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All items for July, 2013


The Healthcare Insurance Industry Abandons Selling The Individual Insurance Policies In Health Insurance Exchanges

Stanley Feld M.D.,FACP,MACE

President Obama is on the campaign trail. He is selling the
virtues of Obamacare to the young uninsured.

He wants the healthy young to buy the health insurance exchange
insurance policies in order to pay for the sick. He wants to prevent
Obamacare’s failure.

His speeches are political. They have little substance and are
loaded with disinformation and hyperbole.

The campaign is a political ploy to blame the Republican Party
for Obamacare’s impending failure.

Last week Harry Reid said he has to increase taxes by another
trillion dollars. This increase will make the economy worse, not better.

When is the public going to learn that socialism doesn’t work?
Taxing and spending does not improve economic growth. Socialism and increased
taxes stifle innovation and productivity.

I think it is time for a
couple of Ayn Rand’s truisms as they apply to Obamacare. Men pursue their
vested interests. They resist being forced to follow orders that contradict
their vested interests. The key in any system success is to align all the
stakeholders’ vested interests. Obamacare does not achieve this goal.

“It only
stands to reason that where there's sacrifice, there's someone collecting the
sacrificial offerings.”

there's service, there is someone being served. The man who speaks to you of
sacrifice is speaking of slaves and masters, and intends to be the master.


America is going through a period of
time where it is evident that something is wrong.  Americans and the traditional media are keeping
our eyes wide closed.

The hardest thing to
explain is the glaringly evident which everybody had decided not to see.

Ayn Rand

Peggy Noonan said it in a paragraph
in this weekend's blog.

"One irony here
is that the Obama White House, always keen to increase the reach and power of
government, also seems profoundly disinterested in good governing
. It is
strange. The long-term project of liberalism involves encouraging the idea of
faith in government as a bringer or guarantor of greater justice. But who needs
more government if government works so very badly, and is in its operations

"This White
House is careless with the reputation of government. They are a campaigning
organization, not a governing one."

Rand goes on to say,

can avoid reality, but you cannot avoid the consequences of avoiding reality.”


 A problem occurs when
constituents finally realize government is not defending its vested interests.
Change is demanded.

Americans are finally
waking up.  

We have seen this phenomenon
in my last two articles when I wrote that unions and hospitals finally realized
that Obamacare does not serve their vested interests.

This is also the reason
Aetna decided to not sell healthcare insurance policies in the California’s
health insurance exchange.


 “Aetna Inc.  will stop selling
health insurance to individual consumers in California at the end of the year,
withdrawing as the federal health law is expected to reshape the market in

Aetna did not comment on
the reasons it is dropping out of the individual market in California.

“A company spokeswoman declined
to comment about the reasons for Aetna's individual-business withdrawal.”

The dominos are starting
to fall as more healthcare insurers realize what is going on.

“Aetna isn't one of the 13
insurers participating in the California state's new consumer insurance
marketplace set to launch this fall under the federal law.”

“Like several other major
national carriers, it has said it would join only a limited number of these
exchanges. A carrier can still offer consumer plans without being in the

President Obama and other supporters argue that the health
insurance exchange is a success because it is encouraging competition and
pushing down prices. It is not true.

 “Insurance-industry experts say
similar moves by other carriers in other states may emerge
in coming months, as
companies with limited market share decide to avoid the uncertainty tied to the
law's changes.”

The Obama administration’s concept of competition and price
reduction is tenuous. President Obama and other CMS official keep saying that
healthcare insurance prices will decrease.

The healthcare insurance industry originally calculated it would
make a killing by selling insurance through the healthcare insurance exchanges.

As the rules and regulations for health insurance exchanges are
slowly rolled out by the administration is it clear to the health insurance
industry they could get killed by selling insurance in the health insurance

The addition of a 3.5% tax on each policy sold is enough for the
insurance industry to realize the health insurance exchanges will cause them to
lose money.

These surprises do not serve the vested interests of the
healthcare insurance industry.

The Obama administration keeps announcing that health insurance
exchanges are decreasing healthcare premiums.

The public and businesses are experiencing double-digit
increases in healthcare insurance premiums since Obamacare was passed.

 The reason is clear. The increases are the result of all the additional
benefits President Obama brags about in his public relations campaign.

Obamacare contains community ratings for pre existing illness
and parental insurance for young adults under twenty-six.

These are important policies. The problem is it leads to an
increase in premiums for everyone.

Healthcare premiums have already increased 20- 30% since the
passage of Obamacare. BlueCross Blue Shield of Tennessee just announced,

 BlueCross BlueShield of Tennessee expects a 20 to 30 percent
increase in rates in the individual market starting next year and a 10 percent
increase in the small group market.”

“BlueCross BlueShield exec warns of
health care cost ‘explosion.’

A healthcare Insurance CE0 told a business group at the Nashville Area Chamber
of Commerce
that health care reform will cause “a lot of disruption in the

The premium hikes will
be needed to offset new taxes
 on insurance payers such as his, he said.

We are getting
ready to have a health care cost explosion

“Details on the plans being offered on the exchanges, including
affordability, aren't yet known, but 
, vice president of regional sales at BlueCross
BlueShield of Tennessee
, said the company is looking at
offering traditional PPO plans, HSA-compatible plans and several other
"unique plan designs."

Only two commercial carriers have
applied to sell health insurance on Tennessee's new federally run insurance
exchange. They do not know if their submissions will be accepted. The deadline
for submission by other companies has passed.

Meanwhile, a New York Times editorial is conditioning Obamacare
fans as to who is to blame for the failure of the health insurance exchanges
. The
Times is putting the blame squarely on the shoulders of the Republican Party.

“To their shame and discredit, Republicans are trying to block
efforts to inform people
about the law and are using scare tactics to keep them
from enrolling.”

This is a typical Obama
administration tactic to blame the other guy for the impending failure of its

Obamacare is failing under
its own weight and the administration’s inability to implement the law.

The New York Times goes on,

The Republican mantra is that the nation will face economic and
medical catastrophe
— a “train wreck,” they say — unless health care reform is
stopped in its tracks.”

Obamacare is a train wreck. Max
Baucus Senator Democrat from Montana and author of Obamacare and head of the
finance committee said it.

Top officials in Ohio
and Indiana who oppose the law have issued dire, misleading forecasts
— roundly
debunked by analysts — that the law will raise premiums to astronomical levels.”

“roundly debunked by analysts”  This is not true. The Obama
administration’s analysis is biased and selective. By stating the analysis as a
fact the New York Times’ editorial board is expressing their bias without facts.

The New
York Times is once again acting as a shill for the Obama administration.  The New York Times is misleading the public.

is a bad law. It does not align any of the stakeholders’ vested interests. All the stakeholders are starting to realize it.

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

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Hospital Systems Are Finally Realizing There Are Problems With Obamacare

Stanley Feld M.D.,FACP, MACE

Hospital systems loved the prospect
of Obamacare. Physicians would be forced into full time salaried hospital
system positions. Hospital systems would own physicians’ intellectual property
and surgical skills.

Physicians would be the hospital
systems’ cash cow. Its brick and mortar model was failing. Surgery and recovery
from surgery was improving. Length of hospital stays was decreasing.

The problem hospital systems were
discovering was that physicians were not as productive when salaried as they
were when they owned their own practices.

Surgery was being performed as
outpatient surgery in freestanding surgery centers. Physicians own most of
these surgery centers independent of hospital systems.

The advantage of these outpatient
surgery centers to patients is they are cheaper, price transparent and have
comparable outcomes.

The healthcare insurance industry has
even encouraged their use. The Obama administration doesn’t like them because they
encourage patient choice and independence.
This is the opposite of Obamacare's goal of government dependence and control of patient choice.

Hospital systems thought Obamacare
would provide millions of newly insured patients. This would translate to
higher profits for the hospital systems.

Obamacare’s supposed
goal was
improving access to care for low-income families and individuals. Hospital systems were led to believe that they would treat more
patients with health insurance through expanded Medicaid eligibility.

With the
introduction of health insurance exchanges, low-income individuals would be
able to purchase healthcare insurance coverage at a subsidized rate.

The subsidy would
come in the form of a tax credit. Hospital systems did not realize that low-income
families do not pay taxes so they would not pay any tax to apply a tax credit.
These families making up to $38,000 dollars a year could not afford the lowest
insurance of $12,000 dollars a year. They would opt to not buy the health
insurance exchange offerings.

The health
insurance exchanges would not reduce the amount of uncompensated care provided
by the nation's hospitals.

Suddenly hospital
systems realized that their hospital consultants were wrong.  While it sounded good on paper, many hospital
finance administrators are terrified that Obamacare will result in a hospital
system taking great losses as a result of decreased reimbursement and a
decrease in the promised insured population.

Nguyen, corporate controller at Palomar Health, a San Diego–based system with
690 licensed acute care hospital beds and $2.5 billion in gross annual revenue
says there is a catch-22 built into the healthcare legislation that will
ultimately hurt hospital systems.”

 There is another catch to Obamacare. I cannot
tell if this was an unintended consequence or purposeful deception by the Obama
administration.  The exchanges will have
different tiers with different deductibles and copays.

health exchanges will have four tiers when the program goes live in January
2014, Nguyen explains: platinum (where the patient pays 10% of total healthcare
expenses); gold (20%); silver (30%); and bronze (40%).”

patients will still be responsible to pay
, and they probably don't make that
much money and are likely to choose the silver or bronze tier to keep the
premiums low. … That will increase our bad debt even though they have

The low- income
families will believe they have good insurance coverage. If they get sick they
will be responsible for the high deductibles and co-pays.

If they choose to buy
the insurance they will use the hospital facilities without realizing that the
insurance does not cover everything.

 After hospitalization
they will be hit with a bill they cannot afford. The hospital system will
pursue payment but will not be able to collect. The hospital will have to write
it off.

 There is total
uncertainty about the rules. However, before a hospital system should accept
the program they should know the rules. Their participation can ruin them financially.

Marlene Zurack is senior vice president of
finance and chief financial officer for New York City Health and Hospitals
Corporation (HCC). HCC is a municipal integrated healthcare delivery system
with $7.1 billion in total operating revenue when combined with HHC's MetroPlus
health plan.

HCC cares for indigent and low-income
patients. It is subsidized by the Medicaid's Disproportionate Share Hospital

She is doubtful that the insurance exchanges
will result in a net benefit to her organization. She insures 1.4 million
people. The systems treat 475,000 uninsured patients. She has two problems with
the health insurance exchanges.

She does not know how many of the uninsured
will get insurance, what level of insurance will they buy and how much of a
difference the insurance payment is from the Medicaid's Disproportionate Share
Hospital program.

is likely to lose revenue in the end
, Zurack says, due to cuts being made to
Medicaid's Disproportionate Share Hospital program, which distributes payments
to qualifying hospitals that serve a large number of uninsured individuals.”

reality, Zurack says, the cuts will be extremely damaging to hospitals that
serve this population.

New York City Health and Hospital Corporation
is scheduled to lose $17.1 billion dollars between 2014 and 2020 due to federal
cuts In the Medicaid Disproportionate Share Hospital program.

Obamacare is becoming a reality. Hospital
systems such as HCC are realizing the financial impact of Obamacare.

Care Organizations are Obamacare’s signature tool to improve access to care and
decrease the cost of care.

The promise to hospital
systems’ is that by increasing efficiency ACOs could increase hospital systems’ profit.

Incorporated into the ACO scheme
is profit sharing with the government if there are reduced costs. Included is
reduction in payment if costs exceed benchmark costs.

Only 10% of hospital systems
have signed up in the last two years. The Obama administration has done a lot
of bragging about enrollment

Originally there were thirty-two “Pioneer”
hospital systems. The Mayo Clinic and the Cleveland Clinic rejected being
Pioneer participants. The goal of ACOs is to develop integrated care delivery

Last week 9 of the original 32
Pioneer ACOs withdrew from the original program.
CMS gave no explanation for
them leaving.

I believe they realized they
couldn’t integrate their delivery system the way the government wants.

They cannot make any money
participating in the Medicare Shared Savings Program.

Seven of the nine are applying to transition
to the Medicare Shared Savings Program, while two are abandoning the program
completely. CMS declined to identify which ACOs are leaving the Pioneer program
and which are simply shifting to the MSSP.

 The nine departing
ACOs are

  • Prime Care Medical Network Inc., an IPA-based ACO serving San
    Bernadino and Riverside counties in California.
  • University of Michigan Health System in Ann Arbor.
  • Physician Health Partners LLC, a medical management company in
  • Seton Health Alliance, a network of providers comprised in the
    11-county Austin area.
  • "Plus ACO," a partership between North Texas Specialty
    Physicians and Texas Health Resources
  • Healthcare Partners Nevada ACO LLC, a multispecialty medical
    group and IPA serving Clark and Nye counties in Nevada
  • Healthcare Partners California ACO LLC, a multispecialty medical
    group and IPA serving Los Angeles and Orange counties in California.
  • JSA Care Partners LLC, a primary medical group and IPA serving
    the Orlando, Tampa and South Florida area.
  • Presbyterian Healthcare Services, an integrated delivery system
    serving the Albuquerque area.

ACO”, a partnership between Texas Health Resources and North Texas Specialty
, has plans to leave the Pioneer ACO program by mid-August, but the
two organizations say they are open to "remaining in the Pioneer ACO
program if we can find an economically viable way to do so."

 ACO’s are doomed. Obamacare is falling apart.

President Obama immediately went on the campaign
trail telling the country how great Obamacare is already.

He continues to ignore problems with Obamacare’s implementation
and costs. He has no regard for America’s financial stability.

Americans’ are starting to understand his attitude.

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

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Obamacare’s Games For Stakeholders And The Unintended Consequences


I can’t help remembering
Nancy Pelosi’s famous statement, “We have to pass the bill to find out what is
in it.”

The public didn’t like
Obamacare to begin with.

Each day “we are finding out what is in it.”

Each day it gets worse
despite the fact the President Obama keeps saying Obamacare is great and will save us
money. Americans do not believe him.

If you are a big
government control advocate, the ideology of Obamacare could be applauded.

Practically, Obamacare is
naïve and an impending “train wreck.
Unintended consequences keep appearing because of defects in the theory and poor

Patients, the healthcare
care insurance industry, physicians, hospital systems, and drug companies could
have predicated these unintended consequence if they knew what was it the bill
at its passage. Those who did understand the Accountable Care Act (Obamacare)
hated the act at its passage.

Many of my progressive
friends blame the problems Obamacare is having on Republicans.

I think they are getting
that idea because the New York Times and its editorial op-ed writers that are making
that claim. However, the New York Times offers no concrete proof.

Obamacare is failing on it
own. Its implementation gets harder and more expensive each day.

The unions were President
Obama biggest ally. All of a sudden Obamacare’s unintended consequences has
angered the unions. The unions realize what Obamacare is doing to them.

On July 12, James Hoffa of the Teamsters (1.4
million members), Joseph Hansen of the Food and Commercial Workers (1.3 million
members) and D. Taylor of UNITE-HERE (200,000 members, mostly culinary and
hotel workers) wrote to complain about the president's Affordable Care Act.

Obamacare is destroying
the 40-hour workweek unions worked many years to achieve.  Employers are hiring part time employees to replace full
time employees that had been laid off because of the recession.

Employers are doing this
to avoid a $2,000 penalty for not providing healthcare insurance for each employee.

The majority of the job
growth figure of 195,000 for June consisted of part time job growth.

leaders are correct. Obamacare "creates
an incentive to keep employees’
work hours below 30
hours a week."

all, employers can avoid a $2,000-per-worker penalty if they don't provide mandated insurance as long as employees
work fewer than 30 hours a week.

" Union leaders have realized—too late—that
ObamaCare will affect the livelihood of millions of workers who wait tables,
wash dishes, clean hotels, man registers, stock shelves and perform other tasks
that can be limited to shifts of less than 30 hours a week."

house Press Secretary Jay Carney said it "is
belied by the facts."

again he was lying. He used 2010 Bureau of Labor Statistics numbers to answer
the complaint.

“So far
this year, as ObamaCare is being implemented, full-time employment has grown at
an average monthly rate of 21,700 while part-time employment has increased an average
of 93,000 a month.”

are terrible numbers that belie Jay Carney’s “facts.”

 Three big unions
worry that the health law will hurt their members' benefits and paychecks.

The letter to Nancy
Pelosi and Harry Reid was unusually harsh.

The letter was not from
Mr. Obama's GOP adversaries but from the president’s allies, the big three most
powerful unions. A fourth union joined the group a few days later.

The unions finally
realized that Obamacare was going to cut unions out of some government
subsidies. Obamacare makes a unionized workforce more expensive for employers.  It makes it less attractive for workers to
join unions.

"Millions of union workers, the
letter notes, are covered by nonprofit health plans jointly administered by
employers and unions, and won't qualify for ObamaCare's generous taxpayer

This will drive union
members out of their unions.

Further, the unions
nonprofit insurance plans are subject to "Obamacare’s new 2-3% tax on each
insurance policy they place."

The union wants their members
exempt from this tax because the union will be forced to pass it on to their
members. Members will be forced to use the health insurance exchanges to buy
their healthcare insurance.

Unions are starting to
realize the goal of Obamacare is to force everyone into his “Public Option”
that will default to a single party payer. The result will be complete
government control of the healthcare system.

There are three insurance
options in the health insurance exchanges. Citizens will buy the cheapest
“affordable option.”  The deductibles
will be high. Citizens will have to pay deductibles out of pocket decreasing
their purchasing power.

Republicans are enjoying
this meltdown. They want Obamacare

House Republicans say their goal is to repeal President Obama's
health care law, not to present an alternative plan.”

This is a big mistake on
the part of the Republicans
. Republicans do not have a viable substitute to
repair the dysfunctional healthcare system.

"Every voter knows what Republicans are against. They don't
know what they're for" on health care, said Rep. Steve Israel of New York,
who heads House Democrats' campaign committee.”

 “He said the strategy would haunt Republicans next year among
moderate and independent voters who want changes, not outright repeal.”

Republicans need an
innovative alternative to Obamacare that will work and excite the public.
  They need a plan that will put consumers in
charge of their health and healthcare dollar. Consumers do not want a healthcare
system that puts the government in charge of their health.

Consumer driven
with my democratic ideal medical savings account should be adopted
by the Republican Party to replace Obamacare.

Republicans must take a
stand and help Americans avoid Obamacare’s impending disaster to our economy,
job growth and financial viability. 

Republicans must show Americans
that they care about them and have a viable solution to our healthcare systems problems.

Otherwise as President
Obama said this week, “he will blow right
through it”
as he
has done in the past.

 Now that Americans are waking up it is time
for the Republican leadership to start waking up and fight back effectively.

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

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Free Market Price Transparency and Price Competition

Stanley Feld M.D.,FACP,MACE

Physicians can take a leadership role in creating price transparency
leading to price competition.

An excellent example is the Surgery Center of Oklahoma.

Dr. Keith Smith and Dr.
Steven Lantier launched the Surgery Center of Oklahoma 15 years ago. I wrote
about the Center’s guaranteed online all-inclusive surgery prices six months

There are several innovative physician driven market driven pricing systems in the nation.

The Surery Center's price transparency is
catching on. It is leading to price competition, which in turn is leading to
reduced healthcare costs.

The Surgery Center of
Oklahoma’s online pricing is disrupting the lack of price transparency in their
local area.

“What we’ve discovered is health care really doesn’t cost that
much,” Dr. Smith said. “What people are being charged for is another matter

are paying a high premium for buying healthcare insurance. The healthcare
industry takes at least 40% off the top of healthcare premiums.

Systems inflate their prices for many reasons. Some insurance companies pay
more than others for hospital systems’ services. Hospital systems do not know
what the consumer’s insurance would pay when consumers come into the hospital
so they register the highest prices on the consumer’s bill.  

systems try to charge as much as they can to collect as much as possible. The
pricing is not based on reality.

Surgery Center of Oklahoma started posting their prices online
about four years ago.

Click here to see the online prices at Surgery Center of Oklahoma.

When we first started we
thought we were about half the price of the hospitals,” Dr. Lantier remembers.
“Then we found out we’re less than half price.

 Then we find out we’re a
sixth to an eighth of what their prices are. I can’t believe the average person
can afford health care at these prices.”

It is important to note that most physicians do not know what
hospital charges are.

The Surgery Center of Oklahoma has stated that they were founded on the simple principle of
price honesty and transparency.
The Surgery Center of Oklahoma’s return on
investment and net profit is extremely healthy at the prices it charges.

The prices for procedures are
all-inclusive quotes and are guaranteed.

 The result was to start a local price war.
The Surgery Center of Oklahoma is disruptive to the hospital pricing in its
community. This disruptive pricing is spreading across the nation. Consumers from
all over have come to the Surgery Center of Oklahoma because the price is
transparent and reasonable compared to hospital systems in their local area. One
specific example is.

“Matthew Gang, 22, tore his patella tendon, dislocating his
knee-cap playing basketball earlier this year.”

Mr. Gang is uninsured. He lives in California.
Surgery in his California community was going to cost him about $30,000.

The Surgery Center of Oklahoma Internet
price was $5,700.

 Matthew and his father Tom Gang flew from
California to Oklahoma for surgery.

“It was well worth it,” Tom Gang said. “I need a rotator cuff
surgery right now. I’m thinking about flying out there and having my surgery
because it was such a positive experience for us.”

Other Oklahoma medical and surgical
facilities have started joining Surgery Center of Oklahoma in posting prices
and becoming price transparent. Hospital systems are realizing they will have
to compete with low price transparent prices to attract patients.

Surgery Center of Oklahoma does accept
private insurance, but the Center does not accept Medicaid or Medicare.

 “Dr. Smith said federal Medicare regulations would not allow for
their online price menu

 “They have avoided government regulation and control in that area
by choosing not to accept Medicaid or Medicare payments”.

order to circumvent the Medicare guidelines the Kempton Group’s website, a
third party administrator, posts prices for other providers in the area.

The difference in billed prices are
staggering between Mercy Hospital in OKC, Intergris Baptist Medical Center and
OU Medical Center vs. Surgery Center of Oklahoma. The prices are,


  • Mercy Hospital charged $16, 244 for a breast biopsy; the procedure
    will cost $3,500 at Surgery Center of Oklahoma.
  • OU Medical Center billed $20,456 for the open repair of a
    fracture; the procedure will cost $4,855 at Surgery Center of Oklahoma.
  • OU Medical Center billed $21,556 for a gall bladder removal
    surgery; the procedure will cost $5,865 at Surgery Center of Oklahoma.
  • OU Medical Center billed $23,934 for an ankle arthroscopy; the
    procedure will cost $3,740 at Surgery Center of Oklahoma.
  • Integris Baptist billed $37,174 for a hysterectomy; the surgery
    costs $8,000 at Surgery Center of Oklahoma.

However, prices may be dropping elsewhere because of the
transparency at Surgery Center of Oklahoma.”

am writing about the Surgery Center of Oklahoma for the second time for two

than crying about the issue of the lack of price transparency as Dr. Uwe
Reinhardt did in my last post, someone is actually doing something about it
. It
is causing hospital systems and large clinics to lower prices and make them

“Second, the government should not be in the
way.  President Obama has provided some
non-transparent favors to hospital systems that are forcing physicians to be
employed by hospitals

"A new
provision buried in Obamacare
 effectively prohibits doctors from
starting their own hospitals or expanding the hospitals they already own, which
has been widely interpreted as a give-away to the American Hospital

As patients are starting to demand price
matching, some hospitals are giving in.

 “Hospitals are having to match our prices because patients are
printing their prices and holding that in one hand and holding a ticket to
Oklahoma City in the other hand and asking that hospital to step up,” Dr. Smith
said. “So we’re actually causing a deflationary effect on pricing all over the
United States.”

The economics are simple even though
hospital systems deny it. One only has to recall the multiple million dollar
salaries of hospital CEOs as well as other hospital administrator salaries to
understand the hospital systems’ desires for less transparency.

Physicians are waking up and realizing
they are not the main cause of escalating costs. The Surgery Center of Oklahoma
is a wonderful example of a price transparent organization that is doing
something to force price competition.

It is clear. The government is not going
to create price transparency.

Physicians and patients must drive the adoption of a free market

Consumers must drive price transparency.


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

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The Lack Of Price Transparency

Stanley Feld M.D., FACP, MACE.

I believe the New York Times is doing a great disservice to the American
public in its biased promotion of the virtues of Obamacare. The intellectuals
of our society read the Times and never question this bias. In fact the Times
publishes letters from these intellectuals that confirm its biased statements.  The more letters that come in the more they
are published. Before anyone knows it the bias becomes the truth.

On July 8 2013 the NYT published an article entitled “What Does Birth Cost? Hard to Tell”

The article's opening
paragraph reveals its bias.

continually told that when it comes to health care, we need to be savvy and
shop around
for the best prices. To that end, policy experts and politicians
promote health care savings accounts, saying they make “health care consumers”
(a k a patients) more conscious of prices, bringing down the cost of medical

It goes through this woeful story of how an uninsured
pregnant woman tries to find a best price for her delivery from hospitals in
her community.

“Here is what happened to my daughter, Therese Allison, when she
tried to be just the sort of shrewd and informed patient that politicians
should love.”

At this point I realized the article was another New York
Times propaganda article implying the potential virtues of Obamacare. President
Obama and the Democrats have mandated that patients like this buy healthcare
insurance from health insurance exchanges. They want patients to be dependent
on the government and not give patients the choice to make their own independent

The healthcare system’s dice are loaded against this woman’s
independent free choice.

“ Pregnancy is a pre-existing
condition, so she can’t get health insurance at any price
. And
now that the birth of her baby is imminent, she wants to find out what a
delivery will cost, maybe even negotiate a price for this expensive procedure.”

Therese’s  midwife offered to call the two hospitals the midwife
uses. She wanted pricing for an uncomplicated normal vaginal delivery without
an epidural. Therese’s plan was to leave the hospital the next day.

One hospital gave her a conditional price estimate. The other
didn’t. The second told her to apply for Medicaid. She thought there should be
a law making hospital systems reveal their prices.

 Uwe Reinhardt, a
Princeton health care economist who is a frequent contributor to The New York
Times said hospitals do not have to their reveal prices.

“He said. Hospitals do not have to tell you their prices, and
often they keep them secret until they send the bill.”

“When I was chair of the New Jersey commission on hospitals two
years ago, my wife, at my behest, tried to get a price for a normal delivery
from the Princeton Medical Center,” Dr. Reinhardt said. “She pretended to be an
uninsured entrepreneur earning $80,000 a year. She got nowhere. I then called
to try out a 
colonoscopy. I got nowhere too.”

Dr. Reinhardt is a big fan of Obamacare. His implication is the
Obama administration is going to fix the non-transparency barrier.

Dr. Reinhardt said, “The situation is all so

The problem is he does not
offer a solution to fix the problem.

The Obama administration has tried to break the price
transparency barrier by publishing Medicare and Medicaid prices. The effort is
confusing, insufficient and incomplete.

Medicare and Medicaid reimbursements have been published in some
states in the past. Private insurance reimbursements to hospital systems have
been published for some diseases but it has been incomplete and

These reimbursement figures have been difficult to find on the
Internet. Additionally the prices have nothing to do with private healthcare insurance
contract prices of private insurance co-pay.

The Obama administration just had Medicare publish a giant spreadsheet with its payments for
the 100 most popular hospital procedures and treatments in 3,000 hospitals
across the country using claims data.

The moment the ICM-10 coding system is mandatory the number of diagnostic
codes will increase from 18,000 to 68,000
. ICM-10 coding will decrease consumers’
ability to understand reimbursement and co-pays.

Pregnancy is not on the Medicare spreadsheet list along with
many other common procedures. The claims data is not connected to private
insurance payments and co-pays. As I have pointed out in the past, claims data
is notoriously inaccurate.

What is needed is a smartphone app listing prices for consumers
by zip code similar to Travelocity and Kayak for airline tickets and hotels. Consumers’
pricing would be instantly transparent.

There is no indication that the Obama administration is working
on this.

It is up to consumers to force the issue of price transparency.
It will lead to price competition and decrease the cost of healthcare..

Physicians in some parts of the country have taken the
initiative to encourage real price transparency and price competition.

I do not think we can rely on the government.

The Obama administration’s goal is to not have a healthcare system
with free market competition. He wants a government controlled healthcare

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President Obama – Do Something That Could Work!

Stanley Feld M.D.,FACP,MACE

The solution to repairing the healthcare system is simple. The
healthcare system must be consumer driven. If consumers were in control of their
healthcare dollars and were responsible for their health and their healthcare
choices the cost of the healthcare system would decrease to manageable levels.

My ideal Medical Savings Account puts the consumer in charge. Its
success is totally dependent on real transparency by all stakeholders including
healthcare insurance companies, hospital systems and physicians. 

A Health Savings Account does not give consumers enough of an
to shop for price and quality with the present lack of transparency.
In a transparent healthcare system Medical Saving Accounts would provide more
incentive than Health Savings Accounts.  

Presently President Obama is trying to eliminate Health Savings
Accounts. HSAs are the single greatest threat to his goal for a single party
payer system. They are also the fastest growing healthcare insurance product.

The lack of transparency for hospitals, healthcare insurance
companies, drug companies and physicians must be eliminated. The public must
demand that the healthcare insurance industry make their expenses transparent
so that its exorbitant salaries and profits can be clearly understood.   

There is no reason that this one stakeholder receives 40% of
every premium dollar
spent either by private corporations or the government.
The medical loss ratio as it is presently constructed by the Obama
administration provides 20% for expenses. The other 20% of the $40% is in the
direct patient care column.

The government should help consumers understand these prices and
understand the measurement of quality. Consumers of healthcare must be turned
into Prosumers of healthcare (Productive Consumers.)

When this happens the consumers can become independent
intelligent consumers. Consumers will become independent of government and its

The Obama administration wants consumers to be more dependent on
government not less dependent.

Intelligent independent Consumers will force the other
stakeholders to be competitive. Competition will drive healthcare costs down.

Government cost controls will not drive prices down. They will
simply distort prices and cause more spending.

Private sources such as Angie’s list help consumers decide on
which plumber to hire. It is important and creates competition and price
lowering. However the defect in Angie’s list is that it is based on other
consumers’ opinions.

It is not based on specific costs or origins of the cost to the
plumber or the measurement of the plumber’s skill. It only deals with price and
consumer satisfaction. Angie’s list does make plumbers competitive.

Competition for consumers will bring down the cost of healthcare.
 By forcing consolidation of doctors and
hospitals Obamacare will decrease competition and increase prices.

policy wonks dismiss this concept because they believe consumers are not smart
enough or interested enough in learning to be intelligent healthcare consumers.
They are wrong.

Their thnking is correct if a system exists where consumers are
spending other people’s money. Obamacare is such a system. It will drive costs
up just as the private first dollar coverage system has driven healthcare
prices up.

There is no financial incentive for healthcare consumers to try
to save money and preserve their health.

Obamacare is a huge entitlement with an overwhelming budget that
will be impossible to execute. We have seen that to be true with ever increasing
waivers and the most recent delay in the mandate until 2015.  There will be delays in other critical
portions of Obamacare in the near future. It could be delayed forever because
it cannot be executed.

In my last blog I forgot to mention the delay in forming and
activating the Independent Physician Advisory Board.

Last year I wrote about the Obama administration’s infatuation
with the Canadian Healthcare System. I reviewed the 2011 Fraser report
explaining that the Canadian Healthcare System is unsustainable.

I also wrote about Canadian consumers’ healthcare experiences in
two provinces I visited.  The fact is the
system doesn’t work well and is unsustainable.

The Fraser Institute in a
2011 report concluded that Canada’s health care
system is spending money 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.

“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.

Total federal, provincial
and territorial government health spending has grown by 8.1 percent annually.
Canada’s GDP increased by 6.7 percent during the same period. The math is
obvious. The Canadian healthcare entitlement system is not working.

“In response to the rapidly
rising costs, provincial governments have raised taxes and rationed care,
increasing patient wait times. Provincial drug plans have also more often refused
to pay for most of the drugs that are certified as “safe and effective” by
Health Canada.

“Unsustainable 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,” Fraser Institute Senior Fellow Nadeem Esmail told The Daily Caller
News Foundation in an email.”

Only 20% of the people utilize the healthcare system at any on
time. If consumers know they are entitled to healthcare and the healthcare
system will fix them if they get sick, consumers of healthcare feel protected. The
feelings of eighty percent of consumers who are not sick believe the system is
great until they have to interact with the system. In this system of
entitlement consumers have a tendency to not take care of their health.  This makes them more likely to interact with
the system in the future when they are very sick. The result is increasing
healthcare costs.

Once an entitlement is created it is almost impossible to
eliminate it even though it has proved ineffective and costly.

England’s NHS has shown this to be true. The NHS is struggling
right now to modify the NHS so it works
better for physicians and patients.
However, the new reform rules have been contaminated with so many amendments
that I suspect no progress will be made

Consumers are realizing that Obamacare is much too complicated
and impossible to execute. Rather than demanding repeal and eliminating the
concept of instituting an entitlement program, the New York Times is publishing
letters from readers that are demanding a single party payer system to simplify
the system.

Let us stop making the same mistakes over and over again.

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

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Holy Cow, He Does It Again!

Stanley Feld M.D.,FACP,MACE

The Obama
administration has not been forthright with Congress and the American people in
explaining Fast and Furious, the Benghazi incident, the IRS scandal, the NSA
scandal, and his unilateral decision not to enforce immigration laws with
respect to young immigrants.

I understand most people know little of the
details of these scandals,unconstitutional maneuvers and bypassing of
congress because the traditional media have ignored the details

The lack of honesty, changing stories and delays in providing explanations
about these scandals has made the administration’s credibility even worse.

There are many who suggest that the authority President Obama has assumed
in bypassing congress through executive orders and regulations has been

The constitutionality of the Obama administration’s most recent action
has been to delay the implementation of the provisions in Obamacare’s mandates requiring
everyone to buy insurance or face a penalty.

I do believe it is unconstitutional to ignore the provisions in a law
without the consent of congress, which passed the law.

A constitutional law professor
at George Washington University Jonathan Turley said that Obama
“has been far
more aggressive in circumventing Congress and far more successful in creating
an imperial presidency” than Bush.”

Barack Obama’s latest legal end run around Congress — delaying enforcement of
the employer health mandate — has sparked more questions about whether he’s
abusing his executive discretion under the Constitution.”

Many congressmen have complained, including some Democrats up for
reelection in 2014.

Rep. Steve King, R-Iowa, said,
“If President Obama wants to make changes to Obamacare, he must come to
Congress. … We are a nation governed by laws written by Congress, not memos
and blog posts written by bureaucrats.”

“President Obama will get his way,” said Michael Tanner.

Michael Tanner, a senior fellow at the Cato Institute, said
Obama appeared to be stretching his authority to the limit.

“It’s less of a frontal assault than it is a flanking maneuver,”
he said. “He may be violating the spirit of the law but not necessarily the

The legality is up in the air.”

When President Obama
has run into opposition to his political ideology he has gone around congress.
He is a master of “gotcha politics.”

Timothy Jost, a longtime supporter of the health care law and a
law professor at Washington and Lee University, defended the mandate decision.

“This is really a question of enforcement and when the
administration runs into practical difficulty, it delays enforcement,” he said.

"He predicted the administration would get its way in the end."

“I don’t see the courts intervening here. I’m sure Congress will
hold hearings but there really isn’t anything they can do.”

 Unfortunately, Obamacare is the law of the land.

Obamacare is a stupid law. President Obama’s delaying implementation is
demonstrating that Obamacare is not going to work.

 Obamacare will destroy the already
dysfunctional healthcare system for the reasons I have outlined.

This delay is
one of many Obamacare delays we are going to see in the coming months.

Others might include.

  1. Implementation of the mandate for individuals.
  2. Implementation of health insurance exchanges.
  3. Implementation of ACO’s.
  4. Implementation of Electronic Medical Records.
  5. IRS policing implementation of Obamacare.

There will be protests against the many waivers and exemptions from the
law that President Obama has given various groups including labor unions,
congressional members and government workers. These exemptions and desired
exemptions have not been reported in detail in the traditional media. I suspect
the exemptions will just happen without awareness by the public.

The Obama administration made a big mistake by spying on the Associated
Press reporters. The press has been his biggest ally in helping him get away
with all the stretching of his executive powers by not informing the public. Now
the press is angry and I suspect might not be as accommodating to him.

The law's implementation is turning into a fiasco for the ages,
and this week's version is the White House decision to delay the law's
insurance mandate for businesses, though not for individuals.

The employer mandate is central to Obamacare's
claim of providing universal coverage. Companies with 50 or more "employee
equivalents" must pay a $2,000 penalty per full-time employee if they
don't provide government-approved health insurance.

Mark Mazur, the deputy assistant Treasury
secretary for tax policy, published a blog Tuesday night July 2, the night
before the July 4 weekend holiday break canceling the insurance reporting rules
and tax enforcement until 2015.

This is a typical Obama administration tactic
hoping the cancellation would be forgotten after the weekend. It didn’t work.
People are still talking about a bureaucrat changing the rules of the law
because it cannot be executed.

“White House
fixer Valerie Jarrett tried to contain the fallout with a separate blog post
promising that ObamaCare is otherwise "staying the course."
true only if she's referring to the carelessness and improvisation that have
defined the law so far.”

The Treasury Department does not have the
computing ability to figure out who is complying with the law. The IRS does not
have the ability or manpower to police the law.

The law does not say the Obama administration
can impose the mandate whenever it feels it is politically convenient. The
individual mandate is next to go.

The damage from Obamacare has already occurred.
Healthcare insurance premiums have risen on average 20% this year.

Small and large companies are only hiring part
time people to avoid the penalty. (Under 30 hours per week). This week’s
unemployment figure was 195,000 only because of part time hiring. There was a
major decrease in full time workers.

There is an increase in non-insured as the
businesses are dropping healthcare insurance for employees.

has become a rolling "train wreck," in Senator Max Baucus's memorable
, and it gets worse the more of it the public sees.

The employer mandate is terrible policy, as I
pointed out before it was passed. The Obama administration has now admitted that it
can't implement Obamacare properly or on time after Americans have been paying the 10
hidden taxes for the past two years

Please wake up America.

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

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I Am Proud To Be An American


Stanley Feld M.D.,FACP,MACE

Stan july 4

July 4th 2013

July 4th should conjure up
feelings of liberty, freedom, and patriotism. It is a celebration of the birth of the United States of

It is not just another holiday from work,
but a celebration of those who have gone before us to ensure our freedoms.

“Americans should remember as they celebrate July
4th that it is also called Independence Day for a reason. 
It should not be lost during the barbecues, fireworks celebrations, concerts,
and parades that this holiday was established to reflect on the meaning of
freedom and personal rights.”





The New York
Times wrote an insipid editorial about July 4

“Every Ordinary Fourth by THE

“Do we, as
a nation, eat more hot dogs on July Fourth than any other day of the year? What
about potato salad and deviled eggs? Are there still legions of children
hand-cranking ice cream, watching the pale gray slurry of rock salt and ice
with appalling impatience while the grown-ups stand by recalling their own
apprenticeship at the crank?”

words liberty, freedom, and
patriotism as a description of the meaning of America
do not occur once in the editorial.

is wrong with the New York Times? What is happening to America? We must wake up
soon before our freedoms are lost.

The Fourth of July is more than a day of
celebration and remembrance; it is another opportunity to say thank you and be
thankful for our freedom.

is especially true of our medical freedom and the impingement of that freedom
with Obamacare.

Man is not freedom
Parade Photo July 4, 2013

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

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