Stanley Feld M.D., FACP, MACE

The House of Representatives Healthcare Bill is 1018 pages long. Many Representatives and Senators did not read the entire economic stimulus bill because “we did not have time” before we experienced a severe economic recession. They claimed to be saving us from another great depression.

I have read a good portion of HR3200. The provisions are unacceptable and sinister. It represents a complete government takeover of our healthcare system. It is not in the interest of the consumer. It is not in the interest of our precious freedom of choice.

A reader of my blog sent me a summary of HR 3200 written by Larry Schweikart. The reviewer FamilySecurityMatters.org Contributing Editor Larry Schweikart is the author o 48 Liberal Lies About American History: (That You Probably Learned in School) and A Patriot’s History of the United States: From Columbus’s Great Discovery to the War on Terror.   He blogs at patriotshistoryusa.blogspot.com. Mr. Schweikart is not the most liberal person on the planet. However, his analysis is about 80% accurate by my reading of the sections Mr. Schweikart summaries.

Every Americans, especially our Senators and Representative must know what is actually in the bill before it is passed. President Obama’s generalities do not cover the details of HR 3200.

It feels like Ayn Rand’s Atlas Shrugged all over again.

The mainstream media is not covering the real story.

Below are few video clips that try to tell the real story

http://online.wsj.com/video/can-americans-keep-their-current-health-care/6043F8F9-0BEB-4E36-8589-7AEEE4C7AB9E.html

http://online.wsj.com/video/can-americans-keep-their-current-health-care/6043F8F9-0BEB-4E36-8589-7AEEE4C7AB9E.html

Mr. Schweikart evaluated 498 of the 1107 page bill. The summary of one half HR3200 is frightening. His summary is a good reference guide to the appreciation of the harshness of the bill. It also explains President Obama’s urgency in getting a bill passed before anyone realizes the implications of the bills contents.

Representatives who vote for this bill should not be reelected. They are not representing their constituents’ rights or protecting their freedoms. Your healthcare, health and freedoms are at stake.

You can check the reviewer’s summary against the actual bill at the link below.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf

“Take a look at what actually is in the Health Care bill. Obama makes disingenuous comments like "You’ll still keep your doctor" or "You’ll keep your existing health care."

Pg 22 of the HC Bill mandates the Government will audit books of all employers that self insured. Can you imagine what that will do to small businesses? Everyone will abandon “self insurance” and go on Government insurance. So when Obama says that there will still be private health care, it’s simply a lie: this mandate will force employers to abandon their private plans.

Pg 30 Sec 123 of HC bill – a Government committee will decide what treatments/benefits a person may receive.

Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE WILL BE RATIONED! President Obama has been saying healthcare is to be rationed all along in code.

Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC Benefits for you. You will have no choice!

Pg 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise.

Pg 58 HC Bill – Government will have real-time access to individual’s finances and a National ID Healthcard will be issued! Government has real-time access to your tax return presently and means test Medicare recipients’ premiums

Pg 59 HC Bill lines 21-24 Government will have direct access to your bank accts for election funds transfer. A further impingement on freedom and privacy.

Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (read: ACORN).

Pg 72 Lines 8-14 Government will create an HC Exchange to bring private HC plans under Government control.

Pg 84 Sec 203 HC bill – Government mandates ALL benefit packages for private HC plans in the Exchange.

Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans = The Government will ration your Healthcare!

Pg 91 Lines 4-7 HC Bill – Government mandates linguistic appropriate services. Example – Translation for illegal aliens.

Pg 95 HC Bill Lines 8-18 The Government will use groups, i.e. ACORN & AmeriCorps, to sign up individuals for Government HC plan.

Pg 85 Line 7 HC Bill – Specifics of Benefit Levels for Plans. AARP members – your Health care WILL be rationed.

Pg 102 Lines 12-18 HC Bill – Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.

Pg 124 lines 24-25 HC No company can sue Government on price fixing. No "judicial review" against Government Monopoly.

Pg 127 Lines 1-16 HC Bill – Doctors/ AMA – The Government will tell YOU what you can earn.

Pg 145 Line 15-17 An Employer MUST auto enroll employees into public option plan. NO CHOICE.

Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.

Pg 149 Lines 16-24 ANY Employer with payroll $400k & above who does not provide public option pays 8% tax on all payroll.

Pg 150 Lines 9-13 Businesses with payroll between $251k & $400k who don’t provide public option will pay 2-6% tax on all payroll.

Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Government will be taxed 2.5% of income.

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)

Pg 195 HC Bill -officers & employees of HC Admin (the GOVERNMENT) will have access to ALL Americans’ finances and personal records. Big brother will be watching your every move.

Pg 203 Line 14-15 HC – "The tax imposed under this section shall not be treated as tax" Yes, it says that.

Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid. Seniors, low income, poor affected. Kill off the poor and elderly.

Pg 241 Line 6-8 HC Bill – Doctors – doesn’t matter what specialty – will all be paid the same.

Pg 253 Line 10-18 Government sets value of Doctor’s time, professional judgment, etc. Literally, value of humans.

Pg 265 Se
c 1131Government mandates & controls productivity for private HC industries.

Pg 268 Sec 1141 Federal Government regulates rental & purchase of power driven wheelchairs.

Pg 272 SEC. 1145. TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!

Pg 280 Sec 1151 The Government will penalize hospitals for what Government deems preventable readmissions.

Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission – Government will penalize you.

Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.

Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion – Government will mandate hospitals cannot expand.

Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!

Pg 335 L 16-25 Pg 336-339 – Government mandates establishment of outcome-based measures which of course forces health care rationing.

Pg 341 Lines 3-9 Government has authority to disqualify Medicare Adv Plans, HMOs, etc., forcing people into Government plan.

Pg 354 Sec 1177 – Government will RESTRICT enrollment of Special needs people!

Pg 379 Sec 1191 Government creates more bureaucracy – Telehealth Advisory Committee. Healthcare by phone.

Pg 425 Lines 4-12 Government mandates Advance Care Planning Consultations. Think Senior Citizens end of life prodding.

Pg 425 Lines 17-19 Government will instruct & consult regarding living wills, durable powers of attorney. Mandatory!

Pg 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in how to die. EVERYONE on Social Security, (will include all Senior Citizens and SSI people) will go to MANDATORY counseling every 5 years to learn and to choose from ways to end your suffering (and your life). Health care will be denied based on age. 500 Billion will be cut from Seniors healthcare. The only way for that to happen is to drastically cut health care, the oldest and the sickest will be cut first. Paying for your own care will not be an option.

Pg 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.

Pg 429 Lines 1-9 An "advanced care planning consultant" will be used frequently as patients’ health deteriorates.

Pg 429 Lines 10-12 "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from the Government to end a life!

Pg 429 Lines 13-25 – The Government will specify which Doctors can write an end of life order.

Pg 430 Lines 11-15 The Government will decide what level of treatment you will have at end of life.

Pg 469 – Community Based Home Medical Services/Non profit orgs. (ACORN Medical Services here?)

Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATION. 1 monthly payment to a community-based organization. (Like ACORN)

Pg 489 Sec 1308 The Government will cover Marriage & Family therapy. Which means they will insert Government into our marriages.

Pg 494-498 Government will cover Mental Health Services including defining, creating, rationing those services. You’d better speak up now before you are on the "advanced care consultation" list.

It gets worse: the Health Care Reform bill that is now about to come up for a vote will absolutely eliminate private health care options. Do not kid yourself: They are going to say that they aren’t going to interfere with your right to go to your "own doctor" or have your own "private health insurance." But there won’t be non-government doctors or private health insurance if the government mandates them out of existence.

Even still, I hear people who want to "get past all this partisanship." Sorry, but GROW UP.

Our system from the beginning has pitted one group against another out of fear of the very giant government that is metastasizing before our eyes. James Madison didn’t like "parties" or "factions," but he finally admitted that they were absolutely necessary to fragment power.

For our system to work there has to be a clear choice, not a mushy middle, because the mushy middle always, always, always gravitates left. There is a "presumption of power" on the left –conservatives, by nature, do not like government, don’t trust it, and do not want to use it to advance their ends, which they see as advanced through liberty, individual achievement, and entrepreneurship.

FamilySecurityMatters.org Contributing Editor Larry Schweikart is the author o 48 Liberal Lies About American History: (That You Probably Learned in School) and A Patriot’s History of the United States: From Columbus’s Great Discovery to the War on Terror.   He blogs at patriotshistoryusa.blogspot.com.

It is hard to read H3200 and comprehend its implications. However, a careful reading leads me to similar conclusions to those of Mr. Schweikart.

Do you think your representatives have studied the bill? If they have and vote for it they should lose your vote. If they have not read it and vote on party lines they should lose your vote.

This bill is not going to Repair the Healthcare System. It will make the healthcare system more complex, restrict access to care, restrict the delivery of care, ration care, limit freedom of choice, and increase the deficit.

Americans have to demand that congress tackle the real problems in the healthcare system. Have you contacted your Representative and Senators? If you have, good for you. If not , what are you waiting for?

Let your Senators and Representatives know the proposals are unacceptable.  Write, fax, call, email, twitter. Tell them:

“We do not want the government to control our lives. We want affordable, universal healthcare coverage that does not limit access to care. We want control over our healthcare dollars. We do not want government to control our lives and our money.”

https://writerep.house.gov/writerep/welcome.shtml

http://www.senate.gov/general/contact_information/senators_cfm.cfm

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

Stanley Feld M.D.,FACP,MACE

Between Thursday July 15^th and Friday July 16^th the President and the House committees somehow persuaded Douglas Elmendorf, head of the Congressional Budget Office, to change his assumptions and score the healthcare reform bill budget deficit differently. He had been very definitive on Thursday July 15^th. It is hard to believe that the next day the negative scoring of the House bill could drop from 1.5 trillions dollar deficit to a $239 billion deficit over the next ten years.

“Late on Friday, hours after two House committees—Ways and Means and Education and Labor—approved healthcare reform legislation, the Congressional Budget Office (CBO) had bad news: HR 3200 would result in a net increase in deficit spending of $239 billion during the next 10 years, according to its analysis. But House leadership immediately challenged the findings—and CBO changed its tune hours later.”

How did administrative pressure manage to change this number overnight? Republicans are not demanding an answer.

“The House bill, CBO said, was able to target key areas for savings. However, a key trigger in increasing Medicare spending occurred when the existing annual "sustainable growth rate" (SGR) in the Medicare physician fee schedule (with a 21% reduction in payment rates scheduled for 2010) was replaced with an inflation-based update.”

This calculation was done using today’s inflation rate. What if inflation skyrockets to 10 or 15%? The bill would create a deficit of greater than 1.5 trillion dollars in 10 years.

CBO estimated that those changes in the physician payment rates ultimately would add up to $245 billion in changed physician rates between 2010 and 2019.

Who are they going to hurt? The weakest link is the physicians because they are the most disorganized and lack leadership and effective representation.

Meanwhile the traditional media has immediately stopped publishing the $1.5 trillion dollar deficit in the “news” this week and replaced the deficit with the $239 billion dollar deficit.

“Peter Orszag, director of the Office of Management and Budget (and former CBO director). "The only reason that the bill shows a deficit" is because of the "payments to physicians…once you take that part out, the bill is deficit neutral," Orszag told Fox News on Sunday.”

This is exactly how you cook the books. You recalculate the figures using assumptions to your advantage. President Obama now has his deficit neutral bill. Magic!!

“Those reformed Medicare physician payment costs, however, should not have been included. CBO’s net calculations, according to a release from the three House committee leaders issued.”

“ Instead, they will be absorbed under the upcoming statutory "pay-as-you-go" budgetary legislation that currently is pending in the House. (With so-called "paygo," the federal government cannot launch new tax cuts or entitlement programs without finding a way to pay for them.) This would make HR 3200 deficit neutral over the 10 year budget window—and even produces a $6 billion surplus.”

If anyone wants a bridge I have one to sell. The deficit money will come from another pot.

“It also would create Medicare and Medicaid savings of $465 billion, coupled with the $583 billion revenue package reported by the Ways and Means Committee on Friday. It would "fully finance" the previously estimated $1.042 trillion cost of reform, which will provide healthcare coverage for 97% of Americans by 2019, the House committee leadership said. About 17 million nonelderly residents would be left uninsured (about half of whom would be unauthorized immigrants).”

It is unbelievable. We still have 17million uninsured. It is no wonder the House and Senate’s approval rating is so low. If the American public believes all this nonsense they will deserve what they will get. Only public opinion can stop this train. When it is all over there will be too few physicians taking care of patients just as there are too few physicians taking care of Medicaid patients.

“CBO and the Joint Committee on Taxation said that approximately $583 billion would be obtained through increasing federal revenue by methods such as issuing a surtax on higher incomes, which was approved by Ways and Means on Friday. Another $219 billion (plus physician payments) would be saved by Medicare and Medicaid by:

• Making permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee for service sector (excluding physicians’ services)—yielding budgetary savings of $196 billion over 10 years
• Setting payment rates in the Medicare Advantage program based on per capita Medicare spending in the fee for service sector—providing savings of approximately $156 billion over the 2010 2019 period.
• Changes to the Medicare Part D program to establish a new prescription drug rebate program for those eligible for both Medicaid and Medicare.”

After all these manipulations of the numbers they have the gall to make the following statement:

"This fulfills the strong commitment of the President and House leadership to enact health reform on a deficit neutral basis," said the release signed by House Committee Chairmen Henry Waxman (D-CA), Charles Rangel (D-NY), and George Miller (D-CA).”

President Obama then says he is correct. He told us he would not sign a healthcare reform bill that was not budget neutral.

President Obama has previously said that he would not sign healthcare reform legislation that was not budget neutral.

Can President Obama be trusted with numbers? His numbers were wrong with the economic stimulus package and we trusted him.

The unemployment rate today is 9.5% — nearly 20% higher than the Obama White House said it would be with the stimulus in place. Keith Hennessey, who worked at the Bush White House on economic policy, has noted that unemployment is now higher than the administration said it would be if nothing was done to revive the economy. There are 2.6 million fewer Americans working than Mr. Obama promised.

The President did tricks with the numbers to pass the economic stimulus package. All of this seems much too confusing to the traditional media and their love affair with President Obama. We are not getting critical reporting.

“

The Blue Chip consensus is an average of some four dozen economic forecasts. In January, the consensus estimated that GDP for 2009 would shrink by 1.6% and that unemployment would top out at 8.3%. Team Obama assumed both higher GDP growth (it counted on a contraction of 1.2%) and lower peak unemployment (8.1%) than the consensus.”
T

he calculations for surplus and deficit depend on the assumptions applied. If you make the wrong assumptions you can get numbers you like. If you make the correct assumptions you might get public disapproval.

So why should we trust President Obama and his Democratic controlled House committees with the assumptions about health care costs? The goal of the present administration is to dominate and control healthcare. Can you trust the administrations with your healthcare needs?

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

Stanley Feld M.D., FACP, MACE

The congressional budget office has scored the House healthcare reform bill and declared it will increase the budget deficit by 1.5 trillion dollars in the next ten years. During his testimony to congress Douglas Elmendorf head of the CBO had the courage to do his job honestly. He contradicted President Obama contention that the House bill will be budget neutral.

“Douglas Elmendorf, head of the Congressional Budget Office, provided a bleak assessment in his testimony on Thursday on whether he thought the healthcare cost curve—which has been steadily rising upward—would finally bend downward under newly introduced reform legislation.”

His response to Sen. Kent Conrad (D-ND), chairman of the Senate Budget Committee, who asked the question: An unequivocal "no."

The legislation expands federal responsibility for healthcare costs without any real structural change in the healthcare system. The only structural changes will be a decrease in reimbursement to physicians and an ineffective pay for performance system.

"In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount," Elmendorf said. "On the contrary, the legislation significantly expands the federal responsibility for healthcare costs."

The CBO is not even including the money allocated to healthcare reform in President Obama’s economic stimulus package i.e. the $60 billion dollars allocated to electronic medical records and the $30 billion dollars allocated to Federal Health Board.

On Friday July 16^th ,President Obama responded with an emergency press conference. He gave Congress a pep talk. His message was not to give up in the home stretch.

On Saturday morning he told the nation:

“I want to be very clear,” Mr. Obama said in his weekly address to the nation. “I will not sign on to any health plan that adds to our deficits over the next decade. And by helping improve quality and efficiency, the reforms we make will help bring our deficits under control in the long term.”

He crafted his message carefully. He claims even though there is a deficit in the first few years the reform will create a surplus at the end of the decade.

How will he create a surplus?

He might achieve his goal by decreasing access to care.

He could decrease care (rationing).

He could decrease reimbursement to physicians.

He could increase taxes.

He could also cook the financial books to create a profit.

One way to pay for the bill is to raise taxes. Is that a smart idea? Is raising taxes a good idea during a recession? The answer of most economists is no! President Obama,s reply reply is he is only going to tax the rich. Who create the jobs that will revive the economy?

How does President Obama maintain his high approval ratings? He maintains his high ratings by leaving the dirty work up to others while he speaks in generalities and gives pep talks. He uses powerful new media tools to provide Americans with a “voice in government.” The problem is he does not tell us what we are signing up for other than his healthcare reform. He asks us to help defeat his opponents who want to maintain the status quo.

“The same folks who controlled the White House and Congress for the past eight years as we ran up record deficits will argue — believe it or not — that health reform will lead to record deficits,” Mr. Obama said. “That’s simply not true.”

He argued that his proposals would cut “hundreds of billions of dollars” in unnecessary spending and change incentives so health providers “will give patients the best care, not just the most expensive care.”

It sounds great. It gives me a bad feeling. It sounds like big brother will take care of us. We should be empowered to take care of ourselves.

And, he said, he has urged Congress to adopt a plan for a standing commission of doctors and other medical experts to oversee cost-saving measures.

Shorty thereafter, David Plouffe, who crafts his new media internet campaign, sent a note to all his email addresses to have all of us sign up for President Obama’s healthcare reform plan blindly.

Dear Supporter

President Obama is in the White House today because last year people like you got involved and made it happen.
Passing health care reform in 2009 is a top priority for the President. Achieving it will require everyone working together — we can’t do this without you.
Please listen to the President’s call and then sign your name, asking Congress to deliver health care reform that lowers costs, guarantees choice, and ensures affordable care for all.

http://my.barackobama.com/ObamaCall
Thanks for getting involved,
David Plouffe
Organizing for America

America: It is all doubletalk!!

Think about the double talk in the last six months, the economic recovery plan, the financial sectors bailout and then huge profits to Goldman Sachs. Think about the continued huge bonuses and taxpayers’ burdens. Think about the increasing unemployment rate beyond President Obama’s predictions.

Do you trust the government to dictate your healthcare options? Do you think government should decide the course of your medical care for you and your doctor?

Government should regulate the abuse of our healthcare options not dictate medical care.

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

.

Stanley Feld M.D.,FACP,MACE

President Obama still enjoys a high approval rating. During the election he represented hope for change to the American people. We need hope because many of our systems are abused and broken. The divide between the rich and the poor is increasing and is at the most dangerous point in our history.

Our systems are abused and broken because Congress has been influenced by vested interests. Congress has been gridlocked on energy, environment, healthcare, education and many other vital issues. The systems need to be fixed to stimulate vigor in our economy and the spirit of innovative.

President Obama represented this hope. He has a fresh face and the right words. When we look beyond the words and analyze his style we find we are confronted with the same old double talk. He has the right words but the wrong solutions. He is telling us he will fix the broken and abused systems. However, he is demonstrating that the Democrats want to control the systems.

The result of the proposed legislation will be to control our personal decision making and our lives. I believe Americans will react negatively to this when they discover what has been done to them.

In order to accomplish this control over the healthcare system Congress is going to have to increase spending. The result of increased spending higher taxes.

President Obama wants to add a surtax on incomes over $250,000 plus and addition 4% income tax. The surtax will be on incomes from any source. In addition there are indirect tax increases on all citizens.

Medicare and Medicaid are entitlement programs. This is a fact. Medicare and Medicaid are in serious financial difficulty. Medicare Part B is funded by general revenues. The Medicare Board of Trustee’s responsibility is to warn Congress if more than 45% of Medicare expenditures are projected to come from general revenues. If they issue a warning in two consecutive years, Congress and the President must act to reform Medicare. The warning has been issued in the last 4 consecutive years. Congress has not acted.

The best way to quiet an agency is to eliminate it. This is exactly what the House bill does on page 836 of the 1081 page.

Rather than deal with Medicare’s situation directly, the President and his allies promise to "bend the curve" to achieve savings across the health care spectrum — including Medicare. 

If this is true, why then would page 836 (Section 1901) of the House bill repeal the "Medicare trigger" that is intended to force legislative action when Medicare’s finances worsen?

• The Medicare Modernization Act of 2003 had mandated that if more than 45 percent of Medicare expenditures were projected to come from general revenues (as opposed to dedicated revenues, such as payroll taxes and beneficiary premiums) within a seven-year period, the trustees would issue a warning.
• Two consecutive years of this warning would require the President to offer reform legislation and Congress to give that legislation expedited consideration.

This warning has been triggered four consecutive years — the last three of which would have required legislative action.  Yet the Democratic Congress has regularly passed rules suspending their responsibility to address Medicare’s unsustainability.  Now, the House health care bill would repeal the trigger altogether.”

President Obama has stated on numerous occasions that his health care reform bill will save money. It will not create a larger deficit. It is easy to save money when you eliminate the findings of the agency that reports the overspending.

“President Obama has repeatedly claimed that his health care reforms represents entitlement reform. He has stated that he will not sign a healthcare reform bill that is not budget neutral.”

Meanwhile, the Congressional Budget Office has scored the healthcare reform measures increasing the budget deficit by 1.5 trillion dollars in the next ten years. This finding is not budget neutral.

Even if President Obama gets everything in the house bill passed he will not solve the problem of the healthcare system.

The major problems in healthcare are being ignored. Malpractice reform, the cost for the healthcare insurance industry’s administrative services, and patients’ responsibility for their own health and their own healthcare dollars are major issues that must be addressed and solved innovatively in order to repair the healthcare system.

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

Stanley Feld M.D.,FACP,MACE

In the last six President Obama has pushed through congress much legislation. Legislation that will increase the budget deficit to at least $3.4 trillion dollars. Republicans have been unable to express effective opposition because of President Obama’s political tactics.

Much of government spending in the past is has been riddled with inefficiency and unintended consequences. The intent might have been to help the little guy but has consistently created an advantage for large corporations.

How does President Obama do it? Jonthan Chait of the New Republic, a liberal periodical, described the process.

“The thing that people haven’t figured out about President Obama’s conduct of foreign policy is that it’s the same as his conduct of domestic policy. Obama believes in the power of negotiation and public dialogue to split his adversaries–Republicans at home, Islamists abroad–and strengthen his own position.

President Obama begins by finding common ground with his enemies. He then expresses respect for their core beliefs. He follows with profuse hope for cooperation.

“This rhetoric removes the locus of debate from the realm of tribal conflict– red state versus blue state, Islam versus America–and puts it onto specific questions–Is the American health care system fair? Is terrorism justified?– where Obama believes he can win support from soft adherents of the opposing camp.”

He keeps the agreement general as he moves the process along. However, the devil is in the details. The common ground in healthcare does not solve the healthcare system’s problems.

Universal healthcare, affordable cost and increased quality are the common ground.He then leaves it up to the congress to write the law. The underlying strategy is to throw money at the problem even if the strategy will fail. The leaders from both parties are starting to see through this tactic.

“In January 2008, Obama told a newspaper editorial board that Ronald Reagan provided a "sense of dynamism and entrepreneurship that had been missing." Paul Krugman complained, "Where in his remarks was the clear declaration that Reaganomics failed?"

Most Democrats believe Reagonomics failed. They are angered at how President Obama could applaud Reagonomics. I believe it was a less than sincere attempt to stand on common ground with Republicans. He removes the debate from the realm of tribal conflicts. He avoids fighting with Republican over Reagan. The populous applauds because they believe he is on their side. He is then free to craft any policy he pleases. He promotes his policy using the new media (internet). He stays on the high ground and avoids discussing details or detail consequences.

“Obama’s method entails small acts of intellectual dishonesty in the pursuit of common ground.”

Greg Scandlen exposed President Obama’s healthcare whiz kids and their attempts to shape public opinion.

“ The Obama administration kids are Peter Orszag, Ezekiel Emanuel (Rahm’s brother), and outside advisors like David Cutler and Atul Gawande. They are convinced of their own genius. They think they can create the data driven management systems to eliminate $700 billion of wasted care in the American health care system. They are dismissive of any skeptics. Their very hubris causes them to overlook essential factors that may impede their plans.”

The key to fulfillment is to maintain Americans’ anger at the old way and desperation for change.

President Obama stays in a position to spin his story and paralyze the opposition. (Rope a Dope). He used Dr. Atul Gawande’s (an advisor) June 1 article in the New Yorker to demonize physicians. I pointed out that the article was a masterpiece of disinformation.

“ Dr. Gawande ,an advisor on President Obama’s healthcare team, had an article published in the New Yorker about a month ago that laid out in great detail what he viewed as the inadequacies of the health care system in McAllen, Texas.”

He pointed out that Medicare and Medicaid patients cost twice as much in McAllen as in El Paso. He compared the costs in McAllen to the cost of Medicare patients at the Mayo Clinic.

“He concluded that we needed to replicate the management systems (not-for-profit, salaried employees, team approaches to service delivery) of the Mayo Clinic in places like McAllen, and indeed, throughout the United States. Voila! Problem solved.”

Dr Gawande omitted a few important data points. Mayo Clinic does not care for indigent,Medicare or Medicaid patients long term. He ignored the fact that Medicare has the machinery to discover and deal with cost outliers and impose heavy fines.
The Texas Medical Association checked on some of the data Dr. Gawande used and ignored. He overlooked the following in exposing McAllen’s physicians.

• “Its population is the poorest in the entire United States.
• It has the fewest physicians per capita in the entire United States.
• It has the second highest uninsured rate in a state that is the Uninsured Capital of the United States.
• It is heavily reliant on Medicaid and Medicare payments to finance its entire health care system.
• It is plagued by very high rates of obesity, diabetes, lack of exercise, and overall poor health status”(chronic disease demanding long term care).

The TMA article explains the poverty rate in McAllen is nearly three times that of the Mayo Clinic. McAllen’s physician supply is half that of the Mayo Clinic.

"Where there is poor availability of outpatient care, patients are far more likely to seek routine care in hospital emergency rooms, where costs are high and diagnostic testing is more frequent. This is also far more likely to result in costly hospital admissions. The data that Dr. Gawande depended on – but did not report – show just this. McAllen has a pattern of unusually high inpatient costs, while outpatient costs are close to average."

Many intelligent people reading the New Yorker article believed physicians in private practice are crooks. This is the point of the disinformation. It is typical of President Obama’s method of winning public support.

If President Obama’s tactics succeed in crafting his healthcare policy the nation is facing a $1.5-3.5 trillion dollar deficit with zero improvement in our healthcare system.

President Obama’s tactics are becoming transparent. Everyone is getting tired of false hope. Policy and plans are ill conceived and destined to fail. However the cost will be dear to tax payers.

Wake up Americans!!!.

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

Stanley Feld M.D.,FACP,MACE

What is the problem with President Obama’s public option? It guarantees insurability to all Americans of any age with any pre-existing condition. Providing basic healthcare insurance to everyone might guarantee protection from financial disaster from healthcare expenses.

An actuary would say the public option is actuarially unsound.

At the heart of President Barack Obama’s health-care plan is a healthcare insurance program funded by taxpayers, administered by Washington, and open to everyone. The healthcare plan is modeled on Medicare.

The Medicare model has two important problems. The existing Medicare entitlement is unaffordable. It will have to be funded in the future by taxpayers with some kind of income tax increase.

If enacted, “the public option" will soon become the single dominant healthcare plan. This would represent an expansion of the Medicare entitlement program.

“Republicans and Democrats agree that the government’s Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama’s plan for a centrally managed government insurance program exacerbates Medicare’s problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors’ financial incentives.”

The defects in President Obama’s public option are multiple. The unintended consequences are exponential. President Obama’s healthcare team is not analyzing the public option’s defects and its effects on the healthcare system. The public option goal is to provide healthcare insurance coverage for the uninsured.

The government would charge employees a monthly premium for healthcare coverage. The premium would probably be the same or more than Medicare. The premium would be means tested. It would be calculated from all income reported to the IRS.

It will be cheaper for employers to discontinue healthcare coverage for employees and pay a penalty than provide private healthcare insurance.

“Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.)”

The Lewin Group, a health-care policy research and consulting firm, predicts enrollment in the public option will reach 131 million. It will be open to everyone. The premium will be similar to Medicare premium rates which are not cheap.

“Fully two-thirds of the privately insured will move out of or lose coverage as patients shift to a lower-paying government plan”

Medicare plans to lower physician reimbursement by 20% in 2010. Primary care physician are having difficulty financially with overhead increasing and revenue decreasing. It will only get worse under the public option. The primary care physicians’ only option would be to seek other sources of income.

“Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins.”

Physicians’ overhead will increase under President Obama’s healthcare reform plan. Electronic prescriptions and Electronic medical records (EMR) are mandated. The government is going to subsidize some qualified medical practices. The subsidy for the EMR is estimated, at the maximum, to be $40,000 per physician. A functional EMR costs $65,000 per physician plus a sizable yearly maintenance fee. This subsidy will still be out of reach for most self employed physicians.

“Doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan.”

The government must create regulations and compliance rules in order to control potential abuse. Physicians will need to increased full time employees and documentation experts in order to comply with the new rules. The government promises a crackdown on fraud and abuse and severe penalties.

Sixty percent (60%) of physicians are self-employed. Some of those physicians will be driven into large groups or hospital owned practices to spread their overhead. Some of these newly formed groups are having problems. Some physicians will accept a salary and allow hospitals to deal with the government. The trend will further serve to commoditize medical care. It will destroy the therapeutic benefit of the patient physician relationship.

The primary care physicians who stay self employed will be driven to cram more patients into their schedule in order to increase their net profit. This will further decrease their ability to relate positively to patients and their illness.

The existing trends will increase wait times already high (18 days) for an appointment to see a Family Practitioner and 30 days for specialists. It will also decrease the length of time the physician can spend with patients. The result will be to drive patients into expensive emergency rooms.

Physicians will be forced to close their practices to Medicaid and Medicare (public option) patients when they discover government reimbursement is less than their expenses. This has already happened with Medicaid patients.

Some physicians will opt out of public insurance and only accept cash. The next step is obvious. The government will outlaw the private practice of medicine. This action would be a challenge to the Bill of Rights and the constitution.

I have described some of the unintended consequences of very good goals. The goals are universal healthcare coverage at an affordable cost, with improved quality. I agree with these goals. President Obama is going about accomplishing these goals the wrong way.

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