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Those Indecipherable Medical Bills? Part 2 CPT Coding Is One Reason Health Care Costs So Much

Stanley Feld M.D.,FACP,MACE

After Ms. Wanda Wickizer was discharged from the University of Virginia Healthcare System (Part 1) the catastrophe caused by the healthcare system’s coding process began.

“The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS).”

“Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA).”

HCPCS was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care.

The cost of Medicare and Medicaid became so high that the government decided to start knowing what it was paying for and standardizing the payments.

Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner.”

This coding system has been dysfunctional since the government developed it for Medicare and Medicaid in 1978.

The unspoken goal was to decrease reimbursement for services provided for Medicare and Medicaid patients.

The government wanted to commoditize can reduce reimbursement by the evaluation of physician and hospital usage of procedure and services.

Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions involving health care information became mandatory.[2]

Ms. Rosenthal’s story is about how this poor woman, Wanda Wickizer, got trapped in the dysfunction of the healthcare system’s coding system.

Wanda Wickizer should have been insured through Obamacare. However, through the inefficiencies of the government or Ms. Wickizer lack of understanding of Obamacare she did not have insurance.

The healthcare system makes no provisions for billing the uninsured.

There are multiple prices charged for treatments and procedures. Hospital systems and physician groups have their own individual retail prices for services and procedures.

These providers negotiate prices with the government and the healthcare insurance industry.

There are many different prices negotiated by many different providers with the healthcare insurance industry. A healthcare insurance company negotiates many of the government’s final prices. The healthcare insurance company acts as the surrogate for the government.

None of these prices are transparent.

There is no one that negotiates price for the uninsured. The uninsured are responsible for the retail price of the services rendered unless they can negotiate a better price.

“And so in early 2014, without an insurer or employer or government agency to run interference between her and the hospital, she began receiving bills:

  • $16,000 from Sentara Norfolk (not including the scan or the E.R. doctor), $50,000 for the air ambulance.
  • Her local hospital
  • By the end of January, there was also one for $24,000 from the University of Virginia Physicians’ Group: charges for some of the doctors at the medical center. “I thought, O.K., that’s not so bad,” Wickizer recalls.
  • A month later, a bill for $54,000 arrived from the same physicians’ group, which included further charges and late fees.
  • Then a separate bill came just for the hospital’s charges, containing a demand for $356,884.42 but little in the way of comprehensible explanation.”

The uninsured are the only people who are responsible for the original retail prices. All the rest of the payment providers, namely the government and various members of the healthcare insurance industry pay their negotiated fees.

Shouldn’t the government pass a law requiring hospitals and doctors to charge only Medicare prices to the uninsured? It would eliminate Ms. Wickizer bill, a bill that reflects retail prices for services rendered.

The big mistake the University of Virginia made was that it did not provide her with a line item bill identifying the price of each service and procedure.

The University of Virginia subsequently refused to provide a line item bill to the patient. It was as if the university was hiding something.

Any thoughtful hospital administrator would have solved the problem in a minute.

It must be remembered that each provider has a different retail price per procedure and service. The reasoning is that they are trying to collect the highest amount they can.

There is something called a “chargemaster price.” It could help the uninsured figure out the wholesale price for services and procedures if they knew what the line item services and procedures they were charged for were.

The patient could then figure out what Medicare pays for those services and procedures.

However none of these line item charges are in the patients (EOB) Explanation Of Benefits. The EOB is impossible to interpret.

A simple rule should be passed by congress or issued by CMS saying a clear explanation of charges is required for payment of the bill.

The Obama administration knew about this uninsured billing problem. It did nothing about it because it wanted to force patients into buying Obamacare insurance even if they couldn’t afford it or didn’t need it.

I believe Tom Price M.D. (President Trump’s head of CMS) is aware of the problem. He also understands this simple way of solving it.

The healthcare insurance industry and the government get a detailed EOB for services rendered through the CPT coding system first established in 1978.

The Obama administration added 74,000 new codes to the CPT coding system. The government and the insurance companies wanted to know what they were paying for in detail.

This led to the requirement for Electronic Medical Records (EMR) and then meaningful use EMRs. Physicians and hospital systems will not get paid if they do not have a meaningful use EMR this year.

This led to a very expensive EMR development industry. EMRs were expensive. They did not function as meaningful use EMRs. They had to undergo extensive upgrades.

An EMR function should really be a teaching tool, teaching physicians how to upgrade their services to the best evidence based medicine practices.

Instead it has become a tool for the government and the healthcare insurance industry to punish patients.

The EMRs are unaffordable to many physicians. It has force them to sign up to become hospital system employees.

The government should have built a universal EMR in the cloud and charged physicians by the click.

The increase in codes led to an expensive coding industry. People are trained to teach physicians and hospital systems how to use the new 88,00 codes correctly.

The industry essentially teaches those providers how to how to game the healthcare system so that they can collect the most money for their services from the government and the healthcare insurance industry.

The goal of the government is to reduce reimbursement to providers.

Where is the consideration for patients in all of these maneuvers?

Where is the consideration for the uninsured patients?

Ms. Rosenthal’s main point is that CPT gaming by the medical professions and hospital systems are driving up healthcare costs.

However, missing from her argument is who developed the dysfunction CPT system.

Why was it developed?

Why was coding made so complex that it drives users of the coding system to game the system?

Ms. Rosenthat gives a few examples of coding driving the costs up.

  1. The diagnosis code for “heart failure” (ICD-9-CM Code 428) instead of the one for “acute systolic heart failure” (Code 428.21), the difference could mean thousands of dollars.

“In order to code for the more lucrative code, you have to know how it is defined and make sure the care described in the chart meets the criterion, the definition, for that higher number.”

In order to code for “acute systolic heart failure,” the patient’s chart (EMR) ought to include supporting documentation, for example, that the heart was pumping out less than 25 percent of its blood with each beat and that he was given an echocardiogram and a diuretic to lower blood pressure. Submitting a bill using the higher code without meeting criteria could constitute fraud.”

“Each billing, then, can be seen as a battle of provider coder versus payor coder.

The coders who work for hospitals and doctors strive to bring in as much revenue as possible from each service, while coders employed by insurers try to deny claims as overreaching.”

Hospital based physicians are taught how to up-code to generate the most income. They have little say in the coding process. Patients have no way of knowing if a procedure or service is coded.

  1. In a doctor’s office, a Level 3 visit (paid, say, at $175) might be legally transformed into a Level 4 (say, $225) by performing one extra maneuver, like weighing the patient or listening to the lungs, whether the patient’s illness required that or not.
  2. E.R. doctors have been taught that insurers might accept a higher-reimbursed code for the examination and treatment of a patient with a finger fracture (usually 99282) if — in addition to needed interventions — a narcotic painkiller was also prescribed (a plausible bump up to 99283), indicating a more serious condition.

The actual cost and expertize that might go into these services are never discussed or considered by bureaucrats decision and policy makers.

Price transparency for the patients would make a world of difference to costs. It would drive the cost of care and healthcare premiums down.

It might even result in the development of competitive pricing and a free market system.

I am sure the Trump administration is aware of this defect in the dysfunctional healthcare system.

President Obama ignored the problem as he tried to control hospital systems and physicians. He simply down coded services.

He probably figured that a single payer system would make everything much easier.

All I can say is look at the government run Veteran Administration Healthcare System.

Why most politicians ignore the coding defect in coding is beyond me?

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much: Part 1

Stanley Feld M.D.,FACP,MACE

Elisabeth Rosenthal is editor in chief of Kaiser Health News and a former senior writer at The New York Times.

She wrote an extensive article in the New York Times Sunday Magazine Section on the abuse of a hospital system on a patient without healthcare insurance.

Ms. Rosenthal usually points out defects in the healthcare system in great detail. She usually ignores the primary causes of those defects which leads to stakeholders’ adjustments.

Those adjustments lead to abuses of both the healthcare system and consumers utilizing the healthcare system.

It is important for all consumers and politicians (designated surrogates of consumers) to understand these abuses in detail.

It is doubly important that consumers and politicians understand the primary causes for these abuses.

The ideal goal would be to fix the primary causes so that stakeholders cannot abuse the system. In Ms. Rosenthal’s case study the University of Virginia’s bureaucrats are the decision makers who are far removed from the primarily medical care of patients.

They are far removed from the development of a physician/patient relationship. The patient/physician relationship is so vital to the success of a healthcare system.

These bureaucrats are immune to the tragedy that had befallen Ms. Rosenthal’s example, Ms. Wanda Wickizer. They are stuck in the rules its organization made or their interpretation of these rules.

There does not seem to be any flexibility built into the University of Virginia’s Medical School billing system.

The patient in Ms. Rosenthal story is not entirely immune to the disaster that occurred subsequently.

Her husband died in 2006. He had great city of Norfolk Virginia health insurance. The city of Norfolk continued providing her and her kids with insurance for the next three years.

“Her husband, who died in 2006, worked for the city of Norfolk, which insured their family while he was alive and for three years beyond.”

“After his death, Wanda Wickizer worked in a series of low-wage jobs, but none provided health insurance. A minor pre-existing condition — she was taking Lexapro, a common medicine for depression — meant that her only insurance option was to obtain Obamacare insurance through a health insurance exchange in 2010.

In 2009 only ineffective and costly state administered “high-risk pools” were available. High risk pools disappeared in 2010 with the passage of Obamacare.

She said she could not afford her Obamacare option. However, she did not consider the Obamacare option in her economic condition. Obamacare would have subsidized her insurance coverage up to 100%.

“She thought she would need to pay more than $800 per month for a policy with a $5,000 deductible, and her medical procedures would then be reimbursed at 80 percent. She felt she couldn’t afford that.”

She made a decision that did not take into account a potential medical catastrophe.

“In 2011, she decided to temporarily stop working to tend to her children, which qualified them for Medicaid; with trepidation, she left herself uninsured.”

At this point she probably would, also, have qualified for Medicaid or gotten insurance through the health insurance exchanges that would have been subsidized up to 100% by Obamacare.

Additionally, after she was sick she could have applied for Obamacare insurance. She would have supposedly received full insurance coverage at no cost to her. The application for Obamacare after the onset of an illness is one of the major objections to Obamacare.

This is a defect in Ms. Rosenthal’s story. It could have easily been avoided if Ms. Wickizer applied for insurance available to her at minimal charge.

The casual reader of the Sunday NYT magazine section could easily overlook this defect.

The rest of the story is about the billing catastrophe. Ms. Rosenthal exposes all the defects in the healthcare billing system structure.

A catastrophic illness struck Wanda Wickizer on Christmas Day 2013. It was a subarachnoid hemorrhage that can strike at any time.

“The catastrophe struck Wanda Wickizer on Christmas Day 2013.”

It occurred four years after Obamacare was enacted. She had a debilitating headache. The ambulance paramedics missed the diagnosis. They thought she had food poisoning and did not take her to the hospital.

Later, she, at 3 a.m. became confused and groggy. Her boyfriend raced her to Sentara Norfolk General Hospital. A CAT scan revealed a subarachnoid hemorrhage.

Sentara Norfolk General Hospital felt it could not handle the subarachnoid hemorrhage and air evacuated her by helicopter to University of Virginia Medical Center in Charlottesville 160 miles away.

At UVM the hemorrhage was stopped and the previous accumulation of blood evacuated. She was in the hospital for 3 weeks. When she was home the catastrophe of the healthcare system coding process began.

Ms. Wanda Wickzer’s story will be continued in Part 2 of Those Indecipherable Medical Bills? CPT Coding Is One Reason Health Care Costs So Much

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Feld Men’s Weekend

Stanley Feld M.D.,FACP,MACE

Every year I have gone away with each of my sons, Brad and Daniel for a weekend. We just talk about our lives and have a good time being with each other.

I figure it is good for our health. The boys agree.

My readers have had an extremely positive response to past where I have written about these one on one trips.

Readers know my bother and I are very close. He also lives in Dallas. We meet and have a pastrami sandwich together once a month whether we need it or not.

We have also gone away for weekends in the past with all the Feld men, my two sons and my brother’s two sons.

These weekends have been great for all of us. My sons live in Boulder Colorado, Kenny lives in Atlanta and Jon lives in Dallas.

The boys were close as kids. They have not gotten together very much in the last few years.

However, they love the weekends we have had to bond and just have fun.

It has been very difficult to get everyone together the past four years. This year Brad was determined to make it work. He got tickets to the NCAA finals.

The notification said anyone who can come should come. Unfortunately, Daniel could not come. He and his family were going to be in Japan that week.

The Feld Men have officially added a new member to the group. Jon’s son Jack is now 16.

Jack is a very smart kid. He kept up with all of our conversations. He even taught us a bunch of things.

I welcome Jack to the club!

My brother and I took 7.30 am Southwest Airlines flight to Phoenix on Friday March 31.

Kenny, Jon and Jack were not coming in until Saturday at 10.am. Brad was in Scottsdale for the previous month.

Charlie and I decided we wanted to hang out with Steve Hochschuler and his wife Kim all day Friday.

Steve is co-founder of Texas Back Institute. He has been a good friend since 1970. We both graduated from Columbia College.

Steve now lives in Desert Mountain part-time. He and Kim showed us a great time. Desert Mountain is very upscale. There are lots of big houses, and fancy cars.

There are very few trucks in his neighborhood. Steve has been irreverent all of his life. Steve has the biggest truck with the biggest and bad-est tires I have ever seen.

Their house is magnificent. Lunch and diner at local Desert Mountain restaurants were wonderful.

Steve and Kim took us to a neighbor’s house for a wine tasting with food before dinner. Both the wine and the food were out of sight.

They are living the good life.

This was a good start for the weekend. Charlie and I then drove to the Sanctuary in Paradise Valley to meet up with Brad.

The house Brad rented was beautiful. It had a pool and a tennis court with magnificent mountain views.

I was so tired I fell asleep instantly.

On Saturday morning Jon, Kenny and Jack all arrived at 10 am. We went out for breakfast/brunch to a place Brad and Amy found called Scramble.

Scramble looks like a PF Changs with menus on the sidewall as you wait on line to order and choose your food. The have everything from the simple breakfast to the most exotic omelets, waffles and pancakes.

Scramble

We ate enough breakfast for a week but we were not finished.

Our next stop was Dairy Queen. This old Dairy Queen was a standout in a contemporary designed Scottsdale shopping center.

Dq

Neither Jon, Kenny nor Jack ever had a Dairy Queen Blizzard.

Brad and I told them they had to have a Chocolate Extreme Blizzard.

All three were hesitant by finally complied.

On line DQ

They all loved it.
Gang at DQ
DQ icream thick enough not to spill.

Next back to the Sanctuary and Brad’s house. It was time to hang out with each other.

Brad and Kenney

After a while we all took our Feld traditional afternoon nap.

Me napping
I learned to nap in a chair as a medical intern in 1963.

The “car” picked us up at 2:15 for a 5:09 starting time for Gonzaga vs. South Carolina. The games were being played at the Arizona Cardinals football field in Glendale Arizona.

It was far from Scottsdale and the traffic on Saturday afternoon was horrible.

Me and kenny in crowd

Brad had Jon pick the seats because Jon was experienced in watching basketball in a football stadium.

He picked great seats on the 50 yard line in row D of the first deck. The people watching on the floor had to strain their necks. They were always looking up. The playing field was raised a couple of feet.

Tip off

The North Carolina vs. Oregon game followed. It thought both games stunk. All four teams had terrible shooting percentages.

The television timeouts were endless. They took up more time than the regular timeouts. It became annoying.

The food was the typical terrible stadium food. Some stadiums and arenas I have been to have pretty good food including Coors Field, Fenway Park, the Yankee Stadium and the American Airlines Arena in Dallas.

After the games we found our driver easily. He was a master of heavy traffic driving and got us home nicely.

All of us were bushed except for Jack. He was hungry. He wanted a hamburger at 10:30 pm. I guess this is what happens when you are a sixteen year old.

On Sunday morning we all met at 9:30 a.m. for a 9:45 a.m. reservation at Rita’s Kitchen at the suggestion of Kim Hochschuler.

She took Cecelia and me to Rita’s once before. The atmosphere was as good as ever. It was a two and a half hour brunch.

After brunch some quiet time at the Sanctuary. At about 2:30 I went to the fitness center to work out and then to the pool.

We had a six o’clock reservation at the Wildfish Sea Food Grille in Scottsdale. Jack picked up the fact that the font on the menu and the description of the dishes were the same as Eddie V’s in Dallas.

Everyone wiped out their cell phones to see if there was a relationship. There is. The Darden Restaurant chain owns both restaurants as well as Olive Garden, Red Lobster, Seasons 52 and the Capital Grille.

Three of us had steak and three had fish. The waiter was upset that the chef undercooked the steaks. He complimented desert for the table.

I was afraid we were all going to miss the hot fudge sundaes at the Sugar Bowl in Downtown Scottsdale.

The desert was fair. They did not have chocolate ice cream in the restaurant.

After diner we went back to Brad’s rental house. We all watched 1941. I thought it was the dumbest movie I ever saw.

It was a 1979 flick for teenage boys. My bother and Kenny baled after 20 minutes. I stay to the end. Brad and Jon were teenagers in 1979. They thought it was great then but lousy now.

Monday was the day of the finals between Gonzaga and North Carolina.

We had lunch at a Sports Bar. Then we finally got to the Sugar Bowl to have their fabulous hot fudge sundae.

Sugar bowl

Sugar Bowl 2

Me and brad at sugar

Brad and me eating at Sugar Bowl

We left for the NCAA Final at 2:30 to beat the traffic for a 6:09 p.m. game.

I will not complain about the traffic in Dallas, Texas anymore. We got to the stadium at 5:30 p.m.

Both teams played a lousy game. Shooting percentage for both was under 40%. Free throw percentage was not much better.

However, the festival of the NCAA final and the excitement of the crowd made the lousy game worth it.

When we arrived at Brad’s house Jack needed a hamburger at 10:30 p.m. again.

I went to sleep immediately because we were leaving for the airport at 5.15 a.m.

I slept on the plane for the entire ride home.

This was another successful “Feld Men’s Trip.” I can’t wait until next year.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Let The Buyer Beware: Medicare Part D

Stanley Feld M.D.,FACP,MACE

The mystery of buying drugs under Medicare Part D increases each year. The plans offered become more costly and complicated. https://en.wikipedia.org/wiki/Medicare_Part_D

Medicare did not cover outpatient prescription drugs until January 1, 2006, when it implemented the Medicare Part D prescription drug benefit.

Congress authorized Medicare Part D with the heading the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003.”

Private insurance companies administer Medicare Part D plans for the government. The government is not allowed to negotiate drug prices with the pharmaceutical companies.

The VA healthcare system negotiates prices with the pharmaceutical companies. The prices are at least 60% lower than the Part D prices.

Multiple plans are offered with increasing premium prices and deductibles each year.

The increases in deductibles are significant. Below are the increases between 2016 and 2017. Most seniors do not pay attention to the increase in premiums, deductibles or coverage because they automatically enroll each year.

They become aware of the changes changes when they go to pay for their medication

Initial Deductible:
will be increased by $40 to $400 in 2017.

Initial Coverage Limit:
will increase from $3,310 in 2016 to $3,700 in 2017.

Out-of-Pocket Threshold:
will increase from $4,850 in 2016 to $4,950 in 2017.

Coverage Gap (donut hole):
begins once you reach your Medicare Part D plan’s initial coverage limit ($3,700 in 2017) and ends when you spend a total of $4,950 in 2017.


In 2017, Part D enrollees will receive a 60% discount on the total retail cost of their brand-name drugs purchased while in the donut hole.

Generally, not all drugs are covered at the same out of pocket cost to the beneficiary. This gives participants incentives to choose certain drugs over others. This is most often implemented—as is the case for drug coverage for those not on Medicare—through incentives to use generic drugs over brand-name drugs.

The incentive is also often implemented via a system of tiered formularies in which some brand-name drugs are less expensive than others and not subject to step therapy.

Generic drugs are less expensive than brand named drugs. Patients learned this quickly. They encouraged their physicians to provide them with a prescription for generic drugs.

When patients buy drugs with Medicare Part D the deductible price is the patients’ cash outlay. However, the Medicare Part D plan charges patients the total retail price of the drug against their donut.

For example if a 90 day supply of a generic drug is $10 and the retail price is $60 dollars, the $60 is charged against the patient’s donut to be added to future purchases.

If patients paid $10 cash already shouldn’t only $50 of the $60 be charged against the donut?

Many generics can be purchased for a cash price or using a discount drug card coupon for $10 without using Medicare Part D and incurring the $60 retail charge against a donut.

Many generics can be purchased for less using a discount drug card coupon than the cash price a senior on Medicare Part D has to pay using Medicare Part D insurance.

It is not uncommon for senior patients to reach their donut in less than a year. At that time those senior patients have to pay 100% (60% in 2017) of the retail price for a drug until they reach $4,950.

The amount is an additional cash price of $1,250.

It was difficult to figure this out before discount drug cards became available.

How do these discount drugs card work and the discount drug card companies make money?

The Middle Men are:

“1.    Cardholder – the consumer

  1. Pharmacy – the retail outlet in which the purchase is made
  2. Pharmaceutical Company – the manufacturer of the medication
  3. Adjudicator – the organization that negotiates the discounts with the drug makers
  4. Card Marketer – the organization whose brand is on the card
  5. Card Marketer Affiliate – an organization that assists the Card Marketer in distribution

 Each time a card is used there is a transaction fee applied to the purchase price. 

 That fee is split 3 or 4 ways (though perhaps not evenly) between the Pharmacy, the Adjudicator, the Card Marketer and their Affiliate.

This transaction fee comes at the Cardholder’s expense.

However, usually the negotiated discount cost of the medication far exceeds the transaction fee so the Cardholder still wins. 

For example, the retail price for a medication is $100. The prescription discount card has negotiated a 40% discount, so the cost would be $60 but there is a $10 transaction fee. So the Cardholder pays $70 instead of $100. Of the $10 transaction fee, the Pharmacy might take $2, the Adjudicator $2 and the Card Marketer $6.

The Card Marketer might pay out $1 to their marketing

affiliate.”

Many Medicare Part D patients have figured out how to optimize their drug cost through the use of the discount drug cards.

None of these government policy manipulations are to senior recipients of Medicare Part D advantage. They all benefit the middlemen.

A simple solution is to change the Medicare Part D law so the government can negotiate the cost of drugs just as all the middlemen in the Discounted Drug Card industry are negotiating the price of drugs to the advantage of seniors.

Sometimes the discount cards yield different discounts in different pharmacies in the same zip code.

Sometimes the pharmaceutical companies figure out how to combine two medications that are just as effective when taken separately to increase the cash price to senior patients.

These companies do it with FDA approval.

I became aware of the vast price differences recently with two commonly used drugs Dutasterile (Brand name Avodart) and Tamusulosin (Flow Max). Both drugs have been on the market long enough to be sold as generic drugs.

Using the Good RX discount card these are the variation in prices for the combination drug and the drugs sold separately in one zip code.

Dutasterilde +

Tamsulosin 90

Dutasterile 90 Tamusulosin 90
Walgreens $183.00 $183.08 $113.93
Kroger $316.98 $45.61 $30.62
CVS $388.69 $84.63 $58.62
Tom Thumb $391.85 49.85 $31.85
Albertson $391.60 $52.60 $31.85
Walmart $475.10 $398.71 $55.23
Target $388.69 $388.71 $136.41

Table 1

None of the pharmacies receive an appropriate discount for the combination of Dutasterile plus Tamulosin. Only Kroger’s negotiator received an appropriate discount for the two drugs sold separately. The total price is $76.23 for 90 pills vs. $316.98 for the combination.

However, seniors have run into a problem in shopping for the best price in a neighborhood.

The government provides a bonus to physician practices that have meaningful use electronic medical records.

One criterion for a meaningful use electronic medical record is the electronically ordering prescriptions for patients.

If a patient usually used the Wal-Mart Pharmacy that telephone number would be in the record. The physician’s prescription would automatically be sent to the Wal-Mart Pharmacy. If the physician wrote for the combination for it would cost $475.10. If the physician wrote the prescription for each medication separately in would cost the patient $453.94 as opposed to cost him $76.23 at Kroger’s.

Compounding the complexity of the electric medical records unintended consequence the pharmacist would automatically fill the combination prescription using that senior’s Medicare Part D insurance. It would be much cheaper than the cash price.

The senior would pay only $146.50 for the combination but his donut would be charged the full retail price of $475.10.

The physician’s office should be aware of the difference in price between the generic combination and the generic drugs sold separately. However, that is not the physicians job.

He should be able to give the patient a paper prescription for both the combination and separate medication so the patient would be able to shop for the best price in his zip code if he was so inclined.

Clearly Medicare Part D is a mess and needs straightening out.

The discount drug cards are not the answer on top of the rising Medicare Part D premiums.

Many retired seniors are living month to month on a pension. The Medicare Part D premiums are paid with after tax dollars not pre-tax dollars.

Many seniors simply cannot afford to pay for their medication. If they do not take their medication they will develop complications of their disease.

Medicare Part A and B will cost the government more and become more unsustainable.

A few simple fixes can solve the problems in Medicare Part D that policy makers and congressmen do not seem to be aware of.

Patients must be responsible for their medical care and their healthcare dollars.

It would be nice if the government would help a little with fixes in information and policies that work for senior patients.

In the meantime it is imperative to “Let the Patient Beware.”

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE


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Obamacare Coverage: The Big Lie

Stanley Feld M.D., FACP, MACE

President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success.

The Obama administration told us that 20 million new people have obtained healthcare insurance because of Obamacare.

We know 14.5 million people lost their healthcare insurance in the individual market the year after Obamacare was passed.

Many assumed they got their insurance back through Obamacare. There is no evidence for that assumption.

I followed Obamacare enrollment carefully on acasignup.net.

This site was supposed to be publishing the exact numbers published by the government weekly. www.acasignups.net

It turns out that the numbers published were inaccurate. They were too high.

“Since the release of the HHS study, the government has published two additional surveys of health-insurance coverage – the Current Population Survey (CPS) and the American Community Survey (ACS). Both offer data through the end of 2015, allowing for comparison with the NHIS estimate.”

The government now claims these studies are only estimates of nonelderly adults, under the age of 65, who gained insurance coverage.

The estimate in increased adult coverage ranges from 13.5 million in the CPS study to 16.5 million in the NHIS study.

Where did the number 20 million new lives covered come from? Bill Clinton boosted the number to 25 million when campaigning for Hilary Clinton.

Edmund F. Haislmaier and Drew Gonshorowski of the Heritage foundation examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.

“Their study found that 14 million people (including children) gained public or private coverage in 2014 and 2015.”

This total is even lower because it includes S-Chip coverage for children.

Compounding the government lies of estimated enrollees was that 84% of the new enrollees was either Medicaid or S-Chip children.

This means only 2,240,000 people signed up in President Obama’s Health Insurance Exchanges.

It also means that there were 11,760,000 new Medicaid or S-Chip patients.

Edmund F. Haislmaier concluded in testimony to congress;

“While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that

for the three year period 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private sector coverage enrollment.”

http://budget.house.gov/uploadedfiles/house_budget_testimony-haislmaier.pdf

Eighty-five percent of the 2.7 million have pre-existing conditions. Most are receiving government subsidies.

The 2.7 million covered under Obamacare have destabilized the healthcare insurance market so that healthcare costs for businesses have become unaffordable.

No one has even mentioned the cost of this Obamacare folly to the average hard working taxpayers with healthcare coverage from their employers.

Obamacare’s failure to has been devastating.

The authors also found that nearly half the new Medicaid enrollees met eligibility standards that were in place before the ACA.”

Maybe Jonathan Gruber is right when he said we, the public, are too stupid to know the wool is being pulled over their eyes.

 

“For all the hoopla about the ACA exchanges, it appears that Medicaid accounts for the lion’s share of coverage gains and that many new Medicaid enrollees would have been eligible for that program even if the ACA had never passed.”

Medicaid is a single party payer system (socialized medicine) that works very poorly. It is almost as bad as the VA Healthcare System.

Is this what the public wants? No

America needs a better healthcare system. Hopefully Dr. Tom Price knows what to do replace Obamacare with once he dismantles all of the Obama administrations regulation.

Maybe Jonathan Gruber is wrong.

The general taxpayer may be smarter than Dr. Gruber thinks. Maybe it is the reason the public elected Donald Trump.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Stop The Noise: Start Working

Stanley Feld M.D.,FACP, MACE

The New York Times is filled with case reports of people helped by Obamacare.

The implication is Obamacare is successful and the Republicans do not have a better plan.

Articles appear daily defending Obamacare despite the fact that premiums and deductibles are up, access to care and coverage is down and the medical profession and consumers are despondent.

Obama Says Healthcare Law is Working Fine

https://www.nytimes.com/2013/05/01/health/obama-says-health-care-law-is-working-fine.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obama Says Healthcare Law is Helping White Americans Despite Perceptions

http://www.nytimes.com/politics/first-draft/2014/12/29/obama-says-health-law-is-helping-white-americans-despite-perceptions/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Is The Healthcare Law Creating More Part Time Work?

http://takingnote.blogs.nytimes.com/2013/09/27/is-health-care-reform-creating-more-part-time-work/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Why Even Some Republicans Are Rejecting The Replacement Bill

https://www.nytimes.com/2017/03/07/upshot/why-even-some-republicans-are-rejecting-the-replacement-bill.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obamacare Users Await Repeal and Replacement With Dread Anticipation

http://www.cbsnews.com/news/obamacare-users-await-repeal-and-replacement-with-dread-anticipation/

All of this is “Fake News.”

I cannot understand how Dr. Ezekiel Emanuel, with a straight face on national television, can say Obamacare is not failing.

Dr. Emanuel thinks Obamacare is a great deal. He is one of its authors.

His problem is he cannot prove it is great in reality.

 

 https://youtu.be/1-PRvZ_R0-0

I guess the Democrats hope is if you tell a lie enough times it becomes the truth.

The conservative media is starting to figure out how to neutralized this tactic that engenders sympathy for Obamacare. The Wall Street Journal published an article “How Obamacare Punishes the Sick.”

This article stimulates feeling against President Obama’s lies.

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions.”

 If one can disregard the fact that one case does not win a medical argument, one can start talking about what might work to create a cost effective quality healthcare system.

Obamacare and its bureaucracies have set up perverse incentives for stakeholders and against consumers.

A recently reported study by Harvard and the University of Texas in Austin demonstrated these perverse incentives.

Obamacare is supposed to help the sick. It turns out Obamacare punishes the sick with certain illness.

“But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.”

Diseases such as multiple sclerosis, rheumatoid arthritis, infertility and others high cost conditions are being charged higher deductibles, experiencing more prior-authorization for drugs, an increase in lesser quality substitution drugs, and often no coverage for the drugs they need.

Most of these conditions require long- term expensive medications.

Therefore consumers with these diseases cannot get treated adequately.

For example, a patient with multiple sclerosis might file a $61,000 claim.

Insurers lose money on every MS patient. An incentive is created for insurers to avoid enrolling patients with MS. The insurers then make its healthcare policy unattractive to people with multiple sclerosis.

Obamacare’s subsidy for patients with multiple sclerosis is inadequate for the cost of the disease’s care.

To mitigate that perverse incentive, ObamaCare lobs all manner of taxpayer subsidies at insurers. Yet the researchers find insurers still receive just $47,000 in revenue per MS patient—a $14,000 loss per patient.”

 

The insurer doesn’t want to loss $14,000 per patient. Patients are not stupid. They find the best coverage at the lowest price,

This insurer suffers high losses. He either leaves the market or decreases coverage. The perverse incentive leads to low quality care.

Patient with multiple sclerosis on Obamacare are not getting high quality healthcare.

Everyone losses. The government loses, the insurer loses but most of all the patient loses.

There is a better way to insure these people. In a free market system driven by my ideal medical saving accounts the creation of a high risk pool funded by all participating insurance companies in the lucrative private market spreads the risk to insurance companies and government while providing high quality care to qualified patients.

Politicians must start thinking smart.

The format of previous high-risk healthcare insurance pools was a disaster for all the stakeholders. High-risk pools can be formatted in a way that works for patients and does not contaminate the private market with spiraling insurance prices.

The Democrats ought to give up Obamacare. It is a dead horse.

Obamacare has failed for the many reasons I have pointed out in my blog over the past 7 years.

The Democrats’ knee jerk reaction would be why not just adopt a single party payer system.

The answer is look at the mess the VA system is in with it bureaucracy and apathy.

Republicans ought to stop trying to prove Obamacare is a failure.

The politicians ought to try to do something right for the people who put them in power.

They ought to get rid of Obamacare in the least disruptive way possible as quickly as possible.

I believe President Trump, Tom Price M.D., and Paul Ryan are trying to do just that with the American Healthcare Act that is being voted on the house tomorrow.

The conservative coalition in the house should get off its high horse and not shoot itself in the foot.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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  • Paritosh C. Dutta, M.D.

    It was your brilliant presentation at the Dallas County Medical Society meeting last week. I learnt a lot of the problems of the health care system of this country. You gave some insight how to repair the broken system.
    You are doing a great service to this great country with your efforts. Best wishes.

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I Was Wrong

Stanley Feld M.D.,FACP,MACE

I was profoundly disappointed when The American Healthcare Act was introduced last week. There was immediate rejection by Republicans and Democrats in both the House and Senate.

The mainstream media commentators emphasized the Republicans’ rejections and added their own scornful objections. The mainstream media painted the Republican Party as a party is disarray.

The media was presumably giving a boost to the Democratic Party and Obamacare’s failure.

Both Paul Ryan and Dr. Tom Price gave complete explanations of their strategies on how this bill, along with its two other components, will repeal and replace Obamacare.

I was profoundly disappointed in the bill until I was able to hear Dr. Tom Price and Paul Ryan’s explanation of their reasons for the initial reconciliation bill and the plan of the other two components necessary for replacement.

Vice President Pence and President Donald Trump then repeated Ryan ad Price’s strategy in less detail.

I reacted immediately to the bill being a sell-out to the healthcare insurance industry and central government control of healthcare. It looked like Obamacare Lite or Obamacare 2.0. There was no other explanation presented.

It took them 24 to 36 hours to explain the logic of the strategy.

By that time there was so much mainstream media noise and politician noise that It was impossible to hear what Tom Price and Paul Ryan were trying to say.

No one listened to what President Trump was trying to say. They were only listening to the media describing Republican caucus’ members outburst against the bill.

President Trump tweeted “it is a beautiful healthcare bill. Everyone will be happy with the result.”

No one listened. No one heard.

The mistake Ryan and Price made was that in the initial introduction of the bill they were being too cute, cunning and clandestine. In reality they were very prepared. They have been working of this repeal and replacement since 2010.

The plan to repeal and replace Obamacare has three parts.

  1. Reconciliation
  2. Administrative Action
  3. Additional Action

It would be very helpful to understand their positions if you watch them explain their positions in their entirety.

 

This lecture by Paul Ryan is an excellent review of the metodology necessary to Repeal and Replace Obamacare

 

Both videos are a must see in order to understand the Trump administration and congressional leadership strategy.

Obamacare was supposed to provide an opportunity for people in the individual insurance market to buy healthcare insurance at an affordable price. It was not meant to affect the employer provided healthcare insurance market.

This was supposed to be done by State Health Insurance Exchanges that would supply this insurance. Much of the individual market would be subsided by the federal government..

Only 22 states signed up and most have failed after receiving over $200 billion dollar loans to cover startup cost. These state health insurance exchanges are never going to pay back the federal loans.

Additionally, Obamacare extended Medicaid coverage by increasing the poverty levels in states. This increased the eligibility for patients to participate in Medicaid.

President Obama completely ignored the fact that Medicaid was a financially unsustainable subsidy that was failing rapidly.

Thirty-three States signed up for this expanded Medicaid coverage because they were afraid to get stuck with the bill.

All states are supposed to have balanced budgets. Most states have budget deficits.

They share the costs of Medicaid with the federal government to provide free healthcare coverage to the poor.

President Obama said he would pay 90% of the Medicaid bill. He then increased it to 95% and then 100% in the first few years in order to induce states to join.

Remember, President Obama’s ultimate goal was to have the federal government be in total control of healthcare with a single party payer system.

Twelve million new people have signed up for Medicaid under Obamacare. Additionally new immigrants have been added to the Medicaid roles.

Only nine million have signed up for Obamacare through the health insurance exchanges. Most of the enrollees have preexisting illness.

Most of the enrollees cannot afford the premiums even though President Obama provides subsides to 85% of these people.

Additionally, these enrollees cannot afford the deductibles that are up to $6,000 in some states.

Obamacare has affected the employer market. Obamacare does not pay the insurers enough or have a high enough enrollment distribution to give the insurance industry a high enough return on investment.

Insurers compensate by increasing insurance rates in the employer sponsored private market in almost all of the states. The industry increased rates in both individual and employer sponsored private market by as much as 116% in Arizona.

This forces small and large employers to decrease insurance coverage for employees.

If they did not provide healthcare insurance many small businesses had to pay Obamacare’s mandated penalty.

A mandated penalty was avoided if people worked less than 29 hours a week. Therefore, large employers reduced full time jobs to part time.

There are many other reasons that Obamacare has failed. It has inhibited economic growth.

Obamacare must be completely repealed.

The Ryan plan’s process is repealing as much of Obamacare as it can through the reconciliation process. This is only the first stage. does.

Congressional reconciliation only needs 50 votes in the reconciliation process thanks to Harry Reed.

“Congress and the Trump Administration must completely repeal the law, beginning by seizing the opportunity to accomplish as much of repeal as possible through the reconciliation process.”

After passage of the American Healthcare Act, Dr. Tom Price will then move on to part two.

He will repeal all the administrative rules and regulations that President Obama and Donald Berwick put in place that hurt Americans and the economy.

He will replace them (one regulation for two eliminated) that will help people obtain affordable healthcare insurance and help our economy grow.

Republicans opposed to the Ryan plan do not seem to get this point.

If Republicans could get total repeal through the House of Representatives with they would not get the 60 votes necessary to get Senate approval.

In stage three Republicans will be able to get the 60 votes necessary for Senate approval.

There are 18 vulnerable Democratic senators up for reelection in 2018.

With Obamacare’s rules and regulations repealed at that time, Democrats’ opposition to things like expanded Health Savings Accounts, malpractice Reform, insurance Reform and insurance across state lines will melt. It will be important for these vulnerable Democrats to vote for these reforms in order to get reelected..

The Ryan plan now looks like an excellent strategy to me. I do not see why the opposition Republicans cannot see it.

Doing it their way with complete repeal a stage one might not work. Then will be stuck with Obamacare and the loss of both Republican controlled of the house and senate in 2018.

There are still refinements necessary to be a consumer driven healthcare plan that is patient-centered.

I hope the Ryan/Price plan is passed by congress.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Profoundly Disappointed

Stanley Feld M.D.,FACP, MACE

I am profoundly disappointed in Paul Ryan, the Republican caucus and the RINO establishment for introducing the Paul Ryan bill to repeal and replace Obamacare.

It doesn’t completely repeal Obamacare or completely replace it.

In fact the supposed anti- entitlement party (Republicans) are adding another entitlement.

They are even leaving the healthcare insurance industry in charge of the money and the access to care.

It doesn’t even fulfill the five principles President Trump listed in his address to congress.

Those five principles alone would not Repair the Healthcare System.

The bill does nothing to encourage consumers to be responsible for their health and their healthcare dollars.

Consumers must be involved in driving the healthcare system in order for the healthcare system to be viable.

The bill continues to allow the government and the healthcare insurance companies to drive the cost and the healthcare system.

The Republican bill does not provide incentives for consumers to use their healthcare dollars wisely.

It does not include malpractice reform.

If President Trump buys the nonsense Republicans are calling a repeal and replacement for Obamacare, then the RINO’s have pulled the wool over his eyes.

It would be a gigantic mistake to push this bill in its present form. You would be producing political capital for the politically bankrupt Democrats.

This bill is a typical bait and switch. Rand Paul is correct. It is Obamacare lite.

It does not put consumers in charge. It keeps the healthcare insurance industry in full control of medicine, healthcare and the government.

Rather than discontinuing an entitlement it creates another one.

Refundable tax credit is another term for redistribution of wealth. You give money to everyone. You then take it back from some and let the others have it.

It does not repeal most of the Obamacare regulations.

It extends many of the programs past 2019.

President Trump, it does not help drain the swamp as you promised. It makes the swamp worse.

The insurance companies are not returned to a free market. It is a clever way to support the insurance companies by switching from a mandate and penalty to a tax credit (giving the money away to everyone).

This is another entitlement to further enrich the healthcare insurance industry.

Americans elected these Republican politicians to drain the swamp. This bill is no different than Obamacare.

Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons said:

Refundable” tax credits – for those who don’t owe taxes – are still a subsidy. It is still redistribution of wealth, with winners (those who get the subsidy) and losers (those who pay for it). And the chief winner is the “health plan.” It gets money; the supposed beneficiary may get nothing, or only rationed care from a narrow network.

“The problem is comprehensive third-party payment,” Orient adds. “The bill perpetuates this disastrous concept. A true free-market bill – “there shall be a free market in health insurance” – would remove all federal mandates, subsidies, barriers to competition, or protections or advantages for cartels.”

“Instead of returning the insurance market to the vigor of a free market, the government will be supporting it with tax credits – the flip side of the ACA insurance penalty.”

Americans are not stupid. The Republican bill will expose all the Republicans who are for the bill. They are not working for the good of the people

Democrats have already demonstrated they do not work for the people.

An group like the tea party can put up candidates against these guys and elect people who are for the people.

Where are the plans for consumer driven healthcare, patient centered healthcare, malpractice reform and the physician patient relationship?

Where are incentives for consumers to focus on their health, to help cure the obesity problem in order to decrease the incidence of diabetes and other chronic diseases?

Where is a free insurance market?

Paul Ryan’s plan is the road to failure.

The next step would be replacement of the Republican’s failure with a government controlled single party payer system.

It will fail as it is in so many countries.

President Trump. Wake up!!! Keep your promise to the American people.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Who Is Tom Price M.D. ?

Stanley Feld M.D.,FACP,MACE

Tom Price M.D. is an Atlanta orthopedic surgeon who had practice orthopedic surgery in a group at Emory University Medical School and who had been active in the Georgia medical Association.

“Thomas Edmunds “Tom” Price (born October 8, 1954). He is an American physician and Republican politician who is currently the 23rd United States Secretary of Health and Human Services. Price was the U.S. Representative for Georgia’s 6th congressional district, encompassing the northern suburbs of Atlanta from 2005 until his resignation in 2017. Price served as chairman of the House Budget Committee[1]and had previously served as chairman of the Republican Study Committee and the Republican Policy Committee

Dr. Price is a patient/physician advocate. All the secondary stakeholders such as insurers, the government establishment, hospital systems, and pharmaceutical companies are terrified of him.

The Democrats are terrified of him because they are afraid he is going to take the evolving government control of healthcare away from the government and try to put it back in the patients’ hands.

The American public had not heard much about Dr. Price from the mainstream media. The mainstream media’s message to the public is he had a hard time getting confirmed by the Senate.

He really should not have had a hard time getting confirmed by the Senate. The Senate Democrats made it look as if there was something wrong with his nomination.

His confirmation should have been a slam-dunk. He was eventually confirmed.

Dr. Price is a strong, gentle, quite man. I think he has mostly figured out how to repair the healthcare system.

There are several soft spots in his previously passed bill. It didn’t matter then because President Obama vetoed it.

Hopefully these have been fixed. I noticed malpractice reform is a big part of his present blue print. Plaintiff attorneys are terrified. Tort reform is finally is on the agenda.

I hope President Trump listens to him. The Republican establishment seems very timid for some reason. Perhaps it is afraid of failure.

The health insurance industry does not know what is in the replacement bill.

It is trying to generate doubt about the wisdom of his replacement bill for Obamacare with the following statements that the public doesn’t understand.

1.   The health insurance industry claims that Dr. Tom Price is going to assault narrow networks.

2.   He will force reimbursement tied to outcomes and related value-based models.

3.   He wants doctors in control of the healthcare system

4.    He wants tort reform.

5.    He wants doctors paid from insurers with fewer hurdles and less barriers.

The healthcare insurance companies are terrified of the abbreviated blueprint. The blueprint represents a threat to the healthcare insurance industry’s power over the healthcare system in both the government and the private insurance sectors.

The mainstream media is babbling about a lack of harmony in the Republican Party. In the next few weeks we are going to hear how disorganized the Republicans in congress are.

Democrats claim the Republicans do not have anything better than Obamacare. They are starting to make up stories about what the Republicans do or do not have. Everything is designed to make the public nervous about President Trump and his administration. These stories are parroted by the Democrat’s ally, the mainstream media.

Meanwhile, the Democrats, the mainstream media, and the public do not know what will be in the replacement act after Obamacare is repealed.

President Trump. Paul Ryan and Tom Price know if all the details are released now most of it would be attacked out of context by the mainstream media.

The Democrats’ goal would be to make the public uncertain about the Republican replacement bill. The Democratic ally, the mainstream media, is all ready spreading the misinformation about the replacement without knowing what is in it.

I even saw a poll published in the mainstream media that said more people like Obamacare than don’t like it.

This is a fake poll. It does not represent the sentiment of the majority of the people.

The political chicanery on the part of the Democrats and the biased mainstream media can be overwhelming.

I do not think the political chicanery is going to overwhelm the public, President Trump or Paul Ryan. I believe they have figured out the Democrats and the media.

Some Republicans have a slightly different opinion on how Obamacare should be replaced. Political action groups oppose some of the methodology being used to replace Obamacare.

The groups—including Heritage Action, the Club for Growth and Freedom Partners, a super PAC funded by billionaire industrialists Charles and David Koch—are troubled by the notion of refundable tax credits to help consumers pay for health insurance, a central tenet of Mr. Ryan’s plan that President Donald Trump appeared to endorse in his address to Congress last week.”

“They also are deeply opposed to a commitment to temporarily maintain an expanded form of Medicaid, as numerous GOP governors are demanding.”

Paul Ryan is trying to transition out of Obamacare so that the 11 million new Medicaid patients and the 9 million Obamacare patients do not lose their insurance as the new Republican plan is put in place. Someone does not understand the word temporary.

Several in congress want immediate repeal and replacement. I believe this will give the Democrats more fuel for the fire to subvert anything Republicans are trying to accomplish.

Reps. Mark Walker (R., N.C.), chair of the Republican Study Committee, and Rep. Mark Meadows (R., N.C.), chair of the Freedom Caucus, both announced their opposition to the Republican leadership’s plans last week. Each of those groups includes dozens of conservative lawmakers, meaning if either bloc votes against Mr. Ryan’s plan, it almost certainly wouldn’t pass.

“To the extent that they’re doing something else with this plan other than full repeal, the concerns that conservatives in the House are expressing are completely valid,” said Michael Needham, chief executive of Heritage Action.”

https://www.wsj.com/articles/conservative-groups-jeopardize-gop-plan-to-repeal-affordable-care-act-1488715237

It is important to remember that190 million Americans and their families receive healthcare insurance from their employers. Obamacare has negatively affected employers. The increases in costs, access, deductibles and coverage provided by employers have negatively impacted employees.

Both are demanding relief. These people, at town hall meetings, have made it clear to the Republican congressmen and Senators not to slow down Paul Ryan and President Trump. They want relief and they want it fast.

I believe President Trump will help Paul Ryan get a bill through congress that will provide relief for the entire population.

Hopefully, they have included some of my suggestions.

I am certain that Republicans will work out their differences before they present the bill to the people and the congress.

It the meantime I would suggest that Republics and Democrats keep the noise of the demagoguery down.

The United States of America desperately needs a financially sustainable healthcare system that will provide everyone with access to affordable healthcare.

We have seen that Obamacare is not that system.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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