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Obama Administration Continuously Declines To Renew Indiana’s Medicaid Waiver

 Stanley Feld M.D.,FACP,MACE

In light of the recent alleged IRS
scandel targeting certain groups, I am reminded of the Medicaid incident in
Indiana. I believe the incident is resolved now with the Obama administration
granting a waiver to Indiana after two years of bureaucratic haggling.

In 2007 Governor Mitch Daniels (R.) was
successful in getting the Indiana state legislature to pass a Medicaid reform
plan called the Healthy Indiana Plan. It is an expansion of Medicaid. It uses a consumer-driven
health plan to encourage low-income beneficiaries to take control of their
health and healthcare dollars.

This healthcare plan is a variant of my
ideal medical saving account.

 The Healthy Indiana Plan has been very successful.

Healthy Indiana Plan has been the most
innovative and successful reform of Medicaid in the history of the Medicaid
program.

The federal government’s waiver for the
plan was given in 2007 and set to expire on December 31, 2012. Indiana applied
for an extension of the Medicaid wavier in early 2011. In November 2011 the
Obama Administration rejected the state’s request to extend its federal waiver.

Over 45,000 poor Hoosiers on Medicaid
were scheduled to lose this innovative Medicaid coverage in 2013.

Medicaid is theoretically run by the
states in cooperation with the federal government.  In reality, any time a state wants to make
the tiniest changes in its
Medicaid program, it has to go hat-in-hand to the U.S. Department of Health and
Human Services with a formal request for a waiver and these waivers are usually
denied.

 This federal control has been part of the
disagreement states have with the federal government over health insurance
exchanges. The central government wants to shift the financial burden on the
states while controlling the states’ decisions.

Indiana succeeded in gaining a waiver in 2007
because it was seeking to expand Medicaid to
a group of people who weren’t then eligible for the program and because the
state’s effort required no additional outlays from the federal government.  Governor
Mitch Daniels paid for the
Medicaid expansion by increasing the state’s cigarette tax by 44 cents. It made
sense to everyone except the people that smoked. 

Patients had skin in the game because
they had to pay 2 -5% of their income for their insurance coverage. The plan
provided financial as well as wellness incentives.

We did a lot of reading on
criticism of health savings accounts,” says Seema Verma, who was the
architect of the Indiana
program. “One of the criticisms was that people didn’t have enough money to pay
for preventive care. So we took preventive care out, made that first-dollar
coverage.

“ Also, people said that people didn’t have enough for the
deductible, so we fully funded it. Then, you have to make your contribution
every month, with a 60-day grace period. If you don’t make the contribution,
you’re out of the program for 12 months. It’s a strong personal responsibility
mechanism.”

 I described the Healthy Indiana plan in
detail in January 2008 pre President Obama
.

Medicaid patients get a specified amount
of preventive care for free.  Included
are free annual physical exams, pap smears and mammograms for women,
cholesterol tests, flu shots, blood glucose screenings, and tetanus-diphtheria
screenings.

Medicaid beneficiaries have no
cost-sharing requirements (co-pays, deductibles, etc.) except for non-urgent
use of emergency rooms.

The money remaining in the Medicaid
patients’ POWER accounts at the end of the year can be applied to the following
year’s contribution only if they obtain the required free preventive disease
services.

“The program has been, by many measures, a smashing success. “What
we’re finding out is that, first of all, low-income people are just as capable
as anybody else of making wise decisions when it’s their own money that they’re
spending,” Mitch Daniels explains in a Heritage Foundation video.”

“And they’re also acting more like good consumers. They’re
visiting emergency rooms less, they’re using more generic drugs, they’re asking
for second opinions. And some real money is starting to accumulate in their
[health savings] accounts.”

The program has been
very popular. Ninety (90) percent of enrollees are
making their required monthly contributions. Employers didn’t dump their
workers onto the program, crowding others out, because you needed to be
uninsured for six months in order to be eligible for it.

 “The program’s level of
satisfaction is at an unheard-of 98 percent approval rating,” Verma told 
Kenneth Artz.

Lower income families are not too stupid
to be wise healthcare consumers despite popular belief.

2010 study by
Mathematica Policy Research found that in the program

71 percent met the preventive care
requirement and were able to roll the balances over to the following year.  Only 39% obtained preventive care in the
first six months. It proves financial incentives work.

The lack of physician access is the
biggest reason why health outcomes for Medicaid patients lag far behind those
of individuals with private insurance.

Healthy Indiana pays better than
traditional Medicaid. The physician access trend has been reversed. Preventive
care participation rates are higher than the
privately-insured population.

Why would the Obama administration, which
controls the states’ Medicaid programs, refuse to grant a waiver for Indiana’s successful
program?

The first excuse HHS used was “ HSS  hadn’t written the regulations for Obamacare
yet.”

According to Seema Verma  “the state will now have to file a much more
complex “State Plan Amendment” that may not get approved before the Healthy
Indiana program is set to expire.”

Before his term expired Gov. Daniels
had written to HHS Secretary
Kathleen Sebelius asking her for permission to use the Healthy Indiana Plan to
handle Obamacare’s mandatory expansion of Medicaid. He had not heard back.

The Obama Administration claims to be on
the side of the poor.  Why would it not
approve a waiver of a popular program for the poor that provides the poor with
superior health care?

Whatever the reason, tens of thousands of people will be
needlessly harmed.

Regulatory
burdens and “poison pills” have been thrown at the Indiana health plan. One
such poison pill is not allowing the state to include the $1100 Power account given to Medicaid patients to make
wise medical care choices.

Yet
the government pays the healthcare insurance industry for help desks and rent
for buildings where there are help desks as direct patient care instead of
expenses.

It is
not only bewildering, it is obscene.

The
controversy continued throughout 2012 past the expiration date of the 2007
waiver into 2013.

Mike
Pence, the new governor, kept fighting off bureaucratic rules but got nowhere
through March of 2013.

The subtext of all of this is the
Obama administration wants a top down centrally controlled Medicaid system with
the financial burden on the states and Indiana wants to control its own destiny
with its successful plan.

Stuff
like the following has been going on. Diane Gerrits, CMS' director of state
demonstrations and waivers, wrote in a Feb. 25 letter that the state will have
to resubmit its application because it had not yet held two public hearings
required by law.

CMS said as a result of the failure to comply with the transparency portion of
the proposal, the state must begin a 30-day state public comment and notice
period. The state must follow with an additional 30-day federal public comment.

This
has been going on since 2011

Governor
Mike Pence fired back,

 "The Feb. 25, 2013, letter from HHS does not
indicate in any way that the waiver application process has been
jeopardized," he wrote Thursday. "It does, however, speak to the
flawed bureaucratic process that has impeded progress on our successful Healthy
Indiana Plan."

The
Obama administration is trying to destroy all health savings accounts both
public and private. This is probably the reason for these artificial delays.

Suddenly,
in mid April, under public pressure and possibly the impending IRS scandal Indiana’s
waiver request was approved.

This
is a happy ending to the Indiana saga and perhaps a model to get all the
Medicaid programs out of the deep ditch they are in.

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

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Don’t Confuse Me With Facts

Stanley
Feld M.D.,FACP,MACE

The Obama administration refuses to believe that
physicians are not interested in seeing Medicaid patients. The Obama
administration must think that by increasing Medicaid enrollment the number of
physicians willing to see these patients will increase. I believe the Obama
administration is wrong.

A
survey called the Health Tracking Study Physician Survey,
sponsored by the Center for Studying Health System Change, polled more than
4,700 physicians around the country in 2008.

The survey covered many private practice
issues. One question surveyed was about new patients these physicians would
likely accept.

The survey showed that Internists are 8.5 times
more likely to reject all Medicaid patients as opposed to patients with private
insurance.


There is an additional cohort of doctors who
only accept “some” (i.e. reject most) new Medicaid patients.

These numbers might surprise some but they
reflect reality.

 The physicians who accept “all” or “most”
Medicaid patients are a concentrated minority.

This means that if you have Medicaid
insurance coverage it will be very hard to find a physician who will see you.

Medicaid and MD

 

The administration refuses to believe
that the 32 million new Medicaid patients will have a difficult time finding a
physician.

Most other observers accept the fact that
Medicaid beneficiaries have a tough time finding physicians. The main reason is
due to the fact that Medicaid deeply underpays physicians and hospitals for
their services.

There is also resistance by progressive
thinkers to believe that Medicaid coverage has poor performance outcomes.

In reality Medicaid coverage is bad
insurance coverage.

Scott Gottlieb M.D.’s article in the WSJ in 2011
stated;
 

Medicaid Is Worse Than No Coverage at All!

“New
research shows that patients on this government plan fare poorly. The question is
why does the President Obama want to shove one in four Americans into it?"

Dr. Gottlieb’s question is a very good
question.

The Oregon Experiment just published in
the New England Journal of Medicine reached the same conclusion.

We found no significant effect of Medicaid coverage on the prevalence
o
r diagnosis of hypertension or high cholesterol levels or on the use of
medication for these conditions. Medicaid coverage significantly increased the
probability of a diagnosis of diabetes and the use of diabetes medication, but
we observed no significant effect on average glycated hemoglobin levels or on
the percentage of participants with levels of 6.5% or higher.”

The was no difference
in “clinical outcomes.”  However, as I
explained on many occasions, in the past there are large defects in measuring
clinical outcomes.

In additional, the
findings in clinical outcome studies are often misinterpreted.

Medicaid coverage decreased the probability of a positive
screening for depression (−9.15 percentage points; 95% confidence interval,
−16.70 to −1.60; P=0.02)
, increased the use of many preventive services, and
nearly eliminated catastrophic out-of-pocket medical expenditures.”

The results of
screening for depression in the Oregon Experiment are not statistically
significant. In order to be statistically significant a p value has to be less
that .05.

Ezra Klein of the Washington Post found the
words to publish the results as very positive for Medicaid
coverage using the
Oregon Experiment as proof. The article was entitled Here’s what the Oregon Medicaid
study really said”

Since the media
is the message Ezra Klein used the media to get his biased message out even if
the message is wrong.

He might be
right that Medicaid coverage is important but the Oregon Experiment did not
prove it.

The real
problem with the Oregon Experiment is that the design of the study is
defective. If a study’s design is wrong the conclusions are wrong on both sides
of the argument.

There are
real structural problems with Medicaid coverage in its present form. Its
reimbursement method is also wrong. The only way to provide quality affordable
care to lower income families is to fix Medicaid’s structural defects.

To force 32
million people into a defective system is going to lead to disastrous fiscal
and medical care consequences.

I have to think
the Obama administration does not care about the results or the administration is
blinded by its own ideology.

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

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Surprises For Physicians Coming With In Health Insurance Exchanges

Stanley Feld M.D.,FACP, MACE

 Two
important components of Obamacare are Accountable Care Organizations (ACOs) and
Health Insurance Exchanges (HIEs).


The
adoption of both by medical communities and the states has been slow for good
reason.

I have
discussed the difficulties of setting up and the executing effective Accountable
Care Organizations
.

Some hospital systems are trying to set up ACO’s. These hospital systems
are buying up physicians’ practices and trying to develop integrated care
organizations.

The hospital systems are buying the physicians’ intellectual property and
surgical skills sets. It will not work once physicians realize what happened.

The relationship between community hospital systems and practicing
physicians had always been tense. Physicians do not trust hospitals and hospitals
do not trust physicians.

Some physician groups are trying to develop their own ACOs. They are trying
to convert hospital systems from being providers of patient care to vendors for
their physician ACO.

If there are two hospitals in a community or town the hospital systems
might become competitive.

The huge problem for physicians is the assuming of risk. If healthcare
insurance companies cannot manage risk, why would physicians think they can
manage risk?

 A variable that cannot be controlled
in managing risk are patients. With all the obesity and the increase in
diabetes mellitus it seems patients do not have the incentives to manage their
own risks.

 Patients and physicians must be provided with appropriate financial
incentives if there is the slightest chance of managing risk and decreasing the
cost of healthcare.

 The adoption of ACOs has been slower than the Obama administration has anticipated.
  

 Adoption
of the Health Insurance Exchanges has been slow by states. Some states
recognize the financial risk the Obama administration is trying to force on
them.

This
risk is ever present even if the federal government is going to pay the entire
bill for the first three years.

As soon as physicians realize
the risk the Health Insurance Exchanges are going to impose on them, they will
not be willing participate.

These risks become more
apparent will each succeeding release of regulation.

Kathleen Sebelius said it two
weeks ago when she said there would be plenty of surprises ahead for physicians.

Health
and Human Services Secretary Kathleen Sebelius, who told a gathering a few
weeks ago at the Harvard School of Public Health that she has been
"surprised" by the political wrangling caused so far by Obamacare,
there are likely to be plenty of surprises ahead.”

Physicians could face dramatic
financial challenges for treating patients who receive health coverage through
the Affordable Care Act's (ACA) Health Insurance Exchanges starting next year.

Insurance companies will not
process claims on patients who haven't paid their premiums in 3 months
, leaving
doctors on the hook to recoup payment directly from the patients.”

Obamacare provides a 3-month grace
period to individuals who haven't paid their premiums for insurance purchased
through the Health Insurance Exchanges.

This provision will prove to be a
problem for physicians.

In Obamacare patients who fail to
pay their premium are free to sign up for another plan provided by the Health Insurance
Exchange.  

They can also start seeing another
physician without the insurance company or new physicians being aware of the
patient’s delinquent premium record.

"Why would a doctor sign up to treat these patients] if
they're going to be completely at risk and have to collect from the patient
directly for their care?"  "This
is a really bad provision in the bill, and we've got to get it fixed."


Under traditional insurance provided
by employers, the plan is still liable for paying doctors even if the patient
or employer hasn't paid their premiums,

Under the health insurance exchange
the individual is responsible for their monthly premium. If the patients
discontinue payment of their premium the healthcare insurer is not obligated to
pay the physician for the care provided.

Most of the time patients have stopped
paying premiums because they cannot afford them. Patients buying healthcare
insurance from the Health Insurance Exchanges are lower income producing
patients. 

 The
expected annual, out-of-pocket cost for an individual is estimated to be around
$6,400 and $12,800 for a family. This is not an insignificant expense for low
wage earners.

Recent premium estimates indicate
that the premium will be higher. This could be one of the surprises Kathleen
Sibelius is referring to.

Another potential shortcoming of the
Health Insurance Exchange is the reimbursement rates provided to physicians.
The Obama administration believes Medicaid rates are sufficient.

I wonder if any of President Obama’s
healthcare policy wonks ever questioned why so many physicians do not accept
Medicaid.

The answer is simple. The
reimbursement rate is less than the physicians fixed overhead to see the patient.

Medicaid physicians are driven to
see many patients a day to try to make a living.

It would be difficult maintaining a
physician patient relationship and a high quality of care seeing over 100
patients a day.

When their overproduction is
discovered these physicians are investigated for fraudulent practices.

 The rates the healthcare insurance industry
will pay physicians will not be set until late summer.

The big provider groups are negotiating with plans on their
payments. Small groups will only get a "take it or leave it" contract
from the health plans.

It seems obvious that fewer
physicians will sign up to accept patients receiving coverage through the
Health Insurance Exchanges once physicians understand what Obamacare is doing.

 This will result in a further physician
shortage.

 The simple question is what is Obamacare
trying to do to the healthcare system?

 Is Obamacare trying to destroy the
healthcare system?

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

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Consumers Are Becoming Terrified Of Obamacare

Stanley Feld M.D.,FACP,MACE

Congress has finally figured out Obamacare’s financial burden to them
personally and their staff. They want out and are trying to sneak in a waiver for
themselves.

Millions of Americans are going to pay more for their healthcare
insurance and get less coverage and a higher deductible cost.

Can ordinary American get the same waiver as government workers?

Actuary consultants
from Oliver Wyman in an article published in the journal of the American
Academy of Actuaries, found that "around six million of the 19
million people with individual health policies are going to have to pay
more—and this even after accounting for the government subsidies offered under
the law."

 "For example, single adults age 21-29 earning
300% to 400% of the federal poverty level will be hit with an increase of 46%
even after premium assistance from tax credits."

The number of people seeking individual healthcare insurance
will be even higher when it becomes clear that employers presently providing
healthcare insurance to employees will drop the coverage and elect to pay the
penalty.

The present estimate is that 65% of employers are either
definitely going to drop healthcare coverage or are seriously considering
dropping coverage.

The
healthcare insurance industry claims the reason for the increases in premiums
is the Obama administration’s regulatory policies for participating in health
insurance exchanges.

 Obamacare's community-rating regulations, which
require insurers to accept everyone but limit or ban them from varying premiums
based on age or health.

  1.  The law
    also mandates "essential" benefits that are far more generous than
    those currently offered and thus raise the premiums.
  2. The healthcare insurance industry will be
    required to pay a tax on every healthcare insurance policy sold through the
    health insurance exchange. The industry is anticipating the tax and passing it
    on the anticipated cost to the consumer.
  3. Employers with over 50 employees are decreasing the
    number of employees to less than 50 employees so as not to pay a penalty for
    not providing insurance.
  4. Employers are not required to
    provide insurance for employees working less that 30 hours a week and so
    employers are decreasing employee work hours.

 The Bureau of Labor
Statistics reported on a category of workers who will almost surely be
involuntarily under-employed as a result of health reform.

“The present
estimate is that 10 million part-timers now working 30-34 hours per week will
have their work week decreased to under 30 hours a week.”

According
to Congressional Budget Office projections in July and September 2012, three
million people will lose their insurance altogether in 2014 due to Obamacare.

Six
million will have to pay the individual-mandate tax penalty in 2016 because
they don't want or won't be able to afford coverage, even with the government subsidies.

It is anybody’s guess how many people will be uninsured. The more
uninsured people that are eliminated from the insurance pool the higher the
insurance premium for those insured.

Rather than providing universal affordable care the Obama
administration has created a system that will result in more uninsured consumers and faced with unaffordable costs.

Are all these people going to qualify for Medicaid? I do not believe so.
They will earn too much to qualify for Medicaid and too little money to afford
the upcoming premiums.

It is estimated that 30 to 40 million American families’ will
experience an adverse affect in healthcare coverage as a result of Obamacare.

Americans are becoming concerned as the reality of the negative effects
of Obamacare become clear.

Even the traditional mainstream media is starting to report those
concerns as Obamacare’s negative effects are being felt.

Theoretically Obamacare sounds good. Practically it will collapse
the healthcare system.

Health and Human Services Secretary Kathleen Sebelius, who told a
gathering a few weeks ago at the Harvard School of Public Health that she has
been "surprised" by the political wrangling caused so far by Obamacare,
there are likely to be plenty of surprises ahead.”

What are the other surprises? What is going to happen to all the
uninsured and underinsured?

It looks like the outcomes are going to be the opposite of the goal of
Obamacare.

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

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Why Does Congress Want to Exempt Itself from Obamacare?

 Stanley Feld
M.D.,FACP.MACE

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

 

 
.
 
 

 

http://youtu.be/Y9airckwqA8

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

West Virginia Senator Jay Rockerfeller said Obamacare is beyond
comprehension.

  

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

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

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

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

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

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

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

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

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

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


  

http://youtu.be/KoE1R-xH5To

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

Congress is content to let the rest
of us suffer.

What is
congress afraid of?

 

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

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

1. They fear the
impact on Capitol Hill employment.

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

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

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

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

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

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

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

 

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

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

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

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

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

  

 

 

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

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

This is the petition

To: 

Senator Harry Reid, Senate Majority Leader 


Rep. Nancy Pelosi, House Minority Leader 

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


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


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


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

Sincerely, 

[Your name]

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

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

 

Please sign
the petition. Thank you.

 

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

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The Traditional Mainstream Media Is Waking Up To Obamacare’s Defects

 Stanley Feld M.D.,FACP,MACE

 

Joe
Klein is TIME's political columnist
and author of six books, most recently “Politics
Lost
.” His weekly TIME column, "In the Arena," covers national
and international affairs. In 2004 he won the National Headliner Award for best
magazine column.

He
is a Democrat and a big supporter of President Obama.

Joe
Klein is a major liberal leaning reporter within the traditional mainstream media.
His last two articles in TIME magazine are finally starting to show
understanding of the problem with Obamacare. Here are some of these articles
more important statements.

He
starts one article with,

 Let
me try to understand this: the key incentive for small businesses to support
Obamacare was that they would be able to shop for the best deals in health care
superstores — called exchanges.

 "The Administration has had three years to set
up these exchanges. It has 
failed to do so."

 "This is a really bad sign.”

The
administration continuously claims it is not its fault programs are failing. It
is always the other guy’s fault.

The
other “guys fault” was the main
strategy of President Obama’s reelection campaign. He needs more time to make
things work.

There will be those who argue that
it’s not the Administration’s fault
. It’s the fault of the 33 states that have
refused to set up their own exchanges. Nonsense. Where was the contingency
planning?” 

The
Obama administration just announced it couldn’t have the health insurance
exchanges program ready by January 2014.

It
is refreshing to read a liberal mainstream media writer saying what I have said
all along.

The
Obama administration’s trick here was to stick the states with the costs of the
exchanges.

The
states that have thought out the consequences have refused to accept
responsibility for the health insurance exchange.

The
Obama administration has also demanded that states follow the administration’s
conditions and rules. The states have viewed this as a threat to states rights.

The
Supreme Court sided with the states’ rights argument.

 

"The Obama Administration has announced
that it won’t have the exchanges ready in time, that small businesses will be
offered one choice for the
time being — for a year, at least."

A hidden story is the administration does not have the funding
to pay the states for the health insurance exchanges for three years.

This is one of the reasons President Obama is again demanding
the ability to raise taxes in a budget agreement. Republicans are saying he has
received his tax increases January 1, 2013.

“No doubt, small-business owners will be skeptical of the Obama
Administration’s belief in the efficacy of the market system to produce lower
prices through competition. That was supposed to be the point of this plan.”

Joe Klein goes on to say,

“We are now seeing weekly examples of this Administration’s
inability to govern.
Just a few weeks ago, I 
reported on the failure of the Department of Defense and Veterans
Affairs to come up with a unified electronic health care records system.”

We have been told that the VA had an excellent electronic health
record. The VA advertises that every physician can download it and use it free.
I downloaded it.

The VA EHR is very difficult to use.

 Joe Klein had sharp
criticism for the “Head Start Program”,

 "There have been the
oblique and belated efforts to reform Head Start, a $7 billion program that a
study conducted by its own bureaucracy — the Department of Health and Human
Services — has found nearly worthless." 

 The
list of Obama administration failures is indeed endless. It is the work of a
community organizer trying to run a big business.

 “Barack
Obama is not a “how” President.
Oh, he pays lip service to government reform.
His people can tell you the number of unnecessary regulations they’ve
eliminated.”

 “
It barely scratches the surface of what needs to be done—there is no creative
destruction in government, regulations pile up on top of each other like silt,
generation after generation.”

 The
next statements confirm Joe Klein’s liberal leanings.

 “One thing is clear:
Obamacare will fail if he doesn’t start paying more attention to the details of
implementation.”

 “But, as a Democrat — as
someone who believes in activist government
— he has a vested interest in
seeing that federal programs actually work efficiently. I don’t see much
evidence that this is anywhere near the top of his priorities.”

 “And, in a larger sense,
the notion of activist government will be in peril — “  

The problem is not, as the Republicans
claim, big government. It’s bad government.”


At
last the traditional mainstream media is starting to get it. There is starting
to be recognition of the problem with government controlled and operated
systems.

I
have explained many times that the mess in the healthcare system is not a
liberal or conservative problem
.

It
is a problem in creating a healthcare system that aligns all the stakeholder
incentives and works for every consumer of healthcare.

A
consumer driven healthcare system with appropriate tort reform will have to be developed
by the government.

A
healthcare system must be constructed that allows consumers to own their
healthcare dollars and be responsible for their health and healthcare.

The
government could provide the subsidy to the needy. The result would be a
healthcare system that would be more efficient and less costly.

Individual
responsibility and freedom to choose is essential for a successful healthcare
system.

 

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

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Permalink:

Why Not Avoid The Financial Problems?

 Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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Permalink:

Why Obamacare Will Fail

Stanley Feld M.D.,FACP,MACE

Obamacare will fail because none of the stakeholders’ vested
interest are aligned.

The storm is brewing in the healthcare system.

Even Democrats are concerned.

Recently, I have been criticized for blaming the impending failure
on President Obama. President Obama would rather blame the impending failure on
congress.

 A reader wrote;

“President Obama is a nice
guy. He is trying very hard. Give him a chance.”

It is true. He seems like a nice guy. My criticism is not personal.
The fact is his philosophy and tactics are responsible for the mess. As time
goes on it seems more likely that Obamacare will not work out.

There are multiple reasons for the impending failure. A major
reason is Obamacare is developing new perverse incentives for stakeholders
rather than aligning all the stakeholders’ vested interests.

Obamacare is extraordinarily complex. It is confusing to all the stakeholders,
 especially as new rules and regulations
are being written.

By forcing the development of programs such as health insurance
exchanges, accountable care organizations, pay for performance plans,
functional electronic medical records, and the consolidation of healthcare
hospital systems and physicians against their will, Obamacare is creating
tensions and uncertainties that will be difficult to overcome.

Patients’ medical care and their relationships with their
physicians are personal issues. Obamacare is commoditizing medical care. It is
destroying the patient physician relationships. These relationships account for
at least one half of the therapeutic effect of medical treatment.

The 2300 page law usurps the power of the legislative branch of
government and shifts it to the executive branch. This is dangerous. It has
created additional tension and uncertainty for the nation.

Many congressmen who voted for the law did not read the law’s 2300
pages. The implications of much of the law were not understood. It did not have
bipartisan support.

In 2012, the executive branch of the federal government issued another
70,000 pages of guidance for participants in Obamacare. The executive branch
has created at least 22,000 new regulations and 68,000 new ICM codes.

The more complex a law becomes the more likely it is to be unsuccessful.

There is no question the healthcare system nears repairing. Healthcare
costs are exploding. Waste and bureaucracy are expanding.  Dysfunctional interactions between
stakeholders are mounting.

All of this results in an inability to deliver effective medical
care.

At present 55% of Americans of all ages receive healthcare
insurance through an employer sponsored healthcare plan. An additional 32% receive
healthcare insurance through government programs.

Thirteen percent (13%) of the population are uninsured or under
insured. Obamacare’s goal is supposed to provide healthcare insurance for that
13%.

Present predictions are that Obamacare will not provide universal
care. It is predicted that it will not save $850 billion dollars. The CBO, on
the basis of numbers provided by the administration,
predicted the law would
save $850 prior to the passage of the law.  The CBO’s current prediction is Obamacare will
cost the nation an additional  $1.2
trillion dollars over 10 years.

Healthcare insurance rates are rising by double digits each year.
Employers are passing the costs of the increasing insurance rates to their
employees through higher deductibles and copays along with lower healthcare
coverage plans.

 Obamacare will require
employers, who offer skimpy healthcare benefits such as Mini-med insurance, to
provide more robust ones.

To date the Obama administration has waived more than 2000
employers from providing more robust healthcare insurance coverage. At the time
these waivers expire companies with waivers, such as McDonald’s, will scream
bloody murder.

They will opt out of providing any healthcare insurance at all and
avoid government penalties. They will accomplish this by decreasing the number
of hours an employee will work to less than 30 hours a week. This is not good
for minimum wage workers. The uninsured rolls will increase.

The penalty of $3,000 per employee is less than the $15,000 healthcare
insurance cost per employee for employees working more than 30 hours a week.

Surveys have been published concluding that more than 50% of
employers are planning to drop healthcare insurance coverage.

The federal government is trying to discourage this by invoking
the IRS anti-abuse rules;

“The IRS has indicated that anti-abuse rules
will be implemented to curtail the use of Obamacare loopholes to
dodge the play or pay requirement.

  Yet as
some have already questioned, can the IRS legitimately utilize rule-making to modify
core components of a federal act? Or will this rule-based clean-up effort
simply spawn more lengthy litigation?”
 

Obamacare’s health insurance exchange program is in big trouble.
Less than half the states have signed up to participate.

 States have opted out
because of the potential cost overruns. States are struggling to balance their
budgets. The federal government is only going to pay for health insurance
exchanges’ development and execution for the first two years.  The cost burden will then fall on the states.

The federal government keeps extending the deadline for states to
sign up. The federal government does not have infrastructure or manpower to set
them up.

The health insurance exchanges are supposed to be up and ready to sign
up consumer up in October 2013 and operating in January 2014.

Physicians do not know what to do about Obamacare. Physicians feel
helpless. They know Obamacare cannot work. Physicians do not have a leadership
organization that can direct physicians to have an effective voice.

Accountable Care Organizations (ACO’s) will fail because physicians
are trained to use medical judgment. They have not been trained to obey the
rules of hospital administrators.

They bristle when their value is determined by hospital systems or
federal agencies such as IPAB. They prefer to have their value determined by
their patients.

Physician leadership needs a new mentality to enable physicians to
act and articulate  the steps needed to
be taken to repair the healthcare system.

Physicians want the healthcare system to function equitably for
all the stakeholders and effectively for their patients.

Medical organizations have been consistently losing membership
because it has not represented or articulated the needs of practicing
physicians.

If Obamacare works as President Obama hopes, he will have secured
his legacy and solved the long-festering problem of the uninsured.

Obamacare will not solve the problems of increasing healthcare
costs nor provide universal care in its present form. This has been a pipe
dream all along.

Another reason Obamacare will fail is because it does not consider
the cost of defensive medicine significant. President Obama is not interested
in tort reform.

Obamacare doesn’t align any of the stakeholders’ vested interests.

When Obamacare fails it will provoke a citizen backlash that will
be very difficult to overcome.

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



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Permalink:

“What A Revoltin’ Development This Is !!”

Stanley Feld M.D.,FACP,MACE

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

President Obama rhetoric causes him to contradicts
himself.

 

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

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

"What a revoltin' development this
is!"

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

 

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

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

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

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

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

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

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

“Obama's yearly budgets are record-breaking.

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

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

So this is what we end up with: 

2008:  $2.98 trillion 

2009:  $3.27 trillion

2010:  $3.46 trillion

2011: $3.60 trillion

2012: $3.65 trillion

2013:  $3.72 trillion”

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

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

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

“George W. Bush

2001-08 2.0
2002-09 3.4
Average 2.7

Barack Obama

2009-12* 9.1
2010-12 8.7
Average 8.9

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

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

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

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

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

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

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

Regulatory costs have skyrocketed during the
Obama administration.

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

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

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

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

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

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

The long-term effects are not being talked
about.                                             

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

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

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

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

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

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

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

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

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

Imagine
replacement doctors in our medical care.”

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

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

Consumers are not stupid!

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

“ What a revolting development this is.”

 

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



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