Sunday, May 15, 2016
Mr. Andy Slavitt Acting Administrator Center for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Re: MACRA Regulations Dear Mr. Slavitt, While trying to control costs, Congress and CMS have over the years been in the process of destroying the patient-physician relationship, paradoxically increasing costs. MACRA only exacerbates this problem. This has happened as physicians take time from patients to enter data demanded by the bureaucracy. Additionally physicians have less time to think about and conceptualize their cases causing the need for greater testing. It is true that healing is better when patients feel a bond with their physician. This is becoming more difficult as the government tries to micro-manage the patient-physician interaction. Also the negative impact of this law on physician training will be massive. Residents now are spending more time with computers and less with their patients. Their history taking and physical diagnostic skills are rapidly decaying. Thus, in the future, we will have physicians with less skill needing to order more tests greatly increasing costs, while providing care of lower quality. The idea of providing bonuses and penalties around an arbitrary price-fixed amount devoid of market verification is economically unsound. The value of a physician visit should be determined by the individual patient and not by a distant bureaucracy. A way to accomplish this change would be a voluntary program for seniors. Those who wish to do so would have an actuarially determined yearly deposit into a special health account. This account would be used to pay for most outpatient care and fund a nationally available high deductible plan. In this light the only solution regarding regulations for MACRA is for your agency to return to the Congress and ask for re-addressing the “SGR FIX”, advising them to implement this voluntary Medicare plan addressing physician re-imbursement. Sincerely, Kenneth A. Fisher, M.D. Nephrologist – Author “Understanding Healthcare: A Historical Perspective” Cc. Congressman Fred Upton
Monday, April 25, 2016
Two recent articles In Forbes (in electronic form) discuss how this administration is doing its best to eliminate health savings accounts and what an enlightened policy would look like. In “HSAs Under Attack In Obama Exchanges” by Grace-Marie Turner, Forbes, 4/21/2016 http://www.forbes.com/sites/gracemarieturner/2016/04/21/health-savings-accounts-under-attack-in-obamacare-exchanges/#7bbe09fe1ceb In this article Ms. Turner writes that instead of giving Americans more choices, this administration is formulating rules that make purchasing the popular health savings account on the exchanges just about impossible. While Dr. John Goodman in Forbes, 4/19/2016, “Roth Health Savings Accounts: What The World Needs Now” http://www.forbes.com/sites/johngoodman/2016/04/19/roth-health-savings-accounts-what-the-world-needs-now/#18c15fae6d30 Writes that unencumbered by legal restrictions Roth Savings Accounts would via tax policy balance payments by the individual for routine healthcare with third party insurance that would for big-ticket items. This could be available to all Americans who choose to do so via a refundable tax credit.
Monday, April 18, 2016
Follow how we got to this dysfunctional state in healthcare and how going back to American individuality we can fix it. This electronic book is available at: http://www.amazon.com/Understanding-Healthcare-perspective-Kenneth-Fisher-ebook/dp/B01BX98TC2/ or https://store.kobobooks.com/en-us/ebook/understanding-healthcare
Thursday, March 3, 2016
This book was written with a historical perspective so that the reader will gain a clear understanding of the misconceptions and accidents of history that have led to our present dysfunctional healthcare situation. To most people the American healthcare system is a confusing maze of inefficient complexity. I explain how this happened and what should we do about it. The reader will also learn about the scientific method, one of man’s greatest achievements, which led to modern medicine and the development of the profession. To understand the path we must take for all Americans to have access to comprehensive care at a price we can afford, we must understand the forces at work and the false starts we have taken over the years trying to achieve this so far elusive goal. The audience for this book would be the public, political leaders and academics. The book is available electronically at a very reasonable price at: http://www.amazon.com/Understanding-Healthcare-perspective-Kenneth-Fisher-ebook/dp/B01BX98TC2/ or https://store.kobobooks.com/en-us/ebook/understanding-healthcare