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The Medicare Actuary Weighs In


Stanley Feld M.D.,FACP,MACE


On April 22, 2010 Richard S. Foster CMS Chief Actuary issued a report entitled “On the Estimated Financial Effects of the Patient Protection and Affordable Care Act as Amended. “

Mr. Foster’s disclaimer introduces the report.

“Office of the Actuary has prepared this memorandum in our long standing capacity as an independent technical advisor to both the administration and the Congress. The statement, estimates, and other information provided in the memorandum are those of the office of the Actuary and do not represent an official position of the Department of Health & Human Services or the administration.”

The report is an independent assessment of the fiscal reality of President Obama healthcare reform plan. The report contradicts President Obama’s fantasy that a new entitlement will lower health costs. President Obama used a series of trick plays to feed the Congressional Budget Office unrealistic assumptions in order for the CBO to conclude his healthcare bill will reduce the deficit. The only way there can be a deficit reduction is greater tax increases for all Americans.

President Obama’s Healthcare Reform plan does not solve the healthcare systems problems. The present healthcare reform bill will make the problems worse and increase the deficit further.

Here are some of the Actuary Report findings:

  1. President Obama claims health care costs will go down but the actuary says they will go up. National health expenditures will increase from 17 percent of GDP now to 21 percent under the new law. Healthcare costs will be higher than they would have been without the legislation. [Page 4] Net federal spending on health care will also increase by $311 billion dollars.
  1. The healthcare reform bill will result in the loss of employer coverage by 14 million employees. Employees of small firms are especially at risk despite small employer tax credit subsidies. It is cheaper to pay the penalty than pay for the insurance[Page 7]
  1. Two million employees who lose coverage will have to enroll in Medicaid. [Page 3] Medicaid enrollment will increase by 20 Million new beneficiaries. [pages 3-4]
  1. Qualifying for a Medicaid insurance card is not a guarantee of medical care. There is no corresponding increase in the supply of physicians. Other health professionals will try to care for the additional Medicaid patients. The quality of medical care must be questioned.
  1. A significant portion of the increased demand for Medicaid care would be difficult to service. [Page 20]. Physicians are not participating in Medicaid presently because of the low reimbursement. Further reductions in reimbursement will lead to further non participation. The government could try to force physicians to participate in Medicaid.
  1. There are more than one-half trillion dollars in Medicare cuts scheduled. The new health law cuts “$575 billion” from Medicare. [Page 4]. The result will be lower reimbursement and rationing of care. President Obama did not address this comment when the bill was being passed.
  1. Medicare Part A cuts would threaten the viability of 15% of hospitals. These Part A Medicare providers would become unprofitable within the 10-year projection period.” [Page 10]
  1. Health care shortages are “plausible and even probable.” Because of the increased demand for health care, “supply constraints might initially interfere with providing the services desired by the additional 34 million insured persons.” [Page 20]
  1. By 2019, more than 10% of insured workers will “be in employer plans with benefit values in excess of the thresholds (before changes to reduce benefits) and will be taxed. The percentage of workers taxed would increase rapidly thereafter.” [Page 13]
  1. The new taxes on medical devices, prescription drugs, and insurance plans “would generally be passed on through to health consumers in the form of higher drug and device prices and higher insurance premiums.” [Page 17]
  1. The reimbursement decreases will challenge Medicare providers to continue to take Medicare patients. Medicare providers will find it difficult to remain profitable and might decide not to participate in the program. [Page 10]
  1. Enrollment in Medicare Advantage is planned to be cut in half (from its projected level of 14.8 million under the current law to 7.4 million under the new law). [Page 11]
  1. The new “Medicare Tax” doesn’t go to Medicare. Despite the Medicare tax title, the revenues generated by this tax on unearned income are not allocated to the Medicare trust funds. [Page 9]
  1. Budgetary double-counting does not improve Medicare’s solvency. Medicare cuts “cannot be simultaneously used to finance other federal outlays (such as the coverage expansions) and to extend the [life of the Medicare] trust fund, despite the appearance of extending the trust using present accounting conventions.” [Page 9]
  1. The new long-term care insurance plan (CLASS Act) faces “a significant risk of failure” because the high costs will attract sicker people and lead to low participation. [Page 15]
  1. The promise to those with pre-existing conditions is unfunded. “By 2011 and 2012 the initial $5 billion in Federal funding for [high risk pools] would be exhausted, resulting in substantial premium increases to sustain the program.” [Page 16]. The healthcare insurance industry is still in control of the healthcare dollars.

These are just some of the Actuary Report finding

Despite President Obama’s repeated promises to curb healthcare costs and allow people to keep their current coverage, the President and Congress have enacted a healthcare law that will escalate healthcare costs, raise taxes, and decrease patient choice. President Obama’s political agenda ignores the will of the people.

The government takeover of healthcare heralds a financial disaster. There will be unsustainable spending and ballooning budget deficits. The financial disaster will not occur overnight. President Obama’s healthcare reform bill is spread out over many years. The increased taxes will be collected for four years before significant benefits will start.

This healthcare reform bill is fatally-flawed. It must be replaced with common-sense healthcare reforms that will solve the problems in a dysfunctional healthcare system. Instead we have a bill that will increase the systemic dysfunction.

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

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President Obama Please Re-examine Your Premises

Stanley Feld M.D.,FACP,MACE

President Obama’s goal might be for his healthcare reform plan to fail. Once it fails the default plan will be a public option with a single party payer system.

Everyone will be forced to opt into the public option. There will not be a private option.

The cost of healthcare will not decrease. The government will be paying the private healthcare insurance industry to administer the public option. Hospitals and physicians will figure out how to game the new system. The increasing costs will force a restriction to access to care.

President Obama must re-examine his premises. The medical care crisis is neither a Democratic nor Republican problem. It is an American problem. Americans need to be motivated to live a healthier existence. Only then will the cost of care diminish.

Consumers must be provided with education to live a healthier existence. The culture must be changed to emphasize better nuitrition and exercise.

Brad Feld pointed me to a fascinating paper by Carliss Y. Baldwin (Harvard) and (Brad’s mentor) Eric von Hippel (MIT). The paper suggests that some of the most basic theories on which the patent system is based are wrong. The thesis is our present patent system might hinder innovation.

The same logic can apply to the premises President Obama and his healthcare policy wonks apply to medical care. President Obama’s healthcare reform plan is punitive to both patients and physicians. It does not promote patient responsibility. It penalizes physicians for poor patient care outcomes.

Effective healthcare reform should promote patient responsibility and physician innovation. Inappropriate patient incentives and punitive regulations for physicians encourage patients and physicians to get around the healthcare reform system. President Obama’s healthcare reform plan does not achieve its goal of saving money and building efficient medical care systems.

A way to develop efficient medical care systems is through a consumer driven healthcare system with patients being in control of their healthcare dollars.

Nevertheless, President Obama’s healthcare plan is law. He won the election and forced through a partisan vote for a healthcare reform plan the overwhelming majority of the public and the physician community oppose. Only time will demonstrate the impending disaster in the healthcare system.

“Mindful that the new health care law’s ability to slow rising medical costs will depend to a great extent on how it is put in effect, President Obama is assembling a high-level team to carry out key elements of the overhaul and is considering moving faster than the law requires to put them into action. “

Kathleen Sebelius, the secretary of health and human services is reorganizing the Centers for Medicare and Medicaid Services. She is developing an innovation center whose goal is to test ways to reduce reimbursing providers.

She can enforce ideas she deems important nationwide without Congressional approval. The power of the secretary of health and human services has been expanded greatly without checks and balances.

She has started working on new regulations in an attempt control Medicare, Medicaid costs. She is also working on regulations to control independent private health care providers. President Obama wants an Independent Payment Advisory Board for controlling Medicare spending before 2014.

The problem with the Independent Payment Advisory Board is its total independence of congressional oversight. In the past Congress has ignored the Medicare Trustees’ recommendations to reduce costs. President Obama’s healthcare reform bill eliminates congressional oversight. Congress has not exercised its responsibility. However congress is accountable to the public and the Independent Payment Advisory Board is not.

The new board’s responsibilities will be in the hands of a 15 member board nominated by President Obama and confirmed by the Senate for the six-year term. The memberships will be full-time positions.

“Each year that Medicare spending exceeds annual targets, as most analysts expect it will, the board must propose ways to reduce payments to care providers.”

The Independent Payment Advisory Board provides Congress with an excellent opportunity to shirk its responsibility. The executive branch will have a firm grasp on control of the healthcare system.

“With the federal debt projected to rise to levels that many economists consider unsustainable, mainly due to growing health costs and an aging population, Congress might have little choice in coming years but to accede to unpopular limits on payments for doctors, hospitals and other health care providers of the kind that lawmakers have ignored in the past. The board would give them political cover to do so. “

“It’s a very promising structure,” said Peter R. Orszag, Mr. Obama’s budget director. “But like anything else in life, it’s what you make of it. So whether it realizes its potential depends on how it’s implemented.”

Tom Daschle, wants the board to be expanded to deal with not only Medicare but also all healthcare insurance.

Otherwise, he said, doctors will shift their costs that Medicare does not fully reimburse to patients with private insurance, “which really exacerbates the problem.

Tom Daschle said it. It is all about the government takeover of the healthcare system. It is about government regulating the healthcare system at the expense of all the stakeholders including patients. It is not about healthcare reform to produce efficient and safe systems of care through patients influencing physicians to develop innovative systems of medical care.

When was the last time a government controlled system was efficient and cost effective? Government should make the rules and then get out of the way.

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

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Family Travel

Stanley Feld M.D.,FACP,MACE

Cecelia and I believed it was important to expose our children to as much of the world as possible as they were growing up. The belief was not from our travels as children with our families. My longest trip was an occasional summer trip to the Catskill mountains with my parents and brother.

I did not travel in college and medical school but yearned to explore foreign countries. I worked in the Catskill mountains as a waiter for seven years including my senior year in high school to help pay for tuition.

College opened my eyes to the potential of world travel. When I met Cecelia I met a woman that had the same goals about world travel. We promised each other when we had enough money we were going to take at least one vacation trip overseas a year to experience other cultures

My philosophy is, “if you do not have goals you cannot score baskets.”

When Brad was 11 years old and Daniel was 8, Cecelia and I decided to take the kids to England during Spring break. We would start in London, go to Scotland and then drive back to London. The goal was to experience average British life.

We flew to London. We stayed at a Bed and Breakfast in Knightsbridge. Cecelia did a magnificent job planning the itinerary for both the daily activities and living accommodations. The Feld family was the only American group in this Bed and Breakfast that accommodated eight other families of similar size from all over Europe. The stay was an interesting cultural experience.

We walked all over London. We took the tube or bus to everything we wanted to see.

Our goal was to expose Brad and Dan to all the fine art London had to offer. Cecelia and I had been to London a few times before and knew where to go.

I did not realize how much pain we inflicted on the boys schlepping them though all the museums and galleries. It turned out that if there is no pain there is no gain. Brad and his wife Amy and Daniel and his wife Laura have a deep appreciation of fine art.

There were many memorable experiences during that trip. Harrods’ food court enchanted the boys.

One night, dinner ran late. The scheduled visit was the Tower of London. The trip on the tube was long. We arrived at the tube stop 30 minutes before closing. The Tower closed at 9 pm. We didn’t realize how long it would take to get there. Tension mounted on the tube ride.

I saw the excitement rising in Brad and Daniel. We ran through the dark streets and were the last people to go on the last tour. We got lost in the tube on the way home. All of this delighted of the boys.

On our last day we were scheduled to take a sleeper train to Scotland at 11 pm at Kings Crossing. I had arranged to have dinner at a medical school roommate’s cousin’s house outside of London. This cousin was a Family Doctor with four kids. They lived in a modest apartment. The doctor had a lot of negative things to say about America.

He compared Americans’ attitude to the British attitude. He said; if there was a black kid in the back of the bus in London and a man in a Rolls Royce the black kid would be thinking about how that guy ripped off the country and how he could be destroyed. In America the black kid would be thinking how he could achieve enough to own that Rolls Royce.

I thought this was very constrictive thinking. Our family discussed it in Scotland.

The doctor drove us to King’s Crossing. It was the first sleeper train for all of us. None of us slept a wink. We arrived in Edinburg at 5.45 am. Our rental car was a Ford Escort equivalent. It was not the most comfortable vehicle for the four of us but we managed.

We stayed at a farm in Tweed after having our share of lamb chops. It was beautiful but cold. The farmer gave us hot water bottle to keep our feet warm in lieu of heat. There was an overnight frost and not enough blankets.

I could not find the farm. I stopped at a house and ask a guy where it was. He jumped on his BMW motorcycle and said follow him.

We showed the boys more old castles and churches than one could imagine existed. In a bed in breakfast in one village a woman charged us the equivalent of a quarter to take a bath.

To an American boy this was certainly old world.

Lake Windermere was a great experience. We stayed in an old mansion. The structure was beautiful but again no heat. Cecelia and I had a date night to the best restaurant in England by the most famous chef in England. I found a pizza joint in town and bought a very large pizza for Brad and Daniel to share with the owner of the house. They sat in the living room before the fireplace wrapped in blankets watching the telie and eating pizza.

They were happy and we were off to have one of the best meals of our life.

The trip was wonderful. Brad and Daniel were great sports. I hope the warm memories of that trip linger in their minds as is does in mine. This is what family travel is about.

  • Lisa Stalin

    A family care insurance plan is not the type of plan that is offered commercially. It is offered by the local government of the states in order to provide its residents the health care that they need. Programs like this come with the objective of helping parents with low income and their kids to have access to medical services. I have read more about Family Care Insurance at what do you think about this page.

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Will Obamacare Fail?


Stanley Feld M.D.,FACP,MACE

Unfortunately, the answer is yes.

President Obama’s healthcare reform plan will fail because of its poor construction.

The majority of Americans agree with President Obama’s goals. Americans want affordable universal high quality healthcare. President Obama’s healthcare reform bill will not accomplish these goals.

President Obama’s healthcare reform bill will waste 2 trillion dollars, restrict access to care, raise taxes, ration care and destroy infrastructure of a healthcare system that provides excellent medical care to the sick.

Our healthcare system is broken because prices are out of control. President Obama’s healthcare reform bill with a mushrooming government bureaucracy will not control prices by competition. It will try to control prices by regulations and force. Price controls never work.

Previous behavior is a predictor of future behavior. It follows that previous healthcare system reform failures are a predictor of future healthcare reform failure.

President Obama’s healthcare reform plan is similar to the failed Massachusetts healthcare reform plan (Romneycare). Romneycare was destined to fail from the onset.


The similarities between Obamacare and Romneycare are glaring;

  1. Both the Massachusetts healthcare reform plan and Obamacare mandate individual healthcare insurance.
  2. If individuals do not have insurance they must pay a penalty.
  3. Most businesses are required to participate or pay a fine.
  4. Both healthcare reform plans rely on government-designed purchasing exchanges (healthcare insurance exchanges)
  5. The healthcare insurance exchanges are supposed to provide a vehicle to control private health insurance.
  6. The uninsured are covered by the expansion of Medicaid and with Obamacare the expansion of Medicare.
  7. Qualified citizens receive healthcare insurance subsidies to help pay for their mandated healthcare insurance policies.
  8. The state of Massachusetts has set up many new boards and committees to oversee and administer the healthcare reform plan. The added bureaucracy has failed to control costs.

I predicted the Massachusetts plan would fail at its onset. It has been plagued with cost overruns from the start. I cannot image President Obama’s plan can be budget neutral after ten years. I suspect many Americans can’t image it either. I think the Scott Brown election has given America the notion that the citizens of Massachusetts don’t think Obamacare can be successful.

Why did the Massachusetts Healthcare Reform Plan fail?

  1. The healthcare reform plan is administered by the healthcare insurance industry. It controls the healthcare dollar and determines the premiums based on defective accounting rules. These rules permit the healthcare insurance industry to overestimate expenses and underestimate reserves. The result is increased premiums.
  2. No one has the political will to challenge or change these rules. The rules permit the healthcare insurance industry to declare a loss while it is removing sixty five cents out of every healthcare dollar from the healthcare dollar pool.
  3. There are 410,000 people who are newly insured in Massachusetts. Of those 200,000 are fully subsidized by Massachusetts state insurance exchange.

Policy makers underestimated the number of people that would qualify for subsidy.

  1. 3% of the population remains uninsured. The total 140,000 uninsured are required to pay a penalty. Half (70,000) uninsured cannot afford the premiums or penalty and receive a waiver.
  2. The state’s premiums have increased every year since the onset of healthcare reform. A typical family of four’s annual premium costs almost $13,788, the highest in the country. This is twice the cost of premiums in Texas. The premiums are 27% higher than the national average.
  3. This cost does not include out of pocket expenses.
  4. Massachusetts regulations serve to eliminate competition in the healthcare insurance market.
  5. Mandates dictate the services needed to be covered.
  6. Healthcare insurance vendors are required to sell "just-in-time" policies even if people wait until they are sick to buy coverage.
  7. Patients game the system by purchasing health insurance when they need it. Patients then drop insurance a few months later and pay the less expensive penalty. The same will apply to President Obama’s plan.
  8. Massachusetts’ safety-net hospitals are treating a disproportionate number of lower-income and uninsured patients. State compensation of these safety-net hospitals has been reduced under the new healthcare plan. It is only a matter of time before the safety net hospitals will declare bankruptcy. The alternative is to increase state taxes further. The result is people will move out of Massachusetts lowering the tax base
  9. There is a "critical shortage" of primary-care physicians as a result of increasing the number of people covered and an increase in demand for medical services.
  10. Physician compensation is decreasing. Physicians are fleeing the state. Patients cannot get doctor appointments.
  11. New patients wait 44 days to get an appointment with a primary-care doctor. A secondary market for primary-care doctor appointments is developing. People are selling their appointment times to patients.
  12. Appointment time shortages have led to an increasingly expensive emergency room visit for basic medical services. Emergency room visits increased 7%. More than half need emergency room attention. ER visits are very costly.
  13. President Obama gave the state of Massachusetts an 8 billion dollar bailout to help cover healthcare reform expenses. The healthcare insurance industry benefited by the stimulus bailout.

The state has refused to permit the insurance industry to raise rates. The insurance industry will leave the state or decrease reimbursement for services. The results are obvious.

If you do not fix the defects in the healthcare system you will not fix the financial difficulties. People must own their healthcare dollar, be responsible for their own care and have the freedom to choose. All this adds up to consumer driven healthcare using the ideal medical saving accounts.

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

  • Geriatric Medicine doctor Michigan

    I really do hope that everything will go well in this. We must be cooperative enough to survive.


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Who Doesn’t Get It?


Stanley Feld M.D., FACP, MACE

California Senator Diane Feinstein speaking on health care on Monday April 12, 2010 said;

“I’ve gotten 90,000 emails and faxes on the health care bill and over 85,000 of them are against it. After all the debate we’ve had, I can’t believe so many people still don’t get it!"

What debate?

President Obama’s healthcare reform debate was one sided and not bipartisan.

Didn’t Nancy Pelosi say; “Americans will understand the bill once it is passed.”

Maybe Diane Feinstein doesn’t get it?

If 94.4% of her constituents are against the bill, maybe 94.4% of her constituents will vote against her in the upcoming election.

The will of the people is being ignored by President Obama and the Democrats.


The Democrats believe:

  1. Americans need to be guided by big government in order to survive in our complex society.
  2. Big government is superior to free enterprise.
  3. Bureaucrats are more important than entrepreneurs.
  4. Planning is more effective than innovation.
  5. Redistribution of wealth and services are more important and much fairer than individual success.

Americans know that big government does not work. The government’s role should be to make the rules and then get out of the way. If the rules do not provide a level playing field the rules should be modified.

There are many examples of big government failure. One notable example is the U.S. Postal Service. It is going bankrupt while Fed Ex and UPS are successful.

I am sure President Obama wants to do the right thing.

However, he is going about it in wrong way. He is piling new healthcare reform on top of a failed healthcare system. (Medicare and Medicaid). His healthcare reform law cannot work. It can only waste more money

President Obama’s advisors have not been in the pits practicing medicine. If he really wanted to do something effective he should try to understand the real problems in the healthcare system and repair them.

Republicans have done no better. They have expressed their opinions within a framework established by President Obama and the Democrats rather than presenting a bold and new approach to healthcare reform.

The American people know President Obama’s healthcare reform law will fail at a high cost to the economy and the nation’s welfare. The Tea Party might represent the peoples’ rebellion. The movement is frightening both the Democrats and Republicans. Republican like to think the Tea Party is an arm of the Republican Party. I think both parties will be in for a surprise.

President Obama cannot throw money after a failed system and expect the system to improve. The healthcare system will not improve until the primary stakeholders (consumers and physicians) are provided with incentives and the ability to be innovative.

The primary stakeholders are the engine of the healthcare system. Bureaucrats and “non partisan experts” cannot make the healthcare reform system more efficient and operate at decreased cost.

The incentives should be directed to the patients and not the healthcare insurance industry or hospital systems. In a healthcare system Patients are First. In President Obama’s healthcare law big government and the secondary stakeholders are first.

Government should not require people to buy insurance. People must be responsible for themselves even if government gives them the money. I believe it is fine to provide for people who cannot afford healthcare insurance. However, the incentive must be financial. Healthcare reform will work only if it is consumer driven.

The healthcare insurance industry must be reformed. President Obama’s healthcare bill does not reform the healthcare insurance industry. The law does not revise the healthcare industry’s accounting rules. The healthcare industry will continue to take sixty five cents out of every healthcare dollar.

President Obama must provide incentives for to buy healthcare insurance. Instead the law imposes penalties if consumers do not buy healthcare insurance.

The ideal medical saving accounts provide consumers with the control of the first dollar coverage. It encourages consumers to use their money wisely. What they do not spend they keep for retirement. If a consumer has a chronic disease and uses his money wisely he receives a bonus.

President Obama must change American’s eating habits using public service announcements. He must change the way the farm industry is subsidized. The obesity epidemic is devastating the healthcare system.

President Obama must deal with the expense of defensive medicine. The only way to decrease defensive medicine is through effective malpractice reform.

Forcing Americans to be dependent on big government does not work. It creates all sorts of unintended consequences. President Obama should encourage an environment of self-reliance, innovation and independence.

None of the important issues needed to have effect a positive impact on the healthcare system are addressed in President Obama’s healthcare reform bill.

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

  • Andrew Nance

    Feinstein’s comment about not getting it is appalling and disrespectful to those who put her in office. However, by misspelling her name in this article, the writer leaves himself open to criticism from those who support the lady from California. It’s Dianne (with two n’s)

  • ML

    regardless how he name is spelled she’s still a douchebag who doesn’t get it!

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Fourteen States Sue Federal Government On Constitutionality Of The Healthcare Reform Law

Stanley Feld M.D.,FACP,MACP

Fourteen states are suing the U.S. Government in order to block the healthcare reform bill. The participating plaintiff states are Florida, South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington State, Idaho, and South Dakota.

Virginia has filed a separate lawsuit. It is anticipated that other states will join the lawsuit.

“State attorneys general wasted no time filing legal challenges to President Obama’s healthcare reform law, swinging into action with legal filings in Florida and Virginia within minutes of the White House signing ceremony on Tuesday.”

The state attorneys general charged that the new healthcare reform package exceeds Congress’ power to regulate commerce, violates 10th Amendment protection of state sovereignty and imposes an unconstitutional direct tax.

“This lawsuit should put the federal government on notice that Florida will not permit the constitutional rights of our citizens and the sovereignty of our state to be ignored or disregarded,”

President Obama’s administration has dismissed the lawsuits. Robert Gibbs said White House lawyers have advised them that the administration would win the lawsuits. Mr. Gibbs’ contention received more traditional media coverage than the reasons for the lawsuits.

A Democratic Party spokesman has turned the table on reality and said the lawsuits are a waste of state funds that will create large state deficits.

Who is paying for the federal government’s defense expenses?

Virginia filed a separate law suit in federal court in Richmond. The suit focuses on the mandate issue. A state law protects Virginia residents freedom to refuse unwanted health insurance. President Obama’s healthcare reform bill imposes penalties on anyone who avoids buying healthcare insurance.

It has never been held that the Commerce Clause [of the Constitution] … can be used to require citizens to buy goods and services,” the suit says. “To depart from that history to permit the national government to require the purchase of goods and services would deprive the Commerce Clause of any effective limits.”

The goal of the multi-state lawsuit is to move through the court system to the U.S. Supreme Court. The states are confident the U.S. Supreme court will declare the new healthcare law unconstitutional.

“The multi-state lawsuit maintains that new law infringes the liberty of individual state residents to choose for them whether to have health insurance. It also says the states themselves are victims of a federal power grab by leaders in Washington.”

During the writing of the U.S. Constitution, our founding fathers worked hard to preserve individual freedoms and states’ rights. The fear was that a federal system of government would attempt to control those rights and freedoms. These debates are beautifully outlined in Richard Deeman’s book”Plain Honest Men”

Michael Connelly is a constitutional lawyer who explains the constitutional issues in President Obama’s healthcare reform bill. His explanation of the issues are clearly stated on his blog.

“The entire bill is a blatant attempt to hide what is really going on when it comes to the Constitutional implications for individual Americans and the states that we live in.”

“Instead, this is a summary of the most important parts of the bill that will deal a severe and possibly fatal blow to the Constitution of the United States of America.”

Michael Connelly permitted me to print his first analysis of the unconstitutionality of the HR 3200. President Obama, Harry Reid, and Nancy Pelosi used a number of tricks to get the bill passed by a partisan congress.

Many of the tricks are unconstitutional. The methodology and results were not the intention of the founding fathers’.

It is essential that the American people understand the specifics of the constitutional issues. The Public should not accept the administrations sleight of hand comments about the lawsuits.

I salute the state governments who are taking a stand. I hope many other states will join the lawsuits.

It is important to present Michael Connelly’s comments as a source reference to the constitutional issues of President Obama’s healthcare reform law.


“ I won’t even attempt to deal with all of the items covered in the bill because that would probably require a book.        

1. the passage of this bill far exceeds the powers granted to Congress under the provisions of Article 1, Section 8 of the Constitution which specifically states what Congress can do.

2. The bill grants powers to President Obama and the Executive Branch of government that are not authorized under the Constitution.

3. The new law requires every American, simply by virtue of the fact that they are alive, to purchase health insurance from private companies that will be heavily regulated by the Federal government. This is not authorized under the commerce clause of the Constitution and the Supreme Court has never rendered a decision saying that such power exists.

4. The legislation not only requires people to purchase health insurance, but establishes the terms and conditions that such insurance plans will have. In other words, Americans will be forced to enter into contracts for coverage that they may not want or need.

5. Failure to comply with the requirements to buy health insurance or even health insurance approved by the Federal Government will result in punitive action against American citizens. People will be fined for this failure although the bill calls it a tax. This is an effort to bypass the provisions of the 5th Amendment to the Constitution which provides protection against the taking of our property without “due process”.

6. This tax will be collected by the Internal Revenue Service that will have an additional 16,500 agents and auditors hired to enforce it. This opens the door for people who fail to pay the “tax” being subjected to criminal penalties.

7. In order to facilitate the actions by the IRS the Federal government will have real time access to the formerly private information of Americans including medical records and financial information. This is a violation of our right to privacy and the 4th Amendment protection against illegal searches and seizures.

8. The imposition of this so called “tax” also violates Article 1, Section 9 of the Constitution that limits the type of taxes that Congress can levy.

9. The bill also takes away from the states their historic right to regulate the health care industry, including health care insurance, within their own borders. Everything will now be regulated by the Federal government. This is a clear violation of the 10th Amendment to the Constitution.

10. In addition, the legislation will force State Governments to add millions of people to Medicaid, yet the Federal government will not be funding most of this. In other words, the bill will force the states to impose massive tax increases on their citizens in order to pay for this coverage. Congress has no authority to do this and it is
another clear violation of the 10th Amendment.

11. The impact on senior citizens in the United States will be immediate and devastating and will entail a breach of contract between Americans and their own government. We are required to pay taxes for Medicare coverage and have a right to expect that they will have adequate health care coverage when we reach age 65. However, enormous cuts in the funding of Medicare under the provisions of the new law will deny us the coverage we have paid for and inevitably lead to the rationing of health care for senior citizens.

12. There are also numerous new taxes imposed under this law ranging from taxes on so called “Cadillac” policies that provide a high level of coverage, to taxes on medical devices, and even taxes on tanning booths. I consider all of these to be questionable under the powers granted to Congress in the Constitution.

            These are just some of the important Constitutional issues about this bill, yet there are other disturbing aspects that Americans need to consider.

For example, the bill does not prohibit Federal Funding of abortions and that is something many Americans want. Yet, the votes of some members of Congress who opposed this provision were purchased by the President’s promise to sign an Executive Order prohibiting such Federal funding.

In fact, he did sign such an order shortly after he signed the health care bill. This was a ruse. The President has no authority under the Constitution to issue an Executive order changing the provisions of a law passed by Congress that he has just signed. The Executive Order is meaningless.

            Finally, there is another section of the legislation that has nothing to do with health care. It is an authorization for the Federal Government to take complete control of the granting of student loans for our children to further their education.

If you are preparing to send your son or daughter to college you will no longer be able to go to your local bank to take out a student loan. Instead, federal bureaucrats will decide who gets student loans and under what terms and conditions. What will be owed to the Federal government besides the repayment of loans? Will some type of Federal service will be required and will your child have to attend a university approved by the Government. The potential implications are staggering.”

As the bill was unfolding the trick plays and unconstitutional aspects of the healthcare reform bill were obvious. Besides ignoring the constitution President Obama’s healthcare reform bill ignores the will of the people.

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

  • Evan Falchuk

    Dr. Feld,
    There were always very good policy grounds to oppose the reform plans.
    But the constitutionality of them was never one of them.
    The states had plenty of opportunity to oppose the plans on the policy grounds they are now trying to turn into questions of constitutional law.
    But they failed to make their voices heard, for reasons that are inexplicable to me. It’s too late now, and borderline frivolous constitutional arguments aren’t going to change anything.
    You’re right that this is an important shift in power to the federal government. But the governors supporting these lawsuits only have themselves to blame for not raising this argument when it could have made a difference.
    Evan Falchuk

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The Impending Physician Shortage.


Stanley Feld M.D.,FACP,MACE


Sixty three percent of physicians are unhappy with the implications of President Obama’s healthcare reform plan. The government has reduced reimbursements arbitrarily over the last decade.

Physicians have had an underlying mistrust of government healthcare policy. Congress and especially Pete Stark mistrust physicians. Pete Stark feels all physicians game the healthcare system.

I believe there is some abuse of the healthcare system by a small percentage of physicians. I also believe congress has a lack of understanding of medical practice expenses, the value of physicians’ intellectual property and skill sets.

In September 2009 an Investor Business Daily Survey was criticized for its findings in a physician opinion survey.

“We were harshly criticized last September for an IBD/TIPP Poll that showed 45% of doctors would consider leaving medicine if a health care takeover passed.”

The liberal media refused to believe the survey. It is a pity the media is so polarized. The liberal media is blind to information that could affect liberal healthcare policy adversely.

"IBD/TIPP Doctors Poll Is Not Trustworthy," ran the headline of one much-read piece on the FiveThirtyEight: Politics Done Right blog.

The Huffington Post attacked the very integrity of our poll: "Investor’s Business Daily Publishes Ludicrous Poll Claiming 45% Of Doctors Would Quit Over Reform."

While the Democratic caucus in the Senate and the House were crafting the healthcare reform bill, no one asked practicing physicians how they felt about a government takeover of the healthcare system. The implementation of healthcare reform is dependent on physician support.

The government villainized the healthcare insurance industry. It is hard to tell who is the bigger villain the healthcare insurance industry or the government.

The government will hire the healthcare insurance industry to provide administrative services for the healthcare reform bill.

The healthcare insurance industry will continue to receive 65 cents of every healthcare dollar.

The Medicus Firm, a physician search firm, conducted a survey published in the Investor’s Business Journal, March 18, 2010. 

For text:


The Medicus Firm survey was emailed to a random sample of 2,250 physicians from their physician database. Of the 2,250 emailed, 1,195 responded. Of the 1,195 responses, 36.4% were primary care physicians (family practice, internal medicine, or pediatrics), and 63.6% were specialists.

This survey response was impressive.

  • 45% said they’d consider closing their practice or retiring early if the healthcare reform bill being considered was enacted.
  • 65% said they opposed the government’s attempts at taking over the health care system.
  • 33% supported President Obama’s healthcare reform bill.

“Given that the White House and Congress both promised then — as they do now — to provide health care coverage for 31 million new patients while at the same time cutting costs from the $2.4 trillion a year we spend on medical care.”

“The poll reveals that doctors won’t go along with it, says IBD:”

  • If the sampling is valid of the 800,000 physicians practicing in the United States in 2006, as many as 360,000 might leave the profession.
  • President Obama will be trying to cover 31 million more patients with up to 45 percent fewer doctors. 

“Impossible.  It can’t be done, says Investor Business Digest.”

· 29.2 percent of the 1,200 doctors said they would quit or retire early if a health reform bill was passed.

  • That number jumped to 45.7 percent — the same Investor Business Digest‘s original survey — if a public option were included. 

"Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases," wrote Kevin Perpetua, managing partner of the Medicus Firm, summing up his findings.

“So for the record, we still stand by our findings said IBD. Our poll wasn’t "ludicrous" or "untrustworthy." It was dead-on. And it’s still relevant.”

It is interesting to look at some of the survey questions and answers. The questions were asked without or with a public option.

Only 24% of the physicians were in practice for more than 20 years.

Without a Public Option

Your Career Satisfaction:

  • 1.2%= improve Dramatically
  • 13% = Improve Somewhat
  • 40% = No Impact / Remain Same
  • 33% = Decline/Worsen Somewhat
  • 13.2% = Decline/Worsen Dramatically

With a Public Option

Your Career Satisfaction:

  • 5.5% = Improve Dramatically
  • 16.5% = Improve Somewhat
  • 14% = No Impact / Remain Same
  • 25% = Decline/Worsen Somewhat
  • 39% = Decline/Worsen Dramatically

Without a Public Option

Physician Supply in General:

  • 2% = Improve Dramatically
  • 9% = Improve Somewhat
  • 33% = No Impact/Remain the Same
  • 42% = Decline/Worsen Somewhat
  • 14% = Decline / Worsen Dramatically

With a Public Option

Physician Supply in General:

  • 3% = Improve Dramatically
  • 11% = Improve Somewhat
  • 14% = No Impact/Remain the Same
  • 27% = Decline/Worsen Somewhat
  • 45% = Decline / Worsen Dramatically

Without a Public Option

Quality of Medical Care in General:

  • 1% – Improve Dramatically
  • 11% = Improve Somewhat
  • 34% = No Impact/Remain Same
  • 40% = Decline/Worsen Somewhat
  • 14% = Decline/Worsen Dramatically

With a Public Option

Quality of Medical Care in General:

  • 9% – Improve Dramatically
  • 17% = Improve Somewhat
  • 6% = No Impact/Remain Same
  • 30% = Decline/Worsen Somewhat
  • 40% = Decline/Worsen Dramatically

Which of the following best describes your overall opinion / support for health reform?

  • I support the current proposed legislation – 28.5%
  • I support the current proposed legislation minus the public option* – 5.0%
  • I support reform but would prefer a different, more incremental approach – 63.0%
  • I prefer the status quo – the healthcare system is fine the way it is – 3.6%

*at the time of th
e survey, public option was still a possibility.
It still is by default.

President Obama ought to pay attention to physician opinion. If he doesn’t there are going to be severe shortages in physician manpower.

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

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Unintended Consequence: The Law Suits Begin


Stanley Feld M.D.,FACP,MACE


President Obama and the Democratic Party controlled congress have used multiple procedural tricks to pass a terrible healthcare reform bill. In the opinion of many constitutional lawyers they have passed legislations that are unconstitutional.

The majority of the public has felt President Obama and the Democrats have ignored the will of the people. President Obama does not think so. He has stated Americans will decide in his favor in the November midterm elections.

President Obama has been disingenuous and arrogant in his selling his healthcare reform bill. His attitude was made clear during his speech in Maine on April 1st. (Go to you tube below and start at 7.47 minutes).

President Obama’s goal is default to the public option. The public will have no other choice.

The public option will socialize medicine, increase taxes, increase healthcare insurance premiums (subsidized by the government, ration care, decrease access to care, eliminate freedom of choice, decrease the quality of care and bankrupt the nation.

Federal deficit spending has increased to over 2 trillion dollars this past year. The federal deficit ceiling has been increased from $11 trillion to almost $14 trillion dollars. Despite all the deficit spending unemployment is almost 10% and not falling. The only new jobs are government jobs or government related jobs.

The legislative and executive branches of government have totally disregarded the will of the American people. The only option left for the public is to appeal to the judicial branch of government.

Legal action does not add value to the healthcare system. However, when people feel abused they take legal action. The winners are always the lawyers.

The losers will be the taxpayers. Taxpayers will be paying both the plaintiff and defendant fees to lawyers.

There is no question the healthcare system is dysfunctional. President Obama’s healthcare reform bill will make the healthcare system worse.

I have demonstrated that the healthcare reform bill can only increase the deficit. The bill might appear to have the potential to reduce the deficit because of the disinformation the administration feeds to the traditional media.

There has been much criticism of the AMA and its President because of the position they have taken to support the healthcare reform bill. The AMA is losing membership. Other physician organizations such as Sermo and the Association of American Physicians and Surgeons have an equal number of members

The Association of American Physicians and Surgeons (AAPS) became the first medical organization to sue the government to overturn the newly enacted health care bill, the Patient Protection and Affordable Care Act (PPACA). AAPS v. Sebelius et al.).

If the PPACA goes unchallenged, then it spells the end of freedom in medicine as we know it,” observed Jane Orient, M.D., the Executive Director of AAPS. “Courts should not allow this massive intrusion into the practice of medicine and the rights of patients.”

The law suit makes many compelling arguments. These arguments represent the vested interest of patients first. Physician leadership and input is required to educate the public and the courts.

  1. “There will be a dire shortage of physicians if the PPACA becomes effective and is not overturned by the courts.
  2. The PPACA requires most Americans to buy government-approved insurance starting in 2014, or face stiff penalties.
  3. This violates the Fifth Amendment protection against the government forcing one person to pay cash to another. AAPS is the first to assert this important constitutional claim.

Insurance company executives will be enriched by this requirement. Federal and State government will be forced to subsidize the unaffordable healthcare insurance premiums. Ultimately taxes will be increased. The result will be a slowing of the economic recovery.

  1. The PPACA also violates the Tenth Amendment, the Commerce Clause, and the provisions authorizing taxation.

Taxing and spending power are unconstitutional when payments go to private healthcare insurance companies. President Obama and Congress recognized that PPACA cannot be funded without the insurance mandates.

5. The traditional sovereignty of the States over the practice of medicine is destroyed by the PPACA.

6. AAPS asks the Court to enjoin the government from promulgating or enforcing insurance mandates.

7. AAPS asks HHS Secretary Kathleen Sebelius and Social Security Commissioner Michael Astrue to provide the Court with an accounting of Medicare and Social Security solvency.

8. Court action is necessary “to preserve individual liberty” and “to prevent PPACA from bankrupting the United States generally and Medicare and Social Security specifically,”

AAPS contends Congress imposed assumptions on the Congressional Budget Office resulting in the PPACA reducing the budget deficit. These include assumptions leading to a $500 billion savings in Medicare. The savings was accomplished by moving the Doctor Fix out of the Healthcare Reform Bill budget. Moving the Doctor Fix out of the healthcare budget still increases the federal deficit.

AAPS contends that Congress and President Obama know the opposite to be true. They know the CBO’s assumptions are unrealistic.

This law suit is the first of a long list of law suits to come. The states are lining up to defend their state sovereignty and protect their state budgets.

President Obama’s view is that everyone is playing into his hands. He has many legal tricks up his sleeves. The public is sick of his trick plays.

A fear is the American public will get tired of the healthcare debate before it is too late to repeal.

The education of the public must continue.

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

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