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Obamacare’s Games For Stakeholders And The Unintended Consequences

July 21, 2013
inConsumer Driven Health Care, Medicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP,MACP

I can’t help remembering
Nancy Pelosi’s famous statement, “We have to pass the bill to find out what is
in it.”


  

http://youtu.be/lAt54NKsRRk

The public didn’t like
Obamacare to begin with.

Each day “we are finding out what is in it.”

Each day it gets worse
despite the fact the President Obama keeps saying Obamacare is great and will save us
money. Americans do not believe him.

If you are a big
government control advocate, the ideology of Obamacare could be applauded.

Practically, Obamacare is
naïve and an impending “train wreck.”
Unintended consequences keep appearing because of defects in the theory and poor
design.

Patients, the healthcare
care insurance industry, physicians, hospital systems, and drug companies could
have predicated these unintended consequence if they knew what was it the bill
at its passage. Those who did understand the Accountable Care Act (Obamacare)
hated the act at its passage.

Many of my progressive
friends blame the problems Obamacare is having on Republicans.

I think they are getting
that idea because the New York Times and its editorial op-ed writers that are making
that claim. However, the New York Times offers no concrete proof.

Obamacare is failing on it
own. Its implementation gets harder and more expensive each day.

The unions were President
Obama biggest ally. All of a sudden Obamacare’s unintended consequences has
angered the unions. The unions realize what Obamacare is doing to them.


On July 12, James Hoffa of the Teamsters (1.4
million members), Joseph Hansen of the Food and Commercial Workers (1.3 million
members) and D. Taylor of UNITE-HERE (200,000 members, mostly culinary and
hotel workers) wrote to complain about the president's Affordable Care Act.

Obamacare is destroying
the 40-hour workweek unions worked many years to achieve.  Employers are hiring part time employees to replace full
time employees that had been laid off because of the recession.

Employers are doing this
to avoid a $2,000 penalty for not providing healthcare insurance for each employee.
 

The majority of the job
growth figure of 195,000 for June consisted of part time job growth.

Union
leaders are correct. Obamacare "creates
an incentive to keep employees’ work hours below 30
hours a week."

After
all, employers can avoid a $2,000-per-worker penalty if they don't provide mandated insurance as long as employees
work fewer than 30 hours a week.

" Union leaders have realized—too late—that
ObamaCare will affect the livelihood of millions of workers who wait tables,
wash dishes, clean hotels, man registers, stock shelves and perform other tasks
that can be limited to shifts of less than 30 hours a week."

White
house Press Secretary Jay Carney said it "is
belied by the facts."

Once
again he was lying. He used 2010 Bureau of Labor Statistics numbers to answer
the complaint.

“So far
this year, as ObamaCare is being implemented, full-time employment has grown at
an average monthly rate of 21,700 while part-time employment has increased an average
of 93,000 a month.”


These
are terrible numbers that belie Jay Carney’s “facts.”

 Three big unions
worry that the health law will hurt their members' benefits and paychecks.

The letter to Nancy
Pelosi and Harry Reid was unusually harsh.

The letter was not from
Mr. Obama's GOP adversaries but from the president’s allies, the big three most
powerful unions. A fourth union joined the group a few days later.

The unions finally
realized that Obamacare was going to cut unions out of some government
subsidies. Obamacare makes a unionized workforce more expensive for employers.  It makes it less attractive for workers to
join unions.

"Millions of union workers, the
letter notes, are covered by nonprofit health plans jointly administered by
employers and unions, and won't qualify for ObamaCare's generous taxpayer
subsidies."

This will drive union
members out of their unions.

Further, the unions
nonprofit insurance plans are subject to "Obamacare’s new 2-3% tax on each
insurance policy they place."

The union wants their members
exempt from this tax because the union will be forced to pass it on to their
members. Members will be forced to use the health insurance exchanges to buy
their healthcare insurance.

Unions are starting to
realize the goal of Obamacare is to force everyone into his “Public Option”
that will default to a single party payer. The result will be complete
government control of the healthcare system.

There are three insurance
options in the health insurance exchanges. Citizens will buy the cheapest
“affordable option.”  The deductibles
will be high. Citizens will have to pay deductibles out of pocket decreasing
their purchasing power.

Republicans are enjoying
this meltdown. They want Obamacare
repealed.

“House Republicans say their goal is to repeal President Obama's
health care law, not to present an alternative plan.”


This is a big mistake on
the part of the Republicans. Republicans do not have a viable substitute to
repair the dysfunctional healthcare system.

"Every voter knows what Republicans are against. They don't
know what they're for" on health care, said Rep. Steve Israel of New York,
who heads House Democrats' campaign committee.”


 “He said the strategy would haunt Republicans next year among
moderate and independent voters who want changes, not outright repeal.”

Republicans need an
innovative alternative to Obamacare that will work and excite the public.  They need a plan that will put consumers in
charge of their health and healthcare dollar. Consumers do not want a healthcare
system that puts the government in charge of their health.

Consumer driven
healthcare with my democratic ideal medical savings account should be adopted
by the Republican Party to replace Obamacare.

Republicans must take a
stand and help Americans avoid Obamacare’s impending disaster to our economy,
job growth and financial viability. 

Republicans must show Americans
that they care about them and have a viable solution to our healthcare systems problems.

Otherwise as President
Obama said this week, “he will blow right
through it” as he
has done in the past.

 Now that Americans are waking up it is time
for the Republican leadership to start waking up and fight back effectively.

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

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Free Market Price Transparency and Price Competition

July 17, 2013
inConsumer Driven Health Care, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

Physicians can take a leadership role in creating price transparency
leading to price competition.

An excellent example is the Surgery Center of Oklahoma.

Dr. Keith Smith and Dr.
Steven Lantier launched the Surgery Center of Oklahoma 15 years ago. I wrote
about the Center’s guaranteed online all-inclusive surgery prices six months
ago.

There are several innovative physician driven market driven pricing systems in the nation.

The Surery Center's price transparency is
catching on. It is leading to price competition, which in turn is leading to
reduced healthcare costs.

The Surgery Center of
Oklahoma’s online pricing is disrupting the lack of price transparency in their
local area.


“What we’ve discovered is health care really doesn’t cost that
much,” Dr. Smith said. “What people are being charged for is another matter
altogether.”

Consumers
are paying a high premium for buying healthcare insurance. The healthcare
industry takes at least 40% off the top of healthcare premiums.

Hospital
Systems inflate their prices for many reasons. Some insurance companies pay
more than others for hospital systems’ services. Hospital systems do not know
what the consumer’s insurance would pay when consumers come into the hospital
so they register the highest prices on the consumer’s bill.  

Hospital
systems try to charge as much as they can to collect as much as possible. The
pricing is not based on reality.

Surgery Center of Oklahoma started posting their prices online
about four years ago.

Click here to see the online prices at Surgery Center of Oklahoma.

“When we first started we
thought we were about half the price of the hospitals,” Dr. Lantier remembers.
“Then we found out we’re less than half price.

 Then we find out we’re a
sixth to an eighth of what their prices are. I can’t believe the average person
can afford health care at these prices.”

It is important to note that most physicians do not know what
hospital charges are.

The Surgery Center of Oklahoma has stated that they were founded on the simple principle of
price honesty and transparency. The Surgery Center of Oklahoma’s return on
investment and net profit is extremely healthy at the prices it charges.

The prices for procedures are
all-inclusive quotes and are guaranteed.

 The result was to start a local price war.
The Surgery Center of Oklahoma is disruptive to the hospital pricing in its
community. This disruptive pricing is spreading across the nation. Consumers from
all over have come to the Surgery Center of Oklahoma because the price is
transparent and reasonable compared to hospital systems in their local area. One
specific example is.

“Matthew Gang, 22, tore his patella tendon, dislocating his
knee-cap playing basketball earlier this year.”

Mr. Gang is uninsured. He lives in California.
Surgery in his California community was going to cost him about $30,000.

The Surgery Center of Oklahoma Internet
price was $5,700.

 Matthew and his father Tom Gang flew from
California to Oklahoma for surgery.

“It was well worth it,” Tom Gang said. “I need a rotator cuff
surgery right now. I’m thinking about flying out there and having my surgery
because it was such a positive experience for us.”

Other Oklahoma medical and surgical
facilities have started joining Surgery Center of Oklahoma in posting prices
and becoming price transparent. Hospital systems are realizing they will have
to compete with low price transparent prices to attract patients.

Surgery Center of Oklahoma does accept
private insurance, but the Center does not accept Medicaid or Medicare.

 “Dr. Smith said federal Medicare regulations would not allow for
their online price menu.

 “They have avoided government regulation and control in that area
by choosing not to accept Medicaid or Medicare payments”.

In
order to circumvent the Medicare guidelines the Kempton Group’s website, a
third party administrator, posts prices for other providers in the area.



The difference in billed prices are
staggering between Mercy Hospital in OKC, Intergris Baptist Medical Center and
OU Medical Center vs. Surgery Center of Oklahoma. The prices are,

 .

  • Mercy Hospital charged $16, 244 for a breast biopsy; the procedure
    will cost $3,500 at Surgery Center of Oklahoma.
  • OU Medical Center billed $20,456 for the open repair of a
    fracture; the procedure will cost $4,855 at Surgery Center of Oklahoma.
  • OU Medical Center billed $21,556 for a gall bladder removal
    surgery; the procedure will cost $5,865 at Surgery Center of Oklahoma.
  • OU Medical Center billed $23,934 for an ankle arthroscopy; the
    procedure will cost $3,740 at Surgery Center of Oklahoma.
  • Integris Baptist billed $37,174 for a hysterectomy; the surgery
    costs $8,000 at Surgery Center of Oklahoma.

However, prices may be dropping elsewhere because of the
transparency at Surgery Center of Oklahoma.”

I
am writing about the Surgery Center of Oklahoma for the second time for two
reasons.

Rather
than crying about the issue of the lack of price transparency as Dr. Uwe
Reinhardt did in my last post, someone is actually doing something about it. It
is causing hospital systems and large clinics to lower prices and make them
transparent.
 

“Second, the government should not be in the
way.  President Obama has provided some
non-transparent favors to hospital systems that are forcing physicians to be
employed by hospitals. 

"A new
provision buried in Obamacare effectively prohibits doctors from
starting their own hospitals or expanding the hospitals they already own, which
has been widely interpreted as a give-away to the American Hospital
Association."

As patients are starting to demand price
matching, some hospitals are giving in.

 “Hospitals are having to match our prices because patients are
printing their prices and holding that in one hand and holding a ticket to
Oklahoma City in the other hand and asking that hospital to step up,” Dr. Smith
said. “So we’re actually causing a deflationary effect on pricing all over the
United States.”

The economics are simple even though
hospital systems deny it. One only has to recall the multiple million dollar
salaries of hospital CEOs as well as other hospital administrator salaries to
understand the hospital systems’ desires for less transparency.

Physicians are waking up and realizing
they are not the main cause of escalating costs. The Surgery Center of Oklahoma
is a wonderful example of a price transparent organization that is doing
something to force price competition.

It is clear. The government is not going
to create price transparency.

Physicians and patients must drive the adoption of a free market
place.

Consumers must drive price transparency.

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The Lack Of Price Transparency

July 14, 2013
inConsumer Driven Health Care, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D., FACP, MACE.

I believe the New York Times is doing a great disservice to the American
public in its biased promotion of the virtues of Obamacare. The intellectuals
of our society read the Times and never question this bias. In fact the Times
publishes letters from these intellectuals that confirm its biased statements.  The more letters that come in the more they
are published. Before anyone knows it the bias becomes the truth.

On July 8 2013 the NYT published an article entitled “What Does Birth Cost? Hard to Tell”

The article's opening
paragraph reveals its bias.

“We’re
continually told that when it comes to health care, we need to be savvy and
shop around for the best prices. To that end, policy experts and politicians
promote health care savings accounts, saying they make “health care consumers”
(a k a patients) more conscious of prices, bringing down the cost of medical
care.”

It goes through this woeful story of how an uninsured
pregnant woman tries to find a best price for her delivery from hospitals in
her community.

“Here is what happened to my daughter, Therese Allison, when she
tried to be just the sort of shrewd and informed patient that politicians
should love.”

At this point I realized the article was another New York
Times propaganda article implying the potential virtues of Obamacare. President
Obama and the Democrats have mandated that patients like this buy healthcare
insurance from health insurance exchanges. They want patients to be dependent
on the government and not give patients the choice to make their own independent
choices.

The healthcare system’s dice are loaded against this woman’s
independent free choice.

“ Pregnancy is a pre-existing
condition, so she can’t get health insurance at any price. And
now that the birth of her baby is imminent, she wants to find out what a
delivery will cost, maybe even negotiate a price for this expensive procedure.”

Therese’s  midwife offered to call the two hospitals the midwife
uses. She wanted pricing for an uncomplicated normal vaginal delivery without
an epidural. Therese’s plan was to leave the hospital the next day.

One hospital gave her a conditional price estimate. The other
didn’t. The second told her to apply for Medicaid. She thought there should be
a law making hospital systems reveal their prices.

 Uwe Reinhardt, a
Princeton health care economist who is a frequent contributor to The New York
Times said hospitals do not have to their reveal prices.

“He said. Hospitals do not have to tell you their prices, and
often they keep them secret until they send the bill.”

“When I was chair of the New Jersey commission on hospitals two
years ago, my wife, at my behest, tried to get a price for a normal delivery
from the Princeton Medical Center,” Dr. Reinhardt said. “She pretended to be an
uninsured entrepreneur earning $80,000 a year. She got nowhere. I then called
to try out a colonoscopy. I got nowhere too.”

Dr. Reinhardt is a big fan of Obamacare. His implication is the
Obama administration is going to fix the non-transparency barrier.

Dr. Reinhardt said, “The situation is all so
pathetic.”

The problem is he does not
offer a solution to fix the problem.

The Obama administration has tried to break the price
transparency barrier by publishing Medicare and Medicaid prices. The effort is
confusing, insufficient and incomplete.

Medicare and Medicaid reimbursements have been published in some
states in the past. Private insurance reimbursements to hospital systems have
been published for some diseases but it has been incomplete and
incomprehensible. 

These reimbursement figures have been difficult to find on the
Internet. Additionally the prices have nothing to do with private healthcare insurance
contract prices of private insurance co-pay.

The Obama administration just had Medicare publish a giant spreadsheet with its payments for
the 100 most popular hospital procedures and treatments in 3,000 hospitals
across the country using claims data.

The moment the ICM-10 coding system is mandatory the number of diagnostic
codes will increase from 18,000 to 68,000. ICM-10 coding will decrease consumers’
ability to understand reimbursement and co-pays.

Pregnancy is not on the Medicare spreadsheet list along with
many other common procedures. The claims data is not connected to private
insurance payments and co-pays. As I have pointed out in the past, claims data
is notoriously inaccurate.

What is needed is a smartphone app listing prices for consumers
by zip code similar to Travelocity and Kayak for airline tickets and hotels. Consumers’
pricing would be instantly transparent.

There is no indication that the Obama administration is working
on this.

It is up to consumers to force the issue of price transparency.
It will lead to price competition and decrease the cost of healthcare..

Physicians in some parts of the country have taken the
initiative to encourage real price transparency and price competition.

I do not think we can rely on the government.

The Obama administration’s goal is to not have a healthcare system
with free market competition. He wants a government controlled healthcare
system.

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President Obama – Do Something That Could Work!

July 10, 2013
inDisinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

The solution to repairing the healthcare system is simple. The
healthcare system must be consumer driven. If consumers were in control of their
healthcare dollars and were responsible for their health and their healthcare
choices the cost of the healthcare system would decrease to manageable levels.

My ideal Medical Savings Account puts the consumer in charge. Its
success is totally dependent on real transparency by all stakeholders including
healthcare insurance companies, hospital systems and physicians. 

A Health Savings Account does not give consumers enough of an
incentive to shop for price and quality with the present lack of transparency.
In a transparent healthcare system Medical Saving Accounts would provide more
incentive than Health Savings Accounts.  

Presently President Obama is trying to eliminate Health Savings
Accounts. HSAs are the single greatest threat to his goal for a single party
payer system. They are also the fastest growing healthcare insurance product.

The lack of transparency for hospitals, healthcare insurance
companies, drug companies and physicians must be eliminated. The public must
demand that the healthcare insurance industry make their expenses transparent
so that its exorbitant salaries and profits can be clearly understood.   

There is no reason that this one stakeholder receives 40% of
every premium dollar spent either by private corporations or the government.
The medical loss ratio as it is presently constructed by the Obama
administration provides 20% for expenses. The other 20% of the $40% is in the
direct patient care column.

The government should help consumers understand these prices and
understand the measurement of quality. Consumers of healthcare must be turned
into Prosumers of healthcare (Productive Consumers.)

When this happens the consumers can become independent
intelligent consumers. Consumers will become independent of government and its
bureaucracy.

The Obama administration wants consumers to be more dependent on
government not less dependent.

Intelligent independent Consumers will force the other
stakeholders to be competitive. Competition will drive healthcare costs down.

Government cost controls will not drive prices down. They will
simply distort prices and cause more spending.

Private sources such as Angie’s list help consumers decide on
which plumber to hire. It is important and creates competition and price
lowering. However the defect in Angie’s list is that it is based on other
consumers’ opinions.

It is not based on specific costs or origins of the cost to the
plumber or the measurement of the plumber’s skill. It only deals with price and
consumer satisfaction. Angie’s list does make plumbers competitive.

Competition for consumers will bring down the cost of healthcare.
 By forcing consolidation of doctors and
hospitals Obamacare will decrease competition and increase prices.

 Healthcare
policy wonks dismiss this concept because they believe consumers are not smart
enough or interested enough in learning to be intelligent healthcare consumers.
They are wrong.

Their thnking is correct if a system exists where consumers are
spending other people’s money. Obamacare is such a system. It will drive costs
up just as the private first dollar coverage system has driven healthcare
prices up.

There is no financial incentive for healthcare consumers to try
to save money and preserve their health.

Obamacare is a huge entitlement with an overwhelming budget that
will be impossible to execute. We have seen that to be true with ever increasing
waivers and the most recent delay in the mandate until 2015.  There will be delays in other critical
portions of Obamacare in the near future. It could be delayed forever because
it cannot be executed.

In my last blog I forgot to mention the delay in forming and
activating the Independent Physician Advisory Board.

Last year I wrote about the Obama administration’s infatuation
with the Canadian Healthcare System. I reviewed the 2011 Fraser report
explaining that the Canadian Healthcare System is unsustainable.


I also wrote about Canadian consumers’ healthcare experiences in
two provinces I visited.  The fact is the
system doesn’t work well and is unsustainable.

The Fraser Institute in a
2011 report concluded that Canada’s health care
system is spending money at an unsustainable rate. Six of ten Canadian
provinces are on track to spend half of their revenues on health care,
according to the institute.

“In 2011, health care
spending consumed 50 percent of revenues in Canada’s two largest provinces,
Ontario and Quebec.

By 2017, four more
provinces — Saskatchewan, Alberta, British Columbia and New Brunswick — will
spend half of their revenues on health care, according to the institute.

Total federal, provincial
and territorial government health spending has grown by 8.1 percent annually.
Canada’s GDP increased by 6.7 percent during the same period. The math is
obvious. The Canadian healthcare entitlement system is not working.

“In response to the rapidly
rising costs, provincial governments have raised taxes and rationed care,
increasing patient wait times. Provincial drug plans have also more often refused
to pay for most of the drugs that are certified as “safe and effective” by
Health Canada.

“Unsustainable rates of
growth in health care spending crowd out the resources available for other
purposes including education, public safety, and economic growth-enhancing tax
relief,” Fraser Institute Senior Fellow Nadeem Esmail told The Daily Caller
News Foundation in an email.”

Only 20% of the people utilize the healthcare system at any on
time. If consumers know they are entitled to healthcare and the healthcare
system will fix them if they get sick, consumers of healthcare feel protected. The
feelings of eighty percent of consumers who are not sick believe the system is
great until they have to interact with the system. In this system of
entitlement consumers have a tendency to not take care of their health.  This makes them more likely to interact with
the system in the future when they are very sick. The result is increasing
healthcare costs.

Once an entitlement is created it is almost impossible to
eliminate it even though it has proved ineffective and costly.

England’s NHS has shown this to be true. The NHS is struggling
right now to modify the NHS so it works better for physicians and patients.
However, the new reform rules have been contaminated with so many amendments
that I suspect no progress will be made.

Consumers are realizing that Obamacare is much too complicated
and impossible to execute. Rather than demanding repeal and eliminating the
concept of instituting an entitlement program, the New York Times is publishing
letters from readers that are demanding a single party payer system to simplify
the system.

Let us stop making the same mistakes over and over again.

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

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Holy Cow, He Does It Again!

July 7, 2013
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The Obama
administration has not been forthright with Congress and the American people in
explaining Fast and Furious, the Benghazi incident, the IRS scandal, the NSA
scandal, and his unilateral decision not to enforce immigration laws with
respect to young immigrants.

I understand most people know little of the
details of these scandals,unconstitutional maneuvers and bypassing of
congress because the traditional media have ignored the details

The lack of honesty, changing stories and delays in providing explanations
about these scandals has made the administration’s credibility even worse.

There are many who suggest that the authority President Obama has assumed
in bypassing congress through executive orders and regulations has been
unconstitutional.

The constitutionality of the Obama administration’s most recent action
has been to delay the implementation of the provisions in Obamacare’s mandates requiring
everyone to buy insurance or face a penalty.

I do believe it is unconstitutional to ignore the provisions in a law
without the consent of congress, which passed the law.

“A constitutional law professor
at George Washington University Jonathan Turley said that Obama “has been far
more aggressive in circumventing Congress and far more successful in creating
an imperial presidency” than Bush.”

“President
Barack Obama’s latest legal end run around Congress — delaying enforcement of
the employer health mandate — has sparked more questions about whether he’s
abusing his executive discretion under the Constitution.”

Many congressmen have complained, including some Democrats up for
reelection in 2014.

Rep. Steve King, R-Iowa, said,
“If President Obama wants to make changes to Obamacare, he must come to
Congress. … We are a nation governed by laws written by Congress, not memos
and blog posts written by bureaucrats.”

“President Obama will get his way,” said Michael Tanner.

Michael Tanner, a senior fellow at the Cato Institute, said
Obama appeared to be stretching his authority to the limit.

“It’s less of a frontal assault than it is a flanking maneuver,”
he said. “He may be violating the spirit of the law but not necessarily the
letter.

The legality is up in the air.”

When President Obama
has run into opposition to his political ideology he has gone around congress.
He is a master of “gotcha politics.”

Timothy Jost, a longtime supporter of the health care law and a
law professor at Washington and Lee University, defended the mandate decision.

“This is really a question of enforcement and when the
administration runs into practical difficulty, it delays enforcement,” he said.

"He predicted the administration would get its way in the end."

“I don’t see the courts intervening here. I’m sure Congress will
hold hearings but there really isn’t anything they can do.”

 Unfortunately, Obamacare is the law of the land.

Obamacare is a stupid law. President Obama’s delaying implementation is
demonstrating that Obamacare is not going to work.

 Obamacare will destroy the already
dysfunctional healthcare system for the reasons I have outlined.

This delay is
one of many Obamacare delays we are going to see in the coming months.

Others might include.

  1. Implementation of the mandate for individuals.
  2. Implementation of health insurance exchanges.
  3. Implementation of ACO’s.
  4. Implementation of Electronic Medical Records.
  5. IRS policing implementation of Obamacare.

There will be protests against the many waivers and exemptions from the
law that President Obama has given various groups including labor unions,
congressional members and government workers. These exemptions and desired
exemptions have not been reported in detail in the traditional media. I suspect
the exemptions will just happen without awareness by the public.

The Obama administration made a big mistake by spying on the Associated
Press reporters. The press has been his biggest ally in helping him get away
with all the stretching of his executive powers by not informing the public. Now
the press is angry and I suspect might not be as accommodating to him.

The law's implementation is turning into a fiasco for the ages,
and this week's version is the White House decision to delay the law's
insurance mandate for businesses, though not for individuals.

The employer mandate is central to Obamacare's
claim of providing universal coverage. Companies with 50 or more "employee
equivalents" must pay a $2,000 penalty per full-time employee if they
don't provide government-approved health insurance.

Mark Mazur, the deputy assistant Treasury
secretary for tax policy, published a blog Tuesday night July 2, the night
before the July 4 weekend holiday break canceling the insurance reporting rules
and tax enforcement until 2015.

This is a typical Obama administration tactic
hoping the cancellation would be forgotten after the weekend. It didn’t work.
People are still talking about a bureaucrat changing the rules of the law
because it cannot be executed.

“White House
fixer Valerie Jarrett tried to contain the fallout with a separate blog post
promising that ObamaCare is otherwise "staying the course." That's
true only if she's referring to the carelessness and improvisation that have
defined the law so far.”

The Treasury Department does not have the
computing ability to figure out who is complying with the law. The IRS does not
have the ability or manpower to police the law.

The law does not say the Obama administration
can impose the mandate whenever it feels it is politically convenient. The
individual mandate is next to go.

The damage from Obamacare has already occurred.
Healthcare insurance premiums have risen on average 20% this year.

Small and large companies are only hiring part
time people to avoid the penalty. (Under 30 hours per week). This week’s
unemployment figure was 195,000 only because of part time hiring. There was a
major decrease in full time workers.

There is an increase in non-insured as the
businesses are dropping healthcare insurance for employees.

Obamacare
has become a rolling "train wreck," in Senator Max Baucus's memorable
phrase, and it gets worse the more of it the public sees.

The employer mandate is terrible policy, as I
pointed out before it was passed. The Obama administration has now admitted that it
can't implement Obamacare properly or on time after Americans have been paying the 10
hidden taxes for the past two years.

Please wake up America.

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

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I Am Proud To Be An American

July 4, 2013
inLife's Experiences
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Stanley Feld M.D.,FACP,MACE

Stan july 4

July 4th 2013

July 4th should conjure up
feelings of liberty, freedom, and patriotism. It is a celebration of the birth of the United States of
America. 

It is not just another holiday from work,
but a celebration of those who have gone before us to ensure our freedoms.

“Americans should remember as they celebrate July
4th that it is also called Independence Day for a reason. 
It should not be lost during the barbecues, fireworks celebrations, concerts,
and parades that this holiday was established to reflect on the meaning of
freedom and personal rights.” 

 


 

 

 

The New York
Times wrote an insipid editorial about July 4th


“Every Ordinary Fourth by THE
EDITORIAL BOARD

“Do we, as
a nation, eat more hot dogs on July Fourth than any other day of the year? What
about potato salad and deviled eggs? Are there still legions of children
hand-cranking ice cream, watching the pale gray slurry of rock salt and ice
with appalling impatience while the grown-ups stand by recalling their own
apprenticeship at the crank?”

The
words liberty, freedom, and
patriotism as a description of the meaning of America
do not occur once in the editorial.

What
is wrong with the New York Times? What is happening to America? We must wake up
soon before our freedoms are lost.

The Fourth of July is more than a day of
celebration and remembrance; it is another opportunity to say thank you and be
thankful for our freedom.

This
is especially true of our medical freedom and the impingement of that freedom
with Obamacare.

 
 
Man is not freedom
Parade Photo July 4, 2013

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

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An Interesting Unintended Consequence of Obamacare

June 30, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley
Feld M.D.,FACP , MACE

 The Obama administration has encouraged local hospital systems
throughout the United States to consolidate physicians practicing in their
hospitals.

Hospital systems have found this attractive. There has been a
movement to buy physicians’ practices and then pay physicians a salary. This
has been encouraged by the Obama administration because someone in the
administration believes this will encourage physicians to stop over testing.

Hospital systems love it because they understand that brick and
mortar facilities are not worth as much as they use to be. If they own
physicians’ intellectual property in the form of primary care physicians and
skills in the form of surgeons, the value of the hospital system increases. 

It has not worked out as well as many hospital systems would
like because when physicians worked for themselves they were more productive
than when they worked for the hospital system.

The Obama administration also believes that it can bundle the
payment of a treatment and share the savings with the hospital system if the
treatment costs less. If the treatment uses more assets and costs more the
hospital system will not be paid.

In other words, the government and the healthcare insurance
industry want to offload the risk of treatment to the hospital system. They
administration thinks this will force hospital systems to deliver a better
quality of care. You may recall quality of care has not been defined
adequately.

The example often used is the non-payment for hospital
readmissions within thirty days.

This policy doesn’t work because reasons for hospital
readmissions are multifactorial. Many of those factors are uncontrollable. One
hospital system can also divert the patient to another hospital system or treat
the readmitted patient in the emergency room.

The Obama administration is encouraging Accountable Care
Organizations. There are so many problems in forming, administrating and
managing ACOs that they are destined to fail.

Anyone reading the administration’s propaganda would not think
so, but it is true, and as time goes on it will become apparent.

Finally, hospital systems and physician groups are realizing the
negotiating power they are accumulating by consolidating and integrating
physicians’ practices.

Consolidation is not good
for the patients. It is great for the hospital system and the large independent
physician specialty groups. Physicians who have sold their practices to
hospital systems will not do so well because the hospital systems are in
control of the collections and salaries.

Large medical specialty groups are negotiating with Obamacare’s
new healthcare plans. These providers are demanding, and in some cases
securing, pretty rich reimbursement rates from the new Obamacare health plans.

It is the same thing that happened in the 1980’s when HMOs
negotiated high reimbursement deals with medical and surgical specialists the
HMO wanted in the group. The HMO’s reasons were to promote the HMO’s brand and
to get better medical results for the patients they had enrolled.

“To take care
of patients that will be covered by the new insurance scheme, these providers
are requesting payment rates that are higher than what they're being offered by
Medicare. Some providers are even insisting on premiums over what they're paid
by the existing private, employer-based health plans.”

Hospital systems in a town they dominate are doing the same
thing. The result will be an increase in the costs to the government and the
healthcare insurance companies. They will pass the increased costs on to the
consumers.

“Some of the
Obamacare plans, stuck in markets where there are few competing groups of
providers to choose among, are being forced to accept these high prices.”

The Obama administration told us, at the passage of Obamacare,
that providers would be discounting to get the volume of business that
Obamacare offered as the new legislation banded large groups of patients into
statewide insurance pools.

The defective central premise was that Obamacare would entice
providers to take lower reimbursement because of increased volume.  

“The people
that now seem most likely to enter these state-based insurance pools, and buy
the new coverage, represent a costly mix of patients with a lot of pre-existing
medical conditions. The volume is also unlikely to materialize.”

Obamacare has tripped over its central premise. It is not going
to lower costs. It is going to raise costs.

Obamacare has stimulated the consolidation of hospitals and
physician groups that's now rampant in healthcare. This consolidation is
starting to give providers leverage over Obamacare’s health plans.

This unintended consequence of Obamacare was obvious to most
healthcare policy thinkers who believe that control and planning do not work.
Unfortunately, President Obama did not listen to them.

The other thing President Obama did not listen to is that Health
Maintenance Organizations (HMO’s) of the 1980 and 1990s did not work. Obamacare
is a HMO on steroids.  

 “Under the scheme, doctors are paid lump sums of money to care
for large groups of patients.

“The idea is to put the financial risk on the doctor for the
cost of the medical care that they deliver. This was a central premise for how
Obamacare would put financial pressure on providers as a way to help to lower
healthcare costs.”

Physicians and Hospital Systems have been to this movie before. 

Hospital Systems are making believe they are taking Obamacare’s
financial bait. They are using the concept to frighten physicians and buying
local medical practices.

Hospital systems’ goal is to get a geographic monopoly then take
advantage of the negotiating monopoly. Physician groups especially specialty
groups will stay independent of hospital systems, integrate practices and get
in a negotiating reimbursement.

This will increase the cost of medical care. Everyone knows all
healthcare is local. Central control of healthcare is innately flawed. 

This is one of the many defects in Obamacare’s structure.

Obamacare has dismantled the last vestiges of local competition
among physicians for patients.

Now Obamacare will have to deal with the physician and hospital
system cartels it has created.

 The victims in all of this are patients
and the cost of patient care.

The Obama administration’s public service campaign is starting
to sell Obamacare’s virtues to young people through the NFL, NBA and major
league baseball. It is also signing up non suspecting consumers at supermarkets and churches.

Good luck. I think everyone is starting to catch on.

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

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Where Is Obamacare’s Transparency?

June 26, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

 Stanley Feld M.D., FACP,MACE

As we get closer to the implementation date of Obamacare it becomes
more and more obvious that there are more and more things we do not know about
the law.

Something we do know is that the law gives all the decision-making discretion
to the head of the Department of Health and Human Services. This is an obvious
defect in Obamacare as new regulations are produced by the Secretary of HHS
daily.

The Health and Human Services Department is
the most secretive department in the government.

The new rules are a huge black box
secret. The steps being taken to implement Obamacare have also been a secret.
None of what is going on with Obamacare is transparent. 

Health and Human Services has not
provided coherent answers to congressional oversight committees that have
requested answers to certain questions. Neither have comprehensive answers to
questions been provided to the press.

The Government Accountability Office
released the results of two investigations of Obamacare. The implementation of
Obamacare has blown deadlines and has improvised on regulation. There has been general
chaos at HHS.

The GAO said HHS isn't close to being ready to launch in October.
The Obama administration has told
congress and the press that it will be ready.

HHS has already announced it is throwing in the
towel on small business health insurance exchanges. These exchanges were
supposed to allow employees to choose from competing healthcare insurance
plans.

These small business health insurance exchanges have been put off
for at least one year. It is not clear whether these exchanges are the same as
those that are supposed to launch on October 1,2014.

The employees must choose from their employer’s private
plan options. However it is not clear if employers are going to stop offering
healthcare coverage and pay the “tax” penalty Obamacare imposes.

Employees will have to buy healthcare insurance
from the health insurance exchanges with after tax dollars. Prior to Obamacare employers
bought healthcare insurance with pre-tax dollars.

This is another Obamacare hidden tax increase.

If everyone is driven into health insurance exchanges
and the healthcare industry drops out of the health insurance exchange because
of the tax it will have to pay for every policy sold, America will have a
single party payer (the government) system by default.

This is President Obama’s goal.

The healthcare insurance industry will continue to
make its money with a single party payer because it is the government’s
administrative service provider. As administrator service providers the healthcare
insurance industry still takes its 40% off the top.

Consumers will be the ones that get penalized
through increased taxes.

HHS will be forced to run 34 of the 50 health
insurance exchanges and pay for the cost overruns expected. These cost overruns
are not in the healthcare budget. There are more than 100 “key activities”
necessary to set up exchanges.

Sixteen states have opted to run their own exchange
and take the money the federal government has offered. These states still have
between 16-52% of the key activities undone in order to qualify as a health
insurance exchange.

The complete set of regulations for these
key activities has not been completely written by HHS.

Two states, Massachusetts and Utah, have had functioning   health
insurance exchanges. These exchanges were developed pre Obamacare. These
exchanges might have to be redone once all the rules and regulations are
written and federal requirements are known.

“If HHS had any appreciation for basic accountability it would
release the facts itself instead of going dark and running ObamaCare as a
black-ops mission.”

“HHS has insurance premium filings for the 34 federal exchanges
but it decreed in a May memo that it would keep that information secret until
September.”

“Could it be that the department doesn't want people to know about
the coming "rate shock" like that in California?”

The traditional
media have declared that there will be lower rates in the health insurance
exchange in California. The facts are the opposite.

An interesting observation using the Covered California calculator is
that a family earning  $38,000 a year would
be entitled to a tax credit of $11,448 after they file their tax return for the
previous year. The yearly outlay for the health insurance exchange silver plan
for this family of four would be $13,164.

This family would have a theoretical cost of $1716 dollars per year for
silver plan healthcare insurance plus deductibles which are significant.

This family making $38,000 a year pays no income tax. I tried to figure
out how the government applies the tax credit if they pay no income tax.

Does the government write a check of $11,448 dollars for their tax
credit after they file their income tax return the following year? This is not
the definition of a tax credit.

This family earning $38,000 a
year cannot afford to pay the $1,097 a month for the insurance the first year.
It is thirty-three percent of their salary.

Second, the tax credit is worthless because they do not pay any tax to
be credited.

I wonder if Kathleen Sibelius thought of this?

The health insurance exchanges developed so far are
experiencing massive cost overruns.

The CBO originally estimated that setting up all the 50
exchanges would cost $5-10 billion dollars. California has spent $900 million
dollars so far and they are not completely set up.

The Obama administration has been taking money out of other
federal health budgets to find more money to help states develop the health
insurance exchanges.

“In June Kaiser
Family Foundation health tracking poll—which also found that public support for
ObamaCare hit a new post-passage low of 35%—reports that nearly one of three
Americans between the ages of 18 and 30 do not believe that insurance "is
worth the money it costs."

 “And persuading young, healthy people to sign
up for coverage requires them to act against their own economic interest, since
they can always enroll later when they need it as a result of ObamaCare's
mandates.”

The health insurance plans are expensive and the exchanges will
malfunction. Physicians won’t participate because the reimbursement fees have
not been published. If someone files a claim wrong, they will not get paid. 

These are just a few of the issues that can and will come up
that have not been explained.

The public must become
aware of the facts and not buy into the Obama administration propaganda
campaign that Obamacare is the greatest.

It is time for Americans to stop being passive. The protest
must start now before implementation is a disaster and taxes and premiums
escalate because of massive cost overruns.

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

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  • natural garcinia • October 26, 2013

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Permalink:

Games On!

June 23, 2013
inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld
M.D.,FACP,MACE

Articles
about the virtues of Obamacare are appearing almost daily. It is pretty clear that
the information is being fed to the media by the Obama administration.

The
problem is the sound bites are not truthful. The best sound bites are in the
Obama administration has to offer are in play. All the virtues expressed about
Obamacare are expensive and un-executable by the Obama administration.

On June 16th
Timothy Egan was called on to spin the Obamacare tale in the New York Times.

He lauded
the virtues of Obamacare while executing the blame game once again. He starts
by describing an under 26 year old with Hodgkin’s lymphoma who was treated to
remission using his parents’ employer provided healthcare insurance.

The parents’
employer’s healthcare insurance premiums increased the past few years since it
is the law under Obamacare to cover children until they are 26 years old. The
coverage pre Obamacare covered only up to 18 years old.

Here is
the blame game.

“But he’s (the under 26 year old) still a pariah in the eyes
of the insurance industry, which means they can deny him a policy that might
save his life.

Not for long. In six months’ time, the heartless practice of
refusing to let sick people buy affordable health insurance — private-sector
death panels, the most odious kind of American exceptionalism — will be illegal
from shore to shore.”

Timothy Eagan’s example is true. However,
Obamacare’s most disturbing
feature is the Independent Payment Advisory Board. The IPAB, sometimes called a
"death panel," threatens to nullify Mr. Eagan’s euphoria for
Obamacare.

Maybe this person will not get approved for retreatment if
the determination for retreatment is not cost effective according to the IPAB

A vivid example of government’s control over an individual’s
personal life and death decisions is the rules that bared access by 10-year old
Sarah Murnaghan to the adult lung-transplant list.

Health and Human Services Secretary Kathleen Sibelius refused
to waive rules made by bureaucrats to permit this 10 year old a lung
transplant. 

Who knows what can happen when the power to make rules and
enforce them is in the hands of a bureaucracy? Bureaucracies have a tendency to
create rules in which no one has to take responsibility for decisions that affect
others’ lives and personal freedoms.

It is obvious that the grip of the bureaucracy will clamp
down much harder once the Independent Payment Advisory Board gets going in the
next two years. There will be no going back.

The Obamacare’s IPAB is not answerable to any one.

Cost will be an issue in the bureaucratic IPAB’s decision-making process
and not the patient’s vested interests.

Timothy Eagan goes on to say,

“The early indications are that most Americans will be
pleasantly surprised. Millions of people, shopping and comparing prices on the
exchanges set up by the states, are likely to get far better coverage for the
same — or less — money than they pay now.

There is no data for this statement except the
misinformation and number fudging done by California Covered. The costs in
California will be outrageous.

The state of Washington also published disinformation
about the cost of care under their health insurance exchange.

 The law, as honest
conservatives predicted, before they orphaned their own idea, is injecting
competition into a market dominated by a few big names.

Washington only has one insurance company signed up.

The real number prediction for Washington's health insurance exchange is that even in over-regulated
Washington State, Obamacare will increase individual health insurance premiums
by 34-80%

What will happen if, in the end, Obamacare really works?”

The early indications from the State of California and Paul
Krugman are misleading and dead wrong. I have pointed out that in an earlier
article. Obamacare is going to be a train wreck both financially and medical
care wise.

In additional, the Obama administration has to build 34 of
its own health insurance exchanges. It couldn’t suck 34 states into the Obamacare
overspending mud hole.

Auditors at the Government Accountability Office released
the results of two investigations. It optimistically concluded that it
"cannot yet be determined" if Obamacare will be ready for enrollment
a mere four months from now.

The health insurance exchanges are supposed to open October
1. The administration insists that it will.

The GAO's
detailed portrait of blown deadlines, regulatory improvisation and general
chaos explains why HHS has been anti-transparent.  

HHS will run 34
federal versions in whole or part as Governors continue their Obamacare
resistance.

Some of the health insurance exchange preparations have
barely begun. The Obama administration has already blamed it on conservatives
and Republicans.

The GAO attempted to track "key activities"
necessary to set up exchanges and identified "more than 100." But the
auditors can't give a precise number because "the nature of the activities
that [HHS] and the states will conduct has not been finalized and may continue
to evolve."

Mr. Eagan then criticizes
Republicans.

“They
have good reason to fear it: if Obamacare works, the game will be over for
those who oppose the most significant change in American life in a generation’s
time.”

The chance that Obamacare
will work is minimal. In either case it will be the most significant change in
American life in a generation’s time.

Ben Carson M.D.  has a very
practical comment about the health insurance exchanges.

Obamacare will be a disastrous
change and the Democrats will try to blame its failure on Republicans. It has
nothing to do with Republicans. It is simply a law that is destined to be a
train wreck.

Obamacare cannot be executed
and America cannot afford the cost of Obamacare.

Young people will not buy
individual insurance from the health insurance exchanges.

The young individuals who
do not receive healthcare coverage from their employer are not stupid. It makes little financial
sense for them to subsidize the medical care of others given the choice.

The traditional media is
getting nervous as they see President Obama using them to promote Obamacare and
convince young healthy people to join with a campaign of disinformation.

The media have lately
emphasized the real challenge of enticing healthy young adults to sign up for
Obamacare. Obamacare needs these young people to sign up and buy the insurance.

The states that have signed
on to the health insurance exchanges and the federal government are counting on
young people who are healthy to make Obamacare work.

Obamacare will not work even if they sign up. President Obama will
have to impose more and more taxes as hiddden taxes and means tested taxes as
there are more and more shortfalls.

This has been the destiny of all entitlement states and countries. These
higher taxes will have a devastating effect on the economy and economic growth.

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

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The problem is that as the Obama administration and
its media surrogates tell lies they start believing these lies until the devastation
hits.

Devastation of the healthcare system, the economy and
the financial structure is closer than they think.

 

  • Eugene Charter Service • October 14, 2013

    Everything is very open with a clear clarification of the challenges. It was definitely informative. Your site is very helpful. Many thanks for sharing!

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