Stanley Feld M.D.,FACP,MACE

During the last few weeks I have discussed the problems with Medicare Part
B, D and F.

The problems are the result of abuse of the healthcare system by the various secondary stakeholders protecting their vested interests. The stakeholders use their resources to influence our elected politicians. The peoples’ votes should be their only influence.

Politicians take the money from these various lobbying groups because they need the money to campaign for re-election. Media advertising is not cheap.

“The media exercises its greatest influence during elections . Candidates who lack an effective media strategy are likely to be destined for failure.”

“Candidates routinely spend 80 percent of their “war chests” on television and radio advertising. In larger states such as California, Texas, and New York, television advertising is the only way for candidates to reach the tens of millions of voters. In 2000, political novice John Corzine spent a mind-numbing $60–80 million of his own money — most of it on television commercials — to win a Senate seat in New Jersey.”

These two outstanding sound bites summarize the issue:

“The media is the message. Marshell McCluen.”

‘If you tell a lie enough times, it becomes the truth. Carl Sandberg.”

I can imagine the number of jobs created in advertising and in the media during the election season. The media are not willing to relinquish jobs and revenue for unbiased reporting.

President Obama has already been funding his reelection campaign on the taxpayers’ dime. His goal is to raise $1 billion dollars. The goal of the $1 billion dollars contributed by donors implies the purchase by these donors of political influence to support their vested interests.

The traditional media has not been criticized this practice. Campaign advertising is a large part of the traditional media’s yearly revenue. The media is cautious about criticizing large donors for fear of losing the campaign advertising revenue.

The voices of American voters are being drowned out by special interest money. Millions of dollars are poured into campaigns each election, and the amount continues to climb. Instead of turning to their constituents, members of Congress look to wealthy individuals and businesses to fund their campaigns.

Public Citizen is working hard to change the current system of campaign finance so that members of Congress are responsible to their voters, not to their contributors.  

President Obama has been beholden to these special interests. He has used trick plays to fulfill his obligations to his donors. He has disguised his intentions by claiming he is doing everything for the interest of the little guy.

I have difficulty believing anything President Obama says anymore. I also have difficulty believing Democrats and most Republicans in congress.

The recent raising of the debt limit tied to deficit reduction is a case in point.

It is a total fake.

Let us assume a person makes $50,000 a year. He spends $150,000 a year. That means he spends $100,000 a year more than he makes. He must go to the bank to borrow the $100,000.

Will any bank lend him $100,000?  No! He would have to prove how he would pay the $100,000 back.

He promises the bank he will reduce his “deficit spending” of $100,000 by 10% a year over the next ten years. That means that next year he will spend $90,000 more than he earns. He will only have to borrow $90,000.  In ten years I would increase his deficit by 680,000 rather that the 1,000,000 if he did not promise to decrease his deficit spending by 10% a year for 10 years. The banker would still say no.

The United States is not decreasing its deficit or balancing the budget with this latest deal. It is increasing the deficit will decreasing the “deficit spending.” The net effect is creating more debt.

 Why the deal is a fake. President Obama and the congress are not interested is being serious about being fiscally responsible. President Obama has faked out the American public once again.

There are many things government can do for the American public.  Everyone would agree that corporate interests, if given a chance, would take advantage of the public’s interest and the government. The government must protect the public from corporate interests and itself.

It can be accomplished by aligning corporate interests with the public’s interests. The use of force and penalties (price controls) always fail.

An example is food inspection and the Cargill turkey scandal. How are the complex food safety regulations enforced? They were not enforced in the turkey scandal. The inefficiencies and possible corruption that exist in government bureaucracy made the regulations impossible to enforce.

Did the government correct the deficiency? I think not. Last year’s hamburger scandal should have created the incentive and opportunity to correct the deficiency.

Would the pharmaceuticals companies step out and not sell the antibiotics to Cargill? They have not.

How does this relate to the dysfunctional healthcare system?

Why is Medicare so expensive and healthcare costs rising so fast?

 Physician fees are not rising. Why penalize physicians? Healthcare insurance fees are rising. Bureaucratic infrastructure is increasing, as it is becoming less efficient. As this is happening the waste, fraud and abuse is mounting.

The only way to get out of the healthcare mess is to let consumers own, control and be responsible for their healthcare dollars. Social networking will be the driver of consumers’ demand for independence from government control.

The government bureaucracy’s role must be to create appropriate rules to protect the consumers from abuse.

The conundrum is the government’s bureaucracy is the biggest part of the problem

Government must also create educational programs to help consumers make wise choices.

 Consumers should be given incentives to make wise healthcare decisions.  

Increased government control will only create a bigger government mess.

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

Stanley Feld M.D.,FACP,MACE 

It is hard to remember all the defects in President Obama’s Healthcare Reform Act at once.

President Obama’s Healthcare Reform Act is so flawed it cannot possibly work as it was intended. It must be repealed. A serious, thoughtful, practical and common sense way to “Repair The Healthcare System” must be enacted before all the stakeholders have adjusted to President Obama’s coming changes that will create a more dysfunctional system.

A reader sent me a photo of a poster hanging in his local ice cream store. It is a reminder of previous criticisms of President Obama’s Healthcare Reform Act.

I predicted and discussed all the defects it the Healthcare Reform Act that will come back to haunt President Obama and  America’s consumers.

The last month the cracks in President Obama’s Healthcare Act have started to widen. Some of the cracks are starting to look like the entire Healthcare Reform Act is falling apart.

1.  President Obama’s selected model Clinics for his integrated care “experiment” (ACOs) have turned down applying to this pilot study. The goal of these pilot projects was to demonstrate that Accountable Care Organizations (ACOs) will reduce the cost of medical care and increase the quality of medical care. ACOs are a primary tool in proving that President Obama’ Healthcare Reform Act will be effective in reducing cost and increasing quality of medical care. There are too many impractical and costly regulations. There are too many logistical barriers to creating ideologically effective ACOs.

2. Individual States are refusing to set up federal directed State Health Insurance Exchanges as directed by President Obama’s law. The insurance exchanges’ economic burdens will be shifted to the state at the direction of the federal government. The end result will be to increase state budget deficits and decrease state control over their local healthcare delivery systems. Texas is planning to set up its own Health Insurance Exchange under Texas rules even though Governor Perry believes “Obamacare” will be repealed.

“Governor Perry firmly believes that Texans should be in charge of our health care programs.”

There is great antipathy between Governor Perry and President Obama. Texas officials have concerns that President Obama’s administration in the end will say,

 “You all didn’t bother to make a significant effort with the lead time you had,’ ”

 “I wouldn’t put it past President Obama’s administration not to certify what we come up with.”

President Obama’s advisors at the Urban Institute have told him that he is creating an additional entitlement and increasing hidden taxes with his Health Insurance Exchanges. Once the America people discover that this is President Obama’s intention they will oppose Healthcare Insurance Exchanges. The exchanges are not going to put a muzzle on the healthcare insurance industry’s devouring of the healthcare dollar. One must question why the healthcare insurance industry is in favor of Healthcare Insurance Exchanges. The answer is they will increase their share of the healthcare dollar with Healthcare Insurance Exchanges.

 I suspect few people understand this.

President Obama is once again decreasing states’ rights and limiting personal freedom to choose. President Obama’s exchanges will increase states’ budget deficits. The result will be an increased tax burden for all.

"The exchanges don't just handle health insurance. Rather, they are expected indirectly to operate an entirely new "tax" system that collects another 9 or 10 cents from most insured household for every additional dollar earned and a new "welfare" system that tries to determine in advance and at various later stages households' eligibility for different subsidies."  

3. A discovery of a quirk in the law would allow an additional 3 million who earn over $64,000 to $80,000 a year to enrollee in Medicaid. Medicaid cannot attract enough physicians for its current enrollees. Physicians refuse to participate because its reimbursement is less than physicians’ overhead. Adding 16 million new enrollees plus an additional 3 million is untenable.  

4. The lawsuits by 24 states challenging the constitutionality of President Obama’s Healthcare Reform Act is slowly proceeding to the Supreme Court. The Supreme Court might have tipped its hand as to the direction it is leaning last week by another decision in favor of “States Rights” and “individual rights.”

Justice Kennedy wrote in an opinion,

 "The whole point of separation of powers, the whole point of federalism, is that it inheres to the individual and his or her right to liberty; and if that is infringed by a criminal conviction or in any other way that causes specific injury, why can't it be raised?"   

5.  Last week McKinsey published an in-house survey that showed that at least 30% of corporations would drop employee sponsored healthcare insurance (ESI) and let employees buy the government’s  “affordable and subsidized” healthcare insurance (the Public Option) through government’s Healthcare Insurance  Exchanges in each state.The government criticism of the survey was unjustified. The criticism weakened President Obama’s support even further because it became apparent that he was going to try to intimidate his distractors and not heed reality.

All of these defects in Obamacare are becoming more apparent to all consumers. Public support is decreasing daily. It is going to take the Supreme Court to declare it unconstitutional or a Republican President with a Republican House and Senate.

President Obama remains oblivious to the defects and unpopularity of his Healthcare Reform Act. 

Stanley Feld M.D.,FACP, MACE

Last week McKinsey published an in-house survey that showed that at least 30% of corporations would drop employee sponsored healthcare insurance (ESI) and let employees buy their own “affordable” “government subsidized” healthcare insurance (Public Option”) through the Government’s Healthcare Insurance Exchanges in each state. Adding thirty percent of the corporate work force to Healthcare Insurance Exchanges would place states and the federal government in deeper debt.

The McKinsey survey echoes what Doug Holz-Eakin (economist and former head of the CBO) and John Goodman (a healthcare economist and CEO of NCPA) have said about the impact of President Obama’s Healthcare Reform Act.

“If Mr. Holtz-Eakin is correct that there will be 11 million more people in the exchange, then costs could be nearly 40% higher than the $511 billion price tag. If between 78 million and 117 million people are moved into the exchanges the NCPA predicts the costs could more than triple to $2 trillion dollars more than expected over the first decade.”

“Most of this extra expense would come from workers losing their employer-sponsored insurance.” 

Immediately, President Obama’s administration attacked McKinsey’s honesty. The Obama administration accused McKinsey of patronizing their clients and working for the sponsors of the survey.

The administration had no proof to support any of its accusations against McKinsey. Its aim was to tarnish McKinsey’s reputation as well as intimidate McKinsey and other organizations that might draw negative conclusions about his healthcare law.

Nancy Parmalee, the deputy chief of staff who is running “ObamaCare” from the White House in her Whitehouse blog, launched a ferocious attack on McKinsey.

 “Unfortunately, the study misses some key points and doesn’t provide the complete picture about how the Affordable Care Act will strengthen the health care system and make it easier for employers to offer high quality coverage to their employees. Here are the facts:

She said the McKinsey survey is an outlier. She also accused the survey of being fixed. The results of the McKinsey survey were the opposite of the results of respected independent organizations and the CBO.

She said “McKinsey says they obtained their data after they “educated respondents” about reform and that their survey used proprietary research. We don’t know what respondents were told or whether they had the chance to check with their colleagues or crunch the numbers for their business before responding.”

In Ms. Paralee’s mind McKinsey cooked the survey in favor of a negative result about Obamacare. She then quotes the findings of three independent surveys.

Respected independent organizations have examined whether employers will continue to offer coverage. Here’s what they found:

The Rand Corporation: "The percentage of employees offered insurance will not change substantially, but a small number of employees in small firms (defined as those with under 100 employees in 2016) will obtain employer-sponsored insurance through the state insurance exchanges."

The Urban Institute: "Some have argued that the Patient Protection and Affordable Care Act would erode employer-sponsored insurance (ESI) by providing incentives for employers to stop offering coverage. Others have claimed that most businesses would face increased costs as a result of reform. A new study finds that overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform."

Mercer: "In a survey released today by consulting firm Mercer, employers were asked how likely they are to get out of the business of providing health care once state-run insurance exchanges become operational in 2014 and make it easier for individuals to buy coverage. For the great majority, the answer was 'not likely.'" 

 The White House has routinely tried to intimidate its health-care critics. Nancy Parmalee’s facts in the administration’s campaign against McKinsey are wrong. She misread the studies she quoted.

1. The White House sponsored the Urban Institute study cited by Nancy Parmelee. Bowen Garrett who now works for McKinsey wrote it.
2.  Some of the notable work on employers discontinuing to sponsor healthcare insurance and pay the penalty comes from Eugene Steuerle of the Urban Institute. His paper predicts a mass discontinuation of ESI by corporation of all sizes.

 “Even so, droves of employees—potentially tens of millions—are likely to shift out of employer-provided insurance over the next decade or two, especially as newer firms and their employees find it more profitable to get the exchange subsidies than the subsidies for health insurance provided by the employer.”

 Eugene Steuerle of the Urban Institute wants universal coverage run by the government as the single party payer. I could just see President Obama saying, “Don’t worry Gene we will get there.” 

Nancy Parmalee also misstated the Mercer findings.  The graphs show exactly what Mercer reported. It is not dissimilar to McKinsey’s survey.

David Brooks expressed common sense in a recent New York Times article.

He said,

 "Obamacare incentivizes companies to drop health coverage for their employees. Employers who drop coverage have to pay a fine, but the fine is cheaper than offering health insurance. Employees will be able to buy their insurance on state-based “exchanges,” where they can take advantage of the law’s new subsidies.

(Americans making less than 400 percent of the federal poverty level are eligible for subsidized coverage on the exchanges.) AT&T has calculated that it would save $1.8 billion a year by dumping its workers into the government’s lap.

Other companies are keeping quiet about their plans for now, but make no mistake: If Obamacare remains the law of the land, nearly every corporation in America will do what AT&T has contemplated. So will cash-strapped state governments." 

McKinsey released the entire methods, detail and results of its survey. The survey was non biased, well designed and answered each of President Obama’s administration’s criticism.

1.McKinsey and not clients funded the survey. 

2.Ipsos, a well-established neutral opinion research firm, conducted the survey. 

3.The companies surveyed were representative of corporations and businesses from the broader economy. 

4.Respondents were required to be either the “primary decision maker” or “have some influence in the decision-making process” for employee health benefits. 

5.Respondents were informed of Obamacare’s exchange subsidies in a neutral, factual manner.

6.Employer surveys (McKinsey survey) and economic simulations (CBO’s analysis) are different. CBO analysis has underestimated the result by a factor of five.

The attack on McKinsey was unfounded. Hopefully, McKinsey’s reply will not inhibit others from revealing the truth about President Obama’s policies not only in healthcare but in other areas.