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All items for January, 2015


It’s De Ja Vu All Over again!

 Stanley Feld M.D.,FACP,MACE

President Obama uses the same moves over and over again in order to fool the traditional media and the American citizens. Why change tactics when they always work?

He knows Americans want to believe him.

Jonathan Gruber, a consultant economic architect of Obamacare was correct when he said that a lack of transparency is a powerful political tool. He said Americans are too stupid to see through the charade.

President Obama thinks his job is to transform America. He never defined what transforming America means.

Americans assumed he would make America a better place to live for the average citizen.

In the last six years the average American has not had job security, healthcare  security or a better standard of living. President Obama keeps telling Americans they have a better life.

President Obama saying it does not make it so.

Americans are starting to perceive reality and do not believe him or in him anymore.

In February 2014 I published the following blog. The tactic President Obama uses is to present a half-truth that is not close to the truth. He confuses Americans so they do not know what to believe. They stop paying attention to what is happening to them and society. They do not search for the truth until it affects them directly.

President Obama’s fantasy is now affecting the hard working middle class. They now know he lies to them. They feel they have been taken for fools.

In the last few weeks he has been putting out false narrative about how well Obamacare is doing.

Last years blog will set they stage to understand the way the tactic has been played over and over again.


"Why Use Facts and Logic?  

Stanley Feld M.D.,FACP,MACE

 February 27,2014

I 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 it the most.

President Obama’s opponents have not figured out how to neutralize  the Alinsky formula. 

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 by the uproar about the 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 his 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 deficit 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.

Both were lies. It doesn’t seem to 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 henchman at the New York Times. Paul Krugman is the chief.

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!"  Feburary 27 2014


In February 2015 President Obama’s misdirection continues. There is a lack of transparency about the 2015 enrollment figures. The goal for enrollment is rigged.  Last year is was initially published that there were 9 million enrollees.

Those figures were false. It was eventually corrected down to 6.8 million.

The 6.8 million figure included the people who have lied to get higher subsides. Presumably they lied with the help of President Obama’s Navigators who receive $48 an hour from the government to help people complete their applications.

 At least 15% (1 million plus) of these people have dropped their healthcare insurance coverage because they lost the subsidies and/or the deductibles were too high.

As the Republic House and Senate are preparing to repeal Obamacare, the public is hearing from President Obama through the traditional media that Obamacare is working well and will not be repealed.

His fantasy is expressed in the following January 2015 headlines.

President Obama’s Fantasy

Obamacare Will Cost 20% Less Affordable will Cost 20% Less Than Initial Projections, CBO Says

Right-Wing Media Won't Tell You That The CBO's New Obamacare Cost Estimates Are Lower Than Expected

 New York Times: "Budget Office Slashes Estimated Cost Of Health Coverage." 

 HHS: More Than 7.1M Have Enrolled In 2015 Plans Via

Obamacare website enrollment crests 7M as Feb. 15 deadline looms

7 Obamacare Facts You Need to Know at the Halfway Point of Enrollment

Burwell: ‘Time is running out’ for ObamaCare signups

To a casual observer the problems are solved. The cost of healthcare are affordable. Obamacare’s enrollment numbers are great.

 The Facts next time.


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

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The Needs Of Patients and Physicians

Stanley Feld M.D.,FACP,MACE

 Our present healthcare system is driving both patients and physicians away from what they need in caring for a patient’s illness.

 Medical care is being forced into becoming a commoditized industry. Every step in medical care must fit into a protocol in order to be reimbursed. This is true for private practice as well as healthcare systems in which physicians receive salaries from the institutions.

 It is commonly believed by the public that these physicians have no incentive to be productive. This is a false perception. If these physicians are doing direct patient care daily the unit manager’s job is to push the physicians to be productive and generate income.

Many of the salaried physicians are not motivated to develop a relationship with the patient because they will not see them again.

 A complete history and physical examination is the first thing future physicians are taught in medical school.

If a physician lets the patient tell his story and it is followed by a complete physical exam, a physician can make a diagnosis 90% of the time.

Economic pressures have bastardized the system of complete history and physical. Physicians do not have time to develop a physician/patient relationship.  

Dr. Abraham Verghese TED talk : A Doctor's Touch says it all. Everyone who is interested in what happened to medical care and a physician/patient relationship should watch this You Tube.

The physician/patient relationship is the desire of many patients. This is one of the reasons for the growth of concierge medicine practices in the country. Physicians have enough time to spend with their patients. The upfront concierge fee subsidizes the physician’s income.  Physicians have enough time to perform a complete history and physical.

 I was talking to a retired internist this last weekend about Dr. Ezekiel Emanuel’s pronouncement about the yearly physical being worthless.

He said that was crazy. His yearly physical saved his life three different times over a thirty year period.

The first was the discovery of his cancer of the prostate. It was picked up on his yearly physical.

The second time was when leaking of his mitral and aortic valve was discovered on yearly physical. It resulted in valve replacements.

Third time his life was saved on another yearly examination was when a mass found in lung on a chest x-ray during a routine annual check up.

He said he would have been dead long ago if he did not have an annual physical.

It is easy for a politician or policy wnk to say something is worthless if he is not the patient.

This example is further evidence that government should not be responsibile for the patient's healthcare dollars and make the patient's medical treatment decisions.  

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

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View Of A Young Doctor: Dr. Starner Jones

Stanley Feld M.D.,FACP,MACE

 A reader sent this note to me with a request to pass it on. The note hits the nail on the head.

 Dr. Starner Jones is an intern in a large community hospital.

 As a young physician he understands the folly of America’s entitlement society.

His short two-paragraph letter to President Obama accurately puts the blame for America’s dysfunctional healthcare system and its accelerated unsustainability on our  "Culture Crisis." Our country has a "Health Care Crisis" as a result of its "Cultural Crisis".

He presents the crisis, its diagnosis, prognosis and cure in just three (3) short paragraphs.

If you doubt any part of what Dr. Jones says, go visit your local hospital emergency room as an observer for an hour or so some Friday or Saturday night. Then see how many responsible people you can send his solution to for them to send it on. 

 “Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ring tone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! (A Completely Free Healthcare Program provided by our Government) During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

And you and our Congress expect me to pay for this woman's health care?

 I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture", a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based on the irresponsible credo that "I can do whatever I want to because someone else will always take care of me."

Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.


 If you agree…pass it on to responsible friends. 

There are additional reasons for America’s “healthcare crisis.” However, as long as we elect local, state and federal politicians who believe that all of society must be responsible for the welfare of the irresponsible members of society, America’s unsustainable economic situation will become worse.

Someone told me America is the greatest economic machine in the world “only because we print more money and suck less.”

 The more people receiving the benefits of the inefficient redistribution of wealth through entitlement programs the harder it will become to reinvigorate the American dream.

America is working its way toward a totally socialist society where the government supports us and tells us what to do and where and when to do it.

We will wake up one day and ask what happened to the freedoms guaranteed by the Constitution and Bill of Rights.

The answer is we gave them away to power hungry politicians who want to control us.

France just dropped its 75% tax rate because its society was economically unsustainable no matter how high its tax rate and the economy is collapsing.

France has had a "Culture Crisis "that is causing its social and economic collapse. The country finally realizes the people must have incentives to be creative. Progress does not happen as a result of entitlement and the redistribution of wealth.

The British National Health Service is in grave financial difficulty. 

 The NHS is in danger of being shut down.

"It’s a period of unprecedented pressure, of undue pressure. the NHS is facing very difficult times, yes. The word "crisis" implies that you can’t deal with it."

"A Department of Health spokesman said: "In common with healthcare systems around the world, the NHS is facing unprecedented demand, but undermining the principle of services being free at the point of use is not the answer."

I think rather than repeating the same mistakes over and over again, someone would learn something about fixing the “Culture Crisis”.

 As other countries are trying to fix their “Culture Crisis”, President Obama is going in the other direction and accelerating the road to economic failure.

Jack P, Athens wrote the following comment in,  

“Socialism always brings a good laugh when it collapses as the politicians raise taxes to cover their mistakes.”

President Obama is destroying the healthcare system with Obamacare.

I would try to fix America’s “Culture (entitlement) Crisis” by helping people become responsible and act independently. I would not increase policies that promote individual dependency on the government.

Somehow Americans have to wake up as a people and try to stop the government from following this path.

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

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Are You Kidding?

Stanley Feld M.D.,FACP,MACE

The New York Times continues to have Ezekiel Emanuel M.D., Provost of the University of Pennsylvania write a medical opinionator column.

It is no wonder the Times circulation has fallen to only 2 million readers. It is no longer the newspaper that prints “all the news that is fit to print.’

Malcolm Gladewell, in a critique of Steven Brill’s “Bitter Pill”, describes Ezekiel Emanuel as follows,

Emanuel was the “brashest” and most “academically credentialed of the trio of brilliant Emanuel brothers,” took “edgy” positions, and had an “MD and a PhD (in political philosophy) from Harvard, a master’s from Oxford, and a position teaching oncology at the Dana-Farber Cancer Institute in Boston.”

 He had “brains, cunning and [a] biting persona,” and was “ready, willing and able to layer it with the self-righteousness of a guy who treated cancer patients.”  

He also does not give a straight answer when challenged.

In my opinion he des not understand either the healthcare system or the medical care system. He does not understand patients’ problems or needs.

Yet President Obama has used him as his medical care advisor for Obamacare. Two recent articles that he has written emphasize the above. 

The first is “Why I Hope to Die at 75” An argument by Ezekiel Emanuel that society and families—and himself—will be better off if nature takes its course swiftly and promptly.

It must be read to be believed. No amount of commentary can describe this unbelievable argument. It left me speechless. It is a set up for government to ration medical care.

It also made me wonder how the President of the United States can permit Dr. Emanuel to be the spokesman for medical care in America. President Obama can only permit it if he agrees that government should control our freedom of choice.

Dr. Ezekiel Emanuel, last heard from claiming that he wants to die at 75 in order to avoid becoming a burden on society, writes in the New York Times that “screening healthy people who have no complaints is a pretty ineffective way to improve people’s health.”

He believes that government should control patients’ freedoms.

In an article he wrote that appeared in Lancet he stated;  We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favoring the worst-off, maximizing total benefits, and promoting and rewarding social usefulness. 

Dr. Emanuel is all about rationing care for individuals. He is all about the government telling individuals what care they are entitled to depending on their age and usefulness to society.

The second article that solidified my concept of this man was his article Skip Your Annual Physical.

It should be read to understand his mission.

President Obama had built into Obamacare preventive services requirements. This resulted in at least 5 million people in the individual healthcare market losing their insurance and their doctors.

Obamacare mandates that Americans pay via new taxes and inflated health insurance premiums for services they do not need or they do not want. One ridiculous service would be birth control for the elderly.

Additionally the National Commission on Prevention Priorities found that by increasing just five preventive services, clinicians could save more than 100,000 lives per year. These services include breast cancer screening in women 40 and older, flu immunizations in adults 50 and over, colorectal cancer screening in adults 50 and over, smoking cessation counseling, and a daily aspirin in high risk cardiovascular patients.

Ezekiel Emanuel now contradicts this previously adopted notion. Now he wants it out. President Obama can probably take it out by executive order.

One can get a deeper an understanding of this man’s temperament when listening to these two interviews.

Obamacare’s architects are setting up Americans to be resolved to accept what the government will decide and provide. Americans will have no option to decide what medical care they can have and what physicians they can see. Non-elected bureaucrats will decide for us.

I implore Americans, congress, all of organized medicine and all physicians to say enough is enough. Obamacare should be repealed.

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

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Obamacare’s Solyndras

Stanley Feld M.D.,FACP, MACE

Peter Orszag was previously President Obama’s director of Office of Management and Budget. He was wrong about Obamacare’s economic impact, improvements in the healthcare system and efficiency in 2009.  He is wrong about it in 2015 in his critique of Steven Brill’s book “A Bitter Pill”.

The problem is Peter Orzag still believes in the Obama administration’s fiction. He quotes the Obama administration’s spin of the results as proof of Obamacare’s success. There is little valid data to back up the spin.

Obamacare has had its share of Solyndras. Solyndra was destined to fail. It had a lot of built in organizational waste.

I fear the few Obamacare experiments that we are aware of that have failed are only the tip of the Obamacare failure iceberg. There will be many more debacles that the Obama administration is probably hiding. 


Community Living Assistance Services and Supports, or CLASS, was designed to provide cash benefits for those patients needing long-term services and support. CLASS was a part of Obamacare (Affordable Care Act). Many Republican and moderate Democrats objected to CLASS and considered it fiscally unsustainable. It would only waste money.

Senate Budget Committee Chairman at the time Kent Conrad D-N.D. called CLASS “a Ponzi scheme of the first order”. In any event the $68 billion dollar program was rammed through as part of Obamacare.  

Two years later the Department of Health and Human Services determined CLASS could not be implemented in a fiscally solvent manner, and in January 2013 Congress repealed CLASS.

In 2015 the American public still does not know how much of the $68 million dollars was wasted.

Just how much did cost?

 The American public will never know. We will never know what we should have paid for the website or what we finally paid.

In October 2013 as soon as it was apparent that was a train wreck the Obama administration denied all the published prices contracted for building the website.

Prices to build the website varied from $91 million dollars to $634 million dollars to over 1 trillion dollars ($1,000,000,000.00).

Americans did not know what the website should have cost. They never found out what the cost was to rebuild the website after the initial disaster.

It was never clear whether the contract to CGI was won by competitive bid. The Obama administration never answered the question of Michelle Obama’s influence in choosing CGI.

The history is clear. CGI has failed to deliver for other projects they have done in other parts of the world.

What is the truth? Why would the Obama administration pick this company? What can we do about this waste of taxpayers’ money?

I guess Americans can remain passive and pay more taxes.

Americans have given up on the truth about the

 debacle. The attitude of many is that it is what it is. We must go on.

All Americans are hearing or want to hear is the current website is easy to use and is working well.The important question is, Is it?

It is easy to understand why Jonathan Gruber would say Americans are stupid and the lack of transparency is a powerful tool. The implication of that statement indicates an Obama administration attitude. It is the reason the administration says they hardly knew the guy.

CoOportunity Health falters, taken over by state

This Obamacare debacle almost got away from recognition by the American public.

 CoOportunity Health is a fledgling Iowa health insurance cooperative set up under  Obamacare with Obamacare money.  It is going bankrupt.

CoOportunity Health was set up by the Obama administration. The Obama administration granted the company $146 million dollars in funding from Obamacare funds. The idea was to provide consumers and small businesses alternative insurance in healthcare markets with limited insurance choices. It could also be thought of as a disguised “Public Option”.

The healthcare insurance industry had refused to participate in the federal and state insurance exchanges in many states. The healthcare insurance companies thought the risk was too great. They would lose money.

Just before this year’s open enrollment period President Obama activated the reinsurance provisions in Obamacare guaranteeing insurance companies that they can only make money and not lose money on providing insurance through the government health insurance exchanges.

The Healthcare insurance companies are falling all over themselves to provide healthcare insurance in high risk states now.

 Where else can you sell insurance to more people at no risk?

“As of December 12,2013 Cooportunity has only $17 million of the $146 million dollars left.  CoOportunity has been taken over by state regulators and could soon go under, officials said Wednesday.

The Obama administration knows they can now throw government funded insurance companies like CoOportunity under the bus because they have guaranteed backup companies from the healthcare industry that want to sell no risk insurance.

 The CoOportunity hasn't reached insolvency yet but it doesn’t have  enough money on hand to continue to run the company.  It will leave 96,350 consumers uninsured with unresolved claims healthcare insurance claims. These consumers will also lose their un-used premiums.

The 96,350 should be able to get insurance through the federal health insurance exchange in their state.

The federal government as banker has simply cut CoOportunity’s credit and took a $146 million dollar loss.

I wonder how many other Obamacare funded insurance companies are out there?

I wonder how many other Solyndra like experiments Obamacare has. I can think of at least 4 or 5.

I wonder how much money Obamacare is losing on experiments and bureaucratic waste?

It is making medical care more expensive for taxpayers and for patients with increased out of pocket expenses.

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

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Kicking The Sleeping Dog

Stanley Feld M.D., FACP,MACE

 Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost.

The benefits to the nation are not at a reasonable cost. The waste imposed on to the healthcare system is escalating daily. The cost healthcare coverage provided to the Harvard faculty by the Harvard administration has escalated significantly since Obamacare was enacted into law.

The Harvard administration has absorbed the increased cost of Obamacare for the faculty. The Harvard faculty continued to believe President Obama and the Obama administration were doing a noble deed for the nation until the costs affected them directly.

Now the Harvard administration has shifted some of the increased costs on to the faculty in the form of higher deductibles and direct costs. Corporations have been doing this since Obamacare was passed.

“ The Harvard faculty, and the professors are in an uproar”

I have touched on Harvard’s faculty outrage lightly while others felt this was a huge story pointing out Harvard’s faculty’s liberal hypocrisy.

It proves the point of an old Texas saying, “you shouldn’t kick a sleeping dog because if you do he will awaken and come back to bite you.”

The more important issue that the Harvard faculty should wake up to is the yearly  tax increases that Obamacare has imposed on both the taxpaying and non taxpaying members of our society.

 A big question is, are Americans getting their money’s worth?

The Harvard faculty outrage should be about the Obamacare tax increases.

“Cost of ObamaCare"

 $1.4 Trillion ($1,383,000,000,000) *

ObamaCare's coverage provisions will cost the federal government $1.4 trillion (net) over the next 10 fiscal years, according to the CBO.

That is the net cost to the federal government of the provisions to expand and subsidize health insurance coverage over the fiscal 2015-2024 period.

 The gross cost of the coverage provisions – before individuals and employers have paid their penalties and insurers have paid their excise taxes on "Cadillac" plans – stands at more than $1.8 trillion over the same period.

 Since some will pay large penalties and some will pay none, this taxpayer calculator analysis doesn't attempt to distribute the $456 billion in coverage spending that is expected to be offset by penalties, excise taxes, and some other tax revenues.

*Congressional Budget Office”

We all know how wrong the CBO can be. The CBO is totally dependent on the data given to it. If there is bad data in bad data comes out. We can all recall the CBO publishing a surplus from Obamacare at the end of ten years before the bill was passed.

It is important for everyone to recognize the increased taxes that have been imposed with little evidence for significant payback. Below is my second printing of an article I wrote in March 2014.

 "Obamacare's New Taxes And The Middle Class"

Stanley Feld M.D.,FACP, MACE

“It is important to review all the taxes written into the Affordable Care Act (Obamacare). Americans are recognizing that those tax increases are being passed on to all consumers.  The middle class was not supposed to experience tax increases. The middle class is realizing it has less disposable income because of these new taxes.

Since 65% (sixty-five percent) of America’s economy is dependent on consumers discretionary spending, America is destined to further economic difficulty.

These new tax increases are timed in the hope that no one would notice them.

The increased taxes are supposed to fund Obamacare. The taxes continue to be collected even though much of the law’s implementation is delayed.

The increases in Obamacare taxes arearranged by their respective effective dates. Below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today: 


Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that took effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.


Capital Gains











*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:


First $200,000
($250,000 Married)

All Remaining Wages

Current Law

2.9% self-employed

2.9% self-employed

Obamacare Tax Hike

2.9% self-employed

3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that take effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following


1 Adult

2 Adults

3+ Adults


1% AGI/$95

1% AGI/$190

1% AGI/$285


2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085

 Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

 Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

This “tax” is under everyone’s radar. It has never been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present
 Monthly Fee of $96.40, rising to:

$104.20 in 2012

$120.20 in 2013

$247.00 in 2014."

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.

These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

Please send this blog to everyone you know and their children. It is important for them to know that President Obama is throwing seniors under the bus.  Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation and create a diversion to the facts.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare must be repealed.   

Everyone interested in America’s economic future must tell a friend to repeal these crippling taxes. President Obama has deceived Americans with Obamacare and its new taxes.  

It is time for everyone to get angry and give control of the House and Senate to the Republicans in November.”

It is difficult for Americans to comprehend all of these taxes. It is important for our surrogates that begged us to elect them to understand these taxes and act on our behalf.

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

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Republican Leadership Is Chickening Out!

 Stanley Feld M.D.FACP, MACE

Since the Republican’s massive victory in November President Obama has been setting up strategy to blame Republicans for all that will go wrong as that majority pledged they would repeal Obamacare.

It was strange that President Obama was not contrite or acted defeated by the election. He said 66% of the people did not vote. He said that those 66% did agreed with his policies and therefore it was a mandate for him to carry on.

President Obama knows he has the RINO’s on their heels

 The traditional mainstream media did not question President Obama’s premise that 66% liked his policies.

Another explanation could be that those 66% disagree with   President Obama’s policies. They believe in President Obama but believe his policies are wrong and did not vote for them.

After all, President Obama said the election was about his policies.

He has not paid attention to needs or will of the Americans people.

President Obama has used the traditional mainstream media (TMM) to promote his agenda. After the TMM publishes the Obama administration’s lies over and over again it becomes the truth even though it remains a lie.

A perfect current example is the administration’s lie that open enrollment for Obamacare is going great.

 The Republican moves come, ironically, as the Affordable Care Act is working fairly well. The three-month enrollment season for 2015 is going smoothly and will likely surpass the administration’s modest second year goals of having 9 million covered in exchange plans.’

After two years of open enrollment if Obamacare signs up the original estimate of 13 million, it still has 320 million people short.  However, President Obama will tout the amazing success ever though Obamacare is unsuccessful and harmful to Americans who were satisfied with their insurance and their doctor before Obamacare.

President Obama has been collecting increased taxes for Obamacare for 4 years.

 “Republicans have been vowing to repeal Obamacare for nearly five years. But 2015 could be the year that Republicans finally define how they would replace it.”

Now Republicans are chickening out. Some Republicans want to delay their repeal strategy until after the Supreme Court rules on the King v. Burwell case in June. Some want to delay it until the presidential campaign in 2016.

I believe Republicans should be aggressive. They should lay out a business model that will work immediately. Then repeal Obamacare . Let the President veto the bill as Republican actively work to replace Obamacare with a carefully explained alternative that makes sense to the public. Republicans can then try to overturn the Presidents veto.

President Obama has asked Republicans over and over again to give him some ideas to fix Obamacare. Obamacare cannot be fixed because of President Obama’s ideology. It must be repealed.

Republicans have many ideas to replace Obamacare with. For years they’ve discussed tax credits to buy insurance, high-risk insurance pools that work and allowing insurance to be sold across state lines. They need to put these ideas together with a compelling and viable business plan such as my ideal medical savings account.

Republicans must create a consumer driven healthcare system.

President Obama and the media have mocked Republicans for not having a plan or offering a fix for Obamacare. I said previous there is not fix for Obamacare. The American public does not want their freedoms restricted. In addition a single party payer system have failed economically in all of the developed countries except Switzerland.

Various Republican proposals have been put forth over the years, but forging agreement requires bridging deep ideological differences among Republicans about the scope of a plan, the role and responsibility of the federal government in health care, and how much to money to spend.”

A plan must include an entirely new system that includes a business plan. The plan must include the freedom for consumers of healthcare to choose and provide access to care without rationing of care.

The plan must also include systems of care for the most expensive chronic diseases such as Diabetes, Asthma, Cancer and Chronic Infectious Diseases.

The plan must not exclude access of care for the elderly that need hip replacements, knee replacements, cancer treatment or heart disease.  

The plan must develop a system for decreasing the cost of the treatment of chronic diseases. It must have within the treatment system a plan to make the consumers more responsible for the health and healthcare dollars.

It should shift the responsibility of care from the government and insurance companies to consumers. Consumers should decide what they need not the government.

Republicans have had six years to decide on what they should be promoting.

President Obama is in a perfect position to mock and veto any Republican piecemeal suggestion.

President Obama has already smiled regarding the new Republican majorities when he said he has to sharpen his veto pencil implying all they will do is present bills that are stupid.

However, the Republican leadership, rather than passing bills in the senate and house of representative to repeal Obamacare, have chosen to work with the Democrats and President Obama.

The Republican leadership is too afraid to do anything scary. They are afraid to lose votes to the Saul Alinsky tactic of ridicule. It might cause them to lose the 2016 Presidential election.

So what does the Republican leadership do the first day they are in power? They take away key healthcare committee chairmanships of leaders who have voted for the removal of Speaker Boehner.

Next they propose a lame reform to change the definition of part-time employment from 29 hour a week to 40 hours per week.

 President Obama would veto Republican legislation that would alter the definition of full-time work under Obamacare from 30 to 40 hours, the White House said Tuesday.”

 It is a stupid proposal on many levels.

 The Harvard faculty uproar of the last few days is very important. Almost all the faulty were big supporters of Obamacare until it affected them. I hope the rest of the country reacts the same way and demands their local newspapers publish multiple stories about their citizens pain.

Now that the Republicans are in power in both houses they should be educating the public about the irreparable issues in Obamacare and define its business model for 2020.

The Republicans should let everyone know they are feeling the public’s pain. Republicans should define a business plan that will provide healthcare for everyone at an affordable cost.

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

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Things Happen When No One is Looking

Stanley Feld M.D.,FACP,MACE

I wish you all a Happy and Healthy New Yew Year.

I have not written blogs during the holiday season because I figured no one would pay attention to what is happing in healthcare.

President Obama figured the same and snuck in a few things to continue to destroy the healthcare system.

Obamacare “innovative programs” seem to be going nowhere. The Obama administration continues to insist that all is going well.

The money spent is being wasted. The taxes for the funding of Obamacare’s 6.7 million enrollees is increasing as it attempts to increase enrollment to 9 million down from the original enrollment goal of 12 million.

I received a note from a reader who said Obamacare is here to stay. It is what it is. We should try to repair Obamacare rather than repeal it and replace it.

In my view Obamacare cannot be repaired. It was created to destroy the healthcare system. President Obama’s goal is to replace Obamacare with a government controlled single party payer system.

 The result will be to control and restrict access to care and ration care. It is a step on the way to restrict citizens’ freedoms.

Every week indications of Obamacare’s failures appear but are kept under the public’s radar.  The Obama administration spins the facts and the mainstream media’s regurgitates that spin.

 The Obamacare signup figures as complied by as of 12/30 2014 are very different that the administration’s spin to the media that the open enrollment period is going great.

Obamacare’s enrollment is still 1 million below estimate at this point

Confirmed 2015 QHPs: 7,403,558 as of 12/29/14
Estimated 2015 QHPs (Cumulative):
11/21: 610K (462K HCgov) • 11/28: 1.02M (765K HCgov) • 12/05: 1.80M (1.35M HCgov)
12/12: 3.26M (2.46M HCgov) • 12/15: 4.70M (3.52M HCgov) • 12/19: 8.52M (6.40M HCgov)
12/23: 8.65M (6.50M HCgov) • 12/30: 8.84M (6.54M HCgov)

state-level projections

 HHS finally announced that approximately 87% of Americans who selected 2015 health insurance plans through in the first month of open enrollment are receiving financial assistance to lower their monthly premiums. This percentage of subsidy awards is higher than in the same period last year.

The number is significant because, should the U.S. Supreme Court decide against the Obama administration in the King v. Burwell case it is scheduled to hear in March, consumers living in the 37 states relying on the subsidies from could lose their premium subsidies.

Another problem is even with the subsidy the people who received them cannot afford the insurance deductible. They do not seek medical care.

HHS has yet to disclose if it has a contingency plan should a ruling come down that only those who buy Obamacare insurance through state exchanges are eligible for coverage subsidies.

The CMS Innovation Center was established by section 3021 of the Affordable Care Act (Obamacare) for the purpose of testing “innovative payment” and service delivery models to reduce healthcare expenditures while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.

To date the CMS Innovation Center has awarded $2.6 billion through September 2014 to hospitals, doctors and others through nearly two dozen programs that tested new ways to deliver healthcare and pay for it.

“Results of those programs some underway since 2011including more than 60,000 providers and 2.5 million patients in Medicare, Medicaid and the Children's Health Insurance Program, are largely not yet available, the Innovation Center said in its second report to Congress.”

The ICD-10 diagnostic and procedure codes were to be implemented two years ago. It appears to be going nowhere because it is too complicated. President Obama will probably delay it again.

The change toICD-10 from ICD-9 has been pushed forward at least three times. It is too complicated. It is designed to commoditized medical treatment and eliminate physician judgment. Codes have been increase from 18,000 (complicated enough) to 68,000. Neither physicians nor their unsophisticated computer systems can comply correctly.

The Obama administration is still pushing for its execution and wasting money yearly. Physicians cannot and will not comply with this government regulation.

 It is destined to fail at a tremendous waste of taxpayers’ dollars.

President Obama promised the AMA he would fix the defective Medicare Sustainable Growth Rate formula( GRF) for calculating Medicare reimbursement to physicians. As a result of that promise the AMA supported President Obama’s healthcare reform bill.” 

The GRF is not fixed yet. Congress delays the reductions in reimbursement due to this defective bureaucratic formula  each year and adds the percentage reduction in physician reimbursement to next year’s reimbursement reduction.

This year physicians can expect another 4% reduction for a total of 32% since 2002.  We will see if congress fixes this defective formula this year.  

On January 1, 2015 physicians are going to experience a series of pay cuts from CMS.  If functional electronic medical records are not implemented physicians will experience additional reimbursement reductions from Medicare and Medicaid.

Physicians are struggling to deal with new measurements to improve quality and deal with a myriad of new changes in Medicare and Medicaid rules and regulations.

Two years ago in order to attract more physicians to accept Medicaid to care for the growing number of enrollees in Medicaid, Obamacare increased Medicaid reimbursement by 40%. The increase in reimbursement was to last only until January1, 2015 and then revert to the 2012 reimbursement schedule.

Those pediatricians, family practitioners and internists were faked out once more by Obamacare and President Obama’s promises.

The biggest pay surprise to physicians will come when the old reimbursement returns. Poor Americans on Medicaid will suffer when they cannot find a physician.  

No other segment of the health care industry faces penalties as steep as these and no other segment faces such challenging implementation logistics,” Dr. James Madara, the AMA’s CEO wrote to the Obama administration.  “The tsunami of rules and policies surrounding the penalties are in a constant state of flux due to scheduled phase-ins and annual changes in regulatory requirements.”

 The cascade of rules and regulations will affect every specialty of medicine. The only thing left is for physicians to quit participating in government programs.

Then government can force medical license renewal to be tied to participation in government healthcare programs.

Where is physicians’ choice and freedom? There is currently a physician shortage. If physicians quit medicine and surgery what will happen to patient care?

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

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