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Disinformation and the healthcare system

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The Meaning Of Trust

Stanley Feld M.D.,FACP,MACE

 Trust is a big five letter word.

 

a :  assured reliance on the character, ability, strength, integrity or truth of someone or something

b :  one in which confidence is placed

2 a :  dependence on something future or contingent :  hope

 

Thanksgiving is a time of giving thanks for all we have to be grateful for.

This Thanksgiving the majority of Americans do not trust President Obama.

Suddenly there is an awareness that most of us were mislead on many of his policies.

The biggest mistrust resulted from his signature legislation, Obamacare.

Americans have also been programed by television and their digital devices to have a short attention span.

We become easily distracted.  

Overloading us with incongruous facts that have nothing to do with our livelihood causes us to forget these details quickly.

On this Thanksgiving we should be grateful that we have the freedom to put the facts together to give them coherent meaning.

In short, our President and our government officials have lied to us for the last 5 years. The goal was a government take over of our lives.

Americans are finally paying attention as their livelihoods and healthcare coverage are being threatened.

President Obama has lost the trust of the American people.

The details of this erosion of President Obama’s trustworthiness is demonstrated by the following You Tubes.

1. The lack of privacy and avoidance of HIPA Compliance is pointed out in this congressional hearing. The traditional media has not covered this important confession. The testimony emphasizes his disregard of a promise of privacy by President Obama.

  

http://youtu.be/uOk0vOup4yA

 2. This video puts every promise and lie into historical perspective. It is worthwhile viewing to the entire video

 

http://youtu.be/LGeWMPFlGlY

3. The following video is a navigator explaining credit risks and the insurance companies deciding to admit people to Obamacare after they have applied.

Please start at 9 minutes and 55 seconds into the You Tube.

  

http://youtu.be/Aywn34RcAIo?t=9m55s

 

4. The last video is called “Obamacare Is The Biggest Swindle Ever.” This is nothing people do not know.

However it is a good memory stimulator. Everyone remembers the quote “You can fool me once, you can fool me twice, etc.”

  

http://youtu.be/sMFLbRilj3M

On this Thanksgiving we should be thankful for our freedoms. We should be thankful for our freedom to think and our freedom to express ourselves.

Even though the first amendment has taken a beating in the last 5 years it is surviving.

We must be thankful we live in a country that is run by government of the people, by the people and for the people.

We must appreciate our power as individuals.  

We must recognize which government officials have done the people wrong.

At this time we must exercise the power of our vote to get rid of them and elect surrogates who will run the government for the people and not surrogate who want to control the people.

President Obama has relinquished our faith in bestowing our trust in him as our surrogate.

His attempts at talking his way out of the mistrust is only making the mistrust worse.

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

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Obamacare’s Disasters Are Unfolding

Stanley Feld M.D.,FACP,MACE

Along with the web site’s disastrous failures, other impending Obamacare disasters are unfolding.

Things look so bad for Obamacare that President Obama sent out a directive to change its name from Obamacare to the Affordable Care Act.

I believe Americans are well aware of the fact that Obamacare is neither affordable nor accountable to consumers. A name change will not help. Obamacare will not bend the cost curve nor save each family $2500 a year for healthcare insurance.

I have pointed out the problems with Obamacare since before its inception.

The list includes;

 Loss of your current insurance policy.

  1. Loss of your present doctor.
  2. Loss of participating doctors in your network.
  3. Loss of your present insurance coverage.
  4. Failure of the development of Accountable Care Organizations.
  5. Failure of Pay4Performance measures to reimburse physicians and hospitals.
  6. The lack of incentive for consumers to take care of their health or healthcare dollars.
  7. The lack of dealing with the issue of tort reform. Tort reform would lower the cost of care dramatically.
  8. It does not decrease healthcare insurance industry abuse of the Medical Loss Ratio.
  9. It has not increased the ease of data transfer among providers.
  10. The loss of freedom of choice for consumers and physicians.  

 Consumers are becoming outraged at the inefficiency of implementation as all these are beginning to affect them personally.

 Where is the physicians’ outrage?

Premiums and deductibles are rising. Medical care is starting to be rationed. The intensity of the outrage will rise as access to care decreases.

A physician friend of mind who is over 65 years old on Medicare said Medicare has been good to him and his wife.

Medicare has also been good to his practice of internal medicine. He believes America should have Medicare for all with a single party payer.

I just listened and smiled. The old Medicare system is unsustainable. Wait until he sees the new Medicare premiums for seniors and the reimbursement schedule for physicians in 2014.

Forget the regulations he is going to have to deal with. Forget the restrictions of access to care he will have to deal with. Forget the rationing of care he will have to deal with.

It will not be pleasant.

Consumers are realizing they are the victims of higher prices and lower levels of care. Hospitals, insurance companies and doctors are also going to be the victims of enslavement by regulations.

 Government bureaucracy, inefficency and waste will flourish.

I hope everyone realizes that the individual market was the first market to be attacked by Obamacare because it is the smallest market. The individual market only affects 5 million people.

The next market in line to be destroyed is seniors and Medicare. It is starting already with the destruction of Medicare Advantage.

The employer sponsored healthcare insurance market will start being destroyed in 2014.

President Obama just delayed the implementation of the private market mandate from October 15th until after the November 2014 elections.

The delay will not take the spotlight off the failure of Obamacare and protect Democrats from the outrage of Americans toward Democrats during to 2014 election campaigns.

I believe the American people are on to President Obama’s tactics of attacking his enemies personally.

Consumer outrage about Obamacare will dominate the media despite President Obama’s attempt to manipulate the liberal traditional media.

 He seems desperate to create a distraction. His Iranian deal will create a temporary distraction.

President Obama brought several selected progressive “influential  commentators” to the White House for a little policy briefing last week.

They all said the meeting was confidential. I say the meeting was an attempt at media manipulation. Hopefully the media is realizing reality.

Obamacare was supposed to be built by the best minds in the healthcare policy business. It appears the problem was these best minds knew little about the healthcare insurance business, the hospital system business or the practice of medicine.

Obamacare has not aligned any of the vested interests of the primary and secondary stakeholders. In fact, misalignment of vested interests has increased since passage of the law.

I cannot figure out what the President Obama was thinking. All signs point to the fact that President Obama wants to destroy the present healthcare system and replace it with a single party payer system.

I have pointed out multiple examples in this thinking including President Obama’s declaration as far back as 2003 and since that he prefers a single party payer system.

He has also emphasized that the universal care system he will put into place (Obamacare) is a transitional system. It is a system that will collapse and be replaced with a single party payer.

  

http://youtu.be/BKkTRMEyAhs

This You Tube is compelling. It demonstrates President Obama’s ideological goal not practical goals. 

President Obama admits that Obamacare is a transition system. He wants to eliminate employer sponsored healthcare coverage and the destruction of the healthcare insurance industry.

President Obama simply ignores the fact that the administrative services are provided by the healthcare insurance industry to administer Medicare and Medicaid.

The government could not do it without the healthcare insurance industry. The cost of the administrative services is a non-transparent 40% of every Medicare and Medicaid dollar.

Medicare and Medicaid are single party payer systems. The healthcare insurance industry presumably bids for each states contract. Indirectly the healthcare insurance company rips off the consumers by ripping off the government for the administrative service for Medicare and Medicaid.

All we have to do is remember the $2,000 toilet seats in a government cargo plane to understand the efficiency of a government run program that outsources the fulfillment of a mission.

It is hard for most people to believe that President Obama’s purpose all along was to destroy Obamacare (his namesake) and replace it with a single party payer system.

Everyone must notice that he is now been calling Obamacare the Affordable Care Act.

 

I am sure he wanted the hysteria that is going on right now over dropped insurance coverage, dropped physicians and changed insurance plans to subside.

However he did not expect the mistrust the public has for him. The genie is out of the bottle. The country doesn’t trust this nice guy anymore.

He did not expect the outrage to be directed at him. This is the reason he is blaming the failure on the Republican Party one day, the healthcare insurance companies the next and doctors and hospital systems the next.

He has also giving special favors to his political base. These favors has made the middle class public very angry at him.

A more glaring favor is exempting all of congress from participating in Obamacare.

The fast food companies’ exemption has angered small business owners.

Exempting unions from Obamacare has been totally disgraceful.  

The destruction of Medicare Advantage for seniors is on the way.  Senior outrage will be seen in the next few months.

President Obama is going to try to blame the healthcare insurance industry, hospital systems and physicians for this disaster.

Very few Americans are going to believe him.

Americans understand that he is forcing premium prices and out of pocket expenses up with unnecessary bureaucracy and regulations.

He is restricting care to the elderly and access to care in hospitals and doctors’ offices.

He has created greater dysfunction in the healthcare system.

The dysfunction is going to get worse.

He will achieve his goal to force the healthcare system to collapse.

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

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President Obama’s “Noble Lie”

Stanley Feld M.D.,FACP,MACE

The Obama administration has been riddled with multiple scandals such as Fast and Furious, IRS, Benghazi, the red line on Syria, saying he is protecting Israel’s back, NSA and now the Obamacare roll out.

Bob Woodward on the Chris Wallace Show on November 18th said he was not impressed with President Obama’s lie about Americans keeping their own insurance and their doctor if they like him. 

To paraphrase Bob Woodward’s comment he said President Obama’s goal was to do something Noble for the American people. He wanted to provide insurance for the 30 million uninsured Americans.

My impression is Bob Woodward was forgiving President Obama’s  “Noble Lie.” He moved on to the disastrous rollout of the Obamacare  web site.

  

 

http://youtu.be/gVp54E18NFU

I was floored.

I thought about Bob Woodward’s statement for a long time. His statement reminded me of Plato’s Philosopher King.

My humanities teacher at Columbia College, Gilbert Highet ,was obsessed with Plato’s concept of the “Noble Lie.”

Gilbert Highet believed it is the duty of the intellectual to support freedom and defend pluralism.

He emphasized that the concept of the “Noble Lie” was exactly what the American founders rejected in the Declaration of Independence, the Constitution and the Bill of Rights.

The very next day one of my readers sent me an article by historian and author Arthur Herman ("The Cave and the Light: Plato Versus Aristotle, and the Struggle for the Soul of Western Civilization) concerning Plato’s “Noble Lie.”

 

He wrote,

Thomas Jefferson once confessed to John Adams that he had been rereading Plato’s "Republic" and “laid it down often to ask myself how it could have been that the world should have so long consented to give reputation to such nonsense as this,” including the notion of the Noble Lie.

They knew rulers, no matter how well educated or experienced, actually have no superior knowledge to ordinary people, because they all understand and judge reality at the same level.

That’s why Noble Lies aren’t just wrong. They also don’t work very long because citizens can see what’s real and true just as clearly as any of Plato’s Philosopher Kings, and sooner or later will catch them out.

President Obama has a knack of moving the traditional media quickly off one “Noble Lie” on to another before the first lie and its consequences can be fully appreciated by the people.

George Will had a wonderful statement about this ability. He called it

Clunker progressivism.

“Barack Obama’s presidency has become a feast of failures whose proliferation protects their author from close scrutiny of any one of them.

Now, however, we can revisit one of the first and see it as a harbinger of progressivism’s downward stumble to HealthCare.gov.”

The following quote of Plato by Arthur Herman sounds a little bit like Bob Woodward’s statement last Sunday.

 It is the business of the rulers of the city,” Plato wrote in his "Republic," “to tell lies, deceiving both its enemies and its own citizens for the benefit of the city…”  

In fact, the wise ruler — Plato’s Philosopher King — must be prepared to “administer a great many liesand falsehoods,” Plato went on, for the benefit of the masses.  

Plato goes on to justify the “Noble Lie.”

 “The Philosopher King knows that they are too ignorant to ever see the truth about their city’s problems and how to fix them.”

“And at times it’s only through telling what Plato called “a noble lie” that he or she can get the people’s cooperation in achieving it.” 

Mr. Obama, you are not Plato!

The traditional media and the Democratic Party promote these Noble Lies.

Arthur Herman goes on to say,

And every lie is planted for a single end: to justify increasing the power of the federal government, and with it the clout of its Number One champion, the Democrat Party.”

The Democrats who voted for Obamacare either knew or understood its provisions. If they did not understand the provisions because they did not read the bill before they voted for Obamacare they were not doing their job.

It was predictable that Obamacare would be a disaster for ten of millions of Americans already holding health insurance policies. 

Above all, they knew their president had deceived the American public into accepting this financial and moral disaster, in order to clear the way for a single payer, completely government-run health system”

In either case they should all be thrown out of office.

Americans have not seen anything yet!

Wait until they try to see a doctor or receive access to needed medical care once Obamacare get further on down the implementation road.

It is going to get worse!

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

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Medicare’s Perverse Incentive Against Seniors

Stanley Feld M.D.,FACP,MACE

It is all about money. It is about the government spending less, the hospital collecting more and the patients getting stuck with the bill.

Government officials realize that Medicare costs are unsustainable. CMS creates rules and regulations to expose Medicare to less liability.

Unfortunately the unintended consequence is that CMS exposes Medicare patients to more liability in the process.

Less than 20% of seniors are sick enough at any point in time to require hospitalization.

In an attempt to save money, a distinction has been made between a hospitalized patient and patients in the hospital under observation.

This system has been a disadvantage to many Medicare patients.

It has helped the government slightly in reducing costs. It has helped the profitability of the hospitals greatly.

Seniors are not aware of these perverse incentives until they get stuck with the out of pocket costs of being admitted for observation.

The government and the courts have ignored seniors’ protests.

 What are the issues?

Under the rules, Medicare pays the entire bill for the first 20 days in an approved skilled nursing facility (nursing home) for rehab or other care if the patient needs it.

Seniors must spend at least three full days as hospital admitted patients in order to qualify for the approval.

 If a patient was admitted under observation, for all or part of two midnights, he or she would be responsible for the entire cost of rehabilitation. The government has agreed to pay for rehab for hospitalized patients because its daily cost of skilled nursing care is less than the daily hospital costs.

“The federal Centers for Medicare and Medicaid Services tried to clarify this confusing situation in the spring of 2013 with a policy popularly known as the “two-midnight rule.”

When a physician expects a patient to stay in the hospital for more than two midnights that person is admitted to the hospital as an inpatient hospitalization.

The patient’s care is covered under Medicare Part A, which pays for inpatient hospitalizations.

If a physician expects that the patient will stay less than two midnights, the physicians are forced by the hospital to admit the patient as an outpatient.

As an outpatient only Medicare Part B pays for hospital outpatient services to the hospital and physicians.

The hospital makes more money from outpatient services than it does from inpatient services. All procedures are billed as separate entities rather than the hospital receiving a bundled fee for the disease being treated.

Hospitals have figured out how to stretch the outpatient admissions days to three days. Patients are admitted for observation one minute past midnight.

Under Part B, they’re billed separately for every procedure and visit and drug, and the co-pays can mount until patients owe hundreds or thousands of dollars — which they may only discover upon receiving the bills.

Medicare Part F pays the deductibles. However many seniors cannot afford Medicare Part F.

“People are shocked when they receive the bill. Nobody is required to tell them they’re outpatients.”

Those patients who have been outpatient admissions do not qualify for the rehab benefits. Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services

The Medigap supplemental policy (Medicare Part F) does not pay the out-of-pocket costs of services that Medicare Part A does not cover. Since Medicare Part A does not cover outpatient admissions the patient is stuck with the bill.

Over the past several years, hospitals throughout the country have increasingly classified Medicare beneficiaries as observation patients instead of admitting them, according to researchers at Brown University, who recently published a nationwide analysis of Medicare claims in the journal Health Affairs.

 The results showed that in just three years, 2007 through 2009, the ratio of Medicare observation patients to those admitted as inpatients rose by 34 percent.

Medicare tells hospitals that the decision to admit or discharge a patient who is under observation can most often be made in less than 24 hours.

 "In only rare and exceptional cases do reasonable and necessary outpatient observation services span more than 48 hours," says the Medicare Benefit Policy Manual (PDF), the agency's coverage bible.

But the Brown University study found that more than 10 percent of patients in observation were kept there for more than 48 hours. And it identified more than 44,800 who were kept in observation for 72 hours or longer in 2009 — an increase of 88 percent since 2007.”

How come?

There are two important reasons.

Outpatient hospitalizations mean increased out of pocket expenses for most patients. Prescription drugs in Outpatient hospitalizations are covered under Part B or Medicare Part D drug benefit plans.

Some Part D drug benefit plans have very high deductibles. This is true of brand drugs. It increases the out of pocket costs of the senior.

The hospital determines whether a patient is classified as an inpatient or placed under observation. In many cases the hospital overrules the patients physician’s judgment.

Hospitals are placing more and more patients under observation to protect themselves against new government policies.

These policies penalize hospitals for unnecessary admissions and frequent readmissions of the same patient. These policies withhold payment for patients re-hospitalized within 30 days. Patients hospitalized under observation are not counted as a readmission.

Hospitals have figured out a way of controlling costs as well as increasing profit.  This hospital action is absolutely understandable. Physicians do not benefit.

Who loses?

The unintended consequence is that the senior patients lose.

The problem is most seniors are not aware of what is going on.

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

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The American Awakening

 

Stanley Feld
M.D.,FACP,MACE

Many of my good liberal
friends have been upset with me since Obamacare was passed into law.

I read the 2000 plus
page bill. I was distressed by the many changes to Americans’ freedom to
choose, increased hidden taxes, and the obvious road to the destruction of the
healthcare system.

I immediately regretted
my vote in 2008 for President Obama even though I liked the guy’s style.

I felt he knew little
about how the healthcare system worked. I soon learned he was not interested in
listening to practicing physicians.  

I have tried to follow
the 20,000 new regulations that have served to increase the mess that has been
created. I have reported on some of them.

Unfortunately the
traditional media has remained enamored by President Obama’s charm. The
traditional media had continued to dismiss reality until the recent web site
disaster.

The Obamacare disaster
is much worse than the web site disaster by itself. I sense the traditional
media is buying the explanation.

The reality is this web
site disaster represents the worst example of cronyism. It is even worse than
the Solyndra scandal. The Solyndra scandal on cost $535 million in federal guarantees .


The administration
issued a non- bid contract of $634 million dollars to a company in which an
executive is a good friend of Michelle Obama.
CGI’s web site looks fantastic.
The reality is they have had health insurance exchange software programs that
have failed in three provinces in Canada.

President Obama has been
lying his way through the web site disaster. The bizarre thing is he thinks he
will get away with it.

 

 
 

http://videos.nymag.com/video/If-You-Like-Your-Plan-Supercut

The public is becoming aware of the fact that Americans are
losing their healthcare coverage by political design.

President Obama is rapidly losing the trust Americans had in
him as reflected in the polls.
They fear they might lose their own healthcare
coverage next.

The
law is systematically dismantling the individual insurance marke
t, as its
architects intended from the start.”

I have been saying this since 2008. The aim of
Obamacare is for Americans to not to have a choice remaining. It will be a
single party payer system by default.

The traditional media is waking up. The first
wave is the 14 million people in the individual insurance market. Those 14
million Americans are being trapped into Obamacare. The 14 million are making a
big stink. President Obama is caught in an outright lie.

“Until
this month, consumers who weren't insured through their jobs were allowed
to
buy insurance that provides the best value based on their own needs. One of
every 10 private policies is sold through the individual market, covering about
7% of the U.S. population under age 65.”

President Obama did a clever thing. He gave a
waiver to the group insurance market until 2015. The traditional wisdom is that
the waivers were given because Obamacare was not ready to service the group
market.

The real reason for the waiver was to avoid
the uproar from 160 million people who have group insurance.

The 160 million Americans who will lose their
group insurance coverage next year will find out they have been deceived by
President Obama.

“The millions of Americans who are receiving
termination notices because their current coverage does not conform to Health
and Human Services Department rules may not realize this is by design.”


The administration is rolling out its media
spin. President Obama is trying to blame everyone in sight except himself. He
is blaming the healthcare insurance industry and Fox News for his debacle.  
 

President
Obama has blamed Fox News for inciting people to be against Obamacare. A reader
sent me this You Tube of Neil Cavuto's reply to President Obama. Mr. Cavuto
hits the nail on its head.

Cavuto: Mr. President, we at Fox News are not
the problem.”

 


 

http://youtu.be/DDdmtJCEWPA

President
Obama felt that free choice is a threat to Obamacare. If too many
people could keep the insurance policies they liked instead of joining the
government exchanges Obamacare could fail.

It has
been now been shown that his goal in 2010 was to destroy the private healthcare
coverage market.

“Liberals
believe they must destroy the market in order to save it.”

 The healthcare plans
the President promised people could keep have been intentionally outlawed by
regulations written by Kathleen Sibelius in the Federal Register as far back as
2010.

“The
goal is to force individuals earning more than $46,000 or a family of four
above $94,000, who don't qualify for subsidies, into the overpriced health
insurance exchange.”

“If these middle-class ObamaCare
losers can be forced into the exchanges, they become financiers of the new
pay-as-you-go entitlement.”

They
will pay $10,000 a year for a healthcare plan that people earning under that
amount will pay less than $1,000 per year. The government subsidy will finance
the difference.

If
enough people earning more than $46,000 and $94,000 a year do not sign up for
Obamacare, the federal government will have to make up the difference to the
insurance company that is providing the administrative services for that
healthcare coverage.

I hope
people remember another of President Obama’s promises. He said families making
under $250,000 a year would not pay one
dime extra in taxes
. The traditional media has ignored this lie.

 

http://youtu.be/cJ5fOsyj-bk

The operative
word that exposes the lie is “Not a
penny more in taxes on nothing because the last thing we want to do is to put a
burden on the middle class.”

  

http://youtu.be/7uoE_NicaMY

What
about all the hidden taxes? What about all the tax increases passed on to the
middle class in the form of increased prices?

One
can say President Obama is a genius as well as a liar. His goal is to destroy
the healthcare system and the middle class.

He is
on course to succeed unless the American people stop him.

I am
pleased that Americans are starting to wake up to his goals and are starting to
rebel.

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

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The Devil Is In The Details

Stanley Feld M.D., FACP,MACE

 

The devil
is in the details. Many of the Obama administrations sound bites are lies.

The Megyn
Kelly interview of Ezekial Emanual on the Kelly File October 25th
2013 is a must watch video. It is worth 9 minutes of every American’s time.

The Obama
administration rolled out one of the chief architects of Obamacare to provide
disinformation about the pending success of Obamacare.

 

  

 http://youtu.be/cwfk3vOvzvE

I have
written about Ezekial Emanuel’s disinformation campaigns.
His misinformation is
based on incorrect facts leading to misguided conclusions.

This Megyn
Kelly interview is a perfect example of President Obama’s disinformation
campaign.

The
interview starts with President Obama’s promise that Obamacare will let you
save up to $2500 on insurance premiums and be able to keep your doctor and your
insurance plan if you like them.  Obamacare
will bend the cost curve. It looks like Obamacare is going to bend the cost
curve up not down.

Dr. Emanuel
says it is not President Obama’s fault that people cannot keep the same doctor or
healthcare plan
. Corporations and the healthcare insurance industry changed their
insurance rules for business reasons. Obamacare did not change the rules.

Obamacare
forced the healthcare insurance industry to change its rules.

Is Dr.
Emanual in denial or is he lying?   

Dr. Emanuel
contradicts himself immediately by saying it is unethical and immoral to sell
healthcare insurance plans that do not cover bare minimum care coverage such as
maternity care, preventive care (not defined), pregnancy, pediatric dental care
and drug coverage.

It should
be obvious that everyone does not need maternity care or pediatric dental care.

Ezekial
Emanuel then continues with a rant about McDonald’s Minimed insurance coverage
plans
being immoral and unethical.

This is a
point at which reality and being disingenuous gets buried in the weeds.

President
Obama has allowed corporations to avoid penalties by using “minimal essential coverage” criteria. 

Dr. Emanuel certainly knows about and understands this nuance. The Obama
administration has certainly not explained it to the public.

Dr. Emanuel
also ignores the fact the President Obama’s gave waivers to 13,000 companies permitting
them to continue to provide Minimed coverage until January 2014. It has now
been extended until January 2015.

President
Obama has modified minimal essential coverage
criteria
through CMS administrative regulations bypassing congress.

In August
2013 The Kaiser Foundation News published an article called “Why Health
Law's 'Essential' Coverage Might Mean 'Bare Bones' “

 “It came as a surprise
to some that the Affordable Care Act seems to allow large employers to offer
health insurance that pays for preventive care and not much else.”
 

“How can Ezekial Emanual
brag about a law he praises for expanding coverage — one that includes an
"employer mandate" to offer "minimum essential coverage" —
allow companies to offer insurance that might not even cover hospitalization?

I will
spend the rest of this blog explaining this nuance.

Dr. Emanuel
misinforms the audience throughout the interview.  

There has
been no outright ban on these skinny plans — even after the employer mandate
kicks in in 2015.

Instead,
large employers — those with 50 or more full-time employees — run the risk of
fines (penalty) only if the coverage
doesn't conform to ACA (Obamacare) rules.

 The
regulations published so far, however, seem to allow skinny plans
with a
penalty that many employers may choose to pay because it is less costly than
offering fuller coverage.”

There are two fines in the health law for
large employers.   There is a $2,000 per
employee fine for any company that does not offer "minimum essential coverage."

Most people
do not know that the fine is only triggered when at least one employee enrolls
in the health insurance exchange and receives subsidized coverage.

If none of
the employees enroll and get subsidized coverage from the government, the
corporation is not liable for the $2,000 per employee fine.

What
is the definition of “minimum essential
coverage
”? It is not the same as  "essential health benefits," that
include maternity benefits and prescription drugs. Those essential health benefits vs. minimum essential coverage are
benefits that must be included in plans sold to individuals or small employers.

Who
suffers? The small businessman, and the individual buyer in the health
insurance exchange will suffer the most.

Most
large corporations are self- insured. A self-insured company provides dollar
coverage for their employees’ illness. The company pays the bills minus the
deductibles for each employee. The corporation is assuming the risk rather than
the healthcare insurance company.

The
insurance company does the administrative services just as they do for the
federal government for Medicare, Medicaid and government worker insurance
(Medicare Part C). 

The
self-insured corporation is the sponsor for the health insurance. A
self-insured corporation passes one test necessary for “minimum essential coverage.” This avoids the $2,000 per employee
penalty (fine).

If
the company goes over the amount the company paid the previous year to cover
employees’ illnesses, the corporations pays the difference in the following
years administrative services fee to the healthcare insurance carrier.  

 The regulations are
obscure
, defining minimum essential coverage largely in terms of what it is not.
Therein lies the loophole.

“As a result, many
experts believe large employers can shield themselves from the $2,000 penalty
by offering a plan that covers the health law's required preventive care, but
still leaves workers vulnerable to thousands in bills if they're hospitalized.”

The young people working for
minimum wage at McDonald don’t want to spend their money on full healthcare
insurance. They believe they will not get sick. They cannot to buy insurance
through the health insurance exchange.

They do not want to go on Medicaid.
Many physicians view Medicaid as unacceptable insurance.

Government reimbursement is for
Medicaid is extremely low. In some cases it is lower than the physician’s
overhead to provide the care.

Many physicians do not take
Medicaid patients. This results in long waits for appointments, a lack of
access to timely care and in many cases rationing of care.

Medicaid is free to the
needy. Nonetheless the government must pay the insurance industry for their
administrative services.

According
to Alden Bianchi, a Boston-based benefits and compensation lawyer. “

“Skinny coverage flunks the
test, based on regulations that
measure minimum value
against "benchmark plans" in each state.”

The trick
is the employer penalty is only $3,000 for each worker enrolling in subsidized
exchange coverage. The fine is not imposed on the employer for all workers.  

The fine
will be much less than the fine for not offering a minimum essential coverage
plan of $2,000 per employee if one employee buys subsidized coverage through
the health insurance exchange.

Bianchi,
who represents large employers said in an industry
brief
.

 “The people who wrote the law intended to give
companies a bare-bones option.”

"The ability to
offer such plans is a result of conscious policy decisions by Congress, as
implemented by the regulators."

I
think he is wrong.

I
think the Cato Institute’s Michael Cannon is right.

Cannon
suspects the administration "had no idea what they were doing," as he wrote
on the libertarian think tank's blog.

I
think President Obama’s goal is to drive everyone into the health insurance
exchanges and use the “public option.” 

The
health insurance exchanges’ non-subsidized options are in some cases double the
previous price for healthcare insurance despite the claims of the Obama
administration.

Obamacare
is now backfiring on the President and his administration.

I
apologize for not exposing the misinformation of each point Ezekial Emanual was
sent out by the Obama administration to make on the Kelly File.

It
is all disinformation and spin.

I felt
it was important to explain the confusion created about the $2,000 and $3,000
dollar penalties attached to the mandates.

The
corporate self-insured have figured out a way to get around the mandate and
penalty. They also get around the mandate by hiring only part-time new
employees who work less than 30 hours per week.

President
Obama has bragged that new job creation is slowly improving. However, 77% of
the new job creation is for part time employment.

If
one puts it all together it spells hard times for economic growth and
Obamacare.

I
implore you to watch the video and hear disinformation one of President Obama’s
architects is peddling.

 The issue is becoming clear. Can the American
people trust President Obama to tell them the real story?

My
impression is that it is doubtful.

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

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Permalink:

The Method Of Operation

Stanley Feld M.D.,FACP,MACE

It’s clear. President Obama
has used the same techniques to neutralize the scandals and mishaps during his
administration.

In has been the same for Benghazi,
NSA, IRS, and Fast and Furious scandals.

President Obama makes his
characteristic statement, “This is unacceptable
and we will get to the bottom of this.”

After this statement there is
never any follow-up. What has been done? Has President Obama gotten to the
bottom of it?

The public never learns who
was responsible for the debacle. No one ever gets fired and the traditional
media carries on. The public soon forgets about a non-resolved scandal.   

President Obama always leads the
public to believe he had nothing to do with the scandals or the decision-making
leading to the scandals.

He is the President. He should
know. If congress investigates the scandal it gets stonewalled by the administration. The investigationg committee then is accused
of muckraking.

Somehow the traditional media
buys this story and sells it to the public. It is the journalist’s obligation to
dig into a scandal and find out the real story. It is not done.

Nothing this administration
does has been transparent. The traditional media ignores the scandals and so
does the public.

The devil is always in the
details.  

The real story is the attack on individual
freedoms and choices. They are being impinged upon by the bureaucratic regulations of
big government. The traditional media should make this clear.

America does have a freedom
of information act and constitutional rights that have to be protected and not
ignored.

All the participants in the
various scandals finger point to others being responsible for the actions that
would not be approved by the people.

No one ever questions whether President Obama is
responsible for the scandals.  

The same method of operation
is being put in place to explain the colossal disaster of www.healthcare.gov’s rollout.

The Obamacare web site has
many problems. It is not a simple fix as the President and his administration
has declared it to be.

President Obama claims he did
not know anything about the problems before the launch. He has promised to get
to the bottom of this.

He is finger pointing to
everyone except himself and his administration. 

If the Obama administration
did not know about the impending failure it is either stupid, or irresponsible
or both.

President Obama is not stupid. He is cunning.

These are President Obama’s remarks in the
Rose Garden of the White House last week.

 “Shortly
before the president’s appearance, White House officials 
let it be known that the “president will directly address the technical
problems with HealthCare.gov – troubles he and his team find unacceptable.” But
in that Rose Garden appearance, the president did not explain what the
technical problems with HealthCare.gov were, though he did acknowledge their existence and stated “there is no excuse” for them.

He then promised he would recruit the best
information technology talent in the country to come to the rescue and fix the
problems.

President Obama happened to hire one of Michelle
Obama classmates at Princeton in a no-bid contract to build the web site.
The
administration paid $634 million taxpayer dollars to Michelle Obama’s friend’s
company and got a disaster.

"Toni
Townes-Whitley, Princeton class of ’85, is senior vice president
at CGI Federal, which earned the no-bid contract to
build the $678 million Obamacare enrollment website at Healthcare.gov. CGI
Federal is the U.S. arm of a Canadian company.

"Townes-Whitley
and her Princeton classmate Michelle Obama are both members of the Association of Black Princeton Alumni."

The Obama administration also awarded CGI
another no-bid contract for 2 billion dollars to clean up from the Sandy
Hurricane.

 Mr.
Nelson
chair
of Housing Trust Fund Corporation
presented that the State
received a $1.7 billion allocation in CDBG Disaster Recovery aid from HUD to
aid impacted businesses and residences.



 The
corporation requires immediate access to consultant services to assist in policy and
procedure development, training, surge capacity, and call center assistance,
and stated that CGI Federal Inc. could provide such services.

The
resolution was passed and scheduled to “take effect immediately.”

Nearly a
year after the devastating storm, a majority of the 24,000 families that have
requested monetary assistance have yet to receive a penny from the federal aid
package.”

Does anyone think something funny going on at
taxpayers’ expense?

Shouldn’t President Obama have hired the best
minds in the country to build the web site to begin with?

Do you
remember this famous statement?


 
 

http://nyti.ms/18ThbbJ

Ezra Pound
is a big fan of President Obama and Obamacare. What happened? Did he change his
mind?

  

http://www.youtube.com/watch?v=AQxYY2dyChY&feature=player_detailpage

 Uwe Reinhardt is an economics professor
Princeton. He
gave
President Obama an F on his mid-term grade on Obamacare.

 “With proper management and more energetic work earlier
on, and untainted by the political desiderata
 reported to have affected the architecture of
HealthCare.gov, that Web site’s management team should have been able to
achieve the same success. It did not, hence the midterm grade F.”


 

A key discussion being avoided in the
mainstream media is whether President knew about the impending disaster. I suspect
he did.

It was one of the reasons he gave the group
healthcare insurance holders a one-year waiver. Parenthetically, he is not
seeking the advice or consent of the congress. This is probably
unconstitutional.

The group healthcare insurance market represents
the largest percentage of people insured. The individual insurance market represents
a relatively small percentage of the total insured population. The number of
people affected cannot make a big enough stink to be noticed by the traditional
media.

If the group insurance market were included in
the rollout, the community uproar would be too great for the Obama administration
to ignore or pivot from.

The public is already hearing the pivot from
President Obama and Kathleen Sibelius. They claim the past is the past. We must
ignore the past and go forward to fix the problem.

It sounds like the same story Hillary Clinton
told congress about Benghazi when she scolded a congressman during her Benghazi
testimony about Ambassador Stevens death. “He
is dead. Let us go on and deal with the problem.”

This method of operation is going to back fire
on President Obama for two reasons.

1. Americans are finally recognizing the Obama
administration’s methods of operation. It is to deflect with half-truths,
deceive and pivot. The public is getting angry.

2. There are an increasing number of people
who have lost their job, their healthcare insurance and the doctors. In the last
week 650,000 people lost healthcare insurance coverage they liked.

This is because of the exclusive regulatory
control the Democrats gave Kathleen Sibelius in passing Obamacare.

Not one single Republican voted for the
Affordable Care Act (Obamacare). 

The preparations for the implementation of
Obamacare for the group healthcare insurance market through health insurance
exchanges and www.healthcare.gov have unleashed gigantic outcries from both the
young and the middle-aged middle class.

The outrage is not over yet.

President Obama said he did not anticipate
that so many corporations would reduce insuring so many of their workers.

President Obama has discovered an obviously
scapegoat.

The “glitch” is not
Obamacare fault. It is the big bad corporations that are trying to make a
profit.

Wait a minute! Isn’t that the American way?
You build a business to try to make a profit within the rules.

The 40,000 new Kathleen Sibelius healthcare
regulations are preventing them from making a profit while providing healthcare
insurance. They want to provide affordable healthcare coverage.

The only way corporations can make a profit is
by dropping healthcare insurance of their employees.

Maybe driving people into the health insurance
exchange was President Obama’s goal in the first place. Remember Barney Frank
and John Kerry’s dismay about passing a bill without a public option. President
Obama response was don’t worry.

Well, we have an expensive public option that
doesn’t work. Who is going to pay for it?

 The
middle class is going to pay for it with increased healthcare insurance
payments and increased taxes. 

 The
cost of insurance on the health insurance exchange is high unless one qualifies
for a government subsidy. I have previously explained the dynamics involved in the
cost of healthcare insurance when a person receives a government subsidy.

Young healthy people will not buy insurance.
With the present computer programs the government will not know who qualifies
for a subsidy or be able to identify people will should be penalized.

A key to a business’ survival is to adjust to
adverse circumstance as long as the business has the freedom to adjust.

Watch out for the freedom to adjust to
anything.

Watch out seniors. Medicare is next.

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

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Permalink:

Additional Defects In Obamacare

Stanley Feld M.D.,FACP,MACE

I have been saying Obamacare is going to fail long before
the bill was passed into law. Obamacare will fail because of multiple system
design defects.

I would hate to believe these defects were built into the
system purposefully.

It was done to prove that free market forces do not work.
The Obama administration created a “not so free market”. These not so free
markets have been proven to fail over and over again.

It seems logical that given the $1 trillion dollar a year
deficits of the Obama administration, someone, somewhere would be interested in
decreasing the deficit spending.

None of the increased government spending has improved the
economy, decreased unemployment or decreased uncertainty.

The computer system defects in the health insurance
exchanges are much deeper than the sound bite treatment they getting from the
Obama administration.

The task of integrating 40-50 year old legacy computer
systems is an extremely difficult task using 50-year-old software.

Information technology experts have told me that the
health insurance exchange computer sign up system (healthcare.org) is months to
years away from getting the health insurance exchange information system fixed.

It should be destroyed after spending $634 million dollars
and redone using modern technology.               

The verification of people who qualify for government
subsidies is being dropped. The patient’s word about need is being accepted in
lieu of verification.

This is a tremendous glitch in the system, opening the
system to tremendous fraud and abuse. It is not a way to run a business.

John McAfee former CEO and founder of McAfee antivirus
said the health insurance exchange web site is a hacker's wet dream. The You
Tube explains why he came to this conclusion.

 

 

http://youtu.be/5TCtLtzSe6I

Poor patients who might qualify for the Obamacare tax
credits do not pay income tax. Therefore they have no income to apply a tax
credit against.

The administration has dropped word tax credit. It is now called
a subsidy. The law’s tax credit will be given to the healthcare insurance
company selling the insurance.

This is a “glitch.” The law was written to pay the states
for those who qualify for a tax credit. A Washington D.C. ruled that the case
by states against Obamacare has merit.

The states contend that persons’ insured through the
federal government exchanges do not qualify for federal tax credits.
Only
states can receive and distribute the tax credits.

The law was reinterpreted by the Obama administration
without the consent of congress.

Another “glitch” is that the healthcare insurance industry
is given limitless power to collect money from the Treasury. The mechanics are not
transparent.

 “The
Affordable Care Act may give health insurance companies a virtually limitless
power to tap the U.S. Treasury, thereby lifting insurers' profits to
undreamt-of heights. This power derives from the mathematical formula for
calculating individual subsidies.”

The mathematical formula for calculating the subsidies
will cause America’s deficit to skyrocket further each year.

President Obama told America that Obamacare would bend the
cost curve downward and provide an efficient cost effective healthcare system
for all.

Let us look at the payment formula. A family of four
earning $30,000 year will not pay more than 2% a year for healthcare insurance
($600/year). This makes the Accountable Care Act (Obamacare) affordable for the
poor (maybe).  

If the premium of the healthcare insurance policy obtained
by this poor family costs $10,000 a year through the health insurance exchange the
federal government will pay the remaining $9,400 in the form of a tax credit to
the insurance company.

Originally, it sounded like the family would get a tax
credit after the family paid $10,000. A family making up to $40,000 a year does
not pay any taxes and therefore a tax credit is worthless.

The wording was changed from a tax credit to a
subsidy.  The tax credit now goes to the
healthcare insurance company providing the insurance policy.

The tricky thing about all this is the insurance
industry’s tax credits  reduce the
governments tax receipts and increases the insurance companies net profit.

The net effect is an increase in tax-free income from the
federal treasury.

The government collects less income tax from the insurance
company.

 The Obama
administration has given the healthcare insurance industry a huge tax break.
The tax break will increase the industry’s bottom line profits.

Obamacare has permitted the insurance company to have a
Medical/Loss ratio of 80/20. The Medical/Loss ratio means that the healthcare
industry must spend at least 80% of the insurance premiums collected on direct
medical care.

If it only spends 75% on direct medical care, the healthcare
company must give provide a 5% rebate.  

Here in lies the rub. The Obama administration has let the
healthcare insurance industry define direct medical care.

These are some of the services the Obama administration
has permitted the healthcare insurance industry to categorize as direct medical
care.

 

  1. The cost of verifying the credentials
    of doctors in its networks.
  2. The cost of ferreting out fraud such as
    catching physicians over testing patients or doing unnecessary operations.
  3.  The cost of programs such as help desks
    that keep people who have
    diabetes
    out of emergency rooms.
  4.  Some insurers have insisted that
    typical business expenses are included — such as sales commissions for
    insurance agents and taxes paid on healthcare insurance companies investments

Each one of these "direct medical care expenses"
has an added on profit included in the direct medical care expense category.

This is the way the healthcare insurance industry takes
40-60% of each premium off the top and leaves only 40-60% of healthcare dollars
for direct medical care.

Next year the healthcare insurance company will be
permitted to raise the healthcare insurance premium of a poor family to
$12,000. Its excuse will be that it is losing money.

If the premium is not raised the healthcare insurer will
quit providing the insurance. The government is totally dependent on the
insurer whether the insurer provides insurance as it does in the health
insurance exchanges or for administrative services as it does for Medicare (a single
party payer).  

The poor family still makes $30,000 dollars a year and
still pays $600 dollar a year for the now $12,000 dollar premium.

The insurance company now keeps $2,400 vs. $2,000 for
overhead and profit plus all the profit they can get from the direct care
dollars that should really be overhead.

The federal government gives the healthcare insurer a tax
credit of $11,400 vs. $9,400.

 The poor insurance
enrollee doesn't pay a penny more for his healthcare insurance.

The only loser is the American taxpayer who will pay the
subsidy in the form of increased taxes.

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

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Permalink:

A Disaster, Not A Glitch

 

Stanley
Feld M.D.,FACP,MACE

 

There is an important
lesson in the recent Healthcare Insurance Exchange computer program “glitches”.

Once more the Obama
administration only presents a fragment of the truth. Unfortunately, the
traditional media accepts President Obama’s explanation and that is the news.

 

http://youtu.be/OCZLy_-IJ_s

The online
health insurance exchange program should be very easy to execute. All of the
major healthcare insurance companies have an online presence. People can go
online, put in simple demographics, and in a matter of seconds they can have at
least 100 healthcare insurance products to choose from. 

The Obama administration told the media that the software
developed for the web site, by CGI a Canadian company with offices in
Washington D.C., had an estimated cost of $93 million.

USAspending.gov said it cost the government $634 million dollars. The site calculated the cost from grants paid to CGI. This is seven times the
estimate published by the administration.

“Not only was the site still experiencing
substantial problems a week after launching, but the White House had reportedly
been aware for months that the HealthCare.gov website had flaws and might not be
ready to launch. Yet officials insisted on the Oct. 1 roll out anyway.”

The problems experienced by people trying to use the user
interface was something that was tested least or not done right — or both.'

– James
Turner, a member of the technical staff at software firm Beeonics, Inc
.

The healthcare industry,
participating in the new exchange, complained “loudly” that the site had
experienced problems before the launch.  

Speaker of the
House John Boehner asked, "How can we tax people for not
buying a product from a website that doesn't work?"

The front end user experience is only a fraction
of the problem with the federal health insurance exchange site.
A front end user’s
experience typically means there is something wrong with the basic construction
of the software.

The
monumental issue of the site involves interfacing seamlessly the multiple
government agencies (IRS, HSS, CMS, Welfare, Food Stamps and others) and
private insurers legacy’ computer networks. Each agency and organization has a
myriad of computer networks that must interface with the health insurance
exchange web site.

It is
reality easy to have a pretty front end interface with the user. If the
software program is poor the interface is a disaster.

These
computer networks must be integrated into what appears to be a fancy front end.
It looks as if this software is incapable of this very complex integration.

It is
one of the reasons that verifying patient for subsides has been dropped and the
government is going to take the patient’s word.

These
problems were published in blogs for months. The software  failed initial testing.

The
Obama administration did not delay the launch despite these warnings.

Now President Obama has
told us that this is a small “glitch.” He compare it a glitch Apple had with
its launch and it did not put them out of business.

"Take
away the volume and it works," President Barack Obama's chief technology
adviser, Todd Park, 
told
USA Today. 

Either
President Obama does not know what is going on or he is not telling the truth to
the American people.

The
administration has blamed the glitch on the high volume of people trying to
access the site. This is partially true.  

The prediction by experts is it will likely take
months to get it running properly. The rollout was disastrous.  There were 8.6 million unique visitors in the
first 3 days hoping to apply and enroll in a healthcare
insurance plan.  Instead they experienced
an online nightmare, with websites crashing, refusing to load, and failing to
offer comprehensive choices.

 The demographics of the 8.6 million are
unknown. They may all have been high risk uninsured people.

The Daily Mail is reporting that
sources within HHS are saying only 51,000 people signed up for insurance via
the government run website Healthcare.gov in the first 12 days,
 

Two HHS career civil servants told
the Daily Mail that only 6200 people signed up on the first day. “

White House and administration officials continue to insist they
have no idea how many people have signed up but will release the numbers
monthly after November 1.

Is the administration trying
to hide something?

“If the state-run
exchanges were to have a similar response rate for six months, the national
enrollment total would be approximately 2 million in six months."

That number is less than
29 per cent of the 7 million the Obama administration would need, according to
the nonpartisan Congressional Budget Office, in order to balance the new health
insurance system's books and keep it from financial collapse.”

The White
House’s published goal is to enroll at least 2.7 million young, healthy people
between the ages of 18 and 35 in 6 months.

The monthly
premiums of healthy, low risk people are needed to offset the cost
of health care for older, sicker Americans who will certainly try
enroll.

The CGI website states;

“Exchanges
must provide many different functions, the soundest approaches bring together
expertise and best practices in federal and state health programs, commercial
insurance, data exchange, portals, e-commerce over the cloud, and financial
management.”

“ CGI
brings all of this expertise to the table, along with direct experience in
developing sustainable HIX programs. We also have a dedicated group of subject
matter experts tracking best practices for state HIX and
integrated
eligibility systems
across the United States.”

CGI knows
what to say. It has not shown that they know what to do.

The Obama
administration may have wasted $634 million taxpayer dollars on software that
does not work.

This is
more than a glitch. This is a disaster.

Just wait
and see the prices for a Bronze level healthcare insurance plan once people can
negotiate the site.

No one is
going to be able to afford the insurance in the Affordable Care Act
(Obamacare).

Another
disaster will be coming your way complements of Obamacare.

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

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