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Are You Kidding?

January 18, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

The New York Times continues to have Ezekiel Emanuel M.D., Provost of the University of Pennsylvania write a medical opinionator column.

It is no wonder the Times circulation has fallen to only 2 million readers. It is no longer the newspaper that prints “all the news that is fit to print.’

Malcolm Gladewell, in a critique of Steven Brill’s “Bitter Pill”, describes Ezekiel Emanuel as follows,

Emanuel was the “brashest” and most “academically credentialed of the trio of brilliant Emanuel brothers,” took “edgy” positions, and had an “MD and a PhD (in political philosophy) from Harvard, a master’s from Oxford, and a position teaching oncology at the Dana-Farber Cancer Institute in Boston.”

 He had “brains, cunning and [a] biting persona,” and was “ready, willing and able to layer it with the self-righteousness of a guy who treated cancer patients.”  

He also does not give a straight answer when challenged.

In my opinion he des not understand either the healthcare system or the medical care system. He does not understand patients’ problems or needs.

Yet President Obama has used him as his medical care advisor for Obamacare. Two recent articles that he has written emphasize the above. 

The first is “Why I Hope to Die at 75” An argument by Ezekiel Emanuel that society and families—and himself—will be better off if nature takes its course swiftly and promptly.

http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

It must be read to be believed. No amount of commentary can describe this unbelievable argument. It left me speechless. It is a set up for government to ration medical care.

It also made me wonder how the President of the United States can permit Dr. Emanuel to be the spokesman for medical care in America. President Obama can only permit it if he agrees that government should control our freedom of choice.

“Dr. Ezekiel Emanuel, last heard from claiming that he wants to die at 75 in order to avoid becoming a burden on society, writes in the New York Times that “screening healthy people who have no complaints is a pretty ineffective way to improve people’s health.”

He believes that government should control patients’ freedoms.

In an article he wrote that appeared in Lancet he stated;  We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favoring the worst-off, maximizing total benefits, and promoting and rewarding social usefulness. 

Dr. Emanuel is all about rationing care for individuals. He is all about the government telling individuals what care they are entitled to depending on their age and usefulness to society.

The second article that solidified my concept of this man was his article Skip Your Annual Physical.

http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html?_r=0

It should be read to understand his mission.

President Obama had built into Obamacare preventive services requirements. This resulted in at least 5 million people in the individual healthcare market losing their insurance and their doctors.

Obamacare mandates that Americans pay via new taxes and inflated health insurance premiums for services they do not need or they do not want. One ridiculous service would be birth control for the elderly.

Additionally the National Commission on Prevention Priorities found that by increasing just five preventive services, clinicians could save more than 100,000 lives per year. These services include breast cancer screening in women 40 and older, flu immunizations in adults 50 and over, colorectal cancer screening in adults 50 and over, smoking cessation counseling, and a daily aspirin in high risk cardiovascular patients.

Ezekiel Emanuel now contradicts this previously adopted notion. Now he wants it out. President Obama can probably take it out by executive order.

One can get a deeper an understanding of this man’s temperament when listening to these two interviews.

  

http://youtu.be/7XD7650Rl04

 

http://youtu.be/QgHTzbZ4crU

Obamacare’s architects are setting up Americans to be resolved to accept what the government will decide and provide. Americans will have no option to decide what medical care they can have and what physicians they can see. Non-elected bureaucrats will decide for us.

I implore Americans, congress, all of organized medicine and all physicians to say enough is enough. Obamacare should be repealed.

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

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Obamacare’s Solyndras

January 14, 2015
inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System
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Stanley Feld M.D.,FACP, MACE

Peter Orszag was previously President Obama’s director of Office of Management and Budget. He was wrong about Obamacare’s economic impact, improvements in the healthcare system and efficiency in 2009.  He is wrong about it in 2015 in his critique of Steven Brill’s book “A Bitter Pill”.

http://www.bloombergview.com/articles/2015-01-12/what-brills-bitter-pill-gets-wrong-on-obamacare

The problem is Peter Orzag still believes in the Obama administration’s fiction. He quotes the Obama administration’s spin of the results as proof of Obamacare’s success. There is little valid data to back up the spin.

Obamacare has had its share of Solyndras. Solyndra was destined to fail. It had a lot of built in organizational waste.

I fear the few Obamacare experiments that we are aware of that have failed are only the tip of the Obamacare failure iceberg. There will be many more debacles that the Obama administration is probably hiding. 

CLASS

Community Living Assistance Services and Supports, or CLASS, was designed to provide cash benefits for those patients needing long-term services and support. CLASS was a part of Obamacare (Affordable Care Act). Many Republican and moderate Democrats objected to CLASS and considered it fiscally unsustainable. It would only waste money.

Senate Budget Committee Chairman at the time Kent Conrad D-N.D. called CLASS “a Ponzi scheme of the first order”. In any event the $68 billion dollar program was rammed through as part of Obamacare.  

Two years later the Department of Health and Human Services determined CLASS could not be implemented in a fiscally solvent manner, and in January 2013 Congress repealed CLASS.

In 2015 the American public still does not know how much of the $68 million dollars was wasted.

Just how much did HealthCare.gov cost?

 The American public will never know. We will never know what we should have paid for the website or what we finally paid.

In October 2013 as soon as it was apparent that www.healthcare.gov was a train wreck the Obama administration denied all the published prices contracted for building the website.

Prices to build the website varied from $91 million dollars to $634 million dollars to over 1 trillion dollars ($1,000,000,000.00).

Americans did not know what the website should have cost. They never found out what the cost was to rebuild the website after the initial disaster.

It was never clear whether the contract to CGI was won by competitive bid. The Obama administration never answered the question of Michelle Obama’s influence in choosing CGI.

The history is clear. CGI has failed to deliver for other projects they have done in other parts of the world.

What is the truth? Why would the Obama administration pick this company? What can we do about this waste of taxpayers’ money?

I guess Americans can remain passive and pay more taxes.

Americans have given up on the truth about the www.healthcare.gov

 debacle. The attitude of many is that it is what it is. We must go on.

All Americans are hearing or want to hear is the current website is easy to use and is working well.The important question is, Is it?

It is easy to understand why Jonathan Gruber would say Americans are stupid and the lack of transparency is a powerful tool. The implication of that statement indicates an Obama administration attitude. It is the reason the administration says they hardly knew the guy.

CoOportunity Health falters, taken over by state

This Obamacare debacle almost got away from recognition by the American public.

 CoOportunity Health is a fledgling Iowa health insurance cooperative set up under  Obamacare with Obamacare money.  It is going bankrupt.

CoOportunity Health was set up by the Obama administration. The Obama administration granted the company $146 million dollars in funding from Obamacare funds. The idea was to provide consumers and small businesses alternative insurance in healthcare markets with limited insurance choices. It could also be thought of as a disguised “Public Option”.

The healthcare insurance industry had refused to participate in the federal and state insurance exchanges in many states. The healthcare insurance companies thought the risk was too great. They would lose money.

Just before this year’s open enrollment period President Obama activated the reinsurance provisions in Obamacare guaranteeing insurance companies that they can only make money and not lose money on providing insurance through the government health insurance exchanges.

The Healthcare insurance companies are falling all over themselves to provide healthcare insurance in high risk states now.

 Where else can you sell insurance to more people at no risk?

“As of December 12,2013 Cooportunity has only $17 million of the $146 million dollars left.  CoOportunity has been taken over by state regulators and could soon go under, officials said Wednesday.”

The Obama administration knows they can now throw government funded insurance companies like CoOportunity under the bus because they have guaranteed backup companies from the healthcare industry that want to sell no risk insurance.

 The CoOportunity hasn't reached insolvency yet but it doesn’t have  enough money on hand to continue to run the company.  It will leave 96,350 consumers uninsured with unresolved claims healthcare insurance claims. These consumers will also lose their un-used premiums.

The 96,350 should be able to get insurance through the federal health insurance exchange in their state.

The federal government as banker has simply cut CoOportunity’s credit and took a $146 million dollar loss.

I wonder how many other Obamacare funded insurance companies are out there?

I wonder how many other Solyndra like experiments Obamacare has. I can think of at least 4 or 5.

I wonder how much money Obamacare is losing on experiments and bureaucratic waste?

It is making medical care more expensive for taxpayers and for patients with increased out of pocket expenses.

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

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Kicking The Sleeping Dog

January 11, 2015
inMedicine: Healthcare System
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Stanley Feld M.D., FACP,MACE

 Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost.

The benefits to the nation are not at a reasonable cost. The waste imposed on to the healthcare system is escalating daily. The cost healthcare coverage provided to the Harvard faculty by the Harvard administration has escalated significantly since Obamacare was enacted into law.

The Harvard administration has absorbed the increased cost of Obamacare for the faculty. The Harvard faculty continued to believe President Obama and the Obama administration were doing a noble deed for the nation until the costs affected them directly.

Now the Harvard administration has shifted some of the increased costs on to the faculty in the form of higher deductibles and direct costs. Corporations have been doing this since Obamacare was passed.

“ The Harvard faculty, and the professors are in an uproar”

I have touched on Harvard’s faculty outrage lightly while others felt this was a huge story pointing out Harvard’s faculty’s liberal hypocrisy.

It proves the point of an old Texas saying, “you shouldn’t kick a sleeping dog because if you do he will awaken and come back to bite you.”

The more important issue that the Harvard faculty should wake up to is the yearly  tax increases that Obamacare has imposed on both the taxpaying and non taxpaying members of our society.

 A big question is, are Americans getting their money’s worth?

The Harvard faculty outrage should be about the Obamacare tax increases.

“Cost of ObamaCare"

 $1.4 Trillion ($1,383,000,000,000) *

ObamaCare's coverage provisions will cost the federal government $1.4 trillion (net) over the next 10 fiscal years, according to the CBO.

That is the net cost to the federal government of the provisions to expand and subsidize health insurance coverage over the fiscal 2015-2024 period.

 The gross cost of the coverage provisions – before individuals and employers have paid their penalties and insurers have paid their excise taxes on "Cadillac" plans – stands at more than $1.8 trillion over the same period.

 Since some will pay large penalties and some will pay none, this taxpayer calculator analysis doesn't attempt to distribute the $456 billion in coverage spending that is expected to be offset by penalties, excise taxes, and some other tax revenues.

*Congressional Budget Office”

We all know how wrong the CBO can be. The CBO is totally dependent on the data given to it. If there is bad data in bad data comes out. We can all recall the CBO publishing a surplus from Obamacare at the end of ten years before the bill was passed.

It is important for everyone to recognize the increased taxes that have been imposed with little evidence for significant payback. Below is my second printing of an article I wrote in March 2014.

 "Obamacare's New Taxes And The Middle Class"

Stanley Feld M.D.,FACP, MACE

“It is important to review all the taxes written into the Affordable Care Act (Obamacare). Americans are recognizing that those tax increases are being passed on to all consumers.  The middle class was not supposed to experience tax increases. The middle class is realizing it has less disposable income because of these new taxes.

Since 65% (sixty-five percent) of America’s economy is dependent on consumers discretionary spending, America is destined to further economic difficulty.

These new tax increases are timed in the hope that no one would notice them.

The increased taxes are supposed to fund Obamacare. The taxes continue to be collected even though much of the law’s implementation is delayed.

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


 


Taxes that took effect in 2010:


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



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



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



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



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


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



Taxes that took effect in 2011:



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



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



Taxes that took effect in 2012:


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



Taxes that took effect in 2013:


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

 

Capital Gains

Dividends

Other*

2012

15%

15%

35%

2013+

23.8%

43.4%

43.4%


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

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

 

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

All Remaining Wages
Employer/Employee

Current Law

1.45%/1.45%
2.9% self-employed

1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike

1.45%/1.45%
2.9% self-employed

1.45%/2.35%
3.8% self-employed



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


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


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

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

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


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



Taxes that take effect in 2014:

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

 

1 Adult

2 Adults

3+ Adults

2014

1% AGI/$95

1% AGI/$190

1% AGI/$285

2015

2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085

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

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

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

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


Taxes that take effect in 2018:


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



This “tax” is under everyone’s radar. It has never been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

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



$104.20 in 2012



$120.20 in 2013





$247.00 in 2014."

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

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

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

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

Everyone must stay focused. President Obama is going to try to change the conversation and create a diversion to the facts.

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

Everyone interested in America’s economic future must tell a friend to repeal these crippling taxes. President Obama has deceived Americans with Obamacare and its new taxes.  

It is time for everyone to get angry and give control of the House and Senate to the Republicans in November.”

It is difficult for Americans to comprehend all of these taxes. It is important for our surrogates that begged us to elect them to understand these taxes and act on our behalf.

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

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Republican Leadership Is Chickening Out!

January 7, 2015
inConsumer Driven Health Care, Medicine: Healthcare System
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 Stanley Feld M.D.FACP, MACE

Since the Republican’s massive victory in November President Obama has been setting up strategy to blame Republicans for all that will go wrong as that majority pledged they would repeal Obamacare.

It was strange that President Obama was not contrite or acted defeated by the election. He said 66% of the people did not vote. He said that those 66% did agreed with his policies and therefore it was a mandate for him to carry on.

President Obama knows he has the RINO’s on their heels

 The traditional mainstream media did not question President Obama’s premise that 66% liked his policies.

Another explanation could be that those 66% disagree with   President Obama’s policies. They believe in President Obama but believe his policies are wrong and did not vote for them.

After all, President Obama said the election was about his policies.

He has not paid attention to needs or will of the Americans people.

President Obama has used the traditional mainstream media (TMM) to promote his agenda. After the TMM publishes the Obama administration’s lies over and over again it becomes the truth even though it remains a lie.

A perfect current example is the administration’s lie that open enrollment for Obamacare is going great.

 ‘The Republican moves come, ironically, as the Affordable Care Act is working fairly well. The three-month enrollment season for 2015 is going smoothly and will likely surpass the administration’s modest second year goals of having 9 million covered in exchange plans.’

After two years of open enrollment if Obamacare signs up the original estimate of 13 million, it still has 320 million people short.  However, President Obama will tout the amazing success ever though Obamacare is unsuccessful and harmful to Americans who were satisfied with their insurance and their doctor before Obamacare.

President Obama has been collecting increased taxes for Obamacare for 4 years.

 “Republicans have been vowing to repeal Obamacare for nearly five years. But 2015 could be the year that Republicans finally define how they would replace it.”

Now Republicans are chickening out. Some Republicans want to delay their repeal strategy until after the Supreme Court rules on the King v. Burwell case in June. Some want to delay it until the presidential campaign in 2016.

I believe Republicans should be aggressive. They should lay out a business model that will work immediately. Then repeal Obamacare . Let the President veto the bill as Republican actively work to replace Obamacare with a carefully explained alternative that makes sense to the public. Republicans can then try to overturn the Presidents veto.

President Obama has asked Republicans over and over again to give him some ideas to fix Obamacare. Obamacare cannot be fixed because of President Obama’s ideology. It must be repealed.

Republicans have many ideas to replace Obamacare with. For years they’ve discussed tax credits to buy insurance, high-risk insurance pools that work and allowing insurance to be sold across state lines. They need to put these ideas together with a compelling and viable business plan such as my ideal medical savings account.

Republicans must create a consumer driven healthcare system.

President Obama and the media have mocked Republicans for not having a plan or offering a fix for Obamacare. I said previous there is not fix for Obamacare. The American public does not want their freedoms restricted. In addition a single party payer system have failed economically in all of the developed countries except Switzerland.

“Various Republican proposals have been put forth over the years, but forging agreement requires bridging deep ideological differences among Republicans about the scope of a plan, the role and responsibility of the federal government in health care, and how much to money to spend.”

A plan must include an entirely new system that includes a business plan. The plan must include the freedom for consumers of healthcare to choose and provide access to care without rationing of care.

The plan must also include systems of care for the most expensive chronic diseases such as Diabetes, Asthma, Cancer and Chronic Infectious Diseases.

The plan must not exclude access of care for the elderly that need hip replacements, knee replacements, cancer treatment or heart disease.  

The plan must develop a system for decreasing the cost of the treatment of chronic diseases. It must have within the treatment system a plan to make the consumers more responsible for the health and healthcare dollars.

It should shift the responsibility of care from the government and insurance companies to consumers. Consumers should decide what they need not the government.

Republicans have had six years to decide on what they should be promoting.

President Obama is in a perfect position to mock and veto any Republican piecemeal suggestion.

President Obama has already smiled regarding the new Republican majorities when he said he has to sharpen his veto pencil implying all they will do is present bills that are stupid.

However, the Republican leadership, rather than passing bills in the senate and house of representative to repeal Obamacare, have chosen to work with the Democrats and President Obama.

The Republican leadership is too afraid to do anything scary. They are afraid to lose votes to the Saul Alinsky tactic of ridicule. It might cause them to lose the 2016 Presidential election.

So what does the Republican leadership do the first day they are in power? They take away key healthcare committee chairmanships of leaders who have voted for the removal of Speaker Boehner.

Next they propose a lame reform to change the definition of part-time employment from 29 hour a week to 40 hours per week.

 “President Obama would veto Republican legislation that would alter the definition of full-time work under Obamacare from 30 to 40 hours, the White House said Tuesday.”

 It is a stupid proposal on many levels.

 The Harvard faculty uproar of the last few days is very important. Almost all the faulty were big supporters of Obamacare until it affected them. I hope the rest of the country reacts the same way and demands their local newspapers publish multiple stories about their citizens pain.

Now that the Republicans are in power in both houses they should be educating the public about the irreparable issues in Obamacare and define its business model for 2020.

The Republicans should let everyone know they are feeling the public’s pain. Republicans should define a business plan that will provide healthcare for everyone at an affordable cost.

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

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Things Happen When No One is Looking

January 4, 2015
inMedicaid, Medicare, Medicine: Healthcare System, Patients Problems, Physician's Problems, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

I wish you all a Happy and Healthy New Yew Year.

I have not written blogs during the holiday season because I figured no one would pay attention to what is happing in healthcare.

President Obama figured the same and snuck in a few things to continue to destroy the healthcare system.

Obamacare “innovative programs” seem to be going nowhere. The Obama administration continues to insist that all is going well.

The money spent is being wasted. The taxes for the funding of Obamacare’s 6.7 million enrollees is increasing as it attempts to increase enrollment to 9 million down from the original enrollment goal of 12 million.

I received a note from a reader who said Obamacare is here to stay. It is what it is. We should try to repair Obamacare rather than repeal it and replace it.

In my view Obamacare cannot be repaired. It was created to destroy the healthcare system. President Obama’s goal is to replace Obamacare with a government controlled single party payer system.

 The result will be to control and restrict access to care and ration care. It is a step on the way to restrict citizens’ freedoms.

Every week indications of Obamacare’s failures appear but are kept under the public’s radar.  The Obama administration spins the facts and the mainstream media’s regurgitates that spin.

 The Obamacare signup figures as complied by http://acasignups.net as of 12/30 2014 are very different that the administration’s spin to the media that the open enrollment period is going great.

Obamacare’s enrollment is still 1 million below estimate at this point

Confirmed 2015 QHPs: 7,403,558 as of 12/29/14
Estimated 2015 QHPs (Cumulative):
11/21: 610K (462K HCgov) • 11/28: 1.02M (765K HCgov) • 12/05: 1.80M (1.35M HCgov)
12/12: 3.26M (2.46M HCgov) • 12/15: 4.70M (3.52M HCgov) • 12/19: 8.52M (6.40M HCgov)
12/23: 8.65M (6.50M HCgov) • 12/30: 8.84M (6.54M HCgov)
state-level projections

 HHS finally announced that approximately 87% of Americans who selected 2015 health insurance plans through HealthCare.gov in the first month of open enrollment are receiving financial assistance to lower their monthly premiums. This percentage of subsidy awards is higher than in the same period last year.

The number is significant because, should the U.S. Supreme Court decide against the Obama administration in the King v. Burwell case it is scheduled to hear in March, consumers living in the 37 states relying on the subsidies from HealthCare.gov could lose their premium subsidies.

Another problem is even with the subsidy the people who received them cannot afford the insurance deductible. They do not seek medical care.

HHS has yet to disclose if it has a contingency plan should a ruling come down that only those who buy Obamacare insurance through state exchanges are eligible for coverage subsidies.

The CMS Innovation Center was established by section 3021 of the Affordable Care Act (Obamacare) for the purpose of testing “innovative payment” and service delivery models to reduce healthcare expenditures while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.

To date the CMS Innovation Center has awarded $2.6 billion through September 2014 to hospitals, doctors and others through nearly two dozen programs that tested new ways to deliver healthcare and pay for it.

“Results of those programs some underway since 2011including more than 60,000 providers and 2.5 million patients in Medicare, Medicaid and the Children's Health Insurance Program, are largely not yet available, the Innovation Center said in its second report to Congress.”

The ICD-10 diagnostic and procedure codes were to be implemented two years ago. It appears to be going nowhere because it is too complicated. President Obama will probably delay it again.

The change toICD-10 from ICD-9 has been pushed forward at least three times. It is too complicated. It is designed to commoditized medical treatment and eliminate physician judgment. Codes have been increase from 18,000 (complicated enough) to 68,000. Neither physicians nor their unsophisticated computer systems can comply correctly.

The Obama administration is still pushing for its execution and wasting money yearly. Physicians cannot and will not comply with this government regulation.

 It is destined to fail at a tremendous waste of taxpayers’ dollars.

“President Obama promised the AMA he would fix the defective Medicare Sustainable Growth Rate formula( GRF) for calculating Medicare reimbursement to physicians. As a result of that promise the AMA supported President Obama’s healthcare reform bill.” 

The GRF is not fixed yet. Congress delays the reductions in reimbursement due to this defective bureaucratic formula  each year and adds the percentage reduction in physician reimbursement to next year’s reimbursement reduction.

This year physicians can expect another 4% reduction for a total of 32% since 2002.  We will see if congress fixes this defective formula this year.  

On January 1, 2015 physicians are going to experience a series of pay cuts from CMS.  If functional electronic medical records are not implemented physicians will experience additional reimbursement reductions from Medicare and Medicaid.

http://www.forbes.com/sites/brucejapsen/2015/01/01/multiple-pay-cuts-hit-doctors-in-2015/#comment_reply

Physicians are struggling to deal with new measurements to improve quality and deal with a myriad of new changes in Medicare and Medicaid rules and regulations.

Two years ago in order to attract more physicians to accept Medicaid to care for the growing number of enrollees in Medicaid, Obamacare increased Medicaid reimbursement by 40%. The increase in reimbursement was to last only until January1, 2015 and then revert to the 2012 reimbursement schedule.

Those pediatricians, family practitioners and internists were faked out once more by Obamacare and President Obama’s promises.

The biggest pay surprise to physicians will come when the old reimbursement returns. Poor Americans on Medicaid will suffer when they cannot find a physician.  

“No other segment of the health care industry faces penalties as steep as these and no other segment faces such challenging implementation logistics,” Dr. James Madara, the AMA’s CEO wrote to the Obama administration.  “The tsunami of rules and policies surrounding the penalties are in a constant state of flux due to scheduled phase-ins and annual changes in regulatory requirements.”

 The cascade of rules and regulations will affect every specialty of medicine. The only thing left is for physicians to quit participating in government programs.

Then government can force medical license renewal to be tied to participation in government healthcare programs.

Where is physicians’ choice and freedom? There is currently a physician shortage. If physicians quit medicine and surgery what will happen to patient care?

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

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Notice The Enrollment Spin

December 21, 2014
inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP,MACE

The disinformation coming from the Obama administration is unrelenting.

CMS has released Obamacare’s open enrollment numbers through 12/15/14.

 On December 15,2014 all of last years enrollees who did not change their health plan or did not discontinued their plan were automatically re-enrolled for 2015.

 

“ Confirmed 2015 QHPs: 3,039,524 as of 12/15/14”

“Estimated 2015 QHPs (Cumulative):


11/21: 610K (462K HCgov) • 11/28: 1.02M (765K HCgov) • 12/05: 1.80M (1.35M HCgov) Thru 12/15: 4.70M (3.52M HCgov”

http://acasignups.net

Enrollment by state can be studied in the following link.

The Obama Administration bragged with the following statement.

The number of people enrolling or re-enrolling last week was considerably higher than in previous weeks. Week one saw 500,000 enrollees, week two had 300,000 and week three saw 600,000 sign up through HealthCare.gov.

Week four saw 850,000 people enrolling or re-enrolling.

The cumulative estimate of people needed to sign up was 4.7 million through 12/15/14. The sign up number included people who were automatically re- enrolled with the same insurance policy they bought last year. This year’s premiums and deductibles will be higher that last year’s premiums in most cases.

The Obama administration picked up 1 million enrollees for the week as a result of the automatic re-enrollment. These enrollees have been warned that they will be paying a higher premium than if they searched for a different plan by a different insurance carrier.

Only 3.4 million sign ups were confirmed to receive healthcare coverage by January 1,2015.

This is only seventy percent (70%) of the expected enrollment through 12/15/14. The enrollment had been extended previously to February 15, 2015.

http://acasignups.net/spreadsheet

CMS told us that last year 8 million were enrolled. The number was modified to 7.2 million and then changed to 6.7 million as 400,000 were not enrolled in healthcare but bought dental care insurance.

We were never told that 65% of the enrollees received federal subsidies in the traditional media. How many of those people who received subsidies subsequently lost their subsidy because the IRS could not confirm their reported income?

The next critical question is how many of the people who lost their subsidy dropped their insurance because they could not afford the premiums and deductibles.

How many people that enrolled have preexisting illnesses? How many of the people who enrolled can pay the high deductibles and copays?

How many people in the individual market can afford to pay the insurance premiums with pre-tax dollars?

Whatever the premium is in the individual market the enrollee has to have twice as much disposable income to pay the premium because the premium is not tax deductible.

Healthcare insurance premiums are tax deductible to employers in the employer group markets.

How many taxpayers know that the Obama administration is subsidizing the healthcare insurance industry so the industry cannot loss money if the healthcare insurance is bought through Obamacare?

The original goal for enrollment for 2015 was 13.5 million. It was lowered to 12 million and now 9 million by the time the enrollment started. If 6.7 million were originally enrolled the increase in new enrollment will only be 2.3 million.

What happened to all the millions of people who lost insurance through their employer because they were shifted to part-time work?

It seems that Obamacare is unattractive or unaffordable to those who need it most. If taxpayers knew the waste in Obamacare’s administration and guarantees to the healthcare industry, taxpayers would not be very happy.

It goes back to Jonathan Gruber’s statement that the people are stupid and the lack of transparency is very powerful political tool.

Meanwhile, the enrollment rate is low but the Obama administration is feeding the traditional media the spin that enrollment is surging. This game is not going to promote Obamacare’s credibility.

“More than a million people signed up for health insurance plans onHealthCare.gov in the past week, bringing the overall total of signups for the first four weeks of the current open-enrollment period to nearly 2.5 million, the CMS announced Tuesday.

Dec. 15 was the HealthCare.gov deadline to enroll for coverage to go into effect Jan. 1.” 

“More than half of the people who enrolled between Dec. 6-12 were renewing their coverage.

Many of the State Health Exchanges are already extending the deadline for coverage to begin January 1,2015, California, Maryland and Minnesota, Idaho, Massachusetts, New York, Rhode Island and Washington already have extended their deadlines for signing up.

If enrollment was going as well as the Obama administration claims, there would not be so many 2 week extensions.

 “Our community wants to do everything we can to make sure consumers have greater peace of mind about their healthcare coverage and to support them throughout the open-enrollment process,” Karen Ignagni, CEO of America's Health Insurance Plans, said in a statement Monday.ė

Why wouldn’t the healthcare insurance companies want more enrollees? They are selling insurance policies for the Obamacare at no financial risk.
 
“Federal plans are underway for a special outreach campaign to the roughly 250,000 individuals whose existing plans are no longer being offered on the federal exchange for 2015. HHS plans to point these people in the direction of a plan that is substantially similar to the ones they've lost but they won't be auto-enrolled.”

The Obamacare’s enrollment period is desperate for more enrollees

HHS is rolling out online partnerships with three online firms to further promote HealthCare.gov during the current open-enrollment period,which ends Feb. 15.
The partnerships are with Monster.com, Peers.org, and Higi, a provider of interactive health stations tracking weight, BMI and other vital signs to supermarkets such as Kroger and Meijer. The company will post messages informing users of the open-enrollment period. 

The partnerships are innovative but have a low probability of success.

President Obama and his administration continue its information  spin. The real truth is the Obama administration is not transparent at all. It takes hard work to figure out what is the truth.

The public is beginning to figure out that they are not getting the truth.  Consumers are directly affected by the manipulation of the truth personally. Consumers are not showing up to participate.

Presently, Obamacare is only covering consumers in the individual marketplace.

Just wait until Obamacare affects the small group and large group employers that are going to have to pay a penalty for providing  unqualified Obamacare healthcare coverage. 

One outstanding example is the worthless Mini-med plans of McDonald and Burger King that President Obama gave a waiver to until 2017.

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

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Looking For Alternatives To Obamacare

December 10, 2014
inConsumer Driven Health Care, Disinformation 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

The dice have been loaded against the American people by the rules and regulations in Medicare and Obamacare.

Patients liked their doctors. Once they discovered that they could not keep their doctors under Obamacare they became angry at President Obama for lying to them. The soon to be released new payment rules will increase the anger.

Physicians have found it more difficult to run small private practices.  The complexities of compliance with the rules, regulations and the payment systems for both Medicare and Obamacare are forcing physicians to sell out to hospital systems.

These complexities are in effect ending independent medical practices. This has been intentional. The Obama administration doesn’t want to control 600,000 independent physicians. It wants to deal with the hospital systems the are involved with. The hospital systems can then deal with the doctors.

Republicans are looking for a compelling alternative to Obamacare.

Just as Obamacare was forced through congress, President Obama is trying to force how medicine is practiced in America down the throats of Americans.

It is consistent with Jonathan Gruber’s view that Americans are to stupid to understand what is going on. It follows that Americans are too stupid to be responsible for their own care.

Americans want freedom of choice. They do not want the government to tell them what to do.

Republicans are looking for an alternative to Obamacare. A viable alternative could be to save the private practice of medicine and not subject Americans to the inefficiencies of a government controlled bureaucracy.

 Physicians by nature and education are competitive. Competition leads to improvement of the delivery of medical care.

All medicine is local. The alternative to Obamacare is to have local completion among physicians and permit patients to choose their doctors.

The answer to the Republican’s dilemma is right in front of their eyes.

A real Republican alternative to Obamacare would support physician ownership of independent medical practices and preserve local competition between doctors and maintain choice for patients.

Obamacare’s promotion of large hospital systems with salaried physicians eliminates physicians competing for patients. The lack of physicians competing for patients destroys the physician/patient relationship.

Physicians listen to patients if patients have a choice. The interaction is a partnership called the patient /physician relationship.

This solves the problem of President Obama’s lie. “If you like your doctor you can keep your doctor period.” Patients choose their doctors.

Dr. Donald Berwick and Jonathan Gruber’s view the consolidation of physicians and hospital systems as a necessary step to enable payment liability onto providers through hospital systems and away from government programs such as Medicare and Obamacare.

President Obama does not understand that doctors are not stupid either. At the moment physicians feel financially cornered by the government and the hospital systems and are joining hospital systems as a temporary means of surviving.

President Obama also does not realize that over the last 50 years there has been a build up of physician distrust for most hospital administrations.

Most administrators have tried to repair that mistrust but it has not been very successful. Hospital systems have been trying for years to own their physicians’ intellectual property and surgical skills for their hospital system’s profit. It is all about economics. Patient care is secondary.

As hospital systems consolidate competition will be eliminated.  Then hospital systems will realize they are losing money because of the risk they agreed to accept from the government. Hospital systems will demand more money from the government or consumers or go out of business.

Who loses? 

Patients lose, taxpayers lose, and the American healthcare system loses.

The abuses of the healthcare system by all the stakeholders must be fixed. It will never be fixed by forcing stakeholders to fix it. It will only be fixed by aligning incentives of all the stakeholders. Consumers must lead the way.

A recent Physicians Foundation survey of 20,000 U.S. doctors found that 35% described themselves as independent, down from 49% in 2012 and 62% in 2008.

It has also been reported that hospital systems are complaining that they are losing money on their physicians in these integrated systems.

Hospital systems are dropping out of the Obamacare Accountable Care Organization programs. There have been reports that salaried physicians are less productive that independent practicing physicians.

I believe in the team approach to the management of chronic disease. The patient must be at the center of the team with the physician being the head coach or manager and his team being an extension of the physician’s care.

Medical decision making entities must not be the insurance company or the government.

The idea that integrated systems with salaried physicians leads to increased economic efficiency, better quality of care and clinical outcomes than small independent private practices never made syllogistic sense to me.

Patient care becomes depersonalized in large hospital systems. Both patients and physicians become commodities in systems focused on the bottom line.

Small practices have the advantage of providing a personal style of care. Consumers want that comfort when they are sick. They want someone they know who is going to listen to them and talk to them.

In a private setting physicians can practice the way they want, without interference by a large, impersonal organization driving efficiency.

If a physician in private practice does not satisfy the consumer’s need the consumer can leave the practice and go somewhere else.

  "When you work closely with patients and empower them, they are going to make better choices," said Craig C. Koniver, MD, a solo family physician in North Charleston, South Carolina. He said a team of caregivers at a large practice will not have the same impact, because none of them are as close to the patient as he is.”

Health Affairs published a study in August 2014 looking at primary care physicians in small practices and “ambulatory care sensitive” admission rates. The study included such conditions as congestive heart failure in which admission to the hospital can be preventive by high quality primary care. The patient relates positively to the physician and the physician relates positively to the patient (positive patient/physician relationship).

“The study found that practices with 1 to 2 physicians had ambulatory care-sensitive admission rates fully 33% lower than practices with 10 to 19 physicians.”

This is not the only study that shows that small independent private practices can deliver just as high or higher quality of care than large integrated hospital systems with salaried physicans.

“ A 2013 study[2] showed that small practices in general had slightly lower hospital readmission rates than large practices.”

Additionally, “a 2012 study[3] looking at practices ranging from 5 to 750 physicians found that the smaller ones had fewer ambulatory care-sensitive admissions and lower overall costs of care for diabetes.”

 All three studies turned a piece of conventional wisdom on its head; that large practices, with their care management teams and sophisticated clinical information systems, produce better clinical outcomes.

Republicans should start presenting alternatives to Obamacare. The alternative must provide consumers with what they want rather than systems that let the government to tell consumers what they are going to get.

The ideal medical savings account will let consumers choose and keep their doctor if they like their doctor.

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

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If You Like You Doctor

December 7, 2014
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

 This is a message for the Republican majorities in the House and Senate. Obamacare is a disaster built on a failed ideology, deceptions and lies.

Obamacare started off with lies and continues to deceive the American public.  

Its emotional seductions have also deceived many physicians.

All one has to remember is Jonathan Gruber’s statement about the lack of transparency being a powerful political tool. Gruber said given the lack of transparency, the public is too stupid to figure out the truth.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=Jonathn+Gruber&x=28&y=9

President Obama told us; ”If you like your doctor you can keep you doctor, period.”

This statement was not true for an instant. President Obama knew it but ideology trumps reality. Many have blamed Obamacare’s failure on President Obama’s inexperience as a manager. This is not the reason.

The failed progressive ideology of big government controlling choices and freedoms of the American people is the reason for Obamacare’s failure.

Last week, Senator Charles Schumer (D-N.Y.) admitted the passage of Obamacare was a mistake. Not surprisingly, the mainstream traditional media has not mentioned Schumer’s admission.

The mainstream media has been a shill for Democrats and President Obama. It has helped the Obama administration keep the truth from the American public.  

 

 

 

http://youtu.be/O9m7fsSUUKQ

 

  

http://youtu.be/kOJfyT8juhA

President Obama keeps the American public uninformed with the help from the traditional mainstream media. His goal is central government control of Americans’ choices and freedoms. President Obama’s support is derived from his appeal to Americans’ emotions and not from the facts.

His problem is Americans are not stupid. They can separate reality from appearance when they pay attention. Obamacare is now affecting them directly and they are paying attention.

President Obama is waking up the sleeping tiger of Patient Power.

Obamacare is failing, but Obama’s lies keep coming. One recent lie is Obamacare’s open enrollment period is going well. I have shown evidence to the contrary in my last blog. So far the administration is 50% behind their estimated sign ups.

As of 12/05/2014 open enrollment is still (884,354/1,050,000) behind with 59% of estimates to sign up.

 

Confirmed 2015 QHPs: 884,354 as of 12/04/14


 

Estimated 2015 QHPs (Cumulative):11/21: 610K (462K HC.gov) • 11/28: 1.02M (765K HC.gov)
12/05: 1.50M (1.12M HC.gov) (special: 1.64M / 1.23M HCgov)

Thru 12/06: 1.57M (1.18M HC.gov)

 The biggest lie, since “you can keep your doctor, period” is that healthcare spending is decreasing because of Obamacare. This lie is a complicated lie. It is important to understand this lie.

 Obamacare is not lowering healthcare spending. It is increasing healthcare spending. Premiums and out of pocket costs are increasing for consumers.

 As a result of Obamacare deductibles have increased beyond affordability. Consumers cannot afford to utilize their “healthcare insurance” until absolutely necessary. The result will be higher costs when patients are forced to use the insurance because of the development of complications from a chronic disease.

 “The Bureau of Economic Analysis issued its advance estimate of first-quarter growth in 2014, which barely made it into the black with an annualized GDP growth rate of 0.1 percent.

Healthcare spending rose at an annualized rate of 9.9 percent, far outstripping inflation and standing in stark contrast to other components of the BEA report.

 Exports fell 7.6 percent, and demand for imports declined by 1.4 percent. Consumer consumption rose 3.0 percent, but that came in part from the high rate of health-care spending.

Without the spending on health care in 2014 Q1, annualized GDP would have dropped to a recessionary -1.0 percent, according to economist Ian Shepherdson.”

 In 2008, pre Obamacare, the US had seen a drift downward in health-care spending.

 The downward trend began to reverse as Obamacare first officially launched in October 2013. In the fourth quarter of 2013, health-care spending rose 5.6 percent, far above the 2.6 percent growth rate of the economy, to which it significantly contributed.

 The New York Times writes article after article claiming that the cost of healthcare is decreasing. The implication is that Obamacare is working.

 Nothing could be further from the truth.

“The rapid increase in spending does not indicate that the system is working to lower costs, an absurd if not Orwellian construct by President Obama.

“Nor is the debate “over,” no matter how many times Obama claims otherwise. Too bad the White House chose not to take advice from National Journal’s Ron Fournier. 

“The president risks insulting a vast majority of Americans by dismissing their concerns with a consultant's talking point,” Fournier wrote before the economic figures were released, “and Obama can't afford any more blows to his credibility.”

Consumers are tired of President Obama’s lies. He has lost all credibility with the American public.

The Obama administration keeps telling us how well Obamacare’s Accountable Care Organizations are doing. The Obama administration keeps saying hospital systems must set up integrated healthcare systems (ACOs) to increase the quality of care.  

 Hospital systems have been promised increased revenue incentives by setting up ACOs. Most hospital systems are losing money with their ACO’s.

As a result of losing money hospital systems are dropping out of the federal ACO program.

 This week, the Obama administration published regulations to decrease the hospital systems’ risk and increase its financial incentives, in order to decrease the ACO dropout rate.

President Obama refuses to believe that even though the ACO model sounds great its successful execution is difficult to impossible. 

The chances for ACOs to succeed is not only dependent on the hospital system’s ability to decrease utilization, it is heavily dependent on patients taking responsibility for their own care. Patients must follow instructions.

President Obama believes he can lie his way out of reality. The American public is not buying these lies any more.

Republicans must focus on the reasons for the obvious failures of Obamacare.

Consumers want to have freedom of choice. They do not want the government to control them.

Republican must focus on creating programs to provide incentives for consumers to be in control and responsible for their health and healthcare dollars. 

Republican must focus on ways to permit consumers “to keep their doctors if they like their doctors period.”

My ideal medical saving account will do all of the above.

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

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What Republicans Must Do Now

December 2, 2014
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

The following is a weekly tracking of 2015 enrollees for Obamacare. I will try to report it weekly. Open enrollment ends February 28, 2015.

The only information the Obama administration has provided to the traditional mainstream media is the statement that open enrollment is going well.

 ACASignup.net is providing weekly tracking against the estimates CMS has provided on the government’s web site. The data is there but the traditional mainstream media does not look at it or report it.

ACASigup.net

Tracking Enrollments for the Affordable Care Act (aka Obamacare)

 

Confirmed 2015 QHPs: 534,000 as of 11/27/14


Estimated 2015 QHPs (

Cumulative): 1st Week: 610K (462K HC.gov) • 2ndweek: 1.04M (780K HC.gov)
1,160,000 as of 11/30/14

 

The actual enrollment versus estimate enrollment is  minus 626,000 for the first 2 weeks of open enrollment. To look at state by state enrollment go to http://acasignups.net/projection

What must Republicans do about Obamacare now that they have control of the Senate and the House of Representatives?

The Republican majorities in the House of Representatives and the Senate must develop positive alternatives to Obamacare that all the stakeholders can accept.

 Republicans must address the concerns that led to Obamacare’s enactment in the first place. The dysfunctional parts of the healthcare system pre-Obamacare were unsustainable healthcare costs, too many uninsured and a lack of protection for patients with pre-existing conditions.

The healthcare system’s business model was dysfunctional before President Obama forced Obamacare through congress. All Obamacare has done is add more rules, regulations and bureaucracy to the healthcare system while imposing increasing government control.

 The result has been greater impingement on Americans’ freedoms as well as increased costs to taxpayers. Taxpayers are experiencing less personal care, less choice of care, less access to care, higher taxes and higher out of pocket expenses.

The healthcare costs to society are becoming more, rather than less, unsustainable as a result of Obamacare. These increased costs have had a negative impact on the entire economy.

 “We need to get rid of Obamacare instead of attempting to fix it because it is fundamentally flawed, cleverly designed to lead us over time to a single-payer system.”

This notion is widely accepted. Is a single party payer system a dirty phrase? No.

The problem is that a single party payer system has not worked efficiently anywhere in the developed world except Switzerland despite progressives’ spin to the contrary.

Obamacare’s road to a single party payer will become clearer when the employer mandate provisions kick in. The employer mandate was to begin in January 2015. It has already been delayed to 2016 or 2017. The Obama administration changed the law in order to make the ultimate goal of a single party payer system less obvious to consumers.

Meanwhile, new taxes to pay for Obamacare have been in effect since 2010.

Companies have already dumped workers from their employer plans into government-run exchanges by decreasing full time jobs to part time jobs.

The exchanges should have theoretically swelled. They haven’t because the premiums and deductibles are too high. If the exchanges swell they will become more costly to taxpayers. Americans will be told we must switch to a single payer system because a government monopoly will be more cost-efficient.

At that point it will be Medicare for all. Medicare is a single party payer system that has become unsustainable. Where is the logic?  

Republican majorities must articulate Obamacare’s destructive mayhem to the American public. The public is experiencing this mayhem right now. Republican must describe it and its cause.

President Obama is going to come back and blame Republicans for being obstructionist. Republicans must be right there and explain that President Obama and his administration owns the mayhem.

The public is not stupid.

Republicans should start proposing constructive alternatives. I have outlined these constructive alternatives in the past.

Republicans must present a plan which addresses the unsustainable healthcare costs, the uninsured and the lack of protection for patients with pre-existing conditions.

These alternatives should be developed through congressional committee debate, media debate and a public relations campaign.

Stakeholders other than consumers have invested lots of money in  adjusting and profiting from Obamacare’s new rules and regulations. They think they have a competitive advantage. They are wrong.

Medical care must between patients and physicians. Patients have tremendous power in the healthcare system. They just do not realize it yet.

Large financial companies with their lobbying power are investing in healthcare in order to profit from the Obamacare chaos. They view consumers and physicians as commodities.

Soon their companies will be too big to fail. However, the government is the only entity that can bail them out. The problem is the government will have failed too. These companies will have no one to bail them out.

Republicans must be responsible and responsive right now. 

Republicans must promote and harness Patient Power so that consumers, not government, are in control of their health, healthcare dollars and their medical care.

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

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