Stanley Feld M.D., FACP, MACE Menu

Disinformation and the healthcare system

Permalink:

Managing Points Of View and Healthcare

Stanley Feld M.D.,FACE, MACE

Finally, it is official. Ben Rhodes, the deputy national security adviser for strategic communications, admitted that the Obama administration lied about the Iranian Nuclear deal to the press, public and congress.

His interview with David Samuels in a New York Times Magazine typified the approach to manipulating the truth by the Obama administration in all areas of the administration’s activities.

The administration has been trying to walk back Ben Rhodes’ statements for a week. The traditional media is trying to bury his statements even though the king of the mainstream media (the New York Times) published the interview.

The justification for this behavior is that it has been used by all-previous administrations including that of George Bush. It is therefore an insignificant objection.

Ben Rhodes explained to David Samuels, in the New York Times profile that,it was first necessary to lie to a corrupted and inexperienced American media about all sorts of things, beginning with the nature and intentions of the enemy in this case the Iranian regime.

Subsequent lies were added, as the White House took advantage of a dangerous mix of journalists’ ignorance, their ideological and partisan commitment to the administration, and finally, their career aspirations.

It reminds me of Jonathan Gruber’s attitude toward the press and President Obama’s pretense that he hardly knew Jonathan Gruber.

http://stanfeld.com/?s=Jonathan+Gruber

https://www.google.com/search?q=Ben+Rhodes+Iran+nuclar+deal&ie=utf-8&oe=utf-8

Rhodes went on to say, The average reporter we talk to is 27 years old, and their only reporting experience consists of being around political campaigns… They literally know nothing.”

This implies the lack of respect the Obama administration has for the press, Americans and for the virtue of honesty. It is not a good example for our youth’s future behavior and the way to mange a Point of View.

Thus they (the press) will believe what he tells them. He also tells friendly non-governmental organizations and think tanks what he is telling the journalists. Those outlets produce “experts” whose expert opinion is just what Rhodes wants it to be. These ignorant young journalists thus have quotes that look like independent confirmation of the White House’s lies. :

Ben Rhodes admitted, when David Samuels asked,We created an echo chamber of freshly minted experts cheerleading for the deal. ‘They were saying things that validated what we had given them to say.’

This is the apparent attitude of President Obama and his administration. It is applied to every lie they have told to the American people.

Ben Rhodes described a tactic that is an extension of Sol Alinsky’s playbook. I believe the American people are catching on.

The defendants of the Obama administration marginalize the people who expose the lies with additional lies.

The Obama administration and its defendants are usually effective in marginalizing their opponents.

The defendants of the lie have the power of the pulpit and a friendly mainstream media.

The same tactics are used in defending Obamacare as I have described many times in my blog.

I find it difficult to believe that so many smart people believe these lies.

Carl Sandberg said “if you tell I lie enough times its eventually becomes the truth. This is especially true when people start adjusting and investing in the lie.

Marilyn Travenner, now that she is CEO of the healthcare insurance industry lobbying group, has a different point of view than when she was the head of CMS. Someone else other than government is paying her.

I have said that the dysfunction in the healthcare system is the fault of all the stakeholders, namely the government, the healthcare insurance companies, the drug companies, the physicians and the patients.

Each group adjusts to a dysfunctional element making the healthcare system more dysfunctional. The growing dysfunction is driven by the multiple points of view.

President Obama’s ideology has accelerated the dysfunction.

Marilyn Travenner is now diverting blame for the dysfunction away from the healthcare insurance industry. Many do not realize that the government run healthcare system is totally dependent on the healthcare insurance industry. The healthcare insurance industry does the administrative services for the government.

The administration brags that CMS’ overhead is only 2.5-5% of Medicare’s cost. This is an illusion; It is false.

The percentage of overhead published does not include the cost paid by the government to outsource the administrative services to the healthcare insurance industry.

The administrative services overhead is added into the cost of healthcare. Insurance premiums are calculated using the Medical Loss Ratio calculation. Many insurance company expenses are considered direct medical care expenses. Direct medical care expenses should only be for direct medical care.

The government programs set payments to the healthcare insurance industry for administrative service according to the Medical Loss Ratio.

Insurance administrative expenses, like a help desk or network selection expenses, should not be included in direct medical cost. Presently, it is the method used by the healthcare insurance industry to ultimately take 30-40% of the healthcare dollars off the top.

President Obama and his administration brag that Obamacare is bending the healthcare cost curve for Medicare and Medicaid. The only reason this was true in 2012 and 2013 was because Obamacare’s hidden taxes from citizens at every income level were being collected while there were no Obamacare medical care expenditures until 2014. The 2014 and 2015 cost curve was bent upward contributing to the 19 trillion dollar deficit.

In my last blog I mistakenly left out the word contributing to the 19 trillion dollar deficit. Obamacare is not budget neutral. It is not presently bending the healthcare cost curve.

Some smart people believe Obamacare is bending the healthcare curve because they uncritically believe all the administration’s press releases.

In the last few weeks we have been warned not to believe everything President Obama and his administration tell us.

I am sure the judge in Texas who was lied to by the Department of Justice about immigration reform is not very happy.

The cost of physician services might be increasing on a retail level. However, government and insurance reimbursement to physicians is decreasing.

Travenner, in her previous life blamed the rising cost of medical care on physicians. In order to divert attention from the healthcare insurance industry she continues to blame physicians.

The cost for everything from office visits to complex surgeries is on the rise, so there’s not much that can be done here to ebb this common cause of premium inflation.”

This is an incorrect premise. It is true that hospital costs are rising. If the premise is incorrect the solution is usually incorrect.

Next, Ms. Travenner explains additional reasons for increasing premiums.

“Prescription drug price inflation is a far bigger problem. A lack of a universal health plan, long periods of patent exclusivity, high demand for pharmaceutical products in the U.S., and the speed with which approved drugs can be brought to pharmacy shelves are all reasons why prescription drug costs could continue soaring in 2017 and future years.”

She omits the most important reasons for the increase in drug prices to the public.

President Bush’s deal with congress to pass Medicare Part D was to eliminate government’s ability to negotiate drug prices with the drug companies. The government negotiates drug prices for the military and VA. It gets negotiated prices that are comparable to all other countries on the globe.

At the same time the government restricts consumers from buying prescription drugs in Canada, suppressing competition.

The Obama administration keeps blaming the drug rules on President Bush’s administration. Why hasn’t President Obama renegotiated a better deal in the last seven years, or just change the rules by executive order as he usually does?

Tavenner also hit onthe point that restructuring the insurance market hasn’t paid benefits as expected.”

New regulations requiring Obamacare insurers to provide plans with a host of minimum benefits, as well as being unable to deny benefits to people with pre-existing conditions, has left insurers exposed to adverse selection.

In plainer terms, it means sicker people who’d been shut out of the insurance system previously have flooded in, and not enough healthier individuals have enrolled.

This last point is valid. The claim that the insurance industry is losing money is not true. It is losing money on adverse selection but they are making up that loss by increasing premium prices to the government and the corporate market.

If they did not make money how could they pay CEOs of some healthcare insurance industry companies 100 million dollars a year?

Finally, Tavenner cautioned that the turbulence can be expected because insurers “sit in the three-R world.”

What Tavenner is alluding to are two programs that are set to end in 2017: the reinsurance program that provided payments to plans that enroll higher-cost members, and the risk corridor, which acted like a modern day Robin Hood by taking excessive profits from top-performing insurers and giving them to Obamacare insurers losing excessive amounts of money.

Without the risk corridor, new insurance entrants could be discouraged, since they’d be responsible for covering the entirety of their losses. The third “r,” risk adjustment, will remain in place to distribute capital from plans with low-risk enrollees to those with high-risk.

The reinsurance aspect of Obamacare was probably illegal. The government guaranteed the insurance companies that it would make up whatever loss they claimed. The Obama administration paid the healthcare insurance industry only 12% of the promised amount. This deception by the government has led to some of the reasons UnitedHealthcare and now Aetna are pulling out of Obamacare’s health exchanges.

However, the government is totally dependent on the healthcare industry for it administrative services.

The devil is always in the details.

There is an ever-growing need to lie to manage the public’s point of view in favor of Obamacare.

The public is becoming aware of the Obama administration’s attempt to mange the public’s point of view. Ordinary citizens are madder than hell at the Obama administration and the establishment in both the Democratic and Republican parties.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

A Point Of View Is Not Reality

Stanley Feld M.D.,FACP,MACE

I find it harder and harder to believe the administration’s press releases. Every press release and press conference seem to be a lie.

How can President Obama’s press secretary live with himself?

America’s government is supposed to be a government by the people, for the people. The three branches of government are supposed to balance each other’s power.

The executive branch under the Obama administration has usurped much of the power of the legislative and judicial branches of government.

I have pointed out that things are not going well for Obamacare.

Consumers cannot keep their doctors.

Consumer cannot keep their insurance.

Obamacare’s hidden taxes have raise taxes at least 10%. Many increases are passed on to all consumers in every tax bracket.

Healthcare premiums have increased for everyone.

The only real increase in Obamacare enrollment has been in Medicaid enrollment. The central government currently pays for 100% of the insurance cost for Medicaid patients.

The Obama administration pays for the yearly increases for Medicaid premiums billed to it by the healthcare insurance industry.

Eighty-five percent (85%) of Obamacare enrollees receive subsidies. The average taxpayer does not know these facts.   I suspect most congressmen do not know these facts.

Meanwhile, during President Obama’s term in office, the budget deficit has increased from 12 trillion dollars to 19 trillion dollars.

Marilyn Tavenner was the former head of the Centers for Medicare and Medicaid Services. She helped construct policy, publicize, sell, and administer Obamacare and its expansion of Medicaid.

Ms. Taverner had one point of view as head of CMS. She helped create greater dysfunction in the healthcare system.

Now, she has a completely opposite point of view. She is presently president and CEO of America’s Health Insurance Plans, the healthcare insurance industry’s premier lobbying group.

She continuously defended Obamacare after each mishap such as the enrollment web site, the enrollment errors in counting enrollees, the insurance premium increases, the poor enrollment and the decrease in service. Each disaster increased the dysfunction of the healthcare system.

Now that her point of view has changed she has become extremely critical of Obamacare.

Her criticisms of Obamacare have gotten her closer to reality. Now, her point of view is that of the healthcare insurance industry.

However, it is not a point of view that supports the needs of consumers.

Someone ought to look at the consumers’ and physicians’ point of view.

Marilyn Tavenner has harsh criticism of the program she once helped get off the ground.

The Obama administration’s continuous praise of Obamacare’s success has marginalized Ms. Taverner’s recent criticism of Obamacare.

Unfortunately, the Obama administration’s praise of Obamacare’s success is a lie.

The news that UnitedHealth Group, the country’s largest health insurer, announced last month that it would pull out of many ACA markets next year is a very big deal.

UnitedHealth, which actually operates in nearly two-thirds of all U.S. markets, has predicted it could lose $500 million on its individual Obamacare plans in 2016.

The Obama administration’s response was a classic misdirection response.

“The news is not all that shocking, and it is not a sign that the law is failing.”

 United is not a dominant player in the marketplaces that the ACA “Obamacare” set up for individual insurance buyers. It covers only about 6 percent of 12.7 million marketplace participants. United does not appear to have been very effective at competing to attract customers.

 UnitedHealth CEO Stephen Hemsley has blamed higher medical utilization rates for Obamacare members, as well as the ease of switching plans, for his company’s Obamacare woes.

The higher utilization rates are because the government subsidizes 85% of the people in Obamacare. Medical care is essentially free. People do not join Obamacare or pay premiums unless they are sick.

A huge study released by the Blue Cross Blue Shield Association recently analyzed the medical claims of millions of Obamacare and employer-based members and found that Obamacare members are 22% costlier than employer-based members. Obamacare enrollees also tend to be sicker, coming with a host of chronic or expensive-to-treat conditions.” 

United plans offer the largest network of doctors, hospitals and other providers to choose from.

All this is expensive. Unsurprisingly, marketplace insurance buyers tend to pick lower-cost options. All this causes their premiums to be higher.

Most people believe free is best. Many are being conditioned by the administration to love free healthcare insurance.

The quality and availability of care is ignored in the administration’s boasting of Obamacare’s success.

The Obama administration wanted insurance companies with large networks to join. Only companies with restricted networks are joining. These companies are not providing the infrastructure for the access to quality care.

Obamacare ignores individual responsibility for healthcare and emphasizes individual dependence on the federal government.

The Obama administration’s misdirection continues;

“United’s selective exit from ACA marketplaces appears to reflect two positive features of the law. “

First, Obamacare was meant to spur competition among insurance companies, thus constraining premiums; in many markets, this dynamic appears to be at work, to the detriment of United.”

How is Obamacare promoting competition when UnitedHealth Group is leaving and Aetna is threatening to leave?

“Second, the law has curtailed many of the ways that insurers used to contain their costs, such as refusing to cover certain people or certain treatments, or jacking up premiums for older customers.”

This “positive feature” has caused premium prices and deductibles to increase and the affordable care act (ACA) to become the unaffordable care act (UAC).

“Many insurers on the ACA marketplaces have responded by offering plans that keep costs down by narrowing their networks of providers. This is a better way to contain costs than those the law forbids”.

Does anyone think this will make access to quality care more available?

 

Marilyn Tavenner is now implying the worst is yet to come. She made this prediction when she rolled out Obamacare and is declaring the same now as she runs the healthcare insurance lobbying group.

“I’ve been asked, what are the premiums going to look like [in 2017]? I think the overall trend is going to be higher than we saw in previous years. That’s my big prediction.”

 Marilyn Tavenner was formally a big fan of Obamacare. Her point of view has now changed.

She doesn’t see just one problem pushing premium prices substantially higher next year. She sees a confluence of many factors. This would suggest that overcoming these obstacles isn’t going to be easy.

I will discuss the factors Ms.Taverner is referring to my next blog.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

One Could Go Nuts

Stanley Feld M.D.,FACP,MACE

Measuring quality care in the healthcare system is out of control. My conclusion is that these measurements of hospitals and providers by Obamacare to determine medical care quality is distraction to quality medical care.

The method used is so complex that its measurements are inaccurate and the system is destined to fail.

The measurements are a distraction and costly. They end up diverting resources away from the hospitals’ and providers’ primary mission to provide quality healthcare at an affordable price.

In March 2016, the Healthcare Association of New York State (HANYS) published a report called Measure Madness. The report identified 2,100 required measurements of “quality care” imposed by the federal government and in turn the healthcare insurance industry on hospitals and physicians. The goal is to rate the quality of care given by hospitals and physicians.

The measurement agency claims that the rating system is set up to help consumers make better healthcare choices.

Below is a graph of the various measurements:

Measurement madness final. jpg

Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on time spent per physician to enter the data into the electronic health record to keep track of newly introduced measures and create protocols to track and report them.

Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures.”

 This report only covers 4 common specialties,and not all specialties and all hospital costs. There is no telling what it costs other hospitals and providers
HANYS report stated “

The volume of measures that exist, promulgated by lack of alignment and poor coordination, has created an environment of measure madness, “Consuming precious resources that could be directed toward meaningful efforts to continuously enhance quality and patient safety.”

The “measurement madness” may be doing more harm than good, according to the report. It’s the latest in a growing number of reports urging consolidation and standardization among the various groups that require reporting of healthcare quality and safety data. 

The Electronic Medical Record is a great idea in theory. I have discussed functional Electronic Medical Records in detail previously. A reader can go to the search engine on this blog to review my criticism of the defects in the Electronic Medical Records sold to hospitals and doctors.

A major defect in EMR is hardly ever discussed. There is a massive amount of copy and pasting to complete the “documentation. The record does reflect anything about the patient’s illness or real progress. It does not provide a true reflection of the patient’s quality of care, natural history of his disease or disease improvement. It does not compare efficiency of medical care outcomes with the financial results of care.
The HANYS report listed the number of reports required for a computer program to evaluate the quality of medical care delivered. It is reflected in the crazy cartoon at the top of this blog.

Number of Reports Per Measurement

Accountable care organizations: 33

The Delivery-System Reform Incentive Payment (or DSRIP) : more than 100

Private Health Plans: 546

National Quality Forum: 635

CMS: 850

Each report has at least one sub report. One has only to recall all the agencies Obamacare has set up.

ObamaCare-Chart.jpeg

Ocachart

This bureaucratic scheme can never work efficiently.

HANYS urges stakeholders to do the work to fix the system.

The call for action was for providers of healthcare to jointly commit to the minimum number of measures needed to evaluate healthcare quality, align them with national, standardized, evidence-based data, and focus on efforts that target the most vital aspects of care.

Last week CMS was forced to delay publishing its hospital quality ratings until July 2016 because of the perceived defects in the Obamacare’s measurements.

Congress received tremendous pressure from hospitals because of the confusion the measurements have created.

CMS also plans to host calls with providers to clear up questions about current methodology and get feedback on refining the program”.

Obamacare has been promoting the ratings for hospitals, nursing homes, dialysis facilities and other providers as a way for consumers to compare and select providers.

If one measures the wrong things one will get the wrong answer.

Only 87 hospital of more than 3,600 U.S. hospitals got the highest five-star rating, according to the American Hospital Association.

Just over half of the hospitals fell within the three-star range.

A total of 142 got one star. In January, the AHA challenged the CMS, stating that the program “oversimplifies the complexity of delivering high-quality care.”

Hospitals reviewed the ratings earlier this year.
Sixty U.S. senators heard the hospitals’ message. They sent a letter to CMS earlier this month urging the delay of the program. The senators warned of confusing methods, compromised outcomes for hospitals in disadvantaged communities and the potential to mislead consumers.

The American Hospital Association (AHA) has not been able to come up with the same conclusions as CMS, using the same data sets and methods.

“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients,” the AHA said in a statement.

On May 12 a conference call is scheduled to educate hospitals on how to analyze and interpret the data. In general, even the government has been confused about how best to interpret the data.

Ben Harder and Avery Comarow of U.S. News & World Report said in a recent article, “Different methodologies can produce different results even when the same raw data sets are used, said cent article.

“No approach to identifying outstanding medical centers is ideal—not ours or the government’s or anyone else’s,” the column stated.”

 A case in point: none of CMS’ five-star facilities made it onto U.S. News’ annual Honor Roll. Ben Harder said, It is likely because the CMS does not yet adjust for socio-economic factors.

 Again the Obama administration is making another costly complicated mistake that is making hospitals and providers go nuts and distract from their main mission of providing quality care at an affordable price.

If anyone thinks complete control of the healthcare system by the federal government via a single party payer system can do better than this government mishmash they should think again.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

We Don’t Need A Public Option

Stanley Feld M.D.,FACP.MACE

When President Obama told Barry Frank and John Kerry “We don’t need a Public Option in the Affordable Care Act legislation” he was right.

https://youtu.be/SHPsEVQ9dGQ

 

https://youtu.be/4iR_iKRKewQhttps://youtu.be/4iR_iKRKewQ

 

Senator Chuck Grassley know all along what President Obama’s scheme was. His problem was none of his Republican friend would listen to him or do anything about it.

https://youtu.be/-522hcm3woA

President Obama’s goal all along was to sneak in a Public Option in through the expansion of Medicaid. He wanted the local states to be administratively and financially responsible for Medicaid while the Federal government controlled the system through regulations.

President Obama had figured out the way to get to a single party payer without a Public Option. However, he and his advisors misjudged the defects in Medicaid.

Republicans have been opposed to a single party payer system and government control of the healthcare system. Republicans felt government control would increase the cost of healthcare, increase inefficiency in the administration of healthcare care, ration healthcare and decrease access to healthcare.

President Obama thought he could use a myriad of regulations to help Obamacare back into a single party payer system. The State and Federal Health Exchanges (“so called Obamacare competitive model”) has resulted in both the health exchange and the private insurance industry increasing the cost of healthcare to unaffordable levels, decreasing access to care, rationing of care and destroying the healthcare system.

The politicians, in a state like California, by following the federal money, ignored the will of the people. The people hate Obamacare because it is restrictive. They are angry about the lie President Obama told them to get their support. “If you like your doctor you can keep your doctor. If you like your insurance you can keep your insurance.”

President Obama has created a healthcare system infrastructure that played on states’ greed. Many states have tremendously high budget deficits. They have over taxed state residents.

State citizens and businesses are leaving for more tax friendly states. The migration has created larger state budget deficits. State politicians say a way of getting more federal money into the states and perhaps attracting people back to the state will be by expanding Medicaid. The federal government promised to pay 100% for the first three years of the Medicaid expansion program

Twenty-two states fell into President Obama’s trap. These states are on their way to a single party payer system without even knowing it.

I predict his scheme will fail.

California was the first state to jump into this pot of boiling water.

The federal government is going to pay 100% of newly qualified enrollees to Medicaid until 2017. Medicaid is under state control.

A record number of people have signed up for Medi-Cal in California. This has led to huge cost increases in Medi-Cal. Its price tag has jumped from $59 billion to $91 billion.

Where does President Obama get the money to pay for it? He increased the federal deficit. I guess $32 billion dollars would be considered a rounding error to most Democrats in congress.

States will have to start paying 5% of the bill for the newly eligible and enrolled enrollees in 2017. In 2020 the states will start paying 10% of the bill.

Medi-Cal is the state’s Medicaid plan for low-income Californians. Nearly one in three Californians now receive coverage in Medi-Cal. With its continued Medi-Cal expansion it is predicted to expand to 20 million by 2020.

Medi-Cal Explosion

Medi-Cal Growth of enrollment

The people of California are going to be the first victims of the increased costs and decreased services.

Every government program creates a complex bureaucracy along with money wasting inefficiencies and abuses.

California politicians were bragging about the great deal the government had given them.

That’s a really great deal for California,” said Scott Graves, research director at the California Budget & Policy Center. “You don’t find that anywhere else.”

Advocates say the expansion, with the huge infusion of federal money, should in fact eventually yield savings for states, possibly enough to make up for the costs.”

UC researchers calculated that each new federal dollar brought to California by Medi-Cal will generate 5.4 cents in tax revenue for the state, which would mean several billion dollars. That’s because the money creates jobs in healthcare, which creates income and sales tax.”

Over the years because of the cost overages, Medi-Cal has been forced to decrease reimbursement to physicians and ration both care and access to care. Physicians have opted out of Medi-Cal participation. As Medicaid has grown as a result of Obamacare, Medi-Cal patients cannot find a physician to care for them.

I suppose President Obama could force physicians to accept Medicaid payment in order to retain their license to practice medicine. This executive action would attack freedom of choice and propelling the United States further down the road to serfdom.

As predicted, a group of Californians filed a civil rights complaint against Medi-Cal, alleging that failures in the program have prevented Latinos from accessing their healthcare they needs.

“But the complaint filed with the U.S. Department of Health and Human Services claims that because Medi-Cal administrators don’t pay doctors enough to see patients, they “effectively deny the full benefits of the Medi-Cal program to more than seven million Latino enrollees.”

Many complain that Medi-Cal’s reimbursement rates, among the lowest in the nation, create a shortage of doctors willing to see Medi-Cal patients.

The audit confirmed our long-standing concerns about access for Medi-Cal patients,” said Anthony Wright, executive director of the advocacy group Health Access California. “The findings of the audit cry out for more oversight.”

Gov. Jerry Brown’s budget for the 2014-15 fiscal year accommodates an influx of uninsured residents into Medi-Cal.

However, at Governor Brown’s request, the Legislature left in place a 10 percent recession-era cut in reimbursement to most doctors, dentists and other health care providers who treat Medi-Cal patients.”

Health providers predicted this harmful contradiction. The contradiction is that Medi-Cal expansion will provide more of the poor with adequate healthcare coverage. It is, in fact, reducing  poor persons ability to get into clinics, practices and even hospitals.

The California HealthCare Foundation reported that 76 percent of primary physicians accept new patients through private insurance. Only 57 percent accept new Medi-Cal patients.

Medicaid and MD

The optimism of politicians for the expansion of Medi-Cal improve state revenue has vanished. California’s deficit is increasing rapidly as a result of Obamacare’s largess.

In California, state officials are discussing how they’ll afford the program next year (2017). Gov. Jerry Brown called a special legislative session this year to address funding for Medi-Cal.

“It’s a strained system,” said Hernandez, “and I really believe we need to figure out how to resolve.

The 20 states that have not accepted President Obama’s offer to expand Medicaid were correct. These states wanted to make their own decision in the name of states’ rights. Many of the states could not afford expansion in the way President Obama was dictating it. Their budget deficits and taxes would have to increase.

California has just proven these states fears. In 2017 California will start paying 5% into the Medi-Cal expansion. It will make the budget deficit worse.

California will, once again, start begging the federal government to bale it out.

President Obama’s plan was to dump the financial burden on the states while controlling the system and creating a single party payer by default.

There is a much better way to provide healthcare to all people at an affordable cost.

The better way is to put consumers in control of their healthcare dollars.

They will control their health to avoid costly complications of chronic diseases. The people will be given financial incentive to be responsible for their health to try to avoid the onset of chronic disease.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Biased Newspaper Reporting

Stanley Feld M.D.FACP, MACE

I used to read every word of the New York Times. After all it was “all the news fit to print.”

It took me a long time to figure out it was the same sensational journalism as the New York Daily News and the New York Post. Its sensationalism is subtler.

Both the News and the Post had better Sports sections than the Times. All three newspapers are biased. They all leave out important facts.

The New York Times leaves out important facts and does not connect related facts. The result is intelligent people reading and believing the New York Times can have one world view, while another group of intelligent people reading and connecting the facts can have an opposite world view.

The following headline appeared on the front page of the Sunday Times on Easter Sunday.

On Campaign Trail, Republicans Tone Down Criticism of Obamacare.

On its surface the headline infers that Obamacare is working and citizens like it.

The Times claim is, “Among the most embattled Senate Republican incumbents, the campaign websites of Kelly Ayotte of New Hampshire, Mark Kirk of Illinois and Ron Johnson of Wisconsin barely mention the health care law.

The article goes on to quotes Health and Human Services Secretary Sylvia Mathews Burwell.

“The explanation for (the lack of criticism of Obamacare) may be that for all its controversy and imperfections, the sweeping law has taken hold.”

 “This (Obamacare) is in the fabric of the nation,” said Burwell.

 “To be sure, the presidential election outcome will be a determinant of whether the health care law is reshaped, bolstered or downsized.”

Is reporting this Obama administration bias?  To me it certainly is. This conclusion is total nonsense. It is an attempt by the New York Times to help the Obama administration spin the truth and save President Obama’s legacy

The Times also points out that; President Obama took part in a celebration in Milwaukee this month after the city was given an award for increasing health insurance enrollment.”

Paul Krugman’s New York Times articles have been telling reders how successful Obamacare has been. The problem with his commentary is it does not fit the facts.

Meanwhile President Obama and the administration have been modifying the law almost monthly without the consent of congress.

It has also been spending money without congressional approval because the law has not worked out well for President Obama and his administration.

Obamacare has been a failure for all the stakeholders. It has had a negative impact on the economy and the delivery of medical care.

It cannot be fixed with a few modifications.

I hope the New York Times is just printing the Obama administration’s press releases. However, the Times editorials reflect the lies.

Anyone running for congress who believes the New York Times propaganda about the success of Obamacare should not be elected.

Many patients credit the President with giving them access to coverage even if they have a pre-existing condition and are not in a group plan. Meanwhile, the cost of the insurance has changed with higher premiums and deductibles, and the cost of coverage is increasing annually for both Obamacare and private insurance.

Remember President Obama’s promise, “If you like your insurance you can keep your insurance

 The cost of HealthCare.gov has been a debacle. It had been riddled with scandals, inefficiency, cronyism, and disrespect for consumers’ intelligence. I thought the original $800 million dollar cost estimate was ridiculously high. Its present estimate is $2.1 billion dollars. the web site healthcare.gov is still not right.

Thumbnail

How much did CMS really spent on Obamacare? No one really knows. It has not been cheap. Most of the expenditures have not been approved by congress.

For the last three years the Obama administration has lied about the enrollment numbers. At the same time they have bragged about the enrollment success. In 2014 the grand total enrollment in private insurance through the Obamacare exchange was 260,000 while 14 million privately insured lost coverage.

However the total number of consumers enrolled through Medicaid was 8.99 million. This occurred with only 23 states participating in the expansion of Medicaid

Image1

The enrollment figures had not improved at the end of 2015 even though the Obama administration extended the enrollment period constantly throughout the year.

“Earlier this month (2016), the Centers for Medicare and Medicaid Services announced that nearly 8.8 million Americans had “effectuated” coverage at the end of 2015, meaning they were paying their health insurance premiums.”

The agency praised this number as a sign of Obamacare’s success in expanding access to coverage.”

This is a perfect example of spinning the news. At the of the 2015 enrollment period before the enrollment extensions 11.69 million members signed up and paid. At the end of 2015 only 8.78 million people continued to pay their premiums.

Image1

This represents less than the Obama administration claimed enrollment of 2014.

 The New York Times is publishing fiction because of it’s bias toward President Obama and Obamacare. The truth about Obamacare’s lack of success is public record. Unfortunately the New York Times ignores the truth.

Obamacare enrollment decreased even further this year (2016). The insurance premiums and deductibles are too high for people making over 50,000 dollars a year. Only the fully subsidized people can afford to stay in Obamacare.

 Obamacare’s State Co-Ops were formed to have states run their own state insurance exchanges. Inefficiencies and faulty business model cause 13 of the 23 to fail so far.

The Obama administration provided 2.5 billion dollars in loans to these State Co-Ops. So far the federal government has lost 1.2 billion dollars of it 2.5 billion loaned to the state Co-Ops.

The Affordable Care Act allowed for the creation of consumer-operated and oriented plans, or co-ops, that were intended to inject competition into areas where consumers had few choices.

At present 8 more Co-Ops are on the verge and will probably close for enrollment for 2017.

The Centers for Medicare and Medicaid Services have little hope or collecting the money lent to the State Co-Ops. Information surrounding the liability of the failed state Co-Ops for the loans has not been transparent.

A total of $2.4 billion in loans was awarded to 23 Co Ops start-up and solvency loans to the 23 co-ops.

Now, 12 of the 23 co-ops that opened their doors in 2013 have closed and have left 900,000 consumers without insurance. No one can tell if these people were assimilated into the federal health exchanges. Republicans in Congress are questioning whether the taxpayers will ever get repaid $1.2 billion loaned to those failed Co-Op insurers.

Image1

Obamacare has made insurance available to millions of Americans with pre-existing conditions were denied coverage. This is true. However both the premiums and the $6000 deductibles are unaffordable.

A diabetic wrote to me, “Obamacare is great! Now I can buy insurance. My premium cost $12,000 a year. My deductible is $6,000 for a total of $18,000 a year. My medical bills were $100,000 last year.

I asked what was her HbA1c. She said it was 9.2% (normal 4.5% -5.5%).

The high HbA1c means she is a poorly controlled diabetic.

Shouldn’t this patient be responsible to lower the HA1c to 6% in order to reduce her diabetes complication rate?

Not everyone can afford $18,000 per year. Most of the diabetic patients who cannot afford the high insurance rates in the federal health exchanges have even higher HbA1c levels. They will ultimately cost the payer of last resort, the government, even more after the patient is bankrupt.

A better system needs to be developed to incentivized these people to be responsible for their own diabetes control.

 

Another feature of Obamacare that is publicized as one of the great successes is that children can stay on their parents’ plans until age 26.

The unintended consequence of this feature has given the healthcare insurance industry and excuse to raise insurance premiums by double digits increase each year.

President Obama has bragged, and the New York Times has applauded him for it, that health care inflation has been lowered since Obamacare was passed into law. He say that Obamacare has bent the healthcare cost curve.

This is false. Obamacare was collecting Obamacare imposed tax increases on every income bracket for three years prior to implementation of the healthcare coverage.

The cost curve was bent because there were no expenditures in the delivery of healthcare. In 2015 the healthcare cost curve is rising.

There are 20 hidden taxes in the law that effect citizens earning less than $250,000 dollars a year. .

These new taxes contradict President Obama’s promise that “anyone making under $250,000 a year will not pay a dime in new taxes.” Many of these taxes on businesses are being passed on to consumers in the form of higher prices.

https://youtu.be/eHlRY3kHhBk

Insurance companies are leaving the federal health exchanges in droves because they are not making as much money as promised by the Obama administration. Obamacare will disappear without insurance company participation.

When compared to 2015, 22 states and the District of Columbia have fewer insurers offering coverage on the exchanges in 2016.

 Just 10 states have more insurers offering coverage on Obamacare’s exchange.
The New York Times presents deceiving information about Obamacare. I cannot understand why readers believe these lies.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

More ICD-10 Codes

Stanley Feld M.D., FACP, MACE

Everything the Obama administration’s healthcare administrators do, to increase their control over the healthcare system backfires.

The Obama administration has not admitted that the new coding system (ICD-10) has not worked out as well as it should have.

The fact that CMS has to add 5,500 codes in 2017 suggests that somehow the new system is being gamed.

The increase in codes from16,000 codes (in ICD-9) to 68,000 codes (in ICD-10) is a way to force providers to more fully document their diagnosis and treatment.

It is described as a way to improve patient care. I suspect it will be used as a weapon to decrease reimbursement.

The best way to improve patient care and decrease healthcare cost is to let the patients be responsible for their health and healthcare dollars.

A way needs to be developed to measure medical out as it relates to medical costs. These outcomes must be provided to patients.

The more codes there are the more the coding system can be gamed and abused by hospitals, physicians and other providers.

At this point the government is paying many other providers. These providers can also game the system. The increase in codes can result in a further increase in costs to the healthcare system.

Never the less the Obama administration seems to spin everything that backfires on it into a positive. The people are not accepting the spin anymore.

One example of the spin is the information paper CMS published about ICM-10.

One section is entitled;

How will my practice benefit from ICD-10?

ICD-10 provides an enhanced platform for physician practice. As of October 1, 2015, the ICD-10 coding classification became the new baseline for clinical data, clinical documentation, claims processing, and public health reporting.

The statement means physicians have to provide more documentation in order for the government and the healthcare insurance industry to have more control over physicians’ practices.

From proper observation and documentation to improved clinical documentation, progress notes, operative reports, and histories, the benefits of ICD-10 begin with enhanced clinical documentation enabling physicians to better capture patient visit details and lead to better care coordination and health outcomes.

It does not enable physicians to better capture patient visit details and lead to better care coordination and health outcome.

It enables government and the healthcare insurance industry to capture patient visit details. It does not necessarily lead to better care coordination and health outcomes.

Ultimately, better data paves the way for enhanced quality and greater effectiveness of patient care and safety. The benefits of ICD-10 will impact everything from patient care to each practice’s bottom line.

Better data might not lead to enhanced quality care or lead to better care coordination and health outcome. It can lead to more paperwork and more false data.

It also could conclude that the best physicians are the best documenters. It will not tell us which physicians have the best clinical judgment.

Reasons to prepare for ICD-10 can be broken down into four categories:

Clinical

  • Informs better clinical decisions as better data is documented, collected, and evaluated
  • Provides new insights into patients and clinical care due to greater specificity, laterality, and more detailed documentation of patient diseases
  • Enables patient segmentation to improve care for higher acuity patients
  • Improves design of protocols and clinical pathways for various health conditions
  • Improves tracking of illnesses and severity
  • Improves public health reporting and helps to track and evaluate the risk of adverse public health events
  • Drives greater opportunity for research, clinical trials, and epidemiological studies.
  • A lot of this is just word salad.

Operational

  • Enhances the definition of patient conditions, providing improved matching of professional resources and care teams and increasing communications between providers
  • Affords more targeted capital investment to meet practice needs through better specificity of patient conditions
  • Supports practice transition to risk-sharing models with more precise data for patients and populations.

Professional

  • Provides clear objective data for credentialing and privileges.
  • Captures more specific and objective data to support professional Maintenance of Certification reporting across specialties.
  • Improves specificity of measures for quality and efficiency reporting
  • Aids in the prevention and detection of healthcare fraud and abuse
  • Provides more specific data to support physician advocacy of health and public health policy

This section clearly defines the intention of the expanded ICD-10. It is an attempt to define physicians’ quality of care by computer and award or penalize physicians based on a potentially faulty definition of quality care. It could lead to quality care being defined by documentation, not by clinical judgment.

Financial

  • Allows better documentation of patient complexity and level of care, supporting reimbursement for care provided
  • Provides objective data for peer comparison and utilization benchmarking
  • May reduce audit risk exposure by encouraging the use of diagnosis codes with a greater degree of specificity as supported by the clinical documentation

Physicians can interpret this category as a threat to their reimbursement and their clinical judgment.

Physicians might conclude that they should do what the government tells them to do or they will lose their livelihood.

The government’s healthcare policy wonks. They are not practicing physicians. They do not understand physicians’ potential reactions. They do not consider the unintended consequences of this policy.

Once physicians understand the goal is let the government control physicians’ medical judgment there is no telling what will happen to the quality of medical care.

Quality medical care is not a science or a social science that can be managed by computer. It is a learned process by physicians integrating scientific knowledge an art of personal relationships.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

The Obamacare Spin Goes On

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

People Are Not Stupid

Stanley Feld M.D.,FACP, MACE

The next time I hear that people are stupid I am going to scream.

The next time I hear Bernie Sanders saying college education should be free, and medical care should be free I am going to scream.

The next time I here that the healthcare insurance industry is losing money I am going to scream.

How can the healthcare insurance industry be losing money when insurance executives receive these salaries?

Does the healthcare insurance industry think we are stupid?

Salaries exec

The healthcare insurance industry loads premiums with all kinds of expenses.

There are hundreds of insurance executives making a million dollars or more a year reporting to each one of the above chief executives in each company.

There are hundreds of empty office buildings owned by the healthcare insurance industry. These buildings pay rent to the subsidiaries of each insurance company.

Those rents are an expense and are used to justify to state and federal regulators the reason for increasing insurance premiums yearly. Claims adjustors who previously occupied those buildings have been replaced by computer software.

Those buildings are empty but are still considered an expense by state and federal regulators.

The more money the taxpayers are forced to pay for healthcare premiums the more the healthcare system uses in its inefficient bureaucracy.

It is estimated that the healthcare insurance industry takes 40% out of every healthcare premium dollar for expenses. Many expenses are paid to subsidiaries of each company. Each subsidiary generates a profit that helps pay the executives’ inflated salaries.

The insurance company’s actual profit is not the 3% that is claimed.

This behavior by the healthcare insurance industry and state and federal regulators is enough to make a guy like Bernie Sander mad as hell.

In turn he has made all of his Democratic followers mad as hell. Something should to be done about this healthcare insurance industry rip off.

What is Bernie Sanders going to replace the present system with? Bernie Sanders will tell us healthcare coverage is going to be free as he replaces the present healthcare system with a healthcare system that will provide more money to insurance companies in order to provide the administrative services.

He is propagating a lie and he knows it.

Healthcare coverage will never be free.

Nothing is free. Taxes will increase to unbearable levels as beauracratic inefficiencies increase.

The taxpayers get it. All they have to do is look at the VA healthcare System.

The government cannot provide the administrative services in a universal healthcare system. The government will have to outsource the administrative services to the healthcare insurance industry.

The government will provide an increased opportunity for these companies to abuse the taxpayer even further.

I always hear that Medicare for all is the answer. That it is a single party system that works. Yes, it works for the beneficiaries. However, it is unsustainable. Most experts agree that is unsustainable for the government and the taxpayer.

It is an irrational thought that Medicare work for all at an affordable cost for everyone. Bernie Sanders should be smart enough to know it. The taxpayers are smart enough to know it.

Taxpayers are demanding that our politicians stop trying to feed us Kool-Aid.

The only way to fix the system is to replace it with a system that demands that the people are responsible for their health and their healthcare dollars.

On the other side, big governments entitlement programs are out of control. People can play our entitlement system so hard that it does not pay to look for work. The article below is unbelievable.  

New American Way

America has come to an interesting juncture. Both the right and the left take advantage of the systems provided by big government.

There is massive abuse on both the right and the left. The abuse is so great that it has proliferated so that the ethic of everyone working hard at a job is evaporating.

The loser is the middle class hard working taxpayer who is paying for all the abuse in the unsustainable systems that have been created.

The Obama administration either does not know what to do or doesn’t want to do anything. Once we experience economic collapse the government can take over.

I believe it knows exactly what it is doing. The Obama administration is changing America as promised. The administration is pushing us on to the Road to Serfdom.

For this reason alone we have to throw the bums out and elect new people who will help us get back to economic growth and the American hard work ethic.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.

Permalink:

Accelerating The Destruction Of The Healthcare System

Stanley Feld M.D.,FACP,MACE

Most of you are familiar with my slide of the demise of the healthcare system.

Thumbnail

Obamacare is accelerating the total collapse of the healthcare system. Once total collapse has occurred Americans might beg for a complete government taken over of the healthcare system with a single party payer system.

I have pointed out most of Obamacare’s new rules causing the unintended consequences and accelerating the healthcare system’s demise.

An unintended consequence in the Accountable Care Organization leads to a new rule to correct the consequence. Unelected officials then create another rule. The new rule results in other unintended consequences. All of these consequences accelerate the healthcare system’s demise.

Obamacare’s first year in operation was 2014. The Obama administration started taxing everyone in 2010 to support the added expenses Obamacare would generate.

Only the individual insurance portion of Obamacare was initiated.

The following are examples of unintended consequences.

Fourteen million people lost their individual healthcare insurance coverage in 2012 because of Obamacare’s new rules. Insurance coverage premiums increased because of the ACA’s required coverage.

Many workers lost their full time jobs. They were put on part-time employment in order for employers to avoid Obamacare penalties.

CMS reported that 13 million signed up for Obamacare in 2014 despite the healthcare.gov website disaster. The number of enrollees was revised a few of times down to 6.6 million because of counting errors.

The direct and indirect costs of Obamacare were never reported to the public.

Obamacare activated a reinsurance program that was built into the Affordable Care Act. The reinsurance program was a bailout to entice the healthcare insurance industry to participate in the Federal Health Insurance Exchanges without experiencing any loses.

The insurance industry has claims the Obama administration owed it 2.5 billion dollars in 2014. The Obama administration was able to pay only 12%. The law restricted the government’s reinsurance payment to a certain percentage of the premiums paid. The amount owed as promised to the healthcare insurance industry for their participation in Obamacare was $2.2 billion short.

I believe the healthcare insurance industry will be loath to participate in the Federal Health Insurance Exchanges in 2017. UnitedHealth has already threatened to quit participating.

This year (2016) during open enrollment only 8.1 million enrolled in the Federal Health Insurance Exchanges.

It has been difficult to trust CMS’s overall claims for the number of enrollees. It has nothing to do with how many people have paid first premium or the anticipated number who will continue to pay premiums throughout the year.

President Obama stated in his state of the union speech that 18 million previously uninsured have received insurance under Obamacare. This is not true.

For argument’s sake let say his number is correct.

More than half the enrollees received Medicaid. President Obama is urging states to expand Medicaid.

What is going to happen when Medicaid is expanded? More people will get free government supplied healthcare insurance but will not be able to find physicians. Medicaid reimbursement is so poor that few physicians participate.

The healthcare system’s demise is rapidly accelerating. Obamacare’s claiming to increase people being covered but these people cannot obtain healthcare services.

Obamacare does not incentivize these people to be responsible consumers. Obesity continues to increase and the dollars spent for healthcare continues to increase.

The truth is enrollment has been terrible for 2016. President Obama is expanding the enrollment period again this year to try to increase enrollment.

“Eager to maximize coverage under the Affordable Care Act, the Obama administration has allowed large numbers of people to sign up for insurance after the deadlines in the last two years, destabilizing insurance markets and driving up premiums, health insurance companies say.”

“The administration has created more than 30 “special enrollment” categories and sent emails to millions of Americans last year urging them to see if they might be able to sign up after the annual open enrollment deadline.

The Obama administration has done nothing to verify whether these late arrivals are eligible for insurance. They just sign up and are insured.

People have figured out they can wait until they become ill or need medical services to sign up. They then sign up and pay their premiums a few months’ premiums. They stop paying their premiums after they have received their medical services. They figure they do not need insurance any more.

“Individuals enrolled through special enrollment periods are utilizing up to 55 percent more services than their open enrollment counterparts” who sign up in the regular period, the Blue Cross and Blue Shield Association, whose local member companies operate in every state, told the administration.

The Obama administration has told the healthcare insurance industry that it has heard their concerns. The problem is that CMS has not done anything about the insurance industry’s concerns.

“Many individuals have no incentive to enroll in coverage during open enrollment, but can wait until they are sick or need services before enrolling and drop coverage immediately after receiving services, making the annual open enrollment period meaningless,” Steven B. Kelmar, an executive vice president of Aetna.

Twenty five percent of Aetna enrollees have signed up during the special extended enrollment periods. It has been reported that last year 950,000 people enrolled during the special enrollment period between February and July 2015.

“Kevin J. Moynihan, the chief executive of the federal insurance marketplace, said it shows the marketplace is working to meet people’s needs. He said certain life changes like losing your coverage, having a child, turning 26, moving or getting married may qualify you for a special enrollment period.”

People who are qualified for insurance do not get verified for insurance. It is easy to understand that this leads to unstable insurance markets and subsequent increases in premium prices.

It is o.k. for progressives if healthcare insurance is considered a right under a single party payer system with the losses taken by the government even if the deficit increases.

It is not o.k. if the Obamacare healthcare system pretends to be developing an efficient free enterprise system with the healthcare insurance industry experiencing the loss under the weight of unidentified risks created by the federal government.

The number of people not continuing to pay their insurance premiums their entire year is enormous. The healthcare insurance industry had no way of anticipating this occurrence.

“On average,” Aetna said, “special enrollment period enrollees stay with us for less than four months, while enrollees who come to us during the annual open enrollment period maintain their coverage on average for eight to nine months.

The same turnover rate has happened to UnitedHealth. It is one of the many reasons UnitedHealth has threatened to quit participating in Obamacare in 2017.

The result will be even higher insurance premiums next year. Most of the Obamacare insurance rates are unaffordable this year.

Enroll America, a nonprofit group with close ties to the Obama administration, said the government “should not tighten eligibility or verification standards in ways that could place an undue burden on consumers.”

There is no verification for late enrollment. The last statement by “Enroll America” reflects President Obama’s progressive and irresponsible attitude toward fiscal responsibility.

It is no wonder the national debt has grown to $19.2 trillion dollars.

It is another way to accelerate the collapse of the healthcare system.

I believe President Obama knows exactly what he is doing. His problem is he does not understand or care about the significance of the effect the deficit increase will have on America’s financial stability.

Middle class Americans are getting slaughtered.

Additionally he does not understand that Americans will not accept a government controlled single party payer system.

The Republican Party must get on the stick right now. They must offer a viable alternative to President Obama’s goal of a single party payer system. They should not wait until after the election.

The alternative should work in an efficient way. It should put consumers in charge of their health and healthcare dollars.

It would be a good idea for Republicans to understand and offer as an alternative My Ideal Medical Saving Accounts.

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

Please have a friend subscribe

  • Thanks for leaving a comment, please keep it clean. HTML allowed is strong, code and a href.