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Stakeholder Abuse of the Healthcare System

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Big Pharma’s Interactions With Obamacare

Stanley Feld M.D.,FACP,MACE

President Obama strategy is to provide favors to potential enemies and then throw them under the bus when he has gotten what he needed from them.

He managed to seduce the American Medical Association, the American Hospital Association and the American Pharmaceutical Association (Big Pharma) to support Obamacare as it was being passed.

Recently he has thrown the American Pharmaceutical Association under the bus.

President Obama needed Big Pharma’s support in order to decrease the resistance to the passage of Obamacare in 2009.  In order to get Big Pharma’s support President Obama made many promises to Big Pharma and satisfied Big Pharma’s vested interests.

These promises included political protection against the left wing wish list to control drug prices. The wish list included weakening drug patents, decreasing intellectual property shelters for new drugs from 12 years to seven years and decrease payment rates for medications administered in the hospital (namely cancer drug therapies). 

Additionally, the White House agreed to spare the drug companies from central planning such as allowing the Health and Human Services Department to “negotiate” lower drug prices.

President Obama succeeded in getting Big Pharma to contribute $80 billion dollars via drug discounts that would affect Obamacare’s bottom line. Big Pharma did that largely by increasing the Medicaid’s drug discount from 15.1% to 23.1%.

Big Pharma also agreed to mark down prescriptions for seniors by 50% above a certain drug cost.

It might appear that President Obama got the better of the deal to obtain Big Pharma’s support for Obamacare.  

This was definitely not true. Big Pharma is making a killing from the government and from out of pocket payment from consumers.

A small part of the killing is explained in Dr. Dale Fuller’s article (that appear in the blog) about Oncology drugs "Is Pharmaceutical Pricing Weird, Or What?"

“Remember the business line, circa 2009, that if you weren’t at the Obamacare table you were on the menu (to be eaten)? Well, Big Pharma sat at the table, gave Mr. Obama what he wanted, and is now back on the menu as the cheese course. “

I believe President Obama’s agenda was to take all the favors away after Obamacare was passed and became law.  He tried to take Big Pharma’s favors away in the 2015 budget. He did not succeed.

He slowly worked to get most brand name drugs covered by eliminating the price fixing reprieve. Medicare Part D pays nothing or little for Brand Drugs. 

“ 2009 was then. The budget directors now claims to be “deeply concerned with the rapidly growing prices of specialty and brand name drugs” and, sure enough, it rescinds the price-fixing reprieve.”

President Obama is becoming more aggressive. He is using the mainstream media to create a furor over the price of specialty drugs. A well-publicized example is the price of the drug that cures hepatitis-C. The government will negotiate a lower price.

Drug prices had been escalating long before Obamacare. Obamacare simply let the genie out of the bottle with its favors to Big Pharma.

Big Pharma overplayed its favors and took advantage of the price reprieve inviting Big Government to step in.

I predict we are going to see all of the favors given to Big Pharma  rescinded before President Obama’s time in office is over.

The federal government will launch a price fixing offensive and choke Big Pharma’s profit making machinery completely.

This is the era of generic drugs. Big Pharma gave this away to the federal government to retain control of the new drug profit margin.  

Since government doesn’t pay for new drugs it can brag, 

“Taxpayer costs were $353 billion or 36% less than the Congressional Budget Office’s original projections for 2006-2013.”

"President Obama’s order to rescind his deal with Big Pharma will result in unintended consequences. Big Pharma will have not the incentive to develop new drugs.

President Obama’s with Big Pharmadeal should have never been  made in the first place.

Handing the $1.093 trillion HHS bureaucracy Soviet-style price fixing powers will undermine the pharmaceutical innovation that depends on large returns on the few medicines that succeed. Even the threat of price fixing could distort investment decisions

President Obama double-crossed Big Pharma.

“ In this double cross lies a warning for the next CEOs and lobbyists who are deluded enough to trust Washington liberals.   Everyone will get devoured eventually.”

“It’s tempting to say the drug makers deserve their fate, except that the ultimate costs of their folly will be born by Americans who won’t enjoy the longer lives, fewer hospitalizations and less suffering that new therapies can bring.”

 It is clear to me that a centrally controlled market rather than a free market leads to a distorted marketplace that is not self-correcting. Consumers, and not the government, must be in control of the healthcare system.

The government should protect consumers from being abused by other stakeholders in the system.

Government should not make under the table deals that hurt consumers.

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

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Let’s Do The Numbers : Another Obama Trick

Stanley Feld M.D.,FACP,MACE

Have the increased Obamacare taxes added enough value to the healthcare system to be worth the costs?

The answer is no.

Are the increased taxes becoming painful yet?

The answer is yes.

The yearly cost of Obamacare has not been transparent.  There have been multiple delays in the implementation of Obamacare.

Favored businesses and unions have received waivers and exemptions from the laws required coverage. All the while taxes have increased and less than 10 million people have received healthcare coverage from the healthcare insurance exchanges. Eighty-five percent of those people enrolled are receiving federal subsidies.

No one has explained how a tax credit becomes a federal subsidy.

The public has no idea what the costs of Obamacare are or will be in the future. The CBO has revised its estimates several times.

Are all the Obamacare pronouncements confusing?

Yes. I believe they are intentionally confusing.

All the stakeholders are dissatisfied. Neither President Obama nor his administration is listening to the primary stakeholder (patients). 

Why are there so many waivers and exemptions being handed out by the Obama administration? I believe it is because President Obama is listening to his political base.

He is delaying the implementation of his agenda so his goal of socialized medicine is not obvious to all Americans.

President Obama and his administration have mislead us about the exact number of enrollees since the very beginning of the first enrollment period,  October 1,2013.

The American public was mislead about ,

 

  1. The disastrous website development, reason for website crashes and cost of website development.
  2. The exact number of enrollees the first year. (9.5 million correct to 8 million and then down to 6.8 million)
  3. The resulting further correction by a decrease in 800,000 more people losing insurance because of discovered ineligibility for subsidies.
  4. Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
  5. The change in the start of enrollment from October 1,2014 to November 15th to avoid discussion of enrollment around the time of the November 2014 elections.
  6. Extending the 2014 enrollment three months.
  7. Extending enrollment for 2015 for one to three months.
  8. Finally in 2015 announcing the back end of the website sending information to the IRS was still not complete.
  9. Rehiring CGI the same Canadian company that built the disastrous healthcare.gov to fix the back end of the website.
  10. Discovering that 1.2 million were counted that should not have been because they got dental insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
  11. Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
  12. Eight hundred thousand (800,000) enrollees lost their subsidy because they lied on their application
  13. Announcing that the group market Obamacare enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

Along the way I got the feeling that none of the enrollment numbers could be trusted.  HHS and CMS keeps on modifying and lowering them.

The Obama administration keeps telling us how great the enrollment is and that Obamacare is a success.

However, only ten million people have Obamacare insurance. Eighty five percent of those on Obamacare are receiving subsidies and still cannot afford the deductibles.

The rest of the enrollees have a pre-existing illness. They cannot find private insurance to buy. What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?    

After five years with all these new Obamacare taxes, I would not call this a successful healthcare reform program.

All of these enrollees were in the individual market. These numbers do not include the group insurance market.

14 million lost their healthcare insurance on the individual market. 10 million gained insurance on the healthcare insurance exchanges.

Several states healthcare insurance exchanges have failed.

An unknown number of enrollees in 2014 did not re-enroll in 2015 because of the loss of the subsidy and the high deductibles.

Other enrollees did not sign up again because they could not afford the high deductible.

The following is President Obama’s next trick play.

At the end of 2015 enrollment the Obama administration declared that 11.5 million people were enrolled.

On March 16,2015 the administration said about 16.4 million people have gained health insurance coverage since the Affordable Care Act became law nearly five years ago.

Please notice the tricky wording. The Obama administration is counting children under 26 that now can be included in their parents’ group insurance plans and the additional Medicaid recipients added by some states.

The count is not only the people who enrolled in Obamacare through the healthcare insurance exchanges.

The present discussion is about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

Confirmed Exchange QHPs: 11,699,473 as of 3/18/15

Estimated: 11.95M (9.06M via HCgov) as of 3/18/15

 

Estimated ACA Policy Enrollment: 33.1M
(10.46M Exchange QHPs, 8.20M OFF-Exchange QHPs, 330K SHOP, 14.1M Medicaid/CHIP)

 http://acasignups.net

There are two possible reasons for the Obama administration’s pronouncement at this time.

The first is the Republicans are about to announce its alternative plan to Obamacare. The administration’s goal would be to blunt the impact of the alternative plan by announcing the false success of Obamacare.

The second reason is to play mind games with the Supreme Court.

Justice Kennedy’s questioning at the hearing of King vs. Burwell expressed his concern for 85% of 10 million people who would loss their federal subsidy. Justice Kennedy did not address the letter of the law in his questioning.

Only the state healthcare exchanges can provide subsidies not the federal exchanges according to the written law. This is executive overreach of power granted by the constitution. President Obama should have asked congress to rewrite the law’s provision.

In an attempt to pressure the Supreme Court to vote in President Obama’s favor the administration has given the impression of confidence the Supreme Court will act in its favor.

The Obama administration has announced, a few times, that it does not have an alternative plan if the Supreme Court rules against it.

This is not true. The Obama administration has at least three alternative plans in the works.

It looks as if President Obama cannot help himself from trying to manipulate the American public and now the Supreme Court.

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

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Nobody Seems To Care About The Increases In Obamacare Taxes

Stanley Feld M.D.,FACP,MACE

There are at least two ways to balance the budget. Increase taxes or decrease spending.

If you increase spending without increasing taxes, you increase the budget deficit. If taxes are increased enough the budget deficit might be reduced.  

It was the Obama administration’s hope that if taxes were raised slowly, Americans would not notice the increases.

This is exactly what President Obama and the tax and spend Democrats are doing.

A frustrated reader writes about the slow rise but unrelenting rise in taxes.

“Here is a message from my buddy Brad.

As Jim Naybors/Gomer Pyle used to say – "surprise surprise."

Here is what happened on January 1, 2015:

Top Medicare tax went from 1.45% to 2.35%

Top Income tax bracket went from 35% to 39.6%

Top Income payroll tax went from 37.4% to 52.2%

Capital Gains tax went from 15% to 28%

Dividends tax went from15% to 39.6%

Estate tax went from 0%to 55%

Remember this fact:

These taxes were all passed only with Democrat votes, no Republicans 
voted for these taxes.

These taxes were all passed under the Affordable Care Act, aka 
Obamacare.

The problem is taxes are at the tipping point. The rich and the middle class are now noticing the yearly tax increases. They are starting to shout, “no new taxes. Where is the value of these new taxes?”

A problem in America is an increasingly large  group of people who pay no taxes. These people have no choice but to accept government handouts to survive.

It has been reported that government handouts are equivalent to about a $50,000 a year post tax income. The entitlements blunt incentives to take the initiative and find work in order to be productive citizens.

Working people are experiencing the increased tax burden and are unhappy.

I have written a few articles listing Obamacare increases in taxes. President Obama has steadily increased taxes each year for the last six years.

The most irritating thing about the increased taxes is Americans are not getting value for their money.  All they are getting is lies and failed programs.

Administrator Marilyn Tavenner is resigning her post overseeing Obamacare just months after she admitted that the Obama White House’s highly publicized 8 million Obamacare enrollment figure was inflated by at least 1.3 million.

There is always a fall guy. It is never President Obama or his policies that are at fault. There is never full disclosure or transparency about these failed programs.

A vivid example of the lack of transparency is a recent disclosure by the budget committee about the Obama administration’s using unauthorized funds to pay for Obamacare cost overruns. Congress is supposed to authorize the use of funds according to the constitution.

Obamacare was having trouble getting insurance companies to participate in Obamacare’s health insurance exchanges. President Obama activated the government guarantee reinsurance program to subsidize the insurance industry. The goal was to induce the healthcare insurance industry to participate in the health insurance exchanges. The Obamacare reinsurance program guarantees the insurance industry that it cannot loss money in providing insurance through the health insurance exchanges.

 The Treasury Department has rebuffed a request by House Ways and Means Chairman Rep. Paul Ryan to explain $3 billion in payments that were made to health insurers even though Congress never authorized the spending through annual appropriations.

At issue are payments to insurers known as cost-sharing subsidies. These payments come about because President Obama’s healthcare law forces insurers to limit out-of-pocket costs for certain low income individuals by capping consumer expenses, such as deductibles and co-payments, in insurance policies. In exchange for capping these charges, insurers are supposed to receive compensation.

What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway.

There are several other incidences of money shifting without congressional appropriation.

President Obama continually forgets that the constitution provides for three independent branches of government. They were formed in order to maintain checks and balance so one branch does not become all powerful.

The apparent disregard for the constitution is ubiquitous in the Obama administration.

If anyone is bothered by these actions by the Obama administration, please write to your representatives in congress.

If you think it is important that everyone in the U.S. should 
know these things, feel free to pass this on.

If there is value to the healthcare system with Obamacare, a debate about the need for increased funds is appropriate.

Most Americans do not like Obamacare. Most physicians do not like Obamacare. America’s budget cannot stand Obamacare.

President Obama loves Obamacare. Isn’t President Obama supposed to represent the will of the people?

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

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Simple Fixes

Stanley Feld M.D.,FACP,MACE

Republicans are trying to figure out what to change in Obamacare to make it work. I believe Republicans should change all the perverse biases built into Obamacare. The result would be a small but important dent in Repairing the Healthcare System.

It is best to start all over again with a bill that puts consumers in charge of their healthcare dollars. Consumers must be responsible and own their healthcare decisions and healthcare dollars. Consumers must drive the healthcare system in order to have reduced costs, increased efficiency of care and competition among stakeholders.

Obamacare is a political strategy by progressives to get more power. It is not about improving delivery of healthcare.

It is about  "redistribution of wealth"… or, by its more common name, "SOCIALISM.

Republicans do not understand this. They don’t have the courage to call out President Obama or the Democrats.

Democrats cannot or do not want to understand the power of market based consumer driven healthcare because their ideology of central government control of healthcare does not allow it.

Consumers, taxpayer and voters must drive the change to a better, more cost efficient and less dysfunctional healthcare system.

 Obamacare’s basic theme is built on hospital ownership of physicians’ practices. If hospitals or hospital systems own all the physicians’ practices in a community, the government has to only negotiate prices with the hospital system. The central government can then control a community and decide on access to care and the rationing of care of the community’s citizens.

The hospital receives a bundled reimbursement for a disease encounter. The hospital divides the reimbursement between the doctor and the hospital.

Once physicians are in the employ of hospitals, the government and hospital systems think that the non-compete clause will hold up in court and physicians will be afraid to leave the hospital systems.

Hospitals think they can lower the salary of physicians during negotiations for renewal of physician employment contracts since physicians will be afraid to leave the hospitals’ employ.

I’ll bet if a group of physicians decided to leave at the same time, the hospitals would be in the trap hospitals set to apply to physicians. Physicians should wake up. Some physicians have.

These are some of the perverse biases Obamacare has created against physician practices and patients.

The biases created against groups of private practitioners and to the advantage of hospital systems costs government and healthcare insurers more than it would if there was a level playing field for practicing physicians. It would create market place competition. Consumers and taxpayers absorb these government overpayments. 

A common belief is that the payment system must be changed from a fee for service system to a bundled payment system.

HMOs failed in the 1980’s and early 1990’s because of the pressure of patient and physician dissatisfaction with the quality of care that was provided with a bundled payment system.

Accountable Care Organizations (ACOs) run by hospital systems are the organizations that will take risk and accept a bundled fee. It is similar to the HMO’s that failed previously.

ACOs will fail because it is difficult to predict medical risk.  The increases in premiums are the result of the insurance industry’s miscalculation of risk.

Physicians are not willing to take on the risk of patients’ compliance and adherence. Physicians are not mechanics that put a new part in patients and then patients are fixed.

The popular notion is payment reform requires coordinated delivery of medical care in an Accountable Care Organization in which a single institution owns the physicians.

Everyone knows the physicians are at risk. Much of that risk depends on the patients’ responsibility to understand their illness and their behavior toward caring for that illness.  

Obamacare is biased against less centralized engagements where independent doctors enter into contractual relationships with their patients. The government has imposed less reimbursement and more paperwork for these independent practices to discourage them from remaining in private practice.

Private practitioners cannot afford to participate in reformed payment plans. Private physicians need complex IT infrastructure in order to comply with the rules and regulations needed to participate in the complex payment reform structure that shifts risk to physicians.

“It makes participation absurdly expensive for anyone but a hospital that already has its own server hub.”

The problem is hospital systems cannot control physician’s medical judgments.  Medical judgments are complex and cannot be boiled down to cookbook decision solutions.

Obamacare also provides favorable anti-kickback provisions to hospital systems only when hospital and physicians qualify as Accountable Care Organization. ACO qualification is dependent on requirements that create the same need for physical infrastructure and bureaucratic overhead that is hard to replicate outside the hospital setting.

In the end physicians shouldn’t care to be in an ACO because their freedom to practice medicine according to their medical judgment could be impaired.

However, many physicians still feel compelled to join hospital systems so they are not left out of the “new age.”

Those physicians who do not participate are joining the surge of interest in the fast growing concierge medicine phenomenon. Consumers want someone to relate to them and not to be a commodity in a failing healthcare system.

I know of only one group of physicians in a small city in Texas who have supposedly taken control of the hospital and enjoy government provided benefits for developing an ACO. 

The hospital is dependent on the organized physician group rather than the hospital taking over the physician’s group and dictating how these physicians should practice medicine.

In order for real reform to occur Congress must level the playing field between hospitals and independent private practice physicians. Only then will there be a competitive system where both hospitals and physicians will compete for patient pools.

Congress has to put consumers in the drivers seat, not hospital systems.  

The government could set up a new class of “independent risk managers” to help groups and individual physicians analyze and manage risk.

Managing risk depends on patients assuming responsibility in the participation in managing their diseases.

Hospital systems do not evaluate risk very well. Neither does the healthcare insurance industry or the government.

Government should be the facilitator of improving care, not the manager of the healthcare system.

 “Obamacare deliberately crowds out this sort of market innovation in favor of hospitals and their existing networks.”

Another simple solution to increasing costs would be to provide physician owned private groups and individual physicians with the same reimbursement provided to hospitals and hospital owned physicians.

Medicare is paying much more for many procedures when performed in a hospital outpatient clinic rather than an independently owned medical office.

 Things as common as heart scans ($749 versus $503), colonoscopies ($876 versus $402) and even a 15-minute doctor visit ($124 versus $70) all pay more when done by a hospital-based doctor than a privately owned medical office.”

This is true in all coding categories. The difference produces a sizable profit incentive to the hospital at a great cost to government.

Hospital systems are driven to buy physicians’ practices to take advantage of the difference since money-making long inpatients hospital stays are becoming a thing of the past with new advances in medical and surgical care.

The profit margin from owning brick and mortar is shrinking and the profit from owning intellectual property and surgical skills is increasing. Hospitals want to take advantage of this phenomenon.

Why is the Obama administration doing this?

Once the hospital own the physicians in the community the government can then squeeze the reimbursement to the hospital system. Hospital systems will have no option but to accept the reduced reimbursement.

It is called “got you in checkmate.”

 It has happened before. This strategy has never worked.

When will the government ever learn?

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

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Here’s One For You, Stan

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

 

 “Here's one for you Stan. 

 

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

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

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

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

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

 A Note From An Engineer

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

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

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

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

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

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

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

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

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

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

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

Now consider this:

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

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

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

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

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

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

Obamacare: It's all about political power.

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

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

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

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

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The Facts

Stanley Feld M.D.,FACP,MACE

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

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

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

 Recent headlines have been

Obamacare Will Cost 20% Less

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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It’s De Ja Vu All Over again!

 Stanley Feld M.D.,FACP,MACE

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

He knows Americans want to believe him.

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

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

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

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

President Obama saying it does not make it so.

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

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

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

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

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

 

"Why Use Facts and Logic?  

Stanley Feld M.D.,FACP,MACE

 February 27,2014

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

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

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

The middle class independents voters are feeling it the most.

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

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

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

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

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

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

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

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

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

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

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

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

Speaker Boehner did not do so bad. 

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

 

 

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

 

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

 

http://youtu.be/9uzJYlbhH54

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

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

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

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

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

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

He makes pronouncement without facts.

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

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

No evidence was presented for the statement.

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

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

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

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

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

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

This statement is nonsense

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

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

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

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

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

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

It is clear the administration is withholding this information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 We do not trust you!"  Feburary 27 2014

 

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

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

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

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

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

His fantasy is expressed in the following January 2015 headlines.

President Obama’s Fantasy

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

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

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

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

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

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

Burwell: ‘Time is running out’ for ObamaCare signups

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

 The Facts next time.

 

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

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The Needs Of Patients and Physicians

Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

 

 

 http://youtu.be/sxnlvwprf_c

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

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

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

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

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

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

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

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

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

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

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View Of A Young Doctor: Dr. Starner Jones

Stanley Feld M.D.,FACP,MACE

 A reader sent this note to me with a request to pass it on. The note hits the nail on the head.

 Dr. Starner Jones is an intern in a large community hospital.

 As a young physician he understands the folly of America’s entitlement society.

His short two-paragraph letter to President Obama accurately puts the blame for America’s dysfunctional healthcare system and its accelerated unsustainability on our  "Culture Crisis." Our country has a "Health Care Crisis" as a result of its "Cultural Crisis".

He presents the crisis, its diagnosis, prognosis and cure in just three (3) short paragraphs.

If you doubt any part of what Dr. Jones says, go visit your local hospital emergency room as an observer for an hour or so some Friday or Saturday night. Then see how many responsible people you can send his solution to for them to send it on. 

 “Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ring tone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! (A Completely Free Healthcare Program provided by our Government) During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

And you and our Congress expect me to pay for this woman's health care?

 I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture", a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based on the irresponsible credo that "I can do whatever I want to because someone else will always take care of me."

Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully, 
STARNER JONES, MD"

 If you agree…pass it on to responsible friends. 

There are additional reasons for America’s “healthcare crisis.” However, as long as we elect local, state and federal politicians who believe that all of society must be responsible for the welfare of the irresponsible members of society, America’s unsustainable economic situation will become worse.

Someone told me America is the greatest economic machine in the world “only because we print more money and suck less.”

 The more people receiving the benefits of the inefficient redistribution of wealth through entitlement programs the harder it will become to reinvigorate the American dream.

America is working its way toward a totally socialist society where the government supports us and tells us what to do and where and when to do it.

We will wake up one day and ask what happened to the freedoms guaranteed by the Constitution and Bill of Rights.

The answer is we gave them away to power hungry politicians who want to control us.

France just dropped its 75% tax rate because its society was economically unsustainable no matter how high its tax rate and the economy is collapsing.

France has had a "Culture Crisis "that is causing its social and economic collapse. The country finally realizes the people must have incentives to be creative. Progress does not happen as a result of entitlement and the redistribution of wealth.

The British National Health Service is in grave financial difficulty. 

 The NHS is in danger of being shut down.

"It’s a period of unprecedented pressure, of undue pressure. the NHS is facing very difficult times, yes. The word "crisis" implies that you can’t deal with it."

"A Department of Health spokesman said: "In common with healthcare systems around the world, the NHS is facing unprecedented demand, but undermining the principle of services being free at the point of use is not the answer."

I think rather than repeating the same mistakes over and over again, someone would learn something about fixing the “Culture Crisis”.

 As other countries are trying to fix their “Culture Crisis”, President Obama is going in the other direction and accelerating the road to economic failure.

Jack P, Athens wrote the following comment in MailOnline.com,  

“Socialism always brings a good laugh when it collapses as the politicians raise taxes to cover their mistakes.”

President Obama is destroying the healthcare system with Obamacare.

I would try to fix America’s “Culture (entitlement) Crisis” by helping people become responsible and act independently. I would not increase policies that promote individual dependency on the government.

Somehow Americans have to wake up as a people and try to stop the government from following this path.

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

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