Hillary Clinton is a tax and spend Democrat. She will be an extension of the Obama administration.

Her list of promises and expenditures will continue in healthcare without success in providing better cost effective care to Americans.

Her plans for healthcare will result in increased government control of Americans’ lives and freedoms while escalating the federal deficit.

The expansion of President Obama’s failed programs will simply accelerate the path toward total collapse of our healthcare system.

Dr. Robert Kocher was special assistant to President Obama for health care and economic policy from 2009 to 2010. He was instrumental in promoting the consolidation of healthcare systems. He also encourage these healthcare systems to buy physicians practices in order to consolidate networks.

The rational was the government would then deal with one provider (the hospital system). The communications within the network would improve the quality of care and decrease the cost of care.

Theoretically, this should be true. However, the differences between the culture of hospital administrator and physicians made Dr. Kocher’s goals impossible to achieve.

“I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA.”

This last week he admitted that he was wrong and individual practicing physician groups are more efficient and less expensive than “hospital controlled networks of physicians.”

“I, along with Ezekiel Emanuel and Nancy-Ann DeParle, argued that “these reforms will unleash forces that favor integration across the continuum of care.”

“We thought only hospitals or health plans can afford to make the necessary investments” needed to provide the care we will need in a post-ACA world.”

“Now I think we were wrong to favor it.”

“What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care.”

In 2010, I predicted hospital systems owning physicians would not work. Anyone with an understanding of hospital politics and hospital administrators thinking knew it could not work.

The only reason physicians let hospital systems buy their practices was because the physicians were disgusted with the intrusive government rules and regulations and they were afraid they would be left out of the growing future trend.

It was clear to me the trend was misguided political manipulation.

The best of the clinicians tried to make it work but failed. ACO’s controlled by hospital systems were destined to fail and not save money.

ACO’s that are owned by private group practices are barely saving money and profiting by that savings.

President Obama and his administration fell for the concept because they visualized it as a path to control physicians and the healthcare system.

The Obama administration and its experts never considered what the consumers might want or need.

The healthcare insurance industry is now suing the government because the government is reneging on its reinsurance commitment totaling billions of dollars.

President Obama and Hillary Clinton are calling for a public option. This is a diversionary tactic The public option is certain to fail.

The government will continue to remain totally dependent on the healthcare insurance companies for administrative services.

The reintroduction of the public option will accelerate the collapse of the healthcare system. It appears that Ms. Clinton has no idea of the unintended consequences.

The unspoken reality of the “public option” is to destroy private healthcare insurance. It is not a good idea. It will accelerate the  collapse of the healthcare system.

I have written extensively about the consequences of the public option.

The government would squeeze private insurance out of the marketplace through regulatory control over access to care, premium control over consumers, and financial control over providers. The government would undercut the marketplace.

The government will remain dependent on the healthcare insurance industry to administer the services provided for all of the existing government healthcare services including Medicare, Medicaid and Obamacare.

The healthcare insurance industry would be in better shape because all the insurance risk would be transferred to the government.

The government programs are unsustainable at the moment. This unsustainability will escalate.

“While private plans must negotiate market rates with doctors and hospitals, a Medicare-like “public option” would fix payment rates by fiat, well below the rates that would otherwise prevail in a real market.”

President Obama said just the opposite in his Journal of the American Medical Association article.

“Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.”

President Obama’s statement is a total lie. However, the mainstream media is repeating the lie as a fact.

I hope President Obama and Hillary Clinton’s public option is no more convincing today to the public than it was in 2009.

It should be less convincing in the face of all the Obamacare failures to date.

Taxpayers are realizing that the public option will put them at more real financial risk. Taxpayer financial risk was clearly stated in the first version of the public option with no congressional questions asked.

The public option does not create a competitive marketplace and level the playing field. The competition will disappear at the taxpayers’ expense.

“Using a market mechanism, like a “health insurance exchange,” then adding a “public option” to undercut private plans and destroy a competitive private market was a political strategy.”

“All the public relations rhetoric about expanded “consumer choice,” promoting “market competition,” and keeping private plans “honest” was, of course, classic boob bait.”

It is clear that both Barack Obama and Hillary Clinton think the American public is stupid.

President Obama has been playing the American public for 71/2 years. He was correct when he told Senator Kerry and Representative Barney Frank that we don’t need a public opinion.

Obamacare was enough to get central government control of the healthcare system.

Let us think about it a little.

The federal government mandated coverage. The problem is the mandates didn’t work.

Then, Obamacare defined what healthcare plans are permissible.

These Obamacare regulations escalated the premiums and the deductibles to unaffordable heights.

The federal government determined what health benefits consumers could receive.

It didn’t work. If a benefit was not included, consumers bought that benefit outside the system or did not buy healthcare insurance if the benefits where too many.

Physicians started to not participate in the Obamacare system. This non-participation has caused a shortage of providers.

Some medical procedures or treatments were not covered. The government decided what should be covered, what level of coverage should exist and what copayments and deductibles were to be allowed.

Consumers have been protesting. The government has not been listening.

Obamacare has all the tools and power of the law to control the healthcare system without a public option.

However, the Obama administration and another future Clinton administration feel they must destroy the healthcare insurance industry in order to give the public no choice and compel them to comply.

The public option will also fail. It will lead to restrictions on freedoms and liberty. When this is clear the public will get very angry.

The cost of healthcare will rise, not fall, because of greater inefficiency and bureaucratic control.

There will be reams of red tape and unenforceable provisions as a result of government control.

There will be special deals to certain providers in order to avoid uncontrollable protest.

Who will lose? The poor and the middle class!

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

All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

 I have written many articles on why I believe Accountable Care Organizations (ACOs) will fail.

ACOs are critical to the success of Obamacare as are many the other programs introduced by the Affordable Care Act.

If one listens to the Obama administration’s propaganda about how wonderful Obamacare has been for the American public, one would be living in a dream world, not the real world.

Obamacare has failed on many levels. The administration believes the public will not remember the previous failures.

Here are the failed promises.

1. You can keep your doctor if you like your doctor.
2. You can keep your health insurance policy if you like your health insurance policy.
3. Each family will save $2500 dollars on healthcare each year.
4. Anyone making less than $250,000 a year will not pay one red      cent in new tax.

The failures of Obamacare

1. Obamacare will bend the healthcare cost curve. It bent the cost   curve for the first three years because Obamacare collected new taxes without providing healthcare services until 2014.
2. Thirty-two (32) states refused to expand Medicaid.
3. Twenty-two (22) of 50 states signed up to have state health insurance exchanges.
4. All of the states that developed state co-ops with federal loans are under water. Fourteen of the 22 are bankrupt now. All will be bankrupt by 2017 or 2018.
5. Private insurance enrollment though the federal health insurance exchanges has not increased for the last 3 years. Many of the buyers of health insurance exchange insurance have pre-existing illness. The health insurance exchanges are the only available insurance.
6. The hospital system and private practice meaningful use electronic medical records have not increased percentage wise as expected.
7. Worthless electronic medical records have increase at high costs to medical practices and hospital systems. These electronic medical records are providing some false big data information to the government and healthcare insurance industry to generate defective policy regulations. Hospital systems and physicians benefit little from the data generated.
8. Healthcare.gov is still not right after spending billions of dollars over budget.
9. Healthcare insurance premiums have skyrocketed for companies providing healthcare insurance to its employees.
10. Healthcare insurance premiums have skyrocketed for people buying healthcare insurance from the federal and the few remaining state health insurance exchanges.

The only success I have seen is in Medicaid enrollment for the poor and illegal immigrants. The access of care has not improved for tax paying people.

These are just a few of the Obamacare failures. The public would never remember there have been so many failures reading the propaganda and press releases that appear from the government in the traditional mass media.

The Obama administration’s information has blurred those failures. I sense the public does not want to know about the impending disaster in the healthcare system.

Many intelligent people ignore these facts. They keep reciting the administration’s talking points about Obamacare’s success.

ACOs were supposed to lower healthcare costs. They were supposed to provide incentives for hospital groups and private practice groups to save money by providing more efficient medical care.

If these groups did lower the cost of care they would share in the savings along with the government.

There are many ways to achieve these savings and many measurements to determine these saving.

In short, ACOs were designed to shift the financial risk of care from the government to the physicians. If the physicians didn’t hit the benchmark they would lose money. The goal was also to shift to a flat rate payment for each illness from the individual fee for service based payment system.

Physicians will get paid a flat rate for a particular illness. It means that the risk for taking care of the illness at a particular cost shifts the financial burden to physicians and not the insurance company or the government.

The gigantic defect in the system is there is no burden on the consumer nor is there an incentive for consumers to be responsible for their health or healthcare dollars.

No risk is placed on the patient for compliance with treatment advice.

I have pointed out most of the defects in the ACO model in past blogs. ACOs are essentially an HMO on steroids. Hillary Clinton did not do too well in 1993 with the HMO model

ACOs do not address the problem of the high salaries of hospital administrators and healthcare insurance executives (who provide administrative services for the government). These salaries increase the cost of the healthcare system.

Last week CMS released another final rule intended to improve the way Medicare pays accountable care organizations (ACOs) in its Medicare Shared Savings Program (MSSP).

It is clear that if another final rule is made the last final rule is not working.

The hype of this new final rule is that the Obama administration has solved what many viewed as a critical flaw in the bonus structure for Medicare’s accountable care organizations.

I think the new final rule might make ACOs fail completely.

CMS spokesman said, ”Physician buy-in is critical for the long-term sustainability of the ACO program, which could play an important role within Medicare’s broader reforms to physician payments under the Medicare Access and CHIP Reauthorization Act, or MACRA.

MACRA is another poorly designed program that makes payment for physician service more difficult to understand.

MACRA could inspire physicians to quit the whole ACO enterprise.

A group of executives on the MACRA (Medicare Access and CHIP Reauthorization Act) task force said,

“The goal is to force physicians and payers determine how to most effectively tie payment to performance and value.”

“A panel of healthcare experts and organizational leaders who began adapting to value-based payment years before the Medicare Access and CHIP Reauthorization Act started fleshing out regulations talked about their programs at the event sponsored by the Commonwealth Fund.”It is obvious to me that you cannot force anyone to do anything they do not want to do. You can only provide motivation and incentive for people to do what is best for themselves from their point of view.

MACRA will not get physician buy in because it will be too restrictive, arbitrary and controlling.

So far there are only 433 Medicare Shared Savings Program ACOs. There are 3000 hospital systems that should be participating in the Obamacare’s ACO program.

Only 14% of the hospital systems are participating after 3 years.

There are many large physician practices that should be participating in the ACO program. The number of these groups are unknown.

The lack of participation is a result of the complexity of the ACOs, the inability to form a unified culture of physicians in a hospital system and the difficulty hospital systems have with pricing risk.

Pricing risk is the job of the healthcare insurance industry and not physicians or hospital systems.

The government wants to put that task on the shoulders of the physicians and hospitals.

There are two risk tracts for ACO. Tract one is called one-sided risk.

The ACO only shares in the savings and does not participate in the losses if they spend more than the benchmark costs.

Tract 2 is call two-sided risk. The ACO shares in the savings with a more generous bonus from Medicare than the bonus of the tract 1 participants but pays a penalty to Medicare if doesn’t save money or demonstrate high quality care.

Only 22 of the shared-savings 433 ACOs or 5% of the participating ACOs have chosen two-sided risk. The Obama administration’s goal is to have all 3000 hospital systems participate the two-sided risk model.

The participation rate is .7% participation rate for the 3,000 hospital system that should be participating. It is far short of the Obama administration’s goal.

I would not rate the ACO participation rate as a success after 3 years.

This absolute failure has not been acknowledged by the Obama administration or the Obamacare praise singing traditional mass media.

The new final regulations and MACRA will not fix this failure. It will only make the failure worse. I will discus both the new final rule and MACRA next time.

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

All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE