Politicians,Healthcare and Vested Interests

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Creating Confusion And Blame

July 23, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama is in the midst of a leadership crisis on many fronts. A large number of voters have no idea of the details of each crisis or scandal.

They figure they elected a President who will not only take care of a crisis when it develops but he will look after America’s best interests.

There are other voters who have become news junkies. They are interested in each crisis. The source of their information is the traditional media. The traditional media provides filtered sound bites that lead them to erroneous conclusions.

People are mistrusting the administration and the traditional media because they are realizing that are being fed disinformation. They realize they are being manipulated. It is becoming clear that the administration is not defending the constitution and the people’s freedoms.

The defects in Obamacare are affecting people directly. All of a sudden seniors cannot find a physician who will take Medicare.

If they sign up with a concierge physician they receive no reimbursement from the government for Medicare premiums they have paid.

People with employer sponsored healthcare insurance are having difficulty finding a physician unless they pay a fee to a concierge physician.

Their portion of the healthcare insurance premium has increased with a threat of higher premiums next year. A 15-50% increase is expected. Their copays and deductibles have also increased.

The employer sponsored healthcare insurance plans are going to be available to only full time employees.

Last month there was an increase in employment of 288,000. However there was a decrease in 708,000 fulltime jobs and an increase in 1,115,00 part time jobs because of Obamacare and its mandate to provide healthcare coverage for people who work more than 35 hours a week or face a penalty.

“Writing in the Wall Street Journal, Mortimer Zuckerman — real estate developer and editor in chief of U.S. News & World Report — says yes. Some data seem convincing. In June, part-time jobs (defined as less than 35 hours a week) increased by 1,115,000, reports the Bureau of Labor Statistics (BLS); full-time jobs fell by 708,000.”

“Just think of all those Americans working part time, no doubt glad to have the work but also contending with lower pay, diminished benefits and little job security,” wrote Zuckerman.”

The New York Times and Paul Krugman keep telling us Obamacare is a success. They ignore the facts.

A few weeks ago a study showed that 85% of the people who signed up for Obamacare on the individual market received subsidies from the government.

It turns out many people lied on their enrollment applications and they will not receive the subsidy. The Obama administration took their enrollee's word because it did not have the infrastructure to check the applications. These people cannot afford the premium now much less after the subsidy is removed and back payment to the government is made.

This will reduce the 8 million claimed valid enrollees to below 5 million enrollees.

The execution and implementation of Obamacare is a great setup for fraud and abuse. It is described in the following You Tube.

I do not think President Obama is going to demand back payment. This is not the first time President Obama has changed the law without consulting congress.

The law states that people can qualify for tax credits. A tax credit is defined as a deduction off the income tax due. People making under $40,000 do not pay income tax. Some receive a check from the government.

How was a tax credit changed to a subsidy?

The law specifically states that the state health exchanges and not the federal health insurance exchanges can provide the tax credits. Thirty-six states have not set up state health exchanges.

Those thirty-six states predicted that the exchanges would be a failure and a tax burden to its citizens.

Many of the remaining states that set up health insurance exchanges are failing.

The federal government set up health insurance exchanges in those thirty-six states instead. The federal health insurance exchanges have not been a success despite the statements by the New York Times and Paul Krugman to the contrary.

President Obama’s pledge to bail out the healthcare insurance industry if the industry does not make as much money as they expected to make because of the demographic profile of the people who sign up is another sign of failure. It points out how dependent the Obama administration is on the participation of the healthcare insurance industry.

Where is President Obama going to get the money to pay for all the pledges? The CBO now predicts Obamacare create a 1 trillion dollar deficit rather than an excess over the next decade. This is after collecting increased taxes for 6 years before full implementation of Obamacare.

There are many other defects in Obamacare. It is a failure.

The Obama administration with the help of the traditional media is trying to distract the public from the facts by withholding facts and feeding the media confusing facts, disinformation and lies about Obamacare’s success.

The administration blames Obamacare’s difficulties on the Republicans using non-facts.

The Obama administration can get away with this for only so long. The middle class is realizing the economic burden Obamacare has created for the middle class and the economy.

The middle class is realizing this because the facts are affecting them directly.

With the atmosphere of mistrust, and distrust created by the economy, the decrease in the value of the dollar, the lies and withholding of information about Bengasi, Fast and Furious, the IRS, the Ukraine, Syria, Iraqi, Afghanistan, Iran debacles, and the VA scandals it is going to take a lot for the people to regain its trust in President Obama.

Alinsky’s methods of lies, obfuscation of the truth and blame are running out of steam.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  Please have a friend subscribe

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Another President Obama Lie

June 11, 2014

inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

At the moment, ideology and political philosophy stands in the way of Repairing the Healthcare System.

President Obama believes in central control of the healthcare system. Central control of other healthcare systems has not worked to control healthcare costs while maintaining quality of care. The only possible exception is Switzerland’s healthcare system.

Each province in Canada spends at least 50% of its GDP on healthcare according to the Frazier Report. The access to care is less than ideal. Healthcare spending is unsustainable in Canada

England is slowly switching to a private healthcare system.

Obamacare has already demonstrated its inefficiencies and lack of cost control even though most of the population has received waivers from Obamacare for at least one year.

The trajectory of failure is not going to change until President Obama is out of office and the system changes to put the consumers in control of their health and healthcare dollars rather than having the government in control.

President Obama declared in 2010;

“Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the regulations, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.”

Unfortunately, for Americans, President Obama tells us what we want to hear in a very seductive way and then does the opposite.

President Obama is always calling for someone to provide a new idea in order to fix Obamacare. His promise to the public is a good idea. However it is not reflected in the Obamacare regulations.

What is the meaning of Medical Loss Ratio?

The definition of medical loss ratio is the incurred claims received divided by premiums collected.

The healthcare insurance industry negotiated all the rules it wanted from President Obama and Kathleen Sebelius in defining incurred claims in the new Obamacare regulations. The rules contradict Mr. Obama’s promise to the American public.

The healthcare insurance industry is supposed to spend 85% of the premiums collected on direct medical care costs.

The remaining 15% of the premiums is for the insurance industry’s expenses and profit.

The healthcare insurance industry claims it is lucky if it clears 3% profit under the Obamacare rules.

In order to encourage the healthcare industry to participate in Obamacare, President Obama pledged that the government would subsidize the healthcare insurance industry for any shortfall in profit.

A self-insured employer sponsored healthcare plan outsources the administrative services to the lowest bidding healthcare insurance company. The government outsources Medicare, Medicaid and Tricare (VA insurance) to the lowest bidding healthcare insurance company.

The Obama administration has included most of the healthcare insurance industry’s requests in the incurred claims (direct patient care) formula that is used to calculate the medical loss ratio.

Inflating the incurred claims decreases the amount of money spent on direct patient care in order to maintain an eighty-five percent (85%) medical loss ratio.

If the incurred claims costs go up the medical loss ratio goes down. The potential increase in the medical loss ratio is the justification used by the insurance industries to increase premiums.

Obamacare requires insuring with a pre-existing condition. Insuring everyone with a pre-existing condition increases the insurance risk. Hence Americans experience double-digit increases in healthcare of insurance premiums.

The expenses the industry wanted included:

1. The cost of verifying the credentials of doctors in its networks.

2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.

3. The cost of programs that keep people who have diabetes out of emergency rooms.

4. The sales commissions paid to insurance agents.

5. Taxes paid on investments.

6. Taxes paid on premium income.

7. Unpaid claim reserves associated with claims incurred.

8. Change in contract reserves.

9. Claims-related portion of reserves for contingent benefit.

10. Lawsuits experience-rated refunds (exclude rebates based on issuers MLR.

All these expenses are administrative expenses in my view. It is questionable that these should be included in direct patient care (incurred claims).

These expenses also increase a healthcare insurance company’s profit. Each incurred cost has a built in 15-20% profit.

As these expenses continue to be are permitted as incurred claims (direct medical care expenses), the resources available for direct medical care decrease from eighty-five cents to sixty cents on every premium-collected dollar.

At the same time people complain about the grotesque profits and salaries of those in the healthcare insurance industry.

Obamacare, contrary to President Obama’s promise, did nothing to solve this abuse.

It is almost as bad as the promise," If you like your doctor you can keep your doctor. If you like your insurance plan you can keep your insurance plan.

The closest I could get to transparency and the distribution of one healthcare dollar to direct medical care is the following.

Fifteen cents goes to the doctor and twenty-five cents to the hospital. The remaining sixty cents goes to the healthcare insurance companies.

The definition of direct medical care according to Obamacare is:

Definition of Medical Claims By Obamacare

Incurred claims = direct claims incurred in MLR reporting year + unpaid claim reserves associated with claims incurred + change in contract reserves + claims-related portion of reserves for contingent benefits and lawsuits +

experience-rated refunds (exclude rebates based on issuers MLR

Medical Claims and Quality Improvement Expenditures

As illustrated in Figure 1, increases in either medical claims or quality improvement expenditures (holding other factors constant) will increase

the MLR and reduce the likelihood of premium rebates to policyholders. Conversely, reductions in medical claims and/or quality improvement

expenditures (holding other factors constant) will decrease the MLR and increase the likelihood that insurers will have to provide rebates to policyholders.

Medigap plans (Medicare Part F) have separate medical loss ratio requirements. The healthcare insurance industry has to meet a 65% level for individuals and a 75% level for groups. It means that for every dollar in premium the individual has 65 cents minus incurred expenses coverage for direct medical care and for groups 75 cents minus incurred expenses.

Medigap plans, which are supplemental policies that Medicare beneficiaries can purchase to fill gaps in Medicare coverage, are not covered by the ACA MLR provisions.

Medigap plans are subject to their own separate MLR requirements, found in Title 18 of the Social Security Act; the MLR requirements are 65% in the individual marketplace and 75% in the group market.

Finally, the ACA’s MLR requirements do not apply to long-term care, dental, vision or retiree healthcare plans.

President Obama promised to fix these problems. He said,

He didn’t. He won’t.

He knows the problem. Fix it.

If he did he would save Obamacare and tax payers a great deal of money.

I am confident this suggestion will be ignored and at election time more false promises will be made.

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

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Another Obamacare Trick Exposed And Backfiring

May 18, 2014

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

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Stanley Feld M.D., FACP, MACE

The drug industry has been quiet during the Obamacare debate. However, the industry’s lobbying group worked with the Obama administration to get Obamacare.

Why would PhRMA do that when President Obama encouraged everyone to buy generic drugs in order to get full coverage for their drug costs?

It is because President Obama promised PhRMA huge concessions and windfall profits after the health insurance exchanges were successful.

PhRMA is not going to make those windfall profits. When Americans see that the health insurance exchanges are more expensive than the private plans. Only those who cannot buy private insurance because they have pre-existing illnesses will sign up for Obamacare.

This will drive the health insurance exchange premiums higher,cover less, restrict access to care and drugs and ration care.

President Obama provided waivers from the implementation of Obamacare to many special groups except the individual market. Those waivers delayed implementation of Obamacare for one to two years.

The administration was concerned that implementation of Obamacare to everyone would cause a storm of protest that the administration could not contain.

These special groups will lobby for the continuation of those waivers as they realize that premiums and deductibles will be higher in the health insurance exchange market than the private market.

The profits PhRMA expected will evaporate.

Consumers not subsidized by Obamacare who bought Silver plans in the individual market through the health insurance exchanges are cooked.

They will pay one and one half to two times the price for drugs next year than they are paying this year.

The government will be paying drug companies for the increased price of drugs for people whose Silver plans are subsidized.

The result will be an increased cost of Obamacare to the public as President Obama redistributes wealth on the backs of the middle class making $50,000.01 or more

How did PhRMA help President Obama get Obamacare passed?

PhRMA paid for the multimillion dollar Harry and Louise ad campaign on TV during the debate for passage of Obamacare.

It financed a false message that was in support of Obamacare as opposed to its original Harry and Louise message that sunk the passage of Hillarycare in 1993.

http://youtu.be/fOr17a4ZOIU

“A new report by Milliman, Inc. finds that Silver plans with combined deductibles offered through the Health Insurance Exchanges may require patients to pay more than twice as much out of pocket for prescription medicines overall as they would under a typical employer plan.”

“This is a far larger increase in out-of-pocket costs than was found for other medical care.”

The cost of drugs to consumers buying a Silver plan through the Health Insurance exchange without government subsidy and high deductibles will cost twice as much as employer sponsored plans.

“Americans participating in the Exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” said John Castellani, President and CEO of PhRMA.

Patients’ with high deductible Silver plans will have difficulty affording medicines necessary to manage their illnesses. Paying for medications will be especially difficult for consumers earning more than $50,000.00 who are not subsidized and have chronic diseases. These people need multiple medications to control their chronic disease in order to avoid complications of their disease.

Eighty percent of the healthcare dollars are spent on treating the complications of chronic disease.

The unaffordability of medication to prevent acute and chronic complications of chronic diseases such as Diabetes Mellitus results in an increase in hospitalizations and higher health care costs overall.

Conversely, programs that encourage better adherence have been shown to reduce emergency department visits, hospitalizations, and other preventable, costly care.

The Obamacare rules and regulations are going to encourage an increase, not a decrease, in healthcare costs for non-subsidized Americans.

This contradicts President Obama’s pledge to encourage prevention of illness.

However, it fulfills President Obama’s goal of redistribution of wealth. It could also be interpreted as increasing the tax on the middle class.

If the public realized this would happen with Obamacare it would have protested the passage of Obamacare.

A house panel uncovered the secret deal in an email between PhRMA and the Obama administration in 2012. It was not revealed to the public until recently.

Nancy Pelosi’s statement about not knowing what is in Obamacare until it is passed was an ominous signal that the public would be taken advantage of. No one picked up the signal.

President Obama’s signal legislation is leaving hard working Americans no option but to demand that Obamacare be repealed.

It must be replaced by a healthcare plan that will work.

It must be replaced by a plan that gives consumers the opportunity to be responsible for their health and their healthcare dollars.

It must be replaced by a plan where common sense prevails.

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

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Physicians Have To Wake Up!

May 11, 2014

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

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Stanley Feld M.D.,FACP,MACE

It is time for physicians to wake up and take an active part in Repairing the Healthcare System.

Physician job satisfaction is at an all time low. Physicians are uncertain about staying in private practice. Others who have joined hospital systems as salaried physicians are uncertain about the wisdom of that decision.

Patient satisfaction is even lower as medical care is becoming less personalized. The patient/physician relationship has all but disappeared.

None of the secondary stakeholders (hospital systems, insurance companies, pharmaceutical companies and even government) are having a good time. The government is unable to sustain the costs without raising taxes and restricting access to care.

Today, I want to concentrate on the problems as physicians are feeling them.

A reader sent me this commentary a few weeks ago.

"Have you ever been to Sea World?"

"Last evening I was at a staff meeting at my community hospital. The hospital had recently rolled out “Computerized Physician Order Entry” software that was supposed to enable improvements in the orders and delivering of pharmaceuticals to the patients in the hospital.

Apparently, it did not go well. One of the speakers at the meeting was an articulate physician from the “world headquarters” who came to offer encouragement and reassurance. He cited the benefits: instant transmittal of the doctors’ orders to the pharmacy.

Orders were legible, reducing the risk for misreading of the doctor’s handwriting. Quicker delivery of medication to the patient was also cited.

After the doctor’s presentation, questions rained down upon his head from the physicians in the audience.

They cited a wide range of problems, and the speaker attempted to answer them with patience and courtesy.

Finally one physician asked, “Why are we doing this at all, when there are so many problems?” Another added, “Why is the company using an antiquated platform for the new software, since the platform is 20 years old, and so obsolete?”

And so it went lots of problems, and no solutions except a request for patience as the problems are addressed, with remedies apparently months away.

That set me to thinking:

If we go back to the formulation of the >2000 pages that evolved to become “Obamacare”, we would be hard pressed to find evidence of the input from working doctors as the legislation and the resulting regulations were formulated and decreed.

We can, if we want to feel really good, go back to Medicare itself and the rules that came along as to what could and could not be done without pre-approval.

Medicare part D added another layer of similar rules that seemed to appear de novo from sources other than working doctors.

Managed care, in its various ramifications showed a similar tendency to be created by people who didn’t have patients as their first concern, but rather the cost of services.

So, how, you ask, does all this relate to “Sea World”?

Think about the trained seals act. The seals do their thing on command from trainers who are not seals.

The seals bark loudly, the crowd applauds, and if the seals perform well, they each get a fish.

Doctors are much like that, in that they do their thing the best way they can, but they are abiding by rules they had little input in their creation, reporting their charges using codes they did not write, accepting payments that have no relation to the charges they report, using a system they did not create and one that gets sillier by the year.

So, fellow physicians, welcome to Sea World, as long as we continue to act like the seals, we’ll be able to get a fish now and then, I suppose."

Ladies and gentlemen, we are highly trained professionals. Our job is to solve and fix medical illness using clinical judgment gained through clinical experience and life long learning.

We are not trained seals.

It is time for physicians to wake up and take an active part in Repairing the Healthcare System.

The medical profession got itself into this position because it did not step up and fix the dysfunction itself.

There would not be a healthcare system with consumers and physicians.

Neither consumers nor physicians know how powerful they are. Consumers must exercise their power and drive the healthcare system by owning their healthcare dollars and be responsible for their health and their medical care

Physicians must teach consumers how to drive the healthcare system.

The politicians, businessmen and bureaucrats think they can fix it.

They can’t.

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

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President Obama Tries To Shut Up Media

April 30, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Physician's Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

On April 16^th President Obama tried to shut up the media’s criticism of Obamacare with his announcement that 8 million people have enrolled in Obamacare. The administrations had reached its goal. Obamacare is a success

Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.

"The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working and I know the American people don't want us spending the next 2½ years refighting the settled political battles of the last five years."

One month earlier we heard from the same administration that the 6.6 million people who had lost their healthcare insurance because of Obamacare was an insignificant sliver of the population.

President Obama’s announcement contained few new details about enrollment.

The entire point of Obamacare was supposed to be to insure people who were uninsured previously.

It turns out (from insurance company data) that as many as 80% of the 8 million enrollees were replacing extremely expensive healthcare insurance policies with Obamacare healthcare policies.

Individual healthcare insurance for older people with a pre-existing disease is unobtainable or extremely expensive.

These people were in the individual healthcare market only. Many had pre-existing diseases and chronic diseases.

Their risk is much higher than low risk patients. Many of these people received government subsidies because they made less than $50,000 dollars a year.

The administration has still not published the number of people who did not have insurance before Obamacare went into effect and have signed up and paid their premium.

President Obama claims he does not know that number. If the healthcare insurance companies know the exact number the Obama administration has to know that number.

President Obama’s declaration of success is ludicrous.

Patients who enrolled and paid their premium are going to realize the negative impact it will have on their medical care shortly.

There is no class of American professionals who will be more negatively impacted by Obamacare than physicians.

Obamacare reinforces the worst features of third-party payment arrangements for payment of medical care. The third party payment system of healthcare insurance has already compromised the independence and integrity of the medical profession.

“With Obamacare physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. “

These are some of the difficulties physicians will face with Obamacare.

The Medicare Payment Formula is flawed. Physicians continue to face the threat of deep payment cuts under Medicare’s sustainable growth rate (SGR) formula.

The SGR governs the annual growth of Medicare physician payments. Congress has kicked the can down the road since 2003. Physicians have incurred a potential reduction of 30% from the present payments if congress does not provide a permanent fix.

Medicaid will be expanded in states that agree to do so to cover any individual earning up to 138 percent of the federal poverty level—$15,856 for an individual in 2013. Many states have refused to expand Medicaid.

The Congressional Budget Office (CBO) projects that this expansion will add 12 million individuals to Medicaid by 2015.

The physician reimbursement rates for Medicaid patients is 58% lower than the reimbursement physicians receive in the private sector.

Thirty three percent of physicians do not participate in Medicaid. Patients’ access to physicians is decreased. The result is Emergency room overcrowding. ER overcrowding was the very thing the President Obama’s healthcare policy wizards wanted to decrease.

Obamacare is imposing more bureaucracy, rules, regulations, and restrictions on physicians.

Since 2010, with few exceptions, the law prohibited physicians from referring Medicare patients to hospitals in which they have ownership.

Thus, a whole class of physician-owned, specialty hospitals has been removed from competition, even though they enjoyed an undisputed record of providing high-quality patient care.
This regulation has driven a large number of physicians to stop accepting Medicare even thought their service is of high quality and less expensive than hospital systems.
There have been mountains of new regulations that are impossible to keep up with. These regulations have driven physicians away from accepting Medicare reimbursement.
Obamacare has created multiple federal agencies, boards and commissions to regulate the practice of medicine.
These creations are partly the fault of physician groups not effectively regulating their peers.

a. Obamacare created a “nonprofit” Patient-Centered Outcomes Research Institute. The institute will determine clinical effectiveness of medical treatments, procedures, drugs, and medical devices.

The result will be an administrative implementation nightmare. All medicine is local. Only financial incentive can work. Penalties and regulatory requirements will not work. It will simply generate an atmosphere of mistrust and non-cooperation.

The Patient-Centered Outcomes Research Institute could be a teaching tool for physicians and patients.

However, the likelihood of the government dictating cookbook care guidelines and regulations, and interfering with physicians’ clinical judgment and the further destruction of the patient-physician relationship is high. The Institute will also retard clinical innovation in the delivery of care.

b. President Obama’s Independent Payment Advisory Board (IPAB) is comprised of 15 unelected bureaucrats. It will be composed of non-practicing physicians, lawyer, laypersons and government bureaucrat.

The goal is to reduce the growth rate of Medicare spending and non-federal spending through health insurance exchanges.

“IPAB’s recommendations would go into effect unless Congress enacts an alternative proposal of equivalent savings.”

The chance of congress presenting an alternative equivalent saving is small. President Obama has stated in the past that the IPAB has little power except to make recommendations. This is not true!

Former Vermont Democratic Governor Howard Dean (D) has said,

"IPABs are essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."

This is the only thing that Dr. Dean has ever said that I have ever been able to agree with.

The IPAB will control spending through reimbursement cuts. It can enable limited or no payment for selected services and medical procedures or for Medicare physician payment.

It looks as if it could drive physicians out of practice and hospital out of business. This is especially true in the absence of tort reform.

c. Pay-for-performance programs are another terrible idea. Physicians can only control some of the outcomes. Patients’ compliance/adherence is the key to most outcomes.

Payment will be adjusted to reflect performance. The measurement will be based on data from the Physician Quality Reporting System and cost data from Medicare fee-for-service claims.

I have previously demonstrated the ineffectiveness of using claims data to make outcomes decisions.

These programs can be used to create powerful economic incentive by complying with standardized guidelines at the expense of individual patient care.

All you have to do is “check the box” to achieve a high and financially beneficial score as a condition of participating in the government’s health programs.

It is aa attempt created by bureaucrats that will not work in the real world.

Most physicians hate Obamacare. Forty-three percent of physicians are considering retiring in the face of the need for an additional 91,500 physicians by 2020.

“Obamacare neglects physicians’ most pressing concerns, such as tort reform, and significantly worsens the already painful problems that come with third-party payment and government red tape.”

Obamacare misses all the keys necessary for Repairing the Healthcare System. Obamacare steers out of the skid (wrong direction). It makes things worse.

Consumers must drive the healthcare system. The physician/patient relationship must be restored. Physicians must help patients make treatment decisions not government, insurance executives and other bureaucrats.

Repairing the Healthcare System will not be achieved until patients, not the government, control their health care dollars and decisions at the advice of their physicians in a viable physician patient relationship.

My Ideal Medial Savings accounts steer into the skid and repairs the healthcare system.

The Obamacare debate is hardly over as President Obama has declared.

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

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President Obama’s New Joke

April 20, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama announced Thursday that 8 million people have signed up for health insurance under the Affordable Care Act.

He called the feat a success story that Democrats should "forcefully defend and be proud of" in the face of Republican election-year attacks on the law.

He told the press the impending failure of Obamacare is no longer a headline story that should be covered.

Obamacare is here to stay.

If anyone believes the information in this press conference, I have a bridge to sell you.

President Obama’s story, at the press conference, mirrors Paul Krugman’s article one week ago. It is the same talking points filled with half-truths and lies. He offers no evidence, statistics or demographics except his word.

His word has been proven to be shaky in the past.

The real story behind Obamacare is the redistribution of wealth. The socialistic idea has continued to crush economic growth in an economy yearning to grow as a result of all the money that has been printed by the Federal Reserve Bank.

In order to gain real insight into Obamacare and its effect on economic growth please watch this video.

http://www.liveleak.com/view?i=91d_1386194531

Democratic representatives and senators up for reelection are still running away from President Obama and Obamacare. They realize that he (President Obama) gave another pep talk without substance.

He also belittled Republicans for being misguided, stupid and devoid of ideas.

This is obviously not true but why should President Obama care.

The media is the message.

The temptation is to answer back one point at a time.

There is no need for that rebuttal because Obamacare’s effect is on individual voters directly now. It is no longer an abstraction. It is not pretty.

Those signed up will have high deductibles and limited access to care. The CEO of Wellpoint predicts that health insurance plan premiums will double next year.

Indivduals are starting to see it and feel Obamacare’s effect on their standard of living. They are angry.

The only people who are happy are the people with a preexisting illness or chronic illness who could not buy healthcare insurance at a reasonable price prior to Obamacare. The healthcare industry did not want the risk.

Now they can buy healthcare through the health insurance exchanges and be subsidized by taxpayers. They will be surprised when their access to care is limited.

The problem America will have is that is going to take a little time and waste a lot of taxpayer dollars to repeal the law.

I believe most Americans have noticed that politicians and the traditional media lie. They try to manipulate us into believing the lies.

The saying is if you tell a lie enough times it becomes the truth. The addendum to that cliché’ should be until it affects individuals directly. The then stop believing the lies.

Please watch the video. It is funny and sad.

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

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Paul Krugman’s Inappropriate Victory Lap

April 13, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Paul Krugman is one of President Obama’s henchmen. Mr. Krugman also won the Nobel Prize in Economics.

Last week he wrote a victory lap article for Obamacare. He continues to write articles without solid facts and a total disregard for basic economics. He works very hard to freeze and then belittle his opponents and the Republican Party.

“When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.”

He attempted to freeze Mitch McConnell by ridiculing him.

“Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare.”

Mr. Krugman then pours out his non-facts as irrefutable facts by quoting the Rand survey that was just released in full.

“The same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.”

The results of the Rand survey were published in the Rand Corps’ blog. The blog itself questions the significance of the 9.3 million numbers of enrollees through the Health Insurance Exchanges as implied in government statements.

Although a total of 3.9 million people enrolled in marketplace plans, only 1.4 million of these individuals were previously uninsured.

The purpose of Obamacare was to insure the previously uninsured. The Obama administration has not published the actual number of uninsured that have been covered in the initial enrollment period.

The actual number of previously uninsured receiving healthcare insurance from the government’s Health Insurance Exchanges is closer to 895,000 people.

Paul Krugman’s fact that 9.3 million have been insured as a result of Obamacare is not a fact according to the Rand survey.

The headline of the RAND blog was “Survey Estimates Net Gain of 9.3 million American Adults With Health Insurance.”

"Our survey work can't say for certain, which of these shifts are due to the ACA and which are due to other factors, but we can draw some limited conclusions. A more detailed report describing the results summarized below can be found here."

http://www.rand.org/blog/2014/04/survey-estimates-net-gain-of-9-3-million-american-adults.html

Paul Krugman statement is a direct contradiction of the RAND survey’s statement

The RAND Corp, uses the number of uninsured as 40.7 million people in 2013. This could be a low number.

Many have used an estimate of 48 million were uninsured. It means the RAND number has a large margin of error. Estimates Net Gain of 9.3 Million American

The RAND Corp., also states that 5.2 million lost healthcare insurance coverage in 2013 as a result of dropped healthcare insurance plans.

It is estimated by many that 6.6 million lost their healthcare plans because the plans did not comply with Obamacare standards.

Let us use the RAND Corp’s numbers to understand the facts of enrollment through Obamacare. The RAND Corp survey labeled these numbers as estimates.

"Of the 40.7 million who were uninsured in 2013, 14.5 million gained coverage, but 5.2 million of the insured lost coverage, for a net gain in coverage of approximately 9.3 million.
This represents a drop in the share of the population that is uninsured from 20.5 percent to 15.8 percent.
The 9.3 million person increase in insurance is driven not only by enrollment in marketplace plans, but also by gains in employer-sponsored insurance (ESI) and Medicaid.
Enrollment in ESI increased by 8.2 million."

Let us assume the 9.3 million estimate of the total increase in number of people insured is correct.

If 8.2 million people received healthcare insurance from employer sponsored healthcare insurance then only 1.1 million received healthcare care insurance from either private insurance plans or Medicaid on Obamacare’s Health Insurance Exchanges.

There is claimed to be an increase in 3.6 million people receiving Medicaid. Of that 3.6 million increase in Medicaid enrollment, 1.4 million have signed up through a marketplace.

The remainder gained Medicare coverage through other sources.

This means a net loss of three hundred thousand Americans having private insurance as a result of Obamacare and the Health Insurance Exchanges (1.1 million- 1.4 million = – 300,000)

Mr. Krugman builds on these non-facts and concludes with an undocumented conclusion. He states as a fact;

“Obamacare is looking like anything but a nightmare. Let’s start with the good news about reform, which keeps coming in.

First, there was the amazing come-from-behind surge in enrollments.”

He then criticizes his opponents in an attempt to make those who disagree with him and the Obama administration appear mean spirited and unwise.

“Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage.

Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress."

“There are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.”

Paul Krugman attacks the Koch brothers and Mitch McConnell.

“It’s worth noting that, so far, not one of the supposed horror stories touted in Koch-backed anti-reform advertisements has stood up to scrutiny, suggesting that real horror stories are rare.”

It is important to note that Mr. Krugman offers no documentation to his quote. There are many honor stories that are documented.

When he attacks Mitch McConnell he offers facts from Talking Points.com. http://talkingpointsmemo.com/livewire/obamacare-cuts-kentucky-uninsured-rate-by-40-percent

The talking point article contradicts the RAND survey numbers.

So, which is right?

It does not matter to Paul Krugman because the Media is the Message. Paul Krugman has gotten his message across in the New York Times.

“At the state level, however, Republican governors and legislators are still in a position to block the act’s expansion of Medicaid, denying health care to millions of vulnerable Americans.”

The concluding message is Republicans are bad. Democrats are good.

Paul Krugman said the health economist Jonathan Gruber, one of the principal architects of health reform recently summed it up:

“The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.’

It is not true Democrats care for the poor according to Chicago Pastor James Meeks as he throws his support behind the Republican Gubernatorial candidate in Illinois.”

“The Democratic party just assume always that 97 percent of the African-American vote will go to the Democratic party. If that assumption is true, they never have to work for our vote,” Meeks said.

He worries about the gun violence, the poverty and the no-end-in-sight outlook. “Our schools are still broken and getting worse. We’re last in employment or business. Our neighborhoods are deplorable,” says Meeks. “And we still get the same promises from the Democratic party, but we don’t get any deliverable. I think it’s time we should look at another candidate.”

Poster Meek summed it up saying: “The Democratic party just assume always that 97 percent of the African-American vote will go to the Democratic Party. If that assumption is true, they never have to work for our vote,” Meeks said.

Pastor Meek has 23,000 members in his church.

The Democratic Party and Mr. Krugman’s methods of operation are to accuse, confuse and then conclude.

Obamacare is spending money like a drunken sailor. Obamacare has an outlandish bureaucracy that has produced little benefit. As this new entitlement grows it will bankrupt the country.

It is best for Democrats to blame the bankruptcy on the Republicans’ resistance.

Paul Krugman is an economist. He should heed the lessons of Economics 101.

Mr. Krugman please watch this You Tube.

http://www.liveleak.com/view?i=91d_1386194531

The pity of it all is Paul Krugman is spinning the Story Of Obamacare away from reality.

Fewer and fewer Americans are buying into Obamacare as they see how it is affecting them in daily life through increased taxes and false rhetoric.

Obamacare is not an abstraction anymore. It is an ugly reality for those affected.

There is a much better way to provide healthcare coverage for all.

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

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April Fools Day

April 6, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Universal Healthcare

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Stanley Feld M.D.,FACP, MACE

On Tuesday April 1,2014 President Obama did a victory lap for Obamacare. April 1^st is April Fools Day.

He stopped calling it the Affordable Care Act and once again called it “Obamacare”.

He announced that 7.1 million American have signed up for Obamacare on the Health Insurance Exchange web site healthcare.gov.

Since October the Obama administration has avoided providing the number of enrollees in Obamacare and its demographic makeup. The administration claimed they did not have the exact numbers.

The public viewed this as the administration’s avoidance of the number of enrollees who have purchased insurance because the numbers were so pitiful.

On April Fools Day one day after enrollment ended, President Obama announced the exact number that has signed up to the exact decimal point. It was 7.1 million.

Is that not strange?

I am publishing President Obama’s entire press conference. It is a must watch.

His words and body language is a site to behold. The audience's body language in also very telling.

http://youtu.be/hmONeJ_j8EU

President Obama is extremely charming. The speech is littered with half-truths, misinformation and lies.

He calls all his critics liars just as Harry Reid did. The president doesn’t point out where they have lied just as Harry Reid did not.

This is a Saul Alinsky tactic.

He is so charming in his delivery that the audience wants to believe him despite the dysinformation.

He even threated the media. He warned them not to headline news of these glitches and problems just because there are some glitches and bad events ahead with Obamacare.

The most transparent half-truth was when he said “we haven’t seen any death panels yet as our opponents predicted.”

He right correct. He postponed initiating his “death panels”, the Independent Physicians Advisory Board (IPAB) himself until after the November 2014 elections.

His message is the Republicans are liars. The Democrats in vulnerable states can run on Obamacare because Obamacare is great for the people. He gave three examples to prove his point. Beware of the man with three cases.

He did not discuss the Congressional Budget Office’s view of Obamacare’s effect on the economy.

In Appendix C of the rather dense document, the CBO concludes that various provisions of Obamacare will “reduce the total number of hours worked,” “will cause a reduction…in aggregate labor compensation,” and most dramatically will result in “a decline in the number of full-time equivalent workers of about 2.0 million in 2017, rising to about 2.5 million in 2024” as compared to employment growth in the absence of the Affordable Care Act.

The Obama administration called the CBO report a lie. It measured the wrong things.

The main cause of this trend is the work-discouraging combination of taxes and subsidies for lower-income Americans in Obamacare. In other words, the implied tax and subsidy penalties for success are so high that it won’t be worth a lower-income person’s effort to try to climb up the income ladder.

There goes the American dream. A dream that has driven America to the success it has achieved.

And while the CBO does suggest that demand for labor will not decline substantially due to the costs imposed by Obamacare, they do say that costs “will be borne primarily by workers in the form of reduced wages or other compensation.” So even the White House’s good news is bad news for working Americans.

Here is what he failed to discuss.

How many of those who signed up have actually paid the premium and purchased the healthcare insurance?

How many of those 7.1 million included the 6.6 million who lost insurance because of Obamacare?

How many were young adults signed up?

How many of the young and uninsured enrolled and paid their first premium?

How many of the older adults signing up had preexisting illness?

What is going to happen to the additional millions who are going to lose their healthcare insurance when their work hours are reduced below 30 hours per week?

How will they afford Obamacare insurance?

How will the McDonald waiver insurance workers afford insurance when the waivers expire?

What will happen to unions when the workers realize they are losing $5 dollar an hour in pay because of Obamacare?

If 7.1 billion people now have healthcare insurance what does it cover?

The are hundreds of examples of cancer patients losing their doctors, buying health insurance care insurance and discovering that their cancer therapy is not covered?

How many of the previously 48 million uninsured now have become insured?

The entire idea of Obamacare is to insure the uninsured.

The Rand Corporation has completed a secretive survey for the Obama administration. The goal was to estimate how many uninsured received healthcare insurance.

Numbers from a RAND Corporation study that has been kept under wraps suggest that barely 858,000 previously uninsured Americans – nowhere near 7.1 million – have paid for new policies and joined the ranks of the insured by Monday night March 31,2014.

Isn’t the price America has paid so far for overturning, uprooting, and revolutionizing 18% of the economy and the medical care ecosystem staggering for only insuring 875,000 of the previously uninsured.

Someone should add up the cost in newly levied taxes, the effect on middle class income and standard of living, the cost of the massive bureaucracy, and the cost regulations as well as the cost of economic growth that Obamacare has had on the American economy.

The bizarre thing is Obamacare does not solve the issue of the dysfunction in the healthcare system. The ever increasing price of healthcare is the result of the misalignment of all the stakeholders' incentives.

The misalignment has increased with Obamacare.

A new business plan that aligns all the stakeholders incentives which is focused on consumers must be developed.

Obamacare does not bend the cost curve no matter how President Obama has lies about it.

President Obama has had no interest in the cost of Obamacare to America. His goal is complete central control over the healthcare system.

His April Fools Day press conference is no joke!

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

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Bigger Problems Ahead For Obamacare

March 30, 2014

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

Accountable Care Organization are supposed to be the organizations that reduce Obamacare’s healthcare costs.

Accountable Care Organizations (ACOs) were supposed to be operational in 2012 throughout the United States.

ACOs are supposed to provide financial incentives to health care organizations in order to reduce costs and improve quality of medical care. There are too many defects in the ACOs’ infrastructure to improve the financial and medical outcomes.

At a conceptual level, the incentive for ACOs is to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members (physicians and hospital systems) would share the savings resulting from the coordination and integration of care.

Accountable Care Organizations (ACOs) are not designed to decrease the waste in the healthcare system.

Waste occurs because of:

1. Excessive administrative service expenses by the healthcare insurance industry that provides administrative services for private insurance and Medicare and Medicaid. A committee is writing the final regulations covering Medical Loss ratios for President Obama’s healthcare reform act. The insurance industry regulations are far from curative.

2. The excessive administrative waste in hospitals and hospital systems leading to outrageous nontransparent hospital fees.

3. The lack of patient responsibility in preventing the onset of chronic disease. The obesity epidemic is an example.

4. The lack of patient education to prevent the onset of complications of chronic diseases. Effective systems of chronic disease self- management must be developed.

5.The use of defensive medicine resulting in over testing. Defensive medicine can be reduced by effective malpractice reform.

ACOs are not a market-based system. They do not put patients at the center of their medical care or permit patients to choose their medical care.

The government assigns patients to certain ACOs. The government controls the healthcare dollars and is at the center of patients’ medical care decisions directly and indirectly.

Consumers/patients are the only stakeholders in the healthcare system that can demand that this waste be eliminated. “They with walk will their feet” if given the chance.

Keith Smith M.D. and the Surgery Center of Oklahoma have proven that consumers desire choice and making their own medical care decisions with the Surgery Center’s transparent prices and their light administrative costs.

Patients must control their healthcare dollars and be responsible for their care in order to Repair The Healthcare System. Consumers/patients will make sure prices become competitive. Patients in control of their healthcare dollars will not allow duplication of services.

In order to truly Repair The Healthcare System a system of incentives for patients and physicians must be created.

“In theory, ACOs provide financial incentives to health care organizations to reduce costs and improve quality. In reality, given the complexity of the existing system, ACOs will not only fail; they will most likely exacerbate the very problems they set out to fix.”

ACOs shift the risk of patient care away from the healthcare insurance industry to physicians and hospital systems.

Most physicians are reluctant to assume accountability for patient outcomes. Physicians recognize that much of the outcome is directly under the patients’ behavior and adherence to recommended therapy.

ACOs remove the consumer/ patient from being responsible or accountable for their medical care. ACOs undermine any attempt to create a truly accountable healthcare system that can drive down costs.

There are also grave uncertainties and practical issues in distributing savings between the hospital system and physicians. There is a long history of hospital systems taking advantage of physicians’ skills and intellectual property.

Many physicians and hospital systems are concerned about the shifting of risk and the lack of control over this risk.

“The Mayo Clinic says it will not be part of a critical piece of national health care reform under the government's proposed rules.”

“ The Mayo Clinic announced that the proposed regulations “conflict with the way it runs its Medicare operations.” Mayo treats about 400,000 Medicare patients a year. The bottom line is that Mayo figured out that they would assume too much risk, lose too much money and relinquish too much control over its processes to the federal government.”

ACOs are really HMOs on steroids. There is too much risk that neither physicians nor hospitals can control. Neither consumers or physicians nor hospital system liked HMOs.

This same sentiment is reflected in statistics released the Leavitt Partners Center for Accountable Care Intelligence. Centers for Medicare and Medicaid Services (CMS) and the Obama administration are spinning these numbers the same way they are spinning the figures for Obamacare enrollment.

Chart 4: Accountable Care Organizations by State; Source: Leavitt Partners Center for Accountable Care Intelligence

California leads all states with 58 ACOs followed by Florida with 55 and Texas with 44. ACOs are primarily local organizations, with 538 having facilities in only one state.

Chart 5: Accountable Care Organizations by Hospital Referral Region; Source: Leavitt Partners Center for Accountable Care Intelligence

The number of ACOs, again, is of secondary importance to the number of covered lives. Nationally, approximately 6 percent of the population is estimated to be enrolled in an ACO.

Chart 6: Estimated Accountable Care Organization Covered Lives by State; Source: Leavitt Partners Center for Accountable Care Intelligence

Chart 7: Estimated Accountable Care Organization Covered Lives by Hospital Referral Region; Source: Leavitt Partners Center for Accountable Care Intelligence

President Obama and his administration must be living in some fantasy world. It does not matter what the Obama administration is saying adoption of ACOs by physician groups and hospital systems is poor.

The call for forming ACOs started in 2010. The government tried to stimulate the formation of ACOs with sizable grants. It has not worked very well.

Many of the formed ACOs are not functioning in a cost effective manner. In ACOs that are sharing cost saving with the government the fighting between the hospital systems and physicians is just beginning.

Patients in ACOs are starting to feel the dysfunction.

The delivery of medical care under Obamacare and the ACOs are in big trouble.

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

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