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Simple, Viable Republican Alternatives To Obamacare

Stanley Feld M.D., FACP, MACE

There are many simple and viable alternatives to Obamacare which Republicans should start considering.

Republicans should seriously consider My Ideal Medical Savings Account as an alterative to Obamacare. It is logical, simple, does not require a large complicated infrastructure and aligns all the stakeholders’ incentives.

It is easy for consumers to understand.

Consumers want to have choices. The dysfunction of our healthcare system has gotten to the point where most consumers don’t have a choice. Consumers simply do not know they lost their freedom of choice and access to care until they get sick.

Consumers think they have adequate healthcare coverage until they get sick. Only 20% of the population gets sick.

The other 80% of the population refuses to think about the problem.

When they do experience illness, the dysfunction in the healthcare system makes them furious. They want to blame someone. Physicians are usually the targets of their frustration.  

Most physicians are trapped in a situation that causes them to fight for their own survival for all the reasons I have previously enumerated. This creates a more dysfunctional healthcare system.

All the stakeholders fight for their own vested interests. These vested interests have become misaligned. The vested interest of the government is to control of the system and decrease its costs.  

Costs cannot be controlled by regulations without consumer involvement.   Consumers of healthcare must understand the effectiveness of their care is dependent on their involvement in their own medical care.

Consumers’ adherence to treatment is a key component in the effectiveness of medical care.

Medical costs cannot be controlled by government price fixing.

Medical costs cannot be controlled by government restrictions to access of care. Consumers will become sicker resulting in a higher cost illness.

Consumers must be empowered to be intelligent, motivated and responsible consumers of medical care. Only then can healthcare costs be controlled.

A functional healthcare system must provide financial incentives to consumers in order for them to want to be empowered to control costs. Consumers should not be dependent on the government to control costs.

The government must repair the actuary and accounting rules of the healthcare insurance industry. Insurance reserves should not be scored as a loss to justify premium increases.

The healthcare insurance industry takes 40 cents off the top of every insurance dollar that is spent. Consumers with both private insurance and government insurance are only getting 60 cents value for every healthcare dollar spent. The healthcare industry is allowed to do some strange accounting with their required reserves.

If this accounting method were repaired, premium costs would decrease.

Effective malpractice reform would result in a significant decrease in healthcare costs. The Obama administration refuses to believe tort reform is needed.  

Many of the rules written into Obamacare, Medicare, and Medicaid are so screwy they defy common sense and penalize consumers. One glaring rule is Medicare permitting hospitals to admit Medicare patients to the hospital for observation for 48 hours.

Medicare does not pay for Observation admissions. Patients have to pay out of pocket for these admissions.

Consumers must become aware of these screwy rules and protest them. These rules have been written by the Obama administration to save the government money. These rules penalize patients the government professes to help.

Consumers are the only stakeholders that can motivate President Obama and congress to fix the significant points of waste in the healthcare system. Consumers have the power to vote.

I do not believe that President Obama has an interest in repairing the healthcare system. All of his actions signify that he wants the healthcare system to fail. After it fails people will beg the government to completely take over and have a single party payer.

Does anyone trust the government to take over our most valuable asset, our healthcare?

The government take over will also fail because dependent consumers will figure out how to game the system just as food stamp recipient have figured out how to game that inefficient system.

The goal of a sincere administration and congress is to figure out how to motivate consumers to be “PROSUMERS” (productive consumer) with an economic interest in the healthcare system.

Airlines, banks, bookstores, entertainment venues have all figured it out. Why can’t the government help consumers figure it out?

My blog entitled “My Ideal Medical Saving Account Is Democratic” presents a consumer driven healthcare formula. It gives every socioeconomic group the opportunity to be an effective “Prosumer”.

It gives all Prosumers the incentive to be responsible for their health and healthcare dollars.

Below is the blog My Ideal Medical Savings Account Is Democratic!

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) “was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrict freedom of choice and decrease in access to care.

The excellent example of increasing costs, decreasing choice, and decreasing access to care is Medicaid.

The fact that someone is covered by healthcare coverage does not mean they have access to medical care.

 I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health.  Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self- insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk is low. 

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust.  If they spent over $6,000 they would receive first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes Mellitus, or heart disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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Republicans who really want to repair the healthcare system should take notice of these suggestions. They should stop proposing complicated alternatives to Obamacare that will not work.

Republicans should start trying to understand the real problems in the healthcare system.

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

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The Republican Alternative to Obamacare

Stanley Feld M.D. FACP MACE

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

The Obama administration insists that the Republicans do not have a viable alternative. I doubt that anyone in the administration has read the alternatives.

President Obama’s tactic is to marginalize any opposition even if he has not reviewed it.  

The Republicans have some good ideas. However, they do not address the basic problems in our healthcare system.

The implementation of their ideas will not repair our healthcare system.

 “Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.”

Obamacare has so many parts. Most of Obamacare’s parts could have been predicted to fail. It is clear that congress did not understand this destiny before passage.

Obamacare was destined to fail from the start. It is on the way toward failure today. It will also destroy the entire healthcare system.

The Republican alternative is called, "The Patient Choice, Affordability, Responsibility, and Empowerment Act." 

It's key provisions include:

A Full Repeal and Replacement of Obamacare

Eliminate Individual Mandate to Buy Health Insurance or an Employer Mandate to Offer Coverage

Consumer Protections – Republicans want to retain the popular consumer protections in Obamacare including no lifetime limits, coverage for children to age 26 on their parent's plan, and guaranteed renewability of coverage.

However, they propose to decrease the costs of healthcare insurance for younger consumers but want to increase the cost of healthcare insurance for older buyers.

The Republicans would create a new set of losers (older buyers) while increasing the incentive for younger people to buy insurance.

Republicans should be providing financial incentives for consumers to be responsible for their health and their own healthcare dollars. Consumers with chronic diseases should also be responsible for the control of their chronic disease.

 A Return to Pre-Existing Condition Limits.  This is a ridiculous provision. It guarantees the biggest villain in the healthcare system (the healthcare insurance industry) its control of premiums and profitability.

Default Enrollments – Republicans would allow states to create a default enrollment system for those eligible for tax credits as a means to reduce the number who would otherwise remain uninsured.

A complex agency would be needed to administer a complicated process.

  
High Risk Pools for the Uninsured – High-risk insurance pools did not work previously because of healthcare insurance companys’ control of the premiums for the sickest people and their high risk of disease.

 Affordable Insurance Policies – This is also a pipe dream. America’s population is becoming more obese. Obesity generates more illness and higher risk. As long as the healthcare insurance industry is calculating and is in control of the actuary risk, healthcare insurance will not be affordable. The problem is how the insurance industry is allowed to do its accounting.  

The Republicans are proposing the elimination of benefit mandates and downsizing guaranteed insurability with their "continuous coverage" provision.  

This proposal is ridiculous. As long as consumers are not responsible for their health and their healthcare dollars and the healthcare insurance industry controls  price,  the healthcare system will be increasingly more expensive and dysfunctional.

Tax Credits to Buy Coverage – Tax credits are an unearned entitlement. Unearned entitlements do not work. Tax credits would be available for those in the individual health insurance market, those working for businesses with fewer than 100 employees, and those working for larger employers that do not offer coverage.

Tax Credits Only Up to 300% of Poverty – A system of tax credits leads to an agency that must be connected to another government agency, which leads to a larger government bureaucracy. In turn the bureaucracy leads to fraud and abuse

Flat Amount Tax Credits By Age – The goal of this proposal is to eliminate federal and state exchanges. Obamacare’s state and federal exchanges have not worked no matter how the administration spins the truth.

It would be easy to just give everyone a tax credit by age. A new bureaucracy would not be needed.

However, control of price and actuarial risk is still determined by the healthcare insurance industry. Consumers are not empowered. The healthcare insurance industry is empowered. Only at the time consumers are stimulated to control their health and healthcare dollars will the system work. Tax credits and price controls do not work.
 
 No Limits on the Kind of Insurance Policies That Could Be Offered – This is not a bad idea.

Capping the Tax Exclusion on Employer-Provided Health Insurance – The entire tax benefit for the employer and the individual should be equalized. Benefits should not be exclusive. Healthcare insurance premiums should be paid for with pre-tax dollars by all. The individual market should not pay for premiums with after tax dollars and the group market pay for premiums with pre-tax dollars. The present system is a hidden tax on consumers buying insurance in the individual market.
 
 
Moving Toward Defined Contribution Health Insurance – This is a stab in the dark by Republicans. It would penalize consumers and it would benefit employers. Employer want to avoid providing the same level of healthcare coverage for all their employees
 
Medical Malpractice Reform – This is a sensible reform. It is estimated that is would lower healthcare cost between $300 and $750 billion dollars a year if all costs were included.

If malpractice reform took the right form to protect consumers and physicians, the abuse in the malpractice system by lawyers and the insurance industry would be eliminated.

Both the Democrats and the Republican have protected the lawyers and the insurance industry in the past. Past behavior is a predictor of future behavior.    

Repealing the Medicaid Expansion – Medicaid should be eliminated and replaced by an all-inclusive healthcare system.

The poor should have the same insurance coverage as the rest of society. The immediate response is the nation couldn’t afford it. Yet President Obama is expanding Medicaid as access to care is being restricted. Therefore formulas that try to control costs fail because the development of severe illness is more expensive than consumers of healthcare learning how to control their disease. A consumer having healthcare insurance coverage does not make those consumers well.  

 Empower Poorer Consumers by Giving Them Mainstream Health Plans

Republicans do not offer a plan of action within this category. It sounds good but feels as if it is an empty promise. Actually it is an important factor in repairing the healthcare system. I will explain in the next blog.

The solution to the healthcare system’s dysfunction must be a simple solution.

The Republican solutions are almost as complex as Obamacare. It does not decrease governmental bureaucracy nor does it avoid the potential for fraud and abuse.

The Republican solutions promote continued control over consumers and their freedoms.

The Republican solutions do not get to the main problem in the healthcare system.

The healthcare system must be set up so consumers are motivated to have incentive to be responsible for their own health and healthcare dollars.

The alternative to Obamacare should exclude the government from making consumers dependent on the government. 

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

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King vs. Burwell

Stanley Feld M.D.,FACP,MACP

 In January 2015 fifty-six percent of the population surveyed knew nothing at all about the King vs. Burwell case to be heard by the Supreme Court in March 2015. Only 5% said they knew a lot about it. Nine percent said they knew something about it. Thirty percent of those surveyed said they knew only a little about the case.

I could not believe these numbers. So I decided to do a little personal survey of college graduates I ran into during the week. These people, in my opinion, are educated people. They would not consider themselves low information voters. Some, informally surveyed, were physicians.

To my amazement the numbers in the Kaiser survey taken before the Supreme Court hearing were similar to my informal survey taken after the Supreme Court hearing.

The leaders of the Republican Party are hoping the Supreme Court will uphold the challenge to Obamacare. They hope a favorable decision will subsequently cause Obamacare to collapse. The Republican Party would rather not have a open public debate about the federal health exchange’s unconstitutional subsidies.

The Republican Party does not want to be blamed for Obamacare’s collapse. They are also afraid to present Obamacare’s defects to the American people in simple terms. They are afraid to provide the leadership necessary to create outrage by the populous to stimulate public pressure to repeal this awful law.

  King burwell picture

King vs Burwell is a very simple case. The Affordable Care Act was passed into law by a partisan vote. The ACA did not receive one Republican vote.

None of the stakeholders approve of it. President Obama has made temporary modifications to the law to prevent a united popular outrage against the law.

The lawsuit by King against the Obama administration’s head of HHS, Sylvia Burwell, is that Obamacare (partisan passed law) is not upholding the letter of the law.

 The law clearly states that only states with a state health insurance exchange can provide subsidies for the purchase of healthcare insurance.

The Obama administration is providing subsidies through the 39 federal health exchanges. There are 39 federal health exchanges because 39 states refused to participate in the formation of a state insurance exchanges.

The law was written that way to encourage states to set up the exchanges. There is plenty of profit built into the state exchanges for the debt-ridden states to decrease its deficits.

As a result of the poor state response, President Obama even promised to fully fund the program for three years. He received little state response to that proposal.

The states that did not set up state exchanges exercised their states rights. Those states could visualize the losses they would incur when the first three years were over. It would necessitate the states to raising taxes on their citizens in order to avoid bankruptcy.

These states were also opposing a federal take over of the authority given to the states by the constitution.

A few state exchanges have closed down all ready even with total federal funding. In many cases people were not signing up because the insurance was too expensive.

The issue before the Supreme Court is simple.

The job of the executive branch of government is to implement and enforce the law as written. The executive branch of government cannot change the law without the consent of congress.

The lawsuit against the Obama administration is a constitutional question. It is nothing else.

If the court rules for the Obama administration, then President Obama has set a precedent so laws can be rewritten by the executive branch of government without the consent of congress.  

In reading the extensive coverage of the New York Times by Margot Sanger-Katz  everything but the constitutional issue is discussed.

http://www.nytimes.com/2015/02/25/upshot/health-secretary-says-theres-no-backup-plan-if-court-rules-against-health-law.html?abt=0002&abg=1

http://www.nytimes.com/2015/03/10/upshot/a-roadmap-for-how-many-people-could-lose-their-health-insurance.html?emc=edit_tnt_20150309&nlid=8639975&tntemail0=y

http://www.nytimes.com/interactive/2015/02/03/upshot/obamacare-back-at-the-supreme-court-frequently-asked-questions.html?abt=0002&abg=1#subsidies

All sorts of emotional issues are discussed such as 7 million people will loss their healthcare insurance subsidy and in turn lose their healthcare insurance coverage.

As stakeholders have tried to adjust to the law, they have discovered ways to profit from the law. Now some of the stakeholders now do not want the executive order to be ruled unconstitutional because it will harm their vested interest.

The administration’s argument focuses on everything but the core issue in this case. The executive branch (President Obama) cannot change the letter of the law. The legislature is the only body in our checks and balances system that can change the law. Therefore, President Obama’s action is unconstitutional.  

Worse yet, the Obama administration by itself and through its surrogates, such as the mainstream media (New York Times), have been muddying the water in an effort to intimidate the Supreme Court and its decision.

The Obama administration has begged the constitutional question in favor of having the public generating pity for the 7 million people who could lose their healthcare coverage.

Many of those 7 million people cannot afford the healthcare coverage provided by the health exchanges.

President Obama has also said, over and over again, that the Republicans have not provided a better plan to influence the court in considering  the simple constitutional issue.

The solution is simple. The Obama administration should ask congress to change the law.

The administration should ask a Democratic congressman to amend the law to changing the language of the law so that the federal healthcare exchange can provide subsidies.

If the executive branch is permitted to change a law, America could be on the path toward a dictatorship.

The Obama administration has announced that is has no contingency plan if the Supreme Court rules against it.

This could be interpreted in two ways. President Obama believes he is on the right side of the constitution. He feels that the Supreme Court judges have no choice but to agree with him.

The second is the Supreme Court will be intimidated by President Obama and modify the reading of the constitution to have a broader interpretation.  The court will let the executive branch change the law as written to one that fits the President’s agenda.

I do not believe the Supreme Court will be intimidated. I do not believe the media will affect the decision of the Supreme Court.

In fact the Obama administration has been working secretly with alternative plans. Unfortunately these plans are intended to bypass a Supreme Court decision and not execute the Supreme Court’s decision.

This is a very important constitutional issue.

The Republicans must start to educate and heighten awareness of this decision by the public.

It is unacceptable and sad that only 53% of the public is aware of the case much less the importance of the decision.

  Skeleton Republican

 

https://mail.google.com/mail/u/0/#inbox/14c3d6566f26ca10?projector=1

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

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Obamacare Tax Hikes That Are Forgotten

Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens earning less than $250,000 dollars a year.

According to Grover Norquist there will be ½ trillion dollars ($500 billion) in new taxes collected from the group of people making less than $250,000 a year.

These new taxes contradict President Obama’s promise that “anyone making under $250,000 a year will not pay a dime in new taxes.” Many of these taxes on businesses have been passed on to consumers in the form of higher prices.

  

 

https://youtu.be/eHlRY3kHhBk

 

 

 

I am not talking about the increase in taxes on capital gains and dividends that seniors rely on to survive. I am talking about all the other taxes that affect purchasing power.

In 2012, Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

The traditional media have ignored these new taxes and Mr. Norquist’s summary.   No one is talking about how these taxes are hurting seniors and the middle class economically.  

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said people earning under $250,000 would not pay one single dime more in taxes.

I suggest everyone watch President Obama’s lying and defending of his lies. After the first You Tube let it keep playing to hear subsequent You Tubes.

  

http://youtu.be/56c1fSdTAWI

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organized the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in their taxes.

Mr. Norquist’s article appeared in 2012.

“Obamacare contains 20 new or higher taxes on American families and small businesses. 

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

Taxes that took effect in 2010:

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

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

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

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

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

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

Taxes that took effect in 2011:

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

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

Taxes that took effect in 2012:

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

Taxes that take effect in 2013:

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

 

Capital Gains

Dividends

Other*

2012

15%

15%

35%

2013+

23.8%

43.4%

43.4%


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

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

 

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

All Remaining Wages
Employer/Employee

Current Law

1.45%/1.45%
2.9% self-employed

1.45%/1.45%
2.9% self-employed

Obamacare Tax Hike

1.45%/1.45%
2.9% self-employed

1.45%/2.35%
3.8% self-employed

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

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

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

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

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

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

Taxes that took effect in 2014:

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

 

1 Adult

2 Adults

3+ Adults

2014

1% AGI/$95

1% AGI/$190

1% AGI/$285

2015

2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085


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

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

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

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

Taxes that take effect in 2018:

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

© 2012 Newsmax. All rights reserved.

Mr. Norquist left out the worst tax of all. The “tax” is under everyone’s radar. It has not been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

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

$104.20 in 2012

$120.20 in 2013

And

$247.00 in 2014."

 

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

 

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

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

 

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

Everyone must stay focused. President Obama is going to try to change the conversation.

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

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.  

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

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Here’s One For You, Stan

Stanley Feld M.D.,FACP,MACE

I wish to thank my readers for the many comments and suggestions sent to me over time.

I am starting to receive some serious criticisms of Obamacare that everyone should take note of.

Americans do not realize how bad the law is until they experience it.

People are starting to pay attention to the Obamacare disaster. They  realize it is affecting them directly.

Many people are having trouble finding a doctor. Many are having trouble getting access to care. Emergency rooms have become overcrowded. It is an awful experience to try to get care.

A note from previously insured patient who became uninsured because of Obamacare’s insurance requirements.

 

 “Here's one for you Stan. 

 

Here are the 10,535 pages of Obama Care condensed to 4 sentences.  
As ridiculous as this sounds…..every last word is absolutely TRUE!

1. In order to insure the uninsured, we first have to uninsure the insured. 
2. Next, we require the newly uninsured to be re-insured. 
3. To re-insure the newly uninsured, they are required to pay extra charges to be re-insured.
4. The extra charges are required so that the original insured, who became uninsured, and then became re-insured, can pay enough extra so that the original uninsured can be insured, which will be free of charge to them.

This is called "redistribution of wealth"… or, by its more common name, "SOCIALISM.

There are many more people confused by Obamacare. The reader is correct. The summary is spot on.

On top of this I got this note from another reader.  The public is starting to figure out Obamacare. This is a note written by a Californian.

 A Note From An Engineer

 “THIS IS WHAT OBAMACARE IS REALLY ABOUT!!!!!!!!!!!!! 

I'm a 54-year-old consulting engineer and make between $60,000 and $125,000 per year, depending on how hard I work and whether or not there are work projects out there for me. 

My girlfriend is 61 and makes about $18,000 per year, working as a part-time mail clerk. 

For me, making $60,000 a year, under Obamacare, the cheapest, lowest grade policy I can buy, which also happens to impose a $5,000 deductible, costs $482 per month. 

For my girlfriend, the same exact policy, same deductible, costs $1 per month. That's right, $1 per month. I'm not making this up. 

Don't believe me? Just go to http://www.coveredca.gov/, the Obamacare website for California and enter the parameters I've mentioned above and see for yourself. By the way, my zip code is 93940. You'll need to enter that. 

So OK, clearly Obamacare is a scheme that involves putting the cost burden of healthcare onto the middle and upper-income wage earners. But there's a lot more to it. Stick with me.

And before I make my next points, I'd like you to think about something:

I live in Monterey County, in Central California. We have a large landmass but just 426,000 residents – about the population of Colorado Springs or the city of Omaha.

But we do have a large Hispanic population, including a large number of illegal aliens, and to serve this group we have Natividad Medical Center, a massive, Federally subsidized county medical complex that takes up an area about one-third the size of the Chrysler Corporation automobile assembly plant in Belvedere, Illinois (see Google Earth View). Natividad has state-of-the-art operating rooms, Computed Tomography and Magnetic Resonance Imaging, fully equipped, 24 hour emergency room, and much more. If you have no insurance, if you've been in a drive-by shooting or have overdosed on crack cocaine, this is where you go. And it's essentially free, because almost everyone who ends up in the ER is uninsured. 

Last year, 2,735 babies were born at Natividad. 32% of these were born to out-of-wedlock teenage mothers, 93% of which were Hispanic. Less than 20% could demonstrate proof of citizenship, and 71% listed their native language as Spanish. Of these 876 births, only 40 were covered under [any kind of] private health insurance. The taxpayers paid for the other 836. And in case you were wondering about the entire population – all 2,735 births – less than 24% involved insured coverage or even partial payment on behalf of the patient to the hospital in exchange for services. Keep this in mind as we move forward.

Now consider this:

If I want to upgrade my policy to a low-deductible premium policy, such as what I had with my last employer, my cost is $886 per month. But my girlfriend can upgrade her policy to the very same level, for just $4 per month. That's right, $4 per month. $48 per year for a zero-deductible, premium healthcare policy – the kind of thing you get when you work at IBM (except of course, IBM employees pay an average of $170 per month out of pocket for their coverage). 

I mean, it's bad enough that I will be forced to subsidize the Obamacare scheme in the first place. But even if I agreed with the basic scheme, which of course I do not, I would never agree to subsidize premium policies. If I have to pay $482 a month for a budget policy, I sure as hell do not want the guy I'm subsidizing to get a better policy, for less that 1% of what I have to fork out each month for a low-end policy.

Why must I pay $482 per month for something the other guy gets for a dollar? And why should the other guy get to buy an $886 policy for $4 a month? Think about this: I have to pay $10,632 a year for the same thing that the other guy can get for $48. $10,000 of net income is 60 days of full time work as an engineer. $48 is something I could pay for collecting aluminum cans and plastic bottles, one day a month.

Are you with me on this? Are you starting to get an idea what Obamacare is really about?

Obamacare is not about dealing with inequities in the healthcare system. That's just the cover story. The real story is that it is a massive, political power grab. Do you think anyone who can insure himself with a premium policy for $4 a month will vote for anyone but the political party that provides him such a deal? Obamacare is about enabling, subsidizing, and expanding the Left's political power base, at taxpayer expense. Why would I vote for anyone but a Democrat if I can have babies for $4 a month? For that matter, why would I go to college or strive for a better job or income if it means I have to pay real money for healthcare coverage? Heck, why study engineering when I can be a schlub for $20K per year and buy a new F-150 with all the money I'm saving?

And think about those $4-a-month babies – think in terms of propagation models. Think of just how many babies will be born to irresponsible, under-educated mothers. Will we get a new crop of brain surgeons and particle physicists from the dollar baby club, or will we need more cops, criminal courts and prisons? One thing you can be certain of: At $4 a month, they'll multiply, and multiply, and multiply.

Obamacare: It's all about political power.

Does anyone think this is going to leave us with an affordable and efficient healthcare system that is going to increase the quality of care and lower the cost of care?

The previous notes are important. Most Americans are starting to pay attention to the damage Obamacare is doing to our healthcare system.

  Are Americans going to tolerate this kind of political maneuver to have politicians accumulate political power?

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

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Uncertainty Leads to Ineffectiveness

Stanley Feld M.D.,FACP,MACE

The implementation of Obamacare has progressed at a slow pace because of the Obama administration’s lack of understanding of physicians’ and patients’ needs.

In order to adjust to plans and policies not working as the Obama administration visualized, the administration has had to adjust policies, plans and costs.

There is no question in my mind that medicine is primed for a new age because of the advances in science, information technology and medical technology.

In my view Obamacare is a bad law. It is inhibiting progress on these upcoming advances. President Obama is trying to control provider behavior by measuring it in microscopic detail. He is trying to shift the cost and risk of patient care to physicians and patients in order to reduce costs by decreasing risk to the healthcare insurance industry.

He is trying to commoditize patient care. Obamacare is destroying the patient/physician relationship.These relationships are vital to the therapeutic index of any treatment.

Many of the Obama administration’s policy adjustments have led to uncertainty. Uncertainty of ad-lib changes in policy inhibits progress, increases costs, and produces anxiety and inefficiency.  .

One delay that has immobilized physicians has been the constant changing of implementation dates for ICDM-10 from ICM-9. Physician offices, physician groups and hospital systems are way behind in having fully functional computer information systems.

For many, the computer systems are too expensive even with President Obama’s promise of financial supplementation. It is difficult to change coding for treatment and procedures from 18,000 codes to 88,000 codes.

The reason for this coding change is for government to evaluate the work of physicians and hospitals microscopically in order to determine how much to pay them.

The government does not trust physicians. Physicians do not trust the government. In order for any system to work effectively and efficiently there must be mutual trust. Absence of mutual trust leads to more fraud and abuse, not less   

 The uncertainty about this year’s “doctor fix” is another example of uncertainty. 

In 2003 the government set up a defective measurement system intended to reduce physician reimbursement by about 5% per year. Each year the congressional “doctor fix” relieves physicians of the decrease in reimbursement from Medicare.

The SGR formula makes no sense. Medicare has reduced physician reimbursement to physicians as physicians' expenses have increased.

President Obama promise the AMA he would SGR problem.

However, each year’s “doctor fix” is cumulative. This year physicians face a 30% decrease in reimbursement despite the fact that many reimbursement codes have decreased reimbursement yearly in addition to the looming 30% decrease in reimbursement.

The policy has led physicians and physician groups to hold off on investing in coordinated care and technology. Additionally, physicians have a dim view of their return on investment for two reasons. Physicians cannot pass the cost of these new systems on to patients or the insurance industry because of the government’s pricing policies and because the government does not pay for much of the coordinated care or education of patients with chronic disease.

As a result of this uncertainty and anxiety physicians are selling their practices to hospital systems. Many physicians are salaried. These physicians figure the hospital system can have all the aggravation.  Other physicians are paid a salary plus a bonus determined by productivity. This does not eliminate the complaint that physicians have incentive to do more testing.

Many hospital systems have taken advantage of physicians’ intellectual property and surgical skill over the years. There has been a tradition of local adversarial relationships between physicians and hospitals. The hospitals’ tactics have not been obvious to many physicians. Many hospital policies are not transparent to their hospital-based physicians.

However, when it becomes apparent, the animosity between the physicians and hospitals becomes deep seated. The passive aggressive behavior of physicians inhibits the hospital system’s growth and development.

 

The Obama administration is discovering how difficult it is to form Accountable Care Organizations (ACOs).

The defects inherent in the purpose, formation, risk and implementation of ACO’s adds to its lack of success and the constant delays in implementation.

Obamacare has increased the number of Medicaid patients. Once these patients are on Medicaid, they cannot find a doctor.

President Obama had increase Medicaid payment to Primary Care Physicians in order to encourage more physician participation in Medicaid.

Physicians were hesitant to take Medicaid patients because this increased payment was temporary. The PCPs would be stuck with many low reimbursed patients.

“Kaiser Health News noted, the increases were temporary, so doctors had little incentive to alter their practices.”

This year the temporary Medicaid reimbursement increases have expired. The Medicaid rolls have increased. The PCPs were correct.  President Obama did not fix the Medicaid doctor shortage. It has only made it worse.

The number of physicians seeing patients with Medicare coverage has also decreased because of decreases in Medicare reimbursement despite the upcoming 30% decrease in Medicare payment.

President Obama ’s recent unilateral decision to alter immigration policy and provide these immigrants with healthcare insurance will only make things worse.

The ad-lib change in healthcare policy is driving physicians crazy. Many are frightened about their professional future in practicing medicine. 

There is a pervasive bias in Obamacare that favors hospital ownership of medical practices. The call for payment reforms and the call for coordinated delivery of medical care (like Accountable Care Organizations and payment “bundles”) all turn on arrangements where a single institution owns the doctors.

Where are patients’ feelings and needs in all of this? Patients are the commodities in a lucrative business that benefits secondary stakeholders.

The healthcare system as an efficient and effective healthcare system is destined to get worse because of the underlying uncertainty created by Obamacare.

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

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The Facts

Stanley Feld M.D.,FACP,MACE

The fact that the Obama administration believes that Americans are stupid as expressed by Jonathan Gruber is an insult on its own. The fact that the Obama administration persists in treating us as if we are stupid simply compounds the insult.

In the run up to the February 15th ending of the 2015 www.healthcare.gov enrollment period and the new Republican congress’ upcoming vote to repeal Obamacare, the Obama administration is trying to convince Americans that Obamacare is working and is good for all Americans.

The public knows better by now. The middle class is feeling the economic pain Obamacare has created. They sense President Obama telling another lie.

 Recent headlines have been

Obamacare Will Cost 20% Less

Affordable Care Act will Cost 20% Less Than Initial Projections, CBO Says

Right-Wing Media Won't Tell You That The CBO's New Obamacare Cost Estimates Are Lower Than Expected

President Obama’s deception implies Obamacare is cost effective. All the CBO is saying is the numbers given to it, this time, by the Obama administration show the cost of Obamacare will be 20% lower than the CBO original estimate in 2011.

The additional new taxes for Obamacare were initiated in 2011 based on those CBO estimates.

One important reason for the 20% decrease in cost from the original estimate in 2010 is that fewer people have chosen to enroll in www.healthcare.gov in 2014.

Since fewer people enrolled there is a $51 billion of savings in federal subsidies for fewer enrollees in health insurance exchanges.

This represents a failure of Obamacare not a success as claimed by the Obama Administration.

The government estimates a total 10.7 million will enroll by February 15,2015. On February 2,2015 there were 7.53 million qualified enrollees. The original estimate in 2010 was 17.5 million. The first 2015 estimate enrollment in 2014 was reduced 3 months ago to 13 million. The enrollment figure was modified.

The taxes the middle class have been forced to pay for Obamacare were not modified.

The real numbers are totally confusing because the government documentation is very difficult to follow. CMS modifies the numbers constantly with corrections. The modifications serve to keep Americans stupid and confused.

The Obama administration is now spinning the significance of the CBO report to its political advantage.

The online Daily Mail of Britain published this online story. The headline does not exactly reflect potential consequences of the Facts.

"Obamacare program costs $50,000 in taxpayer money for every American who gets health insurance, says bombshell budget report."

  • ·       Government will spend $1.993 TRILLION over a decade and take in $643 BILLION in new taxes, penalties and fees related to Obamacare
  • ·       The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best
  • ·       The law will still leave 'between 29 million and 31 million' nonelderly Americans without medical insurance
  • Numbers assume Obamacare insurance exchange enrollment will double between now and 2025 "

  Buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook were numbers to calculate the cost of Obamacare legislation to add patients to the insurance role. “The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best.”

It is impossible to judge whether these estimated figures are correct because estimates are mostly wrong.

What we do know is Obamacare is not doing well from everyone’s except President Obama’s point of view. The spin is keeping all Americans who are seeking the truth confused. Americans want a solution to the deterioration of the healthcare system.

Another reason for the reduction in Obamacare healthcare spending could come from the reduction in reimbursement to physicians.

Insurance companies have not suffered the same reimbursement insult because the government has subsidized the healthcare insurance industry and provides a guaranteed profit that is not included in the CBO estimate.

A third reason for the reduction in spending could be explained in part by the growth of consumer-driven health plans and the Great Recession.

A fourth reason for the 20% reduction could be that the insurance products on the health insurance exchanges have high deductibles. It takes a while before the patients reach their deductibles and the government starts spending money on reimbursement. Patients can also be staying away from receiving appropriate medical care because they cannot afford the deductible.

The CBO report projects that 75 percent of enrollees will receive subsidies in 2015. However, 87 percent received subsidies in 2014. This is wishful thinking on the part of those who provided the data for the CBO to evaluate to believe the subsidy percentage will decrease.  The CBO projected a further decrease in subsidy to 71% in 2025.

The health insurance exchange experience so far suggests there is adverse patient selection. It can be assumed that there will be an increase in healthcare risk and an increase subsidy percentage in the future.

CBO projects the average exchange subsidy per covered enrollee in 2015 will be $4,330 and increase to $7,710 by 2025. These costs represent a 78 percent increase in costs.

However, I do not think anyone can draw any conclusions from the CBO’s report.

I do believe that Obamacare is President Obama's  push to a single party payer healthcare system because of the structure of its market driven elements are destined to fail.

Government will then take over telling us what medical care we can or cannot have.

”We are fast approaching the stage of ultimate inversion: the stage where the government is free to do anything it pleases, while the citizens may act only by permission.” - Ayn Rand

The CBO report of a 20% reduction is spending as a result of Obamacare is meaningless. It is being used by President Obama to confuse the public for political reasons.

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

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It’s De Ja Vu All Over again!

 Stanley Feld M.D.,FACP,MACE

President Obama uses the same moves over and over again in order to fool the traditional media and the American citizens. Why change tactics when they always work?

He knows Americans want to believe him.

Jonathan Gruber, a consultant economic architect of Obamacare was correct when he said that a lack of transparency is a powerful political tool. He said Americans are too stupid to see through the charade.

President Obama thinks his job is to transform America. He never defined what transforming America means.

Americans assumed he would make America a better place to live for the average citizen.

In the last six years the average American has not had job security, healthcare  security or a better standard of living. President Obama keeps telling Americans they have a better life.

President Obama saying it does not make it so.

Americans are starting to perceive reality and do not believe him or in him anymore.

In February 2014 I published the following blog. The tactic President Obama uses is to present a half-truth that is not close to the truth. He confuses Americans so they do not know what to believe. They stop paying attention to what is happening to them and society. They do not search for the truth until it affects them directly.

President Obama’s fantasy is now affecting the hard working middle class. They now know he lies to them. They feel they have been taken for fools.

In the last few weeks he has been putting out false narrative about how well Obamacare is doing.

Last years blog will set they stage to understand the way the tactic has been played over and over again.

 

"Why Use Facts and Logic?  

Stanley Feld M.D.,FACP,MACE

 February 27,2014

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

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

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

The middle class independents voters are feeling it the most.

President Obama’s opponents have not figured out how to neutralize  the Alinsky formula. 

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

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

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

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

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

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

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

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

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

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

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

Speaker Boehner did not do so bad. 

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

 

 

http://news.investors.com/ibd-editorials/022114-690858-obama-budget-and-his-phony-complaint-about-austerity.htm

 

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

 

http://youtu.be/9uzJYlbhH54

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

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

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

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

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

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

He makes pronouncement without facts.

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

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

No evidence was presented for the statement.

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

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

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

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

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

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

This statement is nonsense

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

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

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

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

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

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

It is clear the administration is withholding this information.

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

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

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

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

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

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

Paul Krugman is being intellectually dishonest with the American people. The American people are being forced into an entitlement program they do not want.                                                                                                                                                            This is not “Health Care Horror Hooey Mr. Krugman.  It is reality.                                                       At the time of Krugman’s article a CMS report was publish that found 65% of small businesses that offer insurance will likely see their premiums rise thanks to ObamaCare. That translates into higher insurance costs for 11 million workers.

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

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

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

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

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

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

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

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

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

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

 We do not trust you!"  Feburary 27 2014

 

In February 2015 President Obama’s misdirection continues. There is a lack of transparency about the 2015 www.healthcare.gov enrollment figures. The goal for enrollment is rigged.  Last year is was initially published that there were 9 million enrollees.

Those figures were false. It was eventually corrected down to 6.8 million.

The 6.8 million figure included the people who have lied to get higher subsides. Presumably they lied with the help of President Obama’s Navigators who receive $48 an hour from the government to help people complete their applications.

 At least 15% (1 million plus) of these people have dropped their healthcare insurance coverage because they lost the subsidies and/or the deductibles were too high.

As the Republic House and Senate are preparing to repeal Obamacare, the public is hearing from President Obama through the traditional media that Obamacare is working well and will not be repealed.

His fantasy is expressed in the following January 2015 headlines.

President Obama’s Fantasy

Obamacare Will Cost 20% Less Affordable will Cost 20% Less Than Initial Projections, CBO Says

Right-Wing Media Won't Tell You That The CBO's New Obamacare Cost Estimates Are Lower Than Expected

 New York Times: "Budget Office Slashes Estimated Cost Of Health Coverage." 

 HHS: More Than 7.1M Have Enrolled In 2015 Plans Via HealthCare.gov.

Obamacare website enrollment crests 7M as Feb. 15 deadline looms

7 Obamacare Facts You Need to Know at the Halfway Point of Enrollment

Burwell: ‘Time is running out’ for ObamaCare signups

To a casual observer the problems are solved. The cost of healthcare are affordable. Obamacare’s enrollment numbers are great.

 The Facts next time.

 

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

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The Needs Of Patients and Physicians

Stanley Feld M.D.,FACP,MACE

 Our present healthcare system is driving both patients and physicians away from what they need in caring for a patient’s illness.

 Medical care is being forced into becoming a commoditized industry. Every step in medical care must fit into a protocol in order to be reimbursed. This is true for private practice as well as healthcare systems in which physicians receive salaries from the institutions.

 It is commonly believed by the public that these physicians have no incentive to be productive. This is a false perception. If these physicians are doing direct patient care daily the unit manager’s job is to push the physicians to be productive and generate income.

Many of the salaried physicians are not motivated to develop a relationship with the patient because they will not see them again.

 A complete history and physical examination is the first thing future physicians are taught in medical school.

If a physician lets the patient tell his story and it is followed by a complete physical exam, a physician can make a diagnosis 90% of the time.

Economic pressures have bastardized the system of complete history and physical. Physicians do not have time to develop a physician/patient relationship.  

Dr. Abraham Verghese TED talk : A Doctor's Touch says it all. Everyone who is interested in what happened to medical care and a physician/patient relationship should watch this You Tube.

 

 

 http://youtu.be/sxnlvwprf_c

The physician/patient relationship is the desire of many patients. This is one of the reasons for the growth of concierge medicine practices in the country. Physicians have enough time to spend with their patients. The upfront concierge fee subsidizes the physician’s income.  Physicians have enough time to perform a complete history and physical.

 I was talking to a retired internist this last weekend about Dr. Ezekiel Emanuel’s pronouncement about the yearly physical being worthless.

He said that was crazy. His yearly physical saved his life three different times over a thirty year period.

The first was the discovery of his cancer of the prostate. It was picked up on his yearly physical.

The second time was when leaking of his mitral and aortic valve was discovered on yearly physical. It resulted in valve replacements.

Third time his life was saved on another yearly examination was when a mass found in lung on a chest x-ray during a routine annual check up.

He said he would have been dead long ago if he did not have an annual physical.

It is easy for a politician or policy wnk to say something is worthless if he is not the patient.

This example is further evidence that government should not be responsibile for the patient's healthcare dollars and make the patient's medical treatment decisions.  

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

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