Stakeholder Abuse of the Healthcare System

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Why Does Congress Want to Exempt Itself from Obamacare?

April 30, 2013

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

In mid-April
Max Baucus one of the authors of Obamacare and a major proponent of the law
made the following statement to Health and Human Services Secretary Kathleen
Sibelius at a Senate hearing.

http://youtu.be/Y9airckwqA8

Unfortunately only 11,723 people watched this 29 second You Tube. The traditional media gave his statement
sound bite coverage without explaining the reasons for him saying Obamacare is
going to be a "train wreck."

West Virginia Senator Jay Rockerfeller said Obamacare is beyond
comprehension.

Only 157 people looked at this You Tube whick has been up for 3 weeks.

It would have
been a good idea for congress to have read and understood the bill.

Meanwhile, congressional leaders in both
parties have been engaged for months now in high-level, secretive confidential
talks about exempting lawmakers and Capitol Hill aides from Obamacare’s health insurance exchanges that they are
mandated to join as part of President Barack Obama’s health care overhaul,
sources in both parties said.

These talks involve the Obama administration,
Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner
(R-Ohio), along with other top lawmakers.

“These talks are extraordinarily sensitive,
with both sides acutely aware of the potential for political fallout in the
2014 mid term elections from giving carve-outs from the hugely controversial
law to 535 lawmakers and thousands of their aides. “

Politico
along with other Internet news agencies has been the only news agency to have
in depth coverage of this attempt to exempt congress and its aids from
Obamacare and its health insurance exchanges.

Henry Chao, the Administration’s chief
technical official in charge of the
implementation of the Obamacare’s health insurance exchanges, “just hopes that Americans can avoid a “third-world experience.”

Why would both
Democrats in congress want to avoid participating in Obamacare and its health
insurance exchanges?

We need to
be reminded that the Democrats had overwhelming majorities in both houses of
congress at the time of passage of the law in 2009 without a single Republican
vote.

I am
reminded of Nancy Pelosi’s argument for Obamacare's passage.

http://youtu.be/KoE1R-xH5To

Now that
congress knows what is in Obamacare they want to be exempt.

Congress is content to let the rest
of us suffer.

What is
congress afraid of?

Higher
healthcare costs for themselves, their families and their aides.
Being
mandated into Obamacare’s health insurance exchanges will result in them not qualifying for government subsidy.
Congresspersons and their aids could
also lose their employer-based coverage.
This is also true for millions of
ordinary Americans.
They would also face higher costs of
insurance through health insurance exchange.
Every policy the healthcare insurance
industry sells will be taxed. It will result in passing the tax on to the
policy holders.
Contrary to the President’s promises, independent analysts expect health insurance premiums to
rise sharply, particularly for younger workers and their families.

Congressional
members have other fears if they fail to create an exemption for themselves and
their aides. These fears are:

1. They fear the
impact on Capitol Hill employment.

2. The increase in healthcare insurance
costs “could lead to a ‘brain drain’ on
Capitol Hill, as several sources close to the talks put it.”

3. Ordinary Americans who run businesses
are also faced with the same problem. President Obama and Democratic
congressmen have refused to be responsive to the dilemma faced by ordinary
businessmen.

4. American business owner fear they will not
be able to hire or retain valued employees.

5. These businessmen are presently
reducing full-time workers to part-time employees in order to avoid Obamacare’s
mandatory insurance coverage or penalty.

6. This will have the consequence of
increasing the unemployment rate and decreasing consumer spending.

7. In turn it will create an unending
spiral which will seriously impact economic growth.

8. The question Americans must ask is “what about me.”

The Obama
administration and congress have done similar things before in their effort to
passing Obamacare.

Obamacare
was passed using backroom dealings such as the “Cornhusker Kickback,” the
“Louisiana Purchase,” and the threats to political careers.

This congressional
exemption also brings back memories of (more than
1,200 waivers) to favored
businesses and unions who received special exemptions from Obamacare’s
insurance rules.

“If Congress quietly wants
to exempt itself from Obamacare, that’s great—so long as it includes the rest
of us in that midnight amendment.”

If you are "mad as hell and do not want to take this anymore"
sign this petition.

Please
click on this link to sign up and send the link on to your friends.

https://www.change.org/petitions/force-congress-to-obey-obamacare

This is the petition

To:

Senator Harry Reid, Senate Majority Leader

Rep. Nancy Pelosi, House Minority Leader

You told me we had to pass
Obamacare to find out what was in it. Now your gold-standard health insurance
is on the chopping block as Obamacare is implemented.

If the tin-plated plan is good enough for me, my family, and my friends, it is
good enough for you and your staff.

You passed the law — now live with it like the rest of us. Or overturn the whole
rotten thing!

Stop the effort by liberal Democrats to seek an exemption from Obamacare for
Members of Congress and their staff.

Sincerely,

[Your name]

Some of us will remember
Walter Cronkite’s signature was ending
each newscast with the phrase, "And that's the way it is".

I am adding this “it is now up to you ladies and gentlemen.”

Please sign
the petition. Thank you.

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Obamacare’s Actions To Destroy The Healthcare System

March 16, 2013

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

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Stanley
Feld M.D., FACP, MACE

The Obama administration is doing
everything it can to destroy the healthcare system. President Obama continues
to campaign that he is going to save Medicare and Medicaid and provide
universal care while saving $4.25 trillion dollars.

It does not add up. The Obama administration keeps raising taxes,
decreasing benefits and increasing deductibles on Medicare and Medicaid
premiums. The administration is decreasing the work force by regulation and
executive order.

Everything that is being done increases
the burden on seniors and insured workers.

To my amazement no one in organized
medicine except the American Association of Physicians and Surgeons (AAPS) has
protested.

I applaud Jane Orient M.D. executive
director of AAPS and her Board of Directors for stepping forward and trying to
defend the rights of patients and their physicians.

At stake are patients’ ability to
choose their physicians and physicians’ ability to practice medicine as they
choose.

Where are the AMA and all the specialty
organizations in the federation medical organizations? It is little wonder these organizations are
losing members.

All medical organizations should join
with Jane Orient M.D. and her Board of Directors lawsuit against the government.

AAPS filed suit
against PPACA three days after it was signed into law, but the National
Federation of Independent Business (NFIB) and 26 states stayed the case pending
a Supreme Court decision in the case brought.

All of us know that the Supreme Court
upheld the Obamacare law. It was deemed by Chief Justice Robert that the
executive branch has the power to levy a tax. It is not within the power of the
executive branch to create a mandate. President Obama insisted throughout the
legal process that this was a mandate and not a tax.

In my opinion this decision by Justice
Roberts was a big mistake. Obamacare is a terrible law that will not create
universal healthcare. It will be ineffective and inefficient. It will destroy
the healthcare system. Obamacare cannot possible work.

I think this is President Obama’s goal.

The Supreme Court in its decision acknowledged,
"any tax must still comply with other requirements in the
Constitution."

No one except the AAPS has challenge
this point.

“The motion filed by AAPS is the first to ask an appellate
court to rule on whether PPACA violated the Origination Clause of the U.S.
Constitution, which requires that all "bills for raising revenue"
originate in the House of Representatives.”

More and more physicians are not participating
in Medicare. Physicians still have the ability to choose to participate in
Medicare and Medicaid.

At the beginning of 2013 a new
regulation went into effect. Previously, if a physician did not participate in
Medicare the patient had to pay the physician his fee. The patient could then
bill Medicare and collect 70% of Medicare’s allowable fee. Medicare does not pay the patient after
January 1^st,2013.

Non-participating physicians may use
laboratory, x-ray departments or consultants that participate in Medicare. The
participating consultants, labs and x-ray departments can bill Medicare
directly and receive their usual and customary fee from Medicare.

Effective May 1, 2013 (a new regulation
issued March 1, 2013 by HHS) the Department of Health and Human Services will
deprive patients of benefits for blood tests, x-rays, and specialist
consultations—benefits for which they were forced to pay all their working
lives, and which would be covered if ordered or referred by a non participating
Medicare physician.

I believe the Obama administration’s
goal is to force physicians to participate in Medicare.

"Because of Medicare's increasingly costly and
restrictive rules placed on doctors, many Medicare-eligible patients are
receiving medical care from physicians not enrolled in the program,"
states Jane M. Orient, M.D., executive director of the Association of American
Physicians and Surgeons (AAPS).

AAPS filed an
emergency motion for injunctive relief in the U.S. Court of
Appeals for the District of Columbia Circuit.

The
Founding Fathers fought for independence largely because of excessive taxation
without representation. When the Constitution was drafted, the founders
insisted that taxes originate in the House, the legislative body closest to the
people, both in representation and in election cycles.

“ObamaCare
originated in Senator Reid's 2000-page amendment to a 6-page House bill about
tax credits for members of the armed forces who are called into overseas
assignments. AAPS has raised several arguments why ObamaCare constitutes an
illegal tax, including violation
of the constitutions Origination Clause.”

This new executive order disregards the
constitution’s “Origination Clause” to try to stop physicians from not
participating in Medicare

Only
the AAPS had the guts to speech out against this executive branch breech of its
power and defend patients and physicians rights as granted by the constitution.

Hooray
for the AAPS.

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

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cell phone glass repair • October 27, 2013

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Why Not Avoid The Financial Problems?

February 24, 2013

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

It is
very clear to me that neither the Obama administration nor the senate wants to
solve the root causes of the federal deficit problem.

The
sequestration debates are not getting to the root causes of the deficit. Eighty
five billion dollars will not make a dent in America’s 16 trillion dollar
budget deficit.

President
Obama is running around the country scaring everyone with the notion that vital
services must be cut or else the country will be paralyzed.

Recently
the congress and the President appropriated $60.2 billion dollars for aid to
Sandy victims. This is almost as much as the sequestration is going to
eliminate.

“The Senate voted
Monday to provide $50.5 billion in aid for victims of Superstorm Sandy. The
vote means Congress has approved a total of $60.2 billion in aid for Sandy
victims”.

America’s
big deficit problem is created by out of control entitlement programs. Obamacare
is adding to entitlement spending. It will only increase the deficit.

Our
politicians’ should be working hard to figure out a solution to increasing entitlement
spending. Yet the Obama administration has refused to consider entitlement
reform.

America’s
two largest entitlements are Medicare and Social Security. Food stamps, and unemployment
insurance, among others has some impact on the deficit.

Simple
reforms and a decrease in waste could solve the problem.

The
following two articles summarize the illusion of the existence of Social
Security and Medicare Trust Funds.

In
reality the money goes into these trust funds from payroll withholdings. The
government then borrows the money to pay general expenses. It provides an IOU
to the trust funds. In essence the trust funds are broke and the IOUs are an
unfunded liability of the federal government..

“And since the
federal government borrows the surplus from both funds (Social Security and
Medicare) to pay other expenses, the only thing in those trust funds own
special, non-negotiable, interest-bearing IOUs.”

http://articles.washingtonpost.com/2012-10-18/opinions/35502037_1_trust-fund-medicare-trustees-health-care

http://www.forbes.com/sites/merrillmatthews/2012/08/21/think-social-securitys-trust-fund-is-a-scam-medicare-has-one-too/

In order
to pay Social Security and Medicare obligations the government shifts revenue
of current accounts into the trust fund accounts.

Citizens
paying into Social Security and Medicare all those years thought they were
paying for a retirement annuity. The assumption was the money would grow with
wise government investments and those funds would be able to pay their promised
liability to seniors.

Those
payments were really a disguised tax. As baby boomers become eligible for
Medicare and Social Security the obligation is increasing.

America
is reaching the point where more people are receiving these entitlement
benefits than the younger people who are funding them.

The logical result is the premium price for
Medicare coverage is scheduled to double in 2014. The deductibles for services are
scheduled to increase. The age requirement for eligibility is about to rise. Access to care is decreasing as physicians
refuse to take Medicare. Rationing of care is increasing as hospitals are being
forced to assume risk. No one wants to assume the risk of taking care of sick
people. Especially when they are not very good at evaluating the risk.

Everyone
knows all of this. Nevertheless they turn away as the government either borrows
more or prints more money.

Americans
have been told by multiple administrations that citizens could not handle their
own Social Security or Medicare annuity very well. Therefore the government
must do it for them.

The
government has done an awful job managing our retirement annuities.

Social
Security and Medicare Trust Funds must become real trust funds that grow in
value in the future or the government should hand control over to the people.

The Obama
administration refuses to believe the significance of defensive medicine.
Defensive medicine’s cost to the healthcare system is somewhere between 300 to
700 billion dollars a year.

The Obama
administration’s estimate is it costs 3 billion dollars a year. They are wrong. Ask any physician.

Why
should physicians or hospital systems assume the risk of missing a diagnosis by
not doing a test?

The
emotional and financial consequences of a frivolous lawsuit can be devastating.

Simple
and fair tort reform will save the healthcare system around 500 billion dollars
a year. The 500 billion dollars is more
than 5 times the cost of the 85 billion dollar sequestration. The administration
is wasting 500 million dollars to protect the business of malpractice trial
lawyers.

The
administration claims its overhead for Medicare is only 2 ½ %. This represents
the cost to pick an insurance company to adjudicate insurance claims. The true
cost is not clear. However, it is somewhere between 40-60% of every Medicare
dollar spent.

The
insurance company is permitted by the government to pack many expenses into the
direct patient care column and avoid going over the 15% medical loss ratio
allowed.

The ten
hidden taxes written into Obamacare are now starting to be felt. The Obamacare taxes
are going to increase the cost of medical care not decrease the cost as the
affordable care act promises.

Patients
are directly responsible for many of their own medical outcomes. If patients had skin in the game and
financial incentives they would pay attention to their self -care and their
physicians’ recommendations.

There are
no incentives in Obamacare for patients to manage their care effectively.
Financial gain would get their attention.

These are
just a few of the solutions to the real problems in healthcare. There is much
more waste in federal spending than $85 billion dollars a year.

All you
have to do is look at the list of extraordinary waste that Senator Tom Coburn
has compiled.

Rand Paul
did a clever thing. He sent $600,000 of his senate office budget back to the
U.S. Treasury after carefully trying to save money. The 49 other senators and
over 400 congressperson ought to do the same. It would set an example for all
of the bureaucracy to do the same. In fact President Obama ought to demand it.

“The
Kentucky Republican returned $600,000 in funds he saved from his Senate office
budget in the last year, the Louisville Courier-Journal reported.

“It’s
the only budget I control,” Paul said at a news conference in Louisville. “It’s
not enough, but it’s a start.”

If every
congressperson saved 600,000 a year as Rand Paul did the deficit would be
reduced by $321 million dollars more a year. If all the cabinet positions and
their agencies tried to save money and were rewarded for saving money we would
start to make some progress in decreasing the deficit.

The Simpson
Bowles Report commissioned by President Obama would be helpful in eliminating
unnecessary agencies and duplication. Their report has been ignored by the
Obama administration.

Why has
President Obama refused to listen to people who have exposed the many areas of
government waste? It is incomprehensible.

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

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“What A Revoltin’ Development This Is !!”

February 6, 2013

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama stated that he believes that deficit
spending is harmless. It follows that any amount of deficit spending will do no
harm.

President Obama rhetoric causes him to contradicts
himself.

The Life of Riley, with William
Bendix in the title role as Chester Riley, was a
situation comedy on radio in the 1940s and early black and white television in
the 1950s.

Chester Riley always inserted his exclamation of indignation about a
situation he experienced into in the comedy,

"What a revoltin' development this
is!"

The statement became one of the most famous catchphrases in American popular culture.

Americans find
themselves in a similar situation weekly just as Chester did in the 1950s

In the CBO's analysis of the
president's preliminary 2013 budget, the spending is $3.72
trillion. The CBO predicted that collections will be $2.5 trillion dollars. The
CBO predicted that there will be a $1.22 trillion dollar deficit added to
America’s debt in 2013.

If the economy slows as many predict the projected deficit get
worse.

On February 5, 2013, a day after President Obama missed his budget
due date, the CBO revised its preliminary prediction.

The CBO said the deficit spending for 2013 would be reduced from a
predicted $1.22 trillion to “only” $845 billion dollars without a decrease in
unemployment, a decrease in government spending or an increase in the 1.2%
growth of the economy.

This decrease in deficit spending is a result of the increase in taxes
January 1,2013 to avoid the fiscal cliff.

The reality is that
President Obama is increasing government spending yearly.

“Obama's yearly budgets are record-breaking.

Here's a
summary of a fact-check analysis:

The correct figure to use is the CBO's analysis of the
president's 2013 budget, which clocks in at $3.72
trillion.

So this is what we end up with:

2008: $2.98 trillion

2009: $3.27 trillion

2010: $3.46 trillion

2011: $3.60 trillion

2012: $3.65 trillion

2013: $3.72 trillion”

“Starting in 2008 as the base year and ending
with 2012, the compound annual growth rate for Obama's spending starting in
2009 is 5.2 percent.”

President
Obama's deficit-to- Gross Domestic Product
(GDP) ratio is huge. Democrats and the traditional media complained that George
W. Bush was overspending.

George W.
Bush’s overspending was tame compared to President Obama’s.

“George W. Bush

2001-08 2.0
2002-09 3.4
Average 2.7

Barack Obama

2009-12* 9.1
2010-12 8.7
Average 8.9

*Fiscal 2012 ends Sept. 30, 2012, so this figure
is estimated”.

The median annual income has dropped in the last 4 years under President Obama’s
reign.

“Using constant 2012 dollars (to adjust for
inflation), the median annual income of American households was $53,718 as of
June 2009, the last month of the recession. Now, after 38 months of this
"recovery," it has fallen to $50,678 – a drop of $3,040 per
household.”

The
Senate, controlled by Democrats, voted unanimously against Obama's 2012 and
2013 budget proposals 0-97 and 0-99 respectively. The House of Representatives
voted 0-414.

Both the Senate and the House knew that
continuing deficit spending is economic suicide.

The U.S. government’s economic problems are
never solved by increased regulations.

Regulations costs the government billions of dollars
to write and execute. It also costs businesses additional billions to comply
with new regulations. This spending detracts from investments in economic
growth.

Regulatory costs have skyrocketed during the
Obama administration.

The costs of regulations have more than doubled since
President Clinton’s administration and tripled President George W Bush’s
administration. The present regulatory
costs are almost double the combined costs of Presidents Clinton and Bush.

What does this have to
do with Repairing the Healthcare System?

The massive increases in healthcare regulations
are distorting the physician-patient relationship. They are commoditizing
medical care.

The result is large increases in healthcare
costs for consumers. The increases are occurring long before Obamacare has been
fully implemented.

The administration’s regulations have not
touched on the major causes of the rising costs in the healthcare system. The
top two causes are defensive medicine and the need for tort reform and
effectively challenging the abuse of the healthcare insurance industry.

The short-term effects will be devastating to
the delivery of medical care to patients.

The long-term effects are not being talked
about.

Physicians
are blamed for the rising medical costs. Each year the government threatens
physicians with a 25-30% reduction in reimbursement.

Physicians
collect only 10% of the total healthcare dollars spent. A major question is
what is the rest of the money being spent for?

How
do you measure the value of physicians’ services? Medicare and Medicaid pay
physicians a small percentage of the value for their services.

When
Obamacare is fully implemented payment to physicians will be lower. Physicians
will be responsible for their financial performance and penalized if
performance is poor.

“When people
don't get paid adequately, the quality of their work suffers over the long
haul. The best and brightest would-be doctors won't sign up for medical school when they figure out they
won't get paid enough.”

Another option is that physicians will unionize.
They will hire effective negotiators to be paid their true value.

Obamacare’s hidden taxes are fudging our real
unfunded obligations. The ballooning deficit will slow our economic growth. Millions
will remain unemployed and uninsured.

The Independent Payment Advisory Board's cost-cutting measures will ration medical care. The board will decide what
treatment is worthy of reimbursement not the consumers of
healthcare.

“ Remember
the recent replacement refs for the NFL? The NFL went downhill, and the
fans booed and demanded a change.

Imagine
replacement doctors in our medical care.”

Healthcare consumers are confused and angered
by swiftly rising premiums and high deductibles, according to focus groups in four U.S. cities conducted by researchers for the
Robert Wood Johnson Foundation.

These focus groups were likely to question
physicians’ recommendations and compare costs and quality information just like
shopping for a car or a TV set. They knew their costs “practically down to the
penny.”

Consumers are not stupid!

They are starting to say, as Reilly did on his
weekly sitcom,

“ What a revolting development this is.”

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

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Socrates Is A Man

January 13, 2013

inDisinformation and the healthcare system, Medicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld
M.D.,FACP,MACE

All Men Are Mortal

Socrates Is A Man

Socrates Is Mortal

This is the classical syllogism. Syllogisms are a
form of decisive logic that leads to a certain conclusion.

“A
syllogism (Greek: συλλογισμός – syllogismos
– "conclusion," "inference") is a kind of logical
argument in which one proposition
(the conclusion) is inferred from two or more others (the premises)
of a specific form. “

In my last blog I reported the 3.5% tax the Obama
administration is levying on the healthcare insurance industry for ever
healthcare insurance policy it sells through Obamacare’s health insurance
exchanges.

In 2014 the healthcare insurance industry is going to
be required to sell healthcare insurance policies through the health insurance
exchanges.

The healthcare insurance industry will also be
required to sell plans that comply with the rules and regulations of the Obama
administration.

The 3.5% tax “users fee” was published on a Friday
afternoon at the end of November. The tax received little media attention. I
said the healthcare insurance industry would pass this “users fee” on to the
consumer.

At the end of December the healthcare insurance
industry did better than that. It increased healthcare insurance premium rates
by double digits.

“Health
insurance companies across the country are seeking and winning
double-digit increases in premiums for some customers, even though one of the
biggest objectives of the Obama administration’s health
care law was to stem the rapid rise in insurance costs for
consumers.”

The consumers most affected by the higher rates are
small businesses and consumer who must purchase insurance on their own.

"In California, Aetna is proposing rate increases of
as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of
California 20 percent for some of those policy holders.

The rate requests are in
addition to the 39% increase in rates last year.

In other states, like Florida and Ohio, insurers have been
able to raise rates by at least 20 percent for some policy holders. The rate
increases can amount to several hundred dollars a month.

In 2010 the
increase in healthcare insurance premiums increases provided springboard for
public opinion sympathy of the Affordable Care Act (Obamacare).

Obamacare will go into full effect in 2014.

Why would a business (the healthcare insurance
industry) facing loss of its customers because of high premiums increase
premiums even further?

Why, if the traditional media has published articles
stating that the cost of healthcare has been decreasing would a premium
increase be justified?

“A report issued by the Department of
Health and Human Services today includes findings that might surprise
some people.

“During
the fiscal year that ended Sept. 30, 2012, the amount Medicare spent per beneficiary
rose by just 0.4 percent. That's three percentage points less than the economy,
as measured by gross domestic product, grew during that same period.”

If Medicare spending has risen only
.4% why would Medicare premiums increase by at least 33% while private healthcare
insurance premiums are increasing by 10-30%?

Annually physicians’ reimbursement continues to
decrease.

Why do consumers’ deductibles continue to increase
each year?

It is illogical. The numbers do not make sense. The
actions do not follow the syllogistic logic.

How can Medicare be losing money? Medicare premiums
are means tested and represent a redistribution of wealth.

The average
premium for Medicare with after tax dollars for a couple with a reasonable
pension fund is $15,000 dollars.

The average direct cost of care per Medicare patient
is $6,600 dollars.

In 2014 Medicare premiums are scheduled to increase
to more than $20,000 for full Medicare insurance coverage.

Seniors have paid for Medicare insurance in payroll taxes
continuously for the last 47 years.

There is something wrong with the numbers. They do
not add up. Where is the extra money going?

Consumers must start becoming aware of these facts.

Only consumer protest will bring out the truth about
these illogical numbers.

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

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It Is All About Trust

November 4, 2012

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

I
voted for President Obama in 2008 because he promised us hope and change. I
knew little of his past or present ideology. He was an attractive candidate and
promised hope. The New York Times never
went into depth about his past, past interests or past performances.

Americans
trusted him and voted for him. He looked like and acted like the candidate of
hope. I trusted him to lead America on the right path.

President
Obama has done so many things wrong in the last 4 years that it is amazing to
me that anyone trusts him today.

Yet
he even said in one of his stump speeches “you
know me and you know you can trust me.”

Immediately
after his inauguration America was confronted with an $800 billion dollar
stimulus package that promised to produce millions of shovel ready jobs.

There
weren’t many shovel ready jobs. He baled out some companies and not others. All
the bale outs were at taxpayer expense.

This
stimulus package provided lots of money to increase the size of government. In
fact, President Obama used a sizable about of this money to build a government
bureaucracy for a healthcare bill that was yet to be written.

A
few things developed that made me suspicious of President Obama’s ideology. President Obama is dedicated to big
government and big spending even though it is inefficient and not directed
toward its original goal.

I
have not been a fan of John Maynard Keynes since I read Fredrick Hayek ‘s “Road to
Serfdom.”

FDR
did not spend his way out of the depression. World War II got us out of the
depression.

Keynesian
economic has not worked. President Obama was clearly putting us on a “Road to
Serfdom” with his out of control spending and increased national debt by over
$4 trillion dollars.

President
Obama has made many annoying moves in the last four years to fake out the
American public.

Common
denominators have been a lack of transparency, a disregard for the legislative
branch of government and an overuse of executive orders.

Recent
lack of transparency is illustrated by Fast and Furious and the tragic Benghazi
tragedy.

The
mainstream media’s coverage has been disgraceful. http://query.nytimes.com/search/sitesearch/#/Bengasi%2C+Libya+consulate/

Other
annoying actions have been the transfer of power from the congress to the
executive branch and the intimidation of the Supreme Court.

It
seems that he either ignores the constitution or gets around its meaning in
some way. The notion that the constitution is an antiquated document is
offensive and appalling.

The
media as been manipulated by the way events and facts are presented. November 2nd unemployment results are an
outstanding example.

Americans
have been conditioned over the years to get their news from sound bites and not
detailed facts. Whichever sound bite is present the most times becomes the
fact.

The
economy is not doing well. It is growing at a very slow pace. Job growth is
slow. The presentation of the monthly data is confusing.

The November 2 unemployment
headline was; “Latest Jobs Report Shows Persistent Economic
Growth.”

The first sentence was there were 171,000 new
jobs in October. The economy needs 500,000 new jobs per month for a normal recovery.

Consumers
still cannot get jobs, credit or loans from banks.

The
last sentence in the press release stated that unemployment rate rose from 7.8%
to 7.9%. No one remembers the last sentence

Since
the media is the message and 171,000 new jobs sounds like a big number that is
better than expected. It gives the illusion that the economy is improving on
President Obama’s watch.

Americans are not
stupid. The New York Times is trying much too hard to get President Obama re-elected.

President
Obama has generated mistrust by Americans for the promises he made about Medicare
and Obamacare. The amount of money spent, so far, by the President Obama on
Obamacare is not available to the public.

The
analysis of the increase in middle class taxes already in place as a result of
Obamacare are not discussed by the main stream media nor by President Obama.

There
are 10 hidden taxes on citizens making less than $250,000 a year i.e. the
Medicare payroll tax. This tax is going up from 2.9 percent to 3.8 percent. There is an additional 3.8
percent Medicare tax added to investment income. Together, this will cost
taxpayers $318 billion from 2013 to 2022. These taxes were not obvious to the
great majority.

The
impact of future Obamacare taxes on the middle class is going to be
overwhelming. The new taxes were written into Obamacare but not presented to
the public. This serves to increase the mistrust for President Obama and his
promise for transparency.

The
one thing I learned from Hayek is that you cannot manipulate the economy by
edict or force without limiting freedom. In a “free” society “ the unintended
consequences and costs are certain to get out of control.

Costs
can be controlled in a level playing field competitive free market. The
consumer driven market is non-existent. Consumers must start to understand
their power in society.

Government
should make rules that level the paying field for all and then get out of the
way. No spinning the facts and no non-transparent activities. No favoritism to
lobbyists, associations or unions.

Rules
should be made for the benefit of the people in a competitive environment.

Medicare
premiums and deductible expenses for senior will raise not decrease as promised
by President Obama. Out of pocket expenses will rise.

Seniors’ standard Medicare
Part B monthly premiums will jump from $99.90 to $128.20 at the low end of the
means testing while their Part B deductibles will rise from $140 to $180. Seniors’ Medicare hospital deductible on admission will
increase from $1,156 to $1,336, while their daily hospital
coinsurance will climb from $289 to $334 in out of pocket expenses.

I
have pointed out that Obama care’s main feature, ACO’s, will be impossible to
execute and will subsequently fail. This will lead to greater distortions of
the healthcare system.

The
result will be a decrease in choice, a decrease in the freedom to choose your
physicians or recommended care, a decrease in access to care and rationing of
care once the government has total control.

This
does not included increases in costs to seniors and the middle class that has
been scheduled by Obamacare.

All
the stakeholders have taken advantage of the healthcare system in its present
form. The stakeholders are the healthcare insurance industry, the hospital
systems, the government, the patients and the physicians.

The
healthcare system needs a new business model in order to survive. President
Obama’s business model is not the one. The public does not trust it.

The
actions of the stakeholders are natural as these stakeholders try to survive.

It is government’s job to make the rules so
these dysfunctional survival methods cannot flourish.

President
Obama cannot be an effective leader in the future. The public does not trust
him any more.

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

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Medicaid Patients And Physicians

September 3, 2012

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

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Stanley Feld M.D.,FACP, MACE

Obamacare becomes
more complicated and expensive by the week. President Obama has intentionally
made the real costs of Medicaid more difficult to follow.

He originally fudged
the information to the CBO in order to obtain favorable scoring. The first
scoring created a deficit decrease of 108 billion dollars over 10 years. He
used this CBO scoring to convince the Democrats in both the House and the
Senate to vote for the bill.

Then the states that paid
most of the Medicaid bill complained. They
had budget deficits that would increase.
States are obligated by law to balance their budgets. The people could
not afford a raise in taxes.

President Obama said
he would pay 90% of the Medicaid bill for two years.

This would increase
federal expenditures for Medicaid. The increase was not calculated into the
original CBO scoring.

Now a study shows
that 33% of physicians will not accept Medicaid patients because the
reimbursement is too low.

This study is probably
not accurate. There will be less than 66% of physicians accepting Medicaid
patient. Physicians’ reimbursement has fallen below physicians’ operating
expenses. In 2014 Medicaid enrollment will explode. Under Obamacare an additional
16 million people will be eligible for Medicaid.

I wonder what is to
become of the other 16 million uninsured when the promise was to insure 32
million people?

Avik Roy pointed out that states with Democratic governors tend to have lower physician
reimbursement rates for Medicaid. Those Democratic governors have the highest
budget deficits.

It is easier to cut
physicians’ reimbursement rates than reduce the already minimal services. Entitled
patients have been more vocal than physicians.

A higher percentage
of physicians will quit Medicaid. They cannot pay their office expenses with
the present level of reimbursement.

They will say, “I
quit.”

If this happens and enough
physicians quit, these states will tell their licensed physicians that they
will not be able to renew their license to practice medicine unless they accept
Medicaid patients.

I predict they will
quit anyway.

“This could
prove true in a state like California, where 1.8 million residents are expected
to gain coverage – but fewer than 60 percent of providers presently accept new
patients in the program.”

President Obama anticipated
this in the Obamacare bill. The law increases Medicaid reimbursements for
primary care doctors to match those of Medicare providers.

The goal is to entice primary care physicians to participate in
the program.

There are several things wrong with this thinking,

The increases are short term. The
Federal government will only increase payment for two years. Clearly if the
increase in reimbursement is successful it will have to be extended to maintain
the increase in participation. Some interest groups already have their eyes on an extension.
The increases do not include specialists
so few specialists will participate at the onset, paralyzing the Medicaid system.
If President Obama increases payment to specialists the Obamacare deficit will
increase even further.
Medicare reimbursement is decreasing and may end up being lower
than present Medicaid reimbursement. Therefore this entire exercise is another
Obama trick play.
“As long as
a doctor or hospital isn't losing money, they will probably accept new
patients.”

The key then, is Medicaid reimbursement. Federal dollars
will only last two years. It means states will have
an additional hundreds of thousands of Medicaid recipients for which they will be
on the hook for either keeping the
higher level of reimbursement once the money from Washington dries up, or cut reimbursement rates and watch
doctors bail out.

It is obvious the “fix”
is in, but without specialists included it will not work. Obamacare will have to subsidize the increase. This will increase
the federal deficit even more. In fact it will bankrupt the country.

“This was
apparently the plan all along. The two year funding was put in to reduce the initial
10 year costs and fool the public into thinking Obamacare costs less than it
actually will”.

This is only one of the trick plays that President Obama
included in Obamacare to deceive Congress and the people. Remember Nancy
Pelosi’s famous statement, “We will not
know what is in the bill until after we pass it.”

Obamacare contains hundreds of deficit increasing tricks
claimed to be deficit reducing.

He spent money without attention to consequences.

The only sane thing to do is to repeal it and start over
again unless the goal is to bankrupt the country.

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

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“Here You Go Again”

August 26, 2012

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

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Stanley Feld M.D.,FACP,MACE

In
recent days President Obama and his team have ramped up a coordinated effort to
depict Paul Ryan as a candidate that will destroy Medicare with vouchers. His
team is doing this to scare seniors into voting for President Obama.

President
Obama has been disingenuous throughout this campaign. He has had little success
in fixing the economy despite his promise to do so.

American
are less better off in 2012 than they were is 2008. I believe President Obama
has weakened institutions that have strengthened American democracy and the freedoms
its citizens enjoy.

With
executive orders and the bully pulpit he has weakened the balance of power
between the executive branch, the legislative branch and the judicial branch. He
has ignored many of the principle tenets of the U.S. Constitution.

He has trampled States Rights in favor of his
notion of central government control. In turn, Americans are feeling the freedoms
they have enjoyed are being taken away by central government executive orders.

President
Obama does not have a record of achievement to sell to the American people. The
only option he has is to destroy the character and credibility of his opponents. He character assassination
tactics have been disingenuous and irrelevant.

The
traditional media have been our surrogates in the past for news and
information. However the traditional media have been biased and have supported
President Obama’s tactics. The traditional media have ignore the real issues of
the day.

What
could Governor Romney’s perfect reaction be to President Obama’s now hollow
promises for America’s future?

The
perfect response could be Governor Reagan’s reaction to President Jimmy Carter
during the 1980 Presidential Debate.

President
Carter’s unsuccessful policies were not congruent with America’s desires for economic
prosperity and freedom. During the debate Reagan’s response to a Carter
soliloquy on what he wanted to achieve was simple.

http://youtu.be/px7aRIhUkHY

One big issue is the escalating deficit. A
principle cause of the increasing deficits is President Obama’s excessive
spending on failed entitlement programs. Medicare is a failing program.
Obamacare is adding 30 million more people to a failing program and increasing
its complexity. This new entitlement program is increasing the deficits and will
bankrupt the U.S. quicker.

None of the “improvements” have been proven or
shown to be executable. This certainly will lead to increased central
government control of the distribution of medical care.

“Former vice
presidential candidate Sen. Joe Lieberman said last year, "We can't save
Medicare as we know it. We can only save Medicare if we change it."

President
Obama isn’t taking the deficit crisis seriously. He has caused in excess of 1
trillion dollars in deficits yearly for a total of 4 trillion dollars during he
term as President.

He
has no regard for fiscal responsibility. He has ignored the recommendations of
his own Bowles Simpson commission on deficit reduction.

Through a disingenuous marketing campaign he ridicules Paul Ryan’s comprehensive alternative.

Erskine Bowles, President Clinton's former chief of staff
and the co-chairman of the Bowles-Simpson commission, described the Ryan budget
that passed the House in March as "sensible, straightforward, honest,
[and] serious."

About President's Obama's budget, which failed in the
Senate in May by a vote of 97 to zero, Mr. Bowles said, "I don't think
anybody (including
President Obama) took that budget very seriously."

Since President Obama doesn’t take the deficit
crisis seriously, the traditional media has not taken the deficit crisis
seriously. The traditional media are President Obama fans.

How can we expect the public to understand the
seriousness of the deficit crisis?

It is hard to imagine the meaning of a 16
trillion dollar deficit much less the significance of an increase of 1 trillion
dollars a year. It is difficult to understand the deficit reduction compromise
the congress has come to with respect to the deficit as these numbers are
thrown around.

It is difficult to visualize the breadth of the
deficit when speaking in trillions of dollars.

Last week a reader sent me an easy to
understand explanation. Everyone needs
to understand the scope of the deficit. President Obama should not take us to
be fools.

It is easy to become agitated by these numbers.

U.S. 2011 Financial Statement

U.S. Revenue
$ 2,170,000,000,000 or
$2.17 trillion dollars

Federal Money Spent $
3.820,000,000,000 or
$3.82 trillion dollars

New Debt
$ 1,650,000,000,000 or
$1.65 trillion dollars

National Debt
$14,271,000,000,000 $
14.271 trillion dollars

Recent Budget cuts
$ 35,500,000,000 $ 35.5 billion dollars

Congress and President Obama have agreed to
$35.5 billion dollars of recent budget cuts. It sounds like a lot of money. There
has been a lot of tradition media babble and coverage on this insignificant reduction.

It makes us think the President and congress
are doing something significant to reduce the deficit. Everyone understands the
waste inherent in government spending on government programs.

If we pretend these financial figures are a
family budget, we can see that the budget cuts are ludicrous.

Let us remove all the zero’s from the trillion
dollar numbers to arrive at understandable amounts. Then let us pretend it represents
a family financial statement.

Family 2011 Financial Statement

Annual Family Income is $ 21,700 dollars in the year.

The family spends $ 38,200 dollars that year.

New credit card interest bearing debt increases
by $16,500.

Outstanding Balance on the credit card
increases to $142,710 dollars.

The reaction of most people is this is crazy.
He will never repay the family debt.

The head of the family promises the credit card
company he is going to decrease

spending.

He cuts family spending by $35.50 a year after
he promises the credit card company he would decrease his debt by 50% in 4
years.

The head of the family has three choices. He
can increase revenue somehow but his boss does not want to raise his salary. He
can raise the debt ceiling. His lender does not want to raise his debt ceiling
because he is a bad risk. Raising the debt ceiling means he has to manufacture
more money with credit card borrowing. The lender said enough is a enough.

His last choice is to decrease his family’s
unnecessary spending.

President Obama’s decrease in spending is a
joke and an insult to a lender.

President Obama is not serious about lowing the
deficit. Paul Ryan is. He has presented a sensible way to save Medicare.

Whom do you think the creditors of the United
States would trust more?

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

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Where Is The Healthcare Money Going ?

August 5, 2012

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The article in the Dallas Morning News on Sunday, July 29,2012 entitled “Your Doctor’s Big Fat Paycheck” by Eli Lehrer is misleading. The article ignores the real cause of the rising costs in the healthcare system.

Physicians are the easiest stakeholder to criticize because they are the least organized and least represented. This makes them the easiest and most vulnerable target.

The subtitle is “High wages in the medical sector are the underlying cause of ballooning healthcare costs.”

Eli Lehrer does a disservice to the medical profession as well as to patients. It does not represent the truth-value added effect of a physician's services to patients.

Mr. Lehrer article devalues physicians’ services. He has a lack of understanding of the costs of medical care vs. healthcare.

He quotes the Bureau of Labor statistics saying that primary care physicians earned just over $200,000 a year while specialists earned $355,000 per years in 2010. The Bureau of Labor Statistics used Medical Group Management Association (MGAMA) data for this estimate.

Those numbers are pretty close to the numbers reported by MGMA physician Compensation and Production Survey for 2011.

The number needs some correction but it is unnecessary to quibble.

The MGMA has a group of consultants that teach physicians how to make more money from the healthcare system.

Physician Compensation

Median compensation levels for primary and specialty care physicians

Source: MGMA Physician Compensation and Production Survey: 2012 Report Based on 2011 Data

http://www.mgma.com/physcomp/

http://www.bls.gov/oco/ocos074.htm#earnings

Anesthesiology $407,292

General surgery $343,958

Obstetrics/gynecology $281,190

Internal medicine $205,379

Psychiatry $200,694

Pediatrics/adolescent medicine $192,148

Family practice (without obstetrics) $189,402

Quick Facts: Physicians and Surgeons
2010 Median Pay	This wage is equal to or greater than $166,400 per year or $80.00 per hour.
Entry-Level Education	Doctoral or professional degree
Work Experience in a Related Occupation	None
On-the-job Training	Internship/residency
Number of Jobs, 2010	691,000
Job Outlook, 2010-20	24% (Faster than average)
Employment Change, 2010-20	168,300

The MGMA summarize physicians scope of work layman’s terms on its web site.

What Physicians and Surgeons Do

"Physicians and surgeons diagnose and treat injuries and illnesses in patients. Physicians examine patients, take medical histories, prescribe medications, and order, perform, and interpret diagnostic tests. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.

Work Environment

Many physicians work in private offices or clinics, often helped by a small staff of nurses and other administrative workers. Surgeons and anesthesiologists usually work in sterile environments while performing surgery and may stand for long periods.

How to Become a Physician or Surgeon

Almost all physicians complete at least 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on their specialty.

Pay

Wages of physicians and surgeons are among the highest of all occupations. According to the Medical Group Management Association, physicians practicing primary care received total median annual compensation of $202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010."

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2011/11/where-is-the-healthcare-money-going.html

I am temped to answer Mr. Lehrer’s article point by point. There is so much misinformation and disinformation in this article that it makes Yellow Journalism look tame.

The more important issues are how much does the healthcare system cost and where is the money going?

Then, and only then, can we begin to know the underlying cause of the ballooning healthcare cost.

There are 691,000 practicing physicians in the U.S. Let us assume that the average salary is $250,000 dollars. This is probably a high average number.

The healthcare system costs America approximately $2.5 trillion dollars ($2,500,000,000,000) a year.

691,000 physicians averaging $250,000 equals $172,750,000,000 ($172 billion 750 million dollars).

$172,750,000,000 billion divided by $2,500,000,000,000 trillion equal 6.91% of the healthcare dollars spent for physicians’ salaries.

Let us assume that each practicing physician’s overhead is 50%. This is also a high average. Therefore, physicians’ overhead and salaries are 13.8% of the total healthcare dollars spent.

There real issue in the raising cost of healthcare is where is the 86.2% of the U.S. healthcare costs going?

Mr. Lehrer ignores this issue.

The money is wasted on administrative bureaucracy, healthcare insurance executives’ salaries, hospital administrator salaries and an exorbitantly complex and expensive pharmaceutical bureaucracy.

Over 20 WellPoint executives make more than 10 million dollars a year with these numbers being stratified upward to over 25 million dollars a year plus bonus and stock options.

Some healthcare insurance executives receive over a billion dollars a year in bonuses and stock options.

Many levels of hospital administrative executive make over one million dollars a year with chief executives making over $15 million dollars a year.

I have been told “it is hard to get good help.”

With these sobering numbers on board the critical question is how much is a physician worth that has the education and ability to save lives?

This is the main reason Mr. Lehrer’s article in the Dallas Morning News is worse that Yellow Journalism.

The editors of the Dallas Morning News should be embarrassed by their publication of this article.

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

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