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Stakeholder Abuse of the Healthcare System

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Different Views Of The Elephant

 Stanley Feld M.D.,FACP,MACE

There are many different ways of looking at a large elephant.  The cost of the healthcare system is similar to the large elephant in the room.

There are so many ways one could look at healthcare costs. A person can become crazy trying to solve the ever increasing cost through the prism of one’s  view.

The information available can be dizzying.  There are so many ways of looking at the problem. Much of the information is untrue or incomplete.

I have provided examples previously in which patients tried to find out fees from hospital systems for certain procedures. The fees have been totally opaque. Hospital systems should not be allowed to withhold fee information.

Price transparency is important because it has the potential to set up a system of competition.

The healthcare insurance companies could be a good source of this information because they are billed by the hospital systems. 

The big data they publish is essentially worthless because they pay only the contracted price the hospitals and physicians negotiate with each insurance company.

A few weeks ago an article in the Wall Street Journal published the billings from different hospital systems for certain diseases in the same location.

Hospital prices

Prices for the same diseases are differ all over the place in hospitals close to each other in California.

However these retail prices are meaningless. This is not price transparency.

The hospital is only going to receive the contracted price from that particular insurance company.

The variation in “retail price” only reflects a variation of service that hospital system performed in each particular disease category.

How much of that service needed to be done for the hospitals population is an important question. The comparison is not necessarily apples to apples.

What was the hopital system’s actual cost for that services?

How did they arrive at its billing?

How much is waste and bloated administration costs and how much is actual medical care?

How did that hospital system calculate the profit for that service?

If this was real price transparency we should be told how much the hospital system paid was for that actual service.

The WSJ article states “It's a simple idea, but a radical one. Let people know in advance how much health care will cost them—and whether they can find a better deal somewhere else.”

This is almost as foolish a question as the chart of the varying hospital prices for various diseases.

If consumers have sudden onset of chest pain they need medical care immediately. The consumer does not have the luxury of shopping for the best price in the area. Those consumers need to be treated at the closest hospital.

Medical bills are outrageous. They are also incomprehensible. In many cases the negotiated reimbursement varies within various healthcare insurance companies.

Hospital systems submit these high prices simply to get the most money from the various negotiated reimbursement deals they have accepted. They do not individualize the prices negotiated with each insurance company because their computer systems can’t handle it.

Physicians do the same thing. They accept the negotiated price for reimbursement by the various insurance companies even though their retail prices are higher.

Occasionally they bill an uninsured consumer. Then the hospital system and physician can collect their retail fee from an uninsured consumer. There is seldom any negotiating to benefit the consumer.

This is absurd but true.

Unlike other industries, prices for health care can vary dramatically depending on who's paying. The list prices for hospital stays and doctor visits are often just opening bids that insurers negotiate down.”

“ The deals insurers and providers strike are often proprietary, making comparisons difficult. Even doctors are generally clueless about what the tests, drugs and specialists they recommend will cost patients.”

The primary stakeholders in the healthcare system are consumers and their physicians. If consumers and physicians cannot get the prices of the services they are about to use they should demand them or use another vendor.

The declaration of proprietary prices sounds very official and mysterious.

Price transparency is common in most industries. Price transparency stimulates competition with lower cost and better quality.

Price transparency is rare in health care. The  "charges," "prices," "rates" and "payments" are all opaque. They bear little relation to actual costs.

It is essential that consumers drive the requirement of providers to publish their prices in order to get customers. The government has no interest in doing it.

If consumers were spending their own money, most consumers would demand price transparency.

If a third party is paying the bill for healthcare, consumers would have no interest in the price of care or controlling the price of care.

Last year, 38% of Americans with employer-sponsored insurance had a deductible of $1,000 or more—up from 10% in 2006, according to the Kaiser Family Foundation.”

Obamacare is expanding the services required for insurance policies. The services include unnecessary coverage for a lot of potential participants. Both health insurance premiums and private insurance require coverage of unnecessary services. President Obama is also taxing the insurance companies for every insurance policy they sell.

These additional costs are passed on to consumers without consumers’ knowledge in this price opaque world of healthcare.

Premium prices are skyrocketing; deductibles and copays are also increasing.

Obamacare mandates people to buy these healthcare insurance policies.

At the same time the silver and bronze plans created by the Obamacare (Affordable Care Act) carry average family deductibles of $6,000 and $10,386 respectively as opposed to $1,000 pre Obamacare.

More than half of bronze plans also require patients to pay 30% of doctors' fees, according to health-information site HealthPocket.com.

Obamacare and all its regulations are not so affordable to anyone making over $50,000.

Everyone earning under $50,000 receives a subsidy from the government. Over 50% of the people earn under $50,000 dollars. These consumers do not have incentive to shop for cheaper medical care.

People making over $50,000 are trapped. The middle classes’ discretionary income is being reduced by the very program President Obama  (Obamacare) promised to protect.

My ideal Medical Savings Account solves all of these problems.

President Obama doesn’t want a solution to the healthcare system. He wants control of the healthcare system. He wants the government to be in control of the entire system.

Only then can he tell consumers what medical care they can and cannot have.

When the present Obamacare system implodes people will beg the government (payer of last resort) to bail them out even at the price of freedom and independence.

The next step will be to control all of the freedoms that Americans have left.

 

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

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President Obama’s New Joke

Stanley Feld M.D.,FACP,MACE

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

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

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

Obamacare is here to stay.

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

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

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

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

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

    

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

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

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

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

The media is the message.

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

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

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

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

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

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

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

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

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

Please watch the video. It is funny and sad.

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

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Risk

Stanley Feld M.D.,FACP,MACE

The purpose of insurance is to cover risk. For many years the government has protected the healthcare insurance industry’s profit through laws and administrative regulations.

The state insurance regulators are supposed to protect consumers again abuses by the healthcare insurance companies. Many State Boards of Insurance have not administered their responsibility effectively.   

The federal government put out for bid the administration of the federal programs such as Medicare, Medicaid and the VA systems. It has not done this job very effectively. There has been much fraud and abuse in this system.

Somehow the healthcare insurance industry has talked these regulators into permitting the insurance industry to take 40% of the healthcare premiums off the top.

Obamacare mandated a Medical Loss ratio of 80/20. Eighty percent of the premium dollars are to be spent on direct patient care and 20% can be held back for expenses and profit.

However, the regulatory agencies have permitted an additional 20% of expenses to be written off as direct patient care.

The details of these expenses are so complex that few can understand the direct patient care expenses.

Recently, we have heard that if the insurance demographic mix is inappropriate, provisions are written into Obamacare that permit the healthcare insurance industry to achieve a profit.

If it does not reach its profit goal, Obamacare will bail out the healthcare industry. The traditional media has not paid much attention to this provision.

High deductible healthcare plans are very attractive to people who are at low risk for disease. If an unforeseen illness occurs they could buy an inexpensive first dollar coverage plan.

Obamacare is slowly eliminating those plans.

President Obama is trying to drive everyone into a health insurance exchange plan in the name of creating competition among insurance companies. His administration is also picking preferred insurance companies to sell these plans state by state.

President Obama is also choosing hospitals to participate in the state insurance plans’ networks. In some states the insurance company choices are thin to nonexistent. An example is New Hampshire with one healthcare insurance vendor. The same state has eliminated two thirds of hospitals and physicians eligible to participate in the health insurance exchanges.

Some of the best hospitals and clinics are not participating in the exchanges. In some cases reimbursement is too low.

Obamacare’s excuse is this will eliminate the facilities that overcharge and eliminate the risk of cost overruns.

All this keeps the healthcare insurance industry in charge of the risk. In order to reduce costs patients have to be motivated to avoid illness and be responsible for their own health and healthcare dollars.

This concept is not embodied in Obamacare. The government and the healthcare insurance industry will make the healthcare decisions for consumers. 

Another big idea included in Obamacare is the concept of shifting risk from the government and the healthcare insurance industry to physicians and consumers.

Accountable Care Organizations (ACOs) are supposed to be set up to integrate care. If an organization does better than average or better than the year before it gets to share the cost savings with the government. If it does worse it receives less money.

If it improves one year there is little room for improvement the next year. Its share will be less. It is self-defeating motivation.

A major problem is physicians can only control certain risks. Many risks depend on patients’ ability or willingness to adhere to the care recommended. Eighty percent of the healthcare dollars for any chronic disease is spent on treating the complications of the chronic diseases.

There are no provisions for risk weighting payments to physicians for disease complications resulting from patients’ lack of adherence to treatment. The more complications of a chronic disease patients have the greater the risk of higher costs that cannot be controlled.

Severe complications and decreased adherence increases the risk of higher medical costs.

ACO’s bundle payments for disease entities. One size does not fix all.

ICM-10 increases the number of diagnostic and treatment codes from 18,00 to 68,000 codes. This increases the complexity of coding. It is an opening for fraudulent coding. It also can result in the possibility of over or under coding as well as miscoding.  It will take years to learn and years to get right.

If physicians miscode those physicians will not get paid by the government or the insurance industry.

This brings us to the next barrier to the success of Obamacare. There is a constant threat of penalty to consumers and physicians. There should be a constant incentive to receive a monetary reward.

Consumers have higher deductible and higher premiums with Obamacare. Many middle class people cannot afford the higher premiums and higher deductibles. The government subsidizes the healthcare insurance for the poor.

The funding for these subsidies is unclear. It will probably result in yet another tax increase for the middle class. The poor are exempt from income tax payments.

Is this redistribution of wealth?

There are no incentives for anyone to stay healthy and avoid unnecessary and expensive physician visits and diagnostic testing.

There is no tort reform in Obamacare. The lack of tort reform increases the need for excess testing in order to avoid lawsuits for physicians not doing a complete workup.

Physicians and hospital systems have never figured out how to calculate Health Maintenance Organizations’ reimbursement. Physicians and hospitals lost a great deal of money trying to price HMOs bundled payments.

Physicians and hospital systems know less about pricing bundled payments for ACOs. They have no control over consumer usage even though they are being asked to cover the risk. They are hesitant to assume risk.

This is part of the reason ACO participation has been so poor as I pointed out in my last blog.

 It is Insurance coverage (public or private) that should cover and assume the risk. This is the definition of insurance. It is not in the physicians power to control risk nor should it be his responsibility.

It is the responsibility of the State Insurance Boards to price that risk for the healthcare insurance industry wisely. These boards should provide a wide range of products to fit consumers needs. The consumer should have the freedom to choose.

Federal and State officials should not accept the insurance industry’s word.

It is unacceptable.    

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

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Disinformation Campaign In Full Force.

Stanley Feld M.D.,FACP,MACE

The consequence of Obamacare is hitting home to many people as taxes and the cost of insurance premiums increase.

Obamacare is not an abstract concept anymore.

People cannot keep their doctors as promised by President Obama. People cannot keep their insurance as promised by the president either.

Healthcare insurance premiums have increase for the middle class, who are being forced to use Obamacare’s Health Insurance Exchange. These health insurance exchanges have been inefficient. Many of the State Health Insurance Exchanges are failing.

Healthcare insurance premiums have increased by $2,500 a year and not decreased by $2,500 a year as promised by President Obama during the disinformation campaign to pass Obamacare.

If you make less than $50,000 a year it might be a good deal. The government through tax increases is paying the difference to the insurance companies.

Consumers are angry. In order to counteract and neutralize this anger away from President Obama and the Democrats running for congress and the Senate (especially the Senate) in November 2014 President Obama has put into operation the Saul Alinsky disinformation tactics.

The traditional mainstream media is falling for this tactic once again.

The intent of the tactic is to keep your enemy off balance. Whether by mockery, subterfuge, or any available strategy, the purpose behind the tactic is to keep the pressure on you opponent, constantly jabbing and goading them until they lose their clarity of thought, and react in a way that you can exploit to defeat them. “ Rules for Radicals”  

Saul Alinsky has been very direct in his instructions. He also puts the burden of creative execution of these rules on the executor of the rules. The goal is to change the public’s believing the facts by discrediting the person or persons exposing the true facts.

“The job then is getting the people to move, to act, to participate; in short to develop and harness the necessary power to effectively conflict with the prevailing patterns (the truth) and change them.”

When those prominent in the status quo turn and label you an “agitator” they are completely correct, for that is, in one word, your function- to agitate to the point of conflict.

The key to success is to be an outside agitator.

This has been one of President Obama’s major problems. He is the inside agitator.  He is being discovered even though he has done everything is his power to look as if he does not have his fingerprints on any of the agitation.

The first step of the agitator is to disrupt the present system in order to replace it with a new system.  The public must be made uncomfortable enough to demand change in the old system.

Isn’t this what President Obama has done in the financial system, the environmental system, and the healthcare system?

It is backfiring on him because of the uncertainty is has created.  In turn it has affected economic growth and caused great pain for middle class consumers.

However, he is smart. He has exempted almost everyone from the mandate temporarily. The exemptions are going to create other problems.

By exempting everyone from the Obamacare mandate, he is not only ignoring the constitution, he is disrupting his new system (Obamacare) that the major stakeholders are trying to execute. The result has been havoc. However, the Obama administration believes it have shifted the blame for the havoc onto the healthcare insurance industry.

He methodology is very transparent. It has become unsuccessful.

The next step is a disinformation campaign.

The eba.benefitnews.com published an article entitled Americans Stick With Obamacare As Opposition Burns Bright. This headline is totally false. Americans are not sticking with Obamacare. Nevertheless administration press releases fed to the traditional media are published without appropriate fact checking.

President Barack Obama’s health-care law is becoming more entrenched, with 64% of Americans now supporting it outright or backing small changes. This is a lie.

A major talking point of the Democrats now is that “Obamacare is great but it just needs to be fixed.” If you tell a lie enough times it becomes the truth.

Tell voters they can fix ObamaCare, but Republicans won't let them.”

This is the Democrats' midterm election strategy, as revealed in a memo Politico got its hands on this week. The Democrats are going to admit that Obamacare has flaws. They will promise to repair the flaws. They will argue that Republicans will only make things worse.

However, it has not worked in the Florida special election where Ms. Alex Zisk (Dem) lost to David Jolly (Rep), an unknown, after outspending him by 500%.  The people in the district did not buy the disinformation lie that Obamacare is great and Ms. Zisk will fix the errors.

 A week ago, HHS Secretary Kathleen Sebelius, President Obama's top health official, declared there was no evidence Obamacare was costing any jobs.

HHS Secretary Kathleen Sebelius said.  “There is absolutely no evidence, and every economist will tell you this, that there is any job loss related to the Affordable Care Act,"

This is another lie in order to confuse the facts.

 The Congressional Budget Office a couple weeks ago concluded that Obamacare would shrink the workforce by 2.5 million jobs because of its work disincentives.

President Obama admitted to the law's adverse effects on businesses when he twice put off the employer mandate.   

 Senator Harry Reid addressed the American people from the Senate floor and solemnly claimed that “there’s plenty of horror stories being told,” about ObamaCare. “All of them are untrue, but they’re being told all over America.”

The tactic is to tell lies to obfuscate the true.

 That dog will not hunt anymore. The American people got it!

 "In addition, 54% of Americans say they’re unhappy with the president’s handling of the issue, according to a Bloomberg National Poll."

That’s an improvement since the last poll, in December, when Obama’s public standing on health care hit a low of 60% disapproval after the botched rollout of the insurance exchanges, according to the March 7-10 poll of 1,001 adults.

The Obama administration’s spin of the story is a complete lie. This week the number shot up to close to 60%.

Things definitely seem to be getting better,” said Paul Attard, 50, a political independent in Evergreen, Colorado and a program manager for a cell-phone company who wants the law modified rather than repealed.

“It seems like they are getting a lot more people to join. It’s a sign that the system is working.”

This is another lie. I think in real numbers Obamacare will be lucky if 3.5 million have signed up and have paid their premiums by March 31.

All that has to be done to confuse the truth with misleading statistics in the press.

 The discussion moves from statistics that might not be correct from the true. The real question i:.

Can Obamacare work? I have presented data along with many others that show that Obamacare cannot possibly work.

 All the agitators have to throw at the public is confusing statistics and lies.

One such incorrect fact is that 4.2 million have enrolled. The public does not know if the 4.2 million include Medicaid or are just private insurance plans.

What about the 48 million people who were uninsured before the 2013 rollout? What about the additional 6.6 million consumers who lost their healthcare insurance? None of this is part of the discussion.

The public does not know how many have not paid their premiums. The administration says it does not know. Those people are technically uninsured.  

Private institutions have claimed that 20-30% who have applied have not paid premiums. Only 25% of those who purchased insurance are under 30 and healthy. The administration needs at least 37% of the insured to be healthy for Obamacare to be financially viable.

The health insurance exchanges enrolled less people last month than it did in January. The number for success has changed from 7 million for Obamacare to be viable to an unspecified millions. The Obama administration refuses to publish the health demographics for consumers who have purchased insurance through the exchanges.  

My guess is less than 3 million previously uninsured people became insured under Obamacare compared to the 48 million uninsured that were supposed to become insured. It is a pretty awful number.

 President Obama is throwing a bunch of statics at us to confuse us. Here are some examples

1.Fifty-one percent of Americans favor retaining the Affordable Care Act with “small modifications,” while 13% would leave the law intact and 34% would repeal it in the Bloomberg poll.

Vs.

2. Seventy-three percent of Bloomberg poll respondents who would repeal Obamacare say the law will be a “major” decider of their vote, compared with 45% of those who support modifications and 33 percent of those who back the law as is.

Isn’t this confusing? The confusion is generated on purpose. It should not be tolerated anymore.

November elections are just around the corner!

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

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Spinning The Truth

Stanley Feld M.D.,FACP,MACE

President Obama and the Democrats are trying to spin the truth to win the congressional election in November 2014. The Democrats can lose the majority in the Senate in November because of Obamacare. Democrats in the Senate passed the bill. They own it.

Democrats hope to minimize the importance of Obamacare as a political issue by focusing on other topics in this November's midterm elections.

After weeks of trying everything they could to get Obamacare off the front page of even the traditional mainstream media, it took the Russian invasion of the Ukraine to accomplish the feat.

Democrats recognize that Obamacare is flawed. Democrats are promising to fix the flawed national health care plan they passed in 2010.

President Obama and the Democrats are trying to blame Obamacare’s problems  on the Republicans. They are appealing to voters who have been helped by the law to speak out.

Almost every day there is a prominent article in the traditional mainstream media reporting about people who have been helped by Obamacare.

President Obama has asked the Republicans to help fix Obamacare rather than criticize it. President Obama keeps saying “It is the law.” “Live with it and help us fix it.”

Mr. President, IT CANNOT BE FIXED.

In the meantime President Obama has changed the law 25 times by executive order because things have not worked out as he planned. There are questions about whether his executive orders are constitutional.

 I do not think the public will buy his trick plays this time around.  The Alinsky rule in “Rules For Radicals” of attacking your enemy with lies or half-truths is not going to work the way it worked in the Presidential elections of 2008 and 2012.

The consequences of Obamacare are not abstract anymore. They are personal.

Obamacare will be an issue in November 2014. The issue cannot be controlled by the Obama attempts at diversion. Obamacare as an issue in the November 2014 elections can only be controlled by Obamacare’s performance as law in the next 10 months.

Obamacare was destined to failure at the onset. Obamacare’s failures and burdens to this point have directly affected people who had not paid attention to the law’s details at passage.

President Obama has lost the trust of the people. The Democratic Party is not protecting the interest of the American people. The Democratic Party has also lost total credibility.

With each passing day the failures of Obamacare and its burdens to all Americans increase. It is time to examine the increased taxes that have occurred since the passage of Obamacare.

President Obama has just delayed implementation of Obamacare to 2016 to try to avoid discussion of its failures before the 2014 elections.

Obamacare’s changes have added to economic uncertainty in the country. Most insurers are trying to keep the higher costs hidden even though their premiums are increasing. President Obama promised to bail them out if they lose money.

 Blue Cross Blue Shield of Alabama, has decided to itemize the impact of Obamacare. It has added a separate line item to its premium call the "Affordable Care Act Fees and Taxes." 

“The new taxes on one customer’s bill added up to $23.14 a month, or $277.68 annually, according to Kaiser Health News. It boosted the monthly premium from $322.26 to $345.40 for that individual.”

The extra $23.14 per month per individual has increased premium cost by $1,100.72 a year for a family of four.

There are additional new taxes and fees levied on every health plan. There is also an additional $2 fee per policy that goes toward a new medical-research trust fund.

Americans will pay hidden taxes, such as the 2.3 percent medical-device tax that will inflate the cost of items such as pacemakers, stents and prosthetic limbs.

 There is another sneaky tax to those with high out-of-pocket medical expenses. They will get smaller income-tax deductions.

 The currently allowed deduction is for medical expenses that exceed 7.5 percent of their annual income. The threshold jumps to 10 percent under Obamacare.

This hidden tax affects both the rich and the middle class.  

President Obama’s statement “no new taxes on anyone making less than $250,000 a year” was a lie.

Historically, raising taxes has been shown to decrease economic growth.

Democrats belittle Republicans and conservatives by saying all they know how to do is decrease taxes.

The American public is angry about President Obama’s deceptions about Obamacare. He cannot blame the impending failure on the Republicans and get away with it.

Explaining Obamacare In One (1) Sentence

 

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 http://youtu.be/mZbFrAAV3-o

Democrats have the tax and spend reputation. Big government and increasing bureaucracy has come to mean inefficient execution.

More government cannot fix Obamacare. Americans have learned their lesson.

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

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“What’s So Great About America?”

Stanley Feld M.D.,FACP,MACE

Last week a reader sent me the link for the full debate between Dinesh D’Souza and Bill Ayers at Dartmouth College on January 30 2014.

Dinesh D’Souza wrote, directed and produced 2016:Obama’s America in 2012’

 It is based on D'Souza's book The Roots of Obama's Rage (2010). Through interviews and reenactments, the film compares the similarities of the lives of D'Souza and President Barack Obama as D'Souza presents his theory of how early influences on Obama are affecting the decisions he makes as president. http://en.wikipedia.org/wiki/Dinesh_D%27Souza

 

The film has grossed over $33.45 million in the United States, making it the fourth highest-grossing documentary (domestically) since 1982.

Those who didn’t see documentary can see it here for free.

https://archive.org/details/ObamaBiography

Recently Dinesh D’Souza has been the subject of a recent IRS probe.

I had read about the debate but never had the time to listen to Bill Ayers.   Bill Ayers is an American elementary education theorist and a former leader in the counterculture movement that opposed U.S. involvement in the Vietnam War.

He is known for his 1960s radical activism as well as his current work in education reform, curriculum, and instruction. In 1969 he co-founded the Weather Underground, a self-described communist revolutionary group that conducted a campaign of bombing public buildings (including police stations, the U.S. Capitol Building, and the Pentagon) during the 1960s and 1970s in response to U.S. involvement in the Vietnam War.

He is a retired professor in the College of Education at the University of Illinois at Chicago. President Obama worked with and for in the 1980s and 1990s as a community organizer. 

 A reader sent me a link to the debate last week and I watched it. It is a worthwhile use of your time.

http://www.realclearpolitics.com/video/2014/01/30/full_debate_dinesh_dsouza_vs_bill_ayers_at_dartmouth_college.html

Obamacare cannot work improve the healthcare system. After listening to Bill Ayers and rereading Saul Alinsky’s thoughts on how to create a socialist state President Obama’s only goal is to control healthcare. If you control healthcare you control the people.   

 According to Saul Alinsky there are 8 levels of control that must be obtained before you are able to create a socialist state.

"The first is the most important.

1) Healthcare — Control healthcare and you control the people

2) Poverty — Increase the Poverty level as high as possible, poor people are easier to control and will not fight back if you are providing everything for them to live.

3) Debt — Increase the debt to an unsustainable level. That way you are able to increase taxes, and this will produce more poverty.

4) Gun Control — Remove the ability to defend themselves from the Government. That way you are able to create a police state.

5) Welfare — Take control of every aspect of their lives (Food, Housing, and Income).

6) Education — Take control of what people read and listen to — take control of what children learn in school.

7) Religion — Remove the belief in the God from the Government and schools.

8) Class Warfare — Divide the people into the wealthy and the poor. This will cause more discontent and it will be easier to take (Tax) the wealthy with the support of the poor.'

 

Read more at http://www.snopes.com/politics/quotes/alinsky.asp#RGukF0aROOEmmdSO.99

 President Obama is using these tactics to control our country and drive it into being a socialist state.

President Obama combines these tactics with Alinsky’s rules for radicals.

Alinsky’s third rule is: “Wherever possible go outside the experience of the enemy.” Here you want to cause confusion, fear, and retreat. He did this to Mitt Romney during his re-elections. Mitt Romney’s people did not know how to handle it. 

The fourth rule is: “Make the enemy live up to their own book of rules. “ You are free to act as you wish.

You can kill your opponent with this, for they can no more obey their own rules than the Christian church can live up to Christianity.

The fifth rule: “Ridicule is man's most potent weapon.” It is almost impossible to counterattack ridicule. Also it infuriates the opposition, who then react to your advantage.

How many times have we seen the President and Vice-President try to ridicule their opponents? They use this rule often in domestic policy but are afraid to use it in foreign policy.

The eighth rule: “Keep the pressure on, “with different tactics and actions, and utilize all events of the period for your purpose.

Pick the target, freeze it, personalize it, and polarize it.”  Doesn’t this sound familiar?

The ninth rule: The threat is usually more terrifying than the thing itself.

 The eleventh rule : If you push a negative hard and deep enough it will break through into its counterside; this is based on the principle that every positive has its negative.

The twelfth rule: The price of a successful attack is a constructive alternative. You cannot risk being trapped by the enemy in his sudden agreement with your demand and saying "You're right — we don't know what to do about this issue. Now you tell us."

 If one studies the lies President Obama has told the public he has gotten trapped by his own pressure on his opponents and could not escape or change the subject.

I will have the most transparent administration in history.  It is not transparent at all.

TARP is to fund shovel-ready jobs. He finally had to admit the jobs were not shovel ready.

I am focused like a laser on creating jobs. Each month job growth was less which is the goal of a socialist society.

The IRS is not targeting anyone. Each cover up statement makes the lie worse.

If you like your healthcare plan, you can keep your healthcare plan, period. This was never the intent.

Benghazi was a spontaneous riot about a movie. Something very bad went wrong here.

If I had a son… T Martin. Stirring racism. It was a mistake.

I will put an end to the type of politics that "breeds division, conflict and cynicism". This was never the intention.

You didn't build that! This was an attempt to make Americans uncertain about their achievement and way of life. It failed and President Obama’s credibility shrank even further.

I will restore trust in Government. All the obvious deception during President Obama’s times President Obama contradicts this statement.

However a good offense is many times the best defense. He tried but failed. Attacking FOX News is was not a good strategy as his credibility waned.

The public will have 5 days to look at every bill that lands on my desk. He never kept his word.

It's not my red line — it is the world's red line. You cannot step away from your commitments when people are depending on you.

Whistle blowers will be protected in my administration. This is another lie and empty promise.

We got back every dime we used to rescue the banks and auto companies, with interest. This is an outright lie. He could not control the auditors. 

I am not spying on American citizens. This is a beauty!

ObamaCare will be good for America. It has been very bad for America. It is going to get worse because Americans do not trust President Obama anymore.

Premiums will be lowered by $2500. Premiums have increased and taxes have been increasing. It has cost Americans much more that the $2,500 they were suppose to save.

People making less than $250,000 a year will not pay one dime more in taxes. This is totally untrue as the middle class is learning..

If you like it, you can keep your current healthcare plan Lie of the year.

It's just like shopping at Amazon. President Obama should have tried himself. I did it and it was tedious. If Amazon was like it I would never use it.

I knew nothing about "Fast and Furious" gunrunning to Mexican drug cartels. You should have known everything. You are President. If you didn’t know about Fast and Furious you were not doing your job.

I knew nothing about IRS targeting conservative groups. You should know everything about IRS targeting. Who would make that decision.

I knew nothing about what happened in Benghazi. You should know everything about Benghazi. It was reported to you instantaneously acoording to you own defense department. None of this is very transparent.

 "I, Barrack Hussein Obama, pledge to preserve, protect and defend the Constitution of the United States of America."

In the light of Bill Ayers philosophy and in light of President Obama’s attacks on the constitution and the Bill of Rights, one could question if President Obama meant his pledge to preserve, protect and defend the Constitution of the United States of America.

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

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As President I Can Do Anything I Want To Do

Stanley Feld M.D.,FACP,MACE

The passage of time has a tendency to help us forget promises made with regard to principles and policies.

It is clear to me that one reason President Obama beat John McCain in 2008 was because he was going to go back to the principles of the constitution.

He taught constitutional law and professed to know how important the constitutional principles are to the laws of the land as well as our economic and political freedom.

John McCain represented the past. In the past America experienced a creep toward bigger and bigger government in order to protect our homeland security.

The result was an impingement on our religious, economic and political freedom.

President Obama does not think about the constitution in the way he did when he was trying to win the hearts and minds of the American people in 2008.

  

http://youtu.be/UBZIM0ZFiYU

If fact, after the 2012 election victory he has shown a total disregard for the United States constitution. He has a total disregard for the balance of power.

  

 

http://youtu.be/yiOmwayoSrw

 He has ignored congressional authority. He has issued executive orders changing laws at will. If congress challenges him he accuses them of being obstructionist.

President Obama has made at least 10 significant changes to Obamacare by executive order up to now. Congressmen and Supreme Court scholars have deemed that these executive orders are unconstitutional.

The Obama administration is now dowplaying his executive orders  significance.

We tend to forget abuse of power episodes. I think it is worthwhile to publish all available examples at once to get a complete feel for the abuse of power.  

These large numbers of executive changes were adopted to avoid Obamacare’s failure. Obamacare’s failures have persisted in spite of the unconstitutional changes.

 Obamacare is basically a defective bill. It should be repealed. Small patches will not repair it.

 Many of the executive orders slipped by the traditional media without discussion.

The following are President Obama’s changes by administrative action.

1. Congressional opt-out: The administration decided to offer employer contributions to members of Congress and their staffs when they purchase insurance on the exchanges created by the ACA, a subsidy the law doesn’t provide. (September 30, 2013).

This is a subsidy congress did not have the guts to fight about. It is self-serving. Why should the congress get a special privilege that ordinary people doesn’t have?

2. Delaying the individual mandate: The administration changed the deadline for the individual mandate, by declaring that customers who have purchased insurance by March 31 will avoid the tax penalty. Previously, they would have had to purchase a plan by mid February. (October 23, 2013).

In addition to this order, if a consumer signed up before December 31 they would have insurance January 1St. If they signed up by January 15th they would have insurance by February 1st. If they signed up by February 15th they would have coverage by March 1st. This occurred by executive order in order to encourage enrollment. The government is unable to process these applications. Patients had not paid premiums.

3. Employer-mandate delay: By an administrative action that’s contrary to statutory language in the ACA, the reporting requirements for employers were delayed by one year. (July 2, 2013)

This executive order was issued in July just before Independence Day. This has been typical of the Obama administration. They have released executive order when the public is emotionally preparing for a weekend or a holiday. Friday afternoon at 4.30 is a favorite time.

4. Self-attestation: Because of the difficulty of verifying income after the employer-reporting requirement was delayed, the administration decided it would allow “self-attestation” of income by applicants for health insurance in the exchanges. This was later partially retracted after congressional and public outcry over the likelihood of fraud. (July 15, 2013)

It looks like the administration knew that they did not have the computer systems’ back end connected to check income tax returns with the IRS two and one half months before on October 1st.  Congress was not consulted for advice.

5. Small businesses on hold: The administration has said that the federal exchanges for small businesses will not be ready by the 2014 statutory deadline, and has instead delayed the implementation of the SHOP (Small-Employer Health Option Program) exchanges until 2015. (March 11, 2013)

I did not realize that this executive order appeared so early in 2013.

6. Closing the high-risk pool: The administration decided to halt enrollment in transitional federal high-risk pools created by the law, blocking coverage for an estimated 40,000 new applicants, citing a lack of funds. The administration had money from a fund under Secretary Sebelius’s control to extend the pools, but instead used the money to pay for advertising for Obamacare enrollment. (February 15, 2013)

This is a mind blower. The Obama Administration decided to discontinue funding the high-risk pool in order to have the money to pay for advertising for Obamacare enrollment.

This order was issued on February 15,2013. It was seven and one-half months before Obamacare enrollment was to begin.

7. Medicare Advantage patch: The administration ordered an advance draw on funds from a Medicare bonus program in order to provide extra payments to Medicare Advantage plans, in an effort to temporarily forestall cuts in benefits and therefore delay exodus of MA plans from the program. (April 19, 2011)

Medicare Advantage was a big mistake for reasons beyond the scope of this report. Political pressure forced President Obama to take money out of one pile and apply it to the Medicare Advantage pile without consulting congress.

8. Employee reporting: The administration, contrary to the Obamacare legislation, instituted a one-year delay of the requirement that employers must report to their employees on their W-2 forms the full cost of their employer-provided health insurance. (January 1, 2012)

The one-year delay adds to the uncertainty of what is going to happen the following year. It makes hiring decisions harder for employers in the long run even though it helps in the short run. The net effect is it will be bad for the economy.

9. Doubling allowed deductibles: Because some group health plans use more than one benefits administrator, plans are allowed to apply separate patient cost-sharing limits to different services, such as doctor/hospital and prescription drugs, allowingmaximum out-of-pocket costs to be twice as high as the law intended. (February 20, 2013)

This executive order was issued in February 2013 to the advantage of the healthcare insurance industry.

10. Delaying a low-income plan: The administration delayed implementation of the Basic Health Program until 2015. It would have provided more-affordable health coverage for certain low-income individuals not eligible for Medicaid. (March 22, 2013)

The administration knew what to expect from the rollout as early as February of 2013. The executive orders changed the law in an effort to cover-up the tremendous cost overruns that will occur.

The public does not have any idea what those cost overruns will be.

It is important to see how many of these unconstitutional executive orders were released and how far back in relationship to enrollment they were ordered.

   

http://youtu.be/9FgFUOGFpnk

President Obama’s mind-set is expressed in the above You Tube video.

 As President he “can do anything he wants to do.”

 Wake up America!

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

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President Obama: Please Stop Deceiving Us!

Stanley Feld M.D.,FACP,MACE

President Obama, please stop deceiving Americans. Please tell us the truth. Please be transparent as you promised us you would be.

President Obama promised to transform America. Americans did not know what that meant. They thought is was for the good. 

The healthcare system was dysfunctional before President Obama became president. In order to fix a dysfunctional system, one must try to get to the root of the problem.

President Obama has not done that. He has pasted another layer of bureaucracy on top of an already dysfunctional system. This has created further dysfunction.

He has further compounded the dysfunction in the healthcare system by changing the law unilaterally by executive order without the consent of congress.

There is question on whether his actions are unconstitutional. If they are unconstitutional it is grounds for impeachment.

At best these unilateral changes have destabilized the healthcare system further. The changes have also increase uncertainty in the investment community. The result of the uncertainty is to slow the jobs market and the economy.

President Obama is a charming fellow. The problem is the veneer has rubbed off. At the beginning he pandered to all the stakeholders vested interests.

He told them glorious things about what they could expect. People have recently found out that they have been deceived.

President Obama is not about innovation and opportunity as many hoped for in 2008.

President Obama is about increased central government control over our freedoms and our choices.

All of his actions and deceptions are starting to backfire on him. The majority of the American public is becoming aware of his tricks and abuse of power.

The tricks, deceptions, abuse of power and outright lies are starting to directly affect the majority of Americans in a negative way.

In healthcare we have been deceived by many actions. At present it is the reporting the enrollment figures in the health insurance exchanges.

President Obama, his administration, and even Dick Durbin have inflated the numbers without giving Americans the facts.

Last week even the Washington Post could not take it anymore. 

“The Washington Post, has given "three Pinocchios" to the White House for its claim that 6 million people have enrolled in Obamacare, and warned the media to ignore the distorted government figures.”

After President Obama announced these figures during his Super Bowl interview, he tweeted them on his official Twitter account.

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https://twitter.com/BarackObama/status/421668496120897536/photo/1

The figure comes from a combination of 2.1 million people who have enrolled under federal and state healthcare insurance exchanges, plus 3.9 million who have qualified for coverage on Medicaid through November.

The key words in President Obama’s statement are qualified for coverage on Medicaid through November. These words tells you almost nothing about how the Affordable Care Act is affecting Medicaid enrollment."  

The mainstream media keeps on using the same incorrect numbers over and over again thinking they are fooling the American people.

"No one really knows, though some have tried to tease out figures from the data that has been presented."



 

California was supposed to have the strongest state insurance exchange.  Covered California signed up the most people for Obamacare since October 1,2013. It was the model exchange. After January 1st, 2014 the problems became apparent.

As of Dec. 31, 2013, nearly 500,000 California residents had enrolled in health coverage through Covered California, the state's health insurance exchange created under the Affordable Care Act, according to data released Monday by HHS, KQED's "The California Report" reports.

Overall, California residents accounted for 22% of the total 2.2 million exchange enrollees nationwide (Aliferis, "The California Report," KQED, 1/13).

I would call this bragging without presenting the facts or the potential problems.

These are the potential problems.

According to the data, 85% of the 498,794 Californians who have enrolled in coverage through Covered California received a federal subsidy, compared with 79% nationally (Seipel, Contra Costa Times, 1/14).

The state and the federal government will have to come up with the subsidies. The result will be higher premiums for those that pay full premium price and increased taxes for those who pay taxes.

The data also show that:

  • 61% of enrollees chose a silver-level plan; and
  • 23% chose a bronze-level plan ("The California Report," KQED, 1/13).

          52% of enrollees were between ages 45 and 64 ("The California Report," KQED, 1/13); and

  • 25% were between ages 18 and 34 (Contra Costa Times, 1/14).

 The number of enrollees is different than the number of people who definitely are insured. Enrollees are not insured until they paid their premiums.

Even so, the enrollee mix, if it stays the same will necessitate an increase in insurance premiums and a bailout of the insurance companies. The insurance company bailout was built into Obamacare upon passage of the act.

The public did not know about insurance company bailouts until recently. 

In California consumers have not receive the coverage they thought they bought. Consumers are not able to see physicians who were caring for them before the new year. Many cancer patients who require continuing care have not seen been able to see their physicians.

Seventy percent of the physicians in California have not signed up to accept Covered California because reimbursement is too low.  

 The White House was dealt a stunning new blow on Obamacare sign-up numbers:

Reports have leaked showing that only about half of the people "enrolled" at healthcare exchanges in various states have actually paid their premiums.”

“Minnesota's exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.”

 “But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November's pace of less than 700 per week.”

  “As of Feb. 1, Nevada had just 14,999 paid enrollees — vs. the state's March 31 goal of 115,000.”

 “Washington state, meanwhile, was slightly more than halfway to its goal of 340,000 signups — but only 88,071 had paid as of Feb. 1.”

 “The January data available from a handful of states raise new doubts about whether ObamaCare's downgraded first-year prospects are still too optimistic.”

These numbers have been kept out of the mainstream media.

 The poor premium payments by enrollees of 50% in Washington and 66% in Nevada creates a risk that the demographics of the paid exchange population may be older and possibly sicker than the information the Obama administration has publicized to get more people to enroll.

This is only a partial list of President Obama’s present deceptions.

 A complete list of the 35 changes made to the law by executive order without consent of congress is in order about now.

Why are so few in Congress speaking out?

When are the people going to speak out?

Congresspeople who do not speak up should not be reelected!

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

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TRANSPARENCY? There Is None

Stanley Feld M.D., FACP, MACE

President Obama promised Americans transparency in government. He has not fulfilled his promise.

Transparency in the Healthcare System must be considered on multiple levels. It consists of transparency as it related to both primary and secondary stakeholders.

The primary stakeholders in the healthcare system are patients (consumers) and physicians.

The secondary stakeholders are the government, insurance industry, hospitals and drug companies.

Each stakeholder has it own issues with transparency. There is a lack of transparency with each other. Most of all there is a total opacity of all the stakeholders toward consumers of healthcare.

A reader sent me these Medicare Part B documents. He asked if I would explain these document to him. He went to the hospital to do a pre-op evaluation for knee surgery. The evaluation included blood testing as well as an EKG and chest x-ray.

 This document is an EOB (explanation of benefits) for the outpatient evaluation services at a hospital.

It is now called Outpatient Claims for Medicare Part B.  If these procedures were done as an inpatient the fees would be higher.

The hospital outpatient fees are outrageous. A freestanding physician’s lab fees would be much lower.

The EOB has changed a little over the years. At one point a patient could not tell what the payment was for and how much Medicare would allow and pay for each procedure.

This year it is clearer. However, Medicare has done something with allowable fee that is incomprehensible. Medicare has created a conflict within its own form.

Lyle page 1 copy
 

Lyle 2Claim example 1b (1) copy 3

 

 

A simple example is the service of drawing blood.  Code 36415. The facility charged $30.80. The Medicare approved amount was $30.80. However, the amount paid by Medicare was $2.94. The maximum the patient could be billed was $0.00.  

Here is the contradiction. In the definition of columns section the Medicare –Approved Amount is defined as follows.

“Medicare-Approved Amount: This is the amount a facility can be paid for a Medicare service. It may be less than the actual amount the facility charged. The facility has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.”

In the case of the needle stick to collect blood note A for above claim says;

A. This service is paid at 100% of Medicare approved amount. 

The contradiction is the Medicare approved amount was $30.80.

Why did the government change the approved amount from $30.80 to the $2.94 that it approved? Why did they ignore the $30.80?

Why would the hospital accept $2.94 when they had a Medicare approved amount of $30.80?

Something fishy is going on.

If patients are not covered by healthcare insurance, the patient would be liable for $30.80. The facility can always claim this is a legitimate charge because Medicare approved it.

Who will get stuck paying full price?

People who are poor and cannot afford insurance. Persons who do not qualifying for a government subsidy will get stuck.  Young people who refuse to buy insurance from the health insurance exchange.

This could be another one of President Obama’s tricks to drive everyone into the health insurance exchanges. The result could lead to total destruction of the private insurance industry. Then the only option will be  a single party payer system.

I have said previously that President Obama’s goal is to destroy Obamacare. It would prove to everyone that a free market system does not work.

What President Obama doesn’t realize is that Americans recognized that Obamacare has not set up a free market system. It has set up a system of regulations that place horrible restraints on a free market system.

 The American people do not trust President Obama anymore.

As we look at the other claims in this document there is more that is deceiving. The hospital facility charged $726 for a chemistry profile (code 80053). Medicare approved $726 but paid $14.24 for the chemistry profile.

 In 1980 Medicare approve $24.00 and paid 80% of $24. The price Medicare pays for a chemistry profile has dropped since 1980.

The hospital charged $752.50 for a simple blood typing and cross matching (code 86850,86900,86901). Medicare approved the fee but only paid $28.20, which is 80% of what Medicare approved amount is. The patient or his Medicare supplement would be responsible for $7.79

The Medicare approved amount for an automated CBC (Code 85027) was $452.80 but Medicare paid $8.71.

An EKG is an important part of the pre op testing. The facility charged $593.95 and Medicare approved that amount. However Medicare only paid $20.49. The patient or their supplement is responsible for $5.24. Since the beginning of Medicare in 1965 the Medicare approve amount for an EKG has never been greater that $80.00.

There is definitely something fishy with the determination of the Medicare approved amount calculation and Medicare Part B payment.

I hope I have succeeded in explaining how to understand this Outpatient Claims for Medicare Part B.

I also hope I have succeed in explaining the crazy Medicare approved amount pricing.

I believe that the only conclusion to be reached is that there is deception in the document.

There is absolutely no transparency for the patient. The hospital will not give the patient the price before he gets the work done.  The consumer cannot make a wise healthcare choice for the use of his healthcare dollars.

The government is not interested in giving patients control of their healthcare dollars.  Consumers are the victims.

Neither the government nor the insurance company gives the consumer any help.

Physician owned laboratories charge patients much less than the hospital facilities.

At the same time the government is putting more and more restrictions on physician owned laboratories in order to eliminate physician owned laboratories even though the cost is less.

 The government’s excuse for restricting physician laboratories is that physicians will have incentive to do additional testing.  

The bottom line is the government does not want to control costs or to put the patient in control of their healthcare and their healthcare dollars.

 Remember the statement, “I am the government and I am here to help.”

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

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