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All items for February, 2015

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Here’s One For You, Stan

Stanley Feld M.D.,FACP,MACE

I wish to thank my readers for the many comments and suggestions sent to me over time.

I am starting to receive some serious criticisms of Obamacare that everyone should take note of.

Americans do not realize how bad the law is until they experience it.

People are starting to pay attention to the Obamacare disaster. They  realize it is affecting them directly.

Many people are having trouble finding a doctor. Many are having trouble getting access to care. Emergency rooms have become overcrowded. It is an awful experience to try to get care.

A note from previously insured patient who became uninsured because of Obamacare’s insurance requirements.

 

 “Here's one for you Stan. 

 

Here are the 10,535 pages of Obama Care condensed to 4 sentences.  
As ridiculous as this sounds…..every last word is absolutely TRUE!

1. In order to insure the uninsured, we first have to uninsure the insured. 
2. Next, we require the newly uninsured to be re-insured. 
3. To re-insure the newly uninsured, they are required to pay extra charges to be re-insured.
4. The extra charges are required so that the original insured, who became uninsured, and then became re-insured, can pay enough extra so that the original uninsured can be insured, which will be free of charge to them.

This is called "redistribution of wealth"… or, by its more common name, "SOCIALISM.

There are many more people confused by Obamacare. The reader is correct. The summary is spot on.

On top of this I got this note from another reader.  The public is starting to figure out Obamacare. This is a note written by a Californian.

 A Note From An Engineer

 “THIS IS WHAT OBAMACARE IS REALLY ABOUT!!!!!!!!!!!!! 

I'm a 54-year-old consulting engineer and make between $60,000 and $125,000 per year, depending on how hard I work and whether or not there are work projects out there for me. 

My girlfriend is 61 and makes about $18,000 per year, working as a part-time mail clerk. 

For me, making $60,000 a year, under Obamacare, the cheapest, lowest grade policy I can buy, which also happens to impose a $5,000 deductible, costs $482 per month. 

For my girlfriend, the same exact policy, same deductible, costs $1 per month. That's right, $1 per month. I'm not making this up. 

Don't believe me? Just go to http://www.coveredca.gov/, the Obamacare website for California and enter the parameters I've mentioned above and see for yourself. By the way, my zip code is 93940. You'll need to enter that. 

So OK, clearly Obamacare is a scheme that involves putting the cost burden of healthcare onto the middle and upper-income wage earners. But there's a lot more to it. Stick with me.

And before I make my next points, I'd like you to think about something:

I live in Monterey County, in Central California. We have a large landmass but just 426,000 residents – about the population of Colorado Springs or the city of Omaha.

But we do have a large Hispanic population, including a large number of illegal aliens, and to serve this group we have Natividad Medical Center, a massive, Federally subsidized county medical complex that takes up an area about one-third the size of the Chrysler Corporation automobile assembly plant in Belvedere, Illinois (see Google Earth View). Natividad has state-of-the-art operating rooms, Computed Tomography and Magnetic Resonance Imaging, fully equipped, 24 hour emergency room, and much more. If you have no insurance, if you've been in a drive-by shooting or have overdosed on crack cocaine, this is where you go. And it's essentially free, because almost everyone who ends up in the ER is uninsured. 

Last year, 2,735 babies were born at Natividad. 32% of these were born to out-of-wedlock teenage mothers, 93% of which were Hispanic. Less than 20% could demonstrate proof of citizenship, and 71% listed their native language as Spanish. Of these 876 births, only 40 were covered under [any kind of] private health insurance. The taxpayers paid for the other 836. And in case you were wondering about the entire population – all 2,735 births – less than 24% involved insured coverage or even partial payment on behalf of the patient to the hospital in exchange for services. Keep this in mind as we move forward.

Now consider this:

If I want to upgrade my policy to a low-deductible premium policy, such as what I had with my last employer, my cost is $886 per month. But my girlfriend can upgrade her policy to the very same level, for just $4 per month. That's right, $4 per month. $48 per year for a zero-deductible, premium healthcare policy – the kind of thing you get when you work at IBM (except of course, IBM employees pay an average of $170 per month out of pocket for their coverage). 

I mean, it's bad enough that I will be forced to subsidize the Obamacare scheme in the first place. But even if I agreed with the basic scheme, which of course I do not, I would never agree to subsidize premium policies. If I have to pay $482 a month for a budget policy, I sure as hell do not want the guy I'm subsidizing to get a better policy, for less that 1% of what I have to fork out each month for a low-end policy.

Why must I pay $482 per month for something the other guy gets for a dollar? And why should the other guy get to buy an $886 policy for $4 a month? Think about this: I have to pay $10,632 a year for the same thing that the other guy can get for $48. $10,000 of net income is 60 days of full time work as an engineer. $48 is something I could pay for collecting aluminum cans and plastic bottles, one day a month.

Are you with me on this? Are you starting to get an idea what Obamacare is really about?

Obamacare is not about dealing with inequities in the healthcare system. That's just the cover story. The real story is that it is a massive, political power grab. Do you think anyone who can insure himself with a premium policy for $4 a month will vote for anyone but the political party that provides him such a deal? Obamacare is about enabling, subsidizing, and expanding the Left's political power base, at taxpayer expense. Why would I vote for anyone but a Democrat if I can have babies for $4 a month? For that matter, why would I go to college or strive for a better job or income if it means I have to pay real money for healthcare coverage? Heck, why study engineering when I can be a schlub for $20K per year and buy a new F-150 with all the money I'm saving?

And think about those $4-a-month babies – think in terms of propagation models. Think of just how many babies will be born to irresponsible, under-educated mothers. Will we get a new crop of brain surgeons and particle physicists from the dollar baby club, or will we need more cops, criminal courts and prisons? One thing you can be certain of: At $4 a month, they'll multiply, and multiply, and multiply.

Obamacare: It's all about political power.

Does anyone think this is going to leave us with an affordable and efficient healthcare system that is going to increase the quality of care and lower the cost of care?

The previous notes are important. Most Americans are starting to pay attention to the damage Obamacare is doing to our healthcare system.

  Are Americans going to tolerate this kind of political maneuver to have politicians accumulate political power?

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

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Uncertainty Leads to Ineffectiveness

Stanley Feld M.D.,FACP,MACE

The implementation of Obamacare has progressed at a slow pace because of the Obama administration’s lack of understanding of physicians’ and patients’ needs.

In order to adjust to plans and policies not working as the Obama administration visualized, the administration has had to adjust policies, plans and costs.

There is no question in my mind that medicine is primed for a new age because of the advances in science, information technology and medical technology.

In my view Obamacare is a bad law. It is inhibiting progress on these upcoming advances. President Obama is trying to control provider behavior by measuring it in microscopic detail. He is trying to shift the cost and risk of patient care to physicians and patients in order to reduce costs by decreasing risk to the healthcare insurance industry.

He is trying to commoditize patient care. Obamacare is destroying the patient/physician relationship.These relationships are vital to the therapeutic index of any treatment.

Many of the Obama administration’s policy adjustments have led to uncertainty. Uncertainty of ad-lib changes in policy inhibits progress, increases costs, and produces anxiety and inefficiency.  .

One delay that has immobilized physicians has been the constant changing of implementation dates for ICDM-10 from ICM-9. Physician offices, physician groups and hospital systems are way behind in having fully functional computer information systems.

For many, the computer systems are too expensive even with President Obama’s promise of financial supplementation. It is difficult to change coding for treatment and procedures from 18,000 codes to 88,000 codes.

The reason for this coding change is for government to evaluate the work of physicians and hospitals microscopically in order to determine how much to pay them.

The government does not trust physicians. Physicians do not trust the government. In order for any system to work effectively and efficiently there must be mutual trust. Absence of mutual trust leads to more fraud and abuse, not less   

 The uncertainty about this year’s “doctor fix” is another example of uncertainty. 

In 2003 the government set up a defective measurement system intended to reduce physician reimbursement by about 5% per year. Each year the congressional “doctor fix” relieves physicians of the decrease in reimbursement from Medicare.

The SGR formula makes no sense. Medicare has reduced physician reimbursement to physicians as physicians' expenses have increased.

President Obama promise the AMA he would SGR problem.

However, each year’s “doctor fix” is cumulative. This year physicians face a 30% decrease in reimbursement despite the fact that many reimbursement codes have decreased reimbursement yearly in addition to the looming 30% decrease in reimbursement.

The policy has led physicians and physician groups to hold off on investing in coordinated care and technology. Additionally, physicians have a dim view of their return on investment for two reasons. Physicians cannot pass the cost of these new systems on to patients or the insurance industry because of the government’s pricing policies and because the government does not pay for much of the coordinated care or education of patients with chronic disease.

As a result of this uncertainty and anxiety physicians are selling their practices to hospital systems. Many physicians are salaried. These physicians figure the hospital system can have all the aggravation.  Other physicians are paid a salary plus a bonus determined by productivity. This does not eliminate the complaint that physicians have incentive to do more testing.

Many hospital systems have taken advantage of physicians’ intellectual property and surgical skill over the years. There has been a tradition of local adversarial relationships between physicians and hospitals. The hospitals’ tactics have not been obvious to many physicians. Many hospital policies are not transparent to their hospital-based physicians.

However, when it becomes apparent, the animosity between the physicians and hospitals becomes deep seated. The passive aggressive behavior of physicians inhibits the hospital system’s growth and development.

 

The Obama administration is discovering how difficult it is to form Accountable Care Organizations (ACOs).

The defects inherent in the purpose, formation, risk and implementation of ACO’s adds to its lack of success and the constant delays in implementation.

Obamacare has increased the number of Medicaid patients. Once these patients are on Medicaid, they cannot find a doctor.

President Obama had increase Medicaid payment to Primary Care Physicians in order to encourage more physician participation in Medicaid.

Physicians were hesitant to take Medicaid patients because this increased payment was temporary. The PCPs would be stuck with many low reimbursed patients.

“Kaiser Health News noted, the increases were temporary, so doctors had little incentive to alter their practices.”

This year the temporary Medicaid reimbursement increases have expired. The Medicaid rolls have increased. The PCPs were correct.  President Obama did not fix the Medicaid doctor shortage. It has only made it worse.

The number of physicians seeing patients with Medicare coverage has also decreased because of decreases in Medicare reimbursement despite the upcoming 30% decrease in Medicare payment.

President Obama ’s recent unilateral decision to alter immigration policy and provide these immigrants with healthcare insurance will only make things worse.

The ad-lib change in healthcare policy is driving physicians crazy. Many are frightened about their professional future in practicing medicine. 

There is a pervasive bias in Obamacare that favors hospital ownership of medical practices. The call for payment reforms and the call for coordinated delivery of medical care (like Accountable Care Organizations and payment “bundles”) all turn on arrangements where a single institution owns the doctors.

Where are patients’ feelings and needs in all of this? Patients are the commodities in a lucrative business that benefits secondary stakeholders.

The healthcare system as an efficient and effective healthcare system is destined to get worse because of the underlying uncertainty created by Obamacare.

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

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Wrong Is Wrong

Stanley Feld M.D.,FACP,MACE

When the Democrats were in power in one or both houses of congress, President Obama had Republicans tied up in knots. Now that Republicans are in charge of both houses of congress, President Obama still has Republicans tied up in knots. The reason is the administrations spin the story to the traditional media blaming the Republicans for everything and the media sends the spin to the American citizens.

Republicans don’t fight back effectively. As a recent example, Republicans are being afraid of being blamed for an impending Homeland Security non-funding.

Aren’t the Democrats holding up progress by filibustering? Why haven’t they made any positive suggestions to move the process along? Come on Republicans. Democrats and the traditional media would attack you for that    behavior. Get smart!

Scott Walker fought back when Howard Dean (a Democratic plant and hatchet man), told Morning Joe that Scott Walker did not graduate from college and he would be unknowledgeable. Unknowledgeable is a new word invented by Howard Dean on the spot.

Scott Walker immediately replied with names of people who have been very effective without a college degree like Steve Jobs, Bill Gates and Einstein, among many others.

Howard Dean’s attack is a typical Saul Alinsky tactic.

Obamacare is a bad law. It is having a negative effect on our economy and healthcare delivery in America.

I said Obamacare would fail. It has failed so far.

President Obama has pulled lots of tricks and caused lots of delays in the implementation of the law so as not to upset too many American at one time.

He has made a lot of promises and told lots of lies to all the stakeholders to get them to support Obamacare.

It is easy to remember President Obama’s promise, “If you like your doctor you can keep your doctor. If you like your insurance policy you can keep your insurance policy.”

Another lie was “Anyone making less that 250,000 a year will not pay a dime, not a dime more in taxes.”

He has promised the insurance industry it would have more customers buying healthcare insurance. The healthcare insurance industry has not seen an increase in subscribers yet. It is betting on future consumers buying insurance that is no risk to the healthcare industry because it has a government guaranteed no risk insurance subsidy attached to it.

So far the healthcare insurance industry has seen nothing but sick people who they would not sell insurance to before Obamacare.

It has not seen a balanced insurance population. President Obama had to subsidize the insurance industry by guaranteeing their profit in order to get the industry participation. I have warned the healthcare insurance industry that this is another President Obama trick play.

He promised that healthcare insurance premiums would decrease. Families would save $2500 dollars year. The premiums have gone up $2500 a year.

In addition, healthcare insurance has increased to unaffordable levels for both the unsubsidized and subsidized Americans buying insurance through the health insurance exchanges. The deductibles are out of reach of the middle class.

Why doesn’t the Republicans expose this issue?

 Only 20% of the population uses the healthcare system at any one time. As it is there are too few physicians accepting both Medicare and Medicaid.

People who can afford it have to go out of the system and pay extra for concierge physicians to have a doctor they can communicate with. Few physicians are willing to accept Medicaid reimbursement. It is hard to get an appointment with a physician.

President Obama just undermined Primary Care Physicians by letting their promised increase in reimbursement expire.

The Obama administration has delayed implementation of the law even though the law specifies an implementation timetable.

Why doesn’t the Republican Party explain this to the public?

The implementation of penalties to consumers and businesses, which are supposed to start January 1, 2015, will probably be delayed by executive order. President Obama’s Democratic base is unhappy with the penalty and that frightens Democrats in congress.

Obamacare taxes have been collected for the past four years while full implementation of the law has been constantly delayed. Some of the executive orders have been constitutional and many of the delays in implementation have been unconstitutional.  

The deceptions and unconstitutional maneuvers are TNTC (too numerous to count.)

Republicans should point this out clearly for taxpayers and those people who do not earn enough to pay tax. Yet the Republican Party gives all these maneuvers a pass.

The Supreme Court will decide the King v. Burwell case in June. The law clearly states that only States with Health Insurance Exchanges can provide subsidies to qualified consumers.

The law does not provide for Federal Health Insurance Exchanges to grant subsidies to consumers buying insurance through Federal Health Insurance Exchanges. It can be done by congressional changes in the law. The Obama administration cannot change laws according to the constitution.

President Obama and his administration have ignored the law. The subsidy restriction was written into the law to encourage States to set up State Health Insurance Exchanges.

Thirty-three states felt that health insurance exchange formation was a bad deal for their state, their state deficits and the people living in the state. Those states   refused to set up a state health insurance exchange.

President Obama even told the state governments he would pay the costs for three years. It still worked out to be too expensive for the states.

Two appeals courts voted in favor of the plaintiffs against the government and one voted for the government. It was a Democratic full court in one state and a judicial panel in Washington D.C that voted in favor of the plaintiff.

Congressional Republicans are convinced that the Supreme Court will rule against the government. If that happens Obamacare will collapse because 85% of the enrollees receive subsidies.

This is part of the reason Republicans are not offering an alternative to Obamacare.

Even though I believe the Obama administration is wrong in providing subsidies that are not written into a law by congress and signed by the President I would not bet on the Supreme Court’s decision.

Secondary stakeholders in the healthcare system are resilient. They have figured out how to make more money with Obamacare. It happens to be at the expense of consumers.

These secondary stakeholders are now appealing to the Supreme Court to uphold President Obama’s unconstitutional executive order.

These business supplicants have little and often nothing to contribute on the legal merits. But they do want the Justices who might be inclined to obey the law’s text—which limits subsidies to exchanges established by states, not the 36 run by the feds—to know the woe that withdrawing the subsidies would visit on patients and especially on their corporate welfare.”

Obamacare enrollment is going poorly. Potential enrollees now understand that Obamacare is a bad deal for them.

In 2015 only 10.5 million have enrolled at the end of the enrollment period. The original projection for 2015 enrollment was 17 million enrollees. This goal was modified by the Obama administration in 2014 to 13 million and then at the start of enrollment to 10.5 million.

The public does not know how many of the 10.5 million enrollees paid their January premium and how many qualify for subsidies in 2015.

America’s Health Insurance Plans notes that 85% of Obamacare enrollees claim subsidies, which on average fund 76% of their premiums. Cancelling this “would make health insurance less affordable—the precise result the tax credits were intended to prevent.” 

The healthcare insurance is unaffordable now even that the subsidies cover 76% of the premiums. The government pays the remaining premium fee.

The deductibles are also unaffordable. Last year many paid their premiums initially and dropped out during the year because of the high deductibles. The number of people dropping out might be more that 1 million of the 8 million who supposedly enrolled and paid their first month’s premium.

The higher the enrollment the more secondary stakeholders profit. The taxpayers and patients are the losers.

A system needs to be developed that levels the playing field for patients.

 These irrelevant arguments belong to the larger lobbying campaign to intimidate the High Court into disregarding the law to rescue the political project of Obamacare. If the Justices must do so, we hope they find a better reason than the health industry’s self-interest.

The lobbying groups must not influence the Supreme Court’s decision. It would be wrong.

 Obamacare is bad law that has been subjected to unconstitutional executive orders.

Two wrongs do not make a right!

 

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

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Another Great Father and Son Weekend

Stanley Feld M.D.,FACP,MACE

Every year Brad and I go on a father and son weekend from a Friday afternoon to Sunday afternoon. The place does matter. We just hang out and shoot the breeze.

I absolutely love the weekends we spend together. Brad teaches me a ton. I teach him a little.

Brad

A few years ago we spent our weekends at the Consumer Electronic Show in Las Vegas. I loved the weekends.  I got to hang out with his Foundry Group partners , Seth Levine,Ryan McIntyre, and Jason Mendelson.

These four guys are really smart. They grasp concepts, trends, patterns and bullshit as fast as Purple Martins catch insects.

I always came back from these weekend invigorated. I love to learn new things. I always feel I understand the technology world a little better.

Last year we both got sick just before we were scheduled to go to Memphis Tennessee.

Why Memphis?

Memphis is a very underrated city with lots to do and see.

However, the most important reason for going to Memphis was that Brad was born on Blytheville Air Force Base in Blytheville, Arkansas during the Vietnam War. He expressed a desire to see the place of his birth. Blytheville is 70 miles northwest of Memphis on Highway 55.

We will get to Memphis one day. However, this year when he asked me where I wanted to go I said Las Vegas just because the weather would be perfect, the food would be good, the walking would be great and experiencing the energy of the crowds would be fun.

Brad pays for everything. It is his treat to his Dad. Mom is not here. He tries to get me to overeat. He always succeeds.

 We had ice cream twice on Friday, once before dinner at Café Gelato in the Bellagio and once after dinner at Ghirardelli Ice Cream & Chocolate Shop.

 The Ghiardelli’s chocolate hot fudge sundae is overpriced but memorable. I remember a weekend with Brad at South Beach Miami where we were at the Ghiardelli's on Lincoln Road four times in one weekend.  

 In 1985, when Brad was at MIT he started Feld Technologies, a software and hardware company that installed office software, hardware and networks.

I hired Feld Technologies to build a network and install all the software and hardware for my large Clinical Endocrinology practice Endocrine Associates of Dallas P.A.. The installation lasted 15 years and put the practice 10 years ahead of other free-standing medical practices.

When he finished dealing with four doctors, a diabetes education center, a nuclear medicine center, an osteoporosis center and an obesity center he said, “Dad, I will not deal with medicine or doctors ever again.”

Unfortunately, our healthcare system desperately needs Brad Feld to grasp the problems and teach the government, healthcare insurance industry, hospital systems, physicians and patients how to fix it.

He refuses to pay attention to the problem.

There are no big thinkers out there.

Nothing was planned for this weekend. Brad sent out a Twitter telling his 197,000 followers that he was taking his dad to Las Vegas and does anyone have any suggestions for us.

 Within three minutes we had a few dozen suggestions. That’s the power of social networking.    

 A fellow named Ryan Negri reached out and suggested Mon Ami Gabi for dinner. It is across the street from the Bellagio. He said he could get us a table on the patio over looking Las Vegas Blvd. I had not heard of the place but it sounded cool.

We were running late for our reservation so we took a cab. The restaurant was just across the street from the Bellagio. The taxi porter that put us in a cab asked us why don’t we walk because it is just across the street? We didn’t know it was across the street.

The cab driver took off without saying a word. We asked him how long he was waiting in the holding area for the fare. He told us three quarters of an hour. He did not say a thing in protest.  

 Brad blew me away taking out a $20 bill and giving it to the cabbie. It made the cabbie’s night.

 It also made me aware of the many acts of kindness my son does for so many people.

It is consistent with his philosophy of giving without expecting to receive. The magnificent power of that philosophy is that you receive much more in the end than you give.

This is a part of his business philosophy and will be the main theme of an upcoming book he is writing in his series of books on  the Startup Revolution.

Cecelia and I are very lucky to have such a wonderful son. I hope all you readers can tell I am a big Brad Feld fan.

On Saturday, after exercise, we tried to get tickets for the Rod Stewart Show at Caesar’s Palace and Absinthe.  Both were sold out. We are both pretty resilient. We decided to opt for dinner at Nobu, plus after dinner ice cream.

After failing to get tickets for a show we headed downtown to see Tony Hsieh’s  Downtown Project. Anyone going to Las Vegas and staying on The Strip should take a cab to The Downtown Project. Tony Hsieh started www.Zappos.com on a shoe string and sold it to Amazon in 2009 for $1.2 billion dollars.

Good Hsieh_t653
The philosophy of Tony Hsieh project has been misinterpreted or misrepresented by most media outlets. He has also made some mistakes while developing the Downtown Projects.

He bought 60 acres of dilapidated Downtown Las Vegas after he moved Zappos.com to Las Vegas’ old downtown city hall. The plan was to transform the acres into a new kind of urban renewal project. It is very cool to people with an open mind.

 “Tony Hsieh promised to spend $350 million to create his own utopian community, a place of inspiration and serendipity where everyone could become smarter and, of course, happier. He wasn’t leading people into the desert, exactly.”

 He hoped to turn the Downtown Project into a thriving hub of high-tech creativity. When he started in 2012, his pitch was, “What if you could play SimCity for real?”

The media confusion started with the use of the word utopian community.

 “Hsieh often said he wanted his $350 million to generate a “return on community,” not just a return on investment.”

“Though Hsieh’s camp used the word often at the Downtown Project’s inception, officials later removed all mentions about “return on community” from the Downtown Project website, adding the word “connectedness” to cut down on confusion.

 “Tony Hsieh said he views the Downtown Project as a startup — an endeavor that often comes with mistakes waiting to happen.

“Every startup makes a ton of mistakes,” Hsieh said. “There have been investments that we’ve made and they’ve gone out of business.”

Hsieh’s key to moving forward?

“Learn and adapt quickly,” he said.

Our first stop was Container City. It is a section of the property made up of restaurant and shops. The business spaces are made up of newly constructed shipping container piled on each other. There are multilevel spaces with playgrounds for kids, dinning area tables and open areas.

Container park
 Container Park Entrance

Container park 2

Container park 3

Container park 4

 

I had a great hamburger. Brad had fried tacos. We had a long conversation at lunch.

Brad and Tony are friends. Tony invited us to hang out with him at his Trailer Village down the street from Container Village.

This Airstream Trailer Village is more novel than the Container Village. It is in a large parking lot. It has security at the entrance. Once you get approval to enter you enter a walkway lined with artificial turf and covered with an archway made of wooden slatted park fencing and artificial ivy. Tony and Jennifer greeted us halfway down the makeshift hallway as we entered the village.

 This space is something special in this day and age. It is kind of like a hippie, flower child experience of the 1960 in a much more cultivated and sophisticated way.

  _Airstream_Village_1 LE14_t300

He has the periphery lined with Airstream Trailers and Wooden House Trailers. There is a large center common space for entertainment and hanging around.

  Airstream_Village_LE16_t1000

Tony told us they show movies and have entertainment on most nights.

_Airstream_Village_3 LE4_t300

Goldspike is a Downtown Project redone casino/hotel with no gambling or booze. 

On Sunday morning, we had brunch with a fellow who reached out to Brad in a classy way. Ryan Negri is a 33-year-old entrepreneur who sold a company he started at age 24. He and his wife moved from Newport Beach California to Las Vegas 14 month ago after he sold his company.

  Ryan and Brad

He is working on getting involved in the start up community is Las Vegas. Brunch was delightful. Ryan impressed me a very bright a fast thinking entrepreneur. I predict he will go places.

 After brunch headed to the airport, concluding another fabulous father,son weekend.

 My number one priority is to schedule my weekend with Daniel Feld.

 

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

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The Facts

Stanley Feld M.D.,FACP,MACE

The fact that the Obama administration believes that Americans are stupid as expressed by Jonathan Gruber is an insult on its own. The fact that the Obama administration persists in treating us as if we are stupid simply compounds the insult.

In the run up to the February 15th ending of the 2015 www.healthcare.gov enrollment period and the new Republican congress’ upcoming vote to repeal Obamacare, the Obama administration is trying to convince Americans that Obamacare is working and is good for all Americans.

The public knows better by now. The middle class is feeling the economic pain Obamacare has created. They sense President Obama telling another lie.

 Recent headlines have been

Obamacare Will Cost 20% Less

Affordable Care Act 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

President Obama’s deception implies Obamacare is cost effective. All the CBO is saying is the numbers given to it, this time, by the Obama administration show the cost of Obamacare will be 20% lower than the CBO original estimate in 2011.

The additional new taxes for Obamacare were initiated in 2011 based on those CBO estimates.

One important reason for the 20% decrease in cost from the original estimate in 2010 is that fewer people have chosen to enroll in www.healthcare.gov in 2014.

Since fewer people enrolled there is a $51 billion of savings in federal subsidies for fewer enrollees in health insurance exchanges.

This represents a failure of Obamacare not a success as claimed by the Obama Administration.

The government estimates a total 10.7 million will enroll by February 15,2015. On February 2,2015 there were 7.53 million qualified enrollees. The original estimate in 2010 was 17.5 million. The first 2015 estimate enrollment in 2014 was reduced 3 months ago to 13 million. The enrollment figure was modified.

The taxes the middle class have been forced to pay for Obamacare were not modified.

The real numbers are totally confusing because the government documentation is very difficult to follow. CMS modifies the numbers constantly with corrections. The modifications serve to keep Americans stupid and confused.

The Obama administration is now spinning the significance of the CBO report to its political advantage.

The online Daily Mail of Britain published this online story. The headline does not exactly reflect potential consequences of the Facts.

"Obamacare program costs $50,000 in taxpayer money for every American who gets health insurance, says bombshell budget report."

  • ·       Government will spend $1.993 TRILLION over a decade and take in $643 BILLION in new taxes, penalties and fees related to Obamacare
  • ·       The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best
  • ·       The law will still leave 'between 29 million and 31 million' nonelderly Americans without medical insurance
  • Numbers assume Obamacare insurance exchange enrollment will double between now and 2025 "

  Buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook were numbers to calculate the cost of Obamacare legislation to add patients to the insurance role. “The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best.”

It is impossible to judge whether these estimated figures are correct because estimates are mostly wrong.

What we do know is Obamacare is not doing well from everyone’s except President Obama’s point of view. The spin is keeping all Americans who are seeking the truth confused. Americans want a solution to the deterioration of the healthcare system.

Another reason for the reduction in Obamacare healthcare spending could come from the reduction in reimbursement to physicians.

Insurance companies have not suffered the same reimbursement insult because the government has subsidized the healthcare insurance industry and provides a guaranteed profit that is not included in the CBO estimate.

A third reason for the reduction in spending could be explained in part by the growth of consumer-driven health plans and the Great Recession.

A fourth reason for the 20% reduction could be that the insurance products on the health insurance exchanges have high deductibles. It takes a while before the patients reach their deductibles and the government starts spending money on reimbursement. Patients can also be staying away from receiving appropriate medical care because they cannot afford the deductible.

The CBO report projects that 75 percent of enrollees will receive subsidies in 2015. However, 87 percent received subsidies in 2014. This is wishful thinking on the part of those who provided the data for the CBO to evaluate to believe the subsidy percentage will decrease.  The CBO projected a further decrease in subsidy to 71% in 2025.

The health insurance exchange experience so far suggests there is adverse patient selection. It can be assumed that there will be an increase in healthcare risk and an increase subsidy percentage in the future.

CBO projects the average exchange subsidy per covered enrollee in 2015 will be $4,330 and increase to $7,710 by 2025. These costs represent a 78 percent increase in costs.

However, I do not think anyone can draw any conclusions from the CBO’s report.

I do believe that Obamacare is President Obama's  push to a single party payer healthcare system because of the structure of its market driven elements are destined to fail.

Government will then take over telling us what medical care we can or cannot have.

”We are fast approaching the stage of ultimate inversion: the stage where the government is free to do anything it pleases, while the citizens may act only by permission.” - Ayn Rand

The CBO report of a 20% reduction is spending as a result of Obamacare is meaningless. It is being used by President Obama to confuse the public for political reasons.

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

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    (MUST READ: HOW I GOT CURED FROM MSA DISEASE)
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