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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.

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


Medical Costs Outrun President Obama’s Projections

Stanley Feld M.D.,FACP,MACE

No one should be surprised that the cost of
healthcare and medical prices are overrunning projections by the Obama
administration. It was self-evident with the passage of Obamacare. Now it is

President Obama has done all the wrong things to
lower costs and all the right things to raise costs.

Health Care Cost Institute analyzes claims data from UnitedHealth Group Inc.,
Aetna Inc. and Humana Inc.
The Institute said the cost for consumers with
employer-sponsored healthcare insurance plans increased 4.6 percent in 2011.
The government estimated a 3.9% increase for 2011.

A recently published study
by the U.S. Centers for Disease Control and Prevention found the number of
people without insurance climbed 1.7 percent in the first quarter of 2012.

Both numbers are the
opposite of the numbers President Obama promised in 2009 when he was forcing
congress to pass Obamacare.

CDC reported that 47.3 million people lacked insurance, and the health
institute said hospitals and doctors raised prices at a clip that outstripped

Why is President Obama not bending the cost
curve as he promised? I would say he either doesn’t know what he is doing or he
knows precisely what he is doing.

My guess is he is trying to force consumers into
a "Public Option" that will be created by the health insurance exchanges. He is
also trying to stick the cost of this “Public Option” onto state governments.
The state governments are required to balance their budget.

Even before states institute the health
insurance exchanges most states are suffering from large budget deficits when
they are supposed to have a balanced budget.

The health insurance exchanges will make it
worse.  The federal government will have
to bail states out as the payer of last resort. This will increase the federal
deficit even further. The federal government will have to print more money.

Printing more money will devalue savings,
salaries and purchasing power. The result will be further inflation. Somewhere someone like a China will not continue to buy the United State's depth and it will default on payment.

America is currently suffering from inflation.
It is being disguised because the government has eliminated fuel costs and food
costs from inflation calculation.

I believe Americans understand this. Governor
Romney must emphasize this in no uncertain terms.

Affordable Care Act, which
promises to expand coverage to 30 million Americans starting in 2014 and trim
health costs.


 “If you don’t bend the cost curve, ultimately
insurance gets more expensive,” said Douglas Holtz-Eakin, the president of the
American Action Forum, a Washington-based advocacy group that opposes the health
law. “It’s a big problem for the Affordable Care Act.”

Obamacare tries to limit insurers’
administrative expenses and profits. The Healthcare insurance industry is
supposed to pay at least 80% of premiums for direct patient care. (Medical Loss
Ratio of 80

However, President Obama
has permitted the healthcare insurance industry to continue to count expenses
for administrative services into the direct medical services column. The result
is a decrease in the amount of money available for direct patient care.

The Health Care Cost
Institute published the direct cost per person under employer- sponsored plans
increased from $4,349.00 in 2010 to $4,547.00 per person in 2011. United, Cigna
and Humana cover 40 million people.

I have previously published
that the cost per Medicare senior is $6,600 a year.

The obvious question is why
should an employer pay $15,000 to $20,000 dollars a person a year when the cost
is $4,547?

Why should I be paying a
premium of over $15,000 a year in after tax dollars for my Medicare premium and
supplements for my wife and me when it costs $6,600 per person? The $6,600 per
year average includes the sickest seniors. 

Each year the government
increases the Medicare premiums on a means tested basis because it spends money
above my premium cost. 

Keep in mind I have been
paying into the Medicare Trust since 1965. Now I am paying an additional
$15,000 a year for direct services that cost $6,600 per year per person.

Any salary earned by a
senior results in them paying into the Medicare trust.

Someone is ripping off the
system. The likely candidates are the healthcare insurance industry and the ever-increasing
government bureaucracy.

institute created last year to analyze claims data from major insurers, found
that charges for hospital emergency rooms rose 9.1 percent in 2011, after
adjusting for a reduction in the intensity of care they delivered.”

This statistic is a
distraction from the real issue. The real issue is to explain the difference in
direct cost compared to premium costs. 

President Obama believes
that hospitals owning and managing physicians practices will result in best
practices using evidence- based medicine.

I believe a system can be
built to teach independent physicians best practices combined with their use of
clinical judgment.

Holtz-Eakin, former CBO
head, believes that Obamacare encourages consolidation among hospitals and
doctors. The consolidation of hospitals and physicians is leading to greater
pricing power by the hospital system.

The problem with the
consolidation of hospital systems and physician practices, is that physicians
are not receiving an increase in reimbursement for their intellectual property
or technical skills.

The hospital system owns physicians’
intellectual property and technical skills. Its staff does the collecting and
financials. The hospital system enjoys the increase in revenues. The salaries
for its administrators have skyrocketed into an average of 1 million to 5
million dollars a year.

It is clear that the price
of adding 30 million people to the healthcare insurance rolls will increase
costs. The increasing price spiral will not be to the advantage of patients and

The costs will become
unsustainable and the government controlled healthcare system will collapse.

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

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What Are The Real Costs Of Obamacare?


Stanley Feld M.D.,FACP,MACE


The traditional media is not discussing the economic consequences of President Obama’s healthcare reform program.

In these final days the traditional media is describing the horse race to the finish line for a deemed vote (“Slaughter rule”) vs. a partisan up and down vote on the Senate bill. The horse race is a distraction to avoid discussing the unintended consequences of the bill.

Congressman Paul Ryan is the Ranking Member of the House Budget Committee and senior member of the House Ways and Means Committee. His focus has been to bring fiscal discipline to federal spending. The House Ways and Means committee’s jurisdiction is tax policy, Social Security and healthcare. He has been addressing America’s long-term fiscal crisis and the dangers of explosive entitlement spending.

He has accused President Obama of being dishonest to the American public about the costs of his healthcare bill.

I can understand the emotional appeal of President Obama’s healthcare reform plan. His solution will not repair the healthcare system. It will increase the price of care, decrease access to care and decrease many freedoms.

President Obama has said repeatedly, “I will not sign a plan that adds one dime to our deficits either now or in the future.”

If passed by this phony congressional “Slaughter maneuver” it will simply make the healthcare reform bill’s failure to solve our healthcare system’s problems even more grotesque. I predict the bill will cripple Americans’ ability to maintain their present standard of living.

I am sure Paul Ryan is frustrated that his remarks to President Obama at President Obama’s Healthcare Summit would be thought of as disrespectful by Democrats.

No one has refuted Paul Ryan’s accusations.

President Obama continues to recite his unsound sound bites about his healthcare plan. He claims it will save Medicare, provide coverage for 30 million more Americans and reduce the deficit.

I believe that anyone who votes for this terrible bill should not be reelected. They are doing a disservice to Americans.

Congressman Paul Ryan of Wisconsin made the following points before President Obama at the Healthcare Summit.

  1. Medicare, right now, has a $38 trillion unfunded liability. That’s $38 trillion in empty promises to my parents’ generation, our generation, our kids’ generation
  2. Medicaid’s growing at 21 percent each year. It’s suffocating states’ budgets. It’s adding trillions in obligations that we have no means to pay for . . .

He then went on to say that the Congressional Budget Office scores bills with the premises and assumptions it is given. If the premises and assumptions are incorrect the score will be incorrect.

  1. “And what has been placed in front of them is a bill that is full of gimmicks and smoke-and-mirrors.”

He continued by saying;

“And if you take a look at the CBO analysis—analysis from your chief actuary—I think it’s very revealing.”

  1. “ This bill does not control costs. This bill does not reduce deficits. Instead, this bill adds a new health-care entitlement at a time when we have no idea how to pay for the entitlements we already have.”

The CBO letter to Harry Reid on March 11, 2010 states the bill will not decrease the deficit as President Obama claims, but it increases the deficit even as it increases costs.

“March 11, 2010

Honorable Harry Reid

Majority Leader

United States Senate

Washington, DC 20510

Dear Mr. Leader:

The Congressional Budget Office (CBO) and the staff of the Joint Committee onTaxation (JCT) have estimated the direct spending and revenue.

“Under the legislation, federal outlays for health care would increase during the

2010–2019 period, as would the federal budgetary commitment to health care.6

CBO now estimates that the federal commitment would increase by about

$210 billion over that period, rather than by $200 billion as previously estimated.”

If anyone is concerned about our budget increased deficit and increasing taxes for a bill that will not repair the healthcare system, understanding the numbers is important.

Paul Ryan dug into the details at the Healthcare Summitt;

  1. “The bill has 10 years of tax increases, about half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending.”

“Therefore the true 10-year cost of this bill in 10 years? That’s $2.3 trillion.”

  1. “It takes $52 billion in higher Social Security tax revenues and counts them as offsets. But that’s really reserved for Social Security. So either we’re double-counting them or we don’t intend on paying those Social Security benefits.”
  2. “It takes $72 billion and claims money from the CLASS Act. That’s the long-term care insurance program. It takes the money from premiums that are designed for that benefit and instead counts them as offsets.”

Kent Conrad (D) Senate Budget Committee chairman said that this is a Ponzi scheme that would make Bernie Madoff proud.

Five hundred million dollars is taken out of Medicare to fund the healthcare reform bill. This is not shoring up Medicare solvency. It is paying to expand the program.

Paul Ryan did not stop there. He kept pounding away at the smoke and mirrors that the traditional media is not even analyzing much less mentioning.

  1. “You can’t say that you’re using this money to either extend Medicare solvency and also offset the cost of this new program. That’s double counting.”
  2. “According to the chief actuary of Medicare as much as 20 percent of Medicare’s providers will either go out of business or will have to stop seeing Medicare beneficiaries”.
  3. “When you strip out the double-counting and what I would call these gimmicks, the full 10-year cost of the bill has a $460 billion deficit. The second 10-year cost of this bill has a $1.4 trillion deficit.”
  4. “Probably the most cynical gimmick in this bill is something that we all probably agree on. We don’t think we should cut doctors [annual federal reimbursements] 21 percent this year and next. We’ve stopped those cuts from occurring every year for the last seven years”.

The “doctor fix” was supposed to go into effect January 1st. It was delayed until March 1st. Now it is delayed until October 1st. It was taken out of the Healthcare Reform Bill and
placed in a separate bill because it added $371 billion dollars to the healthcare reform bill’s deficit.

President Obama’s Healthcare Reform Bill ignores and in actually hides these costs. Hiding these costs does not take the costs off the backs of taxpayers, the deficit, or future tax payers.

12.” I’ll finish with the cost curve. Are we bending the cost curve down or are we bending the cost curve up?”

“If you look at your own chief actuary at Medicare, we’re bending it up. He’s claiming that we’re going up $222 billion, adding more to the unsustainable fiscal situation we have.

13. “We don’t think the government should control our healthcare system. We want people to be in control. And that, at the end of the day, is the big difference.”

14. I’ve got to tell you, the American people are engaged. And if you think they want a government takeover of health care, I would respectfully submit you’re not listening to them.”

President Obama ignored Paul Ryan’s comments. He is ignoring the will of Americans. He is ignoring the fiscal consequences of a bill he is ramming through congress at the expense of the American people for something that will not work.

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




President Obama Should Listen To Physicians

Stanley Feld M.D.,FACP,MACE

Obama keeps saying over and over that Republicans do
not have any good health care reform solutions.

don’t have an agenda to provide health insurance to people at affordable

It all depends
on the definition of a good idea. Is it one that will work or one that will
fail? A good idea is it one that agrees with President Obama’s agenda. If it
doesn’t agree with his agenda it is a bad idea.

By President
Obama and Harry Reid own admission they believe Obamacare is a good step toward
a single party payer. They believe Obamacare will fail.

Any idea that
interferes with President Obama’s is defined as a bad idea.

The Republicans
and thoughtful people with actual healthcare experience have plenty of good
ideas. They do not agree with President Obama’s agenda.

This program containing Republican ideas three years ago had only 807 views on You Tube.

Congress voted for the
law (only Democrats voted for the law). They have now exempted themselves from
the law because they realize it is a bad law. It looks as if Obamacare will be
a train wreck.


Perhaps that is where
President Obama wants it to end.


 As each day
passes Obamacare looks like it will be a very expensive train wreck.

 Physicians are tired of being blamed for the rising
healthcare costs. They are starting to realize that they have to take action to
preserve their professional integrity.

In fact, in a recent study by the Physicians Foundation, six
out of ten physicians said they would quit medicine.

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

 Many physicians
are looking for viable exit strategies to avoid quitting.

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

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

survey pointed out many major problem areas.

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

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

The Massachusetts Medical Society survey pointed out the
scope of defensive medicine. I extrapolated findings of the society’s survey to
the nation.

My conclusion was that $500 billion to $700 billion
dollars a year is spent on defensive medicine testing. Tort reform would
decrease the cost incurred by defensive medicine over testing.

The Mass Medical Society survey demonstrated that
physicians are frightened by the multidimensional stress of malpractice suits.
Physicians will do as much testing as necessary to avoid a malpractice suit for
missing a diagnosis. Most physicians do not experience financial gain in over
testing. The hospital system does.

President Obama and his advisors have ignored tort reform
and defensive medicine as an insignificant cost. Ezekiel Emanuel M.D. one of
President Obama’s advisors thinks defensive medicine only raises the cost of
the healthcare system between $2 to $3 billion dollars a year. This is a
misguided bias.

The Physician Foundation survey notes that many policy
makers, academics, and others identify fee-for-service reimbursement as a key
driver of health care costs. Physicians believe that "defensive
medicine is a far more important cost driver."

percent (40%) of the physicians surveyed said "liability/defensive
medicine pressures" was the least satisfying aspect of medical practice.

 Sixty nine percent
(69%) of physicians said defensive medicine is the "number one ranked
factor" driving up healthcare costs. The survey described the ordering of
tests, prescribing of drugs, and conducting of procedures done "partly or
solely to drive a wedge against potential malpractice lawsuits."  

malpractice lawsuits are common, adding an additional layer of paperwork,
expense, and stress in virtually every physician's work day," the report

The government ought to be listening to physicians practicing medicine every
day rather than ivory tower professors who have never practiced medicine a day
in their lives.

understand to some degree that's the cost of doing business, but the defensive
medicine goes deeper than that, in the ordering of extra tests, doing the extra
procedures, and extra scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of overspending in
American healthcare. President Obama and Obamacare have ignored it. Some states
have addressed it and the cost of care has been decreasing slowly. I believe it
will take time in those states.  If
anyone is sincere about bending the healthcare cost curve they have to take
defensive medicine seriously. 

According to the survey physicians
felt that there is a lack of a forceful cohesive voice representing them.

is a systematic, endemic series of problems," Ray says. "Everywhere there
is defensive medicine, regulation issues, reimbursement issues. We are all in
the same boat. But physician representation is balkanized. There is not a
national organization that represents a majority of physicians."

When the survey asked which best describes
their feelings about the current state of the medical profession, only 3.9
percent of physicians used the words “very positive,” while 23.4 percent of
physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent —
described their feelings as either somewhat negative” or “very negative,” while
only 31.8 percent of physicians’, described their feelings as “somewhat positive”
or “very positive”.

A "least satisfying" aspect of
practicing medicine included dealing with Medicare/Medicaid/government
regulations (27.4%) and reimbursement issues (27.3%).

The American Medical Association (AMA)
represents only 15% of physicians, according to the Physician Foundation report. One of the reasons for the low enrollment is that physicians feel the
AMA does not represent their vested interests.

 Sermo is another physician organization. It is an Internet social
network. In less than 2 years Sermo had as many members as the AMA.

Sermo originally concentrated on
socioeconomic issues. It also discussed difficult clinical cases. 

The socioeconomic activity has recently
faded. Sermo’s power was using the social network to do instant surveys of physicians’
opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to
the public as media stories of physicians’ opinions. It was done through public
service announcements and daily press releases.

Physicians were able to let the public know
how they felt about an issue instantly. It was very attractive. Somehow the
initial vigor stalled. Physicians are now left without a vehicle or organization
to express their feelings.

Government, the healthcare insurance industry
and the hospital systems have little desire to listen to the concerns of
practicing physicians. It is more important for these stakeholders to control
physicians. It will not work long term.

The Physicians Foundation Biennial Survey is
valid and accurate. However it is not dynamic or evolving. Neither the PFB
survey of the Sermo survey have gotten the attention they deserve.

Both are must reads along with the
Massachusetts Medical Society survey for those interested in physician concerns
and behavior.

Patients’ problems with the healthcare system
get less attention. The government and insurance companies tell patients what
they can and cannot do.

Repair of the healthcare system will only
happen when the American healthcare system evolves to a consumer driven
healthcare system with individual responsibility and patient control of their
healthcare dollars.

The reality is that health care should be as decentralized and regulated as close
to the people as possible, not run by Washington mandates.

This concept
opposes President Obama’s agenda.  

Obama has the power of the pulpit and has the gift of misdirection.

healthcare system is going to fail unless the public wakes up to the facts.

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

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President Obama Keeps Doing It

Stanley Feld M.D., FACP,MACE

President Obama is trying to avoid the press attention about  Obamacare’s continuing mess.

The insurance industry announced that insurance premiums in both the federal and state health insurance exchanges are going up to 50% in 2016. The group private markets will increase by the same percentages.

Insurance rates for 2015 were unaffordable for small businesses, and large corporations.

One church that buys insurance in the private healthcare insurance market had its rates increased 37%.

Instead of dropping insurance for their employees and paying the penalty, the church agreed to the pay the increased premiums. The church compensated for this increase in expenses by increasing church membership dues. Some members had to quit the church.

Eighty-five percent of members in Obamacare are receiving a government subsidy. A high percentage of that 85% are receiving higher subsidies than they are entitled to receive because of government lack of verification.

Eventually, when website connects with the IRS, the government will find out that people received higher subsidies than they are entitled to. The recipients will get a bill they cannot afford.

Obamacare’s reinsurance subsidies for the health insurance industries are expiring in 2016.

The insurance industry is raising insurance premiums to cover the revenue lost by not receiving the Obamacare insurance company subsidies in 2016.

President Obama opened the Obamacare reinsurance program when too few insurance companies signed up to sell insurance through the health insurance exchanges.

The reinsurance program was a subsidy to cover the healthcare insurance industry’s supposed loses.

Obamacare hoped that multiple insurance companies would sign up in order create price competition among the companies and result in lower consumer premiums.

The healthcare insurance industry did not want to sign up. The insurance companies knew there would be adverse selection for insurance consumers.

Sicker people would enroll in the federal or state Health Insurance Exchanges. These sicker people could not afford or were not eligible to buy private healthcare insurance. The participating insurance companies would be at risk to pick up these sicker and more expensive patients.

“After finding that new customers were sicker than expected, some health plans have sought increases of 10 percent to 40 percent or more.”

Obamacare healthcare insurance coverage requirements would also cause them to seek an increase in premiums.

None of these issues appear in news stories that are covering this aspect of the story.

The political spin by the Obama administration is that the Obama administration is trying to persuade states to cut back big rate increases requested by many health insurance companies for 2016.”

I predict if the insurance companies do not get their rate increases they will drop out of the healthcare insurance market.

This is exactly what the Obama administration wants. It is a de-facto victory for a single party payout system and all of its ramifications.

It will not work because the Obama administration still needs the healthcare insurance industry to process and pay the claim. The result will be a higher premium for the consumer and an increased payout to the healthcare insurance industry by the government.

The government will be required to raise taxes or increase the deficit.

Kevin J. Counihan, the chief executive of the federal insurance marketplace is trying to convenience the healthcare insurance industry to reconsider its decision.

The facts spin war is starting. Mr. Counihan said in a letter to state insurance commissioners “Recent claims data show healthier consumers.”

This is apparently not true.

Scott Keefer, a vice president of Blue Cross and Blue Shield of Minnesota, which requested rate increases averaging about 50 percent for 2016, said his company had not seen an improvement in the health status of new customers.

“Our claims experience has not slowed at all,” Mr. Keefer said. “The trend has gotten a little worse than we expected.”

I have recently shown that the Obama administration’s claim that it is bending the cost curve is fiction. The cost to the government and the direct out of pocket cost to the consumers has increased.

The government costs have not risen as quickly as predicted by some but they are rising even more now.

Another weak argument the Obama administration is using is the federal tax penalty is increasing in 2016.

The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

Why should these people buy insurance when they cannot afford the premiums or the deductibles?

Two additional weak arguments are being used.

“Federal officials said, much of the pent-up demand for health care has been met because consumers who enrolled last year have received treatments they could not obtain when they were uninsured.”

There has not been a very large increase in those insured by the state and federal exchanges between 2013 and 2014 to eliminate the “pent up” demand.

“Federal officials have also told state regulators that medical inflation will be less than what many insurers assumed in calculating their rates for 2016.”

The Obama administration has told these lies over and over again.

Does the president really believe if you tell a lie over and over again it becomes the truth?

There is a much better way to deliver universal health care and spend less money.


ACOs Are Failing

Stanley Feld M.D.,FACP,MACE

A major component of Obamacare is the development of functioning Accountable Care Organizations (ACOs). The theoretically the ACO concept is good. The practical execution of ACOs is very difficult.

The way the bureaucrats in the government wrote the rules and regulations for executing ACOs make them almost impossible to execute.

The inevitable failure of ACOs was further guaranteed by the complicated reimbursement rules created by Medicare’s bureaucrats.

The goal was to create integrated health care systems that would efficiently deliver quality medical care at a lower cost.

ACOs are one part of this Administration’s vision for improving the coordination and integration of care received by Medicare beneficiaries.

ACOs are groups of doctors, hospitals, and other health care providers that work together to give Medicare beneficiaries in Original Medicare (fee-for-service) high quality, coordinated care.

ACOs can share in any savings they generate for Medicare, if they meet specified quality targets.”

Defining quality care is a problem. Another problem is designing systems to execute quality care. To date no one has defined quality medical care correctly.

I said from the onset of the development of ACO’s that the project would fail. Many experts criticized me. They called me  a dinosaur. They said I did not understand systems of medical care.

These people did not know that I was the guy that wrote the AACE guidelines for A System of Intensive Self-Management of Type 2 Diabetes Mellitus.

The way the Obama administration has designed ACOs, they are in reality HMOs on steroids.

They shift the responsibility of the cost of medical care to physicians and not the government.

In reality the cost of quality medical care should be the patient’s responsibility. Patients should be responsible for their care and their health care dollars.

I cannot understand why physicians do not protest.

I am a big believer in systems thinking. However, it has to be a system that is well thought out and well constructed. ACOs are neither.

It is clear to me that the bureaucrats do not know anything about medical practices or hospital politics.

The Obama administration originally picked 30 healthcare systems to be ACO Pioneers. They were called Pioneer Project Goups. Nineteen of the original Pioneer Groups remain.

The Mayo Clinic and the Cleveland Clinic were included in the original group of healthcare systems. These clinics were considered the most integrated health care clinics in the country.

The Mayo Clinic and the Cleveland Clinic turned down the Obama administration’s offer. They said they were happy with their system of care. The Mayo Clinic said they would not participate because they knew they would lose money participating in the ACO project.

I have written extensively on the reasons the ACOs would fail. I invite you to read or re-read these articles so as not to be puzzled by the upcoming outcomes of failures.

“Three out of four Medicare accountable care organizations did not slow health spending enough to earn bonuses last year.”

 In 2014 there were 353 accountable care organizations approved by Obamacare.  There are potentially 2700 hospital systems eligible to develop ACOs. The 353 accountable care organizations represent only 13% facilities available to participation rate.

The hospital systems not participating either fully understood why they could not form an effective or efficient ACO with the physicians on their staff or they did not have the money to execute the system and make a profit.

President Obama’s administration has bragged that the 353 participants represent a large number. The traditional mainstream media has parroted his assertion.

The mainstream media publishes this deception to the public as if It represents facts.  It is just one more deception by the Obama administration.

Private health insurance companys’ subsidiaries are in the process of setting up ACOs. They are trying to recruit physicians to shift the financial liability to physicians from insurance companies the same way unsuccessful HMO companies tried to shift financial liabilities onto physicians in the late eighties and early nineties.

The 353 participants include hospitals, physicians’ groups and healthcare insurance company ACOS. These groups have agreed to meet Obama administration targets for quality care and decreased costs.
In 2014 only 97 ACOs earned bonuses. The money these 97 ACOs saved was a total of $833 million. The 97 hospitals shared  $422 million dollars of that total.

Let us assume it was equally distributed among the 97 systems. Let us assume each of the 97 hospital systems has 1500 beds or 97 times 1500 for a total of 145,000 beds. Four hundred twenty two million dollars divided by 145,000 beds equals $2,910 dollars a year per bed or $7.91 dollars per bed per day.

A $7.91bonus per bed per day is an awful return on investment for the work and money necessary to develop an ACO.

What is more bizarre is there are only a few quality targets measured. Some of those measurements are not an accurate measurement of quality medical care.

It also means that the remaining 258 ACOs of the 353 ACOs either lost money because they did not reach targets or they came out even.

In 2013 hospital systems that lost money on certain targets had to pay the government back. The rule was dropped by the Obama administration after the bureaucracy figured out that this was not the way to promote the development of additional ACO’s.

I think I did the math correctly.

“Bonuses are awarded under formulas that account for hospital system performance on quality targets after the first year in the program.”

The results suggest that ACOs might not be the answers to bending the cost curve just as fudging the books is not an answer to delivering the quality healthcare improvement the Obama administration is seeking to have us believe.

The delivery of high quality coordinated care is very difficult to achieve in a government-regulated system of ACOs.

I believe the Obama administration’s plan for Obamacare has failed and has been very costly.

The government should develop a consumer driven healthcare system using my Ideal Medical Savings Account.

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

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Consumers must drive the healthcare system. Consumers have to be provided with the financial incentives to drive the system.


If America continues to go in the direction Obamacare is going, the cost will bankrupt the country.


Lies About Government Spending

Stanley Feld M.D.,FACP,MACE

President Obama and the mainstream media have been bragging about how well Obamacare is working. They cite that Obamacare is bringing down government health-spending growth.

However they have not been telling the truth. They have taken numbers out of context and have spun a lie.

The evidence presented by federal actuaries is that health growth has been under 4% in the five years prior to 2014.

The Obama administration has made a big deal out of this finding. President Obama has bragged that he is bending the cost curve with Obamacare.

His statements are deceptive. It means government health spending growth has been just under 4%. It is still increasing by 4% year to year and not the usual 6%-10% increase.  

Obamacare spending for direct medical care did not go into effect until 2014. All that went into effect was increases in taxes from 2010 until 2014 and spending on the growth of the bureaucracy resulting in a 4% growth. The math had nothing to do with increased direct medical care.

According to federal actuaries, spending on all health care grew 5.5% in 2014. Actual enrollment was lower than expected enrollment in 2014.

2014 was the first year of spending on direct medical care. Healthcare spending will continue to increase in 2015 to 5.3%. The reason is spending for Obamacare took affect in 2014 and continued in 2015. The reason for the slight predicted percentage decrease for 2015 is at least two fold. Less people signed up for Obamacare in 2015 than predicted and reimbursement for physicians and hospitals decreased.

Other reasons for a government decrease in spending are consumers are paying a greater share of their medical bills and reining in their use of medical care services.

One in three Americans said they or a family member delayed medical care because of costs in 2014, according to a report late last year by survey company Gallup.”

President Obama and his administration are deceiving the American public about the success of Obamacare.

The cost to taxpayers and people who are insured has actually increased. President Obama continually tells us costs are decreasing.

The mainstream media, especially The New York Times and Paul Krugman, continually repeat the lie. If you repeat a lie enough times people begin to believe it is the truth.

A reader asked me where did the New York Times readers leave their thinking apparatus. Someone else pointed out that the New York Times readership is decreasing because the newspaper has lost its credibility.

The New York Times opinions seem to be presented without supporting evidence.

The truth is premiums are increasing, coverage is decreasing and insurance deductibles are increasing for everyone including the middle class. Access to medical treatment is decreasing. Out of pocket expenses are skyrocketing.

The deception continues unchallenged by Republicans. No one is talking about the fact that the Obama administration is lying about what is happening on the ground.

“According to a report from actuaries at the Centers for Medicare and Medicaid Services published in the journal Health Affairs. In the years through 2024, spending growth is expected to average 5.8%, peaking at 6.3% in 2020.”

The cost of healthcare to the government is going to increase further and faster than predicted by federal actuaries as a result of expanded government insurance coverage under the 2010 health law, and the ever expanding Medicare’s baby-boom beneficiaries entering Medicare age.

As technology increases and as the baby boomers enter Medicare and more expensive life-saving drugs are developed costs to the government are going to increase.

The cost of pharmaceuticals is reported to have increased by 12% last year. The deals the government makes with the pharmaceutical companies are pathetic. The prices continue to mount for the government as consumer out of pocket costs for drugs increase.

By 2024 healthcare costs to the government and consumers are projected to be over 20% of our GDP and rising at the present Obamacare rate.

Americans will be older and sicker.

There is little government focus on helping our population become motivated to become  healthier and more responsible for their health and their own healthcare as they age.

Obamacare is forcing Americans to become more dependent on the government for their healthcare needs.

Hopefully, people are noticing that government does not work and more government will be a disaster to our medical and financial health.


Obamacare Deceptions Keep Coming

Stanley Feld M.D.,FACP,MACE

President Obama and CMS have been extremely quiet about Health Insurance Exchange enrollment since enrollment opened November 15,2014

President Obama reported that on  opening day the health insurance marketplace performed much better than last year. However, some consumers reported long, frustrating delays trying to buy insurance and gain access to their own accounts at

Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which also vexed many people last fall.

Some people did complete their applications, but it often took them 90 minutes. Some people were unable to finish what they started, so they left the clinic with plans to return at another time.

The insurance exchanges are supposed to be the centerpiece of Obamacare.

 Ms.Sylvia Burwell, the Secretary of the Department of Health and Human Services said, “23,000 people had completed online applications in the first eight hours after, the federal website, opened on Saturday morning.”

Twenty three thousand is a low number for a 45-day enrollment period with four days each at Thanksgiving and Christmas.  It is only 1,035,000 enrollees (45 x 23,000). We do not know if they are new or old enrollees. 

Ms. Sylvia Burwell has given us signals previously that all is not well with Obamacare.

The estimate of total enrollees (old and new) for the end of the 2015 enrollment period was lowered from 13 million to 9 million. If 8 million were enrolled in 2014 this is only an increase of 1 million new enrollees.

There were clearly not 8 million valid enrollees when President Obama did his victory lap at the end of the extended enrollment period on March 31,2014.


It was later announced that 85% of enrollees were to receive subsidies (tax credit). The tax credits were to make the insurance premiums affordable to enrollees earning less than $50,000 a year.

It turned out that 65% of those approved for subsidies originally had the subsidy reduced when they could not verify their claimed income.

The American taxpayers, who are responsible for the subsidy (tax credit), were never told how the government was going to collect the government over payment. Taxpayers were never told the amount of  payment due from people who received the invalid subsidies.

 How many of those over subsidized people dropped out of Obamacare because they could not afford the premium or the deductible.

How many enrollees remained from the 8 million claimed to have enrolled?

 Somehow the published number of enrollees dropped to 7.3 million. Did the decrease from 8 million to 7.3 million include the over subsidized dropouts?  

I should think an inspector general or someone in congress would start connecting the dots.

I would think the CBO would recalculate their estimates.

I should think someone in the press would sense there was something fishy and start investigating.


Last week it was discovered that 400,000 people were counted in the total enrollment number that did not buy healthcare insurance. The 400,000 enrolled for low cost dental insurance.

 This new revelation lowered the total number of claimed enrollees to 6.9 million from the 7.3 million claimed enrollees.

Kathleen Sibelius declared over a year ago that Obamacare would have to have over seven million enrollees to be viable and declared successful.

In a previous blog my estimate of valid enrollees for 2014 was 3 million. I have also pointed out that the healthcare insurance industry is not worried about the number of enrollees because if they lose money the government would bale them out and subsidized the difference.

The loser is the taxpayer. We have been paying a tax increase of more than 10% for Obamacare since 2010.

The public has not yet seen any numbers proving Obamacare’ s viability or it’s bending of the cost curve.

 We have seen patients complaining that they cannot afford the 6-10 thousand dollar deductibles of the health insurance policies. People have realized that they are not covered by insurance until they reach their deductibles. People have been hesitant to get necessary medical care in order to avoid paying the deductibles.

The Obama administration claims to have reduced healthcare costs. The administration does not count the patient’s deductible costs (out of pocket costs) in their bogus calculation of costs to the healthcare system.

The avoidance of follow-up care by patients with pre-existing illnesses (chronic diseases) is only going to lead to complications of those chronic disease and higher societal healthcare costs.

Lowering the goal for the number of enrollees to 9 million if only there are only 3 million valid enrollees that stayed in the system is going to be a very difficult task.

The changing of the date to begin open enrollment from October 1 to November 15 for political reasons is not going to help achieve the goal.

President Obama will probably extend the enrollment period from December 15,2014.

The Obama administration already announced the 2016 open enrollment period. It starts October 1 2015 and ends December 15, 2015.

There is a great website that calculates the estimated weekly enrollment and actual enrollment. Enrollment is not going very well. President Obama and his administration are very quiet about the enrollment. The mainstream traditional media is also ignoring enrollment.    


The website is,

As of 11/21/2014 the website reports confirmed enrollees for 2015 QHPs: at least 39,215 have enrolled as of 11/21/14 as opposed to the government estimated enrollees for 2015 QHPs of at least 410,000 as of 11/21/14.

No one is paying attention to the website. The Obama administration is not providing the information necessary for consumers to judge how well Obamacare enrollment is doing.

Ms. Burwell said,

Ms. Burwell said that attention should be on all of the people who now have health insurance, rather than the miscalculation.

While we understand some will be skeptical, our clarity that this is mistake and the fact that we have quickly corrected the numbers should give people confidence,” she said. “It is important to continue to focus on the fact that millions of Americans are getting affordable health care.”

The Obama administration persists in trying to distract the American public.

I think the Obama administration continues to believe, as Jonathan Gruber believes, that Americans are too stupid to understand what the administration is doing.

The administration wants to prove that the free market and private insurance cannot provide healthcare coverage for all that only total government control of the healthcare system can work.

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

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Everyone Has A Hidden Agenda

 Stanley Feld M.D.,FACP,MACE


In my last two blogs I
covered several points
. I also asked readers to consider  the unanswered questions.

"Why would a business (the healthcare insurance industry) facing loss of
its customers because of high premiums increase premiums even further?"

"Why, if the traditional media has published articles stating that the
cost of healthcare has been decreasing would a premium increase be justified?"

"Why do consumers’ deductibles continue to increase
each year?"

"How can Medicare be losing money?"

"Where is the extra money going?"

It seems obvious to me that
the Obama administration wants to put healthcare insurance companies out of the
business of selling private insurance.

An Obama administration
regulation created a “user fee” on every healthcare insurance policy sold
through the Health Insurance Exchanges.

In January 2014 Health
Insurance Exchanges will be the only vehicle through which healthcare insurance
can be sold.

At present less than half
the states have signed up to develop State Health Insurance Exchanges.

States are not signing up
because the exchanges will put a tremendous financial burden on individual
states after the second year.  In the end
states will have little say in developing operating rules for the exchanges.

States will also be losing
their independence and freedom.

President Obama’s
administration has said the federal government will run the Health Insurance
Exchanges if states refuse for form their own exchanges.

It looks as if the
healthcare insurance industry is in check-mate. The industry’s response was to
not only pass the 3.5% tax “user fee” for every policy sold but to raise
premiums by double digits.

"My question is why would an
industry having problems holding on to its customers because present premiums
are unaffordable raise premiums?"

I believe the healthcare
industry has lost interest is selling private healthcare insurance.

At present the healthcare
insurance industry sell its administrative services to the government to run
Medicare, Medicaid, Tricare and Government workers Medicare.

The healthcare insurance
industry will continue selling its administrative service to the government for
the new government run Health Insurance Exchanges. Ultimately these exchanges
will be selling National Healthcare Insurance 
(“The Public Option”).

The healthcare insurance
industry is raising premiums now to set a new standard for the fees it will
charge the federal government in the future.

These fees are not

President Obama’s
administration claims the government’s overhead for  Medicare is 2.5%
. That statement is true. It
will go up to 5% with all the new Obamacare bureaucracies.

However, the 2.5% only
covers the cost for the bureaucrats that out source administrative service to
the healthcare insurance industry. The processing and    adjudication of claims are the administrative
services done by the healthcare insurance industry.

The fees for those services
are anywhere between 30 and 50% of every healthcare dollar spent.

Some of the healthcare
insurance industry’s true “overhead” and expenses are  counted as a direct medical care expense.

The law mandates that 80% of
healthcare dollars are spent on direct patient care and 20% can be for
healthcare insurance expenses.

The problem is direct
medical care expenses include creating provider networks, administering those
networks, negotiating a very complex web of allowable fees and reserving unpaid

The healthcare industry’s
recent response to the new “user fee” has been,

Health plans share the
goal of affordable health care coverage for all Americans. Arbitrarily capping
premiums without addressing underlying cost drivers will not move the country
closer to that goal.”

The healthcare insurance industry
claims they are for affordable care for all Americans.

Data show that premiums are increasing
because of the unsustainable rise in medical costs, new benefit mandates that
make coverage more expensive, and the effect of younger and healthier people
forgoing insurance because of a slow economy.

My question is where is the
data? The administration has told us that the costs of medical care is .4% as
opposed to a 2.7% rise in the GNP. The implied claim is Obamacare is bending
the cost curve

“Moreover, the health care
reform law imposed new rate review requirements and a federal cap on health
plan administrative costs and profits, further suggesting that rising premiums
are being driven by increased spending on medical care”.

America’s Health Insurance
Plans association response is lame and unbelievable. The traditional media has
taken the response at face value.

“Focusing on affordability
is critical as the reform law is fully carried out in 2014. That is why policy
makers should address provisions that will further increase premiums, like the
health insurance tax, and take steps to ensure broad participation in the

President and Chief Executive
America’s Health Insurance Plans
Washington, Jan. 7, 2013”


Karen Ignagni has a very difficult job.
She is at times effective. Her current response is a nice gentle way of saying
the government is to blame for the rising premiums.


As I see it both the government and the
healthcare insurance industry are not telling the exact truth. The hope is to
let the rise in premiums slip by the public notice.  

All President Obama has to
do is raise taxes once more to cover the increases he did not anticipate in his
takeover of the healthcare system.

The healthcare insurance industry
will continue to walk away with unconscionable profits.

The victims will be
consumers who feel powerless already.

The dirty little secret is
consumers are not powerless. Consumers simply have to wake up.

Then loud and effective consumer
protests must be organized. These organize orderly protests will get the President's and the congresses' attention.

If nothing is said the
President and the Democratic congress believe consumers are happy with all the tax
increases, premium increases, the deterioration in health care coverage and failures to form new bureaucracies.

It will only get worse for everyone as consumers remain silent.

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

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