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More Disinformation From Paul Krugman

June 16, 2013
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

I
just finished watching the movie “Wag The Dog” starring Dustin Hoffman, Robert
DeNiro, Anne Heche, and Woody Harrelson. It is movie worth seeing again to
understand the Obama administrations campaign to promote Obamacare.

 Idiom
Definitions for 'Wag the dog'


To
'wag the dog' means to purposely divert attention from what would otherwise be
of greater importance, to something else of lesser significance. By doing so,
the lesser-significant event is catapulted into the limelight, drowning proper
attention to what was originally the more important issue.

Just days before a presidential election, a Washington,
D.C. spin doctor, distracts the electorate from
a sex
scandal by hiring a Hollywood film producer to construct a fake war with Albania. 

Paul
Krugman’s recent Obamacare article contains multiple misdirections and
half-truths. It offers fictitious examples that when stitched together sound as
if Obamacare is the greatest thing that ever happened to the American people.

Nothing
could be further from the truth.

Paul
Krugman declares that healthcare reform has worked in Massachusetts since 2006.
Therefore, Obamacare, which is essentially the same program, can work in the
rest of the nation.

“Massachusetts has had
essentially this system since 2006; as a result, nearly all residents have health
insurance, and the program remains very popular. So we know that ObamaCare —
or, as some of us call it, ObamaRomneyCare — can work.

Does
Massachusetts’ healthcare reform really work?

It
is true that nearly all Massachusetts residents are insured. The Massachusetts
government subsidized healthcare insurance sold in the Massachusetts exchange.
Physicians’ and hospitals’ reimbursement is only about 10% more than what Medicaid pays.

Massachusetts
physicians seem to be less willing to see the newly insured (with exchange subsidies) than Medicaid
patients even though the reimbursement is 10% more than they recieve for
Medicaid patients.

Physicians
are also less likely to accept Medicaid patients than privately insured
patients. This has resulted in a physician shortage for recipients of Medicaid.

In
Worcester Massachusetts there is a 3 months wait to see a primary care
physician. There is scalping for physician appointments in Worcester.

Patients
make appointments and then sell those appointment times to other patients that
have to see a physician quickly. The other option is to go to the emergency
room.

Many
of the healthcare policy wonks that wrote the Massachusetts law wrote the
Obamacare law. These same healthcare policy wonks believed that once everyone
was insured, patients would go to the doctor’s office for primary care rather
than to the hospital emergency room.

There
has been a decrease in the demand for care as a result of a decrease in the supply
of physicians. The result has been that hospital emergency room
traffic is higher today
than before health reform in
Massachusetts.

There
has been an increase in community healthcare centers manned by physician substitutes.
This traffic to community health centers is almost one-third higher than it was
before reform.

The
time it takes to get medical care is growing in every city and town in Massachusetts.  The wait to see a new doctor in Boston today is two months.  This is the longest wait in the entire
country.

The
only thing that has changed in Massachusetts is the cost of healthcare. A few
years ago the federal government had to bail out Massachusetts before it went
bankrupt. Massachusetts received 8 billion dollars for healthcare reform from
President Obama.

 

“On
balance, the only thing that seems to have changed in Massachusetts is that
patients are waiting longer. They are going to the same places to get care that
they went to before. They are getting the same care
from the same providers. In the
process, more money is being moved around. A lot more money.”

Paul
Krugman states “There are, however,
millions of Americans who don’t receive insurance either from their employers
or from government programs.”

I agree this
must be fixed. However, I believe Obamacare is going to make things worse.

“ They can get
insurance only by buying it on their own, and many of them are effectively shut
out of that market.”

This is
also true. However you cannot force businesses to do things they do not want to
do as Obamacare is attempting to do. You also cannot increase medical benefits
without raising healthcare insurance prices and permit the insurance industry
to take 40% off the top.

The
healthcare insurance industry will be taxed for every policy sold and the cost
will be passed on to consumers.

You also
cannot stop excessive demand for healthcare unless you provide incentives to
consumers to decrease demand. Obamacare provides incentives to increase demand
by expanding healthcare entitlements. The result will be a further increase in
federal and state taxes.

The tax
increase will further decrease investment and in turn increase unemployment.

Meanwhile
all large and small companies are decreasing full time employment to under 30
hours a week to avoid penalties for not providing healthcare insurance.

Who is
getting stuck?

Ordinary
consumers are getting stuck. Things are getting worse, not better.

In some states, like California, insurers reject applicants with past
medical problems. In others, like New York, insurers can’t reject applicants,
and must offer similar coverage regardless of personal medical history
(“community rating”).

 Community rating
is a concept associated with health insurance, which
requires health insurance providers to offer
health insurance policies within a given territory at the same price to all
persons without medical
underwriting, regardless of their health status.

Pure
community rating prohibits insurance rate variations based on demographic
characteristics such as age or gender, whereas adjusted or modified
community rating allows insurance rate variations based on demographic
characteristics such as age or gender in a region or city.

It has nothing to do with
requiring the issuing of healthcare insurance.

 He says by having community ratings,
“it leads to a situation in which premiums are very high because only those
with current health problems sign up, while healthy people take the risk of
going uninsured.”

This is a misinformed statement. If there are
many young people in a community the insurance rates should be lower regardless
of whether they have insurance.

 The
claims experienced by the healthcare insurer will be higher if the young people
do not sign up for insurance. Therefore the healthcare industry wants to set
prices on claims not community performance.

Again,
the government should not be able to force consumers to purchase a product they
do not want. The Supreme Court said the government could tax consumers if they
do not purchase healthcare insurance.

If the
tax is 10% of the cost of insurance and you cannot afford the insurance you
would pay the penalty and forgo the insurance. A consumer would also try to
avoid the penalty.

Paul
Krugman proclaims the principles Obamacare demands.

Obamacare closes this
gap with a three-part approach.

 First, community rating everywhere — no more
exclusion based on pre-existing conditions.

This is
good but costly unless you change the profit structure for the healthcare insurance
industry.

Second, the “mandate”
— you must buy insurance even if you’re currently healthy.

This is
against the law.

Third,
subsidies to make insurance affordable for those with lower incomes.

This
is also O.K. but it will create a situation that is unsustainable for the
federal government. The federal government is going to want to stick the
unsustainable costs on to the states after the first three years of complete
federal funding. The federal government cannot afford the first three years.

Paul
Krugman then goes on to play the very effective blame game.

“Some people are too
poor to afford coverage even with the subsidies. These Americans were supposed
to be covered by a federally financed expansion of Medicaid, but in states
where Republicans have blocked Medicaid
expansion, such unfortunates
will be left out in the cold.”

I thought
the Obamacare was going to set up health insurance exchanges in states that
refused to participate.

 Paul Krugman goes on to say,

“There will
probably be a lot of administrative confusion as the law goes into effect,
again especially in states where Republicans have been doing their best to
sabotage the process.”

“States like
Texas whose politicians are doing their best to undermine it, the sheer mean-spiritedness
of the Obamacare opponents will become ever more obvious.”

Maybe,
just maybe Texas and the governors of the other 24 states that are not
participating because they are smart. They see the coming train wreck. They
understand that Obamacare is unsustainable. They do not want to be stuck with
the obligation to adopt an unsustainable program. They want to avoid bigger
state deficits. They want to avoid raising state taxes for a program that
cannot work.

If the
Obama administration wants to execute the program let it do it on its own.

The Obama
administration has not taken steps to set up health insurance exchanges in
states that are not participating.

They are
taking steps to develop a campaign to promote Obamacare and steps to blame the
states that are not interested in participating in its demise.

Paul
Krugman is a pawn for the Obama administration. He is helping the
administration construct a similar blame game scenario that had been so
effective in passing Obamacare and in winning reelection for President Obama.

The states
that are not participating should organize and offer a strong offense
describing the obvious reasons they are not participating in the health
insurance exchanges.

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

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Obamacare’s Medicaid Deals With States Are Deceptive

June 2, 2013
inDisinformation and the healthcare system, Medicaid, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP, MACE.

Tennessee Gov. Bill Haslam (R.) has asked the
Obama administration for flexibility in implementing Obamacare's Medicaid
expansion; he has been rebuffed.

It is becoming clear to me that the Obama
administration is heavy on the posturing and light on the reform. The goal
seems to be to have the healthcare system fail completely in order to create a
public panic.

The panic will result in the federal
government taking over the healthcare system completely and instituting a
healthcare system that controls patients, physicians and hospitals.

Some might call it socialized medicine. I
call it total impingement on incentive, initiative and innovation which will decrease
productivity and economic growth.

This is all being done by the Obama
administration with a total disregard for cost. President Obama’s assumption is
cost overruns can be covered by increased taxes. However, he is not considering
the effect of increased taxes on economic growth. He is also not considering
the effect of increasing taxes and increasing the money supply on purchasing
power. An increase in economic growth usually translates to an increase in GNP
and increased federal revenue.

Several examples come to mind
immediately.

  1. States
    who have thought out the Obamacare expansion of Medicaid through health
    insurance exchanges have discovered that they are going to have tremendous cost
    overruns when the federal government stops paying the total costs. Originally the
    federal government was going to share the costs with the states.
  2. The
    100% federal funding will be in effect only from 2014 to 2016. Then the states
    pick up their share of the burden. The problem is the federal government will continue
    to control all the rules. This leaves no room for states to be innovative.
  3. We
    have seen HHS refuse to give Indiana’s Medicaid improvement plan a waiver even
    though it is wildly successful. Its success can be attributed to several
    factors.
  4.  It
    provides incentives for patients not to overuse the system.
  5.  It
    expands the income requirements for eligibility into the system.
  6. The
    definition of poverty is an obsolete 1955 definition. Obamacare eligibility
    requirement is 133% of the poverty level or $14,400 per year.
  7.  Indiana requires eligible consumers to put up a
    small percentage of their income (2-5%)     to enter into its Medicaid system. It
    also permits recipients to put money not spent into a health saving account for
    future use.
  8. The
    effect of this is to encourage patients not to overuse the healthcare system
    and not to show up in emergency rooms for care that can easily be performed in
    less complex facilities.
  9. Simple observations have led to intensive
    studying of the population that costs the most money to treat. 

 It turns out that, “According to a report released earlier this year by the Agency for Healthcare Research and Quality,
1 percent of patients accounted for roughly a fifth of all health care spending
in 2009, or more than $90,000 per person. Five percent of patients accounted
for half of overall health care costs. By contrast, 50 percent of patients
accounted for only 3 percent of health care spending, the AHRQ report found.”

The high spending by this small
percentage of high utilizers is not linked to a patient simply being uninsured
without access to a primary care physician.

According to a recent report from
the IMS Institute for Healthcare Informatics,
1 percent of patients in a survey of 10.6 million health plan members accounted
for 25 percent of their plan's total costs, and 5 percent accounted for
slightly more than half, mirroring the AHRQ survey.

Most ER physicians and social workers
know who shows up in emergency rooms over and over again and which patients are
readmitted to the hospital over and over again. These physicians also know the
reason for this. However, no one ever asks these physicians the reasons.

Isa Gorman analyzed the data
of the value of insurance for the indigent in saving lives.” Does Lack of Health Insurance
Kill?” She demonstrates that all the studies that support
the notion of a lack of insurance are in error.

The Richard Kronick study proves they are wrong.

Kronick found that “adjusted for demographic, health status, and
health behavior characteristics, the risk of subsequent mortality is no
different for uninsured respondents than for those covered by
employer-sponsored group insurance at base line.”


 He concluded that “the
Institute of Medicine’s estimate was that lack of insurance leads to 18,000
excess deaths each year is almost certainly incorrect.”

Arkansas Gov. Mike Beebe (D.) first announced that he had reached
a deal with the Obama administration to use the Affordable Care Act’s private
insurance exchanges to expand coverage to poor Arkansans.

His Democratic base for the deal congratulated Governor Bebee.
Arkansas was able to accept health insurance exchanges. The Republican majority
in the state’s congress was skeptical. 

Governor Beebe reached a deal with
Kathleen Sibelius to provide the poor in Arkansas with higher quality private
insurance through the health insurance exchanges.

“Then the Good Friday memo came from HHS stating that its deal
with Arkansas is not that different from its traditional endorsement of the use
of private managed-care plans to administer the Medicaid benefit.”

“The memo makes clear that it will only permit state variations on
the coverage expansion that are “comparable” to what HHS would have spent
otherwise.”

“The HHS memo explicitly
states that these private plans cannot modernize the design of Medicaid
insurance to make it more cost-effective.”

 Governor Beebe was surprised and deceived.

“A Good Friday memo from the U.S.
Department of Health and Human Services, however, splashes cold water on that
aspiration. It’s now clear that the Beebe-HHS deal applies a kind of
private-sector window dressing on the dysfunctional Medicaid program, and it’s
not obvious that the Arkansas legislature should go along.”

According to the
law these low income individuals will be automatically enrolled in Medicaid with
significantly expanded insurance coverage. Medicaid
has been plagued by concerns about its quality, access, and financing virtually
since its inception.

Obamacare is
supposed to add 17 million new patients to the rolls of Medicaid.

Medicaid had posed a severe fiscal threat to many
state budgets. The federal restrictions on the states Medicaid program’s
management has limited the state’s ability to manage states budgets and adjust
payment of the severe low reimbursement to Medicaid providers.

The result has been severe underpayment of
physicians. The underpayment resulted in a lack of physicians’ participation in
the Medicaid program and limited access to care. In turn this has led to
significantly worse outcomes and higher mortality rates for Medicaid recipients
vs. private insured and Medicare.

“Under
the Obamacare, individuals and families with incomes between 138 percent and
400 percent of the Federal Poverty Level (FPL) will be eligible for generous
premium subsidies and cost-sharing credits, which they can use to offset the
cost of purchasing private insurance on state or federal insurance exchanges
created under the law.”

I have a feeling Governor John Kasich (R)
of Ohio fell for the same bogus deal as he agreed to sign up for the health
insurance exchanges. His Republican base is screaming their lungs out.

He will get his rude awaking soon as HHS
changes the deal he thought he got.

Medicaid is a failed program medically
and fiscally. Adding more recipients is not going to solve Medicaid problems.
Accepting the health insurance exchanges is going to make the states’ budget
problems worse.

An innovative program such as Indiana’s
Health Plan can do much more toward making Medicaid viable. The Obama
administration has objected to this plan.

Why? I can think of several possible reasons
including the desire to have the healthcare system result in total collapse.

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

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  • stairlifts • October 2, 2013

    This is my first time visit at here and i am actually impressed to read all at alone place.

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Another Obama Political Campaign Has Started

May 26, 2013
inDisinformation and the healthcare system, Medicaid, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld
M.D.,FACP,MACE

I have predicted Obamacare will fail ever
since its passage. Proponents of Obamacare believe Obamacare is America’s last
hope for meaningful healthcare reform with affordable care for all.

They now admit there are some problems
with Obamacare but little tweaks will fix it.

Obamacare is not America’s last chance for
healthcare reform. Obamacare is a series of regulations pasted on to an already
dysfunctional healthcare system. It is destined to collapse on it own weight
and regulations. There are over 20,000 new regulations to date with thousands
coming each week as we get closer to January 1,2014.

I believe the business model I outlined
using 2013 technology is the system that will align all the stakeholders’
incentives and provide universal care at an affordable cost for all.


It will provide freedom of choice and
enhance the patient physician relationship. It will be a system that is patient
centered as opposed to Obamacare being government and outcome centered.

An outcome centered healthcare system puts
the government and the healthcare insurance industry in control of medical care
decisions. It will control access to care and result in rationing medical care.

The passage of Obamacare was a political
farce.

The bill was slipped through the Senate just
before dawn three Christmas eves ago with only one Republican vote in both
houses of congress. Obamacare is not a bipartisan act.

Nancy Pelosi told the American public and congress
that we would not know what is in it until we pass it.

We have been told that most of congress has not
read the act completely.

The new entitlement’s start-up date is October
2013. The implementation date is January 1,2014. No one is ready for either
date.

 “The size and
complexity of the Affordable Care Act meant that its implementation was never
going to easy. But behind the scenes, even states that support or might support
the Affordable Care Act are frustrated about the Health and Human Services
Department's special combination of rigidity and ineptitude.”

Individual
state governments have tried to get a clear idea of how Obamacare would work in
practice with the health insurance exchange.

 The states are terrified of the economic burden the health
exchanges could impose on their deficit-ridden states.

The Supreme Court has given the states a choice of signing on
whereas there was not a choice in the original bill.  

Some states felt they could not turn down the health insurance
exchange because the Obama administration was offering them too much money,

The Obama administration is starting to make preliminary deals
with states that have rejected the health insurance exchanges at this point.

The administration is giving Ohio and Arkansas more money to pay
for health insurance for people earning up to 133% above the poverty level. (Income
of $14,400 a year). This deal nowhere as creative as the Indiana Health Plan
and will cover many fewer people.

This offer will not cover people who really need insurance.

The preliminary deals with Arkansas and Ohio will be more costly
that deals with other states. It is questionable whether the Obama
administration has the authority to spend the additional money.

As new regulations keep being produced none of the real hard
operational questions are being answered.

A regulation usually requires 60 days of public comment. The Obama
administration has unilaterally shortened public comment to 30 days. The shortened
public comment period for new regulations can be challenged by the states and
congress.

There are other problems that states are having with Medicaid and
Obamacare. Many feel that HHS is treating states not as partners but as serfs
to the federal government.

The central government is building a data hub to determine who is
eligible for Medicaid and Obamacare health insurance exchanges. This new
federal bureaucracy will dispense insurance subsidies and police the market.

Many states want to cut their administrative costs to balance
their budget. They are combining the application process for Medicaid, food
stamps, cash assistance and other antipoverty programs into one agency.

HHS's privacy rules say the hub can only be used for Obamacare.
HHS will force states to become less efficient by having a free standing
bureaucracy for Obamacare and has flatly refused to consider participating
states’ requests for combining all the agencies under one roof.

Twenty-four (24) states have still refused to participate as of
May 15th. The Obama administration will have to run a federal
exchange in those states.

HHS has not revealed how it will handle these exchanges. The
agency running the federal exchange won't reveal how it will operate.

The irony is that many of the states would participate if HHS gave
them more flexibility to manage their own programs and control costs.

“At a House Energy and Commerce hearing on Thursday, Obamacare
point man Gary Cohen all but took the Fifth on how he'll deal with this and
other challenges.”

It seem as if it is going to be a vast
undertaking that can not possible be in place in October or operational on
January 1st, 2014.

Chris Christie (N.J.) and Bill Halsam
(Tenn) wanted to participate but now feel the health insurance exchange in not
a sane or rational marketplace. The costs
and risks were too high.

“This is all-or-nothing
political gambit is meant to put the governors of states not participating in a
bad political spot at home if they don’t participate.”

“At this point, the total administrative burden on the federal
government has massively increased. Yet neither the federal government nor the
states have the human or financial resources to discharge these tasks in a
timely fashion, making it highly unlikely that these exchanges will be up and
running by January 1, 2014.”

 

 

 Making things worse for
Obamacare is no fewer than 18 Democratic Senators came out against Obamacare's
$28 billion tax on medical device sales.


The list of Democratic Senators
includes Chuck Schumer, Dick Durbin and Patty Murray. Either they believe it or
the lobbyists got to them.

The medical device industry has received little
guidance about how to comply with the tax. This has caused significant
uncertainty and confusion for medical device businesses.

These are some of the problems Obamacare is
facing.

President Obama is unfazed. In the face of criticism from
Democrats about his incompetent implementation of Obamacare, he is going on the road to spin some misinformation and make it
look like Obamacare is great and his critics are political.

President Obama co-opted
Mother’s Day in his latest campaign to sell Obamacare that begins now and will
last until the 2014.

President Obama kicked off
another campaign-style effort to get people to sign up for the so-called
Affordable Care Act.

“In a
statement dripping with condescension Obama tried to blame misinformation for
his health care troubles.”

He said, “Precisely because there’re been so much
misinformation, sometimes people may not have a sense of what the law actually
does.   

He continued,   “We’re going to need everybody out there to make sure
they get the right information.”

“Don’t
just read a blog or some commentary from some pundit that has a political
agenda.  Make sure you know what the actual facts.”

Don’t
let people confuse you.  Don’t let them run the okeydokey on you. 
Don’t be bamboozled.”

Doesn’t this sound like his
political campaign of 2012?

President Obama seems to
have forgotten that a lot of misinformation about Obamacare results from his
statements.

Wasn’t he was the guy that
said, “If you like you doctor you will be able to
keep your doctor and if you like your healthcare plan you can keep your
healthcare plan.”

None of this is true
including free choice, affordable healthcare insurance, and free access to
care.

I wonder when Americans are
going to get tired of President Obama’s misinformation and false promises.

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

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  • save electricity • October 14, 2013

    Quality articles or reviews is the key to interest the visitors to go to see the site, that’s what this website is providing.

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Chargemaster Data And Transparent Pricing

May 22, 2013
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

 The
chargemaster, or charge description master (CDM), is a
comprehensive listing of items billable to a hospital patient or a
patient's health insurance provider. It is published every
year from billing data and payments.

 Chargemasters include
thousands of hospital services, medical
procedures, drugs, supplies, and diagnostic evaluations such as imaging and
blood
tests.

Each
item in the chargemaster is assigned a unique identifier code and a set price
that are used to generate patient bills.

The
impact of the chargemaster is such that those with good insurance pay the least for that care,
whereas the uninsured, and others who pay out-of-pocket for healthcare
pay the full chargemaster listed price for the same services.

There are multiple
list prices for hospital services and one price the government pays. Some of
the list prices are unconscionable. They are not tied to the cost of the
service. A drug most often quoted is the price of an aspirin. An aspirin cost a
penny a pill. Hospitals charge $45.

With the ubiquitous
Internet, we as patients and we as physicians can easily look up what the
hospital systems are overcharging for each service and procedure.

Both the list price and the price
paid by the government’s for each hospital system is in the report. The
government pays different hospital systems in the same area different prices.  The reason for this is not transparent.

When I send a patient for a test in
the hospital, I have no idea of what the test costs the patient. If I knew the
prices and felt the patient was overcharged, I would sent the patient another
hospital for that test. 

There are two important issues
to notice here.

 1. Hospital
systems are trying to buy physicians practices so physicians have no choice
for his patients.

 2.Hospital
systems are trying to consolidate with other hospitals so physicians cannot
send their patients to another hospital system.

3. The Obama government thinks this is a good thing. I think decreasing local competition
is a bad thing for patients.

"The important issue will be for
those folks that end up having to deal with chargemaster charges, which is the
uninsured consumers,"

Chargemaster is "For them and their advocates, something to use in
negotiation around how the cost of their care should be discounted."

It will not affect the insured who already
have had prices negotiated by their healthcare insurance company. However, many consumers are going
to be uninsured as companies drop it healthcare insurance coverage. Consumers might choose to go bare.
All of a sudden prices will be forced to be transparent.

Something unfair is still going on. The average Medicare payment
for people treated for respiratory infection and inflammation with major
complex comorbidities ranges from $24,084 at the University of California San
Diego Medical Center, to $18,862 at Sharp Memorial Hospital to $11,989 at
Pomerado Hospital.

Treatment given in each hospital system is probably not different. The political connections are different.

These price differences go on all over the country.

The distraction from the politics in the chargemaster
list price for the respiratory infection described above was as high as
$133,347 at Sharp Chula Vista Medical Center. This difference between list
price and paid price is absurd.  Hospital systems search for the highest price they can get.

Medicare Advantage plan beneficiaries might find chargemaster
very useful.

If they go to a hospital out of network they might find
themselves liable for the entire retail price of the hospital charges.

The rules are unfavorable to Medical Advantage
policyholders.

The Obama administration wants to eliminate the popular
Medicare Advantage program.

The trick for Medicare Advantage patients is to go only
to hospitals within the network for their plan.

“Joseph Fifer, President
and CEO of the Healthcare Financial Management Association, says he thinks
“hospitals should publish all of their charges for all of their DRGs on their
webpages. And that will happen, he thinks, but it will take some time.”

Until now, he says,
"hospitals didn't know what other hospitals were charging. The restraint
of trade lawyers would put the fear of God into their chief financial officers
saying, we can't find out what the pricing is at other hospitals for fear of
(being accused of) anti-trust behavior."

This is a hollow
excuse not to create transparent fees and to continue to confuse the public.

 I believe the government should require
hospital systems to post prices that the government pays for services,
procedures and hospitalization.

If a hospital
system refuses to post its prices, the state government should withhold that hospital
systems license until it does.

The alignment of
incentives should alway be in favor of consumers.

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

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Obama Administration Continuously Declines To Renew Indiana’s Medicaid Waiver

May 19, 2013
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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 Stanley Feld M.D.,FACP,MACE

In light of the recent alleged IRS
scandel targeting certain groups, I am reminded of the Medicaid incident in
Indiana. I believe the incident is resolved now with the Obama administration
granting a waiver to Indiana after two years of bureaucratic haggling.

In 2007 Governor Mitch Daniels (R.) was
successful in getting the Indiana state legislature to pass a Medicaid reform
plan called the Healthy Indiana Plan. It is an expansion of Medicaid. It uses a consumer-driven
health plan to encourage low-income beneficiaries to take control of their
health and healthcare dollars.

This healthcare plan is a variant of my
ideal medical saving account.

 The Healthy Indiana Plan has been very successful.

Healthy Indiana Plan has been the most
innovative and successful reform of Medicaid in the history of the Medicaid
program.

The federal government’s waiver for the
plan was given in 2007 and set to expire on December 31, 2012. Indiana applied
for an extension of the Medicaid wavier in early 2011. In November 2011 the
Obama Administration rejected the state’s request to extend its federal waiver.

Over 45,000 poor Hoosiers on Medicaid
were scheduled to lose this innovative Medicaid coverage in 2013.

Medicaid is theoretically run by the
states in cooperation with the federal government.  In reality, any time a state wants to make
the tiniest changes in its
Medicaid program, it has to go hat-in-hand to the U.S. Department of Health and
Human Services with a formal request for a waiver and these waivers are usually
denied.

 This federal control has been part of the
disagreement states have with the federal government over health insurance
exchanges. The central government wants to shift the financial burden on the
states while controlling the states’ decisions.

Indiana succeeded in gaining a waiver in 2007
because it was seeking to expand Medicaid to
a group of people who weren’t then eligible for the program and because the
state’s effort required no additional outlays from the federal government.  Governor
Mitch Daniels paid for the
Medicaid expansion by increasing the state’s cigarette tax by 44 cents. It made
sense to everyone except the people that smoked. 

Patients had skin in the game because
they had to pay 2 -5% of their income for their insurance coverage. The plan
provided financial as well as wellness incentives.

“We did a lot of reading on
criticism of health savings accounts,” says Seema Verma, who was the architect of the Indiana
program. “One of the criticisms was that people didn’t have enough money to pay
for preventive care. So we took preventive care out, made that first-dollar
coverage.

“ Also, people said that people didn’t have enough for the
deductible, so we fully funded it. Then, you have to make your contribution
every month, with a 60-day grace period. If you don’t make the contribution,
you’re out of the program for 12 months. It’s a strong personal responsibility
mechanism.”

 I described the Healthy Indiana plan in
detail in January 2008 pre President Obama.

Medicaid patients get a specified amount
of preventive care for free.  Included
are free annual physical exams, pap smears and mammograms for women,
cholesterol tests, flu shots, blood glucose screenings, and tetanus-diphtheria
screenings.

Medicaid beneficiaries have no
cost-sharing requirements (co-pays, deductibles, etc.) except for non-urgent
use of emergency rooms.

The money remaining in the Medicaid
patients’ POWER accounts at the end of the year can be applied to the following
year’s contribution only if they obtain the required free preventive disease
services.

“The program has been, by many measures, a smashing success. “What
we’re finding out is that, first of all, low-income people are just as capable
as anybody else of making wise decisions when it’s their own money that they’re
spending,” Mitch Daniels explains in a Heritage Foundation video.”

“And they’re also acting more like good consumers. They’re
visiting emergency rooms less, they’re using more generic drugs, they’re asking
for second opinions. And some real money is starting to accumulate in their
[health savings] accounts.”

The program has been
very popular. Ninety (90) percent of enrollees are
making their required monthly contributions. Employers didn’t dump their
workers onto the program, crowding others out, because you needed to be
uninsured for six months in order to be eligible for it.

 “The program’s level of
satisfaction is at an unheard-of 98 percent approval rating,” Verma told Kenneth Artz.

Lower income families are not too stupid
to be wise healthcare consumers despite popular belief.

A 2010 study by
Mathematica Policy Research found that in the program

71 percent met the preventive care
requirement and were able to roll the balances over to the following year.  Only 39% obtained preventive care in the
first six months. It proves financial incentives work.

The lack of physician access is the
biggest reason why health outcomes for Medicaid patients lag far behind those
of individuals with private insurance.

Healthy Indiana pays better than
traditional Medicaid. The physician access trend has been reversed. Preventive
care participation rates are higher than the
privately-insured population.

Why would the Obama administration, which
controls the states’ Medicaid programs, refuse to grant a waiver for Indiana’s successful
program?

The first excuse HHS used was “ HSS  hadn’t written the regulations for Obamacare
yet.”

According to Seema Verma  “the state will now have to file a much more
complex “State Plan Amendment” that may not get approved before the Healthy
Indiana program is set to expire.”

Before his term expired Gov. Daniels
had written to HHS Secretary
Kathleen Sebelius asking her for permission to use the Healthy Indiana Plan to
handle Obamacare’s mandatory expansion of Medicaid. He had not heard back.

The Obama Administration claims to be on
the side of the poor.  Why would it not
approve a waiver of a popular program for the poor that provides the poor with
superior health care?

Whatever the reason, tens of thousands of people will be
needlessly harmed.

Regulatory
burdens and “poison pills” have been thrown at the Indiana health plan. One
such poison pill is not allowing the state to include the $1100 Power account given to Medicaid patients to make
wise medical care choices.

Yet
the government pays the healthcare insurance industry for help desks and rent
for buildings where there are help desks as direct patient care instead of
expenses.

It is
not only bewildering, it is obscene.

The
controversy continued throughout 2012 past the expiration date of the 2007
waiver into 2013.

Mike
Pence, the new governor, kept fighting off bureaucratic rules but got nowhere
through March of 2013.

The subtext of all of this is the
Obama administration wants a top down centrally controlled Medicaid system with
the financial burden on the states and Indiana wants to control its own destiny
with its successful plan.

Stuff
like the following has been going on. Diane Gerrits, CMS' director of state
demonstrations and waivers, wrote in a Feb. 25 letter that the state will have
to resubmit its application because it had not yet held two public hearings
required by law.

CMS said as a result of the failure to comply with the transparency portion of
the proposal, the state must begin a 30-day state public comment and notice
period. The state must follow with an additional 30-day federal public comment.

This
has been going on since 2011

Governor
Mike Pence fired back,

 "The Feb. 25, 2013, letter from HHS does not
indicate in any way that the waiver application process has been
jeopardized," he wrote Thursday. "It does, however, speak to the
flawed bureaucratic process that has impeded progress on our successful Healthy
Indiana Plan."

The
Obama administration is trying to destroy all health savings accounts both
public and private. This is probably the reason for these artificial delays.

Suddenly,
in mid April, under public pressure and possibly the impending IRS scandal Indiana’s
waiver request was approved.

This
is a happy ending to the Indiana saga and perhaps a model to get all the
Medicaid programs out of the deep ditch they are in.

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

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Why Does Congress Want to Exempt Itself from Obamacare?

April 30, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

 Stanley Feld
M.D.,FACP.MACE

In mid-April
Max Baucus one of the authors of Obamacare and a major proponent of the law
made the following statement to Health and Human Services Secretary Kathleen
Sibelius at a Senate hearing.

 

 
.
 
 

 

http://youtu.be/Y9airckwqA8

Unfortunately only 11,723 people watched this 29 second You Tube.  The traditional media gave his statement
sound bite coverage without explaining the reasons for him saying Obamacare is
going to be a "train wreck."

West Virginia Senator Jay Rockerfeller said Obamacare is beyond
comprehension.

  

Only 157 people looked at this You Tube whick has been up for 3 weeks.

It would have
been a good idea for congress to have read and understood the bill.

Meanwhile, congressional leaders in both
parties have been engaged for months  now in high-level, secretive confidential
talks about exempting lawmakers and Capitol Hill aides from Obamacare’s  health insurance exchanges that they are
mandated to join as part of President Barack Obama’s health care overhaul,
sources in both parties said.

These talks involve the Obama administration,
Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner
(R-Ohio), along with other top lawmakers.

“These talks are extraordinarily sensitive,
with both sides acutely aware of the potential for political fallout in the
2014 mid term elections from giving carve-outs from the hugely controversial
law to 535 lawmakers and thousands of their aides. “

Politico
along with other Internet news agencies has been the only news agency to have
in depth coverage of this attempt to exempt congress and its aids from
Obamacare and its health insurance exchanges.

Henry Chao, the Administration’s chief
technical official in charge of  the
implementation of the Obamacare’s health insurance exchanges, “just hopes that Americans can avoid a “third-world experience.”

Why would both
Democrats in congress want to avoid participating in Obamacare and its health
insurance exchanges?

We need to
be reminded that the Democrats had overwhelming majorities in both houses of
congress at the time of passage of the law in 2009 without a single Republican
vote.

I am
reminded of Nancy Pelosi’s argument for Obamacare's passage.


  

http://youtu.be/KoE1R-xH5To

 Now that
congress knows what is in Obamacare they want to be exempt.

Congress is content to let the rest
of us suffer.

What is
congress afraid of?

 

  1. Higher
    healthcare costs for themselves, their families and their aides.
  2. Being
    mandated into Obamacare’s health insurance exchanges will result in  them not qualifying for government subsidy.
  3. Congresspersons and their aids could
    also lose their employer-based coverage.
  4. This is also true for millions of
    ordinary Americans.
  5. They would also face higher costs of
    insurance through health insurance exchange.
  6. Every policy the healthcare insurance
    industry sells will be taxed. It will result in passing the tax on to the
    policy holders.
  7. Contrary to the President’s promises, independent analysts expect health insurance premiums to
    rise sharply, particularly for younger workers and their families.       

Congressional
members have other fears if they fail to create an exemption for themselves and
their aides. These fears are:

1. They fear the
impact on Capitol Hill employment.

2. The increase in healthcare insurance
costs “could lead to a ‘brain drain’ on
Capitol Hill, as several sources close to the talks put it.”  

3. Ordinary Americans who run businesses
are also faced with the same problem. President Obama and Democratic
congressmen have refused to be responsive to the dilemma faced by ordinary
businessmen.

4. American business owner fear they will not
be able to hire or retain valued employees.

5. These businessmen are presently
reducing full-time workers to part-time employees in order to avoid Obamacare’s
mandatory insurance coverage or penalty.

6. This will have the consequence of
increasing the unemployment rate and decreasing consumer spending.

7. In turn it will create an unending
spiral which will seriously impact economic growth.

8. The question Americans must ask is “what about me.”

 

The Obama
administration and congress have done similar things before in their effort to
passing Obamacare.

Obamacare
was passed using backroom dealings such as the “Cornhusker Kickback,” the
“Louisiana Purchase,” and the threats to political careers.

This congressional
exemption also brings back memories of (more than
1,200 waivers) to favored
businesses and unions who received special exemptions from Obamacare’s
insurance rules.

“If Congress quietly wants
to exempt itself from Obamacare, that’s great—so long as it includes the rest
of us in that midnight amendment.”

If you are "mad as hell and do not want to take this anymore" 
sign this petition.

  

 

 

Please
click on this link to sign up and send the link on to your friends.

https://www.change.org/petitions/force-congress-to-obey-obamacare

This is the petition

To: 

Senator Harry Reid, Senate Majority Leader 

Rep. Nancy Pelosi, House Minority Leader 

You told me we had to pass
Obamacare to find out what was in it. Now your gold-standard health insurance
is on the chopping block as Obamacare is implemented. 


If the tin-plated plan is good enough for me, my family, and my friends, it is
good enough for you and your staff. 


You passed the law — now live with it like the rest of us. Or overturn the whole
rotten thing!


Stop the effort by liberal Democrats to seek an exemption from Obamacare for
Members of Congress and their staff.

Sincerely, 

[Your name]

Some of us will remember
Walter Cronkite’s signature was ending
each newscast with the phrase, "And that's the way it is".

 I am adding this “it is now up to you ladies and gentlemen.”

 

Please sign
the petition. Thank you.

 

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

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Permalink:

Obamacare’s Actions To Destroy The Healthcare System

March 16, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System
• Leave a comment

Stanley
Feld M.D., FACP, MACE

The Obama administration is doing
everything it can to destroy the healthcare system. President Obama continues
to campaign that he is going to save Medicare and Medicaid and provide
universal care while saving $4.25 trillion dollars.

It does not add up.  The Obama administration keeps raising taxes,
decreasing benefits and increasing deductibles on Medicare and Medicaid
premiums. The administration is decreasing the work force by regulation and
executive order.

Everything that is being done increases
the burden on seniors and insured workers.

To my amazement no one in organized
medicine except the American Association of Physicians and Surgeons (AAPS) has
protested.

I applaud Jane Orient M.D. executive
director of AAPS and her Board of Directors for stepping forward and trying to
defend the rights of patients and their physicians.

At stake are patients’ ability to
choose their physicians and physicians’ ability to practice medicine as they
choose.

Where are the AMA and all the specialty
organizations in the federation medical organizations?  It is little wonder these organizations are
losing members.

All medical organizations should join
with Jane Orient M.D. and her Board of Directors lawsuit against the government.

AAPS filed suit
against PPACA three days after it was signed into law, but the National
Federation of Independent Business (NFIB) and 26 states stayed the case pending
a Supreme Court decision in the case brought.

All of us know that the Supreme Court
upheld the Obamacare law. It was deemed by Chief Justice Robert that the
executive branch has the power to levy a tax. It is not within the power of the
executive branch to create a mandate. President Obama insisted throughout the
legal process that this was a mandate and not a tax.

 

In my opinion this decision by Justice
Roberts was a big mistake. Obamacare is a terrible law that will not create
universal healthcare. It will be ineffective and inefficient. It will destroy
the healthcare system. Obamacare cannot possible work.

I think this is President Obama’s goal.

The Supreme Court in its decision acknowledged,
"any tax must still comply with other requirements in the
Constitution."

No one except the AAPS has challenge
this point.

“The motion filed by AAPS is the first to ask an appellate
court to rule on whether PPACA violated the Origination Clause of the U.S.
Constitution, which requires that all "bills for raising revenue"
originate in the House of Representatives.”

More and more physicians are not participating
in Medicare. Physicians still have the ability to choose to participate in
Medicare and Medicaid.

At the beginning of 2013 a new
regulation went into effect. Previously, if a physician did not participate in
Medicare the patient had to pay the physician his fee. The patient could then
bill Medicare and collect 70% of Medicare’s allowable fee.  Medicare does not pay the patient after
January 1st,2013.

Non-participating physicians may use
laboratory, x-ray departments or consultants that participate in Medicare. The
participating consultants, labs and x-ray departments can bill Medicare
directly and receive their usual and customary fee from Medicare. 

Effective May 1, 2013 (a new regulation
issued March 1, 2013 by HHS) the Department of Health and Human Services will
deprive patients of benefits for blood tests, x-rays, and specialist
consultations—benefits for which they were forced to pay all their working
lives, and which would be covered if ordered or referred by a non participating
Medicare physician.

I believe the Obama administration’s
goal is to force physicians to participate in Medicare.

"Because of Medicare's increasingly costly and
restrictive rules placed on doctors, many Medicare-eligible patients are
receiving medical care from physicians not enrolled in the program,"
states Jane M. Orient, M.D., executive director of the Association of American
Physicians and Surgeons (AAPS).

AAPS filed an
emergency motion for injunctive relief  in the U.S. Court of
Appeals for the District of Columbia Circuit.

The
Founding Fathers fought for independence largely because of excessive taxation
without representation. When the Constitution was drafted, the founders
insisted that taxes originate in the House, the legislative body closest to the
people, both in representation and in election cycles.

“ObamaCare
originated in Senator Reid's 2000-page amendment to a 6-page House bill about
tax credits for members of the armed forces who are called into overseas
assignments. AAPS has raised several arguments why ObamaCare constitutes an
illegal tax, including violation
of the constitutions Origination Clause.”

This new executive order disregards the
constitution’s “Origination Clause” to try to stop physicians from not
participating in Medicare

Only
the AAPS had the guts to speech out against this executive branch breech of its
power and defend patients and physicians rights as granted by the constitution.

Hooray
for the AAPS.

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



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  • cell phone glass repair • October 27, 2013

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Permalink:

Why Not Avoid The Financial Problems?

February 24, 2013
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

 Stanley Feld M.D.,FACP,MACE

It is
very clear to me that neither the Obama administration nor the senate wants to
solve the root causes of the federal deficit problem.

The
sequestration debates are not getting to the root causes of the deficit. Eighty
five billion dollars will not make a dent in America’s 16 trillion dollar
budget deficit.

President
Obama is running around the country scaring everyone with the notion that vital
services must be cut or else the country will be paralyzed.

Recently
the congress and the President appropriated $60.2 billion dollars for aid to
Sandy victims. This is almost as much as the sequestration is going to
eliminate.

“The Senate voted
Monday to provide $50.5 billion in aid for victims of Superstorm Sandy. The
vote means Congress has approved a total of $60.2 billion in aid for Sandy
victims”.

America’s
big deficit problem is created by out of control entitlement programs. Obamacare
is adding to entitlement spending. It will only increase the deficit.  

Our
politicians’ should be working hard to figure out a solution to increasing entitlement
spending. Yet the Obama administration has refused to consider entitlement
reform.

America’s
two largest entitlements are Medicare and Social Security. Food stamps, and unemployment
insurance, among others has some impact on the deficit.

Simple
reforms and a decrease in waste could solve the problem.

The
following two articles summarize the illusion of the existence of Social
Security and Medicare Trust Funds.

In
reality the money goes into these trust funds from payroll withholdings. The
government then borrows the money to pay general expenses. It provides an IOU
to the trust funds. In essence the trust funds are broke and the IOUs are an
unfunded liability of the federal government..

“And since the
federal government borrows the surplus from both funds (Social Security and
Medicare) to pay other expenses, the only thing in those trust funds own
special, non-negotiable, interest-bearing IOUs.”

 http://articles.washingtonpost.com/2012-10-18/opinions/35502037_1_trust-fund-medicare-trustees-health-care

http://www.forbes.com/sites/merrillmatthews/2012/08/21/think-social-securitys-trust-fund-is-a-scam-medicare-has-one-too/

In order
to pay Social Security and Medicare obligations the government shifts revenue
of current accounts into the trust fund accounts.

Citizens
paying into Social Security and Medicare all those years thought they were
paying for a retirement annuity. The assumption was the money would grow with
wise government investments and those funds would be able to pay their promised
liability to seniors.

Those
payments were really a disguised tax. As baby boomers become eligible for
Medicare and Social Security the obligation is increasing.

America
is reaching the point where more people are receiving these entitlement
benefits than the younger people who are funding them.

The logical result is the premium price for
Medicare coverage is scheduled to double in 2014. The deductibles for services are
scheduled to increase. The age requirement for eligibility is about to rise.  Access to care is decreasing as physicians
refuse to take Medicare. Rationing of care is increasing as hospitals are being
forced to assume risk. No one wants to assume the risk of taking care of sick
people. Especially when they are not very good at evaluating the risk.

Everyone
knows all of this. Nevertheless they turn away as the government either borrows
more or prints more money.

Americans
have been told by multiple administrations that citizens could not handle their
own Social Security or Medicare annuity very well. Therefore the government
must do it for them.

The
government has done an awful job managing our retirement annuities.

Social
Security and Medicare Trust Funds must become real trust funds that grow in
value in the future or the government should hand control over to the people.

The Obama
administration refuses to believe the significance of defensive medicine.
Defensive medicine’s cost to the healthcare system is somewhere between 300 to
700 billion dollars a year.


The Obama
administration’s estimate is it costs 3 billion dollars a year. They are wrong. Ask any physician.

Why
should physicians or hospital systems assume the risk of missing a diagnosis by
not doing a test?

The
emotional and financial consequences of a frivolous lawsuit can be devastating.

Simple
and fair tort reform will save the healthcare system around 500 billion dollars
a year.  The 500 billion dollars is more
than 5 times the cost of the 85 billion dollar sequestration. The administration
is wasting 500 million dollars to protect the business of malpractice trial
lawyers.

The
administration claims its overhead for Medicare is only 2 ½ %. This represents
the cost to pick an insurance company to adjudicate insurance claims. The true
cost is not clear. However, it is somewhere between 40-60% of every Medicare
dollar spent.

The
insurance company is permitted by the government to pack many expenses into the
direct patient care column and avoid going over the 15% medical loss ratio
allowed.

The ten
hidden taxes written into Obamacare are now starting to be felt. The Obamacare taxes
are going to increase the cost of medical care not decrease the cost as the
affordable care act promises. 

Patients
are directly responsible for many of their own medical outcomes.  If patients had skin in the game and
financial incentives they would pay attention to their self -care and their
physicians’ recommendations. 

There are
no incentives in Obamacare for patients to manage their care effectively.
Financial gain would get their attention.

These are
just a few of the solutions to the real problems in healthcare. There is much
more waste in federal spending than $85 billion dollars a year.

All you
have to do is look at the list of extraordinary waste that Senator Tom Coburn
has compiled.

Rand Paul
did a clever thing. He sent $600,000 of his senate office budget back to the
U.S. Treasury after carefully trying to save money. The 49 other senators and
over 400 congressperson ought to do the same. It would set an example for all
of the bureaucracy to do the same. In fact President Obama ought to demand it.

“The
Kentucky Republican returned $600,000 in funds he saved from his Senate office
budget in the last year, the Louisville Courier-Journal reported.

“It’s
the only budget I control,” Paul said at a news conference in Louisville. “It’s
not enough, but it’s a start.”

If every
congressperson saved 600,000 a year as Rand Paul did the deficit would be
reduced by $321 million dollars more a year. If all the cabinet positions and
their agencies tried to save money and were rewarded for saving money we would
start to make some progress in decreasing the deficit.

The Simpson
Bowles Report commissioned by President Obama would be helpful in eliminating
unnecessary agencies and duplication. Their report has been ignored by the
Obama administration.

Why has
President Obama refused to listen to people who have exposed the many areas of
government waste? It is incomprehensible.  

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



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Permalink:

What Is The Insurance Value Of Medicare?

November 19, 2012
inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 

Healthcare insurance is
great if you do not need it.

The wonderful thing
about Medicare is private insurance is not available to seniors.  

Healthcare insurance companies
are not interested in covering consumers with health risks or preexisting
illnesses.

In fact private
individual healthcare insurance policies are not available to an unemployed 55
year old person with mild obesity and hypertension.

If you are employed and
over 65 years old with mild obesity and hypertension the healthcare insurance
industry is required to insure you under your employer healthcare plan.

The employed person
receives healthcare coverage with pre-tax dollars.

 A person who might be
eligible to purchase individual healthcare insurance must pay with after-tax
dollars.

This is unfair but
easily corrected.

The pre-tax/post tax
issue could be solved if the state insurance boards required the healthcare
insurance companies, wanting to sell private insurance in that state, cover
everyone applying for insurance. The insurance company should be required to
set the premiums based on community rating.

Everyone should pay
premiums with pre-tax dollars.

Medicare, through
government inefficiency, has become very expensive. If it were efficient
insurance it would be less expensive to both consumers and the government.

Most working people have
no idea of Medicare’s cost to them during their working years.

Medicare’s yearly tax
withholding is 1.45% of salary. A worker earning
$100,000 a year pays $1450 yearly to the Medicare Trust Fund. In 40 years that
person would pay $58,000 into the Trust Fund.

When they became eligible
for;

 Medicare Part B the yearly premium in 2012 was
means tested.

 

If your yearly income in 2010 was

You pay (in 2012)

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

$99.90

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$139.90

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$199.80

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$259.70

 

 

 

In
2013 the Medicare Part B premiums are going to increase.

 

 

 

 

 

 

 

 

 

 

 

 

 
   

 

 

 

 

 

If your yearly income in 2011 was

You pay (in 2013)

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

$104.90

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$146.90

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$209.80

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$272.70

above
$214,000

above
$428,000

$335.70

 

Income is defined as
income from all sources such as capital gains, interest, pension annuities,
social security and all earned income.

Further premium increases have been announced for 2014 but
have not been published.

Medicare premiums are
taken out of each Social Security check.

The Medicare Part B
insurance has deductible and co-pay rules. Medicare Part B deductibles apply
for each hospital stay, ER visits and physician office visits.

For each benefit period
you pay:

  • A total of $1,156 for each hospital admission of
    1-60 days.
  • $289 per day for days 61-90 of a hospital stay.
  • $578 per day for days 91-150 of a hospital stay
    (Lifetime Reserve Days).
  • All costs for each day beyond 150 days.
  •  

Skilled Nursing Facility
Coinsurance

  • $144.50 per day for days 21 through 100 each
    benefit period. Days 1-20 are free.
  •  

Part B: (covers Medicare eligible physician services, outpatient
hospital services, certain home health services, durable medical equipment)

  • $140.00 per year. (Note: You pay 20% of the
    Medicare-approved amount for services after you meet the $140.00 deductible.)

 

The deductible for the
first $140 dollars worth of services plus 20% of any physicians and hospital
bill can add up as one gets older. It becomes unaffordable for many seniors.

 

Medicare Part B’s deductibles
and copays’ costs makes Medicare gap coverage   essential.

Premiums For Medicare Part
F   

Policy Summary

Monthly Premium:
$84 – $302  depending on age and benefits

Estimated Annual
Cost: $6,050.00

Benefits

  • Basic Benefits Medigap
    Basic Benefits definition[?] – Opens in a
    new window
  • Skilled Nursing Facilities Skilled
    Nursing Facility definition[?] – Opens in a
    new window
  • Part A Deductible Part
    A (Hospital Insurance) definition[?] – Opens
    in a new window
  • Part B Deductible Part
    B (Medical Insurance) definition[?] – Opens
    in a new window
  • Part B Excess Charges (100%)
  • Foreign Travel Emergency
  • Preventive Services

 Medicare
Part D is the drug benefit plan. Medicare Part D helps reduce the cost of
medications.

Medicare
Part D is also means tested. There are multiple plans to pick. Some include
complete payment for brand named drugs and some cover the donut. The price can
range from $40 to $120 per month per senior depending on the coverage a senior
picks. The additional means tested fees are below.

The
brand named drugs are expensive. Most drug chains have followed Wal-Mart’s lead
and charge $4.00 for generic drugs. This forces seniors to purchase generic
drugs

Medicare
Part D is expensive and unfair for seniors needing brand named drugs.

The Means Testing Formula For Medicare
Part D 2012

 If your yearly income in 2010 was

You pay

File individual tax return

File joint tax return

$85,000
or less

$170,000
or less

Your
plan premium

above
$85,000 up to $107,000

above
$170,000 up to $214,000

$11.60
+ your plan premium

above
$107,000 up to $160,000

above
$214,000 up to $320,000

$29.90
+ your plan premium

above
$160,000 up to $214,000

above
$320,000 up to $428,000

$48.10+
your plan premium

above
$214,000

above
$428,000

$66.40
+ your plan premium

 http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

 Medigap
fees and Medicare Part D fees are paid with post tax dollars.

These
costs are in addition to seniors having contributed $58,000 to the Medicare
Trust Fund during their working years.

“The reason we have
health insurance at all is not that health care is expensive, but rather that
there is great uncertainty about who will need very expensive and potentially
lifesaving care and when they will need it. Medicare should give beneficiaries
not just access to medical care, but also protection from the risk of
catastrophic spending.” 

Medicare
coverage is not cheap. President Obama’s Obamacare is going to make it more
expensive with less access to care.

 Why
is Medicare Part B,F,D  so expensive when
the average person on Medicare spends only $6,600 dollar per year?

This
is the major question. The government should focus on the answer. It should not
be spending time and money on a system that is punitive to patients and
physicians and has little chance of being successful.

The
money creating the Medicare deficit is going somewhere. Where?

The cost to Medicare beneficiaries is high.
The protection against economic ruin is limited. The basic benefit lacks a cap
on out-of-pocket spending, so beneficiaries are exposed to the risk of
open-ended cost sharing that can generate substantial financial strain (or
deplete assets for surviving spouses).1 

Moreover,
the odds of facing a catastrophic expense mount over time. Almost 50% of
beneficiaries are hospitalized at least once over a 4-year period.2 

If
we are going protect our seniors from financial strain or ruin Medicare must
reassess it premises and reduce its administrative waste. It must be completely
transparent. If the government did it correctly it would provide an affordable
healthcare insurance plan for seniors.

“Everyone knows the dice is loaded.”
Leonard Cohen.

  

http://youtu.be/GUfS8LyeUyM

 

At
the moment seniors do not have another choice. It is the only game in town.

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

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  • Julie Anderson • November 20, 2012

    Healthcare policies must even beneficial to the seniors but they shows the less interest and they concentrate on the other categories.\They show the less interest because these are already with the problem and with them we will have no benefit!!!
    Medicare

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