Politicians,Healthcare and Vested Interests

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Donald Trump on Healthcare Reform

September 16, 2016

inHealth Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D. FACP, MACE

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

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

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

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

A market based system should:

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

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

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

Donald Trump’s web site starts by declaring that Obamacare must be repealed.

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

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

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in the House and Senate and signed into law by the most divisive and partisan President in American history must be repealed.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Any reform effort must begin with Congress.”

Donald Trump says;

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

This is the correct process according to the constitution.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

8. Block-grant Medicaid to the states.

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

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

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

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

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

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

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

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

Donald Trump is proposing a lot of important changes.

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

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

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

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

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

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We Never Learn: Watch Out Colorado

August 10, 2016

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

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

Winston Churchill

There are many smart people in America.

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

The art of presenting misinformation and disinformation has been perfected.

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

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

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

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

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

The ColoradoCare website goes an to say,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He goes on to say,

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

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

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

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

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

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

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

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

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

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

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

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

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

Consequences.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It has already been proven in Oregon and Vermont.

There is a more effective and less expensive way!

If you are interested please read the following links.

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

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

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

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

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

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

July 27, 2016

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

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

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

The public must keep their eyes and ears open.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition she wants a public option.

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

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

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

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

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

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

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

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

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

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

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

He has now changed his mind.

https://youtu.be/f3BS4C9el98

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

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

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

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

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

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

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

It would result in an increase in federal taxes.

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

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

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

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

Stepehen • August 3, 2016

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

May 2, 2016

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

Its getting boring to hear about Obamacare’s double-digit health insurance premium increases each year. The healthcare insurance industry is now preparing the public for another round of double-digit premium increases in 2017.

It is important to remember the public experienced double-digit health insurance premium every year since 2014.

The cost of buying insurance has skyrocketed since Obamacare was enacted. The public is not forgetting this.

The table below compares health insurance premiums before and after Obamacare.

This table includes both the numbers in the federal and state exchanges and the private healthcare insurance markets.

President Obama and his administration are bragging that the healthcare insurance markets are stabilizing.

All the federal funded state health Co-ops will be bankrupt before the 2017 enrollment period.

Updated state reports on enrollment since the close of 2016 extended enrollment period indicates that more than 1 million of the 12.7 million who were reported to enroll for 2016 have dropped their Obamacare healthcare insurance policies.

In 2015 only 1.5 million consumers out of 11.7 million enrollees dropped out the entire year.

Arielle Levin Becker of the Connecticut Mirror reported, “In Connecticut of the 18,800 customers who dropped out (16%), 20% failed to provide required information; 53% didn’t pay; 10% asked to have their plans canceled; and 12% shifted to Medicaid.

Those exiting customers were partly offset by nearly 8,000 latecomers, more than one-third of whom lost Medicaid.”

The truth is the Obamacare health exchanges are not stabilizing the healthcare insurance markets. Obamacare is destabilizing the healthcare markets.

It is becoming more and more difficult to believe anything President Obama says or his administration reports.

United Healthcare declared they are dropping out of most of the exchanges they are participating in because of the toll the health exchanges have taken on their bottom line.

Aetna just announced it lost more than $100 million on its healthcare exchange business last year (2015) but hopes to break even this year (2016).

This is a pipe dream on Aetna’s part. Less people have signed up for Obamacare and the people who signed up have been sicker people with pre-existing illnesses.

Aetna chairman and CEO Mark Bertolini said Thursday, “ the nation’s third-largest health insurer still sees a good business opportunity, but Congress needs to provide leeway for companies to design lower-cost plans tailored to young, healthy people.”

President Obama is not going to let insurers design lower cost policies tailored for young, healthy people. His legacy legislation is built on equal premiums for all.

These announcements can put the healthcare debate back in the headlines for the general election. It can re-ignite consumer and voter backlash once again.

President Obama ignored the backlash before. Can Hillary Clinton ignore the upcoming price increase backlash?

“Hillary Clinton is the only one promising to build on the Affordable Care Act. She’s proposed an aggressive effort to increase enrollment along with measures to reduce consumer costs.”

Hillary Clinton is mouthing words that sound good but are impossible to fulfill. People understand these empty promises now.

“ The Republican candidates all want to repeal “Obamacare.”

No one has come up with a solid proposal. Not even Donald Trump.

“Vermont Sen. Bernie Sanders would incorporate it into a bigger government-run system covering everyone.”

Bernie Sanders is dead wrong. America cannot afford the cost and it has been proven not to work in the healthcare systems in the rest of the world.

The health law has many problems. The problems are too numerous to list here. The biggest problem in terms of costs for next years premiums (2017) are the lower-than-hoped-for enrollment, sicker-than-expected customers, and a bloated bureaucracy that is not an efficient business model.

Obamacare has created a financial drain for many healthcare insurance companies. The increase in premiums and the government pressure to keep prices low have in turn created pressure on insurance companies to lower reimbursement to physicians and hospitals.

Hospitals have to participate in the health exchanges, Medicare and Medicaid for survival. Physicians do not. Obamacare has created a more severe physician shortage.

The healthcare insurance companies would never consider becoming more efficient and lowering their cost. Some top executives are making more than 100 million dollars a year.

The healthcare insurance industry is setting the stage for 2017 premium hikes that could reach well into the double digits.

Virginia has nine returning insurance companies participating in Obamacare in 2017. These companies have submitted premium price increases ranging from 9.4 percent to 37 percent to the state board of insurance.

I am sure the Virginia state board of insurance will start negotiating with the participating insurance companies.

Obamacare will only cover 11 million enrollees in 2016. As more enrollees drop out of Obamacare because they cannot afford the premiums the total might be closer to 8 million. Many of the enrollees are subsidized. These subsidized enrollees have dropped out because they cannot afford the remaining premiums and deductibles.

The healthcare insurance industry increases premiums in the individual and group private markets to protect its profit margin.

This is occurring on top of the destruction of Health Saving Accounts and does not speak well for a stable healthcare insurance market.

President Obama’s goal is to destroy the healthcare system and replace it with a single party payer system.

Does anyone think a government run single party payer system will be more efficient or deliver cost effective care?

If you do, please think of the efficiency and effectiveness of the VA healthcare system?

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

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One Could Go Nuts

April 26, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Quality medical care measures

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Stanley Feld M.D.,FACP,MACE

Measuring quality care in the healthcare system is out of control. My conclusion is that these measurements of hospitals and providers by Obamacare to determine medical care quality is distraction to quality medical care.

The method used is so complex that its measurements are inaccurate and the system is destined to fail.

The measurements are a distraction and costly. They end up diverting resources away from the hospitals’ and providers’ primary mission to provide quality healthcare at an affordable price.

In March 2016, the Healthcare Association of New York State (HANYS) published a report called Measure Madness. The report identified 2,100 required measurements of “quality care” imposed by the federal government and in turn the healthcare insurance industry on hospitals and physicians. The goal is to rate the quality of care given by hospitals and physicians.

The measurement agency claims that the rating system is set up to help consumers make better healthcare choices.

Below is a graph of the various measurements:

Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on time spent per physician to enter the data into the electronic health record to keep track of newly introduced measures and create protocols to track and report them.

“Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures.”

This report only covers 4 common specialties,and not all specialties and all hospital costs. There is no telling what it costs other hospitals and providers
HANYS report stated “

The volume of measures that exist, promulgated by lack of alignment and poor coordination, has created an environment of measure madness, “Consuming precious resources that could be directed toward meaningful efforts to continuously enhance quality and patient safety.”

The “measurement madness” may be doing more harm than good, according to the report. It’s the latest in a growing number of reports urging consolidation and standardization among the various groups that require reporting of healthcare quality and safety data.

The Electronic Medical Record is a great idea in theory. I have discussed functional Electronic Medical Records in detail previously. A reader can go to the search engine on this blog to review my criticism of the defects in the Electronic Medical Records sold to hospitals and doctors.

A major defect in EMR is hardly ever discussed. There is a massive amount of copy and pasting to complete the “documentation. The record does reflect anything about the patient’s illness or real progress. It does not provide a true reflection of the patient’s quality of care, natural history of his disease or disease improvement. It does not compare efficiency of medical care outcomes with the financial results of care.
The HANYS report listed the number of reports required for a computer program to evaluate the quality of medical care delivered. It is reflected in the crazy cartoon at the top of this blog.

Number of Reports Per Measurement

Accountable care organizations: 33

The Delivery-System Reform Incentive Payment (or DSRIP) : more than 100

Private Health Plans: 546

National Quality Forum: 635

CMS: 850

Each report has at least one sub report. One has only to recall all the agencies Obamacare has set up.

ObamaCare-Chart.jpeg

This bureaucratic scheme can never work efficiently.

HANYS urges stakeholders to do the work to fix the system.

The call for action was for providers of healthcare to jointly commit to the minimum number of measures needed to evaluate healthcare quality, align them with national, standardized, evidence-based data, and focus on efforts that target the most vital aspects of care.

Last week CMS was forced to delay publishing its hospital quality ratings until July 2016 because of the perceived defects in the Obamacare’s measurements.

Congress received tremendous pressure from hospitals because of the confusion the measurements have created.

“CMS also plans to host calls with providers to clear up questions about current methodology and get feedback on refining the program”.

Obamacare has been promoting the ratings for hospitals, nursing homes, dialysis facilities and other providers as a way for consumers to compare and select providers.

If one measures the wrong things one will get the wrong answer.

Only 87 hospital of more than 3,600 U.S. hospitals got the highest five-star rating, according to the American Hospital Association.

Just over half of the hospitals fell within the three-star range.

A total of 142 got one star. In January, the AHA challenged the CMS, stating that the program “oversimplifies the complexity of delivering high-quality care.”

Hospitals reviewed the ratings earlier this year.
Sixty U.S. senators heard the hospitals’ message. They sent a letter to CMS earlier this month urging the delay of the program. The senators warned of confusing methods, compromised outcomes for hospitals in disadvantaged communities and the potential to mislead consumers.

The American Hospital Association (AHA) has not been able to come up with the same conclusions as CMS, using the same data sets and methods.

“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients,” the AHA said in a statement.

On May 12 a conference call is scheduled to educate hospitals on how to analyze and interpret the data. In general, even the government has been confused about how best to interpret the data.

Ben Harder and Avery Comarow of U.S. News & World Report said in a recent article, “Different methodologies can produce different results even when the same raw data sets are used, said cent article.

“No approach to identifying outstanding medical centers is ideal—not ours or the government’s or anyone else’s,” the column stated.”

A case in point: none of CMS’ five-star facilities made it onto U.S. News’ annual Honor Roll. Ben Harder said, It is likely because the CMS does not yet adjust for socio-economic factors.

Again the Obama administration is making another costly complicated mistake that is making hospitals and providers go nuts and distract from their main mission of providing quality care at an affordable price.

If anyone thinks complete control of the healthcare system by the federal government via a single party payer system can do better than this government mishmash they should think again.

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

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Social Engineering

March 10, 2016

inConsumer Driven Health Care, Medicine: Healthcare System, Physician's Problems, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Obamacare has been a failed attempt at social engineering.

As I have said previously President Obama and his administration have backed off and are continuing to back off many of the deadlines in the law.

Many of Obamacare’s new ideas are ideological utopia. Theses ideas cannot work in system that is dependent on physician judgment and interpersonal patient/physician relationships.

Social engineering’s goal is to eliminate judgment (craftsmanship) and reduce production of goods and services to a commodity production.

I believe the origin of the dysfunctional healthcare system began with government intervention over the last 60 years.

I want to start with some basic points. The delivery of medical care should be between physicians delivering medical care and surgical care to patients. Without physicians or patients there is no need for a healthcare system.

The two main participants (physicians and patients) have a large responsibility to the healthcare system in order to have good outcomes. The patients’ responsibility in the system has been constantly ignored by healthcare policy wonk.

Patients should exercise, must not become obese, do not do dangerous things that could injure themselves, don’t smoke, diligently take their recommend medicine and follow their physicians orders.

Eighty (80%) of the healthcare dollars are spent on the complications of chronic disease. Much of this expense could be avoid if patients were responsible for the care of their health and avoid the onset of chronic diseases and their complications.

At the beginning of the 20^th century the United States was growing rapidly. It was believed that our institutions could not handle this growth adequately.

Social engineering of our industries, manufacturing and political systems became the fad of the day in the early 20^th century.

What is social engineering?

“Social engineering is a discipline in social science that refers to efforts to influence particular attitudes and social behaviors on a large scale, whether by governments, media or private groups in order to produce desired characteristics in a target population.”

The discipline of social engineering attempts to manipulate a population of people by manipulation of norms and ideas using tools available to institutions whether it is a government, the media or an industry.

The goal was to modernize social systems that where outmoded in the society that existed in the late 19^th and early 20^th century in order “to achieve the intelligent management of Earth’s resources and human capital with the highest levels of freedom, prosperity, and happiness within a population.”

The obvious question is who has the authority to manipulate the behavior of billions of people?

The wrong decision-making can affect the safety and survival of literally billions of people.

In a democracy, in which the government should be by the people and for the people, the government should act as a surrogate for the people and not an authority that rules the people.

When something doesn’t work for the people, the government must change to express the will of the people.

“As a result of abuse by authoritarian regimes and other non-inclusive attempts at social engineering, the term has in cases been imbued with a negative connotation.”

In the last 60 years progressives have been enamored with social engineering. However, most of our government’s attempts at social engineering have been a failure.

Universal Health Care”, “Single Payer”, “National Health Insurance”, “Socialized Medicine” are all terms invented in an attempt to social engineer America’s healthcare system. These terms aim is to social engineer the healthcare system so that physicians’ and their patients’ relinquish their autonomy to government control for the sake of the common good.

The unspoken promise to the people is that the healthcare system will be free to the people.

Progressive’s claim that healthcare is a right! Healthcare is rather an individual’s responsibility!

Nothing is free!

Socialized medicine eliminates the need for an individual to be responsible to maintain health and to comply with treatment. The government will take care of us if we get sick.

The people have soundly rejected socialized medicine’s terms and intentions. The present government is ignoring the will of the people.

The result is a mistrust for our elected officials (establishment) and a chaotic and joke-book of candidates on both the Democratic and Republican side.

Who should determine the common good? Who should determine actual good for consumers? The obvious answer to me is the consumer and not some ideology or its attempt at social engineering.

Max Weber was a Prussian 20^th century political philosopher. He laid the foundation for modern sociology and the need for social engineering.

However Max Weber was one of the first to proclaim,

“Bureaucratic administration means fundamentally the exercise of control of institutions on the basis of knowledge. This is the feature of bureaucracy which makes it sound specifically rational.”

However, Weber also recognized the limitations of bureaucracy. He observed that the goal of a rational bureaucracy was more often elusive than realized, if it is ever realized.

In the early 20^th century Frederick Taylor was the leading proponent of scientific management, also called Taylorism. Scientific management is an extension of social engineering.

Taylorism is a theory of management that analyzes and synthesizes workflows.

Its main objective is improving economic efficiency, especially labor productivity. It was one of the earliest attempts to apply science to the engineering of processes and to management.

Taylorism includes the important parts of today’s industrial engineering and management.

“The elements of industrial engineering include analysis; synthesis; logic; rationality; empiricism; work ethic; efficiency and elimination of waste; standardization of best practices; disdain for tradition preserved merely for its own sake or to protect the social status of particular workers with particular skill sets;

It includes the transformation of craft production into mass production; and knowledge transfer between workers and from workers into tools, processes, and documentation.”

The last sentence is exactly what the Obama administration is trying to do to the healthcare system. It is trying to turn the practice and art of medicine into a commodity control by the government.

The major criticism of Taylorism had been;

“for turning the worker into an “automan” or “machine.” Due to techniques employed with scientific management, employees claim to have become overworked and were hostile to the process.”

Consumers are presently experiencing this same reaction from physicians in their response to Obamacare.

Indeed the healthcare system must become more efficient. It can become more efficient with improvements in some processes.

However, a process that causes consumers to be more responsible for their health and the treatment of their chronic diseases must accompany the improved processes.

The expensive creation of bureaucracy that measures physician behavior in inefficient ways and decides on inadequate payment leads to the hostile reaction to the process and increased inefficiency.

Consumers and not the government should drive the healthcare system.

Ronald Reagan said in a 1964 speech long before he was president, “No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth!”

The bureaucracy by ever expanding has given unelected officials the authority to social engineer the healthcare system. The public’s will is marginalized and the central government increases its control over the public’s healthcare decision making.

Obamacare is not working out very well because it is an enormous task to force physicians and consumers to participate in a program that marginalizes the two most important stakeholders, physicians and consumers.

There is little chance that Obamacare will work as intended. Consumers are not interested in becoming commodities.

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

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President Obama Somehow Finds The Money

February 26, 2016

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

It is almost impossible to follow the tricks President Obama and his administration use to ignore congress and avoid the law. Few media outlets even try to understand the tricks. No one cares.

The media simply republishes the press releases of the Obama administration. The information is usually out of context.

ObamaCare was sold to the public and congress with a bunch of lies:

1.You can keep your healthcare insurance plan if you like it.

You can keep your doctor if you like your doctor.
Anyone making less that $250,000 per year will not pay a dime more in taxes.

President Obama’s promises were then followed by a long string of lawless executive actions to keep an unworkable scheme (Obamacare) going despite the damage being done to employers, doctors, consumers and the economy.

Statutory deadlines were routinely ignored.
Government funds were shifted from one program to another ignoring the law.
The employer and employee mandate built into the law was illegally delayed, repeatedly
Individual mandates were illegally delayed.
Free Obamacare healthcare plans were illegally granted to illegal immigrants.
Granting waivers to special favored groups.
And many more.

Now, it looks like President Obama is diverting public funds to bail out the health insurance-companies in defiance of the law passed by congress one year ago. President Obama signed it into law.

I am also surprised that Marco Rubio has not been screaming about it because he claimed to initiate that law passage of the law to prevent overspending for reinsurance.

President Obama desperately needs healthcare insurance industry to participation in Obamacare in order to prevent its collapse. He somehow had to come up with the bailout money.

Not only is he in the process of destroying our healthcare system as well as our economy, he is destroying America’s most important asset, the rule of law.

The mainstream media ignores the facts. One reason could be because the Obama administration keeps confusing the facts presented to the media. Another reason is the media bias toward President Obama.

These are probably the facts;

Last fall UnitedHealth said they were considering dropping out of the Federal Health Exchanges in 2017. The company said they were losing money on Obamacare. Aethna followed shortly thereafter

“The latest jolt is the $475 million loss UnitedHealth Group booked on the insurance exchanges in 2015, which the largest U.S. mega-insurer by membership expects to rise this year to another $500 million.”

Only three months ago the company projected losses of $400 million to $425 million. Every other line of UnitedHealth’s business is thriving.

In my last blog I published the outrageous healthcare insurance company executive salaries. The insurance industry cannot be losing money.

The real reason for UnitedHealth’s threat to quit was because the Obama administration underpaid the healthcare insurance industry $2.8 billion dollars for its 2014 obligated reinsurance payment.

When the reinsurance programs were activated congress passed the “Rubio” addendum stating that CMS could not pay out to the insurance industry more than they took in from insurance premiums.

The Obama administration had promised the healthcare insurance industry the reinsurance money for health risk overruns for participating in Federal Health Exchange.

The reinsurance programs were activated in 2014 for 3 years in an attempt to stabilize the insurance market (i.e. guarantee the healthcare insurance industry would not lose any money).

After he realized he could not pay more than 12% of what was owed he promised the healthcare industry he would make good on his commitment and pay as soon as he found the money.

This headline appeared, out of the blue, late on Friday afternoon February 12 at the start of Valentine Day Weekend.

“CMS readies $7.7 billion for ACA reinsurance payouts”

Some how President Obama found the money. The low enrollment in Obamacare resulted in high-risk patients with pre-existing illnesses. The few low risk young patients could not cover the cost overruns.

The shortfall was $2.8 billion for 2014. Somehow in the flurry of numbers thrown at the American public late that Friday afternoon it looked like the 2014 $2.8 billion shortfall was settled with the healthcare insurance industry for $1 billion by the government.

The 2015 reinsurance bill looks like it is $7.9 billion.

The reinsurance program was high in 2015 because the Obamacare health exchanges sold droves of healthcare insurance on the exchanges in 2015 to high risk people with preexisting illnesses.

So far the Obama administration has only found $5.5 billion of that $7.9 billion owed to the healthcare insurance industry.

“Just three California insurers—Anthem, Blue Shield of California and Kaiser Permanente—raked in more than $1 billion of reinsurance payments combined.”

Something is fishy about all of this, especially in the face of the Rubio amendment.

Where are you Marco Rubio?

Are you letting President Obama pull another trick on the American people at tax-payers’ expense?
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Deals With The Devil, How To Destroy The Healthcare System | Stanley Feld M.D., FACP, MACE
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Stop Confusing Me With Misleading Facts

February 8, 2016

inPoliticians,Healthcare and Vested Interests

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Stanley Feld M.D. FACP, MACE

The truth is derived from facts. In social sciences such as politics and economics isolated facts can lead to conclusions that are far from the truth. It is also possible to manipulate statistics that lead to false conclusions.

Misleading facts can lead to false conclusions and inaccurate opinions.

The Obama administration has mastered the art of picking isolated facts and manipulating statistics. It has used that skill and the traditional mainstream media to mold public opinion.

Government agencies are supposed to be politically neutral. The Obama administration uses isolated reported facts out of context to mold favorable public opinion using the traditional media.

This methodology has been pervasive in misinforming and transforming America. This phenomenon is especially true as it relates to the healthcare system.

Healthcare.gov’s enrollment supposedly ended for 2016 on January 31, 2016. Enrollment has been abysmal for 2016. It is no higher that the enrollment reported in 2014.

The only real increase has been the increase in Medicaid enrollment.

“As announced yesterday, the official QHP selection number ended up coming in right in the middle of this: 12.7 million nationally (9.6 million via HC.gov).”

Nevertheless, Secretary Burwell announced that enrollment surpassed expectations.

In mid-December President Obama announced as proof of the success of Obamacare;

“Nearly 6 million Americans so far have enrolled in insurance for 2016 through HealthCare.gov, President Obama announced on Friday, touting a big increase over last year that he said shows the Affordable Care Act is succeeding.”

The truth is Obamacare is a failure. State healthcare exchanges are failing. Many states have closed down their state healthcare exchanges. Yet, President Obama’s message is that his signature legislation, the Affordable Care Act, is succeeding.

The administration never addresses the reason Obamacare is failing. However, people who know the facts know it is failing and why it is failing. Obamacare simply does not meet the needs of the middle class consumers.

“It’s time to look at the major reasons for the shortfall.

Some of these are well-documented criticisms: Premiums and/or deductibles are simply too damned high for many policies/regions in general.”

There are many additional reasons for the poor enrollment but that is not the point of this article.

The point of this article is the Obama administration deceiving the public .

There are other areas of consumer (public) deception by the Obama administration.

One outstanding example is the administration’s conclusion that there is no inflation in America, which is hard to believe. Every time we go into a grocery store the price of food seems to increase. Every time we buy clothing, an appliance, a car or a restaurant meal the price seems to increase.

Few people know that food and fuel are not included in the Consumer Price Index (CPI). The CPI is a measure used in determining the inflation rate.

The article that stimulated me to write this blog was last week’s announcement that the unemployment rate has just decreased to below 5%.

President Obama, who expressed frustration that he has not received the credit he feels he deserves for the country’s improving economy, said the jobs numbers were further signs of progress.

“After reaching 10 percent in 2009, the unemployment rate has now fallen to 4.9 percent even as more Americans joined the job market last month,” he told reporters at a White House briefing in Washington. “Americans are working.”

The New York Times reported that the Obama administration has used this figure to brag about how well the economy is doing under his administration.

A non-traditional media publication, PJ media, has reported, in detail, the interpretation of the real numbers using the government’s own statistics. It is worthwhile reading the entire article and forming your own opinion about the unemployment rate.

“Every so often a monthly employment report is full of so many irregularities that it pays to discount the report. This might be one of those times.

We’ve commented several times over the years about the BLS cooking the books on jobs. James Pethokoukis lists some other stats that tell far more of the real story about the employment picture than the bare-bones numbers highlighted by the media:

Not everything was great: job gains far short of 185,000 expectations (though averaging 231,000 the past three months), U-6 unemployment-underemployment rate unchanged at 9.9%, long-term unemployment worsened, labor force participation and employment rate still way below pre-recession levels, wages gains short of what you would expect to see in a full-throttle economy. Particularly vexing for Barclays was job weakness in the service sector.

The unemployment rate figure is a fact used to mold public opinion. The mainstream media is the message. The problem is the Obama administration’s message is an absolute lie.

“In other words, the job situation in America still sucks, and the president is blowing smoke by touting the numbers as good news.”

One commenter wrote, using the government raw data;

“empiresentry 1st Boomer • 15 hours ago

Yeah that 30% was a ‘laugh’ and the Dims fell for it. Cali and some other Dim states mistakenly were unable to submit their numbers (cough cough)
.
For January 2016:
First time INITIAL jobs claims for unemployment insurance
Jan. 9, 2016 284,000
Jan. 16, 2016 294000
Jan. 23, 2016 277000
Jan. 30, 2016 285000
————-
940,000 human being lost their jobs

Jan. 623,000 “stopped looking for work”.
We did not stop looking for work. The government stopped counting us because our unemployment insurance ran out.

151,000 people found new jobs, most were retail and restaurant part time.”

The Obama administration and its agencies have presented distorted facts to us over and over again during the past 7 years. It has distorted the truth and, in turn, public opinion.

If one uses the wrong facts, one will come to the wrong conclusion.

Everyone is entitled to his or her own opinion. They are not entitled to their own facts.

That includes the President of the United States of America and his administration’s agencies.

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

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Here It Comes!

February 3, 2016

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

The mainstream media has been very quiet about Obamacare lately as the defects in its execution keep rolling along.

You may recall President Obama telling Senator John Kerry and Representative Barney Frank not to worry about including a Public Option in the bill. He told them they would not have to include the Public Option in the Affordable Care Act.

Barney Frank said we would never get a single party payer system unless we have a Public Option in the bill.

President Obama was right. He didn’t need a Public Option because the single party payer system was already embedded in the bill without anyone knowing it.

Medi-Cal is California’s name for its Medicaid program. California is one of the states that have expanded the Medicaid program under Obamacare.

Twenty states have not expanded their Medicaid program for fear of the federal government impinging on states rights while sticking their state with the bill.

The states also feared increases in their budget deficit. States are required to balance their budget. The result would be an increase in state taxes.

The increase in state taxes would render the state unattractive to companies and their business. Less company growth would mean an increase in unemployment and a decrease in state tax revenue. A decrease in tax revenue would result in a decrease in state services.

President Obama said, “Don’t worry.” He promised to fund Medicaid expansion fully for the first 3 years. Federal funding would decrease after the first three years to 50%. The funding percent has changed a few times since that promise. One could not know the present decrease unless one read the Federal Register daily.

Expanding Medicaid was a key part of the Affordable Care Act (Obamacare). It was also a hidden trap set by President Obama to slip the healthcare system into a single party payer system by default. That is why President Obama insisted we did not need a Public Option.

Obamacare required nearly all Americans, under penalty of law, to have insurance starting in 2014.

“Though a surprise, the high Medi-Cal enrollment is generally hailed as a success. California’s uninsured population has been cut in half since Obamacare, in large part because so many Californians signed up for Medi-Cal, which is free for beneficiaries.

Medi-Cal was opened to all low-income Californians starting two years ago, with the federal government paying for those new enrollments.”

In 2016 one third (1 in 3) or 12.7 million Californians are covered by Medi-Cal.

The total cost of the Medi-Cal explosion is $91 billion dollars, up from $54 billion dollars in 2012. California is responsible for $12 billion dollars. It will increase California’s budget deficit and may result in another tax increase.

The cost per insured is $7,165.35.

“The Medi-Cal program continues to grow at a very substantial rate, which is great. We are very happy that we’re able to provide healthcare to getting close to 13 million Californians,” said Mari Cantwell, chief deputy director at the state Department of Health Care Services, at a hearing in downtown L.A. this month. But, Cantwell added: “Obviously with that comes cost.”

The Medi-Cal is viewed by many state officials as being underfunded.

Medi-Cal patients are struggling to find doctors.

Many patients are receiving low quality of care by government standards.

A psychiatrist in Los Angeles told me that all the private practice internists in L.A. require an upfront concierge fee of at least $2,000 a year at the beginning of the year to be in their panel. If this is true, Internists in L.A. are insulating themselves against the low reimbursement of Medi-Cal. This concierge fee increases the California physician shortage.

The result has been that groups of activists have filed a federal civil rights complaint alleging that Latinos are being denied access to healthcare because the program does not pay doctors enough.

“The Affordable Care Act allowed states to open up Medicaid to anyone making less than 138% of the federal poverty level.”

Twenty states did not sign up for the expanded Medicaid because of the fear of federal takeover and the further impingement of state rights.

Pre-Obamacare, states were required to pay 43% of Medicaid’s cost and the federal government paid 57% of the costs. States ran the program and determined reimbursement.

As costs increased reimbursement was decreased and physician participation decreased because of the decreased reimbursement.

As a result of the 20 states resisting Medicaid expansion the federal government will pay 100% of the cost of new expansion enrollees and 93 percent off the cost of expanding Medicaid over the next nine (9) years instead of the next two (2) years.

The present rule looks like a great deal for the states. However with the federal government paying most of the Medicaid bill for the next nine (9) years the federal government will want to control Medicare.

Who needs a Public Option to get to a single party payer?

Who is going to stop the federal government from changing the eligibility for Medicaid to 200 or 400% of the poverty level?

Who is going to force doctors to participate in Medicaid if they want to practice medicine with a federal license?

Where is the government going to get the money without having skyrocketing increases in taxes?

Tax laws and lack of pro-growth tax reforms are inhibiting America’s economic growth.

America has been set up to have the future state of healthcare be a single party payer system. President Obama has done it in a clever way. He has had no regard for being fiscally responsible in the face of a 19 trillion dollar, and rising, debt.

Single party payer systems have failed in England and Canada.

Why should America create another failure?

Can Americans have a future state healthcare system that is not destined to fail?

Yes we can!

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

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