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Disinformation and the healthcare system

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Medical Care Must Not Be Converted To A Commodity

April 19, 2015
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

This blog post is a follow up to my last blog "Restricting Access To Care." I published this blog on May 10 2010. The Obama administration has ignored every word. As consumers and physicians might have notice the quality of medical care and the patient/physician relationships have deteriorated as I predicted because Obamacare.

Medical care is not patient centric. Healthcare reform (Obamacare) has been focused on process and not patients. This focus has distorted the effectiveness of medical care even more that it was pre Obamacare.

President Obama has increased the complexity of healthcare in an attempt to make medical care a commodity. His scheme is failing at the expense of consumers.

President Obama keeps on telling the same lie. “Obamacare is a success.” Consumers are not that stupid.

The public must start understanding what is happening now and not complain about why medical care has been destroyed later.

Once the public understands what is happening, individuals must write their congressperson and protest.

Consumers must not believe every lie thrown at them by the traditional media especially when the lie is counter to their every day experience.

I am republishing a previous blog that explains the attempt of turning medical care into a commodity.

Medical Care Must Not Be Converted To A Commodity

Stanley Feld M.D.,FACP,MACE

" President Obama is creating a new bureaucratic agency. It is called the Independent Payment Advisory Board. The Independent Payment Advisory Board will not be measuring clinical judgment or patient compliance when judging the effectiveness of treatment. Its measurement will be physician compliance with evidence based medicine. President Obama, please reexamine your premises.

I am in favor of clinical practice guidelines and evidence based medicine. However, both should be used as an educational tool for physicians and not as a punitive tool to judge payment.

The USPHTF will determine the evidence based medicine to be used. I have pointed out the deficiencies in the USPHTF in the past.

This bureaucracy is an attempt by the government to commoditize medical care. Once medical care is commoditized the cost for medical care is suppose to decrease.

Intensive control of the blood sugar for Type 2 Diabetes Mellitus can be expensive in the short run. If intensive control decreases the complications of Type 2 Diabetes Mellitus it can decrease costs in the long term.

The conclusion of the ACCORD study was intensive control was not worth the cost of medical care in the short term or long term. After the data was reexamined it turned out that the ACCORD conclusions were incorrect.

“It was not hypoglycemia from intensive control or intensive control itself that caused the increased deaths in the ACCORD study.”

Unfortunately, this information was not being reported on every TV station as the original study results were. The original study results set back universal use of intensive control of Type 2 Diabetes at least a decade.

“ It was important to say that in the intensive group it really was not the people with lower A1c who had problems, it actually was those who had the higher A1c who, despite intense efforts, we couldn't get under control."

This means patients did not comply with their responsibility to intensively control their chronic disease or their physicians did not teach them to control their blood sugar adequately.

"This reexamination gives a stronger momentum to the idea that we need to be thinking that one size doesn't fit all, we need to have different targets for different groups of people and perhaps different treatment strategies to reach those different targets as well. That's troubling both clinically and to the trialist.”

"This is something of a new idea, because previously there has been a strong impetus to having standardized guidelines for doctors and people with diabetes, but it's probably not the right thing to do.”

The reader can sense the discomfort of the academic physicians. They are realizing they cannot commoditize medical treatment. Ask any experienced practicing physician about their patients. Patients have different attitudes about their disease and treatment.

Each patient has to be related to differently. This is clinical judgment. Physicians communicating with their patients is called the physician patient relationships. Patients should be responsible for their outcomes along with physicians. This is the art of medicine. Neither patient nor physician can be treated as a commodity.

President Obama, I hope you are listening. Medical care is difficult to commoditize.

The ACCORD study originally suggested that the goal to normalize the HbA1c resulted in an increase in cardiovascular deaths. It turned out not to be true.

On the other hand an observational study was just published concluding that the lower the HbA1c the lower the complication risk.

“The Atherosclerosis Risk in Communities (ARIC) study is a community-based assessment of 11,092 middle-aged adults in four US communities with normal HbA1c were followed for up to 15 years (4 visits at about 3-year intervals) for onset of new diabetes, new CVD, stroke, and all-cause mortality.”

The higher the HbA1c the higher the average blood sugar and the greater the risk for chronic complications of Type 2 Diabetes Mellitus. HbA1c is a measure of the average blood sugar over the previous three months.

Table. HbA1c Levels and Corresponding Multivariate Hazard Ratios

HbA1c Level

Multivariate-Adjusted Hazard Ratio

< 5%

0.52 (0.40-0.69)

5% to < 5.5%

1.00 (reference)

5.5% to < 6%

1.86 (1.67-2.08)

6% to < 6.5%

4.48 (3.92-5.13)

≥ 6.5%

16.47 (14.22-19.08)

HbA1c = hemoglobin A1c

“The hazard ratios for stroke were similar, but for all-cause mortality, HbA1c displayed a J-shaped association curve. All associations remained significant after adjustment for the baseline FPG.”

The study found HbA1c values predicted Cardiovascular Disease (CVD) or death, whereas fasting plasma glucose (FPG) levels were not significant after adjustment for other risk factors.

“The recent ADVANCE [Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation], ACCORD [Action to Control Cardiovascular Risk in Diabetes], and VADT [Veterans Affairs Diabetes Trial] trials left us wondering about the value of tight glycemic control in reducing CVD risk.”

“One of the many shortcoming of each of these trials was that most participants had had diabetes for many years, and the designs could not account for the long-term accumulation of glycemic burden.”

The authors claim that the vascular damage from high HbA1c may have already occurred. Tight control during the trials might have had relatively little effect. This is probably not true.

There is evidence that normalizing the blood glucose can lead to regression of the vascular lesions that cause the complications of Diabetes.

The current ARIC analysis demonstrates that higher HbA1c levels, even in the normal range, increase CVD risk.

These results are not conclusive because it is an observational study as opposed to a double blind placebo controlled study. The USPHTF and President Obama’s Independent Payment Advisory Board would not give this study as much credit as the ACCORD study.

The ACCORD study was a placebo controlled double blind study. Its conclusions have more power than an observational study (ARIC). The problem is ACCORD measured the wrong endpoint. ACCORD has resulted in a great disservice to the standard of medical care of diabetes.

The results of The Atherosclerosis Risk in Communities (ARIC) study suggest that maintaining a HbA1c as near normal as possible even before the onset of diabetes may help prevent CVD.

As President Obama tries to quantify the standard of care he could be picking the wrong standard of care in order to reduce the cost of medical care. All medicine is local. Standards of care are always evolving. The standard of medical care should be determined by local medical leaders who are respected as teachers by local practitioners. It can also be enforced by local peer review with no monetary interest in the outcome.

President Obama’s effort to improve medical care at a reduced price will not succeed if it is interpreted as a punitive measure by a national bureaucracy.

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

May 30, 2010 "

A healthcare system that would work and be cost effective must be a consumer driven healthcare system. It must be patient centered and not stakeholder centered.

It must put consumers in a position of responsibility for their health and healthcare dollars and not in a position of dependence on the government.

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

Please have a friend subscribe

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Medical Care Must Not Be Converted To A Commodity

April 19, 2015
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

This blog post is a follow up to my last blog "Restricting Access To Care." I published this blog on May 10 2010. The Obama administration has ignored every word. As consumers and physicians might have notice the quality of medical care and the patient/physician relationships have deteriorated as I predicted because Obamacare.

Medical care is not patient centric. Healthcare reform (Obamacare) has been focused on process and not patients. This focus has distorted the effectiveness of medical care even more that it was pre Obamacare.

President Obama has increased the complexity of healthcare in an attempt to make medical care a commodity. His scheme is failing at the expense of consumers.

President Obama keeps on telling the same lie. “Obamacare is a success.” Consumers are not that stupid.

The public must start understanding what is happening now and not complain about why medical care has been destroyed later.

Once the public understands what is happening, individuals must write their congressperson and protest.

Consumers must not believe every lie thrown at them by the traditional media especially when the lie is counter to their every day experience.

I am republishing a previous blog that explains the attempt of turning medical care into a commodity.

Medical Care Must Not Be Converted To A Commodity

Stanley Feld M.D.,FACP,MACE

" President Obama is creating a new bureaucratic agency. It is called the Independent Payment Advisory Board. The Independent Payment Advisory Board will not be measuring clinical judgment or patient compliance when judging the effectiveness of treatment. Its measurement will be physician compliance with evidence based medicine. President Obama, please reexamine your premises.

I am in favor of clinical practice guidelines and evidence based medicine. However, both should be used as an educational tool for physicians and not as a punitive tool to judge payment.

The USPHTF will determine the evidence based medicine to be used. I have pointed out the deficiencies in the USPHTF in the past.

This bureaucracy is an attempt by the government to commoditize medical care. Once medical care is commoditized the cost for medical care is suppose to decrease.

Intensive control of the blood sugar for Type 2 Diabetes Mellitus can be expensive in the short run. If intensive control decreases the complications of Type 2 Diabetes Mellitus it can decrease costs in the long term.

The conclusion of the ACCORD study was intensive control was not worth the cost of medical care in the short term or long term. After the data was reexamined it turned out that the ACCORD conclusions were incorrect.

“It was not hypoglycemia from intensive control or intensive control itself that caused the increased deaths in the ACCORD study.”

Unfortunately, this information was not being reported on every TV station as the original study results were. The original study results set back universal use of intensive control of Type 2 Diabetes at least a decade.

“ It was important to say that in the intensive group it really was not the people with lower A1c who had problems, it actually was those who had the higher A1c who, despite intense efforts, we couldn't get under control."

This means patients did not comply with their responsibility to intensively control their chronic disease or their physicians did not teach them to control their blood sugar adequately.

"This reexamination gives a stronger momentum to the idea that we need to be thinking that one size doesn't fit all, we need to have different targets for different groups of people and perhaps different treatment strategies to reach those different targets as well. That's troubling both clinically and to the trialist.”

"This is something of a new idea, because previously there has been a strong impetus to having standardized guidelines for doctors and people with diabetes, but it's probably not the right thing to do.”

The reader can sense the discomfort of the academic physicians. They are realizing they cannot commoditize medical treatment. Ask any experienced practicing physician about their patients. Patients have different attitudes about their disease and treatment.

Each patient has to be related to differently. This is clinical judgment. Physicians communicating with their patients is called the physician patient relationships. Patients should be responsible for their outcomes along with physicians. This is the art of medicine. Neither patient nor physician can be treated as a commodity.

President Obama, I hope you are listening. Medical care is difficult to commoditize.

The ACCORD study originally suggested that the goal to normalize the HbA1c resulted in an increase in cardiovascular deaths. It turned out not to be true.

On the other hand an observational study was just published concluding that the lower the HbA1c the lower the complication risk.

“The Atherosclerosis Risk in Communities (ARIC) study is a community-based assessment of 11,092 middle-aged adults in four US communities with normal HbA1c were followed for up to 15 years (4 visits at about 3-year intervals) for onset of new diabetes, new CVD, stroke, and all-cause mortality.”

The higher the HbA1c the higher the average blood sugar and the greater the risk for chronic complications of Type 2 Diabetes Mellitus. HbA1c is a measure of the average blood sugar over the previous three months.

Table. HbA1c Levels and Corresponding Multivariate Hazard Ratios

HbA1c Level

Multivariate-Adjusted Hazard Ratio

< 5%

0.52 (0.40-0.69)

5% to < 5.5%

1.00 (reference)

5.5% to < 6%

1.86 (1.67-2.08)

6% to < 6.5%

4.48 (3.92-5.13)

≥ 6.5%

16.47 (14.22-19.08)

HbA1c = hemoglobin A1c

“The hazard ratios for stroke were similar, but for all-cause mortality, HbA1c displayed a J-shaped association curve. All associations remained significant after adjustment for the baseline FPG.”

The study found HbA1c values predicted Cardiovascular Disease (CVD) or death, whereas fasting plasma glucose (FPG) levels were not significant after adjustment for other risk factors.

“The recent ADVANCE [Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation], ACCORD [Action to Control Cardiovascular Risk in Diabetes], and VADT [Veterans Affairs Diabetes Trial] trials left us wondering about the value of tight glycemic control in reducing CVD risk.”

“One of the many shortcoming of each of these trials was that most participants had had diabetes for many years, and the designs could not account for the long-term accumulation of glycemic burden.”

The authors claim that the vascular damage from high HbA1c may have already occurred. Tight control during the trials might have had relatively little effect. This is probably not true.

There is evidence that normalizing the blood glucose can lead to regression of the vascular lesions that cause the complications of Diabetes.

The current ARIC analysis demonstrates that higher HbA1c levels, even in the normal range, increase CVD risk.

These results are not conclusive because it is an observational study as opposed to a double blind placebo controlled study. The USPHTF and President Obama’s Independent Payment Advisory Board would not give this study as much credit as the ACCORD study.

The ACCORD study was a placebo controlled double blind study. Its conclusions have more power than an observational study (ARIC). The problem is ACCORD measured the wrong endpoint. ACCORD has resulted in a great disservice to the standard of medical care of diabetes.

The results of The Atherosclerosis Risk in Communities (ARIC) study suggest that maintaining a HbA1c as near normal as possible even before the onset of diabetes may help prevent CVD.

As President Obama tries to quantify the standard of care he could be picking the wrong standard of care in order to reduce the cost of medical care. All medicine is local. Standards of care are always evolving. The standard of medical care should be determined by local medical leaders who are respected as teachers by local practitioners. It can also be enforced by local peer review with no monetary interest in the outcome.

President Obama’s effort to improve medical care at a reduced price will not succeed if it is interpreted as a punitive measure by a national bureaucracy.

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

May 30, 2010 "

A healthcare system that would work and be cost effective must be a consumer driven healthcare system. It must be patient centered and not stakeholder centered.

It must put consumers in a position of responsibility for their health and healthcare dollars and not in a position of dependence on the government.

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

Please have a friend subscribe

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Restricting Access To Care

April 15, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP, MACE

As a retired Clinical Endocrinologist I don’t have a vested interest in generating income for myself from the healthcare system.

What I am trying to do is help consumers and healthcare policy makers understand the present healthcare system. I fear they have no interest in understanding what would work to repair the healthcare system.

I am also trying to explain to consumers that few politicians are interested in helping them. Politicians are interested in power. They are interested in making the people dependent on them.

Politicians and the central government are interested in controlling the healthcare system, the financial system, the Internet and the environment. Once politicians control these systems the people have lost their independence and freedom. Politicians will have the power they seek.

Many of our constitutional freedoms have been disappearing. American have been on the Road To Serfdom for many years.

President Obama has hastened the journey on the road to serfdom with his blatant disregard for the constitution and the bill of rights. To my chagrin he is succeeding.

President Obama is pretending to want to provide universal care. His goal is to destroy the healthcare system so that the people will beg for the central government to control the healthcare system.  There are more uninsured people now than when he became President.

Paul Krugman is one of President Obama’s henchmen. He stated in a recent article that Obamacare is costing the government less money than the administration thought it would. He therefore calls Obamacare a success.

This administration and its henchmen in the traditional media flood us with half-truths.

Obamacare might be costing the government less than they expected. The Obama administration never told Americans what they expected to spend.

The Obama administration is the most non-transparent administration in my lifetime.  Meanwhile, the Obama administration tells Americans it is the most transparent administration in history.

CGI is a Canadian company with offices in the U.S. It had the contract to develop the Obamacare website healthcare.gov. The website was a disaster. The development cost overruns were unbelievable.

CGI received the contract through an Obama crony capital award and a non-competitive bid.

CGI receive another contract to complete the backend of healthcare.gov.

The Affordable Care Act (Obamacare) is supposed to be affordable for consumers. Consumers are experiencing higher premiums and out of pocket expenses for medical services.

1. Obamacare has been under subscribed. Only 10 million people are verified premium paying subscribers. The Obama administration projected 30 million subscribers by 2015 when Obamacare was passed in 2010.

2. The deductibles are unaffordable. Obamacare is even unaffordable to those people who receive subsidies.

The subsidized people have avoided seeing physicians in a timely manner. The result is government costs are less in the short run but will be more in the long run as people get very ill.

3. The Obama administration is keeping the expenses for infrastructure and bureaucratic structure non transparent.

4. Obamacare’s rules and regulations are resulting in restricting access to care.  

5. Paul Krugman and the Obama administration spin the truth by ignoring consumer out of pocket expenses.

There has been an explosive increase in premiums and higher deductibles though the health insurance exchanges as well as private insurance.

The Obama administration has been silent about this reality.

The Affordable Care Act is not affordable. It has not increased the “quality of care.”  

Paul Krugman does not publish the real truth in his New York Times articles. Those who still read the New York Times take his words literally. They are deceiving themselves.

One of the ways the Obama administration is restricting access to care to lower its costs is through the U.S. Preventive Services Task Force’s (USPSTF) recommendations.

I have criticized the USPSTF methodology in the past for its conclusions about many clinical practices.

The task force is composed of a group of physicians that do not have clinical expertise in the medical or surgical topic they are evaluating.

The group simply reads the medical papers assigned to them to evaluate. The committee decides the efficacy of treatment on the quality of the literature they are given to evaluate.  Clinical judgment is not included in their evaluation.

A positive decision is made if the literature contains a double blind controlled study yielding positive results.  

Last month the U.S. Preventive Services Task Force (USPSTF) issued its final recommendation statement on Screening for Thyroid Dysfunction. The USPSTF studied this topic in 2004 with the same final opinion.

This time Obamacare will probably take action and restrict the evaluation on the basis of this recommendation

 “ In its statement, the task force said that without more data from randomized clinical trials it could not assess the balance of benefits and harms from pre-clinical thyroid disease treatment and, thus, could not recommend that asymptomatic, non-pregnant adults be screened for thyroid dysfunction.”

 The Annals of Internal Medicine (AIM), a journal of the American Medical Association published the USPSTF recommendation without expert clinical endocrinology comment or critique.

R. Mack Harrell, MD, FACP, FACE, ECNU current President of the American Association of Clinical Endocrinologists (AACE) is having the AACE Thyroid Scientific Committee submit a note to the Annals of Internal Medical addressing AACE’s concerns with the USPSTF’s paper.

AACE has studied and written many guidelines on the evaluation and treatment of thyroid disease. Its members have vast experience as practicing clinicians in the treatment of thyroid disease. Its input should be sought by the Obama administration not ignored in favor of a default decision that saves Obamacare money and puts the financial burden of care on consumers.

The following is Dr. Mack Harrell’s comment to AACE’s membership.

In my opinion Dr. Harrell’s’ comments are totally correct and should be heeded by the Obama administration.

“While agreeing with the USPSTF’s call for new, controlled thyroid screening studies, AACE issued a press release outlining its position on aggressive case finding suggesting: that this approach is an appropriate alternative to screening in patient groups where thyroid risk factors are present.

More specifically, AACE stressed that testing and treatment are indicated in those patients who are at highest risk for developing life-altering, overt thyroid disease, including:

Patients over 60, in whom symptoms of hypothyroidism are often minimal, absent or atypical

  • Newborns (continued mandatory screening for congenital hypothyroidism recommended)
  • Those with autoimmune diseases often associated with thyroid disease, such as type 1 diabetes and pernicious anemia
  • Patients with a prior history of thyroid disease or thyroid surgery, an abnormal thyroid exam, or taking drugs known to affect the thyroid
  • Patients with a family history of thyroid illness

AACE further emphasized that careful consideration should be given to thyroid testing in women who are planning pregnancy or are already pregnant given the clear-cut detrimental effects of thyroid hormone lack on fetal development in the early phases of pregnancy.

We also intend to submit to AIM a formal statement from the AACE Thyroid Scientific Committee to address concerns that the task force’s “lack of data” argument could be incorrectly interpreted as a “lack of clinical need” to find and treat thyroid disease.

For years, members of AACE and the American College of Endocrinology have worked diligently to provide up-to-date, useful clinical guidelines and recommendations regarding decision-making about thyroid function testing for physicians. We will continue to keep our members and the medical community apprised as we communicate our position regarding thyroid disease testing.

Best regards,

R. Mack Harrell, MD, FACP, FACE, ECNU

The Obama administration has made many mistakes in writing Obamacare. Most of them have not been in favor of the consumers it professed to help.

About 50% of women over the age of 60% might have subclinical hypothyroidism. Overt clinical hypothyroidism can take several years to declare itself. During the time of subclinical hypothyroidism evolves to overt hypothyroidism patients can suffer mild to moderate symptoms that would decrease their quality of life on many levels.

I believe President Obama should show compassion and responsibility toward the millions of who people would suffer from subclinical hypothyroidism. President Obama is setting up the healthcare system to restrict access to care for these people.

I do not think he should rely on a committee that does not have the expertise in the field of clinical thyroidology.  

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

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Simple, Viable Republican Alternatives To Obamacare

April 12, 2015
inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Medicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust, Universal Healthcare
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Stanley Feld M.D., FACP, MACE

There are many simple and viable alternatives to Obamacare which Republicans should start considering.

Republicans should seriously consider My Ideal Medical Savings Account as an alterative to Obamacare. It is logical, simple, does not require a large complicated infrastructure and aligns all the stakeholders’ incentives.

It is easy for consumers to understand.

Consumers want to have choices. The dysfunction of our healthcare system has gotten to the point where most consumers don’t have a choice. Consumers simply do not know they lost their freedom of choice and access to care until they get sick.

Consumers think they have adequate healthcare coverage until they get sick. Only 20% of the population gets sick.

The other 80% of the population refuses to think about the problem.

When they do experience illness, the dysfunction in the healthcare system makes them furious. They want to blame someone. Physicians are usually the targets of their frustration.  

Most physicians are trapped in a situation that causes them to fight for their own survival for all the reasons I have previously enumerated. This creates a more dysfunctional healthcare system.

All the stakeholders fight for their own vested interests. These vested interests have become misaligned. The vested interest of the government is to control of the system and decrease its costs.  

Costs cannot be controlled by regulations without consumer involvement.   Consumers of healthcare must understand the effectiveness of their care is dependent on their involvement in their own medical care.

Consumers’ adherence to treatment is a key component in the effectiveness of medical care.

Medical costs cannot be controlled by government price fixing.

Medical costs cannot be controlled by government restrictions to access of care. Consumers will become sicker resulting in a higher cost illness.

Consumers must be empowered to be intelligent, motivated and responsible consumers of medical care. Only then can healthcare costs be controlled.

A functional healthcare system must provide financial incentives to consumers in order for them to want to be empowered to control costs. Consumers should not be dependent on the government to control costs.

The government must repair the actuary and accounting rules of the healthcare insurance industry. Insurance reserves should not be scored as a loss to justify premium increases.

The healthcare insurance industry takes 40 cents off the top of every insurance dollar that is spent. Consumers with both private insurance and government insurance are only getting 60 cents value for every healthcare dollar spent. The healthcare industry is allowed to do some strange accounting with their required reserves.

If this accounting method were repaired, premium costs would decrease.

Effective malpractice reform would result in a significant decrease in healthcare costs. The Obama administration refuses to believe tort reform is needed.  

Many of the rules written into Obamacare, Medicare, and Medicaid are so screwy they defy common sense and penalize consumers. One glaring rule is Medicare permitting hospitals to admit Medicare patients to the hospital for observation for 48 hours.

Medicare does not pay for Observation admissions. Patients have to pay out of pocket for these admissions.

Consumers must become aware of these screwy rules and protest them. These rules have been written by the Obama administration to save the government money. These rules penalize patients the government professes to help.

Consumers are the only stakeholders that can motivate President Obama and congress to fix the significant points of waste in the healthcare system. Consumers have the power to vote.

I do not believe that President Obama has an interest in repairing the healthcare system. All of his actions signify that he wants the healthcare system to fail. After it fails people will beg the government to completely take over and have a single party payer.

Does anyone trust the government to take over our most valuable asset, our healthcare?

The government take over will also fail because dependent consumers will figure out how to game the system just as food stamp recipient have figured out how to game that inefficient system.

The goal of a sincere administration and congress is to figure out how to motivate consumers to be “PROSUMERS” (productive consumer) with an economic interest in the healthcare system.

Airlines, banks, bookstores, entertainment venues have all figured it out. Why can’t the government help consumers figure it out?

My blog entitled “My Ideal Medical Saving Account Is Democratic” presents a consumer driven healthcare formula. It gives every socioeconomic group the opportunity to be an effective “Prosumer”.

It gives all Prosumers the incentive to be responsible for their health and healthcare dollars.

Below is the blog My Ideal Medical Savings Account Is Democratic!

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) “was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrict freedom of choice and decrease in access to care.

The excellent example of increasing costs, decreasing choice, and decreasing access to care is Medicaid.

The fact that someone is covered by healthcare coverage does not mean they have access to medical care.

 I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health.  Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self- insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk is low. 

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust.  If they spent over $6,000 they would receive first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes Mellitus, or heart disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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Republicans who really want to repair the healthcare system should take notice of these suggestions. They should stop proposing complicated alternatives to Obamacare that will not work.

Republicans should start trying to understand the real problems in the healthcare system.

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

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The Republican Misguided Alternative to Obamacare

March 30, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System
• Leave a comment

 

Stanley Feld M.D., FACP, MACE

Several important ideas can be derived from the Republican’s preliminary alternative to Obamacare.

Obamacare had been poorly conceived. Its execution has been worse.  Obamacare was developed by academic policy wonks that had no idea of  the culture of the physician practice community.  

These academic health policy wonks designed a system that is rigorous in the sense that outlines how all physicians should practice medicine. Physicians should use algorithms outlining this year’s best practices as developed by the interpretation of this year’s best clinical studies.  Obamacare was designed to measure physicians’ performance and inhibit physicians’ judgment. Healthcare policy wonks decided that the only way to accomplish this was by demanding an integrated care.

In order to effectively measure physicians’ efficiency, physicians must be under one hospital system. Physicians’ efficiency should be measured by a hospital’s bureaucrats. The government should control the rules and regulations. The set-up was satisfactory to President Obama because his goal was always central control of the healthcare system along with a single party payer (socialized medicine)

 If a hospital system performs better than some goal set the year before it gets a modest reward and shares it with the physicians on staff.  If their performance is more costly than the previous year they will be penalized.

This is a bad formula because success depends on the hospital staff, the physician staff and patient performance. Patient performance is not measured in Obamacare. No one even considers the patient’s responsibility to effectively improve outcomes of care.

patients are being treated as commodities. Physicians are being treated as commodities.

Patients are run through a bureaucracy with various physicians and physician extenders. They do not have one doctor caring for them.  The system is not going to improve patients’ knowledge of their disease or improve their outcomes. Patients must have ownership in their diseases.

All one has to consider is President Obama’s lie “if you like your doctor you can keep your doctors,” along with the tremendous growth of concierge medicine and out of pocket medical expenses since Obamacare was passed.

Concierge medicine adds $2,000 to $10,000 dollars to consumers’ out of pocket expense for the patients desire to have the ability to have contact with their their doctor and their desire to have the ability have questions answered and care coordinated by their doctor.   

Positive physician/ patient relationships will improve outcomes and decrease the cost of care.  

Most of the practice of medicine and surgery has been performed by independently practicing physicians. 

No one in the Obama administration has asked leading physicians in the practicing community what they think should be done to fix Obamacare.

Neither has the Republican Party listened to leading physicians in the practicing community about what should be included in their alternative to Obamacare.

I suspect the Republican leadership in the Senate is ignoring the few Republicans in the house and senate who were practicing physicians.

I know Rep. Michael Burgess, MD (R-TX-26) OB/GYN. Both Michael and his father used to send me Endocrine consultations when we all were in practice. I think the Republican leadership in the Senate has probably marginalized Michael  and the nine other Representatives  in the GOP House’s Doctors Caucus.  

Michael knows what has to be done after Obamacare is repealed and replaced. So far the GOP house caucus has only produced generalities.

he GOP Doctors Caucus: Utilizing medical expertise to develop patient-centered health care reforms focused on quality, access, affordability, portability, and choice.

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

The Republican congresspersons as well as President Obama and Democratic congresspersons have left out the most important elements necessary for real healthcare reform.

The maintenance of the physician/patient relationship, with built in consumer responsibility for their own healthcare maintenance plus consumers’ responsibility for their own health and healthcare dollars, whatever their income, is the key to Repairing the Healthcare System.

Congress should pass a law with a light bureaucracy that provides a subsidy for the qualified indigent to receive healthcare insurance and financial incentives to stay healthy as well as education to learn to manage their chronic disease.

Effective Healthcare reform must include financial incentives for consumers to remain healthy.

I will review the Republican Party’s proposal in my next blog. They have some good ideas.

However, the Republican Party totally misses the key elements needed to  Repair the Healthcare System

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

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Let’s Do The Numbers : Another Obama Trick

March 19, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Have the increased Obamacare taxes added enough value to the healthcare system to be worth the costs?

The answer is no.

Are the increased taxes becoming painful yet?

The answer is yes.

The yearly cost of Obamacare has not been transparent.  There have been multiple delays in the implementation of Obamacare.

Favored businesses and unions have received waivers and exemptions from the laws required coverage. All the while taxes have increased and less than 10 million people have received healthcare coverage from the healthcare insurance exchanges. Eighty-five percent of those people enrolled are receiving federal subsidies.

No one has explained how a tax credit becomes a federal subsidy.

The public has no idea what the costs of Obamacare are or will be in the future. The CBO has revised its estimates several times.

Are all the Obamacare pronouncements confusing?

Yes. I believe they are intentionally confusing.

All the stakeholders are dissatisfied. Neither President Obama nor his administration is listening to the primary stakeholder (patients). 

Why are there so many waivers and exemptions being handed out by the Obama administration? I believe it is because President Obama is listening to his political base.

He is delaying the implementation of his agenda so his goal of socialized medicine is not obvious to all Americans.

President Obama and his administration have mislead us about the exact number of enrollees since the very beginning of the first enrollment period,  October 1,2013.

The American public was mislead about ,

 

  1. The disastrous website development, reason for website crashes and cost of website development.
  2. The exact number of enrollees the first year. (9.5 million correct to 8 million and then down to 6.8 million)
  3. The resulting further correction by a decrease in 800,000 more people losing insurance because of discovered ineligibility for subsidies.
  4. Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
  5. The change in the start of enrollment from October 1,2014 to November 15th to avoid discussion of enrollment around the time of the November 2014 elections.
  6. Extending the 2014 enrollment three months.
  7. Extending enrollment for 2015 for one to three months.
  8. Finally in 2015 announcing the back end of the website sending information to the IRS was still not complete.
  9. Rehiring CGI the same Canadian company that built the disastrous healthcare.gov to fix the back end of the website.
  10. Discovering that 1.2 million were counted that should not have been because they got dental insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
  11. Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
  12. Eight hundred thousand (800,000) enrollees lost their subsidy because they lied on their application
  13. Announcing that the group market Obamacare enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

Along the way I got the feeling that none of the enrollment numbers could be trusted.  HHS and CMS keeps on modifying and lowering them.

The Obama administration keeps telling us how great the enrollment is and that Obamacare is a success.

However, only ten million people have Obamacare insurance. Eighty five percent of those on Obamacare are receiving subsidies and still cannot afford the deductibles.

The rest of the enrollees have a pre-existing illness. They cannot find private insurance to buy. What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?    

After five years with all these new Obamacare taxes, I would not call this a successful healthcare reform program.

All of these enrollees were in the individual market. These numbers do not include the group insurance market.

14 million lost their healthcare insurance on the individual market. 10 million gained insurance on the healthcare insurance exchanges.

Several states healthcare insurance exchanges have failed.

An unknown number of enrollees in 2014 did not re-enroll in 2015 because of the loss of the subsidy and the high deductibles.

Other enrollees did not sign up again because they could not afford the high deductible.

The following is President Obama’s next trick play.

At the end of 2015 enrollment the Obama administration declared that 11.5 million people were enrolled.

On March 16,2015 the administration said about 16.4 million people have gained health insurance coverage since the Affordable Care Act became law nearly five years ago.

Please notice the tricky wording. The Obama administration is counting children under 26 that now can be included in their parents’ group insurance plans and the additional Medicaid recipients added by some states.

The count is not only the people who enrolled in Obamacare through the healthcare insurance exchanges.

The present discussion is about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

Confirmed Exchange QHPs: 11,699,473 as of 3/18/15


Estimated: 11.95M (9.06M via HCgov) as of 3/18/15

 

Estimated ACA Policy Enrollment: 33.1M
(10.46M Exchange QHPs, 8.20M OFF-Exchange QHPs, 330K SHOP, 14.1M Medicaid/CHIP)

 http://acasignups.net

There are two possible reasons for the Obama administration’s pronouncement at this time.

The first is the Republicans are about to announce its alternative plan to Obamacare. The administration’s goal would be to blunt the impact of the alternative plan by announcing the false success of Obamacare.

The second reason is to play mind games with the Supreme Court.

Justice Kennedy’s questioning at the hearing of King vs. Burwell expressed his concern for 85% of 10 million people who would loss their federal subsidy. Justice Kennedy did not address the letter of the law in his questioning.

Only the state healthcare exchanges can provide subsidies not the federal exchanges according to the written law. This is executive overreach of power granted by the constitution. President Obama should have asked congress to rewrite the law’s provision.

In an attempt to pressure the Supreme Court to vote in President Obama’s favor the administration has given the impression of confidence the Supreme Court will act in its favor.

The Obama administration has announced, a few times, that it does not have an alternative plan if the Supreme Court rules against it.

This is not true. The Obama administration has at least three alternative plans in the works.

It looks as if President Obama cannot help himself from trying to manipulate the American public and now the Supreme Court.

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

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Obamacare Tax Hikes That Are Forgotten

March 15, 2015
inDisinformation and the healthcare system, Medicare, Medicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens earning less than $250,000 dollars a year.

According to Grover Norquist there will be ½ trillion dollars ($500 billion) in new taxes collected from the group of people making less than $250,000 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 have been passed on to consumers in the form of higher prices.

  

 

https://youtu.be/eHlRY3kHhBk

 

 

 

I am not talking about the increase in taxes on capital gains and dividends that seniors rely on to survive. I am talking about all the other taxes that affect purchasing power.

In 2012, Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

The traditional media have ignored these new taxes and Mr. Norquist’s summary.   No one is talking about how these taxes are hurting seniors and the middle class economically.  

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said people earning under $250,000 would not pay one single dime more in taxes.

I suggest everyone watch President Obama’s lying and defending of his lies. After the first You Tube let it keep playing to hear subsequent You Tubes.

  

http://youtu.be/56c1fSdTAWI

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organized the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in their taxes.

Mr. Norquist’s article appeared in 2012.

“Obamacare contains 20 new or higher taxes on American families and small businesses. 

Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.

 

Capital Gains

Dividends

Other*

2012

15%

15%

35%

2013+

23.8%

43.4%

43.4%


*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

 

First $200,000
($250,000 Married)
Employer/Employee

All Remaining Wages
Employer/Employee

Current Law

1.45%/1.45%
2.9% self-employed

1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike

1.45%/1.45%
2.9% self-employed

1.45%/2.35%
3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that took effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

 

1 Adult

2 Adults

3+ Adults

2014

1% AGI/$95

1% AGI/$190

1% AGI/$285

2015

2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085


Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

© 2012 Newsmax. All rights reserved.

Mr. Norquist left out the worst tax of all. The “tax” is under everyone’s radar. It has not been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present
Monthly Fee of $96.40, rising to:

$104.20 in 2012

$120.20 in 2013

And

$247.00 in 2014."

 

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

 

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.  

These are provisions incorporated in the Obamacare legislation, purposely
delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

 

Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus.  Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare could be repealed.   

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.  

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

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Here’s One For You, Stan

February 25, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System
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Stanley Feld M.D.,FACP,MACE

I wish to thank my readers for the many comments and suggestions sent to me over time.

I am starting to receive some serious criticisms of Obamacare that everyone should take note of.

Americans do not realize how bad the law is until they experience it.

People are starting to pay attention to the Obamacare disaster. They  realize it is affecting them directly.

Many people are having trouble finding a doctor. Many are having trouble getting access to care. Emergency rooms have become overcrowded. It is an awful experience to try to get care.

A note from previously insured patient who became uninsured because of Obamacare’s insurance requirements.

 

 “Here's one for you Stan. 

 

Here are the 10,535 pages of Obama Care condensed to 4 sentences.  
As ridiculous as this sounds…..every last word is absolutely TRUE!

1. In order to insure the uninsured, we first have to uninsure the insured. 
2. Next, we require the newly uninsured to be re-insured. 
3. To re-insure the newly uninsured, they are required to pay extra charges to be re-insured.
4. The extra charges are required so that the original insured, who became uninsured, and then became re-insured, can pay enough extra so that the original uninsured can be insured, which will be free of charge to them.

This is called "redistribution of wealth"… or, by its more common name, "SOCIALISM.”

There are many more people confused by Obamacare. The reader is correct. The summary is spot on.

On top of this I got this note from another reader.  The public is starting to figure out Obamacare. This is a note written by a Californian.

 A Note From An Engineer

 “THIS IS WHAT OBAMACARE IS REALLY ABOUT!!!!!!!!!!!!! 

I'm a 54-year-old consulting engineer and make between $60,000 and $125,000 per year, depending on how hard I work and whether or not there are work projects out there for me. 

My girlfriend is 61 and makes about $18,000 per year, working as a part-time mail clerk. 

For me, making $60,000 a year, under Obamacare, the cheapest, lowest grade policy I can buy, which also happens to impose a $5,000 deductible, costs $482 per month. 

For my girlfriend, the same exact policy, same deductible, costs $1 per month. That's right, $1 per month. I'm not making this up. 

Don't believe me? Just go to http://www.coveredca.gov/, the Obamacare website for California and enter the parameters I've mentioned above and see for yourself. By the way, my zip code is 93940. You'll need to enter that. 

So OK, clearly Obamacare is a scheme that involves putting the cost burden of healthcare onto the middle and upper-income wage earners. But there's a lot more to it. Stick with me.

And before I make my next points, I'd like you to think about something:

I live in Monterey County, in Central California. We have a large landmass but just 426,000 residents – about the population of Colorado Springs or the city of Omaha.

But we do have a large Hispanic population, including a large number of illegal aliens, and to serve this group we have Natividad Medical Center, a massive, Federally subsidized county medical complex that takes up an area about one-third the size of the Chrysler Corporation automobile assembly plant in Belvedere, Illinois (see Google Earth View). Natividad has state-of-the-art operating rooms, Computed Tomography and Magnetic Resonance Imaging, fully equipped, 24 hour emergency room, and much more. If you have no insurance, if you've been in a drive-by shooting or have overdosed on crack cocaine, this is where you go. And it's essentially free, because almost everyone who ends up in the ER is uninsured. 

Last year, 2,735 babies were born at Natividad. 32% of these were born to out-of-wedlock teenage mothers, 93% of which were Hispanic. Less than 20% could demonstrate proof of citizenship, and 71% listed their native language as Spanish. Of these 876 births, only 40 were covered under [any kind of] private health insurance. The taxpayers paid for the other 836. And in case you were wondering about the entire population – all 2,735 births – less than 24% involved insured coverage or even partial payment on behalf of the patient to the hospital in exchange for services. Keep this in mind as we move forward.

Now consider this:

If I want to upgrade my policy to a low-deductible premium policy, such as what I had with my last employer, my cost is $886 per month. But my girlfriend can upgrade her policy to the very same level, for just $4 per month. That's right, $4 per month. $48 per year for a zero-deductible, premium healthcare policy – the kind of thing you get when you work at IBM (except of course, IBM employees pay an average of $170 per month out of pocket for their coverage). 

I mean, it's bad enough that I will be forced to subsidize the Obamacare scheme in the first place. But even if I agreed with the basic scheme, which of course I do not, I would never agree to subsidize premium policies. If I have to pay $482 a month for a budget policy, I sure as hell do not want the guy I'm subsidizing to get a better policy, for less that 1% of what I have to fork out each month for a low-end policy.

Why must I pay $482 per month for something the other guy gets for a dollar? And why should the other guy get to buy an $886 policy for $4 a month? Think about this: I have to pay $10,632 a year for the same thing that the other guy can get for $48. $10,000 of net income is 60 days of full time work as an engineer. $48 is something I could pay for collecting aluminum cans and plastic bottles, one day a month.

Are you with me on this? Are you starting to get an idea what Obamacare is really about?

Obamacare is not about dealing with inequities in the healthcare system. That's just the cover story. The real story is that it is a massive, political power grab. Do you think anyone who can insure himself with a premium policy for $4 a month will vote for anyone but the political party that provides him such a deal? Obamacare is about enabling, subsidizing, and expanding the Left's political power base, at taxpayer expense. Why would I vote for anyone but a Democrat if I can have babies for $4 a month? For that matter, why would I go to college or strive for a better job or income if it means I have to pay real money for healthcare coverage? Heck, why study engineering when I can be a schlub for $20K per year and buy a new F-150 with all the money I'm saving?

And think about those $4-a-month babies – think in terms of propagation models. Think of just how many babies will be born to irresponsible, under-educated mothers. Will we get a new crop of brain surgeons and particle physicists from the dollar baby club, or will we need more cops, criminal courts and prisons? One thing you can be certain of: At $4 a month, they'll multiply, and multiply, and multiply.

Obamacare: It's all about political power.

Does anyone think this is going to leave us with an affordable and efficient healthcare system that is going to increase the quality of care and lower the cost of care?

The previous notes are important. Most Americans are starting to pay attention to the damage Obamacare is doing to our healthcare system.

  Are Americans going to tolerate this kind of political maneuver to have politicians accumulate political power?

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

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Uncertainty Leads to Ineffectiveness

February 22, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Physician's Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The implementation of Obamacare has progressed at a slow pace because of the Obama administration’s lack of understanding of physicians’ and patients’ needs.

In order to adjust to plans and policies not working as the Obama administration visualized, the administration has had to adjust policies, plans and costs.

There is no question in my mind that medicine is primed for a new age because of the advances in science, information technology and medical technology.

In my view Obamacare is a bad law. It is inhibiting progress on these upcoming advances. President Obama is trying to control provider behavior by measuring it in microscopic detail. He is trying to shift the cost and risk of patient care to physicians and patients in order to reduce costs by decreasing risk to the healthcare insurance industry.

He is trying to commoditize patient care. Obamacare is destroying the patient/physician relationship.These relationships are vital to the therapeutic index of any treatment.

Many of the Obama administration’s policy adjustments have led to uncertainty. Uncertainty of ad-lib changes in policy inhibits progress, increases costs, and produces anxiety and inefficiency.  .

One delay that has immobilized physicians has been the constant changing of implementation dates for ICDM-10 from ICM-9. Physician offices, physician groups and hospital systems are way behind in having fully functional computer information systems.

For many, the computer systems are too expensive even with President Obama’s promise of financial supplementation. It is difficult to change coding for treatment and procedures from 18,000 codes to 88,000 codes.

The reason for this coding change is for government to evaluate the work of physicians and hospitals microscopically in order to determine how much to pay them.

The government does not trust physicians. Physicians do not trust the government. In order for any system to work effectively and efficiently there must be mutual trust. Absence of mutual trust leads to more fraud and abuse, not less   

 The uncertainty about this year’s “doctor fix” is another example of uncertainty. 

In 2003 the government set up a defective measurement system intended to reduce physician reimbursement by about 5% per year. Each year the congressional “doctor fix” relieves physicians of the decrease in reimbursement from Medicare.

The SGR formula makes no sense. Medicare has reduced physician reimbursement to physicians as physicians' expenses have increased.

President Obama promise the AMA he would SGR problem.

However, each year’s “doctor fix” is cumulative. This year physicians face a 30% decrease in reimbursement despite the fact that many reimbursement codes have decreased reimbursement yearly in addition to the looming 30% decrease in reimbursement.

The policy has led physicians and physician groups to hold off on investing in coordinated care and technology. Additionally, physicians have a dim view of their return on investment for two reasons. Physicians cannot pass the cost of these new systems on to patients or the insurance industry because of the government’s pricing policies and because the government does not pay for much of the coordinated care or education of patients with chronic disease.

As a result of this uncertainty and anxiety physicians are selling their practices to hospital systems. Many physicians are salaried. These physicians figure the hospital system can have all the aggravation.  Other physicians are paid a salary plus a bonus determined by productivity. This does not eliminate the complaint that physicians have incentive to do more testing.

Many hospital systems have taken advantage of physicians’ intellectual property and surgical skill over the years. There has been a tradition of local adversarial relationships between physicians and hospitals. The hospitals’ tactics have not been obvious to many physicians. Many hospital policies are not transparent to their hospital-based physicians.

However, when it becomes apparent, the animosity between the physicians and hospitals becomes deep seated. The passive aggressive behavior of physicians inhibits the hospital system’s growth and development.

 

The Obama administration is discovering how difficult it is to form Accountable Care Organizations (ACOs).

The defects inherent in the purpose, formation, risk and implementation of ACO’s adds to its lack of success and the constant delays in implementation.

Obamacare has increased the number of Medicaid patients. Once these patients are on Medicaid, they cannot find a doctor.

President Obama had increase Medicaid payment to Primary Care Physicians in order to encourage more physician participation in Medicaid.

Physicians were hesitant to take Medicaid patients because this increased payment was temporary. The PCPs would be stuck with many low reimbursed patients.

“Kaiser Health News noted, the increases were temporary, so doctors had little incentive to alter their practices.”

This year the temporary Medicaid reimbursement increases have expired. The Medicaid rolls have increased. The PCPs were correct.  President Obama did not fix the Medicaid doctor shortage. It has only made it worse.

The number of physicians seeing patients with Medicare coverage has also decreased because of decreases in Medicare reimbursement despite the upcoming 30% decrease in Medicare payment.

President Obama ’s recent unilateral decision to alter immigration policy and provide these immigrants with healthcare insurance will only make things worse.

The ad-lib change in healthcare policy is driving physicians crazy. Many are frightened about their professional future in practicing medicine. 

There is a pervasive bias in Obamacare that favors hospital ownership of medical practices. The call for payment reforms and the call for coordinated delivery of medical care (like Accountable Care Organizations and payment “bundles”) all turn on arrangements where a single institution owns the doctors.

Where are patients’ feelings and needs in all of this? Patients are the commodities in a lucrative business that benefits secondary stakeholders.

The healthcare system as an efficient and effective healthcare system is destined to get worse because of the underlying uncertainty created by Obamacare.

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

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