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All items for June, 2013


An Interesting Unintended Consequence of Obamacare


 The Obama administration has encouraged local hospital systems
throughout the United States to consolidate physicians practicing in their

Hospital systems have found this attractive. There has been a
movement to buy physicians’ practices and then pay physicians a salary.
has been encouraged by the Obama administration because someone in the
administration believes this will encourage physicians to stop over testing.

Hospital systems love it because they understand that brick and
mortar facilities are not worth as much as they use to be. If they own
physicians’ intellectual property in the form of primary care physicians and
skills in the form of surgeons, the value of the hospital system increases. 

It has not worked out as well as many hospital systems would
because when physicians worked for themselves they were more productive
than when they worked for the hospital system.

The Obama administration also believes that it can bundle the
payment of a treatment and share the savings with the hospital system if the
treatment costs less. If the treatment uses more assets and costs more the
hospital system will not be paid.

In other words, the government and the healthcare insurance
industry want to offload the risk of treatment to the hospital system. They
administration thinks this will force hospital systems to deliver a better
quality of care. You may recall quality of care has not been defined

The example often used is the non-payment for hospital
readmissions within thirty days.

This policy doesn’t work because reasons for hospital
readmissions are multifactorial. Many of those factors are uncontrollable. One
hospital system can also divert the patient to another hospital system or treat
the readmitted patient in the emergency room.

The Obama administration is encouraging Accountable Care
. There are so many problems in forming, administrating and
managing ACOs that they are destined to fail.

Anyone reading the administration’s propaganda would not think
so, but it is true, and as time goes on it will become apparent.

Finally, hospital systems and physician groups are realizing the
negotiating power they are accumulating by consolidating and integrating
physicians’ practices.

Consolidation is not good
for the patients. It is great for the hospital system and the large independent
physician specialty groups. Physicians who have sold their practices to
hospital systems will not do so well because the hospital systems are in
control of the collections and salaries.

Large medical specialty groups are negotiating with Obamacare’s
new healthcare plans. These providers are demanding, and in some cases
securing, pretty rich reimbursement rates from the new Obamacare health plans.

It is the same thing that happened in the 1980’s when HMOs
negotiated high reimbursement deals with medical and surgical specialists the
HMO wanted in the group.
The HMO’s reasons were to promote the HMO’s brand and
to get better medical results for the patients they had enrolled.

“To take care
of patients that will be covered by the new insurance scheme
, these providers
are requesting payment rates that are higher than what they're being offered by
Medicare. Some providers are even insisting on premiums over what they're paid
by the existing private, employer-based health plans.”

Hospital systems in a town they dominate are doing the same
thing. The result will be an increase in the costs to the government and the
healthcare insurance companies. They will pass the increased costs on to the

“Some of the
Obamacare plans, stuck in markets where there are few competing groups of
providers to choose among, are being forced to accept these high prices.”

The Obama administration told us, at the passage of Obamacare,
that providers would be discounting to get the volume of business that
Obamacare offered as the new legislation banded large groups of patients into
statewide insurance pools.

The defective central premise was that Obamacare would entice
providers to take lower reimbursement because of increased volume.  

“The people
that now seem most likely to enter these state-based insurance pools, and buy
the new coverage, represent a costly mix of patients with a lot of pre-existing
medical conditions. The volume is also unlikely to materialize.”

Obamacare has tripped over its central premise. It is not going
to lower costs. It is going to raise costs.

Obamacare has stimulated the consolidation of hospitals and
physician groups that's now rampant in healthcare. This consolidation is
starting to give providers leverage over Obamacare’s health plans.

This unintended consequence of Obamacare was obvious to most
healthcare policy thinkers who believe that control and planning do not work.
Unfortunately, President Obama did not listen to them.

The other thing President Obama did not listen to is that Health
Maintenance Organizations (HMO’s) of the 1980 and 1990s did not work. Obamacare
is a HMO on steroids

 “Under the scheme, doctors are paid lump sums of money to care
for large groups of patients.

The idea is to put the financial risk on the doctor for the
cost of the medical care that they deliver
. This was a central premise for how
Obamacare would put financial pressure on providers as a way to help to lower
healthcare costs.”

Physicians and Hospital Systems have been to this movie before. 

Hospital Systems are making believe they are taking Obamacare’s
financial bait. They are using the concept to frighten physicians and buying
local medical practices.

Hospital systems’ goal is to get a geographic monopoly then take
advantage of the negotiating monopoly. Physician groups especially specialty
groups will stay independent of hospital systems, integrate practices and get
in a negotiating reimbursement.

This will increase the cost of medical care. Everyone knows all
healthcare is local. Central control of healthcare is innately flawed. 

This is one of the many defects in Obamacare’s structure.

Obamacare has dismantled the last vestiges of local competition
among physicians for patients.

Now Obamacare will have to deal with the physician and hospital
system cartels it has created.

 The victims in all of this are patients
and the cost of patient care.

The Obama administration’s public service campaign is starting
to sell Obamacare’s virtues to young people through the NFL, NBA and major
league baseball. It is also signing up non suspecting consumers at supermarkets and churches.

Good luck. I think everyone is starting to catch on.

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

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Where Is Obamacare’s Transparency?

 Stanley Feld M.D., FACP,MACE

As we get closer to the implementation date of Obamacare it becomes
more and more obvious that there are more and more things we do not know about
the law.

Something we do know is that the law gives all the decision-making discretion
to the head of the Department of Health and Human Services. This is an obvious
defect in Obamacare as new regulations are produced by the Secretary of HHS

The Health and Human Services Department is
the most secretive department in the government.

The new rules are a huge black box
secret. The steps being taken to implement Obamacare have also been a secret.
None of what is going on with Obamacare is transparent. 

Health and Human Services has not
provided coherent answers to congressional oversight committees that have
requested answers to certain questions. Neither have comprehensive answers to
questions been provided to the press.

The Government Accountability Office
released the results of two investigations of Obamacare. The implementation of
Obamacare has blown deadlines and has improvised on regulation. There has been general
chaos at HHS.

The GAO said HHS isn't close to being ready to launch in October.
The Obama administration has told
congress and the press that it will be ready.

HHS has already announced it is throwing in the
towel on small business health insurance exchanges. These exchanges were
supposed to allow employees to choose from competing healthcare insurance

These small business health insurance exchanges have been put off
for at least one year. It is not clear whether these exchanges are the same as
those that are supposed to launch on October 1,2014.

The employees must choose from their employer’s private
plan options. However it is not clear if employers are going to stop offering
healthcare coverage and pay the “tax” penalty Obamacare imposes.

Employees will have to buy healthcare insurance
from the health insurance exchanges with after tax dollars. Prior to Obamacare employers
bought healthcare insurance with pre-tax dollars.

This is another Obamacare hidden tax increase.

If everyone is driven into health insurance exchanges
and the healthcare industry drops out of the health insurance exchange because
of the tax it will have to pay for every policy sold, America will have a
single party payer (the government) system by default.

This is President Obama’s goal.

The healthcare insurance industry will continue to
make its money with a single party payer because it is the government’s
administrative service provider. As administrator service providers the healthcare
insurance industry still takes its 40% off the top.

Consumers will be the ones that get penalized
through increased taxes.

HHS will be forced to run 34 of the 50 health
insurance exchanges and pay for the cost overruns expected. These cost overruns
are not in the healthcare budget. There are more than 100 “key activities”
necessary to set up exchanges.

Sixteen states have opted to run their own exchange
and take the money the federal government has offered. These states still have
between 16-52% of the key activities undone in order to qualify as a health
insurance exchange.

The complete set of regulations for these
key activities has not been completely written by HHS.

Two states, Massachusetts and Utah, have had functioning   health
insurance exchanges. These exchanges were developed pre Obamacare. These
exchanges might have to be redone once all the rules and regulations are
written and federal requirements are known.

“If HHS had any appreciation for basic accountability it would
release the facts itself instead of going dark and running ObamaCare as a
black-ops mission.

“HHS has insurance premium filings for the 34 federal exchanges
but it decreed in a May memo that it would keep that information secret until

“Could it be that the department doesn't want people to know about
the coming "rate shock" like that in California?”

The traditional
media have declared that there will be lower rates in the health insurance
exchange in California. The facts are the opposite.

An interesting observation using the Covered California calculator is
that a family earning  $38,000 a year would
be entitled to a tax credit of $11,448 after they file their tax return for the
previous year. The yearly outlay for the health insurance exchange silver plan
for this family of four would be $13,164.

This family would have a theoretical cost of $1716 dollars per year for
silver plan healthcare insurance plus deductibles which are significant.

This family making $38,000 a year pays no income tax. I tried to figure
out how the government applies the tax credit if they pay no income tax.

Does the government write a check of $11,448 dollars for their tax
credit after they file their income tax return the following year? This is not
the definition of a tax credit.

This family earning $38,000 a
year cannot afford to pay the $1,097 a month for the insurance the first year.
It is thirty-three percent of their salary.

Second, the tax credit is worthless because they do not pay any tax to
be credited.

I wonder if Kathleen Sibelius thought of this?

The health insurance exchanges developed so far are
experiencing massive cost overruns.

The CBO originally estimated that setting up all the 50
exchanges would cost $5-10 billion dollars. California has spent $900 million
dollars so far and they are not completely set up.

The Obama administration has been taking money out of other
federal health budgets to find more money to help states develop the health
insurance exchanges.

“In June Kaiser
Family Foundation health tracking poll—which also found that public support for
ObamaCare hit a new post-passage low of 35%—reports that nearly one of three
Americans between the ages of 18 and 30 do not believe that insurance "is
worth the money it costs."

 “And persuading young, healthy people to sign
up for coverage requires them to act against their own economic interest,
they can always enroll later when they need it as a result of ObamaCare's

The health insurance plans are expensive and the exchanges will
malfunction. Physicians won’t participate because the reimbursement fees have
not been published. If someone files a claim wrong, they will not get paid. 

These are just a few of the issues that can and will come up
that have not been explained.

The public must become
aware of the facts and not buy into the Obama administration propaganda
campaign that Obamacare is the greatest.

It is time for Americans to stop being passive. The protest
must start now before implementation is a disaster and taxes and premiums
escalate because of massive cost overruns.

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

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Games On!

Stanley Feld

about the virtues of Obamacare are appearing almost daily. It is pretty clear that
the information is being fed to the media by the Obama administration.

problem is the sound bites are not truthful. The best sound bites are in the
Obama administration has to offer are in play. All the virtues expressed about
Obamacare are expensive and un-executable by the Obama administration.

On June 16th
Timothy Egan was called on to spin the Obamacare tale in the New York Times.

He lauded
the virtues of Obamacare while executing the blame game once again. He starts
by describing an under 26 year old with Hodgkin’s lymphoma who was treated to
remission using his parents’ employer provided healthcare insurance.

The parents’
employer’s healthcare insurance premiums increased the past few years since it
is the law under Obamacare to cover children until they are 26 years old. The
coverage pre Obamacare covered only up to 18 years old.

Here is
the blame game.

“But he’s (the under 26 year old) still a pariah in the eyes
of the insurance industry, which means they can deny him a policy that might
save his life.

Not for long. In six months’ time, the heartless practice of
refusing to let sick people buy affordable health insurance — private-sector
death panels, the most odious kind of American exceptionalism — will be illegal
from shore to shore.”

Timothy Eagan’s example is true. However,
Obamacare’s most disturbing
feature is the Independent Payment Advisory Board. The IPAB, sometimes called a
"death panel," threatens to nullify Mr. Eagan’s euphoria for

Maybe this person will not get approved for retreatment if
the determination for retreatment is not cost effective according to the IPAB

A vivid example of government’s control over an individual’s
personal life and death decisions is the rules that bared access by 10-year old
Sarah Murnaghan to the adult lung-transplant list.

Health and Human Services Secretary Kathleen Sibelius refused
to waive rules made by bureaucrats to permit this 10 year old a lung

Who knows what can happen when the power to make rules and
enforce them is in the hands of a bureaucracy? Bureaucracies have a tendency to
create rules in which no one has to take responsibility for decisions that affect
others’ lives and personal freedoms.

It is obvious that the grip of the bureaucracy will clamp
down much harder once the Independent Payment Advisory Board gets going in the
next two years. There will be no going back.

The Obamacare’s IPAB is not answerable to any one.

Cost will be an issue in the bureaucratic IPAB’s decision-making process
and not the patient’s vested interests.

Timothy Eagan goes on to say,

“The early indications are that most Americans will be
pleasantly surprised. Millions of people, shopping and comparing prices on the
exchanges set up by the states, are likely to get far better coverage for the
same — or less — money than they pay now.

There is no data for this statement except the
misinformation and number fudging done by California Covered. The costs in
California will be outrageous.

The state of Washington also published disinformation
about the cost of care under their health insurance exchange.

 The law, as honest
conservatives predicted, before they orphaned their own idea, is injecting
competition into a market dominated by a few big names.

Washington only has one insurance company signed up.

The real number prediction for Washington's health insurance exchange is that even in over-regulated
Washington State, Obamacare will increase individual health insurance premiums
by 34-80%

What will happen if, in the end, Obamacare really works?”

The early indications from the State of California and Paul
Krugman are misleading and dead wrong
. I have pointed out that in an earlier
article. Obamacare is going to be a train wreck both financially and medical
care wise.

In additional, the Obama administration has to build 34 of
its own health insurance exchanges. It couldn’t suck 34 states into the Obamacare
overspending mud hole.

Auditors at the Government Accountability Office released
the results of two investigations. It optimistically concluded that it
"cannot yet be determined" if Obamacare will be ready for enrollment
a mere four months from now.

The health insurance exchanges are supposed to open October
1. The administration insists that it will.

The GAO's
detailed portrait of blown deadlines, regulatory improvisation and general
chaos explains why HHS has been anti-transparent.

HHS will run 34
federal versions in whole or part as Governors continue their Obamacare

Some of the health insurance exchange preparations have
barely begun. The Obama administration has already blamed it on conservatives
and Republicans.

The GAO attempted to track "key activities"
necessary to set up exchanges and identified "more than 100." But the
auditors can't give a precise number because "the nature of the activities
that [HHS] and the states will conduct has not been finalized and may continue
to evolve."

Mr. Eagan then criticizes

have good reason to fear it: if Obamacare works, the game will be over for
those who oppose the most significant change in American life in a generation’s

The chance that Obamacare
will work is minimal. In either case it will be the most significant change in
American life in a generation’s time.

Ben Carson M.D.  has a very
practical comment about the health insurance exchanges.

Obamacare will be a disastrous
change and the Democrats will try to blame its failure on Republicans. It has
nothing to do with Republicans. It is simply a law that is destined to be a
train wreck.

Obamacare cannot be executed
and America cannot afford the cost of Obamacare.

Young people will not buy
individual insurance from the health insurance exchanges.

The young individuals who
do not receive healthcare coverage from their employer are not stupid. It makes little financial
sense for them to subsidize the medical care of others given the choice.

The traditional media is
getting nervous as they see President Obama using them to promote Obamacare and
convince young healthy people to join with a campaign of disinformation.

The media have lately
emphasized the real challenge of enticing healthy young adults to sign up for
Obamacare. Obamacare needs these young people to sign up and buy the insurance.

The states that have signed
on to the health insurance exchanges and the federal government are counting on
young people who are healthy to make Obamacare work.

Obamacare will not work even if they sign up. President Obama will
have to impose more and more taxes as hiddden taxes and means tested taxes as
there are more and more shortfalls.

This has been the destiny of all entitlement states and countries. These
higher taxes will have a devastating effect on the economy and economic growth.

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

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The problem is that as the Obama administration and
its media surrogates tell lies they start believing these lies until the devastation

Devastation of the healthcare system, the economy and
the financial structure is closer than they think.


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The Obamacare Public Relations Offensive Is In Full Swing


The Obama
Administration promised us a full offensive to promote Obamacare. It is now in
full swing. The Obama administration is using traditional media outlet to
promote the greatness of Obamacare.

The main
outlet so far has been the New York Times. Paul Krugman had two articles filled
with misinformation and misdirection.

June 12th a Bloomberg News article was “Obamacare Shows Hospital Savings
as Patients Make Gains.”

In the opening
sentences the statement “Hospitals
are improving care and saving millions of dollars with one of the least touted
but potentially most effective provisions of the law”
is made.

“252 hospitals and physician groups
across the U.S. have signed up to join the administration’s 
accountable care program,
in which they share the financial risk of keeping patients healthy.”

One can conclude this is a
spin article from the first two paragraphs of the Bloomberg News article.

How can one know hospitals
are improving care and savings millions of dollars when measurements are not
going to start being made until after January 1,2014.

Second, there are 252
hospitals and physician groups across U.S. that have signed up to join the
Obama administration Accountable Care Organization's program (ACO).

This statement generated
two questions in my mind. How many hospitals have signed up and how many
physician groups have signed up?

If they were all hospital
groups this is an extremely small number. There are a total of 5724 registered
hospitals in the U.S. of which 4973 are community hospitals. In that group
there are 2903 non-government not for profit community hospitals and 1025
Investor owned for profit community hospitals. 

 The 252 ACOs, if they are all hospital ACOs,
represent 6.4% of the total community hospitals and 8.6% of the non-profit
community hospitals.

The 252 ACOs are not a
significant number of hospitals to have signed up at this point to draw a
significant conclusion of cost saving even if the cost savings could be
measured at this point.

This article is total spin
article from a probable Obama administration press release.

The second point is why
would physicians or hospitals want to share financial risk with the government
or an insurance company when much of the risk results from patients demographic
and behavior.

Risk assessment is the
healthcare insurance industry’s job not the responsibility of hospitals or

Another article that
appeared in the New York Times was “What Sweden Can Tell Us About Obamacare.

It starts with
the blame game scenario.  

LAST month, for the 37th time, the House of
Representatives voted to repeal Obamacare, with many Republicans saying that
its call for greater government involvement in the health care system spells

progressive thinkers dislike conservative thinkers. They believe most
conservative thinkers are simplistic or dumb. The New York Times is playing to
its audience with blame game statements such as this one.

On close
inspections conservatives are neither simplistic nor dumb and statements such
as the above are not constructive. However, these comments are effective in spinning the story.

"Visiting Swedish health economists were asked to shared their thoughts about healthcare. Like economists in most other countries, they tend to be skeptical of large bureaucracies."

"So if extensive government involvement in health care is indeed a recipe for doom, they should have clear evidence of that by now."

"Yet none of them voiced the kinds of complaints about recalcitrant bureaucrats and runaway health costs."

is plenty of evidence that extensive government involvement in healthcare is
indeed a recipe for doom. All you have to do is look at Britain and the lack of
success of its healthcare system.

at most all of the Democratic Socialist countries in Europe. They are all on
the brink of collapse with healthcare costs being a large contributory of the collapse. The only thing holding them up is the funny money they
are printing.

is one of the reasons America shouldn’t be printing funny money. Obamacare is going
to force us to print more funny money. It is going to drive us into the same
situation that Greece, Italy, Portugal, Spain and France are in.

 When are we going to learn that socialistic entitlement
societies are not economically or financially viable?

healthcare system has problems but they are problems resulting from  not dealing with the abuse of all of the

the next few months we are going to see more and more public service
announcements, editorials and articles promoting Obamacare with little critical
evidence proving the virtues or viability of the claims.

hope the public will not buy the spin. The Obamacare promotion campaign will
consist of a number of crisp sound bites. The sound bites are backed by little
evidence that they are viable.

promotion campaign will also contain criticisms and attacks on the big bad
conservative Republicans. The Republicans will be accused of having a difficult
time thinking critically or understanding the big picture.

this time the public won’t fall for the spin and misinformation.

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

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More Disinformation From Paul Krugman

Stanley Feld M.D., FACP, MACE

just finished watching the movie “Wag The Dog” starring Dustin Hoffman, Robert
DeNiro, Anne Heche, and Woody Harrelson. It is movie worth seeing again to
understand the Obama administrations campaign to promote Obamacare.

Definitions for 'Wag the dog'

'wag the dog' means to purposely divert attention from what would otherwise be
of greater importance, to something else of lesser significance. By doing so,
the lesser-significant event is catapulted into the limelight, drowning proper
attention to what was originally the more important issue.

Just days before a presidential election, a Washington,
spin doctor, distracts the electorate from
a sex
by hiring a Hollywood film producer to construct a fake war with Albania.

Krugman’s recent Obamacare article contains multiple misdirections and
It offers fictitious examples that when stitched together sound as
if Obamacare is the greatest thing that ever happened to the American people.

could be further from the truth.

Krugman declares that healthcare reform has worked in Massachusetts since 2006.
Therefore, Obamacare, which is essentially the same program, can work in the
rest of the nation.

Massachusetts has had
essentially this system since 2006; 
as a result, nearly all residents have health
insurance, and the program remains very popular. So we know that ObamaCare —
or, as some of us call it, ObamaRomneyCare — can work.

Massachusetts’ healthcare reform really work?

is true that nearly all Massachusetts residents are insured. The Massachusetts
government subsidized healthcare insurance sold in the Massachusetts exchange.
Physicians’ and hospitals’ reimbursement is only about 10% more than what Medicaid pays.

physicians seem to be less willing to see the newly insured (with exchange subsidies) than Medicaid
patients even though the reimbursement is 10% more than they recieve for
Medicaid patients.

are also less likely to accept Medicaid patients than privately insured
patients. This has resulted in a physician shortage for recipients of Medicaid.

Worcester Massachusetts there is a 3 months wait to see a primary care
physician. There is scalping for physician appointments in Worcester.

make appointments and then sell those appointment times to other patients that
have to see a physician quickly. The other option is to go to the emergency

of the healthcare policy wonks that wrote the Massachusetts law wrote the
Obamacare law. These same healthcare policy wonks believed that once everyone
was insured, patients would go to the doctor’s office for primary care rather
than to the hospital emergency room.

has been a decrease in the demand for care as a result of a decrease in the supply
of physicians. The result has been that hospital emergency room
traffic is higher today
than before health reform

has been an increase in community healthcare centers manned by physician substitutes.
This traffic to community health centers is almost one-third higher than it was
before reform

time it takes to get medical care is growing in every city and town in Massachusetts.  The wait to see a new doctor in Boston today is two months.  This is the longest wait in the entire

only thing that has changed in Massachusetts is the cost of healthcare. A few
years ago the federal government had to bail out Massachusetts before it went
bankrupt. Massachusetts received 8 billion dollars for healthcare reform from
President Obama.


balance, the only thing that seems to have changed in Massachusetts is that
patients are waiting longer.
They are going to the same places to get care that
they went to before. They are getting the same care
from the same providers
. In the
process, more money is being moved around. A lot more money.”

Krugman states “There are, however,
millions of Americans who don’t receive insurance either from their employers
or from government programs.”

I agree this
must be fixed. However, I believe Obamacare is going to make things worse.

They can get
insurance only by buying it on their own, and many of them are effectively shut
out of that market.”

This is
also true. However you cannot force businesses to do things they do not want to
do as Obamacare is attempting to do. You also cannot increase medical benefits
without raising healthcare insurance prices and permit the insurance industry
to take 40% off the top.

healthcare insurance industry will be taxed for every policy sold and the cost
will be passed on to consumers.

You also
cannot stop excessive demand for healthcare unless you provide incentives to
consumers to decrease demand. Obamacare provides incentives to increase demand
by expanding healthcare entitlements. The result will be a further increase in
federal and state taxes.

The tax
increase will further decrease investment and in turn increase unemployment.

all large and small companies are decreasing full time employment to under 30
hours a week to avoid penalties for not providing healthcare insurance.

Who is
getting stuck?

consumers are getting stuck. Things are getting worse, not better.

In some states, like California, insurers reject applicants with past
medical problems. In others, like New York, insurers can’t reject applicants,
and must offer similar coverage regardless of personal medical history
(“community rating”).

 Community rating
is a conce
pt associated with health insurance, which
requires health insurance providers to offer
health insurance policies within a given territory at the same price to all
persons without medical
, regardless of their health status.

community rating prohibits insurance rate variations based on demographic
characteristics such as age or gender, whereas adjusted or modified
community rating allows insurance rate variations based on demographic
characteristics such as age or gender in a region or city.

It has nothing to do with
requiring the issuing of healthcare insurance.

 He says by having community ratings,
“it leads to a situation in which premiums are very high because only those
with current health problems sign up, while healthy people take the risk of
going uninsured.”

This is a misinformed statement. If there are
many young people in a community the insurance rates should be lower regardless
of whether they have insurance.

claims experienced by the healthcare insurer will be higher if the young people
do not sign up for insurance. Therefore the healthcare industry wants to set
prices on claims not community performance.

the government should not be able to force consumers to purchase a product they
do not want. The Supreme Court said the government could tax consumers if they
do not purchase healthcare insurance.

If the
tax is 10% of the cost of insurance and you cannot afford the insurance you
would pay the penalty and forgo the insurance. A consumer would also try to
avoid the penalty.

Krugman proclaims the principles Obamacare demands.

Obamacare closes this
gap with a three-part approach.

 First, community rating everywhere — no more
exclusion based on pre-existing conditions.

This is
good but costly unless you change the profit structure for the healthcare insurance

Second, the “mandate”
— you must buy insurance even if you’re currently healthy.

This is
against the law.

subsidies to make insurance affordable for those with lower incomes.

is also O.K. but it will create a situation that is unsustainable for the
federal government. The federal government is going to want to stick the
unsustainable costs on to the states after the first three years of complete
federal funding. The federal government cannot afford the first three years.

Krugman then goes on to play the very effective blame game.

“Some people are too
poor to afford coverage even with the subsidies. These Americans were supposed
to be covered by a federally financed expansion of Medicaid, but in states
where Republicans have blocked Medicaid
, such unfortunates
will be left out in the cold.”

I thought
the Obamacare was going to set up health insurance exchanges in states that
refused to participate.

 Paul Krugman goes on to say,

“There will
probably be a lot of administrative confusion as the law goes into effect,
again especially in states where Republicans have been doing their best to
sabotage the process.”

States like
Texas whose politicians are doing their best to undermine it, the sheer mean-spiritedness
of the Obamacare opponents will become ever more obvious.”

just maybe Texas and the governors of the other 24 states that are not
participating because they are smart. They see the coming train wreck. They
understand that Obamacare is unsustainable. They do not want to be stuck with
the obligation to adopt an unsustainable program. They want to avoid bigger
state deficits. They want to avoid raising state taxes for a program that
cannot work.

If the
Obama administration wants to execute the program let it do it on its own.

The Obama
administration has not taken steps to set up health insurance exchanges in
states that are not participating.

They are
taking steps to develop a campaign to promote Obamacare and steps to blame the
states that are not interested in participating in its demise.

Krugman is a pawn for the Obama administration. He is helping the
administration construct a similar blame game scenario that had been so
effective in passing Obamacare and in winning reelection for President Obama.

The states
that are not participating should organize and offer a strong offense
describing the obvious reasons they are not participating in the health
insurance exchanges.

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

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Where Is The Intellectual Integrity?

Stanley Feld M.D, FACP, MACE

Paul Krugman did it again. He demonstrated his bias
for Obamacare by ignoring or misrepresenting the facts.

 “As long as someone with Krugman’s
professional status gets his facts wrong in column after column
, and does so in
an arrogant and pompous manner, attacking the integrity and hurling insults at
all who disagree with him…well, there will always be a market for a writer who
is able to show that the scourge of sensible people everywhere has written one
more erroneous editorial.

This is a perfect description of Paul Krugman’s methodology.
His opening sentences demonstrate the arrogance and pompous manner in which he
attacks the integrity of his opponents and hurls insults at them.

“The Affordable Care Act, a k a Obamacare, goes
fully into effect at the beginning of next year
, and predictions of disaster
are being heard far and wide. There will be an administrative “train wreck,”
we’re told; consumers will face a terrible shock. Republicans, one hears, are
already counting on the law’s troubles to give them a big electoral advantage.”

He uses misleading and false evidence to undermine his critics’

“Yet important new evidence — especially from
California, the law’s most important test case — suggests that the real
Obamacare shock will be one of unexpected success.”

The LA Times told part of the story to unmask
Paul Krugman’s disinformation.

California's health insurance rates for some
companies with some physician networks for the new state-run marketplace (health
insurance exchange) did come in lower than expected.

However, there are certain downsides for many
consumers that Paul Krugman ignores.

There will be far fewer doctors and hospitals to
choose from in Covered California. 
Covered California is California’s version of Obamacare’s health
insurance exchange.

Consumers who want UCLA Medical Center and its
doctors in their health plan network next year will have only one choice in
California's exchange. Anthem Blue Cross is the only carrier.

Additionally, Blue Shield of California said its
exchange customers will be restricted to 36% of its regular physician networks

These two insurers are decreasing physician reimbursement.  Physicians and their networks are refusing to

Cedars-Sinai Medical Center, one of Southern California’s most
prestigious and expensive hospital systems and physician networks said it’s not
included in any exchange plans at the moment because physicians and the
hospital system will not accept the reduced reimbursement.

There is a problem with Paul Krugman’s statement because he
does not define  the real cost of healthcare
to the state.

The California health insurance exchange (Covered
California) is trying to make consumers believe they are getting more for less.

The facts are, when you get in the
weeds, Californians are getting less for more.

The health insurance exchange must be analyzed within the context
of each individual patient. The insurance industry is excited about Obamacare
because they believe young patients will be forced into the marketplace.

A hypothetical healthy 25 year old in San Francisco earning
$46,000 a year in 2013 can buy a PPO plan
from a major insurer with a $5,000 deductible
and a 30% coinsurance plus a $10 copay for generic drugs and a total $7,000 out
of pocket expense for $177 per month.

“Covered California,
a “Bronze” plan from the exchange with nearly the same benefits, including a
slightly lower out-of-pocket maximum of $6,350, will cost him between $245 and
$270 a month.

The cost of coverage under Covered California is 38% higher
than comparable coverage in the present overpriced private sector for someone
whose chances of being sick are small.

Paul Krugman is talking about a fudged figure when he quotes
a 29% reduction using the health insurance exchange

“The rates submitted to Covered California for
the 2014 individual market,” the state said in a 
press release, “ranged from two
percent above to 29 percent below the 2013 average premium for small employer
plans in California’s most populous regions.”

This sentence led Paul Krugman’s triumphant

is a home run for consumers in every region of California,” exulted the head of
Covered California.”

Obamacare will drive
premiums up by between 100 and 123 percent
for a typical nonsmoking 25-year-old
earning $45,000 per year.

It will also drive
them out of the market for healthcare insurance. They will buy healthcare
insurance from the health insurance exchange only in case of an emergency or if
they develop a chronic illness.

This is exactly what
President Obama wants to happen. He wants to drive everyone into health
insurance exchanges and then stick the bill to the states.

The traditional media
represented by Paul Krugman is spinning the story and the American public isn’t
buying it.

The problem is they aren’t
feeling the pain yet. When Americans start feeling the pain there will be an

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

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The Anatomy of Healthcare Billing


The start of exposing the real cause of healthcare inflation has begun.  The billing and reimbursement system is
finally being questioned.

I hope the debate creates an uproar among consumers who are the most
important and most disadvantaged stakeholders in the debate. My hope is consumers will realize they
are pawns in the complex billing and reimbursement system created.

Consumers must also realize they have the power to demand control over their
healthcare dollars and not hope the government will protect them.

Brill’s article in TIME magazine started the debate.
The demand for transparent
pricing has started.  Steve Brill’s
numbers are far from accurate.  However,the
pricing information is close enough to get consumers mad as hell.

The Centers for Medicare and Medicaid
Services finally released its massive database containing what 3,000 hospitals
charge for 100 of the most common medical procedures.

The database compares the hospital
“chargemaster” to the prices Medicare actually paid.

The reimbursement to hospitals is based
on the hospital system’s estimates of the actual hospital costs plus hospital
administrative overhead. These estimates are an error. The calculation should be the actual costs
and not an estimate of the actual cost.

The database only covers 100 of the
most common illnesses.

I have written about hospital
administrators’ salaries being in excess of 1 million dollars a year with many
being up to 15 million dollars a year.
These salaries are included in the
overhead covered by Medicare payment.

I have questioned the appropriateness
of these massive salaries. In Boston there seems to be a contest between hospital
systems for which CEO gets a bigger salary.

Another important question is how many
hospital administrators in a hospital system get an excessive salary for the
value they add to medical treatment.

Who is worth more, a physician or a
hospital administrator?

 In many cases the
reimbursement by Medicare to some hospitals is 10% of the hospital’s billing.  In other hospitals the difference is 20-40%.

The payment gap between hospital charges
for procedures and Medicare payments is also stunning. The average difference
between hospital charges for the 100 procedures tracked and what Medicare’s
average actually payment is a difference of 72%.

A good metric is to beware of the man
that quotes average percentages if you want to understand the actual

The best example I have seen to visualize the variation of these prices
in simple terms is as follows.


“Imagine a banana in a supermarket. It costs $1 for those paying
with Visa, $3 for those paying with MasterCard, and $32 for those paying with

You can't sign up for Visa until you're 65, and you can only get
a MasterCard if you have a nice employer or a decent income.

Worse, customers have no
idea that such price discrepancy exists. They don't even know how much they'll
pay for the banana until long after they've eaten it.”

“That would be absurd. No
one would put up with it.

But it's how our health
care system works.”

Why should healthcare consumers in
America put up with it? Isn’t it the government’s job to protect us from this
abuse and not have a system that encourages it? Obamacare claims to stop the
abuse as it has been going on its merry way to encourage it.

This is not the entire grizzly story.

The average prices by states shows
massive discrepancies. In California, the average hospital charges $101,844 to
treat respiratory infections. In Maryland the average price for the same respiratory
infection is $18,144. The difference is 82% for the same disease in two
different states. The government is the same payer for both states.

 New Jersey hospitals bill an average for
$72,084 for "simple pneumonia," while Massachusetts’ hospitals charges
an average of $20,722. Neither of the state’s hospitals receives that much
reimbursement for treating these infections from Medicare. However, New Jersey
hospitals receive more.

Uninsured patients and the indigent
without insurance are getting the shaft. These people will have to pay retail
hospital prices or get sued by the hospital system.

None of the hospital prices are
transparent. A patient cannot even beg the hospital system to get a price.

Many treatments can be administered as
an outpatient. The government pays at least three times more for chemotherapy
in a hospital setting or a hospital outpatient clinic as it would to a freestanding
private outpatient oncology clinic.

 What’s the deal? The government doesn’t
trust physicians. It is afraid physicians will overcharge.

What does the government think the
hospital systems are doing?

I have also written about primary care
physicians’ salary being about $100,000- $120,000 a year. Surveys of physician
salaries have shown salaries varying between $100,000 to $600,000 per year. Surgical
subspecialists receive more than primary care physicians.

Let us assume the average physician’s salary
is $300,000 per year. There are approximately 600,000 practicing physicians in
the U.S.

The total physician reimbursement is $180
billion dollars a year in a $2.7 trillion dollar industry
. This is less than
10% of the total dollars spent. Even if you doubled physicians’ salaries to
include an overhead of 50% physicians receive 13.2% of the healthcare dollars

A major question is where is the
remaining 2.5 trillion dollars going?

The healthcare insurance companies take
40% off the top of all care delivered including Medicare and Medicaid and other
government programs. They do all the government administrative services and
hide the fees through deductions that should go to expenses but with the
government’s permission go to direct patient care.

The most important metrics are never
discussed and inaccurately measured. 
They are clinical outcomes and quality of procedures performed with
respect to financial outcomes.

The reason this measurement is not done
is because there is no accurate definition or measurement of these metrics.
Clinical outcomes as it relates to cost of care has to be included in the
measurement of quality of care.  No one
knows how to do this.

How does all this get fixed?

Consumers must drive the healthcare
My ideal medical saving account would go a long way in
dis-intermediating the healthcare insurance industry

An easy to use web site should be constructed
using the Travelocity, Expedia or the Orbitz formula.

All hospital and physicians’ prices
should be online. All insurance and government reimbursement should be
published on this web site, plus
insurance premiums and their justifications. The real government overhead
should also be available to consumers. 

A government web based educational
program to make consumers smart medical consumers would decrease healthcare
costs immediately.

All of the above would be a good start.

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

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A Special Message from the Dallas County Medical Society President

Stanley Feld M.D.,FACP,MACE

The following is a special message to members of the Dallas
County Medical Society (DCMS) from Dr. Cindy Sherry. Dr. Sherry is a very smart
woman and an excellent physician.

She is also extremely tactful. If you read between the lines of
her message, you will sense the difficulty and mistrust physicians have for
hospital systems.  You will also
understand the government’s lack of interest in physician innovation.

If physicians threaten hospital system’s vested interest even if
it is to improve patient care in a community the hospital system is against it.

There is no need to ask why physicians should mistrust the
promises of hospital systems. Hospital systems must prove their sincerity to
the physicians in the community and not the other way around.

Dr. Sherry describes the way Centers for Medicare and Medicaid
Services (CMS) received the Dallas County Medical Society (DCMS)
representatives. The DCMS has a plan that can help the indigent patients in our

I think the plan will work.

The message I got from Dr. Sherry’s special message is CMS is too
busy to listen to physicians.

They simply do not have the time or the bench strength to work
on something that might capture the imagination of medical communities in other
cities and other states. The physicians’ ideas might lead to additional
innovative ideas that could markedly decrease the cost of delivering medical
care in America.

However, the government has its mind made up and is not

“DCMS News: Special
Message from the Dallas County Medical Society President


Fellow Members of DCMS:

As your
president, I would like to tell you about your DCMS executive committee’s May
visit to the national headquarters of CMS (Centers for Medicare and Medicaid
Services) in Baltimore. Joining me were Immediate Past President Rick Snyder
III, MD; President-elect Jeff Janis, MD; Secretary-treasurer Jim Walton, DO,
and CEO Michael Darrouzet.

To begin
with, getting into CMS was more complicated than getting through security at
DFW airport. At the gate, our car was thoroughly checked, including under the
hood, in the trunk and inside all suitcases, and all passenger IDs were
examined. IDs were rechecked at the building entrance, plus we and all our
belongings passed through metal detectors, overseen by armed guards and guard

preparation for the trip, we acknowledged that the Medicaid 1115 Waiver
opportunity had passed to transition Project Access Dallas to a physician-led
ACO (accountable care organization) called My Medical Home. Therefore, the
intent of our meeting with CMS was not to create a last-minute effort to revive
the program, but rather to keep our concerns about the Waiver alive, and to
express these concerns to the people in charge. We wanted to inform the CMS
policymakers about how their plans and goals for the underserved population of
our region are being interpreted and implemented in the offices of physicians
and in the halls of hospitals. Furthermore, although we remain sorely
disappointed in our Big 5 Dallas-area hospital systems for their role in
thwarting the transition of Project Access Dallas to My Medical Home, we did
not make this trip to air dirty laundry or to ask CMS to intervene in a
hospital-physician dispute.

concerns are centered on the reality that health care is in transformation
across this country, including Dallas. Now is the time for DCMS physicians to
assert our leadership and to work to ensure that the transformation occurs
according to guiding principles — principles that will lead to programs that
provide quality care to all of our citizens; principles that will ensure that
resources are deployed across the healthcare continuum, not only for
hospitalizations and ER visits. We had embraced the principles and goals
espoused in the Waiver, including collaboration, accountability, transparency,
and a focus on access, wellness and quality.

While in
Baltimore, we spent about 90 minutes voicing our concerns with CMS representatives,
including Steven Cha, MD, chief medical officer; Rob Nelb, Texas 1115 Waiver
project officer; Therese DeCaro, senior adviser to Cindy Mann, deputy
administrator, responsible for development and implementation of national
policies governing Medicaid; and Julia Hinckley, acting deputy director of the
Children and Adults Health Program Group. We realized that they are
office-based, policy personnel who have no interaction with patients or
physicians that would enable them to fully grasp how their plans play out
across communities. We also recognized that a resolution to our immediate
problem would not be forthcoming, so we remained focused on constructively
sharing concerns that have the potential to impact future programs and

emphasized our belief that a truly transformative plan would create a new
financing and delivery model that would include outpatient clinics, specialty
and primary care physicians, community care transitions, community health and
pharmacy navigation and transportation, referral management and case
management, and preventive and wellness services.

We further
stressed the need for more balance in the use of funds. With current funding
focused on hospitals, how could one realistically expect the transition to more
affordable and more coordinated outpatient care? The current focus on hospital
funding disregards the recent results of the needs assessment completed as part
of the Waiver process, which largely is outpatient-focused. This funding
imbalance omits ambulatory care clinics, care coordinators and physician
compensation from the equation.

How did
the CMS staffers respond to us? They pointed out the depth of the problem they
face — each state is submitting numerous proposals, adding up to innumerable
programs from across the country. They simply don’t have the bench strength or
depth to adequately oversee the programs in the detail we described. They used
glorified terms of transformation such as “collaboration,” “innovation” and
“transparency” in the Waiver, but also acknowledged that these are long-term
goals, and that they do not expect their immediate fulfillment. They have no
plan or capability to police the programs, instead relying on state and local
administrators. They acknowledged that the letter from county medical societies
represented a desirable component of a region’s proposal, but the medical
society did not possess veto power, and that the letter would be considered as
one piece of information among many in the proposals. In point of fact, the
medical society letter was a requirement added at the state level; it did not
originate at the federal level. 

CMS officials also acknowledged that the dispersal of funds should be more
balanced. However, they said there is no mechanism or pathway for the funds to
flow differently, and integration of outpatient care truly is a big challenge.

To the CMS
officials, our visit was a reality check for them to hone in on questions such
as, “How is the process working? Can it be improved?” Our visit served as the
launching pad for them to begin a conversation for future policies. Based on
our initial conversation, they have bolstered some of their regulations for
interim follow-up reports and they have incorporated requirements for learning
collaboration plans. These midcourse corrections now allow for future 2-year
funding windows rather than 5-year approvals.

their best take-home message for us was that we (physicians, in general, and
DCMS, specifically) need to strengthen our voice and increase our clout through
our political connections, and that we should have been able to recruit
political allies locally and statewide to help us be more effective and support
our position.

conclusion, the visit with CMS strengthened the DCMS executive committee’s
resolve that the Blue Ribbon Task Force for the Underserved is heading in the
right direction. We remain committed to moving forward and creating an
innovative plan through activating leaders — including physicians, hospitals,
outpatient facilities and services, midlevel providers, and business leaders—
from all corners of the community to work together to blaze a trail for a more
cohesive plan to provide health care for the underserved citizens of Dallas. It
was an honor to represent the 6,500 members of DCMS in Baltimore.

Cynthia Sherry, MD
President, Dallas County Medical Society”

 Many physicians
throughout the country have said, “Why bother?” The answer is because you cannot give up. Some how Americans will wake up. 

Our government is by the people for the people. We are the people.

Not government bureaucrats!

There you have it. Leonard
Cohen is right. “The Dice are Loaded.”



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

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  • Wake County

    Greetings! Very useful advice in this particular article! It’s the little changes which will make the most significant changes. Many thanks for sharing!

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Obamacare’s Medicaid Deals With States Are Deceptive



Tennessee Gov. Bill Haslam (R.) has asked the
Obama administration for flexibility in implementing Obamacare's Medicaid
expansion; he has been rebuffed.

It is becoming clear to me that the Obama
administration is heavy on the posturing and light on the reform.
The goal
seems to be to have the healthcare system fail completely in order to create a
public panic.

The panic will result in the federal
government taking over the healthcare system completely and instituting a
healthcare system that controls patients, physicians and hospitals.

Some might call it socialized medicine. I
call it total impingement on incentive, initiative and innovation which will decrease
productivity and economic growth.

This is all being done by the Obama
administration with a total disregard for cost. President Obama’s assumption is
cost overruns can be covered by increased taxes. However, he is not considering
the effect of increased taxes on economic growth. He is also not considering
the effect of increasing taxes and increasing the money supply on purchasing
power. An increase in economic growth usually translates to an increase in GNP
and increased federal revenue.

Several examples come to mind

  1. States
    who have thought out the Obamacare expansion of Medicaid through health
    insurance exchanges have discovered that they are going to have tremendous cost
    overruns when the federal government stops paying the total costs. Originally the
    federal government was going to share the costs with the states.
  2. The
    100% federal funding will be in effect only from 2014 to 2016. Then the states
    pick up their share of the burden. The problem is the federal government will continue
    to control all the rules. This leaves no room for states to be innovative.
  3. We
    have seen HHS refuse to give Indiana’s Medicaid improvement plan a waiver even
    though it is wildly successful. Its success can be attributed to several
  4.  It
    provides incentives for patients not to overuse the system.
  5.  It
    expands the income requirements for eligibility into the system.
  6. The
    definition of poverty is an obsolete 1955 definition. Obamacare eligibility
    requirement is 133% of the poverty level or $14,400 per year.
  7.  Indiana requires eligible consumers to put up a
    small percentage of their income (2-5%)
    to enter into its Medicaid system. It
    also permits recipients to put money not spent into a health saving account for
    future use.
  8. The
    effect of this is to encourage patients not to overuse the healthcare system
    and not to show up in emergency rooms for care that can easily be performed in
    less complex facilities.
  9. Simple observations have led to intensive
    studying of the population that costs the most money to treat. 

 It turns out that, “According to a report released earlier this year by the Agency for Healthcare Research and Quality,
1 percent of patients accounted for roughly a fifth of all health care spending
in 2009, or more than $90,000 per person. Five percent of patients accounted
for half of overall health care costs. By contrast, 50 percent of patients
accounted for only 3 percent of health care spending, the AHRQ report found.”

The high spending by this small
percentage of high utilizers is not linked to a patient simply being uninsured
without access to a primary care physician.

According to a recent report from
the IMS Institute for Healthcare Informatics,
1 percent of patients in a survey of 10.6 million health plan members accounted
for 25 percent of their plan's total costs, and 5 percent accounted for
slightly more than half, mirroring the AHRQ survey.

Most ER physicians and social workers
know who shows up in emergency rooms
over and over again and which patients are
readmitted to the hospital over and over again. These physicians also know the
reason for this. However, no one ever asks these physicians the reasons.

Isa Gorman analyzed the data
of the value of insurance for the indigent in saving lives.” Does Lack of Health Insurance
” She demonstrates that all the studies that support
the notion of a lack of insurance are in error.

The Richard Kronick study proves they are wrong.

Kronick found that “adjusted for demographic, health status, and
health behavior characteristics, the risk of subsequent mortality is no
different for uninsured respondents than for those covered by
employer-sponsored group insurance at base line.”

 He concluded that “the
Institute of Medicine’s estimate was that lack of insurance leads to 18,000
excess deaths each year is almost certainly incorrect.”

Arkansas Gov. Mike Beebe (D.) first announced that he had reached
a deal with the Obama administration to use the Affordable Care Act’s private
insurance exchanges to expand coverage to poor Arkansans.

His Democratic base for the deal congratulated Governor Bebee.
Arkansas was able to accept health insurance exchanges. The Republican majority
in the state’s congress was skeptical. 

Governor Beebe reached a deal with
Kathleen Sibelius to provide the poor in Arkansas with higher quality private
insurance through the health insurance exchanges.

“Then the Good Friday memo came from HHS stating that its deal
with Arkansas is not that different from its traditional endorsement of the use
of private managed-care plans to administer the Medicaid benefit.”

“The memo makes clear that it will only permit state variations on
the coverage expansion that are “comparable” to what HHS would have spent

“The HHS memo explicitly
states that these private plans cannot modernize the design of Medicaid
insurance to make it more cost-effective.”

 Governor Beebe was surprised and deceived.

“A Good Friday memo from the U.S.
Department of Health and Human Services, however, splashes cold water on that
aspiration. It’s now clear that the Beebe-HHS deal applies a kind of
private-sector window dressing on the dysfunctional Medicaid program, and it’s
not obvious that the Arkansas legislature should go along.”

According to the
law these low income individuals will be automatically enrolled in Medicaid
significantly expanded insurance coverage. Medicaid
has been plagued by concerns about its quality, access, and financing virtually
since its inception.

Obamacare is
supposed to add 17 million new patients to the rolls of Medicaid.

Medicaid had posed a severe fiscal threat to many
state budgets. The federal restrictions on the states Medicaid program’s
management has limited the state’s ability to manage states budgets and adjust
payment of the severe low reimbursement to Medicaid providers.

The result has been severe underpayment of
physicians. The underpayment resulted in a lack of physicians’ participation in
the Medicaid program and limited access to care. In turn this has led to
significantly worse outcomes and higher mortality rates for Medicaid recipients
vs. private insured and Medicare.

the Obamacare, individuals and families with incomes between 138 percent and
400 percent of the Federal Poverty Level
(FPL) will be eligible for generous
premium subsidies and cost-sharing credits, which they can use to offset the
cost of purchasing private insurance on state or federal insurance exchanges
created under the law.”

I have a feeling Governor John Kasich (R)
of Ohio fell for the same bogus deal
as he agreed to sign up for the health
insurance exchanges. His Republican base is screaming their lungs out.

He will get his rude awaking soon as HHS
changes the deal he thought he got.

Medicaid is a failed program medically
and fiscally. Adding more recipients is not going to solve Medicaid problems.
Accepting the health insurance exchanges is going to make the states’ budget
problems worse.

An innovative program such as Indiana’s
Health Plan can do much more toward making Medicaid viable. The Obama
administration has objected to this plan.

Why? I can think of several possible reasons
including the desire to have the healthcare system result in total collapse.

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

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  • stairlifts

    This is my first time visit at here and i am actually impressed to read all at alone place.

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