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Did Obamacare Cause The Increase In Private Healthcare Insurance Premiums?

Stanley Feld M.D.,FACP, MACE

A reader of my blog received this question from one of his friends.

The reader asked me his friend’s question  “I have a question and I don’t want it to be political (as I stay away from that for many reasons).                                                                                                                                 
Health insurance is so expensive and it does not cover hardly anything. We had to get the worst plan with the worst coverage. But it was not this way 6 years ago. We could afford good coverage.   

 The question is: Did Obamacare cause this change in healthcare insurance and these problems in access to care?

A reader asked:

Which of your blogs would be the best one to show him to answer his question?

The answer to the question is YES!! I will try to explain.

If I sent all the links to your friend would be overwhelmed. There are too many to count.  I will summarize some of the major reasons Obamacare is to blame for some of the increases in private healthcare insurance premiums and the decrease in the access to care. Obamacare has led us into a financial disaster. “Medicare for All” is not the answer.

I believe the goal of Obamacare was to create greater dysfunction in the healthcare system which would lead to huge premium increases for private healthcare coverage. The public would then beg the government to adopt a single party payer system with “Medicare for all.” This has been the progressives”  goal since 1935. Do you remember Barney Frank and John Kerry saying we cannot have a single party payer system yet because we do not have the votes?

https://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2018/10/the-main-reason-behind-rising-medical-costs.html

The government has not had a very successful single party payer systems record.  The VA Health Administration, the Indian Health Service, Medicare and Medicaid are all inefficient and financially unsustainable.

“Our federal government already runs three single-payer systems—Medicare, the Veterans Health Administration, and the Indian Health Service—each of which is in a shambles, noted for fraud, waste, and corruption.”

“Why would we want to turn over all of the American medicine to those who have proved themselves incompetent to run large parts of it?”

https://imprimis.hillsdale.edu/short-history-american-medical-insurance/

The federal government depends on healthcare insurance companies to do the administrative services for Medicare, Medicaid and Obamacare. Administrative services include negotiating payments to hospitals, nursing homes, physicians and providers on all levels.

The various healthcare insurance companies are supposed to bid for these service contracts. The insurance companies receive one global fee.  The healthcare insurance company with the contract must pay providers on a fee for service basis. The healthcare insurance companies do not have good enough data to make an accurate bid estimate.  Actuary science is not rocket science. The healthcare insurance company builds in a twenty percent cushion to the bid. If the bid was low and the healthcare insurance company that lost money Obamacare guaranteed through a complicated reinsurance formula reimbursement to the company for its loss.

Recently the government audit discovered an overpayment of $10 billion dollars to the healthcare insurance industry for Medicare Part D.

I believe there is much more overpayment in Medicare Part A, B and D because of the government bureaucracy. The government only had the money to pay 12% of the reinsurance claims of the healthcare insurance company one year. The insurance industry simply raised the premium in the private sector.

http://stanfeld.com/president-obama-somehow-finds-the-money/

http://stanfeld.com/accelerating-the-destruction-of-the-healthcare-system/

http://stanfeld.com/the-deception-and-disinformation-continues/

Nationwide, the Obama administration made $7.3 billion in reinsurance payments to health insurers. The reinsurance program, funded by taxes on health insurers and self-funded employer health plans, has been criticized by Republicans as a “bailout” for insurers.

https://www.ibj.com/blogs/12-the-dose-jk-wall/post/53906-obamacare-shovels-another-122m-to-indiana-insurers

The healthcare insurance industry then once again raised premiums on the private healthcare sector to make up for its losses. to

The government reinsurance payments weren’t enough in all cases. New York-based Assurant Inc. asked for a 26 percent hike in private premiums for 2016, due to high claims in Indiana, before that company decided to exit the Obamacare markets in all states.

This was typical price shifting.

http://stanfeld.com/?s=price+shifting

Healthcare insurance companies projected that Obamacare would result in them losing money because of adverse selection. Obamacare’s increase required benefits for both public and private insurance. Obamacare’s rules included coverage for oral contraceptives for all and coverage of pre-existing illnesses among others. A sixty-year-old male does not need an insurance policy the receives oral contraceptives.

The healthcare insurance industry asked for double-digit increases in private healthcare insurance in every state. The logic was that these enrollees would pay for the loses that would occur from the Obamacare enrollees.

http://stanfeld.com/managing-points-of-view-and-healthcare/

The government’s argument is all should pay for everyone ’s healthcare needs. These healthcare needs have increased as the population has gotten more obese and has had a rise in drug addiction. These increased healthcare risks resulted in increased actuary estimates of healthcare cost. It does not put a burden on consumers who do not act responsibly.

The increased healthcare premiums caused many employers to drop healthcare coverage for their employees. The decrease in healthcare insurance coverage added to the pressure of healthcare premium increases.

The healthcare insurance industry also plays games with the Medical Loss ratio. The result is an increase in healthcare premiums and deductibles while decreasing services. The Obamacare issued regulations that the insurance industry must dedicate 80% of the healthcare premium to direct medical care and 20 % can be used for administrative expenses for both the public government insurance and private insurance. It is the state insurance regulators responsibility to enforce the regulation.

The expenses the industry wanted to be included are;

Expenses to be included in direct medical care are:

  1. The cost of verifying the credentials of doctors in its networks.
  2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.
  3. The cost of programs that keep people who have diabetes out of emergency rooms.
  4. The sales commissions paid to insurance agents.
  5. Taxes paid on investments.
  6. Taxes paid on premium income.

All these expenses are administrative expenses in my view and not medical expenses. If these expenses are permitted as benefit expenses, premium money available for direct medical care would decrease. The eighty percent required for direct medical care would be markedly reduced. The result would be an increase in healthcare insurance premiums.

http://stanfeld.com/medical-loss-ratio-how-did-the-healthcare-insurance-industry-do/

http://stanfeld.com/what-is-the-medical-loss-ratio/

The calculation for direct medical care helps the healthcare insurance company prove it lost money. The insurance company then applies to state regulators for a premium increase. The state regulators permit the premium increases.  If the premium increase is refused by the regulators the insurance company threatens to leave the state. The other option the healthcare insurance company uses is to decrease the insurance services and/or increase the insurance deductibles.

Another problem has developed in the healthcare insurance industry that is causing it to raise premiums and reduce services and access to care as a result of Obamacare.

Hospital systems are buying out physicians’ practices. Obamacare has put many restrictions on physician practices. It has increased practices overhead. Obamacare has decreased the ability for physicians to use their medical or surgical judgment that they have become happy to sell their practices to hospital systems. The hospital systems now have to deal with the problems of medical practice. The cost of electronic medical records, which have not added to the quality of medical care, increased many physicians’ willingness to sell their practices to hospital systems. At the moment the percentages of hospital-owned practices are up to 65% from only 17% ten years ago.

http://stanfeld.com/physicians-barriers-to-practice-their-profession/

https://www.wsj.com/articles/SB10001424052748704122904575315213525018390

As premiums have gone up physicians have not experienced an increase in reimbursement. They have been forced to see more patients quickly to earn almost as much as before Obamacare. Obamacare has destroyed the patient-physician relationship which in my view is essential in medical care. Physicians simply do not have time to talk to patients.

Hospital systems have taken over physician populations in many communities. This gives the hospital leverage over the healthcare insurance industry. The hospital system can demand higher reimbursement because it provides all the physicians.

The large hospital systems can demand that the insurance company only use the physicians in its hospital system even if there are lower cost of care options in a community.

The result is an increase in healthcare premiums and decreased the quality of care.

All of this is the result of Obamacare. There are about ten more reasons why Obamacare has increased premiums and decreased access to care. I have left link exposed. You are encouraged to look at them to see the full explanation for some of the point I have made.

I hope this blog answers your friend’s question. :  Did Obamacare cause this change in healthcare insurance and these problems in access to care? 

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



Copywrite 2006-2019

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How Jeff Bezos, Warren Buffett and Jamie Diamond Can Disrupt The Healthcare System

Stanley Feld M.D., FACP,MACE

Jeff Bezos, Warren Buffett and Jamie Diamond should try this disruptive approach in their venture into healthcare reform.

All the other approaches that have been tried have not worked or have become unsustainable. Most of the approaches have been unfair to consumers and the majority of taxpaying Americans.

The only way to empower all the consumers in a healthcare system is to encourage them to become responsible for their health and healthcare dollars.

I believe it can only be accomplished by providing easily understandable financial incentives for consumers to save money for themselves.

Providing financial incentives to consumers to save money for themselves can be disruptive to the present models used to pay for medical services just as Amazon has been disruptive to retail sales.

The delivery of medical and surgical care has advanced tremendously in the last sixty years.

At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.

The incidence of obesity has risen every year. Over fifty percent of Americans are obese.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well. However the treatment of chronic disease complications are costly.

How do you decrease the incidence of obesity in America?

Physicians must attack the core causes of obesity.

Among those causes are excess food intake, lack of daily exercise, mental depression, cultural milieu and/or a combination of all of the above.

The cure of obesity depends on the ability to eliminate these core drivers. Financial incentives can get patients involved in eliminating the core drivers of obesity.

The responsibility for obese patients’ healthcare depends on patients’ lifestyle, popular cultural milieu, and patient education.

In America, it is almost impossible to buy a meal in any level restaurant without excess calories.

How do you get people to be responsible for their health and healthcare dollars?

The one key element ignored by policy makers to decrease obesity is to give obese consumers of healthcare financial incentives to concentrate on trying to lose weight.

Obamacare went in the wrong direction. It limits personal liability for their obesity. It does not promote personal responsibility

The only incentive Obamacare provided was the incentive to overuse the healthcare system.

This was especially true for patients on Medicaid. They had zero premiums and deductibles. The only deterrent to accessing medical care was physician availability.

Physicians refused to participate in Medicaid because of low professional reimbursement. Low reimbursement by the government was necessary because of the decreases in funding and participant overuse of the system.

Obamacare planned to cure the shortage of “medical providers” by increasing the number of “valid medical providers” who could bill on their own, such as nurse practitioners and certified physician assistants.

However, the defect there is that patients were not under the supervision of physicians engaged in their care. It ignores the patient physician relationship that is so important to effective medical care.

If Jeff Bezo, Warren Buffet and Jamie Diamond (BBD group) are serious about Repairing the Healthcare System for their employees as a nonprofit organization, they should consider my Ideal Medical Savings Account.

http://stanfeld.com/?s=My+Ideal+Medical+Savings+Account

The Ideal Medical Savings Accounts (MSA) are tax-sheltered accounts used to pay for non-catastrophic medical expenses. These non catastrophic medical expenses account for the bulk of the cost of medical care.

Money left from the Medical Savings Account at the end of the year is put into a consumer’s retirement account.

The MSA provides the financial incentive to not overuse the healthcare system.

Warren Buffet understands the money making potential of re-insurance. He is heavily invested in re-insurance companies.

If one of the BBD Groups employee’s gets sick and spends of all of his MSA money, reinsurance provides first dollar coverage for the illness.

The BBD Group could teach employees how to shop for price and value. Insurance companies are supposed to shop for value. However the shopping is never to the patient’s advantage. It is to the advantage of the insurance company.

 Critics always claim this is unrealistic:

  1. The claim is that patients are not smart enough to shop for price and value. 2. Are you supposed to shop around from the back of the ambulance?

 The critics’ use the ambulance argument to eliminate the possibility of consumers using their own judgment to make price decisions.

Patients are smart enough to figure out which hospital they want to go to before they get into the ambulance.

Emergency care represents only 6% of health care expenditures.

But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

ttps://www.wsj.com/articles/the-health-reform-that-hasnt-been-tried-1507071808

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

ttp://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/

“My Ideal Medical Saving Account provides that financial incentive to not overuse the healthcare system. All the articles about my ideal medical saving accounts are attached to this link.

http://stanfeld.com/?s=My+ideal+Medical+Savings+Accounts

 Likewise, nearly 60% of Medicaid money goes to outpatient care.”

 Medicaid patients also overuse the healthcare system.

Most Medicaid patients can understand the MSA’s financial incentive.

“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”

These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system. It would save the re-insurance company a great deal of money.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and deliver it to consumers retirement accounts.

Both HSA’s and MSAs have the unique advantage of providing the financial incentive to for consumers to save money for themselves.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health. 

 The financial incentives decrease the overuse of the healthcare system.

According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”

 https://www.healthaffairs.org/do/10.1377/hpb20160204.950878/full/

 My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ MSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”

MSAs should also apply to Medicaid recipients. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to MSAs should be raised to $6000 or $7000 dollars. If a consumer gets sick and experiences a cost of more that $6000 he should receive 100% (first dollar) coverage through the BBD group’s provided reinsurance policy. A reinsurance policy would cost the BBD Group less than $6000 a year.

The total insurance package to BBG Group employees should cost the BBD Group $12,000 rather than the present cost of $18,000.

BBD is a self insured association. The association has elimated the multiple middlemen in the present healthcare system.

 When a person with an MSA dies, the funds should be allowed to roll over tax-free to surviving family members.

This financial incentive should be included in My Ideal Medical Savings Account.

“The information that patients require to assess value must be made more transparent. 

2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”

A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.

At present healthcare prices are not transparent. Consumers are not motivated to shop prices. The BBD Groups leverage with its employees would force transparency.

“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”

 In this age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines. It would supply instant access to expertize at an affordable cost.

Everything possible should be done to encourage consumer responsibility and provider competition.

The present tax code does the opposite. Consumers in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.

The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.

The BBD Groups volume of consumers would have tremendous leverage with providers.

The younger and healthier the corporate employees are the lower the premiums.

The formation of associations with large memberships of all ages would lower the cost of healthcare. Large associations would have great leverage in negotiating price with providers. They would also spread the risk.

Self- insured associations such as the BBD Group would also spread the risk and lower the cost.

Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars the same as the corporate group plan policy holders.

These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.

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

 All Rights Reserved © 2006 – 2018 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

 

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The Plan To Empower Consumers Of Healthcare

 Stanley Feld M.D., FACP,MACE

The only way to empower consumers of healthcare is to allow them be responsible for their health and healthcare dollars.

The delivery of medical and surgical care has progressed markedly in the last sixty years. Life expectancy has also increased.

At the same time medical care has become unaffordable and the cost of healthcare has become unsustainable.

The incidence of obesity has risen every year. Over fifty percent of Americans are obese. The percentage is rising yearly.

Obesity begets many chronic diseases and subsequently the complications of these diseases.

Physicians can treat these complications fairly well but the treatment of these complications comes at a high cost.

How do you decrease obesity in America?

How do you get people to be responsible for their health and healthcare dollars?

One of the key elements in decreasing obesity is to give consumers financial incentives to use the healthcare system efficiently.

ObamaCare went in the wrong direction. Its regulations—including required “essential benefits”—raised prices on these plans and limited their availability.”

The only incentive Obamacare provided was the incentive to overuse the system. This was especially true for patients on Medicaid. They had zero premiums and deductibles.

A second tool for motivating patients to consider price is large liberalized health savings accounts. These tax-sheltered accounts are generally used to pay for the noncatastrophic expenses that form the bulk of medical care.

First, equip consumers to consider prices.”

 Critics always claim this is unrealistic: Are you supposed to shop around from the back of the ambulance?

 The critics use the ambulance excuse argument to eliminate the possibility of consumers using their own judgment to make price decisions.

But emergency care represents only 6% of health expenditures.”

“For privately insured adults under 65, almost 60% of spending is on elective outpatient care. “

The critics argument is that consumers do not know how to shop prices. Consumers are smarter than the critics think. It would be easy to teach consumers to shop prices.”

http://stanfeld.com/the-failure-of-the-republican-establishment-to-repeal-and-replace-obamacare/

“My ideal medical saving account provides that financial incentive to not overuse the healthcare system. The many articles about my ideal medical saving accounts are attached to this link.

Likewise, nearly 60% of Medicaid money goes to outpatient care.”

 Medicaid patients also overuse the healthcare system.

“ For the top 1% of spenders—a group responsible for more than a quarter of all health expenditures—a full 45% is outpatient.”

These patients can be identified as outliers and educational vehicles can be created to decrease this overuse of the system.

In my opinion Medical Savings Account are better than Health Savings Accounts. Medical Savings Accounts take the money out of the healthcare insurance company’s hands and delivers it to consumers.

Both HSA’s and MSAs have the unique advantage of providing and financial incentive to save.

When people have savings to protect in HSAs, the cost of care drops without harmful effects on health. 

 The financial incentive decreases the overuse of the healthcare system.

“ According to a 2012 study in Health Affairs if even half of Americans with employer-sponsored insurance enrolled in this kind of coverage, U.S. health expenditures would fall by an estimated $57 billion a year.”

My ideal Medical Savings Accounts provide an even a greater financial incentive and should decrease costs even further.

“ HSAs should be available to all Americans, including seniors on Medicare. Given that seniors use the most health care, motivating them to seek value is crucial to driving prices lower.”

Scott Atlas has publicized the obvious. This would apply to Medicaid recipient also. The details for Medicaid recipients can be found in my article “My Ideal Medical Savings Accounts Is Democratic. “

The maximum contribution to a MSAs should be raised to $6000 or $7000 dollars. If a consumer get sick and experiences a cost of $6000 he should receive 100% (first dollar) coverage through a reinsurance policy that would cost less than $6000.

There can be many variations on this theme for the consumers benefit.

 When a person with an HSA dies, the funds should be allowed to roll over tax-free to surviving family members.  

This financial incentive should be added to My ideal Medical Savings Account.

“The information that patients require to assess value must be made radically more visible. A 2014 study on magnetic resonance imaging showed that price-transparency programs reduced costs by 18.7%.”

A consumer driven system would force providers to compete for patients. Information on price could easily be provided to consumers by the government and the healthcare insurance industry.

“The most compelling motivation for doctors and hospitals to post rates would be knowing that they are competing for price-conscious patients empowered with control of their own money.”

 In his age of technology and rapid communication telemedicine should be promoted and paid for. One way to do it is to permit physicians to practice telemedicine across state lines.

It would supply instant access to expertize at an affordable cost.

Everything possible should be done to encourage consumer responsibility and provider competition.

The present tax code does the opposite. Consumers’ in-group plans provided by large and small corporations receive their healthcare insurance from the corporation with tax-free dollars.

The larger the corporation the more leverage the corporation has for negotiating the premiums with the healthcare insurance companies.

The younger and healthier the corporate employees are the lower the premiums.

This is where the formation of associations with larger memberships of all ages fits in to lowering the price of healthcare. Large associations would have great leverage in negotiating price with insurance companies. They would also spread the risk.

If financial incentive with my ideal medical saving account was added to the price the association negotiated and the consumer paid for the premium, usage would fall and the cost of insurance would decrease.

Tax deductibility must be given to these “individual” insurance policy holders and association policy holders so they are, in reality, paying for healthcare insurance with pre-tax dollars as the corporate group plan policy holders.

These simple changes in the law would result in an affordable healthcare system that was market driven by consumers. The changes would force providers and the healthcare insurance industry to become competitive.

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

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

Please have a friend subscribe

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Describing Fake News

Stanley Feld M.D.,FACP,MACE

The front-page headline in the Sunday New York Times on August 26 read;

“Health Insurers Start To Prosper.

The subtitle was; Trump’s Warnings on Affordable Care Act Masks Upside.”

 “Supporters of the Affordable Care Act achieved a major victory this past week when, thanks to cajoling and arm-twisting by state regulators, the last “bare” county in America — in rural Ohio — found an insurer willing to sell health coverage through the law’s marketplace there.”

“So despite earlier indications that insurance companies would stop offering coverage under the law in large parts of the country, insurers have now agreed to sell policies everywhere.”

 A casual Sunday Times reader would respond to this headline and initial paragraph by thinking that President Trump is frightening the public about Obamacare’s failures.

The casual reader would conclude this is just another one of President Trump lies. Obamacare is not failing. He is just trying to scare the public.

The New York Times is telling the public that the insurance industry is going to offer insurance through Obamacare in every county in the country.

The American people cannot trust President Donald Trump.

The causal reader got the message. Obamacare is doing fine. It is not necessary to continue reading the article.

The online Sunday NY Times headline of the dame article was different than the headline that appeared in print.

Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers”

This headline is also misleading. One insurer in a bare county signed up. This does not represent a upside gain or create a competitive market place.

“The Centers for Medicare and Medicaid Services (CMS) reported that 1,476 counties, over 45 percent of counties nationwide, will only have one health insurer on the Obamacare exchanges next year.”

This article is an example of “fake news.” It is totally misleading to the casual reader

Why a single insurance company will sell insurance in that bare county in Ohio is not explained. All the other insurance companies have pulled out of that county.

If the reader got this far into the story he could still be satisfied that Obamacare was not imploding.

However, the article goes on to explain the potential failure of Obamacare.

“But a moment of truth still looms for the industry in the coming weeks under the law known as Obamacare.”

“Companies must set their final plans and premiums by late September, even as the Trump administration continues to threaten to cut off billions of dollars in government subsidies promised by the legislation.”

This is more fake news aimed at blaming Donald Trump for Obamacare’s failure.

The NYT ignores the fact that President Obama promised the healthcare insurance industry the reinsurance subsidy in order to get them to participate in Obamacare in the first place.

President Obama paid the healthcare insurance industry only 12% of what the insurance companies claimed President Obama promised them in their reinsurance package.

President Obama promised the healthcare insurance industry a subsidy through the government backed reinsurance package, if there were cost overruns in Obamacare.

The costs overruns were massive according to the healthcare insurance industry. The legislator only budgeted 12% of that claimed by the healthcare insurance industry.

President Obama could not find the money to pay the remaining 88%.

The industry continues to demand the remaining 88% promised in order to participate in this year’s (2018) Obamacare health insurance exchanges.

All twenty-two of the state run insurance administrative companies that received loans from the federal government have gone bankrupt and have not paid the insurance industry.

Those federal loans will never be paid back to taxpayers.

The Democrats and the mainstream media are trying to blame President Trump for this deficiency in payment and the lack of insurance company participation.

The shortfalls resulted in healthcare insurance premium raises for both the Obamacare health insurance exchanges and the premiums for private group insurance.

Subsequently, most of the healthcare insurance companies have dropped out of providing the insurance through the Obamacare health insurance exchanges.

A third piece of fake news is the success of providing insurance for twenty million enrollees.

The NYT article ignores the fact that Obamacare through the health insurance exchanges only enrollee nine million people in the individual market. Fourteen million lost individual coverage lost their insurance at the onset of Obamacare.

The 22 million additionally insured includes the additional thirteen million were added to the Medicaid roles. Some of those thirteen million are illegal immigrants.

Soon a portion of the financial burden of the Medicaid increase will be dumped on the states.

The Obamacare law requires comprehensive insurance coverage packages for both the individual market and the group markets driving the price of coverage up.

These increases make Obamacare unaffordable. Obamacare is not successful as implied in the New York Times article.

President Trump did not do anything to distort the Obamacare coverage. President Obama did it with his tremendous cost overruns.

It is possible President Obama wanted to prove that an insurance-based healthcare system couldn’t work. It would have to be replaced with a government controlled single payer system.

It is the reason he wanted to include the “Public Option.”

However he placed so many regulations in the way of any possible success.

President Obama believes that the only system that would work is a single party payer system with the government being in control of the money, the coverage and the freedom to choose by the public.

President Obama had no concern for the government inefficiency or cost to the government.

There was no consideration for a more cost efficient and affordable healthcare system.

“The fate of the landmark law, Obamacare, depends in large part on the health of the insurance marketplaces and the ability of insurers to make a viable business out of selling coverage to individuals.”

Healthcare insurers have tried to make a viable business plan out of Obamacare. When the law passed seven years ago, insurers saw a potential bonanza: tens of millions of brand-new paying customers, many backed by generous government subsidies and required by the new law to have health coverage.

The burdensome regulations, lack of coverage flexibility and one size fits all coverage all have cause people not to sign up for Obamacare. They would rather pay the penalty even though they can ill afford it.

On Thursday, Northwell Health, the largest hospital system in New York State, announced that it would shut down its insurance unit, CareConnect, which had been selling coverage in the state marketplace. The move forces tens of thousands of its customers to find another plan for 2018. Northwell’s chief executive put much of the blame on Washington.

As we get closer to enrolling participants in Obamacare for 2018 and the insurance industry’s publishing their premiums more insurance companies are dropping out of participating in the health insurance exchanges.

Most of the startup insurance companies and state sponsored have closed down their business.

The article quoted is fake news.

The article starts off giving the casual reader the impression that Obamacare’s insurance coverage is doing fine.

The reality is It is not fine. Americans have to worry about it. Affordable healthcare insurance will not be available at an affordable price.

The Democrats are happy because then the country will be offered a single party payer system.

The problem is that the federal government cannot afford a single party payer system. At this moment Medicare and Medicaid are not sustainable. A single party payer system will be inefficient and unsustainable.

I don’t know how Mitch McConnell can to say most of the news is not fake news.

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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Senate Republicans Are Making Repeal and Replace Harder Than It Should Be

 Stanley Feld M.D.,FACP,MACE

I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.

It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.

Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.

People like entitlements because they are free. Someone else is paying for them.

Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.

“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.

Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”

The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.

The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.

Congress needs the healthcare insurance industry’s ability to provide administrative services whether it is for Medicare, Medicaid, health insurance exchange coverage (Obamacare) or private insurance.

The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.

President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..

Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.

The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.

Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.

Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.

It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.

They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.

Canada’s health-care wait times costing patients many millions in lost time, wages”

Ontarians wait longer for health care than citizens of other universal health-care countries”

The fact is single party payer systems do not work for all the stakeholders.Both Democrats and Republicans are missing the essential point about what would work to provide an affordable healthcare system that aligns the incentives of all stakeholders.An essential element is to develop a system that encourages consumers of healthcare to be responsible for their health and have control over their healthcare dollars.

The Senate’s present revision does not consider this. The Senate is considering the needs of the healthcare insurance industry and not the needs of consumers.

The Senate should be considering the following in order to repeal and replace Obamacare.

  1. My Ideal Medical Savings Account should be instituted immediately. It will provide financial incentives for consumers as well and incentives to maintain health.

Self-management of chronic disease is essential for a healthcare system to become affordable. My Ideal Medical Saving Account provides that financial incentive.

1. The Ideal Medical Saving Account will provide instant adjudication of medical care claims.

  1. The ideal Medical Savings Accounts will encourage patient responsibility for their health, the care of their disease and their healthcare dollars.
  2. The Republican Party should establish an organized system of disease management education for persons with chronic disease. The education system should be designed to be an extension of physicians’ care. It should not be a free-standing education system. Physicians should be provided with incentives to set up these educational systems.

http://stanfeld.com/chronic-disease-management-and-education-as-an-extension-of-physicians-care/

  1. A system of social networking with physicians and their patients should be developed. The government could provide the template for physicians and their team.

http://stanfeld.com/social-networks-patient-education-and-the-healthcare-system/

The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.

  1. Social networking between physicians should also be developed.
  2. Integrated care systems with generalists to specialists must be developed for both treatment and cost transparency for the physicians and patients.
  1. There must be instant communication between physicians and patient via an effective electronic medical record. The EMR must be a teaching tool for physicians. It must not be a tool to judge physicians’ care and penalize them. The EMR should be cloud based. Maintenance and upgrades should be free and seamless. Physicians should be charged by the click.

http://stanfeld.com/?s=EMRs

  1. Tort Reform is an essential element in a healthcare system that would work and be affordable. It would decrease the cost of over testing. It would also decrease the cost of malpractice insurance and legal fees. These cost are built into the cost of care. The cost of care would be reduced significantly. http://stanfeld.com/?s=tort+reform

The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.

Align patient 1

Align government

Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.

The house bill to repeal and replace Obamacare touches on some alignment.

The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.

The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.

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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The Republican Health Care Con By THE NYTimes EDITORIAL BOARD JAN. 21, 2017

Stanley Feld M.D., FACP, MACE

The New York Times editorial “The Republican Healthcare Con” should really be entitled “The New York Times Con of The Republican Health Care Con”

In my opinion The New York Times has become a biased newspaper. Instead of publishing “all the news fit to print”, it is printing articles and editorials that are biased opinions with incomplete facts.

The Republicans have not introduced their replacement of Obamacare yet this editorial is critiquing the replacements effect on the healthcare system..

Everyone is entitled to his or her own opinion. No one is entitled to his or her made up facts.

Republicans say the Affordable Care Act provides health insurance that manages to be both lousy and expensive.”

This is true. Most of the population seems to agree with this statement.

The only people buying insurance from the health insurance exchanges are people with pre-existing illnesses. These people have no other insurance available.

“Whatever the flaws of these policies (Obamacare), the new Trump administration is trying to pull off a con by offering Americans coverage that is likely to be so much worse that it would barely deserve the name insurance.

It would also leave many millions without the medical care they need.”

How does the New York Times editorial board know this when the Trump administration’s healthcare plan has not been introduced?

The liberal media keeps saying the Republicans have no plan. If Republicans do not have a plan how can the NYT criticize it?

How can a non-existent healthcare plan leave many millions without the medical care they need”?

There is no evidence for the statement above.

This reality became increasingly clear when President Trump’s choice to run the Department of Health and Human Services, Tom Price, testified before a Senate committee last week.

He looked pained as he described the terrible predicament of people who earned around $30,000 to $50,000 a year and had to deny “themselves the kind of care that they need” because they had Obamacare policies with deductibles of $6,000 to $12,000.

Tom Price M.D. is correct in saying the Obamacare deductibles are $6,000-$12,000. The NYT left out that the Obamacare networks available are restrictive and the access to proper healthcare is difficult.

The NYT editorial board also left out the fact that 85% of people buying healthcare insurance from the health insurance exchanges are subsidized by the government and have a pre-existing illness.

“ Yet, earlier in the same hearing, Mr. Price extolled the virtues of policies that would be woefully inadequate — policies that cover medical treatment only in catastrophic cases.”

This is a misrepresentation of Dr. Price’s testimony.

Perhaps the NYT editorial Board does not understand Health Savings Accounts?

If you want to understand a potential Trump administration proposal read my blog “Medical Savings Accounts Are Democratic.”

Dr. Price was talking about the virtues of health saving accounts without being specific.

The goal of health savings accounts are to put consumers in control of their medical care and healthcare dollars while providing them with financial incentives to save retirement dollars and not waste medical care dollars.

Consumers could have control of what they spend for their own healthcare.

The employer or government would pay for the deductible and the reinsurance above the deductible.

The money would be put in a healthcare trust. The money in the trust would pay for medical care.

If consumers did not spend the money on medical care that year, it would go into a personal saving trust for those consumers retirement.

“ Such policies often have deductibles of around $14,000 for family coverage.”

FALSE! One can get excellent coverage with a $6,000 deductible and first dollar coverage after spending $6,000 at a reasonable price.

Health Savings Accounts are the fastest growing healthcare insurance vehicle.

The government has put so many restrictions on health savings account that employees are hesitant to offer it. The government must remove these restrictions. www.unitedheath.com

“ This is simple hypocrisy. Condemn the policy you don’t like, propose something far worse as a replacement and claim that it is much better”

This paragraph is written to condemn Dr. Price and rile up the anti-Trump forces with false information.

The editorial completely disregards the fact that a proposal has not yet been announced by the Trump administration.

There were 2000 plus pages published about President Obama’s Obamacare proposal. There were glaring defects in he proposal.

The NYT did not comment on these defects at the time. Others did. I turned out that the defects were the source of Obamacare’s failure.

In reality the NYT has no idea of what the Trump administration’s proposal will be.

The NYT editorial also ignores the fact that Obamacare is unsustainable, unaffordable and is restricting access to care while rationing care for the very citizens that need the care.

“Mr. Price and Mr. Trump have recently said that their goal is to offer health care to many more people than are covered by the current health care law, which has driven the uninsured rate to historic lows.”

I believe historic lows are a counting error just as the unemployment rate and the inflation rate are counting errors in order to provide the Obama administration acceptable numbers.

Average people know exactly what is happening.

Mr. Price’s testimony and the legislation he introduced in the House (a few years ago), where until recently he was the Budget Committee chairman, show that the new administration will make decent health care less affordable and less accessible for most people.

The underlined portion is a NYT editorial opinion. It is an opinion without facts or evidence. It could also be a lack of understanding of the bill Dr. Price’s introduced.

The Trump administration’s upcoming proposal might be completely different.

How would the NYT know the Trump administration’s healthcare plan would make decent health care less affordable and less accessible for most people?

This is an unsubstantiated bias that would qualify as fake news.

“Those Health Savings Accounts would not help families earning the median household income of $56,000 a year because these families would never be able to sock away enough money.”

The NYT editorial either missed the concept of Health Savings Account totally or is reporting the concept to fit its bias.

The best description of what Mr. Price stands for can be found in a bill he introduced in 2015, the Empowering Patients First Act. It would “empower” Americans by eliminating the health care law’s expansion of Medicaid that has helped more than 10.7 million newly eligible people enroll in that government-run insurance program.

Many of these Medicaid patients cannot find a physician or hospital that accepts Medicaid.

Therefore they have very limited access to care.

A potential proposal could expand Medicaid patients’ access to care using health savings accounts.

It would also drastically cut subsidies that have helped 11.5 million people purchase private insurance on federal and state health exchanges.

There is no evidence for this wild statement.

Under his bill, people buying insurance for themselves would get between $1,200 and $3,000 a year in subsidies, down from an average of $4,600 that people get now on HealthCare.gov.

The amount of tax benefits or tax credits for Health Savings Accounts have been restricted by Obamacare in order to discourage its use.

The Obama administration wanted to control medical care and eliminate consumer choice and power.

President Obama wanted healthcare decisions to be in the hands of the central government.

The Trump administration plans to modify these restrictions. President Trump has stated he wants to put healthcare decision making back into consumers’ hands and not the government’s hands.

The bill would even get rid of the requirement that allows young people to stay on their parents’ insurance policy until age 26, a provision that is widely popular.

This is totally false and once again fake news.

And it would hurt people who get insurance through their employers by setting a cap on how much of that expense businesses can claim as a deduction on their taxes. Experts say that over time this would encourage companies to stop offering health benefits to workers.

The independent insurance market has not had tax deduction. It should be on a level playing field with group insurance. There is no evidence that the group market will lose its tax deduction.

“When it comes to health care, Mr. Price and other Republicans say their goal is to give people more choices. It is hard to argue against choice. But in the ideological world inhabited by Mr. Price, House Speaker Paul Ryan and many other Republicans, choice is often a euphemism for scrapping sensible regulations that protect people.”

This claim also has no basis in fact. It is pure opinion by the NYT editorial board.

“Some Americans might well be tempted by this far-right approach. They would have to pay less up front for these skeletal policies than they do now for comprehensive coverage.”

Has Obamacare provided comprehensive care? It is unaffordable and inaccessible to all.

But over time, when people need health care to recover from accidents, treat diabetes, have a baby or battle addiction, they will be hit by overwhelming bills.

Where did this come from? It came from a negative bias toward Donald Trump and his administration without facts or evidence.

The Trump administration seems perfectly willing to sell those people down the river with false promises.

People are not stupid. They do not need government to rule their life and make healthcare decisions for them.

People need incentive to control their health and healthcare dollars.

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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Defective Thinking About Single Party Payer Systems

Stanley Feld M.D.,FACP, MACE

Sowell

 

In a government controlled single payer health care system the government provides the healthcare coverage for all. The government pays providers for various services at a cost determined by the government.

Advocates of a single party payer system in the United States have publicized that Canada, Britain and the European Countries have successful single party payer systems.

These declarations are untrue.

The definition of success is variable, problematical and questionable. It is successful in the fact that healthcare coverage is universal.

It is problematical in the sense that access to care is difficult. The rationing of medical care has inevitable because of the escalation of costs.

It is questionable as to whether these countries can afford to cover everyone. The National Healthcare System in Britain is falling apart rapidly. Hospitals are closing because of lack of funding. Patients’ waiting lines are increasing, access to care and rationing of care is increasing.

Britain has a robust private healthcare insurance industry for those who can afford to pay. The National Healthcare Systems costs are unsustainable.

In Britain the private healthcare insurance industry is thriving.

In Canada the healthcare system is absorbing 50% of Canada’s GDP.

Canada’s unsustainable healthcare system has resulted in government rationing of care as well as long waiting lines for patients to receive even rudimentary care much less hip or knee replacement.

The United States has three single party healthcare systems: the VA healthcare system, Medicaid and Medicare.

The VA Healthcare System is a treatment and financial disaster. It has evolved into a bureaucratic monster. Employees who do not perform cannot be fired according to government rules. Too many employees have been hired to try to get the job done. The infrastructure is administratively bloated.

The second reason for the VA Healthcare System’s problems is there is no intellectual or financial incentive to do a responsible and better job on the part of employees.

The culture of the VA System is that of a typical government bureaucracy. The federal government throwing more money at the VA System, to help our veterans receive better care, has not improved the system.

Patients are not satisfied with Medicaid because there is limited assess to care. Physicians do not accept Medicaid patients because reimbursement is too low. Medicaid provides an opportunity for the indigent to receive medical care. However the ability to get medical care is limited.

Seniors are satisfied with the care available through Medicare. However, as reimbursement is decreasing and the delivery of care is becoming more bureaucratic, physicians are leaving the Medicare system and demanding cash from seniors for medical care.

There is also an increase in concierge medicine for seniors.

Drugs are increasing in price. Seniors cannot afford their medication. Medicare Part D coverage (Drug Medicare) has become too expensive to afford.

The result is patients are becoming sicker because they cannot afford the prescribed medications. Then they end up in the hospital. The result is an increased cost to the Medicare System. Since deductibles and co-pay are increasing seniors are being bankrupt by the Medicare system.

The advocates of a single party system ignore basic inefficiencies inherent in government controlled bureaucratic systems.

These bureaucratic systems are inefficient and ineffective. They become unsustainable in all the single party payer systems in existence.

The deception sold to the public by progressive politicians is the advantage that medical care is free to all. The simple concept that nothing is free is ignored.

A system must replace these failed systems that provides incentives to consumers for consumers to drive the system.

Below are the claimed advantages to a single party payer system. I have noted the deception in each claim.

  1. Healthcare Coverage is Universal

Everyone has health care coverage to the full extent that his or her health needs require.

People with pre-existing illness cannot be refused medical treatment.”

This should be the goal of any healthcare system.

The problems with healthcare systems in which consumers are entitled almost always get abused. The healthcare system has to be developed where people are responsible for their health and healthcare dollars.

  1. Decrease Amount of Necessary Paperwork

That a single party payer system will “decrease the amount of necessary paperwork” is a fictitious advantage. It will increase the amount of paperwork as has been proven over and over again.

The goal of any government run healthcare system is to measure what the healthcare system is doing so that the government can determine the quality of care delivered on the basis of the information provided. The fact that the information provided could be fudged is immaterial to the documentation.

The delivery of medical care is complex. It is almost impossible to commoditize. In an effort to measure quality of care there are increased regulations and documentation requirements.

The more complex an illness is the more paperwork will be needed to enable evaluation of the quality of care.

The result will be there will be less time, not more time, for the medical staff to spend providing care for the patient.

The belief of single party payer advocates is “providers will have more time to spend with patients.”

Additionally because medical care is free the entitled inevitably overuse the healthcare system making it even less efficient.
“Advocates believe the costs of single payer health care systems will be lower.”

  1. Lower Costs

Progressives think the reasons for “the lower costs is there isn’t any competition, a not for profit structure, and a reduced number of administrative staff.”

“ The high salaries for administrators and sales people are eliminated in a single payer system.”

The costs of government run systems are never lower. The costs to patients are lower because it is free. The costs to the healthcare system are higher because there is no incentive to be competitive.

The government will have to outsource the administrative services to the healthcare industry. The healthcare industry will make the money even as they do now.

Obamacare’s administrative costs were supposed to be lower. The administration is in panic mode because of its high costs and impending failure.

A small part of the failure is the result of healthcare insurance companies non-participation in the health insurance exchanges and the failure of government set up Co-Op Insurance funds.

President Obama paid only 12% of what the healthcare insurance companies claim they are owed to cover their loses through the crazy reinsurance program the government promised the healthcare insurance industry.

President Obama, through the Justice Department is going to raid the Treasury’s Judgment Fund” to pay the insurance industry what they were promised in the reinsurance program.

It is essential for the survival of Obamacare that the healthcare insurance industries participate in Obamacare’s health insurance exchanges. Justice and the Treasury are ignoring the appropriation power of the congress.

This happens to be against the law.

In a 1998 letter the Government Accountability office pointed out that the Judgment Fund “is not a tool to circumvent congressional restrictions on appropriations.”

This is precisely what President Obama is doing.

The Administration will do anything to rescue its flailing Affordable Care Act, and nothing so meager as the law will interfere. This damage to the separation of powers, not a health-care bill, will be President Obama’s abiding legacy.”

The problem is congress will letter President Obama get away with doing this.

  1. No Insurance Companies Needed

The notion that the healthcare insurance industry is not needed for administrative services is a deception that progressive politicians continue to state falsely.

  1. Only One Buyer Required

“Only one buyer (the government) is required” is partially true and false. In the military the cost of drugs are cheaper than either the cost of drugs for government employees with Medicare Part C or seniors with Medicare Part D. The government is restricted from negotiating prices for drugs. The middlemen infrastructure for purchasing drug will remain.

I believe Americans are becoming more and more cynical about big government’s intentions and efficiencies. They want a change for good reason.

The following the ideas of progressives is not working. It is destroying the healthcare system.

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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