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Did Your Representatives Read The House of Representatives Healthcare Bill HR3200?


Stanley Feld M.D., FACP, MACE

The House of Representatives Healthcare Bill is 1018 pages long. Many Representatives and Senators did not read the entire economic stimulus bill because “we did not have time” before we experienced a severe economic recession. They claimed to be saving us from another great depression.

I have read a good portion of HR3200. The provisions are unacceptable and sinister. It represents a complete government takeover of our healthcare system. It is not in the interest of the consumer. It is not in the interest of our precious freedom of choice.

A reader of my blog sent me a summary of HR 3200 written by Larry Schweikart. The reviewer Contributing Editor Larry Schweikart is the author o 48 Liberal Lies About American History: (That You Probably Learned in School) and A Patriot’s History of the United States: From Columbus’s Great Discovery to the War on Terror.   He blogs at Mr. Schweikart is not the most liberal person on the planet. However, his analysis is about 80% accurate by my reading of the sections Mr. Schweikart summaries.

Every Americans, especially our Senators and Representative must know what is actually in the bill before it is passed. President Obama’s generalities do not cover the details of HR 3200.

It feels like Ayn Rand’s Atlas Shrugged all over again.

The mainstream media is not covering the real story.

Below are few video clips that try to tell the real story

Mr. Schweikart evaluated 498 of the 1107 page bill. The summary of one half HR3200 is frightening. His summary is a good reference guide to the appreciation of the harshness of the bill. It also explains President Obama’s urgency in getting a bill passed before anyone realizes the implications of the bills contents.

Representatives who vote for this bill should not be reelected. They are not representing their constituents’ rights or protecting their freedoms. Your healthcare, health and freedoms are at stake.

You can check the reviewer’s summary against the actual bill at the link below.

“Take a look at what actually is in the Health Care bill. Obama makes disingenuous comments like "You’ll still keep your doctor" or "You’ll keep your existing health care."

Pg 22 of the HC Bill mandates the Government will audit books of all employers that self insured. Can you imagine what that will do to small businesses? Everyone will abandon “self insurance” and go on Government insurance. So when Obama says that there will still be private health care, it’s simply a lie: this mandate will force employers to abandon their private plans.

Pg 30 Sec 123 of HC bill – a Government committee will decide what treatments/benefits a person may receive.

Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE WILL BE RATIONED! President Obama has been saying healthcare is to be rationed all along in code.

Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You will have no choice!

Pg 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise.

Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Healthcard will be issued! Government has real-time access to your tax return presently and means test Medicare recipients’ premiums

Pg 59 HC Bill lines 21-24 Government will have direct access to your bank accts for election funds transfer. A further impingement on freedom and privacy.

Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (read: ACORN).

Pg 72 Lines 8-14 Government will create an HC Exchange to bring private HC plans under Government control.

Pg 84 Sec 203 HC bill – Government mandates ALL benefit packages for private HC plans in the Exchange.

Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans = The Government will ration your Healthcare!

Pg 91 Lines 4-7 HC Bill – Government mandates linguistic appropriate services. Example – Translation for illegal aliens.

Pg 95 HC Bill Lines 8-18 The Government will use groups, i.e. ACORN & AmeriCorps, to sign up individuals for Government HC plan.

Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans. AARP members – your Health care WILL be rationed.

Pg 102 Lines 12-18 HC Bill – Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.

Pg 124 lines 24-25 HC No company can sue Government on price fixing. No "judicial review" against Government Monopoly.

Pg 127 Lines 1-16 HC Bill – Doctors/ AMA – The Government will tell YOU what you can earn.

Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.

Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.

Pg 149 Lines 16-24 ANY Employer with payroll $400k & above who does not provide public option pays 8% tax on all payroll.

Pg 150 Lines 9-13 Businesses with payroll between $251k & $400k who don’t provide public option will pay 2-6% tax on all payroll.

Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Government will be taxed 2.5% of income.

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)

Pg 195 HC Bill -officers & employees of HC Admin (the GOVERNMENT) will have access to ALL Americans’ finances and personal records. Big brother will be watching your every move.

Pg 203 Line 14-15 HC – "The tax imposed under this section shall not be treated as tax" Yes, it says that.

Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid. Seniors, low income, poor affected. Kill off the poor and elderly.

Pg 241 Line 6-8 HC Bill – Doctors – doesn’t matter what specialty – will all be paid the same.

Pg 253 Line 10-18 Government sets value of Doctor’s time, professional judgment, etc. Literally, value of humans.

Pg 265 Se
c 1131Government mandates & controls productivity for private HC industries.

Pg 268 Sec 1141 Federal Government regulates rental & purchase of power driven wheelchairs.

Pg 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!

Pg 280 Sec 1151 The Government will penalize hospitals for what Government deems preventable readmissions.

Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission – Government will penalize you.

Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.

Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion – Government will mandate hospitals cannot expand.

Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!

Pg 335 L 16-25 Pg 336-339 – Government mandates establishment of outcome-based measures which of course forces health care rationing.

Pg 341 Lines 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc., forcing people into Government plan.

Pg 354 Sec 1177 – Government will RESTRICT enrollment of Special needs people!

Pg 379 Sec 1191 Government creates more bureaucracy – Telehealth Advisory Committee. Healthcare by phone.

Pg 425 Lines 4-12 Government mandates Advance Care Planning Consultations. Think Senior Citizens end of life prodding.

Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of attorney. Mandatory!

Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in how to die. EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (and your life). Health care will be denied based on age. 500 Billion will be cut from Seniors healthcare. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.

Pg 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.

Pg 429 Lines 1-9 An "advanced care planning consultant" will be used frequently as patients’ health deteriorates.

Pg 429 Lines 10-12 "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from the Government to end a life!

Pg 429 Lines 13-25 – The Government will specify which Doctors can write an end of life order.

Pg 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.

Pg 469 – Community Based Home Medical Services/Non profit orgs. (ACORN Medical Services here?)

Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATION. 1 monthly payment to a community-based organization. (Like ACORN)

Pg 489 Sec 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into our marriages.

Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services. You’d better speak up now before you are on the "advanced care consultation" list.

It gets worse: the Health Care Reform bill that is now about to come up for a vote will absolutely eliminate private health care options. Do not kid yourself: They are going to say that they aren’t going to interfere with your right to go to your "own doctor" or have your own "private health insurance." But there won’t be non-government doctors or private health insurance if the government mandates them out of existence.

Even still, I hear people who want to "get past all this partisanship." Sorry, but GROW UP.

Our system from the beginning has pitted one group against another out of fear of the very giant government that is metastasizing before our eyes. James Madison didn’t like "parties" or "factions," but he finally admitted that they were absolutely necessary to fragment power.

For our system to work there has to be a clear choice, not a mushy middle, because the mushy middle always, always, always gravitates left. There is a "presumption of power" on the left –conservatives, by nature, do not like government, don’t trust it, and do not want to use it to advance their ends, which they see as advanced through liberty, individual achievement, and entrepreneurship. Contributing Editor Larry Schweikart is the author o 48 Liberal Lies About American History: (That You Probably Learned in School) and A Patriot’s History of the United States: From Columbus’s Great Discovery to the War on Terror.   He blogs at

It is hard to read H3200 and comprehend its implications. However, a careful reading leads me to similar conclusions to those of Mr. Schweikart.

Do you think your representatives have studied the bill? If they have and vote for it they should lose your vote. If they have not read it and vote on party lines they should lose your vote.

This bill is not going to Repair the Healthcare System. It will make the healthcare system more complex, restrict access to care, restrict the delivery of care, ration care, limit freedom of choice, and increase the deficit.

Americans have to demand that congress tackle the real problems in the healthcare system. Have you contacted your Representative and Senators? If you have, good for you. If not , what are you waiting for?

Let your Senators and Representatives know the proposals are unacceptable.  Write, fax, call, email, twitter. Tell them:

“We do not want the government to control our lives. We want affordable, universal healthcare coverage that does not limit access to care. We want control over our healthcare dollars. We do not want government to control our lives and our money.”


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

  • Health Remedies

    This is quite a detail and comprehensive posting on The House of Representatives Healthcare Bill HR3200. Thanks for all these information. It is really helpful.

  • JCF

    I would like to better understand your read of this. In some ways your points of interpretation are completely the opposite from what I read. The language in the bill seems simple enough, but maybe I’m missing something. We’ll use the example of rationing. Please excuse the numbers and word cutoffs, but I wanted to copy and past directly from the draft of the bill i read.
    First mention I saw pertaining to Rationing: On page 28 of the draft I’ve read continuing to page 29:
    24 In developing such recommendations, the Committee
    25 shall take into account innovation in health care and
    1 ensure that essential benefits coverage does not lead
    2 to rationing of health care.
    Pertaining to treatment of cancer and your arguments regarding rationing of their care: page 212
    19 Section 1833(t) of the Social Security Act (42 U.S.C.
    20 1395l(t)) is amended by adding at the end the following
    21 new paragraph:
    24 ‘‘(A) STUDY.—The Secretary shall conduct
    25 a study to determine if, under the system under
    1 this subsection, costs incurred by hospitals de
    scribed in section 1886(d)(1)(B)(v) with respect
    3 to ambulatory payment classification groups ex
    4 ceed those costs incurred by other hospitals fur
    5 nishing services under this subsection (as deter
    6 mined appropriate by the Secretary).
    8 Insofar as the Secretary determines under sub9
    paragraph (A) that costs incurred by hospitals
    10 described in section 1886(d)(1)(B)(v) exceed
    11 those costs incurred by other hospitals fur
    12 nishing services under this subsection, the Sec
    13 retary shall provide for an appropriate adjust
    14 ment under paragraph (2)(E) to reflect those
    15 higher costs effective for services furnished on
    16 or after January 1, 2011.’’.
    All this is saying is that they will monitor to ensure that hospitals that offer the same services will be compensated accordingly.
    I really want to understand, from which specific lines (not your read-ins or comments) are you drawing rationing? The above are two sections you reference in making such arguments. It will help the credibility of your point and perhaps help others who may be similarly confused.

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Obama Double Talk: He Says Health Plan Won’t Add to Deficit: Part 3

Stanley Feld M.D.,FACP,MACE


Between Thursday July 15th and Friday July 16th the President and the House committees somehow persuaded Douglas Elmendorf, head of the Congressional Budget Office, to change his assumptions and score the healthcare reform bill budget deficit differently. He had been very definitive on Thursday July 15th. It is hard to believe that the next day the negative scoring of the House bill could drop from 1.5 trillions dollar deficit to a $239 billion deficit over the next ten years.

“Late on Friday, hours after two House committees—Ways and Means and Education and Labor—approved healthcare reform legislation, the Congressional Budget Office (CBO) had bad news: HR 3200 would result in a net increase in deficit spending of $239 billion during the next 10 years, according to its analysis. But House leadership immediately challenged the findings—and CBO changed its tune hours later.”


How did administrative pressure manage to change this number overnight? Republicans are not demanding an answer.

The House bill, CBO said, was able to target key areas for savings. However, a key trigger in increasing Medicare spending occurred when the existing annual "sustainable growth rate" (SGR) in the Medicare physician fee schedule (with a 21% reduction in payment rates scheduled for 2010) was replaced with an inflation-based update.”

This calculation was done using today’s inflation rate. What if inflation skyrockets to 10 or 15%? The bill would create a deficit of greater than 1.5 trillion dollars in 10 years.

CBO estimated that those changes in the physician payment rates ultimately would add up to $245 billion in changed physician rates between 2010 and 2019.

Who are they going to hurt? The weakest link is the physicians because they are the most disorganized and lack leadership and effective representation.

Meanwhile the traditional media has immediately stopped publishing the $1.5 trillion dollar deficit in the “news” this week and replaced the deficit with the $239 billion dollar deficit.

“Peter Orszag, director of the Office of Management and Budget (and former CBO director). "The only reason that the bill shows a deficit" is because of the "payments to physicians…once you take that part out, the bill is deficit neutral," Orszag told Fox News on Sunday.”

This is exactly how you cook the books. You recalculate the figures using assumptions to your advantage. President Obama now has his deficit neutral bill. Magic!!

“Those reformed Medicare physician payment costs, however, should not have been included. CBO’s net calculations, according to a release from the three House committee leaders issued.”

“ Instead, they will be absorbed under the upcoming statutory "pay-as-you-go" budgetary legislation that currently is pending in the House. (With so-called "paygo," the federal government cannot launch new tax cuts or entitlement programs without finding a way to pay for them.) This would make HR 3200 deficit neutral over the 10 year budget window—and even produces a $6 billion surplus.”

If anyone wants a bridge I have one to sell. The deficit money will come from another pot.

“It also would create Medicare and Medicaid savings of $465 billion, coupled with the $583 billion revenue package reported by the Ways and Means Committee on Friday. It would "fully finance" the previously estimated $1.042 trillion cost of reform, which will provide healthcare coverage for 97% of Americans by 2019, the House committee leadership said. About 17 million nonelderly residents would be left uninsured (about half of whom would be unauthorized immigrants).”

It is unbelievable. We still have 17million uninsured. It is no wonder the House and Senate’s approval rating is so low. If the American public believes all this nonsense they will deserve what they will get. Only public opinion can stop this train. When it is all over there will be too few physicians taking care of patients just as there are too few physicians taking care of Medicaid patients.

“CBO and the Joint Committee on Taxation said that approximately $583 billion would be obtained through increasing federal revenue by methods such as issuing a surtax on higher incomes, which was approved by Ways and Means on Friday. Another $219 billion (plus physician payments) would be saved by Medicare and Medicaid by:

  • Making permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee for service sector (excluding physicians’ services)—yielding budgetary savings of $196 billion over 10 years
  • Setting payment rates in the Medicare Advantage program based on per capita Medicare spending in the fee for service sector—providing savings of approximately $156 billion over the 2010 2019 period.
  • Changes to the Medicare Part D program to establish a new prescription drug rebate program for those eligible for both Medicaid and Medicare.”

After all these manipulations of the numbers they have the gall to make the following statement:

"This fulfills the strong commitment of the President and House leadership to enact health reform on a deficit neutral basis," said the release signed by House Committee Chairmen Henry Waxman (D-CA), Charles Rangel (D-NY), and George Miller (D-CA).

President Obama then says he is correct. He told us he would not sign a healthcare reform bill that was not budget neutral.

President Obama has previously said that he would not sign healthcare reform legislation that was not budget neutral.

Can President Obama be trusted with numbers? His numbers were wrong with the economic stimulus package and we trusted him.

The unemployment rate today is 9.5% — nearly 20% higher than the Obama White House said it would be with the stimulus in place. Keith Hennessey, who worked at the Bush White House on economic policy, has noted that unemployment is now higher than the administration said it would be if nothing was done to revive the economy. There are 2.6 million fewer Americans working than Mr. Obama promised.

The President did tricks with the numbers to pass the economic stimulus package. All of this seems much too confusing to the traditional media and their love affair with President Obama. We are not getting critical reporting.

The Blue Chip consensus is an average of some four dozen economic forecasts. In January, the consensus estimated that GDP for 2009 would shrink by 1.6% and that unemployment would top out at 8.3%. Team Obama assumed both higher GDP growth (it counted on a contraction of 1.2%) and lower peak unemployment (8.1%) than the consensus.”

he calculations for surplus and deficit depend on the assumptions applied. If you make the wrong assumptions you can get numbers you like. If you make the correct assumptions you might get public disapproval.

So why should we trust President Obama and his Democratic controlled House committees with the assumptions about health care costs? The goal of the present administration is to dominate and control healthcare. Can you trust the administrations with your healthcare needs?

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

  • shearwater

    Obama’s double talk on health care insurance leads one to believe that he is a liar willing to sacrifice his integrity to get a reformed and socialized system of government run health care insurance installed by hook or by crook.

  • just click the next document

    just click the next document

    Repairing the Healthcare System: Obama Double Talk: He Says Health Plan Wont Add to Deficit: Part 3

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Obama Double Talk: He Says Health Plan Won’t Add to Deficit: Part 2


Stanley Feld M.D., FACP, MACE

The congressional budget office has scored the House healthcare reform bill and declared it will increase the budget deficit by 1.5 trillion dollars in the next ten years. During his testimony to congress Douglas Elmendorf head of the CBO had the courage to do his job honestly. He contradicted President Obama contention that the House bill will be budget neutral.

“Douglas Elmendorf, head of the Congressional Budget Office, provided a bleak assessment in his testimony on Thursday on whether he thought the healthcare cost curve—which has been steadily rising upward—would finally bend downward under newly introduced reform legislation.”

His response to Sen. Kent Conrad (D-ND), chairman of the Senate Budget Committee, who asked the question: An unequivocal "no."


The legislation expands federal responsibility for healthcare costs without any real structural change in the healthcare system. The only structural changes will be a decrease in reimbursement to physicians and an ineffective pay for performance system.

"In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount," Elmendorf said. "On the contrary, the legislation significantly expands the federal responsibility for healthcare costs."

The CBO is not even including the money allocated to healthcare reform in President Obama’s economic stimulus package i.e. the $60 billion dollars allocated to electronic medical records and the $30 billion dollars allocated to Federal Health Board.

On Friday July 16th ,President Obama responded with an emergency press conference. He gave Congress a pep talk. His message was not to give up in the home stretch.

On Saturday morning he told the nation:

“I want to be very clear,” Mr. Obama said in his weekly address to the nation. “I will not sign on to any health plan that adds to our deficits over the next decade. And by helping improve quality and efficiency, the reforms we make will help bring our deficits under control in the long term.”

He crafted his message carefully. He claims even though there is a deficit in the first few years the reform will create a surplus at the end of the decade.

How will he create a surplus?

He might achieve his goal by decreasing access to care.

He could decrease care (rationing).

He could decrease reimbursement to physicians.

He could increase taxes.

He could also cook the financial books to create a profit.

One way to pay for the bill is to raise taxes. Is that a smart idea? Is raising taxes a good idea during a recession? The answer of most economists is no! President Obama,s reply reply is he is only going to tax the rich. Who create the jobs that will revive the economy?

How does President Obama maintain his high approval ratings? He maintains his high ratings by leaving the dirty work up to others while he speaks in generalities and gives pep talks. He uses powerful new media tools to provide Americans with a “voice in government.” The problem is he does not tell us what we are signing up for other than his healthcare reform. He asks us to help defeat his opponents who want to maintain the status quo.

The same folks who controlled the White House and Congress for the past eight years as we ran up record deficits will argue — believe it or not — that health reform will lead to record deficits,” Mr. Obama said. “That’s simply not true.”

He argued that his proposals would cut “hundreds of billions of dollars” in unnecessary spending and change incentives so health providers “will give patients the best care, not just the most expensive care.”

It sounds great. It gives me a bad feeling. It sounds like big brother will take care of us. We should be empowered to take care of ourselves.

And, he said, he has urged Congress to adopt a plan for a standing commission of doctors and other medical experts to oversee cost-saving measures.

Shorty thereafter, David Plouffe, who crafts his new media internet campaign, sent a note to all his email addresses to have all of us sign up for President Obama’s healthcare reform plan blindly.

Dear Supporter

President Obama is in the White House today because last year people like you got involved and made it happen.
Passing health care reform in 2009 is a top priority for the President. Achieving it will require everyone working together — we can’t do this without you.
Please listen to the President’s call and then sign your name, asking Congress to deliver health care reform that lowers costs, guarantees choice, and ensures affordable care for all.
Thanks for getting involved,
David Plouffe
Organizing for America

America: It is all doubletalk!!

Think about the double talk in the last six months, the economic recovery plan, the financial sectors bailout and then huge profits to Goldman Sachs. Think about the continued huge bonuses and taxpayers’ burdens. Think about the increasing unemployment rate beyond President Obama’s predictions.

Do you trust the government to dictate your healthcare options? Do you think government should decide the course of your medical care for you and your doctor?

Government should regulate the abuse of our healthcare options not dictate medical care.

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


  • Michael Kirsch, M.D.

    A few weeks ago, even newshounds like myself had never heard of Douglas Elmendorf. Now’s he’s a hero for many of us. He told us what many of us have been saying and fearing: we can’t afford Obamacare. This in only 1 reason to oppose it. I am as concerned that his plan will extend medical mediocrity across the country in his quest for universal coverage. It’s fascinating that the recent opposition and obstruction to health care reform has come from his own party. Obamacare the cure may be worse than the disease. More on reform and medical quality issues at

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President Obama’s Double Talk: He Says Health Plan Won’t Add to Deficit Part 1

Stanley Feld M.D.,FACP,MACE

President Obama still enjoys a high approval rating. During the election he represented hope for change to the American people. We need hope because many of our systems are abused and broken. The divide between the rich and the poor is increasing and is at the most dangerous point in our history.

Our systems are abused and broken because Congress has been influenced by vested interests. Congress has been gridlocked on energy, environment, healthcare, education and many other vital issues. The systems need to be fixed to stimulate vigor in our economy and the spirit of innovative.

President Obama represented this hope. He has a fresh face and the right words. When we look beyond the words and analyze his style we find we are confronted with the same old double talk. He has the right words but the wrong solutions. He is telling us he will fix the broken and abused systems. However, he is demonstrating that the Democrats want to control the systems.

The result of the proposed legislation will be to control our personal decision making and our lives. I believe Americans will react negatively to this when they discover what has been done to them.

In order to accomplish this control over the healthcare system Congress is going to have to increase spending. The result of increased spending higher taxes.

President Obama wants to add a surtax on incomes over $250,000 plus and addition 4% income tax. The surtax will be on incomes from any source. In addition there are indirect tax increases on all citizens.

Medicare and Medicaid are entitlement programs. This is a fact. Medicare and Medicaid are in serious financial difficulty. Medicare Part B is funded by general revenues. The Medicare Board of Trustee’s responsibility is to warn Congress if more than 45% of Medicare expenditures are projected to come from general revenues. If they issue a warning in two consecutive years, Congress and the President must act to reform Medicare. The warning has been issued in the last 4 consecutive years. Congress has not acted.

The best way to quiet an agency is to eliminate it. This is exactly what the House bill does on page 836 of the 1081 page.

Rather than deal with Medicare’s situation directly, the President and his allies promise to "bend the curve" to achieve savings across the health care spectrum — including Medicare. 

If this is true, why then would page 836 (Section 1901) of the House bill repeal the "Medicare trigger" that is intended to force legislative action when Medicare’s finances worsen?

  • The Medicare Modernization Act of 2003 had mandated that if more than 45 percent of Medicare expenditures were projected to come from general revenues (as opposed to dedicated revenues, such as payroll taxes and beneficiary premiums) within a seven-year period, the trustees would issue a warning.
  • Two consecutive years of this warning would require the President to offer reform legislation and Congress to give that legislation expedited consideration.

This warning has been triggered four consecutive years — the last three of which would have required legislative action.  Yet the Democratic Congress has regularly passed rules suspending their responsibility to address Medicare’s unsustainability.  Now, the House health care bill would repeal the trigger altogether.”

President Obama has stated on numerous occasions that his health care reform bill will save money. It will not create a larger deficit. It is easy to save money when you eliminate the findings of the agency that reports the overspending.

“President Obama has repeatedly claimed that his health care reforms represents entitlement reform. He has stated that he will not sign a healthcare reform bill that is not budget neutral.”

Meanwhile, the Congressional Budget Office has scored the healthcare reform measures increasing the budget deficit by 1.5 trillion dollars in the next ten years. This finding is not budget neutral.

Even if President Obama gets everything in the house bill passed he will not solve the problem of the healthcare system.

The major problems in healthcare are being ignored. Malpractice reform, the cost for the healthcare insurance industry’s administrative services, and patients’ responsibility for their own health and their own healthcare dollars are major issues that must be addressed and solved innovatively in order to repair the healthcare system.

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

  • Anne Hudson

    Any time that the government steps in, it adds to the deficit. And, it doesn’t matter which government- local to federal. This “new” plan will be socialistic in nature. I fyou want ot see how it will work, just go to any VA hospital.You see who they think is best for you, appointemnts are from two to six months apart. YOu get the medicines available on their formulary, even if another medicine might be better for you. If you need surgery, you getnot only second opinions but sometime third and fourth opinions. It can take weeks just to get dentures relined (while you are without) and months if you need new ones. The co-pay is based on your income and/or your statis as a veteran (have compensation for injuries inthe service or not. this is our future.
    I know; I am a veteran who has to use the VA for medical care.

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Gotta Pass This Healthcare Bill Before America Catches On


Stanley Feld M.D.,FACP,MACE


President Obama wants Congress to get a healthcare bill on his desk before the August recess. I can hear the train whistle blowing. He wants the bill passed before the public understands the implications of the bill. The House bill has provisions that declare individual private medical insurance illegal.

“Under the header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:”

"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.”

President Obama told Americans they can keep their private insurance if they like it. He did not tell us about the exceptions. He did not tell us we could not switch healthcare insurance companies.

“Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.”

The only choice will be the public option. So much for creating competition to lower price. He did say the public option would be 30% to 40% cheaper than the current healthcare premiums. He did not say taxpayers would be funding the difference. Employers would gladly drop healthcare coverage especially if they cannot deduct the expense of private insurance. Employers do not need more incentive to drop private coverage. To be sure of this Congress will outlaw private insurance. 

What else is he not telling us when a 1018 page bill is presented with many confusing provisions? How much more of our freedom of choice will be restricted? The healthcare insurance industry is presently charging 15%-20% for administrative services for private healthcare coverage.

The government outsources administrative services to the healthcare insurance industry. As best as I can tell it is charging the government 15% for administrative services. The government claims administration cost 2% for Medicare. The 2% is before government outsourcing of administrative services. This 2% is going to balloon to at least 15% with the additional government bureaucracy. (Figure 1)


Figure 1


Who loses? The consumers of healthcare, the patients and the taxpayers lose. President Obama’s preference is rich tax payers.

“What wasn’t known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law.”

The bill also outlaws the sale of health savings accounts.

“The Democrats want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs.”

All my readers know that Medical Savings Accounts not Health Savings Accounts are the answer to giving patients control of their healthcare dollar. The Democrats want to control the people and not permit freedom of choice.

“Neither the government nor the President has the constitutional nor moral authority to outlaw private markets in which parties voluntarily participate. Government shouldn’t be killing business opportunities, or limiting choices, or legislating major changes in Americans’ lives.”

With the house bill the public option becomes a mandate forcing citizens to buy government healthcare. A free people should be outraged at limitation of freedom of choice.

The Kennedy Senate bill has restricted input from the Republicans. Republicans have had to present 398 amendments to the Kennedy bill. All have been rejected.

“Unless you’ve been carefully watching the mark-up of the Kennedy health bill, you wouldn’t be aware that Senators have been battling over many of the 398 amendments proposed to the legislation. You also wouldn’t know that all attempts to protect patients from health care rationing were defeated.”

President Obama has already funded 1.1 billion dollars for Comparative Effectiveness Research (CER). The research is supposed to compare the clinical and/or cost-effectiveness of two health care treatments for the same condition.

The Kennedy bill expands the role for CER. Sen. Pat Roberts’ (R-KS) amendment ,Sen. Tom Coburn’s (R-OK) amendment, Sen. Mike Enzi’s (R-NV) amendment, would all have prevented the use of CER to ration or deny care or mandate coverage. All three were defeated by straight Democratic Party-line votes. This action has gotten little public attention in the general media.

“If CER can be used by the government to make payment, treatment, and coverage decisions, it could also be used as a rationing tool.”

“One of the key issues emerging in the national health care debate is whether or not there will be official limits on the kinds of care, medical treatments, or procedures that Americans can get. As The Post reporter noted, when asked a specific question on this issue, the President failed to respond.

The Democratic Senators on Senator Kennedy’s Committee have responded in a way that would astonish and outrage and most ordinary Americans.

”The truth is that with legislation authorizing the federal government to make key decisions on medical benefits and medical procedures, dictating the kinds of health benefits Americans will and will not have in the government-approved health insurance plans, federal officials would retain enormous power over the kind of care Americans would receive.”

The President has repeatedly promised that if you enjoy your relationship with your doctor, his proposals would not interfere with that relationship. If CER powers are expanded rationing will occur, and government policy would destroy the doctor-patient relationship.


  The health care debate is not a battle over the uninsured, over rules governing insurance markets. It is a debate over government controlling our freedom of choice. It is not even a debate. It is a SPEEDING TRAIN.

Let your Senators and Representatives know the proposals are unacceptable.  Write, fax,call,email,twitter. Tell them:

“We do not want the government to control our lives. We want affordable, universal healthcare coverage that does not limit access to care. We want control over our healthcare dollars. We do not want government to control our lives and our money.”

Additional Reading: IBD Exc Series: Government-Run Healthcare: A Prescription For Failure

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

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Here Comes The Judge!


Stanley Feld M.D.,FACP,MACE


Here Comes The Judge!!

President Obama has promised that the savings of his healthcare reform plan would be budget neutral. The Congressional Budget office has contradicted his statement by scoring the proposed bills and predicting it will generate at least 1.5 trillion dollars deficit over 10 years. The independent HSI Network scored the House’s initial draft at a heart-stopping $3.5 trillion.

Congress is trying to figure out how to generate increased tax revenue to pay for the healthcare reform plan. The popular press has not discussed the congressional proposals for raising taxes

House and Senate Democrats appeared yesterday to be on a collision course over how to pay for a sweeping overhaul of the nation’s healthcare system, with the House planning to propose an income tax increase on the wealthiest Americans”

Congress is going to raise taxes for healthcare reform. The President has not opposed the notion. No one is talking about the real issues. The real issue is to fix the defects in the healthcare system effectively.

Can Americans trust politicians? Americans want universal healthcare, affordable healthcare coverage, access to care and an increase in quality of care. President Obama’s generality promises this. He never goes into the details.

“Senate negotiators had been considering a tax on some employer-provided health benefits.”

The Democrats are trying to figure out who to tax first to cover the 1.5-3.5 trillion dollar deficit that will be created by President Obama’s healthcare reform plan. They have decided to tax the “rich.”

Taxing the rich has not worked in the past for many reasons. The house proposal presently is a surcharge on the rich in addition to raising the tax rate to 39%.

“The House Ways and Means Committee was said to be nearing agreement on an income tax surcharge of 2 percent or more on Americans with the highest incomes – those earning more than $250,000. The surtax would rise for those earning $500,000 and rise again for those earning more than $1 million.”

Tax the rich to help the poor. The rich usually disappear as a taxable entity when this occurs.

One commenter said;

Look, the "Rich" don’t pay taxes. The Kennedys don’t pay taxes. Their money is in offshore trusts. George Soris doesn’t pay taxes. Al Gore is making bazillions off his energy soapbox but he’s not paying taxes.
This will all come out of the hides of the middle class, until we have meaningful tax reform

The Senate and the House are now fighting over which tax increases should be incorporated into the healthcare bill. I suspect the public will become aware of the tax increases after they are passed.

“A proposed sales tax on sodas and other sugary drinks and a new payroll tax of 0.3 percent to be paid by employees and employers was in favor last week but has gone underground for now.”

There are lots of ideas on how to increase taxes to pay for President Obama’s healthcare reform plan.

“The Senate seemed to be narrowing their focus on a plan that would tax only the most generous employer-provided health plans – those worth $25,000 or more a year – as well as a modified limit on tax deductions proposed by Obama.”

Democrats’ mode of operation is first spend and then tax. I believe all large employers will have their employees buy insurance through the public option. The penalty will cost less than providing healthcare insurance

“Senators are also considering a plan to apply the Medicare payroll tax of 1.45 percent to nonwage income like dividends and capital gains.”

Congress seems to be doing everything in its power to decrease investment incentives in the name of healthcare reform without even realizing what they are doing. Investment incentives have made America strong.

“One tax increase would bar drug companies from deducting the cost of advertisements as a business expense on their corporate tax returns.”

If congress wanted to fix the healthcare system and lower costs they would restrict direct to public advertising completely.

“Another would end a tax break for healthcare flexible spending accounts.”

Democrats in congress are going to increase taxes in multiple ways to pay for President Obama’s healthcare reform.

“Senators don’t like to raise revenues,’’ Baucus said, using a euphemism for tax increases.

The White House has not expressed a position on the surtax, but lawmakers said they had heard no objections so far.

It seems to me the Democrats have not learned anything in the last 50 years.

They have not learned that :

Entitlements are bottomless pits.

The public does not like bottomless pits because it leads to tax increases.

Increasing tax leads to a decrease in economic growth by decreasing innovation and risk taking.

Government’s role should be to make rules that level the playing field for all the stakeholders and then get out of the way. (Adam Smith)

I believe the Democrats are heading for another 1994 congressional debacle without the Republicans doing one smart thing. The Obama healthcare plan is doing nothing to improve in the healthcare system. Congress is going to pass a bill that spends a lot of money and accomplishes nothing

The Obama method lets others do his dirty work. He makes sure it is what he approves as he stays on the high road.

Obama’s chief of staff, Rahm Emanuel, who visited the Capitol twice this week to discuss healthcare proposals with House Democrats.

He said the president would prefer that money to pay for the legislation come from within the healthcare system.

But unlike a tax on employer-provided benefits, which Obama opposed during the presidential campaign, a tax on the wealthy would be in keeping with his promise not to raise taxes on Americans earning less than $250,000 a year.

America’s healthcare system’s costs are going to escalate with Obama’s healthcare plan just as they have in Massachusetts. The President will be forced to raise taxes even further.

I am afraid this will not stimulate a faltering economy. It will make it worse. With increasing taxes we will all be on the way toward working for the government.

“The trouble with socialism is that you eventually run out of other people’s money” –Margaret Thatcher.

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

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The Obama Method


Stanley Feld M.D.,FACP,MACE

In the last six President Obama has pushed through congress much legislation. Legislation that will increase the budget deficit to at least $3.4 trillion dollars. Republicans have been unable to express effective opposition because of President Obama’s political tactics.

Much of government spending in the past is has been riddled with inefficiency and unintended consequences. The intent might have been to help the little guy but has consistently created an advantage for large corporations.

How does President Obama do it? Jonthan Chait of the New Republic, a liberal periodical, described the process.

“The thing that people haven’t figured out about President Obama’s conduct of foreign policy is that it’s the same as his conduct of domestic policy. Obama believes in the power of negotiation and public dialogue to split his adversaries–Republicans at home, Islamists abroad–and strengthen his own position.

President Obama begins by finding common ground with his enemies. He then expresses respect for their core beliefs. He follows with profuse hope for cooperation.

“This rhetoric removes the locus of debate from the realm of tribal conflict– red state versus blue state, Islam versus America–and puts it onto specific questions–Is the American health care system fair? Is terrorism justified?– where Obama believes he can win support from soft adherents of the opposing camp.”

He keeps the agreement general as he moves the process along. However, the devil is in the details. The common ground in healthcare does not solve the healthcare system’s problems.

Universal healthcare, affordable cost and increased quality are the common ground.He then leaves it up to the congress to write the law. The underlying strategy is to throw money at the problem even if the strategy will fail. The leaders from both parties are starting to see through this tactic.

“In January 2008, Obama told a newspaper editorial board that Ronald Reagan provided a "sense of dynamism and entrepreneurship that had been missing." Paul Krugman complained, "Where in his remarks was the clear declaration that Reaganomics failed?"

Most Democrats believe Reagonomics failed. They are angered at how President Obama could applaud Reagonomics. I believe it was a less than sincere attempt to stand on common ground with Republicans. He removes the debate from the realm of tribal conflicts. He avoids fighting with Republican over Reagan. The populous applauds because they believe he is on their side. He is then free to craft any policy he pleases. He promotes his policy using the new media (internet). He stays on the high ground and avoids discussing details or detail consequences.

“Obama’s method entails small acts of intellectual dishonesty in the pursuit of common ground.”

Greg Scandlen exposed President Obama’s healthcare whiz kids and their attempts to shape public opinion.

“ The Obama administration kids are Peter Orszag, Ezekiel Emanuel (Rahm’s brother), and outside advisors like David Cutler and Atul Gawande. They are convinced of their own genius. They think they can create the data driven management systems to eliminate $700 billion of wasted care in the American health care system. They are dismissive of any skeptics. Their very hubris causes them to overlook essential factors that may impede their plans.”

The key to fulfillment is to maintain Americans’ anger at the old way and desperation for change.

President Obama stays in a position to spin his story and paralyze the opposition. (Rope a Dope). He used Dr. Atul Gawande’s (an advisor) June 1 article in the New Yorker to demonize physicians. I pointed out that the article was a masterpiece of disinformation.

“ Dr. Gawande ,an advisor on President Obama’s healthcare team, had an article published in the New Yorker about a month ago that laid out in great detail what he viewed as the inadequacies of the health care system in McAllen, Texas.”

He pointed out that Medicare and Medicaid patients cost twice as much in McAllen as in El Paso. He compared the costs in McAllen to the cost of Medicare patients at the Mayo Clinic.

“He concluded that we needed to replicate the management systems (not-for-profit, salaried employees, team approaches to service delivery) of the Mayo Clinic in places like McAllen, and indeed, throughout the United States. Voila! Problem solved.

Dr Gawande omitted a few important data points. Mayo Clinic does not care for indigent,Medicare or Medicaid patients long term. He ignored the fact that Medicare has the machinery to discover and deal with cost outliers and impose heavy fines.
The Texas Medical Association checked on some of the data Dr. Gawande used and ignored. He overlooked the following in exposing McAllen’s physicians.

  • “Its population is the poorest in the entire United States.
  • It has the fewest physicians per capita in the entire United States.
  • It has the second highest uninsured rate in a state that is the Uninsured Capital of the United States.
  • It is heavily reliant on Medicaid and Medicare payments to finance its entire health care system.
  • It is plagued by very high rates of obesity, diabetes, lack of exercise, and overall poor health status”(chronic disease demanding long term care).

The TMA article explains the poverty rate in McAllen is nearly three times that of the Mayo Clinic. McAllen’s physician supply is half that of the Mayo Clinic.

"Where there is poor availability of outpatient care, patients are far more likely to seek routine care in hospital emergency rooms, where costs are high and diagnostic testing is more frequent. This is also far more likely to result in costly hospital admissions. The data that Dr. Gawande depended on – but did not report – show just this. McAllen has a pattern of unusually high inpatient costs, while outpatient costs are close to average."

Many intelligent people reading the New Yorker article believed physicians in private practice are crooks. This is the point of the disinformation. It is typical of President Obama’s method of winning public support.

If President Obama’s tactics succeed in crafting his healthcare policy the nation is facing a $1.5-3.5 trillion dollar deficit with zero improvement in our healthcare system.

President Obama’s tactics are becoming transparent. Everyone is getting tired of false hope. Policy and plans are ill conceived and destined to fail. However the cost will be dear to tax payers.

Wake up Americans!!!.

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

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The Unintended Consequences of President Obama’s Public Option

Stanley Feld M.D.,FACP,MACE

What is the problem with President Obama’s public option? It guarantees insurability to all Americans of any age with any pre-existing condition. Providing basic healthcare insurance to everyone might guarantee protection from financial disaster from healthcare expenses.

An actuary would say the public option is actuarially unsound.

At the heart of President Barack Obama’s health-care plan is a healthcare insurance program funded by taxpayers, administered by Washington, and open to everyone. The healthcare plan is modeled on Medicare.

The Medicare model has two important problems. The existing Medicare entitlement is unaffordable. It will have to be funded in the future by taxpayers with some kind of income tax increase.

If enacted, “the public option" will soon become the single dominant healthcare plan. This would represent an expansion of the Medicare entitlement program.

Republicans and Democrats agree that the government’s Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama’s plan for a centrally managed government insurance program exacerbates Medicare’s problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors’ financial incentives.”

The defects in President Obama’s public option are multiple. The unintended consequences are exponential. President Obama’s healthcare team is not analyzing the public option’s defects and its effects on the healthcare system. The public option goal is to provide healthcare insurance coverage for the uninsured.

The government would charge employees a monthly premium for healthcare coverage. The premium would probably be the same or more than Medicare. The premium would be means tested. It would be calculated from all income reported to the IRS.

It will be cheaper for employers to discontinue healthcare coverage for employees and pay a penalty than provide private healthcare insurance.

“Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.)”

The Lewin Group, a health-care policy research and consulting firm, predicts enrollment in the public option will reach 131 million. It will be open to everyone. The premium will be similar to Medicare premium rates which are not cheap.

“Fully two-thirds of the privately insured will move out of or lose coverage as patients shift to a lower-paying government plan”

Medicare plans to lower physician reimbursement by 20% in 2010. Primary care physician are having difficulty financially with overhead increasing and revenue decreasing. It will only get worse under the public option. The primary care physicians’ only option would be to seek other sources of income.

“Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins.”

Physicians’ overhead will increase under President Obama’s healthcare reform plan. Electronic prescriptions and Electronic medical records (EMR) are mandated. The government is going to subsidize some qualified medical practices. The subsidy for the EMR is estimated, at the maximum, to be $40,000 per physician. A functional EMR costs $65,000 per physician plus a sizable yearly maintenance fee. This subsidy will still be out of reach for most self employed physicians.

“Doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan.”

The government must create regulations and compliance rules in order to control potential abuse. Physicians will need to increased full time employees and documentation experts in order to comply with the new rules. The government promises a crackdown on fraud and abuse and severe penalties.

Sixty percent (60%) of physicians are self-employed. Some of those physicians will be driven into large groups or hospital owned practices to spread their overhead. Some of these newly formed groups are having problems. Some physicians will accept a salary and allow hospitals to deal with the government. The trend will further serve to commoditize medical care. It will destroy the therapeutic benefit of the patient physician relationship.

The primary care physicians who stay self employed will be driven to cram more patients into their schedule in order to increase their net profit. This will further decrease their ability to relate positively to patients and their illness.

The existing trends will increase wait times already high (18 days) for an appointment to see a Family Practitioner and 30 days for specialists. It will also decrease the length of time the physician can spend with patients. The result will be to drive patients into expensive emergency rooms.

Physicians will be forced to close their practices to Medicaid and Medicare (public option) patients when they discover government reimbursement is less than their expenses. This has already happened with Medicaid patients.

Some physicians will opt out of public insurance and only accept cash. The next step is obvious. The government will outlaw the private practice of medicine. This action would be a challenge to the Bill of Rights and the constitution.

I have described some of the unintended consequences of very good goals. The goals are universal healthcare coverage at an affordable cost, with improved quality. I agree with these goals. President Obama is going about accomplishing these goals the wrong way.

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

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Medicare is Not Cheap For Either Seniors Or The Government: Part 3: The Real Issues Needed To Be Solved To Reform The Healthcare System Reform


Stanley Feld M.D.,FACP,MACE

President Obama is pushing a healthcare reform plan that will fail. However something has to happen and he is creating a populous uprising.

The reason it will fail if his healthcare reform plan is passed is the government cannot afford to pay for Medicare coverage for all. . Expanding coverage to the entire population will create bigger unsustainable defects in addition to the present unsustainable defects for seniors.

Private corporations and small businesses cannot afford to pay for private healthcare insurance coverage either. It is looking for a way to unload their private insurance obligation. The public option will be a way to do it.

This is the dilemma. The present public debate is not discussing the real issues. Healthcare coverage should be universally available at an affordable cost and be high quality. There is no argument with President Obama’s goals. The route he is taking will increase bureaucracy, decrease efficiency of medical care, restrict access to care, decrease quality of care and increase the cost of care. It will also increase government control over healthcare delivery and decrease patient choice.

What are President Obama’s options for reducing the cost of healthcare coverage if he gets his proposal passed?

a. Reduce the medical care coverage to patients

b. Ration care

c. Increase the patient deductible costs

d. Increase patients premiums

e. Decrease payment to physicians and hospitals

f. Decrease administrative waste

g. Decrease profits of healthcare insurance companies who will be the government’s administrative service provider. .

h. Decrease unnecessary medical treatments. Who decides what is unnecessary?

Other options not on the table

i. Develop a plan for end of life ethical decisions. Politicians are not interested in discussing this issue.

I wonder what Ted Kennedy’s bill will be and who will be paying it?

j. Decrease defensive medicine practices by instituting effective tort reform. President Obama said he is not considering this and received boo’s at the AMA meeting. He believes the lawyer claim that the cost is insignificant.

k. Decrease physicians’ overhead by decreasing rent, paperwork, committee meetings and needed full time employees for the excessive administrative work.

The government should develop an ideal electronic record and charge users by the click. Upgrades and maintenance would be free. It would create a completely functional EMR. President Obama 50 billion dollar plan will make vendors rich and have little impact on electronic medical record development.

l. Decrease Healthcare insurance industry’s administrative waste. It will not occur in a non price transparent and cost transparent environment.

m. Decrease patient abuse or the healthcare system.

n. Fund effective chronic disease management program.

There is no plan for re-teaching physicians how to run chronic disease management programs. A few poorly designed studies outsourced chronic disease management to proprietary disease management companies. The failed to report improvement in outcomes because they were not extensions of the primary physicians care.

o. Define responsibilities in the therapeutic unit (physician and patient). Patient physician contracts for chronic disease.

Who is responsible for the defects in the healthcare system leading to increased costs?

I believe these are the key questions to ask. Once answered, systems can be set up to correct the defects. The easiest group to blame is physicians. They are the least organized, the least effective lobbying group and the least generous to politicians.

1. Who is responsible for obesity?

Patients become obese by overeating and under exercising. Food industry by producing cheap high caloric value processed food. Government through subsides encourages food industry and farm industry to produce these food. There is little public service campaign to discourage obesity.

2. Who is responsible for AID’s infection?

Patients by sexual habits and behavior. Government has conducted public service education campaign that has encouraged effective prevention but has not been intense enough.

3. Who is responsible for drug and alcohol addiction?

Patients are responsible for their behavior. There are no public service campaigns that discourage this behavior. Many of our entertainment icons encourage the masses misbehavior.

4. Who is responsible for smoking?

Patients are responsible for this behavior. Government has been effective in promoting a non smoking policy. The tobacco companies have gotten around government efforts. Agricultural policy has not discouraged tobacco growth.

5. Who is responsible for air pollution leading to chronic lung disease, asthma and lung cancer?

The government is with its lack of a coherent environmental policy. The bill passed by the House of Representatives does not decrease pollution. It increases the cost to pollute. It is defective in have many negative exceptions.

6. Who is responsible for the epidemic of Diabetes Mellitus, lung disease, end stage renal disease, and osteoporosis?

All the stakeholders with the government most responsible for not having a positive health policy

6. Who is responsible for the high cost of insurance?

The healthcare insurance industry with the nature of its price structure, the practice of defensive medicine by physicians, the patients with first dollar coverage, the government by not enforcing regulations.

The Obama administration is focused on the wrong reforms. It is talking about expanding a broken non functioning system. All the actions by the various stakeholders are driven by perverse incentives. All of these perverse incentives are driven by economics. The economic morass has evolved since the introduction of Medicare in 1965. Most political decisions are driven by vested interests protecting their economic interests.

In order to create an affordable and functioning healthcare system for all, President Obama and his team should be discussing how to align all the stakeholders’ vested interests so all are satisfied with the economic outcomes. The consumers are the primary stakeholder. The systems should be built to empower the consumers. President Obama should be focused on decreasing these factors and issues that stimulating our excessively expensive and dysfunctional healthcare system.

With his stimulus program for electronic medical records and his proposed healthcare plan he is throwing good money after bad. The money will be wasted and the healthcare system will not be improved. More people will be covered by healthcare insurance. The healthcare insurance coverage will be restricted by the government as a third party and not by the patients. Less medical care will be available and that will be bad.

I discuss most of these issues and the solutions in my blog The summary blogs are at

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

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