Repairing the Healthcare System

Medicare is Not Cheap For Either Seniors Or The Government: Part 2; The Government

 

Stanley Feld M.D.,FACP,MACE

Medicare is partially funded through payroll taxes of the workforce for the benefit of seniors. The unfunded liability of the government for seniors is enormous. It gets bigger each year. As baby boomers reach Medicare age the government unfunded liability is going to escalate more rapidly.

President Obama and the Democratic controlled congress are ignoring the Medicare trustee annual report of Medicare’s unfunded liabilities. They keep promising us the public option will provide the same insurance the congress receives under Medicare Part C. The only way to fix the unfunded liabilities is to decrease services or increase taxes or both. These reports are public information.

Medicare is funded by a combination of dedicated revenues (payroll taxes, beneficiary premiums, and state payments) and general revenues.

“Medicare's Hospital Insurance (HI) trust fund, (Medicare Part A) financed by payroll taxes, is currently running a deficit and is projected to be exhausted by 2019” according to the 2005 Medicare trustee report.

“Conversely, the Supplementary Medical Insurance (SMI) trust funds’( Medicare Part B and Part D ) which cover outpatient services and prescription drugs, never face a deficit nor become exhausted, because annual adjustments are made each year—mainly drawing more from general revenues—to match expected costs.”

Nevertheless, with projected increases in demands on the Medicare program by retiring baby boomers and rising health costs, growth in program expenditures, which are already heavily reliant on general revenues, will soon require additional taxpayer funding.

The projection in unfunded liability in the next 75 years increased from $12.7 trillion in 2005 Medicare Trustee report to $34.2 trillion in 2007. The 2008 report estimated the unfunded liabilities will increase to $100 trillion in 75 years. These numbers are estimates for seniors only. If President Obama extends Americans covered under the public option the unfunded liability will be higher. The only way to cover these costs is to increase taxes, decrease coverage or both.

In 2006, total Medicare expenditures were $408 billion, or approximately 3.1 percent of GDP. But as a share of GDP, Medicare expenditures are projected to double to 6.5 percent by 2030 and nearly quadruple to 11.3 percent by 2081.

This was a 2007 estimate. In 2008 the estimate doubled. President Obama’s healthcare reform plan will knock the ball out of the park. $1 or $2 trillion dollars is a lot of money. $100 trillion dollars is unimaginable.

“The Medicare Trustees report shows that Medicare poses the single greatest challenge to taxpayers of all government programs.”

 

In 2005 Senator Judd Gregg R-NH, President Obama’s choice for Secretary of Commerce expressed the need for fiscal responsibility while the U.S. Comptroller General could not express the urgency in more graphic terms.

[W]e as a Congress has an obligation to try to fix [those entitlement programs] today so that they don’t end up bank­rupting our children and our children’s children tomorrow.

—Senator Judd Gregg (R–NH)[1]

There is no way we are going to deliver all the Medicare promises that have been made. No way.

—David M. Walker, U.S. Comptroller General[2]

Now we are hearing from President Obama that we cannot afford not to spend the money. The common invective about the Democratic Party is they are the tax and spend party. President Obama is turning the invective around. He plans to spend and then tax.

The administration is not testing reality. Government estimates are usually notoriously underestimated. In recent weeks the CBO estimated a $1 trillion dollar increase in the next ten years if the government adopts Ted Kennedy’s plan. $1trillion dollars is a big number. I believe the Congressional Budget Office is being kind to Ted Kennedy’s bill and the estimate of costs of the public option.

The Centers for Medicare and Medicaid Services (CMS), the agency that runs the Medicare program, gen­erated its own estimate in 2003 and has continued to do so every year since the bill’s enactment. Though not made public until 2004, the CMS’s 2003 estimate was $534 billion dollars in unfunded liabilities for the period 2004 to 2013. In CMS’s February 2005 estimate, the 10-year price tag of the drug provision is $724 billion dollars for the period 2006 to 2015.

Americans are being numbed by the numbers. A trillion here, several trillion dollars there and everything will be alright. Today the Medicare estimated unfunded liability will increase by $2 trillion in just one year without President Obama’s healthcare reform.

If the government really wanted to reform the healthcare system, be able to afford universal care and increase the quality of care to increase the health of the nation he would focus on the real problems in the healthcare system as I have outlined them.

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

Medicare Coverage Is Not Cheap For Either Seniors Or The Government : Part 1; Seniors

 

Stanley Feld M.D.,FACP,MACE

Many people believe Medicare works well. Many people have said all we need to do to repair the healthcare system is lower the eligibility age from 65 to newborns.

America would then achieve a. universal care, b. affordable costs c. improved quality care. The healthcare system would be fixed. The statement is simplistic but popular.

Medicare coverage does work well for seniors if they have both adequate supplemental coverage and Medicare Part D to cover the Medicare gaps in coverage and drugs.

Medicare Part D( drug coverage) was poorly constructed. It was built to the advantage of the healthcare insurance industry not seniors. If seniors do not have supplemental Medicare insurance (Medigap) they could be bankrupted because of the Medicare deductibles and co-pays. .

Medicare does protect the senior from the retail price of medical care. It does guarantee insurability at a price not determined by pre-existing illness. It does permit choice of provider providing the provider sees Medicare patients.

Fewer and fewer physicians are accepting Medicare patients. Medicare reimbursement and coverage decline with each passing year. In many cases physician reimbursement is lower than the physician’s cost to provide the service.

This has been a constant battle for physicians since the government cost savings program was mandated in the 1980’s. Another 20% reduction in reimbursement is scheduled for 2010.

Seniors can still go to physicians who do not accept Medicare. However, seniors will be responsible to pay the retail price for the service. Seniors will collect directly from Medicare 80% of Medicare’s acceptable fee after they submit the bill to Medicare.

For example, if a medical bill is $200 and Medicare’s allowable fee is $80, Medicare will pay you 80% of the allowable fee or $64. The senior has already paid the physician $200. The senior’s out of pocket expense is $135 . If the physician honors Medicare $120 of his $200 fee is disallowed.

Medicare will pay the physician $64. The senior is liable for $16. If the senior has supplemental insurance (Medigap) the supplemental insurance will pay the remaining $16. .

The Medicare premium paid by seniors monthly is not cheap. The base assessment is $99 per month per senior. This assessment might not be affordable to many who are on a fixed income.

The Medicare Part D helped pay for prescription drugs. Many seniors cannot afford to buy the medication they need. Medication needed to stay well and out of the hospital.

1. Medicare has recently imposed an added assessment to the basic Medicare premium. It is called the Modified Adjusted Income Calculation. The IRS supplies Medicare with a senior’s previous year income tax returns. Capital gains, dividends, tax free dividends, and salaries are including in the Modified Adjusted Income calculation.

2. A married couple with a joint return and income from all sources is going to have an additional assessment of between $51.60 and $284 dollars per person per month depending on their combined Modified Adjusted Income calculation assessment.

3. The assessment starts at $160,000/yr and ends at $410,000 per year. A widow with dividends, capital gains, an annuity and rental income of $164,000 per year is assessed an additional $103.30 per month or $1239.60 per year.

4. This assessment is paid with pre tax dollars. It gets deducted from the Social Security payment. If a person has earned income in addition to passive income the person is also paying additional tax on his Social Security check.

5. The deductible of 20% of the allowable fee and the initial $992.00 deductible for a hospital admission becomes expensive quickly.

6. In order for the Medicare recipient to have full coverage for the deductibles they have to buy Medigap insurance. There are seven Medigap insurance policies. The best and most complete is the Medigap Part F. Several private healthcare insurance companies sell this coverage. For persons under 70 years the cost of the policy is $140 dollars per person per month in after tax dollars. The effective post tax cost per month is $200 per person or $400 per couple. The yearly after tax dollar cost is $4800 per year.

7. If you add Medicare Part D for prescription drug coverage, it adds another $24 per person or $34.28 dollars in after tax dollars per month per person or $822 dollars per couple per year. This cost does not consider the extra cost of the infamous doughnut hole.

8. The total premium for adequate Medicare insurance is $2244 plus $4800 plus $822 or $7866 per year. This calculation excludes the modified adjusted gross income. The modified adjusted income can add $619.20 to $3408 per couple per year to the premium. The MAGI creates a means adjusted premium. The maximum means adjusted premium is $11,274. per year per couple in 2008.

It should be clear that Medicare has its benefits. However it also has limitations because despite these premiums and deductibles the government’s unfunded liabilities for Medicare is escalating to unsustainable levels.

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

Are The Wheels Coming Off?

 

Stanley Feld M.D.,FACP,MACE

During the past week the healthcare debate has increased in intensity. President Obama has drawn a line in the sand. He wants a bill on his desk by August 1, 2009.

It also looks as if his healthcare reform plan is being derailed not by Republicans but by his own party.

President Obama has also given the AMA a glimpse of where he stands on malpractice reform. He received boos from members of the AMA.

He has set out the fundament principles of his healthcare reform.

1. Universal coverage

2. Affordable cost

3. Increase in quality of care.

President Obama then asked key committees in both houses to craft a bill compatible with his goals. He is very smart.

“What the president wisely assessed, looking at what did not happen in the early ’90s, was that unless there was some real ownership, unless members of Congress owned drafting and crafting and did some heavy lifting and then owned the final work product, it wasn’t going to work.”

This is clever but it could be the down fall of any healthcare reform. Max Bacchus has presented Tom Daschle’s plan. Ted Kennedy has presented a plan that is fiscally irresponsible according to the congressional budget office. His healthcare reform plan completely ignores the warning of the congressional budget office. The House of Representatives released the Conyer healthcare reform plan that would create an even larger deficit than Ted Kennedy’s plan.

None of the plans from either side of the aisle are focused on the real problems in the healthcare system.

Kathleen Sebelius, secretary of health and human services, summarized the mood that is motivating the country to move forward. The country feels government needs to do something. She disregards the fact that what is done needs to be constructive and must repair the healthcare system.

“ I think the underlying factor is that the status quo is not sustainable and it’s not acceptable. And in many ways the economic downturn has shaken the status quo.”

Economically, emotionally, and morally the status quo is not sustainable. Everyone agrees. The debate is getting very confusing while focusing on the wrong issues.

In the early ’90s, there was a sense that doing nothing was an O.K. alternative. For some people it was better than doing something that they felt would lead us in a wrong direction. I really don’t know of a single stakeholder group or party in this discussion who is willing to say out loud doing nothing is O.K.

Everyone agrees something must be done. The momentum for healthcare reform is compatible with Heidi Klein’s “Shock Doctrine.”

If people are frightened enough about an issue they will accept any policy. She says this is the method politicians use to gain power over the people.

All the healthcare reform proposals are confusing and difficult to follow. At this point citizens are so frightened and disgusted that they relinquish their power to elected officials who they hope understand the problem. They assume these politicians will look after their vested interests.

I think the weight of inertia is always more powerful often than the forces of change. But in this case there’s an underlying turmoil, whether it’s people looking at the moral imperative, people looking at the financial imperative, and people frankly looking at what’s happening to our country in terms of health outcomes. Nobody feels this is acceptable

Kathleen Sebelius explained the legislative confusion away by saying this is how legislation works. The people want a bill.

President Obama is going to prove to congress that the people are demanding a change through his house parties and blogs calling for support of his healthcare plan. The Democrat controlled congress will have no choice but to give them a bill. The problem is the plan will make things worse as proven in Massachusetts.

When Secretary Sebelius was asked the question; “So are you not concerned about the Congressional Budget Office release on the HELP bill? Do you think it doesn’t really pose problems? (The office “scored” the bill produced by Sen. Edward M. Kennedy’s committee as costing at least $1 trillion over 10 years, while leaving 36 million people uninsured).”

She said don’t worry. Whenever you see a big price tag and the notion that lots of people are not covered it will raise questions.

“ What I’ve been told is that we shouldn’t spend a lot of time and energy on that because it( Kennedy’s plan) is a partial hit on a partial bill.

I think the American people are tired of these general responses to some positive data by impartial sources. The administration believes all it has to be do is to respond by repeating President Obama’s generally accepted idealistic principles. The people will believe everything will be alright.

I’m still optimistic at the end of the day that a bill that meets what the president said all along, some fundamental principles — cover every American who lacks health insurance right now, build on what is working in the health system, so people who have coverage and a health provider that they like and they feel is good for their family keep it, that we have a new system in place to really lower costs over all for everybody and that we begin to drive quality, which is now available to some Americans some of the time depending on where you enter the system. So around those principles I’m convinced we’re going to have a proposal.

What are the details of President Obama’s program? What is the cost to the tax payers going be? Is the congressional budget office wrong about the 1 trillion dollars over ten years? Is Senator Kennedy wrong about 36 million uninsured because the government cannot afford it? How is the quality of care going to improve with the bills on the table when quality medical care is not defined properly? Is a board of experts’ going to be able to define and enforce its definition of quality medical care?

This is not the time to give in or give up!

Summary Blogs to Repair the Healthcare System

 

Stanley Feld M.D.,FACP,MACE

I am posting what I consider summary blogs. It would be difficult to read all the summaries in one sitting. I compiled this list for people who have just started following “Repairing the Healthcare System.” The links are intended to get you started and to be used as a reference.

The links below are my view of the policies that must be adopted to Repair the Healthcare System. The letters written to President-elect Obama and then President Obama were written when he promised that everything was on the table and he was open to all ideas. It is now clear to me that nothing was on the table. He will expand a government entitlement the country cannot afford and most people would not want. President Obama should be concentrating on the real problems in the healthcare system.

If you follow the links in each article you will understand my views on the policies needed to repair the healthcare system. I believe it can be repaired without enlarging unaffordable entitlements and the resultant increase in public debt. I have proposed specific policy changes that will enhance quality, improve coverage and decrease costs.

The Healthcare System’s Problems Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/11/fall-2007-what-.html

The Healthcare System’s Problems Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/11/fall-2007-wha-1.html

The Ideal Medical Savings Account

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2006/10/the_ideal_medic.html

The Ideal Electronic Medical Record Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/01/the_complexity_.html

The Ideal Electronic Medical Record Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/01/the_ideal_elect.html

E prescriptions

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/12/e-prescriptions.html

Real Price transparency

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/11/physician-focus.html

The Definition Of The Physician Patient Relationship Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/the-therapeutic-magic-of-the-physician-patient-relationship-part-1.html

The Definition Of The Physician Patient Relationship Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/the-therapeutic-magic-of-the-physician-patient-relationship-part-2.html

Dear President Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president--elect-barack-obama-part-5.html

Dear President Obama Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Rationale for Effective Malpractice Reform Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

Rationale for Effective Malpractice Reform Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

Electronic Medical Record Stimulus Fiasco Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/the-electronic-medical-record-stimulus-fiasco-part-1.html

Electronic Medical Record Stimulus Fiasco Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/the-electronic-medical-record-emr-stimulus-fiasco-part-2.html

Electronic Medical Record Stimulus Fiasco Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/05/the-electronic-medical-record-emr-stimulus-fiasco-part-3.html

Call to Action

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/to-my-readers-a-call-to-action.html

Republican Healthcare Proposal Executive Summary : Part 2

 

Stanley Feld M.D.,FACP,MACE

Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice

The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important improvements to both programs without limiting eligibility or benefits by:

• Integrating low‐income families with dependent children into higher‐quality private plans through direct assistance

What is the definition of higher-quality private plans? Who is going to judge quality? How is government going to fund these “higher quality private plans?”

• Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans

How will this be accomplished when Medicaid reimburses so poorly. There is a shortage of Medicaid physicians already. These physicians must do a volume business (Medicaid Mills) to make ends meet. These volume practices (Medicaid Mills) are being investigated for fraud.

• Realigning responsibility between federal and state governments in order to better coordinate benefits by requiring the Medicare program to assume Medicaid responsibility of premiums, cost‐sharing, and deductibles for low‐income seniors

The above is just words. It almost sounds as if the federal and state government are going to be responsible for increased funding for private enterprise.

• Rebalancing long‐term care services to ensure choice between institutionalized and home‐based care

• Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage

Medicare Advantage is recognized as an insurance product designed to rid the government of the Medicare entitlement . The government under the Republican administration paid an extra $3,000.00 per person to outsource the responsibility for Medicaid from the state to the healthcare insurance industry. The cost is unsustainable. Excess profits flow to the healthcare insurance industry.

• Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to

physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction while reducing costs

This is a “pay for performance a system” that ultimately cannot work because of intrinsic defects in the pay for performance concept. Quality medical care has not been defined appropriately. Is it defined as medical outcomes, financial outcomes, number of test performed or disease discovery?

• Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D

Medicare Part D is a poorly constructed in the present form. It is written to the advantage of the healthcare insurance industry, the pharmacies and the pharmachuetical companies. It is not a patient centric plan.

Ensuring Compensation for Injured Patients

Our current legal system does a poor job at compensating patients for medical mistakes in a fair and efficient manner. Instead of nurturing an environment where medical professionals can openly learn from their mistakes, our legal system often forces doctors and patients into contentious courtroom disputes. The Patients’ Choice Act would reform this broken system that helps drive health care costs out of control by:

• Encouraging states to adopt a number of legal alternatives entirely run by the state that would include the establishment of expert medical panels to resolve disputes, creation of health courts, or a combination of both

This is logical. How are they going to encourage states to adopt legal alternatives when the law makers are lawyers? When there aren’t specific legislative action points nothing gets done.

Establishing Transparency in Health Care Price and Quality

For a vibrant health care market to function properly, patients must know what services cost and who provides the best service. Uniform and reliable measures of reporting quality and price information should be designed by the stakeholders in health care rather than the heavy‐hand of government. The Patients’ Choice Act would bring this much needed transparency into the health care market by:

• Creating a Healthcare Services Commission that relies on a public/private partnership to enhance the quality, appropriateness and effectiveness of health care services through the publication and enforcement of quality and price information

• Empowering the private sector – rather than Washington bureaucrats – to set standards on price and quality with the input from all major stakeholders in health care, as well as the general public

• Ensuring that measures of effectiveness keep pace with innovation

This is the most logical proposal in the plan. It also contains specific action points. However it keeps the power in the healthcare insurance industry’s hands. It should put the power in the consumers’ hands. If the private sector (healthcare insurance industry) does not cooperate, it should be restricted from selling insurance by the state board of insurers.

There is the entire proposal. There is nothing new and no outline of action to accomplish any part of the proposal.

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

Republican Healthcare Proposal Executive Summary : Part 1

 

Stanley Feld M.D.,FACE,MACE

It is not fair to criticize the Republican Party’s healthcare proposal without providing the reader with the source material. The source material comes from Senator Tom Coburn’s web site. My negative comments should be judged in light of the original proposal. The executive summary follows.

Preventing Disease and Promoting Healthier Lifestyles

· Critical investments in public health and disease prevention will go a long way in restraining

health care costs and improving the quality of Americans’ lives. The Patient’s Choice Act of 2009 would:

• Encourage increased coordination of federal prevention efforts and bring long‐overdue accountability to these programs

• Require CDC to undertake a national campaign highlighting science‐based health promotion strategies

• Equip recipients of Supplemental Nutritional Benefits with easily understandable information about nutritious food options and target the use of food stamps to healthy food choices

• Invest $50 million annually for increased vaccine availability and bonus grants to states that achieve 90 percent or greater coverage of CDC‐recommended vaccines

• Provide incentives for states to reduce rates of chronic disease like heart disease and diabetes

All of the above proposals should be executed. How will they be implemented? The Republicans do not have a plan but not having a plan does not make the Democrat’s plan a good one.

Creating Affordable and Accessible Health Insurance Options

Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant market for health insurance that is consistent and fair will allow all Americans access to health coverage.

How will Republicans make a vibrant market for healthcare insurance? How will people who cannot afford healthcare insurance pay for it? The tax credits might help a little. However, if you do not have the cash you cannot pay for the insurance.

The Patient’s Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the following:

• Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different health insurance policies and select the one that meets their unique needs

• Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range of choices

• Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating Exchange insurers based on age or health

What will the premium be for those with preexisting illnesses? Will the premiums be higher for patients with preexisting illnesses? The high risk pool premiums have been very expensive.

• Creates a non‐profit, independent board to risk adjust among participating insurance companies to penalize companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover patients with pre‐existing conditions.

• Expands coverage through auto‐enrollment at state and medical points of service, for individuals who do not select a plan at the beginning of the year

This is an empty statement. How will this be administered? The devil is in the details and there are no details presented.

• Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’

Risk pooling has been tried and has been unsuccessful. It has been an excuse to allow the insurance industry to spread the risk. The proposal also implies variable premiums.

Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage

Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get their health coverage through their employers, discriminating against the self‐employed, the unemployed, and small businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless of employment status, the ability to purchase health insurance by:

• Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family

• Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid with HSAs without a tax penalty

• Allowing preventative services to be covered by High Deductible Health Plans

• Increasing the amount of money an HSA owner may annually contribute to their account

Healthcare insurance premiums are $14,000.00 a year for a family. A $5,700.00 tax credit does not cover it. It also assumes the consumer has enough income to have a $5,700.00 be tax liability. Citizens are not subject to income tax if they make up to $38,000.00 year. HSA’s retain the healthcare dollar to be used for future spending on healthcare. The healthcare insurance industry retains control over the premium and the healthcare dollars. It is not a pro consumer proposal. It does not offer financial incentives to consumers .

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

Republican Healthcare Plan Unveiled.

 

Stanley Feld M.D.,FACP.MACE

 

Republicans in Congress have introduced their health care reform plan. "The Patients' Choice Act of 2009," has been introduced by U.S. Senators Tom Coburn, (R-OK) and Richard Burr (R-NC) and U.S. Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA).

The proposal that relies heavily on private mechanisms does not contain an individual mandate to have healthcare insurance, It offers insufficient tax credits for families and individuals previously insured and not in a group insurance plan. It must be noted that people who make less than $38,000 per year pay no income tax. A tax credit is meaningless to them. These are the people who are uninsured.

Individuals not in a group insurance plan pay retail for healthcare insurance premiums with after tax dollars. Employers that have group healthcare insurance for employees, pay the insurance premiums with pretax dollars.

The new Republican healthcare plan would eliminate employers tax deductible benefit. This would discourage employers from providing healthcare insurance to employees. The plan is not dissimilar to the proposal championed by John McCain during the presidential campaign. His proposal was considered inadequate.

“The focus of the proposal is to push for a "guaranteed choice of coverage" in the private market through federal-state partnerships know as State Health Insurance Exchanges.

Individuals will have a "one-stop marketplace" to choose plans in the exchange, including the option of keeping their employer coverage and/or existing insurer.

The plan eliminates pre-tax dollar deduction for employers who provide health coverage to their employees. It provides a $5,710 tax credit to families and a $2,290 tax credit to individuals toward the purchase of health insurance coverage.

This is not enough of a tax credit to be effective for those who can afford to buy healthcare insurance. In reality it will save the government money. It would eliminate employer tax deduction. An unintended consequence will be an increase in thenumber of uninsured.

Healthcare insurance premiums average $14,000 per family and $7,000 per individual. The healthcare insurance industry cherry picks patients. It eliminates the sick and over 55 year olds with a high potential for illness. If its ability to cherry pick is eliminated the healthcare insurance premiums will be even higher.

The Republican healthcare plan does not state if the non insurable sick will be subject to the same or higher premiums.

"Participating insurers," meanwhile, would be required to "offer coverage to any individual -- regardless of patient age or health history" though there is no mandate for an individual to purchase that insurance”.

Many things are wrong with the Republican party’s proposal. I am disappointed in Senator Tom Coburn. He is a “practicing M.D” he should know the real problems in the healthcare system..” The proposal has some good ideas but no suggestions on how to implement those ideas.

His plan ignores the real problems. The uninsured cannot afford to purchase healthcare insurance. Some young healthy people do not want spend the money for healthcare insurance. Many people are underinsured. Illegal immigrants are uninsured. They show up for care in our safety net hospitals. Our safety net hospitals are underfunded. The plan does not contain incentives for patients to work hard to remain healthy.

The reasons healthcare costs are so high are many. Price Waterhouse has calculated 1.1 trillion dollars is wasted dollars between defensive medicine and unnecessary administrative cost.

Medical care for the complications of chronic diseases absorbs 80% of the healthcare dollars. The complication rate can be reduced by at least 50% if patients became “professors of their disease” and they themselves prevented the complications. This can only be accomplished through education and financial incentives.

The proposal does not repair any of the abuses of the healthcare insurance industry, the government, the hospital systems or physicians.

The proposal gives employers a perfect excuse to drop insuring employees by the removal of their tax exemption for premiums. President Bush tried very hard to accomplish this and failed. .

The Republican plan would leave a greater number of Americans uninsured with no improvement in the health of the nation.

The Patients’ Choice Act contains many of the popular sound bites. It does not have a plan to achieve change. The only way change will occur is by leveling the playing field and providing incentives for patients. The plan keeps the healthcare insurance industry in control of the healthcare dollars.

It states; “ the Act transforms health care in America: strengthening the relationship between the

patient and the doctor; using the forces of choice and competition rather than rationing and restrictions to contain costs; and ensuring universal, affordable health care for all Americans.”

I am disappointed in the Republican proposal. It is a proposal of empty words. The public will not be fooled. The public wants change. I will publish the executive summary so readers can judge for themselves.

Under the Republican plan, instead of a competitive marketplace for healthcare coverage I can visualize a market place dominated by a few healthcare insurance companies. The result will be further increase in cost of premiums. The healthcare insurance industry would continue to own the healthcare dollar and be non transparent.

The healthcare insurance industry would continue to abuse patients, physicians, hospitals and the government.

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

“Rope A Dope”

 

Stanley Feld M.D.,FACP,MACE

 

There are many issues involved in healthcare reform. The major issues to decrease defensive medicine with malpractice reform, rapid affordable installation of electronic health records, control of the obesity epidemic, effective chronic disease management and a change in the healthcare insurance model are not on the radar screen of the President or Congress.

The issue with effective healthcare reform is about money. In order to save a significant amount of money the above problems must be solved. As President Obama plan progresses in the congress the battle is all about political tactics and positioning for the midterm elections in 201

“On the one hand, President Obama and his party say they're hoping to strike a good-faith compromise on health care. On the other, they're threatening this "budget reconciliation" maneuver to coerce Republicans into rubber-stamping liberal policy.”

The Democrats want to get a handful of GOP Senators to support the bill before in gets to the floor. The goal is to short circuit a bloody debate before it begins. The Democrats are to join their fold. Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe voted for expanding the state children's insurance program (Schip).

SCHIP was a compassionate bill and logical. However it is a bill that does not create patient incentives. It is difficult to imagine Republicans defecting to the poorly constructed bill that will created greater costs and more dysfunction to the healthcare system.

“This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise.”

All the the Democrat’s rhetoric in nonsense. Without a change healthcare insurance healthcare costs will continue to rise . We need only to look at the Massachusetts experience.

The administration is prepared to make promises to Republican such as the government healthcare plan would only be sold to the uninsured and small businesses that can not afford to provide employees with healthcare insurance because of the costs. Once the Republicans on on board and the bill is past the administration could modify this proposal and make it all inclusive.

“ The White House strategy is to dilute the healthcare plans proposal just enough to win over credulous Republicans. That is what has always happened with government health programs:”

President Obama is playing a game of got uh. Some one wrote to me and called it Rope A Dope.

“When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers”.

Medicare’s cost to seniors has also risen with a base month cost of $99 per month per person or $2400 per year per couple. The catch is the deductible are $999 for hospital admission and and 80/20 deductible. The monthly payment per person is means tested and can go to $275 per month per person with after tax dollars. The a senior has to by Medicare Part F for deductible coverage. Its cost is 170 per month per person. Medicare Part D at it least expensive is $47 per month per person with high deductible.

In order to get full coverage the cost can be as high as $15,000 per year in after tax dollars.

Congressional actuaries expected Medicare to cost $3.1 billion by 1970. Medicare today costs $455 billion and rising.

Medicaid was intended as a last resort for the poor. It now covers one-third of all long-term care expenses in the U.S.. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.

Over time end stage renal disease and disabled person have been added to the Medicaid roles Other person also have been included.

“SCHIP was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.”

A common denominator to all of this unsustainable increases is the way the healthcare insurance industry controls the healthcare dollars. This leads to abuse by other stakeholders. Incentives must be aligned with the consumer controlling their healthcare dollars.

The Lewin group estimates that 119 million more persons with private insurance could be added to the 90 million already on Medicare and Medicaid. Health habits must be changed to combat obesity. The only way it will be changed is a change in farm policy and the consumers owning their healthcare dollars. Otherwise we are doomed to every increasing premiums and overuse of the healthcare system.

Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they've guaranteed otherwise.

President Obama is going to mount a public opinion campaign for his plan. The Republicans are going to cave in. They are trapped

Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.

President Obama will have successfully “Roped A Dope” Who is the Dope? All of us unless we get wise quickly.

The only way to Repair the Healthcare System is to enable consumers to own their healthcare dollars and to provide incentives to consumers to be responsible for their health. The government should make the rules to level the playing field and empower consumers to drive the healthcare system to their benefit.

These actions allow healthcare affordable to all including the government.

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

What Is Reality?: America Is Heading Toward Financial Disaster

Stanley Feld M.D.,FACP,MACE

The United States cannot afford to provide universal healthcare coverage under a single party payer. The country is in financial difficulty without expanding Medicare.

“Bernie Madoff is small-time compared to the federal government. Really. You want Ponzi schemes? The new Obama-Democrat budget deficit is $1.8 trillion, four times larger than it was only last year. The national public debt has increased by more than 10 percent since Inauguration Day.”

Social Security and Medicare are underfunded entitlement programs. Medicare for the entire country is not viable.

These are the published numbers for 2008.

• Social Security's unfunded liabilities stood at $13.6 trillion.
• Medicare's unfunded liabilities are more than $30 trillion.
• Medicaid, another severely underfunded and politically untouchable entitlement program, only adds to the total.
• The federal government's current entitlement bill, including future obligations-based only on promises it has made in the past -- is greater than $57 trillion.”

The first Baby Boomers started drawing early retirement benefits from Social Security last year.”

78 million people are going to stop working, stop paying taxes, stop paying into retirement programs and start drawing Social Security and Medicare benefits. The federal government has made explicit and implicit promises to millions of retiring citizens. It does not have the funds to keep those promises without a big hike in taxes.

“According to a recent forecast by the Congressional Budget Office shows that Medicare and Medicaid alone are going to crowd out everything else the federal government is doing by mid-century”

In order to get close to funding our current obligations it is estimated that the income tax rate will have to increase to 66%. With all the bailouts and economic stimulus packages the federal government’s debt can only get worse.

Yet the game of who can have better sound bites and who can win is the only thing that is important to President Obama, the healthcare insurance industry, and the Democratic congress.

Healthcare reform should not be about a National Healthcare Insurance Exchange or universal healthcare with a single party payer. This is not going to fix the healthcare system. It will make our financial problems worse. Our government officials should face reality. It should do what all physicians know needs to be done.

It should be passing legislation to create a less polluted environment. It should revise the Farm Bill. It should eliminate the use of corn syrup. It should fight obesity with public service educational campaigns. It should create an insurance product that provides consumers with financial incentives to stay healthy. It should eliminate the causes of administrative waste and defensive medicine. These should be the areas of discussion in order to repair the healthcare system. These bold topics threaten powerful vested interests and are politically explosive.

America should set up a healthcare insurance system that provides incentives consumers to demand better foodstuff and a healthier environment. Consumers should own their healthcare dollars and be able to save what they do not use. (ideal medical savings account).

The federal government should make the conversion to functional electronic medical records easier and less costly to physicians (ideal electronic medical record). We should have major tort reform to decrease the intolerable cost of defensive medical.

These are areas in which the healthcare reform debate should be focused. If the Republican Party wants to seize the initiative from the Democratic Party and excite the citizens of our country they need to act .

Instead, we have a silly debate pitting the new media (Democratic Party) against the old media (Republican Party) over systems we cannot afford. The new media will win. Americans lose no matter which side wins.

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

Consumers’ Anger Toward The Healthcare Insurance Industry Mounts

 

Stanley Feld M.D.,FACP,MACE

President Obama is utilizing the well earned anger consumers have for the healthcare industry in order to promote his healthcare reform plan. Eighty percent of consumers are not sick. Those 80% think their healthcare insurance policy is great. The 20% of the population that is sick is very unhappy with the healthcare insurance industry.

The internet and the blogosphere have enabled those 20% to express their anger. In less than 5 hours there were 177 negative comments to the article describing how the healthcare insurance industry double crossed President Obama. This anger has been ignored in the past. The new media has created an environment in which the anger cannot be ignored. The healthcare insurance industry has killed the goose that laid its golden eggs.

President Obama has made the internet his town hall to permit consumers to express their discontent for the healthcare system. I suspect President Obama will receive more than 5 million complaints in his campaign to expose the abuse of patients by the healthcare insurance industry.

It will not bring us closer to having an affordable healthcare system. If the complications of chronic diseases were prevented, defensive medicine eliminated by effective malpractice reform, and healthcare insurance companies’ administrative waste stopped, America would have an affordable healthcare system.

Consumers need to control their healthcare dollars, receive incentives and be responsible for their own health and healthcare. ( ideal medical savings accounts).

The following are a few consumer comments

“Not surprised at all by this. The health insurance companies have had an unbelievable advantage, they can do anything they want. The only thing they need to do is keep Congress happy with lobbyists because Congress is not their customer, they have their own insurance paid by you and I. It's gloves off time on health reform. These guys will pull no punches, they are fighting for their yachts. While we lose insurance if we file a claim.”

A consumer terminated from his job.

“I am a 56 year old professional with master degrees and many years of experience in my industry & for 19 years plus I worked for the same large corporation that just terminated me from employment because I was diagnosed with a blood cancer.
My family and I have lost medical coverage because of this and at a time when I need it the most. I would like to continue buying the same insurance even with the termination but I can not do so because I am excluded from group employment. I have lost all my rights to buy insurance like everyone else and with pre-existing medical problems nobody will insure me (or my family which depended on me).
At the very least, because I worked all my life and have never been unemployed, I should have been allowed to keep my insurance that I had while I was healthy. When I tell my friends overseas what my employer, Sun Chemical Corporation has done with me, they all say it is illegal in their country and it is a total horror that our society has chosen to discriminate so savagely against the sick and those unfortunate to lose their employment.
It is a travesty that corporations and health insurance companies collude to cleanse their ranks of those that are sick and those that are getting old as it has happened at Sun Chemical Corporation a multinational division of Dainippon Ink & Chemicals a Japanese conglomerate. “
An abused person”

This man’s corporation dropped him. He should be able to get COBRA insurance but the COBRA premium is at least 150% more than the employer paid premium. The premiums must be paid with after tax dollars. This increases the real cost of the COBRA premiums by an additional 35%.Corporate self insured plan’s can avoid the COBRA coverage requirement.

This consumer is 9 years away from being eligible for Medicare coverage. He cannot qualify for private insurance because of his age and his preexisting illness. The rest of his family might not qualify for more expensive individual healthcare insurance policies.

A byproduct of the new media is others can be made aware of the healthcare systems inequities.

“I am so sorry and hope there is some sort of alternative for you found very soon - for you and your family's sake. This is why we have to hang solidly behind healthcare reform. Personally, I would prefer single payer because these guys do not want to reform, they want to continue holding everyone's health hostage. What you're going through is awful. Please take care...so sorry.”

+ I'm a fan of this user

There are pleas for people to exercise our People Power.

Dear J,

“It's exactly stories like you that need to get out in front of this thing and bury Blue Cross in their hypocritical "we provide better service" grave.
Just like so many scare-tactic politicking, these ads are nothing more than a mirror aimed outward. The private insurance industry is broken because there are really no better options.
If they want to survive, they're just going to have to do better...

As far as I'm concerned, no one will be upset if they don't survive.”

There are even comments containing color words.

Blue Cross Blue Shield s@#%&--they have raised my rates every year for the past three years, even though they have not had to pay ANY medical charges for me. What do you expect these insurance guys to do? They don't want to lower costs. No doubt, if there were a cure found for cancer, there would be some idiots, like insurance companies and republicans, rushing to undermine the cure and bury it because it hurt the chemotherapy industry. That's the way they think. They have NO interest in making health care more affordable, more efficient, and less necessary. Don't threaten the system that helps the fat cats.

The negative comments are endless. President Obama will receive lots of documentation. Documentation he will use against the healthcare insurance industry. He will win. Unfortunately, he will not solve any of the problems in the healthcare system.

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

How To Neutralize The Healthcare Insurance Industry’s Attack. Part 2

 

Stanley Feld M.D.,FACP,MACE

Move On.org ability to social network is legend. MoveOn.org acted immediately with a call to action as soon as it was obvious that the healthcare insurance industry was going to attack President Obama’s healthcare plan. Its plan is to attack the healthcare insurance industry

Blue Cross Blue Shield is trying to kill "a key plank in Obama's reform platform." So we're trying to raise $150,000 in two days to fight back. Can you chip in $35 right now? Click Here

“Dear MoveOn member, “

Breaking news on health care: The Washington Post is now reporting that insurance giant Blue Cross Blue Shield "is putting the finishing touches on a public message campaign aimed at killing a key plank in Obama's reform platform."¹

The Huffington Post sums it up as "Insurers Planning on Double-Crossing Obama."²

MoveOn.org drew the line in the sand before the healthcare insurance industry using old media tactics finished its storyboard.

“We knew the insurance companies would eventually turn on the president, but this is much sooner than expected. And they're targeting the public health insurance option—the crucial piece that will help cover everyone. So we're immediately launching a rapid-response campaign to go toe-to-toe with Blue Cross Blue Shield and win quality health care for all Americans.”

MoveOn.org makes the point that the insurance companies turned on the President. It has prepared a rapid-response to help the President get his healthcare reform package passed in 2009.

“We need to raise $150,000 in the next two days. It's a lot, but we'll need every penny to take on Goliath. We'll run ads, hold events, and work like crazy to get the real truth out to voters. AND we'll keep the pressure on Congress to make sure they don't get bullied into gutting the president's plan to guarantee health care coverage for everyone. Can you chip in $35 right now to make it happen?”

https://pol.moveon.org/donate/blueshield.html?id=16165-7180088-yqI_hAx&t=3

MoveOn.org’s message is clear. It is asking people to send money to prevent the healthcare insurance industry from destroying a key provision, (“National Insurance Exchange”) in the President’s healthcare reform plan. President Obama’s healthcare reform plan claims it will provide a public health insurance plan option that will not subsidize neither healthcare Insurance companies CEO’s salaries nor stockholders profits therefore reducing healthcare costs.

MoveOn.org ignores the fact that our country presently cannot afford the costs of Medicare . Expanding Medicare will be a disaster.

“If we had the choice of a public plan, private insurers would have to lower rates and improve quality to compete, so they're dead set against it. Today's news just confirms that fact.”

You bet the healthcare insurance industry is dead set against his plan. However the healthcare insurance industry is the administrative service provider for government operated healthcare plans. Everyone will move to the public plan. The healthcare insurance industry will make a greater profit because everyone will be insured. The process of setting price will be in the hands of the healthcare insurance industry.

There will be not improvement in access to care or quality of care because the incentives in the healthcare system will not be changed.

“In the past, Blue Cross Blue Shield has been sued for underpaying doctors and fined for refusing to cover necessary medical treatments for their customers.³ Now, with what watchdog group Media Matters calls a "desperate attempt to deceive,"⁴ they've gone one step too far.”

The healthcare insurance industry has killed the goose that laid its golden egg. It is impossible for consumers or physicians to sue the government. The government will be forced to underpay physicians as well as restrict access to necessary medical treatment.

The debate is not a debate on Repairing the Healthcare System. It is a debate between the government and the healthcare insurance industry about who controls the healthcare dollar

MoveOn raised $270,000 in 24 hours surpassing the goal of $150,000. The message is loud and clear. Consumers are mad as hell and they do not want to take it any more.

---

“Dear MoveOn member,

Amazing! After news broke of Blue Cross Blue Shield's new campaign to defeat Obama's health care plan, MoveOn members responded in a huge way. Together, we smashed our goal and raised $270,000 in just one day. (Thanks!)”

Move on.org will not stop there and set a new goal of $350,000 for the next 24 hours.

“If we can hit this mark, we'll send a strong message to the entire industry that if they start trying to block Obama's key health care proposal to cover everyone, we'll be ready to fight back—hard.”

This is too much for Harry and Louise to take on. When consumers realize that President Obama’s plan will not work they will demand control of their healthcare dollars.

There are three take home points.

1. The old media will not work.

2. People power using the new media is very powerful

3. Healthcare will become consumer driven.

4. The debate is focused on the wrong issues

How To Neutralize The Healthcare Insurance Industry’s Attack. Part 1

Stanley Feld M.D.,FACP,MACE

Yesterday Blue Cross and Blue Shield of North Carolina started rolling out the healthcare insurance industry’s attack on President Obama’s National Health Insurance Exchange. The 1993 Harry and Louise attack campaign will not work in 2009. Consumers do not trust the healthcare insurance industry to look after their needs. President Obama is playing off this mistrust and counter attacking. He sent an email to 20 million consumers asking them to join his call. He wants us ask congress to pass real healthcare reform in 2009. He asked us to join and donate money. After we join his cause we could then tell our story about the dysfunction in the healthcare system. He said your voice will make a difference. He says nothing in specific terms about how he will Repair the Healthcare System.

“Stanley –

You will note every email is personalized.

“The chance to finally reform our nation's health care system is here. While Congress moves rapidly to produce a detailed plan, I have made it clear that real reform must uphold three core principles -- it must reduce costs, guarantee choice, and ensure quality care for every American.”

Healthcare insurance premiums are constantly increasing while coverage is decreasing. Most healthcare insurance policies do not have a choice of physicians (physician networks). Quality healthcare (undefined) is not available for every American (universal healthcare). The healthcare insurance industry’s control of the healthcare system is responsible for most of these defects.

“As we know, challenging the status quo will not be easy. Its defenders will claim our goals are too big, that we should once again settle for half measures and empty talk. Left unanswered, these voices of doubt might yet again derail the comprehensive reform we so badly need. That's where you come in.”

President Obama invites us to fight those who would derail the comprehensive reform we so badly need. He does not define the reform (Hillary Clinton’s 1993 reform?). He does not describe the route to reform. It sounds good is meaningless.

When our opponents spread fear and confusion about the changes we seek, your support for these core principles will show clarity and resolve. When the lobbyists for the status quo tell Congress to hold back, your personal story will give them the courage to press forward.

President Obama’s message is clear. The call to action is to neutralize the healthcare insurance industry’s attack.

Join my call: Ask Congress to pass real health care reform in 2009.

“After adding your name, please consider sharing your personal story about the importance of health care reform in your life and the lives of those you love.”
“I will be personally reviewing many of these signatures and stories. If you speak up now, your voice will make a difference.”

http://my.barackobama.com/HealthCareOrganizing

When I tried to tell my story there was only one place to tell my story to President Obama. The space was to donate and join the call to action. He promises to personally review my story yet he has not listened to my call for a system of patient responsibility or patient reward. He has not listened to the plea for major tort reform. He has not listened to the need for a free electronic medical record in the cloud paid for by physicians by the click. President Obama does not have a clear the way to achieve his goals. He is going to get a bill passed that is worse than the Massachusetts plan.

In our sound bite society one, he wins using the new media. The healthcare insurance industry does not get it.

http://my.barackobama.com/HealthCareOrganizing

“Last November, the American people sent Washington a clear mandate for change. But when the polls close, the true work of citizenship begins. That's what Organizing for America is all about. Now, in these crucial moments, your voice once again has extraordinary power. I'm counting on you to use it.”

Thank you,
President Barack Obama

President Obama followed up with another email call to action. He is organizing People Power, one block at a time, one neighborhood at a time and one city at a time. His costs are minimal.

President Obama, using the new media, has the healthcare insurance industry on its heels. He used the old media to declare that the healthcare insurance industry made a commitment to reduce healthcare costs by 2 trillion dollars in the next 10 years. His sound bite is “ you’ve made a commitment; we expect you to keep it.” Now the healthcare insurance industry has backed down. Implied is how can it be trusted?

Patient power and the new media will not let this happen. “When our opponents spread fear and confusion about the changes we seek, your support for these core principles will show clarity and resolve.”

“On June 6th, in thousands of homes across the country, we'll gather to launch our grassroots campaign for health care. We'll watch a special message from the President. We'll build the teams and draw up the plans for winning health care reform the same way we won the election: Building support one block, one neighbor, one conversation at a time. And we'll put those plans into action.” “Please sign up today to host or attend a kickoff near you.”
http://my.barackobama.com/HCkickoff

This time the healthcare insurance industry must do better than Harry and Louise.

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

Harry and Louise Are Coming Back: Insurers Planning on Double-Crossing Obama

 Stanley Feld M.D.,FACP,MACE

 One week after President Obama announced that the nation's health insurance lobby pledged to reduce healthcare costs by $2 trillion in ten years, Blue Cross Blue Shield of North Carolina is putting the finishing touches on a public message campaign aimed at killing a key plank in the Presidents reform platform.

“Mr. Obama had told the health care executives, “you’ve made a commitment; we expect you to keep it.”

When the healthcare insurance lobby realized the trap it fell into it immediately went to work to defend its control over the healthcare dollar. It is going to roll out Harry and Louise as it did in 1993. I do not think it will work. We are living in different times with different media tools.

“From a distance everything Barack Obama says sounds great. The events of the last eight years have created cynicism and despair. We are a nation thirsty for hope to solve our many problems.”

The healthcare insurance industry is going to try to destroy President Obama’s “National Health Insurance Exchange”. If congress passes the National Health Insurance Exchange it will lead to a single party payer system. The government as the single party payer is unsustainable.

“As part of what it calls an "informational website," the company has hired an outside PR company to make a series of videos sounding the alarm about a government-sponsored health insurance option, known as the public plan.’

The industry argues that creating a public insurance program will undermine the marketplace and eventually lead to a single-payer style system.

Somehow, this isn't surprising. The health insurance industry has showed it is not serious about controlling costs by backing away from the promise they made to President Obama.

Now, it wants to eliminate the public health insurance option. The public insurance option would provide an option for people who cannot afford buy private insurance because of the healthcare insurance industry’s restrictions.

“The public health insurance option is a key provision in President Obama's plan to help cover all of us. It would finally give everyone the choice between keeping our current insurance or switching to a new, high-quality public plan. And under a public health insurance plan our premiums wouldn't subsidize CEO salaries or stockholder profits we'd all save a lot on health care costs.”

There are basic problems with private healthcare insurance. Its premiums are a very rough calculation with large profits built in. The industry has reduced provider reimbursement and restricted access to care while raising premium and maintaining grotesque administrative fees. The process is opaque to all.

The government will do the same as a single party payer because it cannot afford the program.

President Obama’s thinking on cost savings is defective. The government outsources the administrative services of its present government healthcare programs Medicare and Medicaid to these very same healthcare insurance companies. The healthcare insurance companies do the same thing to the government. Its providers (physicians and hospitals) and consumers (patients) will experience the same reductions and rationing of care. The program will fail just as the Massachusetts program has failed to be affordable to the state. A systemic change in the healthcare systems payment structure must occur in favor of patients and physicians.

“If we had the choice of a public plan, private insurers would have to lower rates and improve quality to compete, so they're dead set against it.”

The crafting of a campaign by Blue Cross Blue Shield of North Carolina is the first of many campaigns we will see in the coming months in an attempt to turn public sentiment against the “National Health Insurance Exchange.”

President Obama’s insurance exchange is another way of expanding the Medicare program. His plan is to arrive at a single party payer through the back door while promising to maintain the private insurance option. It is Hillary Clinton’s healthcare plan of 1993 all over again. Nobody asked the practicing physicians for solutions. Physicians’ representing associations have not done of very good job of articulating solutions.

The healthcare insurance industry is not looking to protect its customers (consumers). It is looking to control the healthcare dollars and protect its profits. However they have cooked the goose that laid their golden eggs by abusing consumers, employers and physicians. Harry and Louise will not work.

Consumers are frustrated and angry. They do not trust government or the healthcare insurance industry. They are looking for a creative solution.

The new media, the internet and blogs provide a chance for consumers to express themselves.

“ Obama will backtrack on this one, too! I don't have any hope that America will join the 20th century to become a "progressive" democracy. We are an oligarchy and it will stay that way. Just look how we elect people for office. Millions raised, millions disappearing in someone's pocket. Money rules! ”

Consumers, it is time we drove the healthcare system because our surrogates have let us down.  

“Not surprised at all by this. The health insurance companies have had an unbelievable advantage, they can do anything they want. The only thing they need to do is keep Congress happy with lobbyists because Congress is not their customer, they have their own insurance paid by you and I. It's gloves off time on health reform. These guys will pull no punches, they are fighting for their yachts. While we lose insurance if we file a claim.”

It is time for consumers to demand control of their healthcare dollar. It is time they have incentives to be responsible for their own health and be rewarded for staying healthy. My ideal medical savings account either funded by employers if the consumer is employed or funded by the government with insurance for all is the solution that must be demanded.

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

President Obama’s Healthcare Reform: A Slam Dunk: No Defense

Stanley Feld M.D.,FACP,MACE

 

After a White House meeting with healthcare leaders, President Obama pronounced that is was “a historic day, a watershed event,”. He brought doctors, hospitals, drug makers and insurance companies voluntarily together and they offered $2 trillion in cost reductions over 10 years.

“The savings, he said, “will help us take the next and most important step — comprehensive health care reform.” The meeting’s results were announced as if President Obama engineering a political coup bringing leaders of the health care industry to the White House and built momentum for his ambitious health care agenda.”

All the proposals from the meeting are vague and unenforceable. None of the proposals guarantee cost savings to the healthcare system. It is another trick play to break down the defense of the major stakeholders in the healthcare system. It represents an attempt at consensus building.

Mr. Obama had told the health care executives, you’ve made a commitment; we expect you to keep it.”

The healthcare insurance executives and the hospital system did not realize what the President was doing. The healthcare insurance industry says nice things in order to have a seat at the table. It knows it is the real villain. The President is saying nice things in order to avoid confrontation, “build consensus ” and impress the media with a sense of agreement among stakeholders for his healthcare reform package.

“The consensus-building approach has already yielded some results. Insurance executives have offered to end certain underwriting practices, like refusing to cover individuals with pre-existing conditions or charging women higher rates than men, and they have invited Congress to impose stringent, uniform federal regulation on their industry.”

The healthcare insurance industry has made promises without realizing what it has done.

“ But even as insurers and health care providers stand shoulder to shoulder with Mr. Obama in vowing to slow the growth of health spending, they oppose him on other fronts.”

“For example, insurance companies are opposed to a new government-sponsored health plan, which Mr. Obama supports but insurers fear could drive them out of business.”

 

The next day the healthcare insurance industry and the hospital systems realized the impact of the President’s coup. They realized he was wooing them but not talking about the same thing they were. President Obama’s noose is tightening around the healthcare insurance industry’s neck.

“Health care leaders who attended the meeting have a different interpretation. They say they agreed to slow health spending in a more gradual way and did not pledge specific year-by-year cuts.”

In separate press releases the American Hospital Association and the American Association of Healthcare Insurers clarified their positions. The American Medical Association seems to have bitten President Obama’s hook. It has not protested President Obama’s healthcare plan nor has it offered effective executable reform measures. It has offered high level goal without a path to achieving the goals.

“There’s been a lot of misunderstanding that has caused a lot of consternation among our members,” said Richard J. Umbdenstock, the president of the American Hospital Association. ”

“The A.H.A. did not commit to support the ‘Obama health plan’ or budget. No such reform plan exists at this time.”

It sounded like President Obama faked out the AHA. They came back strong and denied agreement with the form that was presented by the President.

“Moreover, Mr. Pollack EVP of AHA wrote, “The groups did not support reducing the rate of health spending by 1.5 percentage points annually.” They had agreed to squeeze health spending so the annual rate of growth would eventually be 1.5 percentage points lower.”

The America’s Health Insurance Plans had the same reaction.

“Karen M. Ignagni, president of America’s Health Insurance Plans, said the savings would “ramp up” gradually as the growth of health spending slowed.”

Nancy-Ann DeParle reply tried to appease these two powerful vested interests. Her reply and correction of her reply made things worse.

Nancy-Ann DeParle, director of the White House Office of Health Reform, said “the president misspoke”. After providing that account, Ms. DeParle called back about an hour later on Thursday and said: “I don’t think the president misspoke. His remarks correctly and accurately described the industry’s commitment.”

Few speak of the details of President Obama’s healthcare reform plan. President Obama is going to slam dunk his healthcare reform. Congress and the stakeholders will be defenseless. Everyone will be caught flat footed.

Congressional Democrats are starting to complain about the process being secretive. Only a select group is writing the legislation. Republicans are lost. They are not offering insight or executable alternatives. If they have alternatives have not told stakeholders or the public. Before Americans know it a disastrous healthcare reform plan will pass by 51 votes in the senate.

Americans: Please wake up.

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

President Obama’s Healthcare Reform Trick Play

 

Stanley Feld M.D.,FACP,MACE

Healthcare policy definitions are easy to confuse. I am an advocate for universal healthcare coverage. I am not an advocate for a single party payer. I believe the only way to be successful in repairing the healthcare system is to remove control of the healthcare dollar from the healthcare insurance industry. Consumers must be in control of their health care dollars. The ideal Medical Savings account can motivate patients to be responsible for their health.

Patients with chronic disease must be motivated to control their chronic disease. If they are motivated to control their disease healthcare costs would decrease. Using the ideal medical savings account a patient with diabetes for example would be expected to spend $4000 dollars a year. It they controlled their disease well and avoided hospitalization their employer or the government could afford to provide a bonus. If they controlled their disease and avoided hospitalization they would have $2000 to put in a retirement account. They could be eligible for an additional $2000 bonus. The result is a savings of $4000 into their retirement account. Patient responsibility and motivation are the only way we have a chance to Repair the Healthcare System.

President Obama healthcare plan is going to make patients more dependent on government and less responsible for their care and choices. In fact choice will be rationed. His allies in the single party payer camp are complaining that he has “caved” in to hospitals and healthcare insurance companies.

They claim he was elected to install a single party payer system. They ignore the point that the government cannot afford to pay for the Medicare single party payer system much less universal coverage for the entire population as the single party payer.

The function of the government should be to make appropriate rules to align the incentives of all the stakeholders in the healthcare system. President Obama is confusing everyone with his position on healthcare reform in order to decrease resistance to his plan. My guess is he is doing it intentionally.

“Although Barack Obama was elected on a health care reform platform, his version ignores single payer. Nor is single payer advocated by his allies in the well-funded coalition called Health Care for America Now, composed of MoveOn, USAction, ACORN, Americans United for Change, the unions SEIU and UFCW and other liberal heavy hitters.”

President Obama is a clever politician. He understands that it would be political suicide to directly advocate a single party payer system. The American public wants choice. They do not want to have healthcare rationed. The American public understands the government cannot afford a single party payer system for all. The public outrage would dominate the debate. His healthcare plan is designed to arrive at a single party payer system by default.

The advocates of a single party payer do not understand the subtlety of President Obama’s positioning in the healthcare reform debate. .

“Journalist Russell Mokhiber, founder of the new group Single Payer Action, notes that no advocate of a single payer system was invited to the recent White House summit on health care reform. Only protests by Progressive Democrats of America and others won an invitation for Congressman John Conyers, sponsor of the United States National Health Care Act: H.R.676.”

The advocates of single party payer system are now attacking President Obama. They are accusing him of caving in to the demand of powerful vested interests.

“Mokhiber quotes Dr. David Himmelstein of Physicians for a National Health Program: “The President once acknowledged that single payer reform was the best option, but now he’s caving in to corporate health care interests and completely shutting out advocates of single payer reform," even though "the majority of Americans favor single payer, and it’s the most popular reform option among doctors and health economists."

This is political spin. President Obama is not caving into anyone. The majority of Americans are do not want rationing of health care that usually follows the high cost of a single party payer by government that exists in other western countries.

The President knows the best way to achieve a single party payer system. His plan is to get there by default.

The Obama healthcare reform plan is create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

I believe his National Health Insurance Exchange will drive the private insurance companies out of the healthcare insurance business. This might not be a half bad idea since the healthcare insurance industry controls healthcare cost and earns a grotesque amount of money.

It could change the healthcare insurance industry but I doubt it. It should become a 6% broker as the administrative service organization instead of 15% broker in a private insurance system. However there is no price transparency. In reality the government pays 18% for Medicare administrative services. President Obama healthcare reform proposals will not repair this abuse. Nothing will change. The government will restrict access and ration healthcare.

Watch out.

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