Stanley Feld M.D.,FACP,MACE

President Obama promised seniors on Medicare that Medicare would not be affected by Obamacare. He has also told us Obamacare is a success.  

President Obama lied to seniors.

One way to stop the lies is to vote against all the Democrats up for reelection in both houses of congress. The Democrats were the only ones who voted for Obamacare. Both representatives and senators rely on the senior vote to be elected or re-elected. Democrats in congress are terrified by the threat of losing the senior vote.

Many of my friends read the New York Times and listen to network news. These people believe they are well informed. They are constantly arguing with me about what they think President Obama has accomplished with Obamacare.

They believe President Obama’s sound bites about Obamacare.

Many seniors trust President Obama. They believe he would not deceive them about Medicare. Seniors have held on to their beliefs about Obamacare until it affects them personally.  

 In November 2013 I wrote a blog entitled “Medicare’s Perverse Incentive Against Seniors.”

Many seniors did not believe my post until they or a friend personally experienced the perverse incentive Obamacare had on Medicare.

A senior named Evelyn, who sometimes publishes my blog, received a letter about Medicare from a gentleman and sent it to her contacts.   

This letter was about the perverse incentives Obamacare has imposed on hospitals. Seniors are being penalized by not receiving Medicare coverage and having to pay out of pocket expenses.

The new Medicare rules were intended to decrease the number of re-hospitalizations within 30 days of discharge. Many seniors are admitted to the hospital in congestive heart failure. Many of those seniors have difficulty staying out of congestive heart failure. They have to be readmitted in 30 days.

If a senior is readmitted in 30 days after discharge from the hospital, Medicare does not cover the hospital bill. The senior is not responsible for the bill. The hospital system takes the financial hit.

The implication of the readmission is the hospital system did not do a good job in treating the patient.

It could be that the patient did not do a good job taking care of himself and staying out of congestive heart failure. It could also be that the patient is too sick to stay out of congestive heart failure.

Hospitals can avoid being penalized by admitting seniors for outpatient observation.

This is a glaring defect in government rules created by bureaucrats who have little clinic experience.   

Hospitals can admit patients to observation and send them home in less than 48 hours. If they are readmitted within 30 days it does not count as a re-hospitalization. Medicare would cover the bill for the seniors’ readmission. The hospital will get paid.

Medicare will not cover the outpatient observation admission bill.

I wrote:

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

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

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

Once more President Obama lied to us.

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

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

 Evelyn’s friend writes about his experience with a recurring urinary tract infection that has been easily treated of the years:

 “I just found myself in the middle of a medical situation that made it very clear that "the affordable care act" is neither affordable, nor do they care.”

 This is where Evelyn’s friend’s story gets interesting.

 He said he was diagnosed as having of prostate cancer diagnosed by needle biopsy in 2007. He had a “radical prostatectomy.”  The final pathology report of the tumor turned out to be benign.

Since surgery he has had numerous “urinary tract infections (UTIs).” He assumed the UTIs were a side effect of the surgery since he never had a UTI pre surgery. His Family Physician confirmed his assumption.

In March 2014 he developed a UTI. He went to an Urgent Care Center (Doc In The Box) to get his usual urine culture and an appropriate antibiotic.

After a forty-five minute wait for a physician he had to urinate. He also became nauseous and light headed. The receptionist told him he should not to go to the bathroom until after he saw the doctor and he (the patient) provided a urine specimen.

He then passed out. This can happen with a full, irritated and distended bladder. Hypotension (low blood pressure) can occur and cause a patient to faint.

He woke up with dry heaves and was confused. He tried to stand but was still hypotensive.

He was told by the Urgent Care Center that an ambulance was called to bring him to the nearest hospital emergency room for evaluation.

The cause of the hypotensive episode was clear. However because of  malpractice concerns the Urgent Care Center staff was required to send him to the nearest hospital emergency room for complete evaluation.

If an emergency room physician could have used his clinical judgment (not the dictated care rules) the physician would have concluded, after work-up, past history, and clinical evaluation of the work-up, that the patient could get necessary treatment as an outpatient at home.

The patient wrote;  

 “Now, "the rest of the story", and the reason for sending this to so many of you.”

 “I finally got to see a Doctor.   I asked "what is going on." I'm just having a UTI, just get me the proper medication and let me go home.” 

The Emergency Room Physician told him;

“That his symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.”

The appropriate studies were done over the next three hours. At about 7:30 pm the nurse came back to his room to tell him that one of the tests takes 1- 2 days to complete.

He asked if the hospital could email the (the results) to him. I assume the missing test were a urine culture and a blood culture.

The nurse informed him that he wouldn't need the tests emailed because he wasn't going anywhere. 

He told her he had no intention of staying overnight. He wanted to see the doctor. He asked the physician if he was going to be admitted for treatment or admitted for outpatient observation.

“He told me that I would be admitted for observation.   I said Doctor, correct me if I'm wrong, but if you admit me for observation Medicare will not pay anything.  The non Medicare coverage was due to the affordable care act ( An Obamacare regulation). The doctor said that's right, it won't.”

Another physician came into the room as he was getting dressed to leave the hospital ER against doctor’s orders. The next physician confirmed the patient’s interpretation of Medicare rules.

After the last physician prepared his discharge papers, the discharge nurse came into the room for him to sign the papers in order to relieve the hospital of any liability.

The patient told her; “ I wasn't trying to be obstinate, but I wasn't going to be burdened with the full (financial) responsibility for my hospital stay.”

 After making sure the door was closed, she said, "I don't blame you at all, I would do the same thing."  

 She went on to say, "You wouldn't believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney." 

 She further said, "The 'Affordable Care Act' is going to be a disaster for seniors. 

Yet, if you are in this country illegally, and have no coverage, you will be covered in full."

The patient went for a follow up appointment with to his Family Practitioner since his white blood count was pretty high. 

“During the visit I shared the experience at emergency, and that I had refused to be admitted. “

“His response was "I don't blame you at all, I would have done the same thing".  

 “He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.”

 “I told him that I had heard that the affordable care act (Obamacare) would no longer pay for cancer treatment for those 76 and older, is that true?

“His understanding is that it is true.”

 “The more I hear, and experience the Affordable Care Act (Obamacare), the more I'm beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they'll be.”

Evelyn is doing a great service by publishing this man’s letter. I hope it makes seniors aware of what is happening to Medicare coverage.

I am repeating a lot of this letter to re-emphasize, to followers of my blog, much of what I have said in the past. It is important to point out that all of Obamacare’s defects are becoming a reality to patients.

The defects are directly affecting seniors and their access to healthcare coverage.

Seniors must become “professors of their diseases” and control  their health and healthcare dollars.

Remember, politicians are supposed to be working for seniors, not controlling them.

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

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