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All items for February, 2014

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Why Use Facts and Logic?

 Stanley Feld M.D.,FACP,MACE

 I have previously pointed out the tactics used in Saul Alinsky’s Rules For Radicals.

 President Obama uses these tactics over and over again to attack his opponents, obfuscate reality and confuse the public.

The public has figured out President Obama out. Reality is now in healthcare and Americans are feeling it.

The middle class independents voters are feeling the most pain.

If someone points out the truth he is attacked, belittled and marginalized. President Obama is using executive powers to attack the constitution in order to restrict Americans’ rights to freedoms.

The most recent FCC foray to determine the quality of news reporting was cancelled immediately by the uproar about its attack on free speech.

President Obama has tried to shift public attention away from Obamacare by bringing up many topics at once.

The traditional media goes along with this because President Obama is the number one newsmaker. The media have only a limited time or space to cover topics.

Let’s face it. These important topics are not entertainment. They are boring.

A story that floored me was President Obama’s austerity claim. He said his new budget would finally end the dreary "era of austerity."

Did he think increasing Americans national debt $6 trillion dollars over 5 years was austere?

The federal government will still spend $561 billion more this year than it did in 2008.

I was under the impression that the Republicans took a shellacking from President Obama once again by the way the recent budget and debt ceiling resolutions were reported. The opposite is true.

President Obama wanted the sequester abolished, roughly $2 trillion more in spending, and almost $1 trillion in higher taxes over the next decade.

The latest budget deals delivered none of that. While the sequester was relaxed, all the additional spending was offset with no higher taxes.

Speaker Boehner did not do so bad.

 In 2014 President Obama’s take on the debt ceiling is extremely interesting.

 

 In the last few weeks President Obama has been telling his base over and over again that Obamacare is going to be a non-issue in the November 2014 elections. He told Bill O’Reilly in his Super Bowl interview that 6 million people have already received insurance.

 

http://youtu.be/9uzJYlbhH54

Both were lies. It doesn’t seem bother him to lie.

Dick Durbin, the second man in the senate, told a Sunday morning talk show that 10 million have signed up by end of January.  

On February 25th President Obama announced that 4 million have signed up. He did not say how many of those were on Medicaid, how many bought private insurance, how many lost their insurance because of Obamacare, how many bought private insurance on the health insurance exchange and how many never had healthcare insurance.

He has used the 6 million over and over again even though he received 4 Pinocchio’s from the Washington Post fact checker.

The traditional media just publishes what he tells them even though they have stories with facts that contradict his pronouncements.

President Obama has henchmen at the New York Times. Paul Krugman is the chief henchman.

He makes pronouncement without facts.

His February 23, 2014 article “Health Care Horror Hooey” is one of those articles. He starts by brow beating his audience about the death tax (Estate Tax).

“You might think that such heart-wrenching cases are actually quite rare, but you’d be wrong: they aren’t rare; they’re nonexistent. “

No evidence was presented for the statement.

In particular, nobody has ever come up with a real modern example of a family farm sold to meet estate taxes.

One reason is that there are few family farms in existence today.

The whole “death tax” campaign has rested on eliciting human sympathy for purely imaginary victims.

The problem in my view is people paying estate taxes are being taxed a second time on the same money.

I do not care how rich a person might be the government should not be entitled to tax money twice.

And now they’re trying a similar campaign against health reform.

This statement is nonsense

I’m not sure whether conservatives realize yet that their Plan A on health reform — wait for Obamacare’s inevitable collapse, and reap the political rewards — isn’t working.”

My sense is Paul Krugman views conservative as shiftless idiots. He presents no proof as to whether Obamacare is working or not. He simply declares Obamacare isn’t collapsing.

“But it isn’t. Enrollments have recovered strongly from the law’s disastrous start-up; in California, which had a working website from the beginning, enrollment has already exceeded first-year projections.”

Mr. Krugman ought to read his own newspaper. The New York Times reported that California does not have enough physicians participating in Covered California to service its subscribers. Many subscribers have not paid their first premium.

 The mix of people signed up so far is older than planners had hoped, but not enough so to cause big premium hikes, let alone the often-predicted “death spiral.”

There is absolutely no information about age mix and health risk available for Covered California that I could find.

It is clear the administration is withholding this information.

In fact, Covered California has had to close its website in order to try to cover the discrepancies.

Paul Krugman claims insurance premiums and deductible have not gone up. I think he ought to look at the health exchange insurance premiums and deductibles for the individual market on the health insurance exchange.

He does not talk about the reasons for all the waivers given by President Obama. He does not talk about the congressional exemption.

He does not speak about the exemption delay for the corporate insurance market. Why not?

Millions of families will lose their insurance coverage and be driven into the Obamacare health insurance exchanges or face government penalty.

The IRS sent out a warning this week that if person does not have adequate qualified healthcare insurance a penalty would be assessed on to their tax bill in 2015.

Paul Krugman is being intellectually dishonest with the American people. The American people are being forced into an entitlement program they do not want.                                                                                                                                                

This is not “Health Care Horror Hooey Mr. Krugman.  It is reality.                                                                                                                                                                                                                                                                                       At the time of Krugman’s article a CMS report was publish that found 65% of small businesses that offer insurance will likely see their premiums rise thanks to ObamaCare. That translates into higher insurance costs for 11 million workers.

“No doubt, Obamacare boosters will charge that this information is from some right wing think tank.      “                                                                                                                                                                                                                     

The Obama administration immediately started shouting foul to the CMS study. They said the study was incomplete and the conclusions will change.

This is a typical use of an Alinsky tactic by President Obama.

David Horowitz writes in his book Barack Obama’s Rules For Radicals, "There can be no conversation between the organizer and his opponents.  The latter must be depicted as being evil."

In this case his own CMS is depicted as being evil.

One study, for example, found that 63% of small employers in Wisconsin will see premiums jump 15% because of ObamaCare. A separate study found that 89% of small companies in Maine would see rate hikes of 12% on average.

Another, by consulting firm Oliver Wyman, concluded that ObamaCare would push up small group premiums nationwide 20%.

As soon as the CMS report came out, Democratic leaders rushed to the microphones to dismiss it.

House Minority Leader Nancy Pelosi's spokesman said it was "incomplete" and that the GOP would use the report "to mislead and deceive Americans."

President Obama, the American people got it. After all the lies, deceptions and misrepresentations we know what you are doing with your people and your shills.

 We do not trust you!

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

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“What’s So Great About America?”

Stanley Feld M.D.,FACP,MACE

Last week a reader sent me the link for the full debate between Dinesh D’Souza and Bill Ayers at Dartmouth College on January 30 2014.

Dinesh D’Souza wrote, directed and produced 2016:Obama’s America in 2012’

 It is based on D'Souza's book The Roots of Obama's Rage (2010). Through interviews and reenactments, the film compares the similarities of the lives of D'Souza and President Barack Obama as D'Souza presents his theory of how early influences on Obama are affecting the decisions he makes as president. http://en.wikipedia.org/wiki/Dinesh_D%27Souza

 

The film has grossed over $33.45 million in the United States, making it the fourth highest-grossing documentary (domestically) since 1982.

Those who didn’t see documentary can see it here for free.

https://archive.org/details/ObamaBiography

Recently Dinesh D’Souza has been the subject of a recent IRS probe.

I had read about the debate but never had the time to listen to Bill Ayers.   Bill Ayers is an American elementary education theorist and a former leader in the counterculture movement that opposed U.S. involvement in the Vietnam War.

He is known for his 1960s radical activism as well as his current work in education reform, curriculum, and instruction. In 1969 he co-founded the Weather Underground, a self-described communist revolutionary group that conducted a campaign of bombing public buildings (including police stations, the U.S. Capitol Building, and the Pentagon) during the 1960s and 1970s in response to U.S. involvement in the Vietnam War.

He is a retired professor in the College of Education at the University of Illinois at Chicago. President Obama worked with and for in the 1980s and 1990s as a community organizer. 

 A reader sent me a link to the debate last week and I watched it. It is a worthwhile use of your time.

http://www.realclearpolitics.com/video/2014/01/30/full_debate_dinesh_dsouza_vs_bill_ayers_at_dartmouth_college.html

Obamacare cannot work improve the healthcare system. After listening to Bill Ayers and rereading Saul Alinsky’s thoughts on how to create a socialist state President Obama’s only goal is to control healthcare. If you control healthcare you control the people.   

 According to Saul Alinsky there are 8 levels of control that must be obtained before you are able to create a socialist state.

"The first is the most important.

1) Healthcare — Control healthcare and you control the people

2) Poverty — Increase the Poverty level as high as possible, poor people are easier to control and will not fight back if you are providing everything for them to live.

3) Debt — Increase the debt to an unsustainable level. That way you are able to increase taxes, and this will produce more poverty.

4) Gun Control — Remove the ability to defend themselves from the Government. That way you are able to create a police state.

5) Welfare — Take control of every aspect of their lives (Food, Housing, and Income).

6) Education — Take control of what people read and listen to — take control of what children learn in school.

7) Religion — Remove the belief in the God from the Government and schools.

8) Class Warfare — Divide the people into the wealthy and the poor. This will cause more discontent and it will be easier to take (Tax) the wealthy with the support of the poor.'

 

Read more at http://www.snopes.com/politics/quotes/alinsky.asp#RGukF0aROOEmmdSO.99

 President Obama is using these tactics to control our country and drive it into being a socialist state.

President Obama combines these tactics with Alinsky’s rules for radicals.

Alinsky’s third rule is: “Wherever possible go outside the experience of the enemy.” Here you want to cause confusion, fear, and retreat. He did this to Mitt Romney during his re-elections. Mitt Romney’s people did not know how to handle it. 

The fourth rule is: “Make the enemy live up to their own book of rules. “ You are free to act as you wish.

You can kill your opponent with this, for they can no more obey their own rules than the Christian church can live up to Christianity.

The fifth rule: “Ridicule is man's most potent weapon.” It is almost impossible to counterattack ridicule. Also it infuriates the opposition, who then react to your advantage.

How many times have we seen the President and Vice-President try to ridicule their opponents? They use this rule often in domestic policy but are afraid to use it in foreign policy.

The eighth rule: “Keep the pressure on, “with different tactics and actions, and utilize all events of the period for your purpose.

Pick the target, freeze it, personalize it, and polarize it.”  Doesn’t this sound familiar?

The ninth rule: The threat is usually more terrifying than the thing itself.

 The eleventh rule : If you push a negative hard and deep enough it will break through into its counterside; this is based on the principle that every positive has its negative.

The twelfth rule: The price of a successful attack is a constructive alternative. You cannot risk being trapped by the enemy in his sudden agreement with your demand and saying "You're right — we don't know what to do about this issue. Now you tell us."

 If one studies the lies President Obama has told the public he has gotten trapped by his own pressure on his opponents and could not escape or change the subject.

I will have the most transparent administration in history.  It is not transparent at all.

TARP is to fund shovel-ready jobs. He finally had to admit the jobs were not shovel ready.

I am focused like a laser on creating jobs. Each month job growth was less which is the goal of a socialist society.

The IRS is not targeting anyone. Each cover up statement makes the lie worse.

If you like your healthcare plan, you can keep your healthcare plan, period. This was never the intent.

Benghazi was a spontaneous riot about a movie. Something very bad went wrong here.

If I had a son… T Martin. Stirring racism. It was a mistake.

I will put an end to the type of politics that "breeds division, conflict and cynicism". This was never the intention.

You didn't build that! This was an attempt to make Americans uncertain about their achievement and way of life. It failed and President Obama’s credibility shrank even further.

I will restore trust in Government. All the obvious deception during President Obama’s times President Obama contradicts this statement.

However a good offense is many times the best defense. He tried but failed. Attacking FOX News is was not a good strategy as his credibility waned.

The public will have 5 days to look at every bill that lands on my desk. He never kept his word.

It's not my red line — it is the world's red line. You cannot step away from your commitments when people are depending on you.

Whistle blowers will be protected in my administration. This is another lie and empty promise.

We got back every dime we used to rescue the banks and auto companies, with interest. This is an outright lie. He could not control the auditors. 

I am not spying on American citizens. This is a beauty!

ObamaCare will be good for America. It has been very bad for America. It is going to get worse because Americans do not trust President Obama anymore.

Premiums will be lowered by $2500. Premiums have increased and taxes have been increasing. It has cost Americans much more that the $2,500 they were suppose to save.

People making less than $250,000 a year will not pay one dime more in taxes. This is totally untrue as the middle class is learning..

If you like it, you can keep your current healthcare plan Lie of the year.

It's just like shopping at Amazon. President Obama should have tried himself. I did it and it was tedious. If Amazon was like it I would never use it.

I knew nothing about "Fast and Furious" gunrunning to Mexican drug cartels. You should have known everything. You are President. If you didn’t know about Fast and Furious you were not doing your job.

I knew nothing about IRS targeting conservative groups. You should know everything about IRS targeting. Who would make that decision.

I knew nothing about what happened in Benghazi. You should know everything about Benghazi. It was reported to you instantaneously acoording to you own defense department. None of this is very transparent.

 "I, Barrack Hussein Obama, pledge to preserve, protect and defend the Constitution of the United States of America."

In the light of Bill Ayers philosophy and in light of President Obama’s attacks on the constitution and the Bill of Rights, one could question if President Obama meant his pledge to preserve, protect and defend the Constitution of the United States of America.

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

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As President I Can Do Anything I Want To Do

Stanley Feld M.D.,FACP,MACE

The passage of time has a tendency to help us forget promises made with regard to principles and policies.

It is clear to me that one reason President Obama beat John McCain in 2008 was because he was going to go back to the principles of the constitution.

He taught constitutional law and professed to know how important the constitutional principles are to the laws of the land as well as our economic and political freedom.

John McCain represented the past. In the past America experienced a creep toward bigger and bigger government in order to protect our homeland security.

The result was an impingement on our religious, economic and political freedom.

President Obama does not think about the constitution in the way he did when he was trying to win the hearts and minds of the American people in 2008.

  

http://youtu.be/UBZIM0ZFiYU

If fact, after the 2012 election victory he has shown a total disregard for the United States constitution. He has a total disregard for the balance of power.

  

 

http://youtu.be/yiOmwayoSrw

 He has ignored congressional authority. He has issued executive orders changing laws at will. If congress challenges him he accuses them of being obstructionist.

President Obama has made at least 10 significant changes to Obamacare by executive order up to now. Congressmen and Supreme Court scholars have deemed that these executive orders are unconstitutional.

The Obama administration is now dowplaying his executive orders  significance.

We tend to forget abuse of power episodes. I think it is worthwhile to publish all available examples at once to get a complete feel for the abuse of power.  

These large numbers of executive changes were adopted to avoid Obamacare’s failure. Obamacare’s failures have persisted in spite of the unconstitutional changes.

 Obamacare is basically a defective bill. It should be repealed. Small patches will not repair it.

 Many of the executive orders slipped by the traditional media without discussion.

The following are President Obama’s changes by administrative action.

1. Congressional opt-out: The administration decided to offer employer contributions to members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013).

This is a subsidy congress did not have the guts to fight about. It is self-serving. Why should the congress get a special privilege that ordinary people doesn’t have?

2. Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid February. (October 23, 2013).

In addition to this order, if a consumer signed up before December 31 they would have insurance January 1St. If they signed up by January 15th they would have insurance by February 1st. If they signed up by February 15th they would have coverage by March 1st. This occurred by executive order in order to encourage enrollment. The government is unable to process these applications. Patients had not paid premiums.

3. Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013)

This executive order was issued in July just before Independence Day. This has been typical of the Obama administration. They have released executive order when the public is emotionally preparing for a weekend or a holiday. Friday afternoon at 4.30 is a favorite time.

4. Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013)

It looks like the administration knew that they did not have the computer systems’ back end connected to check income tax returns with the IRS two and one half months before on October 1st.  Congress was not consulted for advice.

5. Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and has instead delayed the implementation of the SHOP (Small-Employer Health Option Program) exchanges until 2015. (March 11, 2013)

I did not realize that this executive order appeared so early in 2013.

6. Closing the high-risk pool: The administration decided to halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment. (February 15, 2013)

This is a mind blower. The Obama Administration decided to discontinue funding the high-risk pool in order to have the money to pay for advertising for Obamacare enrollment.

This order was issued on February 15,2013. It was seven and one-half months before Obamacare enrollment was to begin.

7. Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay exodus of MA plans from the program. (April 19, 2011)

Medicare Advantage was a big mistake for reasons beyond the scope of this report. Political pressure forced President Obama to take money out of one pile and apply it to the Medicare Advantage pile without consulting congress.

8. Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (January 1, 2012)

The one-year delay adds to the uncertainty of what is going to happen the following year. It makes hiring decisions harder for employers in the long run even though it helps in the short run. The net effect is it will be bad for the economy.

9. Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowingmaximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)

This executive order was issued in February 2013 to the advantage of the healthcare insurance industry.

10. Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)

The administration knew what to expect from the rollout as early as February of 2013. The executive orders changed the law in an effort to cover-up the tremendous cost overruns that will occur.

The public does not have any idea what those cost overruns will be.

It is important to see how many of these unconstitutional executive orders were released and how far back in relationship to enrollment they were ordered.

   

http://youtu.be/9FgFUOGFpnk

President Obama’s mind-set is expressed in the above You Tube video.

 As President he “can do anything he wants to do.”

 Wake up America!

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

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President Obama: Please Stop Deceiving Us!

Stanley Feld M.D.,FACP,MACE

President Obama, please stop deceiving Americans. Please tell us the truth. Please be transparent as you promised us you would be.

President Obama promised to transform America. Americans did not know what that meant. They thought is was for the good. 

The healthcare system was dysfunctional before President Obama became president. In order to fix a dysfunctional system, one must try to get to the root of the problem.

President Obama has not done that. He has pasted another layer of bureaucracy on top of an already dysfunctional system. This has created further dysfunction.

He has further compounded the dysfunction in the healthcare system by changing the law unilaterally by executive order without the consent of congress.

There is question on whether his actions are unconstitutional. If they are unconstitutional it is grounds for impeachment.

At best these unilateral changes have destabilized the healthcare system further. The changes have also increase uncertainty in the investment community. The result of the uncertainty is to slow the jobs market and the economy.

President Obama is a charming fellow. The problem is the veneer has rubbed off. At the beginning he pandered to all the stakeholders vested interests.

He told them glorious things about what they could expect. People have recently found out that they have been deceived.

President Obama is not about innovation and opportunity as many hoped for in 2008.

President Obama is about increased central government control over our freedoms and our choices.

All of his actions and deceptions are starting to backfire on him. The majority of the American public is becoming aware of his tricks and abuse of power.

The tricks, deceptions, abuse of power and outright lies are starting to directly affect the majority of Americans in a negative way.

In healthcare we have been deceived by many actions. At present it is the reporting the enrollment figures in the health insurance exchanges.

President Obama, his administration, and even Dick Durbin have inflated the numbers without giving Americans the facts.

Last week even the Washington Post could not take it anymore. 

“The Washington Post, has given "three Pinocchios" to the White House for its claim that 6 million people have enrolled in Obamacare, and warned the media to ignore the distorted government figures.”

After President Obama announced these figures during his Super Bowl interview, he tweeted them on his official Twitter account.

BdoRQ1yCYAAN4dp

https://twitter.com/BarackObama/status/421668496120897536/photo/1

The figure comes from a combination of 2.1 million people who have enrolled under federal and state healthcare insurance exchanges, plus 3.9 million who have qualified for coverage on Medicaid through November.

The key words in President Obama’s statement are qualified for coverage on Medicaid through November. These words tells you almost nothing about how the Affordable Care Act is affecting Medicaid enrollment."  

The mainstream media keeps on using the same incorrect numbers over and over again thinking they are fooling the American people.

"No one really knows, though some have tried to tease out figures from the data that has been presented."



 

California was supposed to have the strongest state insurance exchange.  Covered California signed up the most people for Obamacare since October 1,2013. It was the model exchange. After January 1st, 2014 the problems became apparent.

As of Dec. 31, 2013, nearly 500,000 California residents had enrolled in health coverage through Covered California, the state's health insurance exchange created under the Affordable Care Act, according to data released Monday by HHS, KQED's "The California Report" reports.

Overall, California residents accounted for 22% of the total 2.2 million exchange enrollees nationwide (Aliferis, "The California Report," KQED, 1/13).

I would call this bragging without presenting the facts or the potential problems.

These are the potential problems.

According to the data, 85% of the 498,794 Californians who have enrolled in coverage through Covered California received a federal subsidy, compared with 79% nationally (Seipel, Contra Costa Times, 1/14).

The state and the federal government will have to come up with the subsidies. The result will be higher premiums for those that pay full premium price and increased taxes for those who pay taxes.

The data also show that:

  • 61% of enrollees chose a silver-level plan; and
  • 23% chose a bronze-level plan ("The California Report," KQED, 1/13).

          52% of enrollees were between ages 45 and 64 ("The California Report," KQED, 1/13); and

  • 25% were between ages 18 and 34 (Contra Costa Times, 1/14).

 The number of enrollees is different than the number of people who definitely are insured. Enrollees are not insured until they paid their premiums.

Even so, the enrollee mix, if it stays the same will necessitate an increase in insurance premiums and a bailout of the insurance companies. The insurance company bailout was built into Obamacare upon passage of the act.

The public did not know about insurance company bailouts until recently. 

In California consumers have not receive the coverage they thought they bought. Consumers are not able to see physicians who were caring for them before the new year. Many cancer patients who require continuing care have not seen been able to see their physicians.

Seventy percent of the physicians in California have not signed up to accept Covered California because reimbursement is too low.  

 The White House was dealt a stunning new blow on Obamacare sign-up numbers:

Reports have leaked showing that only about half of the people "enrolled" at healthcare exchanges in various states have actually paid their premiums.”

“Minnesota's exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.”

 “But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November's pace of less than 700 per week.”

  “As of Feb. 1, Nevada had just 14,999 paid enrollees — vs. the state's March 31 goal of 115,000.”

 “Washington state, meanwhile, was slightly more than halfway to its goal of 340,000 signups — but only 88,071 had paid as of Feb. 1.”

 “The January data available from a handful of states raise new doubts about whether ObamaCare's downgraded first-year prospects are still too optimistic.”

These numbers have been kept out of the mainstream media.

 The poor premium payments by enrollees of 50% in Washington and 66% in Nevada creates a risk that the demographics of the paid exchange population may be older and possibly sicker than the information the Obama administration has publicized to get more people to enroll.

This is only a partial list of President Obama’s present deceptions.

 A complete list of the 35 changes made to the law by executive order without consent of congress is in order about now.

Why are so few in Congress speaking out?

When are the people going to speak out?

Congresspeople who do not speak up should not be reelected!

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

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TRANSPARENCY? There Is None

Stanley Feld M.D., FACP, MACE

President Obama promised Americans transparency in government. He has not fulfilled his promise.

Transparency in the Healthcare System must be considered on multiple levels. It consists of transparency as it related to both primary and secondary stakeholders.

The primary stakeholders in the healthcare system are patients (consumers) and physicians.

The secondary stakeholders are the government, insurance industry, hospitals and drug companies.

Each stakeholder has it own issues with transparency. There is a lack of transparency with each other. Most of all there is a total opacity of all the stakeholders toward consumers of healthcare.

A reader sent me these Medicare Part B documents. He asked if I would explain these document to him. He went to the hospital to do a pre-op evaluation for knee surgery. The evaluation included blood testing as well as an EKG and chest x-ray.

 This document is an EOB (explanation of benefits) for the outpatient evaluation services at a hospital.

It is now called Outpatient Claims for Medicare Part B.  If these procedures were done as an inpatient the fees would be higher.

The hospital outpatient fees are outrageous. A freestanding physician’s lab fees would be much lower.

The EOB has changed a little over the years. At one point a patient could not tell what the payment was for and how much Medicare would allow and pay for each procedure.

This year it is clearer. However, Medicare has done something with allowable fee that is incomprehensible. Medicare has created a conflict within its own form.

Lyle page 1 copy
 

Lyle 2Claim example 1b (1) copy 3

 

 

A simple example is the service of drawing blood.  Code 36415. The facility charged $30.80. The Medicare approved amount was $30.80. However, the amount paid by Medicare was $2.94. The maximum the patient could be billed was $0.00.  

Here is the contradiction. In the definition of columns section the Medicare –Approved Amount is defined as follows.

“Medicare-Approved Amount: This is the amount a facility can be paid for a Medicare service. It may be less than the actual amount the facility charged. The facility has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.”

In the case of the needle stick to collect blood note A for above claim says;

A. This service is paid at 100% of Medicare approved amount. 

The contradiction is the Medicare approved amount was $30.80.

Why did the government change the approved amount from $30.80 to the $2.94 that it approved? Why did they ignore the $30.80?

Why would the hospital accept $2.94 when they had a Medicare approved amount of $30.80?

Something fishy is going on.

If patients are not covered by healthcare insurance, the patient would be liable for $30.80. The facility can always claim this is a legitimate charge because Medicare approved it.

Who will get stuck paying full price?

People who are poor and cannot afford insurance. Persons who do not qualifying for a government subsidy will get stuck.  Young people who refuse to buy insurance from the health insurance exchange.

This could be another one of President Obama’s tricks to drive everyone into the health insurance exchanges. The result could lead to total destruction of the private insurance industry. Then the only option will be  a single party payer system.

I have said previously that President Obama’s goal is to destroy Obamacare. It would prove to everyone that a free market system does not work.

What President Obama doesn’t realize is that Americans recognized that Obamacare has not set up a free market system. It has set up a system of regulations that place horrible restraints on a free market system.

 The American people do not trust President Obama anymore.

As we look at the other claims in this document there is more that is deceiving. The hospital facility charged $726 for a chemistry profile (code 80053). Medicare approved $726 but paid $14.24 for the chemistry profile.

 In 1980 Medicare approve $24.00 and paid 80% of $24. The price Medicare pays for a chemistry profile has dropped since 1980.

The hospital charged $752.50 for a simple blood typing and cross matching (code 86850,86900,86901). Medicare approved the fee but only paid $28.20, which is 80% of what Medicare approved amount is. The patient or his Medicare supplement would be responsible for $7.79

The Medicare approved amount for an automated CBC (Code 85027) was $452.80 but Medicare paid $8.71.

An EKG is an important part of the pre op testing. The facility charged $593.95 and Medicare approved that amount. However Medicare only paid $20.49. The patient or their supplement is responsible for $5.24. Since the beginning of Medicare in 1965 the Medicare approve amount for an EKG has never been greater that $80.00.

There is definitely something fishy with the determination of the Medicare approved amount calculation and Medicare Part B payment.

I hope I have succeeded in explaining how to understand this Outpatient Claims for Medicare Part B.

I also hope I have succeed in explaining the crazy Medicare approved amount pricing.

I believe that the only conclusion to be reached is that there is deception in the document.

There is absolutely no transparency for the patient. The hospital will not give the patient the price before he gets the work done.  The consumer cannot make a wise healthcare choice for the use of his healthcare dollars.

The government is not interested in giving patients control of their healthcare dollars.  Consumers are the victims.

Neither the government nor the insurance company gives the consumer any help.

Physician owned laboratories charge patients much less than the hospital facilities.

At the same time the government is putting more and more restrictions on physician owned laboratories in order to eliminate physician owned laboratories even though the cost is less.

 The government’s excuse for restricting physician laboratories is that physicians will have incentive to do additional testing.  

The bottom line is the government does not want to control costs or to put the patient in control of their healthcare and their healthcare dollars.

 Remember the statement, “I am the government and I am here to help.”

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

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The Obamacare Alternative That Would Work!

Stanley Feld M.D.,FACP,MACE

Some have complained that "My Ideal Medical Savings Account" cannot work. I have communicated with some of these people who made this and similar comments. I discovered two common themes to their comments.

The first theme was that people are too dumb to take care of themselves and make their own medical decisions.

The government must make the healthcare decisions for them.

The second was people would not handle their healthcare dollars appropriately if they were given the money.

These people might be talking about 5% per of the population who will be a burden to society no matter what healthcare system is put into place.

Why burden the other 95% of the population who want to be responsible for their health and healthcare dollars if they were given the chance?

The chance given has to include complete transparency, equal tax treatment, and adequate education to use their healthcare dollars wisely to made wise medical care decisions.

The week Tammy Bruce wrote an article in the Washington Times entitled, “Obamacare Isn’t A Train Wreck, It’s A Cancer.”

She explains how it is metastasizing throughout our economy and culture. It will destroy our society.

It is clear me that people commenting did not read my blog “My Ideal Medical Savings Account Is Democratic” carefully.

I decided to republish that blog at this time when it appears that Obamacare is failing on every level as I had predicted.

My hope is people will read the blog more carefully this time and understand it as an alternative to the impending disaster of Obamacare. 

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrictions on freedom of choice and a decrease in access to care.

I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health.  Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self-insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk of spending $6,000 for most people is low. 

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust.  If they spent over $6,000 they would have first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes, or health disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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I Gave President Obama An Alternative To Obamacare

Stanley Feld M.D.,FACP, MACE

I formulated an alternative to Obamacare in 2006, long before Obamacare existed.  President Obama has ignored a plan that will work and align every stakeholder’s incentive.

Obamacare is failing because President Obama does not know who the customer is in the healthcare system. He is blinded by ideology and the belief that government knows what consumers need.

The consumer is the customer. Without consumers of medical care and physicians to provide medical care we would not need a healthcare system.

Consumers and physicians are the primary stakeholders. All the others are secondary stakeholders.

However, physicians receive between 15-20% of the healthcare dollars. Hospitals receive 25% of the healthcare dollars.

Where does the remaining 60% of the healthcare dollars go?

The insurance industry takes at least 40% off the top. The pharmaceutical industry receives 10% and the government wastes 10%.

It is a pity that only 40% of our healthcare dollars is spent on direct medical care. There is much waste and inefficiency built into that direct medical care.

 There is also much waste included in the 60% the secondary stakeholder take off the top.

How else would UnitedHealth’s CEO get paid $1.8 billion dollars in cash and stock options from 1998 to 2006? 

 The excessive insurance industry profits are the direct result of ineffective regulatory agencies controlling insurance pricing.

In 2006 consumer power was demonstrated when UnitedHealth tried to decrease reimbursement to Hospital Corporations of America. HCA protested and threated to quit participation in United Health. Consumer protests followed.

UnitedHealth was the main insurance carrier in the Denver Area. Consumers threated to boycott buying insurance from UnitedHealth. UnitedHealth backed off.

The HCA/United pushback is the first big step. It represents how “Patient Power” should work. Patients should be madder than hell and not want to take it any more.”

In 2006, many of the uninsured were self employed consumers who cannot qualify for insurance because they have a preexisting illness or they are at risk for illness.

The insurance companies refused to sell them insurance. The same consumer in a group insurance plan by law would receive insurance from the same insurance company that turned down the individual.

A self-employed individual can only buy insurance with after tax dollars. A corporate employee receives healthcare insurance coverage with pre-tax dollars.

The same applies for the individual insurance market post Obamacare.

The price of insurance is very high for small businesses. The small business owners do not have the negotiating power of the large corporations.

This results in both the individual and small business not being covered by healthcare insurance. All of the above can be easily fixed.

The problem with Obamacare is the insurance premiums are higher than they were pre- Obamacare. The reasons are obvious.

The only winner is the individual who makes a low enough income to receive a federal subsidy. The loser is the taxpayer.

Obamacare also creates a perverse incentive resulting in people not striving to get ahead.  

In 2006 I wrote:

  
Patients drive the healthcare system. Patients have tremendous power. They must be taught to use that power in order to Repair the Healthcare System.

Patients must use their  “Patient Power” to take control of their healthcare dollars and their health. They should be provided with financial incentives to save the money they spend on medical care.

Neither the healthcare insurance industry nor the government should determine the consumers’ access to care. Patients’ freedom of choice and self- responsibility is the key to Repairing the Healthcare System.

If there are financial incentives consumers will learn to become informed consumers of healthcare. Reliable education must be provided to give consumers the opportunity to become informed consumers.

There are preconditions.

 Prices must be transparent so consumers know what they are buying. The insurance industry should negotiate the price with the physicians and the hospitals. The industry can remain the surrogate broker for the payment of money belonging to the consumer. Consumers’ who overspend will not receive the financial incentive. They will lose their medical saving account money. Patients who have an expensive illness, like diabetes, can be rewarded for spending money if they keep themselves in good health and prevent complications of disease.

The consumers are then the responsible party purchasing their medical care. It is not the healthcare insurance industry or the government.

The healthcare insurance industry or any financial industry with an adequate computer system can be the administrator and adjudicator of payment.

Medicare director Mark McClellan M.D. said that 90% of the healthcare dollar of a specific disease (Diabetes) is spent on the complications of disease. If we reduce the complications of a disease we could save at least 45% of the current healthcare expenditure for that disease.

Obamacare gives this vital fact lip service. It puts the responsibility of outcomes on physicians’ shoulders. If physicians have poor outcomes they get penalized.

The medical outcome is a dual responsibility of both consumers and physicians. Consumers should be made aware of physicians’ outcomes. Some of the poor outcomes are the result of consumers not taking the responsibility to learn about their disease, prevent the complications of their disease, or comply with the treatment recommended. The result is a poor outcome.

Consumer overspending is another important aspect of increasing healthcare costs. Consumers do not have incentive to be cautious with their healthcare dollars because they have been given first dollar coverage. They do not have financial incentives to save money on medical care.

Consumer overspending was best described by Victor Fuchs an economist from Stanford.

He made the case for a Consumer Driven Health Care System.

The Health Saving Accounts that congress has approved in my opinion is impotent. It does not provide a strong enough financial incentive for consumers to want to save money.

The trust account of $1,000 per year is too low to motivate consumers to become wise shoppers. A Medical Savings Account of $6,000 per year begins to represent financial motivation.

 HSA’s represent the same false hope HMO’s and managed care represented in the 1980’s and 1990’s.

 Dr. Fuchs calls it “The Restaurant Check Problem.”

“You go out to a restaurant with a bunch of friends and you sort of understand that you will split the check,” he said.

 “The waiter comes along and says, ‘the lobster looks very good, and how about a soufflé for dessert?’

The restaurant check balloons, but you are not so careful because you figure everyone is splitting it.

“That’s the way medical care gets paid for,” he said.

 Dr. Fuchs added, “We want to spend our money on the things that will bring the most value for the dollar.

When we are spending collective money as we are in health care, then it becomes much more difficult.”

We want Diabetics to spend money for good medical care in order to prevent complications. Prevention of complications will keep Diabetics out of the hospital and out of the emergency room. The result will be a decrease in medical costs.

The consumer driven healthcare plans can be set up to give provide Diabetic consumer the financial motivation to take care of himself. This reward is much cheaper than paying for a hospitalization or emergency room visit.

 If an insurance product is overloaded with salaries, waste, overhead and unnecessary benefits patients will not buy the product.

The insurance product would have to be modified. It would become more cost efficient.

Patients have it in their power to remove the waste and inefficiency in the system.

Some very clever entrepreneur will realize the consumer is the customer. He will develop an insurance product that everyone wants. State governments have the power to encourage development of this product.

The examples in industry in America are numerous. Sam Walton revolutionized retailing in America with Wal-Mart and Sam’s. Michael Dell almost brought IBM to its knees and revolutionized the distribution of information technology.

 My goal is to describe the necessary components of a healthcare insurance product that does not offer another and false hope.

I hope to show the way to develop an insurance product that can work for patients first and then all the other stakeholders.

There is no reason we cannot provide excellent affordable insurance coverage to all including the corporate employed, the small business employed, the self employed, the unemployed, and the Medicare covered seniors, with all the stakeholders making a reasonable profit in a simplified system.

President Obama, I have provided a viable alternative long before you became President.

I also provided this alternative to you when you became President in the letters I wrote to you.

For you to say no one has come up with a better alternative than Obamacare is disingenuous on your part.

I hope you are listening now.

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

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What An Experience!

Stanley Feld M.D.,FACP,MACE

Every congressman should try registering a poor (below poverty level) constituent for Obamacare aid.

If you have not, you do not deserve to be in office or have a vote.

Most of you know my story of Moses and his healthcare insurance. I have tried to obtain Medicaid healthcare coverage for both Moses and his wife in the past in Texas. I failed after trying hard.

I had been successful in registering his kids for SCHIP.

Moses annual income qualifies him and his family for Medicaid in Texas. Texas is a state that isn’t expanding Medicaid.

You might recall that Medicaid is not great insurance. The reimbursement is extremely low and there are few physicians who participate.

If Moses lived in a state that is expanding Medicaid, he could earn up to $32,500 dollars per year and still qualify.

"If your state is expanding Medicaid, you’ll probably qualify if you make up to about $15,800 a year for 1 person ($32,500 for a family of 4). (These are 2013 numbers, and likely to be slightly higher in 2014.)"

 "If your state isn’t expanding Medicaid in 2014

Some states aren’t expanding their Medicaid programs in 2014. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls.

Moses earns less than $23,500 a year. He should qualify for Medicaid in Texas.

I have encouraged him to apply for Medicaid using the Obama Health Insurance Exchange in Texas. Texas has a federal Health Insurance Exchange.

I offered to help him fill out the application online at the beginning of December. He did not want to bother me.

He said he had a friend in North Texas who works for one of the Texas insurance  companies. He said his company has people who help people like Moses fill out the healthcare insurance application. He said they are called Navigators. 

I told him the Navigator should be able to help him complete the application. The insurance company assigned him a Navigator in Las Vegas, Nevada.

Moses said she was very nice. She asked Moses all of the questions over the telephone.

I called him on December 12th and asked him if he had insurance yet. If you recall President Obama extended the deadline for applying until December 23th and then December 31th in order to have coverage for January 1st, 2014.

Moses said she told him she did not understand why his application was not accepted.  I told him to call her every day and find out what is going on.

She was going to try again the next day. It sounded like she tried at least every other day through December 31st and failed to get any information or his application accepted.

I told him to keep having her try. This went on through the next extended deadline of January 15th. She said could not understand it. I couldn’t understand it either.

Everything I read said the web site healthcare.gov was working smoothly. However, the back end was not connected to the application process.

 She was unsuccessful through January 30th. On January 30th I told him to come over. I would try and I would fill out an application online for him.

Again he did not want to bother me. I insisted. In the meantime another friend in North Texas connected him with a Spanish speaking Navigator in North Texas.

The Navigator called him when we were about to start filling out the application. After speaking with Moses in Spanish, he asked to speak to me. He practically begged me to let him complete the application for Moses and get him healthcare insurance.

I said O.K.

He asked Moses to come over to him that afternoon. Moses went to him. They spoke for an hour. He then gave Moses a list of questions and a telephone number to call.

Moses told me the questions were complicated. He was afraid he would make a mistake in answering them. The Navigator told him he would not get Medicaid but he could buy a number of insurance policies.

I told him to let me try to register him online.

Last Thursday Moses came over to the house with his citizenship papers and social security numbers of his wife and two kids.

I started to complete the form at 9 am. I completed the form for him at 11.30 am. The form was long and tedious.

Ten seconds after the application was completed the health insurance exchange acknowledged the submission of application. It then accepted the application.

The next screen asked if I wanted to see coverage the applicant was qualified to receive. Within four minutes of accepting the application the message was sent that the application does not qualify for Medicaid. 

This decision seems impossible. Healthcare.gov is not connected to insurance carriers or government databases. The decision was too fast. It would have had to be done by hand.

In any event I clicked on the coverage the application was qualified for. As I clicked on that I noticed there was an appeals button on the previous screen. I figured I could get back to the appeals button shortly.

He was given a choice of healthcare policies. There was no discussion of the possibility of government subsidies.

See below.

  Scan

 The deductibles offered for his income level were outrageous. The lowest deductible was $1500 which he couldn't afford it.  

It was painful to see the dejection on his face.

I tried to re-log into his application.  Healthcare.gov would not recognize the registration number they had given him fifteen minutes earlier.

Where is his application?

When will he receive notification of his eligibility for subsidy?

How much subsidy will he receive?

How does he appeal the Medicaid decision?

Is there anyone out there that can help?

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

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