Stanley Feld M.D., FACP,
MACE

Health
Insurance Exchanges are supposed to be state-regulated
and standardized health care plans in the United
States, from which individuals may purchase health insurance
coverage eligible for federal subsidies.

All exchanges must be fully certified and
operational by January 1, 2014 under federal law.^[1]

The health insurance
exchanges in all states are not going to be operational on time.

However, Americans of
all income brackets are experiencing the increases in 20 hidden taxes in
Obamacare right now. The increase in taxes is supposed to amount to $1.2
trillion dollars.

The health insurance
exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing
despite President Obama’s publicity.

If they are created President
Obama will have a clear path to the Democratic Party’s cherished Public Option.

This will be a giant
step to achieving a single party payer healthcare system.

Unfortunately, the
single party payer system will in turn fail because it will be unaffordable for
America.

Individual states and
the healthcare insurance industry will do everything they can to undermine the
success of health insurance exchanges.

Federal officials never
thought they would end up running the Health Insurance Exchanges. President
Obama’s plan was to dump this formidable and complex task on the states. Half
the states have refused to participate.

“Obama
administration officials are getting ready to set up and operate new health insurance markets
in about half the states, where local officials appear unwilling or unable to
do so.” 

“So far, Governors of 13 states with nearly
one-third of the United States population have sent letters to the Obama administration
saying they intend to set up exchanges. Complete applications are due on Nov.
16, 2013.”

In other words, 37 states have not signed up
yet. Once those 13 states that have signed up and start calculating their costs
for setting up and running the health insurance exchanges I suspect they will
also withdraw.

The Secretary of Health and
Human Services, Kathleen Sibelius’ plan was to complete the regulations for the
states to start the health insurance exchanges by January 1,2014. 

The Secretary of Health and
Human Service has emphasized that states must meet her standards of transparency
and accountability.

The federal government requires
state exchanges to develop budgets and project operating costs, revenues and
expenditures to the central government’s satisfaction.

States must explain how the
revenue will be generated and how the exchange will address any financial
deficits.

The federal government wants to
set up the rules and require the states to execute these rules at the states
expense. President Obama promised to “fund” the exchanges for the states for
two years. After that they are on their own.

The health exchange programs
will be delayed because the government pledged to set up the health exchanges
in the states that opted out of the program. It has not started to set up these
exchanges.

Creation
of Health Insurance Exchanges is a complex and expensive task. States are
required to operate under a balanced budget. States cannot balance their
budgets with health insurance exchanges unless they further increase taxes.

 “Federal and state officials and health policy experts expect that
the federal government will run the exchanges in about half of the 50 states.”

 My
guess is it will be closer to 35 states. Federal officials are preparing to do
the job. It will be poorly executed and difficult politically.

President Obama knows the
public fears a federal takeover of the healthcare system. He realizes the
public understands the health Insurance exchanges are one more step toward a
federal takeover of the healthcare system.

The Obama administration
does not want to encourage that fear by taking over the Health Insurance
Exchanges.

Neither does the Obama
administration want to alienate state officials whose help they need to execute
the federally run healthcare exchanges.

The federal government
does not have the manpower to run all these exchanges. It is outsourcing the
work to private contractors.

We have seen the
disastrous abuse to physicians by outsourcing fraud and abuse investigations to
private contractors.

“The Obama
administration has invited advertising agencies to devise an elaborate
“outreach and education campaign” to publicize the federal exchanges and their
potential benefits for consumers.”

The Federal officials
are hiring private contractors to provide “in-person assistance” to consumers
and to operate call centers.

President Obama’s
administration has attacked Mitt Romney and Bain Capital for outsourcing of
jobs.

President Obama is now outsourcing
these jobs to a foreign company, while America desperately needs jobs here.
This is duplicity to its highest degree.

He better keep it out of
the mainstream media or Mitt Romney out to get it in the mainstream media
somehow.

Federal officials
have turned to the American subsidiary of a Canadian company, the CGI Group, to
provide information technology services to the federal exchanges under a
contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency
of state health insurance exchanges yet planning for the federal exchanges has been done
almost entirely behind closed doors.

“We have gotten
little bits of information here and there about how the federal exchange might
operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance
Department.

“I was on a panel at
Rockhurst University here, and I was asked, ‘Where is the Web site for the
federal exchange?’ I chuckled. There really isn’t any federal exchange Web
site.”

In New Hampshire, Thomas
M. Harte, the president of Landmark Benefits, which arranges health insurance
for 300 employers of all sizes, said:

“Nobody has any idea
what the federal exchange will look like. There has not been much communication
between officials drafting plans for the federal exchange and the people who
will use it: consumers, employers, brokers and insurers.”

Administration officials
have not set forth a budget for the federal exchanges.

“They said they
intended to charge “user fees” to the participating health insurance plans.

It is unclear whether
the fees are subject to approval by Congress or whether insurers could pass the
costs on to consumers.”

The Federal Government
is not telling us what they are going to do. It is not following its call for transparent
regulations.

It is pretty clear to me
this will be one of many steps toward the destruction of the healthcare system.
The healthcare system will self implode. At that point everyone will be begging
the government to take over.

It will be impossible
for President Obama to take over a business the government cannot afford.

A key to Repairing the
Healthcare System is to decrease the outsourcing and bureaucratic complexity.

It is to let Americans
be independent, own their healthcare dollars and their health and not be
dependent on government complexity, inefficiency and rationing of care.

Entitlements do not save
money!

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

Please have a friend subscribe

Stanley Feld M.D.,FACP,MACE

As we approach November 6^th (election day)
we will be subjected to more fibs, distortions and lies from President Obama
and his administration.

He has had a miserable record during his first term in
office. The only tactic he has left is to make villains out of Mitt Romney and
Paul Ryan while he makes promises he cannot keep. He has not kept most of the
promises he made before he took office.

As soon as Paul Ryan finished his speech at the
Republic convention he was accused of telling lies.

Carl Sandburg said in The Prairie Years “If you tell a lies enough times it becomes
the truth. The problem is a liar must have a good memory.”

Mr. Sandburg left out the fact that your audience has
to have a good memory to recall your first lie. One of the lies President Obama
told was the lies of Jonathan Gruber in 2009.

At the height of the Obamacare debate, Mr. Gruber’s
lie was all over the op-ed pages throughout the nation. Mr. Gruber, an MIT
economist and architect of Obamacare, stated that Obamacare would reduce the
cost of healthcare insurance for everyone.

“What
we know for sure “is
that [the bill] will lower the cost of buying non-group health insurance.” 

The law
permits children under 26 years old to stay on their parents’ healthcare
insurance plan.

Immediately, the parents’ healthcare insurance premiums rose
significantly.

           Jonathan Gruber
is now telling state governments that the law will significantly increase the
cost of insurance for everyone.

 The result is the opposite of the promise.

President Obama brags about this achievement. In
reality he gave the healthcare insurance industry an excuse to raise premiums.

 Jonathan Gruber asserted that in 2016, young people would save 13 percent, and older
people 31 percent, on their insurance premiums.

 “President Obama, too, touted the
bill’s ability to “bend the cost curve,” repeatedly
promising that the law would “bring down premiums by
$2,500 for the typical family.”

Jonathan Gruber now: “Obamacare will increase premiums by 19-30 percent.”

President Obama now figures he can call Paul
Ryan a liar.

He has a sympathetic audience in the traditional
media. However, President Obama with Obamacare is throwing Grandma over the
cliff. In fact it looks like he is pulling a Thelma and Louise with the United
Sates of America.

 http://youtu.be/4z88U915uq8

President Obama still seems like a nice guy. Everyone
would love to believe in him but they just can’t trust him.

 During
his speech Paul Ryan said,

“And the biggest, coldest power play of all in Obamacare came at
the expense of the elderly.

You see, even with all the hidden taxes to pay
for the health care takeover, even with new taxes on nearly a million small
businesses, the planners in Washington still didn’t have enough money. 
They needed more.  They needed hundreds of billions more.”

 “So, they just took it all away from
Medicare.  Seven hundred and sixteen billion dollars,
funneled out of Medicare by President Obama.  An obligation we
have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn’t even ask for. 
The greatest threat to Medicare is Obamacare.”

Paul Ryan’s statement is correct.  President Obama accused Paul Ryan of leaving
the $716 billion dollars in Medicare. He did but he does not use it for
Obamacare. Mitt Romney will repeal Obamacare his first day in office.  

The
$716 billion left in Medicare by Paul Ryan will shore up the solvency of the
Medicare program itself.

Below
is what President Obama was using the $716 billion dollars in Medicare cuts for.
Notice the $1.2 trillion dollars in new taxes and the $716 billion dollars in
Medicare cuts are being used to pay $644 billion dollars for Medicaid expansion
and $1.19 trillion dollars for subsided exchanges. The a deficit would be $141
billion dollars.

Does
anyone believe the deficit would be that low? I doubt it.

President Obama was going to cut $542 billion from
Medicare in the original CBO scoring.

It
turns out that President Obama is the liar. Someone ought to tell President
Obama, “The public is getting tired of
his lies once they understand them.”

Paul
Ryan also said,

 “President Obama created a bipartisan
debt commission. They came back with an urgent report.  He thanked them,
sent them on their way, and then did exactly nothing.”

Paul Ryan is
absolutely correct. Simpson and Bowles are still steaming about their
commission’s treatment by the President. Paul Ryan then went on to say,

“Republicans stepped up with good-faith reforms and solutions
equal to the problems.  How did the president respond?  By doing
nothing – nothing except to dodge and demagogue the issue.”

This is what Erskine Bowles,
President Clinton’s former chief of staff and the leader of President Obama’s
deficit commission, had to say about Paul Ryan in September of 2011;

“I’m
telling you, this guy is amazing. I always thought I was okay with arithmetic.
This guy can run circles around me. He is honest, he is
straightforward, he is sincere. And the budget he came forward with
is just like Paul Ryan. It is a sensible,
straightforward, honest, serious budget and it cut the budget deficit just like
we did by four trillion dollars.”

President
Obama attacked Paul Ryan by saying Ryan voted against the Simpson-Bowles
commission.

The
traditional mainstream media has supported President Obama’s attack without
fact checking. The media was satisfied that President Obama’s message
neutralized Mr. Ryan’s attack on the President.

The
mainstream media never bothered to find out why Paul Ryan voted against the
Simpson-Bowles recommendations.

The
media figured it, the media, is the message. President Obama figured the
media’s message would take care of Mr. Ryan. Mr. Ryan was clearly a hypocrite
to the mainstream media.

 It’s
true that Paul Ryan voted against the Simpson-Bowles recommendations because Simpson-Bowles
raised taxes while doing little
to nothing about health-care spending, the biggest driver of
growing deficits.

By
rejecting Simpson-Bowles, Ryan decided to put forward his own plan for deficit
reduction the Path
to Prosperity.

On
the other hand this is what Erskine Bowles had to say about President Obama’s
budget:

“President Obama, as you remember, came out with a budget.
And I don’t think anybody took that budget very seriously. The
Senate voted against it 97 to nothing.

He therefore, after a lot of pressure from folks like me, he came
out with a new budget framework. And in that budget framework, he cuts the
budget by four trillion dollars over twelve years. And, to be candid, this four trillion dollars cut was very heavily back-end loaded.
So, that if you looked at it on a ten-year basis and compared apples to apples,
it really was about a two and a half trillion dollar cut.”

More tricks to deceive the public. I could go on and on. Americans
have been fibbed and lied to by its purveyor of hope (President Obama).

However, I think President Obama has lost his tall with the
public. He is now calling for sympathy. He wants the public to let him finish
the difficult work he started.

I hope the public does not give him that chance.

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

Please have a friend subscribe

Stanley
Feld M.D.,FACP,MACE

The need for effective Medicare reform is becoming
increasingly apparent. Both the public and providers do not like Obamacare.

The cost overruns for Obamacare are hidden
from the public but are becoming evident.

There is an ideological divide between policies
that work and policies that don’t work.

President Obama believes the only policies
that work are government policies that control providers, insurers, and
consumers.

There are multiple examples that have shown
that these policies have never worked. Government has never controlled spending
for any projects for myriads of reasons.

What makes President Obama think his
government can force the healthcare system to become more efficient and control
healthcare costs?

Price controls and restriction of access to
medical care will not work.  

Entitlement programs have been fertile
grounds for fraud and abuse by all the vested interests including government
agencies.

Government should be of the people for the
people.

Government should level the playing field so
secondary stakeholders compete for primary stakeholders’ business.

I voted for President Obama because I thought
he offered this hope. He fooled me as he has fooled millions of other Americans.

President Obama has a cool, seductive
speaking delivery. He is general enough to make one think he believes in what
you believe but his agenda is central government control over all areas of life.

The agenda is the opposite of the individual
freedoms our country stands for.

None of President Obama’s policies have
worked in the last 3.5 years.   

He has snuck in higher taxes on the middle
class for his healthcare bill and has not lowered healthcare costs.  Healthcare costs have increased.

Americans are not dumb. They are beginning to
realize they are on the road to serfdom.

President Obama is using every dirty trick
known in American politics to attack Governor Romney and now Representative
Ryan in order to keep  from talking about
his record on jobs, the economy, healthcare costs, the deficit and its meaning,
our National Security, foreign policy, energy, and immigration.

For some reason the traditional media is on
President Obama side. The result has been a loss of their audience by newspapers,
magazines, and network television.  

America is in a fiscal crunch. Entitlement
spending is at the center of the fiscal crunch and must be reformed effectively.

 “Medicare
is at the center of our fiscal crunch, with outlays that have grown about twice
as fast as the economy over the past decade, according to the Congressional
Budget Office (CBO)”.

 The fiscal crunch is only going to get worse
as 76 million baby boomers retire in the next two decades.

“Medicare
will consume an ever-increasing share of the federal budget unless policies are
adopted to bend Medicare's cost curve.”

The Medicare trust fund has been depleted by the
federal government borrowing from the trust fund. Over time and as unemployment
rises less Americans are paying into the fund. The government’s depletion of
the fund has occurred since the beginning of Medicare.

The Medicare premiums paid by seniors for
Medicare Part B is going to double in the next two years. This is a tax on
seniors on fixed incomes that no one is talking about and few can afford.  

President Obama is expanding an entitlement
with Obamacare.  It will accelerate the
consequences of the fiscal crunch.

“Even
if the substantial reductions in payments to health care providers included in
the Affordable Care Act (ACA) are fully implemented and Congress allows the
27.4% reduction in physician payments required under current law to go through,
Medicare spending will continue to grow at unsustainable rates.”

 The Ryan
plan can change the direction of Medicare and save it.

         What does
the Ryan Plan do?

• No one over 55 years old is affected.
• People younger than 55 will have the option to choose
  between traditional Medicare or premium support from government to pay for
  competing private healthcare insurance plans.
• Traditional Medicare is a defined benefit plan. The
  government decides on the price
  it will pay for medical services.
• Ryan’s plan is a "defined contribution" plan. The
  government decides on an amount of money ("premium
  support") to provide to individuals to buy private insurance of
  their choice.
• Consumers will choose from an approved set of competing
  private insurance plans along with traditional
  Medicare.
• There is an open enrollment period each year, allowing
  people to choose either of the
  plans.

The goal is to force the healthcare
insurance industry to compete for patients
as well as give seniors the right to choose the most appropriate plan for
their needs.

 The Ryan plan allows competition among
in the private sector which will increase efficiency and drive down
costs.

President
Obama is scorning this system as a “voucher system.” 

Nonsense!

Once
again President Obama is obfuscating the truth with a sound bite.

Americans
55 years old and younger have paid into the system all their working life jus
as senior 55 years and older have. The “premium support” is not a free give
away as are food stamps.

Premium support is determined each year by the government
calling for competitive bidding by the healthcare insurance industry.

“ The government would then provide seniors
in each region of the country with a "premium support" equal to the
second-lowest bid in that region, or one equal to the bid of the federal
fee-for-service Medicare program — whichever is lower”.

Seniors could choose the traditional Medicare, since the
government would still contain a package of required benefits that would
constitute its comprehensive insurance coverage, just as Medicare does today.

Seniors would be guaranteed freedom of choice. A private
healthcare insurance option would equal the “premium support” payment.  

The premium of the private insurance might even become
cheaper than the Medicare premium seniors would have to pay.

The Ryan plan would allow the healthcare insurance
industry to compete with Medicare.  

The healthcare insurance industry could be forced to
lower its net profit by the competition just like it has occurred in other
industries. The competition could also force increase efficiency and quality of
product.

Tort Reform and fraud and abuse are not addressed in the
Ryan Plan yet.

The Ryan Plan is a good start to change from central
control to individual choice. It I not there yet.

 Presidential candidate
Romney’s pick of Paul Ryan as running mate has made Romney the good guy in the
Medicare issue.

“ It's
President Obama who has put Democrats in the position of being the party that
is cutting current seniors' benefits, rationing care (thanks to the IPABs), and
letting the program collapse as it becomes unsustainable.”

If
you're a senior now or in the future, Democrats are offering you nothing except
a grim, mean, rationed future when it comes to medical care.

It's the
Republicans who are offering hope for a sustainable Medicare future with
freedom of choice.

“Given
the serious fiscal problems facing this country, slowing the growth of Medicare
spending is no longer optional. The only question is how to do it.

The
Wyden–Ryan proposal outlines a strategy for Medicare reform that harnesses
market forces to control costs. It provides a real alternative to the top-down
controls favored in the Obamcare.

 Paul Ryan and Ron Wyden have defined the
policy parameters that could be the basis for real Medicare reform in 2013.

   Amazingly,
the Washington Post and liberal healthcare policy wonks are starting to think
the Ryan Plan might be a good idea.

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

Please have a friend subscribe

Stanley Feld M.D., FACP,MACE

Health Insurance Exchanges are supposed to be state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

 All exchanges must be fully certified and operational by January 1, 2014 under federal law.^[1] 

It is not going to happen on time. However the 20 hidden taxes in Obamacare are happening right now.

The health insurance exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing.

President Obama will then have a clear path to a Public Option and a single party payer healthcare system.

Unfortunately, the single party payer system will fail because it will be unaffordable for Americans and the federal government.

The states and the healthcare insurance industry will do everything they can to undermine its success.

Federal officials never thought they would end up running the Health Insurance Exchanges. Their plan was to dump this formidable and complex task on the states. Half the states refused to participate.

“Obama administration officials are getting ready to set up and operate new health insurance markets in about half the states, where local officials appear unwilling or unable to do so.”

 “So far, Governors of 13 states with nearly one-third of the United States population have sent letters to the Obama administration saying they intend to set up exchanges. Complete applications are due on Nov. 16, 2013.”

Stated another way, 37 states have not signed up yet. Once those 13 states that have signed up calculate the cost to setting up and running the health insurance exchanges I suspect they will withdraw.

The Secretary of Health and Human Services, Kathleen Sibelius’,plan was to create regulations for the states to develop the health insurance exchanges by January 1,2014. She has emphasized that states must meet her standards of transparency and accountability.

The federal government requires state exchanges to develop budgets and project operating costs, revenues and expenditures.

 There are a great many regulations attached to qualify as a state exchange.

States must explain how the revenue will be generated and how the exchange will address any financial deficits.

 The federal government wants to set up the rules that require the states to execute these rules at the states expense after the federal government funds the exchange for two years.

The health exchange program will be delayed because the government pledged to set up the health exchanges in the states that opted out of the program.

Creation of Health Insurance Exchanges is a complex and expensive task. States have to operate under a balanced budget. States cannot afford this undertaking.

“Federal and state officials and health policy experts expect that the federal government will run the exchanges in about half of the 50 states.”

My guess is it will be closer to 35 states. Federal officials are preparing to do the job but it will be a difficult political task.

The public fears a federal takeover of the healthcare system. This takeover is one more step by the government to increase its control over the healthcare system.

The Obama administration does not want to encourge that fear with its takeover of Health Insurance Exchanges.

The Obama administration does not want to alienate state officials whose help they need in the execution of the federally run healthcare exchanges.

The federal government does not have the manpower to run all these exchanges. It is outsourcing the work to private contractors.

We have seen the disastrous abuse to physicians by outsourcing fraud and abuse investigations to private contractors.

“The Obama administration has invited advertising agencies to devise an elaborate “outreach and education campaign” to publicize the federal exchanges and their potential benefits for consumers.” 

The Federal officials are hiring private contractors to provide “in-person assistance” to consumers and to operate call centers.

President Obama’s administration has attacked Mitt Romney and Bain Capital for outsourcing of jobs.

President Obama is now outsourcing these jobs to a foreign company, while America desperately needs jobs here.

Federal officials have turned to the American subsidiary of a Canadian company, the CGI Group, to provide information technology services to the federal exchanges under a contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency of state health insurance exchanges yet planning for the federal exchanges has been done almost entirely behind closed doors.

“We have gotten little bits of information here and there about how the federal exchange might operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance Department.

“I was on a panel at Rockhurst University here, and I was asked, ‘Where is the Web site for the federal exchange?’ I chuckled. There really isn’t any federal exchange Web site.”

In New Hampshire, Thomas M. Harte, the president of Landmark Benefits, which arranges health insurance for 300 employers of all sizes, said:

“Nobody has any idea what the federal exchange will look like. There has not been much communication between officials drafting plans for the federal exchange and the people who will use it: consumers, employers, brokers and insurers.”

Administration officials have not set forth a budget for the federal exchanges.

“They said they intended to charge “user fees” to the participating health insurance plans.

It is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.”

I get it.

The Federal Government is not telling us what they are going to do because they probably want to follow its non-transparent regulations.

It is pretty clear this will be one of many steps toward the destruction of the healthcare system. The healthcare system will self implode. At that point everyone will be begging the government to take over.

It will be impossible for President Obama to take over a business system it cannot afford.

A key to Repairing the Healthcare System is to decrease the outsourcing and bureaucratic complexity.

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

Please have a friend subscribe