Medicare

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Who Losses? Who Wins?

September 11, 2013

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

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Stanley Feld M.D.,FACP,MACE

IBM wins because it wants out of
providing healthcare insurance for retirees.

The government wins because it gains more
control over the healthcare system.

It is as if big business is playing right
into the Obama administration’s hands.

The healthcare insurance industry wins because
it gets more administrative services fees from the government without risk.

The brokers for the healthcare insurance
industry win because they will take more commissions from individual consumers than
they would from an institutional company.

IBM retirees
lose.

Most retirees will go on Medicare Part B or
Medicare Advantage. President Obama is planning to eliminate Medicare
Advantage.

Medicare Part B is means tested so the
more income that is generated from any source by a retiree the higher the premium
paid to the government for Medicare Part B.

The Medicare premiums are paid with pre
tax dollars from retirees Social Security payment. The supplemental insurance
(Medicare Part F) covering deductibles and co-pays are not tax deductible.

Medicare is increasing the deductible and
co-pay requirement in 2014. Therefore the non tax-deductible supplemental
premiums will increase in price.

The premiums of both Medicare and
Medicare supplements for services and drugs can amount to more that $16,000 a
year for a husband and wife calculated in terms of after tax dollars..

Large companies provided the healthcare
coverage as a benefit to retirees tax-free.

IBM has been trying to get out of
providing healthcare coverage for employees since 1999. Obamacare has provided
an excuse for IBM to discontinue its coverage for retirees.

General Electric (GE) made the same
announcement a while ago. Time Warner made its announcement right after IBM.

Companies who have changed their
healthcare coverage for retirees include DuPont, Caterpillar, Sears and Darden
Restaurants.

Many more companies are about to joint in.

It is obvious this was coming as a result
of Obamacare.

The move
disregards the social contract made with employees when employees were first
hired.

International Business
Machines Corp.
(IBM) is going to discontinue its company-sponsored health plan for about
110,000 retired employees.

IBM plans to provide retirees a fixed payment.
The payment will be used for retirees to buy their own health care coverage
through a “private” health insurance exchange.

Once retirees are eligible for Medicare at age
65, IBM would not be responsible for managing these retirees’ healthcare
benefits.

IBM said,
“the growing cost of care makes its current plan unsustainable without big
premium increases.”

IBM told retirees, “that its current retiree coverage will end
for Medicare-eligible retirees after Dec. 31, 2013.”

IBM is shifting the responsibility to the
retirees for buying their own coverage through “Private Health insurance
Exchanges.”

It sounds like a costly rip off to the retiree.
IBM is providing a subsidy for now. Then IBM will discontinue the subsidy.

One Private Health Insurance Exchange
executive said.

"Companies
were turning off plans," he said. "We've given them a proven way to
subsidize. At some point every single retiree will join a Medicare
exchange."

Some union-affiliated groups and retirees
weren't convinced. Lee Conrad, national coordinator for the IBM Global Union
Alliance, said

The
worker group sees this as
just another take-away of retiree and employee benefits."

Donald
Parry, an engineer who retired in 1992 after nearly 32 years at IBM, said he is
concerned he may have to pay more. "The worst thing right now is not
knowing what's going on,"

At the moment the cost of the government
providing Medicare coverage is unsustainable according to the CBO. This is
despite Medicare premiums being means tested and the escalation of Medicare
premiums.

Despite the increase in premiums Medicare
will run out of funds by 2024.

The choices are higher means tested
Medicare premiums (redistribution of wealth), decreased access to care or
rationing of care. I believe it will be all of the above. The burden of this
change will fall on the taxpaying consumers’ shoulders.

As big businesses drop coverage for
retirees, the Medicare roles will increase and the government will run out of
fund prior to 2024.

Excessive costs, commissions, and bureaucratic
inefficiencies part of any government program.

The Obamacare bureaucracies seem to have
no concern for the inefficiencies and increase in deficit spending.

It is as if they are saying, “Bring it on.”
All the government wants is control of the healthcare system.

The result will not be affordable care.
It will be unaffordable care that is rationed with limited access to care.

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

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mg security • September 29, 2013

You made some really good points there. I looked on the internet to learn more about the issue and found most individuals will go along with your views on this web site.
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A Review Of The Deception In Obamacare

August 14, 2013

inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley
Feld M.D.,FACP, MACE

The goal to provide
affordable healthcare and access to care for all Americans is an admirable
goal.

Obamacare is making
Americans dependent on the government for their healthcare access and health
decisions. This is bad.

President Obama is doing
this slowly but surely. The goal is to first destroy the present healthcare
system. The more he destroys, the more the stakeholders, healthcare insurance
industry, hospital systems, physicians, drug companies and patients game the
system

Americans are known to
be individualists. They cherish their freedoms. However, over the last 50 years
many entitlements have been introduced at the price of forfeiting many
freedoms.

Some entitlements have
been for consumer protection. Others have not.

Obamacare is about
government control and takeover of the healthcare system. President Obama
understands that he cannot force people to do what they do not want to do.

However they will do
anything when they have no choice. He is creating a no choice environment
slowly but surely. He is doing it with a bad law, lots of lies and
disinformation, and a golden tongue,

He changes and ignores
parts of the law he wrote to fit he needs by executive order, disrespects the
will of the people and congress and folds to pressures of lobbying from his
base. He marginalizes his enemies.

His changing the law
without the consent of congress is probably unconstitutional. However no
Republican has questioned his tactics.

He stays on the
offensive and keeps Republicans on the defensive. Republicans must have someone
who could parry his offenses and put him on the defense even though he has the
unequivocal support of the traditional media.

On Friday August 9^th
was a perfect example of this offensive.

The idea that you
would shut down the government unless you prevent 30 million people from
getting healthcare is a bad idea...

I'm assuming they will not take that path…I have
confidence that common sense, in the end, will prevail.

He explained his delay
of the employer mandate by saying going through congress would be the
"normal thing" to do "but
we're not in a normal atmosphere around here when it comes to
'Obamacare.'"

The president called efforts to defund and repeal Obamacare the
Republicans' "holy grail" and an "ideological fixation."

You have got to give it
to him. No one would ever think Obamacare is having so much trouble because it
is a lousy law, that is impossible to build out its structure, Impossible to
implement, impossible to execute and impossible to enforce.

The majority of the
country and majority of the stakeholders are against the bill. President Obama
just goes right ahead despite the will of the people.

Obamacare did not get
one single Republican vote. President Obama’s twist and turns have kept
Republicans in a reactive and defensive mode.

Every time Republicans
go on the offense they are blamed for the bad law’s (Obamacare’s) failure. They
do not answer back.

I believe the majority
of the people know what President Obama is about. They do not trust him. The
lack of trust renders him ineffective.

Someone needs to turn
the tables on him.

I also believe President
Obama is about to turn the tables on himself. His says he is all ears for a
good idea but Republicans have not presented him with one.

This is not true. The
problem is President Obama doesn’t listen.

The list of lies and
misrepresentations are enormous. These lies and misrepresentations have
resulted in the lack of trust.

Below are some of the things promised that so
we should not forget.

1. Imposing President Obama’s idea of
transformation by social engineering in which the majority of the population
does not agree with.

2. Imposing 21 hidden taxes that few knew
about before the bills passage. Few knew the effect of these taxes on small
business until after passage of Obamacare. These tax increases amount to
the biggest tax increase in our history.

This occurred after
President Obama pledged no new taxes for anyone making less than $250,000
dollars. All of these taxes are passed on to consumers.

3. The medical device
tax alone is a job-killing and innovation-stifling medical device tax. 33 Democrat senators are now opposed to this tax. He does not have the support of his
party on this tax.

4. Independent Payment
Advisory Board (the IPAB) is going to ration healthcare. Sarah Palin called it aka death
panels. Howard Dean, recently termed it a "health care rationing body" that
Congress should be "getting rid of." The Obama administration insists
there is not going to be rationing of care.

5. The original CBO
cost estimate was a reduction in healthcare costs in 10 years. The
CBO used six years of costs and ten years of taxes. The next estimate using
rigged numbers given to the CBO by the Obama administration was less than $1
trillion.

The ten-year CBO cost
estimate has now reached $2.6 trillion. We have not heard from the Obama
administration about this new estimate.

6. Health
insurance premiums are soaring despite President Obama’s recent statements that
healthcare premiums are falling. All employer and employees will say President
Obama is wrong.

Four years ago President
Obama promised the public that, “Obamacare
would reduce a "typical family's premium by up
to $2,500 a year."

7. We will all recall these famous lines, “If you like your doctor, you
will be able to keep your doctor. Period.”

If you like your healthcares plan, you will be able to
keep your health care plan. Period.

“No one will take it
away. No matter what.”

No statement is more
dramatic but false.

8. Obamacare is making an already serious shortage of doctors worse. Many physicians are opting out of Obamacare, Medicare and Medicaid.

To make thing worse
patients will have to pay physicians directly. The Obama administration
published a new rule for seniors. CMS will not reimburse patients the 70% of
their out of pocket expenses for physicians that do not accept Medicare or
Medicaid.

The result will be an
increased out of pocket burden for all patients, rich and poor.

9. Many employers
are likely to drop health coverage. There has been widespread reduction of work hours to avoid paying an Obamacare
mandated penalty to provide employee health insurance.

Obamacare has created a burden on economic
growth. It has resulted in the creation of "seven times more part-time jobs"
than full-time jobs. It has decreased the living wage for millions of Americans
and created millions more uninsured patients.

These part time workers
will be forced to buy insurance through the health insurance exchanges. This
will balloon the federal deficit even further.

10. The states have been
given the option to participate in health insurance exchanges and expanding
Medicare and Medicaid. Thirty three states have refused to participate. They
know they cannot afford to increase their states’ budget deficit.

11. The healthcare
insurance industry thought it would make a killing by insuring people through
the health insurance exchanges. In Medicare and Medicaid they bill the
government for doing the administrative services. President Obama has changed
the promised health insurance rules. Several insurers are leaving all of the states. More are to follow.

12. Recent surveys show that 63 percent of voters think the law
needs to be changed, and a 57-percent majority feeling that implementation is
"a joke."

This is happening despite
the traditional media helping President Obama’s political campaign to promote
Obamacare.

These are just a few of
the reasons for the mistrust of the administration.

Next will be a summary
of President Obama’s probable unconstitutional delays in the law without
congressional permission.

Max Baucus was
corrected. Obamacare is an expensive train wreck.

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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More Government Control

August 1, 2013

inDisinformation and the healthcare system, Medicare, Medicine: Healthcare System, Physician's Problems, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

I have covered the discovery of the
tricks Obamacare has played on hospital systems, insurance companies, union
leaders and large corporations in the last three blogs.

The Obama administration needs all three
groups to cooperate if Obamacare has the slightest chance of success.

Physicians are now starting to react to
Obamacare and its restrictive regulations.

It is clear to me that the Obama
administration has no respect for physicians, their intellectual property,
their surgical skills, their honesty or their character.

The Obama administration has labeled
physicians as commodities and thieves. Obamacare devalues physicians and figures
whatever reimbursement it offers physicians will accept.

Ezekiel Emanuel M.D., Obamacare policy advisor, expresses a vivid example of this disrespect in
his recent article in the New York Times entitled “Don’t Give Up On Healthcare
Costs.”

Dr. Emanuel discusses S.G.R., or the Sustainable Growth Rate
formula.

The formula is seriously flawed in its attempt to contain rising
healthcare costs.

The formula is rigged to penalize physicians
yearly for their reimbursement for treating Medicare patients. Every year
Congress waives the penalty for that year. This waiver is commonly known as the
“doc fix.”

The yearly penalty has been accumulating since 2002
so this next year it is scheduled to reduce physician payment by 24.5%.

Neither the AMA nor the traditional media
has articulated the meaning of the S.G.R to the public in a comprehensible way.

The S.G.R provides no incentive for individual
doctors to be more efficient since the target level applies to total nationwide
physician costs.

The cuts from the formula are indiscriminate. The
cuts would affect high quality, cost-effective doctors the same as it would
inefficient free spending physicians. It would also affect underpaid primary
care physicians.

The goal should be to incentivize all physicians to
be efficient and cost effective providers in their treatment and patient recommendations.

Ezekiel Emanual’s disrespect shines through when he
says,

“Physicians
desperately want the S.G.R. repealed and replaced so they can charge what they
want without the potential of massive cuts hanging over them each year.”

Congress agrees with physicians that S.G.R. is seriously flawed. The House Energy and
Commerce Committee is starting to mark up the repeal of the S.R.G formula. It
is going to replace it with a 0.5% yearly increase in physician reimbursement
until 2018. In 2019 the government will link Medicare payment to the quality of
care each physician provides.

The measurement of physician performance will be
measured, by big data provided by the Enhanced Quality Reporting System. The
EHQRS is being developed using the ICM-10 coding system. ICM-10 uses 68,000 codes
vs. 18,000 codes in ICM-9.

Ezekiel Emanual M.D. doesn’t like this
formula. It does not provide incentives for physicians to accept bundle reimbursement
for the treatment of their patients.

Dr. Emanual believes

“fee-for-service
payment incentivizes quantity over quality. Physicians make more money by
ordering more tests, seeing patients more frequently in follow-ups and
providing more treatments. The payment system is a key accelerator driving up
Medicare costs — and therefore the federal government’s deficit”.

Dr. Emanual does not trust physicians to
do the best job possible. He also ignores the defensive medicine issue. He
believes,

“In 2009, the
Congressional Budget Office did a comprehensive assessment of the potential
cost savings from medical malpractice reforms.

Its conclusions: A
package that included a $250,000 cap on noneconomic damages, a $500,000 cap on
punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year
— 40
percent from reduced malpractice premiums and the rest in the form of fewer
defensive procedures like M.R.I.’s.

Dr.
Emanuel concluded that $11 billion
dollars a year savings is insignificant because it is a cost saving below $26
billion dollars a year. He contends tort reform is a distraction from real
efforts to control healthcare costs and should be ignored. The CBO
scoring information has lead Dr. Emanuel to an inaccurate opinion.”

Douglas W. Elmendorf’s,
head of CBO
at the time, conclusion was not nearly as definitive as Dr. Emanuel’s
conclusion.

The malpractice issue of defensive
medicine and over testing is real. The Massachusetts Medical Society survey of
defensive medicine is real. Most physicians in Massachusetts are
liberal/progressive and so the sample is not biased toward conservatives.

The
truth is a full accounting reveals that more than 10 percent of America's
health expenditures per year are spend on tort liability and defensive
medicine.

The
percentage of healthcare costs is even greater when the Massachusetts
Medical Society survey is taken into account. The amount spent for
defensive medicine can be extrapolated to actual costs from this survey.

I have
written a series of blogs analyzing the impact Massachusetts Medical Society’s
survey. The extrapolated costs turn out to be about $700 billion dollars a
year. The real cost of defensive medicine is somewhere between $242 and $700
billion dollars a year.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

In
2008 damage awards alone for medical malpractice claims reached $5.9 billion
dollars. The total of medical tort costs was $16 billion for legal
costs, underwriting costs and administrative expenses. From 1986 the average
jury award was $100,000. In 2006 the average award increased to $637,000. No
one knows what the award value is for cases settled out of court.

Each
year, 25% of practicing physicians are sued. 90% of physician sued are found
innocent. The average defense cost is $100,000. This cost is not included in
the CBO scoring

The
fear of lawsuits causes most doctors to practice "defensive medicine"
as the interviews of Massachusetts physicians points out. The result is
unnecessary testing, referrals, and procedures to protect themselves from
allegations of medical negligence.

A
recent survey of doctors published in the Journal of the American Medical
Association found that 93% of physicians admit to practicing defensive
medicine. A 2008 survey by the Massachusetts Medical Society found that about
25 % of medical procedures are defensive in nature.

This
waste results in increased healthcare insurance premiums. The premium increases
result in an increase of at least 3 million uninsured people per year. When
these uninsured people get sick they avoid going to a physician. This results
in a decrease in work productivity. It is estimated that the annual decrease in
productivity is more than $40 billion dollars a year.

In
states where tort reform has been instituted by placing caps on so-called
non-economic damages, the malpractice costs have decreased 39%. This drop in
costs is a result of decreased malpractice suits. The decrease is economically
bad for the plaintiff attorneys. Annual malpractice premiums have gone down at
least 13%. In fact, the medical malpractice business for plaintiff attorneys
has about dried up in Texas.

Dr. Emanuel and the
administration want to connect the leverage they have with the SGR formula to
getting physicians to accept a bundled rate for treating a patient.

Dr. Emanuel “would tie an
S.G.R. repeal to a slow reduction in fee-for-service payments to those
physicians who do not switch to bundled payments and other payment models.”

In other words, accept risk
for treatment that an insurance company would normally accept risk for while
ignoring the malpractice implications of missing a diagnosis or not seeing a
patient at appropriate intervals.

Isn’t the government going
to test physician’s treatment with 88,000 codes in ICM -10 and the Enhanced
Quality Reporting System?

Isn’t the government going
to force the decisions of the Independent Physician Advisory Board on
physicians?

Now the government wants to
force physicians to accept the potential liability for not using their medical
judgment.

This is not aligning physician
incentives with efficient treatment cost. It is dictating medical treatment to
physicians.

This is putting physicians
well on the Road to Serfdom.

Physicians are getting
tired of all of this. They are about to quit treating Medicare patients.

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

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Games On!

June 23, 2013

inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld
M.D.,FACP,MACE

Articles
about the virtues of Obamacare are appearing almost daily. It is pretty clear that
the information is being fed to the media by the Obama administration.

The
problem is the sound bites are not truthful. The best sound bites are in the
Obama administration has to offer are in play. All the virtues expressed about
Obamacare are expensive and un-executable by the Obama administration.

On June 16^th
Timothy Egan was called on to spin the Obamacare tale in the New York Times.

He lauded
the virtues of Obamacare while executing the blame game once again. He starts
by describing an under 26 year old with Hodgkin’s lymphoma who was treated to
remission using his parents’ employer provided healthcare insurance.

The parents’
employer’s healthcare insurance premiums increased the past few years since it
is the law under Obamacare to cover children until they are 26 years old. The
coverage pre Obamacare covered only up to 18 years old.

Here is
the blame game.

“But he’s (the under 26 year old) still a pariah in the eyes
of the insurance industry, which means they can deny him a policy that might
save his life.

Not for long. In six months’ time, the heartless practice of
refusing to let sick people buy affordable health insurance — private-sector
death panels, the most odious kind of American exceptionalism — will be illegal
from shore to shore.”

Timothy Eagan’s example is true. However,
Obamacare’s most disturbing
feature is the Independent Payment Advisory Board. The IPAB, sometimes called a
"death panel," threatens to nullify Mr. Eagan’s euphoria for
Obamacare.

Maybe this person will not get approved for retreatment if
the determination for retreatment is not cost effective according to the IPAB

A vivid example of government’s control over an individual’s
personal life and death decisions is the rules that bared access by 10-year old
Sarah Murnaghan to the adult lung-transplant list.

Health and Human Services Secretary Kathleen Sibelius refused
to waive rules made by bureaucrats to permit this 10 year old a lung
transplant.

Who knows what can happen when the power to make rules and
enforce them is in the hands of a bureaucracy? Bureaucracies have a tendency to
create rules in which no one has to take responsibility for decisions that affect
others’ lives and personal freedoms.

It is obvious that the grip of the bureaucracy will clamp
down much harder once the Independent Payment Advisory Board gets going in the
next two years. There will be no going back.

The Obamacare’s IPAB is not answerable to any one.

Cost will be an issue in the bureaucratic IPAB’s decision-making process
and not the patient’s vested interests.

Timothy Eagan goes on to say,

“The early indications are that most Americans will be
pleasantly surprised. Millions of people, shopping and comparing prices on the
exchanges set up by the states, are likely to get far better coverage for the
same — or less — money than they pay now.

There is no data for this statement except the
misinformation and number fudging done by California Covered. The costs in
California will be outrageous.

The state of Washington also published disinformation
about the cost of care under their health insurance exchange.

The law, as honest
conservatives predicted, before they orphaned their own idea, is injecting
competition into a market dominated by a few big names.

Washington only has one insurance company signed up.

The real number prediction for Washington's health insurance exchange is that even in over-regulated
Washington State, Obamacare will increase individual health insurance premiums
by 34-80%

What will happen if, in the end, Obamacare really works?”

The early indications from the State of California and Paul
Krugman are misleading and dead wrong. I have pointed out that in an earlier
article. Obamacare is going to be a train wreck both financially and medical
care wise.

In additional, the Obama administration has to build 34 of
its own health insurance exchanges. It couldn’t suck 34 states into the Obamacare
overspending mud hole.

Auditors at the Government Accountability Office released
the results of two investigations. It optimistically concluded that it
"cannot yet be determined" if Obamacare will be ready for enrollment
a mere four months from now.

The health insurance exchanges are supposed to open October
1. The administration insists that it will.

The GAO's
detailed portrait of blown deadlines, regulatory improvisation and general
chaos explains why HHS has been anti-transparent.

HHS will run 34
federal versions in whole or part as Governors continue their Obamacare
resistance.

Some of the health insurance exchange preparations have
barely begun. The Obama administration has already blamed it on conservatives
and Republicans.

The GAO attempted to track "key activities"
necessary to set up exchanges and identified "more than 100." But the
auditors can't give a precise number because "the nature of the activities
that [HHS] and the states will conduct has not been finalized and may continue
to evolve."

Mr. Eagan then criticizes
Republicans.

“They
have good reason to fear it: if Obamacare works, the game will be over for
those who oppose the most significant change in American life in a generation’s
time.”

The chance that Obamacare
will work is minimal. In either case it will be the most significant change in
American life in a generation’s time.

Ben Carson M.D. has a very
practical comment about the health insurance exchanges.

Obamacare will be a disastrous
change and the Democrats will try to blame its failure on Republicans. It has
nothing to do with Republicans. It is simply a law that is destined to be a
train wreck.

Obamacare cannot be executed
and America cannot afford the cost of Obamacare.

Young people will not buy
individual insurance from the health insurance exchanges.

The young individuals who
do not receive healthcare coverage from their employer are not stupid. It makes little financial
sense for them to subsidize the medical care of others given the choice.

The traditional media is
getting nervous as they see President Obama using them to promote Obamacare and
convince young healthy people to join with a campaign of disinformation.

The media have lately
emphasized the real challenge of enticing healthy young adults to sign up for
Obamacare. Obamacare needs these young people to sign up and buy the insurance.

The states that have signed
on to the health insurance exchanges and the federal government are counting on
young people who are healthy to make Obamacare work.

Obamacare will not work even if they sign up. President Obama will
have to impose more and more taxes as hiddden taxes and means tested taxes as
there are more and more shortfalls.

This has been the destiny of all entitlement states and countries. These
higher taxes will have a devastating effect on the economy and economic growth.

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

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The problem is that as the Obama administration and
its media surrogates tell lies they start believing these lies until the devastation
hits.

Devastation of the healthcare system, the economy and
the financial structure is closer than they think.

Eugene Charter Service • October 14, 2013

Everything is very open with a clear clarification of the challenges. It was definitely informative. Your site is very helpful. Many thanks for sharing!
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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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Obamacare’s Deception

March 27, 2013

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

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Stanley Feld M.D.,FACP,MACE

We
all remember Nancy Pelosi’s famous declaration when she said “we will not know
what is in the bill until we pass it.”

I
could remember asking to myself how stupid can Americans be to listen to this
lady?”

Americans
are going to be shocked to learn the extent to which they have been deceived by
Obamacare. The legislation neither protects patients nor makes the Health Insurance Exchange plans affordable.

The
details of Obamacare have been anything but transparent. New details are
appearing every day in the form of new regulations by new agencies.

I
believe it would be impossible for someone without an intense interest in
Obamacare to understand it.

There
have been over 20,000 new regulations from 300 new agencies so far. Mass
confusion has been generated as regulations from one agency contradict regulations from other agencies.

The
Obama administrated has said recently that the public should not expect cost
saving from Obamacare.

The Obama administration has also asked for an
additional $1 trillion dollars over the next ten years in order to fulfill
Obamacare’s promise to the American people.

It
looks as if none of the administration’s advisors or the administration had
considered the unintended consequences.

“Obamacare
works for the insurance companies but not for Americans.”

The
slogans such as “shared responsibility,” “no free riders” and “ownership
society.” dress the insurance industry’s raid on public resources in the cloak
of a “free market” health care system.

Obamacare neither protects patients nor are the healthcare
insurance plans to be offered by the health insurance exchanges affordable.

Americans with incomes between 133% and 400% of the Federal
Poverty Level (Income above 133% of the federal poverty level = $31,322/yr. or $2,610/mo.
Income above 400% of the federal poverty level= $94,200/yr. or $7850/mo.) will
pay for the least expensive subsidized policies from 2% to 9.5% of Modified
Adjusted Gross Income (MAGI) from their IRS reported income.

Americans with the least income are faced with a substantial yearly
and monthly after tax salary reductions even though their healthcare insurance
policy is subsidized by the government.

On January 1,2014 they are mandated to have healthcare coverage.

A person with a Modified Adjusted Gross Income receiving $27,925
from all sources of revenue will pay $187.33 per family member per month.

The total price for a family of four is ($2,247.96 per year times
4) $8991.84 in after tax dollars. This
pays for a Silver level plan that is next to the least expensive plan to be
offered by the health insurance exchanges.

If a person who has this plan goes to a physician or a hospital the patient’s deductible will be sizable
despite the government subsidy.

Even if the family has subsidized healthcare insurance these
families might not be able to afford to use the insurance.

The quality of life of a low earner will be compromised. He must
buy the subsided healthcare insurance. The result will be he will have to make
cuts in buying food and adequate housing in order to pay for the healthcare
coverage.

We have not heard much about this problem from the Obama
administration.

As the insurance industry raises premiums on private insurance
they are also going to raise the prices in the Health Insurance Exchanges.

If the family opts out of buying the insurance they will have to
pay a penalty.

It is actually better to pay the penalty and then sign up for
insurance if you or a member of your family gets sick.

The fee paid for
insurance in 2014 will varying according to 2012 income. If a family income
rose in 2012 and the breadwinners lost their jobs in 2013 and 2014 the family
could not afford the MAGI healthcare insurance premium they would be required
to pay.

If income increased in 2013 they would be liable for the
increase the next year.

“The
stress alone from such a regressive scheme is, without a doubt, not conducive
to good health and well-being.”

On January 1, 2014 everyone is required to buy healthcare
insurance or else pay a penalty. Even with the government’s subsidy a low income
earner could be forced out of the market.

In the meantime, states such as California are decreasing
reimbursement for physicians. Physicians are choosing not to participate in
both Medicare and Medicaid. This will increase the physician shortage.

The only choice states have left is to tie medical license
renewal to physicians accepting Medicare and Medicaid.

At the same time states and the federal government are
decreasing funding to already financially stressed charity safety net hospital
systems. Many of these institutions have closed. Most of them are failing.

The decrease in safety net hospital systems will further
decrease the options for low-income earners to receive medical care.

Obamacare is turning out to be a not well thought out plan. It
is a series of Catch 22s.

The only winner is the healthcare insurance industry which will
provide the administrative services to the government to adjudicate claims. It
will receive both the government subsidy and the payment made by the low-income
earner.

Obamacare has deceived the public. As I have stated in the past Obamacare has
some good ideas but the structure, regulations and execution are terrible.

Obamacare sounds good when President Obama talks about it but it
is an impending disaster medically and financially for Americans.

Only a consumer driven healthcare system with the bullet-proof
ideal medical savings account will align all the stakeholders’ incentives.

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

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Socrates Is A Man

January 13, 2013

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

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Stanley Feld
M.D.,FACP,MACE

All Men Are Mortal

Socrates Is A Man

Socrates Is Mortal

This is the classical syllogism. Syllogisms are a
form of decisive logic that leads to a certain conclusion.

“A
syllogism (Greek: συλλογισμός – syllogismos
– "conclusion," "inference") is a kind of logical
argument in which one proposition
(the conclusion) is inferred from two or more others (the premises)
of a specific form. “

In my last blog I reported the 3.5% tax the Obama
administration is levying on the healthcare insurance industry for ever
healthcare insurance policy it sells through Obamacare’s health insurance
exchanges.

In 2014 the healthcare insurance industry is going to
be required to sell healthcare insurance policies through the health insurance
exchanges.

The healthcare insurance industry will also be
required to sell plans that comply with the rules and regulations of the Obama
administration.

The 3.5% tax “users fee” was published on a Friday
afternoon at the end of November. The tax received little media attention. I
said the healthcare insurance industry would pass this “users fee” on to the
consumer.

At the end of December the healthcare insurance
industry did better than that. It increased healthcare insurance premium rates
by double digits.

“Health
insurance companies across the country are seeking and winning
double-digit increases in premiums for some customers, even though one of the
biggest objectives of the Obama administration’s health
care law was to stem the rapid rise in insurance costs for
consumers.”

The consumers most affected by the higher rates are
small businesses and consumer who must purchase insurance on their own.

"In California, Aetna is proposing rate increases of
as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of
California 20 percent for some of those policy holders.

The rate requests are in
addition to the 39% increase in rates last year.

In other states, like Florida and Ohio, insurers have been
able to raise rates by at least 20 percent for some policy holders. The rate
increases can amount to several hundred dollars a month.

In 2010 the
increase in healthcare insurance premiums increases provided springboard for
public opinion sympathy of the Affordable Care Act (Obamacare).

Obamacare will go into full effect in 2014.

Why would a business (the healthcare insurance
industry) facing loss of its customers because of high premiums increase
premiums even further?

Why, if the traditional media has published articles
stating that the cost of healthcare has been decreasing would a premium
increase be justified?

“A report issued by the Department of
Health and Human Services today includes findings that might surprise
some people.

“During
the fiscal year that ended Sept. 30, 2012, the amount Medicare spent per beneficiary
rose by just 0.4 percent. That's three percentage points less than the economy,
as measured by gross domestic product, grew during that same period.”

If Medicare spending has risen only
.4% why would Medicare premiums increase by at least 33% while private healthcare
insurance premiums are increasing by 10-30%?

Annually physicians’ reimbursement continues to
decrease.

Why do consumers’ deductibles continue to increase
each year?

It is illogical. The numbers do not make sense. The
actions do not follow the syllogistic logic.

How can Medicare be losing money? Medicare premiums
are means tested and represent a redistribution of wealth.

The average
premium for Medicare with after tax dollars for a couple with a reasonable
pension fund is $15,000 dollars.

The average direct cost of care per Medicare patient
is $6,600 dollars.

In 2014 Medicare premiums are scheduled to increase
to more than $20,000 for full Medicare insurance coverage.

Seniors have paid for Medicare insurance in payroll taxes
continuously for the last 47 years.

There is something wrong with the numbers. They do
not add up. Where is the extra money going?

Consumers must start becoming aware of these facts.

Only consumer protest will bring out the truth about
these illogical numbers.

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

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Safety Net Hospitals Are Methodically Being Destroyed.

July 25, 2012

inMedicaid, Medicare, Medicine: Healthcare System

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Stanley Feld M.D., FACP,MACE

Safety net hospitals have played a vital role in the care of America’s indigent population for over one hundred years.

Over the past few years’ safety net hospitals throughout the country have gone out of business. Fifteen percent of the hospitals in the United States are publically owned safety net hospitals. These are city or county hospitals.

“The urban public hospitals are often associated with medical schools.^[7] The largest public hospital system in America is the New York City Health and Hospitals Corporation, which is associated with the New York University School of Medicine.”

These hospitals receive funding from local, state, and federal government. They are also allowed to charge Medicaid, Medicare, and private insurers for the care of patients that have these forms of insurance.

Poor uninsured patients receive their care free from safety net hospitals.

Public hospitals, especially in urban areas, have a high concentration of uncompensated care. Their association with medical schools as teaching hospitals is an additional funding source provided by the federal government.

“The federal government provides funding to hospitals that treat indigent patients through the Disproportionate Share Hospital (DSH) payments.”

About 2,000 hospitals receive this funding. The problem is these DSH payments are highly concentrated.

Sixty-three percent of total DSH payments go to large teaching hospitals in urban areas.

DSH funding method is political and bureaucratic. Payments are manipulated. Medicaid eligibility and coverage vary widely across states and change the distribution of funds.

DSH payments have been distributed unevenly across geographic areas and away from rural safety net hospitals.

The uneven distribution is toward large urban safety net hospitals in the Middle Atlantic, South Atlantic, and Pacific regions. Those hospitals account for 60 percent of all DSH payments but only account for 46 percent of Medicare discharges.^[2]

The result is public safety net hospitals in America are closing at a much faster rate than hospitals overall.

“ The number of public hospitals in major suburbs declined 27% (134 to 98) from 1996 to 2002.”

As the number of uninsured and indigent patients has increased, their expenses in providing uncompensated care have drained the suburban and rural public hospitals funds.

Treating patients without receiving compensation has also drained urban non teaching hospitals.

Public and non-profit rural hospitals form a large part of the health care safety net for the indigent and uninsured in the U.S.^[9]

Several large safety net hospitals have gone into bankruptcy because cities and states could not afford to fund them.

Two prominent examples are Martin Luther King in Los Angeles and Grady Memorial in Atlanta. Grady Memorial in Atlanta has gone into bankruptcy twice only to be rescued the citizens of the city of Atlanta.

Non-profit community hospitals can collect federal funds if they treated a certain percentage of indigent and Medicaid patients.

In order to reach that percentage the federal government has allowed community hospitals to eliminate certain beds from its total hospital bed count. The hospitals can eliminate outpatient observation beds, skilled nursing swing beds and ancillary labor/delivery services beds from its total bed count.

It inflates the percentage of charity beds a non-profit hospital counts toward government subsidy. This is a totally political maneuver.

In effect it decreases federal funding to city and county safety net hospitals.

In October 2012, Obamacare is starting to adjust federal hospital payments based on quality of care. One of the primary metrics will be patient experience rating that covers everything from the communication skills of doctors and nurses to their promptness in responding to complaints about pain.

A new study in the Archives of Internal Medicine finds that this change may add to the financial troubles of safety net hospitals, which primarily serve poor patients. The safety net hospitals tend to get poorer marks from patients than do other hospitals.

“On average, they drew top ratings from 63.9 percent of patients while the hospitals that treated the fewest poor people got top ratings from 69.5 percent of patients.”

The gap has gotten widen over time. It means that the non-profit hospital will get a larger share of the federal money than the safety net hospitals.

I have written several articles on how the federal government has been destroying these safety net hospitals throughout the country.

In the first year of the Hospital Value-Based Purchasing program that starts this October, patient experience scores will determine 30 percent of the bonus.

The rest of the bonus will be determined by how hospitals adhere to basic guidelines for clinically recommended care.

The hospitals that perform best will receive a higher bonus. Those that lag in their scores will end up with less.

Many safety net hospitals do not have the funds to buy adequate information technology to record the required treatment protocols.

It means that non-profit hospitals will receive additional bonus money and safety net hospitals will be penalized.

To add insult to injury the vital safety net hospitals’ decrease in federal funds could push them “closer to bankruptcy.”

President Obama’s program will make it even worse for safety net hospitals in October 2013.

Obamacare will start reducing special payments to hospitals that treat disproportionately large numbers of indigent patients. Safety net hospitals are the hospital treating a disproportionately larger number of indigent patients.

Without this funding the safety net hospitals cannot improve quality or provide services to indigent people.

The questions to ask are,

Are the measurement used to determine quality care wrong?
Is President Obama trying to destroy the safety net hospital system on purpose?
Does he not realize that many indigent Americans depend on safety net hospitals?

What is going on here?

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

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