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President Obama Doesn’t Listen

October 19, 2014
inMedicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama does not listen to the thoughts of the people who elected him. The middle class and independent voters under great economic distress and are frightened.

They are not better off than when President Obama took office.

They have no confidence in President Obama’s promise or desire to help them even though he continues to say he is out to protect the welfare of the middle class.

He claims to be for income equality, yet income inequality has increased in the last six years.

The people do not trust President Obama to make good decisions for them.

The people are scared stiff about the Ebola virus. They do not believe his explanations for letting people into this country from countries that have the Ebola epidemic are logical.

 

Why would he take the chance of letting more cases into the country? It is completely illogical to me.

People have felt the hysteria spreading throughout the nation because of one case. They are feeling the economic effects of so many people quarantined and held in isolation for 21 days. They see economic activity slowing down while they are experiencing a weak recovery after six years. Shopping malls are disserted.

The more he does the less the people trust him. The appointment of a public relations person as the Ebola czar is a mind blower to most people.

The Ebola czar knows nothing about medicine, or transmission of viral disease or human illness.

The Ebola czar knows everything about spinning disinformation.

This is not a good formula for increasing confidence and trust in President Obama’s ability to handle this crisis.

The people are noticing and reacting to crisis after crisis and scandal after scandal. President Obama calling an obvious scandal a phony scandal makes things worse for his being able to convince the voters that he knows what he is doing.

President Obama does not listen to the people who got him into office.

Is his agenda to ignore the people, the constitution and the law in order to basically transform this country?

Last January he said Obamacare would not be an issue in the midterm elections. He keeps on misleading the public about Obamacare.

 He and his henchman keep saying Obamacare is working. Obamacare is a success. The evidence that it is not working is abundant. The people who voted for him are feeling its failure.

All these people are feeling the pain of President Obama’s policies. They also recognize that their wishes are being ignored.  

People do not know what they need.  Voters now know President Obama is ignoring them.

Yet he and Michelle have the audacity to travel around the country telling people “to vote for Democrats for congress to give Barack a chance to finish his work.”

A series of articles have appeared that express voters’s concerns about Obamacare’s failures.  

Radius Global Market Research (Radius GMR did a survey that showed two-thirds of those insured via Obamacare will change healthcare plans in 2015.

 “The survey stimulated competition among healthcare insurance companies to capture this two-thirds of Americans that are dissatisfied with their healthcare insurance policies for 2014.”

The two thirds of the people surveyed wanted,

  • Lower premium and deductible costs
  • Improved access to doctors
  • Improved quality of care by doctors and hospital systems
  • More than half of respondents expect their healthcare premiums to increase
  • More than one-third of those who switched primary doctors after joining ACA plans did so because their doctor was not on the new plan.
  • Twenty five percent of households are visiting their doctor less frequently and/or experiencing longer office wait times.
  • Only 44% of Americans feel they are adequately about the benefits provided by Obamacare.

At present, eighty percent of people who get healthcare insurance through Obamacare receive government subsidies. These subsidies help with the healthcare insurance premiums for people earning up to $50,000 a year.

However, those people are responsible for the deductible under Obamacare. The least expensive coverage is for a bronze plan.  

The average deductible from the Health Insurance Exchange is $5,081 for an individual and $10,386 for a family, according to HealthPocket.

A Silver plan (the next higher plan) had average deductibles of $2,907 for an individual and $6,078 for a family. The initial premiums are higher.

An average family making less than $50,000 cannot afford either deductible. A family making more that $50,000 per year without subsidy cannot afford the premium or the deductible.

People having a pre-existing illness will eat into the deductible that they cannot afford. Therefore they will avoid medical care.

The impact of the deductible is a surprise to people with preexisting illness. They do not have coverage until the deductible is met.

This creates stress on these individuals. It also represents a form of deception for these people. They thought they had good insurance coverage. President Obama promised them good healthcare coverage. He lied to them. They will remember the lie at the voting booth.

“Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network.

 But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.”

Physicians have been deceived as well.

Forty-six percent of doctors give President Obama's healthcare law a "D" or an "F," according to a new survey from the Physicians Foundation. In contrast, just 25 percent of those surveyed gave the law an "A" or a "B."

A number of doctors complained about the vast amount of bureaucracy that has been added to the medical profession.

"Get government OUT of healthcare," one doctor wrote.

Another physician wrote in the survey

"The system is broken and I am out of here as soon as I can. I am tired of being used, abused and lied to. Has anyone here woken up to the fact that we are always the last ones to be considered in the equation of change?"

It is clear the primary stakeholders in the healthcare system (patients and physicians) feel deceived by President Obama.

I do not think they are going to let him finish his work. They will stop him at the voting booth in November.

It will be difficult for the country to survive another two years of Harry Reid’s obstruction if the Democrats hold the senate.

Obamacare remains a big issue among many people despite President Obama’s promise that everyone will like Obamacare by the November election.

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

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Caving In

October 15, 2014
inMedicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

As time goes by the implementation of Obamacare (ACA) becomes more bizarre.

The start of the 2015 enrollment period in Obamacare’s health insurance exchange program was delayed from October 1, 2014 until November 15, 2014.

The reason for the delay is obvious. The Obama administration fears another disastrous enrollment rollout just before the midterm elections.

President Obama is protectingDemocratic candidates who voted for Obamacare from the political fallout.

The enrollment period is supposed to end December 31, 2014 in order for insurance coverage to start January 1, 2015.

This enrollment period is very short. The Thanksgiving and Christmas holidays will make it even shorter.

President Obama will probably delay the end of the enrollment period once again by executive order.

The Obama administration must also deal with people who lied about their enrollment qualification. Hundreds of thousands could not show proof of income or eligibility for government subsidies for their insurance for 2014.

The government has not published any data about the number of people who have been disqualified for providing false information.

These people owe the government money. They cannot afford to pay the amount owed. Is the government going to let these underpayments disappear?

The Obama administration also announced that anyone who was enrolled last year does not have to do anything. They will be enrolled automatically in 2015.

At what price?  Premiums will be higher than last year. Enrollees might not be able to pay the higher or unsubsidized premiums.

Insurance premiums in the health insurance exchanges are going to increase at least 10% in 2015 despite the Obama administrations guarantee, through its reinsurance plan, that it will cover any of the healthcare insurance industry’s claimed losses.

Problems were compounded this week by a CMS announcement that they will not publish the health insurance exchange premiums until November 15,2014.

Medicare premiums are also going to increase dramatically in 2015. Many seniors will not be able to afford to pay them. Senior might not notice the increase until they receive their first social security check.

On January 1, 2015 Obamacare’s “employer shared responsibility reporting requirement”  goes into effect.

“Starting in 2015, applicable large employers will need to identify whether eligible employees have been offered employer-sponsored health care coverage and whether that coverage meets the standard for minimum essential coverage, among other requirements.

Employers will also be required to track employee eligibility for health care coverage, including number of hours worked, etc.”

There is no way employers can track this information manually anymore. They will have to hire a benefits manager to keep track of something that is so fluid as to will be impossible to keep track of.

Employers’ overhead will rise. The large employers will decide it is cheaper to pay the Obamacare’s penalty and force their employees to buy insurance on the federal health insurance exchanges.

How can all these people buy insurance wisely between November 15, 2014 and December 31, 2014 to be insured in 2015.

This will create havoc in the healthcare system.

Creating havoc is the goal of President Obama’s plan to transform America. It follows Saul Alinsky’s game plan precisely. It will lead to population fear. Population fear will lead to a government controlled single payer healthcare system.

The public is presently experiencing a great deal of fear with the potential for an Ebola epidemic. The resulting hospitalizations and deaths that might occur from an epidemic will intensify this fear.

This CDC and the Obama administration keep giving us illogical reason for why they refuse to stop flights from West Africa to the U.S.  

The airport screenings’ protocols are illogical. The training protocols have been unsuccessful.

Havoc will intensify if the United States experiences an influenza outbreak this winter. People will not know whether they have the flu or Ebola. People will overrun the nation’s hospital ERs.

Public and private health insurance policies might not cover the care needed to diagnose and treat these patients.

People will be put in isolation in the hospitals. The patient’s contacts will have to be quarantined. The economy will come to a standstill.

The only option remaining is for the people to beg the government to take over the healthcare system.

I do not know if President Obama and his administration are brilliant or incompetent.

I suspect he is brilliant.

 In either case his goal of socializing medicine will be achieved

Are President Obama and his administration competent enough to control and run the healthcare system?

What is your guess?

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

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Fantasy vs. Facts

October 12, 2014
inHealthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama is continues to mock the critics of Obamacare who predict failure even as Obamacare is obviously failing.

He knows the media is the message even if his message has nothing to do with the facts.

 

President Obam's first victory lap.

 There had been three failures at the time he declared Obamacare a success this month.

1. The Obama administration announced that accountable care organizations (ACOs) in the Pioneer ACO model and Medicare Shared Savings Program (MSSP) have generated more than $372 million in total program savings for Medicare ACOs over the program’s two-year span.

The details of the Pioneer ACO models’ savings are difficult to follow.

  • An estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million
  • Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.
  • The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures.
  • The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013.

 

Can anyone make any sense out of this word salad?

One week later three of the 22 remaining Pioneer ACOs dropped out of the program. The program originally had 32 members. 

The Franciscan Alliance, Genesys PHO and Renaissance Health Network have exited the Pioneer ACO program, which is now in its third year.

Only 19 of the original 32 ACOs remain.

Sharp Healthcare, a San Diego-based health system, dropped out August 2014, saying that the ACO model was “financially detrimental.”

The Mayo Clinic and Cleveland Clinic were invited to be in the Pioneer ACO program but rejected the offer. It was clear to them that ACO’s meant taking on too much uncontrollable financial risk.

The ACOs were supposed to deliver a higher quality of care through their integrated hospital systems. The hospital system would also experience greater profits.

At the onset of the program some hospital systems and integrated medical practices recognized they would lose money and possibly be penalized.

The thirteen integrated systems that quit the Pioneer ACO model recognized their losses after they started the program.

I predicted ACOs would fail and provided detailed reasons. I predicted that ACOs would fail because of the financial risks to the ACO. The job of risk is an insurance issue. A healthcare provider cannot control the confounding variables influencing risk.

“Genesys PHO received a $2.5 million penalty in the program's first year and a $1.9 million penalty in the program's second year (Evans, Modern Healthcare, 9/25; Leventhal/Hagland, Healthcare Informatics, 9/25; Beck, Wall Street Journal, 9/25).”

One could conclude that Genesys’ ACO was becoming an improved integrated better because it experienced a smaller loss the second year. It was not Genesys’ conclusion. It withdrew from the program.

2. Last week President Obama predicted that enrollment in Obamacare increase this year. The web site is fixed and enrollment will be easier.

At the same time at least 300,000 people in last years group of enrollees lost their subsidies or coverage because they did not offer proof of their eligibility by September 30th.

There has been little media coverage of this event. This is not the definition of success.

3. In addition, the insurance industry announced that thousands will lose health insurance their current insurance policy with their employer by the end of 2014.

They will have to apply for which will probably be more expensive through the health insurance exchanges. Insurers are cancelling the private healthcare insurance policies because they no longer make business sense.

Of course, it makes no business sense when the insurance company can make more money from the federal health insurance exchange plans. The Obama administration is guaranteeing the healthcare insurance company’s profit and eliminating its risks.

All this appeared at the time President Obama called Obamacare a success and mocked his critics who predicted failure.

The media is the message. If President Obama can manipulate the media enough he can help the Democrats maintain a majority in the Senate with two more years of Harry Reid control.

I do not think the American public is going to fall for President Obama’s disinformation campaign once again.

I hope not.

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



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A Bureaucratic Thinking Disorder

October 8, 2014
inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System
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Stanley Feld M.D.,FACP,MACE

The Hospital Readmissions Reductions Program (HRRP) is an attempt to decrease healthcare costs by curbing hospital readmissions rates. The program was launched in October 2012.

Hospital reimbursement by Medicare could decreased the following year by 1-3% because of hospital readmission   

It is another alphabet soup program that was not well thought out. It cannot work as envisioned because of the many unintended consequences.

Hospital readmissions are very costly. If patients are readmitted within 30 days after discharge the assumption is patients were not treated effectively as an inpatient so that they could stay out of the hospital.  

Therefore hospitals should be penalized until their treatment improves.

There are other reasons for patient readmissions within thirty days of discharge.

  • Patients might be too sick to be completely healed at discharge from the hospital. If a patient remains in the hospital too long for his diagnosis the hospital is also penalized.
  • Patients did not pay attention to the outpatient treatment regime they were given.
  • Patients did not take the medication they were prescribed.
  • Patients were too depressed from their illness to take the medication and comply with follow-up treatment.
  • Patients were not smart enough to understand the instructions given at discharge.

The measurement of all these metrics would be very complicated even though I think patient adherence to treatment regime is the most significant cause of readmission.

The sicker patients are the more likely adherence to outpatient treatment  is a problem.

The Obama administration chose the easiest measurement to make to this complex problem. CMS would withhold 1% of reimbursements in 2012 and 2% in 2013 to hospitals that have too many patient readmissions within 30 days of discharge for three conditions: heart attack, heart failure and pneumonia.

This is foolish thinking.

One cannot measure a outcome using one variable when you have so many confounding variables that are not evaluated.

The results will also yield unintended consequences. One such consequence is the increase in outpatient observational admissions for 48-72 hours.

Medicare will not cover the outpatient observation admission.

In May 2014 I wrote “Seniors Should Be Madder Than Hell About Obamacare And Not Take It Anymore.”

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

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

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

Once more President Obama lied to seniors.

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

Those patients who have been outpatient observation admissions do not qualify for the rehabilitation benefits.

Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services.

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

In 2014 CMS has increased the maximum fine to 3% and added chronic lung problems and elective hip and knee surgery to the list of conditions.

Hospitals are not taking any chances. They are putting everyone they can on outpatient observation status.

Hospitals are also having problems collecting these non-Medicare covered bills from seniors.

Most seniors simply cannot afford to pay and the stress created is not good for their medical condition either which could result in re-hospitalization.

Seniors are increasingly distrusting the government and President Obama about Medicare changes.

President Obama promised them that Obamacare would not affect Medicare or harm one single senior.

Despite hospitals gaming the system with outpatient observational admissions 2,610 hospitals are facing readmission penalties in 2015.

The 2015 fines and penalties affected about three-quarters of the hospitals subject to the programs. The number of hospitals receiving penalties has increased each year from 2,217 in 2013, 2,225 in 2014 to 2,610 in 2015.

CMS also exempted 1800 hospitals from these penalties.

As more conditions are added more hospitals will be receiving penalties. Hospitals will adjust or go bankrupt. The result will be increased cost, a shortage of hospital beds and a weakened and less effective healthcare system.

Many of these readmissions are not the hospitals’ fault. They are the patients’ and their diseases fault.

These policies are just a fraction of the policies that are creating chaos and havoc in America’s healthcare system. They will lead to the demise of, not the improvement in, a cost effect healthcare system.

President Obama’s policy makers have a bureaucratic thinking disorder.

Part of the reason for this disorder is they do not understand problems in the healthcare systems. Their policies are also getting the healthcare system further and further away from creating a cost effective solution to the healthcare system’s problems.

A market driven system along with a consumer driven system can drive down costs down and create happiness for all the stakeholders involved in the healthcare system except the healthcare insurance industry.

I have presented the steps necessary in this slide presentation entitled The Ideal Future State of the Healthcare system.

Obamacare is forcing the healthcare system to turn into not out of the skid.

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

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Democrats and Ayn Rand

October 5, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

I have never understood why Democrats have always belittled Ayn Rand. Atlas Shrugged is reported to be the best selling book in history aside from the Bible.

I first read it in 1959, two years after it was published. It is a weak love story but a powerful critique of government policy and the effect of expanding government control over society.

I did not think about it much during medical school. I thought about it when the government started to control my medical practice.

In 1984 my son, Brad, insisted I read Atlas Shrugged again. It describes exactly the effect the government was having on the practice of medicine. 

I did not understand why Democrats in congress and the Democratic Party members become were so angry with Ayn Rand and her philosophy. I thought Democrats were problem solvers for the benefit of the people. 

I finally realized that Ayn Rand’s writings are a dangerous threat to the Democrats’ progressive agenda. The agenda is the government’s control over society turning free citizens into clients of big government. 

In this election year the Democrats have decided to combine their anti-Rand rhetoric with a Saul Alinsky tactic.

The Democrats are trying to immobilize Republicans’ replies through a replay of their anti-Rand sound bites. They are using the traditional mainstream media to spread their disinformation.

If a reader wants to know what Ayn Rand’s philosophy is read Atlas Shrugged. I suspect most critics have not read the book.

Democrats attack Ayn Rand by misrepresenting her philosophy as evil.

This year the Democrats’ attack dog is House Minority Leader Steny Hoyer (D-Md.).

“ He accused Republicans of following author Ayn Rand’s advice that “compromise is always evil,” and warned that letting Republicans take over Congress would only lead to more gridlock and partisanship.” 

In reality comprise is usually evil. If a policy or law is wrong, compromising will not fix the problem that policy or law set out to fix. According to Ayn Rand there are issues in which compromise is evil. If a law or policy does not work compromise can be evil is if is not modified by compromise.

Steny Hoyer’s warning Republicans taking over congress would only lead to more gridlock and partisanship does not  logically follow the first part of his sentence.  

The House of Representatives have passed about 350 bills. A 98% of the House passed bills were with  bipartisan.

Harry Reid, chairman of the senate, has created the gridlock by not permitting these bills to be brought to committee or the senate floor for debate.

Harry Reid has been President Obama’s inarticulate creator of gridlock.

“Compromise is not evil,” Hoyer said. “It is the necessary and noble pursuit of those who govern responsibly in a democracy. We listen to one another. We come to an agreement.”

Harry Reid has not compromised on anything. Neither has President Obama.

How does Steny Hoyer have the chutzpah to make such a statement?

Why doesn’t the traditional media react to this ridiculous statement.

Steny Hoyer’s statement is the typical Saul Alinsky lie crafted to immobilize the enemy’s ability to have a strong reply.

If a policy is wrong and is not working or has not been working reasonable men should debate the issue and change the policy so it works to the benefit of the people.

The policy must be changed. It is the responsibility of both parties to change it to something that can work for the benefit of all the people.

Obamacare is a law forced through congress by a Democratic majority that is not working. Compromise can only make it worse.

Who is to blame for congressional gridlock?

Is it the Republicans or Democrats?

If there were a Republican majority in the Senate and bills passed both houses President Obama has threatened to veto the bills. He would then be responsible for his errors not Harry Reid. 

Hoyer accused House Budget Committee Chairman Paul Ryan (R-Wis.) and others as following Rand’s teachings when it comes to operating Congress. 

The implication is Paul Ryan is evil.

The message is President Obama knows what is good for the people. Therefore. elect Democrats to congress this fall.  

Which of President Obama and the Democrat’s policies have worked? All are failing at the expense of the middle class taxpayer.

President Obama’s policy decisions have been proven wrong daily.

  • He has created chaos in the healthcare system with Obamacare.
  • He has increased the costs of unsustainable entitlements programs.
  • Obamacare is another unsustainable entitlement program.
  • He has increased the deficit from $11 trillion dollars to $17 trillion dollars.
  • America’s foreign policy is chaotic.
  • America’s economy is still a mess and getting worse even though the President claims it is better.
  • People are more dependent on government.
  • Individual privacy had been violated.
  • Independence has been discouraged.
  • Individual responsibility has been discouraged.
  • Cronyism has been promoted..

President Obama wants to do away with racism yet makes every issue a racist issue and blames it on Republicans.

I think before Steny Hoyer and the Democrats start attacking Republicans who might have been influenced by Any Rand, he should read Atlas Shrugged or at least watch the three-part movie.

“He should reexamine his premises.”  (A John Galt quote).

President Obama’s own party members are running away from his concepts of big government and central control in order to be elected. 

They are sounding like Republicans.

The people are realizing that “Big Government” has had difficulty in doing anything efficiently.

These days government competence is all too often exposed as a fragile veneer. When an elite corps like the Secret Service can’t remember to lock the White House’s front door and alleged health technocrats can’t build a working Obamacare website for less than $2 billion, a sense of low-level worry about Ebola seems more than reasonable.”

 President Obama is always blaming his failures on President George W. Bush or his advisors.

Many of President Obama’s advisors are now blaming Republicans for their agencys’ shortcomings. Even Dr. Anthony Fauci, head of the National Institute of Health Infectious Disease division, is implying Republicans are to blame for the agencey’s lack of efficient response to the Ebola virus epidemic.   

“Nor does it inspire confidence that the head of infectious diseases for the CDC is resorting to that promiscuous federal excuse—budget cuts.

Anthony Fauci recently told Congress that sequestration “has, both in an acute and in a chronic insidious way, eroded our ability to respond in the way that I and my colleagues would like to see us be able to respond to these emerging threats.”

Is this a joke? There are many other examples of shifting blame such as our foreign policy crisis in the middle east, the crisis with ISIS, nuclear Iran, Israel/Hamas and the Arab spring to name a few.

All these excuses remind me of the excuses that characters in Atlas Shrugged used when the world was falling apart.

“As I listened to President Obama’s repeated statements that government was going to somehow fix what Obama calls “income inequality” it brought to mind several of the more depressing chapters of Any Rand’s novel Atlas Shrugged, which you recall envisioned a dystopian world in which government “looters” stripped society’s producers, thinkers and creators of the fruits of their labor in the name of equalizing society.”

“The looting of the fruit of their labor provoked the producers to withdraw from society. Without producers, thinkers and creators there was an economic implosion and society rapidly declined and fell into chaos.” 

Every time President Obama mentions government enforced income equality or government-led opportunity I think of the villains in Atlas Shrugged such as the politician Wesley Mouch (New York Senator Chuck Schumer) or crony capitalist Orren Boyle (various green energy vampires) to name only two.

In the words of Yogi Berra, “It feels like Da Ja Vu all over again.”

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



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Government Is The Problem Not The Solution

October 1, 2014
inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

 

The government has been attempting to take over the healthcare system since 1935 at the time of the Roosevelt administration.

The government took over the healthcare system 30 years later during the Lyndon Johnson administration. LBJ passed Medicare and Medicaid. It turned out that financial projections were faulty and the business model was defective.

Medicare and Medicaid provided medical care for the elderly and the poor at an affordable price at that time. Everyone loved it. At the time it was also affordable for the government.

I do not think anyone contemplated the healthcare inflation that occurred as a result of the government’s business model.

Inflationary pressure increased rapidly.

Finally, President Reagan said the government could not afford the increasing prices any more. He said enough is enough. He decreased provider (hospital, doctors, pharmaceutical company, and insurance company) reimbursement for Medicare and Medicaid services.

The reduction in reimbursement for services resulted in price shifting increases in reimbursement in the private sector.

Both the private sector and the public sector experienced increased inflationary pressure as a result of this maneuver.

It was clear by 1984 that Medicare and Medicaid were unsustainable long term.  

America did not have a free market healthcare system before Obamacare. It was a hybrid system.

The country already had 90 million Americans in a single-payer system. Ninety million Americans get coverage from Medicare, Medicaid, and the Veterans Health Administration systems.

The problem is these government controlled single-payer systems did not work efficiently. They were financially unsustainable.

Obamacare expands the single party payer system to eventually cover all Americans. Obamacare simply adds on to an existing unsustainable healthcare.   Raising taxes is not going to make it more sustainable.

The expanded bureaucracy will only make the system more inefficient and more prone to fraud and abuse.

President Obama is already modifying the law without congressional approval. He is trying to hide elements of this unsustainability from the American public.

The federal government’s Obamacare enrollment system www.Healthcare.gov alone has already cost taxpayers about $2.1 billion dollars according to a Bloomberg government analysis of contracts related to the project.”

The website is still not working perfectly at the backend after spending $2.1 billion dollars.

Americans will experience more of the www.healthcare.gov dysfunction after the mid term elections.  

Navigator companies hired to help people enroll cost $48 a session. These companies are increasing their prices for the 2015 enrollees.

 

These same companies have had their fraud and abuse exposed. Nevertheless they have been rehired at the increased price by the Obama administration.

President Obama announced to Democrats last spring that Obamacare would not be an issue at the time of the midterms.

This week the administration also announced that the cost of healthcare insurance through the health insurance exchanges is decreasing next year.

It was also announced that there is an increase in the choice of insurance carriers in most states resulting in competitive premium pricing and lower premiums.

President Obama announced that Obamacare is working. He said Obamacare is a non issue in the 2014 mid term elections.

Nothing could be further from the truth.

If our elected officials cannot see President Obama’s trick play how can the public expect to understand the deception?

This is another of the manipulations of Obamacare designed to hide its impending failure from the public.  

The Obama administration set up a reinsurance company funded by taxpayers that eliminates any insurance risk the healthcare insurance companies might incur in insuring enrollees.

Healthcare insurance companies are signing up and competing for market share to gain profit from this no risk insurance. They can easily afford to lower the premiums because the government will cover their supposed loses.

None of this has anything to do with patient care or the quality of patient care.

It has little to do with providing low cost insurance. The cost of insurance keeps increasing. The government pays the difference between the cost of insurance and what patients who receive subsidies pay for their premiums.

Obamacare misses the main problems in the healthcare system. Obamacare creates more dysfunction in the healthcare system.

 Obamacare will result in greater unfunded future liabilities.

“White House spin pretends otherwise, but the unfunded liabilities may exceed $100 trillion.”

 The Congressional Budget Office said,

 “Looking indefinitely into the future, the unfunded liability, with optimistic assumptions, is $43 trillion—almost three times the size of today's economy.”

Based on more plausible assumptions, such as those reflected in the "alternative" scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.

It is the responsibility of our elected officials control America’s expenditures.

Unfortunately, for American’s, this is not how a government controlled system works.

Voters must decide how long they are going to tolerate this abuse of power.

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



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Obamacare: Its Failure Increases

September 28, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

 

C-Span has provided the public with important lessons on how our government is really run by televising various congressional committee meetings.

The traditional mainstream media provides us with little of the important information that comes out of these committee meetings.

C-Span’s coverage has revealed how inefficient, political and bureaucratic our government is.

Americans should elect representatives to be our spokesmen. Our representatives should do what is right for us and not for the vested interests of various special interest groups.

The latest information about Obamacare has not been reported in the media but came out in committee.

The Obama administration had announced publicly to a subcommittee in April 2014 that its "risk corridor" plan would be revenue neutral.

In English, it means that there would be no extra taxpayer dollars available to cover the losses of the healthcare insurance companies. Those healthcare insurance companies insure enrollees through the government’s healthcare insurance exchanges.

Chet Burrell, head of Maryland insurer CareFirst told Valarie Jarrett this plan would result in premium increases of 20% or more later this year as Obamacare policies come up for renewal. 

He warned it would be "an unwelcome surprise" to the Democratic Party and Democrats running for reelection in November.

The Obama administration was very concerned about a 20% premium increase for enrollees in Obamacare. After a while, Ms. Jarrett assured Mr. Burrell the insurance industry would get 80% of the subsidy (bailout) they sought.

The 80% was granted by executive order without congressional approval. A few weeks later the healthcare insurance industry bailout was changed to almost 100% of the request with little notice from anyone.

The government guarantee affects all of the enrollees in Obamacare. It also permits the increase in private insurance plans.

There are 50 million people on Medicare, 65 million people on Medicaid, 9 million in the VA system, 7.3 million in Obamacare and an additional 149 million for employer-provided healthcare insurance.

It turns out that Obamacare is just another government subsidy program with the government throwing more money at the health care insurance industry while the healthcare insurance industry raises the premiums.

President Obama, by executive order, has created an unlimited Obamacare reinsurance program covering the healthcare insurance industry’s supposed losses.

According to some, the total subsidy to the healthcare insurance industry is $1.3 trillion dollars.

It’s no surprise that many more healthcare insurance companies are planning to participate in President Obama’s health insurance exchanges.

If a healthcare insurance company sells insurance without risk it is a great deal. Taxpayers are assuming the risk for the insurance companies. Some insurance companies are decreasing their rate to capture a larger market share. They will  cash in on the Obamacare subsidy.

This subsidy is a mistake. It adds little value in improving the nation’s health. President Obama does not seem to care about how much money he is wasting.

It is all about politics. 

The subsidy adds much political value to Obamacare because it postpones the 20% premium increase at this midterm election.

Bob Laszewski, a policy wonk and former insurance executive said,

 “The administration has succeeded in temporarily suppressing incipient Obamacare price hikes, contributing to an illusion of Obamacare sustainability.”

However, the healthcare insurance industry is finding it necessary to increase premiums an additional twenty percent despite the tremendous subsidies. This is the result of the enrollees who acquired insurance but did not pay the premiums and used the services and the terrible demographic distribution of enrollees who paid their premium.  Eighty-five percent of the people who paid premiums were high risk patients with pre-existing illnesses. 

The rules of Obamacare have turned out to be totally improvised. The Obama administration changes the contents of the law in order to keep it afloat without the approval of congress.

The plot thickens. A challenge is in the courts right now on whether the government health insurance exchanges are allowed to provide subsidies to enrollees.

The law specifically states that tax credits are only available through the state health insurance exchanges and not the federal health exchange.

Funny things are going on in the courts. One panel said yes, the subsidies may be provided by the federal health insurance exchanges. The D.C. panel of three judges said no.

Attorney General Holder appealed to the D.C. court of appeals. He wanted the judgment determined by the entire panel of 9 judges not a subpanel of 3 judges.  The 3 judges’ decision was overruled by the 9 judge panel.

I still do not understand how tax credits are given to people who do not earn enough to apply a tax credit to their income tax. Why do they receive a subsidy? They pay no federal income tax.

I hope Americans wake up soon to the fact that Obamacare is deeply flawed and cannot work. The only thing that will overturn it will be an overwhelming taxpayer protest.

This midterm election cycle is a good place for voters to start. A Republican majority of the senate might be able to stop Obamacare in its tracks.   

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



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A Bogus Attack For A Political End

September 24, 2014
inChronic Disese Management, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D., FACP, MACE

The New York Times continues to be a mouthpiece for the Obama administration. I suspect the editorial board thinks the only thing that will save the healthcare system in America is a government controlled single payer system.

This is President Obama’s goal even if he has to destroy the medical care system.

On September 20th, 2014 the front page top right hand column article in the Sunday New York Times was  After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know appeared.

In the past the New York Times reserved this spot for the most important story of the day.

This story was the most important news story on Sunday September 200h 2014. The Times thought it was more important than a story about the economy, ISIS, the mid-term elections, Israel, Hamas or Iran’s nuclear ambitions. 

The story intended to inflame the New York Times’ readers so they would be angry at the medical profession.

The problem is that the story is peppered with misinformation and disinformation.

The New York Times writer used a typical Saul Alinsky tactic. Her goal was to prevent the opponents of the story from responding intelligently. 

Public opinion will be on her side because the New York Times is supposed to be a credible source.

Saul Alinsky’s rules instruct one to lie if necessary. The next step is to frighten consumers into thinking the system under attack cannot work.

“Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms.”

Peter Drier did not read or modify the consent forms. He should have made the   hospital and his doctor liable for any unauthorized expenses, providers, or events.

Peter Drier is a bank technology manager. Banks have their own small fine print intended to keep consumers liable and uniformed.

Peter Drier should have modified the consent forms before he signed them. He can refuse to authorize treatment or payment to any provider or procedure performed in the hospital that was outside of his insurance network.

In Network providers have to agree to accept the negotiated fee. If they need an additional provider it must be a provider that will accept the negotiated fee of his insurance company.

A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

Every consumer should find out if their providers are in their insurance network .  

All of those prices are ridiculous retail prices. The real question is how much did his insurance company pay and how much is he liable for.

Peter Drier did not do a very good job in researching his insurance company’s coverage. A third party payer would never approve a $56,000 payment to the hospital for the proposed procedure.

Hospitals bill very high retail prices. They will negotiate a price that is 50-90

5 lower than the retail fee.

 

The author, ELISABETH ROSENTHAL, has a list of recent articles criticizing the healthcare system about exorbitant retail pricing. 

  • COLONOSCOPY: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures
  • PREGNANCY: American Way Of Birth, Costliest In The World
  • JOINT REPLACEMENT: In Need Of A New Hip, But Priced Out of the US Market
  • HOSPITAL PRICES SOAR: A Stitch Tops $5000

All of these articles criticize the retail price providers charge. They do not tell the reader what the providers receive as reimbursement by the government or the healthcare insurance company.

Consumers are the victims of the constant effort to try to reduce healthcare costs and stick consumers with the bill.

Obamacare has driven the healthcare insurance industry to raise premiums and decrease coverage in order to cover their supposed actuarial risk.

The decreased reimbursement by the healthcare insurance industry has driven providers to increase their fees for service. The hope is to occasionally catch a consumer who is uninsured and liable for the fee.

The uninsured consumer cannot afford the fee and therefore will not pay the fee. The provider then has to sue the consumer to collect whatever they can. The cost of the suit is not profitable for the provider. He usually writes off a loss.

President Obama and the government control advocates will use the resulting chaos in the marketplace to prove that a free market for healthcare system does not work. Therefore the country needs a government controlled single party payer system.

The problem with these horror articles is they frighten consumers. They do not address the reason that the healthcare industry costs $2.7 trillion dollars a year.  

The chaos in the marketplace is the result of the government (Obamacare) involvement into the free market system.

I am also not sure if the $2.7 trillion dollars is from retail charges or negotiated payments. The answer to the question is totally opaque.

The reasons for the increasing costs are many.

Americans are becoming less healthy because they are not being responsible for their health. It is hard to maintain weight when almost every restaurants main dish is higher than their daily caloric allotment. 

470 cal 9 24 2014

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The result is an obesity epidemic. Over 50% of Americans are Obese.

Obese individuals have a 40% increased incidence of chronic disease.

Eighty percent of the healthcare dollars spent are spent on treating chronic diseases and the complications of those chronic diseases.  

Controlling a chronic diseases can decrease the complication rate of those diseases by at least 50%.  

If we ran the numbers we could reduce the healthcare costs below one trillion dollars a year.

Everyone complains about the grotesque profits the healthcare insurance companies make. Everyone understands the profits result from the inflated bureaucracies and double payments made to segments of the bureaucracy.

If one insurance company wanted to be competitive it would lower its premiums and overhead. All the other insurance companies would do the same to stay competitive.

One has only to look at the cell phone industry. Not only has the cost of the cell phones been lowered but monthly charges are continually decreasing.

One should also look at what ITunes did to the music industry.

Look at what Dr. Keith Smith’s surgical center model is doing to the local hospitals’ costs for surgery in Oklahoma City. They are falling precipitously.

The government should stop feeding the public disinformation leading to confusion of the facts..

President Obama's goal is to destroy the medical system so that consumers will believe the only thing that will work is a government controlled single party system.

Single payer systems throughout the world have proven to be unsustainable.

The healthcare system is dysfunctional. Medical care has been distorted at the consumers’ expense and for the profit of the profit of the healthcare industry.

America has to become innovative and build a healthcare system to the advantage of the consumer.

The solution 

 Is about consumers becoming aware.

 Is about leadership.

 Is about innovation.

 Is about consumers being responsible for their health and their healthcare dollars.    

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



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Keeping Obamacare’s Failures Out Of The News

September 21, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP, MACE

The Obama administration has tried its best to keep Obamacare’s failures away from the people. However, it has been almost as difficult as putting toothpaste back in the tube. The reasons are clear to me.

People are paying attention now because most are personally affected by the failures of Obamacare.

These failures along with President Obama’s other policy failures such as the IRS scandal, Benghazi scandal, Fast and Furious, border control failures, immigration failures, foreign policy failures, NSA privacy intrusions and his lying about those intrusions, attempts at Internet takeover, and unconstitutional unilateral changing of laws through executive orders have lead the American people to lose confidence and trust in whatever President Obama and the Obama administration say.

The traditional mass media has tried mightily to protect President Obama. They have tried to help him keep Obamacare’s failures out of the news.

They have been unsuccessful. If our only source for news was the traditional news media we could be fooled.

Americans must work to stay informed in order to maintain our freedoms.

I will list some of Obamacare’s failures of the last few months.

These failures have had little coverage in the traditional media.  Obamacare has continued to move forward to hobble and then destroy the medical care system in America.

President Obama’s goal is to prove that a free market healthcare system does not work. He has disregarded the fact that the healthcare system is not a free market system.

In a recent blog I presented the reasons for physicians’ discontent with Obamacare.

Survey of Physicians And Their Discontent

In July 2014 the “Physicians Foundation” published a survey sent to 660,000 physicians. Twenty thousand physicians completed the survey.

“Forty-six percent of doctors give President Obama's healthcare law a "D" or an "F," according to a new survey from the Physicians Foundation. In contrast, just 25 percent of those surveyed gave the law an "A" or a "B."

A large number of physicians complained about the vast new bureaucracy that has been added to the medical profession.

A physician comment read, "I'm a Canadian physician practicing in the United States. The politicians and policy makers need to understand that government involvement in healthcare never works."

The only newspaper that reported the survey to my knowledge was the Washington Examiner.

Enrollment Failures

President Obama and his administration are playing a numbers game with the enrollment figures. His March 31,2014 figures were inaccurate. The figures were grossly inflated.

President Obama said on March 31st, "this thing is working” successfully. President Obama claimed that 8 million enrolled in Obamacare.

“At a hearing Thursday September 18, 2014 at House Oversight and Government Reform Committee, Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, finally confessed that 7.3 million were enrolled in ObamaCare plans as of mid-August.”

The 7.3 million figure is also fiction. At least 115,000 additional enrollees have not validated their citizenship or legal status.  The validation must be completed by September 30,2014.

An additional 360,000 could lose their Obamacare subsidies because of discrepancies over their income. Eighty-five percent of the enrollees are receiving government subsides for healthcare coverage.

Most do not pay taxes because they make less than forty thousand dollars a year. They will not be able to afford the overpriced premiums.  

How many of the 8 million have not continued to pay the premiums? No one knows or is telling. Enrollees have a three-month grace period.

California reported in late August that an additional 100,000 of those who enrolled through its state-run exchange were at risk of losing their coverage over citizenship issues.

By my calculations less than three million of the forty-eight (48) million people who were uninsured pre Obamacare became insured. An additional 7 million people lost their healthcare insurance in the individual market.

President Obama provided the American public with a grossly overestimated enrollment figure.

Ms. Tavenner had to put a positive spin on this latest revelation of the fictional enrollment numbers by saying,

 "We are encouraged by the number of consumers who paid their premiums."

No one is buying this explanation.

She didn't provide answers to important details for these latest enrollment figures.

  • How many who dropped out were young and healthy?
  • How many have signed up through the so-called special enrollment process?
  • How many are keeping up with premiums?
  • How sturdy are the back-office computer programs in order to detect enrollment misinformation?
  • How will the government collect the money due to it from these non-paying enrollees?
  • Is the November 15th open enrollment period going to go smoothly?

 

Next Open Enrollment Disaster

It is easy to see that President Obama has delayed the open enrollment time from October 15th to November 15th for political reasons. He wants the potential disaster to occur after the mid-term elections.

 Kevin Counihan, the former chief executive of Access Health CT, Connecticut’s online marketplace, was just named head of the insurance marketplaces for the federal government.

 He said, “Part of me thinks that this year is going to make last year look like the good old days.”

 The front end of the web site looks like it will run smoothly. The back end of the web site still needs work. The government is still trying to see if the links to the IRS, the healthcare insurance industry and social security are functioning properly.

There were not enough healthy young subscribers to keep the insurance rates low. The premiums were too high for many young and healthy uninsured people.

This year the healthcare insurance premiums will be up at least 20%. Healthcare insurers fear it could be even more difficult to sign up young healthy people than it was last year.

Adding to the problem is that the sign up period for choosing a new policy this year will be shorter than last. It will be 3 months instead of six months.

President Obama will probably break the law again and extend the signup period an additional 3 months.

This year it should be more difficult to receive subsidies than last year.

People will drop out of the pool because of the increase in insurance rates. The renewal procedure has not been worked out yet.

Andrew Slavitt, principal deputy administrator for Medicare said they are working hard to make the process as easy as possible.

“We’re putting in place the simplest path for consumers this year to renew their coverage.” 

 This is another Obamacare smokescreen.

I predict it will be a price disaster.

Obamacare And Zeke Emanuel Setting Us Up For Rationing

One of the most bizarre articles imaginable was Zeke Emanuel’s article in the Atlantic Monthly  “Why I Hope to Die at 75”

Dr. Emanuel, one of Obamacare’s authors, gives all the reasons why he doesn’t want to live past 75 years old.

His argument is why should you live longer since you probably are not useful to society.

You have contributed all you are going to contribute. After 75 years old affliction will accumulate and disabilities will make life less pleasant.

It is apparent to me that he is setting us up for government rationing of healthcare for seniors.

The government controls Medicare. It is cheaper for the government not to pay for procedures such as hip replacements, knee replacements, for coronary artery surgery or cardiac pacemakers. All these procedures will extend the life of seniors over 75 years old who need them.

We have also heard rumors that this bureaucratic thinking is already in progress.

Don’t we live in a free country?

Isn’t it up to individuals to make their own life decisions? 

Should we leave these decisions up to the government and bureaucrats?

Should they decide our choose of treatment for us?

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



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