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All items for November, 2013

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The Meaning Of Trust

Stanley Feld M.D.,FACP,MACE

 Trust is a big five letter word.

 

a :  assured reliance on the character, ability, strength, integrity or truth of someone or something

b :  one in which confidence is placed

2 a :  dependence on something future or contingent :  hope

 

Thanksgiving is a time of giving thanks for all we have to be grateful for.

This Thanksgiving the majority of Americans do not trust President Obama.

Suddenly there is an awareness that most of us were mislead on many of his policies.

The biggest mistrust resulted from his signature legislation, Obamacare.

Americans have also been programed by television and their digital devices to have a short attention span.

We become easily distracted.  

Overloading us with incongruous facts that have nothing to do with our livelihood causes us to forget these details quickly.

On this Thanksgiving we should be grateful that we have the freedom to put the facts together to give them coherent meaning.

In short, our President and our government officials have lied to us for the last 5 years. The goal was a government take over of our lives.

Americans are finally paying attention as their livelihoods and healthcare coverage are being threatened.

President Obama has lost the trust of the American people.

The details of this erosion of President Obama’s trustworthiness is demonstrated by the following You Tubes.

1. The lack of privacy and avoidance of HIPA Compliance is pointed out in this congressional hearing. The traditional media has not covered this important confession. The testimony emphasizes his disregard of a promise of privacy by President Obama.

  

http://youtu.be/uOk0vOup4yA

 2. This video puts every promise and lie into historical perspective. It is worthwhile viewing to the entire video

 

http://youtu.be/LGeWMPFlGlY

3. The following video is a navigator explaining credit risks and the insurance companies deciding to admit people to Obamacare after they have applied.

Please start at 9 minutes and 55 seconds into the You Tube.

  

http://youtu.be/Aywn34RcAIo?t=9m55s

 

4. The last video is called “Obamacare Is The Biggest Swindle Ever.” This is nothing people do not know.

However it is a good memory stimulator. Everyone remembers the quote “You can fool me once, you can fool me twice, etc.”

  

http://youtu.be/sMFLbRilj3M

On this Thanksgiving we should be thankful for our freedoms. We should be thankful for our freedom to think and our freedom to express ourselves.

Even though the first amendment has taken a beating in the last 5 years it is surviving.

We must be thankful we live in a country that is run by government of the people, by the people and for the people.

We must appreciate our power as individuals.  

We must recognize which government officials have done the people wrong.

At this time we must exercise the power of our vote to get rid of them and elect surrogates who will run the government for the people and not surrogate who want to control the people.

President Obama has relinquished our faith in bestowing our trust in him as our surrogate.

His attempts at talking his way out of the mistrust is only making the mistrust worse.

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

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Obamacare’s Disasters Are Unfolding

Stanley Feld M.D.,FACP,MACE

Along with the web site’s disastrous failures, other impending Obamacare disasters are unfolding.

Things look so bad for Obamacare that President Obama sent out a directive to change its name from Obamacare to the Affordable Care Act.

I believe Americans are well aware of the fact that Obamacare is neither affordable nor accountable to consumers. A name change will not help. Obamacare will not bend the cost curve nor save each family $2500 a year for healthcare insurance.

I have pointed out the problems with Obamacare since before its inception.

The list includes;

 Loss of your current insurance policy.

  1. Loss of your present doctor.
  2. Loss of participating doctors in your network.
  3. Loss of your present insurance coverage.
  4. Failure of the development of Accountable Care Organizations.
  5. Failure of Pay4Performance measures to reimburse physicians and hospitals.
  6. The lack of incentive for consumers to take care of their health or healthcare dollars.
  7. The lack of dealing with the issue of tort reform. Tort reform would lower the cost of care dramatically.
  8. It does not decrease healthcare insurance industry abuse of the Medical Loss Ratio.
  9. It has not increased the ease of data transfer among providers.
  10. The loss of freedom of choice for consumers and physicians.  

 Consumers are becoming outraged at the inefficiency of implementation as all these are beginning to affect them personally.

 Where is the physicians’ outrage?

Premiums and deductibles are rising. Medical care is starting to be rationed. The intensity of the outrage will rise as access to care decreases.

A physician friend of mind who is over 65 years old on Medicare said Medicare has been good to him and his wife.

Medicare has also been good to his practice of internal medicine. He believes America should have Medicare for all with a single party payer.

I just listened and smiled. The old Medicare system is unsustainable. Wait until he sees the new Medicare premiums for seniors and the reimbursement schedule for physicians in 2014.

Forget the regulations he is going to have to deal with. Forget the restrictions of access to care he will have to deal with. Forget the rationing of care he will have to deal with.

It will not be pleasant.

Consumers are realizing they are the victims of higher prices and lower levels of care. Hospitals, insurance companies and doctors are also going to be the victims of enslavement by regulations.

 Government bureaucracy, inefficency and waste will flourish.

I hope everyone realizes that the individual market was the first market to be attacked by Obamacare because it is the smallest market. The individual market only affects 5 million people.

The next market in line to be destroyed is seniors and Medicare. It is starting already with the destruction of Medicare Advantage.

The employer sponsored healthcare insurance market will start being destroyed in 2014.

President Obama just delayed the implementation of the private market mandate from October 15th until after the November 2014 elections.

The delay will not take the spotlight off the failure of Obamacare and protect Democrats from the outrage of Americans toward Democrats during to 2014 election campaigns.

I believe the American people are on to President Obama’s tactics of attacking his enemies personally.

Consumer outrage about Obamacare will dominate the media despite President Obama’s attempt to manipulate the liberal traditional media.

 He seems desperate to create a distraction. His Iranian deal will create a temporary distraction.

President Obama brought several selected progressive “influential  commentators” to the White House for a little policy briefing last week.

They all said the meeting was confidential. I say the meeting was an attempt at media manipulation. Hopefully the media is realizing reality.

Obamacare was supposed to be built by the best minds in the healthcare policy business. It appears the problem was these best minds knew little about the healthcare insurance business, the hospital system business or the practice of medicine.

Obamacare has not aligned any of the vested interests of the primary and secondary stakeholders. In fact, misalignment of vested interests has increased since passage of the law.

I cannot figure out what the President Obama was thinking. All signs point to the fact that President Obama wants to destroy the present healthcare system and replace it with a single party payer system.

I have pointed out multiple examples in this thinking including President Obama’s declaration as far back as 2003 and since that he prefers a single party payer system.

He has also emphasized that the universal care system he will put into place (Obamacare) is a transitional system. It is a system that will collapse and be replaced with a single party payer.

  

http://youtu.be/BKkTRMEyAhs

This You Tube is compelling. It demonstrates President Obama’s ideological goal not practical goals. 

President Obama admits that Obamacare is a transition system. He wants to eliminate employer sponsored healthcare coverage and the destruction of the healthcare insurance industry.

President Obama simply ignores the fact that the administrative services are provided by the healthcare insurance industry to administer Medicare and Medicaid.

The government could not do it without the healthcare insurance industry. The cost of the administrative services is a non-transparent 40% of every Medicare and Medicaid dollar.

Medicare and Medicaid are single party payer systems. The healthcare insurance industry presumably bids for each states contract. Indirectly the healthcare insurance company rips off the consumers by ripping off the government for the administrative service for Medicare and Medicaid.

All we have to do is remember the $2,000 toilet seats in a government cargo plane to understand the efficiency of a government run program that outsources the fulfillment of a mission.

It is hard for most people to believe that President Obama’s purpose all along was to destroy Obamacare (his namesake) and replace it with a single party payer system.

Everyone must notice that he is now been calling Obamacare the Affordable Care Act.

 

http://youtu.be/kXRm0yVyn7k

I am sure he wanted the hysteria that is going on right now over dropped insurance coverage, dropped physicians and changed insurance plans to subside.

However he did not expect the mistrust the public has for him. The genie is out of the bottle. The country doesn’t trust this nice guy anymore.

He did not expect the outrage to be directed at him. This is the reason he is blaming the failure on the Republican Party one day, the healthcare insurance companies the next and doctors and hospital systems the next.

He has also giving special favors to his political base. These favors has made the middle class public very angry at him.

A more glaring favor is exempting all of congress from participating in Obamacare.

The fast food companies’ exemption has angered small business owners.

Exempting unions from Obamacare has been totally disgraceful.  

The destruction of Medicare Advantage for seniors is on the way.  Senior outrage will be seen in the next few months.

President Obama is going to try to blame the healthcare insurance industry, hospital systems and physicians for this disaster.

Very few Americans are going to believe him.

Americans understand that he is forcing premium prices and out of pocket expenses up with unnecessary bureaucracy and regulations.

He is restricting care to the elderly and access to care in hospitals and doctors’ offices.

He has created greater dysfunction in the healthcare system.

The dysfunction is going to get worse.

He will achieve his goal to force the healthcare system to collapse.

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

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President Obama’s “Noble Lie”

Stanley Feld M.D.,FACP,MACE

The Obama administration has been riddled with multiple scandals such as Fast and Furious, IRS, Benghazi, the red line on Syria, saying he is protecting Israel’s back, NSA and now the Obamacare roll out.

Bob Woodward on the Chris Wallace Show on November 18th said he was not impressed with President Obama’s lie about Americans keeping their own insurance and their doctor if they like him. 

To paraphrase Bob Woodward’s comment he said President Obama’s goal was to do something Noble for the American people. He wanted to provide insurance for the 30 million uninsured Americans.

My impression is Bob Woodward was forgiving President Obama’s  “Noble Lie.” He moved on to the disastrous rollout of the Obamacare  web site.

  

 

http://youtu.be/gVp54E18NFU

I was floored.

I thought about Bob Woodward’s statement for a long time. His statement reminded me of Plato’s Philosopher King.

My humanities teacher at Columbia College, Gilbert Highet ,was obsessed with Plato’s concept of the “Noble Lie.”

Gilbert Highet believed it is the duty of the intellectual to support freedom and defend pluralism.

He emphasized that the concept of the “Noble Lie” was exactly what the American founders rejected in the Declaration of Independence, the Constitution and the Bill of Rights.

The very next day one of my readers sent me an article by historian and author Arthur Herman ("The Cave and the Light: Plato Versus Aristotle, and the Struggle for the Soul of Western Civilization) concerning Plato’s “Noble Lie.”

 

He wrote,

Thomas Jefferson once confessed to John Adams that he had been rereading Plato’s "Republic" and “laid it down often to ask myself how it could have been that the world should have so long consented to give reputation to such nonsense as this,” including the notion of the Noble Lie.

They knew rulers, no matter how well educated or experienced, actually have no superior knowledge to ordinary people, because they all understand and judge reality at the same level.

That’s why Noble Lies aren’t just wrong. They also don’t work very long because citizens can see what’s real and true just as clearly as any of Plato’s Philosopher Kings, and sooner or later will catch them out.

President Obama has a knack of moving the traditional media quickly off one “Noble Lie” on to another before the first lie and its consequences can be fully appreciated by the people.

George Will had a wonderful statement about this ability. He called it

Clunker progressivism.

“Barack Obama’s presidency has become a feast of failures whose proliferation protects their author from close scrutiny of any one of them.

Now, however, we can revisit one of the first and see it as a harbinger of progressivism’s downward stumble to HealthCare.gov.”

The following quote of Plato by Arthur Herman sounds a little bit like Bob Woodward’s statement last Sunday.

 It is the business of the rulers of the city,” Plato wrote in his "Republic," “to tell lies, deceiving both its enemies and its own citizens for the benefit of the city…”  

In fact, the wise ruler — Plato’s Philosopher King — must be prepared to “administer a great many liesand falsehoods,” Plato went on, for the benefit of the masses.  

Plato goes on to justify the “Noble Lie.”

 “The Philosopher King knows that they are too ignorant to ever see the truth about their city’s problems and how to fix them.”

“And at times it’s only through telling what Plato called “a noble lie” that he or she can get the people’s cooperation in achieving it.” 

Mr. Obama, you are not Plato!

The traditional media and the Democratic Party promote these Noble Lies.

Arthur Herman goes on to say,

And every lie is planted for a single end: to justify increasing the power of the federal government, and with it the clout of its Number One champion, the Democrat Party.”

The Democrats who voted for Obamacare either knew or understood its provisions. If they did not understand the provisions because they did not read the bill before they voted for Obamacare they were not doing their job.

It was predictable that Obamacare would be a disaster for ten of millions of Americans already holding health insurance policies. 

Above all, they knew their president had deceived the American public into accepting this financial and moral disaster, in order to clear the way for a single payer, completely government-run health system”

In either case they should all be thrown out of office.

Americans have not seen anything yet!

Wait until they try to see a doctor or receive access to needed medical care once Obamacare get further on down the implementation road.

It is going to get worse!

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

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What Is Going On With Obamacare?

Stanley Feld M.D.,FACP,MACE

President Obama’s implementation of Obamacare is right on course to destroy the healthcare system and replace it with the federal government being the single party payer.

He is out to prove that the free market system does not work.

President Obama uses the strategies of Cloward and Pivan as well as Saul Alinsky to overwhelm the healthcare system. The goal is to create chaos in the system.

At the same time he attacks his enemies personally.

Cloward and Pivan said full enrollment of those eligible for welfare (entitlement/Obamacare) “would produce bureaucratic disruption in welfare agencies and fiscal disruption in local and state governments” that would “deepen existing divisions among elements in the big-city political parties and party coalitions.

The remaining white middle class, the working-class ethnic groups and the growing minority poor would be polarized. This would further weaken democratic institutions and existing political parties.

"In order to avoid the continuation of the chaos the federal government would step in and be obligated to advance a federal solution to poverty that would override local welfare failures, local class and racial conflicts and local revenue dilemmas.”[3]

Doesn’t this sound familiar? This week President Obama presented a non-fix to fix the problem of over five million people losing their insurance coverage. His move will only accelerate the chaos in the healthcare system he has already created.

Saul Alinsky said “do not let the enemy attack with a constructive solution. The enemy must be neutralized before its solution takes hold.”

The way to neutralize the enemy is by focusing on an individual you are going to attack. “Do not attack the constructive solution or the institution.”

Freeze the criticism on the individual; personalize the individual criticism and then polarize the populous against the individual and the constructive solution that individual represents. 

This is exactly what President Obama and the Democrats did to Mitt Romney and Paul Ryan. President Obama ignores the opposition’s constructive solutions.

An unidentified source sent me this comment. I am in total agreement

“Obamacare was designed to fail so that the unwashed masses, at the mercy of a cumbersome and unworkable system would look to Obama and the Feds for salvation in the form of single-payer medical care”. 

The only "incompetent and unknowledgeable" aspect of the situation is that Obama never, ever considered that the sycophantic Mainstream Media would ever call him out on this.

President Obama has never considered the wisdom of the American people.

In reality, government interference with the free market and its bureaucratic structure, inefficiencies and ill informed advisors have been the major cause of all the chaos.

Ben Carson quote

Barney Frank and John Kerry told President Obama that the only way Obamacare would work is with a strong public option and a single party payer system. President Obama’s response was don’t worry just pass the Affordable Care Act.

The creation of chaos in the healthcare system is the first step. Obamacare has succeed is creating chaos for people having their healthcare insurance coverage cancelled.

President Obama promised them that they could keep their insurance if they like their insurance. They could also keep their doctor if they liked their doctor.

He knew that this was not true in 2010. Nevertheless he promised it 23 more times since.

The New York Times reported,” A Contrite Obama Unveils a Health Fix

President Obama announced a fix to his signature health care law that will allow existing customers to keep their insurance plans.”

President Obama was far from contrite in my view. His non-fix fix will serve to accelerate the chaos in the marketplace.

His pronouncement is unconstitutional.

The insurance industry is not inclined to do things obviously against the “law of the land”. The main reason is the insurance industry has already purged the old insurance policies from their systems.

It will be impossible to reactivate them again in four weeks.

Increasing chaos is an important step in accelerating President Obama’s endgame to collapse the entire healthcare system.

Let us look at what he said during his “contrite” press conference.

"His announced fix is aimed at remedying the mass cancellation of individually purchased insurance plans by letting insurance companies re-offer non-compliant policies."

President Obama let slip that this is one big blame-shifting exercise. He announced that no one would be able to say Obamacare caused him or her to lose insurance.  

This is a Saul Alinsky tactic. The insurance industry has no inclination or ability to change its policies this late in the game. The industry can only lose money doing this.

President Obama has thus set up the healthcare insurance industry to take the blame for the before and after crisis in the healthcare system.

The fix undermines the essential premise of Obamacare. The young healthy people need to be forced into buying insurance through the health insurance exchanges. Insurance they do not want or need.

The President’s new fix will explicitly encourage many people to stay out of the exchange. The signal is clear that no one should sign up now because the entire program is in flux.  Young people do not trust President Obama anymore.

There were a series of incredible statements and lies made at the fix press conference.  Those paying close attention could hear them.

We fumbled the rollout on this health-care law.”

No kidding. Where is the lie about the promise you made after you knew this would happen with both the web site and the ability to keep your insurance.

“I completely get how upsetting this can be for a lot of Americans.”

Thank you Mr. President.

“It is a complex process.”

Therefore, no one in the administration is to be blamed for anything that went wrong because it is a complex process.

“I was not informed directly [How about indirectly?], that the Web site would not be working. . . .

I don’t think I’m stupid enough to go around saying this is going to be like shopping on Amazon or Travelocity, a week before the Web site opens, if I thought that it wasn’t going to work.”

This is either an intentional lie or he did not listen to people who were telling him the web site was not ready.

People were telling him for months that the web site was not ready, not secure and not tested.

It is time for President Obama take some personal responsibility.

“With respect to the pledge I made that if you like your plan you can keep it. . . that there is no doubt that the way I put that forward unequivocally ended up not being accurate.”

President Obama didn’t lie. He was just inaccurate. Hah!

“The Affordable Care Act is not going to be the reason why insurers have to cancel your plans.”

President Obama must be kidding. His administration’s regulations made the old insurance policies against the law of the land.

“The federal government does a lot of things really well. One of those things it does not do well is information technology procurement.”

Is it the federal government’s fault when President Obama awarded the non-bid contract to build the web site to Michelle Obama’s girlfriend?

“In terms of what happens on Nov. 30th or Dec. 1st, I think it’s fair to say that the improvement will be marked and noticeable.”

I thought we were promised that the web site would be fixed by November 30.

“What we are also discovering is insurance is complicated to buy.”

 Why make it more complicated with Obamacare? The process could and should be simplified.

“There is no doubt that our failure to roll out the ACA smoothly has put a burden on Democrats, whether they’re running or not.”

The burden is on the Democrats. They were fools to pass this un-executable law without reading it or understanding it.

Didn’t Nancy Pelosi tell fellow Democrats that they have to pass the bill in order to see what is in it?

Democrats were the only ones that voted yes for the bill. They are responsible for what is in it.

They all deserve to be kicked out of office in 2014.

“There have been times where I thought we were … slapped around a little bit unjustly. This one’s deserved, all right?”

Again Saul Alinsky comes up. In the last few days I have once again seen the race card come up in the traditional media and among celebrities. Alinsky said attack your enemy personally.

There is beginning to be outrage and fear among the people of all socioeconomic groups. Everyone is now getting President Obama number. No one trusts him anymore.

 Obamacare must be repealed. America must start all over again to reform the healthcare system.

A good place to start is with My Ideal Medical Savings Accounts and Tort Reform.

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

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 .[3]

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Medicare’s Perverse Incentive Against Seniors

Stanley Feld M.D.,FACP,MACE

It is all about money. It is about the government spending less, the hospital collecting more and the patients getting stuck with the bill.

Government officials realize that Medicare costs are unsustainable. CMS creates rules and regulations to expose Medicare to less liability.

Unfortunately the unintended consequence is that CMS exposes Medicare patients to more liability in the process.

Less than 20% of seniors are sick enough at any point in time to require hospitalization.

In an attempt to save money, a distinction has been made between a hospitalized patient and patients in the hospital under observation.

This system has been a disadvantage to many Medicare patients.

It has helped the government slightly in reducing costs. It has helped the profitability of the hospitals greatly.

Seniors are not aware of these perverse incentives until they get stuck with the out of pocket costs of being admitted for observation.

The government and the courts have ignored seniors’ protests.

 What are the issues?

Under the rules, Medicare pays the entire bill for the first 20 days in an approved skilled nursing facility (nursing home) for rehab or other care if the patient needs it.

Seniors must spend at least three full days as hospital admitted patients in order to qualify for the approval.

 If a patient was admitted under observation, for all or part of two midnights, he or she would be responsible for the entire cost of rehabilitation. The government has agreed to pay for rehab for hospitalized patients because its daily cost of skilled nursing care is less than the daily hospital costs.

“The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring of 2013 with a policy popularly known as the “two-midnight rule.”

When a physician expects a patient to stay in the hospital for more than two midnights that person is admitted to the hospital as an inpatient hospitalization.

The patient’s care is covered under Medicare Part A, which pays for inpatient hospitalizations.

If a physician expects that the patient will stay less than two midnights, the physicians are forced by the hospital to admit the patient as an outpatient.

As an outpatient only Medicare Part B pays for hospital outpatient services to the hospital and physicians.

The hospital makes more money from outpatient services than it does from inpatient services. All procedures are billed as separate entities rather than the hospital receiving a bundled fee for the disease being treated.

Hospitals have figured out how to stretch the outpatient admissions days to three days. Patients are admitted for observation one minute past midnight.

Under Part B, they’re billed separately for every procedure and visit and drug, and the co-pays can mount until patients owe hundreds or thousands of dollars — which they may only discover upon receiving the bills.

Medicare Part F pays the deductibles. However many seniors cannot afford Medicare Part F.

“People are shocked when they receive the bill. Nobody is required to tell them they’re outpatients.”

Those patients who have been outpatient admissions do not qualify for the rehab benefits. Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services

The Medigap supplemental policy (Medicare Part F) does not pay the out-of-pocket costs of services that Medicare Part A does not cover. Since Medicare Part A does not cover outpatient admissions the patient is stuck with the bill.

Over the past several years, hospitals throughout the country have increasingly classified Medicare beneficiaries as observation patients instead of admitting them, according to researchers at Brown University, who recently published a nationwide analysis of Medicare claims in the journal Health Affairs.

 The results showed that in just three years, 2007 through 2009, the ratio of Medicare observation patients to those admitted as inpatients rose by 34 percent.

Medicare tells hospitals that the decision to admit or discharge a patient who is under observation can most often be made in less than 24 hours.

 "In only rare and exceptional cases do reasonable and necessary outpatient observation services span more than 48 hours," says the Medicare Benefit Policy Manual (PDF), the agency's coverage bible.

But the Brown University study found that more than 10 percent of patients in observation were kept there for more than 48 hours. And it identified more than 44,800 who were kept in observation for 72 hours or longer in 2009 — an increase of 88 percent since 2007.”

How come?

There are two important reasons.

Outpatient hospitalizations mean increased out of pocket expenses for most patients. Prescription drugs in Outpatient hospitalizations are covered under Part B or Medicare Part D drug benefit plans.

Some Part D drug benefit plans have very high deductibles. This is true of brand drugs. It increases the out of pocket costs of the senior.

The hospital determines whether a patient is classified as an inpatient or placed under observation. In many cases the hospital overrules the patients physician’s judgment.

Hospitals are placing more and more patients under observation to protect themselves against new government policies.

These policies penalize hospitals for unnecessary admissions and frequent readmissions of the same patient. These policies withhold payment for patients re-hospitalized within 30 days. Patients hospitalized under observation are not counted as a readmission.

Hospitals have figured out a way of controlling costs as well as increasing profit.  This hospital action is absolutely understandable. Physicians do not benefit.

Who loses?

The unintended consequence is that the senior patients lose.

The problem is most seniors are not aware of what is going on.

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

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Father Son Weekend With Daniel

Stanley Feld M.D., FACP,MACE

 

On Halloween Cecelia and I
flew to Denver. We wanted to share Halloween with our granddaughter.

They do trick or treat up big
in Boulder. Everyone was in costume. We wanted to share her thrill of trick or
treating. It was so cold and windy that Cecelia and I lasted less than an hour.

Sabrina lasted two and a half
hours. She was dressed as a ninja. I was dressed as a Boston Red Sox player.
Cecelia wore a fancy mask.

Friday night Cecelia had an
exhibit opening with reception at Artwork Network Gallery in Denver. Brad, Amy,
Dan Laura and Sabrina came to the show. Cecelia and her art were eloquent.

Friday night was a beautiful
fall night in Denver. It was Gallery Walk Night in the Denver Arts District.
Hundreds of people turned out for Cecelia’s show.

Cecelia was there from 5-9pm.
The rest of us went to the Smokehouse at 8pm. When they dropped me off at 9pm
the gallery was still packed. 

We were in the car and back
to Boulder at about 9:45 pm. The gallery was still going strong.

Daniel and I were out of his
house at 7:30 am for our annual Father/Son weekend.

Daniel and I and Brad and I
usually go on one weekend a year. We usually fly to some city and bond with
each other. We do more talking and eating than anything else.

One activity is required. We
must work out each morning first thing.

This year Brad and I are
going to Blytheville,Arkansas, the town of his
birth, when Cecelia and I were in the

Air Force. I must say we have
been warned by people that Blytheville is not much these
days. We are ignoring everyone.

This year because of Dan’s
schedule, we went to Denver. It was Cecelia’s idea.

Our first stop was Zaidy’s in
the Cherry Creek shopping area
. The parking lot was packed at 8:3am.  

Zaidy’s was a pretty good
deli. We shared a pastrami and egg white omelet with an order of potato latkes.
My mother and Cecelia make better potato latkes. The sour pickles were very
good.

We talked and talked for over
an hour at the table. It was then warm enough to go outside. As a Dallasite, I
am not used to being 35 degrees on November 2.

After breakfast we then walked
the shopping area all the while talking about the meaning of life.

It was about noon and time to
check into the Hyatt at the convention center.

We got our room early. Our
goal was to walk and continue our conversation. We were off to Larimer Square. At about one o’clock neither of us felt hungry after the Zaidy's
breakfast so we did not go for a big lunch.

I wanted to take Dan to the
Clyfford Still museum. He had not been there yet. Cecelia and I went to the
Clyfford Still museum with Todd Siler when it just opened. It is a gem. It my
book it is one of the best museums in the country.

The museum sits in the shadow
of the Denver Art Museum. The DAM is about 10 times larger than the Clyfford
Still Museum. Everyone knows size does not matter. Clyfford Still was a genius.
It is hard to understand his genius when most museums have only one Still. The
piece is usually out of context. This exhibition is still a blockbuster even
though many of the paintings were different the second time around.

Daniel and I walked back to
the hotel after the museum. We had an early dinner at John Elway’s. We walked
another mile and a half to the restaurant. We split the steak at Elway’s and
then walked and talked to the Pepsi Center where the Denver Avalanche was playing
the Montreal Canadians. We had great seats.  

I am not a big hockey fan but
I had a great time for 2 of the 3 periods.

I was 10 pm and we had to
leave before all the ice cream parlors closed. We walked back toward the hotel
looking for ice cream. We finally found a café, diner, and coffee shop about
two blocks from the Hyatt. We did not know what we were getting our selves
into. However the place made a great hot fudge sundae.

It was so good we decided to
have breakfast there on Sunday. FAT chance. We got there at 8:30am. There was a
one and one half hour wait for breakfast in a downtown café, diner, and coffee
shop on a Sunday morning. Where did all the people come from?

We went back to the Hyatt and
had breakfast in the three quarters empty hotel dinning room.

Daniel and I checked out of
the hotel and drove to the Denver Museum of Art to meet the girls for the exhibit
Court
to Café: Three Centuries of French Masterworks from the Wadsworth Atheneum
 and Passport to
Paris
.

Passport to Paris was much better than Court to Café but all
five of us had a good time.

 No one was hungry at 1pm. We drove back to Boulder and had a
small bite at Chili’s.

 The weekend with Daniel was a roaring success.

 Sunday night we met Brad and Amy for dinner at Mateo’s in
Boulder.

 Cecelia and I love being with our kids.

 I cannot tell you how lucky we feel.

 

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

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Permalink:

The American Awakening

 

Stanley Feld
M.D.,FACP,MACE

Many of my good liberal
friends have been upset with me since Obamacare was passed into law.

I read the 2000 plus
page bill. I was distressed by the many changes to Americans’ freedom to
choose, increased hidden taxes, and the obvious road to the destruction of the
healthcare system.

I immediately regretted
my vote in 2008 for President Obama even though I liked the guy’s style.

I felt he knew little
about how the healthcare system worked. I soon learned he was not interested in
listening to practicing physicians.  

I have tried to follow
the 20,000 new regulations that have served to increase the mess that has been
created. I have reported on some of them.

Unfortunately the
traditional media has remained enamored by President Obama’s charm. The
traditional media had continued to dismiss reality until the recent web site
disaster.

The Obamacare disaster
is much worse than the web site disaster by itself. I sense the traditional
media is buying the explanation.

The reality is this web
site disaster represents the worst example of cronyism. It is even worse than
the Solyndra scandal. The Solyndra scandal on cost $535 million in federal guarantees .


The administration
issued a non- bid contract of $634 million dollars to a company in which an
executive is a good friend of Michelle Obama.
CGI’s web site looks fantastic.
The reality is they have had health insurance exchange software programs that
have failed in three provinces in Canada.

President Obama has been
lying his way through the web site disaster. The bizarre thing is he thinks he
will get away with it.

 

 
 

http://videos.nymag.com/video/If-You-Like-Your-Plan-Supercut

The public is becoming aware of the fact that Americans are
losing their healthcare coverage by political design.

President Obama is rapidly losing the trust Americans had in
him as reflected in the polls.
They fear they might lose their own healthcare
coverage next.

The
law is systematically dismantling the individual insurance marke
t, as its
architects intended from the start.”

I have been saying this since 2008. The aim of
Obamacare is for Americans to not to have a choice remaining. It will be a
single party payer system by default.

The traditional media is waking up. The first
wave is the 14 million people in the individual insurance market. Those 14
million Americans are being trapped into Obamacare. The 14 million are making a
big stink. President Obama is caught in an outright lie.

“Until
this month, consumers who weren't insured through their jobs were allowed
to
buy insurance that provides the best value based on their own needs. One of
every 10 private policies is sold through the individual market, covering about
7% of the U.S. population under age 65.”

President Obama did a clever thing. He gave a
waiver to the group insurance market until 2015. The traditional wisdom is that
the waivers were given because Obamacare was not ready to service the group
market.

The real reason for the waiver was to avoid
the uproar from 160 million people who have group insurance.

The 160 million Americans who will lose their
group insurance coverage next year will find out they have been deceived by
President Obama.

“The millions of Americans who are receiving
termination notices because their current coverage does not conform to Health
and Human Services Department rules may not realize this is by design.”


The administration is rolling out its media
spin. President Obama is trying to blame everyone in sight except himself. He
is blaming the healthcare insurance industry and Fox News for his debacle.  
 

President
Obama has blamed Fox News for inciting people to be against Obamacare. A reader
sent me this You Tube of Neil Cavuto's reply to President Obama. Mr. Cavuto
hits the nail on its head.

Cavuto: Mr. President, we at Fox News are not
the problem.”

 


 

http://youtu.be/DDdmtJCEWPA

President
Obama felt that free choice is a threat to Obamacare. If too many
people could keep the insurance policies they liked instead of joining the
government exchanges Obamacare could fail.

It has
been now been shown that his goal in 2010 was to destroy the private healthcare
coverage market.

“Liberals
believe they must destroy the market in order to save it.”

 The healthcare plans
the President promised people could keep have been intentionally outlawed by
regulations written by Kathleen Sibelius in the Federal Register as far back as
2010.

“The
goal is to force individuals earning more than $46,000 or a family of four
above $94,000, who don't qualify for subsidies, into the overpriced health
insurance exchange.”

“If these middle-class ObamaCare
losers can be forced into the exchanges, they become financiers of the new
pay-as-you-go entitlement.”

They
will pay $10,000 a year for a healthcare plan that people earning under that
amount will pay less than $1,000 per year. The government subsidy will finance
the difference.

If
enough people earning more than $46,000 and $94,000 a year do not sign up for
Obamacare, the federal government will have to make up the difference to the
insurance company that is providing the administrative services for that
healthcare coverage.

I hope
people remember another of President Obama’s promises. He said families making
under $250,000 a year would not pay one
dime extra in taxes
. The traditional media has ignored this lie.

 

http://youtu.be/cJ5fOsyj-bk

The operative
word that exposes the lie is “Not a
penny more in taxes on nothing because the last thing we want to do is to put a
burden on the middle class.”

  

http://youtu.be/7uoE_NicaMY

What
about all the hidden taxes? What about all the tax increases passed on to the
middle class in the form of increased prices?

One
can say President Obama is a genius as well as a liar. His goal is to destroy
the healthcare system and the middle class.

He is
on course to succeed unless the American people stop him.

I am
pleased that Americans are starting to wake up to his goals and are starting to
rebel.

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

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Permalink:

Combining My “Ideal Medical Savings Accounts” And “Reference Pricing”

Stanley Feld M.D.,FACP,MACE

President Obama has declared over
and over again that no one has presented ideas better than Obamacare. 

I believe he has no interest in
listening to anyone.

I sent him 6 letters between 2008-2009
presenting my solution to repairing the health care system. These ideas were
from a practicing physician’s perspective. President Obama paid no attention.


President Obama fooled many people
with his intentions, including me. The traditional media is finally catching on
to him. 

All of the stakeholders are at fault
in causing the dysfunctional healthcare system. The dysfunction is the result
of all the stakeholders trying to adjust to ever changing government regulations
during the last 48 years

Obamacare is making that dysfunction
worse.

A consumer driven healthcare system
is the only way to Repair the Healthcare System.

I think President Obama wants the
healthcare system to fail. He wants to prove that the free market cannot
succeed.

He is deaf to the fact that the
healthcare system is not a very free market system.  Government regulations, tax favors, and tax
barriers over the years have interfered with the free market in healthcare.

The Affordable Care Act (Obamacare) intends to transform the
health-care system, extend coverage,
reduce costs and increase quality—all
without asking anything of the patients.

 Consumers will pay
with higher taxes, of course, but otherwise will face no incentives to make
wise choices, compare price with performance or shop for value.

 Doctors, hospitals,
insurers and, most of all, the government will do that for them, which is
hardly reassuring.

 This reflects what I
call the "impossibility theorem" in health care. The impossibility theorem maintains that patients cannot
make good choices, but, rather, must be dependent on the well-intentioned
decisions of others.

Policy makers believe this theorem by
definition. But, just to make sure, they have structured the health-insurance
system to ensure that patients are never asked or allowed to make
price-conscious choices.

The arrangement underlies the innumerable
rules, subsidies, entitlements, mandates and prohibitions that collectively
make health care the least efficient part of the economy.

 ObamaCare makes it worse.

I do not think consumers believe or trust President
Obama. Consumers certainly do not believe “the impossibility theorem.”

Consumers are ready for some common sense healthcare
policy. They just do not know what to do.

Consumers must be given incentives to control
healthcare costs. This can be done in several ways.

Consumers must be put in charge of their health and
healthcare dollars.

The
central pillar of effective healthcare reform is the creation of a system that
forces the healthcare insurance industry to be competitive and answerable to
consumers.

Consumers
must have incentives to control costs. This, in turn, would force hospital
systems and physicians to be competitive and reduce costs.

The government’s
role should be to empower consumers to have greater control over their
healthcare decisions, their health, their healthcare dollars and their
healthcare coverage.

The
government should teach consumers to make educated choices in their healthcare
decision-making.

Price
transparency of healthcare fees and parity of tax deductions between the individual
insurance market and the group healthcare insurance market is essential.

It is fool
hearty to assume that the redistribution of wealth, raising taxes by means
testing and price fixing will solve the problems in the healthcare system.

  “Why on earth would we want a system,
especially with something as personal as health care, where all of these free market
signals are lost, and insurers responding to regulators, not to us?”

Entitlement programs have never produced free market
efficiencies
. Entitlements have created unsustainable, unfunded liabilities.

Leadership must face this problem not add to the
problem.     

In the past seventy years medical advances through
research and technology have improved medical care and medical outcomes. Medical
advance has focused on fixing diseases after they have occurred.   

Consumers are the only ones that can prevent most
medical and surgical problems.

They can prevent most chronic diseases such as Type 2
Diabetes, heart disease, lung disease and others. 

Consumers are also the only ones that can prevent the
costly complications of a chronic disease.

A healthcare system must be constructed to incentivize
consumers to be responsible for their health and healthcare dollars.

Eighty percent of the healthcare dollars spend on
diabetes care is spent treating the complications of diabetes.

A healthcare system must be developed to align all of
the primary and secondary stakeholders’ incentives.

Only consumers can align all the stakeholders’
incentives.

Government control of the healthcare system cannot and
has not aligned those incentives.

Right now we are seeing bureaucracies making a $634
million dollar error with healthcare.gov. This is only the tip of the iceberg
for the problems in store for Obamacare.

The solution is not a single party payer. We will have
the same problems or worse because of the expansion of Medicaid. President
Obama’s hope was the cost of increasing Medicaid would be shifted to the
states.

The increase in cost will increase the federal deficit
and unfunded liabilities.

A healthcare system must be constructed to empower
consumers. I have written in detail about my ideal medical savings accounts.

I have pointed out that it can be very democratic.
Everyone can be insured while decreasing the costs.    

The ideal medical
saving accounts will motivate and empower consumers to save money by staying
healthy, staying out of the emergency rooms, and decrease over testing and over
treatment.

Consumers would be
motivated to shop for the top value and quality care.  

The government would
require providers to publish the discounted prices paid by the government and
the healthcare insurance companies to all consumers.

My ideal medical
saving account would incentivize consumers to save money. It would be the
responsibility of consumers to shop for the best price at the best quality.

Consumers would
carry their medical records digitally on a flash drive or on their smart phone
to avoid over testing. They would reap the financial benefits of these cost savings.

Consumers, after
the initial $6,000 dollars was spent, would receive first dollar healthcare coverage.
 

I have always been
satisfied with the front-end incentives. I have never been satisfied with the
catastrophic coverage. It does not provide financial incentive for consumers to
save.

I finally figured
it out. Consumers would continue to receive first dollar coverage if they spent
over the initial $6,000 after the initial stakeholders.

The discounted
hospital, surgical and medical device costs would be published along with
outcomes.

Discounted prices
for services could also vary for the same services. The outcomes could be the
same.

A hospital system
with better outcomes should receive more. If the hospital system negotiates a
higher fee than another hospital system but has the same outcome the consumer
should be liable for the difference.

 In this way the decision for choosing the
provider is in the hands of the consumer.

Combining my ideal medical saving account and “reference
pricing” will incentivize consumers to be in control of their healthcare costs
and their health and healthcare dollars.

Consumers should receive pretax dollar treatment for
all expenditures.

Consumers will then shop for price and quality to
their financial advantage.  This will
incentivize providers to compete on both price and quality.

The Oklahoma Surgical Center has forced local
hospitals to do just that
. The Surgical Centers’ online prices were one half to one
fifth the prices of the local hospital.  The hospital centers are now starting to
compete on price and quality.

 The combination
of the ideal medical saving accounts and reference pricing will incentivize
providers to be aligned with consumers’ goals.  

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

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