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The Next Obamacare Tragedy

March 26, 2014
inMedicine: Healthcare System, Physician's Problems, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP, MACE

Late in the afternoon March 25th  the Department of Health and Human Services announced that it is extending the enrollment period for Obamacare to April 15th from March 31st.

“The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.”

Those who are going to apply have enough time to apply in seven days if the website and the navigators are working correctly.

It sounds as if enrollment figures are not good.

“Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system.”

“The government will not try to determine whether the person is telling the truth.”

This is not a very good way to run a business.

The next tragedy in the implementation of Obamacare is providers’ participation in the Affordable Care Act. There is so much uncertainty in the Obamacare that many physicians and physician groups have opted out of participation in Obamacare.

In California, independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting Covered California, the state health exchange.

Dr. Richard Thorp, president of the California Medical Association said,  “It doesn't surprise me that there's a high rate of nonparticipation,” 

The CMA represents 38,000 of the roughly 104,000 doctors or 20% of the physicians in California. Dr. Thorp said nothing about the California Medical Association doing a study to determine the percentage of physicians who are not participating in Obamacare.

However the Daily Kos ranted about the Washington Examiner story not being true.

“The latest right-wing disinformation campaign, all over the far-right media is that 70 percent of California's doctors are boycotting Obamacare. Is it true? Of course not. Is anything the Washington Examiner, WND, or Breitart publishes true?”

However the Daily Kos did not offer any facts about what is true.

It is a typical Alinsky disinformation tactic. You must freeze your enemy and then criticize and discredit him.

The LA Times reported in December that the state exchange Covered California reported,

In fact, according to Covered California, the only source with verifiable numbers, some 58,000 doctors, or more than 80% of the state's practicing physicians, will be available to enrollees in the exchange's health plans.

First of all, 58,000 physicians are not over 80% of California practicing physicians, if the 58,000 number is true. It is 55.77% of practicing physicians.

“Covered California says that the doctors participating in its exchange plans include 100% of Kaiser Permanente's 14,000 California doctors, 43,000 taking HealthNet patients and 35,000 in Blue Shield's network. (There's probably some overlap between the latter two networks.)”

The twisting of the facts is the method of operation.

On February 7, 2014 the LA Times reported Covered California admitted there are many errors in their physician directory.

“Admitting Covered California gave some consumers bad information, California's health insurance exchange pulled its physician directory for having too many errors.”

It appears that Covered California was not a very good source for the LA Times and Daily Kos to quote. Both media outlets called the Washington Examiner story a right wing lie.

“Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.”

California patients are discovering that their physicians are not participating in Covered California. Some have discovered that they are not covered by healthcare insurance coverage at all because of computer glitches.

The exchange previously yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November.

The updated list at that time still had some serious problems. The list misled consumers into signing up on the exchange. Covered California is bragging about the number of people they have signed up.

California is supposed to be the star of the state exchanges. Yet they had to close down the exchange in February for repairs and updates. The federal government gave the state exchange an additional $155,000 million dollars to fix the exchange. This is not a small amount of money for a “superb exchange”.

Here are some facts from practicing physicians.

In September 2013 insurance companies disclosed that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. This is contrary to the Daily Kos claim that the physician fees are negotiated.

Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor is quoted as saying, “In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal's reimbursement is $24,.” “In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160.

It is logical that physicians in California would say no to the state exchange, Covered California. No matter what lies the spin masters use the facts are the facts.

Physicians say, “We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,”

 

California physicians have protested that the Covered California's website lists many doctors as participants when they aren't. This is false advertising.

“Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy.

Donald Waters, executive director of the Alameda-Contra Costa Medical Association said. “They may be listed as actually participating, but not of their own volition”.  

Waters said. He called the exchange's doctors' list a “shell game” because “the vast majority” of his doctors are not participating.

 “This is a dirty little secret that is not really talked about as California promotes Covered California”.

Dr. Sherry Franklin, a pediatric endocrinologist at Rady’s Children’s Hospital, San Diego said, last summer she "got a letter in the mail letting me know if I wanted to participate with Blue Cross through the exchange, which is different from my regular Blue Cross practice, because they are paying les.s

 They did not tell me how much less. You had to agree or disagree. So, of course, I said no."

Covered California expects 85% of the physicians in California to participate. So far they have made these statements to the press but have not published any proof of participation.

 Covered California asks physicians to participate but does not disclose the reimbursement rates they will pay for participation in Obamacare.

Other state exchanges’ are also in trouble. Oregon and Connecticut are the most outstanding.

This is only the beginning of Obamacare’s provider problems. It is too bad that America is afflicted with this albatross at this time. Obamacare is destroying the healthcare system for consumers and physicians.

President Obama will not be able to charm his way out of the failure of Obamacare.

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

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Disinformation Campaign In Full Force.

March 19, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The consequence of Obamacare is hitting home to many people as taxes and the cost of insurance premiums increase.

Obamacare is not an abstract concept anymore.

People cannot keep their doctors as promised by President Obama. People cannot keep their insurance as promised by the president either.

Healthcare insurance premiums have increase for the middle class, who are being forced to use Obamacare’s Health Insurance Exchange. These health insurance exchanges have been inefficient. Many of the State Health Insurance Exchanges are failing.

Healthcare insurance premiums have increased by $2,500 a year and not decreased by $2,500 a year as promised by President Obama during the disinformation campaign to pass Obamacare.

If you make less than $50,000 a year it might be a good deal. The government through tax increases is paying the difference to the insurance companies.

Consumers are angry. In order to counteract and neutralize this anger away from President Obama and the Democrats running for congress and the Senate (especially the Senate) in November 2014 President Obama has put into operation the Saul Alinsky disinformation tactics.

The traditional mainstream media is falling for this tactic once again.

The intent of the tactic is to keep your enemy off balance. Whether by mockery, subterfuge, or any available strategy, the purpose behind the tactic is to keep the pressure on you opponent, constantly jabbing and goading them until they lose their clarity of thought, and react in a way that you can exploit to defeat them. “ Rules for Radicals”  

Saul Alinsky has been very direct in his instructions. He also puts the burden of creative execution of these rules on the executor of the rules. The goal is to change the public’s believing the facts by discrediting the person or persons exposing the true facts.

“The job then is getting the people to move, to act, to participate; in short to develop and harness the necessary power to effectively conflict with the prevailing patterns (the truth) and change them.”

When those prominent in the status quo turn and label you an “agitator” they are completely correct, for that is, in one word, your function- to agitate to the point of conflict.

The key to success is to be an outside agitator.

This has been one of President Obama’s major problems. He is the inside agitator.  He is being discovered even though he has done everything is his power to look as if he does not have his fingerprints on any of the agitation.

The first step of the agitator is to disrupt the present system in order to replace it with a new system.  The public must be made uncomfortable enough to demand change in the old system.

Isn’t this what President Obama has done in the financial system, the environmental system, and the healthcare system?

It is backfiring on him because of the uncertainty is has created.  In turn it has affected economic growth and caused great pain for middle class consumers.

However, he is smart. He has exempted almost everyone from the mandate temporarily. The exemptions are going to create other problems.

By exempting everyone from the Obamacare mandate, he is not only ignoring the constitution, he is disrupting his new system (Obamacare) that the major stakeholders are trying to execute. The result has been havoc. However, the Obama administration believes it have shifted the blame for the havoc onto the healthcare insurance industry.

He methodology is very transparent. It has become unsuccessful.

The next step is a disinformation campaign.

The eba.benefitnews.com published an article entitled Americans Stick With Obamacare As Opposition Burns Bright. This headline is totally false. Americans are not sticking with Obamacare. Nevertheless administration press releases fed to the traditional media are published without appropriate fact checking.

President Barack Obama’s health-care law is becoming more entrenched, with 64% of Americans now supporting it outright or backing small changes. This is a lie.

A major talking point of the Democrats now is that “Obamacare is great but it just needs to be fixed.” If you tell a lie enough times it becomes the truth.

“Tell voters they can fix ObamaCare, but Republicans won't let them.”

This is the Democrats' midterm election strategy, as revealed in a memo Politico got its hands on this week. The Democrats are going to admit that Obamacare has flaws. They will promise to repair the flaws. They will argue that Republicans will only make things worse.

However, it has not worked in the Florida special election where Ms. Alex Zisk (Dem) lost to David Jolly (Rep), an unknown, after outspending him by 500%.  The people in the district did not buy the disinformation lie that Obamacare is great and Ms. Zisk will fix the errors.

 A week ago, HHS Secretary Kathleen Sebelius, President Obama's top health official, declared there was no evidence Obamacare was costing any jobs.

HHS Secretary Kathleen Sebelius said.  “There is absolutely no evidence, and every economist will tell you this, that there is any job loss related to the Affordable Care Act,"

This is another lie in order to confuse the facts.

 The Congressional Budget Office a couple weeks ago concluded that Obamacare would shrink the workforce by 2.5 million jobs because of its work disincentives.

President Obama admitted to the law's adverse effects on businesses when he twice put off the employer mandate.   

 Senator Harry Reid addressed the American people from the Senate floor and solemnly claimed that “there’s plenty of horror stories being told,” about ObamaCare. “All of them are untrue, but they’re being told all over America.”

The tactic is to tell lies to obfuscate the true.

 That dog will not hunt anymore. The American people got it!

 "In addition, 54% of Americans say they’re unhappy with the president’s handling of the issue, according to a Bloomberg National Poll."

That’s an improvement since the last poll, in December, when Obama’s public standing on health care hit a low of 60% disapproval after the botched rollout of the insurance exchanges, according to the March 7-10 poll of 1,001 adults.

The Obama administration’s spin of the story is a complete lie. This week the number shot up to close to 60%.

“Things definitely seem to be getting better,” said Paul Attard, 50, a political independent in Evergreen, Colorado and a program manager for a cell-phone company who wants the law modified rather than repealed.

“It seems like they are getting a lot more people to join. It’s a sign that the system is working.”

This is another lie. I think in real numbers Obamacare will be lucky if 3.5 million have signed up and have paid their premiums by March 31.

All that has to be done to confuse the truth with misleading statistics in the press.

 The discussion moves from statistics that might not be correct from the true. The real question i:.

Can Obamacare work? I have presented data along with many others that show that Obamacare cannot possibly work.

 All the agitators have to throw at the public is confusing statistics and lies.

One such incorrect fact is that 4.2 million have enrolled. The public does not know if the 4.2 million include Medicaid or are just private insurance plans.

What about the 48 million people who were uninsured before the 2013 rollout? What about the additional 6.6 million consumers who lost their healthcare insurance? None of this is part of the discussion.

The public does not know how many have not paid their premiums. The administration says it does not know. Those people are technically uninsured.  

Private institutions have claimed that 20-30% who have applied have not paid premiums. Only 25% of those who purchased insurance are under 30 and healthy. The administration needs at least 37% of the insured to be healthy for Obamacare to be financially viable.

The health insurance exchanges enrolled less people last month than it did in January. The number for success has changed from 7 million for Obamacare to be viable to an unspecified millions. The Obama administration refuses to publish the health demographics for consumers who have purchased insurance through the exchanges.  

My guess is less than 3 million previously uninsured people became insured under Obamacare compared to the 48 million uninsured that were supposed to become insured. It is a pretty awful number.

 President Obama is throwing a bunch of statics at us to confuse us. Here are some examples

1.Fifty-one percent of Americans favor retaining the Affordable Care Act with “small modifications,” while 13% would leave the law intact and 34% would repeal it in the Bloomberg poll.

Vs.

2. Seventy-three percent of Bloomberg poll respondents who would repeal Obamacare say the law will be a “major” decider of their vote, compared with 45% of those who support modifications and 33 percent of those who back the law as is.

Isn’t this confusing? The confusion is generated on purpose. It should not be tolerated anymore.

November elections are just around the corner!

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

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Obamacare’s New Taxes And The Middle Class

March 16, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

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

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

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

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

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

 


Taxes that took effect in 2010:


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



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



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



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



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


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



Taxes that took effect in 2011:



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



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



Taxes that took effect in 2012:


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



Taxes that took effect in 2013:


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

 

Capital Gains

Dividends

Other*

2012

15%

15%

35%

2013+

23.8%

43.4%

43.4%


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

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

 

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

All Remaining Wages
Employer/Employee

Current Law

1.45%/1.45%
2.9% self-employed

1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike

1.45%/1.45%
2.9% self-employed

1.45%/2.35%
3.8% self-employed



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


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


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

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

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


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



Taxes that take effect in 2014:

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

 

1 Adult

2 Adults

3+ Adults

2014

1% AGI/$95

1% AGI/$190

1% AGI/$285

2015

2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085

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

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

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

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


Taxes that take effect in 2018:


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



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

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



$104.20 in 2012



$120.20 in 2013





$247.00 in 2014."

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

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

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

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

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

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

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

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

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

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Why Use Facts and Logic?

February 26, 2014
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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 Stanley Feld M.D.,FACP,MACE

 I have previously pointed out the tactics used in Saul Alinsky’s Rules For Radicals.

 President Obama uses these tactics over and over again to attack his opponents, obfuscate reality and confuse the public.

The public has figured out President Obama out. Reality is now in healthcare and Americans are feeling it.

The middle class independents voters are feeling the most pain.

If someone points out the truth he is attacked, belittled and marginalized. President Obama is using executive powers to attack the constitution in order to restrict Americans’ rights to freedoms.

The most recent FCC foray to determine the quality of news reporting was cancelled immediately by the uproar about its attack on free speech.

President Obama has tried to shift public attention away from Obamacare by bringing up many topics at once.

The traditional media goes along with this because President Obama is the number one newsmaker. The media have only a limited time or space to cover topics.

Let’s face it. These important topics are not entertainment. They are boring.

A story that floored me was President Obama’s austerity claim. He said his new budget would finally end the dreary "era of austerity."

Did he think increasing Americans national debt $6 trillion dollars over 5 years was austere?

“ The federal government will still spend $561 billion more this year than it did in 2008.”

I was under the impression that the Republicans took a shellacking from President Obama once again by the way the recent budget and debt ceiling resolutions were reported. The opposite is true.

President Obama wanted the sequester abolished, roughly $2 trillion more in spending, and almost $1 trillion in higher taxes over the next decade.

The latest budget deals delivered none of that. While the sequester was relaxed, all the additional spending was offset with no higher taxes.

Speaker Boehner did not do so bad.

 In 2014 President Obama’s take on the debt ceiling is extremely interesting.

 

 In the last few weeks President Obama has been telling his base over and over again that Obamacare is going to be a non-issue in the November 2014 elections. He told Bill O’Reilly in his Super Bowl interview that 6 million people have already received insurance.

 

Both were lies. It doesn’t seem bother him to lie.

Dick Durbin, the second man in the senate, told a Sunday morning talk show that 10 million have signed up by end of January.  

On February 25th President Obama announced that 4 million have signed up. He did not say how many of those were on Medicaid, how many bought private insurance, how many lost their insurance because of Obamacare, how many bought private insurance on the health insurance exchange and how many never had healthcare insurance.

He has used the 6 million over and over again even though he received 4 Pinocchio’s from the Washington Post fact checker.

The traditional media just publishes what he tells them even though they have stories with facts that contradict his pronouncements.

President Obama has henchmen at the New York Times. Paul Krugman is the chief henchman.

He makes pronouncement without facts.

His February 23, 2014 article “Health Care Horror Hooey” is one of those articles. He starts by brow beating his audience about the death tax (Estate Tax).

“You might think that such heart-wrenching cases are actually quite rare, but you’d be wrong: they aren’t rare; they’re nonexistent. “

No evidence was presented for the statement.

In particular, nobody has ever come up with a real modern example of a family farm sold to meet estate taxes.

One reason is that there are few family farms in existence today.

The whole “death tax” campaign has rested on eliciting human sympathy for purely imaginary victims.

The problem in my view is people paying estate taxes are being taxed a second time on the same money.

I do not care how rich a person might be the government should not be entitled to tax money twice.

And now they’re trying a similar campaign against health reform.

This statement is nonsense

“I’m not sure whether conservatives realize yet that their Plan A on health reform — wait for Obamacare’s inevitable collapse, and reap the political rewards — isn’t working.”

My sense is Paul Krugman views conservative as shiftless idiots. He presents no proof as to whether Obamacare is working or not. He simply declares Obamacare isn’t collapsing.

“But it isn’t. Enrollments have recovered strongly from the law’s disastrous start-up; in California, which had a working website from the beginning, enrollment has already exceeded first-year projections.”

Mr. Krugman ought to read his own newspaper. The New York Times reported that California does not have enough physicians participating in Covered California to service its subscribers. Many subscribers have not paid their first premium.

 The mix of people signed up so far is older than planners had hoped, but not enough so to cause big premium hikes, let alone the often-predicted “death spiral.”

There is absolutely no information about age mix and health risk available for Covered California that I could find.

It is clear the administration is withholding this information.

In fact, Covered California has had to close its website in order to try to cover the discrepancies.

Paul Krugman claims insurance premiums and deductible have not gone up. I think he ought to look at the health exchange insurance premiums and deductibles for the individual market on the health insurance exchange.

He does not talk about the reasons for all the waivers given by President Obama. He does not talk about the congressional exemption.

He does not speak about the exemption delay for the corporate insurance market. Why not?

Millions of families will lose their insurance coverage and be driven into the Obamacare health insurance exchanges or face government penalty.

The IRS sent out a warning this week that if person does not have adequate qualified healthcare insurance a penalty would be assessed on to their tax bill in 2015.

Paul Krugman is being intellectually dishonest with the American people. The American people are being forced into an entitlement program they do not want.                                                                                                                                                

This is not “Health Care Horror Hooey Mr. Krugman.  It is reality.                                                                                                                                                                                                                                                                                       At the time of Krugman’s article a CMS report was publish that found 65% of small businesses that offer insurance will likely see their premiums rise thanks to ObamaCare. That translates into higher insurance costs for 11 million workers.

“No doubt, Obamacare boosters will charge that this information is from some right wing think tank.      “                                                                                                                                                                                                                     

The Obama administration immediately started shouting foul to the CMS study. They said the study was incomplete and the conclusions will change.

This is a typical use of an Alinsky tactic by President Obama.

David Horowitz writes in his book Barack Obama’s Rules For Radicals, "There can be no conversation between the organizer and his opponents.  The latter must be depicted as being evil."

In this case his own CMS is depicted as being evil.

One study, for example, found that 63% of small employers in Wisconsin will see premiums jump 15% because of ObamaCare. A separate study found that 89% of small companies in Maine would see rate hikes of 12% on average.

Another, by consulting firm Oliver Wyman, concluded that ObamaCare would push up small group premiums nationwide 20%.

As soon as the CMS report came out, Democratic leaders rushed to the microphones to dismiss it.

House Minority Leader Nancy Pelosi's spokesman said it was "incomplete" and that the GOP would use the report "to mislead and deceive Americans."

President Obama, the American people got it. After all the lies, deceptions and misrepresentations we know what you are doing with your people and your shills.

 We do not trust you!

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

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As President I Can Do Anything I Want To Do

February 19, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The passage of time has a tendency to help us forget promises made with regard to principles and policies.

It is clear to me that one reason President Obama beat John McCain in 2008 was because he was going to go back to the principles of the constitution.

He taught constitutional law and professed to know how important the constitutional principles are to the laws of the land as well as our economic and political freedom.

John McCain represented the past. In the past America experienced a creep toward bigger and bigger government in order to protect our homeland security.

The result was an impingement on our religious, economic and political freedom.

President Obama does not think about the constitution in the way he did when he was trying to win the hearts and minds of the American people in 2008.

  

http://youtu.be/UBZIM0ZFiYU

If fact, after the 2012 election victory he has shown a total disregard for the United States constitution. He has a total disregard for the balance of power.

  

 

http://youtu.be/yiOmwayoSrw

 He has ignored congressional authority. He has issued executive orders changing laws at will. If congress challenges him he accuses them of being obstructionist.

President Obama has made at least 10 significant changes to Obamacare by executive order up to now. Congressmen and Supreme Court scholars have deemed that these executive orders are unconstitutional.

The Obama administration is now dowplaying his executive orders  significance.

We tend to forget abuse of power episodes. I think it is worthwhile to publish all available examples at once to get a complete feel for the abuse of power.  

These large numbers of executive changes were adopted to avoid Obamacare’s failure. Obamacare’s failures have persisted in spite of the unconstitutional changes.

 Obamacare is basically a defective bill. It should be repealed. Small patches will not repair it.

 Many of the executive orders slipped by the traditional media without discussion.

The following are President Obama’s changes by administrative action.

1. Congressional opt-out: The administration decided to offer employer contributions to members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013).

This is a subsidy congress did not have the guts to fight about. It is self-serving. Why should the congress get a special privilege that ordinary people doesn’t have?

2. Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid February. (October 23, 2013).

In addition to this order, if a consumer signed up before December 31 they would have insurance January 1St. If they signed up by January 15th they would have insurance by February 1st. If they signed up by February 15th they would have coverage by March 1st. This occurred by executive order in order to encourage enrollment. The government is unable to process these applications. Patients had not paid premiums.

3. Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013)

This executive order was issued in July just before Independence Day. This has been typical of the Obama administration. They have released executive order when the public is emotionally preparing for a weekend or a holiday. Friday afternoon at 4.30 is a favorite time.

4. Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013)

It looks like the administration knew that they did not have the computer systems’ back end connected to check income tax returns with the IRS two and one half months before on October 1st.  Congress was not consulted for advice.

5. Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and has instead delayed the implementation of the SHOP (Small-Employer Health Option Program) exchanges until 2015. (March 11, 2013)

I did not realize that this executive order appeared so early in 2013.

6. Closing the high-risk pool: The administration decided to halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment. (February 15, 2013)

This is a mind blower. The Obama Administration decided to discontinue funding the high-risk pool in order to have the money to pay for advertising for Obamacare enrollment.

This order was issued on February 15,2013. It was seven and one-half months before Obamacare enrollment was to begin.

7. Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay exodus of MA plans from the program. (April 19, 2011)

Medicare Advantage was a big mistake for reasons beyond the scope of this report. Political pressure forced President Obama to take money out of one pile and apply it to the Medicare Advantage pile without consulting congress.

8. Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (January 1, 2012)

The one-year delay adds to the uncertainty of what is going to happen the following year. It makes hiring decisions harder for employers in the long run even though it helps in the short run. The net effect is it will be bad for the economy.

9. Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowingmaximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)

This executive order was issued in February 2013 to the advantage of the healthcare insurance industry.

10. Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)

The administration knew what to expect from the rollout as early as February of 2013. The executive orders changed the law in an effort to cover-up the tremendous cost overruns that will occur.

The public does not have any idea what those cost overruns will be.

It is important to see how many of these unconstitutional executive orders were released and how far back in relationship to enrollment they were ordered.

   

http://youtu.be/9FgFUOGFpnk

President Obama’s mind-set is expressed in the above You Tube video.

 As President he “can do anything he wants to do.”

 Wake up America!

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

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President Obama: Please Stop Deceiving Us!

February 16, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama, please stop deceiving Americans. Please tell us the truth. Please be transparent as you promised us you would be.

President Obama promised to transform America. Americans did not know what that meant. They thought is was for the good. 

The healthcare system was dysfunctional before President Obama became president. In order to fix a dysfunctional system, one must try to get to the root of the problem.

President Obama has not done that. He has pasted another layer of bureaucracy on top of an already dysfunctional system. This has created further dysfunction.

He has further compounded the dysfunction in the healthcare system by changing the law unilaterally by executive order without the consent of congress.

There is question on whether his actions are unconstitutional. If they are unconstitutional it is grounds for impeachment.

At best these unilateral changes have destabilized the healthcare system further. The changes have also increase uncertainty in the investment community. The result of the uncertainty is to slow the jobs market and the economy.

President Obama is a charming fellow. The problem is the veneer has rubbed off. At the beginning he pandered to all the stakeholders vested interests.

He told them glorious things about what they could expect. People have recently found out that they have been deceived.

President Obama is not about innovation and opportunity as many hoped for in 2008.

President Obama is about increased central government control over our freedoms and our choices.

All of his actions and deceptions are starting to backfire on him. The majority of the American public is becoming aware of his tricks and abuse of power.

The tricks, deceptions, abuse of power and outright lies are starting to directly affect the majority of Americans in a negative way.

In healthcare we have been deceived by many actions. At present it is the reporting the enrollment figures in the health insurance exchanges.

President Obama, his administration, and even Dick Durbin have inflated the numbers without giving Americans the facts.

Last week even the Washington Post could not take it anymore. 

“The Washington Post, has given "three Pinocchios" to the White House for its claim that 6 million people have enrolled in Obamacare, and warned the media to ignore the distorted government figures.”

After President Obama announced these figures during his Super Bowl interview, he tweeted them on his official Twitter account.

BdoRQ1yCYAAN4dp

https://twitter.com/BarackObama/status/421668496120897536/photo/1

The figure comes from a combination of 2.1 million people who have enrolled under federal and state healthcare insurance exchanges, plus 3.9 million who have qualified for coverage on Medicaid through November.

The key words in President Obama’s statement are qualified for coverage on Medicaid through November. These words tells you almost nothing about how the Affordable Care Act is affecting Medicaid enrollment."  

The mainstream media keeps on using the same incorrect numbers over and over again thinking they are fooling the American people.

"No one really knows, though some have tried to tease out figures from the data that has been presented."



 

California was supposed to have the strongest state insurance exchange.  Covered California signed up the most people for Obamacare since October 1,2013. It was the model exchange. After January 1st, 2014 the problems became apparent.

As of Dec. 31, 2013, nearly 500,000 California residents had enrolled in health coverage through Covered California, the state's health insurance exchange created under the Affordable Care Act, according to data released Monday by HHS, KQED's "The California Report" reports.

Overall, California residents accounted for 22% of the total 2.2 million exchange enrollees nationwide (Aliferis, "The California Report," KQED, 1/13).

I would call this bragging without presenting the facts or the potential problems.

These are the potential problems.

According to the data, 85% of the 498,794 Californians who have enrolled in coverage through Covered California received a federal subsidy, compared with 79% nationally (Seipel, Contra Costa Times, 1/14).

The state and the federal government will have to come up with the subsidies. The result will be higher premiums for those that pay full premium price and increased taxes for those who pay taxes.

The data also show that:

  • 61% of enrollees chose a silver-level plan; and
  • 23% chose a bronze-level plan ("The California Report," KQED, 1/13).

          52% of enrollees were between ages 45 and 64 ("The California Report," KQED, 1/13); and

  • 25% were between ages 18 and 34 (Contra Costa Times, 1/14).

 The number of enrollees is different than the number of people who definitely are insured. Enrollees are not insured until they paid their premiums.

Even so, the enrollee mix, if it stays the same will necessitate an increase in insurance premiums and a bailout of the insurance companies. The insurance company bailout was built into Obamacare upon passage of the act.

The public did not know about insurance company bailouts until recently. 

In California consumers have not receive the coverage they thought they bought. Consumers are not able to see physicians who were caring for them before the new year. Many cancer patients who require continuing care have not seen been able to see their physicians.

Seventy percent of the physicians in California have not signed up to accept Covered California because reimbursement is too low.  

 The White House was dealt a stunning new blow on Obamacare sign-up numbers:

“Reports have leaked showing that only about half of the people "enrolled" at healthcare exchanges in various states have actually paid their premiums.”

“Minnesota's exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.”

 “But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November's pace of less than 700 per week.”

  “As of Feb. 1, Nevada had just 14,999 paid enrollees — vs. the state's March 31 goal of 115,000.”

 “Washington state, meanwhile, was slightly more than halfway to its goal of 340,000 signups — but only 88,071 had paid as of Feb. 1.”

 “The January data available from a handful of states raise new doubts about whether ObamaCare's downgraded first-year prospects are still too optimistic.”

These numbers have been kept out of the mainstream media.

 The poor premium payments by enrollees of 50% in Washington and 66% in Nevada creates a risk that the demographics of the paid exchange population may be older and possibly sicker than the information the Obama administration has publicized to get more people to enroll.

This is only a partial list of President Obama’s present deceptions.

 A complete list of the 35 changes made to the law by executive order without consent of congress is in order about now.

Why are so few in Congress speaking out?

When are the people going to speak out?

Congresspeople who do not speak up should not be reelected!

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

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What An Experience!

February 2, 2014
inMedicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Every congressman should try registering a poor (below poverty level) constituent for Obamacare aid.

If you have not, you do not deserve to be in office or have a vote.

Most of you know my story of Moses and his healthcare insurance. I have tried to obtain Medicaid healthcare coverage for both Moses and his wife in the past in Texas. I failed after trying hard.

I had been successful in registering his kids for SCHIP.

Moses annual income qualifies him and his family for Medicaid in Texas. Texas is a state that isn’t expanding Medicaid.

You might recall that Medicaid is not great insurance. The reimbursement is extremely low and there are few physicians who participate.

If Moses lived in a state that is expanding Medicaid, he could earn up to $32,500 dollars per year and still qualify.

"If your state is expanding Medicaid, you’ll probably qualify if you make up to about $15,800 a year for 1 person ($32,500 for a family of 4). (These are 2013 numbers, and likely to be slightly higher in 2014.)"

 "If your state isn’t expanding Medicaid in 2014

Some states aren’t expanding their Medicaid programs in 2014. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls.

Moses earns less than $23,500 a year. He should qualify for Medicaid in Texas.

I have encouraged him to apply for Medicaid using the Obama Health Insurance Exchange in Texas. Texas has a federal Health Insurance Exchange.

I offered to help him fill out the application online at the beginning of December. He did not want to bother me.

He said he had a friend in North Texas who works for one of the Texas insurance  companies. He said his company has people who help people like Moses fill out the healthcare insurance application. He said they are called Navigators. 

I told him the Navigator should be able to help him complete the application. The insurance company assigned him a Navigator in Las Vegas, Nevada.

Moses said she was very nice. She asked Moses all of the questions over the telephone.

I called him on December 12th and asked him if he had insurance yet. If you recall President Obama extended the deadline for applying until December 23th and then December 31th in order to have coverage for January 1st, 2014.

Moses said she told him she did not understand why his application was not accepted.  I told him to call her every day and find out what is going on.

She was going to try again the next day. It sounded like she tried at least every other day through December 31st and failed to get any information or his application accepted.

I told him to keep having her try. This went on through the next extended deadline of January 15th. She said could not understand it. I couldn’t understand it either.

Everything I read said the web site healthcare.gov was working smoothly. However, the back end was not connected to the application process.

 She was unsuccessful through January 30th. On January 30th I told him to come over. I would try and I would fill out an application online for him.

Again he did not want to bother me. I insisted. In the meantime another friend in North Texas connected him with a Spanish speaking Navigator in North Texas.

The Navigator called him when we were about to start filling out the application. After speaking with Moses in Spanish, he asked to speak to me. He practically begged me to let him complete the application for Moses and get him healthcare insurance.

I said O.K.

He asked Moses to come over to him that afternoon. Moses went to him. They spoke for an hour. He then gave Moses a list of questions and a telephone number to call.

Moses told me the questions were complicated. He was afraid he would make a mistake in answering them. The Navigator told him he would not get Medicaid but he could buy a number of insurance policies.

I told him to let me try to register him online.

Last Thursday Moses came over to the house with his citizenship papers and social security numbers of his wife and two kids.

I started to complete the form at 9 am. I completed the form for him at 11.30 am. The form was long and tedious.

Ten seconds after the application was completed the health insurance exchange acknowledged the submission of application. It then accepted the application.

The next screen asked if I wanted to see coverage the applicant was qualified to receive. Within four minutes of accepting the application the message was sent that the application does not qualify for Medicaid. 

This decision seems impossible. Healthcare.gov is not connected to insurance carriers or government databases. The decision was too fast. It would have had to be done by hand.

In any event I clicked on the coverage the application was qualified for. As I clicked on that I noticed there was an appeals button on the previous screen. I figured I could get back to the appeals button shortly.

He was given a choice of healthcare policies. There was no discussion of the possibility of government subsidies.

See below.

  Scan

 The deductibles offered for his income level were outrageous. The lowest deductible was $1500 which he couldn't afford it.  

It was painful to see the dejection on his face.

I tried to re-log into his application.  Healthcare.gov would not recognize the registration number they had given him fifteen minutes earlier.

Where is his application?

When will he receive notification of his eligibility for subsidy?

How much subsidy will he receive?

How does he appeal the Medicaid decision?

Is there anyone out there that can help?

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

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Not One Dime In New Taxes

January 29, 2014
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

I received a note from a reader last week. I debated with myself whether or not to publish it. Americans have discovered, and are continuing to discover, President Obama’s many lies/deceptions about Obamacare.

He kept telling us that the law would only tax families earning over $250,000 a year. People earning less than $200,000 per individual and $250,000 per family will not pay a dime more in taxes.

“No family making less than $250,000 will see "any form of tax increase."

"I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."

Sources:  President Obama

Subjects: Taxes”

 

It has become apparent that President Obama and his administration have told the American people many lies during his administration. The lies are at best half-truths. President Obama promised us an administration that would be totally transparent and truthful.

Americans trusted him to live up to his promise.

Many believed him only to find out he was not telling the truth.

The traditional media has supported many of President Obama’s lies. This same media had zero tolerance for George H Bush’s (41) lie.

 “Read my lips’. No new taxes.”

 There are at least ten hidden taxes imbedded in Obamacare.

In the last few weeks we learned that an insurance industry bailout was imbedded in Obamacare. President Obama knew about the bailout at the time Obamacare was passed.

Nancy Pelosi was correct. “We won’t know what is in the bill until we passed it.”

Americans used to trust their leaders. This administration has made us very cynical.

There is something called a “Medical Device Excise Tax.”  This medical device excise tax is in the original Obamacare legislation. The 2.3% tax is imposed on the manufacturers of the medical device.

The 2.3% is ultimately passed on to all, both the rich and the poor.

The reader sent me the following:

 "The 2.3% Medical Excise Tax that began on January 1st, 2013 as part of Obamacare’s tax structure is supposed to be "hidden" from the consumer, but it's been brought to the public's attention by hunting and fishing store Cabela's who have refused to hide it and are showing it as a separate line item tax on their receipts, the email states.

Cabella 2

I did some research and found directly from the IRS 's website information that PROVES this to be true and an accurate portrayal of something hidden in Obamacare that I was not aware of! Now being skeptical of this I went to the IRS website and found this!"

"Q1. What is the medical device excise tax? A1. Section 4191 of the Internal Revenue Code imposes an excise tax on the sale of certain medical devices by the manufacturer or importer of the device sales of taxable medical devices after Dec. 31, 2012.

Q3. How much is the tax? A3. The tax is 2.3 percent of the sale price of the taxable medical device.

See Chapter 5 of IRS Publication 510, Excise Taxes, and Notice 2012-77 for additional information on the determination of sale price.

 Chapter Five

So being more curious I clicked on "Chapter 5

of IRS Publication 510."

And what do I find under "MEDICAL DEVICES" under

"MANUFACTURERS TAXES"?

The following discussion of manufacturers taxes

applies to the tax on:

Sport fishing equipment;

Fishing rods and fishing poles;

Electric outboard motors;

Fishing tackle boxes;

Bows, quivers, broadheads, and points;

Arrow shafts;

Coal;

Taxable tires;

Gas guzzler automobiles; and

Vaccines."

"I think we have definitely been fooled, if we believe that the Affordable Care Act is all about health care. It truly does appear to be nothing more than a bill laden with a whole lot of taxes that we the people have yet to be aware of."

"Please pass this on. I am still incredulous that this can go on.

Where is our press ?  


What is next? What else is there we do not know about? God help us ."

 This is not the first time we have not been told the truth by this administration.

  

http://youtu.be/VQb8MFUn3QQ

However I did my own fact checking and discovered that the author misread Chapter 5 of IRS Publication 510 Excise Taxes, and Notice IRS Publication 510.

The publication deals with all things subject to excise taxes. Chapter 5 covers “manufacturers taxes” of which the medical devices excise price 2.3% is a part of.

The anonymous author found the list of items including fishing equipment, bows and cars. Some of these excise taxes existed pre Obamacare.  Some of the manufacturers excise taxes are a result of Obamacare. They are all separate from the medical device excise tax.

The publication says the tax on fishing rods and fishing poles is a 10% excise tax not to exceed $10 per article.” The tax on fishing tackle boxes and electric outboard boat motors is 3 percent of the sales price. The tax on bows is even higher, at 11 percent.

Cabela’s sales reflect the manufacturer excise tax because the increase in cost of manufacture of the item is passed on to the consumer.

Cabela was wrong in adding 2.3% to the final bill. It misread the law. The sporting goods store realized its error the first week adding stopped adding the excise tax. Cabela repaid customers who were charged the excise tax.

One must think of the increase in price of an item to all consumers for the manufacturers’ tax is in reality a hidden tax to the middle class. It reduces the consumers’ purchasing power.

This is true for the tax on tanning bed salons also.

What additional Obamacare taxes are affecting the under $200k/$250k earners?

1. Obamacare Home Sales Tax increases taxes on unearned income by 3.8%. 

2. Obamacare increases the medical expense deduction threshold. Unreimbursed medical expense deductions will now be available only for those medical expenses in excess of 10% of AGI, which has been raised from 7.5%.  

3. Starting in 2018, the new health care law imposes a 40% excise tax on the portion of most employer-sponsored health coverage that exceed $10,200 a year and $27,500 for families.

Unions who have negotiated these healthcare plans for its members are upset because the tax will severely affect its membership. Members might elect to quit the union.

There are many more hidden taxes I have not discussed in this discussion.

Democrats now admit after going through the new Obamacare taxes line by line that those taxes will increase the tax burden and decrease the purchasing power of the middle class.   

President Obama has promised that Obamacare will help all Americans get access to quality affordable healthcare and new benefits, rights and protections.

So far Americans have seen the opposite occur.

The reaction to the Cabela incident is simply an indication of the middle class’ cynicism. President Obama promised people making less than $250,000 a year will not pay one dime more in taxes.

It is clear he knew that was a false promise at the time.

Americans do not trust President Obama anymore.

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

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Obamacare is Right On Schedule

January 26, 2014
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

Is President Obama trying to destroy the healthcare system in America?

Yes he is!

 Actually he is right on schedule to have Obamacare implode on itself.

 I remember when he told Barney Frank and John Kerry not to worry about not including the Public Option in the Affordable Care Act.  We will get to a single party payer system.

  

http://youtu.be/f3BS4C9el98

  

http://youtu.be/-522hcm3woA

They did not understand how President Obama could make such a compromise. They thought the Public Option was the only way in the Affordable Care Act Obamacare) to get to their goal.

The goal was a single party payer system.

They did not have the votes then and they do not have the votes now.

President Obama has used a lot of trick plays to get his way in passing and implementing Obamacare. I have pointed out these trick plays along the way. They should be reviewed.

As hard as it is to believe, it seems that President Obama wants his legacy legislation Obamacare to fail.

Otherwise he would not have had Obamacare constructed with so many perverse incentives for stakeholders.

The only route to success is to align both primary and secondary stakeholders incentives. Obamacare is misaligning all of the stakeholders' incentives.

The incentives are more misaligned now than they were in the dysfunctional healthcare systems days before Obamacare.

The stated goal of Obamacare was to provide affordable healthcare insurance to all, with access to quality care to all without rationing of care.

The effect of Obamacare has been just the opposite. The healthcare insurance coverage will not be universal. It is unaffordable to many in the middle class. It is also unaffordable to many of the subsidized poor that do not qualify for Medicaid. There is limited access to care. There is an increase in the rationing of care.

President Obama claimed Obamacare’s health insurance exchanges would create a competitive free market insurance system.

The health insurance exchanges would force the healthcare insurance companies to be competitive. Healthcare insurance competition would lead to a decrease in healthcare costs.

Health insurance exchanges have not worked as advertised. President Obama’s health insurance exchanges have not resulted in a competitive free market system.

Healthcare premiums have skyrocketed.

Healthcare insurance deductibles and copays are higher.

Hospitals and doctor networks are skimping for two reasons. Doctors and hospitals are choosing not to participate in Obamacare. Healthcare insurance companies are not electing to include many well known  doctor and hospital networks.

Many excellent drugs are not on the insurers' formularies because of the cost. When newer brand name medications are on the formulary the co-pays are unaffordable to patients who need them. Patients therefore do not fill the prescription.

The healthcare insurance premiums are often higher than what consumers previously paid for their private insurance pre Obamacare even after some consumers receive government subsides.

The Obama administration will conclude soon that the free market healthcare system does not work. 

The administration will claim that only healthcare system that will work is a government single party payer system.

However, President Obama has not created a free market healthcare system with his health insurance exchanges. It is a highly regulated market.

In his over regulated marketplace he has created incentives that have further misaligned stakeholders vested interests than they were pre Obamacare.

In the Obamacare system the healthcare insurance companies are led to believe they remain the king of the healthcare industry. They believe they can continue to control healthcare costs.

The government remains totally dependent on the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for government healthcare programs.

In performing these services the government has permitted the healthcare insurance industry to pad direct patient care costs with items that are insurance companies expenses and should not be counted as direct patient care.

The increased distortion is magnified when the government dictates the benefits the insurers must offer patients in the health insurance exchanges and the private insurance markets.

This causes the premium prices to skyrocket .

Consumers might not need these added government benefits. Consumers have no choice. They have to pay for unneeded benefits. These benefits are added to the cost of insurance as well as the net profit of the healthcare insurance companies.

The healthcare insurance industry is also permitted to choose their own networks of physicians and hospitals.

The insurance companies try to maximize their net profit at their lowest cost. Therefore they have kept the best hospital and physicians out of their networks. This affects the quality of care.

It must be realized that quality of care has not been adequately defined or accurately measured.

 In some cities and states consumers only have one insurance carrier. Other carriers have opted out. There is not even a pretense of competition.  This insurance carrier usually picks the hospitals and physicians that will accept the lowest reimbursement. The healthcare insurance industry is offering low fees to providers. They will take only those providers into their networks that accept those low fees.

An additional incentive distortion is the Obamacare requirement for the healthcare insurance companies to charge the same premium for anyone who signs up for Obamacare.  There is no risk weighting permitted.

The hope is all consumers will sign up and enable the industry to keep premiums down.This rule generates two negative incentives. The healthcare insurance industry must overcharge the healthy and undercharge the sick. Therefore the healthcare insurance companies try to attract the healthy and avoid the sick.

This has backfired on Obamacare. The healthy young have realized the trap. They are not signing up in the heath insurance exchanges.

Previously when they were employed the employer didn’t mind covering the young. The young help lowered the overall premium because they were young healthy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           &#
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There are only two options left to the government. Obamacare can bail out the insurance industry and bully the healthy and low risk young into buying healthcare insurance from the government health insurance exchanges.

Many cities, towns and stats have underfunded healthcare coverage commitments. These local commitments include retirees. These cities, towns and states can now dump these consumers into Medicare and the health insurances exchanges.

In addition, there are many people who have chronic illnesses who have been afraid to leave their jobs because they could not get healthcare insurance in the individual market in the past.

These patients can now obtain insurance in the health exchanges at the same cost as everyone else. This will further contaminate the risk pool and increase the health insurance exchange premiums.

The Obama administration figures all taxpayers will cover the added costs. Taxpayers will bail out insurance companies for the poor risk pools that are decreasing their profits.

It looks like the real purpose of Obamacare is to destroy the relationship between the employer and his employee by driving employees into the health insurance exchanges just as it has destroyed the relationship between the consumers and their physicians.

President Obama understood this as the bill was written.  

Small employers are dumping employees from their healthcare insurance plans into the individual market and the health insurance exchanges.

In 2015 group employer insurance will affect an estimated 80 million people. They will loss their insurance and be forced into the health insurance exchanges.

The insurance industry will quit providing insurance and President Obama’s plan  to have a single party payer will occur by default. 

Taxpayer will pay the difference through higher taxes. In the meanwhile nothing has been done in making healthcare premiums more affordable, access to care more available, quality of care better or preventing the rationing of care by a government body.

Consumers will not stand for government control over their healthcare decisions.

There is a better and cheaper way. It is to put the consumer in charge, not the government.

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

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