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Stakeholder Mistrust

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Is There A Solution?

Stanley Feld M.D.,FACP
MACE

 

A study of the organization chart presented in my last blog shows
that Obamacare will be an unworkable mess. 


The health insurance exchanges look like they
are going to make healthcare more expensive because of 20,000 new
regulations.  Employers are looking for
ways to avoid Obamacare and get out of the healthcare coverage business.

Employers
are realizing they can avoid certain penalties under Obamacare by offering very
limited plans that lack key benefits which satisfy the true definition of
healthcare insurance. 

Benefits
advisers and insurance brokers are increasing their commissions by offering low
benefit plans that cover minimum benefits such as preventive services. The
healthcare plans provide just enough minimum benefit requirements to avoid Obamacare’s
penalty. If an employee wants real coverage he is on his own.

Obamacare’s
promise was that healthcare insurance coverage would broadly enrich at lower
affordable costs.   

Federal
officials say these limited benefits plans, in concept, would appear to qualify
as acceptable minimum coverage under the law, and let most employers avoid an
across-the-workforce $2,000-per-worker penalty for firms that offer nothing.

 It is unclear how many employers will adopt the strategy this year.
There are dozens of brokers and benefit administrators discussing this strategy
with their clients. I bet many will adopt this strategy.

"There
had to be a way out"
of the penalty for employers with low-wage workers,
said Todd Dorton, a consultant and broker for Gallagher Benefit Services Inc.,
a unit of 
Arthur J. Gallagher AJG -0.44% &
Co., who has enrolled several employers in the limited plans.”

Obamacare
requires employers with 50 or more workers to offer coverage to their workers
or pay a 2,000 per worker penalty.

The
employers and benefits experts initially thought the rules required robust
insurance with a long list of  "essential" benefits.

Federal
officials confirm the mandates affect only plans sponsored by insurers” that are sold to small businesses and
individuals.

Healthcare
insurance “sponsored by insurers”
that are sold to small businesses and individuals affect only about 30 million
of the more than 160 million people with private insurance.

Employers
provide these “insurer sponsored plans”
to 19 million out of the 30 million people. These plans are going to disappear.

 Some benefits advisers feel they face
regulatory uncertainty. New regulation can cancel older regulations. These
advisors say they would adjust to new regulations as regulators clarify the
law.

According
to Obamacare, regulations written by the multiple new agencies, larger
employers with more than 50 workers only have to provide preventive services,
without a lifetime or annual dollar-value limit, in order to avoid the
across-the-workforce penalty.

Such policies would generally cost far
less to provide to employees than paying the penalty or providing more
comprehensive benefits.  

Most low-benefit plans would cost
employers between $40 and $100 monthly per employee, according to benefit
firms' estimates.

These
plans essentially provide no insurance for healthcare problems if someone needs
insurance. The financial burden falls directly on the consumer.

Obama
administration officials confirmed in interviews that the low benefit plans
would be sufficient to avoid the across-the-workforce penalty.

Several
Obama administration officials expressed surprise that employers would consider
the low benefit approach.

"We
wouldn't have anticipated that there'd be demand for these types of band-aid
plans in 2014," said Robert Kocher, a former White House health adviser
who helped shepherd the law. "Our expectation was that employers would
offer high quality insurance."

 Another trick benefit managers are offering
small employers in order for them to avoid higher costs of premiums due to
compliance with some of the provisions in Obamacare is early yearly renewal of
preexisting healthcare coverage. UnitedHealth, Aetna and Humana are offering
small companies this option. The savings is significant.

Self-insured
companies face fewer changes under Obamacare. Many small companies are now switching
to self-insurance. Large corporations have been self-insured for years.

I
have previously discussed the large trend to hire only part time employees to
avoid the penalty as well as the requirement to provide insurance.

Many
employers are trying to get out of providing healthcare insurance to employees.
Employers fear they will be penalized by the Obama administration at a later
time. The administration is constantly changing regulations. This has lead to
tremendous uncertainty.

Some
Obama administration regulators worry that some of these strategies will be
widely adopted. If this happens it could decrease the effectiveness of
Obamacare’s online health-insurance exchanges.

Only
older and sicker workers, who need real healthcare insurance coverage will opt
out of low benefit employer coverage and join the health insurance exchanges.

The
premium cost for good coverage in Obamacare’s health insurance exchanges is
high already. The adverse selection will drive these costs even higher.

The
whole idea behind Obamacare’s health insurance exchanges is to force healthy
people to pay for the resources used by sick people. (“Redistribution of
wealth”)

The
Obama administration refuses to believe options to avoid Obamacare will be a
widespread trend.

How
come? Didn’t congress exempt itself from Obamacare?

"Any
activities that take place on the margins by a small number of employers would
not have a significant impact on the small group or the individual
market," said Mike Hash, director of the department's Office of Health
Reform.”

These
new plans are a substitute for the Obamacare exempt Minimed plans. Companies
that provided Minimed plans received over 13,000 waivers for Obamacare until
January 2014. Companies such as McDonald and Burger King provided Minimed Plans
to employees.  

All
of these twists and turns make Obamacare look like it is unworkable. It is!

President
Obama’s goal is to create more chaos and dysfunction in the healthcare system.

Only
then can the government really step in and say let me help you.

Then
the government can provide a single party payer system and complete the journey
to socialized medicine.

Based
on past experience in many other countries, the result will be skyrocketing costs
and increased deficits. 

Americans
have a lot to look forward to. The only was out is to repeal Obamacare and
replace it with a consumer driven healthcare system.

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

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One Picture Is Worth 1,000 Words

Stanley
Feld M.D.,FACP, MACE

One picture is worth 1,000 words.
The second picture says it all.

Chart of agencies 9 22 2013
The list of one humdred and fifty nine new bureaucratic new agencies can be found at https://libertylegalfoundation.org/obamacare-class-action/quagmire-of-new-obamacare-agencies/#.UkNfRmRgZlQ

The one hundred and fifty–nine new agencies generated by the
Accountable Care Act (Obamacare) increases the complexity of an already
uncontrollable bureaucracy. Americans have seen many examples of the
inefficiency and waste because of the growth of bureaucracy in everyday life.

Jpg height of rules
http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/09/employer-mandate-confusion.html

 

 To date, before Obamacare
has been in full swing, these agencies have created the pile of regulations
demonstrated by Mitch McConnell.

 What are the chances the
recipients of these regulations will understand and obey all these regulations?

 What are the chances the
government bureaucrats can enforce these regulations?

What are the chances favored,
privileged parties will be exempt from these regulations?

What is the value added cost
these agencies and regulations provide for the direct treatment of patients
with disease?

These are all good questions.
The answers are not readily available. The administration, our congressmen or the
traditional media do not discuss these questions.

The American public has
already felt the consequences of the growth of bureaucracy and regulations.

Seventy seven percent of new
jobs have been part-time jobs
. A person working less than 30 hours a week is
not required to receive healthcare insurance from his employer. Employers have
done this to avoid an Obamacare penalty.

Healthcare insurance
premiums for next year are skyrocketing. The Obama administration continually
tells the traditional media that insurance premiums will be affordable and
decrease in 2014.

True unemployment rises to
over double digits while government statistics claim it is falling. It is a
statistical trick.

Americans are noticing the
sting of the 20 hidden taxes Obamacare has put in place. Despite these taxes,
the deficit for this year remains one trillion dollars. It means the
administration is spending more despite the tax increases.

The Democrats keep saying we
must raise the debt limit. The Federal Reserve keeps saying we need to print
more money. President Obama keeps saying you must pay the bills Americans and
congress voted to incur. America cannot default on its debt.

Few are saying we must
decrease the debt by decreasing bureaucracy, regulations and inefficiency.

Fewer are saying we must
stop this overspending.

President Obama has given
countless waivers to countless companies. The first waver was MacDonalds which provides
Mini-Med insurance to their low wage employees. Mini-Med insurance is worthless.
It provides practically no healthcare insurance coverage.

President Obama figures that
all these people would sign up for the Health Insurance Exchange rates. These
exchanges would provide tax credits for the low wage income earner by law. The
law seemed to change in the last few months from tax credits to subsidies
without congressional approval. Law wage earners do not pay taxes and cannot
benefit from tax credits.

After October 1 we will see
if young healthy persons without pre-existing condition sign up for healthcare insurance
through these health insurance exchanges.  

 The only insurance rates
seen through these exchanges so far are the California health Insurance exchange
rates. The rates are too high to buy adequate healthcare coverage for someone
making $40,000 per year. The affordable rates do not provide adequate healthcare
insurance coverage.

 The Obama administration
claim’s that the New York State rates are lower than the private insurance
rates. It might be true for certain levels of coverage. The reality is the
private insurance rates in New York are too high. The New York State Board of
Insurance permits healthcare insurance companies to receive an unconscionable
return on investment.

A one year delay of
Obamacare for corporations will get President Obama past the mid term
elections. It will permit public awareness of the harm Obamacare is doing to
the economy which the administration is striving to keep hidden.

After the election cycle it
will dawn on the majority of the public that Obamacare is a destructive
train-wreck to the economy and economic growth.

The delay will also have a
lesser effect on the tremendous increase in deficit spending that would
diminish the debate on the administration’s overspending.

President Obama doesn’t seem
to think deficit spending is an important issue.  He is also not bothered by the Federal Reserve’s
quantitative easing.

The most offensive action by
President Obama is exempting congress and the congressional staff from
Obamacare.  

Why should the individual
hard working person suffer the effects of Obamacare when government officials
do not? 

Can Obamacare work when we
have so many agencies generating so many regulations? Can it work when so many
people have waivers and exemptions?

I doubt it!

No only is it not fair to
hard working people. It is probably unconstitutional.

It doesn’t look like the
American individual taxpayers that are not exempt from Obamacare are going to
get much help from the Supreme Court.

Maybe President Obama’s goal
is to destroy the healthcare system’s infrastructure. He is setting up the
failure of Obamacare.

Obamacare seems to be designed
to destroy our healthcare system. Maybe Obamacare is not supposed to work. Maybe
it is designed to cost so much that the entire economy will fail.

This can be the only reason
Obamacare has been permitted to continue to exist by both Democrats and
Republicans.

Obamacare is neither affordable
nor executable.

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

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What Are Private Insurance Exchanges?

Stanley Feld M.D.,FACP,MACE

Corporations have been providing healthcare insurance
since after WWII. The cost of healthcare insurance has been rising since.

The increase in premiums became intolerable in the
1980’s when cost shifting occurred. Medicare decreased reimbursement and the
fees were shifted to private insurance.  Several experiments in healthcare coverage
were tried to reduce the cost to employers. All the schemes failed to control
costs.

The schemes include managed care and HMO’s. All the
insurance schemes were defined benefit plans. Employees were immune from
responsibility for themselves or their healthcare dollars.

As the costs have risen to unsustainable levels
corporations have been trying to figure out how to get out of providing
healthcare coverage for their employees as a benefit.

Most employers, large and small, want to limit their
exposure to healthcare premiums and Obamacare penalties.

A movement to limit employment to less than 30 hours
a week to avoid providing healthcare insurance to employees and avoid Obamacare
penalties has become viral.

No one has tackled the real reasons for the rising
healthcare costs. No one has tackled the perverse incentives and advantages
given to the healthcare insurance industry all these years.

I have argued that this perverse incentive can lead
to all the other perverse incentives initiated by the rest of the stakeholders
in the healthcare system in order to survive.

Once more the healthcare insurance industry figured
out how to increase their profits while making it appear they are helping both employers
and employees.

It must be remembered that the healthcare insurance
industry profits through both private insurance and government provided
healthcare coverage.

The industry makes its profits by providing
administrative services. The government outsources the administrative services
to the healthcare insurance industry.

The profit generated in both the private sector and
the government sector is far from transparent.

The healthcare industry’s new scheme converts defined
benefit coverage to defined contribution coverage for healthcare benefits.

In recent months we have seen large corporations
switch their employee healthcare benefits to defined contribution programs.

A partial list of companies includes Walgreens, Home
Depot, Sears, Trader Joes, Xerox and IBM retirees.

Rather than provide a healthcare insurance coverage
benefit through the corporation, the corporation is providing employees with a
defined contribution each year. The employees can then buy their insurance
through their employer’s contracted Private Health Insurance Exchange.

The Private Health Insurance Exchanges are provided
to the corporations by the healthcare insurance industry. There will be a menu
of insurance plans and premium levels employees eligible for coverage can
choose from.

The principals of healthcare coverage include all of
the basic requirements of Obamacare’s Health Insurance Exchanges. Employees
having a preexisting illness must be accepted. However, premiums might be
higher for patients with pre-existing conditions.

The defined contribution amount has not been defined.
It could be a couple of hundred dollars a year to a couple of thousand dollars
a year. In any event it does not sound as if it will be enough to cover the
cost of the healthcare insurance premium.

There will be high deductible plans with patients not
covered for the deductibles and co-pays.

If an employee doesn’t like what he buy in the
companies Private Insurance Exchange, he can always sign up for Obamacare’s
Health Insurance Exchange.

It sounds great for the employer because the employer
can predict costs. It is wonderful for the healthcare insurance industry.

It sounds terrible for the consumer.

It sounds both good and bad for the government. It
depends on how one looks at it.

The Obama administration will have more people sign
up for Obamacare’s Health Insurance Exchanges. The result will be greater
control over the healthcare system. I believe this is the reason the Obama administration has not opposed the Private Health Insurance Exchanges.

However, the consumers signing up for Obamacare Health Insurance Exchanges will be the sickest
consumers. These consumers will use the system more than average.

This will result in an increase in the deficit and
unsustainability of Obamacare. The only way out is to increase premiums and
taxes.

This is called a “redistribution of wealth” because
people making up to $40,000 per year do not pay taxes. If the tax increases are
means tested it will increase the amount of wealth that is redistributed will
increase.

The increase in taxes will decrease economic growth.

At the present time Obamacare’s Healthcare insurance
Exchanges do not have verification software. The system is vulnerable to fraud
and abuse even if it could work.

America is just becoming aware of the fraud and abuse
in the food stamp entitlement program. The food stamp entitlement has double. The
government has not fixed the food stamp program.

It is likely the same thing will happen with the government
run Health Insurance Exchanges. It will drive the federal deficit even higher.

Even though the Private Health Exchanges shift financial
responsibility to the consumer to pay for their own insurance it does not provide
financial incentive for patients to become responsible for their health.

It does not contain educational programs to help
patients deal with their chronic diseases. It does not teach consumers to be
responsible for their health and healthcare dollars.

Obamacare does not provide these incentives either.

The only plan that does is my Ideal Medical Saving
Accounts with employers providing support while shifting responsibility to
consumers by providing incentives for patients to lower the cost of their care.

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

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Who Losses? Who Wins?

Stanley Feld M.D.,FACP,MACE

IBM wins because it wants out of
providing healthcare insurance for retirees.

The government wins because it gains more
control over the healthcare system.

It is as if big business is playing right
into the Obama administration’s hands.

 The healthcare insurance industry wins because
it gets more administrative services fees from the government without risk.

The brokers for the healthcare insurance
industry win because they will take more commissions from individual consumers than
they would from an institutional company.

IBM retirees
lose.

 Most retirees will go on Medicare Part B or
Medicare Advantage. President Obama is planning to eliminate Medicare
Advantage.

Medicare Part B is means tested so the
more income that is generated from any source by a retiree the higher the premium
paid to the government for Medicare Part B.

The Medicare premiums are paid with pre
tax dollars from retirees Social Security payment. The supplemental insurance
(Medicare Part F) covering deductibles and co-pays are not tax deductible.

Medicare is increasing the deductible and
co-pay requirement in 2014. Therefore the non tax-deductible supplemental
premiums will increase in price.

The premiums of both Medicare and
Medicare supplements for services and drugs can amount to more that $16,000 a
year for a husband and wife calculated in terms of after tax dollars..

Large companies provided the healthcare
coverage as a benefit to retirees tax-free.

IBM has been trying to get out of
providing healthcare coverage for employees since 1999. Obamacare has provided
an excuse for IBM to discontinue its coverage for retirees.

General Electric (GE) made the same
announcement a while ago. Time Warner made its announcement right after IBM.

Companies who have changed their
healthcare coverage for retirees include DuPont, Caterpillar, Sears and Darden
Restaurants.

Many more companies are about to joint in.

It is obvious this was coming as a result
of Obamacare.

The move
disregards the social contract made with employees when employees were first
hired.

International Business
Machines
 Corp.
(IBM) is going to discontinue its company-sponsored health plan for about
110,000 retired employees.

 IBM plans to provide retirees a fixed payment.
The payment will be used for retirees to buy their own health care coverage
through a “private” health insurance exchange.

 Once retirees are eligible for Medicare at age
65, IBM would not be responsible for managing these retirees’ healthcare
benefits.

IBM said,
“the growing cost of care makes its current plan unsustainable without big
premium increases.”

IBM told retirees, “that its current retiree coverage will end
for Medicare-eligible retirees after Dec. 31, 2013.”

IBM is shifting the responsibility to the
retirees for buying their own coverage through “Private Health insurance
Exchanges.”

It sounds like a costly rip off to the retiree.
IBM is providing a subsidy for now. Then IBM will discontinue the subsidy.

One Private Health Insurance Exchange
executive said.

"Companies
were turning off plans," he said. "We've given them a proven way to
subsidize. At some point every single retiree will join a Medicare
exchange."

Some union-affiliated groups and retirees
weren't convinced. Lee Conrad, national coordinator for the IBM Global Union
Alliance, said

The
worker group
sees this as
just another take-away of retiree and employee benefits."

Donald
Parry, an engineer who retired in 1992 after nearly 32 years at IBM, said he is
concerned he may have to pay more. "The worst thing right now is not
knowing what's going on,"

At the moment the cost of the government
providing Medicare coverage is unsustainable according to the CBO. This is
despite Medicare premiums being means tested and the escalation of Medicare
premiums.

Despite the increase in premiums Medicare
will run out of funds by 2024.

The choices are higher means tested
Medicare premiums (redistribution of wealth), decreased access to care or
rationing of care. I believe it will be all of the above. The burden of this
change will fall on the taxpaying consumers’ shoulders.

As big businesses drop coverage for
retirees, the Medicare roles will increase and the government will run out of
fund prior to 2024.

Excessive costs, commissions, and bureaucratic
inefficiencies part of any government program.

The Obamacare bureaucracies seem to have
no concern for the inefficiencies and increase in deficit spending.

It is as if they are saying, “Bring it on.”
All the government wants is control of the healthcare system.

The result will not be affordable care.
It will be unaffordable care that is rationed with limited access to care.

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

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You Cannot See the Pattern Unless You Look

 Stanley Feld M.D.,FACP,MACE

Let us assume President Obama wants to destroy the
healthcare system. I have presented steps taken by the Obama administration to
accomplish that goal.

It is possible that this assumption is correct.

It looks as if President Obama uses the same patterns
in the actions he takes to govern.

He promises a group something that group wants to
hear. Then he disregards the promise. He acts to further his political agenda.

This methodology is not the methodology of
leadership, nor does it promote trust.

However, he
has used the same methodology in finance, in the environment, in immigration,
in defense, in energy, in racial relations, and most of all in Medicine.

He first captures his base with ideas that promote
their vested interest. He then undermines his base’s vested interests replacing
these vested interests with his own political agenda.

The
next step is to shift the blame to someone else.
His best victim has been the Republican Party. It
is incomprehensible to me that the Republican Party sits back and takes it. I
guess it is politically correct to do so. However, it does not win elections.

If an element of his base makes a big enough stink,
he provides an executive waiver for the issue.

Some of the patterns are hard to see. The
traditional media under reports them.

Other actions using the same pattern are not seen
because they are not examined carefully. They are only seen after they have a
direct affect on an individual’s or group’s vested interest where they have
been betrayed. This leads to mistrust.

President Obama then proceeds to become the judge.
As judge he plays one group against the other.

He now has angered adjunct university and colleges
teachers. This group has been a steady ally.

“Adjunct faculty at a local college
were asked to sign a 
petition to the White House to "explore
options to prevent colleges/universities from cutting adjunct and contingent
faculty hours to circumvent [the] PPACA," better known as 
ObamaCare

This is in
response to the massive assault on the livelihood of adjunct faculty who
now face devastating salary cuts as a direct result of Obamacare.

University and college
professors have universally been President Obama fans. The tide is shifting for
President Obama.

He has blamed the
shifting tide on the Republicans.

In medicine President
Obama’s budget cuts have already resulted in rationing of care and a decrease
in access to care. Cancer Clinics across the
United States are turning away thousands of Medicare cancer patients.

The cost of the
medication to the cancer clinics is higher than   government reimbursement for the medication.
 

"Patients at these clinics would need to
seek treatment elsewhere, such as at hospitals that might not have the capacity
to accommodate them
."    

The reduced Medicare
funding already has taken place April 1,2013.

Cancer treatment in
hospitals, in many cases, are 2 to 4 times higher than treatment in outpatient
cancer clinics just as surgery done in an outpatient surgery clinic is one half
to one fifth the cost of surgery in a hospital.

Yet the hospital systems
continue to receive adequate fees.

 The Community Oncology Alliance, which
advocates for hundreds of outpatient cancer clinics nationwide has sent letters
to legislators urging them to exempt cancer drugs from the seques
ter for outpatient cancer
treatment to make less expensive outpatient cancer treatment available to
patients.

 The hypocrisy of President Obama, who early on
claimed that the passage of the American Recovery and Reinvestment Act (ARRA)
would "launch a new effort to conquer a disease that has touched the life
of nearly every American
.

 Thus, it
is perplexing that the cuts outlined by CMS will negatively impact cancer
patients, making advances in cancer care more difficult to deliv
er."

Seniors could not know
about this until they develop cancer and experience the cost. It too has been
under reported.

President Obama who introduced the idea of sequestration, in his
negotiations for a continuing resolution last year, has refused to take
responsibility for it.

Republicans attempted to
make the sequester cuts "less reckless,” such as severe military cuts,
closing the White House to visitors and all the other restrictions President
Obama introduced for this two per cent cut in the budget.

Harry Reid said the
Republican’s proposed cuts were dead on arrival in the Senate.

 “Thus,
Obama's duplicity emerged, as he sought to blame the Republicans for
sequestration even though he originated it.”

There have been many instances where the
Obama administration has divided Americans into class warfare. The class
warfare has occurred in immigration reform, cancer victims vs. non cancer victims,
union workers vs. non union workers, right to work states, college teachers and
the administrators, black vs. whites and rich vs. poor for example.

The traditional media
fill the airwaves with these distractions. The real issues are diverted by the
distractions. President Obama plays “Wag the Dog” constantly.

Some examples of real
issues would be how to solve the problem of government inefficiency, waste,
fraud and abuse. It is not to create more agencies, rules and regulations and
impediments on business development to destroy job growth?

Why beat up on doctors
and patients when the real problems are insurance companies, hospitals and tort
reform despite the administration and its advisors’ denials.

Why is he giving out preferential
waivers? America should be outraged to have Obamacare passed into law by a
Democratic Party, which then in turn receives a waiver from President Obama by
executive order to be exempt from Obamacare.

The media should be
outraged. Instead the media has given congress and the President a pass.   

“Though I value my First Amendment right to
petition the government for change, we need far more puissant action.”  

We need to demand a total eradication of Obamacare.
 And it needs to be done as a united front.  Otherwise, we actually
play right into President Obama's overarching aims of 
divide
and conquer
 by
duplicity and coercion.” 

President Obama wants to
avoid personal blame for the expensive, unwieldy health care law. He will
probably figure out a way to blame Republicans for its failure.

The majority of the
people are against the healthcare law. Physicians know it will make the
healthcare systems problems worse and more expensive.  Yet the President ignores all of these voices
while he is spending massive amounts of money on marginally added value medical
projects.

Some believe the tactics
used by the used by the President to pass the healthcare law started all the
problems. In reality Obamacare is a bad law that will be impossible to
implement.

President Obama always uses
the same pattern to avoid personal blame. (“I
did not draw a Red Line, the international community did
”). He always
diverts our attention from the real problems. He tells lies or half-truths
about issues, and divides and conquers to create class warfare.

He uses the same moves
over and over again. If America doesn’t start looking, Americans will not see
the destruction to most of our institutions.

The so-called unintended
consequences in every area might not be so unintended.

President Obama is
accomplishing exactly what he wants to accomplish. It looks to me as if he
wants total government control over our society. Many institutions have begun to
crumble before he reaches his goal.

The disregard for our
constitution is one vivid example. 

What massive government
intervention means to me is that it is creating more misery, resentment and
anger among all the diverse groups in American society. 

Most Americans believed
President Obama when he said it is time for a change. It was time for a change.

 Since he did not define the change he was seeking,
we all assumed it would be for the better.

Our assumption was
wrong. 

It is time we start
looking and seeing.

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

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Employer Mandate Confusion

Stanley Feld M.D.,FACP,MACE

Confusion
about any rules or regulations is not good for business, bad for job growth and
bad for the economy.  Large and small
enterprises become cautious and are afraid to spend money on expansion.
Expansion might increase a tax liability without increasing production.

A
few months ago there was a dispute about how many new rules and regulations
have been released by the Obama administration to implement Obamacare.

“Implementation has
also become a bureaucratic nightmare, with some 159 new government agencies,
boards and programs busily enforcing the roughly 20,000 pages of rules and
regulations already associated with
this law.”

Sen.
Mitch McConnell (R-Ky.), on the third anniversary of the law’s passage,
March 22, 2013

The process the McConnell folks used is fairly
simple. They went to the Web site for the Federal Register and
searched for “Affordable Care Act,” the official name for the health-care law.
That turned up 897 documents.

On the Web site, there’s a button that will download
the documents to an Excel spreadsheet (CVS/excel). Then you use the sum feature
on Excel to add up the pages and presto, you end with 20,202 pages. These were
then printed out and duly stacked in a pile.


Jpg height of rules

Mitch
McConnell might be way off in his calculation. The rules and regulations are
reported in the small print Federal Register. It is possible as many as 40,000
rules and regulations have been published. All of the rules and regulations for
Obamacare will not have been written by January 1, 2014. 

2nd Mcconnel jep

The
cost of the writing of the rules and regulations, the cost of the formation of
new agencies formation, and the cost of implementation have not been discussed.

Rules
and regulations tend to be open to misinterpretation, conflict, lawsuits and
lack of enforcement.

An
increase in rules and regulations leads to more confusion and conflict. Some
rules contradict other rules. This results in greater inefficiency and more not
less costs.

Our
healthcare system can ill afford more non added value expenses.

The
IRS is going to be in control of enforcing the “Employer Manadate.” Many of the
rules and regulations have been written. However, many of the IRS’s rules and
regulations are not clear.

I
have written about employers decreasing the number of hours employees are
permitted to work in order to avoid the penalty “tax”
of not providing healthcare insurance for full time workers.

Seventy
seven percent of the “job growth” in the past few months has been part time
employment growth.
The Obama administration has consistently denied this is
true despite the Bureau of Labor statistic reports.

What
is part time employment? It has been defined in Obamacare as an employee
working less than 30 hours a week.

“Just to understand how the penalty applies practically requires
flow chart. But as the Internal
Revenue Service has tried to 
interpret the mandate, the
agency and the businesses and employees affected by the mandate are discovering
that it is even more challenging than it reads.”

Answers to questions by
the I.R.S. have generated even more questions. Confusion mounts as more rules
and regulations are generated.

A big question has
surfaced. How does an employer determine whether employees whose hours fluctuate
should be offered insurance or pay a penalty “tax”?

Obamacare sets that
threshold at 30 hours per week. Many companies schedule some of their work
force on variable hours. An employee might work 25 hours one week and 33 hours
another week. 

In its preliminary
rules
, released late last year,
the I.R.S. devised an approach to the problem of the variable-hour employee
that it calls the “look-back measurement method.”

The I.R.S regulations
would allow an employer to choose a measurement period of three months to a
year in which to average the employee’s weekly hours.

The measurement period
would then be followed by a stability period of a year for a total of two
years.

Is anyone following this?

If an employee’s schedule
averaged out to full time (over 30 hours a week) during the measurement period,
then the company would be obliged to offer health insurance in the stability
period or pay a penalty.

The new measurement period
would begin immediately after the old one ended. The process of measurement and
stability periods would begin again.

 If the company anticipates that a new hire
will work full-time (over 30 hours a week), it must offer insurance by the
start of the fourth month on the job.

 Why not offer insurance immediately on hiring
the person? Is this not confusing?

 To make things more confusing, what happens if
an employee goes from full time to part-time?
The rules were unclear. “Do you get to keep your coverage?”

The I.R.S. took the
position that the employee would keep the coverage through the end of the
stability period.

If it turned out that the
worker still managed to average a full-time schedule, which would be possible,
if he or she made the switch late in the period. The company would have to
offer insurance in the next stability period as well or face the penalty.

A full-time employee who was
switched to part-time in August, before open enrollment in October, would be
entitled to an additional 16 months of insurance coverage.

Employers have figured out
they should fire the employee and avoid the penalty or the insurance coverage.
This is not good for job creation or the economy.

The law and its rules are
encouraging these actions.

The rule also penalizes an
employee who is switched from part time to full time employment. The employee
has to wait at least a year before the employer must offer that employee
insurance coverage rather than by the fourth month.

Measurement and stability
periods should be used to infer a status of variable-hour employees only,” 

“Once an employee is no longer a variable-hour employee and is
in a full-time position, he or she should be offered coverage within, at most,
four calendar months.”

Is all this confusing? You
bet. Just visualize the cost of the mountain of paper work and reports.

Is all of this cost
effective? No!

This represents a tiny
fraction of the rules and regulations by the Affordable Care Act (Obamacare) that
are causing confusion.

The more confused one gets
the less one wants to participation.

The only option left is a government
take over of the healthcare system. It wouldn’t be bad except for the fact that
America cannot afford it, and the government could not implement it without a
terrible cost to society.

It would result in
rationing of care and a decrease in access to care. The only solution is for
consumers to be responsible for their own care and control their own healthcare
dollars.

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

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  • spinal shock cure

    A dog’s nail consists of two parts, the quick which contains blood vessels and is the base of the nail. All in all, controlling the cost of health insurance plans is essential. Most people who change or lose their jobs also end up losing the health coverage and the Health Insurance Portability and Accountability Act (HIPAA) that was passed in 1996 intends to protect individuals and their families from loss of health insurance.

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Permalink:

President Obama Should Listen To Physicians

Stanley Feld M.D.,FACP,MACE

President
Obama keeps saying over and over that Republicans do
not have any good health care reform solutions.

Republican
don’t have an agenda to provide health insurance to people at affordable
rates.”

It all depends
on the definition of a good idea. Is it one that will work or one that will
fail? A good idea is it one that agrees with President Obama’s agenda. If it
doesn’t agree with his agenda it is a bad idea.

By President
Obama and Harry Reid own admission they believe Obamacare is a good step toward
a single party payer. They believe Obamacare will fail.

Any idea that
interferes with President Obama’s is defined as a bad idea.

The Republicans
and thoughtful people with actual healthcare experience have plenty of good
ideas. They do not agree with President Obama’s agenda.

 

http://youtu.be/4-lnzEwt3HM

This program containing Republican ideas three years ago had only 807 views on You Tube.

Congress voted for the
law (only Democrats voted for the law). They have now exempted themselves from
the law because they realize it is a bad law. It looks as if Obamacare will be
a train wreck.

Image1
Image1

Perhaps that is where
President Obama wants it to end.

 

 As each day
passes Obamacare looks like it will be a very expensive train wreck.

 Physicians are tired of being blamed for the rising
healthcare costs. They are starting to realize that they have to take action to
preserve their professional integrity.

In fact, in a recent study by the Physicians Foundation, six
out of ten physicians said they would quit medicine.

Most physicians love practicing medicine but cannot
understand the unbelievably wrong direction President Obama is taking to reform
the healthcare system.

 Many physicians
are looking for viable exit strategies to avoid quitting.

The
Physicians Foundation commissioned an extensive survey of
nearly 13,575 physicians. Meritt Hawkins, the physician search and consulting
firm, conducted the survey.

 
“The survey found
that 
60% of physicians would
retire today
, if given the
opportunity—an increase from 45% in 2008. And it's not just disgruntled and
tired Baby Boomers who want to abandon their healing work. At least 47% of
physicians under 40 also said they would retire today, if given the
opportunity.”

The
survey pointed out many major problem areas.

Two specific issues consistently agreed on by physicians
were malpractice concerns and the need for tort reform as well as the lack of
cohesive leadership among all physician groups to represent the vested
interests of physicians and their patients.

This survey is an excellent and detailed survey that has
heightened the awareness of physicians’ practice problems.

The Massachusetts Medical Society survey pointed out the
scope of defensive medicine. I extrapolated findings of the society’s survey to
the nation.

My conclusion was that $500 billion to $700 billion
dollars a year is spent on defensive medicine testing. Tort reform would
decrease the cost incurred by defensive medicine over testing.

The Mass Medical Society survey demonstrated that
physicians are frightened by the multidimensional stress of malpractice suits.
Physicians will do as much testing as necessary to avoid a malpractice suit for
missing a diagnosis. Most physicians do not experience financial gain in over
testing. The hospital system does.

President Obama and his advisors have ignored tort reform
and defensive medicine as an insignificant cost. Ezekiel Emanuel M.D. one of
President Obama’s advisors thinks defensive medicine only raises the cost of
the healthcare system between $2 to $3 billion dollars a year. This is a
misguided bias.

The Physician Foundation survey notes that many policy
makers, academics, and others identify fee-for-service reimbursement as a key
driver of health care costs. Physicians believe that "defensive
medicine is a far more important cost driver."

 
Forty
percent (40%) of the physicians surveyed said "liability/defensive
medicine pressures" was the least satisfying aspect of medical practice.

 Sixty nine percent
(69%) of physicians said defensive medicine is the "number one ranked
factor" driving up healthcare costs. The survey described the ordering of
tests, prescribing of drugs, and conducting of procedures done "partly or
solely to drive a wedge against potential malpractice lawsuits."  

"Medical
malpractice lawsuits are common, adding an additional layer of paperwork,
expense, and stress in virtually every physician's work day," the report
adds
.

The government ought to be listening to physicians practicing medicine every
day rather than ivory tower professors who have never practiced medicine a day
in their lives.

"Physicians
understand to some degree that's the cost of doing business, but the defensive
medicine goes deeper than that, in the ordering of extra tests, doing the extra
procedures, and extra scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of overspending in
American healthcare. President Obama and Obamacare have ignored it. Some states
have addressed it and the cost of care has been decreasing slowly. I believe it
will take time in those states.  If
anyone is sincere about bending the healthcare cost curve they have to take
defensive medicine seriously. 

According to the survey physicians
felt that there is a lack of a forceful cohesive voice representing them.

"There
is a systematic, endemic series of problems," Ray says. "Everywhere there
is defensive medicine, regulation issues, reimbursement issues. We are all in
the same boat. But physician representation is balkanized. There is not a
national organization that represents a majority of physicians."

When the survey asked which best describes
their feelings about the current state of the medical profession, only 3.9
percent of physicians used the words “very positive,” while 23.4 percent of
physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent —
described their feelings as either somewhat negative” or “very negative,” while
only 31.8 percent of physicians’, described their feelings as “somewhat positive”
or “very positive”.

A "least satisfying" aspect of
practicing medicine included dealing with Medicare/Medicaid/government
regulations (27.4%) and reimbursement issues (27.3%).

The American Medical Association (AMA)
represents only 15% of physicians, according to the Physician Foundation report. One of the reasons for the low enrollment is that physicians feel the
AMA does not represent their vested interests.

 Sermo is another physician organization. It is an Internet social
network. In less than 2 years Sermo had as many members as the AMA.

Sermo originally concentrated on
socioeconomic issues. It also discussed difficult clinical cases. 

The socioeconomic activity has recently
faded. Sermo’s power was using the social network to do instant surveys of physicians’
opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to
the public as media stories of physicians’ opinions. It was done through public
service announcements and daily press releases.

Physicians were able to let the public know
how they felt about an issue instantly. It was very attractive. Somehow the
initial vigor stalled. Physicians are now left without a vehicle or organization
to express their feelings.

Government, the healthcare insurance industry
and the hospital systems have little desire to listen to the concerns of
practicing physicians. It is more important for these stakeholders to control
physicians. It will not work long term.

The Physicians Foundation Biennial Survey is
valid and accurate. However it is not dynamic or evolving. Neither the PFB
survey of the Sermo survey have gotten the attention they deserve.

Both are must reads along with the
Massachusetts Medical Society survey for those interested in physician concerns
and behavior.

Patients’ problems with the healthcare system
get less attention. The government and insurance companies tell patients what
they can and cannot do.

Repair of the healthcare system will only
happen when the American healthcare system evolves to a consumer driven
healthcare system with individual responsibility and patient control of their
healthcare dollars.

The reality is that health care should be as decentralized and regulated as close
to the people as possible, not run by Washington mandates.

This concept
opposes President Obama’s agenda.  

President
Obama has the power of the pulpit and has the gift of misdirection.

The
healthcare system is going to fail unless the public wakes up to the facts.

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

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Permalink:

Are The Unintended Consequence’s Of Obamacare Unintended?

Stanley Feld M.D.,FACP,MACE
 

It is hard to tell whether the unintended
consequences were really intended consequences on the way to destroying the
healthcare system.

Harry Reid and the President have already
admitted that Obamacare is a good first step on the way to a government
controlled single party payer system.

There are several problems with a single
party payer system,

  1. The
    government cannot afford it.
  2. The
    government cannot run it. It will have to hire the healthcare insurance
    industry to administer it. It costs the government 40% of the healthcare
    dollars to have the healthcare insurance industry provide administrative
    services for Medicare and Medicaid presently.
  3. Providers
    will not have incentive to produce. Reimbursement will be low and salaries will
    be low.

Normally if one works for a company, the
company provides healthcare insurance to the family. When Obamacare raised the
mandate limit forcing employers to provide healthcare insurance for employees’
children living at home to 26 years old, companies have been trying to figure
out how to avoid paying the increased premium cost of healthcare insurance.

Most companies have reduced or are reducing
employment to less than 30 hours to avoid the penalty for not providing
healthcare insurance.

Many companies have applied for wavers.
These companies will get waivers if they are the Obama administration’s
friends. Congress got a waiver.

U.P.S. announced it would discontinue
Health Benefits
for spouses of some workers. U.P.S. joins the list of other
companies doing the same thing. These include large employers like Xerox and Teva Pharmaceuticals. They
have chosen to impose surcharges on employees for spousal coverage.

Cities like Terre Haute,
Ind., are adopting a spousal carve-out so that working spouses would not be
covered under its health plans even if the healthcare insurance plan of the
spouse’s company is worse than Terra Haute’s healthcare insurance plan.

The University of Virginia
has just announced a similar spousal carve out. It is rumored that the state of
Virginia is next.

“UVA said
this is only one of many “major changes” coming to their health plans a
s a
result of ObamaCare. The university says the changes are necessary because the
law is projected to add $7.3 million to the cost of the university’s health
plan in 2014 alone.”

Isn’t Obamacare called the
Affordable Care Act?
In truth it is not. It will drive these spouses into a
health insurance exchange.

 “U.P.S. said, “Limiting plan eligibility is
one way to manage ongoing health care costs, now and into the future, so that
we can continue to provide affordable coverage for our employees.”

 — U.P.S. told employees, “Since the Affordable
Care Act requires employers to provide affordable coverage, we believe your
spouse should be covered by their own employer — just as U.P.S. has a
responsibility to offer coverage to you, our employee.”

Delta Airlines announced
that someone
leaked a letter from Delta Air Lines to the Obama administration.

The
letter stated that the “cost of providing health care to our employees will
increase by nearly $100,000,000 next year.” The letter also states that much of
the increase is due to Obamacare.

It means the airline tickets are going to increase in
price. This will become a burden on businesses who depend on flying to do
business. In turn, products these companies produce will increase in price.  

The ordinary consumer will also be affected by rising
airline ticket prices.

U.P.S. said, “Limiting plan
eligibility is one way to manage ongoing health care costs
, now and into the
future, so that we can continue to provide affordable coverage for our
employees.”

U.P.S. estimates they cover
33,000 spouses. Fifteen thousand (15,000) spouses can get coverage through
their own employers. It should be added that they can get insurance until the companies
of these15,000 spouses drop their own healthcare coverage.

 If U.P.S
cannot lower insurance costs, they will raise shipping prices. Once again the middle
class is the victim. Another option is to drop healthcare insurance for all
employees and let them participate in the health insurance exchanges.

 Companies providing executive insurance
of $27,500 or more for employee family coverage or $10,200 for individual
coverage (Cadillac plans) will have to pay an additional 40% Obamacare tax in
2018.

This Cadillac plan tax is
something many companies are thinking about and making plans to discontinue in
the future.

The whole thing stinks.

It might not be an
unintended consequence. It might be an intended consequence.

 It might be exactly what President Obama wants
to drive as many people as possible into his health insurance exchanges.

His excuse for the increased
costs is that the American people cannot refuse to pay for something they have
obligated themselves to pay. In reality they have been deceived. They have been
tricked, forced and deceived into this obligation.

The Obama
administration is building a detective squad to target and penalize consumers and
companies that don't follow Obamacare's rules.

 The
Department of Health and Human Services has hired 1,814 criminal investigators.
On the day President Obama signed the Affordable Care Act into law in 2010, HHS received authority
to hire 1,814 investigators to
sleuth out violations of the law.

Congressmen who supported Obamacare find this new police force
confusing.

“HHS received authority from the Office of Personnel Management
(OPM) to make as many as 1,814 new hires under an emergency 'Direct Hiring
Authority' order.”

 The Obama administration ordered that employment expansion despite
a government-wide hiring freeze that is in place.

Why doesn’t President Obama
listen to the will of the people?

Everyone is against it. Everyone
has to be more vocal. Everyone has to vote these people out of power.

Otherwise we are on the Road
to Serfdom.

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

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Permalink:

America’s Rural Hospitals Are Being Destroyed

Stanley Feld M.D.,FACP,MACE

There is no question the federal government must decrease the amount of
money it is spending on healthcare. It simply cannot sustain the increasing
cost of health care.

Instead of figuring out how to make the system more efficient and cost
effective, the Obama administration is slowly destroying assets that have been
built at great costs to society in the past.

One example is the community hospital systems in large cities and the
voluntary hospital in smaller cities.
The government has subsidized their
development with tax incentives and reconciliation paybacks.

In recent years rural hospitals have been failing because of decreasing
government reimbursement. Many service the poor and elderly with emergency care
and outpatient clinics.

  • The role and structure of rural
    hospitals is changing,
    but they continue to be important local and
    regional centers of health care activity.
  • Rural hospitals tend to depend
    more on Medicare and Medicaid patients.
  • Most rural hospitals are organized
    on a not-for-profit basis
  • Rural hospitals make an important
    contribution to rural economies; expansion and diversification of the
    services that they offer will be important in their survival.
  • The quality of care provided in
    rural hospitals is generally equal to that provided by urban institutions,
    with some exceptions.

The Department of Health and Human Services' Office of the
Inspector General has recommended that Congress allow the Centers for Medicare
& Medicaid Services to strip critical access designation from any hospital
that was brought into the program under a state "necessary provider"
designation.

Brian Jordan, a program analyst for OIG's Office of
Evaluation and Inspections in Chicago, said that nearly 1,000 of the
approximately 1,300 critical-access hospitals
in 45 states gained the "permanent exemption"
under the necessary provider designation. Congress closed the loophole in 2006,
but grandfathered in the hospitals.

“Without
that designation, Jordan said about 800 hospitals would not have met location
requirements in 2011 because they were too close to another hospital.”

The "necessary provider"
designation is withdrawn if two hospitals are within 15 miles of one another.
It is estimated that Medicare could save 1.3 million per year for every
hospital eliminated from the necessary provider program.  

The total cost savings from eliminating
these rural hospitals would be less
than the
amount of money all salaries of the CEOs and other healthcare executives of healthcare
insurance companies take from Medicare a year.

If there is a problem with rural
hospitals it is their inefficiency and waste. The inefficiency should be fixed.
If the government wanted to do something constructive it should help rural
hospitals fix the inefficiencies.

The
“necessary provider hospitals “never had to meet the distance requirements."


 Necessary provider hospitals get paid more
from Medicare than non- designated hospitals. As towns expand new hospitals are
build close to the older standing hospitals. 

Maybe having a rural hospital in a
small city will increase economic growth of the area? It attracts industry and
more jobs. Many communities need two rural hospitals.

Both hospitals receive necessary
provider status and increased payment.

 Alan Morgan, CEO of the National Rural Health
Association, blasted the report. He said the OIG report would kill rural health
and access to healthcare. The closing of 800 rural hospitals would also close
emergency services in local communities, eliminate rural health clinics, access
to mental healthcare and nursing home support.

Morgan said, OIG
viewed this with blinders on
, not looking at how healthcare is delivered in
rural America.

"It's
about access and this report is only about finances and not access. It is a spending and finance issue and we seem to
have forgotten the rationale for the creation of this program, which was an
access issue."

If the Obama administration is trying to help
seniors and the underprivileged it should study this decision more carefully. I
can only imagine the cost of the unintended consequences to all taxpayers.

I believe the Obama administration wants to
destroy the entire healthcare system and replace it with a single party payer
system.

It is time to go after the real excess cost
drivers in the healthcare system. It is a mistake to destroy the infrastructure.

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

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