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One Could Go Nuts

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:

Measurement madness final. jpg

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

Ocachart

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.

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

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Social Engineering

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President Obama Somehow Finds The Money

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Stop Confusing Me With Misleading Facts

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.

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

 

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Here It Comes!

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.

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

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Premises Must Be Re-examined

Stanley Feld M.D.,FACP,MACE

A few weeks ago I had a terrific exchange with Steve Brachet M.D. who forwarded my blog to Steve Gregg.

“Stan,

I forwarded your recent blog featuring the five essential steps for HC reform to Stephen Gregg of Portland Oregon.

Steve Gregg is a former senior hospital executive, turned CEO of a managed care plan (successful in WA and OR), developer of alternative healthcare products, developer of patient care informatics, and thought leader in past 10 years on dimensions and confounding variables of health care in all its complexities.

He asked me to send the attached (very brief) piece recently published in the Oregon main media.

I don’t know if he expects a comment or two – but if you care to comment feel free to respond to Steve Gregg directly.

I take it that you are continuing to do your best to ‘right this HC ship’ that seems unlikely to improve on its own – nor with the help of the current Congress.

Steve Barchet M.D.”

I was fascinated with the article Steve Gregg wrote. I agree with many of the points he makes. I am publishing his article with Steve Gregg’s permission. I wrote back and said;

Dear Steve

I welcome your article.

My blog explains the elements needed to Repair the Healthcare System from a physician’s point of view.

As a result of the Internet and improved software, consumers have become king and are driving the consumer consumption market. Amazon and ebay have led the way. Opaque purchasing models have been replaced by price transparent purchasing.

Wal-Mart has been forced to close stores because of online purchasing to remain competitive.

A consumer driven transparent online purchasing model has replaced airline ticket purchasing through travel agencies.

Online banking is transforming banking services. Hardly anyone goes into banks anymore.

There is no reason that shopping for healthcare services cannot transform the healthcare industry with all its opacity.

Consumers must be put in a position to drive the healthcare system and be responsible for their health and healthcare dollars.

Our 2020 business model can transform the dysfunctional healthcare system that can align all the stakeholders’ vested interests by empowering consumers and letting them drive the system.

The result will be a decrease in cost. It will eliminate the entitlement mentality of healthcare consumers and create a competitive mentality for all stakeholders as it has done in the examples above.

All Obamacare is doing is trying to put a patch on a healthcare system whose demise has been accelerated since passage of the Affordable Care Act.

Your articles describe many essential premises that must be reexamined.

However, consumers must be involved and be the responsible party in the healthcare system. They have to be given financial incentive to be involved and responsible.

Thank you for letting me reprint your article.

 

Health Reform…What Next?

Steve Gregg

With the expensive collapse of Oregon’s Health Exchange, a New Year, and approaching changes at the Federal level, it is time to reconsider the formative assumptions driving health care reform.

Ten Game Changing Assumptions Shaping Health Reform:

 

  1. The ideologies of the left and right will not sustain a reform solution grounded in compromise and “deal making”.   The endless search for consensus confuses the problem, and is a recipe for failure.

 

  1. The State’s public bureaucracy is too conflicted with its own self interest to impartially govern health reform.

 3.The plethora of proposed actions to reduce demand will not reduce costs. “Supply” being a more important driver of costs than ”Demand”.

  1. Sustainable reform cannot tolerate the variation in provider pricing to patients with differing sources of payment. Perhaps less than 15% of the typical hospital’s patients pay what the hospital bills.

 

  1. It is wrong headed to view reform as a matter of amending the existing system.

 

  1. Financial goals stabilizing health care costs cannot be achieved without prospectively stated and independently measured metrics.

 

  1. Equal access is not a realistic expectation. Universal coverage must be.

 

  1. Genuine Altruism is a deceptive and widely abused value of our non- profit institutions and trade associations.

 

  1. The United States spends twice as much per capita on health care because our health care workers of all stripes (including insurance companies,hospital sytems, government and pharmaceutical companies) s(take out twice as much from the system.

 

  1. The health care structures of other countries, while instructive, are not transferrable to the United States.

 

Bonus:

 The Oregon Healthcare Project rationing experiment was a colossal hoax that channeled billions of new dollars to Oregon’s health care interests. Never measured, never critically evaluated. It was a severe case of the “Emperor Wears No Clothes”.

Conclusion: Think in terms of 2-3 alternative systems reflecting differing ideologies: Liberal / Conservative / Libertarian.

What would this suggest for process?

 

  • Form 3 small task forces assembled around three ideologies: Liberal, Conservative, and Libertarian to articulate assumptions, problem definition, and a broad solution compatible with each ideology.
  • At the end of the process examine what consolidation can occur and if not presume the development of 3 systems available to the free will of people to chose.

 

Liberal: Socially and fiscally liberal

Conservative: Fiscally and socially conservative

Libertarian: Socially liberal / Fiscally conservative

 Note: The prospect of 3 systems capturing U.S. Healthcare, sounds daunting but in reality we have more than that now: Employer, Medicare, Medicaid, TriCare, Municipal, Insured, Self funded etc.

 Alternative List of Assumptions:

 

  1. A sustainable health reform strategy cannot be achieved without the foundation of a well-conceived definition of the problem and formative assumptions.

 

  1. Subsidized or “free” health care is inflationary and will overwhelm administrative protocols for cost reduction.

 

  1. Genuine Altruism is rare and a widely abused cover for proprietary agendas.  Excessive profit is a measure of good management.

 

  1. The community’s health care pathology is infinite and those making a living and profits from health care will seek to capitalize on that.

 

  1. Our health care system in the main is a proprietary endeavor with millions of economic interests seeking to protect or increase revenues. Any initiative that threatens that cash flow will be vigorously resisted.

 

  1. Does the system tilt toward choice and self – determination or equalness, limited choice, and a central authority?

 

  1. “Nearly half of all care delivered produces no medical benefit” is in obvious conflict with a prevailing view of vast health manpower shortages.   Does increasing supply reduce prices and the costs of health care?

 

  1. If the national will demands universal coverage, the utility of competing traditional insurance companies should be called into question.

 

  1. The reformed system must promote individuals seeking care from the “best” provider of care as early as possible in the development of any adverse health care condition.   Forcing patients into an inferior food chain of care is unethical and probably more costly in the end.

 

  1. There is something wrong with a requirement to select a health plan, provider network, and insurance in advance of acquiring a dire condition, and then being locked out of access to the “best” provider.

 


Steve

I do not see consumers playing an active role in your assumptions to Repair the Healthcare System.

Obamacare is wasting money developing an entitlement system that cannot work. The only stakeholder that can develop a healthcare system that can work is a system driven by consumers.

Consumers can force the secondary stakeholders to be competitive and transparent, as they have done in other industries.

It would be cheaper for the government to invest in empowering all consumers using the revolution in information technology and providing financial incentives to all using My Ideal Medical Saving Accounts.

Everyone could be insured as I have described in my article The Ideal Medical Saving Account Is Democratic.

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

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

 

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Obamacare Is Increasing Health Savings Account Participation

Stanley Feld M.D.,FACP,MACE

Patients’ responsibility for their health and their healthcare dollars is one of the most important elements in a functioning and cost effective healthcare system.

Despite the fact that my ideal medical savings account (MSAs) would be more effective than health savings accounts (HSAs) in encouraging patient responsibility for their health and healthcare dollars, health savings accounts are flourishing because of Obamacare is costly and has taken freedom of choice away from individuals.

Devenir is a HSA Mutual Fund that accepts and invests HSA trust contributions and invests those contributions. Devenir just published a study that showed that:

1. As of June 30, 2015, the number of HSAs had climbed 23% from the previous year to 14.5 million.”

  “2. Account balances jumped 25% to approximately $28.4 billion over the same time period.”

In 2010 the year Obamacare was passed, there were 5.7 million HSAs with balances totaling $7.7 billion.

The Obamacare bronze plan is the least expensive federal health insurance exchange plan. Its coverage is poor and it has a high deductible that most people cannot afford.

The premium and deductible are only good for patients with pre-existing illnesses that have no other place to purchase insurance. That is the reason the demographic for enrollees from healthcare.gov is so poor.

The government is loosening the noose on HSAs even though it is still restrictive.

“For the 2016 tax year, you can make a deductible HSA contribution of as much as $3,350 if you have qualifying high-deductible self-only coverage or as much as $6,750 if you have qualifying high-deductible family coverage. If you are age 55 or older as of the end of 2016, the maximum deductible contribution goes up by $1,000.

For 2015, the contribution caps are the same, except the maximum deductible contribution for family coverage is $6,650. These amounts are increased by $1,000 if you were 55 or older as of December 31, 2015. You have until April 18, 2016, to make an HSA contribution for the 2015 tax year.”

You must have a qualifying high-deductible health insurance policy — and no other general health coverage — to be eligible for this HSA contribution privilege. For 2015 and 2016, a high-deductible policy is defined as one with a deductible of at least $1,300 for self-only coverage or $2,600 for family coverage.

For 2016, qualifying high-deductible policies can have out-of-pocket maximums of as much as $6,550 for self-only coverage and $13,100 for family coverage. For 2015, these amounts are $6,450 and $12,900, respectively.

If you are eligible to make an HSA contribution for a tax year, the deadline is April 15 of the following year (adjusted for weekends and holidays) to open an account and make a contribution for the earlier year.”

The government has increased the maximum deductible in 2015 and continues to increase in 2016.

For the 2016 tax year, you can make a deductible HSA contribution of as much as $3,350 if you have qualifying high-deductible self-only coverage or as much as $6,750 if you have qualifying high-deductible family coverage.

“ If you are age 55 or older as of the end of 2016, the maximum deductible contribution goes up by $1,000.”

More large companies are Increasingly offering workers high deductible health saving account. However, the employee is responsible for the high deductible and most of the plans are 70/30 coverage after the deductible is reached up to a maximum of $10,000.

Most large and small employers can afford to pay all or some of the high deductible and buy reinsurance for first dollar coverage beyond the deductible.

Both large employers and small employers are offering their employees health savings accounts. The full insurance premiums have become so high that employers are shifting the burden to employees by having the employee pay the deductible and the employer paying the reinsurance.

UnitedHealth has about 40 individual high deductible plans with 70/30 copays over the limit of the deductible. The maximum out of pocket cost is $10,000. The premium for a young married couple without kids is from $125 to $350 per month depending oo the deductible chosen. The premium increases with the number of children.

A great advantage to these plans now is that UnitedHealth has already negotiated the physicians’ and hospitals’ fees for you. The uninsured would pay retail price for the same services.

The cost to small to large companies is relatively difficult to find in an online search.

Most companies are self-insured and would not fall under the rigid coverage rules of Obamacare. The company can decide on the amount of the deductible they would pay for the employee.

The point of all this is health saving accounts are not as good as my ideal medical saving account. HSA’s do not provide enough incentive for employees or individuals to manage their health or healthcare dollars wisely as an MSA would.

A large defect in Obamacare is patients do not have incentive to be wise shoppers of their healthcare. They have restricted choice. They have little incentive to stay healthy because they have an entitlement program available that will take care of their expenses. There is no financial incentive for them to try and reduce the cost of healthcare.

If the consumers managed their health and healthcare dollars well the cost of healthcare would drop because the complications of chronic diseases would decrease to at least 50%.

If Republicans are looking for an alternative plan to the liberals’ and progressives’ inevitable march to a singe party payer system most of the infrastructure is already in place.

Only small modifications to the HSAs have to be made by the congress and the President and America would be on its way to a free market healthcare system.

This alternative healthcare system would align all of the stakeholders incentives including the government’s incentives, if the Obama administration did not want to increase its power by having more control over its people and its people’s freedom of choice.

My ideal Medical Saving Accounts would be democratic and cover everyone.

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

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

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Obamacare Is In Big Trouble!

Stanley Feld M.D.,FACP,MACE

There are so many parts of Obamacare that are failing it would be impossible to describe each failure in a single blog..

President Obama and his administration keeps telling the American people that Obamacare is working great. It is here to stay.

I cannot believe Americans believe him. I cannot believe he thinks Obamacare is doing great.

It could be true that everything is going great for him if he wants Obamacare to fail and cause hardship for millions of Americans.

At that point Americans would beg President Obama or another progressive president loke Hillary Clinton to institute a single party payer system.

A single party payer system has been Hillary’s dream since Hillarycare 1993. Now she is saying she wants a private insurance based system. The purpose of this statement is to neutralize (freeze) her free market system critics.

Once more America is being exposed to Hillary Clinton’s use of a typical Saul Alinsky tactic. The tactic in his “Rules for Radicals” is to freeze your opponent by stating his position as yours even if it is a lie.

Hillary wrote her senior Wellesley College thesis on Saul Alinsky and “Rules for Radicals”. She also became a big fan and good friend of his.

Hillary Clinton and President Obama know Obamacare is failing. They are just waiting for the tipping point. The tipping point will be when the American people say please help us and give us a single party payer system.

At that point we will hear the typical gee shucks, I guess we will have to try a single party payer system.

A single party payer system will be a bigger financial and patient care disaster than what we have now.

The data on the first week of applications for Obamacare’s healthcare.gov was announced to the rave reviews by the Obama administration.

Since few pay attention to the actual numbers President Obama can get away with the lie.

The CBO predicts 19 to 21 million will sign up for Obamacare for 2016. The administration estimates they are going to have 9.1 to 11 million enrollees for 2016.

The Obama administrations estimate is 30% lower than the announce 13 million enrollees in 2015. In reality only 9.7 million enrollee paid for healthcare insurance through healthcare.gov 2015. Of those 9 million only 6.5 million kept their insurance premiums current for the entire year.

The www.acasignup.net quoted the Obama administrations claim that 595,590 filled out applications to get price insurance quotes. Only 8% of the reported applicants or 47,243 paid their first month’s premium for 2016.

These numbers are not a cause for celebration unless you want to misinform the public by claiming a successful first week enrollment.

Let’s do the math. The enrollment period for 2016 is from November 1st until December 31st 2015 or eight and one have weeks with four major holidays, Veterans Day, Thanksgiving, Christmas and New Years.

Let us the assume all 600,000 that filled out applications will pass the application requirements and pay their assigned premium for each month. Let us also assume the average weekly application rate is 600,000 per week for the 81/2 weeks. The grand total enrollees would be 5.1 million enrollees for 2016. This is 4.5 million less paid enrollees than in 2015.

There was an attrition rate 2% a month in 2015. President Obama extended the enrollment period several times to get more people to sign up.

2015 FULL YEAR ENROLLMENT/ATTRITION RATE TABLE PROJECTION:

2015_full_year_projection_effectuated

2014 FULL YEAR ENROLLMENT/ATTRITION RATE TABLE (FINAL):

  Microsoft ExcelScreenSnapz 2014 458

It is clear that President Obama’s victory laps celebrating the success of Obamacare is unwarranted.

However the media is the message. He controls and manipulates the media. It would have been much easier to provide Medicaid and CHIP coverage to the poor outright than destroying the healthcare system with changes that are not working.

The final enrollment for 2014 was 6,338,622 not over 13 million. The final enrollment for 2015 was 9,736,350 and not over 13 million. This is a net gain of 3.5 million new paying enrollees in 2015.

This year the Obama administration estimates that 9 million will purchase insurance through the health insurance exchanges. At the present rate only 5.1 million will purchase insurance for 2016 at the end of the enrollment period December 31, 2015.

The CBO’s estimate was 19-21 million paid enrollees.

It does not represent a very successful net gain when the government publishes that there are 34 million uninsured Americans. No one knows if the 90 million unemployed Americans are counted in the number uninsured.

Unaffordable care act

All anyone hears is the Obama administration’s reasons our taxes, and insurance premiums are going up, while our insurance coverage is going down. The Obama administration is blaming the healthcare insurance industry and Republicans.

President Obama has used, with the help of the mainstream media, the Saul Alinsky tactic to freeze opponents by shocking them with unsustainable factoids.

 The Avalere Health consultancy’s analysis of 2015 signup data showed surprisingly weak ObamaCare enrollment at modest income levels. At between 150% and 200% of the poverty level, just 41% of those eligible signed up for coverage. The number falls to 30% among those between 200% and 250% of the poverty level.

 In 2016 President Obama is going to penalize people that do not have healthcare insurance.

It’s now clear that the actual impact of ObamaCare’s individual mandate tax penalty will be far worse than the benign intent that the Obama administration claimed.

“What we’re talking about is a penalty for the few people who will refuse to buy health insurance — even though they can afford it — and who expect the rest of us to pick up the tab for their care,” a September 2009 White House defense of the individual mandate states.”

Reality should be coming into focus by now for the average American taxpayer and the poor. Obamacare is ripping everyone off.

The mandate’s primary impact will be to compel low-income households to buy bronze coverage with deductibles of up to $6,850 per adult that are well beyond their capacity to afford.

Even after these poor people pay the $6,850 deductible they have a 40% deductible on the rest of the billing.

Who said poor people are too stupid to handle their own money and be responsible for their healthcare dollars?

They are smart enough to know the government is ripping them off.

George  Shore101  3 months ago

If the Obama administration and Democrats love the poor why did they force the poor to purchase something they can not afford and then penalize them for not being able to afford it?

It is a horrible thought to think President Obama is working to make the poor poorer and make the healthcare system fail the American people.

It looks like he is. His plan to replace it with a single party payer system will result in a bigger failure.

Why are Republicans just standing around doing nothing? Why don’t they publicize my Ideal Medical Saving Accounts?

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

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

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I Told You What To Do 8 Years Ago: Part 2

Stanley Feld M.D. FACP,MACE

There are so many little changes that can have a big affect on repairing the healthcare system.

These changes would go a long way in putting consumers in control of their own health and healthcare dollars.

President Obama and the Democrats want to make consumers dependent on government. Most Republican politicians do not understand the healthcare system’s problems.

Republican senators and congressmen have not been able to come up with a viable solution because they are influenced by vested interests other than the consumers’ vested interests. .

Republicans cannot understand that consumers are smart. Most know how to spend their money wisely. Consumers can solve problems if they are given the right tools and incentives.

In last week’s Republican debate Mike Huckabee got close when he said we have to solve four chronic diseases and the costs to the healthcare system would plummet. He mentioned diabetes, heart disease, cancer and lung disease. He was almost correct.

The care of chronic diseases that are manageable consume 80% our healthcare dollars. Most of the 80% is spent on the complications of these chronic diseases.

Motivating patients to become the “Professor of Their Disease” can prevent at least 50% of the complications of these diseases.

Mike Huckabee missed that part. Patients must be provided with financial incentives to prevent a chronic disease from occurring in the first place and then learn how to prevent complications from occurring.

I am publishing the spring of 2007 blog summaries to demonstrate that none of the obvious fixes have been executed to put consumers in a position to make wise choices and be responsible for them.

What Have I Said So Far? Part 2 Spring 2007

April 3,2007

Stanley Feld M.D.,FACP,MACE

 

The solutions I have proposed are all directed to a patient centered, patient driven, and patient advantaged system. I will review the proposed solutions in the next two blogs.

 Price transparency is an essential beginningNot only must the retail price be published but all of the discounted prices must be transparent as well.

The government must enact legislation so that the providers and the insurance companies post their range of prices. The government has to empower the patient with negotiating power to get the best price.

There are many different prices paid for a service depending on the negotiating power of the purchaser. The net effect of this total price transparency will be lower the prices and decrease cost of health insurance.

Consumer must demand real price transparency. Aetna’s declaration of price transparency last year was a rouse. The hospital associations of Wisconsin and now Texas have developed web sites to provide hospital retail prices.

We have little idea how much the government or insurance companies pay for these services. I assure you the discount is very deep and the hospitals are satisfied with the payments. 

The automobile industry has figured out how to deal with total price transparency and the Internet publication of the MSRP, the invoice prices and the average prices paid for an individual automobile. 

We should demand that the healthcare system does the same. The system should be set up where patients can negotiate price pre or post treatment. Sometimes the patients need a care emergently and are not in a position to negotiate in an emergency room.

Yet an oncologist is not permitted to administer the drug in his office for one and one half times the cost of the drug. It is estimated that $150 billion dollars are wasted on administrative costs in the hospital and in the insurance industry. These costs add not value to the treatment of patients. Increased executive salaries and increasing construction of enlarging hospital facilities absorb the administrative waste. The brick and motor expansion of hospitals should be over since much can be done on an outpatient basis.

 These are some of the solutions necessary to repair the healthcare system. The solutions have to be instituted as a total plan and not introduced piecemeal. Each of the pieces of the solution is dependent on each other in order to have a positive effect on repairing the healthcare system. Next time I will review the other elements of my plan needed to Repair the Healthcare System.

April 03, 2007  

There are two more parts to go. If only our elected officials would listen. The only way that will occur is if consumers start making demands. If the politicians do not listen them kick them out of office.

The most profound thing said at the Republican debate last week was by Marco Rubio. He said the traditional media is the Democrats largest and most powerful special interest group.

I suggest people start reading between the lines of the New York Times articles for a start.

Wake up, America.

 

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

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

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