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Medicine: Healthcare System

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Actions Contradicts Goals

January 30, 2013
inDefective scientific studies, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

The
promise of Obamacare is to deliver quality medical care at an affordable price.
Prevention has been emphasized. Prevention will avoid costly complications of a
disease.

The talk about prevention is excellent. The healthcare
policy action falls short of the promise.

Despite strong efforts by the International Society
for Clinical Densitometry and other sister societies in the Fracture Prevention
Coalition, a provision to increase Medicare payments for DXA was not included
in the fiscal cliff legislation.

Congress adopted the American Taxpayer Relief
Act of 2012, HR 8, on January 1, 2013. The bill included a number of other
provisions affecting Medicare payments to physicians that have caused disappointment. The
bill did not include the need to incentivize the use of bone density for the
early diagnosis of osteoporosis.

Below is
a summary of how the various Medicare provisions were resolved in the act and
the bottom line for DXA:

1.  The new law blocks the 27% Medicare physician payment cut resulting
from the Sustainable Growth Rate (SGR) formula, freezing
Medicare payments at the 2012 level through calendar year 2013.  

2.  The automatic  "sequestration" cuts that would also
have reduced Medicare physician payments by another 2% are postponed
for two months until 3/1/12013.   

3.  The bill authorizes cuts to reimbursement for advanced
imagining services such as MRI and CT. These cuts do NOT apply
to DXA, which is not considered an advanced imaging service.

As a practical matter, the new payment rate for DXA in the office setting
dropped on 1/1/2013 from a national average of $56 to $50. 

I have written about the definition of quality medical care for osteoporosis.

Osteoporosis can be diagnosed early by bone densitometry (DXA). Osteoporosis
is a progressive disease.

Osteoporosis

 

Discouraging the use of DXA is not a step in the right direction for preventing
costly complications.

Osteoporosis affects the spine (vertebral column). It is initially manifested
by a decrease in bone density as determined by DXA. As osteoporosis progresses
patients develop compression fractures. Some compression fractures are painful
and some are not.

Osteoporosis 4

 

Patients lose height and develop a stooped posture.

Osteoporosis 3

The change in patients’ posture causes a change in the patients’ center
of gravity. The change in the center of gravity causes a change patients’
ability to balance herself against a fall.

If patients with osteoporosis fall they can put torsion on their hips.
The bone in the hip is thinned by the long process of developing osteoporosis.
Their hips can fracture.

Princ_rm_photo_of_bone_density_test

The mortality rate after a hip fracture is more than 20%. The morbidity rate
post- op is 40-50%. Very few patients return to having a normal quality of
life.

Patients may be forced to live in nursing homes.

If we look at elderly people around us we will notice that as many as 60%
of people over 70 years old have lost height and are have stooped posture. They
have osteoporosis.

Early osteoporosis starts manifesting itself at about 50 years in women
and 70 years old in men.   

Modern medicine can prevent the onset of osteoporotic fractures. Modern
medicine can also prevent further fracture by treating women and men after they
have developed osteoporotic fractures.

Preventing hip fractures would save the healthcare system billions of
dollars a year in healthcare expenditures. Prevention of further fractures
would also increase the quality of life in elderly osteoporotic patients.

Much has been written about the IPAB (Independent Physician Advisory
Board).  I have written about the
potential defects in the structure of this board and the defects and
functioning of its existing precursor the USPSTF (United States Preventative Services
Task Force).

The USPSTF recommendations are created from its review of the published
literature. Most of the committee members are non-specialists.  They do not have medical experience in
treating osteoporosis. The committee ignores the consideration of the natural
history of the disease.

Yet, the USPSTF recommendations have resulted in a yearly decrease in the
reimbursement by both private insurers and Medicare for bone densitometry (DXA).

In some cases private insurers and Medicare do not pay. This is the way
to restrict access to care and devalue physician' judgment.

Physicians have not done a good
job detecting and treating osteoporosis. The decrease in DXA reimbursement will
further decrease physicians’ interest in treating osteoporosis preventively.

A small short-term cost savings will result in increased long-term expenditures.
The result will be an increase in cost to the healthcare system.

This is the contradiction in Obamacare’s promise of prevention.

Prevention is the key to healthcare savings.

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

 

 

 

 

 

 

 

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The Promise Of Health Information Technology (HIT) Through Electronic Medical Records (EMR) Is Not Fulfilled

January 28, 2013
inEMR, Medicine: Healthcare System
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 Stanley
Feld M.D.,FACP,MACE

 In 2005 the
RAND corporation published a study stating the HIT through EMR can save the
Healthcare System $81 billion dollars a year in a short period of time.

In
2012 HIT and EMR have not come close to fulfilling the RAND study’s prediction.


EMRs
deployed effectively can deliver that promise.

In 2009 the administration’s
stimulus package put aside $19 billion dollars in the first two years and an
extra $50 billion dollars over the next five years to stimulate and subsidize
the adoption of Electronic Medical Records (EMR) to further development of
Health Information Technology (HIT).

The RAND corporation’s 2005 study predicted
a healthcare cost savings of $81 billion dollars a year.

The RAND corporation’s study was
wrong. In the interim healthcare costs have risen $800 billion dollars

 “In
our view, the disappointing performance of health IT to date can be largely
attributed to several factors: sluggish adoption of health IT systems, coupled
with the choice of systems that are neither interoperable nor easy to use; and
the failure of health care providers and institutions to reengineer care
processes to reap the full benefits of health IT.”

Many EMR software development companies have
reaped handsome benefits from the administration’s largess. These software
companies have a strategic defect in common.

These companies are trying to transform the
processes used in the practice of medicine into a process that permits the
government to commoditize the quality of medical care. 

If successful the government believes it
could then “judge quality of care”
and “pay for performance” accordingly.

The goal to ensure success should be aimed at
teaching physicians how to improve the quality of medical care rather than
judging physicians’ care.

The RAND corporation’s new suggestions are
repeating the same mistakes that have failed.

 “We believe that the original promise of
health IT can be met if the systems are redesigned to address these flaws by
creating more-standardized systems that are easier to use, are truly
interoperable, and afford patients more access to and control over their health
data.

Providers
must do their part by reengineering care processes to take full advantage of
efficiencies offered by health IT, in the context of redesigned payment models
that favor value over volume.”

In the meantime annual health care expenditures in the United
States have grown by $800 billion. 

The new RAND study blamed the underperformance on several
factors,

 “Including: sluggish adoption of HIT systems, along with
balky systems that are hard to use and aren't interoperable; and a failure by
providers and hospitals to adjust care processes to better benefit from
HIT. “

The RAND corporation is looking at the EMR problem
from 30,000 feet. On the ground many private practices and hospital systems had
previously installed information systems that cost them dearly and eroded those
providers’ net revenue.

Money is the main
impediment especially when reimbursement for physicians and hospital systems is
decreasing. Presently, physician groups and hospital systems are struggling to
remain solvent. This is partly from decreased reimbursement and partly from the
cost of ineffective non-functional information systems.

A new capital expenditure
of $65,000 dollars per physicians and $200 to $500 million dollars for hospital
systems is unrealistic even with the government’s partial subsidy. The cost
increases when maintenance fees are added.

 Many hospitals simply do not have the capital
to buy systems that can cost $20 million to $200 million, especially when so
many are struggling to remain solvent. Hospitals also worry about high
maintenance costs, an uncertain payoff on their investment, a lack of staff
with adequate technical expertise and resistance from doctors.

 In 2009 only 1.5 percent of
3000 hospitals had a comprehensive and fully functional electronic medical records
system “ comply with meaningful use criteria.”

The meaning of meaningful
use is all major clinical units in a hospital must perform 24 functions deemed
important by a panel of experts.

The EMR should incorporate
data points. It should include physicians’ and nurses’ notes in data point
format.

The EMR must have the ability
to order laboratory and radiological tests.

It must include clinical
guidelines defining criteria for treating various conditions. It should contain
alerts to avoid dangerous drug interactions and 20 other functions.

It is cookbook medicine all
over again. The goal is to eliminate physician judgment.

On January 1,2013 only 11
percent of the hospitals had even a basic EMR system in at least one major clinical
unit that performed 8 of the 24 functions.

Physicians have been slow to cooperate. Intuitively they
know that a functional EMR might collect data that will be used against them,

The question is will the data improve medical outcomes,
result in less medical complications and less morbidity and mortality? Will it
increase or decrease physicians work hours or increase or decrease physicians’ net
revenue?

“Pamela McNutt, senior vice president/CIO at Dallas-based Methodist
Health System, says HIT advocates were a little naïve early in the
process. 

"There was a bit of over-simplistic thought that if we just purchased
and installed some software that suddenly everyone would start connecting and
talking and it is premature," McNutt says. "Even people who have met
high levels and are ready to meet Meaningful Use Stage 2 still have to work to
get efficiencies."

McNutt
says the whole idea of "efficiencies" in HIT is undefined.

"We
have to talk about what are the efficiencies we are looking for," she
says. 

Accumulating
data to judge performance should not be the goal.  Judging performance does not necessarily increase
efficiency.

The
EMR should improve the physician-patient relationship. It should be for the
patients’ benefit. It should not be for data collection to commoditize medical
care..

The
ideal EMR should be constructed through the eyes of practicing physicians and
not through the eyes of bureaucrats and computer software companies. 

It
should be an EMR that is interoperable and compatible with physicians and
patients needs not the administration’s needs.

The
EMR should be cloud based.

It
should be secure and protect patients’ privacy. 

It
should not result in a capital expenditure by physicians or hospital systems.

Provider
would pay by the transaction.

It
should not provide a financial burden to physicians and hospital systems.

It
could be updated and maintained at no cost to providers.

It
would turn an expense into a profit center for the government.

Why can’t the
administration’s healthcare policy makers figure this out?

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

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How Are Accountable Care Organizations (ACOs) Doing?

January 23, 2013
inChronic Disese Management, Consumer Driven Health Care, Medicine: Healthcare System
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Stanley Feld M.D.,
FACP, MACE

 In a word the formation
of Accountable Care Organizations is doing poorly.

If one believes the CMS
press releases one would believe the formation of ACOs is doing well.

In the past, I have gone
into great detail on why I believe Accountable Care Organizations will fail.

I believe physicians and
hospital systems should be accountable for outcomes but only the outcomes they
can control.

They should not be
accountable for outcomes they cannot control.

ACOs are really HMOs on
steroids. Risk is transferred from the government to the healthcare providers.

HMOs failed in the 1980’s
and 1990’s because physicians and hospital systems realized that they could not
evaluate risk or manage risk.

It is impossible for
providers (physicians or hospital systems) to control patients’ behavior in
adhering to treatment for their disease.

It is almost impossible for
the government to commoditize reimbursement accurately for diseases unless the
government can weigh the risk of poor disease outcomes.

No one has figured out
the way to accurately risk weight the outcome of a patient’s disease and
treatment.

CMS believes by
increasing the number of codes in ICD-10  to 68,000 codes vs. ICM-9 18,00 codes, the old coding system, the
government will be able to weigh risk leading to accurate cost assessment.

I believe this is a
fantasy of healthcare policy wonks working for the Obama administration.

Many physician groups
and hospital systems believe they will lose money taking on these risks. These
are the groups that are holding back and not forming ACOs.

It is the reason the
Mayo Clinic and the Cleveland Clinic have refused to form ACOs.

Nevertheless on January 1st CMS proudly announced that
it has nearly doubled the number of ACO programs in the country by adding 106
new ACOs to the existing 148 programs for a total of 254 programs to date.

The CMS announced its latest and
largest round of accountable care organizations under the Medicare
shared-savings program.

I would not be as proud as CMS is to applaud this level of
participation in the ACO program. ACOs are the keystone of Obamacare.

Complete national participation is supposed to occur by January
2014.

There are a total of 254 ACO’s signed up in 50 states or 5.08 ACO’s
per state.  There are many more potential
ACOs per state than 5.08 per state.

“CMS said half of ACOs are physician-led and
care for less than 10,000 Medicare enrollees.” 

This is not a good sign.
The success of the ACO program is defined as shifting the risk of medical care to
hospital systems and physicians.

What is the problem?

The problem is obvious.
The definition of insurance is,

“Insurance is the
equitable transfer of the risk of a loss, from one entity to another in
exchange for payment. It is a form of risk management
primarily used to hedge against the
risk of a contingent, uncertain loss.”

“An insurer, or insurance carrier, is a company selling the
insurance; the insured, or policyholder, is the person or entity buying the
insurance policy. The amount to be charged for a certain amount of insurance
coverage is called the premium.

“Risk management,
the practice of appraising and controlling risk, has evolved as a discrete field of
study and practice.”

Risk management is far
from an exact science. Risk management depends on a large number of people
paying premiums who are not at risk for disease.

Obamacare’s goal is to
have all the low risk consumers pay for the higher risk consumers.

However, President Obama
has provided low risk consumers an out. The penalty for not participating is
modest compare to the cost of the insurance. If a low risk consumer gets sick
he can immediately join the health insurance exchange program without
restrictions.

The increased cost of
illness is compounded when a large number of patients have chronic diseases.

A contributing factor to
developing chronic disease is obesity.

America has a national
obesity epidemic.

Patients with Diabetes
Mellitus are vulnerable to multiple diseases such as hypertension,
hyperlipidemia, kidney disease, eye disease and vascular disease.

Each might be at a
different stage of progression. The risk for costly complications is different
for each at each stage of disease progression.

The diabetic might or
might not adhere to the treatment regime outlined. It is difficult to risk
weight these patients. It is risky to take the responsibility for the medical
care outcomes for these patients.

In reality the principle
risk managers are consumers.

Healthcare policy
experts have not practiced medicine. They either do not understand these risks
or they want to place the risk with physicians and hospital systems and provide
undervalued reward.

Many medical outcomes are
dependent on patient responsibility for managing their own risk. Patients must
participate in their own care to receive maximum benefit and the best medical outcomes.

Patients must become
professors of their disease.

 

There are many reasons ACOs will fail

1. ACOs
do not empower consumers to be responsible for their own medical care. 
Healthcare should be consumer driven with consumers controlling their healthcare
dollars. They will then make informed choices about their care and insurance
coverage.

2. ACOs create artificial
incentives to improve quality medical care and provider performance.

3.  Consumer driven healthcare creates real
incentives to promote price competition by physicians and hospital systems. True
competitors will constantly work to improve their products, attract
consumers, and ultimately increase market share.  

In a systems of ACOs consumers do
not play a role in stimulating completion. Consumers are passive recipients of
treatment from an assigned ACO.

4. Most physicians are reluctant
to assume accountability for patient outcomes.  Physicians recognize that
most medical outcomes are directly under consumers behavioral control.

5.  ACOs structure does not include consumers’
incentive to be responsible or accountable for their own medical care.

 ACOs undermine any attempt to create a truly
accountable healthcare system that can drive down medical costs.

6. ACOs do not encourage provider
accountability.  ACO’s shared savings incentive
does not seem to be adequate for the risk assumption.  

 Providers will continue to
be paid for each service they perform until the government provided
funds run out for that ACO.

7.  There are also grave uncertainties and
practical complications of distributing government funds and savings if any
between the hospital system and physicians on the hospital systems staff.

 8. ACOs create an
unfair competitive advantage for large organizations that are hospital system centric.
Eligibility requirements are vague and ambiguous. The eligibility
requirements suggest that larger organizations have an unspoken
eligibility advantage.

 9.  This is the reason
hospital systems are trying to form ACOs. Hospital systems think they will make
money. I believe hospital systems will lose money. The government will have to
supplement payment for hospital systems to stay afloat.

10. When hospital systems lose
money they will fight with their staff physicians over the distribution of
government reimbursement.

 The cost of hospital services will then
skyrocket further. Consumers will be the losers.

11. Groups of independent
practitioners as well as other types of small and mid-sized practices may
lack the infrastructure, information technology facilities, or other resources
needed to qualify for ACO eligibility.

12.  They will be forced to join hospital systems.
Hospital systems have a long history of taking advantage of physicians
skills and intellectual property.

 Tension between hospital systems and staff
physicians will be created. Hospital systems’ ACOs will crumble. The cost of
medical care will continue to increase further.

These are just a few of the reasons ACO’s will fail.

No matter how hard CMS tries to change the narrative
these are some of the reasons explaining the lack of hospital and physician participation
to this point.

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

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The Real Problems

January 19, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

I
am becoming weary of the continuous political games President Obama and
Congress are playing.

President
Obama does best on playing the blame game.

Republicans
do not know how to deal with President Obama.  

As
we approach another Debt Ceiling increase neither the President, congress or
the press are discussing the major problems the country faces.

One
of the major problems is government waste in all departments and all agencies.

The
waste is reproduced by multiple agencies creating an increasing number of bureaucracies
leading to additional regulations. Some regulations are difficult to understand
and many impossible to enforce.

The
inability to enforce regulations leads to more agencies and greater waste.

The
unsustainable entitlement spending for Medicare, Medicaid and Social Security
are the key drivers of America’s deficit spending.

If
these entitlements were originally constructed properly they would be cost effective
and sustainable. They would not be a threat to America’s solvency.

They
would be actual trust funds. They are presently virtual trust funds. The
government borrows the money collected in the name of the trusts from the trust
funds in order fund increased government spending.

The
Social Security and Medicare Trust Fund receive unsecured government obligation
bonds the trust funds cannot call.

Essentially
the two funds are left to pay their obligation on a pay you go basis. As
Medicare and Social Security rolls increases and longevity increases there will
be more recipients than funders of Medicare and Social Security.

Our
“under-informed society” is not aware of these facts. No one has explained it
clearly enough to create a consumer reaction.

 “It is an
unfortunate fact that these programs cannot be modified for the long-term
without the cooperation of both houses of Congress and the White
House.”  

“There is
absolutely no interest on the part of the Democrats in the Senate or Obama, in
being serious about any meaningful reform, except to demagogue these issues.”

The
media discusses everything but the causes of the problems. The public remains
uninformed.

The
administrative waste in Medicare has been estimated to be $250 billion dollars
in 2008. None of this waste has vanished.

Instead
the bureaucratic structure under Obamacare is causing the waste to increase.

Below
is the new bureaucratic structure being developed by Obamacare.


 

Each one of
these agencies creates rules and regulations. There have been 22,000 new healthcare regulations to date and
still counting.

Most of the
regulations pretend to add value to the healthcare system. However they all
make the healthcare system more complex and complicated. The regulations
decrease the ability of physicians to help patients get well and stay healthy.

The
regulations create industries for secondary stakeholders. These secondary
stakeholders make more money from the bureaucratic healthcare system.

America has
been warned before. Listen to the following You Tube

 

 


 

John Mackey,
CEO of “Whole Foods” is warning us again. The media has obfuscated his point by
jumping on him because he used the word fascist.

The media has
blamed him for calling President Obama a fascist. He did not call President
Obama a fascist. However the “media is the message” and his real message has
been obliterated.

He is
promoting his new book ”Conscious Capitalism: Liberating
the Heroic Spirit of Business.”

 
http://live.huffingtonpost.com/r/segment/john-mackey-whole-foods-/50f802b678c90a0f500001ba 

His position
is capitalism creates value. Capitalism with higher value creates more value.

He is against total
government control over commerce. He state there are two kinds of government
control.

  1. Government controls the system by regulations and owns the
    means of production.
  2. Ownership of the systems is privatized. Production is
    privatized to private companies but production is totally controlled by
    excessive government regulations. This leads to inefficient production.

Mr. Mackey’s
point is neither system works. Free enterprise works because it creates
competition. Free enterprise “capitalism” should have a conscious.  Free enterprise businesses must have a higher
purpose.

Why do
physicians exist?

Physicians’
higher purpose is to make people well. Making money should be secondary and is
in most cases. However they should be compensated for their skills.

A plumber
should have a higher purpose rather than just making money.

The higher
purpose cannot be forced on the individual by government. It can only be
adopted through competition in a consumer driven healthcare system.

Mr. Mackey
wrote a beautiful article in the WSJ in 2009. President Obama and his
administration have ignored Mr. Mackey’s WSJ 2009 advice.

 I think it is time our government starts
listening to our successful entrepreneurs.

Government
must be honest and transparent and inform the public with correct information.
Only then can America be in a position to balance the budget and eliminate
waste.

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



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Socrates Is A Man

January 13, 2013
inDisinformation and the healthcare system, Medicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld
M.D.,FACP,MACE

 

All Men Are Mortal

Socrates Is A Man

Socrates Is Mortal

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

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

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

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

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

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

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

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

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

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

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

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

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

Obamacare will go into full effect in 2014. 

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

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

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


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

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

Annually physicians’ reimbursement continues to
decrease.

Why do consumers’ deductibles continue to increase
each year?

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

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

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

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

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

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

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

Consumers must start becoming aware of these facts.

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

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



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The Destruction of Private Healthcare Insurance

January 9, 2013
inHealthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D., FACP, MACE

One of these days Americans
are going to pay attention to how President Obama is destroying private
healthcare in America.

Many people will fine this
hard to believe because he is such a nice guy and many people like him.

He is making the healthcare
insurance industry destroy itself by forcing them to increase healthcare
insurance rates.

The destruction is so well
designed that the public cannot take notice. The healthcare system will not be
more affordable or accessible to anyone in the nation.

The changes will provide
President Obama with another tool to redistribute wealth and increase the individual’s
dependence on the federal government. This defines President Obama’s goal in affecting
all areas of our life.

Americans are on the Road To
Serfdom.

I remember Barney Frank and
John Kerry saying that healthcare reform would not work without a “Public Option.”
I also remember President Obama saying we can make it work without a “Public Option.”

President
Obama’s original plan was to eliminate private insurance. Americans would have
no choice but a “Public Option.”  (National Health Plan)

 

 Kathleen
Sebelius, the secretary of health and human services
said, she “retains authority to make the
final decision” on insurance rates if she finds that a state acted in an
arbitrary or capricious way in denying a rate increase sought by a nationwide
health plan.

 

This is the first time I
have seen President Obama’s administration use the words “National Health
Plan.”

It was obvious President
Obama was not truthful when he said “if
you like your physician you can keep him” and “if you like your healthcare insurance you can keep it.”

Congress made a gigantic while
passing Obamacare and transferring all healthcare policy decision making power
to the executive branch of government.

President Obama’s goal is to
have complete control over the healthcare system. He wants to force the private
healthcare insurance industry out of business. He wants to socialize the entire
medical care industry into a single party payer system.  The government will be the single party payer.

Healthcare will then be a
ubiquitous entitlement program that the government cannot afford unless it increases
taxes entire population according to the taxpayers means.

This is the pattern behind many
of the articles written in isolation by the traditional media.

The unintended consequences
resulting from each policy change will be overwhelming.

I have been fascinated by President
Obama’s negotiating strategy.  

Americans are going to wake
up to the fact that President Obama has increased taxes for the funding of
Obamacare by $1 trillion dollars over the next ten years aside from the tax
hikes effective January 1st.

Americans are going to wake
up and feel deceived by President Obama when they realize they are getting
little for their increased taxes except government control over their freedoms.

I predict President Obama’s
plans will blow up in his face.

Consumers will protest when
they recognize the impact these multiple new taxes will have on their
discretionary income. President Obama will not get the funding he needs from
congress.  

His physician workforce will
not cooperate. Hospitals are starting to wake up and are seeing they were
deceived. They thought they would do better because they have bought physician
practices.

Recently they automatically
received cuts in reimbursement while the doctor fix was extended for another
year. Physician reimbursement will be cut and the physician workforce will
dwindle.

On Friday afternoon November
30th 2012 the Obama administration pulled a stunt on the healthcare
insurance industry.

“The Obama administration
said Friday that it would charge insurance companies for the privilege of
selling health insurance to millions of Americans in new online
markets run by the federal government.”

The cost of these “user
fees” can be passed on to consumers. The proposed fees could add 3.5 percent to
premiums for private health plans sold in insurance exchanges operated by the
federal government.

The "user fees" are another tax to consumers.

The government is
disregarding the fact that healthcare insurance premiums are too high for
employers to provide healthcare insurance for employees now.

Employers are opting to drop
healthcare insurance coverage and pay the government penalty. Some are dropping
healthcare insurance and avoiding the penalty by decreasing the number of
employees to under 50 employees or decreasing employees work hours to under 30
hours per week.

This will increase, not
decrease the tax burden on the consumer.

The exact effect of the
health insurance exchange on the healthcare industry is muddled.

It looks as if President
Obama is rapidly moving toward a “Public Option.”

Consumer advocates, insurers,
and some state officials had expressed concern about delays in publication of
the rules for this new proposal.

President Obama has used
this is the same tactic before. Consumers and agencies must accept the changes
before the rules are published.

Consumers and state
governments do not trust President Obama. They are afraid to say yes when they
do not know what they are saying yes to. In the end it  looks like the state governments and the
consumers will get stuck with the bill and the federal government will have
complete control over the healthcare system.

CMS said. “These plans will
be offered by private insurance companies under contract with the United States Office of Personnel Management. The agency already provides insurance to eight
million federal employees, retirees and dependents.”

The scary part is the administration said,
“It (the government) retains
authority to make the final decision” on rates if it finds that a state acted
in an arbitrary or capricious way in denying a rate increase sought by a
nationwide health plan.”

The term “Nationwide Health Plan” and “final authority” sounds as if the
government is taking over.

The federal government will
also have control over physicians and hospital fees.  It will also control access to care and the
rationing of care.

It is almost too late for
consumers to wake up.

No one can say President
Obama didn’t tell us.

It can only be said the plan
was so obfuscated, final rules so delayed and unsubstantiated promises made and
not publicized on a Friday afternoon the week after Thanksgiving that the
public did not understand what was going on and could not express an opinion.

The games President Obama
and his administration play are dizzying. The irresponsibility of our elected
congressional officials who are supposed to be our surrogates is
unconscionable.

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



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Problems With State Health Insurance Exchanges

December 17, 2012
inMedicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

December 15th was the deadline
for states to sign up to implement state health insurance exchanges.

President
Obama was hoping all 50 states would agree to set up and implement health
insurance exchanges.

Health
insurance exchanges might be able to dis-intermediate the healthcare insurance
industry. They might also cause the insurance industry to leave the healthcare
business.  

If that happens President
Obama would not have anyone to provide administrative services for Medicare and
Medicaid.

Why
would President Obama be interested in expanding a failed entitlement program
such as Medicaid? Medicaid is bankrupting the healthcare system.  States would 
go deeper in debt if they try to implement health insurance exchanges.
In order to survive states would have to increase state taxes.

Businesses
and people are leaving California in droves because of the real effective tax
rate will be over 60% of gross income on January 1, 2013.  

Governors
realize their state can have a competitive advantage over others in  attracting corporations to move to their state
if they balance their budget. They are trying to avoid this federal government
disaster. 

Over
60% of the population is opposed to Obamacare.  

States
refusing to set up state health insurance exchanges are reflecting public
opinion.

President
Obama’s goal should be to improve entitlement programs such as Medicare and
Medicaid so that the programs would save money and improve the healthcare
system.

 “Even
President Obama has recognized Medicaid is broken," says Mike Schrimpf,
spokesman for the Republican Governors Association. "For many states,
placing more individuals into a broken system would be like adding more
passengers to the Titanic. And regardless of whether it's federal dollars or
state dollars, taxpayers are still on the hook."

A total of 30 states are leaning toward rejection
of the health insurance exchange concept. Only 17 states plus DC have agreed to
run a health insurance exchange.

The federal government will have to set up 30
health insurance exchanges. The latest reports are the administration is not
prepared to set up run the exchanges.

“As
of November 19, 2012, seventeen states, NY, MA, RI, NH, DC, KY, DE, W VA, MS.
NM, CO, CA. OR, NV, MN, WA, and HI have declared their intention to establish a
State-based Exchange (SBE).”

After my recent articles about health insurance
exchanges several readers asked why the health insurance exchanges were a bad
idea from a state’s point of view.

There are many reasons:

 1. States are under
no obligation to create a health insurance exchange that could create a large
financial burden to the state and its citizens. A Supreme Court ruling has given
states that option.

2.  14 states have
enacted either statutes or constitutional amendments (or both) forbidding state
employees to participate in an essential exchange function. It made operating
Obamacare illegal in the following states; Alabama, Arizona, Georgia, Idaho,
Indiana, Kansas, Louisiana, Missouri, Montana, Ohio, Oklahoma, Tennessee, Utah,
and Virginia

States passing these amendments was by a state was part of
the strategy to reject Obamacare.

 3. State governors
estimated that health insurance exchanges would cost the state $10 to $100
million dollars a year. State constitutions prohibit budget  deficits. Health insurance exchanges would
necessitate increased taxes.

Increasing taxes has a negative effect when states are trying
to lure businesses. i

4. Deadlines have continually been delayed. Concrete rules
and regulations have not been published. Uncertainty prevails as if a trap is
going to be sprung on the states.

 President Obama has
not yet provided the crucial information for
states to make an intelligent decision about setting up a health insurance
exchange. President Obama wants the states to trust him, sign up, and then
accept federal regulations.

5. States have been given the option to create health
insurance exchanges at a later date. Some state politicians fear the loss of
federal funds. Others see the federal funds as a carrot that will cost their
state more in the long run.

6. In the preliminary rules the “state-created exchanges”
are not controlled by a state-controlled exchange.
The exchanges are to be controlled by rules created by the Obama
administration.

7.  President Obama has authorized payment to the states
for start up costs and expenses for Medicaid Expansion until 2017.

Congress has not authorized these
funds. President Obama might not be able to get the funds from congress to fund
the states’ health insurance exchanges.

The states’ would be stuck with
the bill.

8. State officials responsible for setting up the exchanges
believe Obamacare will fail. Many feel it will increase private insurance
premiums and deny assess to care.

These state officials do not want to take the blame for this
disastrous mess that they have no control over.  

9. President Obama’s ultimate goal is to create a “Public Option”
and then have the federal government control all the stakeholders in the
healthcare system.  His ultimate goal is
to have a single party payer system.

State governors understand that public outcry will stop it.
States want to control their own destiny.

10. If the federal government must set up health insurance
exchanges because the state refuses, the Obamacare law as written exempts a
state’s employers from the employer mandate of $2,000 per employee per year.

The Supreme Court called the mandate a tax but everyone
knows it’s a mandate.

11.  If the states
avoided the mandate and save $2,000 per state employee it would put the state
at a competitive advantage to improve the prospect for job creation. It would
protect individual and states rights. It would protect some tenants of
religious freedom that Obamacare ignores.

 There is no evidence that Medicaid is
cost effective, that medical outcomes are improved or that access to medical care
for the poor would improve.

“There is scant reliable evidence that Medicaid improves health
outcomes, and no evidence that it is a
cost-effective way of doing so.” 

In the short term it has been predicted that healthcare insurance premiums for the
middle class will increase by 50% and access to medical care will decline.

State health insurance exchanges
will result in higher state taxes, fewer jobs, and less protection of religious
freedom. States are better off defaulting to a federal exchange.

Neither the states nor the federal government has the money
to expand Medicaid.

Theoretically,
health insurance exchanges are a good idea. Practically, they are not.

If all states refuse to set up health insurance exchanges
and avoid falling into President Obama’s trap Obamacare will be doomed.

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

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Permalink:

An Unintended Consequence of Obamacare.

December 12, 2012
inDisinformation and the healthcare system, Medicaid, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

As we get closer to full implementation of Obamacare in 2014 corporations
such as Wal-Mart are figuring out ways of avoiding healthcare insurance
coverage for their employees.

Darden Restaurants, owner of Olive Garden and Red Lobster,
and a New York-area Applebee’s franchise owner has
announced that they will limit hours worked to under the thirty hours a week
threshhold. They will simply hire more employees who will work less than thirty
hours a week.

It will
mean that those workers will be forced to work two jobs if they can. With the
unemployment rates remaining high this might be difficult.

“iNew Obamacare rules that require companies
with at least 50 full-time workers to offer health coverage to all employees
who work 30 or more hours a week or pay penalties.”

However,
these people might not be eligible for Medicaid coverage under Obamacare.

The
definition of eligibility depends on the state rules. HHS just announced rules
for Medicaid expansion. The goal of these “Medicaid Expansion Rules” is to
force states to participate in the expansion of Medicaid.

States must increase Medicaid eligibility to 133% of the poverty level in
order to receive 100% of
the matching federal funds made available under Obamacare.  A state will receive mating funds from January
1,2014- January 1,2017.

After
January 1,2017 the states are on their own. The increase in enrollees will
become a huge burden.

President Obama is counting on the states to
assume the cost of Medicaid as he has the CBO calculate his fictitious scoring
on the cost of Obamacare.

The Federal Poverty Level was defined inaccurately in 1955. The U.S.
still uses the 1955 criteria.

133% Federal Poverty Level for one person means an annual income of $14,856.
For a family of four it means $30,657.

Many states have poverty levels above the nationally defined levels. In Indiana
the eligibility level for Medicaid is an annual income below $63,000 for a
family of four.

An independent
restaurant owner and caterer, in the smallish town of McKinney Texas, employs
55 people full time.  He told me he is
going to have to fire 6 people in order to avoid the Obamacare rule. He must
also reduce hours worked to below 30 hours per week.

He must
also contract his business rather than expand it.  He cannot afford the $110,000 Obamacare penalty.

Wal-Mart is the nation’s
largest private employer. Wal-Mart employs 1.4 million workers.

It plans to begin denying
health insurance to newly hired employees who work fewer than 30 hours a week
starting January 1st 2013 to avoid the Obamacare penalty for not
providing healthcare coverage for employees.

Wal-Mart also reserves the
right to eliminate health care coverage for employees whose hours drop under 30
hour per week.

Tom Billet
a senior consultant at Towers Watson said,

”Some of his clients were planning to track workers’ hours
more carefully. “I expect health plans like Walmart’s won’t be uncommon as
firms adjust to this law.”

 Wal-Mart’s decision to exclude
workers from its healthcare plans is an attempt to limit costs while taking
advantage of Obamacare.  Obamacare is
going to have to expand Medicaid coverage well beyond 31 million people.

Many of Wal-Mart’s employees would qualify for the expanded
Medicaid program.

Wal-Mart would rather pay the $3,500 penalty than pay $12,000 to
$18,000 dollars a year healthcare insurance premium for their employees.

There are many other companies that are going to follow suit such
as McDonald’s, Burger-King and thousands of others that got waivers from
President Obama for Mini-Med healthcare coverage.

Mini Med healthcare coverage is in reality zero healthcare
insurance coverage. It is a giant rip off of people making minimum wage.

“Walmart is effectively
shifting the costs of paying for its employees onto the federal government with
this new plan, which is one of the problems with the way the law is
structured,” said Ken Jacobs, chairman of the Labor Research Center at the
University of California, Berkeley.

“Medicaid Expansion” is a big joke. The uninsured workers will increase
from 31 million to some higher number when companies drop healthcare insurance
coverage and pay the penalty.

“The Supreme Court ruled earlier this year
that the decision to expand the Medicaid program is voluntary for the
states. At least eight states, including Texas, have said
they will not expand the program,’ 

At present before “Medicaid Expansion” the entire Medicaid program is
unaffordable. Medicaid cost will now escalate. President Obama will not be able
to afford to keep his promise to the poor.

States realized President Obama has set them up to get stuck with the
increased Medicaid cost. States are not signing up for the “Medicaid Expansion“
even though they would like the matching federal funds.

The nation’s governors were told,

“States that don't expand
their Medicaid rolls to include residents at 133% of the federal poverty level
won't get 100% of the matching federal funds made available under the Patient
Protection and Affordable Care Act (Obamacare).

The unintended consequence of large employers and corporations not
covering their employees with healthcare insurance is escalating.

Who is going to qualify for Medicaid? Who will get stuck being uninsured?

The poor people earning an annual income of less than 133% Federal
Poverty Level will qualify for Medicaid coverage. 

Anyone earning a penny more than the Federal Poverty Level will be rejected
and not qualify to receive Medicaid coverage.

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

 

 

 

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