Stanley
Feld M.D.,FACP, MACE.

Tennessee Gov. Bill Haslam (R.) has asked the
Obama administration for flexibility in implementing Obamacare's Medicaid
expansion; he has been rebuffed.

It is becoming clear to me that the Obama
administration is heavy on the posturing and light on the reform. The goal
seems to be to have the healthcare system fail completely in order to create a
public panic.

The panic will result in the federal
government taking over the healthcare system completely and instituting a
healthcare system that controls patients, physicians and hospitals.

Some might call it socialized medicine. I
call it total impingement on incentive, initiative and innovation which will decrease
productivity and economic growth.

This is all being done by the Obama
administration with a total disregard for cost. President Obama’s assumption is
cost overruns can be covered by increased taxes. However, he is not considering
the effect of increased taxes on economic growth. He is also not considering
the effect of increasing taxes and increasing the money supply on purchasing
power. An increase in economic growth usually translates to an increase in GNP
and increased federal revenue.

Several examples come to mind
immediately.

1. States
   who have thought out the Obamacare expansion of Medicaid through health
   insurance exchanges have discovered that they are going to have tremendous cost
   overruns when the federal government stops paying the total costs. Originally the
   federal government was going to share the costs with the states.
2. The
   100% federal funding will be in effect only from 2014 to 2016. Then the states
   pick up their share of the burden. The problem is the federal government will continue
   to control all the rules. This leaves no room for states to be innovative.
3. We
   have seen HHS refuse to give Indiana’s Medicaid improvement plan a waiver even
   though it is wildly successful. Its success can be attributed to several
   factors.
4.  It
   provides incentives for patients not to overuse the system.
5.  It
   expands the income requirements for eligibility into the system.
6. The
   definition of poverty is an obsolete 1955 definition. Obamacare eligibility
   requirement is 133% of the poverty level or $14,400 per year.
7.  Indiana requires eligible consumers to put up a
   small percentage of their income (2-5%) to enter into its Medicaid system. It
   also permits recipients to put money not spent into a health saving account for
   future use.
8. The
   effect of this is to encourage patients not to overuse the healthcare system
   and not to show up in emergency rooms for care that can easily be performed in
   less complex facilities.
9. Simple observations have led to intensive
   studying of the population that costs the most money to treat. 

 It turns out that, “According to a report released earlier this year by the Agency for Healthcare Research and Quality,
1 percent of patients accounted for roughly a fifth of all health care spending
in 2009, or more than $90,000 per person. Five percent of patients accounted
for half of overall health care costs. By contrast, 50 percent of patients
accounted for only 3 percent of health care spending, the AHRQ report found.”

The high spending by this small
percentage of high utilizers is not linked to a patient simply being uninsured
without access to a primary care physician.

According to a recent report from
the IMS Institute for Healthcare Informatics,
1 percent of patients in a survey of 10.6 million health plan members accounted
for 25 percent of their plan's total costs, and 5 percent accounted for
slightly more than half, mirroring the AHRQ survey.

Most ER physicians and social workers
know who shows up in emergency rooms over and over again and which patients are
readmitted to the hospital over and over again. These physicians also know the
reason for this. However, no one ever asks these physicians the reasons.

Isa Gorman analyzed the data
of the value of insurance for the indigent in saving lives.” Does Lack of Health Insurance
Kill?” She demonstrates that all the studies that support
the notion of a lack of insurance are in error.

The Richard Kronick study proves they are wrong.

Kronick found that “adjusted for demographic, health status, and
health behavior characteristics, the risk of subsequent mortality is no
different for uninsured respondents than for those covered by
employer-sponsored group insurance at base line.”

 He concluded that “the
Institute of Medicine’s estimate was that lack of insurance leads to 18,000
excess deaths each year is almost certainly incorrect.”

Arkansas Gov. Mike Beebe (D.) first announced that he had reached
a deal with the Obama administration to use the Affordable Care Act’s private
insurance exchanges to expand coverage to poor Arkansans.

His Democratic base for the deal congratulated Governor Bebee.
Arkansas was able to accept health insurance exchanges. The Republican majority
in the state’s congress was skeptical. 

Governor Beebe reached a deal with
Kathleen Sibelius to provide the poor in Arkansas with higher quality private
insurance through the health insurance exchanges.

“Then the Good Friday memo came from HHS stating that its deal
with Arkansas is not that different from its traditional endorsement of the use
of private managed-care plans to administer the Medicaid benefit.”

“The memo makes clear that it will only permit state variations on
the coverage expansion that are “comparable” to what HHS would have spent
otherwise.”

“The HHS memo explicitly
states that these private plans cannot modernize the design of Medicaid
insurance to make it more cost-effective.”

 Governor Beebe was surprised and deceived.

“A Good Friday memo from the U.S.
Department of Health and Human Services, however, splashes cold water on that
aspiration. It’s now clear that the Beebe-HHS deal applies a kind of
private-sector window dressing on the dysfunctional Medicaid program, and it’s
not obvious that the Arkansas legislature should go along.”

According to the
law these low income individuals will be automatically enrolled in Medicaid with
significantly expanded insurance coverage. Medicaid
has been plagued by concerns about its quality, access, and financing virtually
since its inception.

Obamacare is
supposed to add 17 million new patients to the rolls of Medicaid.

Medicaid had posed a severe fiscal threat to many
state budgets. The federal restrictions on the states Medicaid program’s
management has limited the state’s ability to manage states budgets and adjust
payment of the severe low reimbursement to Medicaid providers.

The result has been severe underpayment of
physicians. The underpayment resulted in a lack of physicians’ participation in
the Medicaid program and limited access to care. In turn this has led to
significantly worse outcomes and higher mortality rates for Medicaid recipients
vs. private insured and Medicare.

“Under
the Obamacare, individuals and families with incomes between 138 percent and
400 percent of the Federal Poverty Level (FPL) will be eligible for generous
premium subsidies and cost-sharing credits, which they can use to offset the
cost of purchasing private insurance on state or federal insurance exchanges
created under the law.”

I have a feeling Governor John Kasich (R)
of Ohio fell for the same bogus deal as he agreed to sign up for the health
insurance exchanges. His Republican base is screaming their lungs out.

He will get his rude awaking soon as HHS
changes the deal he thought he got.

Medicaid is a failed program medically
and fiscally. Adding more recipients is not going to solve Medicaid problems.
Accepting the health insurance exchanges is going to make the states’ budget
problems worse.

An innovative program such as Indiana’s
Health Plan can do much more toward making Medicaid viable. The Obama
administration has objected to this plan.

Why? I can think of several possible reasons
including the desire to have the healthcare system result in total collapse.

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

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Stanley Feld
M.D.,FACP,MACE

I have predicted Obamacare will fail ever
since its passage. Proponents of Obamacare believe Obamacare is America’s last
hope for meaningful healthcare reform with affordable care for all.

They now admit there are some problems
with Obamacare but little tweaks will fix it.

Obamacare is not America’s last chance for
healthcare reform. Obamacare is a series of regulations pasted on to an already
dysfunctional healthcare system. It is destined to collapse on it own weight
and regulations. There are over 20,000 new regulations to date with thousands
coming each week as we get closer to January 1,2014.

I believe the business model I outlined
using 2013 technology is the system that will align all the stakeholders’
incentives and provide universal care at an affordable cost for all.

It will provide freedom of choice and
enhance the patient physician relationship. It will be a system that is patient
centered as opposed to Obamacare being government and outcome centered.

An outcome centered healthcare system puts
the government and the healthcare insurance industry in control of medical care
decisions. It will control access to care and result in rationing medical care.

The passage of Obamacare was a political
farce.

The bill was slipped through the Senate just
before dawn three Christmas eves ago with only one Republican vote in both
houses of congress. Obamacare is not a bipartisan act.

Nancy Pelosi told the American public and congress
that we would not know what is in it until we pass it.

We have been told that most of congress has not
read the act completely.

The new entitlement’s start-up date is October
2013. The implementation date is January 1,2014. No one is ready for either
date.

 “The size and
complexity of the Affordable Care Act meant that its implementation was never
going to easy. But behind the scenes, even states that support or might support
the Affordable Care Act are frustrated about the Health and Human Services
Department's special combination of rigidity and ineptitude.”

Individual
state governments have tried to get a clear idea of how Obamacare would work in
practice with the health insurance exchange.

 The states are terrified of the economic burden the health
exchanges could impose on their deficit-ridden states.

The Supreme Court has given the states a choice of signing on
whereas there was not a choice in the original bill.  

Some states felt they could not turn down the health insurance
exchange because the Obama administration was offering them too much money,

The Obama administration is starting to make preliminary deals
with states that have rejected the health insurance exchanges at this point.

The administration is giving Ohio and Arkansas more money to pay
for health insurance for people earning up to 133% above the poverty level. (Income
of $14,400 a year). This deal nowhere as creative as the Indiana Health Plan
and will cover many fewer people.

This offer will not cover people who really need insurance.

The preliminary deals with Arkansas and Ohio will be more costly
that deals with other states. It is questionable whether the Obama
administration has the authority to spend the additional money.

As new regulations keep being produced none of the real hard
operational questions are being answered.

A regulation usually requires 60 days of public comment. The Obama
administration has unilaterally shortened public comment to 30 days. The shortened
public comment period for new regulations can be challenged by the states and
congress.

There are other problems that states are having with Medicaid and
Obamacare. Many feel that HHS is treating states not as partners but as serfs
to the federal government.

The central government is building a data hub to determine who is
eligible for Medicaid and Obamacare health insurance exchanges. This new
federal bureaucracy will dispense insurance subsidies and police the market.

Many states want to cut their administrative costs to balance
their budget. They are combining the application process for Medicaid, food
stamps, cash assistance and other antipoverty programs into one agency.

HHS's privacy rules say the hub can only be used for Obamacare.
HHS will force states to become less efficient by having a free standing
bureaucracy for Obamacare and has flatly refused to consider participating
states’ requests for combining all the agencies under one roof.

Twenty-four (24) states have still refused to participate as of
May 15^th. The Obama administration will have to run a federal
exchange in those states.

HHS has not revealed how it will handle these exchanges. The
agency running the federal exchange won't reveal how it will operate.

The irony is that many of the states would participate if HHS gave
them more flexibility to manage their own programs and control costs.

“At a House Energy and Commerce hearing on Thursday, Obamacare
point man Gary Cohen all but took the Fifth on how he'll deal with this and
other challenges.”

It seem as if it is going to be a vast
undertaking that can not possible be in place in October or operational on
January 1^st, 2014.

Chris Christie (N.J.) and Bill Halsam
(Tenn) wanted to participate but now feel the health insurance exchange in not
a sane or rational marketplace. The costs
and risks were too high.

“This is all-or-nothing
political gambit is meant to put the governors of states not participating in a
bad political spot at home if they don’t participate.”

“At this point, the total administrative burden on the federal
government has massively increased. Yet neither the federal government nor the
states have the human or financial resources to discharge these tasks in a
timely fashion, making it highly unlikely that these exchanges will be up and
running by January 1, 2014.”

 Making things worse for
Obamacare is no fewer than 18 Democratic Senators came out against Obamacare's
$28 billion tax on medical device sales.

The list of Democratic Senators
includes Chuck Schumer, Dick Durbin and Patty Murray. Either they believe it or
the lobbyists got to them.

The medical device industry has received little
guidance about how to comply with the tax. This has caused significant
uncertainty and confusion for medical device businesses.

These are some of the problems Obamacare is
facing.

President Obama is unfazed. In the face of criticism from
Democrats about his incompetent implementation of Obamacare, he is going on the road to spin some misinformation and make it
look like Obamacare is great and his critics are political.

President Obama co-opted
Mother’s Day in his latest campaign to sell Obamacare that begins now and will
last until the 2014.

President Obama kicked off
another campaign-style effort to get people to sign up for the so-called
Affordable Care Act.

“In a
statement dripping with condescension Obama tried to blame misinformation for
his health care troubles.”

He said, “Precisely because there’re been so much
misinformation, sometimes people may not have a sense of what the law actually
does.   

He continued,   “We’re going to need everybody out there to make sure
they get the right information.”

“Don’t
just read a blog or some commentary from some pundit that has a political
agenda.  Make sure you know what the actual facts.”

Don’t
let people confuse you.  Don’t let them run the okeydokey on you. 
Don’t be bamboozled.”

Doesn’t this sound like his
political campaign of 2012?

President Obama seems to
have forgotten that a lot of misinformation about Obamacare results from his
statements.

Wasn’t he was the guy that
said, “If you like you doctor you will be able to
keep your doctor and if you like your healthcare plan you can keep your
healthcare plan.”

None of this is true
including free choice, affordable healthcare insurance, and free access to
care.

I wonder when Americans are
going to get tired of President Obama’s misinformation and false promises.

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

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