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The Significance Of The Jonathan Gruber Controversy

Stanley Feld M.D.,FACP,MACE

Jonathan Gruber, a professor of Economics at MIT and one of the authors of Obamacare, made comments in 2013 about the trick plays the Obama administration used to pass the Affordable Care Act.

Jonathan Gruber’s comments serve to help Americans understand the mechanics of the passage of Obamacare. Hopefully it will serve as a wakeup call for the entire electorate.

Jonathon Gruber’s comments reflect the attitude of President Obama and his entire administration toward the electorate.  

  

http://youtu.be/G790p0LcgbI

The cover-up always makes it worse.

 

http://youtu.be/zhavicDc0Ts

Mr. Gruber admits what many of us have understood throughout President Obama’s years in office. President Obama’s attitude is reflected in all the trick plays he has pulled on congress and the American people during the passage and implementation of Obamacare.

Please look at all the articles covering President Obama’s trick plays since 2008 by clicking here.

The mainstream media has done President Obama’s bidding. It has not covered the meaning of Jonathan Gruber’s comments and the disrespect he and others have for the intelligence of the American public.

A reader sent me this comment before Jonathan Gruber’s comments were discovered.

“Dr. Feld,

There is some science behind the Progressive methodology that non-progressives need to learn.  The Progressive movement talks directly to the limbic portion of the brain while non-progressives tend to sort through facts in the neocortex.

Decisions are made in the emotional limbic portion of the brain, hence the reason and way marketers appeal to emotions versus your facts. 

The bottom line is this, non-progressives need to turn their facts into stories that are emotional or conservatives will always be out sold by those who’s arguments are devoid of facts (or outright lies) but full of emotion.

Have an awesome day.”

The Gruber controversy has given Americans a story that stimulates an emotional response. Americans are offended by being called stupid.

Jonathan Gruber did not make these statements in a void. It had to reflect the thinking of Obama administration. Even John Kerry gave him some help.

 

 

Published on Nov 12, 2014

Gruber explains how Senator John Kerry helped him fool stupid voters into accepting a tax hike.

   

 

http://youtu.be/iUOyqw5HhRI

 Mr. Gruber could not have made the decisions on his own to take the policy actions he described.

He never should have described the actions of those involved in public.

 The Obama administration also provided the Congressional Budget Office (CBO) with wrong information. The information led to wrong CBO’s conclusions regarding Obamacare’s real costs. The CBO crunches numbers fed to it by the Obama administration.

 The Obama administration used CBO’s false scoring to sell the CBO’s economic conclusions to the public through the mainstream media.  

It is clear that President Obama and his administration believe they are smarter than the American people. President Obama believes that his administration knows what is best for Americans.

The only reason the American people have not connected the dots is because they believe the president is an honorable man. The president is not expected to lie to the public.  

The progressive press is trying to divert attention from Jonathan Gruber’s comments. It is trying to get the public to ignore Mr. Gruber.

An initial diversion came from Paul Krugman in his Victory Lap article about Obamacare.

Paul Krugman said the health economist Jonathan Gruber, one of the principal architects of health reform  recently summed it up:

The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.”

Paul Krugman did not provide any facts just an appeal to emotion.

 MSNBC used this emotional stimulation to get its followers to ignore Jonathan Gruber’s comments.

“Part of the problem with the Jonathan Gruber “stupid” story is that it’s a shiny object for the political world to stare at for a while. It offers more heat than light. It’s a bouncing ball for political insiders to chase after, despite its relative insignificance.”

“But since it’s likely to soon be the subject of congressional hearings, and since your crazy uncle who watches Fox News all day will be talking about nothing else at Thanksgiving, let’s grudgingly tackle this week’s Most Important Story Of All Time As Agreed Upon By Republicans And The Beltway Media.”
 

Please note the inference that Republicans and Fox News are stupid for making an issue out of Jon Gruber’s statements. The implication is MSNBC is smart.

Progressives need public support in order to maintain power.

The problem is the public is tired of progressives’ emotional appeals devoid of facts.

The progressive press including MSNBC and The New York Times need examine their premises. They are daily losing listeners and readers .

Nancy Pelosi is incredible.

She said,

“Let’s put Jonathan Gruber aside.”

 “House Minority Leader Nancy Pelosi responds to Jonathan Gruber’s comments on the Affordable Care Act, saying, “I don’t know who he is. He didn’t help write our bill. So with all due respect to your question, you had a person who wasn’t writing our bill commenting on what was going on when we were writing the bill who has withdrew some of the statements that he made. So let’s put him aside.”

It is almost as bad as "we will not know what is in the bill until we pass it."

President Obama and his administration are trying to prevent public understanding of his current tricks plays. He continues to try to divert American from the truth about Obamacare.

President Obama needs to explain the truth to regain his credibility with the American people.

He must address these unanswered issues if he wants to maintain his promise of transparency.

  1. Why the healthcare.gov open enrollment period was delayed until November 15th.
  2. What is the actual number of valid enrollees in Obamacare in 2014? Is it 8 million, 7 million, 5.6 million or 3 million? I thought Obamacare and its mandate would be in effect for small businesses and corporations in 2015.
  3. Why has the estimate of total enrollment for 2015 been reduced from 13 million to 9 million? I thought 2015 Obamacare would be fully implemented and many more people would sign up as they lost employer sponsored insurance.
  4. How many people who received government subsidies last year lied on their application?
  5. Why weren’t the rules for subsidies enforce?
  6. How many people lost their subsidy?
  7. How are you going to collect the subsidy from people that lied?
  8. How many people have claimed they are not going to re-enroll in Obamacare this year and why are they not going to enroll?
  9. How does a person receive a tax credit when he has no taxable income to apply that tax credit to?  

     10. Explain the status of the open enrollment and the mandate for small businesses and large corporations.

      11. What is the status of waivers that companies and unions received from Obamacare for 2015?

      12. Why does the state of Massachusetts have a failed State Health Insurance Exchange that     required  $400 million dollars in federal  supplements each year if Romneycare is so successful?

      13. Why would the government subsidize healthcare insurance companies to participate in Obamacare?

     14. Why is the public being told that healthcare exchanges premiums are going down when in reality they are going up?

     15. What is happening with the Minimed Insurance policies that were supposed to expire in 2015?

     16. What does Obamacare cost the federal government? Is it budget neutral?

     17. What is the exact amount of increased taxes used to fund Obamacare?

     18. What percentage of the increased taxes are collected from each income group?

These are just a few of the questions President Obama and his administration have not provided the answer to.

 The answers to these questions would permit the public to understand Obamacare’s sustainability.

 The Jonathan Gruber incident has made it clear how President Obama and his administration operates as well as its lack of respect for the intelligence of the American public.

 Americans are not dumb. They want to believe their leaders. Their leaders have lied to them. Americans recognize that. President Obama and his administration have little credibility with the American public. President Obama promised a transparent government. There is not any transparency.

The midterm elections proved Americans are aware. It is a good first step.  Now we have to see what the Republicans will do with this leadership opportunity. 

 

 

An explanation of Obamacare.

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

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Why Vermont’s Single Party Payer Healthcare Plan Failed

Stanley Feld M.D., FACP,MACE

Vermont’s single party payer healthcare plan was doomed to fail from the onset for several reasons.

Vermont had a Republican governor for eight years. He decided to retire.  Peter Shumlin (D.) won the Democratic nomination for governor after progressive activists demanded that each candidate for the Democratic Party nomination promise to enact single-payer health care if nominated.

Shumlin’s got the nod, won the election. He was anxious to pass the single party payer system.

Vermont’s consultants were Harvard’s William Hsiao and MIT’s Jonathan Gruber.

William Hsiao has spent most of his academic career helping governments install single-payer healthcare systems.

There is little evidence that the systems by developed in Taiwan and other countries by William Hsiao have been successful. They have not been cost effective or sustainable. They have not preserved freedom of choice.

Gruber and Hsiao made the same mistakes for Vermont that they made for America with Obamacare.

Hsiao and Gruber promised that single-payer health care in Vermont could save $1.6 billion over ten years. With that endorsement in hand, Shumlin and the legislature passed Act 48, a law instructing the state to figure out how to finance a single-payer system. They dubbed it Green Mountain Care.

Governor Shumlin said, “If Vermont gets single-payer health care right, which I believe we will, other states will follow,” pronounced Shumlin. “If we screw it up, it will set back this effort for a long time. So I know we have a tremendous amount of responsibility, not only to Vermonters.”

Unfortunately, Americans have a short memory, the short memory promoted by the conformational bias of the traditional mass media toward a progressive agenda.

Progressive Americans and their progressive politicians had better wake up fast. “Medicare for All” does not work.

Medicare does not work in a financially sustainable way for the government or seniors. It was not sustainable in the Bernie Sanders small state of Vermont. It is nice to believe you can provide healthcare benefits for nothing to all. However, nothing is free especially when it is run by central bureaucrats. It has been proven over and over again.

First, bureaucrats and healthcare policy consultants do not understand the medical care system. The history of Vermont’s single- payor story is interesting.

In December 2014 Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug after four years on Vermont’s single-payer, government-run health care system.

“In my judgment,” Governor Shumlin said, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

Rather than saving $1.6 billion the Green Mountain Care would cost an additional 2.6 billion dollars in tax revenue for 2017 alone. The law would require a 151 percent increase in state taxes.

“Fiscally, that’s a train wreck. Even a skeptical report from Avalere health had previously assumed that the plan would “only” cost $1.9 to $2.2 billion extra in 2017.”

“In 2019, Costa estimated that Green Mountain Care would have required $2.9 billion in tax revenue vs. $1.8 billion under pre-existing law: a 160 percent increase in revenue.”

The result should explain why the dream of single-payer health care in the U.S. should be dead for the foreseeable future.

Daily, we read articles calling for “Medicare for All” from progressive politicians running for office.

How stupid do they think Americans are?

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



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Democrats Still Think Americans Are Stupid

Stanley Feld M.D.,FACP, MACE

The House Republicans finally got their act together and passed their version of the Obamacare repeal and replace act. It seems that many representatives do not trust Paul Ryan, Tom Price and President Donald Trump.

The Republican house version of the bill does not repeal and replace Obamacare completely.

The Affordable Care Act (Obamacare) permitted Kathleen Sibelius, the Secretary of HHS, to issue regulations to administer the act at her discretion. Many of her regulations were destructive to the healthcare system.

Tom Price, the new Secretary of HSS can eliminate many of these destructive regulations. The goal of the Obama administration’s regulations was to cause the healthcare system to fail and be replaced not by free market principals but by a single party payer system.

Her regulations were designed to eliminate any modicum of free choice for patients and physicians.

Tom Price’s actions and regulation eliminations should complete the repeal and replacement of Obamacare.

President Obama ignored the fact that a single party payer system would be destined to bankrupt the country. His plan was to get the health care insurance industry out of the healthcare picture.

The defect in his logic was that the government would have to continue to outsource the administrative services to the healthcare insurance industry. The government now outsources the administrative services for Medicare and Medicaid.

The government then lies to the public declaring that its overhead is only 2.5% while the healthcare insurance industry takes 30% for services that are charged as direct patient care.

The healthcare insurance industry would continue to rip off the healthcare system in a single party payer system for all.

The completion of the repeal and replace act will be done as promised by Ryan, Price and Trump in three stages.

As soon as the house bill is passed the House Democrats came out with their talking points criticizing the act. These talking points had little substance and no compelling evidence. They only declared that the legislation was terrible without any explanation of why it was terrible.

They just said 20 million people are going to lose their insurance coverage. The Republican health care act is going to kill people.

The talking points are mostly lies.

A recent study had reported that Obamacare has cost 80,000 people to die.

“Democrat’s immediately made the accusation that the GOP “repeal and replace” bill will kill Americans.  It seems that Obamacare has already done that.” 

In a previous blog I pointed out that more people have lost insurance in the individual market that have gained insurance from Obamacare’s health insurance exchanges.

Fourteen million lost insurance in the individual market in 2009 and at most 8 million gained insurance through Obamacare’s health insurance exchanges.

The 20 million new insured comes from the 12 million new people receiving healthcare insurance through Medicaid.

“Quoting Oren Cass over at National Review, it turns out that fewer people – not more people – had health insurance after Obamacare.  The only increase in “coverage” was Medicaid, but, sadly, it turns out that Medicaid kills people.  It’s better to have no medical insurance at all.” 

 Researchers have found that in 2015 Medicaid patients experienced worse outcomes than similar uninsured Medicaid eligible patients.

Public-health data from the Centers for Disease Control confirm… [that had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000-13 period, 80,000 fewer Americans would have died in 2015 alone.”

The Democrats are using the typical progressive tactic of creating a lie. Many people died because of Obamacare but the Democrats threaten that the Republican bill will cost many lives. It diverts attention from the Democrats’ failure with Obamacare.

This is fear mongering for the progressives’ political gain.

This is one of Sol Alinsky’s favorite tactics. One should do everything to marginalize opponents even if it needs to be done by lying.

“Democrats are hurting real people with their scary shrieking about death by Republican.”

The Democrats criticize without facts. The Democrats will lie about the effects of the bill without evidence. I would guess that many have not even read it.

One should expect nothing less from Nancy Pelosi and Chuck Schumer.

The Democrats have even rolled out Jonathan Gruber, the MIT professor of economics and co-author of Obamacare, who infamously said, “the stupidity of the American voter” helped get the measure to become law.

This week Gruber blamed President Trump for Obamacare’s failure on one of the Sunday news programs.

“Whose fault is this (rising premium costs)?” Gruber asked on “Fox News Sunday.” “Since President Trump has been elected … premiums are going up and insurers are exiting.”

This is total nonsense.

Jonathan Gruber still thinks Americans are stupid. However he has no credibility with the American public. Therefore his opinion has no impact on the discussion about the new bill.

Nancy Pelosi and Chuck Schumer’s lack of credibility with the American public does not seem to bother them.

Every lie they tell decreases their credibility even further.

Nancy Pelosi said, “the new Obamacare repeal bill is a ‘a very sad, deadly joke’

This is the same woman who said we will not know what is in the Affordable Care Act (Obamacare) until it is passed.

What is so deadly about it? She does not explain her statement. She figures the media is the message. The media will carry the message for her.

Chuck Schumer’s quote was even worse. He said, “Senate GOP should toss House healthcare bill ‘out the window’”

He called on Senate Republicans,

“To avoid following the lead of their colleagues in the House and to work on a bipartisan basis on healthcare reform rather than pushing for repeal of the Affordable Care Act.”

He is trying to save President Obama’s legacy Obamacare. Obamacare is an unmitigated disaster. It is beyond saving.

It was a poorly constructed healthcare bill aimed at giving big government total control of the healthcare system. President Obama totally ignores the fact that Americans did not want it, have not joined it. He felt he clearly know what is best for America.

He goal was to get it passed by the partisan vote. President Obama lied to Americans and lied to his party members.

Obamacare is unsustainable economically to America and is in the process of destroying the economy.

Chuck Schumer said, “Trumpcare is a giant, broken promise to working people, the hard-working people of this great country of ours.

It would be valid if Chuck Schumer could prove his statement.

President Obama broke his promise to the working people, the hard working people of this great country of ours, when he said, “ If you like your doctor you can keep your doctor and if you like your insurance you can keep your insurance.”

Chuck Schumer did not see it then and he does not see Obamacare’s failure now.

I suggest that Chuck Schumer read the Republican bill carefully before he makes his false statements.

Clearly, he was dead wrong in his judgment about Obamacare

If he read the Obamacare law carefully and voted for doing the right thing, America’s healthcare system might not be in the mess it is in.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Obamacare Coverage: The Big Lie

Stanley Feld M.D., FACP, MACE

President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success.

The Obama administration told us that 20 million new people have obtained healthcare insurance because of Obamacare.

We know 14.5 million people lost their healthcare insurance in the individual market the year after Obamacare was passed.

Many assumed they got their insurance back through Obamacare. There is no evidence for that assumption.

I followed Obamacare enrollment carefully on acasignup.net.

This site was supposed to be publishing the exact numbers published by the government weekly. www.acasignups.net

It turns out that the numbers published were inaccurate. They were too high.

“Since the release of the HHS study, the government has published two additional surveys of health-insurance coverage – the Current Population Survey (CPS) and the American Community Survey (ACS). Both offer data through the end of 2015, allowing for comparison with the NHIS estimate.”

The government now claims these studies are only estimates of nonelderly adults, under the age of 65, who gained insurance coverage.

The estimate in increased adult coverage ranges from 13.5 million in the CPS study to 16.5 million in the NHIS study.

Where did the number 20 million new lives covered come from? Bill Clinton boosted the number to 25 million when campaigning for Hilary Clinton.

Edmund F. Haislmaier and Drew Gonshorowski of the Heritage foundation examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.

“Their study found that 14 million people (including children) gained public or private coverage in 2014 and 2015.”

This total is even lower because it includes S-Chip coverage for children.

Compounding the government lies of estimated enrollees was that 84% of the new enrollees was either Medicaid or S-Chip children.

This means only 2,240,000 people signed up in President Obama’s Health Insurance Exchanges.

It also means that there were 11,760,000 new Medicaid or S-Chip patients.

Edmund F. Haislmaier concluded in testimony to congress;

“While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that

for the three year period 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private sector coverage enrollment.”

http://budget.house.gov/uploadedfiles/house_budget_testimony-haislmaier.pdf

Eighty-five percent of the 2.7 million have pre-existing conditions. Most are receiving government subsidies.

The 2.7 million covered under Obamacare have destabilized the healthcare insurance market so that healthcare costs for businesses have become unaffordable.

No one has even mentioned the cost of this Obamacare folly to the average hard working taxpayers with healthcare coverage from their employers.

Obamacare’s failure to has been devastating.

The authors also found that nearly half the new Medicaid enrollees met eligibility standards that were in place before the ACA.”

Maybe Jonathan Gruber is right when he said we, the public, are too stupid to know the wool is being pulled over their eyes.

 

“For all the hoopla about the ACA exchanges, it appears that Medicaid accounts for the lion’s share of coverage gains and that many new Medicaid enrollees would have been eligible for that program even if the ACA had never passed.”

Medicaid is a single party payer system (socialized medicine) that works very poorly. It is almost as bad as the VA Healthcare System.

Is this what the public wants? No

America needs a better healthcare system. Hopefully Dr. Tom Price knows what to do replace Obamacare with once he dismantles all of the Obama administrations regulation.

Maybe Jonathan Gruber is wrong.

The general taxpayer may be smarter than Dr. Gruber thinks. Maybe it is the reason the public elected Donald Trump.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Dear President-elect Trump Part 3

Stanley Feld M.D.,FACP, MACE

The following is Part 3 of my review of your healthcare reform platform. You have a viable alternative to Obamacare. Your alternative needs some vital additions.

In my last blog I omitted the link proving that only 1 million people signed up for Obamacare health insurance exchanges.

I apologize for the oversight. Today enrollment is only 2.3 million. I also noticed that the enrollment date was extended to January 30 from December 31 without fanfare. The site I omitted that follows daily enrollment is acasignups.net.

Obamacare is still a long way from the 20 million claimed and the actual 10 million enrolled for 12 months.

The Obama “experts” still believe that Obamacare is viable. They refuse to believe it has been a healthcare disaster as well as a disaster for America’s economy.

Your next proposal is;

  1. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate.

Health Savings Accounts (HSAs) should be changed to Medical Savings Accounts (MSAs) to provide better financial incentives for people who choose this form of insurance. The Medical Savings Accounts can easily be customized so that consumers can choose the level of insurance they desire.

The cost of first dollar reinsurance for coverage after the deductible is met plus the MSA contribution is much cheaper than the first dollar coverage Medicaid coverage. The insurance vendor will still make a sizable profit by providing first dollar coverage reinsurance.

The contribution to the MSA should be flexible to provide an adequate amount of money to be put into the savings accounts to provide financial incentivizes to consumers to maintain their health.

Obesity is a huge problem to health maintenance of health. Obesity can be effectively cured behavioral change of consumers.

The incidence of chronic diseases in obese people is five times that of normal weight people. Financial incentives must be provided. The is also the area that social engineering might be helpful.

Obese children are becoming diabetic and hypertensive at a young age. This must be prevented because of the potential explosive cost effect of complications of both diabetes and hypertension on individuals. The overall costs to patients, Medicaid and society will be devastating.

Medicaid must be converted to a system where the recipients are responsible for their health with financial incentives. Only then Medicaid patients will not be treated as a commodity. Service will improve. .

  1. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.

Price transparency is an essential provision for individuals, businesses and groups in order to produce smart consumers of healthcare.

It is also necessary to require insurance companies to provide verifiable price transparency for their administrative costs and their direct patient care costs.

Consumers must be empowered to be responsible and shop for the best healthcare service value. They must look for the best prices for procedures, exams or any other medical related procedure.

The only way to decrease the cost of healthcare services is to produce smart and motivated consumers of healthcare.

The Healthcare System must be converted to a Consumer Driven Healthcare System.

Social networking should be used as the backbone for the establishment of consumer empowerment.

The success of Angie’s list, Trip Advisor and Open Table are a result of social networking.

All medical care is local. Local communities have their individual social networks that empower people in their neighborhood to know which vendors provide the best value in their community.

Healthcare consumers can use this simple procedure to decrease the cost of healthcare and medical care.

This could also be a place where government can lead the way in establishing accurate educational resources.

  1. Block-grant Medicaid to the states.

These block grants can be used by the states to fund MSAs without a threat of increasing state budget deficits or giving up states’ rights to the federal government.

Block grants for social networking should be used to provide incentives to help individual Medicaid patients seek out and eliminate fraud, waste and abuse of some of its local providers.

It would eliminate expensive big data collections that often times are inaccurate for policy making by central federal control.

  1. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

Federal and state governments should help their citizens choose safe, reliable and cheaper products for the treatment of their diseases.

This would help with compliance and adherence to recommended treatment and also decrease the cost of care.

It would provide consumers with information to take responsibility for their own health and healthcare dollars.

  1. Encourage Congress to step away from the special interests and do what is right for America.

One example is allowing consumers access to imported, safe and dependable drugs from overseas. It will stimulate competition for consumer dollars in the U.S. and lower the cost of brand and generic drugs sold here. Drug prices are artificially high in the U.S.

This is only one example of many ways to decrease the cost of drugs in this country.

You have made many proposals to make a lot of important changes to the healthcare system.

Some are good proposals. Some are not very well thought out by your advisors.

You left out Tort Reform, which is one of the most important proposals. Effective Tort Reform will result in a precipitous decrease in the cost of medical care.

It is absurd to let Obamacare “experts” like Ezekiel Emanuel and Jonathan Gruber heckle your “non viable” healthcare reform plan.

However, you are missing the other important elements in reforming the healthcare system. Those elements are the elements of the use of consumer power, consumer initiatives, and consumer incentives.

 By utilizing these elements you will begin to “Drain the Healthcare Swamp.”

Your healthcare changes must include a consumer driven system with an ideal medical saving account. Otherwise, the healthcare system will remain an unmanageable, expensive and abused mess.

You have admitted these proposals are simply a start. You can easily fall into the trap of listening to academicians who have never practiced medicine in a private setting. You need people who understand patients’ needs.

Obamacare has been a disaster that is unsustainable. It is increasing the cost of care week by week, while rationing care and decreasing access to care.

You must repeal and replace Obamacare. No one wants it. You have outlined a viable proposal even if the progressives don’t like it.

It is a good start.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Dear President-elect Trump Part 3

 

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Why Vermont’s Single Party Payer Healthcare Plan Failed

 Stanley Feld M.D., FACP,MACE

Vermont’s single party payer healthcare plan was doomed to fail from the onset for several reasons.

Healthcare policy consultants do not understand the medical care system. The healthcare policy consultants for the Vermont healthcare system were the same consulting architects President Obama used for Obamacare.

The consultants were Harvard’s William Hsiao and MIT’s Jonathan Gruber.

William Hsiao has spent most of his academic career helping governments install healthcare systems. William Hsiao is the K.T. Li Research Professor of Economics in Department of Health Policy and Management and Department of Global Health and Population, at Harvard T.H. Chan School of Public Health.

Jonathan Gruber is a professor of economics at the Massachusetts Institute of Technology, where he has taught since 1992.[1]

He is also the director of the Health Care Program at the National Bureau of Economic Research, where he is a research associate.

Jonathan Gruber has been heavily involved in crafting public health policy.

He has been described as a key architect[2] of both the 2006 Massachusetts health care reform, sometimes referred to as “Romneycare”, and the 2010 Patient Protection and Affordable Care Act, sometimes referred to as the “ACA” and “Obamacare”.

There is little evidence that the systems he and Dr. Hsaio have built are overwhelming successful, cost effective or preserve consumer freedom of choice.

In fact, a study by NPR and Harvard’s T.Chan School of Public Health concluded that Obamacare is a complete failure.

Dr. Hsaio is on the faculty the Harvard T.Chan School of Public Health.

NPR AND HARVARD T.H. Chan School of public Health SAY: OBAMACARE IS A COMPLETE FAILURE

In a New York Times interview in 2009 Dr. Hsiao discussed the system of healthcare Reform he installed in Taiwan.

The question was:

What’s the most important lesson that Americans can learn from the Taiwanese example?

Dr. Hsiao.

You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.

The Taiwan government managed to insure 98 percent of the population with a premium cost of 4.6 percent of wages.

Q.

Has your system of healthcare in Tiawan translated into better life expectancy or lower complication rates from major diseases?

Dr. Hsiao.

“There is evidence of positive health results for select diseases, like cardiovascular disease and kidney failure.”

There is no medical or financial data available to prove outcomes have improved.

“Overall, it’s really difficult to say that national health insurance has improved the aggregate health status, because mortality and life expectancy are crude measurements, not precise enough to pick up the impact of more health care.”

“That said, life expectancy is improving, and mortality is dropping. And everyone now has access to good health care”.

This is not good science. It is not even good social science. This is a biased opinion.

Q.

What are the system’s weaknesses?

Dr. Hsaio

“In the legislative process, compromises had to be made. First, the president yielded on payment reform, so Taiwan kept its fee-for-service payment system. Unfortunately, that encourages doctors and hospitals to give more treatment in order to boost their income.

“Second, the Taiwanese system doesn’t have a systematic way to monitor and improve quality of care.”

“Third, in the legislative process, they rejected a provision to adjust the premium automatically when the national health system depletes its reserves.”

“In every country, health care costs are increasing faster than wages. When that happens, the premium has to go up. But that provision wasn’t incorporated into the law. As a result, the system is running a deficit.”

“National health insurance tries to cut the fees for hospital and physician services. But eventually these fee reductions will adversely affect the quality of health care.”

President Obama was so anxious to change the healthcare system in the United States to fit his socialist ideology that he picked two professors, Dr. Hsaio of Harvard and Jonathan Gruber of MIT to be the architects of Obamacare.

Jonathan Gruber has been introduced as the ‘architect’ of the Massachusetts law and/or Obamacare”.[52]

Neither professor had scientific evidence that a single party payer system would work efficiently.

Obamacare was not working efficiently yet the progressives in Vermont hired Dr. Hsaio and Dr. Guber to be the architects for Vermont’s single party payer system.

Jonathon Gruber has turned out to be a honest about the Obama administration’s lies.

Many of the videos show him talking about ways in which he felt the ACA was misleadingly crafted or marketed in order to get the bill passed, while in some of the videos he specifically refers to American voters as ill-informed or “stupid”.

In October 2013, Gruber we said: “the bill was deliberately written “in a tortured way” to disguise the fact that it creates a system by which “healthy people pay in and sick people get money”.

Some of Americans are waking up to the fact that they cannot trust President Obama and his administration to be our surrogate. This is true not only in healthcare but in his decision making in every area of the economy and our live.

Gruber said this obfuscation was needed due to “the stupidity of the American voter” in ensuring the bill’s passage. Gruber said the bill’s inherent “lack of transparency is a huge political advantage” in selling it .[31]

 In 2010, Jonathan Gruber expressed doubts that the ACA would significantly reduce health care costs. He thought lowering costs played a major part in the way the bill was promoted by the Obama administration.[36]

President Obama said he never met Jonathan Gruber and did not think he came to the White House. President Obama forgot he hired him and paid him a $400,000 consultation fee.

In 2014, the Obama administration claimed that Gruber did not have a major role in creating the PPACA.[50]

President Obama acted irresponsibly to the public by hiring healthcare policy wonks to change America’s healthcare system without evidence for the success because their thoughts fit his ideology.

I don’t think President Obama understands he has changed the way hospitals and physicians have changed their approach to healthcare and medical care.

In my opinion, healthcare and medical care has changed for the worse.

Rich Lowry said that the videos were emblematic of “the progressive mind, which values complexity over simplicity, favors indirect taxes and impositions on the American public so their costs can be hidden, and has a dim view of the average American”.[41]

The American public eventually figures it out.

Commentator Charles Krauthammer called the first Gruber video “the ultimate vindication of the charge that Obamacare was sold on a pack of lies.”[42]

 The Vermont governor hired Dr. Hsaio and Dr. Gruber to create a single party payer system in Vermont figuring,the system would be easier in one small state than in the nation.

Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state.

“In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.”

Watch out Colorado!

Why doesn’t a single party payer system work?

All of the healthcare policy wonks, especial Dr. Hsaio and Dr. Gruber, leave out the most important ingredients in a successful healthcare system.

Consumers cannot be treated as a commodity. Consumers cannot be forced to take what is given to them. The healthcare system must have a viable physician patient relationship provision.

The physician patient relationship is a big part of the therapeutic index. If treatment is to be successful patients must participate in their care.

Consumers of the healthcare system must drive the healthcare system. It must not be government or the healthcare insurance industry.

Consumers must be a the center of the healthcare system.

A system needs to be developed that puts patients in charge, not the government. Consumers must be responsible for their healthcare and their healthcare dollars.

This will motivate doctors and hospitals to compete for patients’ business.

My Ideal Medical Savings Account will provide incentives for the consumers to have a consumer driven healthcare system. This system will in turn drive hospital systems and physicians to compete for their care.

The end result will be to decrease the cost of the healthcare system and improve medical care and consumer satisfaction with the healthcare system.

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Managing Points Of View and Healthcare

Stanley Feld M.D.,FACE, MACE

Finally, it is official. Ben Rhodes, the deputy national security adviser for strategic communications, admitted that the Obama administration lied about the Iranian Nuclear deal to the press, public and congress.

His interview with David Samuels in a New York Times Magazine typified the approach to manipulating the truth by the Obama administration in all areas of the administration’s activities.

The administration has been trying to walk back Ben Rhodes’ statements for a week. The traditional media is trying to bury his statements even though the king of the mainstream media (the New York Times) published the interview.

The justification for this behavior is that it has been used by all-previous administrations including that of George Bush. It is therefore an insignificant objection.

Ben Rhodes explained to David Samuels, in the New York Times profile that,it was first necessary to lie to a corrupted and inexperienced American media about all sorts of things, beginning with the nature and intentions of the enemy in this case the Iranian regime.

Subsequent lies were added, as the White House took advantage of a dangerous mix of journalists’ ignorance, their ideological and partisan commitment to the administration, and finally, their career aspirations.

It reminds me of Jonathan Gruber’s attitude toward the press and President Obama’s pretense that he hardly knew Jonathan Gruber.

http://stanfeld.com/?s=Jonathan+Gruber

https://www.google.com/search?q=Ben+Rhodes+Iran+nuclar+deal&ie=utf-8&oe=utf-8

Rhodes went on to say, The average reporter we talk to is 27 years old, and their only reporting experience consists of being around political campaigns… They literally know nothing.”

This implies the lack of respect the Obama administration has for the press, Americans and for the virtue of honesty. It is not a good example for our youth’s future behavior and the way to mange a Point of View.

Thus they (the press) will believe what he tells them. He also tells friendly non-governmental organizations and think tanks what he is telling the journalists. Those outlets produce “experts” whose expert opinion is just what Rhodes wants it to be. These ignorant young journalists thus have quotes that look like independent confirmation of the White House’s lies. :

Ben Rhodes admitted, when David Samuels asked,We created an echo chamber of freshly minted experts cheerleading for the deal. ‘They were saying things that validated what we had given them to say.’

This is the apparent attitude of President Obama and his administration. It is applied to every lie they have told to the American people.

Ben Rhodes described a tactic that is an extension of Sol Alinsky’s playbook. I believe the American people are catching on.

The defendants of the Obama administration marginalize the people who expose the lies with additional lies.

The Obama administration and its defendants are usually effective in marginalizing their opponents.

The defendants of the lie have the power of the pulpit and a friendly mainstream media.

The same tactics are used in defending Obamacare as I have described many times in my blog.

I find it difficult to believe that so many smart people believe these lies.

Carl Sandberg said “if you tell I lie enough times its eventually becomes the truth. This is especially true when people start adjusting and investing in the lie.

Marilyn Travenner, now that she is CEO of the healthcare insurance industry lobbying group, has a different point of view than when she was the head of CMS. Someone else other than government is paying her.

I have said that the dysfunction in the healthcare system is the fault of all the stakeholders, namely the government, the healthcare insurance companies, the drug companies, the physicians and the patients.

Each group adjusts to a dysfunctional element making the healthcare system more dysfunctional. The growing dysfunction is driven by the multiple points of view.

President Obama’s ideology has accelerated the dysfunction.

Marilyn Travenner is now diverting blame for the dysfunction away from the healthcare insurance industry. Many do not realize that the government run healthcare system is totally dependent on the healthcare insurance industry. The healthcare insurance industry does the administrative services for the government.

The administration brags that CMS’ overhead is only 2.5-5% of Medicare’s cost. This is an illusion; It is false.

The percentage of overhead published does not include the cost paid by the government to outsource the administrative services to the healthcare insurance industry.

The administrative services overhead is added into the cost of healthcare. Insurance premiums are calculated using the Medical Loss Ratio calculation. Many insurance company expenses are considered direct medical care expenses. Direct medical care expenses should only be for direct medical care.

The government programs set payments to the healthcare insurance industry for administrative service according to the Medical Loss Ratio.

Insurance administrative expenses, like a help desk or network selection expenses, should not be included in direct medical cost. Presently, it is the method used by the healthcare insurance industry to ultimately take 30-40% of the healthcare dollars off the top.

President Obama and his administration brag that Obamacare is bending the healthcare cost curve for Medicare and Medicaid. The only reason this was true in 2012 and 2013 was because Obamacare’s hidden taxes from citizens at every income level were being collected while there were no Obamacare medical care expenditures until 2014. The 2014 and 2015 cost curve was bent upward contributing to the 19 trillion dollar deficit.

In my last blog I mistakenly left out the word contributing to the 19 trillion dollar deficit. Obamacare is not budget neutral. It is not presently bending the healthcare cost curve.

Some smart people believe Obamacare is bending the healthcare curve because they uncritically believe all the administration’s press releases.

In the last few weeks we have been warned not to believe everything President Obama and his administration tell us.

I am sure the judge in Texas who was lied to by the Department of Justice about immigration reform is not very happy.

The cost of physician services might be increasing on a retail level. However, government and insurance reimbursement to physicians is decreasing.

Travenner, in her previous life blamed the rising cost of medical care on physicians. In order to divert attention from the healthcare insurance industry she continues to blame physicians.

The cost for everything from office visits to complex surgeries is on the rise, so there’s not much that can be done here to ebb this common cause of premium inflation.”

This is an incorrect premise. It is true that hospital costs are rising. If the premise is incorrect the solution is usually incorrect.

Next, Ms. Travenner explains additional reasons for increasing premiums.

“Prescription drug price inflation is a far bigger problem. A lack of a universal health plan, long periods of patent exclusivity, high demand for pharmaceutical products in the U.S., and the speed with which approved drugs can be brought to pharmacy shelves are all reasons why prescription drug costs could continue soaring in 2017 and future years.”

She omits the most important reasons for the increase in drug prices to the public.

President Bush’s deal with congress to pass Medicare Part D was to eliminate government’s ability to negotiate drug prices with the drug companies. The government negotiates drug prices for the military and VA. It gets negotiated prices that are comparable to all other countries on the globe.

At the same time the government restricts consumers from buying prescription drugs in Canada, suppressing competition.

The Obama administration keeps blaming the drug rules on President Bush’s administration. Why hasn’t President Obama renegotiated a better deal in the last seven years, or just change the rules by executive order as he usually does?

Tavenner also hit onthe point that restructuring the insurance market hasn’t paid benefits as expected.”

New regulations requiring Obamacare insurers to provide plans with a host of minimum benefits, as well as being unable to deny benefits to people with pre-existing conditions, has left insurers exposed to adverse selection.

In plainer terms, it means sicker people who’d been shut out of the insurance system previously have flooded in, and not enough healthier individuals have enrolled.

This last point is valid. The claim that the insurance industry is losing money is not true. It is losing money on adverse selection but they are making up that loss by increasing premium prices to the government and the corporate market.

If they did not make money how could they pay CEOs of some healthcare insurance industry companies 100 million dollars a year?

Finally, Tavenner cautioned that the turbulence can be expected because insurers “sit in the three-R world.”

What Tavenner is alluding to are two programs that are set to end in 2017: the reinsurance program that provided payments to plans that enroll higher-cost members, and the risk corridor, which acted like a modern day Robin Hood by taking excessive profits from top-performing insurers and giving them to Obamacare insurers losing excessive amounts of money.

Without the risk corridor, new insurance entrants could be discouraged, since they’d be responsible for covering the entirety of their losses. The third “r,” risk adjustment, will remain in place to distribute capital from plans with low-risk enrollees to those with high-risk.

The reinsurance aspect of Obamacare was probably illegal. The government guaranteed the insurance companies that it would make up whatever loss they claimed. The Obama administration paid the healthcare insurance industry only 12% of the promised amount. This deception by the government has led to some of the reasons UnitedHealthcare and now Aetna are pulling out of Obamacare’s health exchanges.

However, the government is totally dependent on the healthcare industry for it administrative services.

The devil is always in the details.

There is an ever-growing need to lie to manage the public’s point of view in favor of Obamacare.

The public is becoming aware of the Obama administration’s attempt to mange the public’s point of view. Ordinary citizens are madder than hell at the Obama administration and the establishment in both the Democratic and Republican parties.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Single Party Payer Will Fail

Stanley Feld MD, FACP, MACE

Socialism does not work!

Intellectually, socialism is attractive and easy to understand.

 

Simple Definition of Socialism

 

Full Definition of socialism

  • 1
:  any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods

  • 2
a :  a system of society or group living in which there is no private property
b :  a system or condition of society in which the means of production are owned and controlled by the state

  • 3
:  a stage of society in Marxist theory transitional between capitalism and communism and distinguished by unequal distribution of goods and pay according to work done.”


It would be nice to have the government tend to all our needs equally.

Everything would be free to the public.

  • Not one would need to “get ahead.”
  • No one would have special privilege.
  • Everyone would live the same housing.
  • No one would have to have responsibility for anything.
  • No one would have incentive to be creative or inventive.
  • No one would need to take the initiative to be innovative and create new good and services.

The government would then run out of money because people would have little to be innovative about or have any incentive to work hard to provide for their family.

People would have little incentive to produce income that would generate taxes for government to spend on goods and services to support the benefits offered the people in a socialistic system.

The government would have to borrow more money from others because the people would not produce enough income to tax.

What lender would be inclined to lend money to a country that could not pay it back?

The socialistic system would then become unsustainable and collapse.

This explanation might be considered by some to be a fifth grade explanation of socialism. It is simple to understand but direct and to the point.

America is headed in that direction. The present healthcare system as is unsustainable.

Government cannot spend other peoples’ money when the money is not there.

In America the federal government and state governments keep making the same mistakes over and over again.

Obamacare’s regulations caused 335,000 healthcare insurance policies to be cancelled in Colorado. In 2010 Obamacare made these Coloradan healthcare insurance policies illegal.

Obamacare has failed for the citizens of Colorado.

The state’s politicians tried to fix Obamacare by borrowing hundreds of millions of dollars from the federal government to set up Colorado HealthOP the state’s co-op health insurance plan.

The goal was to stimulate competition among insurance companies by providing lower priced insurance. The co-op is in debt to the federal government for hundreds of millions of dollars.

Colorado HealthOP became the largest insurer on a state health insurance exchange in Colorado.

Colorado HealthOp lost so much money that it could not borrow any more. The Colorado HealthOp had to shut down in October 2015 leaving the federal government to absorb its loan to the state of Colorado.

The closure of Colorado HealthOP left 80,000 Coloradans without health insurance coverage for 2016.

The other state insurance plans are increasing premiums an average of 11.7% to stay above water according to state calculations.

It has made premiums and deductibles too expensive for many of these uninsured 80,000 people.

Coloradans are tired of all the insurance changes, increasing prices and uncertainty. They want something new.

The knee jerk reaction is to change to something easy to understand. A socialistic single party payer system (SPPS) is the easiest to understand. Let the state provide healthcare insurance to everyone. Healthcare would be universal and free to the public.

The problem is nothing is free. The advocates in Colorado (progressives and liberals) are mobilizing to replace Obamacare with either the Canadian or United Kingdom healthcare system.

However, both of these nations healthcare systems are unsustainable. They are failing because of the cost, inefficiency, long wait times for diagnosis and treatment and lack of services despite the governments claims and some of the consumers’ perceptions.

The progressive advocates accumulated 100,000 Coloradans’ signatures. These progressive democrats have gotten a single party payer (SPPS) proposal on the 2016 ballot.

“ColoradoCare,” as it is being called, would replace private insurance with health care funded completely by the government, substituting higher taxes for premiums.

The conservatives in Colorado do not have a proposal to replace Obamacare to put on the ballot in 2016. They have been asleep at the switch.

Conservatives and libertarians have been sleeping at the switch in every state except Vermont.

Conservatives and libertarians did nothing in Vermont. Peter Shumlin was elected governor to institute a SPPS.

The Vermont experiment with a single party payer system has been a disaster already.

“In 2010 Vermont voters elected Democratic Gov. Peter Shumlin, who promised to institute single payer in lieu of ObamaCare.”

Jonathan Gruber, who designed Obamacare, and thinks Americans are stupid, along with William Hsiao, who thinks price controls work designed the system for Vermont.

“Helping design the system was advisers such as Jonathan Gruber, the MIT economist often described as the architect of Obamacare, and William Hsiao, the Harvard economist who developed the Medicare price controls that are driving up prices around the country.”

Vermont played right into President Obama’s goal of creating a single party payer system (SPPS). Colorado is trying to follow the same path to disaster.

The Obama administration provided Vermont with many millions of dollars in federal grants in order to accomplish President Obama’s dream of a single party payer healthcare system.

In order to pay for Vermont’s SPPS the state proposed an 11.5% payroll tax on businesses, which would have taken the total payroll-tax burden to nearly 20%.

Vermont contemplated a new state income tax of 9.5% to pay for the SPPS on top of the existing 3.55-8.95% individual state tax.

The state budget would need to be doubled with the SPPS, therefore taxes would need to be doubled.

Even with these increases in taxes the plan would be deep in the red in three to five years.

Gov. Shumlin (Vermont) was elected to create a SPPS. In 2014 he abandoned single payer system he was about to create because of its effect on the state economy.

Gov. Peter Shumlin woke up to the impending disaster, “The potential economic disruption and risks,” he remarked, “would be too great to small businesses, working families and the state’s economy.”

Ben and Jerry might even flee the state and move to Texas because of the high taxes and economic disruption.

The people of Colorado should look carefully at Vermont’s mistake. The Denver Post has already predicted tax increases that would drive business and job growth out of the state.

Colorado also has a large VA Hospital System. In April 2015 the Colorado Springs Gazette reported that four of Colorado’s VA facilities were among the 10-worst in terms of wait times of all VA hospitals.

The Veterans Affairs hospital system is a pure a single-payer system.

A September report by the agency’s inspector general supports the conclusion that thousands of veterans may have died while waiting for the care they needed, although shoddy record-keeping made it impossible to know for sure.”

All Coloradans have to look at is their state’s VA SPPS that cannot take care of the 400,000 veterans in the state. Why should Coloradans expect a SPPS would work for five (5) million residents it their state?

What have conservatives and liberations offered as a substitute for the failed Obamacare experiment?

Nothing!

Leaders should start looking at My Ideal Medical Savings Account system that would put consumers in charge of their health and healthcare dollars.

Please send my summary blogs about an alternative to Obamacare and my Ideal Medical savings accounts to your elected representatives.

Spread the word about My Ideal Medical Savings Account as an alternative to Obamacare.

I wish everyone a HAPPY AND HEALTHY HOLIDAY SEASON

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE