Healthcare Insurance Industry

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One Picture Is Worth 1,000 Words

September 25, 2013

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley
Feld M.D.,FACP, MACE

One picture is worth 1,000 words.
The second picture says it all.

The list of one humdred and fifty nine new bureaucratic new agencies can be found at https://libertylegalfoundation.org/obamacare-class-action/quagmire-of-new-obamacare-agencies/#.UkNfRmRgZlQ

The one hundred and fifty–nine new agencies generated by the
Accountable Care Act (Obamacare) increases the complexity of an already
uncontrollable bureaucracy. Americans have seen many examples of the
inefficiency and waste because of the growth of bureaucracy in everyday life.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/09/employer-mandate-confusion.html

To date, before Obamacare
has been in full swing, these agencies have created the pile of regulations
demonstrated by Mitch McConnell.

What are the chances the
recipients of these regulations will understand and obey all these regulations?

What are the chances the
government bureaucrats can enforce these regulations?

What are the chances favored,
privileged parties will be exempt from these regulations?

What is the value added cost
these agencies and regulations provide for the direct treatment of patients
with disease?

These are all good questions.
The answers are not readily available. The administration, our congressmen or the
traditional media do not discuss these questions.

The American public has
already felt the consequences of the growth of bureaucracy and regulations.

Seventy seven percent of new
jobs have been part-time jobs. A person working less than 30 hours a week is
not required to receive healthcare insurance from his employer. Employers have
done this to avoid an Obamacare penalty.

Healthcare insurance
premiums for next year are skyrocketing. The Obama administration continually
tells the traditional media that insurance premiums will be affordable and
decrease in 2014.

True unemployment rises to
over double digits while government statistics claim it is falling. It is a
statistical trick.

Americans are noticing the
sting of the 20 hidden taxes Obamacare has put in place. Despite these taxes,
the deficit for this year remains one trillion dollars. It means the
administration is spending more despite the tax increases.

The Democrats keep saying we
must raise the debt limit. The Federal Reserve keeps saying we need to print
more money. President Obama keeps saying you must pay the bills Americans and
congress voted to incur. America cannot default on its debt.

Few are saying we must
decrease the debt by decreasing bureaucracy, regulations and inefficiency.

Fewer are saying we must
stop this overspending.

President Obama has given
countless waivers to countless companies. The first waver was MacDonalds which provides
Mini-Med insurance to their low wage employees. Mini-Med insurance is worthless.
It provides practically no healthcare insurance coverage.

President Obama figures that
all these people would sign up for the Health Insurance Exchange rates. These
exchanges would provide tax credits for the low wage income earner by law. The
law seemed to change in the last few months from tax credits to subsidies
without congressional approval. Law wage earners do not pay taxes and cannot
benefit from tax credits.

After October 1 we will see
if young healthy persons without pre-existing condition sign up for healthcare insurance
through these health insurance exchanges.

The only insurance rates
seen through these exchanges so far are the California health Insurance exchange
rates. The rates are too high to buy adequate healthcare coverage for someone
making $40,000 per year. The affordable rates do not provide adequate healthcare
insurance coverage.

The Obama administration
claim’s that the New York State rates are lower than the private insurance
rates. It might be true for certain levels of coverage. The reality is the
private insurance rates in New York are too high. The New York State Board of
Insurance permits healthcare insurance companies to receive an unconscionable
return on investment.

A one year delay of
Obamacare for corporations will get President Obama past the mid term
elections. It will permit public awareness of the harm Obamacare is doing to
the economy which the administration is striving to keep hidden.

After the election cycle it
will dawn on the majority of the public that Obamacare is a destructive
train-wreck to the economy and economic growth.

The delay will also have a
lesser effect on the tremendous increase in deficit spending that would
diminish the debate on the administration’s overspending.

President Obama doesn’t seem
to think deficit spending is an important issue. He is also not bothered by the Federal Reserve’s
quantitative easing.

The most offensive action by
President Obama is exempting congress and the congressional staff from
Obamacare.

Why should the individual
hard working person suffer the effects of Obamacare when government officials
do not?

Can Obamacare work when we
have so many agencies generating so many regulations? Can it work when so many
people have waivers and exemptions?

I doubt it!

No only is it not fair to
hard working people. It is probably unconstitutional.

It doesn’t look like the
American individual taxpayers that are not exempt from Obamacare are going to
get much help from the Supreme Court.

Maybe President Obama’s goal
is to destroy the healthcare system’s infrastructure. He is setting up the
failure of Obamacare.

Obamacare seems to be designed
to destroy our healthcare system. Maybe Obamacare is not supposed to work. Maybe
it is designed to cost so much that the entire economy will fail.

This can be the only reason
Obamacare has been permitted to continue to exist by both Democrats and
Republicans.

Obamacare is neither affordable
nor executable.

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

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What Are Private Insurance Exchanges?

September 22, 2013

inHealthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Corporations have been providing healthcare insurance
since after WWII. The cost of healthcare insurance has been rising since.

The increase in premiums became intolerable in the
1980’s when cost shifting occurred. Medicare decreased reimbursement and the
fees were shifted to private insurance. Several experiments in healthcare coverage
were tried to reduce the cost to employers. All the schemes failed to control
costs.

The schemes include managed care and HMO’s. All the
insurance schemes were defined benefit plans. Employees were immune from
responsibility for themselves or their healthcare dollars.

As the costs have risen to unsustainable levels
corporations have been trying to figure out how to get out of providing
healthcare coverage for their employees as a benefit.

Most employers, large and small, want to limit their
exposure to healthcare premiums and Obamacare penalties.

A movement to limit employment to less than 30 hours
a week to avoid providing healthcare insurance to employees and avoid Obamacare
penalties has become viral.

No one has tackled the real reasons for the rising
healthcare costs. No one has tackled the perverse incentives and advantages
given to the healthcare insurance industry all these years.

I have argued that this perverse incentive can lead
to all the other perverse incentives initiated by the rest of the stakeholders
in the healthcare system in order to survive.

Once more the healthcare insurance industry figured
out how to increase their profits while making it appear they are helping both employers
and employees.

It must be remembered that the healthcare insurance
industry profits through both private insurance and government provided
healthcare coverage.

The industry makes its profits by providing
administrative services. The government outsources the administrative services
to the healthcare insurance industry.

The profit generated in both the private sector and
the government sector is far from transparent.

The healthcare industry’s new scheme converts defined
benefit coverage to defined contribution coverage for healthcare benefits.

In recent months we have seen large corporations
switch their employee healthcare benefits to defined contribution programs.

A partial list of companies includes Walgreens, Home
Depot, Sears, Trader Joes, Xerox and IBM retirees.

Rather than provide a healthcare insurance coverage
benefit through the corporation, the corporation is providing employees with a
defined contribution each year. The employees can then buy their insurance
through their employer’s contracted Private Health Insurance Exchange.

The Private Health Insurance Exchanges are provided
to the corporations by the healthcare insurance industry. There will be a menu
of insurance plans and premium levels employees eligible for coverage can
choose from.

The principals of healthcare coverage include all of
the basic requirements of Obamacare’s Health Insurance Exchanges. Employees
having a preexisting illness must be accepted. However, premiums might be
higher for patients with pre-existing conditions.

The defined contribution amount has not been defined.
It could be a couple of hundred dollars a year to a couple of thousand dollars
a year. In any event it does not sound as if it will be enough to cover the
cost of the healthcare insurance premium.

There will be high deductible plans with patients not
covered for the deductibles and co-pays.

If an employee doesn’t like what he buy in the
companies Private Insurance Exchange, he can always sign up for Obamacare’s
Health Insurance Exchange.

It sounds great for the employer because the employer
can predict costs. It is wonderful for the healthcare insurance industry.

It sounds terrible for the consumer.

It sounds both good and bad for the government. It
depends on how one looks at it.

The Obama administration will have more people sign
up for Obamacare’s Health Insurance Exchanges. The result will be greater
control over the healthcare system. I believe this is the reason the Obama administration has not opposed the Private Health Insurance Exchanges.

However, the consumers signing up for Obamacare Health Insurance Exchanges will be the sickest
consumers. These consumers will use the system more than average.

This will result in an increase in the deficit and
unsustainability of Obamacare. The only way out is to increase premiums and
taxes.

This is called a “redistribution of wealth” because
people making up to $40,000 per year do not pay taxes. If the tax increases are
means tested it will increase the amount of wealth that is redistributed will
increase.

The increase in taxes will decrease economic growth.

At the present time Obamacare’s Healthcare insurance
Exchanges do not have verification software. The system is vulnerable to fraud
and abuse even if it could work.

America is just becoming aware of the fraud and abuse
in the food stamp entitlement program. The food stamp entitlement has double. The
government has not fixed the food stamp program.

It is likely the same thing will happen with the government
run Health Insurance Exchanges. It will drive the federal deficit even higher.

Even though the Private Health Exchanges shift financial
responsibility to the consumer to pay for their own insurance it does not provide
financial incentive for patients to become responsible for their health.

It does not contain educational programs to help
patients deal with their chronic diseases. It does not teach consumers to be
responsible for their health and healthcare dollars.

Obamacare does not provide these incentives either.

The only plan that does is my Ideal Medical Saving
Accounts with employers providing support while shifting responsibility to
consumers by providing incentives for patients to lower the cost of their care.

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

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Garcinia Today Reviews • October 3, 2013

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Are The Unintended Consequence’s Of Obamacare Unintended?

August 25, 2013

inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

It is hard to tell whether the unintended
consequences were really intended consequences on the way to destroying the
healthcare system.

Harry Reid and the President have already
admitted that Obamacare is a good first step on the way to a government
controlled single party payer system.

There are several problems with a single
party payer system,

The
government cannot afford it.
The
government cannot run it. It will have to hire the healthcare insurance
industry to administer it. It costs the government 40% of the healthcare
dollars to have the healthcare insurance industry provide administrative
services for Medicare and Medicaid presently.
Providers
will not have incentive to produce. Reimbursement will be low and salaries will
be low.

Normally if one works for a company, the
company provides healthcare insurance to the family. When Obamacare raised the
mandate limit forcing employers to provide healthcare insurance for employees’
children living at home to 26 years old, companies have been trying to figure
out how to avoid paying the increased premium cost of healthcare insurance.

Most companies have reduced or are reducing
employment to less than 30 hours to avoid the penalty for not providing
healthcare insurance.

Many companies have applied for wavers.
These companies will get waivers if they are the Obama administration’s
friends. Congress got a waiver.

U.P.S. announced it would discontinue
Health Benefits for spouses of some workers. U.P.S. joins the list of other
companies doing the same thing. These include large employers like Xerox and Teva Pharmaceuticals. They
have chosen to impose surcharges on employees for spousal coverage.

Cities like Terre Haute,
Ind., are adopting a spousal carve-out so that working spouses would not be
covered under its health plans even if the healthcare insurance plan of the
spouse’s company is worse than Terra Haute’s healthcare insurance plan.

The University of Virginia
has just announced a similar spousal carve out. It is rumored that the state of
Virginia is next.

“UVA said
this is only one of many “major changes” coming to their health plans as a
result of ObamaCare. The university says the changes are necessary because the
law is projected to add $7.3 million to the cost of the university’s health
plan in 2014 alone.”

Isn’t Obamacare called the
Affordable Care Act? In truth it is not. It will drive these spouses into a
health insurance exchange.

“U.P.S. said, “Limiting plan eligibility is
one way to manage ongoing health care costs, now and into the future, so that
we can continue to provide affordable coverage for our employees.”

— U.P.S. told employees, “Since the Affordable
Care Act requires employers to provide affordable coverage, we believe your
spouse should be covered by their own employer — just as U.P.S. has a
responsibility to offer coverage to you, our employee.”

Delta Airlines announced
that someone
leaked a letter from Delta Air Lines to the Obama administration.

The
letter stated that the “cost of providing health care to our employees will
increase by nearly $100,000,000 next year.” The letter also states that much of
the increase is due to Obamacare.

It means the airline tickets are going to increase in
price. This will become a burden on businesses who depend on flying to do
business. In turn, products these companies produce will increase in price.

The ordinary consumer will also be affected by rising
airline ticket prices.

U.P.S. said, “Limiting plan
eligibility is one way to manage ongoing health care costs, now and into the
future, so that we can continue to provide affordable coverage for our
employees.”

U.P.S. estimates they cover
33,000 spouses. Fifteen thousand (15,000) spouses can get coverage through
their own employers. It should be added that they can get insurance until the companies
of these15,000 spouses drop their own healthcare coverage.

If U.P.S
cannot lower insurance costs, they will raise shipping prices. Once again the middle
class is the victim. Another option is to drop healthcare insurance for all
employees and let them participate in the health insurance exchanges.

Companies providing executive insurance
of $27,500 or more for employee family coverage or $10,200 for individual
coverage (Cadillac plans) will have to pay an additional 40% Obamacare tax in
2018.

This Cadillac plan tax is
something many companies are thinking about and making plans to discontinue in
the future.

The whole thing stinks.

It might not be an
unintended consequence. It might be an intended consequence.

It might be exactly what President Obama wants
to drive as many people as possible into his health insurance exchanges.

His excuse for the increased
costs is that the American people cannot refuse to pay for something they have
obligated themselves to pay. In reality they have been deceived. They have been
tricked, forced and deceived into this obligation.

The Obama
administration is building a detective squad to target and penalize consumers and
companies that don't follow Obamacare's rules.

The
Department of Health and Human Services has hired 1,814 criminal investigators.
On the day President Obama signed the Affordable Care Act into law in 2010, HHS received authority
to hire 1,814 investigators to
sleuth out violations of the law.

Congressmen who supported Obamacare find this new police force
confusing.

“HHS received authority from the Office of Personnel Management
(OPM) to make as many as 1,814 new hires under an emergency 'Direct Hiring
Authority' order.”

The Obama administration ordered that employment expansion despite
a government-wide hiring freeze that is in place.

Why doesn’t President Obama
listen to the will of the people?

Everyone is against it. Everyone
has to be more vocal. Everyone has to vote these people out of power.

Otherwise we are on the Road
to Serfdom.

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

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America’s Rural Hospitals Are Being Destroyed

August 21, 2013

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

There is no question the federal government must decrease the amount of
money it is spending on healthcare. It simply cannot sustain the increasing
cost of health care.

Instead of figuring out how to make the system more efficient and cost
effective, the Obama administration is slowly destroying assets that have been
built at great costs to society in the past.

One example is the community hospital systems in large cities and the
voluntary hospital in smaller cities. The government has subsidized their
development with tax incentives and reconciliation paybacks.

In recent years rural hospitals have been failing because of decreasing
government reimbursement. Many service the poor and elderly with emergency care
and outpatient clinics.

“The role and structure of rural
hospitals is changing, but they continue to be important local and
regional centers of health care activity.
Rural hospitals tend to depend
more on Medicare and Medicaid patients.
Most rural hospitals are organized
on a not-for-profit basis
Rural hospitals make an important
contribution to rural economies; expansion and diversification of the
services that they offer will be important in their survival.
The quality of care provided in
rural hospitals is generally equal to that provided by urban institutions,
with some exceptions.

The Department of Health and Human Services' Office of the
Inspector General has recommended that Congress allow the Centers for Medicare
& Medicaid Services to strip critical access designation from any hospital
that was brought into the program under a state "necessary provider"
designation.

Brian Jordan, a program analyst for OIG's Office of
Evaluation and Inspections in Chicago, said that nearly 1,000 of the
approximately 1,300 critical-access hospitals
in 45 states gained the "permanent exemption"
under the necessary provider designation. Congress closed the loophole in 2006,
but grandfathered in the hospitals.

“Without
that designation, Jordan said about 800 hospitals would not have met location
requirements in 2011 because they were too close to another hospital.”

The "necessary provider"
designation is withdrawn if two hospitals are within 15 miles of one another.
It is estimated that Medicare could save 1.3 million per year for every
hospital eliminated from the necessary provider program.

The total cost savings from eliminating
these rural hospitals would be less than the
amount of money all salaries of the CEOs and other healthcare executives of healthcare
insurance companies take from Medicare a year.

If there is a problem with rural
hospitals it is their inefficiency and waste. The inefficiency should be fixed.
If the government wanted to do something constructive it should help rural
hospitals fix the inefficiencies.

The
“necessary provider hospitals “never had to meet the distance requirements."

Necessary provider hospitals get paid more
from Medicare than non- designated hospitals. As towns expand new hospitals are
build close to the older standing hospitals.

Maybe having a rural hospital in a
small city will increase economic growth of the area? It attracts industry and
more jobs. Many communities need two rural hospitals.

Both hospitals receive necessary
provider status and increased payment.

Alan Morgan, CEO of the National Rural Health
Association, blasted the report. He said the OIG report would kill rural health
and access to healthcare. The closing of 800 rural hospitals would also close
emergency services in local communities, eliminate rural health clinics, access
to mental healthcare and nursing home support.

Morgan said, “OIG
viewed this with blinders on, not looking at how healthcare is delivered in
rural America.

"It's
about access and this report is only about finances and not access. It is a spending and finance issue and we seem to
have forgotten the rationale for the creation of this program, which was an
access issue."

If the Obama administration is trying to help
seniors and the underprivileged it should study this decision more carefully. I
can only imagine the cost of the unintended consequences to all taxpayers.

I believe the Obama administration wants to
destroy the entire healthcare system and replace it with a single party payer
system.

It is time to go after the real excess cost
drivers in the healthcare system. It is a mistake to destroy the infrastructure.

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

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Some More Obamacare Deceptions

August 18, 2013

inDisinformation and the healthcare system, Healthcare Insurance Industry, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

Does anyone remember the CLASS Act as part of
the Obamacare promise for affordable healthcare coverage? I do. It sounded
great but I knew it couldn’t be done without tremendous cost to the federal
government.

It would drive deficit spending through
the roof.

The CLASS Act (Community Living
Assistance Services and Support) was shut down 19 months after passage of
Obamacare.

There was little discussion
of the CLASS Act until Kathleen Sibelius’ announcement to discontinue
CLASS.

She said,

“The administration was shutting down CLASS. After 19 months of research and consultation, “we have not
identified a way to make Class work at this time.

The thing that bothers
me the most about Obamacare is the sneaky machinations the Obama administration
uses to hide the bad news about Obamacare from the American public. When the American
public finds out they are disappointed and feel deceived.

However, it also feels
so complicated that they tend to ignore it.

When the Obama administrated delayed the
employer mandate for a year employers were relieved. None of the traditional
media made a big deal about delaying the employer mandate which meant that Obamacare was
in trouble.

Some conservatives and conservative outlets
cried, “Why not delay the individual
mandate as well?”

The reason is obvious.
The Obama administration wants the entitlement to start whether it is ready or
not so it cannot be repealed or discontinued. People do not like to relinquish
a freebie.

As soon as that
discussion was over the government announced that the verification process for
subsidies might not be ready until October 1, 2013.

If the tests find security
problems in the verification systems, the information officer could delay the
marketplace opening or decide to open the insurance exchanges with
less-than-optimal assurances that users’ personal information is adequately
protected.

The Obama administration
then announced it would provide premium subsidies on an “honor system” so as
not to delay the onset of the individual mandate.

“The administration promises no one will lie
because once they get the verification process started they will be able to
find out who lied about the subsidies.”

The Obama administration’s
navigators program is a program to train and pay people to go into the
community and sign up people to enroll in the Obamacare health insurance
exchange.

“More than 100 groups
will split $67 million to help people “navigate” the new Obamacare health insurance
exchanges.”

These “navigators” will have to undergo mandatory federal
training and become certified.

“The 67 million dollars is more money than the
administration initially said would be available but short of what advocates
say will be needed to help people sign up”.

It sounds like another cash for clunkers program.

When are Republicans or
Conservatives going to say something to make the public aware of what is going on?

To add insult to injury
congress exempted itself from Obamacare because of economic hardships leaving
ordinary people to be subject to penalties if they do not join the health
insurance exchanges.

The Obama administration has given over 2,000 group
waivers.

The Obama administration
and Harry Reid and Nancy Pelosi are working on the Unions’ problems with
Obamacare. One could bet that it will be fair to the Unions as the rest of us
are ignored.

With all of the IRS’s problems of late it is
frightening to think of the IRS monitoring abuses of Obamacare.

The IRS employees union
is presently seeking a way to get a waiver from Obamacare.

“And speaking of haunting, does anyone in this
country look forward to being scrutinized by the IRS on every aspect of his or
her personal health care decisions, especially after we learn of the
politicizing and privacy abuses by that agency?”

Does anyone remember the 60 lawsuits the
Catholic Church initiated challenging President Obama’s contraception mandates?
The church claims the mandate to provide contraceptives represents an attack on
religious freedom and the first amendment.

Despite all this the
traditional media and President Obama keep saying Obamacare is right on
schedule.

We have heard nothing
about the extra costs Obamacare is generating for start-up and implementation.

Last weekend Harry Reid let the cat out of the bag. President Obama real goal is to have Obamacare fail and replace it with a single party payer system.

Harry Ried and a single party payer

http://youtu.be/SXgSKwYMnWo

The biggest political maneuver by President
Obama of all is the maneuver to delay the law’s caps on out of pocket expenses for consumers
such as for deductibles and co-pays.

This is perhaps the most
attractive benefit of Obamacare after guaranteed insurability.

"Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group
health plan and a health insurance issuer offering group or individual health
insurance coverage may not establish lifetime limits on the dollar value of
benefits for the any participant or beneficiary.”

Annual limits on cost-sharing are
specified by Section 1302(c) of the Affordable Care Act; in addition, starting
in 2014, deductibles are limited to $2,000 per year for individual plans, and
$4,000 per year for family plans.

This is a wonderful
benefit. If someone gets sick he is only liable for $2,000 if single and $4,000
if he has a family.

The problem arises when the
healthcare insurance industry calculates the premium with this benefit included.
The insurance premiums skyrocket. Premiums are scheduled to dramatically
increase in 2014.

President Obama’s
problem is that 2014 is a congressional election year. Skyrocketing premiums in
2014 may make Obama fans and the Democratic base angry with President Obama and
the Democrats running for congress.

President Obama having
gotten away with all his other delays in implementation simply delayed this
part of the law until after the election.

The American public
doesn’t realize that he has delayed perhaps the best benefit in the law from
the public’s viewpoint. His hope is the public will not notice the delay with
the help of the traditional media’s lack of coverage.

In 2015 he will sock the
increased premiums to the public. He will then blame it on the
Republicans.

There are two basic
issues. The first is the need for the public to realize all these deceptions in
Obamacare.

The second one is the
public is beginning to realize that it cannot trust President Obama or congress
to represent its welfare.

It is time for
Republicans to stand up and put an end to this charade. I hope someone has the guts
to do it.

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

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Maybe Obamacare Is Not Such A Good Idea

August 7, 2013

inHealthcare Insurance Industry, Medicine: Healthcare System, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley
Feld M.D.,FACP ,MACE

Dear
President Obama;

Maybe Obamacare
is not such a good idea.

I suspect
you will not read this nor have you read my letters to you when you were first
elected.

The letters
were about how our healthcare system became so dysfunctional and what solutions, that will work,
are needed to repair the healthcare system.

Dear President Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president–elect-barack-obama-part-5.html

Dear President Obama Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Respectfully,

Stanley Feld M.D., FACP, MACE

President Obama did not listen to me at all. It looks like his
agenda was not to "Repair the Healthcare System." It was to destroy it and
replace it with a government control single party payer system.

I continually think about the statement President Obama made to
Barney Frank and John Kerry when passing the law. They said the law must have a
public option and a single party payer to work.

President Obama told them not to worry about the public option.

Now Obamacare is experiencing objections from the interest
groups whose support is needed.

The unions, government workers in congress, the IRS, the healthcare
insurance industry, small businesses, large corporations, large fast food
businesses, privately insured Americans, Medicare insured seniors, physicians, hospital
systems all have objections to the law now.

Many states realized they would get stuck with the bill for the
health insurance exchange. Thirty-three states did not want to participate.
Many did not want to increase their budget deficits.

All these stakeholders are realizing that President Obama has thrown
them under the bus despite his initial promises.

Obamacare does not serve the vested interests of any of these
stakeholders.

Some of the stakeholders are going to get special treatment with
waivers.

For Obamacare to work, everyone must participate. The mandate was
included in the law to force everyone to participate.

The Supreme Court called it a tax to allow the Obamacare law to be
constitutional.

A basic insurance principle is that everyone must participate to spread
the risk for the insurance industry.

The present system and Obamacare exempts the insurance companies from incurring risk.
It also exempts patients from being responsible for their own health and
healthcare dollars. When Americans spend their own money the free market works as
we have seen in many industries. They support the best product within their
means.

The government could support the underprivileged by providing them with
their healthcare dollars and teaching them how to use them.

The biggest villains in the healthcare system are the healthcare
insurance companies. They take 40% of every healthcare dollar spent by private
and public insurers off the top.

The healthcare insurance industry is the administrative service
provider for all public employees, public healthcare entitilments and private health insurance plans. The 40% overhead is charged
to all. The charge is not transparent.

Obamacare sets the conditions for continued abuse by the healthcare
insurance industry.

The Obama Administration estimates that
of the projected 7 million exchange enrollees next year, 2.7 million need to be young adults (with a low
risk of being sick) to make the premiums work.

If young people don’t show up for Obamacare,
premiums for everyone else in the exchanges will skyrocket—which, of course,
dramatically increases the cost for taxpayers.

Congress
and congressional government workers wanted to be exempt from Obamacare because

“The 2010 law
generally requires lawmakers and aides who work in their personal offices to
get coverage through the exchanges.”

That implies that they would no longer receive
coverage through the Federal Employees Health Benefits Program…

It does not clearly
authorize the government to pay premiums for federal employees who obtain
insurance through the exchanges.

Nor does it
authorize the government to reimburse federal employees who buy health
insurance on their own.”

Congress and their aides have
the best insurance coverage in the nation. Taxpayers subsidize their healthcare
insurance.

Through the years this
subsidy has been discussed. Many have objected
to the cost of this Congressional benefit.

Congress has
objected to Obamacare changing the healthcare insurance they have enjoyed. Congress wants to be exempt from Obamacare.

“President
Barack Obama privately told Democratic senators he is now personally involved
in resolving a heated dispute over how Obamacare treats Capitol Hill aides and
lawmakers, according to senators in the meeting.”

Few on Capital Hill objected to President Obama changing the
rules of the law himself to protect their benefit.

A question should be asked, “Why should Congress and
congressional aides be treated differently than the general population?”

“At issue is whether
Obama’s health care law allows the federal government to continue to pay part
of the health insurance premiums for members of Congress and thousands of Hill
aides when they are nudged onto health exchanges.”

Currently, the government
pays nearly 75 percent of these premiums.

The government’s contributions are in jeopardy
due to a controversial Republican amendment to Obamacare, which
says that by 2014, lawmakers and their staff must be covered by plans “created”
by the law or “offered through an exchange.”

President Obama declared,
“I'm on it” to clear up Capital Hill’s objections to Obamacare’s effect on
Capital Hill’s healthcare insurance.

The IRS employees also want to be exempt from Obamacare.

IRS
chief Danny Werfel, the head of the agency charged with administering Obamacare
said that he would rather keep his own insurance than get coverage under the
system created by President Barack Obama's single domestic policy
achievement.

Danny Werfel made this statement before the
House Ways and Means Committee,

"I would prefer to stay with the current policy that I'm
pleased with rather than go through a change if I don't need to go through that
change."

Like
most
other federal workers, IRS employees currently get their health insurance
through the Federal Employees Health Benefits Program, which also covers
members of Congress.

House Ways and Means Committee Chairman Dave Camp said he has long
believed, “every American ought to be exempt from
the law, which is why he supports full repeal,”

IRS employees have the
responsibility to enforce much of the health insurance law,
especially in terms of collecting the taxes and distributing subsidies that finance
the whole system.

IRS agents, in addition to
collecting taxes will also collect data and apply penalties for those who fail
to comply with many of Obamacare’s requirements.

The special favors are coming
next. The Obama administration will only create more dysfunction in the
healthcare system. President Obama’s published goals are good. However, the law
is bad and its execution is worse.

Maybe he ought to consider
my Ideal Medical Savings Accounts as a free market solution to our healthcare
system’s problems.

If you do
not like what is going on, please write your senator, congressman and the
President and tell them that,

“Maybe Obamacare Is Not Such A Good
Idea.”

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

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Physicians Opting Out Of Medicare And Obamacare

August 4, 2013

inHealthcare Insurance Industry, Medicaid, Medicare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

I have discussed the disillusionment of Obamacare by several
major stakeholders, hospital systems, insurance companies, union leaders and
large corporations in my last three blog posts.

As Obamacare gets more complicated physicians are opting out of Medicare and will
not participate in Obamacare.

All most physicians want is to practice the best medicine they can
using their intellectual property or surgical skills.

Physicians are people who want to help people. They are not street
crooks.

Obamacare is trying to commoditize medical care, decrease physician
value and reimbursement.

Commoditization of medical care will decrease physicians’ freedom to
exercise their medical judgment. Medical decision-making will be in the hands
of distant involved bureaucrats. Access to care will be determined by
bureaucratic rules and not the patients and their physicians.

Physicians are opting out of Medicare, Medicaid and
Obamacare. They have become totally frustrated
with Medicare and Medicaid reimbursement rates and the mounting rules and
regulations.

Marilyn B. Tavenner R.N., the
administrator of the Centers for Medicare and Medicaid Services told congress
that an insignificant number of physicians have dropped out of Medicare and
Medicaid. This is clearly not true.

A
CMS report said 9,539 physicians who had accepted Medicare in the past opted
out of the program in 2012, up from 3,700 in 2009. That compares with 685,000
doctors who were enrolled as participating physicians in Medicare last year,
according to CMS, which has never released annual opt-out figures before.

The number of physicians opting out of Medicare last year
nearly tripled from three years earlier, according to the Centers for Medicare
and Medicaid Services.

This is not an insignificant number of physicians when
America is experiencing a shortage of primary care physicians.

“A study in the
journal Health Affairs this month found that 33% of primary-care physicians
didn't accept new Medicaid patients in 2010-2011,” even though they continue to participate
in Medicare.

Some physicians are limiting the number of Medicare patients
they treat even if they don't formally opt out of the system.

The reason is Medicare reimbursement is so low and getting
lower. It some cases reimbursement is lower that the cost to deliver the care.

A study found that 4%
of family physicians are now in cash-only or concierge practices.

The Obama administration issued an
executive order this year where Medicare would not reimburse anything to
patients paying cash to non-participating physicians.

This is putting an increased burden on Medicare patients.

“All told, health experts say the number of doctors going
"off-grid" isn't enough to undermine the Affordable Care Act.”

The Obama administration’s bureaucrats are not facing
reality. Today, before the expansion of Medicaid it is difficult for Medicare
and Medicaid patients to find a physician.

Joe Baker,
president of the Medicare Rights Center, said his patient-advocacy group has
had an increase in calls from seniors who can't find doctors willing to treat
them.

Many physicians will not accept Medicaid patients. CMS
administrators want the public to believe this is not true. They say the number
of physicians not taking Medicaid is insignificant.

Medicaid physicians have to see as many as 200 patients or
more a day to make a living. There are
not enough minutes in a day to see that many patients and have a quality care visit.
These physicians have employees who are seeing patients for them. These
physicians then sign off as seeing the patient.

This volume then triggers a probe on their practices and
accusations of fraud. As Medicaid gets expanded through Obamacare to cover the
uninsured, there will be even fewer and fewer Medicaid physicians and a greater
physician shortage.

Medicaid physicians are not interested nor can they take the
government abuse.

Employers are cutting back on hiring full time employees and
hiring part time employees to avoid the rising insurance costs.

Marilyn B. Tavenner, the administrator of the
Centers for Medicare and Medicaid Services, told Congress that she
had heard of only “isolated incidents” in which employers tried to cut back
hours. Representative Steve Scalise, Republican of Louisiana, told her that she
must be “living in some cocoon” because he heard of such actions almost every
day.

Every large corporation is converting as many
full time workers to part-time workers as possible because of Obamacare in
order to avoid the Obamacare mandate. Part-time workers have felt the
disastrous impact on wealth production and economic activity.

These are the revised statistics from the Bureau
of Labor Statistics for May and June.

The establishment
survey showed a gain of 162,000 jobs.  The previous two months were revised
lower. The employment change for May revised down by 19,000 (from +195,000 to
+176,000), and the employment change for June revised down by 7,000 (from
+195,000 to +188,000).  The unemployment rate dropped 0.2 to 7.4%.   Explaining
the Unemployment Rate Drop 

Employment
rose by 227,000 of which 103,000 were part-time jobs.
The Civilian Labor
Force Declined by 37,000 even though population rose by 204,000.
Those "Not in
Labor Force" rose by 240,000.
Participation Rate
fell 0.1 to 63.4%, a mere 0.1 higher than the low of 63.3% dating back to 1979.

July BLS Jobs
Statistics at a Glance

Payrolls
+162,000 – Establishment Survey
US Employment +227,000
– Household Survey
US Unemployment
-263,000 – Household Survey
Involuntary Part-Time Work +19,000 –
Household Survey
Voluntary Part-Time Work +84,000 –
Household Survey
Baseline Unemployment
Rate -0.2 – Household Survey
U-6 unemployment -0.3
to 14.0% – Household Survey
Civilian Labor Force
-37,000 – Household Survey
Not in Labor Force
-240,000 – Household Survey
Participation Rate
-0.1 at 63.4 – Household Survey

Marilyn B. Tavenner making the above statement to congress
makes her a liar or a person not in touch with reality. Have can the American
people entrust our healthcare decisions to these bureaucrats?

The Obama administration needs both the primary and
secondary stakeholders’ cooperation if Obamacare has the slightest chance of
succeeding.

I do not think Obamacare can survive. It will sink under its
own weight as it tries to control all of the stakeholders through oppressive
regulations without regard for their vested interests.

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

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President Obama – Do Something That Could Work!

July 10, 2013

inDisinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Where Is The Intellectual Integrity?

June 12, 2013

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicaid, Medicare, Medicine: Healthcare System

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Stanley Feld M.D, FACP, MACE

Paul Krugman did it again. He demonstrated his bias
for Obamacare by ignoring or misrepresenting the facts.

“As long as someone with Krugman’s
professional status gets his facts wrong in column after column, and does so in
an arrogant and pompous manner, attacking the integrity and hurling insults at
all who disagree with him…well, there will always be a market for a writer who
is able to show that the scourge of sensible people everywhere has written one
more erroneous editorial. “

This is a perfect description of Paul Krugman’s methodology.
His opening sentences demonstrate the arrogance and pompous manner in which he
attacks the integrity of his opponents and hurls insults at them.

“The Affordable Care Act, a k a Obamacare, goes
fully into effect at the beginning of next year, and predictions of disaster
are being heard far and wide. There will be an administrative “train wreck,”
we’re told; consumers will face a terrible shock. Republicans, one hears, are
already counting on the law’s troubles to give them a big electoral advantage.”

He uses misleading and false evidence to undermine his critics’
opinion.

“Yet important new evidence — especially from
California, the law’s most important test case — suggests that the real
Obamacare shock will be one of unexpected success.”

The LA Times told part of the story to unmask
Paul Krugman’s disinformation.

California's health insurance rates for some
companies with some physician networks for the new state-run marketplace (health
insurance exchange) did come in lower than expected.

However, there are certain downsides for many
consumers that Paul Krugman ignores.

There will be far fewer doctors and hospitals to
choose from in Covered California.
Covered California is California’s version of Obamacare’s health
insurance exchange.

Consumers who want UCLA Medical Center and its
doctors in their health plan network next year will have only one choice in
California's exchange. Anthem Blue Cross is the only carrier.

Additionally, Blue Shield of California said its
exchange customers will be restricted to 36% of its regular physician networks
statewide.

These two insurers are decreasing physician reimbursement. Physicians and their networks are refusing to
participate.

Cedars-Sinai Medical Center, one of Southern California’s most
prestigious and expensive hospital systems and physician networks said it’s not
included in any exchange plans at the moment because physicians and the
hospital system will not accept the reduced reimbursement.

There is a problem with Paul Krugman’s statement because he
does not define the real cost of healthcare
to the state.

The California health insurance exchange (Covered
California) is trying to make consumers believe they are getting more for less.

The facts are, when you get in the
weeds, Californians are getting less for more.

The health insurance exchange must be analyzed within the context
of each individual patient. The insurance industry is excited about Obamacare
because they believe young patients will be forced into the marketplace.

A hypothetical healthy 25 year old in San Francisco earning
$46,000 a year in 2013 can buy a PPO plan from a major insurer with a $5,000 deductible
and a 30% coinsurance plus a $10 copay for generic drugs and a total $7,000 out
of pocket expense for $177 per month.

“Covered California,
a “Bronze” plan from the exchange with nearly the same benefits, including a
slightly lower out-of-pocket maximum of $6,350, will cost him between $245 and
$270 a month.”

The cost of coverage under Covered California is 38% higher
than comparable coverage in the present overpriced private sector for someone
whose chances of being sick are small.

Paul Krugman is talking about a fudged figure when he quotes
a 29% reduction using the health insurance exchange.

“The rates submitted to Covered California for
the 2014 individual market,” the state said in a press release, “ranged from two
percent above to 29 percent below the 2013 average premium for small employer
plans in California’s most populous regions.”

This sentence led Paul Krugman’s triumphant
commentary.

“This
is a home run for consumers in every region of California,” exulted the head of
Covered California.”

Obamacare will drive
premiums up by between 100 and 123 percent for a typical nonsmoking 25-year-old
earning $45,000 per year.

It will also drive
them out of the market for healthcare insurance. They will buy healthcare
insurance from the health insurance exchange only in case of an emergency or if
they develop a chronic illness.

This is exactly what
President Obama wants to happen. He wants to drive everyone into health
insurance exchanges and then stick the bill to the states.

The traditional media
represented by Paul Krugman is spinning the story and the American public isn’t
buying it.

The problem is they aren’t
feeling the pain yet. When Americans start feeling the pain there will be an
uproar.

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

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