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All items for January, 2014


Not One Dime In New Taxes

Stanley Feld M.D.,FACP,MACE

I received a note from a reader last week. I debated with myself whether or not to publish it. Americans have discovered, and are continuing to discover, President Obama’s many lies/deceptions about Obamacare.

He kept telling us that the law would only tax families earning over $250,000 a year. People earning less than $200,000 per individual and $250,000 per family will not pay a dime more in taxes.

No family making less than $250,000 will see "any form of tax increase."

"I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."

Sources:  President Obama

Subjects: Taxes


It has become apparent that President Obama and his administration have told the American people many lies during his administration. The lies are at best half-truths. President Obama promised us an administration that would be totally transparent and truthful.

Americans trusted him to live up to his promise.

Many believed him only to find out he was not telling the truth.

The traditional media has supported many of President Obama’s lies. This same media had zero tolerance for George H Bush’s (41) lie.

 “Read my lips’. No new taxes.”

 There are at least ten hidden taxes imbedded in Obamacare.

In the last few weeks we learned that an insurance industry bailout was imbedded in Obamacare. President Obama knew about the bailout at the time Obamacare was passed.

Nancy Pelosi was correct. “We won’t know what is in the bill until we passed it.”

Americans used to trust their leaders. This administration has made us very cynical.

There is something called a “Medical Device Excise Tax.”  This medical device excise tax is in the original Obamacare legislation. The 2.3% tax is imposed on the manufacturers of the medical device.

The 2.3% is ultimately passed on to all, both the rich and the poor.

The reader sent me the following:

 "The 2.3% Medical Excise Tax that began on January 1st, 2013 as part of Obamacare’s tax structure is supposed to be "hidden" from the consumer, but it's been brought to the public's attention by hunting and fishing store Cabela's who have refused to hide it and are showing it as a separate line item tax on their receipts, the email states.

Cabella 2

I did some research and found directly from the IRS 's website information that PROVES this to be true and an accurate portrayal of something hidden in Obamacare that I was not aware of! Now being skeptical of this I went to the IRS website and found this!"

"Q1. What is the medical device excise tax? A1. Section 4191 of the Internal Revenue Code imposes an excise tax on the sale of certain medical devices by the manufacturer or importer of the device sales of taxable medical devices after Dec. 31, 2012.

Q3. How much is the tax? A3. The tax is 2.3 percent of the sale price of the taxable medical device.

See Chapter 5 of IRS Publication 510, Excise Taxes, and Notice 2012-77 for additional information on the determination of sale price.

 Chapter Five

So being more curious I clicked on "Chapter 5

of IRS Publication 510."

And what do I find under "MEDICAL DEVICES" under


The following discussion of manufacturers taxes

applies to the tax on:

Sport fishing equipment;

Fishing rods and fishing poles;

Electric outboard motors;

Fishing tackle boxes;

Bows, quivers, broadheads, and points;

Arrow shafts;


Taxable tires;

Gas guzzler automobiles; and


"I think we have definitely been fooled, if we believe that the Affordable Care Act is all about health care. It truly does appear to be nothing more than a bill laden with a whole lot of taxes that we the people have yet to be aware of."

"Please pass this on. I am still incredulous that this can go on.

Where is our press ?  

What is next? What else is there we do not know about? God help us ."

 This is not the first time we have not been told the truth by this administration.

However I did my own fact checking and discovered that the author misread Chapter 5 of IRS Publication 510 Excise Taxes, and Notice IRS Publication 510.

The publication deals with all things subject to excise taxes. Chapter 5 covers “manufacturers taxes” of which the medical devices excise price 2.3% is a part of.

The anonymous author found the list of items including fishing equipment, bows and cars. Some of these excise taxes existed pre Obamacare.  Some of the manufacturers excise taxes are a result of Obamacare. They are all separate from the medical device excise tax.

The publication says the tax on fishing rods and fishing poles is a 10% excise tax not to exceed $10 per article.” The tax on fishing tackle boxes and electric outboard boat motors is 3 percent of the sales price. The tax on bows is even higher, at 11 percent.

Cabela’s sales reflect the manufacturer excise tax because the increase in cost of manufacture of the item is passed on to the consumer.

Cabela was wrong in adding 2.3% to the final bill. It misread the law. The sporting goods store realized its error the first week adding stopped adding the excise tax. Cabela repaid customers who were charged the excise tax.

One must think of the increase in price of an item to all consumers for the manufacturers’ tax is in reality a hidden tax to the middle class. It reduces the consumers’ purchasing power.

This is true for the tax on tanning bed salons also.

What additional Obamacare taxes are affecting the under $200k/$250k earners?

1. Obamacare Home Sales Tax increases taxes on unearned income by 3.8%. 

2. Obamacare increases the medical expense deduction threshold. Unreimbursed medical expense deductions will now be available only for those medical expenses in excess of 10% of AGI, which has been raised from 7.5%.  

3. Starting in 2018, the new health care law imposes a 40% excise tax on the portion of most employer-sponsored health coverage that exceed $10,200 a year and $27,500 for families.

Unions who have negotiated these healthcare plans for its members are upset because the tax will severely affect its membership. Members might elect to quit the union.

There are many more hidden taxes I have not discussed in this discussion.

Democrats now admit after going through the new Obamacare taxes line by line that those taxes will increase the tax burden and decrease the purchasing power of the middle class.   

President Obama has promised that Obamacare will help all Americans get access to quality affordable healthcare and new benefits, rights and protections.

So far Americans have seen the opposite occur.

The reaction to the Cabela incident is simply an indication of the middle class’ cynicism. President Obama promised people making less than $250,000 a year will not pay one dime more in taxes.

It is clear he knew that was a false promise at the time.

Americans do not trust President Obama anymore.

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

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Obamacare is Right On Schedule

Stanley Feld M.D.,FACP, MACE

Is President Obama trying to destroy the healthcare system in America?

Yes he is!

 Actually he is right on schedule to have Obamacare implode on itself.

 I remember when he told Barney Frank and John Kerry not to worry about not including the Public Option in the Affordable Care Act.  We will get to a single party payer system.

They did not understand how President Obama could make such a compromise. They thought the Public Option was the only way in the Affordable Care Act Obamacare) to get to their goal.

The goal was a single party payer system.

They did not have the votes then and they do not have the votes now.

President Obama has used a lot of trick plays to get his way in passing and implementing Obamacare. I have pointed out these trick plays along the way. They should be reviewed.

As hard as it is to believe, it seems that President Obama wants his legacy legislation Obamacare to fail.

Otherwise he would not have had Obamacare constructed with so many perverse incentives for stakeholders.

The only route to success is to align both primary and secondary stakeholders incentives. Obamacare is misaligning all of the stakeholders' incentives.

The incentives are more misaligned now than they were in the dysfunctional healthcare systems days before Obamacare.

The stated goal of Obamacare was to provide affordable healthcare insurance to all, with access to quality care to all without rationing of care.

The effect of Obamacare has been just the opposite. The healthcare insurance coverage will not be universal. It is unaffordable to many in the middle class. It is also unaffordable to many of the subsidized poor that do not qualify for Medicaid. There is limited access to care. There is an increase in the rationing of care.

President Obama claimed Obamacare’s health insurance exchanges would create a competitive free market insurance system.

The health insurance exchanges would force the healthcare insurance companies to be competitive. Healthcare insurance competition would lead to a decrease in healthcare costs.

Health insurance exchanges have not worked as advertised. President Obama’s health insurance exchanges have not resulted in a competitive free market system.

Healthcare premiums have skyrocketed.

Healthcare insurance deductibles and copays are higher.

Hospitals and doctor networks are skimping for two reasons. Doctors and hospitals are choosing not to participate in Obamacare. Healthcare insurance companies are not electing to include many well known  doctor and hospital networks.

Many excellent drugs are not on the insurers' formularies because of the cost. When newer brand name medications are on the formulary the co-pays are unaffordable to patients who need them. Patients therefore do not fill the prescription.

The healthcare insurance premiums are often higher than what consumers previously paid for their private insurance pre Obamacare even after some consumers receive government subsides.

The Obama administration will conclude soon that the free market healthcare system does not work. 

The administration will claim that only healthcare system that will work is a government single party payer system.

However, President Obama has not created a free market healthcare system with his health insurance exchanges. It is a highly regulated market.

In his over regulated marketplace he has created incentives that have further misaligned stakeholders vested interests than they were pre Obamacare.

In the Obamacare system the healthcare insurance companies are led to believe they remain the king of the healthcare industry. They believe they can continue to control healthcare costs.

The government remains totally dependent on the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for government healthcare programs.

In performing these services the government has permitted the healthcare insurance industry to pad direct patient care costs with items that are insurance companies expenses and should not be counted as direct patient care.

The increased distortion is magnified when the government dictates the benefits the insurers must offer patients in the health insurance exchanges and the private insurance markets.

This causes the premium prices to skyrocket .

Consumers might not need these added government benefits. Consumers have no choice. They have to pay for unneeded benefits. These benefits are added to the cost of insurance as well as the net profit of the healthcare insurance companies.

The healthcare insurance industry is also permitted to choose their own networks of physicians and hospitals.

The insurance companies try to maximize their net profit at their lowest cost. Therefore they have kept the best hospital and physicians out of their networks. This affects the quality of care.

It must be realized that quality of care has not been adequately defined or accurately measured.

 In some cities and states consumers only have one insurance carrier. Other carriers have opted out. There is not even a pretense of competition.  This insurance carrier usually picks the hospitals and physicians that will accept the lowest reimbursement. The healthcare insurance industry is offering low fees to providers. They will take only those providers into their networks that accept those low fees.

An additional incentive distortion is the Obamacare requirement for the healthcare insurance companies to charge the same premium for anyone who signs up for Obamacare.  There is no risk weighting permitted.

The hope is all consumers will sign up and enable the industry to keep premiums down.This rule generates two negative incentives. The healthcare insurance industry must overcharge the healthy and undercharge the sick. Therefore the healthcare insurance companies try to attract the healthy and avoid the sick.

This has backfired on Obamacare. The healthy young have realized the trap. They are not signing up in the heath insurance exchanges.

Previously when they were employed the employer didn’t mind covering the young. The young help lowered the overall premium because they were young healthy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           &#
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There are only two options left to the government. Obamacare can bail out the insurance industry and bully the healthy and low risk young into buying healthcare insurance from the government health insurance exchanges.

Many cities, towns and stats have underfunded healthcare coverage commitments. These local commitments include retirees. These cities, towns and states can now dump these consumers into Medicare and the health insurances exchanges.

In addition, there are many people who have chronic illnesses who have been afraid to leave their jobs because they could not get healthcare insurance in the individual market in the past.

These patients can now obtain insurance in the health exchanges at the same cost as everyone else. This will further contaminate the risk pool and increase the health insurance exchange premiums.

The Obama administration figures all taxpayers will cover the added costs. Taxpayers will bail out insurance companies for the poor risk pools that are decreasing their profits.

It looks like the real purpose of Obamacare is to destroy the relationship between the employer and his employee by driving employees into the health insurance exchanges just as it has destroyed the relationship between the consumers and their physicians.

President Obama understood this as the bill was written.  

Small employers are dumping employees from their healthcare insurance plans into the individual market and the health insurance exchanges.

In 2015 group employer insurance will affect an estimated 80 million people. They will loss their insurance and be forced into the health insurance exchanges.

The insurance industry will quit providing insurance and President Obama’s plan  to have a single party payer will occur by default. 

Taxpayer will pay the difference through higher taxes. In the meanwhile nothing has been done in making healthcare premiums more affordable, access to care more available, quality of care better or preventing the rationing of care by a government body.

Consumers will not stand for government control over their healthcare decisions.

There is a better and cheaper way. It is to put the consumer in charge, not the government.

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

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Where’s The Money Going To Come From?

Stanley Feld M.D.,FACP,MACE

Where is the money coming from to pay for Obamacare? Enrollment has been terrible from October 1st 2013 to December 31st 2013. 

The Obama administration has been bragging that 2.1 million consumers who have signed up for Obamacare.

The Obama administration originally estimated Obamacare needed 7.2 million consumers to sign up on the health insurance exchanges to make Obamacare viable. Of the 7.2 million people, the administration needs at least 2.7 million people to be young and healthy 18-34 year olds. These young, healthy people are needed to pay for the sicker, older people who are likely to use the healthcare dollars.

I believe 7.2 million is a low estimate of the necessary participants to make Obamacare viable. 

As a result of Obamacare, employers have been converting many employees to part time workers. The employers’ goal is to avoid paying for healthcare insurance while avoiding Obamacare penalties. This has resulted in an undisclosed number of uninsured people.

The cancelation of 6.5 million healthcare policies in the individual marketplace due to non-compliant Obamacare mandated coverage will further increase the number of uninsured.

The Obama administration has spun the numbers to look favorable even though they are terrible.

Kathleen Sebelius released the Obamacare participation numbers for the first two month last week.

 “Key findings from today’s report include:

  • Nearly 2.2 million (2,153,421) people selected Marketplace plans from Oct. 1 through Dec. 28, 2013
  • These signups in the state and federal marketplaces represent a nearly five-fold increase from October-November, including nearly 1.8 million (1,788,739) people who selected a plan in December (compared with the previous two-month cumulative total of 364,682 through Nov. 30, 2013).
  • Of the almost 2.2. million:
    • 54 percent are female and 46 percent are male;
    • 30 percent are age 34 and under;
    • 24 percent are between the ages of 18 and 34, and;
    • 60 percent selected a Silver plan, while 20 percent selected a Bronze plan; and
    • 79 percent selected a plan with Financial Assistance.”
  • Today’s report also details state-by-state information where available.  In some cases, only partial datasets were available for state marketplaces. 
  • The report features cumulative data for the three-month period because some people apply, shop, and select a plan across monthly reporting periods.  Enrollment is measured as those who selected a plan.

To read the complete report visit:

There are several problems not emphasized by the report.

How many of the 2.1 million applied and were approved and receive insurance?

How many actually received an insurance card?

How many paid the first month’s premium?

How many applying for insurance lost their insurance as a result of the Obamacare change in insurance requirements?

How many of these people have a pre-existing illness and are an expensive health risk?

What is the average amount of financial assistance the 79% will receive?

The young healthy people have not applied because most are facing at least a 50% increase in the cost of insurance premiums along with higher deductibles.

They feel they are being ripped off by Obamacare and refuse to join. Many simply cannot afford it.

No group has been hit as hard by the Obama economy and Obamacare as America’s young people. After seeing massive premium increases and failed bureaucracy in the Obama administration, it’s no wonder they are staying away,” said Don Stewart, a spokesman for Senate Minority Leader Mitch McConnell.

House Speaker John Boehner’s office said the figures prove the health law has been “a bust so far.” “When they see that Obamacare offers high costs for limited access to doctors — if the enrollment goes through at all — it’s no surprise that young people aren’t rushing to sign up,” said Boehner spokesman Brendan Buck.

 How many have tried to apply for healthcare insurance only to have their application kicked back without explanation?

Moises is a case in point. He is a U.S. citizen with a wife and two kids. His kids have SCHIP. He and his wife do not have Medicaid or other insurance.

I volunteered to fill out his application for him. He said he did not want to bother me. He has a friend who knows someone who will complete the application for free.

He friend works for an insurance company. The company has navigators that will complete the application for free for him.

It took 3 weeks to complete the application. How many hours was the government billed to complete his application at $48 an hour?

The October 31st deadline passed for Moises and his wife to have insurance November 1St.

He and his wife contracted what sounded like a viral illness on October 30th. They went to the doctor on November 2nd. They had some lab tests done and were given a “real expensive antibiotic.”

The encounter cost him $200 that he could not afford. I would guess the same transaction would have cost the insurance company $50.

The navigator promised him she would have the application in by November 15th so that he would have insurance on December 1st. On November 21st the application has yet to be accepted by

There has been no explanation by the navigator as to why his application did not go through. He has called the navigator at least 15 times. She says she will keep trying.How many more people has this happened to as they have tried to apply for Obamacare? 

Last week the Washington Examiner said that the IRS has started bullying young people to sign up.

President Obama is in the midst of multimillion dollar spending public relations campaign to convince young people to sign up for Obamacare.

This bizarre commercial to "Get Covered" by Obamacare received 72,000 hits on You Tube. How many of those 72,000 applied for Obamacare? We will never know.

 Other “Get Covered” bizarre commercials can be seen at the completion of the above video.

 Is this a good use of taxpayers’ dollars?

 President Obama is spending money like a “drunken sailor.”

 After receiving the Obama administration’s original numbers, the CBO’s estimate predicted Obamacare would save $114 billion dollars over the next 10 years.

In May 2013 the CBO revised its estimate of the Obamacare costs. The graph below shows that Obamacare will cost over $140 billion dollars per year over the next 10 years. The net budgetary impact will be $1.4 trillion dollars. The deficit represents an increase more than $1.54 trillion dollars over the cost savings of  $114 billion dollars in the original estimate.

  Cbo budget projections

This estimate is not even close to what the eventual net budgetary impact will be.

The real cost will skyrocket because of all the defects in the law, terrible implementation of the law, the fraud and abuse that will occur because of implementation of the law and the entire skewed enrollment that is going to take place.

America ought to face reality and ignore President Obama’s rhetoric now before disaster occurs and America is bankrupt.

Americans should insist that Obamacare be repealed now before it is too late!

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

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Beware Of Disinformation and Punishment

Stanley Feld M.D., FACP, MACE

The gigantic error President Obama is making is trying to force Americans to do something they do not want to do.

It took a little while for Americans to realize the trap they were getting themselves into by supporting Obamacare.

Now that 2014 has arrived Americans are feeling the punitive effects of Obamacare. The consumer outrage is beginning.

We must realize that the healthcare system was unsustainable before Obamacare was passed. Having Obamacare passed by a totally partisan vote by a left leaning Democrats and left leaning President was another mistake.

Obamacare has accelerated the unsustainability of the current healthcare system.

Group and individual insurance policies have skyrocketed in price. Healthcare insurance deductibles have also increased.

Consumers of medical care previously covered by their company’s healthcare plan have had their work hours reduced to less than 30 hours so their company can discontinue their healthcare insurance coverage and avoid government penalty.

The majority of people were not aware of the 10 hidden taxes collected since 2009 for Obamacare.

Since the disaster of the website rollout more people are becoming aware of the potential impending disaster of Obamacare.

In addition to the 48 million people who were uninsured pre Obamacare at least 6.5 million have lost their insurance in the individual insurance market.

President Obama has provided waivers for the group healthcare insurance market for a year. This was done to avoid a much bigger public outcry for the lose of healthcare insurance they liked than what has resulted from the 6.5 million people that lost their healthcare insurance in the individual market.

The Obama administration is spending $600 million dollars to try to convince millions of uninterested and reluctant 18 to 35 year olds to buy healthcare insurance from the Obamacare health insurance exchanges.

So far less the government reports that only 24% of the risk pool population are healthy young people. This is well below the 40% that are needed to pay for the sick and elderly that have already applied. The young are suppose to pay for the older sick patients.

“The heart of Obamacare is coercion. If Americans fail do what the law's Democratic authors believe is best, the federal government will punish them, through the progressively higher penalties of the individual mandate, until it hurts more not to buy coverage than it does to give up and purchase it.”

Incentives work! Punishment does not!

It looks as if these young Americans are rebelling. They mistrust the government and feel they are being used. They feel they are being misled into buying healthcare insurance that might not meet their needs even if the government is telling them it does meet their needs.

What if they continue to refuse to buy the insurance the government is trying to force them to buy at prices they do not want or cannot afford to pay?

Obamacare has a mandate provision. The Obama administration still calls it a mandate even though the Supreme Court called it a penalty tax.

The Obama administration also calls it by a nicer name. It is called The Shared Responsibility Provision.”

Everyone believes a mandate is a mandate.

 Bob Laszewski, a respected health care analyst said it.

 "How the hell are you going to enforce a mandate to buy something that people don't think is valuable enough to buy? If the uninsured don't start to see value in Obamacare and buy it, is the Democratic solution to fine the heck out of them until it hurts so much they have to buy it? That is great political strategy!"

The mandate, penalty, tax in the first year is meaningless. It is $95. Neither President Obama nor the traditional media have emphasized the more significant part of the penalty. The actual penalty is $95 dollars or 1% of the mean adjusted income whichever is greater.

The mean adjusted income includes capital gains, dividends, interest and royalties. A young healthy person making $50,000 would be penalized $500 dollars the first year, $1,000 the second year and $1,250 the third year. If they had income from inheritance or other sources the penalty would be higher.

“Your tax penalty (shared responsibility fee) for not having insurance is paid on your taxes at the end of the year. If your taxable income is below 133% of the FPL you are exempt from this tax.”

2014 = $95 per person per year or 1% of your Income
2015 = $325 per person per year or 2% of your Income
2016 = $695 per person per year or 2.5% of your Income
2017 = Tax Penalty will increase by the rate of inflation going forward, or 2.5% of your Income

• The penalty is based on modified adjusted gross income.

• The total penalty for the taxable year cannot exceed the national average of the annual premiums of a bronze-level health insurance plan offered through the health insurance marketplaces.

How is the government going to collect the penalty? The present plan is for the IRS to deduct the money from a tax refund. 

Democrats in Congress who passed the bill feared public reaction and political fallout to forcing Americans to write a check to the government to cover the penalty. Therefore this method of collection by the IRS is barred.

If the penalized person is not due a refund the IRS has no legal way of collecting the money.

 Obamacare has some good ideas that need to be incorporated into the healthcare system. However their format and implementation are horrible.

The goal of Obamacare is central government control and implementation of the healthcare system.

Community organizers, lawmakers, and bureaucrats designed the bill. The ideology was socialistic. The designers do not believe in the free market. They were influenced and manipulation of lobbyists.

Obamacare is not consumer driven healthcare system law.

If Obamacare had been designed by businesspeople, it might have had many more features that appeal to customers.

Bon Laszewski said "The problem with Obamacare is it’s product driven and not market driven,".

 "They didn’t ask the customer what they wanted. And I think that’s the fundamental problem with Obamacare.

It meets the needs of very poor people because you’re giving them health insurance for free. But it doesn’t really meet the needs of healthy people and middle-class people."

I believe it could have been designed to be cheaper and more effective to meet the needs of the poor people without destroying the ability to meet the needs of the middle class.

A government can try to force people to do buy something they do not want. However, throughout history this method has not worked.

Should Americans continue to travel down the proven path of failure at great financial, economic and political cost?

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

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What President Obama Forgot To Tell US

 Stanley Feld M.D.,FACP, MACE

Nancy Pelosi was correct. The only way we are going to know what is in the Affordable Care Act is to pass the bill.

The weeks before January 1st when the web site was going so poorly we heard a lot about the healthcare insurance companies taking a bath on Obamacare because of the skewed enrollment.

Only the sick and elderly were buying healthcare insurance from the health insurance exchanges. Young people were needed to buy insurance in order to keep Obamacare from the “death spiral.”

The sick and elderly were more likely to be hospitalized and run up a big hospital bill. The high bills would eat into the insurance companies profits. Young people were needed to stabilize the risk pool or insurance premiums would sky rocket because insurance company profits would fall. Insurance companies could go bankrupt.

The government’s expressed fear is the healthcare insurance industry would not participate in the health insurance exchanges.

President Obama offered to bail out the healthcare insurance companies if this was to occur.

This was another of President Obama’s deception.

It is similar to the deception “If you like your insurance you can keep it. If you like you doctor you can keep him/her.”

Last week we learned that the insurance company bailout was built into the original bill passed in 2010. The President knew about this bailout before Obamacare was passed.

Did the congressional members who passed the bill know about the built in bailout?

If they did they should all be voted out of office. If the Democrats needed to pass Obamacare did not know about the bailout they should have and they should all be voted out.

It should be recalled that this was a Democrat controlled House and Senate. There was not a single Republican vote included in the passage of Obamacare.

The American people did not know about the built in bailout at taxpayers’ expense.

Obamacare contains a "Reinsurance Program that caps big claim costs for insurers (individual plans only)." Robert Laszewski, a prominent consultant to health insurance companies, writes that in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government [read: by taxpayers], for example." 

Private insurance plans bought through the health insurance exchanges are not private health insurance plans. They are plans that are subsidized by the government if the insurance bill goes over $45,000.

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

 Who makes the profit from this subsidy?

 The healthcare insurance industry makes the profit because the insurance policies have been priced at high risk (Increased deductibles, and increased premiums for consumers not eligible for government subsidies).

 "The reinsurance program has done and will continue to do what it was intended to do; help attract and keep more carriers in Obamacare than might have otherwise come."  Thus, Obamacare is being aided by having taxpayers subsidize big insurance companies' business expenses.”

Obamacare also provides the healthcare industry a greater subsidy. It is called the Risk Corridor Program”. The “Risk Corridor Program” limits the overall losses of the healthcare insurance industry to 2.4%.

This is the way the “Risk Corridor Program” works. The healthcare insurance company submits its expected costs to the government for a particular year.

If the expected costs of the insurance exceed 102%, the government will pay the healthcare insurance company 80% of the difference above 102% at taxpayers’ expense.

 Taxpayers' are unwitting generosity toward these "participating health plans" (plans sold through Obamacare's government-run exchanges):

 "[I]f the health plan has costs at 110% of the medical cost target [the costs that the insurer expects to accrue], it will be responsible for only 102.4% of the target (a 2.4% shortfall)-only about a quarter of its losses.”

There is little risk to the healthcare insurance company for being involved in the healthcare insurance exchanges.

The key point is President Obama had this written into Obamacare without telling taxpayers about it. I wonder if the CBO knew about it and calculated it into the original cost estimates of Obamacare.

“In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine ("single payer") that liberals drool about in their sleep.”

The problems with a government controlled single party payer system are multiple. I have enumerated them in the passed.

I will summarize the problems:

1.Consumers are dependent on the government to make their healthcare and medical care decisions.

 2. A single party payer system does not encourage consumers to be responsible for their health, healthcare dollars or medical care.

3. The inevitable cost overruns will result from government bureaucracy, regulations and inefficiencies.

4. The occurrence of fraud and abuse is inevitable. We have seen some fraud and abuse already.

Navigators are paid $48 an hour to help the poor enroll in Obamacare. One reader told me about a case were the navigator had to apply four times before the application was accepted without any errors.

This is only the first step in obtaining healthcare eligibility and then healthcare insurance.

4.  Government will be forced to limit access to care and ration care in order to keep the direct medical care costs down.

 5. All the secondary stakeholder costs are escalating as physician reimbursement is decreasing.

 6. Most importantly freedoms to choose your physician, your insurance and your treatment are being compromised at the expense of all taxpayers.

Something is very wrong with this plan.

This is all going to be done slowly so we do not notice.

America has been deceived. We are already feeling the effects of the deceptions.

There is more to come.

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

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  • Ryan

    You describe this thing very well . Now elections are coming on . Hope new govt do something in this case.

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President Obama Got The Subject Changed

Stanley Feld M.D.,FACP, MACE

I do not know if anyone has noticed that Obamacare has not been discussed in the mainstream media since January 1st.

Obamacare affects consumers negatively. The anger and resistance will not go away by changing the subject.

Obamacare's problems remain.

Many physicians are running for the exits.

Many insurance companies are trying to figure out their next step. Many hospital systems have not been successful in developing of their accountable care organizations.

Hospital systems have not developed functionally adequate electronic medical records.

Hospital systems have not adjusted to the ICM-10 coding system.

There are still delays in signing up for healthcare insurance on the health exchanges.

People do not know if their applications have been accepted and they actually have insurance.   

The minimal numbers of applicants and consumers who actually received insurance is not clear.

The level of mistrust by consumers for the Obama administration continues to escalate.

It is interesting to note the scarcity of articles published about the healthcare system since January 1st.

The mainstream media is not reflecting the chaos created by Obamacare on the healthcare system.

No matter what the Obama administration does to distract people from healthcare it will remain a main issue. Obamacare is not an abstraction any more. It is an unpleasant reality that is affecting consumers directly. It is having a widespread negative effect on healthcare and medical care delivery. Obamacare is also having a negative affect on economic growth and stability.

Headlines about Obamacare are few and far between. Below are some of the few topics published.

New Health Law Frustrates Many in Middle Class

The cheapest insurance plan they can find through the new federal marketplace in New Hampshire will cost their family of four about $1,000 a month, 12 percent of their annual income of around $100,000 and more than they have ever paid before.

Even more striking, for the Chapman’s, is this fact: If they made just a few thousand dollars less a year — below $94,200 — their costs would be cut in half, because a family like theirs could qualify for federal subsidies.

The Chapman’s are caught in the uncomfortable middle: not poor enough for help, but not rich enough to be indifferent to cost.

Most healthcare experts consider health insurance unaffordable if premiums exceed 10 percent of annual income. Lower income families not qualified for Medicaid (>$21,000 per year) have to pay 10% of their income for subsidized healthcare insurance. This amount could be unaffordable to them.

Obamacare is only affordable for the very poor.

More trouble for CGI, Obamacare website designer

CGI Group is being denied payment by Massachusetts and Vermont as a result of dysfunctional state exchange websites that have yet to be fixed.

Massachusetts (Romneycare) is supposed to be doing great according to the traditional media.  Why is Massachusetts switching to Obamacare?

The state is probably getting a bigger subsidy from the federal government by being under federal control. Federal control doesn’t seem to trouble the government officials in Massachusetts.

I was under the impression the Massachusetts web site was working splendidly. The CGI contract for Massachusetts and Vermont cost $69 million dollars.

 Obamacare Contractor Blamed for Slow Medicare Payments to Hospitals

In an attempt to make as much money as possible the outsourced administrative services providers are holding onto money as long as possible.

The report appeared only on a local TV station in Houston, Texas. I suspect it is happening all over the country.

“The contractor building the financial management system for is being blamed by a Houston hospital for delayed Medicare reimbursements that have caused the hospital to miss payrolls for weeks."

" Novitas Solutions is the federal government's new Medicare payment processor for the south-central region of the country hired by the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS.)  ABC-KTRK in Houston reports:"

"According to the CEO Jason Leday, more than 150 employees haven't been paid in nearly a month."

"I understand that they have children and a house payment, bills. Not getting paid is wow," nearby resident Theresa Gutierrez said.” 

 The public can only know about these occurrences, if the mainstream media reports it.

Insurance Customers Still Having Problems With MNsure

A local Minneapolis TV station had this story.

"As the New Year began at midnight, so did benefits for thousands of Minnesotans who signed up for MNsure.

It left some people unsure if they completed the process in time. MNsure has had several problems with it’s website from the start this fall.

Late last week, 50,000 people had completed applications to buy private health plans but hadn’t completed enrollment because of website problems or if they just didn’t continue on in the process. Close to 20,000 people had completed enrollment as of Dec. 27, 2013."

This is not a very good showing for Minnesotans. We were told the state exchanges were doing great.

The Obama administration has not verified any actual enrollment in insurance coverage to date. We have been told that things are looking good.

Lousy results are portrayed as good results.

It’s official: Obamacare debuts with more canceled plans than enrollments

Obamacare may have promised health insurance for the masses. But on its first day, it’s left more Americans without coverage than before the law was passed.

More than 4.7 million Americans had their health insurance canceled as a result of any of the thousand-plus-page law’s new rules, The Associated Press reports, but the Department of Health and Human Services (HHS) confirmed Tuesday that between federal and state exchanges, just two million Americans have signed up for Obamacare coverage. 

 'They had no idea if my insurance was active or not!'

"Obamacare confusion reigns as frustrated patients walk out of hospitals without treatment."

The Mail Online published this story for the American public. It did not appear in the American traditional main media.

 MailOnline spoke with patients who were told they would have to pay their bills in full if they couldn't prove they had insurance

  • One was faced with a $3,000 hospital room charge and opted to leave the hospital after experiencing chest pains
  • 'Should I be in the hospital? Probably,' she said
  • Another, coughing in the cold, walked out without receiving a needed chest x-ray
  • Consumers face sticker-shock from medical costs under the new Obamacare system, made worse if they can't prove they're insured
  • As many as one-third of new enrollees' applications have seen problems when the government transmits them to insurance companies

The group market, the union insurance market, Medicare, the low paid wagers market (MacDonald’s and other fast food chain market) all received waivers from Obamacare for one year. Only the individual healthcare market was not exempt from Obamacare.

The recent Obamacare headlines have not been popularized. Most Americans can conclude that nothing in healthcare has changed.

Americans should be made aware of the things going on in healthcare under Obamacare. They will be shortly. Obamacare is going to affect all Americans directly.

Obamacare is only affecting 5% of the population today. However the public needs to be made aware of what is going to happen to everyone because his or her waivers will expire shortly.

The Obama administration has not been transparent about anything including costs and cost overruns.

The lack of transparency has made everyone suspicious and mistrustful of President Obama and his administration.

It is going to be a rocky year for both healthcare and medical care.

Obamacare is facing headwinds that the Obama administration will not be able to hide from the public.

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

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What Is It All About?

Stanley Feld M.D.,FACP,MACE

It is all about concentrating control over the healthcare system in the federal government. It is about increasing profits of the healthcare insurance industry. It is about decreasing consumers’ freedom to choose a physician. It is about inhibiting physicians’ freedom to use clinical judgment. 

It is designed to happen slowly and insidiously. The trick is to increase control and decrease freedom so that it is not noticed until after it has happened.

Obamacare will not collapse in the next day or two. It will take months to a few years before the major stakeholders (consumers/patients) realize what has happened to our healthcare system.

Only when every consumer is affected will there be a unified public community outcry to repeal Obamacare.  

It might be too late at that time. All the stakeholders will have adjusted to the new but unsuccessful healthcare system at the taxpayers’ expense.

Socialized medicine has not been cost effective anywhere in the free world.

Eighty percent of the people are not sick at any one time. The healthy think the socialized healthcare system in their society is fine until they get sick.

Most people do not realize that the bureaucratic costs and inefficiency in a socialized medicine system consume a high percentage of the GNP.

 Americans would not tolerate 50% of the GNP going to the healthcare system. Especially when the quality of care and access to care has diminished along with the rationing of care.

Medical care is personal. Commoditization of medical care is not personal. When consumers realize they do not have the freedom to choose there will be a reaction.

President Obama’s public relations machine is pumping out deceptions and half-truths right and left about the success of the web site in December without producing any facts except the number of people who visited the site. The implication is these consumers have signed up and received healthcare insurance.

The defects in the implementation are too numerous to count.  The New York Times is not deterred. It is regurgitating the Obama administrations press releases. The administration admits the rollout has had a lot of glitches. However, the administration as well as the New York Times has said that over time all Americans will all be happy with the results of Obamacare.

The mainstream media is spinning President Obama’s story.

Eugene Robinson of the Washington Post started off the New Year with the following statement.

“Now that the fight over ObamaCare is history, perhaps everyone can finally focus on making the program work the way it was designed. Or, preferably, better.”

It is no longer a matter of logic. It is no longer a question of what will work or what will not work. Obamacare is the law of the land. Therefore it is best to shut up and live with it.

No one is talking about Obamacare defects or its inevitable failure.

The fight is history, you realize. Done. Finito. Yesterday's news.

Any existential threat to the Affordable Care Act ended with the popping of champagne corks as the New Year arrived.

 “That was when an estimated 6 million uninsured Americans received coverage through expanded Medicaid eligibility or the federal and state health insurance exchanges.”

“ObamaCare is now a fait accompli; nobody is going to take this coverage away from the millions of uninsured”

 Let us keep half-truths in perspective. Where did Eugene Robinson get the fact that 6 million people got insurance coverage on the health insurance exchanges?

Over 6.5 million people lost their healthcare insurance already under Obamacare and 48 million people were said to be uninsured before Obamacare. President Obama promised that 30 million new people would receive insurance under Obamacare.

These calculations should give most thinking people a headache.

Carl Sandburg, in the Prairie Years ,said that a liar has to have a good memory. However, if you tell enough lies and cover them with enough distractions the audience experiences information overload and doesn’t remember the lies.

It seems to me that Obamacare does not solve any of the problems in the healthcare system.

It is going to make the healthcare insurance industry richer, the pharmaceutical industry richer and the middle class poorer as coverage is reduced, deductibles are increased, access to care is reduced and rationing of care is increased.

Access to medical care should be universal.

Obamacare changes the entire healthcare system. It permits 20% of the population to have access to healthcare insurance while destroying the present healthcare coverage system for 80% of the population. Most of that 80% claim they liked their insurance and their doctor.

President Obama lied to them when he told them they could keep their insurance and their doctor. He is now telling them Obamacare is for their own good.

Why should the government decide on our healthcare coverage?

Healthcare insurance never made people healthy. People help themselves stay healthy.

The main issue is the present healthcare system is unsustainable.

Medicare and Medicaid are unsustainable.

The private employer sponsored healthcare system is unsustainable.

The Veterans Administration healthcare system is unsustainable.

The present and impending failures of Obamacare are unsustainable.   

What can America do?

The consumer’s responsibility is missing from the entire discussion. How do you create a system that lets consumers be responsible for their health and healthcare?

How do consumers stop healthcare insurance executives from making obscene salaries and drug companies obscene profits?

It is by consumers not buying their products.

There must be total transparency of healthcare products available to consumers. Consumers must be educated to evaluate these products. Only then can consumers choose the best healthcare and medical care value for them.

There must also be a financial incentive for consumers to be responsible for their own healthcare and medical care decisions.  

It is not by imposing an ideology that promotes central government control of the healthcare system.

It is not by creating more entitlements

Government bureaucracy is inefficient. It does not help the masses. It helps insiders. It leads to cost overruns.

 It stifles innovations.

 It is not by imposing a system of redistribution of wealth that is going to fix the healthcare system.

Politicians are forced to disguise the redistribution of wealth because it threatens their re-election prospects.  

Our elected officials passed the 10 hidden taxes that have been in force for four years going on five to finance Obamacare before it is fully implemented.

The costs of these taxes have been passed on to consumers. The majority of consumers are in the middle class. They are paying for these taxes indirectly.

In reality President Obama is taxing the working middle class and lower class as well as people making over $250,000 a year. Despite these increased in taxes Obamacare still in for more cost overruns.

The taxpayers’ problem is the administration is unwilling to reveal these cost overruns.

President Obama recently promised to bail out the healthcare insurance industry if they lose money on Obamacare.

This promise is almost as upsetting as providing a waiver to Congress from Obamacare.

Government’s role is to educate consumers.

It is not to create increasing entitlements to have more and more central control over the population.

Entitlements do not work!

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

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  • Richard A Dickey,MD

    I agree with your assertion that the greed of the insurance and drug industry leaders are wrong and that Obama and Congress accepted feeding that greed to get the ACA passed. It is time to correct that but, on the whole, I support the ACA. Here is my recently submitted letter to the Editor of the NC Med Journal about this:
    To the Editor — The November/December NCMJ’s letter to the Editor, ‘Health Care Costs Must Come Down’ by Ron Howrigen, president of Fulcrum Strategies, Raleigh, NC, demands a response. This is mine.
    I heartily agree with the author that Health care costs must come down. This is inarguable and, in spite of the author’s pessimism, I note that the rate of rise of health care costs has already moderated since the Affordable Care Act ( ACA) was passed, even though it will cause a rise (estimated at 6%) as the millions of uninsured (at least double the 6%) are extended coverage by the ACA as it is fully implemented. However, the author totally avoided discussion of the ethical and moral issues the ACA sought to address, particularly the American public’s right to access and coverage of good health care. It has been our obligation, as fellow members of a wealthy nation, to provide that coverage after having failed to address it for over fifty years. Notably, the author, a consultant to physicians, is certainly not a disinterested party in the health care system and therefore his denial of any conflict of interest is hardly forthright. He actually admits his conflict in his statement of his ‘biggest concern,’ i.e. that the ACA will try to control costs by drastically reducing reimbursement to physicians. He and we must realize that our health care system is rapidly evolving to become not nearly as dependent on the physician as it has been in the past.
    When the ACA was being considered by the Congress, those whose corporate bottom lines might be significantly impacted by it and the lobbyists who represent those interests read and studied the ACA carefully. I too read it, all of it. Yet few physicians or patients to whom I spoke had actually read even a small portion of the ACA. As I discussed it with others, I shared my excitement about the significant amount of the ACA which was directed to research ways to assess and improve medical care and coverage. I believe these aspects of the ACA had been included with the expectation that, someday, the findings of the research funded by the ACA could and would be used to improve health care and save money through the implementation of evidence-based practices and payment policies identified by that research. I am not unaware of the considerable compromises and gifts our elected officials in Washington, including our President, had to accept to get the ACA through Congress. I hoped that, over time, the positive effects and benefits of the ACA, such as the coverage of the nearly 50 million Americans without insurance and the removal of the pre-existing condition clauses, would be appreciated by most Americans. While I was disappointed especially in the failure of our President to be successful in his quest to avoid many of those concessions in the final ACA, I hoped those gifts to some corporate interests, including hospital, insurance, and pharmaceutical businesses, could be ameliorated or even reversed with time.
    While I am dismayed by the unrelenting efforts in Congress to undo or limit funds for the ACA, the deficiencies of which are remediable, I remain excited about the good things which have already come and will be coming from this act, one of the most courageous, morally right steps our nation has ever taken.
    Richard A Dickey, MD, FACP, FACE
    Retired endocrinologist
    51 Players Ridge Road
    Hickory, North Carolina 28601-8839
    (828) 495-1230

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We Ain’t Seen Nothing Yet!

Stanley Feld M.D.,FACP,MACE


Have a Happy and Healthy New Year Everyone!

I have received many incredible examples about the effect Obamacare has had on the loss of insurance and the increased cost of insurance through Obamacare’s health insurance exchanges.

President Obama has changed the Obamacare law ad lib for everyone except the 14 million people in the individual healthcare insurance market. He has granted waivers to favorites including the unions and the congress. He has delayed the employer mandate without congressional approval.

This was smart. Maintaining the employer mandate would have affected at least 100,000 families. Everyone would have lost their insurance at once.  

The outrage would have been intolerable.

America will wake up one day with a completely unaffordable healthcare system, with rationing of care and long delays in access to care.

This is reality and not naysayer talk. There are so many things wrong with Obamacare that Max Bacchus’s train wreck will be a reality before we know it.

PolitiFact called “If you like your health-care plan, you can keep it.” the lie of the year.

Obamacare was supposed to be a refinement to the current healthcare system minus its waste and inefficiency.

It was going to increase access to healthcare care and make medical care affordable for all. It was going to force the healthcare insurance industry to provide affordable insurance.

It has already made insurance unaffordable to those middle class families who do not qualify for subsidies.

The "sticker shock" that many buyers of new, ACA-compliant health plans have experienced—with premiums 30% higher, or more, than their previous coverage—has only begun.

The costs borne by individuals will be even more obvious next year as more people start having to pay higher deductibles and copays.

President Obama promised that the Affordable Care Act was not going to cost the federal government a dime.

It was going to decrease the federal deficit over ten years by over 1 trillion dollar.

The current CBO estimate is that it will increase the deficit by over 1 trillion dollars. The Affordable Care Act was misnamed. It should be the Unaffordable Care Act.

Obamacare was force down the throat of the American public by the Democratic majorities in both houses of congress. It did not get one Republican vote. Most of the Democrats have admitted they did not read the bill in its entirety.

Nancy Pelosi told America “we have to pass the bill to know what is in it.”

It is now obvious that President Obama was able to pass the bill by feeding everyone a pack of deceptions about the bill and its implications.

It was a magnificent con job.

The deceptions once discovered must not be tolerated by our congressional representatives and senators.

Government is supposed to be by the people, for the people. Consumers did not pay attention to the defects in Obamacare until it started to affect them directly.  

The mainstream media has been sympathetic to President Obama’s lies and deceptions. Now the people are discovering the deceptions and the media is starting to report them.

Now that over 6 million people have lost their insurance coverage, and premiums have skyrocketed Obamacare is affecting the consumers who make under $250,000 a year.

Obamacare has affected consumers financially. There have been significant Obamacare hidden taxes for four years. Obamacare officially starts January 1,2014.

President Obama or his administration has lost the public’s trust because of all the lies and deceptions.

My guess is the media does not know of all the lies and deceptions. The media also does not understand all the defects in Obamacare.

The Obama administration launched a $685 million dollar public relations campaign to disguise the impending Obamacare disaster.

The disastrous website ( is only the tip of the iceberg.

The web site is incomplete and not secure. It was written using obsolete code at a cost of $650 million dollars. The $650 million dollars is $649 million dollars over what it should have cost according to some sources.

 There remains much work to be done before it is fully functional.

The healthcare insurance industry is becoming fed up with all the constant changes in the rules the Obama administration is making.

 The healthcare insurance premiums on the health insurance exchanges are higher than last year’s commercial insurance. The patient deductibles for these policies put them out of affordable range for the middle class.

It will be a fair deal for consumers with families who earn up to $49,000 per year. This group will qualify for various levels of subsidy. It is a terrible deal for everyone making $50,000 to $250,000 dollars a year.

The 6 million people losing their insurance coverage started American’s wake up call. 

President Obama said their healthcare insurance coverage was defective and inadequate.

 The subtext is the government will decide what you need.

Those who expect better days ahead for the Affordable Care Act are in for a rude awakening. The shocks—economic and political—will get much worse next year and beyond.

In 2014, millions must choose among unfamiliar physicians and hospitals, or paying more for preferred providers who are not part of their insurance network. Some health outcomes will deteriorate from a less familiar doctor-patient relationship.

Those who expected better and more affordable medical care with the government as single party payer will experience tax increases both obvious and disguised and worse medical care.

 The government does not know how to run things efficiently.

The other defects in Obamacare that will shock the nation and hurt all consumers in the near future will be;

  1. The lack of functional electronic medical records and transportability of patient medical information.
  2. Increased paralyzing and incomprehensible regulations for physicians and hospitals leading to patient care delays.
  3. The lack of development of Accountable Care Organizations for integrated care with penalty. ACO’s were suppose to save money but are failing.
  4. The inability of Obamacare to facilitate timely and cost effective medical care.
  5. The decrease in physician practitioners signing up to accept Obamacare leading to an increased physician shortage and decrease in consumers’ access to care.
  6. The lack of tort reform will result in an increase in defensive medicine testing. Physicians and hospitals will refuse to participate in Obamacare. They will demand direct payment from the patients.
  7. The new ICM 10 coding system will drive physicians and hospital out of business and certainly out of participating in Obamacare.
  8. Lack of compelling chronic disease management initiatives will not increase quality of care or decrease the cost of care. The cost of treating chronic disease complications account for 80% of the cost of care.
  9. More Web Site and IT failures are likely. The application process is easier.The complex back-office side of the website—where the information in their application is checked against government databases to determine the premium subsidies and prices they will be charged, and where the applications are forwarded to insurance companies—is still under construction.
  10. Consumers will experience problems in eligibility, coverage, billing, claims, insurer payment and patient information-protection and security.
  11. Obamacare has taxpayer-funded "risk corridors." The risk corridors will bailout potential insurance company losses without bailing out consumers, physicians and hospitals. The bailout could result in an increase in taxes, collapse of the healthcare system, the medical care system and the economy.

The bailout will certainly result in a level of consumer anger worse that the anger caused by 5 million people losing their healthcare coverage.

 One hundred and eighty million people might loss their coverage within a year.

 Obamacare misses the entire point about the way to repair the healthcare system.

 The point is about giving consumers incentives to be responsible for themself and controlling their own healthcare decisions. Most consumers do not want to be dependent of the government.

Americans will take government handouts but as soon as they realize they are being dictated to and controlled by the government there will be a public outcry.

Consumers are much smarter than President Obama thinks.

Unfortunately there is much more money to be wasted and grief that the public is going to experience in the coming year. At that point America’s view of Obamacare will reach the boiling point.

Only then will we experience real healthcare reform.


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

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