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Democrats Still Think Americans Are Stupid

Stanley Feld M.D.,FACP, MACE

The House Republicans finally got their act together and passed their version of the Obamacare repeal and replace act. It seems that many representatives do not trust Paul Ryan, Tom Price and President Donald Trump.

The Republican house version of the bill does not repeal and replace Obamacare completely.

The Affordable Care Act (Obamacare) permitted Kathleen Sibelius, the Secretary of HHS, to issue regulations to administer the act at her discretion. Many of her regulations were destructive to the healthcare system.

Tom Price, the new Secretary of HSS can eliminate many of these destructive regulations. The goal of the Obama administration’s regulations was to cause the healthcare system to fail and be replaced not by free market principals but by a single party payer system.

Her regulations were designed to eliminate any modicum of free choice for patients and physicians.

Tom Price’s actions and regulation eliminations should complete the repeal and replacement of Obamacare.

President Obama ignored the fact that a single party payer system would be destined to bankrupt the country. His plan was to get the health care insurance industry out of the healthcare picture.

The defect in his logic was that the government would have to continue to outsource the administrative services to the healthcare insurance industry. The government now outsources the administrative services for Medicare and Medicaid.

The government then lies to the public declaring that its overhead is only 2.5% while the healthcare insurance industry takes 30% for services that are charged as direct patient care.

The healthcare insurance industry would continue to rip off the healthcare system in a single party payer system for all.

The completion of the repeal and replace act will be done as promised by Ryan, Price and Trump in three stages.

As soon as the house bill is passed the House Democrats came out with their talking points criticizing the act. These talking points had little substance and no compelling evidence. They only declared that the legislation was terrible without any explanation of why it was terrible.

They just said 20 million people are going to lose their insurance coverage. The Republican health care act is going to kill people.

The talking points are mostly lies.

A recent study had reported that Obamacare has cost 80,000 people to die.

“Democrat’s immediately made the accusation that the GOP “repeal and replace” bill will kill Americans.  It seems that Obamacare has already done that.” 

In a previous blog I pointed out that more people have lost insurance in the individual market that have gained insurance from Obamacare’s health insurance exchanges.

Fourteen million lost insurance in the individual market in 2009 and at most 8 million gained insurance through Obamacare’s health insurance exchanges.

The 20 million new insured comes from the 12 million new people receiving healthcare insurance through Medicaid.

“Quoting Oren Cass over at National Review, it turns out that fewer people – not more people – had health insurance after Obamacare.  The only increase in “coverage” was Medicaid, but, sadly, it turns out that Medicaid kills people.  It’s better to have no medical insurance at all.” 

 Researchers have found that in 2015 Medicaid patients experienced worse outcomes than similar uninsured Medicaid eligible patients.

Public-health data from the Centers for Disease Control confirm… [that had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000-13 period, 80,000 fewer Americans would have died in 2015 alone.”

The Democrats are using the typical progressive tactic of creating a lie. Many people died because of Obamacare but the Democrats threaten that the Republican bill will cost many lives. It diverts attention from the Democrats’ failure with Obamacare.

This is fear mongering for the progressives’ political gain.

This is one of Sol Alinsky’s favorite tactics. One should do everything to marginalize opponents even if it needs to be done by lying.

“Democrats are hurting real people with their scary shrieking about death by Republican.”

The Democrats criticize without facts. The Democrats will lie about the effects of the bill without evidence. I would guess that many have not even read it.

One should expect nothing less from Nancy Pelosi and Chuck Schumer.

The Democrats have even rolled out Jonathan Gruber, the MIT professor of economics and co-author of Obamacare, who infamously said, “the stupidity of the American voter” helped get the measure to become law.

This week Gruber blamed President Trump for Obamacare’s failure on one of the Sunday news programs.

“Whose fault is this (rising premium costs)?” Gruber asked on “Fox News Sunday.” “Since President Trump has been elected … premiums are going up and insurers are exiting.”

This is total nonsense.

Jonathan Gruber still thinks Americans are stupid. However he has no credibility with the American public. Therefore his opinion has no impact on the discussion about the new bill.

Nancy Pelosi and Chuck Schumer’s lack of credibility with the American public does not seem to bother them.

Every lie they tell decreases their credibility even further.

Nancy Pelosi said, “the new Obamacare repeal bill is a ‘a very sad, deadly joke’

This is the same woman who said we will not know what is in the Affordable Care Act (Obamacare) until it is passed.

What is so deadly about it? She does not explain her statement. She figures the media is the message. The media will carry the message for her.

Chuck Schumer’s quote was even worse. He said, “Senate GOP should toss House healthcare bill ‘out the window’”

He called on Senate Republicans,

“To avoid following the lead of their colleagues in the House and to work on a bipartisan basis on healthcare reform rather than pushing for repeal of the Affordable Care Act.”

He is trying to save President Obama’s legacy Obamacare. Obamacare is an unmitigated disaster. It is beyond saving.

It was a poorly constructed healthcare bill aimed at giving big government total control of the healthcare system. President Obama totally ignores the fact that Americans did not want it, have not joined it. He felt he clearly know what is best for America.

He goal was to get it passed by the partisan vote. President Obama lied to Americans and lied to his party members.

Obamacare is unsustainable economically to America and is in the process of destroying the economy.

Chuck Schumer said, “Trumpcare is a giant, broken promise to working people, the hard-working people of this great country of ours.

It would be valid if Chuck Schumer could prove his statement.

President Obama broke his promise to the working people, the hard working people of this great country of ours, when he said, “ If you like your doctor you can keep your doctor and if you like your insurance you can keep your insurance.”

Chuck Schumer did not see it then and he does not see Obamacare’s failure now.

I suggest that Chuck Schumer read the Republican bill carefully before he makes his false statements.

Clearly, he was dead wrong in his judgment about Obamacare

If he read the Obamacare law carefully and voted for doing the right thing, America’s healthcare system might not be in the mess it is in.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Those Indecipherable Medical Bills? Part 2 CPT Coding Is One Reason Health Care Costs So Much

Stanley Feld M.D.,FACP,MACE

After Ms. Wanda Wickizer was discharged from the University of Virginia Healthcare System (Part 1) the catastrophe caused by the healthcare system’s coding process began.

“The acronym HCPCS originally stood for HCFA Common Procedure Coding System, a medical billing process used by the Centers for Medicare and Medicaid Services (CMS).”

“Prior to 2001, CMS was known as the Health Care Financing Administration (HCFA).”

HCPCS was established in 1978 to provide a standardized coding system for describing the specific items and services provided in the delivery of health care.

The cost of Medicare and Medicaid became so high that the government decided to start knowing what it was paying for and standardizing the payments.

Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner.”

This coding system has been dysfunctional since the government developed it for Medicare and Medicaid in 1978.

The unspoken goal was to decrease reimbursement for services provided for Medicare and Medicaid patients.

The government wanted to commoditize can reduce reimbursement by the evaluation of physician and hospital usage of procedure and services.

Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for transactions involving health care information became mandatory.[2]

Ms. Rosenthal’s story is about how this poor woman, Wanda Wickizer, got trapped in the dysfunction of the healthcare system’s coding system.

Wanda Wickizer should have been insured through Obamacare. However, through the inefficiencies of the government or Ms. Wickizer lack of understanding of Obamacare she did not have insurance.

The healthcare system makes no provisions for billing the uninsured.

There are multiple prices charged for treatments and procedures. Hospital systems and physician groups have their own individual retail prices for services and procedures.

These providers negotiate prices with the government and the healthcare insurance industry.

There are many different prices negotiated by many different providers with the healthcare insurance industry. A healthcare insurance company negotiates many of the government’s final prices. The healthcare insurance company acts as the surrogate for the government.

None of these prices are transparent.

There is no one that negotiates price for the uninsured. The uninsured are responsible for the retail price of the services rendered unless they can negotiate a better price.

“And so in early 2014, without an insurer or employer or government agency to run interference between her and the hospital, she began receiving bills:

  • $16,000 from Sentara Norfolk (not including the scan or the E.R. doctor), $50,000 for the air ambulance.
  • Her local hospital
  • By the end of January, there was also one for $24,000 from the University of Virginia Physicians’ Group: charges for some of the doctors at the medical center. “I thought, O.K., that’s not so bad,” Wickizer recalls.
  • A month later, a bill for $54,000 arrived from the same physicians’ group, which included further charges and late fees.
  • Then a separate bill came just for the hospital’s charges, containing a demand for $356,884.42 but little in the way of comprehensible explanation.”

The uninsured are the only people who are responsible for the original retail prices. All the rest of the payment providers, namely the government and various members of the healthcare insurance industry pay their negotiated fees.

Shouldn’t the government pass a law requiring hospitals and doctors to charge only Medicare prices to the uninsured? It would eliminate Ms. Wickizer bill, a bill that reflects retail prices for services rendered.

The big mistake the University of Virginia made was that it did not provide her with a line item bill identifying the price of each service and procedure.

The University of Virginia subsequently refused to provide a line item bill to the patient. It was as if the university was hiding something.

Any thoughtful hospital administrator would have solved the problem in a minute.

It must be remembered that each provider has a different retail price per procedure and service. The reasoning is that they are trying to collect the highest amount they can.

There is something called a “chargemaster price.” It could help the uninsured figure out the wholesale price for services and procedures if they knew what the line item services and procedures they were charged for were.

The patient could then figure out what Medicare pays for those services and procedures.

However none of these line item charges are in the patients (EOB) Explanation Of Benefits. The EOB is impossible to interpret.

A simple rule should be passed by congress or issued by CMS saying a clear explanation of charges is required for payment of the bill.

The Obama administration knew about this uninsured billing problem. It did nothing about it because it wanted to force patients into buying Obamacare insurance even if they couldn’t afford it or didn’t need it.

I believe Tom Price M.D. (President Trump’s head of CMS) is aware of the problem. He also understands this simple way of solving it.

The healthcare insurance industry and the government get a detailed EOB for services rendered through the CPT coding system first established in 1978.

The Obama administration added 74,000 new codes to the CPT coding system. The government and the insurance companies wanted to know what they were paying for in detail.

This led to the requirement for Electronic Medical Records (EMR) and then meaningful use EMRs. Physicians and hospital systems will not get paid if they do not have a meaningful use EMR this year.

This led to a very expensive EMR development industry. EMRs were expensive. They did not function as meaningful use EMRs. They had to undergo extensive upgrades.

An EMR function should really be a teaching tool, teaching physicians how to upgrade their services to the best evidence based medicine practices.

Instead it has become a tool for the government and the healthcare insurance industry to punish patients.

The EMRs are unaffordable to many physicians. It has force them to sign up to become hospital system employees.

The government should have built a universal EMR in the cloud and charged physicians by the click.

The increase in codes led to an expensive coding industry. People are trained to teach physicians and hospital systems how to use the new 88,00 codes correctly.

The industry essentially teaches those providers how to how to game the healthcare system so that they can collect the most money for their services from the government and the healthcare insurance industry.

The goal of the government is to reduce reimbursement to providers.

Where is the consideration for patients in all of these maneuvers?

Where is the consideration for the uninsured patients?

Ms. Rosenthal’s main point is that CPT gaming by the medical professions and hospital systems are driving up healthcare costs.

However, missing from her argument is who developed the dysfunction CPT system.

Why was it developed?

Why was coding made so complex that it drives users of the coding system to game the system?

Ms. Rosenthat gives a few examples of coding driving the costs up.

  1. The diagnosis code for “heart failure” (ICD-9-CM Code 428) instead of the one for “acute systolic heart failure” (Code 428.21), the difference could mean thousands of dollars.

“In order to code for the more lucrative code, you have to know how it is defined and make sure the care described in the chart meets the criterion, the definition, for that higher number.”

In order to code for “acute systolic heart failure,” the patient’s chart (EMR) ought to include supporting documentation, for example, that the heart was pumping out less than 25 percent of its blood with each beat and that he was given an echocardiogram and a diuretic to lower blood pressure. Submitting a bill using the higher code without meeting criteria could constitute fraud.”

“Each billing, then, can be seen as a battle of provider coder versus payor coder.

The coders who work for hospitals and doctors strive to bring in as much revenue as possible from each service, while coders employed by insurers try to deny claims as overreaching.”

Hospital based physicians are taught how to up-code to generate the most income. They have little say in the coding process. Patients have no way of knowing if a procedure or service is coded.

  1. In a doctor’s office, a Level 3 visit (paid, say, at $175) might be legally transformed into a Level 4 (say, $225) by performing one extra maneuver, like weighing the patient or listening to the lungs, whether the patient’s illness required that or not.
  2. E.R. doctors have been taught that insurers might accept a higher-reimbursed code for the examination and treatment of a patient with a finger fracture (usually 99282) if — in addition to needed interventions — a narcotic painkiller was also prescribed (a plausible bump up to 99283), indicating a more serious condition.

The actual cost and expertize that might go into these services are never discussed or considered by bureaucrats decision and policy makers.

Price transparency for the patients would make a world of difference to costs. It would drive the cost of care and healthcare premiums down.

It might even result in the development of competitive pricing and a free market system.

I am sure the Trump administration is aware of this defect in the dysfunctional healthcare system.

President Obama ignored the problem as he tried to control hospital systems and physicians. He simply down coded services.

He probably figured that a single payer system would make everything much easier.

All I can say is look at the government run Veteran Administration Healthcare System.

Why most politicians ignore the coding defect in coding is beyond me?

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Profoundly Disappointed

Stanley Feld M.D.,FACP, MACE

I am profoundly disappointed in Paul Ryan, the Republican caucus and the RINO establishment for introducing the Paul Ryan bill to repeal and replace Obamacare.

It doesn’t completely repeal Obamacare or completely replace it.

In fact the supposed anti- entitlement party (Republicans) are adding another entitlement.

They are even leaving the healthcare insurance industry in charge of the money and the access to care.

It doesn’t even fulfill the five principles President Trump listed in his address to congress.

Those five principles alone would not Repair the Healthcare System.

The bill does nothing to encourage consumers to be responsible for their health and their healthcare dollars.

Consumers must be involved in driving the healthcare system in order for the healthcare system to be viable.

The bill continues to allow the government and the healthcare insurance companies to drive the cost and the healthcare system.

The Republican bill does not provide incentives for consumers to use their healthcare dollars wisely.

It does not include malpractice reform.

If President Trump buys the nonsense Republicans are calling a repeal and replacement for Obamacare, then the RINO’s have pulled the wool over his eyes.

It would be a gigantic mistake to push this bill in its present form. You would be producing political capital for the politically bankrupt Democrats.

This bill is a typical bait and switch. Rand Paul is correct. It is Obamacare lite.

It does not put consumers in charge. It keeps the healthcare insurance industry in full control of medicine, healthcare and the government.

Rather than discontinuing an entitlement it creates another one.

Refundable tax credit is another term for redistribution of wealth. You give money to everyone. You then take it back from some and let the others have it.

It does not repeal most of the Obamacare regulations.

It extends many of the programs past 2019.

President Trump, it does not help drain the swamp as you promised. It makes the swamp worse.

The insurance companies are not returned to a free market. It is a clever way to support the insurance companies by switching from a mandate and penalty to a tax credit (giving the money away to everyone).

This is another entitlement to further enrich the healthcare insurance industry.

Americans elected these Republican politicians to drain the swamp. This bill is no different than Obamacare.

Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons said:

Refundable” tax credits – for those who don’t owe taxes – are still a subsidy. It is still redistribution of wealth, with winners (those who get the subsidy) and losers (those who pay for it). And the chief winner is the “health plan.” It gets money; the supposed beneficiary may get nothing, or only rationed care from a narrow network.

“The problem is comprehensive third-party payment,” Orient adds. “The bill perpetuates this disastrous concept. A true free-market bill – “there shall be a free market in health insurance” – would remove all federal mandates, subsidies, barriers to competition, or protections or advantages for cartels.”

“Instead of returning the insurance market to the vigor of a free market, the government will be supporting it with tax credits – the flip side of the ACA insurance penalty.”

Americans are not stupid. The Republican bill will expose all the Republicans who are for the bill. They are not working for the good of the people

Democrats have already demonstrated they do not work for the people.

An group like the tea party can put up candidates against these guys and elect people who are for the people.

Where are the plans for consumer driven healthcare, patient centered healthcare, malpractice reform and the physician patient relationship?

Where are incentives for consumers to focus on their health, to help cure the obesity problem in order to decrease the incidence of diabetes and other chronic diseases?

Where is a free insurance market?

Paul Ryan’s plan is the road to failure.

The next step would be replacement of the Republican’s failure with a government controlled single party payer system.

It will fail as it is in so many countries.

President Trump. Wake up!!! Keep your promise to the American people.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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President-elect Trump: Part 6

Stanley Feld M.D.FACP, MACE

There has been no mention of the importance of tort reform in your proposal to replace Obamacare. President Obama made no mention of tort reform either.

Without medical malpractice reform your administration will not be able to reduce the cost of healthcare and increase the quality of medical care.

It is very difficult to institute malpractice reform. It is in direct opposition to the vested interest of plaintiffs’ malpractice attorneys and malpractice insurance companies. These two group have very powerful lobbies.

I have estimated that there is at least one trillion dollars of waste in our healthcare system because of over-testing, over-treating and over diagnosing as a result of the threat of malpractice lawsuits.

Malpractice insurance and the time and money spent in litigation has to be include in the one trillion dollar estimate. Ezekiel Emanual M.D., Obamacare architect, proposed an artificial threshold of significant cost savings in order to form a policy.

“ A useful threshold for savings is 1 percent of costs of healthcare, which comes to $26 billion a year. Anything less is simply not meaningful.”

One percent is arbitrary. It permits Dr. Emanuel to dismiss problems that cost the healthcare system less than $26 billion a year.

The validity of the data collection is of no concern to Dr. Emanuel. He says only $1.3 billion results in malpractice costs. He ignores over testing, and lawsuit costs.

He said,

“Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable and meaningless.

 In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

Dr. Emanuel has no difficulty in producing fake data to make his point to the unknowing.

 A study, closer to truth than just an opinion, disclosed:

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

This study concludes that $242 billion a year extra is spent because of the lack of tort reform.

The $242 billion is well above Dr. Emanuel’s fictitious threshold.

“Much of this waste is generated or justified by the fear of legal consequences that infects almost every health care encounter. The legal system terrorizes doctors. Fear of possible claims leads medical professionals to squander billions in unnecessary tests and procedures.

Physicians and nurses are afraid to speak candidly to patients about errors. They try to explain the risk reward ratio of treatments for fear of assuming legal liability. The result is the practice of defensive medicine and over testing to cover every possible contingency.

This legal anxiety is also corrosive to the therapeutic magic of the physician patient relationship.

It would be relatively easy to create new rules that would provide a reliable system of justice for patients harmed by medical treatments and procedures without encouraging costly litigation.

A new and effective tort reform system would decrease the costs of defensive medicine significantly. It would encourage physicians to use of clinical judgment rather than expensive tests. It would improve physician/patient relationships.

“ The good news is that it would be relatively easy to create a new system of reliable justice, one that could support broader reforms to contain costs.”

Everyone makes mistakes in every walk of life. The medical legal liability threat could result in further unnecessary errors. Physicians, nurses and hospitals are advised not to offer explanations about mistakes. Sometimes errors are concealed to avoid a legal ordeal. The hidden error could be compounded by additional mistakes.

“Even in ordinary daily encounters, an invisible wall separates doctors from their patients. As one pediatrician told me, “You wouldn’t want to say something off the cuff that might be used against you.”

There are cost multipliers created as mistrust accelerates between the patients and physicians. You would like physicians to adopt electronic medical records. Some physicians avoid using EMRs because the information could be misinterpreted and used against them.

The Electronic Medical Record available through hospitals systems or standalone physician practices is used by the government and the insurance industry to verify the treatment in order to guarantee treatment is best practice treatment.

Physicians are producing cut and paste reports to cover best practice observation by a third party rather than the actual encounter with the patient in order to avoid reimbursement penalty or possible liability.

There is an increasing use of second opinions. Every medical problem is requiring multiple unnecessary laboratory tests to rule out something that might have been missed in the evaluation of patients in order to avoid malpractice suits.

An example is a CAT scan done in Emergency Rooms for the slightest head trauma.

“Medical cases are now decided jury by jury, without consistent application of medical standards.

 According to a 2006 study in the New England Journal of Medicine, around 25 percent of cases where there was no identifiable error resulted in malpractice payments.

 The malpractice insurance companies want to settle the malpractice claims before the court charges mount.

“Nor is the system effective for injured patients — according to the same studies, 54 cents of every dollar paid in malpractice cases goes to administrative expenses like lawyers, experts and courts.”

These are some of the major tort reform issues that must be addressed in effectively.

They must be addressed to decrease wasteful expenditures in the healthcare system.

Malpractice lawsuits have been a growth industry for defense attorneys. The malpractice suits have also been a tremendous psychological and economic burden for physicians who have to defend themselves.

Politically is has been a tremendous economical burden to the healthcare system. In the past politicians have refused to acknowledge the economic burden to the healthcare system.

Malpractice reform is a threat to the vested interests of the defense attorneys and malpractice insurance companies.

Malpractice reform is essential to any meaningful healthcare reform.

President-elect Trump the big question is.

“Do you have the will and the courage to take on the plaintiff attorneys and the malpractice insurance industry in order to correct the medical tort reform system?”

 Effective Malpractice reform must treat both injured patients and physicians fairly.

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Dear President-elect Trump Part 3

 

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If You Tell A Lie

Stanley Feld M.D., FACP, MACE

If you tell a lie enough times it becomes the truth. President Obama and Hillary and Bill Clinton keep telling the American public that there are 20 million new Obamacare enrollees.

Obamacare advocates believe that Obamacare provided healthcare insurance for 20 million people who did not have healthcare insurance before Obamacare.

These Obamacare advocates have little understanding of the details of this lie. They usually react negatively when I tell them the 20 million new enrollee figure is a lie.

Republicans do not pick this up and call Democrats out about this lie. Perhaps they have no understanding of what is going on.

The lie then becomes the truth.

I follow Charles Gabbe at http://acasignups.net. Charles Gabbe is pro Obamacare. He publishes daily and weekly statistics as well as news in general about Obamacare’s progress and enrollment.

His numbers come from government sources. His numbers are very different than the numbers President Obama, Hillary and Bill Clinton are announcing.

The Obama administration continually manipulates the enrollment figures in order to give the impression that Obamacare has been successful.

President Obama continuously lies about the enrollment figures.

Obamacare has been a total failure because of its structure.

On December 9, 2015 ACAsignups.net published these enrollment numbers for 2016.

ACAsignups.net publishes government release enrollment numbers weekly. These are the December 9th numbers.

Confirmed 2016 Exchange QHPs: 3,260,356 as of 12/09/15

Estimated 2016 Exchange QHPs: 4.73M as of 12/09/15 (3.60M via HCgov)

Projected Exchange QHPs: 5.76M by 12/12/15 (4.34M via HC.Gov)

Projected #OE3 QHP Selections: 14.70M nationally (11.23M via HC.gov)

Projected #OE3 QHP Selections by State

http://acasignups.net

Maybe 9 million signed up for Obamacare last year. (2015)

What were the 12/09/14 enrollee numbers with 3 weeks to go until January 1, 2015?

Christmas to New Years consumes one week of enrollment. Holiday shopping will consume the other two weeks.

Why did the government reduce the expected enrollment to 5 million when enrollment was 9 million last year (2016)?

Does the Obama administration expect 4 million people to drop out of Obamacare because it is too expensive?

How did the Obama administration’s data given to the CBO cause the CBO to predict an enrollment of 21 million enrollees for 2016?

The 2016 Obamacare enrollment figures barely touch 10 million, not 20 million.

What is enrollment going to be when most of the major insurance companies have dropped out of the health insurance exchanges?

What is enrollment going to be when 18 of the 22 Obama administration created State Co-Ops have gone bankrupt?

President Obama and his administration have mislead Americans about the exact number of enrollees since the very beginning of the first enrollment period starting October 1, 2013. The first enrollment was delayed until November 1, 2013 and extended 6 months.

The American public has been mislead about:

  • The disastrous website development, reason for website crashes and cost of website development.
  • The exact number of enrollees the first year. (9.5 million corrected to 8 million and then re-corrected to 6.8 million)
  • An additional correction that resulted in another decrease of an additional 800,000 enrollees losing Obamacare insurance. The government belatedly discovered these 800,000 were ineligible for subsidies.
  • Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
  • The change in the start of enrollment from October 1, 2014 to November 15th to avoid discussion of enrollment around the time of the November 2014 elections.
  • Extending the 2014 enrollment 6 months.
  • Extending enrollment for 2015 for one to three months.
  • Finally, in 2015 announcing the back end of the website’s ability to send information to the IRS was still not complete.
  • Rehiring CGI, the same Canadian company that built the disastrous healthcare.gov, to fix the back end of the website. A company’s employee is a friend of Michelle Obama.
  • Discovering that 1.2 million enrollees were counted that should not have been because they got dental insurance instead of healthcare insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
  • Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
  • Announcing that the group market Obamacare insurance enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

Along the way I got the feeling that none of the enrollment numbers could be trusted. HHS and CMS kept modifying and lowering them.

The Obama administration keeps telling American how great the enrollment is and that Obamacare is a success.

However, we are told only ten million enrollees had Obamacare insurance in 2016.

Eighty five percent of those on Obamacare are receiving subsidies so the premiums are affordable. These subsidized recipients still cannot afford the deductibles.

The remaining 15% enrollees have a pre-existing illness. They cannot find private insurance to buy.

What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?

After five years with all the new Obamacare taxes, I would not call Obamacare a successful healthcare reform program.

All of these enrollees are in the individual insurance market. These numbers do not include the group insurance market.

14 million people in the individual market lost their healthcare insurance pre Obamacare.

10 million gained insurance on the healthcare insurance exchanges in 2016. There is a net decrease of 4 million individuals that is not discussed by the Obama administration or the traditional mass media.

Many of the state healthcare insurance exchanges have failed.

Eighteen of the 22 state insurance co-ops have failed so far.

An unknown number of enrollees in 2014 did not re-enroll in 2015 because of the loss of the subsidy.

Other enrollees did not sign up again because they could not afford the high deductible.

At the end of 2015 enrollment the Obama administration announced that 11.5 million people were enrolled.

On March 16, 2015 the administration said about 16.4 million people have gained health insurance coverage since the Affordable Care Act became law nearly five years ago.

Please notice the tricky wording. The Obama administration is counting children under 26 that now can be included in their parents’ group insurance plans and the additional Medicaid recipients added by some states.

The count is not only the people who enrolled in Obamacare through the healthcare insurance exchanges.

The discussion should be about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

The 2014 enrollment figures as of March 18, 2015 were also inflated. It is noteworthy than the Medicaid/CHIP estimate was 14.1 M. It is down to 10 million in 2016.

Confirmed Exchange QHPs: 11,699,473 as of 3/18/15

Estimated: 11.95M (9.06M via HCgov) as of 3/18/15

Estimated ACA Policy Enrollment: 33.1M
(10.46M Exchange QHPs, 8.20M OFF-Exchange QHPs, 330K SHOP, 14.1M Medicaid/CHIP)

 http://acasignups.net

Written into the law is that only state healthcare exchanges can provide subsidies not the federal health exchanges.

President Obama has not asked congress to rewrite the law’s provision.

This was another example of executive overreach of power by President Obama.

It looks as if President Obama cannot help himself from trying to manipulate the American public.

Republicans have not pointed out all this manipulation to the voting public.

I believe the public has figured out the manipulation.

Hillary Clinton has promised she will expand Obamacare. Why expand a failed program?

Her unspoken goal is to institute a single party payer system. A single party payer system will also be unsustainable.

There is a better way!

It is a consumer driven healthcare system with my ideal medical saving account.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Donald Trump on Healthcare Reform

Stanley Feld M.D. FACP, MACE

Donald Trump’s healthcare proposals are totally different from Hillary Clinton’s. His proposals are a step in the right direction to Repair the Healthcare System.

His advisors tried to create a market based healthcare system. However, they have omitted the most important elements necessary to align all the stakeholders’ incentives.

Unfortunately, their approach is the usual healthcare policy wonks market based policy approach. They do not focus on the most important stakeholder in the healthcare system.

The consumer is the most important stakeholder in the healthcare system. The consumer should be the driver of the healthcare system.

A market based system should:

  1. Promote of consumer driven healthcare system.
  2. Promote consumers’ responsibility for their health and healthcare dollars.
  3. Promote the physician/patient relationships.
  4. Promote a respect for consumers’ intelligence. Consumers can judge what is best for their healthcare needs.
  5. Promotion of accurate education about a consumers’ disease and provide resources to help consumers make the best choices to treat their diseases and use their and healthcare dollars.

Donald Trump’s web site starts by pointing out the defects in Obamacare. The Obama administration and Hillary Clinton’s spin machine uses the traditional media to promote the erroneous concept that all that is needed to fix Obamacare’s small defects are small modifications and more money.

This is a wild fantasy. The real goal is to completely control the healthcare system.

Donald Trump’s web site starts by declaring that Obamacare must be repealed.

Since March of 2010, the American people have had to suffer under the incredible economic burden of the Affordable Care Act—(Obamacare.”

The average Americans are starting to understand Obamacare economic burden on the economy in general and them individually

“ The Affordable Care Act, (Obamacare), legislation, passed by totally partisan votes in the House and Senate and signed into law by the most divisive and partisan President in American history must be repealed.”

President Obama and majorities in the House and Senate tightly controlled the debate in congress and the traditional media.

Nancy Pelosi said it all when she said “you will not know what is in Obamacare until it has passed.”

“Obamacare has tragically but predictably resulted in runaway costs.”

The runaway costs for the government and individuals were the result of:

“Websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.”

Obamacare has raised the economic uncertainty of every single person residing in this country.”

This has resulted from the 10 hidden taxes, along the inhibiting effect on the economy and the uncertainty of the potential mandates, that resulted in and from job losses.

As it appears Obamacare is certain to collapse of its own weight, the damage done by the Democrats and President Obama, and abetted by the Supreme Court, will be difficult to repair unless the next President and a Republican congress lead the effort to bring much-needed free market reforms to the healthcare industry.”

Donald Trump concludes that Obamacare cannot be fixed. It must be repealed.

“But none of these positive reforms can be accomplished without Obamacare repeal. On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

Donald Trump recognizes that simply repealing Obamacare will not fix the healthcare system.

He also recognizes that he must work with Congress to have a series of reforms ready for implementation.

“We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country.”

It is refreshing to know that a potential president is willing to work with congress rather than issue executive orders and see if he can get away with them.

“By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans.

Any reform effort must begin with Congress.”

Donald Trump says;

Several reforms will be offered that should be considered by Congress so that on the first day of the Trump Administration, we can start the process of restoring faith in government and economic liberty to the people.

This is the correct process according to the constitution.

It is imperative that Republicans maintain their majorities in the House and Senate in order for Donald Trump to lead legislation to repeal and replace Obamacare.

The following are the suggestions a Trump administration will offer the congress according to his website.

  1. Completely repeal Obamacare.                                                         
  2.  Our elected representatives must eliminate the individual mandate (tax according to the Supreme Court). No person should be required to buy insurance unless he or she wants to.
  3. Modify existing law that inhibits the sale of health insurance across state lines.

Donald Trump assumes eliminating state line restrictions will allow full competition in the healthcare insurance market place. He assumes insurance premium costs will go down and consumer satisfaction will go up. The healthcare insurance companies will try to keep the insurance premiums equally high in all states.

It can only work if consumers can buy insurance they believe they need. Costs of unnecessary insurance should not be piled into one insurance plan fits all. i.e. A post menopausal woman does not need to pay a birth control premium.

4. Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.

Individuals should be allowed to take the same tax deductions as group insurance plans are allowed.

     5. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

This is where Donald Trump’s proposal weakens. The Medicaid program must be modified. Medicaid recipients should be incorporated into my ideal Medical Saving Account program. The government should act as the funding agent for the eligible poor.

This will put the poor on the same payment footing as everyone else.

The Medicaid eligible poor should be given financial incentives to take charge of their health and healthcare dollars.

Our healthcare system must be moved from a system that fixes you when you are sick or broken into a system that rewards people financially for remaining healthy and controlling their healthcare spending.

It is much cheaper to avoid the cost of emergency care than it is to get sick and have to go to the emergency room.

         6. Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate.

Health Savings Accounts (HSAs) should be changed to Medical Savings Accounts (MSAs) to provide better financial incentives for people who choose this form of insurance. The Medical Savings Accounts can easily be customized so that consumers can choose the level of insurance they desire.

The contribution to the MSA can be flexible to provide adequate amounts of money to be put into the savings accounts to incentivize consumers to remain healthy.

Obesity is a huge program that must be consumer driven. Obesity must be cure by the patient and his family, not surgery.

Obese children are becoming diabetic and also hypertensive at a young age. This must be stopped because of the potential explosive effect of complications of both diabetes and hypertension on individual and overall costs of medical care.

      7. Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals.

Price transparency is an essential provision for individuals, businesses and groups. It provides leverage for consumers to be responsible for their healthcare dollars. It is also necessary to require insurance companies to provide verifiable price transparency for their administrative costs and their direct patient care costs

Consumers must be empowered to be responsible and shop for the most value and best prices for procedures, exams or any other medical related procedure.

This is the way to decrease the cost of healthcare services and medical care services.

Social networking should be used as the backbone for the establishment of consumer empowerment.

The success of Angie’s list, Trip Advisor and Open Table are a result of social networking. Local communities have their individual social networks that empower people in their neighborhood to know which vendors provide the best value in their community.

This simple step can be used to decrease the cost of healthcare and medical care.

This could be a place where government can lead the way in establishing this accurate educational resources.

       8. Block-grant Medicaid to the states.

These block grants can be used by the states to fund MSAs without a threat of increasing state budget deficits or giving states rights to the control of the federal government.

Block grants for social networking should be used to provide incentives to help individuals to seek out and eliminate fraud, waste and abuse of some of its local providers. It would eliminate expensive big data collections that many times are inaccurate in decision making by central federal control.

       9. Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.

Federal and state governments should help its citizen choose safe, reliable and cheaper products for the treatment of their diseases.

It would help with compliance and adherence to recommended treatment and decrease the cost of care.

It would promote consumers taking responsibility for their own health and healthcare dollars.

     10.  Congressss will need the courage to step away from the special interests and do what is right for America.

One example is allowing consumers access to imported, safe and dependable drugs from overseas. It will provide more options to consumers. This is only one example of many that ways to decrease the cost of drugs in this country.

Donald Trump is proposing a lot of important changes.

However, he is missing the important element of consumer power, consumer initiative, and consumer incentives.

His healthcare changes must include a consumer driven system with an ideal medical saving account otherwise the healthcare system will remain an unmanageable, expensive and abused mess.

Donald Trump admits this is simply a start. His start is much more powerful than Hillary Clinton’s proposal to continue and build on Obamacare.

Obamacare has been a disaster that is unsustainable. It is weekly increasing the cost of care while rationing care and decreasing access to care.

 

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

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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We Never Learn: Watch Out Colorado

Stanley Feld M.D.,FACP, MACE

“You can always count on Americans to do the right thing – after they’ve tried everything else.”

 Winston Churchill

There are many smart people in America.

Americans form opinions from the information presented to them. When the information presented in incorrect or incomplete it is easy to form the wrong opinion.

The art of presenting misinformation and disinformation has been perfected.

The people of Colorado are now being bombarded with the need to pass Amendment 69 or ColoradoCare.

Most Coloradans have not paid sufficient attention to the amendment. Their opinions are being influenced by misinformation or inadequate information concerning the unintended consequence that are inevitable.

Many might look at ColoradoCare’s official website. http://www.coloradocare.org/know-the-facts/increases-savings/ and read the following.

  • With Amendment 69, ColoradoCare, every Colorado resident can contribute their best, knowing ColoradoCare has everyone covered with universal health care.”   Sounds wonderful.
  • “ Imagine life with ColoradoCare. If you’re a resident and you need any kind of health care (including mental health), you just go to see your provider, and ColoradoCare pays the bill.”Free is great.
  • “Without the layers of hassles, businesses, providers, and everyone in the state can go about their important work of contributing to their families and communities knowing ColoradoCare has everyone covered.”   The problem is nothing is free.                                                                                                        
  •  In a statement to the Colorado Independent October 2016, Bernie Sanders lent his support to the single-payer measure.
  • “Colorado could lead the nation in moving toward a system to ensure better healthcare for more people at less cost. In the richest nation on earth, we should make healthcare a right for all citizens.”

Hillary Clinton has not yet supported ColoradoCare. I believe she is afraid it will steal her thunder by having large increases in government healthcare expenditures she has planned. She plans to increase taxes and get healthcare governance firmly in the hands of the federal government.

The ColoradoCare website goes an to say,

“An economic analysis of health care spending in Colorado has calculated that comprehensive health coverage for every resident could be paid for with pre-tax payroll premiums of 3.33% for employees and 6.67% for employers.”

There has been no effort to prove these numbers are correct.

In fact, all of the Republican establishment politicians in Colorado are against ColoradoCare as well as many high ranking members of the Democratic establishment.

The Democratic establishment includes Governor John Hickenlooper and former governor Bill Ritter. They are opposed to Amendment 69’s passage because they understand the financial burden ColoradoCare would put on the state’s budget and growth.

The size of the current state budget is $25 billion dollars. The tax increase for ColoradoCare would be an additional $25 billion dollars. Everyone can assume the state would need more to implement the program.

ColoradoCare would be far and away the largest tax increase in state history, and would give Colorado the highest tax rate in the nation.”

“ This would be implemented as a payroll tax that would be split into 3.33% for employees, and 6.67% by employers.

An additional $18billion dollars would be asked of the federal government, as well as a waiver to let the state opt out of the Affordable Care Act in order to fund Colorado care.

If voters approve ColoradoCare, it would be written into the state constitution, making it very difficult to dismantle and impossible to amend.

The president of the Denver chamber of commerce is opposed to ColoradoCare because the chamber knows this will drive businesses out of the state and inhibit businesses from coming into the state. The Denver chamber of commerce has worked very hard and very successfully to bring business into the state.

Most of all these politicians know that Obamacare has failed. Oregon’s attempt at the state being the single party payer has failed.

Most recently, Vermont’s attempt at a single party payer system has failed.

Both Oregon’s and Vermont’s governance realized the great fiscal burden to the state budget as well as its businesses and residents.

These states quit before the taxpayers realized the extraordinary tax burden the single party payer system would have on their state.

However, most progressive thinking people cling to the ideology that a single party payer system is the way to universal coverage.

Why did Vermont fail to institute a single party payer system after the state legislature passed the bill?

I will describe the reasons for failure in my next blog.

Walker Stapleton, the Colorado state treasurer said, “a major part of his responsibilities is attention to the fiscal and economic condition of the state.”

He goes on to say,

“If passed by the voters, the provisions of Amendment 69 will have a great negative impact on the state’s fiscal and economic health, as well as impacting individual residents fiscally.”

“If passed, Amendment 69 — creating a governmental entity called ColoradoCare to administer the health care payment system — would amend the Colorado Constitution. It would not be a legislative issue to which the Colorado Legislature could make amendments as needed.”

Walker Stapleton said the state health exchange was supposed be self-sustaining. However, the state health exchange has blown through federal dollars provided.

The State has no way to fix the state exchange or has a way to pay back the federal loan. Walker Stapleton acknowledged the problems with Colorado Health Benefit Exchange, saying, “The exchange was intended to be self-sustaining, and it is anything but, and we have blown through federal dollars.”

United Health and others are leaving the exchange. The exchange has one-fifth of the enrollment anticipated because of cost, network size and service.

“The exchange is in a hole and we have not yet come up with a way to fix it,” he said.

He added that Amendment 69 would assume the state health exchange burden in addition to its debt.

This burden is not good for the single party payer financial burden.

ColoradoCare (Amendment 69) was proposed by a Boulder State Senator, a progressive M.D., with support of the other progressive M.D.s in the Boulder, Colorado community.

Most of the M.D. practices in the Boulder community are owned by Boulder Community Hospital.

I wonder if the M.Ds understand the unintended consequences to the state’s fiscal health, the unintended consequence to the business environment as a result of the increase in tax rate and the unintended consequence to residents experiencing increases in taxes.

I wonder if these physicians are aware of the unintended consequences to their ability to practice medicine.

I suspect the author of the amendment and her followers have not thought about the unintended consequences.

Consequences.

1. Amendment 69 authorizes state taxes be increased $25 billion annually in the first full fiscal year and by such amounts that are raised thereafter.

2. ColoradoCare would be exempt from Taxpayer’s Bill of Rights (TABOR).

3. “A 10 percent payroll tax for every employer in Colorado,” Stapleton said.

The employer would pay 6.7 percent and the employee 3.3 percent. If a taxpayer were self-employed, he/she would pay both, for a total 10 percent.

4. Investment income is subject to this tax.                                                                                                                                                                         5. If the employer is outside the state, the tax does not apply for the employer’s 6.7 percent so the employee pays the full 10 percent.                                                                                                                                                                                                                                     Walker Stapelton said, “It is possible retirement income would be taxed,”

Also of great concern to Stapleton are these additional provisions in Amendment 69:

Transferring administration of the Medicaid and children’s basic health programs and all other state and federal health care funds for Colorado to ColaradoCare;

• Transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers’ compensation insurance;

• Requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado health care system;

• And suspending the operation of the Colorado health benefit exchange and transferring its resources to Colorado Care.

I hope the people of Colorado understand what this dangerous amendment represents to the fiscal health of the state.

The population will only understand its negative connotations if it starts paying attention to the consequences.

If it only believes that free medical care is good they do not understand that nothing is free.

A system in which the state offers free medical care will fail at the expense of all the taxpayers.

It has already been proven in Oregon and Vermont.

There is a more effective and less expensive way!

If you are interested please read the following links.

My ideal medical savings account is democratic and provides universal coverage with the consumers being responsible for their choice of medical care while being in control of their healthcare dollars.

Consumers’ responsibility for their health is always left out of models of healthcare reform.

If the federal government or a state government wants a business model to be successful, it should adapt my future state business model.

It is a consumer driven model with consumer responsibility built in so that consumers control their healthcare dollars.

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

All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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President Obama Continues to Deceive i.e. The Public Option

Stanley Feld M.D., FACP,MACE

President Obama continues to deceive the American people about Obamacare’s success as his term in office is winding down.

He is trying to use his charming personality to erase the fact tat Obamacare is failing.

The public must keep their eyes and ears open.

Obamacare is falling apart as the months continue. President Obama and the liberals are queuing up to pour more money into a failing healthcare reform model by reintroducing the need for a public option.

On June 30, 2016“CMS division of the HHS Dept. released the HHS Dept. released the actual Q1 effectuation report,

Each year the Obama administration has lied to Americans about enrollment in the health insurance exchange program.

As of June 30,2016, only 11.1 million people have signed up and continued to pay their premiums for Obamacare coverage in the 38 federal health exchanges as opposed to over 13 million that were published. State exchanges are closing monthly.

The latest prediction is that only 10.2 million will have insurance through Obamacare for the entire year. Eighty-seven percent of those insured through the federal health insurance exchanges have government subsidies in the government’s attempt to make health insurance purchased through the exchanges affordable.

If President Obama is correct about Obamacare providing insurance for 20 million people who did not have healthcare insurance previously then 9 million new people have signed up for Medicaid coverage.

Medicaid coverage is completely free to the recipients and is a single party payer system. The federal government presently pays for Medicaid coverage. The increased enrollment is also increasing the federal deficit.

Soon the federal government is going to dump some of the financial responsibility on participating states that are already running budget deficits.

It is only a matter of time before all the 23 state Co-Ops will go out of business and the federal health insurance exchange will take over.

Illinois is the 16th state to close its Co-Op doors. It followed one week after Oregon Health Co-Op closed its doors.

Land of Lincoln Health received $160.1 million in loans from the Centers for Medicare and Medicaid Services. More than 54,000 enrolled in coverage from the co-op through March 31.

 Where are these 54,000 people going to go for healthcare insurance?

 “It’s a bad day for the marketplace in Illinois and our consumers,” Jason Montrie, Land of Lincoln Health’s CEO said. “This is the end.”

Who is going to pay CMS back for these federal loans? The state of Illinois cannot afford to pay CMS back. The American taxpayers will re-pay the loan.

So far the total number of federal loans given to the failed nonprofit insurers is more that $1.5 billion for an experiment that was destined to fail from the start.

When are the liberals and progressives going to learn? You cannot keep spending other peoples’ money. You will eventually run out.

These last two weeks have been a big distraction because of party conventions.

Hillary Clinton announced her healthcare proposals. She has proposed an increase of $40 billion dollars in mandatory federal spending insulated from annual budget fights over the next 10 years to develop community health centers.

Hillary Clinton also wants to expand Medicare by letting people age 55 years old or older to opt into Medicare.

In addition she wants a public option.

“Bernie Sanders tweeted. “Together these steps will get us closer to the day when everyone in America has access to quality, affordable health care.”

Who is paying? The middle class taxpayer will pay the burden of the increase in taxes. It will not be paid by the 50% of the entitled citizens who do not pay taxes.

This is an attempt by Hillary Clinton to expand coverage for middle-aged adults. It also gives us a glimpse at how she wants to make Obamacare her own.

President Obama was not taking this lying down. He published an article in the Journal Of the American Medical Association, a “scientific journal.” This article is complete progressive propaganda. Why the AMA permitted this publication is beyond my understanding?

In his “special communication” President Obama once more presents another Trojan Horse (A destructive program that masquerades as a benign application.) to the physicians of America and the consumers of healthcare.

Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan.

Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers.59,60

The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited.

Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.61

In 2009 Barney Frank and John Kerry insisted that a public option was essential for Obamacare to evolve into a single party payer system.

President Obama told them they would get to a single party payer system without a public option.

He has now changed his mind.

https://youtu.be/f3BS4C9el98

 

I have written extensively about the defects in a public option. http://stanfeld.com/?s=public+option

The New York Times writers did not describe the meaning or consequences of the public option in articles about both Hillary Clinton’s and President Obama’s call for a public option.

The American people should be told the real reason for the public option.

The combination of a “public option” within a health insurance exchange system was originally developed by liberal health policy analysts as a dual action mechanism to secure a “single payer” system. It presents the facade of a free market system but the end game is a full-scale government monopoly.

“If a public option became part of government-run health, the Health and Human Services secretary would establish such a plan, set its benefits, and fix its payment rates.

While private plans must negotiate market rates with doctors and hospitals, a Medicare-like “public option” would fix payment rates by fiat, well below the rates that would otherwise prevail in a real market.”

The “public option” would be a better deal for consumers rather than private healthcare coverage. The government would artificially force premiums down with subsidies. It could indiscriminately lower non-negotiated reimbursement to physicians and hospitals and force insurance companies out of the healthcare market.

It would result in an increase in federal taxes.

Additionally, the result will be a defacto single party payer system with less choice and access to care.

President Obama continues to ignore the fact that the government is dependent on the healthcare insurance industry to perform the administrative services for this government program. He ignores the fact that he needs doctors and hospitals to treat and care for sick patients.

He is only interested in financing the healthcare system and controlling the consumer’s ability to choose.

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

All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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    Really very best to know about your blog really this site has been updating about life on the line, thank you for sharing with us. All knowing you are the professional whose job it is to advise keep it up.

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