Monday, December 10, 2012

Health Care Reform NOT Insurance Reform

Why does health care reform have to mean spending more on health care? We spend much more per person than any other country. We d-emphasize the trusting relationship between patient and physician while over-using drugs and devices. Instead of addressing relevant issues Congress has passed an expensive insurance bill. This blog discusses how a physician-patient based system versus a government price control system would provide universal coverage while decreasing costs and providing better care. Every American should have a Health Savings Account, From Birth, with High Deductible Insurance, a reasonable plan is publisher here.

Tuesday, August 14, 2012

We Need Medical Customization NOT Mass Productoin

As industry moves from mass production to mass customization, our soviet style PPACA attempts mass production, ignoring individuality. Using price controls and central planning the Soviet Union imploded under the weight of its own bureaucracy. Instead of promoting individuality and rational pricing using health savings accounts and high deductible insurance the PPACA uses Soviet like price fixing, central planning and rationing in a failed attempt to control costs. In no other field is individuality and judgment more important than in medicine. A centralized bureaucratic system will not work.

Friday, July 27, 2012

We Pay Dearly For A Lack Of Price Transparency

The reality is that no one knows in our price fixed health care system the real value for any activity good, bad or indifferent. With price transparency, health saving accounts and high deductible insurance we could provide excellent care for all in America at far less cost. One only has to look at the state of Indiana to see the success of this model of health care.

Thursday, July 19, 2012

The Misguided Supreme Court Decision

By the Supreme Court not striking down the PPACA our nation will possibly be saddled with an intrusive unworkable health bureaucracy, the inability for physicians to care for their patients appropriately and huge deficits we cannot afford. Many millions will remain uninsured with many millions in Medicaid which borders on having no insurance at all. The irony is that Health Savings Accounts along with High Deductible Insurance was beginning to spread throughout the country lowering health care costs. With creative tax policy we could provide excellent care for all in America with these patient centered insurance policies.

Wednesday, July 18, 2012

The American Medical Association And Others Hypocrisyy

Posted in part on Sermo 7/10/2012 Hypocrisy abounds, the AMA, ACP and others support the bill because they think they will receive more money. Ironic, from a government that has to mortgage the future of our children and grandchildren to do so. There are of course better alternatives that using proven methods would insure all Americans at far less cost and promote a closer relationship between the patient and their doctor. As an example see our article in the Washington times,

Tuesday, May 15, 2012

Washington Times Op-Ed

Published in the Washington Times FISHER AND GROSS: Prudence of a patient-centered approach Allowing patients to choose level of care would result in savings By Dr. Kenneth A. Fisher and Dr. Lee S. Gross Thursday, May 3, 2012 Everyone wants affordable, high-quality health care. The Affordable Care Act (ACA), also known as Obamacare, is proving to be a less-than-viable approach to accomplishing that goal. Physicians, politicians and patients are beginning to realize that the ACA neglects to address problems with cost, quality and access. Obamacare fundamentally changes the doctor-patient relationship. For patients, it neglects individuality and forces a Washington-based, administratively imposed, one-size-fits-all expensive approach to the practice of medicine. It expands the failed government policies that have plagued Medicare and Medicaid for decades. The government’s own actuaries predict that future health care costs will exceed 20 percent of gross domestic product, greater than our present economy-choking 18 percent. Additionally, the projected 10-year cost of the law already has increased from $800 billion to an astonishing $1.76 trillion. Although intended to provide universal coverage, Obamacare still leaves approximately 20 million people uninsured. Sixteen million people are to be covered by expanding Medicaid, a failed system that does not provide adequate care. Just 30 percent of physicians currently see Medicaid patients because the reimbursement they receive for those patients doesn’t even cover their overhead. Practicing physicians know there is a better way, a patient-centered approach. A simple way to restore responsibility to health care spending is to put people in charge of how they spend their own health care dollars. All Americans should have individual health savings accounts (HSAs) coupled with high-deductible health plans (HDHP) for unexpected catastrophic conditions. HSA funds could grow, accumulating tax-free over a lifetime, thereby eliminating the need for succeeding generations to subsidize holders’ care. For the approximately 17 percent of our population who are truly indigent, their HSAs and HDHPs would be funded from Treasury assets. For the 30 percent of families receiving the earned-income tax credit, those funds would be deposited into their HSAs. For the remainder of Americans, HSA contributions would have tax incentives. Employers, instead of providing traditional health insurance, could provide funding for HDHPs, which, because of their lower cost, would increase employees’ take-home income. Individuals and businesses would use pretax dollars for purchasing all health insurances. Historically, the model of HDHPs was criticized because it was thought many people would avoid getting preventive and chronic-disease care because of possible large expenditures out of pocket or from their HSAs. That was a legitimate concern before direct primary care programs, which today remove the obstacles to patients seeking preventive care and management of chronic conditions. Routine expenses should not be the responsibility of an insurance company, anyway. Homeowner’s insurance doesn’t pay for weeds in your lawn, nor should health insurance pay for your cold or sprained ankle. In a direct primary care model, patients meet most of their basic health care needs for less than the cost of their cellphone bills. HDHP is then restored as true catastrophic insurance. This enables health care decisions to remain between the patient and doctor. Free-market principles do work in medicine. Lasik surgery is not covered by third parties, yet over time, the cost of the procedure has decreased markedly while quality has increased significantly. Patients have to determine value, and surgeons must compete on price and quality. HSAs, along with direct primary care plans and high-deductible catastrophic insurance, can provide outstanding individualized care for all Americans. This could enable each generation to fund its own care while decreasing our national health care costs and greatly improving our economy. When compared to the government-centered approach, patient-focused solutions win every time. Dr. Kenneth A. Fisher, a nephrologist, and Dr. Lee S. Gross, a family physician and co-founder of Epiphany Health, are the presidents of the Michigan and Florida chapters of Docs4PatientCare.

Sunday, April 22, 2012

We Need A Health Care Reform Bill

I Posted this on Sermo, a physician discussion web site, Nov. 29, 2010, still pertinent today. In my opinion, both political parties have it wrong, we need a health care reform bill not an insurance reform bill. Isn't it time for physicians to tell the Congress and the American public that given the right tools, we can provide excellent care for all Americans costing about 15% of gross domestic product versus today's 18%. This would require a retro-fit of our medical culture, good histories, good physicals, less reliance on technology, adequate payment for a 30 minute visit and significant changes at the Congressional level. I believe we must offer the nation a viable alternative for our message to be heard.

Thursday, April 5, 2012

Patient Versus Government Centered Health Care

Published by me in the Kalamazoo Gazette March 16, 2012

Everyone wants high quality health care for all Americans at a cost that we, our children and grandchildren can afford. The question we are debating is whether the new health care law is the best approach to accomplish this goal.

Unfortunately this law intrinsically intrudes on the patient-doctor relationship, as it neglects individuality and forces a one-size-fits-all on the practice of medicine. It maintains the failed policy of price controls and central planning, with its emphasis on technology and procedures. Additionally, despite its attempt to control costs, it is extremely expensive as described by the government’s own actuaries, who predict that health care costs for the country would exceed 20 percent of gross domestic product (GDP), significantly greater than our present economy-wrecking 17-18 percent The present law, despite considerable cuts in Medicare spending, still depends on future generations to fund the health care costs for retirees, an impossible situation as the population ages.

A better approach would be to insure that all Americans have health savings accounts (HSA) along with high deductible insurance. Every HSA would be funded through tax policy accumulating over a life-time and free of taxes, specifically for each person’s use, thereby eliminating dependence on succeeding generations. For the approximately 17 percent of our population that cannot afford any type of insurance, their HSA and high deductible insurance would be funded from general treasury funds.

For the 30-plus percent or so of families receiving the earned income tax credit, these funds would be deposited in their HSA. For the 50-plus percent of American paying income taxes, a contribution to each family member’s HSA would be supplemented with a tax credit. For these two employed groups their employer, instead of providing health insurance, would provide funding for high deductible insurance. This would be in the employee’s name, creating total portability, and would cost significantly less.

The major advantage of such a plan is that the patients control the funds and would demand and obtain more face time with physicians. Physicians and hospitals would have to compete for these funds, in contrast to the present day artificially fixed payments which favors procedures and technology versus human interaction and judgment. The costs for these plans are approximately half of the present price-fixed central planning system, as demonstrated in Indiana.

The second class status of Medicaid patients would be eliminated as they would be funded at levels the same as everyone else. States could then devote their present Medicaid funds to adequately educating all our children enabling them to compete in a worldwide economy. As our national health care costs would be reduced, our goods and services would be more competitive on the world market, thus improving our employment picture.

This explains my thinking about this issue and why I joined a new national medical organization,, devoted to universal coverage that is personalized and patient-directed, at a cost our nation can afford.

Sunday, March 18, 2012

What The Free Market Can Acheive

This essay was written by my good friend and President of the Florida Chapter of Docs4PatientCare, Lee Gross, M.D.

Price controls never bring down the cost of care. When a plasma television comes to market, it costs $3,000. There is a limited market at that price point. In order to sell... more, the price comes down. Then, competitors find a way to make them for less, and the price comes down. Eventually, they are $200 in a black friday special at Wal Mart.

Why doesn't that happen in medicine? It's price fix...ed and the patient is disconnected from the actual cost of care through third parties. . A pacemaker insertion costs $100,000 and medicare pays the bill. If people had to pay cash for pacemakers, how many would be installed? One? Two? But, under price controls and third party payers, there is suddenly a huge demand for $100,000 pacemakers. When hospitals and doctors and device companies realize how profitable pacemaker insertion is, many more people learn how to put them in and find new indications to put them in. Now you have a huge market for $100,000 pacemakers and the price doesn't come down a penny. You have now just spent a fortune on questionably necessary pacemaker insertions. Only free market principles and true price transparency can lower the cost of care.

The criticism of the HSA, high deductible health plans (which are being phased out by ObamaCare) is that patients often avoid getting routine care because they have to pay out of pocket and the costs are high. That is a legitimate argument. That's where a Direct Primary Care (DPC) program, like our Epiphany Health program can help. For less than you would pay for a cell phone, you can care for all of your basic health needs and insurance becomes true insurance again, rather than a health management company. When I presented Epiphany in Washington DC, I was asked what will happen if another doctor set up next to me and charged less per month, my response was that we would need to compete on price and quality. Go figure, the biggest concern was that we were going to lower the cost of care. We accomplished in a 2 page brochure what Congress couldn't accomplish with 3,000 pages of legislation and 100,000 pages of rules.

The health care reform law is estimated to cost $1.76 trillion over 10 years to "cover" 32 million people, but many of those will be the responsibility of the states under medicaid. It will also still leave 20 million uninsured. If we enrolled all 52 million uninsured people in Epiphany Health, we could have comprehensive preventive care and disease management for $39 billion over 10 years, a net savings of $1.75 TRILLION and everyone's covered with no out of pocket expenses for routine care. With those savings, you could expand medicare-type coverage to everyone for catastrophic care.

That's the power of Epiphany Health and the free market.

Saturday, March 3, 2012

Why I Joined Docs4PatientCare

Posted by me on the physician discussion website, Sermo, November 15, 2011

The Patient Protection and Affordable Care Act is in itself an intrusion on the patient-doctor relationship. But it is much more; it is the end result of a warped sense of government policies based on central planning and price controls. This law, instead of changing direction and using patient driven market forces to determine the true value of medical services, expands on Medicare’s failed concepts of artificially determining value using the Resource Based Relative Value Scale and its Update Committee. The Congress and the Executive realizing that Medicare and its inferior cousin Medicaid has forced our federal and state governments to the brink of insolvency made a failed attempt to control costs. The law instead, under the guise of subsidized health exchanges, federal mandates, cookbook medicine and supposed decreases in Medicare payments is expected by the government’s own actuaries to increase health care costs to 20-25% of gross domestic product increasing from today’s economy wrecking 17-18%.

The question for us physicians as I see it is: are we willing to allow the free market to determine the true value of our services? To me the answer is a resounding YES. There is growing evidence that patients with health savings accounts along with high deductable catastrophic insurance are much more careful about the resources spent on health care and have equal or superior results. If started at a young age using tax credits and federal subsidies for those in real need this system would dramatically decrease costs, eventually end Medicare/Medicaid, have each generation pay for its own care, provide universal coverage and free our federal and state governments from impending economic ruin.

It is time we physicians said, “Enough!” We will all join Docs4PatientCare, defeat this law and place our nation on the road to more freedom and economic development.

Tuesday, February 21, 2012

The Mess We Are In and A Solution

I posted this short essay first on a physician discussion web site,

For decades physicians in this country have let the AMA be their voice. However, due to monies from Congress for CPT codes and the pharmaceutical industry for the use of our AMA number, the AMA has represented itself and not us physicians. Thus the two major health related problems of our time, the failure of price controls and central planning of Medicare to control costs and the increasing numbers of uninsured have been neglected by the official physician spokesman, the AMA.
This created a political vacuum jumped upon by the liberal left to seek their style of a solution. Unfortunately for our patients and our profession, the left's solution to this problem is more price controls and central planning to the detriment of patient-physician centered medicine.
I believe the government does have a place in health care by providing tax incentives or payments for all Americans to have health savings accounts along with high deductible insurance. Then it would be up to us physicians to provide our services via the free market to the public. The state of Indiana has shown that this works well.
Because of my beliefs I have joined Dr. Richard Armstrong as an active member in Docs4PatientCare as the organization that is best qualified to help us provide better care for our patients and thus save our profession.

Tuesday, February 7, 2012

A Viable American Health Care Plan

There is no doubt that we need universal coverage, but at a lower, not a higher percentage of gross domestic product. We need to provide health insurance to more Americans without increasing the demand on doctors, nurses and hospitals that would drastically increase costs. Therefore the increase use of medical services for the newly insured must be matched by a decrease in the use of these services by those that are presently insured. Health savings accounts along with high deductable insurance have shown to dramatically decrease demand and costs while maintaining excellence in care (Mitch Daniels. An Indiana experiment that is reducing costs for the state and its employees. The Wall Street Journal, New York, New York, March 1, 2010).
These accounts could be funded by tax credits for those who pay income taxes, the earned income tax credit, and federal subsidy for the truly needy providing funding for all Americans. These accounts would be created at birth, grow tax free and provide care throughout one’s lifetime. All Americans would then also have the resources to choose from several nationally offered high deductible insurance to cover especially expensive items. Thus, each generation would be accumulating the capital to care for itself when elderly instead of depending on ever shrinking succeeding generations. Upon death the accumulated unspent capital would be passed on to their beneficiaries. By giving every citizen the authority to spend their own money for health care without the burden of the elaborate bureaucracy of central planning and price controls would allow this nation to insure all its citizens at significantly less cost.

Sunday, January 29, 2012

More than one road to universal coverage

Published: Kalamazoo Gazette Tuesday, December 27, 2011
Health insurance exchanges are a key provision in the new health care law, the Patient Protection and Affordable Care Act (PPACA). The law encourages each state to set up an exchange with federal funds and submit its plan no later than January 1, 2013.
The Secretary of Health and Human Services has sole final authority to determine adequacy and content. The law states that exchanges create a website to compare health insurance options, eligibility for Medicaid and federal premium assistance and maintain data on income, employment and residency. The exchanges would also participate in enforcing the law’s mandate.
If states do not initiate an exchange, a federal exchange would be substituted.
On Dec. 13, the Michigan House of Representatives, in a definitive statement in opposition to the PPACA, voted to strip $9.8 million in federal funds from an appropriation bill that would have funded the creation of a PPACA exchange. The governor and the Senate, originally in favor of accepting these funds, now have agreed with the House action. Because of a glitch in the law with many states refusing to initiate an exchange, premium support most likely will not be available, crippling the PPACA, regardless of what the Supreme Court rules this summer.
In response to this threat Secretary Sebelius on Dec. 16 issued a bulletin that states could choose an existing health plan as a model for essential health benefits. This gesture is problematic because this or any future HHS Secretary could change those requirements and has control over which physicians may participate in an exchange. Additionally, states assume financial support for exchanges January 2015.
Some have argued that the House’s action was the result of a far right wing tea party vote. We strongly disagree with this interpretation.
Docs4PatientCare, a non-partisan growing organization of physicians nationwide, stands for the preservation of the patient-doctor relationship which is threatened because of federal bureaucratic interference. We believe in universal coverage, but not this model, as it relies on central planning, price fixing and a bewildering array of regulations.
Unfortunately, while planning for universal coverage, our political leaders chose to emulate the Massachusetts model rather than the extremely successful plans in Indiana that uses patient-centered health care and financial responsibility through health savings accounts and high deductible catastrophic insurance. Rather, the PPACA is a federal adaptation of the Massachusetts plan which has experienced increased emergency room visits, exploding costs and perverse economic incentives.
Docs4PatientCare believes that through modest changes in tax policy and federal subsidies for those in need, we could provide health savings accounts with high deductible insurance for all Americans, along with care tailored to each individual devoid from bureaucratic interference. Starting at a young age and accumulating throughout a lifetime, each generation would then be able to provide for its health care when elderly, precluding the need for succeeding generations to subsidize their care.