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In Politics, Messaging With Emotion Trumps Messaging with Truth. The Republicans Now Have a Rare Opportunity To Do Both.

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Dr. Edward R. Annis said in the 1960’s (paraphrasing), “The Federal Government will have you believe that there is only one way to fix healthcare- their way.” Whether it’s healthcare or any other problem, most people agree that government solutions are not the answer. Innovation usually results in better outcomes. The government is incapable of utilizing resources appropriately and efficiently. This failure has made FedEx and UPS possible as alternatives to the USPS.

Eight years of Obamacare have taught us a few things. It was not healthcare reform, but rather, more government control of how healthcare is financed. It was an attempt of the federal government to gain more control over healthcare. Many individuals who understand healthcare predicted that Obamacare was flawed and that its collapse was inevitable. Now that Obamacare is indeed failing and in a “death spiral”, its supporters are railing against the Republicans new healthcare plan, the AHCA (American Healthcare Act), but offering no solutions.

Socialized medicine has been the goal of Progressives for over a hundred years. Government run healthcare means control over people and their businesses, with limitless ability to increase taxes to pay for it. Obamacare took us in that direction with mandates – that everyone needed to purchase a product whether they wanted it or not, and the government determining what must be included. In order to pay for it, eighteen new taxes were created. Control over healthcare was concentrated in the hands of a single individual- the Secretary of HHS (Health & Human Services), carrying out the policies of the President.

Despite assertions to the contrary by progressives, we have endured 8 years of failed government run healthcare. Americans have seen healthcare costs soar and access to care go down. They have seen how government mandates regarding healthcare created unemployment and underemployment. And that when special interests are taken care of such as insurance companies, hospitals, and pharmaceutical companies, patients are hurt. People are demanding relief and want more control over their healthcare and the costs.

The GOP now has a rare opportunity to send a positive message- something that typically eludes them. Immediately after the House passed the AHCA, the attack machine from the Left went into high gear, with messaging intended to arouse strong emotion from their base. The problem was that their messaging was a big lie. The typical GOP ploy to counter the Left is to present facts, which usually fails to win against the emotional strategy. However this time, the GOP can counter not only with facts but with emotion too, calling on real life horror stories from 8 years of Obamacare.

Contributed by Jeffrey English, M.D. – National Board of Docs 4 Patient Care Foundation

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Direct Primary Care Setback in Florida

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After success in the Florida House of Representatives, the Senate version of the bill, “Direct Primary Care Agreements” has died on the calendar for this legislative cycle.

HB161 was designed to specify that direct primary care agreements directly between doctors and patients does not constitute insurance and not subject to regulation under the Florida Insurance Code.

Dr. Lee Gross, the President of Docs 4 Patient Care Foundation, has long labored and testified before various committees on the power of Direct Primary Care in delivering real care to people outside of the cost inflated insurance and government systems.

Dr. Gross made the following hopeful response,

“Thanks so much to everyone that supported us this session!!

Bill sponsors are already lining up to sponsor the bill for the 2018 session, which starts in 5 months.

In the meantime, we will keep spreading the message. We are hoping to invite some skeptical [Florida] Senators to our DPC conference in Orlando this October!”

Watch Dr. Gross at 1:30 into the broadcast HERE

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Doctors Respond to Pre-existing Confusion WSJ Op-Ed

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“The entirety of the healthcare debate has been defined by the left using their terms- pre-existing conditions being one of them. Everyone who has seen a doctor has a pre-existing condition. What needs to happen is to make sure that insurance companies cannot deny someone the ability to get health insurance based on their health status. The other thing is to make sure that there is some type of safety net so that a medical condition can get treated without creating an individual financial crisis. How we get there is going to require much more than telling  insurance companies, which are publicly traded corporations, how they  must operate their businesses. At some point, the chains must be taken off of the free market and allow it to operate.” – Hal Scherz MD, FACS, FAAP and Founder of Docs 4 Patient Care Foundation.
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Squandering a Once in Lifetime Opportunity

A demonstrator in support of U.S. President Barack Obama's health-care law, the Affordable Care Act (ACA), holds up a "ACA is Here to Stay" sign after the U.S. Supreme Court ruled 6-3 to save Obamacare tax subsidies outside the Supreme Court in Washington, D.C., U.S., on Thursday, June 25, 2015. The U.S. Supreme Court upheld the nationwide tax subsidies that are a core component of President Barack Obama's health-care law rejecting a challenge that had threatened to gut the measure and undercut his legacy. Photographer: Andrew Harrer/Bloomberg via Getty Images
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America is once again dealing with healthcare, but there is so much more going on than just what you see on TV or read about in the newspaper. For the average American, all they know about Obamacare is how expensive healthcare has become, and the promise by President Trump and the GOP to repeal and replace the Affordable Care Act.

They also see the gridlock in Washington continue and not just between Republicans and Democrats, but between factions in the Republican party. People don’t understand the procedural gymnastics that are occurring which has resulted in stagnation. The GOP has been working behind the scenes to find a compromise that would allow the American Health Care Act to get to the House floor for a vote, but this has not been easy. No one is clear what has to be done to get this done nor how imminent this is.

What is obvious to all, is that Obamacare is on shaky ground and ready to implode, taking its toll on the healthcare system. The cost of healthcare insurance is going up for everyone, unless the federal government does something quickly to stabilize the market.

President Trump has authorized HHS to release money to the insurance companies participating in the healthcare exchanges, which will buy some time for the 6 million people who are getting their insurance under the ACA. This, despite the fact that the House Republicans successfully filed a lawsuit to block these payments because they were illegally made by the Executive branch under President Obama. A US district court has denied the Obama administration appeal, siding with the GOP. But this will be a short term fix. For everyone else, the premiums are escalating and the GOP is playing politics and allowing this to happen.

A major sticking point is how to treat the “goodies” that some Americans found desirable with regard to their healthcare. These would include keeping kids on their parents’ insurance until age 26, compelling insurance companies to cover people with pre-existing conditions, and how to treat minimum essential benefits covered by an insurance policy.

The far right Freedom caucus, sticking to their ideology of doing nothing if it does not include repeal now, want these items removed from the American Health Care Act, and to allow states that wish to have them, apply for waivers to implement them. In this way, they fulfill their campaign promise and it creates a national experiment, to see how high insurance premiums go in states that offer these benefits compared to those states that do not.

The more moderate Tuesday group wants to retain these Obamacare benefits and instead allow states that want to opt out to do so. They did not believe that their constituents would tolerate getting rid of these benefits, needing instead to petition for waivers to get them back. In either case, the end result is the same, but the tactics on how to get there differ.

In the midst of this infighting came the news that the plan supported by the Freedom caucus would not apply to members of Congress or their employees. They would be able to keep the pre-existing conditions and essential benefits. When questioned about this, they did not deny it, but said that it was procedural and needed to be retained in order to get the bill through the Senate, but would of course be fixed.

It is no wonder that most Americans give Congress a favorable grade of under 10%. But specifically, in the case of Republicans, they cannot get done the one thing that they have been complaining about for the past 7 years. They have had plenty of time to prepare for this and now have run out of excuses. They are squandering a once in a generation opportunity and are failing millions of Americans who trusted them.

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Blockchain Causing a Stir

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Crypto-currency the future of EHR?

Doctor’s Lounge host Michael Koriwchak spent the hour of his latest show examining the trends in Health IT and the backbone of Bitcoin came up.

Bitcoin, the digital currency, rose to prominence from its start in 2009 built upon Blockchain encryption and records keeping technology.

Instead of a database that is centrally located and maintains the records (be they currency or health records), blockchain shares the data among a network of computers allowing users to add transactions (or information blocks) to the chain.

The information is kept secure through cryptography and distribution over a wide array of computers.  The implications of a decentralized network maintaining records and overcoming the ongoing challenges of interoperability have excited a flurry of articles and papers over the past six months.

This is precisely the type of innovation that explodes when the regulatory burden in removed and entrepreneurs are free to experiment and solve problems organically rather than by bureaucracy.

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Meeting with HHS Secretary Price

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Key Principles in Shaping Health Care Policy the Focus

Years of sharing the vision for the sanctity of the doctor/patient relationship are paying off.

Health and Human Services Secretary Tom Price, a doctor himself, invited Hal Scherz, M.D. of the Docs 4 Patient Care Foundation to a meeting to discuss the state of health care and important reforms to prioritize over the coming months.

Secretary Price, then a Congressman from Georgia, was instrumental in the creation of our original incarnation as a 501(c)6 organization and remained a steadfast personal and public friend throughout his tenure in Congress.

Scherz and PriceThe meeting entailed many topics but focused on the regulatory burden on doctors and the necessity of freeing physicians to spend more time with patients.  These fiscal and regulatory burdens have driven far too many out of private practice altogether or into the arms of large medical systems.

Scherz explained the need for the protection of Direct Primary Care at the federal level to protect doctors from aggressive state insurance commissioners who seek to regulate the doctor/patient relationship as if the doctor is an insurance provider.

Additionally, Scherz emphasized the need to explicitly allow the use of HSA dollars in DPC relationships.  A simple practical change that would go far to extending actual care to patients at the ground level where most health issues can be resolved if addressed early.

After the meeting, Dr. Scherz released the following,

“The Docs 4 Patient Care Foundation is delighted to have the kind of leader at HHS who has been on the front lines of American medicine actually delivering care to patients combined with the practical legislative experience of a successful tenure in Congress. Most importantly, Secretary Price fully understands the underlying principles behind the sanctity and primacy of the doctor – patient relationship in health care.

We know of no one better equipped by professional experience and personal philosophy to be directing perhaps the largest and most influential entity in health care in America, the Department of Health and Human Services.”

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The GOP Fumble of Health Care Reform – Post Game Analysis

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If Washington politics was the NFL, then the GOP was the Atlanta Falcons in the Super Bowl, snatching defeat out of the jaws of victory. Everything was set up for a clear win – majorities in Congress and a President who was itching to affix his signature to a bill that would send Obamacare to the scrap heap of history. But they fumbled the ball on the one yard line, and now the GOP is licking their wounds and everyone wants to know what the heck happened?

Most GOP supporters around the country are angry and confused because they expected more from this Congress. Others are furious that this bill did not sufficiently differ from Obamacare and are relieved that it failed. The Democrat supporters were against anything that attempted to undermine their beloved Obamacare, blind to the fact that it is imploding and soon will be no more, and ignorant regarding the ramifications.

It might be useful in the post-game analysis to try to explain some things and offer some perspective.

This entire affair can be better understood if certain concepts are introduced into the discussion- politics, strategy, and messaging.They often all run together, as was the case here.

Politics is the art of the possible, not the perfect. In the case of the GOP as opposed to the Democrats, politics is not a team sport, as much as we all wish that it was. There are too many people who want credit, and too many who will take their ball home if they don’t get their way.

One criticism of this bill was that it was crafted by leadership without input from other factions in the Republican House, like the Freedom Caucus or the more moderate Tuesday Group. Maybe that was a strategic error. Ultimately, these groups didn’t get what they wanted, so they sunk the bill.

Messaging has always been a problem for the GOP, and once again they did not disappoint. We heard repeatedly that this was a three-step process, but not enough time was spent explaining the ultimate vision of where we were heading with this process. America wanted specifics, not promises, so it is no wonder most everyone is confused. Only those of us who can identify the photos of all the Cabinet members understood what reconciliation meant and that Speaker Ryan was designing a bill that could be introduced into the Senate via this process.

It is easy being an armchair Monday morning quarterback, but perhaps there is a way to tie politics, strategy and messaging all together. What if the House created a bill that contained ALL of the elements of what we wanted to see in a repeal and replace package? What if they clarified to the American people exactly what the GOP vision of a health care plan would look like? This would be done knowing that the Senate would filibuster this bill and never let it come to the floor for a vote. But it would have put the Democrats on the defensive and it would have telegraphed to the American people what healthcare would look like after Part Three. It would have smoothed out the process of then following up with a reconciliation bill, making it easier to get that Part One passed.

There were more good things in the American Health Care Act than there were bad. It was the first time in history that an entitlement was being eliminated, and in this case it was two: Obamacare and the federal control of Medicaid, by giving it back to the states. Medicaid spending was being capped. The limit on HSA contributions nearly doubled. Tax equalization for individuals who purchase their own healthcare was established. And money was being allocated to states to re-establish high risk pools that were eliminated under Obamacare.

The GOP will get another chance to tackle healthcare reform, because Obamacare is failing and Americans are being hurt by it. They must stop being the opposition party and begin to govern. Let’s hope that the next shot that the GOP has at this is a controlled drive to the goal line and not another Hail Mary pass.

This originally appeared on Townhall.com.

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Doctors Wish List for Health Care Reform

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The Issue:  Health care costs too much.  

It should not be this way because true cost is typically far less than current charges. 

The Reason:  There is no price transparency, so patients are disconnected from costs.

Healthcare is inexpensive to deliver. It is everything that gets between the patient and the doctor that drives up costs – the hospital, the lack of competition, the red tape that doctors have to deal with that increases their overhead and takes them away from their patients, the high cost of drugs, defensive medicine, the “handcuffs” placed on doctors which prevents them from innovating and creating value. 

The current trend has driven doctors out of business. Almost 65% now work for hospitals. Over 15% of medical school graduates will not see a patient in their career. Doctors are burning out and retiring much earlier than ever before. Private practice of medicine is in grave danger.

What can be done to help patients and doctors and to drive down costs?

1. Enforce & strengthen the Primary Care Enhancement Act – uncouple HSAs from insurance so patients can use it for Direct Primary Care. Clarify DPC as a delivery model and not a risk bearing entity

2. Remove anti-physician provisions from ACA (surgery centers, ACOs, IPAB)

3. Relax/repeal Stark laws

4. Fix the Medicare payment system which reimburses hospitals more for services than those delivered outside of the hospital

5. Repeal MACRA

6. Repeal HITECH – these 2 laws have created unnecessary and burdensome regulation and red tape that are putting doctors out of business

7. Promote charity care with tax incentives to providers

8. Protect doctors and patients from having to participate in treatments that violates their conscience

State level issues critical to the overall goals

9. Protect doctors from predatory specialty societies who have colluded with hospitals and insurance companies and force them to pay money to “maintain their certification” (MOC) as conditions to work treating patients

10. Repeal Certificate of Need (CON) laws to foster competition/innovation

11. Meaningful Tort Reform which would put an end to “defensive medicine”

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The CBO Score, Patients Losing Insurance Coverage and Other Myths of This Healthcare Debate

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There are problems with the debate over healthcare and “reforming” it. The first is that the Progressive Left has defined the terms under which we discuss healthcare. The second is that the GOP is terrible at messaging their solutions.

Examine the CBO claim that 24 million people will lose health insurance coverage under the American Health Care Act (AHCA). The only way that people lose their coverage is if the government is giving it to them. Let this sink in. That logic may be true for the greater than 50% of healthcare already being provided through Medicare, Medicaid, CHIP, VA and Indian Healthcare. It may even be the case for the entitlements given to individuals in the form of taxpayer subsidized payments to cover private healthcare premiums through the Obamacare exchanges. However, these exchanges are collapsing and insurance companies are walking away from them. They will soon not exist.

Stating that Americans will lose their healthcare coverage is “progressive speak.” Any plan that moves people into insurance programs that are controlled by patients and not the government moves the country further away from progressive nirvana, which is a single payer system. The AHCA does not result in patients losing coverage. It provides a choice. If patients choose not to participate, it is either because they are unwilling or unable. If the latter, it should be determined if it is because of cost, and if so, then making healthcare more affordable must be the goal.

The GOP needs to reclaim the narrative from the Left. They need to articulate more effectively that government needs to be taken out of healthcare and that people need to find ways to be less dependent upon it. When the government provides healthcare, they can take it away. They have done this previously and it will only get worse. Take for example prostate cancer screening. A government agency, the United States Preventative Services Task Force, downgraded it and Medicare no longer will pay for it. Another problem is that the quality and availability of the healthcare received through Medicaid or “skinny” insurance networks, as was the case in the Obamacare exchanges, is inferior to that which patients get if they, and not the government or 3rd party payers, are making the decisions.

Defending the AHCA can be difficult because it is not perfect and it’s complicated. But contrary to Obamacare, it promotes individual freedom over government control. Watching this come together is ugly and uncomfortable, but that’s how government operates. To use a medical analogy to describe the American healthcare system, the patient is dying from cancer and needs chemotherapy, which will be difficult to take but will ultimately allow him to get stronger and live a healthy life.

Once the cancer is removed in the healthcare system, efforts must be directed at making it stronger. This can be done by removing our dependence on insurance, which will actually make healthcare more affordable, as counterintuitive as that might appear.

The best way to accomplish this is via Direct Primary Care (DPC), which is a delivery model in which a patient pays a fixed amount monthly, often as little as $50, and receives almost unlimited access to THEIR regular doctor. This fee includes services that can be provided in the office, such as basic preventative and diagnostic testing and minor emergency procedures. Services that fall outside of this are available at facilities where steep cash discounts have been pre-negotiated– like a CT scan for $150 or an MRI for $400. Even visits to specialists are a fraction of what they would cost under an insurance model. Thus, DPC is considered “concierge care for the average Joe or Jane”.

One might ask why are we not seeing more DPC? In large part because insurance companies are threatened by this model and spend vast sums lobbying lawmakers to lump DPC in the same category as insurance. Consequently, as the current law stands, patients cannot use their Health Savings Accounts to pay for this.

The Primary Care Enhancement Act (HR365) makes the clarification that DPC is not a risk bearing entity, but a delivery model, and that HSA money should be able to be used to pay for this. Seventeen states have already passed legislation to protect DPC, but federal clarification would be a game changer. This should be strongly considered as an addition to the AHCA.

Healthcare costs are unsustainable, but healthcare is not expensive, as DPC has proven. Unless we embrace disruptive innovation to drive costs down, healthcare insurance premiums will not substantially decrease regardless of what market driven innovations are created. This may be the only opportunity to begin to effectively drive down the cost curve in healthcare and it would be a tragic mistake to let this slip away.

This was originally published at Townhall.

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Physician leaders meet, set plans to address “crisis” in doctor-patient relationship

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Group establishes Galen Doctors Forum to coordinate efforts

Washington, D.C., March 17, 2017 — Physician leaders and patient advocates met yesterday in a forum organized by the Galen Institute to raise awareness of what some called a “crisis” of unprecedented interference blocking doctors from being able to prescribe the treatments they believe are best for their patients. During the conference in Washington, D.C., they heard presentations by fellow physicians and by a noted patient representative on how cost-cutting measures by third-party payers in both private and government health care insurance plans are interfering with the doctor-patient relationship. Regulatory policies in government and cost-cutting measures in private plans are overwhelming doctors with paperwork and forcing them to go through multiple rounds of negotiations to justify their prescribing decisions to provide what they believe is the best care for their patients.

Galen Institute President Grace-Marie Turner commented, “As I travel the country, I have become increasingly concerned as doctors say that their hands are being tied by bureaucrats who second-guess their clinical decisions. At this critical moment in the health care debate, I believe policymakers need to hear the physician point of view.” She noted that, typically, physicians are so busy caring for patients that they do not have much opportunity to take part in discussions of health care policy. “For this reason, we decided to bring this group together to begin a national conversation about this crisis in the medical profession, to ensure that policymakers and patients alike understand the barriers doctors are facing as they attempt to deliver the best care possible to their patients.”

The keynote speaker at the conference, Dr. Seth Baum, said that it is vital that patients become aware that their physicians face great difficulty in prescribing the best innovative treatments for them. “Patients should not have to wonder who is deciding which medicines they take, their doctor, or their insurer,” Dr. Baum said. “In my case, I am forced to complete intricate, 17-page documents so that insurers will allow my patients access to lifesaving new cholesterol medications, only to see them turned down, repeatedly.” He pointed to “fail first” policies, which require doctors to prescribe older, cheaper medicines for patients until those patients “fail” on those drugs, before being allowed to prescribe breakthrough treatments that would be more effective. “These decisions are best made between doctor and patient, not by bureaucrats,” he added. “Insurance should be there to take the worry out of healthcare, not tie doctors and patients up in red tape.”

Another speaker at the conference, Dr. Hal Scherz, a pediatric urologist, said that “Third-party interference has become endemic in the U.S. health care system, and is increasingly destructive to the patient-physician relationship. A recent survey by the Physician’s Foundation found that 53.9% of physicians surveyed claim that some of their decisions are compromised due to their current level of clinical autonomy. I am glad to take part in this discussion, and hope it will increase public awareness of the restrictions doctors encounter in their daily work.”

Meeting participants said that they were energized by the discussion, and pledged to continue to share experiences and ideas under the umbrella of a new Galen project, the Galen Doctors Forum. “We are excited to be able to provide this forum for physicians from a wide array of disciplines and geographical regions – people who might not otherwise have the opportunity to work together to improve conditions for current and future doctors who want only to practice medicine to the best of their ability,” Ms. Turner said. “We heard from many doctors who hope to join our discussion and be part of our efforts going forward. We plan to broaden our reach to develop policy recommendations and to educate the public on the need to put the doctor-patient relationship back at the center of the American health care system.”

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