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Lies and Concealed Failures

Stanley Feld M.D.,FACP,MACE

Americans are now certain that President Obama lies indiscriminately to them. He tells us what we want to hear. At the beginning of his quest for the presidency all Americans wanted to believe him.

Unfortunately he has been lying to us all along.

YouTube has given Americans the ability to easily review statements President Obama has made to see if he was deceiving us.  

His lies about Obamacare are now legend. What follows is a compilation of these lies.

There are compilations of all the lies for each of the scandals including Fast and Furious, Bengashi, the IRS, and the VA among others on YouTube.

President Obama continues to call them all these scandals “phony scandals”.

To paraphrase Carl Sandberg, in his book Prairie Years, “if you tell a lie you better have a good memory.” I do not think President Obama feels he is obligated to have a good memory.  YouTube has made this point clear.

Since March 31, 2014 President Obama and his administration have tried to keep Obamacare out of the news. On March 31,2014 President Obama had declared Obamacare an overwhelming success. He declared there is no further need for the press to generate untrue controversy about Obamacare.

The mainstream media has complied with his request. It has been been silent about Obamacare’s ongoing failures.

In the last three months several reports have been published but never have reached the public through the mainstream media.

Americans may never get an accurate projection of Obamacare's impact on the deficit because the administration has not been transparent and or truthful about its impact.

Before Obamacare became law, the Congressional Budget Office (CBO) projected, using figures given to it by the Obama administration, that Obamacare would cost $938 billion over ten years. The CBO also projected Obamacare would reduce the budget deficit by $143 billion over the first decade.

President Obama collected increased hidden taxes for the four years before Obamacare was supposed to be implemented.

Full implementation has now been delayed by five to six years while the increased taxes continued to be collected.

The delay in full implementation is the result of the unconstitutional waivers President Obama gave to some groups.

The original CBO estimate included a $780 billion reduction in Medicare spending cuts along with a double counting scandal.

In April 2014, the CBO said that the cost of the ACA from 2015 to 2024 would be more than $1.8 trillion — twice as much as its first ten-year projection.”

The addition of $1.8 trillion to the budget deficit as opposed to a $143 billion reduction is a very big difference.

In that same April report, the CBO include a significant footnote:

"CBO and (the Joint Committee on Taxation) can no longer determine exactly how the provisions of the (Affordable Care Act) that are not related to the expansion of health insurance coverage have affected their projections of direct spending and revenues. Isolating the incremental effects of those provisions on previously existing programs and revenues four years after enactment of the ACA is not possible."

“Also it is not clear that the law's proposed Medicare cuts will remain in place. Additionally, unions, insurers, drug makers and medical device companies each would like relief from the law's new tax provisions.” 

It was obvious to everyone that Obamacare would not reduce the deficit or decrease healthcare costs.

The bigger issue is none of this was reported in the traditional media. This represents one failure concealed from the American public.

Nonetheless President Obama is still telling Americans Obamacare will save money and reduce the deficit.

In President Obama’s victory lap on YouTube he states over and over again that Obamacare is a tremendous success.  It is almost as if he is pleading with the American public to believe him. 

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

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The Growth Of Concierge Medicine

 Stanley Feld M.D.,FACP,MACE

In the accelerated chaos Obamacare has created for both patients and physicians an increasing number are trying to find ways to maintain their freedom of choice. Patients are recognizing that Obamacare is causing a commoditizing of healthcare and the destruction of the Patient/Physician relationship.

Patients and physicians yearn to have a good Patient/Physician relationship.

Physicians love the practice of medicine but they hate the burden being imposed on them.,

  1. Increased government regulations and requirements,
  2. Increased paper work to prove every clinical decision they make on the patient’s behalf.
  3. The restrictions on their use of clinical judgment.
  4. The increased overhead to comply with regulations of both the government and the private insurance plans.
  5. The decreasing reimbursement.
  6. The lack of malpractice reform.
  7. The pressure on primary care physicians to see 30-50 patients a day to cover overhead resulting from decreased reimbursement.
  8. The inability to spend more time with patients because of this patient volume pressure.
  9. The inability to get to know their patient better because of time constraints.

      10. Their inability for physicians to have empathy for patients after they see the tenth patient   because of burnout.

       11. Their inability to develop a viable patient/physician relationship.

       12. Spending at least three hours weekly dealing with insurance plans preauthorization.

       13. Their clerical staff and nursing staff spending at least fifteen hours weekly obtaining preauthorization from the insurance company or government before providing patient care.

        14.Their ability to keep up and comply with all the bureaucratic requlations and requirements.

An AMA survey of 2,400 primary care physicians believe private insurers and government insurers have excessive requirements for preauthorization for tests, procedures, and medications.  

  • More than one out of three have a rejection rate of 20 percent for first-time preauthorization on tests and procedures,
  • More than half of physicians have a 20 percent rejection rate on prescriptions.
  • About one half of physicians have difficulty obtaining preauthorization from insurance plans.
  • About two out of three wait several days for permission.
  • About the same proportion report difficulty in determining which tests, procedures and medications require preauthorization.

These are just a few of the reasons the enjoyment has been taken of the practice of medicine. Many physicians have said I am finished dealing with all these rules and regulations, the government and the private insurance industry.

Many Primary Care Physicians are converting their medical practices to Concierge Medical Practices.

Proponents say concierge care is a revolt against the modern health care system where diminishing Medicare and insurance payments have forced doctors to herd dozens of sick patients through their offices in five-minute increments every day.”

What is concierge medicine?

Concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges depending on the business model being used and the retainer charged.

The up front retainer allows physicians to decrease full time staff to a minimum. It decreases the complexity of practicing medicine. Physicians do not deal with insurance companies or the government. They only deal with their patients. This permits physicians to decrease the number of patients they see a day and increase time spent with and relating to patients.

Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies.”

Concierge medicine is a way of taking first dollar coverage away from the healthcare insurance industry and putting control of care in patients’ hands. It prevents the insurance companies from feeling they own physicians and patients.

If the Patient/Physician relationship is not important too many large healthcare companies. Physician are simply one provider among many such as nurse practitioners, physicians assistants, social workers and pharmacists.

All these healthcare companies are interested in is maximizing their profits from this 2.7 trillion dollar business.

Concierge medicine would not be growing by leaps and bonds if this companies concentrated on the welfare of consumers.

Both physicians and patients are feed up with the development of central control of the healthcare system.

All of us remember President Obama’s lie, “If you like your doctor you can keep your doctor with Obamacare.”

Obamacare was passed because of this lie.

The concierge retainer fees can vary from $500 to $38,000 dollars per year. Concierge medicine will create a two tier Healthcare System. I disagree with a two tier system!

It is occurring because we have a dysfunctional healthcare system. Obamacare is making the healthcare system more dysfunctional.

The healthcare system is not servicing either patients or physicians well. Each is searching for an alternative before Obamacare and the entire healthcare system collapses under it own weight.  

Patients yearn for a positive Patient/Physician relationship. As more physicians are adopting the concierge business model patients are signing up to the surprise of the government and the healthcare insurance industry.

These stakeholders have underestimated the value of the Patient/Physician relationship.

Maybe the trend will wake up the government and the healthcare insurance industry and fix the things that are broken.

Obamacare is not doing it! It is making things worse.

Maybe these two stakeholders will realize that they do not own the physicians or patients. Any attempt to own them is futile. It is not in the American culture being to be enslaved.

The answer is not fancy information systems that do not work perfectly. It is not by creating expert panels to tell physicians what they can do. It is not these panels telling patients the care they can have. Our healthcare system is dysfunctional. The system does not evaluate the quality of care effectively.

All one has to do is look at the VA system’s problems. The VA system’s problems are a disgrace. It should also be a warning about the future of Obamacare.

Obamacare and its bureaucracies are going to create another VA system for all Americans.

The answer is to teach consumers what is good treatment and what is not good treatment. It is to help consumers evaluate their physicians. Price transparency is a good beginning in order to get the stakeholders to start competing.

Tort reform is another good start.

Government could help by teaching consumers to ask the right questions.

It should start realizing that we have to have a consumer driven patient centric system where patients are responsible for their health and healthcare dollars.

The problems in the healthcare system can be solved with a consumer driven healthcare system using my ideal medical saving account.

The public health problems are a different issue. There are three diseases we can prevent. They are obesity, alcoholism and drug addiction. The government must deal with these diseases on an educational and social level.

The government has not done a very good job with any of these three diseases. The prevention of these diseases is a public health problem.

It should not be mixed up with individual medical care. Obamacare does with the causes of these diseases or the environmental cures.

Obamacare is another unsustainable entitlement program. The government should not be creating another unsustainable entitlement program.

It should be creating a program that promotes individual responsibility for health, healthcare, and healthcare dollars.  

Hopefully the growth of concierge medicine will be a wake up call to a misguided Obama administration wanting top down control of the healthcare system.

They must realize that the Patient/Physician relationship is sacred to cost effective medical care.

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

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More Magic Of The Patient/Physicians Relationship

Stanley Feld M.D.,FACP,MACE

The complications of chronic diseases account for 80% of the costs of those diseases for the healthcare system.

The role of patients with chronic diseases and their physicians must be clear to both patients and physicians.

President Obama wants to make physicians responsible for the outcome of their care for patients. Physicians have control of making the diagnosis and prescribing treatment.

Physicians do not have control of patients’ adherence to therapy and control of patients’ behavior.

Only patients can be responsible for their behavior. Physicians are managers of a healthcare team. The healthcare team is composed of physician extenders (assistant coaches).

Patients are in the center of the team. Patients live with their disease 24 hours a day. Patients have to learn how to manage the day-to-day fluctuations in the control of their chronic disease.

If the disease is managed well both the acute complications (emergency room visits) and chronic complications (in Diabetes Mellitus heart attacks, blindness, kidney failure and strokes from hypertension) can be avoided.

The cost of care would be markedly reduced if these complications were avoided.

Patients with diabetes need to understand the disease use methods to control their blood sugar, blood pressure and lipid levels.

Patients have to become “professors of their disease” in order to control their disease.

Physician visits are only a snapshot of what is going on in that patient’s disease process. The information brought to physicians by patients can help physicians, using their clinical judgment, help patients control their disease.

Patients must to be inspired to manage their chronic disease. This requires patients having confidence in their physicians and his assistants.

A good patient/physician relationship can encourage patients to control their chronic disease.

It is hard work for patients to monitor their blood sugar, blood pressure and weight. It is also hard to learn the causes of the fluctuations in their blood sugars and blood pressure.

This idea of mutual trust and confidence between the manager and player are illustrated by something that happened between a teacher and me in high school.

This example is an example of a student/teacher relationship.

It is also an excellent example of the power of an effective patient/physician relationship.

It was a rainy day in the spring of 1953 during my junior year in high school. I was on the high school baseball team. The team could not practice that afternoon because of the weather. The team was sent to the Study Hall for the 8th period.

Ms. W. was one of the 8th period Study Hall teachers. She was my geometry teacher. I thought she was the greatest. I never missed a question in class or on a test. She came over to me that rainy spring day to say hello. She asked how I was doing in trigonometry.

I told her I was not doing well. I can not learn a thing from Mr. B. teaching.

Mr. B. was the chairman of the math department. He taught trig in a very dry way. He was detached. Trig had no meaning to me. He did not teach us to understand the logic of trigonometry and its practical use.

No matter how much I tried to derive meaning from the textbook by myself the material covered was not understandable.

 I felt my ability to learn and problem solve was suppressed. Mr. B’s goal was to have us memorize the material.

Mrs. W. asked me which period I had trigonometry and lunch. I told her trig 5th period and lunch 6th period. She said great she taught trig 6th period. She could get me transferred to her class. I could have lunch 5th period.

I was thrilled beyond belief. She also said she hoped I was aware of the departmental quiz being given the next day. I would be required to take the test.

Ms. W said the chances are I would do poorly on the test.  She encouraged me to study for it when I got home.

The most amazing thing happened that night when I started studying for the quiz.

All of a sudden I grasped the concepts I could not grasp in Mr. B’s class. Now that I was in Ms. W. class I solved problems I could not solve previously. A difficult textbook became easy to understand.

The next day I went into Ms. W’s trigonometry class, took the test, and got 100%.

I know this has happened to all of us at some time in our life. I know it was the result of my knowing that someone had respect for and confidence in me.  

The lesson of Mrs. W. is a powerful lesson. Mrs. W. did enable me to have confidence in my learning ability because of her confidence in me.  She empowered me to learn by myself.

If a relationship is positive, with mutual respect and commitment by both physician and patient, patients can learn to control their chronic disease properly.  

 Chronic diseases such as diabetes frighten patients. This fright makes it difficult to learn how to control their disease to avoid its complications.

Physicians must deal with this through a positive patient/physician relationship. A positive patient physician relationship can make it easier for patients to learn to control their disease.

In practicing endocrinology I developed a patient physician contract to define this physician/patient relationship.

My son Daniel wrote a letter to me about my patient-physician contract that brought tears to my eyes.  

Dear Dad;

I love you. I think everyone should know about your patient-physician contract.

I tell people all the time about your patient-physician contract.

The way you use it to have patients take responsibility for their health and healing.

I’ve adopted this myself in my own health and healing and believe it’s critical since we know ourselves better than anyone else.


The Physician Patient contract as it appeared in Endocrine Practice 2002:8 (Supp 1)

  1. a.    Sample Patient-Physician Contract


I understand that if I agree to participate in the System of Intensive Diabetes Self-Management, I will be expected to do 
the following:

1. Dedicate myself to getting my blood glucose level as close to normal as possible by following the instructions of the 
diabetes self-management team.

2. Regularly visit the clinic for a physical examination, laboratory tests, and nutrition counseling; follow-up visits will 
be scheduled every 3 months or more frequently if deemed necessary by my physician or other members of my 
health-care team.

3. Bring a detailed 1-day food record to each follow-up visit, provide necessary nutrition information for me and my 
dietitian, and adjust my eating habits to meet the nutrition goals established by my dietitian.

4. Use medications as prescribed by my health-care team

5. Monitor my blood glucose levels at home as instructed and brings the results to each follow-up visit.

6. Follow my prescribed exercise plan.

7. Obtain identification as a patient with diabetes, for prompt assistance in case of an emergency.

8. Ask my physician and other members of my health-care team to explain any aspect of my care that I do not entirely 

I understand that if I do not monitor myself carefully, there is a risk of hypoglycemia.

I also understand that if I do not strive to normalize my blood glucose, I am at increased risk of developing the 
complications of diabetes mellitus.

My signature indicates that I have read and understand the above agreement.



I agree to provide the leadership for the diabetes self-management team. Team members will be available to answer 
your questions and help you self-manage your diabetes. I will continue to encourage you to maintain the best possible 
control of your diabetes.



Obamacare in its attempt to standardize medical care is converting healthcare into a commodity and in the process destroying patient/physician relationships.

The healthcare system cannot be repaired without effective chronic disease management. Chronic disease management will not be effective without effective patient-physician relationships.

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

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The Therapeutic Magic Of The Physician Patient Relationship

Stanley Feld M.D.,FACP,MACE

A positive physician/patient relationship has magical therapeutic powers.

I believe I can best describe it with an outstanding personal experience.

It is reminiscence of an event that occurred long before I was a physician. It gave me incite into the power of a physician/patient relationship and stimulated my desire to become a doctor.  

During 30 years in private practice as a clinical endocrinologist I always tried to treat my patients remembering the therapeutic magic of that experience. The experience had magnificent healing powers for me.

The episode occurred when I was a first grader in the Bronx Public School System. The year was 1946. In those days being left handed was thought to be a curse. My first grade teacher forced me to write with my right hand to avoid the destiny of the curse. I remember the difficulty I had writing with my right hand. I was forced to persist. I made many mistakes in reading and arithmetic.

I also had difficulty learning new material. Nothing would stick. My father continually told me I was a smart kid. He said to not to believe my teacher’s impression of me.

I was never a difficult child at home. I always seemed to be agitated in school. I remember my teacher considered me a troublemaker.  

Finally, my teacher called my mother in for a conference. The teacher forced me to listen to the conference. She told my mother she was positive I was a disturbed child and needed psychiatric attention.

I was behind in reading, writing and arithmetic and was not adjusting socially. She told my mother she should act immediately before I was permanently damaged. She said if this continued I could be expelled from school.

My mother was beside herself. She did not know what to do. I felt her anxiety but did not know what to say. I did not know what a psychiatrist was. I was told we could not afford a psychiatrist.

I thought the solution to my problem was to be allowed to write with my left hand. No one would listen to me. Everyone, including my parents believed that left-handed people were cursed.

My father’s boss suggested we go to Dr. Schultz, a family practice doctor in the West Bronx. I remember the look of Dr. Schultz’s street. It was tree lined with two rows of attached single-family houses with concrete steps.

We lived in a four-room apartment in a walkup apartment building on Bristol Street across the street from the Boston Post Road movie theater. Dr. Schultz’s house was a mansion to me.

At six years old I was impressed, but terrified. My mother was anxious and terrified.

Dr. Shultz’s office had a desk, a few chairs and a mirror behind the desk. He asked my mother what was wrong. She repeated the teacher’s report almost verbatim. He asked some detailed medical history and took notes. When he finished he turned to me and asked me what I thought was wrong.

This is the first time anyone had asked me to express my opinion. He saw I was nervous and frightened. He calmed me down and told me usually the patient can tell him what is wrong if the patient is given a chance to express himself.

I told him that the teacher made me write with my right hand because left handed people were cursed. He said he heard that was a common superstition but there was no proof it was true. He then asked me to write my name and my brother’s name on a piece of paper with both my right and left hand. I did and he said “son, there is nothing wrong with you.”

My mother looked in disbelief. He then picked up the paper and showed it to her. She still did not understand. He then put the piece of paper in front of the mirror. My right-handed entry was legible now and the left handed writing which was legible at first was now backward. I was mirror writing.

He told my mother my problems were the result of the strain put on me being forced to write right handed. After I was permitted to write left handed for awhile my ability to write, read and do arithmetic would straighten out. My behavior problems would also vanish. He suggested that my mother listen to my complaints in the future. He wrote a note to the teacher telling her to let me write with my left hand.

Then he got up from his chair, came over to me and gave me a big hug. He also told me to show everyone they were wrong about me. I felt like a million bucks. All the tension left my body. I felt I could achieve anything.

There is no question in my mind that this approach to medical care and the therapeutic effect of the positive physician patient relationship saved my academic life.

The pressures on physicians today to see more patients, to test for everything so you do not miss a diagnosis to avoid malpractice suits, the lack of reimbursement for cognitive therapy, the use of interchangeable “providers”, the constant threat of financial penalties for undocumented care, and the continuous assault on physicians’ judgment has decreased the ability of physicians to relate in a human way.

“There is considerable healing power in the physician-patient alliance. A patient who entrusts himself to a physician's care creates ethical obligations that are definite and weighty. Working together, the potential exists to pursue interventions that can significantly improve the patient's quality of life and health status.”

Medical care has and is continuing to become commoditized by non-physicians.  The government and the insurance industry feel they own the healthcare system.  They have determined that through information technology and the evaluation of big data that they can improve healthcare.  They are dehumanizing healthcare delivery and medical care.

These actions are the common denominator to patients’ complaints about the medical care system. Patients feel this dehumanization. An important therapeutic effect of the lost human relationship will result in higher healthcare costs.

Our healthcare system has to change. It must support the humanizing elements of the patient/physician relationship. It has to nurture mutual trust rather than distrust between patients and physicians. A healthcare system that supports distrust, physician and patient penalties and adversarial relationships does not permit the kind of care physicians are capable of giving and patients need.

If information technology and the accumulation of big data are going to work it has to be as a physicians extender so that the physicians can best utilize the therapeutic magic of the physician patient relationship.

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

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  • Mary-Margaret Walker

    Thank you for this great post. I agree with you about the importance of the relationship between a physician and a patient. I still cherish my pediatrician from Fort Worth, Texas and the many wonderful doctors that I have known in my life. I shared this on my Facebook page because it also invokes, for me, the importance of the times and people in our lives who empower us to be ourselves.

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President Obama Ignores The Issue Of Malpractice Reform

Stanley Feld M.D., FACP,MACE

President Obama, in his signature legislation Obamacare ignores the issue of the need for malpractice reform (tort reform).

The need for tort reform is vital if President Obama really wants to reduce the cost of healthcare due to over testing.

The influence of the disinformation by the administration and the traditional media is terrifying. Inaccurate opinions by influential people will never lead to a functional, affordable healthcare system. It will only lead to increased stakeholders’ distrust and greater dysfunction in the healthcare system.

An excellent example of this disinformation is Senate Majority Leader Harry Reid, a Nevada Democrat, claiming: "The whole premise of a medical malpractice 'crisis' is unfounded."

Harry Reed, as usual, offers no data or proof for his statement. It is his opinion based on no facts.

Dr. Ezekiel Emanuel expressed his opinion in 2011.

“Everyone — conservative and liberal — agrees that $2.6 trillion a year is too much to spend on health care, and that we have to cut costs. But they don’t agree on who is to blame or what is to be done.”

I agree with this opinion. Everyone reaches the conclusion they want to reach using whatever facts they want to use.

He proposes an artificial threshold of significant cost savings in order to form a policy.

 “ A useful threshold for savings is 1 percent of costs of healthcare, which comes to $26 billion a year. Anything less is simply not meaningful.”

One percent is arbitrary. It permits Dr. Emanuel to dismiss problems that cost the healthcare system less than $26 billion a year.

The validity of the data collection is of no concern to Dr. Emanuel. He says only $1.3 billion results in malpractice costs. He ignores over testing, and lawsuit costs.

He says,

“Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable is meaningless. In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

A study, closer to truth than just an opinion, disclosed:

The truth is a full accounting reveals that more than 10 percent of America's health expenditures per year are spend on tort liability and defensive medicine.

This study concludes that $242 billion a year extra spent because of the lack of tort reform.

The $242 billion is well above Dr. Emanuel’s fictitious threshold.

Physicians have admitted to over testing in the Massachusetts Medical Society survey for fear of having to defend themselves against frivolous malpractice suits for potentially missing a diagnosis.

Most physicians love practicing medicine but cannot understand the unbelievably wrong direction President Obama is taking to reform the healthcare system.

In fact, in a recent study by the Physicians Foundation, six out of ten physicians said they would quit medicine. Many physicians are looking for viable exit strategies to avoid quitting.

The Physicians Foundation commissioned an extensive survey of nearly 13,575 physicians. Meritt Hawkins, the physician search and consulting firm, conducted the survey. 

“The survey found that 60% of physicians would retire today, if given the opportunity—an increase from 45% in 2008. And it's not just disgruntled and tired Baby Boomers who want to abandon their healing work. At least 47% of physicians under 40 also said they would retire today, if given the opportunity.”

The survey pointed out many major problem areas.

Two specific issues consistently agreed on by physicians were malpractice concerns and the need for tort reform as well as the lack of cohesive leadership among all physician groups to represent the vested interests of physicians and their patients.

This survey is an excellent. It is a detailed survey that has heightened the awareness of physicians’ practice problems.

The percentage of healthcare costs is even greater when the Massachusetts Medical Society survey is taken into account. The amount spent for defensive medicine can be extrapolated to actual costs from this survey.  

I have written a series of blogs analyzing the impact of the Massachusetts Medical Society’s survey. The extrapolated costs turn out to be about $700 billion a year. The real cost of defensive medicine is somewhere between $242 and $700 billion dollars a year.

In 2003, Texas Governor Rick Perry and the Texas legislature unenthusiastically changed tort reform laws in Texas.

Rick Perry and the Texas legislature rewrote the medical malpractice laws, ending plaintiff attorneys’ practice of venue shopping for friendly judges. They also put a cap of $250,000 on noneconomic damages like pain and suffering.

These reforms have changed the malpractice legal climate in Texas. The reforms limited plaintiff’s attorneys’ profitability on frivolous liability claims.

Texans believe that because of these reforms and the lack of a state income tax, Texas is the country's best state for economic growth and job creation.

A Perryman group report concluded,

Perhaps the most visible economic impact of lawsuit reforms is the benefits experienced by Texans who have better access to high-quality healthcare.

Doctors and hospitals are using their liability insurance savings to expand services and initiate innovative programs; those savings have allowed Texas hospitals to expand charity care by 24%.

The medical malpractice business for plaintiff’s attorneys has dried up in Texas. They are moving to other states. Physicians are applying for licenses to move to Texas from high medical malpractice states. 

“In 2001, according to the American Medical Association, Texas’ ranking in physicians per capita was a dismal 48th out of 50.”

“Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years.”

 “Dr. Perryman, subsequent to the issuance of his Report, informed TLR Foundation that at least 1,887 of those physicians are specifically the result of lawsuit reform.”

 The Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.

Medical liability insurance rates declined. Many doctors saw average rates drop between 20% to 50%.

The Perryman Group during the course of this study suggests that premiums are declining even further in 2008.”

The American Medical Association removed Texas from its list of states experiencing a liability crisis; marking the first time it has removed any state from the list.

 A survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures during the Texas malpractice crisis.

 Two simple changes in the tort laws made malpractice suits unprofitable for plaintiff attorneys.

Rick Perry has been so impressed with the results of his tort reforms that he now wants to extend his state's impressive tort reform record.

Mr. Perry is proposing a British-style "loser pays" rule, which would require plaintiffs to pick up the legal costs of their targets if they lose their suits.

Almost all of America's economic competitors in the world follow this standard. “Loser Pays” as a deterrent to law suits decreases the cost of doing business resulting in lower prices and a competitive advantage for business. “Loser Pays” would deter frivolous lawsuits.

If President Obama really wanted to do something sensible about lowering the cost of healthcare, Texas style tort reform should become the law of the land including loser pays all.

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

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Another President Obama Lie

Stanley Feld M.D.,FACP,MACE

 At the moment, ideology and political philosophy stands in the way of Repairing the Healthcare System.

President Obama believes in central control of the healthcare system. Central control of other healthcare systems has not worked to control healthcare costs while maintaining quality of care. The only possible exception is Switzerland’s healthcare system.

Each province in Canada spends at least 50% of its GDP on healthcare  according to the Frazier Report. The access to care is less than ideal. Healthcare spending is unsustainable in Canada

England is slowly switching to a private healthcare system.  

Obamacare has already demonstrated its inefficiencies and lack of cost control even though most of the population has received waivers from Obamacare for at least one year.

The trajectory of failure is not going to change until President Obama is out of office and the system changes to put the consumers in control of their health and healthcare dollars rather than having the government in control.

President Obama declared in 2010;

“Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.  Thanks to the regulations, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement.   If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.”

Unfortunately, for Americans, President Obama tells us what we want to hear in a very seductive way and then does the opposite.

President Obama is always calling for someone to provide a new idea in order to fix Obamacare. His promise to the public is a good idea. However it is not reflected in the Obamacare regulations.

What is the meaning of Medical Loss Ratio?

The definition of medical loss ratio is the incurred claims received divided by premiums collected.

The healthcare insurance industry negotiated all the rules it wanted from President Obama and Kathleen Sebelius in defining incurred claims in the new Obamacare regulations. The rules contradict Mr. Obama’s promise to the American public.

The healthcare insurance industry is supposed to spend 85% of the premiums collected on direct medical care costs.

The remaining 15% of the premiums is for the insurance industry’s expenses and profit.  

The healthcare insurance industry claims it is lucky if it clears 3% profit under the Obamacare rules.

In order to encourage the healthcare industry to participate in Obamacare, President Obama pledged that the government would subsidize the healthcare insurance industry for any shortfall in profit.

A self-insured employer sponsored healthcare plan outsources the administrative services to the lowest bidding healthcare insurance company. The government outsources Medicare, Medicaid and Tricare (VA insurance) to the lowest bidding healthcare insurance company.

The Obama administration has included most of the healthcare insurance industry’s requests in the incurred claims (direct patient care) formula that is used to calculate the medical loss ratio.  

Inflating the incurred claims decreases the amount of money spent on direct patient care in order to maintain an eighty-five percent (85%) medical loss ratio.

If the incurred claims costs go up the medical loss ratio goes down. The potential increase in the medical loss ratio is the justification used by the insurance industries to increase premiums.

Obamacare requires insuring with a pre-existing condition. Insuring everyone with a pre-existing condition increases the insurance risk. Hence Americans experience double-digit increases in healthcare of insurance premiums.  

 The expenses the industry wanted included:  

1. The cost of verifying the credentials of doctors in its networks.

2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.

3. The cost of programs that keep people who have diabetes out of emergency rooms.

4. The sales commissions paid to insurance agents.

5. Taxes paid on investments.

6. Taxes paid on premium income.

7. Unpaid claim reserves associated with claims incurred.

8. Change in contract reserves.

9.  Claims-related portion of reserves for contingent benefit.

10. Lawsuits experience-rated refunds (exclude rebates based on issuers MLR.  

All these expenses are administrative expenses in my view. It is questionable that these should be included in direct patient care (incurred claims).

These expenses also increase a healthcare insurance company’s profit. Each incurred cost has a built in 15-20% profit.

As these expenses continue to be are permitted as incurred claims (direct medical care expenses), the resources available for direct medical care decrease from eighty-five cents to sixty cents on every premium-collected dollar.

At the same time people complain about the grotesque profits and salaries of those in the healthcare insurance industry.

Obamacare, contrary to President Obama’s promise, did nothing to solve this abuse.

It is almost as bad as the promise," If you like your doctor you can keep your doctor. If you like your insurance plan you can keep your insurance plan.

The closest I could get to transparency and the distribution of one healthcare dollar to direct medical care is the following. 

Slide medical loss ratio 2


Fifteen cents goes to the doctor and twenty-five cents to the hospital. The remaining sixty cents goes to the healthcare insurance companies.

What are we paying for?


The definition of direct medical care according to Obamacare is:

 Definition of Medical Claims By Obamacare

Incurred claims = direct claims incurred in MLR reporting year + unpaid claim reserves associated with claims incurred + change in contract reserves + claims-related portion of reserves for contingent benefits and lawsuits +

experience-rated refunds (exclude rebates based on issuers MLR

Medical Claims and Quality Improvement Expenditures

As illustrated in Figure 1, increases in either medical claims or quality improvement expenditures (holding other factors constant) will increase

the MLR and reduce the likelihood of premium rebates to policyholders. Conversely, reductions in medical claims and/or quality improvement

expenditures (holding other factors constant) will decrease the MLR and increase the likelihood that insurers will have to provide rebates to policyholders.

Medigap plans (Medicare Part F) have separate medical loss ratio requirements. The healthcare insurance industry has to meet a 65% level for individuals and a 75% level for groups. It means that for every dollar in premium the individual has 65 cents minus incurred expenses coverage for direct medical care and for groups 75 cents minus incurred expenses.

Medigap plans, which are supplemental policies that Medicare beneficiaries can purchase to fill gaps in Medicare coverage, are not covered by the ACA MLR provisions.

Medigap plans are subject to their own separate MLR requirements, found in Title 18 of the Social Security Act; the MLR requirements are 65% in the individual marketplace and 75% in the group market.

Finally, the ACA’s MLR requirements do not apply to long-term care, dental, vision or retiree healthcare plans.

President Obama promised to fix these problems. He said,

 “Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing.  Thanks to the regulations, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement.    

He didn’t. He won’t.

He knows the problem. Fix it.

 If he did he would save Obamacare and tax payers a great deal of money. 

I am confident this suggestion will be ignored and at election time more false promises will be made.

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

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“Pick The Target, Freeze It, Personalize It, And Polarize It ”

Stanley Feld M.D.,FACP, MACE

The Obama administration uses the same tactics over and over again to neutralize its critics. They are the Saul Alinsky tactics in “Rules For Radicals.”

President Obama has recieved critcism for he ideas and implementation of healthcare policy, education policy, foreign policy, energy policy, military policy and constitutional policy.

Last weekend I was asked to republish the summary of Alinsky’s tactics as a reminder to my readers.

These tactics will be used over and over again in this election year. They should be understood so that when used they are recognized.

It is suddenly relevant to republish the blog post as President Obama exchanged five imprisoned Taliban leaders for one American soldier.

A key point is that President Obama did not notify congress of the prisoners exchange as he was required by a law passed last year. He signed the new law.

The five Taliban leaders are terrorist devoted to the killing of Americans.

 A second key point is many of the soldiers in Sgt. Bowe Bergdahl’s platoon have accused him of being a deserter and a terrorist.

I am not sure Americans will ever know the truth.

However, the Obama administration’s Saul Alinsky tactic machine has started its work to disceidit these soldiers.

The administration have begun to criticize and accuse the troops in the platoon of being liars in an attempt to marginalize, personalize and freeze their testimony. The goal is to polarize the audience’s opinion by creating uncertainty and invalidating his follow soldiers testimony.

The front page of the New York Sunday Times has been used as the messanger. Bergdahl Was in Unit Known for Its Troubles”

"The platoon was, an American military official would assert years later, “raggedy.”

"They were known to wear bandannas and cutoff T-shirts."

" Beau Bergdahl was a misfit soldier in something of a misfit platoon that stumbled through its first months in Afghanistan. It might have made it too easy for him to walk away, as his fellow soldiers say he did."



The New York Times story ommitted the fact that the military had these troops sign a non-disclosure agreement.

My February 23 2014 blog contains a summary of the Alinsky tactics. It also includes a debate between Dinesh D’Sousa and Bill Ayers at Darthmouth College in January 2014.


Stanley Feld M.D.,FACP,MACE

“Last week a reader sent me the link for the full debate between Dinesh D’Souza andBill 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 PresidentBarack Obama as D'Souza presents his theory of how early influences on Obama are affecting the decisions he makes as president.

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

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

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 reformcurriculum, and instruction. In 1969 he co-founded the Weather Underground, a self-described communist revolutionary group that conducted a campaign ofbombing 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.

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.'



 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."  President Obama is asking Republicans for constructive alternative that he ignores.

 If one studied 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 according to your 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.”


Medical care in America is being destroyed methodically by the use of  Alinsky tactics. The physician-patient relationship is almost gone.

We will only know the effect these tactics have had on America after they have destroyed our institutions and our moral fabric unless we start understanding what is happening right now and demand that it stop.

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

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The VA Healthcare System-The Precursor Of Obamacare

Stanley Feld M.D.,FACP,MACE

The VA Healthcare System scandal has been in the headlines for a few weeks. The scandal has brought out the fact, once more, that President Obama lied to the American people.

His excuses are very thin. He knew about the VA problems in 2005. He pledged to fix the problems before he was elected President in 2008. In 2011 he repeated his pledge.

Now he has the gall to tell the American public in 2014 that he didn’t know anything about the problems until he read about them in the press.

President Obama addressed the Veterans Affairs scandal on Wednesday, saying he's waiting for an Inspector General "audit" of what went wrong.

How stupid does he think we are?

President Obama probably wishes he had control over You-Tube and the Internet. He could then eliminate his past statements and promises.

It looks like he is trying his best by attempting to defeat Net Neutrality.

Liberals have long hailed the VA Healthcare System as the model of government health care.  Liberals believe everything the government runs is the best thing for America.

Can you think of anything that the US government runs works really, really well? 

If so, please share that information with the rest of us. 

How can it run a healthcare system?

The government has systems problems in everything it tries to run. It can publish mountains of regulations. It cannot execute much because of the way the systems have been set up or not changed over time. There are multiple examples of such failures of execution.

None of these agencies seem to work including the Post Office, Amtrak, FEMA (Katrina rescue), Obamacare (website or the health insurance exchanges), and even the government itself.

 I believe it is because government has imbedded in it a deadening bureaucracy.

The bureaucracy suppresses innovation and the ability to repair defects quickly as they occur. This leads to cover ups that are eventually leaked.

The fact that no one is ever held responsible for errors of execution just adds to the awkwardness of the cover up.

The recent scandals, Benghazi, the IRS, Fast and Furious and the reporting on Obamacare, are a few examples of this.

The press never shows us facts about the supposed “investigations” and who was responsible for the missteps. It only leads to more mistrust and suspicion.

The forced resignation of VA Secretary Eric Shinseki will not serve as a distraction from the real problems in the VA.  Eric Shinseki’s firing is not going to fix the VA’s Healthcare System’s problems.

Liberals are blinded by their ideology. They have long hailed the VA as the model of government health care. They ignore the facts. The VA Healthcare System’s problems have been around for a long time.  

There is little evidence that President Obama has tried to do anything about the VA Healthcare System since he became President.

 All the public heard is how great the VA system of healthcare delivery is and how his administration is going to make it better.

Paul Krugman is the chief purveyor of the Obama administration’s progressive ideology. Mr. Krugman’s problem is he ignores facts as he formulates his “socialistic” beliefs.

It is almost as if he is saying, “don’t confuse me with facts.” Just believe that I know what I am talking about because I am a Nobel Prize winner.

The crazy thing is many very smart people believe him, just as they believe President Obama.

Paul Krugman praised the VA as a triumph of "socialized medicine."  He even listed what's behind this success.

“Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it.”

“So it's free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense."

The progressives ignore the government system’s own “perverse incentives.” The most important is as VA bureaucrats they must cover their own backside for non- performance.

It leads to long treatment delays and deaths that are preventable. This is only the tip of the iceberg. The rationing of care has been devastating for those veterans awaiting appointments.

 The bureaucracy is forced to cover up the errors. The problem the bureaucrats have is free speech in America. The morality of some is drives them to tell the rest of us about the problems.

“VA centers fudge their data.” The VA has consistently boasted in its performance reviews that more than 90% of patients receive appointments within 14 days of their "desired date."

The hidden waiting lines and treatment delays are not the only problems.

Infection rates and poor treatment outcomes have also been hidden from other bureaucrats in the system as well as the public. These problems are as important or more important than hiding appointment lists.

"The rate of potentially lethal bloodstream infections from central-intravenous lines was more than 11 times as high among patients at the Phoenix facility than it was at top VA hospitals, data from the year ended March 31, 2014, show," notes the Journal.

"Those infections, called sepsis, can quickly cause multiple organ failure and kill an otherwise relatively healthy patient within days or even hours. The data don't show what percentage of patients died as a result."

 The Journal also reports, "Among patients admitted to the hospital for acute care, the Phoenix VA Health Care System had a 32% higher 30-day death rate than did the top-performing VA hospitals, a finding flagged as statistically significant by the agency's medical analysts."

William E. Duncan, supervised publication of VA Healthcare Systems medical outcomes until his 2012 departure.

He said in an interview that he urged that more data be posted regardless of the impact," adds the Journal. But he tells the paper that he was forced out of the VA amid a dispute over the issue.”

President Obama has said all we need to do is throw more money at the problem.


President Obama needs to fix the defects in the VA Healthcare System’s business model.

Inherent in the present VA Healthcare System business model is a system of misallocation of resources and inefficiency. Resources are allocated by political force rather than individual consumer choices.

This is true in most socialistic systems.

It is all about who you know. It is not about who are the most innovative, creative or truthful people trying to execute a system for the consumers’ benefit.

Obamacare's ultimate destination is the same as the VA Healthcare System.

It is going to happen by President Obama’s design. The government will completely control America’s healthcare system. The transformation is happening slowing by design to avoid protest. President Obama doesn’t care about the cost or creating a more efficient system.

He is doing it the same way you cook a live frog. He is raising the temperature one degree at a time. The frog will never notice the heat until he is cooked.

It is time for America to wake up!

We cannot take it any more.

America must demand that we change the business model NOW!

Repeal Obamacare now. 

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

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Salary Difference between Hospital Administrators and Physicians Over Time

In response to my last pos "Doctors’ Salaries; The Media Is The Message" a reader pointed out that the differences in the increases in the salaries of hospital administrators and physicians over a 30 year period between 1970 and 2000.

I did make the point that physician salaries from reimbursement have not increased.

He said I did not make that difference clear in relationship to time and the increase in healthcare costs.

He asked me to include the below slide to emphasis the point of the disconnect.

Difference in payment
I felt to be complete I should publish this slide.

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

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