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The Healthcare System in Switzerland Works

Stanley Feld

Krugman is starting to drive me crazy with all his fact free declarations about
the healthcare system.

He recently declared that consumer driven healthcare has
been a bust everywhere it has been tried. Paul Krugman as an “expert” has once
again made a declaration that contradicts the facts. He is clearly not
interested in being confused by facts.

Paul Krugman is against putting consumers in
control of the healthcare system. He feels,
as President Obama feels, that a central committee (IPAB) should be in charge
of deciding what to do with limited health care resources. 

He has said,

 "Consumer-based" medicine has been a
bust everywhere it has been tried.
Medicare Advantage was supposed to save
money; it ended up costing substantially more than traditional Medicare.

Medicare Advantage costs the government more
money because the government gave the private insurance companies a $3,000 bonus
per senior to get Medicare out of the government’s hands.

This is one of the principle reasons I am not a fan of
Medicare Advantage.

In reality Medicare Advantage provides more
services at lower premiums and deductibles for seniors. Seniors with Medicare Advantage use
fewer services resulting in a lower cost of total services and more profit for the
healthcare insurance industry.

“America has the most "consumer-driven" health care
system in the advanced world. It also has by far the highest costs yet provides
a quality of care no better than far cheaper systems in other countries.”

Krugman is wrong.  Switzerland has the
most consumer driven healthcare system in the world and the Swiss government
pays far less than most countries while the Swiss get a high quality of care.

His ideology
blinds his mind. The healthcare system in Switzerland is a consumer driven
healthcare system that works for the Swiss. The Swiss government makes the
rules and then gets out of the way.

Swiss healthcare system can be used to start a constructive conversation about
healthcare reform in America that can satisfy both conservatives and liberals
and save the U.S. from bankruptcy resulting from expanding entitlements.

healthcare system in Switzerland is a consumer driven healthcare system in
which consumers have choice. It has resulted in a low income tax rate,
universal healthcare, and satisfied stakeholders

Swiss system could not be totally transformed into an American system because
of America’s embedded ideology and prejudices as well as stakeholder vested interests.
However it outlines the government’s role in a healthcare system and highlights
the power of a consumer driven system.

healthcare system must undergo significant changes. Most of these significant
changes have been ignored by President Obama in Obamacare. It empowers
government and not the consumer.

Paul Krugman has stated flatly, "Patients
are not consumers"

“Patients get illness that others (government) should decide on
whether it is cost effective to treat

attitude toward patients points out the disrespect for the intelligence and
judgment of consumers.

The elements
critical to meaningful reform of America’s healthcare system must include the
following changes.

There must be significant and meaningful Tort Reform to decrease the practice
of defensive medicine.

There must be significant reform of the healthcare insurance industry’s
financial rules to stop the industry from listing non-direct care expenses as
direct patient care.

There must be regulations to cause the healthcare industry to be competitive
for consumers’ business. Government should not be the consumer of healthcare.

There must be legislation to change the healthcare insurance industry’s incentives
for profitability in order to create innovative healthcare insurance products
that will reduce healthcare costs.

There must be significant financial incentives for consumers to be motivated to
save healthcare dollars.

Consumer must responsible for their health and healthcare dollars. The
entitlement mentality must be eliminated.

Hospital systems should be competing for patients’ healthcare dollars and not
government healthcare dollars.

Physicians must be responsible to consumers and not hospital systems or the

Insurance costs must be community rated.

healthcare system must be a consumer driven system just as purchasing
groceries, automobiles, computers and televisions are. If the product is poor
the company will go out of business.

America’s goals should be universal healthcare
coverage with freedom of choice, and reduction of healthcare costs.

It is worth understanding the Swiss healthcare
system as a starting point to meaningful reform of the American healthcare

These are the major features
of the Swiss Healthcare System:

1.Swiss citizens
buy insurance for themselves.

2.There are no
employer-sponsored or government-run insurance programs.

prices are transparent to the beneficiary and community rated.

4. The
government defines the minimum insurance benefit packages that must be offered.
 Everyone must have the minimum
healthcare insurance coverage.

5. All
packages require beneficiaries to pick up a portion of the costs of their care
(deductibles and coinsurance) in order to incentivize citizens to be
responsible for their health and the control of healthcare dollars spent.

6. My ideal
medical savings account would provide a positive incentive by rewarding
citizens who did not spend the first $6,000 dollar to keep that money in a
retirement account.

7. Patient
incentive is a critical element in healthcare reform because incentives provide
consumers with a reason to take care of their health and healthcare

8.The Swiss government
subsidizes health care for the poor on a graduated basis, with the goal of
preventing individuals from spending more than 10 percent of their income on healthcare

9. Citizens
can be responsible for a significant component of healthcare costs in Switzerland.

10. Consumers
often opt for the cheaper healthcare insurance packages. They have freedom of
choice.  Many Swiss consumers choice chose
minimal insurance plans combined with high-deductible insurance plans.

11. Citizens
are free to choose comprehensive insurance coverage or some form of
supplemental coverage. It is not a one size fits all system.

12. Ninety-nine
percent (99.5%) of Swiss citizens have health insurance.

13.There are
about 100 different private insurance companies in Switzerland with multiple
healthcare insurance plans.

14. It is clear
that the government has made the rules and then has gotten out of the way. The
rules have set up a market driven competitive healthcare system.

15. The result
has been that healthcare insurers are competing for consumers’ business on
price and service. Consumers gravitate to the best price and service that fits
their needs.

16. The Swiss
healthcare system not only helps to curb health care inflation but most
beneficiaries have complete freedom to choose their doctor.

17. The setup
of the system has resulted is low waiting times for physician and hospital
services with a minimum of bureaucratic slow downs. 

18. The Swiss healthcare
system aligns all the stakeholder incentives by empowering the consumer while
helping less fortunate consumers.

19. Government
spending on health care in Switzerland is only 2.7 percent of GDP, by far the
lowest in the developed world.

government spending on health care was 7.4 percent of GDP in 2008 and will
exponentially grow under Obamacare.

 “ If the U.S. could move its state health spending to Swiss
levels, it would save more than $700 billion a year.”

Dr. Regina Hertzlinger has an excellent description of the
Swiss healthcare system in the following You Tube.

healthcare system cannot be superimposed on the U.S. healthcare system. It can
be used as a starting point to empower consumers to drive the healthcare system
and be part of the solution. 

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

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Does It Work For The Canadian Government?

Stanley Feld M.D.,FACP,MACE

In the last blog post I have discussed how a former Canadian
physician (now a U.S. physician) felt about the Canadian system.

The next question is does the Canadian Healthcare System work for the
Canadian government? 

The answer is No!

The Canadian deficit resulting from the Canadian healthcare system is mounting at a unsustainable rate in a country that is already overtaxed. The problem is
the government is not admitting it and the U.S. government and media are
ignoring it.  

I have discussed how patients I interviewed in Canada feel about
their healthcare system. Some of Canadians are bitter about Canadian physicians
immigrating to the U.S. because the practice conditions are better in the U.S. than
in Canada.

The Canadians complained that physicians coming to Canada from
India and China are not being licensed to practice medicine despite the severe
physician shortage. Most of these physicians are driving taxicabs.  

 I included a You Tube of Canada patients raving about the Canada
Healthcare system.

 The people interviewed looked healthy and probably did little
interacting with the healthcare system.

Is the Canadian healthcare system good or a least better than the
U.S. healthcare system?

There have been two recent articles in American newspapers that
applaud the Canadian system.

  1. Debunking Canadian health care myths
    – The Denver Post

 2. Everything you ever wanted to know about Canadian
health care in one post. Washington Post

Both articles are opinion articles and lack concrete evidence. The
articles contain both misinformation and disinformation.  

 It reminded me of a Justice Scalia’s recent comment on 60 minutes.

“You should not believe what you read about the
court in the newspapers,” Scalia said. “Because the information has either been
made up or given to the newspapers by somebody who is violating a confidence,
which means that person is not reliable.”


The Fraser Institute is a well-respected Canadian think tank. Its
research is accurate with a libertarian slant.

Its 2011 report contradicts the statistics in these articles
concerning the Canadian government healthcare costs.

 Article 1. “Ten percent of Canada's GDP is
spent on health care for 100 percent of the population. The U.S. spends 17
percent of its GDP but 15 percent of its population has no coverage whatsoever
and millions of others have inadequate coverage. In essence, the U.S. system is
considerably more expensive than Canada's.”

 “In 2009, Canada spent 11.4 percent
of its Gross Domestic Product on health care, which puts it on the slightly
higher end of OECD countries.”

This is not true
according to the Fraser report.
Six of ten Canadian provinces are on track to
spend half of their revenues on health care, according to the institute. To be
specific, in 2011, health care spending consumed 50 percent of revenues in
Canada’s two largest provinces, Ontario and Quebec.

According to the

“By 2017,
four more provinces — Saskatchewan, Alberta, British Columbia and New Brunswick
— will spend half of their revenues on health care.

These two articles are
either copying other inaccurate articles or copying each other. It could be
they are just reporting provincial (states) spending and not total costs.
Healthcare costs in Canada are rising faster than the GDP.

federal, provincial and territorial government health spending has grown by 8.1
percent annually, while the national GDP in Canada rose by only 6.7 percent
during the same period.”

Article 1 states that
the decision making for treatment and tests needed are made exclusively by the
patients’ physicians. We know this is not true because of the rationing of care
and the long wait times to see a physician.

“In Canada, the government has absolutely no say in who gets care or how
they get it. Medical decisions are left entirely up to doctors, as they should

There are no requirements for pre-authorization whatsoever. If your
family doctor says you need an MRI, you get one.”

Article 2. states the opposite.  “The Canadian health care system was
built around the principle that all citizens will receive all “
necessary and hospital physician services
.” To that end, each of Canada’s 10
provinces and three territories finance and run a statewide health insurance
program with federal aid. There is no cost-sharing for the health care services
guaranteed under federal law.”

The Fraser report
describes the actions the provincial governments have taken in response to the
rapidly rising costs.

The provincial
governments have raised taxes and rationed care, increasing patient wait times.
This agrees with the reactions of the people I interviewed

drug plans have also more often refused to pay for most of the drugs that are
certified as “safe and effective” by Health Canada.”

rates of growth in health care spending crowd out the resources available for
other purposes including education, public safety, and economic
growth-enhancing tax relief,”

Despite Canada’s
increase in federal funding and rationing of care the cost of care increases.
The federal government has encouraged the individual provinces to make the
necessary reforms to increase their efficiency and decrease bureaucratic waste.
The low overhead figures quoted by the two U.S. newspaper articles are wrong.

We conclude
that Canada’s health system produces rates of growth in health spending that
are not sustainable solely through redistributive public financing,” the report

“In 2011,
health care spending consumed 50 percent of revenues in Canada’s two largest
provinces, Ontario and Quebec.

By 2017,
four more provinces — Saskatchewan, Alberta, British Columbia and New Brunswick
— will spend half of their revenues on health care, according to the institute.”

funding is not a solution: the federal government has already transferred
billions more in health funding to the provinces than the amounts needed to
keep up with general price inflation or population growth.  

The study added that none of the government’s rationing efforts
have made the growth of government spending on health care sustainable.

“The Fraser Institute concluded that Canada’s
health care system is spending at an unsustainable rate. Six of ten Canadian
provinces are on track to spend half of their revenues on health care
according to the institute.”

We conclude that Canada’s health system
produces rates of growth in health spending that are not sustainable solely
through redistributive public financing.”

The media is the message. The message sent controls behavior.

All Canadians want a comfortable entitlement for healthcare. I do
not blame them.

The problem is entitlements are too expensive for the government.  They don’t work because governments cannot
legislate behavior by directives. Individuals must be responsible for their
health and healthcare dollars. Using incentive programs government can help
people be responsible to and for them.

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

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My Impression Of The Canadian Healthcare System

Stanley Feld M.D.,FACP,MACE


Cecelia ad I just returned from a trip to
Halifax, Cape Breton Island and Prince Edward Island. It was a phenomenal trip.


It was too early in the fall season for the
trees to turn color but the weather was great and the countryside was glorious.


We had planed to go there 49 years ago on our

We did not have time to get all the way to
Halifax, Cape Breton or Prince Edward Island. We had to drive back to New York
City to start my medical internship on July 1st. 1963.

 Cecelia and I decided it was time to go for it.

 We stayed in Port Hood on Cape Breton for five
days, enjoyed the singing and dancing and had a wonderful drive around the
Cabot Trail.


I am a friendly guy and I was curious about how
the folks on the street like the Canadian healthcare system. I was tired of
listening to the Democratic Party’s propaganda.

The propaganda contradicts Canadian and former
Canadian physicians feeling about the system.

I spoke to a lot of people in the town we visited
about their feelings about the Canadian healthcare system.

 I came away with several impressions.  

 Dr. Kurisko practiced surgery in Canada before coming to the
United States to practice surgery.

Dr. Kurisko description
of the Canadian Healthcare System is very accurate. It reflects the feeling of
the people who have need to use the system.

Canadians are comfortable
with their medical entitlement. Everyone said they like the fact that if they get sick
they will not get “wiped out” by the costs as Americans might be.

I found a You Tube about the
Canadian system with responses of the common man. It clearly expresses this

This is the impression of a
group of people. The question is the possibility of a bias in selection of the
people interviewed.

Upon deeper questioning of
the people I spoke to, my conclusion is that once people get used to a medical
entitlement they are very hesitant to give it up even if it restricts their
freedom of choice. Only 20% of the population uses the healthcare system at any one time.

The second conclusion is
that this is the way the healthcare system is in Canada.   Canadian feel they must
live with it and get over complaining about it.

The things they did not like
about their healthcare single payer system is the very high sales tax in
addition to federal and provincial taxes.

The income tax baseline is lowe than
the U.S. and the income earned at the top rate of tax is lower than in the U.S. If you combine all taxes paid the rate is above 50%  for some income brackets and at least 30% for
the lowest income bracket.

I was not aware of the fact
that the sales tax on everything in Canada is 15% in addition to business taxes
and personal income taxes.  There is both
a province tax and a central tax on purchases.


Federal Tax Rates

Up to $41,544                                        15.00%

41,545–83,088                                      22.00 %

83,089–128,800                                    26.00 %

128,801 and over                                  29.00 %


Everyone pays federal
income tax in Canada. Fifty percent of U.S. citizens do not pay Federal income

In addition to federal
income tax each province tax is slightly different Below are a few examples


British Columbia       

Up to $36,146           5.06%

36,147–72,293         7.70 %

$72,294–83,001          10.50%

$83,002–100,787        12.29%

$100,788 and over      14.70%



10.00% All income


Up to $40,919     11.00%

$40,920–116,911   13.00%

$116,912 and over 15.00%



 Up to $37,774      5.05%

$37,775–75,550      9.15%

$75,551 and over    20%


New Brunswick


Up to $37,150        9.10%

$37,151–74,300     12.10%

$74,301–120,796    12.40 %

$120,797 and over  14.30%


Nova Scotia

 Up to $29,590         8.79%

$29,591–59,180        14.95%

$59,181–93,000        16.67%

$93,001–150,000      17.50%

$150,001 and over     21.00%


We visited Halifax, Nova
Scotia and Charlottetown, Prince Edward Island but spent most of our time in
the countryside.

The long waiting times to
see a physician in the office and in the ER was a constant complaint.

The people complained about
the shortage of physicians. Their impression was that a lot of physicians fled
to the U.S. causing the physician shortage.

There were few small towns
with physicians. Bigger towns had small hospitals and physician shortages.
Larger towns had tertiary hospitals. These hospitals were full service hospitals.
These hospitals rationed care

The emergency rooms of any
size hospitals are always jammed. Sometimes you can wait for 6 hours and not
see a physician taking care of anyone.

One lady told me she had a
tremendous stomachache. She went to the ER waited more than 6 hours without
anyone in the ER seeing a physician. After 6 hours the pain started to subside.
She was so fatigued she went home.

I guess that is one way to
cure a patient. It took her 4 days before the pain to subside.

Another complaint was
follow-up visits by a patient with her own physician. The patient was a 65-year-old
diabetic female. Her physician was diligent. He wanted to see her every three
months. She could only get an appointment in 5 months.

One 55-year-old male with
heart disease said the healthcare system has been fine for him. He calls his
cardiologist at home. He is an interesting case and the cardiologist will see
him the next day.  

Many complained about the
waiting time for special test such as CAT scans and MRIs, hip and knee
replacements and cardiac catherizations.

Waiting times for hip and
knee replacements can be more than one year.

The Fraser Institute released
a report outlining the government financial difficulties with the Canadian healthcare system.

A 2011 report by the Fraser Institute concluded that
Canada’s health care system is spending at an unsustainable rate. Six of ten
Canadian provinces are on track to spend half of their revenues on health care,
according to the institute.”

“We conclude
that Canada’s health system produces rates of growth in health spending that
are not sustainable solely through redistributive public financing,” the report

I think it is about time Americans paid attention to
Obamacare. It will be worse for all.

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

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Health Insurance Exchanges And The Federal Government

 Stanley Feld M.D., FACP,

Insurance Exchanges
are supposed to be state-regulated
and standardized health care plans in the United
, from which individuals may purchase health insurance
coverage eligible for federal subsidies.

All exchanges must be fully certified and
operational by January 1, 2014 under federal law.[1]

The health insurance
exchanges in all states are not going to be operational on time.

However, Americans of
all income brackets are experiencing the increases in 20 hidden taxes in
Obamacare right now. The increase in taxes is supposed to amount to $1.2
trillion dollars.

The health insurance
exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing
despite President Obama’s publicity.

If they are created President
Obama will have a clear path to the Democratic Party’s cherished Public Option.

This will be a giant
step to achieving a single party payer healthcare system.

Unfortunately, the
single party payer system will in turn fail because it will be unaffordable for

Individual states and
the healthcare insurance industry will do everything they can to undermine the
success of health insurance exchanges.

Federal officials never
thought they would end up running the Health Insurance Exchanges. President
Obama’s plan was to dump this formidable and complex task on the states. Half
the states have refused to participate.

administration officials are getting ready to set up
and operate new 
health insurance markets
in about half the states, where local officials appear unwilling or unable to
do so.”

“So far, Governors of 13 states with nearly
one-third of the United States population have sent letters to the Obama administration
saying they intend to set up exchanges. Complete applications are due on Nov.
16, 2013.”

In other words, 37 states have not signed up
t. Once those 13 states that have signed up and start calculating their costs
for setting up and running the health insurance exchanges I suspect they will
also withdraw.

The Secretary of Health and
Human Services, Kathleen Sibelius
’ plan was to complete the regulations for the
states to start the health insurance exchanges by January 1,2014. 

The Secretary of Health and
Human Service has emphasized that states must meet her standards of transparency
and accountability.

The federal government requires
state exchanges to develop budgets and project operating costs, revenues and
expenditures to the central government’s satisfaction.

States must explain how the
revenue will be generated and how the exchange will address any financial

The federal government wants to
set up the rules and require the states to execute these rules at the states
expense. President Obama promised to “fund” the exchanges for the states for
two years. After that they are on their own.

The health exchange programs
will be delayed because the government pledged to set up the health exchanges
in the states that opted out of the program. It has not started to set up these

of Health Insurance Exchanges is a complex and expensive task. States are
required to operate under a balanced budget. States cannot balance their
budgets with health insurance exchanges unless they further increase taxes.

 “Federal and state officials and health policy experts expect that
the federal government
will run the exchanges in about half of the 50 states.”

guess is it will be closer to 35 states. Federal officials are preparing to do
the job. It will be poorly executed and difficult politically.

President Obama knows the
public fears a federal takeover of the healthcare system. He realizes the
public understands the health Insurance exchanges are one more step toward a
federal takeover of the healthcare system.

The Obama administration
does not want to encourage that fear by taking over the Health Insurance

Neither does the Obama
administration want to alienate state officials whose help they need to execute
the federally run healthcare exchanges.

The federal government
does not have the manpower to run all these exchanges. It is outsourcing the
work to private contractors.

We have seen the
disastrous abuse to physicians by outsourcing fraud and abuse investigations to
private contractors.

“The Obama
administration has invited advertising agencies to devise an elaborate
“outreach and education campaign” to publicize the federal exchanges and their
potential benefits for consumers.”

The Federal officials
are hiring private contractors to provide “in-person assistance” to consumers
and to operate call centers.

President Obama’s
administration has attacked Mitt Romney and Bain Capital for outsourcing of

President Obama is now outsourcing
these jobs to a foreign company, while America desperately needs jobs here.
This is duplicity to its highest degree.

He better keep it out of
the mainstream media or Mitt Romney out to get it in the mainstream media

Federal officials
have turned to the American subsidiary of a Canadian company,
the CGI Group, to
provide information technology services to the federal exchanges under a
contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency
of state health insurance exchanges yet planning for the federal exchanges has been done
almost entirely behind closed doors.

“We have gotten
little bits of information here and there about how the federal exchange might
operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance

“I was on a panel at
Rockhurst University here, and I was asked, ‘Where is the Web site for the
federal exchange?’ I chuckled. There really isn’t any federal exchange Web

In New Hampshire, Thomas
M. Harte, the president of Landmark Benefits, which arranges health insurance
for 300 employers of all sizes, said:

“Nobody has any idea
what the federal exchange will look like. There has not been much communication
between officials drafting plans for the federal exchange and the people who
will use it: consumers, employers, brokers and insurers.”

Administration officials
have not set forth a budget for the federal exchanges.

“They said they
intended to charge “user fees” to the participating health insurance plans.

It is unclear whether
the fees are subject to approval by Congress or whether insurers could pass the
costs on to consumers.”

The Federal Government
is not telling us what they are going to do. It is not following its call for transparent

It is pretty clear to me
this will be one of many steps toward the destruction of the healthcare system.
The healthcare system will self implode. At that point everyone will be begging
the government to take over.

It will be impossible
for President Obama to take over a business the government cannot afford.

A key to Repairing the
Healthcare System is to decrease the outsourcing and bureaucratic complexity.

It is to let Americans
be independent, own their healthcare dollars and their health and not be
dependent on government complexity, inefficiency and rationing of care.

Entitlements do not save

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

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Here Come The Fibs, Distortions and Lies

Stanley Feld M.D.,FACP,MACE

As we approach November 6th (election day)
we will be subjected to more fibs, distortions and lies from President Obama
and his administration.

He has had a miserable record during his first term in
office. The only tactic he has left is to make villains out of Mitt Romney and
Paul Ryan while he makes promises he cannot keep. He has not kept most of the
promises he made before he took office.

As soon as Paul Ryan finished his speech at the
Republic convention he was accused of telling lies.

Carl Sandburg said in The Prairie Years “If you tell a lies enough times it becomes
the truth. The problem is a liar must have a good memory.”

Mr. Sandburg left out the fact that your audience has
to have a good memory to recall your first lie. One of the lies President Obama
told was the lies of Jonathan Gruber in 2009.

At the height of the Obamacare debate, Mr. Gruber’s
lie was all over the op-ed pages throughout the nation. Mr. Gruber, an MIT
economist and architect of Obamacare, stated that Obamacare would reduce the
cost of healthcare insurance for everyone.

we know
 for sure “is
that [the bill] will lower the cost of buying non-group health insurance.” 

The law
permits children under 26 years old to stay on their parents’ healthcare
insurance plan.

Immediately, the parents’ healthcare insurance premiums rose


           Jonathan Gruber
is now telling state governments that the law will significantly increase the
cost of insurance for everyon

 The result is the opposite of the promise.

President Obama brags about this achievement. In
reality he gave the healthcare insurance industry an excuse to raise premiums.

 Jonathan Gruber asserted that in 2016, young people would save 13 percent, and older
people 31 percent, on their insurance premiums

 “President Obama, too, touted the
bill’s ability to “bend the cost curve,”
 that the law would “bring down premiums by
$2,500 for the typical family.”

Jonathan Gruber now: “Obamacare will increase premiums by 19-30 percent.”

President Obama now figures he can call Paul
Ryan a liar.

He has a sympathetic audience in the traditional
media. However, President Obama with Obamacare is throwing Grandma over the
cliff. In fact it looks like he is pulling a Thelma and Louise with the United
Sates of America.

President Obama still seems like a nice guy. Everyone
would love to believe in him but they just can’t trust him.

his speech Paul Ryan said,


And the biggest, coldest power play of all in Obamacare came at
the expense of the elderly

You see, even with all the hidden taxes to pay
for the health care takeover, even with new taxes on nearly a million small
businesses, the planners in Washington still didn’t have enough money. 
They needed more.  They needed hundreds of billions more.”

 “So, they just took it all away from
.  Seven hundred and sixteen billion dollars,
funneled out of Medicare by President Obama
.  An obligation we
have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn’t even ask for
The greatest threat to Medicare is Obamacare.”

Paul Ryan’s statement is correct.  President Obama accused Paul Ryan of leaving
the $716 billion dollars in Medicare. He did but he does not use it for
Obamacare. Mitt Romney will repeal Obamacare his first day in office.  

$716 billion left in Medicare by Paul Ryan will shore up the solvency of the
Medicare program itself.

is what President Obama was using the $716 billion dollars in Medicare cuts for.
Notice the $1.2 trillion dollars in new taxes and the $716 billion dollars in
Medicare cuts are being used to pay $644 billion dollars for Medicaid expansion
and $1.19 trillion dollars for subsided exchanges. The a deficit would be $141
billion dollars.

Untitled.png obams 716

anyone believe the deficit would be that low? I doubt it.

President Obama was going to cut $542 billion from
Medicare in the original CBO scoring.

turns out that President Obama is the liar. Someone ought to tell President
Obama, “The public is getting tired of
his lies once they understand them.”

Ryan also said,

 “President Obama created a bipartisan
debt commission. They came back with an urgent report.  He thanked them,
sent them on their way, and then did exactly nothing

Paul Ryan is
absolutely correct. Simpson and Bowles are still steaming about their
commission’s treatment by the President. Paul Ryan then went on to say,

“Republicans stepped up with good-faith reforms and solutions
equal to the problems.  How did the president respond?  By doing
nothing – nothing except to dodge and demagogue the issue.”

This is what Erskine Bowles,
President Clinton’s former chief of staff and the leader of President Obama’s
deficit commission, had to say about Paul Ryan in September of 2011;

telling you, this guy is amazing.
I always thought I was okay with arithmetic.
This guy can run circles around me. He is honest, he is
straightforward, he is sincere
. And the budget he came forward with
is just like Paul Ryan. It is a sensible,
straightforward, honest, serious budget and it cut the budget deficit just like
we did by four trillion dollars

Obama attacked Paul Ryan by saying Ryan voted against the Simpson-Bowles

traditional mainstream media has supported President Obama’s attack without
fact checking. The media was satisfied that President Obama’s message
neutralized Mr. Ryan’s attack on the President.

mainstream media never bothered to find out why Paul Ryan voted against the
Simpson-Bowles recommendations.

media figured it, the media, is the message. President Obama figured the
media’s message would take care of Mr. Ryan. Mr. Ryan was clearly a hypocrite
to the mainstream media.

true that Paul Ryan voted against the Simpson-Bowles recommendations because Simpson-Bowles
raised taxes while doing little
to nothing about health-care spending
, the biggest driver of
growing deficits.

rejecting Simpson-Bowles, Ryan decided to put forward his own plan for deficit
reduction the Path
to Prosperity

the other hand this is what Erskine Bowles had to say about President Obama’s

“President Obama, as you remember, came out with a budget.
And I don’t think anybody took that budget very seriously. The
Senate voted against it 97 to nothing.

He therefore, after a lot of pressure from folks like me, he came
out with a new budget framework. And in that budget framework, he cuts the
budget by four trillion dollars over twelve years. And, to be candid, this four trillion dollars cut was very heavily back-end loaded.
So, that if you looked at it on a ten-year basis and compared apples to apples,
it really was about a two and a half trillion dollar cut.”

More tricks to deceive the public. I could go on and on. Americans
have been fibbed and lied to by its purveyor of hope (President Obama).

However, I think President Obama has lost his tall with the
public. He is now calling for sympathy. He wants the public to let him finish
the difficult work he started.

I hope the public does not give him that chance.

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

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President Obama Is Doing It Again

Stanley Feld M.D.,FACP,MACE


since 1965, the Democrats have been able to use the Medicare hammer to bash

Romney and Paul Ryan have co-opted the Medicare issue from the Democrats in
this election cycle.  Medicare has been a
popular entitlement program with seniors that has always been unsustainable.

that a huge number of baby boomers are becoming eligible for Medicare coverage is has become more

realize that Obamacare is unpopular. Over 60% of Americans disapprove of the

even realize that the passage of Obamacare had cost them the 2010 midterm

Republicans are using Obamacare as a rallying call to defeat President Obama in
his re-election effort.

knows that Medicare is almost bankrupt because the government has depleted its
Trust Fund.

also know that President Obama has lied, dissembled the truth or has ranted
about the Republicans on the issue of Medicare during his re-election campaign.

Obama cannot change a basic truth. Obamacare was designed to destroy Medicare.

and Ryan are trying to save Medicare without withdrawing the promise of
Medicare coverage for seniors over 55 years old.

Obama can try to defend Obamacare, a new entitlement, which will bankrupt the
nation and destroy Medicare.

can disavow Obamacare but he cannot do both.

plan is to try to confuse everyone into thinking that he can have it both ways.

          “ It's President Obama who has put
Democrats in the position of being the party that is cutting current seniors'
benefits, rationing care (thanks to the IPABs), and letting the program
collapse as it becomes unsustainable”.

year the nation’s healthcare cost was $2.5 trillion dollars. This year the
quoted healthcare system costs are $2.8 trillion dollars. An increase in $300
billion dollars a year for ten years is $3 trillion dollars.

have been blamed for the increase in costs. However, each year physicians have
received reimbursement cuts not increases. President Obama is ignoring the real
causes of the increases in cost.

article in the New England Journal of Medicine stated that the Romney Ryan Plan
could work. Paul Ryan (R) and Ron Wyden (D) stimulated this article submitted
to the NEJM. The NEJM seems a most unlikely place to have this article

assume the NEJM is feed up with President Obama’s rhetoric. The Wyden-Ryan is
an alternative to traditional Medicare.

is a premium support plan. It could shift Americans, under 55 years old, from
traditional Medicare coverage with the total government totally controlling their
healthcare choices by the Independent Physician Advisory Board (IPAB) to a
system of choice by individual seniors controlling their own healthcare decisions.

 “Will this premium-support proposal based on
full competition among private plans and traditional Medicare work?”

President Obama is
afraid the government will lose control over the healthcare system and seniors.
He is arguing that the premium support system is a voucher system. It simply shifts the
cost of care to seniors without improving the efficiency of care.

He makes vouchers sound
like a dirty word.

Traditional Medicare has been shifting the cost of care over to
seniors in the last 4 years by increasing the deductible seniors have to pay
annually. The basic deductible for any hospitalization is now $1300.00 up from
$500.00 in 2007.

The basic premiums are now $109.00 a month up from $96.00 in
2008. The premium is scheduled to increase to $239.00 a month per senior in

Medicare premiums are means tested so the premiums for seniors
earning more than $110,000.00 per year by any means including dividends,
capital gains, sale of a home, retirement fund payments or any source of income
will increase the premiums markedly.

The means testing is done by CMS having a direct connection to the
IRS and seniors’ tax return each year.

Medicare premium payments for seniors are significant especially when less
than 50 cents of every dollar is going to direct medical care.

 “President Obama’s argument would be true only if there were no
room to improve health care efficiency or if private plans ignored
opportunities to cut costs, increase market share, and improve their bottom

 Ryan and Romney believe
government has no business telling private individuals and employers how much
they can budget for healthcare.

A consumer driven plan can force
the market to improve efficiency and quality.

“Under a premium-support system, each additional test or
procedure would not generate additional reimbursement from the government. Most
Medicare beneficiaries live on fixed incomes and are not in a position to pay
more in deductibles or premiums.

That reality can force
health plans and providers to coordinate patient care and find other
efficiencies rather than perpetuating the current fragmented system.

The Wyden–Ryan proposal for people 55 and younger offers this safety
valve.  It converts Medicare to a defined contribution plan from a defined benefit plan. It gets the government out of
the insurance business puts consumers in charge. It saves Medicare.

If President Obama is correct, traditional Medicare with its
price controls and government regulations, will be the low-cost plan in every
market and seniors will shift back to traditional Medicare when the cost
differences become apparent.  The
competitive market place consumer driven healthcare experiment will be declared
a failure.

“One should not be fooled. If the alternative to market
incentives is price controls wielded by the IPAB, access to necessary services
will inevitably be limited, as providers (physicians, hospital and insurance
companies) seek more lucrative business.”

Price controls have never worked.

President Obama is also ignoring the serious fiscal problems
facing this country. The real threat is that America’s creditors will refuse to
lend us more money.

America must slow the growth of Medicare.  Increasing entitlement spending of any kind is
no longer an option.

The only question is how to do it.

“The Wyden–Ryan proposal outlines a strategy for Medicare reform
that harnesses market forces to control costs. It provides a real alternative
to the top-down controls favored in the Obamacare.”

The NEJM article recognizes that Paul Ryan and Ron Wyden have
defined the policy parameters that could be the basis for real Medicare reform
in 2013.

President Obama is starting to realize Obamacare’s problems.  

Seniors are realizing that President Obama is doing more harm to
Medicare with premium increases and rationing care than Paul Ryan.

President Obama is the one throwing grandma off the cliff not
Paul Ryan.

Obama has also been successful at faking out Americans with his trick plays.  

next trick play is to look like he is rebooting Obamacare to eliminate the

He has put together a group led by Neera Tanden, who was a senior member of the White House team that
helped pass the health law.

The group includes Peter Orszag (former budget
director), John Podesta (transition director), Donald Berwick (first Medicare
chief), Ezekiel Emanuel (Orszag's health policy guru), Joshua Sharfstein
(former No. 2 at the Food and Drug Administration) and Tom Daschle, D-S.D. (former
Senate Majority Leader and Healthcare advisor).

“Call it Healthcare Overhaul, Version 2.0. Their
biggest idea is a first-ever budget for the nation's $2.8-trillion healthcare
system, through negotiated limits on public and private spending in each state.”

Another diversionary sham.

So far the group’s proposals include additional
ideas, such as a malpractice liability shield for doctors who follow best
clinical practices and competitive bidding for all Medicare supplies and lab
tests, not just home health equipment.

This group wrote the Obamacare law. It views cost
controls as unfinished business.

imposed control over individual freedoms does not work!

let him fake us out again! I won’t.

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

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Medicaid Patients And Physicians

Stanley Feld M.D.,FACP, MACE

Obamacare becomes
more complicated and expensive by the week. President Obama has intentionally
made the real costs of Medicaid more difficult to follow.

He originally fudged
the information to the CBO in order to obtain favorable scoring
. The first
scoring created a deficit decrease of 108 billion dollars over 10 years. He
used this CBO scoring to convince the Democrats in both the House and the
Senate to vote for the bill.

Then the states that paid
most of the Medicaid bill complained.  They
had budget deficits that would increase. 
States are obligated by law to balance their budgets. The people could
not afford a raise in taxes.

President Obama said
he would pay 90% of the Medicaid bill for two years.

This would increase
federal expenditures for Medicaid. The increase was not calculated into the
original CBO scoring.

Now a study shows
that 33% of physicians will not accept Medicaid patients because the
reimbursement is too low.

This study is probably
not accurate. There will be less than 66% of physicians accepting Medicaid
patient. Physicians’ reimbursement has fallen below physicians’ operating
expenses. In 2014 Medicaid enrollment will explode. Under Obamacare an additional
16 million people will be eligible for Medicaid. 

I wonder what is to
become of the other 16 million uninsured when the promise was to insure 32
million people?

Avik Roy pointed out that states with Democratic governors tend to have lower physician
reimbursement rates for Medicaid. Those Democratic governors have the highest
budget deficits.

It is easier to cut
physicians’ reimbursement rates than reduce the already minimal services. Entitled
patients have been more vocal than physicians.

A higher percentage
of physicians will quit Medicaid. They cannot pay their office expenses with
the present level of reimbursement.

They will say, “I

If this happens and enough
physicians quit, these states will tell their licensed physicians that they
will not be able to renew their license to practice medicine unless they accept
Medicaid patients.

I predict they will
quit anyway.

This could
prove true in a state like California
, where 1.8 million residents are expected
to gain coverage – but fewer than 60 percent of providers presently accept new
patients in the program.”

 President Obama anticipated
this in the Obamacare bill. The law increases Medicaid reimbursements for
primary care doctors to match those of Medicare providers.

The goal is to entice primary care physicians to participate in
the program.

There are several things wrong with this thinking,

  1. The increases are short term. The
    Federal government will only increase payment for two years. Clearly if the
    increase in reimbursement is successful it will have to be extended to maintain
    the increase in participation. Some interest groups already have their eyes on an extension.
  2. The increases do not include specialists
    so few specialists will participate at the onset, paralyzing the Medicaid system.
    If President Obama increases payment to specialists the Obamacare deficit will
    increase even further. 
  3. Medicare reimbursement is decreasing and may end up being lower
    than present Medicaid reimbursement. Therefore this entire exercise is another
    Obama trick play.
  4.  “As long as
    a doctor or hospital isn't losing money
    , they will probably accept new

 The key then, is Medicaid reimbursement. Federal dollars
will only last two years. It means states will have
an additional hundreds of thousands of Medicaid recipients for which they will be
on the hook for either keeping the
higher level of reimbursement once the money from Washington dries up, or cut reimbursement rates and watch
doctors bail out.

It is obvious the “fix”
is in, but without specialists included it will not work. Obamacare will have to subsidize the increase. This will increase
the federal deficit even more. In fact it will bankrupt the country.

This was
apparently the plan all along
. The two year funding was put in to reduce the initial
10 year costs and fool the public into thinking Obamacare costs less than it
actually will”.

This is only one of the trick plays that President Obama
included in Obamacare to deceive Congress and the people. Remember Nancy
Pelosi’s famous statement, “We will not
know what is in the bill until after we pass it.”

Obamacare contains hundreds of deficit increasing tricks
claimed to be deficit reducing. 

He spent money without attention to consequences.

The only sane thing to do is to repeal it and start over
again unless the goal is to bankrupt the country.

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

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