations to close loopholes resulted. These adjustments to regulations have permitted the healthcare insurance industry to capture the greatest share of the money at the expense of the primary stakeholders (consumers).

Your healthcare team is doing nothing other than expanding failed programs (Medicare and Medicaid). Congress has given you the money to repair the healthcare system by the force of your personality and oratory. Your team is in the process of handing the appropriation over to the healthcare insurance companies. Think about it. Why do you think the healthcare insurance industry is in favor of universal care extension of Medicare and Medicaid ? Look at the profit they are generating in Massachusetts.

It is time to be inspirational and innovative. You promised if something did not work you would try something else. You have the money for healthcare, put it in the hands of the consumer with rules and regulations that protect consumers. I believe you and the country will be pleased with the results.

America needs inspiration and innovation, not false hope from failed systems in order to repair the healthcare system.

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

President Obama Don’t Confuse Us With Illogical Thinking.

 

Stanley Feld M.D.,FACP,MACE

Medicare and Medicaid flunk the Institute of Medicine’s criteria defining an effective healthcare plan.

“The President's $634 billion "down payment" on health care reform in his proposed budget depends on raising taxes and saving money largely through administrative payment changes in existing entitlement programs. That is not exactly fundamental reform.” John Goodman’s analysis of Nicholas Kristof New York Times editorial is perfect. He starts off by saying: “I have observed before that when people start talking about health care their I.Q. tends to fall about 15 points.” “The same error in reasoning appears in almost every speech on health care given by Barack Obama and by just about everybody else on the political left as well.” I am not interested in partisanship. I am only interested in logical problem solving. If a plan for medical treatment makes sense and has good clinical evidence to prove a positive outcome, I am for it. The same applies to solving social and economic problems. President Obama’s healthcare team is in the process of formulating a plan that is not logical . The healthcare plan has not succeeded in the past and will fail at a greater cost to taxpayers and society. John Goodman has outlined the logic used by Nicholas Kristof and the administration to justify the validity of the administration’s healthcare reform plan. Classic syllogisms are taught to every high school student ; All men are mortal Socrates is a man Therefore Socrates is mortal John Goodman points out the syllogism used about by Nicolas Kristoff and the administration: “Major Premise: The United States spends twice as much per person on health care as Canada and most European countries and has worse outcomes. Minor Premise: Spending twice as much in return for less is bad. Conclusion: We should tax the rich and spend even more on health care. Whoa! Something's wrong here.” You bet there is something wrong. It is not logical. The proposed solution of taxing the rich does not follow expanding failed programs (Medicare and Medicaid). President Obama’s healthcare reform proposal; 1. Down Payment or Unknown Costs President Barack Obama's budget sets aside $634 billion over 10 years in a health care reserve fund, which is earmarked for the enactment of unspecified policies intended to bring down costs and expand coverage but its true costs are still unknown.. The congressional budget office’s estimates are much higher. 2. Key Provisions in the Health Care Budget Higher Taxes. The President is proposing tax increases on those making over $250,000 annually. This revenue is projected to finance approximately half of the projected health care spending, an estimated $318 billion. The President’s healthcare team is proposing to throw money at a broken system and use the tax increases to pay for it. The result will be a further increases in future taxes. President Obama should be developing a healthcare system that will provide incentives to the primary stakeholder (consumers) and promote innovative thinking and behavior by the other primary stakeholder (physicians) to promote efficiency and decrease costs. His plan does not initiate real change in the healthcare system. The government will still outsource administrative services to the healthcare insurance industry. The healthcare insurance industry will still control the healthcare dollar. 3. Medicare Private Plan Payment Changes. 4. Medicare Prescription Drug Premiums. Under this proposal, higher-income seniors would pay higher premiums than lower-income seniors for Medicare Part D prescription drug coverage. Medicare Part D is presently too expensive. Its premiums have tripled in the last two years. Medicare Part D has benefited the healthcare insurance industry. The healthcare insurance industry’s net profit is $5 billion dollars per  year. Only 20% of Medicare patients participate. 5. Medicaid Prescription Drug Payment. 6. Medicare Payment Changes. “Systemic delivery reforms, such as "pay for performance" (where physician and hospital reimbursement are tied to compliance with government practice guidelines), are intended to result in securing better value for dollars.” Similar “reforms” have lead to providers adjusting by gaming the system. Centralized medical decision making in Washington will lead to political manipulation of the system by healthcare lobbyists. It does not repair the healthcare system.   7. Medicaid Family Planning. 8. Prescription Drug Re-Importation. President Obama’s healthcare plan does little to empower the patient. It does little to change our healthcare system’s flawed public and private payment system. The power to manipulate the system’s payment remains in the healthcare insurance industry’s hands. Its appeal is to the populist notion to “soak the rich” to help the poor. It does not add value to individual freedom of choice and ability to secure valuable healthcare. It does not repair the healthcare system. If President Obama really wanted to repair the healthcare system he would place control and decision making for healthcare needs in the hands of the consumers and their families. The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Consumer Driven Healthcare Plans Trickle

 

Stanley Feld M.D.,FACP,MACE

 

As the healthcare debate heats up the meaning of consumer driven healthcare (CDHC) needs repeating. The true meaning of CDHC has been bastardized by the healthcare insurance industry as represented by Health Savings Accounts (HSA).

The healthcare insurance industry feared that if Medical Savings Accounts dominated it would lose control of the initial healthcare premium dollars. The result would be a decrease in profit and an increase in price competition and real price transparency.

The reality would be America would have universal healthcare in a more efficient healthcare system. The system would be more efficient because it would be driven by the consumer for their benefit and not a third party payer. A more efficient system will maintain healthcare insurance industry’s profit while permitting a decrease in healthcare system costs.

“A lack of consumer understanding has contributed to the glacial growth of consumer-driven plans. Can better information from health plans help CDHPs take hold?”

HSAs place limits on consumers’ incentives. All of the healthcare premium dollars are eventually paid to the healthcare insurance industry.

Our economic recession along with increasing unemployment have set the stage for consumers to accept any help government will provide. Enter a single party payer and all its problems. Since Medicare and Medicaid have proven to be unsustainable, it is foolish to throw money at a failing system. It is time to revitalize the system.

Just the opposite should be occurring. CDHC should be promoted and not be marginalized. President Obama’s universal healthcare with a single party payer system marginalizes CDHPs. The route he is taking to achieve everyone’s goals and will not repair the healthcare system.

“The idea behind consumer-driven health plans is to transform members into healthcare consumers through education and place more responsibility on the individual.”

Health Saving Accounts (HSA) do little to encourage patient responsibility or make patients informed consumers. HSA were a political compromise designed by the healthcare insurance industry. The resulting plan gutted the intent and effect of the CDHC movement.

“ Studies show that the percentage of Americans insured in CDHPs is still in the single digits, largely for two reasons: Consumers simply don't understand the tax-free savings accounts that are connected to CDHPs, and few health plans are providing cost and quality information to allow consumers to compare doctors, hospitals, and treatment options.”

Wrong!

Consumers do not see a financial advantage of the HSA because there are none. The money has to be used to pay present deductibles and future deductibles. There is no reason the future deductable will not be increased reducing the present value of the money in their health savings account. The healthcare insurance industry wants health savings accounts to fail. It feels its margins are presently excellent and does not need a change.

“More than one-quarter those respondents said that HSAs are difficult to open/manage, or too complicated, or they simply didn't understand the accounts.”

Consumer driven healthcare is the only thing that can repair the healthcare system. It would take control out of the healthcare insurance industry’s hands. The route to take is the ideal medical saving accounts.

Healthcare insurance would convert to real at risk insurance. Consumer would own and control their healthcare dollar. The government could teach the consumer to use the healthcare dollar wisely. The government could provide clear price and quality transparency. It would force all the secondary stakeholders to compete for the consumers’ healthcare dollar. This competition would force an increase in efficiency and decrease in administrative waste.

The government should act as the facilitator for the competition. The time has come for politicians to do something for consumers and not for secondary stakeholders.

New Budget Cuts Herald Failure Of Massachusetts’ Bipartisan Universal Coverage Plan

Stanley Feld M.D.,FACP,MACE

 

I have predicted that the Massachusetts bipartisan universal coverage healthcare was destined to fail. I have explained all of the reasons for my prediction.

Never the less, President Obama’s healthcare team is modeling his universal healthcare plan after the Massachusetts plan. It is possible the President’s healthcare team knows this plan will fail. They will then conclude the only remaining option will be a single party payer system run by the government.

However, the government presently outsources Medicare’s administrative services to the healthcare insurance industry. The healthcare insurance industry controls the healthcare dollars and therefore controls the costs and the coverage. A single party payer system will also fail just as Medicare is failing unless the structure of the Medicare system is changed.

The solution is to change the control of the healthcare dollar from the healthcare insurance industry to the consumer.

In the meantime President Obama’s healthcare team will destroy the healthcare system piece by piece.

“Several key public health programs face sharp cuts under the state budget proposed yesterday by Governor Deval Patrick for the next fiscal year.”

“The $28 billion spending plan also freezes Medicaid reimbursement rates for doctors and hospitals who care for poor patients, after steep cuts made in October.”

Massachusetts’ physicians seem to be the most tolerant physicians in the nation. They tolerate continued reimbursement freezes and cuts even though their overhead rises but they are losing their tolerance rapidly.

"We have a state that has been visionary in pioneering health reform and universal coverage," said Dr. Bruce Auerbach, president of the Massachusetts Medical Society and head of emergency care at Sturdy Memorial Hospital in Attleboro. "Anything we do that reduces the ability of physicians to care for Medicaid patients is going to negatively impact our pursuit of true healthcare reform."

You bet it will. Politicians will conclude, as they have in California, is the only way to pull this out of the ditch is to increase taxes. They do not realize that if they increase taxes they could drive business out of the state. The result would ultimately be the reduction of state tax revenue.

The governor's tax proposal also touched on public health: He is seeking new levies on alcohol, candy, and sweetened beverages among other increases in taxes.

This tax idea is not a bad idea. It could encourage lifestyle change and even decrease obesity and alcoholism. The result could be to decrease chronic disease and its complications thereby decreasing healthcare costs.

According to administration estimates, those new tariffs would generate $121.5 million for public health initiatives, if the Legislature goes along with them.

In order to save face the mandated universal healthcare plan was not cut except for one critical element. Eliminating a program that helps the insured enroll will generate more uninsured citizens as unemployment rises during this recession.

“The state's closely observed health insurance initiative, which requires most adults to have coverage, emerged largely, but not entirely, untouched in the budget blueprint. A program that helps the uninsured enroll for health coverage was eliminated, just as thousands of Bay State residents are losing their jobs.”

This is occurring after the federal government has provided Massachusetts with 8 billion dollars in state bailout money. Someday a healthcare plan that aligns all the stakeholder incentives and solves the problem of the complications of chronic disease will be proposed by a governmental body. It would help to ask patients and practicing physicians what they think the solution is. That day does not seem to be on the horizon.

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

Healthcare Leaders In Massachusetts Told To Rein In Costs: Wake Up America!

 

Stanley Feld M.D.,FACP,MACE

It was obvious to me at the onset that the Romney Massachusetts universal healthcare plan would fail. The healthcare insurance industry has remained in control of the healthcare dollars. The state of Massachusetts, rather than the individuals, would become victim to the rising costs. There was no evidence in the Romney plan that the quality of medical care would increase. The plan was not designed to provide incentives to improve the behavior, patients or hospitals. Massachusetts has already received an 8 billion dollar federal bailout and is seeking an additional 2 billion dollars to stay afloat.

“Governor Deval Patrick yesterday asked the state's most prominent hospital and health insurance leaders to take quick action to hold down rapidly rising healthcare costs, suggesting that if they did not take steps on their own, they might face new government regulation.”

The state did not alter the healthcare insurance industry’s control of the healthcare dollar in the healthcare system. It generated more insured patients for the healthcare insurance industry. It did not lower the premiums as predicted. The premiums continue to increase. A lack of real price transparency is the reason for this. The state’s universal healthcare plan did not alter patients’ or physicians’ behavior. It lacks patients’, physicians’ and hospital systems’ incentives to change behavior. The Massachusetts plan provides a guarantee for universal coverage but did not improve coverage, or quality or decrease costs.

“Governor Patrick said he is considering holding hearings on health insurance premiums and the primary driver of premium increases - the rates hospitals charge insurers for members' medical care.”

The governor knows exactly who the primary driver of the costs is. It is the healthcare insurance industry with hospital system collusion. However, he will never be able to prove it without a requirement for real price transparency.

" “ Insurance executives at a meeting said they would welcome such an investigation", according to Charles D. Baker, chief executive of Harvard Pilgrim Health Care, the state's second-largest health insurer.”

The inspector general (Mr. Sullivan) asked the healthcare insurance executives to refrain from signing new contracts that cover patient care beyond this year until the government has time to consider potential reform measures.

Mr. Sullivan singled out the largest private contract in Massachusetts, the state's dominant provider, Partners HealthCare, and its largest insurer, Blue Cross and Blue Shield of Massachusetts. The Boston Globe has had multiple stories exposing the abuse to the state and patients by these providers.

“The two agreed last summer to a multiyear contract that calls for annual rate increases of about 5 to 6 percent. Spokesmen for Partners and Blue Cross said yesterday the agreement was final.”

Got cha, tough luck.

The state of Massachusetts response has been to set up a reform payment commission. The commission will examine alternatives to the traditional payment model in healthcare. In Massachusetts the large hospital systems hire most physicians and pay a salary. Physicians have little control over their charges and salaries. I suspect the hospital systems are profiting from physicians intellectual property.

Partner's healthcare executives and healthcare insurance executives are trying to distract the state from the real issue which is inflated charges.

“ Many insurance executives and healthcare reformers argue that providers should be paid for healthy outcomes, not as they are now - based on the number of tests and procedures they perform on patients.”

“Dr. James J. Mongan, chief executive of Partners, said Patrick "understands [healthcare costs] are national issues, but the state of Massachusetts showed it could lead on national issues with [healthcare] coverage and it's going to try and lead on national issues with costs."

This rhetoric has not fooled Governor Patrick. However, he seems to be powerless to do anything about it because Partners and Blue Cross control his work force.

“Governor Patrick "made clear that this is sort of a today issue, not a tomorrow issue.”

A state sponsored Spotlight team reported a deal made by Partners and Blue Cross in 2000. Blue Cross would pay for services of Brigham and Women’s and Mass General Hospital (Partners) in exchange Partners would insist on receiving payments from other insurers that were at least equal.

“Healthcare costs have risen dramatically since that time.” Healthcare coverage has also decreased

Tufts Medical Center announced it would stop accepting Blue cross insurance company patients because Blue Cross is paying Tufts 32% less than they are paying Mass General and the Brigham.

“Blue Cross says demands for higher payments by Tufts would increase healthcare costs.”

The state of Massachusetts wanted to do the right thing (universal coverage). It became the victim rather than the cure. In the words of Yogi Berra it is “Deja vue” all over again.

Please listen carefully to Tom Daschle’s proposals for healthcare reform. It is similar to the failing Massachusetts plan.

Wake Up America!!

Obama Will Ration Health Care!: Wake Up America: Part 2

Stanley Feld M.D.,FACP, MACE

Mr. Obama has promised a quick, hard push to overhaul the healthcare system. Americans can expect a quick push to build a larger federal bureaucracy, impose price controls, restrict the use of new medications and technologies, boost taxes, mandate the purchase of health insurance, and expand government control of health care. This is the promise Mr. Daschle made in his book "Critical: What We Can Do About the Health-Care Crisis,"

If Mr. Obama continues on the present path the prognosis is horrible for patients, physicians and taxpayers. Tom Daschle’s excuse is the present system is an intolerable status quo. An intolerable status quo is not an excuse to destroy the healthcare system in America.

“In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs.”

Healthcare coverage will likely expand to greater government healthcare control. Businesses and corporations are anxious to get out of the business of providing healthcare coverage for their employees. They would rather pay the penalty proposed than provide unaffordable healthcare insurance for their employees. The result will be defacto socialized medicine before we know what hit us. Socialized medicine is Mr. Daschle’s plan for all Americans even though America can’t afford it. He is going to claim this is the plan the people want. I would add until the people realize the consequences of his plan.

“Given the opportunity, Mr. Daschle would likely charge the board with determining which treatments and drugs are cost effective and therefore permissible to use for patients covered by the government.”

“It is nearly certain that the process of determining which drugs and which treatments would be approved for use would be quickly politicized.”

The Federal Health Board will be made up of “expert clinicians” from academic centers who will determine what physicians can and cannot do. The enforcement of these rules will be impossible. The punitive weapon will be withdrawal of physician reimbursement. I have said over and over again that punitive measures do not work to force a workforce to comply.

“In his book, Mr. Daschle complains about overuse of new technology and praises the United Kingdom's National Institute for Health and Clinical Excellence (NICE), a rationing system that controls government costs.”

Mr. Daschle believes that America needs to ration new technology and drugs because the cost of care is skyrocketing. Another reason is the government cannot afford to provide access to care. The result will be rationing of care rather than giving patients the freedom of choice. The British system is well known for restricting access to drugs and medical care.

He is ignoring the waste in administrative services outsourced to the healthcare insurance vendors. He is ignoring the inefficient billing practices of hospital systems. He is ignoring the responsibility patients have to adhere to treatment medications prescribed and the maintenance of their health. He is ignoring the fact that patients should be responsible for their health and their healthcare.

“Health care is personal and voters will pressure lawmakers on access to care. Americans will not put up with such limits, nor will our elected representatives.”

Mr. Daschle is claiming that through his community home meetings in December people are demanding the changes he is proposing. I believe once the voters realize what he is proposing the will voice the opposite opinion.

Managed care of the 1990’s was nothing more that managed cost. It provided the healthcare insurance industry with the opportunity to place restrictions on access to care and decrease reimbursement to vendors. It temporarily reduced the increase in the costs of care. However, managed care failed work because the public objected to the restrictions and it did not hold down costs. The HMO experiment failed for the same reason.

Tom Daschle has learned something from these lessons. He learned that he has to strike quickly and deflect the decisions about rationing of care to a “neutral board” and not the market. It is clear he does not respect the intelligence of the consumer. He does not understand the responsibility of the consumer. If he was doing this right he would be going after the abuses in the system and not the decision making engine in the system.

Tom Daschle is in the process of creating a giant HMO. It will fail as the Massachusetts experiment has failed.

“Mr. Daschle's model is Massachusetts. But Massachusetts's plan is an unfolding disaster and demonstrates how Mr. Daschle's private/public model is merely a stalking horse for government-dominated health care.”

Massachusetts helped 442,000 people obtain healthcare insurance. However an additional 80,000 people were put on Medicaid. 176,000 people were put on government subsided healthcare insurance. The cost to taxpayers has exploded because the basic cause of increased cost of care has not been addressed. The healthcare insurance industry control over the healthcare dollar has to be reduced. The onset of chronic disease and the reduction of the complications of chronic disease must be attacked effectively.

“Costs have exploded, requiring additional tax hikes and the entire system is only possible due to sizable transfers from the federal government. The plans are so unaffordable that in 2007, 62,000 people were exempted from the individual mandate.

So much for universal coverage. It could work if the consumer controlled their healthcare dollars with the government protecting the consumer.

The only way the Massachusetts plan will survive is with continued and increasing federal subsidies -that is, tax revenue from the residents of other states.

Tom Daschle’s plan is going to follow the same misguided path. The problem is worse the healthcare system becomes the harder it will be to dig our way out.

Wake up America

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

President Obama Will Ration Healthcare. Wake Up America! : Part 1

Stanley Feld M.D.,FACP,MACE

I spent a glorious weekend with Brad and Daniel in Las Vegas at the Consumer Electronic Show (CES). I thought there were some phenomenal electronics exhibited which will be coming to Main Street soon.

Brad introduced me to many young entrepreneurs who are very concerned about providing healthcare insurance for their employees. They are having trouble finding affordable healthcare insurance. My suggestion is for them to consider my ideal medical savings account.

Most of these young entrepreneurs realize they do not understand the issues that have resulted in the exorbitant healthcare insurance premiums.

I told them to not listen to the sound bytes of Tom Daschle and his team. They do not understand the issues either. If they did, they would be pursuing a different course. Tom Daschle is going to try to force the Democratic Party’s healthcare agenda of the last forty five years down the country’s throat. .

I have described most of the issues. I like President-elect Obama very much. Many voted for him because of the promise of renewal, new thinking and hope for the future.

David Remnick of the New Yorker summarized Barack Obama’s appeal.

“Barack Obama was not elected the forty-fourth President based on the depth of his legislative achievements or on the length of his public service. John McCain and Hillary Clinton were the “experience” candidates. Rather, Obama projected an inspiring message, a “narrative,” of change at a moment when so much in American life––the economy, the environment, national security, health care––is in such parlous condition that, for many voters, political familiarity seemed less a source of solace than a form of despair.

Barack Obama has hired “experienced people” to run his healthcare team( Daschle, et al). His “team” has the same old tired ineffective story that Hillary Clinton and others have had for healthcare reform. It is a story the American public does not want to hear.

“

During the campaign, Obama embodied novelty and a broader American coalition, and everything we heard about his temperament—as a community organizer in Chicago, as a president of the Harvard Law Review, as a legislator, as a campaigner—spoke of someone who, in contrast to the outgoing, faith-based President, possessed a gift for rational judgment and principled compromise. “

His healthcare advisors are old school. They do not understand the importance of the physician patient relationship. They refuse to understand the problems in the healthcare system. They ignore the importance of patient responsibility for their own health and healthcare. They do not seem to believe in the importance of the role of incentives and self reliance as an engine of America’s greatness. They believe government can fix everything.

President Barack Obama’s healthcare team is going to be successful in passing healthcare legislation. Healthcare system reform they will propose and pass will fail. It will bankrupt America as it is bankrupting Massachusetts.

The Congressional budget office estimated a 100 trillion dollar a year healthcare deficit in forty years without an improvement in the health of seniors alone. Adding the entire population to the Medicare roles will make this deficit unimaginable.

Tom Daschle’s plan is similar to the Massachusetts universal healthcare plan. We must understand the cause for the failure of the Massachusetts plan in order to comprehend the impending failure of Tom Daschle’s plan. There is nothing innovative about his plan. It is the same plan Hillary Clinton advocated in 1993 and others in the Democratic Party advocated for many years.

The plan will probably pass in a congressional vote because Americans are frightened by a huge economic recession. They have little idea what is being advocated by the Daschle healthcare team.

When a population is frightened all politicians have to promise is hope. People will give unprecedented power to politicians even if they do not understand the results of those promises.

Many are claiming Ayn Rand was right 52 years ago when “Atlas Shrugged” was published. The names of the new controlling bureaucracy are different but the methodology is the same.

Where are you John Galt?

Mr. Obama is taking a dangerous chance by advocating these old, and proven to be ineffective ideas. The Congressional Budget Office (CBO) noted in its report the failure to reduce the cost of healthcare significantly or increase the quality of care. The CBO’s report was published just before Christmas when everyone’s thoughts were on the holiday.

Wake up America!! Please !!

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

Is Medical Care a Right or a Responsibility?

 

Stanley Feld M.D., FACP, MACE

During the debate on October 7 the presidential candidates were asked if healthcare was a right or a responsibility. In my view neither candidate answered correctly. It demonstrated each candidate’s lack of understanding of the issue.

McCain said:

"I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. … But government mandates I — I’m always a little nervous about. But it is certainly my responsibility."

John McCain’s answer is  incomprehensible. He is desperately trying to stay on message. He wants to transfer all entitlements including Medicare, and Social Security to the private sector. One has the think of the disaster the privatization of Social Society would have been during this economic meltdown. I think John McCain understands the weakness of his position on entitlements. He weakened himself even further with unconnected gibberish.

Obama said:

"I think it should be a right for every American. … for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that"

Barack Obama’s answer does not prove it should be a right. It shows the power and callousness of the healthcare insurance industry. I have said over and over again that the healthcare insurance industry is not the solution, it is the problem

Both candidates' get a poor grade for their answer. Their answers indicate neither one has an understanding of the healthcare problem. If you do not understand a problem you can not develop a viable solution to fix the problem. The solution has to be fair to all stakeholders.

The correct answer is the individual’s healthcare should be both a right and a responsibility. Healthcare coverage should be the right of every citizen regardless of age, preexisting illness or income. If citizens choose not to be responsible for their health they should suffer a penalty. If a person is ill he should be responsible for adhering to the medical treatment and follow up or suffer a penalty.

If a citizen suffers a random non-curable illness it is an actuarial hazard that insurance should protect against. If a citizen takes care of his chronic disease to avoid complications he should receive a reward. The process will stimulate responsible behavior for the person's well being.

Obesity should be discouraged. It is a self inflicted major risk for chronic disease. Nothing is being done to reduce its' incidence.

Affordable availability of healthcare should be a right of every citizen. At the far end we have  viable safety net hospitals. It seem the present administration is doing everything in it power to eliminate these facilities. John McCain’s thinking implies he will do the same.

Citizens should own their healthcare dollar as outlined in my ideal medical savings account. Employer based healthcare insurance has been the foundation of our healthcare system. In recent years employers have been ripped off by the healthcare industry. If the first $6000 of healthcare coverage was the responsibility of the employee and the employee could keep any money not spent for retirement, the employee would have the incentive to shop for the best medical care at the best price. A communications system could be set up to direct patients to this best care model. This system would provide incentives for caregivers to provide better care.

If a person was self employed or unemployed, means testing would determine the subsidy or payment on a fair basis.

Educational programs for avoiding chronic diseases must be set up or supported through grants by the government to encourage citizens to be responsible for their right.

The government must be responsible for passing legislation to promote environment reforms. Dirty coal plans should be banned. We could prevent at least 21,850 hospital admissions per year nationally. There were 26,000 Emergency room visits for asthma alone last year. Asthma is the No. 1 cause of kids ending up in the Emergency Room. Dirty coal burning power plants cause 554,000 asthmatic attacks, 16,200 attacks of chronic bronchitis, 38,200 heart attacks and 23,600 deaths per year.

I have emphasized that preventing chronic disease and its complications is the key to reducing our healthcare costs. Eighty percent of our healthcare dollar is spent on the complications of chronic disease. Ninety percent of the Medicare dollars are spent on the complication of chronic disease.

 

The narcotics industry is another big problem ”The cost to society of illicit drug abuse alone is $181 billion annually.”

Societal costs combined with alcohol and tobacco costs, exceed $500 billion including healthcare, criminal justice, and lost productivity.

The cost of drug addiction is a tremendous burden to the healthcare system. Yet we are supporting a government in Afghanistan where both the enemy and the government profit from narcotics without the United States doing anything about it. There is no sign that the next administration will do differently.

Americans must wake up. The Presidential candidates must wake up. We need universal healthcare. It is a right and responsibility of every citizen. It is the responsibility of the government to promote a healthy environment so we can exercise our responsibility to remain healthy.

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

Costs Soar For Mass. Health Care Law

Stanley Feld M.D.,FACP,MACE

I hesitate to spend more time on the impending failure of the new Massachusetts healthcare law. However, the results of this experiment have consequences for the up coming presidential election. I have previous stated that Hillary Clinton healthcare plan is similar to the Massachusetts plan. The difference is Ms. Clinton would have the government plan competing with the insurance companies plan. It is destined to fail. The outcome will be the complete government take over of the healthcare system, an entitlement plan America can ill afford.

America can not afford the future value of our present entitlements. The debt will be compounded by adding the entire population to the healthcare insurance rolls. Politicians at all levels have ignored the debt problem of 100 trillion dollars.

Hopefully, someone will wake up and realize the present healthcare insurance system must change. .

“Two years after the state's landmark health law was signed, the cracks are starting to show.”
“Costs are soaring and Massachusetts lawmakers are weighing a dollar-a-pack hike in the state's cigarette tax to help pay for a larger-than-expected enrollment in the law's subsidized insurance plans”.

I believe the cracks were present before the law was passed. Governor Romney was going to run for President and needed an innovative and heroic accomplishment. A bipartisan healthcare law with mandated universal coverage was politically driven and foolishly passed.

“But that hasn't dampened enthusiasm at the Statehouse. Leaders there boast that in the two years since former Gov. Mitt Romney signed the law with a choreographed flourish at historic Faneuil Hall, the number of insured residents has soared by nearly 350,000.”

The lawmakers in Massachusetts are living in a dream world denying the problem of the program’s cost and the increased state spending deficit. The state is raising the healthcare premium, decreasing the healthcare coverage and increasing taxes. Nonetheless, the state can not afford the entitlement.

“Along the way the law has been scrutinized by other states, sparked the ire of critics on the right and left, and drawn the attention of presidential candidates.”

The blind are leading the blind. One state develops a healthcare system that does not work and all the others try to jump in with slight modifications of the same plan with its mistakes.

"It's the very first question I get when I'm with other governors," said Massachusetts Gov. Deval Patrick. "I don't think anybody is prepared to say that what we have done here in Massachusetts is necessarily the formula for the rest of the country or for a national reform, but at least we are trying."

Massachusetts has tried to maintain the private healthcare insurance system without reforming the private healthcare insurance system. It has to fail because the basic problem is the incentives for the private healthcare insurance industry have not been changed.

"The Massachusetts reform law remains the focal point for other states and the nation in trying to figure out if state-based reform is possible," said Alan Weil, head of the Maine-based National Academy for State Health Policy. "It's the biggest game in town."

“One of the most radical fixtures of the law is the so-called "individual mandate" — the requirement that virtually everyone have health insurance or face tax penalties.”

Policy makers are always thinking in punitive terms toward patients and physicians rather than creating incentives for people. I believe people should get a tax credit for losing weight, controlling their chronic disease and not over utilizing the healthcare system. They should be rewarded for good health and not a penalized for not wanting to pay an inflated healthcare insurance premium.

“Anyone deemed able to afford health insurance but who refused to buy it during 2007 already faces the loss of a $219 personal tax exemption. New monthly fines that kicked in this year could total as much as $912 for individuals and $1,824 for couples by December.”

How can a government determine the reward? It could be difficult. It is easier for the government to collect a penalty for a person not having insurance. The reward should be contributed to the person is tax free retirement fund. Patients should own their healthcare dollar. They would be motivated to shop for the best price. The more they saved the more they would have added to their retirement fund. If someone had a chronic disease and controlled the disease with proper treatment they should receive a reward. The payer could afford to give that person a bonus because of the money saved on the treatment of complications of that disease. My plan would in effect shift responsibility and motivation to control cost to the patients. It would motivate patients to fight the War on Obesity.

“Michael Tanner, a senior fellow at the libertarian-leaning Cato Institute, said the law has been an unqualified failure. He also noted the vast majority of the newly insured are receiving subsidized care.”

"They said it would get us universal coverage and reduce costs and it's done neither," Tanner said. “

The biggest problem is the rising costs of healthcare. Neither the Massachusetts plan nor any of the other state plans have done anything to change the motivation of the drivers of the old healthcare system.

“The law — and its individual mandate — has become a key talking point in the presidential race.”

None of the presidential candidates have even spoken of the importance of patient responsibility. If the government set the appropriate rules it could eliminate all the administrative waste in the system and decrease the complications of chronic disease. We would then have an affordable healthcare system. This can be accomplished by motivating and not punishing the patients and physicians.

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

Health Care Up to Public, Edwards Says Part 2

Stanley Feld M.D.,FACP,MACE

I will conclude analysis of John Edwards’ plan for healthcare even though he has dropped out of the presidential race. His plan represents the goal and direction of the Democratic Party with respect to healthcare reform. It will fail.

John Edwards had experienced the dysfunction of the healthcare system when he was suing physicians and hospitals.

He realized then the healthcare system did not make any sense. He took advantage of it. It still doesn’t make any sense. There are too many perverse incentives.

“Mr. Edwards did not propose a universal coverage plan when he ran for president in 2004, focusing instead on expanding enrollment of children. But a day after the Kerry-Edwards ticket lost, his wife, Elizabeth, was found to have breast cancer, and his family began its first-hand education in the vagaries of the system.”

“I mean, when you get the statements by the providers and the insurance companies about what’s covered and what’s not covered, even for two people who are well versed in the law and experienced with the health care system, it seems completely arbitrary in many cases,” said Mr. Edwards, a lawyer. “It doesn’t make any sense.”

Senator Edwards is correct looking at the system from the patients’ point of view. He ought to look at the system from the physicians’ point of view. The healthcare system makes less sense from the physicians’ point of view. Even though patients complained about their healthcare insurance carrier before 2004 he did not hear them until his family was one of the 20% of the population needing the system at any one time.

“The public nature of Mrs. Edwards’s illness — she announced a recurrence at a news conference last year — drew people with health care horror stories to the Edwards campaign. As health care costs and the number of uninsured continued to rise, Mr. Edwards sensed that people were ready for more radical surgery on the insurance system.”

Something needs to be done about the healthcare insurance system. If Senator Edwards understood how we got to this point he would understand his proposed solutions will not fix anything.

“I concluded that something bolder was needed, that the health care system had become increasingly dysfunctional,” he said. “And my contact with a lot of uninsured Americans, who were not children, made it clear to me that the plan had to be universal, that it had to cover everybody.”

I agree. Healthcare reform plans have to be universal. It should also be clear that absolute control has to be removed from the insurance industry. The control of the healthcare system has to be transferred to the consumers and not the governments.

“Under Mr. Edwards’s proposal, which resembles the plan adopted in Massachusetts in 2006, the government would require individuals to have insurance (illegal immigrants excepted).”

The Massachusetts plan is failing already. There are critical shortcomings of the plan. Thousands of residents are exempted from the insurance requirement because they cannot afford even subsidized premiums. The reason is the healthcare insurance industry has been instrumental is setting the price and protecting its vested interest.

“Mr. Edwards' proposal would prohibit insurance companies from rejecting high-risk applicants and would restrict their profits and overhead to 15 percent of revenue from premiums.”

This is a good idea. It might motivate the insurance companies to compete with each other and decrease the premium prices. The more people a company insures the more premium dollars it collects. The percentage profit from premium would be decreased but the total amount of revenue would not.

The defect in this idea is it lacks real price transparency with respect to insurance real costs. The healthcare insurance industry could easily load the administrative overhead and keep their profit from premiums below 15%.

“Government subsidies and tax credits would be available to low- and middle-income families that cannot afford insurance. Those below the federal poverty line — currently $21,200 for a family of four — would get free coverage, Mr. Edwards said. Those making less than 250 percent of the poverty level — currently $53,000 — would be heavily subsidized and there would be some financial help for those making up to about $100,000.”

There is no question that the definition of people eligible for subsides should be higher than the antiquated definition of poverty. This subsidy is exactly the increased money the insurance industry wants injected into the present system.

However, the patients must be responsible for their care or else any plan will fail. Consumers have to have ownership of their healthcare dollar and incentive to use it wisely. Nothing in the Democratic Party's or Edwards' plan takes incentive into consideration.

“Employers that do not offer medical benefits to their workers would have to contribute 6 percent of their revenues to the regional government pools that would offer Medicare-style plans. Midsize businesses and employers with large numbers of low-wage workers might be asked to pay less, and the smallest businesses would be exempt.’
“

"To pay for those subsidies, which account for much of the estimated $90 billion to $120 billion cost of the plan, Mr. Edwards would rescind President Bush’s income tax cuts for those with incomes above $200,000. Additional revenue would be produced through a broad menu of cost-control measures.”

Punitive measures have never been effective. Just image the resistance of employers and entrepreneurs to mandates that represent tax increases.

Mr. Edward is proposing private sector promotion that will fail. The new Democratic president would then say "Gee shucks", everything else we have tried has failed. The only thing left is create universal healthcare using a single party payer."


There you have it. If they succeed in passing this type of reform we have arrived at socialized medicine through the backdoor.

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

Health Care Up to Public, Edwards Says - Part 1

Stanley Feld M.D.,FACP,MACE

The obvious goal of the Democratic Party if they win the Presidential election is to institute a socialized medicine system. Not one candidate is talking about an incentive driven healthcare system to increase wellness of Americans and decrease the cost to the healthcare system by preventing the complications of chronic diseases. If we created a hype for creating a consumer driven healthcare system with the ideal medical saving account, America would have a chance at effective healthcare reform.
Senator Edwards’ healthcare plan became clear this week. I believe it will fail.

“In Patrick, S.C. Former Senator John Edwards does not discount the possibility that his health care proposal, which would allow Americans to buy new government insurance packages modeled on Medicare, could evolve into a federalized system like those in Canada and many European countries. And if it does, Mr. Edwards said he would be just fine with that.”

To my surprise, Senator Edwards has revealed the Democratic Party’s goal sooner than I anticipated.

“American health consumers will decide which works best,” Mr. Edwards said “It could continue to be divided. But it could go in one direction or the other, and one of the directions is obviously government or single-payer. And I’m not opposed to that.”

The present Medicare model is failing. The cost and cost overruns are unaffordable for the government. Medicare is increasing premiums annually for the elderly and decreasing their benefits. Medicare is also decreasing the reimbursements to providers annually.

“Each of the three Democratic front-runners has called for government insurance that would be available to an expanded number of consumers, not just the elderly and disabled as is currently the case with Medicare. If the government is able to undercut private insurers on price — by forgoing profit, reducing overhead, and maximizing economies of scale — it theoretically could put the private system out of business. and become the de facto insurer for the nation.”

Medicare claims to have minimal overhead. However, they outsource the administration and adjudication of claims to various healthcare insurance companies. The healthcare insurance industry is their administrative services organization. The healthcare insurance companies bury the administrative fees into the cost of the service to Medicare. The overhead fees do not show up as overhead.

“Republican candidates and policy strategists have raised the specter of “socialized medicine” and depicted the Democratic plans as a back-door route to a so-called single-payer government system.”
“Mr. Edwards brushed off that critique. “There is nothing back-door about it,” he said. “It’s right through the front door. We’re going to let America decide what health care system works for them.”

All I can say to Mr. Edwards and the Democratic Party is, “Look out for Harry and Louise.”

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

Are Patients Smart Enough To Make Their Own Healthcare Choices?

Stanley Feld M.D.,FACP,MACE

The following comment is from a physician. He brings up important points.

“Your blog of January 13, 2008, raises my concern for an important and critical factor in you’re repair of the healthcare system proposals:”

I have received many questions concerning my proposals to Repair The Healthcare System. I am grateful for the comments. It means people out there are paying attention and thinking.

“Even if you give the patient the right and responsibility to decide on the way to spend his/her healthcare dollar, that patient is relatively uninformed and most cannot make the important choices about their healthcare because he is uninformed.”

People are smarter that many think. An important element missing from other healthcare reform proposals is providing patients with incentives to make informed choices. A second element is teaching patients how to make informed choices.

Presently the healthcare insurance industry makes the choices for the patient. Unfortunately many of those choices are restricting access to care and driving the patients to lowest cost providers. These choices are made for the healthcare insurance company’s benefit and not the patient.

The healthcare insurance companies make their decisions on price not quality of care. Neither the government nor the healthcare insurance industry has defined quality medical care accurately.

At any one time eighty percent of the people are not sick.The urgency to recognize that the healthcare system has a problem is not on their mind. In recent years as the healthcare system has become so dysfunctional, healthcare insurance so expensive and in many cases unavailable, it is becoming a concern to most people. Additionally, with the growth of information on the internet consumers are becoming more aware of the criteria for diagnosis of many chronic diseases along with the most effective treatment and follow-up. Consumers are starting to make their own judgments about their physicians and the quality of care they receive.

We have seen the growth of demand for diabetes education, and intensive diabetes self management. Intensive diabetes education is important in improving the quality of diabetes care. The methodology to create an effective Diabetes Education program is available.

I believe when patients are responsible for their healthcare dollar and there is a financial reward for effective chronic disease management we will see all the facilitator stakeholders respond by competing for these patients healthcare dollar. The infrastructure will be created to teach everyone to be an informed consumer.

The new web based phenomena of social networking will create social networks for specific chronic diseases. These social networks will stimulate an even greater level of informed patient choices. The patient will be able to distinguish between excellent care and mediocre care.

There are many examples on the internet of information that can help consumers make intelligent choices. Fifteen years ago we depended on travel agents to pick the best hotels in different cities. Today we use www.Trip Advisor.com. We not only receive editorial comment on the hotels but reactions from people who stayed at these hotels. Another simple example is Amazon.com. for book reviews.

“ And whose fault is this? Is it the fault of patients themselves, or physicians and other healthcare professionals, or those who own the healthcare insurance business and our legislators.”

Everyone is at fault! It starts with the patients. They have to be responsible to themselves and their disease. Physicians do not get paid to prevent the complications of disease. In our present system they only get paid to fix things. It is against the vested interest of the hospital to keep the patients out of the hospital. If physicians reduced the incidence of coronary artery disease in diabetes mellitus by 50%, hospitals would be in big trouble. The healthcare insurance industry does not pay adequately for preventive services. If all the stakeholders’ vested interests were align for the patient’s benefit we could decrease the cost of healthcare by at least 50%.

When the healthcare insurance industry or government reimburse for preventive services, the payment is not sufficient to motivate physicians to develop an infrastructure for chronic disease management. When consumers own their healthcare dollar and are motivated to spend their healthcare dollar wisely we will see the development of viable diabetes education centers, asthma centers, and other chronic disease management centers. (Focused Factories)

Effective chronic disease management will not only increase the quality of care, it will also decrease the cost of care by decreasing complications of chronic disease.

And who is going to be able to remedy this?

It is going to have to be the consumer. The mechanism will be the ideal medical savings account with patients being responsible for their healthcare dollar and their healthcare. Hospital systems, healthcare insurance companies and physicians practices will be transformed. It is easy to understand that none of the secondary stakeholders wants to give up its power. The changes involve web based real price transparency, an ideal medical savings account, an insurance industry that continues to negotiate price, accurate definitions of quality medical care for specific diseases and patient web based social networking. It is essential that all of this occur at once.

“One must not only empower that consumer but inform him/her. Please address, in your proposals, the solutions for this deficiency, which must precede all others if a system such as you propose is to work.”

I refer you to my review in the Fall of 2007. The healthcare system must work within a new set of comprehensive rules. We simply can not continue to patch the system.

I believe the consumers is not stupid. If he chooses to take advantage of the system he is in reality taking advantage of himself. The overwhelming majority of patients will make the correct choices. They will utilize technologies of the 21st century to help them spend their healthcare dollar wisely.

Neither the Democrats or the Republicans are close with their proposals to repair the healthcare system.

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

HillaryCare v. Obama – Part 3

Stanley Feld M.D.,FACP,MACE

Baruch Obama’s healthcare plan seems different than Hillary Clinton’s.The only difference is Hillary Clinton’s plan is a mandate and Omba’s is a choice. Both plans create a public option managed by the government. (Socialized medicine)

“Once Hillary Clinton got roughed up in Iowa, she was bound to strike back against Barack Obama. Her first line of attack debuted at the Democratic debate over the weekend, and a big part of it concerns health care. Their differences are more political than substantive, but the debate does tell us something about current policy ambitions on the American left.”

The term universal healthcare does not have to be synonymous with government as a single party payer. However, to Mrs. Clinton and Mr. Obama they are synonymous.

"Universal" health care is of course a major Democratic issue, and Mr. Obama laid out a proposal in May, Mrs. Clinton in September. Both plans create a public insurance option managed by the government. Both plans impose more stringent regulations on insurance companies, and both institute new taxes on business."

The Republican Party’s interpretation of these plans is that it represents socialized medicine. The reality is that this is a big step on the way to a totally socialized medicine system. The plans will generate another headache for the federal government. Entitlements are bottomless pits with multiple failures. They will fail to control cost, or increase the quality of medical care. They will fail to improve patient or physician satisfaction. They will increase taxes and cost to business without increasing coverage. They will fail because they lack incentives for consumers and providers.

I predict the inefficiencies in the healthcare systems will increase. adding patches to a broken system does not improve the system.

“The so-call “individual mandate” has become the preferred liberal health policy tool after Mitt Romney introduced it in Massachusetts.”

Romney’s Massachusetts plan has been modified after nine months because of extreme cost overruns.

In theory, such a law would force everyone to sign up for health insurance--either through their employers, a private plan or a government option--or otherwise pay penalties.

Mitt Romney knows the wheels are coming off the Massachusetts Program. You do not hear him talk about it very much except to take credit for the plan. Romney’s plan does not provide incentives for the consumer or the providers.

“ Mr. Obama's mandate has led to a primary catfight that runs back several months and Mrs. Clinton is pressing the issue especially hard now to attract liberals who think Mr. Obama is the better bet for "change." She said on Saturday that Mr. Obama "proposed a health-care plan that doesn't cover everybody." Mr. Obama counters that the reason many people aren't insured is because they can't afford it.”

He has been accused by Clinton of echoing right-wing talking points,” He fires back that he is testing reality.
“In modifying its original plan Massachusetts has exempted almost 20% of uninsured adults who don't qualify for subsidies from mandated coverage because it is too expensive.”

In Massachusetts more and more people can not afford the mandated healthcare insurance program. The State of Massachusetts cannot afford the rising costs of the plan.

I believe the Democratic Party’s goal is to use incremental steps to gradually achieve a totally government-run health-care system. Hillary Clinton is making a big mistake in highlighting herself as a change agent. She failed with HillaryCare in 1994.

"She's betting that Democratic primary voters will give her credit for having tried. The new liberal consensus is that her 1994 effort got the policy right but botched the politics. That's why Mrs. Clinton--and John Edwards--posits insurance and pharmaceutical companies as villains who must be vanquished for liberal reform to prevail."

Hillary Clinton’s goal is to convert a political liability to a political asset. She wants credit for a failed plan. In 1994 she never asked patients and practicing physicians what they needed or wanted. She is making the same mistake now.

"By contrast, Mr. Obama says a genuine health-care overhaul must be negotiated at a "big table" including industry."

Whatever the minor policy differences among Democrats, their major domestic ambition this campaign season is the government takeover of the health-care market.

We have heard nothing constructive from Republican candidates. I do not think any of their presidential candidates have a viable plan. No one seems to understand the Consumer Driven Healthcare concept.No one seems to understand the ideal Medical Saving Account concept.

Healthcare is a major issue to the voters. Now is the time “People Power” must express itself.

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

Clinton, Obama Clashing On Healthcare – Part 2 Democrats Debate Requiring People To Buy Coverage

Stanley Feld M.D.,FACP,MACE

None of the candidates are discussing the origins of our dysfunctional healthcare system. If they understood the origin of the dysfunction I believe the cure would be obvious. The problems started with Medicare and mandated price controls.

Instead they fight over relatively insignificant issues.

“ Clinton is not alone among Democrats in calling for all adults to buy insurance. Former Sen. John Edwards of North Carolina, New Mexico Gov. Bill Richardson and Sen. Christopher J. Dodd of Connecticut have included the requirement in their health plans, making Obama the most notable outlier in the party's presidential field.”

An important question is; what is the definition of the middle class? The Drum Major Institute, a progressive think tank, has a website called www.themiddleclass.org that places the range for middle class at individuals making between $25,000 and $100,000 a year. The middle class comprise 60% of our population. These are the people the presidential candidates are begging to vote for them. However, the candidates from neither party are presenting viable solutions to the voters’ problems.

A middle class male with a family of four earning $40,000 per year will not be able to spend $10,000 a year with after tax dollars for healthcare insurance. He needs to feed and clothe his family. His home could cost $12,000 a year. Fuel, electricity and gasoline could cost at least $8,000, all with after tax dollars. Income tax bill could be at least $6,000 or more. All this without mentioning food and clothing and other essential expenditures to keep a roof over his family’s head.

A male independent contractor with a family of four who has hypertension and high cholesterol earns $50,000 a year. He does not have access to group healthcare insurance. He would not be eligible to purchase healthcare insurance from any healthcare insurance company. He is a poor insurance risk. Even if he was eligible, this middle class family could not afford the present healthcare insurance premiums.

“The idea of making health insurance a requirement has grown in appeal as politicians and health advocates look for ways to cover the estimated 47 million Americans who do not have it.”

On the other hand, insurance executives are earning millions of dollars a year; hospital administrators feel they deserve one million dollar plus salaries. We all recognize the inefficiencies and waste in the system. The presidential candidates are not talking about how to solve these problems.

Pharmaceutical companies sell their drugs directly to the public through advertising. The FDA has recently taken many drugs of the market. How can the public develop trust in medications? Not a single candidate is discussing the patient safety issues of prescription medication.

Neither are any of the candidates discussing ideas to solve our national obesity epidemic. Obesity is the cause of many chronic diseases. Here is an idea for a candidate. Why don’t you make the War on Obesity a national issue. Two issues can be highlighted. First is the excessive calories in fast food and second the perverse incentives in the farm bill. The farm bill incentives can redirect corn and soybean from foodstuffs to fuel. The result would be decreasing our dependence on foreign oil and promoting a cleaner greener environment. Both initiatives would have a significant impact on our health.
Ninety percent of our healthcare dollar is spent on treating the complications of chronic disease. No candidate is advocating funding for teaching patients to prevent these complications.

Compliance/adherence rate for medication prescribed is about 50% for most chronic diseases. No candidate has mentioned developing public service educational programs to emphasize this problem.
These are a few of the problems that should be addressed.

Yet Clinton is attaching Obama with meaningless sound bites. "He's called his plan 'universal.' Then he called it 'virtually universal.' But it is not either," she asserted in a recent Iowa speech. "And when it comes to truth in labeling, it simply flunks the test."

The debate about healthcare is entertaining but shallow and negative.

"Clinton mailed a letter to Iowa voters, over the signature of former Gov. Tom Vilsack, which says "Mr. Obama threw back talking points worthy of Rudy Giuliani or Mitt Romney" when questioned about "flaws" in his plan.

In response, Obama distributed a piece in New Hampshire that defended his health proposals and urged voters to "remind Hillary Clinton" that the Jan. 8 primary "won't be won by launching misleading, negative attacks."

However Americans are tired of political rhetoric. Someone has to tell the candidates that we are smarter than they think.

“But as the concept of a health insurance mandate gains currency within top ranks of the Democratic Party, the feasibility of the idea remains uncertain and its effects are unproven. As the Obama campaign points out, similar requirements in other areas, such as mandatory automobile insurance and motorcycle helmet use, never result in universal compliance.”

I do not believe Hillary Clinton is interested in the feasibility of her ideas. She is more interested in spinning her sound bites so she can become president.

Obama might be the only one that has respect for our intelligence. I hope America’s intelligence shows up in the polls.

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

Clinton, Obama Clashing On Healthcare - Part 1: Democrats Debate Requiring People To Buy Coverage

Stanley Feld M.D.,FACP,MACE

“ Sen. Hillary Rodham Clinton is on the attack against her main rival, charging that Sen. Barack Obama's health plan would leave millions of Americans without medical protection while hers provides coverage to all.”

The real issue should be that everyone should be the able to purchase healthcare insurance if they want to. It should not be mandated with a penalty. There should be no restriction on eligibility. Everyone should be able to purchase healthcare insurance with pre-tax dollars. The government should subsidize the less fortunate on a means tested basis. Everyone should own their healthcare dollar. Everyone should have financial incentives to use their healthcare dollar wisely.

Patient education is critical for the prevention of the complications of chronic disease.Patient education should be adequately compensated. Patient education programs to teach patients to use their healthcare dollar wisely should be available on the internet.

Consumers can force the healthcare insurance industry to compete for their healthcare dollar. If real price transparency was required for hospital systems and physicians, both would be forced to compete for the consumers’ healthcare dollar.

With consumer driven healthcare, the market economy would force the healthcare insurance industry to become more efficient. It would decrease its 150 billion dollars in administrative costs.
Consumer driven healthcare would also stimulate hospital systems and physician groups to deliver more efficient medical care. Both groups would be interested in eliminating administrative waste through the use of information technology. The consumer must be the primary driver of the healthcare system, not the government nor the healthcare insurance industry.

Consumer driven healthcare would create a more orderly evolution toward the adoption of information technology rather than the punitive administrative rules and bureaucratic inefficiency advocated by Gingrich and Kerry in their E-prescriptions article.

I have mentioned that it costs a physician $7 to pull a chart from his filing racks. It costs another $15 to complete the chart. The use of the ideal electronic medical record would decrease this cost to pennies. In turn, it will decrease the physicians costs to deliver medical care which would reduce fees.

If an innovative software company provided universal software to physicians and hospital systems and charged physicians and hospital systems by the click, we could eliminate the burden of start up costs and capital expenditure.

Hospital systems’ pharmaceutical charges and bed charges should be based on its cost plus a reasonable profit.

Healthcare premiums must be community rated and available to all with pre-tax dollars and subsidies if necessary. Consumers electing not to purchase healthcare insurance would be responsible for the retail charges. This might create incentives for those would choose not to take advantage of the universal coverage opportunity.

Incentives should be given to physicians to develop patient education services to prevent the complications of chronic diseases. All the presidential candidates are ignoring the fact that 80-90% of the healthcare dollars are spent on the complications of chronic disease.

“ Hillary Clinton's assertion, flatly rejected by the Obama campaign, rests on a pivotal difference between the two Democratic presidential candidates' health proposals. Clinton says she wants the government to require all citizens to buy insurance or face a penalty. Obama relies on a mandate for children only, and instead emphasizes ways to make coverage more affordable."

I believe the basic difference between Hillary and Obama is Hillary thinks you have to force people to do things and Obama thinks you have to provide the environment and incentives to get people to do things. Obama has more respect for our intellect than Hillary does. However, both candidates are advocating systems that will fail. After they fail the next step is universal coverage by a single party payer. The single party payer will be a disaster for America.

“ The seemingly technical distinction has launched an impassioned debate among economists, health care analysts and politicians, and has fueled a key campaign argument in early-voting states such as Iowa. It will likely receive more attention as the election season grinds ahead.”

Here we go again. The media seeks openings to make the election a spectator sport. Americans want serious discussion of the issues and well thought out solutions.