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Disinformation and the healthcare system

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More Bad News For Obamacare And Taxpayers

Stanley Feld M.D.,FACP,MACE

The Obama administration and the traditional mainstream media are working very hard to keep the bad news about Obamacare away from the general public.

The Colorado exchange (Connect for Health Colorado) expects nearly 24% of the enrollees to drop health exchange coverage in fiscal 2015.

This is a direct contradiction to the Obama administration’s projection of the growth of health insurance exchanges.

“In April 2014 after open enrollement closed, the staff of Connect for Colorado projected 13 percent of people enrolled will drop or not pay for policies in fiscal 2015, but now they are expecting about 24 percent to drop their policies, according to the latest model.”

“And in fiscal 2016, the revised figures show dropped policies going from the 16 percent projected in April to nearly 22 percent.”

The Colorado Health Insurance Exchange’s chief financial officer Cammie Blais said the staff is using the higher drop rate in more recent models because that is how national figures are tracking.

President Obama and the Obama administration are aware of these figures. As usual they are keeping it from the public.

Why is happening nationally? There are multiple reasons.

Eighty five percent of the people who have enrolled have qualified for subsidies on the basis of the information they gave on the enrollment form.

The federal government was not set up to verify the information given on the enrollment form at the time of enrollment.

President Obama told everyone he would take his or her word for the information’s accuracy. This was a tremendous defect in the Obamacare system.

Many enrollees are going to lose part or the total subsidy provided by Obamacare. For some, the original subsidy was not enough to reduce the burden of insurance. In many cases the burden included high deductibles and copays that were unaffordable.

Many of the remaining fifteen percent of the enrollees had preexisting illnesses and could not buy insurance on the open market and/or were making over $50,000 a year.

Their premiums plus deductibles and copays are so high that enrollees making over $50,000 a year realize they cannot afford the insurance and have to drop out of next year’s exchange.

As a result of this adverse selection healthcare insurance industry’s premiums are going to skyrocket in 2015 as they have skyrocketed in 2014.

If the government starts convincing the majority of the public that the free market solution of the health insurance exchanges doesn’t work, the only choice will be a single party payer system for the entire population.

The VA system is an example of a single party payer system run by the government. It is a bureaucratic mess that is inevitable with a government run single party payer system.

A large bureaucratic single party payer systems relying on rules and regulations will end up with as non-transparent bureaucracy built for the benefit of the bureaucrats and not the people.

I think the public understands this. I think the Obama government is out of touch with the people.

President Obama ought to reexamine his premises.

The Obamacare system being built is destined to fail. It is not a consumer driven free market system. It does not follow that a single party payer system will work.

In reality none of the government controlled single party payer systems throughout the world work. They are just free. However, these systems are unsustainable.

The 8 million enrollees that President Obama ran his Obamacare victory lap on continues to dwindle at an accelerated rate.

If the DC appeals court rules against the federal government ability to provide subsidies, the number of enrollees will decrease even further.

The law states that only State health insurance exchanges can provide subsidies.

Obamacare is getting further and further away from being functional.

The Obama administration and the traditional media are working very hard to keep this information from the general public.

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

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President Obama’s Hatchet Man

Stanley Feld M.D.,FACP, MACE

President Obama’s favorite hatchet man is Paul Krugman. Paul Krugman has reinforced the Obama message in his most recent weekly article in the New York Times using Saul Alinsky’s tactics. He ridicules his opponents and Republicans in an attempt to marginalize their opinions.

Have you been following the news about Obamacare? The Affordable Care Act has receded from the front page, but information about how it’s going keeps coming in — and almost all the news is good.”

“What’s interesting about this success story (Obamacare) is that it has been accompanied at every step by cries of impending disaster.”

"Obamacare’s critics made at least six distinct predictions about how Obamacare would fail — every one of which turned out to be wrong."

The New York Times’ resident Nobel Prize winner has spoken.

Republicans have not figured out how to answer these statements by Paul Krugman for fear of losing votes in the 2014 election.

President Obama keeps telling us all these criticisms and accusations are phony scandals.

He says Republicans are the ones responsible for generating news of these phony scandals.

Once again Paul Krugman’s articles are fact-less.

He declares the enemies of health reform are 0 for 6.

“For reference: I count at least six distinct predictions of Obamacare doom made by the usual suspects (Republicans and conservative pundits), not one of which has come true. Here they are:”

Paul Krugman and President Obama’s enemies are in reality 6 for 6. Paul Krugman and President Obama are winless at 0 for 6.  

Paul Krugman and the President keep churning out fact-less information in order to keep the public misinformed. 

The evidence Paul Krugman uses to make his points about President Obama’s Obamacare follow. His “evidence” is incorrect on all six points.

 1Enrollment will be very low

Paul Krugman gives the critics one zero for being wrong about enrollment because enrollment was 8 million on March 31.

The real truth about enrollment is that of the fourteen million in the individual market seven million people lost their insurance.

The traditional media has portrayed it as showing a generally positive response to the healthcare law. They emphasized that about 6 in 10 of the enrollees were previously uninsured.

HHS Secretary Kathleen Sebelius for the first time on May 1,2014  unveiled demographic details (PDF) about the more than 8 million people who have signed up for health insurance through state and federal exchanges.

The vast majority of those enrolling, 85%, received financial assistance. Those receiving assistance needed to report if they had insurance coverage prior to enrollment.”

5.2 million people applied for financial assistance through the federal exchange. Thirteen percent said they had coverage at the time of application without subsidies. 

Eight million people enrolled through the health insurance exchange and 7 million lost their insurance as a result of Obamacare.

This represents a gain of only 1 million insured.  This is not an impressive gain in insurance coverage.

We do not know how many people will lose their insurance in the group markets as large corporations are only hiring people to work less that 29 hours a week to avoid the corporations’ penalty resulting from the Obamacare mandate.

 President Obama delayed implementation of Obamacare in the group market by granting waivers to the group market for one to two years in order to avoid exposing Obamacare to an increase in the uninsured.

2. Even if people sign up, they won’t pay their premiums.

Reality: Signups exceeded expectations, and the vast majority paid.

The real truth is the closing of the enrollment period was delayed twice. The Obama administration paid millions of dollars in television ads and endorsements by celebrities encourage young people to sign up. Enrollees were not supposed to be counted as enrolled unless they paid the first month’s premium.

Sebelius should read her own agency's report. It states quite clearly that "it is important to note that the Marketplace plan selection data as of the end of the open enrollment period do not represent effectuated enrollment (e.g., those who have paid their premium)." 

Many who paid the first month’s premium have not paid their second month’s premium because they could not afford it. Even some subsidized enrollees cannot afford the premium.

Even worse, the HHS inspector general provided the first independent look at widespread issues the government is having effectively fact-checking the information applicants have put on their applications.

President Obama informed us that applicants lying on the website applications and receiving government subsidies for 2014 will be penalized on their tax return in 2015.

“According to the report, the administration was unable to resolve 2.6 million so-called "inconsistencies" out of a total of 2.9 million such problems from October through December 2013. 

“The government needs to determine applicants' eligibility in order to verify they can enroll and, in some cases, get government subsidies.”

Eighty-five percent of enrollees are receiving government subsidies. The report only covers people enrolled as of December 2013 when the total nuber of enrollees was only 3.5 million. 

“ Without that step (government verification), coverage could be jeopardized. Critics fear these issues also could cause chaos during the 2015 tax-filing season, as many would have to pay back subsidy money they were not entitled to.” 

According to the report, those running the federal marketplace are having trouble resolving problems of eligibility for subsidies. 

"The federal marketplace was generally incapable of resolving most inconsistencies," the report said, claiming the government could not resolve 89 percent of the problems

 So far Paul Krugman is zero for two.

 The American people will never know the truth because of the lack of transparency.

The truth does not matter to Paul Krugman or President Obama.

The media is the message. The American public is getting an untruthful message from the Obama administration through a non-critical traditional media. Wait until the taxpayers realize what the bill will be.

3. “More people will lose coverage cancelled by Obamacare than gain it.

Reality: Sharp drop in the number of uninsured.”

The real truth is there is something wrong with the Gallup survey of 3400 people. There are more people who lost insurance that had insurance previously when one compiles insurance policies lost as in section 1.

4. “Rate shock.

Reality: Like it says, affordable care.”

Paul Krugman should look at the Kaiser Foundation survey for the real truth.

Insurance premiums have only decreased for people making less than $50,000 because they receive government subsidies. The government pays the difference for those receiving subsidies.  

“Among plan switchers, 39% have higher premiums. In order to get the 46% number of switchers who had lower premiums, government subsidies had to be taken into account.”

According to the Kaiser report four in ten people in ACA-Compliant Plans say it is difficult to pay monthly premiums.

The majority of the Non-Group Enrollees (independent market) are confident about being able to pay for routine care with the high deductibles from the exchanges. They are less confident they will be able to pay the deductibles for a major illness.

 Obamacare is not affordable according to the Kaiser family foundation survey.

The Obama administration is heavily subsidizing people who are making less that $50,000 a year. The taxpayer is paying for the subsidy. It will be even worse for taxpayers when the healthcare insurance companies make less that their stated goal.

President Obama has by executive order put machinery in place to bail out the insurance industry to deliver the insurance industry’s expected profit at the taxpayers’ expense.

5.” Young people not signing up, and death spiral.

Reality: Pretty good demographics.”

These two references have nothing to do with the facts or the point Paul Krugman wants to make. He is pretty confident no one would read them the references.

“It’s still the case that just 28 percent of those sign-ups were between the ages of 18 and 34, far short of the administration’s target of 39 percent.”

The real truth is that the President needed 39% enrollment by young persons in order to make Obamacare financially viable in the individual healthcare insurance marketplace. President Obama ended up with only a 28% enrollment of young people.

Kathleen Sibelius announced that 28% was good enough.

6.” Soaring health costs.

Reality: Health costs are below anyone’s expectations.”

Does anyone believe the Obama administration when they tell us there is no inflation?  If you leave food and fuel out of the index there is no inflation. Food and fuel is what everyone buys and inflation is skyrocketing.

Health insurance premiums are also skyrocketing. Deductibles and co-pays are becoming unmanageable. The profits of the healthcare insurance industry unconscionable.

“Insurance firms participating in New York’s ObamaCare health exchange are seeking double-digit hikes for patient medical premiums in 2014.’

“Leading the charge is Excellus Health Plan, which is seeking to sock more than 24,000 customers with a 19.7 percent hike.”

“Health Republic Insurance of New York — the largest on the exchange with more than 68,000 members — requested a 15.2 percent increase for individual plans.”

Paul Krugman seems to have no interest in the facts.

Paul Krugman says, “It’s about politics and ideology, not analysis. But while this observation isn’t particularly startling, it’s worth pointing out just how completely ideology has trumped evidence in the health policy debate.”

Paul Krugman’s ideology trumps evidence. He is not even close to the truth. It is pure disinformation.

He is the one that is zero for six not his critics.

President Obama and Paul Krugman are concealing the truth about Obamacare’s failures.

What is worse is the traditional media and in particular the New York Times is letting them get away with it. 

What the public needs to do is obvious.

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

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Lies and Concealed Failures

Stanley Feld M.D.,FACP,MACE

Americans are now certain that President Obama lies indiscriminately to them. He tells us what we want to hear. At the beginning of his quest for the presidency all Americans wanted to believe him.

Unfortunately he has been lying to us all along.

YouTube has given Americans the ability to easily review statements President Obama has made to see if he was deceiving us.  

His lies about Obamacare are now legend. What follows is a compilation of these lies.

 

http://youtu.be/4puS-yjwsiE

There are compilations of all the lies for each of the scandals including Fast and Furious, Bengashi, the IRS, and the VA among others on YouTube.

President Obama continues to call them all these scandals “phony scandals”.

To paraphrase Carl Sandberg, in his book Prairie Years, “if you tell a lie you better have a good memory.” I do not think President Obama feels he is obligated to have a good memory.  YouTube has made this point clear.

Since March 31, 2014 President Obama and his administration have tried to keep Obamacare out of the news. On March 31,2014 President Obama had declared Obamacare an overwhelming success. He declared there is no further need for the press to generate untrue controversy about Obamacare.

 

http://youtu.be/1YqXCFCXXL8

The mainstream media has complied with his request. It has been been silent about Obamacare’s ongoing failures.

In the last three months several reports have been published but never have reached the public through the mainstream media.

Americans may never get an accurate projection of Obamacare's impact on the deficit because the administration has not been transparent and or truthful about its impact.

Before Obamacare became law, the Congressional Budget Office (CBO) projected, using figures given to it by the Obama administration, that Obamacare would cost $938 billion over ten years. The CBO also projected Obamacare would reduce the budget deficit by $143 billion over the first decade.

President Obama collected increased hidden taxes for the four years before Obamacare was supposed to be implemented.

Full implementation has now been delayed by five to six years while the increased taxes continued to be collected.

The delay in full implementation is the result of the unconstitutional waivers President Obama gave to some groups.

The original CBO estimate included a $780 billion reduction in Medicare spending cuts along with a double counting scandal.

In April 2014, the CBO said that the cost of the ACA from 2015 to 2024 would be more than $1.8 trillion — twice as much as its first ten-year projection.”

The addition of $1.8 trillion to the budget deficit as opposed to a $143 billion reduction is a very big difference.

In that same April report, the CBO include a significant footnote:

"CBO and (the Joint Committee on Taxation) can no longer determine exactly how the provisions of the (Affordable Care Act) that are not related to the expansion of health insurance coverage have affected their projections of direct spending and revenues. Isolating the incremental effects of those provisions on previously existing programs and revenues four years after enactment of the ACA is not possible."

“Also it is not clear that the law's proposed Medicare cuts will remain in place. Additionally, unions, insurers, drug makers and medical device companies each would like relief from the law's new tax provisions.” 

It was obvious to everyone that Obamacare would not reduce the deficit or decrease healthcare costs.

The bigger issue is none of this was reported in the traditional media. This represents one failure concealed from the American public.

Nonetheless President Obama is still telling Americans Obamacare will save money and reduce the deficit.

In President Obama’s victory lap on YouTube he states over and over again that Obamacare is a tremendous success.  It is almost as if he is pleading with the American public to believe him. 

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

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The VA Healthcare System-The Precursor Of Obamacare

Stanley Feld M.D.,FACP,MACE

The VA Healthcare System scandal has been in the headlines for a few weeks. The scandal has brought out the fact, once more, that President Obama lied to the American people.

His excuses are very thin. He knew about the VA problems in 2005. He pledged to fix the problems before he was elected President in 2008. In 2011 he repeated his pledge.

Now he has the gall to tell the American public in 2014 that he didn’t know anything about the problems until he read about them in the press.

President Obama addressed the Veterans Affairs scandal on Wednesday, saying he's waiting for an Inspector General "audit" of what went wrong.

How stupid does he think we are?

President Obama probably wishes he had control over You-Tube and the Internet. He could then eliminate his past statements and promises.

It looks like he is trying his best by attempting to defeat Net Neutrality.

Liberals have long hailed the VA Healthcare System as the model of government health care.  Liberals believe everything the government runs is the best thing for America.

Can you think of anything that the US government runs works really, really well? 

If so, please share that information with the rest of us. 

How can it run a healthcare system?

The government has systems problems in everything it tries to run. It can publish mountains of regulations. It cannot execute much because of the way the systems have been set up or not changed over time. There are multiple examples of such failures of execution.

None of these agencies seem to work including the Post Office, Amtrak, FEMA (Katrina rescue), Obamacare (website or the health insurance exchanges), and even the government itself.

 I believe it is because government has imbedded in it a deadening bureaucracy.

The bureaucracy suppresses innovation and the ability to repair defects quickly as they occur. This leads to cover ups that are eventually leaked.

The fact that no one is ever held responsible for errors of execution just adds to the awkwardness of the cover up.

The recent scandals, Benghazi, the IRS, Fast and Furious and the reporting on Obamacare, are a few examples of this.

The press never shows us facts about the supposed “investigations” and who was responsible for the missteps. It only leads to more mistrust and suspicion.

The forced resignation of VA Secretary Eric Shinseki will not serve as a distraction from the real problems in the VA.  Eric Shinseki’s firing is not going to fix the VA’s Healthcare System’s problems.

 

http://youtu.be/eBc8ag-fS3s

Liberals are blinded by their ideology. They have long hailed the VA as the model of government health care. They ignore the facts. The VA Healthcare System’s problems have been around for a long time.  

There is little evidence that President Obama has tried to do anything about the VA Healthcare System since he became President.

 All the public heard is how great the VA system of healthcare delivery is and how his administration is going to make it better.

Paul Krugman is the chief purveyor of the Obama administration’s progressive ideology. Mr. Krugman’s problem is he ignores facts as he formulates his “socialistic” beliefs.

It is almost as if he is saying, “don’t confuse me with facts.” Just believe that I know what I am talking about because I am a Nobel Prize winner.

The crazy thing is many very smart people believe him, just as they believe President Obama.

Paul Krugman praised the VA as a triumph of "socialized medicine."  He even listed what's behind this success.

“Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it.”

“So it's free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense."

The progressives ignore the government system’s own “perverse incentives.” The most important is as VA bureaucrats they must cover their own backside for non- performance.

It leads to long treatment delays and deaths that are preventable. This is only the tip of the iceberg. The rationing of care has been devastating for those veterans awaiting appointments.

 The bureaucracy is forced to cover up the errors. The problem the bureaucrats have is free speech in America. The morality of some is drives them to tell the rest of us about the problems.

“VA centers fudge their data.” The VA has consistently boasted in its performance reviews that more than 90% of patients receive appointments within 14 days of their "desired date."

The hidden waiting lines and treatment delays are not the only problems.

Infection rates and poor treatment outcomes have also been hidden from other bureaucrats in the system as well as the public. These problems are as important or more important than hiding appointment lists.

"The rate of potentially lethal bloodstream infections from central-intravenous lines was more than 11 times as high among patients at the Phoenix facility than it was at top VA hospitals, data from the year ended March 31, 2014, show," notes the Journal.

"Those infections, called sepsis, can quickly cause multiple organ failure and kill an otherwise relatively healthy patient within days or even hours. The data don't show what percentage of patients died as a result."

 The Journal also reports, "Among patients admitted to the hospital for acute care, the Phoenix VA Health Care System had a 32% higher 30-day death rate than did the top-performing VA hospitals, a finding flagged as statistically significant by the agency's medical analysts."

William E. Duncan, supervised publication of VA Healthcare Systems medical outcomes until his 2012 departure.

He said in an interview that he urged that more data be posted regardless of the impact," adds the Journal. But he tells the paper that he was forced out of the VA amid a dispute over the issue.”

President Obama has said all we need to do is throw more money at the problem.

Wrong!

President Obama needs to fix the defects in the VA Healthcare System’s business model.

Inherent in the present VA Healthcare System business model is a system of misallocation of resources and inefficiency. Resources are allocated by political force rather than individual consumer choices.

This is true in most socialistic systems.

It is all about who you know. It is not about who are the most innovative, creative or truthful people trying to execute a system for the consumers’ benefit.

Obamacare's ultimate destination is the same as the VA Healthcare System.

It is going to happen by President Obama’s design. The government will completely control America’s healthcare system. The transformation is happening slowing by design to avoid protest. President Obama doesn’t care about the cost or creating a more efficient system.

He is doing it the same way you cook a live frog. He is raising the temperature one degree at a time. The frog will never notice the heat until he is cooked.

It is time for America to wake up!

We cannot take it any more.

America must demand that we change the business model NOW!

Repeal Obamacare now. 

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

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Salary Difference between Hospital Administrators and Physicians Over Time

In response to my last pos "Doctors’ Salaries; The Media Is The Message" a reader pointed out that the differences in the increases in the salaries of hospital administrators and physicians over a 30 year period between 1970 and 2000.

I did make the point that physician salaries from reimbursement have not increased.

He said I did not make that difference clear in relationship to time and the increase in healthcare costs.

He asked me to include the below slide to emphasis the point of the disconnect.

Difference in payment
I felt to be complete I should publish this slide.

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

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Keeping Obamacare Out Of The News

Stanley Feld M.D.,FACP,MACE

President Obama has tried to keep the bad news about Obamacare from us.  The bad news concerning errors in design and execution are being recognized daily. The administration has not published the demographic figures of those who enrolled in Obamacare yet.

It is going to be impossible for the administration to keep Obamacare implementation errors out of the news. Even the traditional media, big Obamacare fans, are starting to realize the huge defects in Obamacare and the hardships it is about to bring.

The defects are becoming obvious because they are affecting the majority of the working middle class signed up through the health insurance exchanges. 

Bureaucracy has created evaluation of care panels. While the panel members, most of them clinicians, agreed that a study could be impressive in its implementation and results, they have concluded that some studies were not good enough to recommend a new coverage policy to the CMS.

The members of the committees are usually not the most expert in the field they are evaluating. Thus, access to care through government coverage is denied when it should not be.

I previously gave the example of Medicare’s discussion to not pay for lung cancer screening even though the U.S. Preventive Services Task Force made the following recommendation based on their review.

"Smoking-related lung cancer kills about 130,000 Americans each year. The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease. The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented."

The USPSTF is not the ultimate authority in my view, but even using it as the ultimate authority Medicare ignores its recommendation because of the cost burden.

The Affordable Care Act (Obamacare) has touted Preventive Services.

What is the meaning of Preventative Services?

I guess it is to prevent diseases from occurring.

I believe if we could prevent obesity, stop cigarette smoking and alcoholism we could prevent a lot of diseases from occurring.

However, patients are the only ones' who can only prevent these diseases from occurring.
 

If we could genetically type diseases and alter those genes we could prevent the disease from occurring. This would relieve individuals of their own responsibilities.

The government defines Preventive Services as identifying disease by screening for disease in people who have no signs or symptoms of disease. 

The idea of screening patients for diseases is to make the diagnosis early enough in a disease process so that when treated early patients can be cured. 

In other words, a 40 year- old woman can have a free screening mammogram.

If the same woman notices a breast lump by self-examination and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram.

The mammogram can be as much as $300. With a high deductible Health Insurance Exchange plan she would pay out of her pocket because of the high deductible.

It means that a woman with no breast lump and at lower risk for cancer has incentive to be tested because it is free while the woman with a lump at higher risk of cancer faces financial disincentive to get a mammogram.

Isn’t that a little crazy? That’s the problem with giving patients things for free under different circumstances.

Subsequent interventions are an integral part of all screening. Were I a mammographer, I’d happily argue that additional mammographic views, ultrasounds, M.R.I.s and breast biopsies are all part of screening.”

This decision should not be made by the by a committee of non-experts. Individual patients should make these decisions after discussion with their physicians.

This is a defect in the bureaucratic definition of Preventative Services. Should the government provide the entire work up free?

A crazier example is a 50 year old undergoing a screening for colon cancer.

If a patient had a fecal test for occult blood for screening for colon cancer and it was positive, the patient would have to have a colonoscopy. Occult blood screening is inaccurate. It is cheap and free. It has a lot of false positives.

If the patient had an initial colonoscopy for screening it would also be free according to the Obamacare rules.

If during a colonoscopy a polyp were found the screening test would be reclassified as a diagnostic test. If it were a diagnostic test patients would have to pay for it. It would be an out of pocket expense for the patient on Obamacare making over $50,000 a year.

The outcry caused the government to change the rule. The polyp biopsy would be part of the colonoscopy and still be free to the patient. Do not forget someone is paying for it.

Medical decisions should not be made by government rules. Patients should make the medical decisions for themselves with the advice of their physicians.   

If patients had control of their health care dollars with the ideal medical savings account they would become true consumers of healthcare.

Patients would become responsible for making the decision on when to screen and what diagnosis to screen for and how often to screen for disease.

Patients would have to have the information to make those decisions. With the state of the information available and their physicians’ help responsible patients can make those judgments.

Patients have to drive the healthcare system. The government should be concentrating on setting up systems to teach patient how to be educated purchasers of healthcare.

The confusion created by confusing and ever-changing rules puts an emotional and a financial burden on all stakeholders.

Some use the argument that patients are not smart enough to be responsible for they health and healthcare dollars. It is their reason for totally free healthcare for all.

I believe this is disrespectful to our intelligence and our ability to learn to survive.

Paul Krugman a devoted liberal/progressive has shown little respect for the average Americans’ intelligence.

In my view Paul Krugman has been wrong about almost everything. He writes articles of opinion for the New York Times that are not based on any facts.

In 2011 he wrote an article  “The VA Is A Huge Policy Success Story’

Paul Krugman wrote;  “The V.H.A. is a huge policy success story, which offers important lessons for future health reform.”

And yes, this is “socialized medicine”.  But it works — and suggests what it will take to solve the troubles of U.S. health care more broadly.

Where is Paul Krugman’s evidence?  The VA healthcare system didn’t work in 2011 and it doesn’t work today. The VA produces nice reports that do not have anything to do with reality.

There is much to write about the recent VA problems.  I promise to get to these problems shortly.

The lessons to be learned from the VA’s problems are these problems a precursor to the Obamacare problems.

I fear this is what the American public is going to be facing as the Obama administration tries to implement Obamacare.

Obamacare is a terrible business model. America cannot afford this business model that is destined to failure.

A effective business model is needed which will be advantageous for all the stakeholders must replace it.

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

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What Is Net Neutrality?

Stanley Feld M.D.,FACP,MACE

Net neutrality is the idea that broadband operators shouldn't be allowed to block or degrade Internet content and services–or charge content providers an extra fee for speedier delivery or more favorable placement.

In November 2011 I wrote about the government attempt to control the Internet Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261).

  The title of the article was “The Government and American Censorship: 1984 in 2011.”

I searched the New York Times to see what the newspaper that (“Prints all the news fit to Print”) had to say about the bills. My search produced this reply.

 Your search – Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261). – did not match any documents under All Results Since 1851.

 The most vital part of our economy and job growth at the moment is the Internet. These two bills will destroy this monumental jobs creating machine.

 It is another piece of lunacy brought to you by our federal government. I wonder how many Representatives and Senators have read the bills.

There are two very disturbing bills making their way through Congress: These bills are coated in rhetoric that I find disgusting since at their core they are online censorship bills. It’s incredible to me that Congress would take seriously anything that censors the Internet and the American public but in the last few weeks PIPA and SOPA have burst forth with incredibly momentum, largely being underwritten by large media companies and their lobbyists.”

 Let me remind everyone that large media companies offered huge support to President Obama and the Democrats in congress. These bills are congruent with the large antiquated media”s vested interest and President Obama’s goal of central control over our lives.

EFFFree Software FoundationPublic Knowledge, Progress, Fight, Participatory Politics Foundation, and Creative Commons in support of free speech and a free and open Internet are opposing the bills and have organized American Censorship Day for tomorrow (11/16/11). The goal is to make every American aware of this new trick play and stop this lunacy.

 This video does a great job of explaining the two bills’ potential primary and secondary impact. I do not believe our congressional representatives understand the impact of the bills.

Someone is trying to railroad passage through congress.

 

PROTECT IP Act Breaks The Internet from Fight for the Future on Vimeo.

Both failed to pass in congress because of the overwhelming outcry by the technology community.

President Obama promised the American public he would issue regulations through executive orders and agency powers to enact laws that congress failed to enact.

When President Obama was running for president in 2007 and 2008 he was a strong proponent of Net Neutrality.

At that time President Obama was asked: "Would you make it a priority in your first year of office to reinstate Net neutrality as the law of the land? And would you pledge to only appoint FCC commissioners that support open Internet principles like Net neutrality?"

"The answer is yes," Obama replied. "I am a strong supporter of Net neutrality."

The White House announced: President Obama is strongly committed to Net Neutrality in order to keep an open Internet that fosters investment, innovation, consumer choice, and free speech.  The announced action by FCC Chairman Genachowski, building on the work of Chairman Waxman's collaborative effort to craft legislation in this area, advances this important policy priority. 

 

http://youtu.be/-Lz-bPHojVE

 <iframe width="420" height="315" src="//www.youtube.com/embed/mP01t0Z4Hr8" frameborder="0" allowfullscreen></iframe>

http://youtu.be/mP01t0Z4Hr8

 

In 2014 President Obama hires a lobbyist Tom Wheeler who is a former telecommunication lobbyist. Mr. Wheeler is opposed to Net Neutrality. The president has the FCC issuing regulations that oppose Net Neutrality and transfer great power and a complex bureaucracy to the federal government.

 It represents another broken promise by President Obama.

“Federal Communications Commission Chairman Tom Wheeler went ahead with his proposal on Thursday to give his agency the power to decide whether the terms and prices of broadband Internet services are "reasonable."

 

 

http://youtu.be/km1AhFkt4Dk

This is another power grab by the central government to have control of the Internet. The concept is once again not covered by the traditional media in an understandable way.

As a reaction to satisfy the “Net Neutral” community Mr. Wheeler said the goal is not to have a fast and slow speed Internet no matter how much broadband they consume.

Mr. Wheeler said he prefers the "reasonable" pricing standard. But he also suggested another, even worse option to regulate broadband prices: reclassifying Internet connections as "telecommunications services."

A reader of my blog wrote, "Can you think of anything that the U.S. government does really, really well?" 

“For two decades Congress has wisely refused to give the FCC the same power over the Internet that it holds over the telephone system. And for two decades the Internet has enabled a gusher of creativity that was unimaginable over a century of regulated telephony. “

Regulators from every state will also be able to get into the act. I cannot imagine it will be regulated for the benefit of consumers. There is something strange about all the telecoms companies merging with each other in the past few months.

“Mr. Wheeler's brainstorm to change all this is simply to pretend the Internet is a phone network.”

Since this designation would automatically impose myriad obligations that have nothing to do with current customer needs—and that many modern firms could not possibly fulfill—the commission would then have to issue a flurry of exemptions ("forbearance" in FCC parlance) to prevent chaos in the market for Internet connections.

The FCC is inventing an Obamacare for the Internet. It is enacting an unworkable system upon a system (the Internet).  Then the FCC will have to get busy issuing waivers which will prevent the new system from operating as it was theoretically designed to operate.

 The telecommunication industry will have a field day at the expense of the public.

“GOP Commissioner Michael O'Rielly, who also dissented, notes that the FCC's net-neutrality campaign "rests on a faulty foundation of make-believe statutory authority."

Imagine all the costs, confusion, lawsuits, legal fees, and regulations that will occur to restrict the freedom of the internet and all the innovations in commerce the Internet has created.

The elimination of Net Neutrality is all about increasing government power, restricting individual freedoms and shifting the costs of government’s inefficient control on to consumers.

Anna Eshoe is the ranking Democrat on the Communications and Technology Subcommittee.  She has pointed out that the new FCC wording has not fooled Silicon Valley entrepreneurs.

 Like many Internet users, I fear that the latest round of proposed Net Neutrality rules from the FCC will not do enough to curtail discrimination of Internet traffic, but rather leave the door open to discrimination under more ambiguous terms.”

The new regulations diminish Net Neutrality while empowering government bureaucracy. The online gatekeepers threaten free speech, harm competition and diminish the continued openness of the Internet. The proposed regulations do not protect the freedoms and available to  consumers and businesses in a Net Neutral environment.

Barack Obama promised in the 2008 and 2012 campaigns that he would enforce Net Neutrality. He has not kept that promise.  

The affect on Americans’ freedoms will be as bad or worse than Obamacare.

Please write to your congressmen and President Obama and ask them to preserve Net Neutrality.

Thank you

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

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Bureaucratic Barriers To Medical Care

Stanley Feld M.D.,FACP,MACE

The greatness of America lies in the freedoms provided by the constitution and the bill of rights.

These freedoms have stimulated Americans to be innovative, creative and inventive.

The constitution promotes individual freedoms with the federal government being held in check by the states.

Many feel that over the last 50 years as society has become more complex the power of Federal government has increased. The central government has increased its power, limited individual freedoms and increased control over the people.

The usurping of power by the Federal government seems to have accelerated over the last 5 years.  President Obama has even usurped power over the congress and might have intimidated the Supreme Court. He has decreased the effectiveness of the checks and balance system.

It could be argued that congress has given President Obama and his administration the power and control in the checks and balances system that congress is supposed to have.  

Obamacare is the best example of this. When Sarah Palin screamed about the Independent Physician Advisory Board (IPAB) being a “Death Panel” she was ridiculed as being ignorant.   

Sarah Palin’s fear was that government bureaucrats, opposed to individuals making that decision, would usurp the individuals’ right to make their own life-and-death medical decisions.

The argument for the formation of the IPAB is that this board will make rational and cost effective medical treatment decisions that individuals are incapable of making.

The IPAB will take the freedom of treatment choice out of the individual’s hands.

I contend that the ultimate goal of Obamacare is to work toward a single party payer system. The government will be the single party payer.

Since the government is the payer, the government will say it is entitled to make the best and most cost efficient treatment decisions for patients.

I have heard cries from Democrats that this is not President Obama’s intention.

The irony is that it is happening right now. CMS is issuing regulations to restrict care even before the IPAB has been formed.

“The introduction of a powerful and largely unaccountable board into health care merits special scrutiny.”

In the Affordable Care Act unfettered power to make policy decisions has been given to the Secretary of Health and Human Services by a partisan Democratic congressional vote.

Last year (2013) government bureaucrats had already usurped a life-and-death medical decision. Health and Human Services Secretary Kathleen Sebelius refused to waive the bureaucratic rules barring access to the adult lung-transplant list by 10-year old Sarah Murnaghan.

 A judge ultimately intervened and Sarah received a lifesaving transplant June 12,2013. 

There will not be recourse for patients to any IPAB decision once the IPAB is formed. Obamacare also stipulates that there "shall be no administrative or judicial review" of the board's decisions. Its members will be nearly untouchable, too.

 “But the grip of the bureaucracy will clamp much harder once the Independent Payment Advisory Board gets going in the next two years.”

“An Obamacare Board Answerable to No One.”

The IPAB is directed to:

  1. Develop detailed and specific proposals related to the Medicare program.
  2. Include proposals cutting Medicare spending below a statutorily prescribed level.
  3. Encourage to make rules "related to" Medicare.

 The IPAB will control more than a half-trillion dollars of federal spending annually. After the health insurance exchanges failure the IPAB will control the 2.7 trillion dollar healthcare industry.

Once the board acts, its decisions can be overruled only by a three-fifths supermajority in Congress. If the IPAB fails to implement cuts in spending, all of its powers are to be exercised by the HHS Secretary.

None of the Republican congressmen have made a stink about this board since Democrats shot down Sarah Palin for being so ignorant as to call the IPAB “Death Panels.”

The Obama administration is feeling its oats even before the IPAB has been formed.

CMS created its own panel to restrict access to care. The panel is called Medicare Evidence Development and Coverage Advisory Committee.

Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers. The nine-member panel is against Medicare paying for the screening tool.

 A December 2013 recommendation by the U.S. Preventive Services Task Force said current or past heavy smokers ages 55 to 80 should get the scans. The two government agencies have contradicted each other.

I wonder if there was a pulmonologist or lung cancer special on either panel. Is this what we are to look forward to with the IPAB?

Under Obamacare, the U.S. Preventative Services Task Force's recommendation means that private insurers are required to cover the screening with no out-of-pocket obligation for their non-Medicare members.

The reason is Obamacare offers better insurance policies through the health insurance exchanges than insurance coverage pre Obamacare. The increased cost is passed on to the consumer in higher premiums.

This is called redistribution of wealth.

The CAT scan should typically cost $300 to $400. If the patients were responsible for the bill under present law, it might cost $1,000- $2,000 dollars.
 
The Medicare Evidence Development and Coverage Advisory Committee advises CMS on coverage determinations. The committee gave a lame explanation for the reason to discontinue coverage.

 The committee members said they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.

The USPSTF made their decision based on the National Lung Screening Trial, which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays.

Smoking-related lung cancer kills about 130,000 Americans each year.

 The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease.

The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented.” 

Which government agency is right?

It is not enough for the Medicare panel to say, “they agreed the study was impressive in its implementation and results, they concluded it was not enough to recommend a new coverage policy to the CMS.”

Is the makeup of the committee qualified to make that judgment that will affect 20,000 patients’ lives?  Unknown.

Please note that patients (consumers) had no input on the decision. We are told that President Obama is an advocate of disease prevention.

This recommendation contradicts President Obama’s pledge to prevent the onset of disease or to catch disease early in order to cure the disease.

 The two agencies even contradict each other. Which one is right? Where is the scientific discussion?

Should Americans give up their freedom of choice to inconsistent government bureaucrats who might not be qualified to make the personal decisions for them?

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

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Who Can You Trust?

Stanley Feld M.D.,FACP,MACE

On April 16th President Obama declared that Obamacare is a success. He said over 8 million people had enrolled through the health insurance exchanges.

He did not know how many had paid the first month’s premium or how many enrollees would be subsidized by the government.

He did not know how many had a chronic illness or pre-existing conditions. He said that 35% of the enrollees were under 34 years of age. This is short of the 37% needed to make Obamacare financially viable but he said it was close enough.

 It turns out that only 66% of the enrollees paid their first month’s premium by the April 15th.  This was the deadline set by the administration. Republican lawmakers issued a report last week using healthcare insurers data.

If the insurers knew the numbers the Obama administration and President Obama certainly knew the numbers.

My guess is less than 2 million people who were previously uninsured obtained insurance. The administration is withholding the figures to avoid protest about its failure to provide insurance for the uninsured.

In his press conference he declared Obamacare is a success and Republicans and the media should stop talking about Obamacare’s failure

“Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.”

"The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working and I know the American people don't want us spending the next 2½ years refighting the settled political battles of the last five years."

It turns out President Obama’s success numbers of 8 million enrollees contradicts all the healthcare insurance companies’ tallies of insurance holders.

Why did President Obama lie? President Obama’s goal is to manipulate the media and fulfill his agenda.

The mainstream media does not believe him or his administration any more. This mistrust has been accentuated by the recent Benghazi information that the administration had tried so desperately to withhold.

I do not want to talk about these lies.

I want to talk about other promises about Obamacare that are turning out to be lies and deceptions.

In a recent report a New York woman suffering from a neurological disease that has required four brain surgeries has been dropped by all of her doctors and denied medications due to her Obamacare plan.

She suffers from a disease known as Arnold Chiara Malformation and Syringomyelia.

This 49-year-old woman said, "I've been vomiting. I lost 22 pounds. The pain is unbearable.”  "My medication helps me function during the day."

The Obamacare plan she purchased assured her that she was covered for her medications and her disease.

Nevertheless her insurance card was denied when she went to fill her prescriptions. None of her doctors have accepted her Obamacare plan.

In all of Staten Island there are only six doctors who accept her plan. She has been unable to get an appointment with any of them.

This is one of many complaints that patients are making to their congressmen who face the same problem with Obamacare’s narrow networks and the extreme restrictions of Obamacare to physicians and hospitals.

 "Even though the insurance company cashed your check, it doesn't mean it (the policy) has been implemented."  

These stories are just beginning since most of the people who have signed up have pre-existing illnesses. Obamacare is already making people furious. The fury might be disguised by the traditional media’s ignoring the fury or downplaying it. The complaints might be further diluted by the fact that President Obama has given waivers to the majority of people covered by their employers or unions.

This strategy is clever. After people in the individual market get tired of complaining Obamacare will be so rooted that the rest of the populations will find it unproductive to complain.

I think President Obama is miscalculating the American peoples’ resolve. The strategy will not work.

Obamacare’s narrow networks are limiting specialty centers. The Associated Press says just 4 of 19 nationally recognized comprehensive cancer centers offer Obamacare access through all insurance plans in their state Obamacare exchanges.

President Obama’s promise of access to care and the lack of rationing of care is turning out not to be true.

All one has to remember is that President Obama ridiculed the Republican’s suggestions that Obamacare was going to create “death panels.”

He said it would never happen. It looks like it is happening.

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

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