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Stakeholder Mistrust

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I Told You What To Do 8 Years Ago: Part 2

Stanley Feld M.D. FACP,MACE

There are so many little changes that can have a big affect on repairing the healthcare system.

These changes would go a long way in putting consumers in control of their own health and healthcare dollars.

President Obama and the Democrats want to make consumers dependent on government. Most Republican politicians do not understand the healthcare system’s problems.

Republican senators and congressmen have not been able to come up with a viable solution because they are influenced by vested interests other than the consumers’ vested interests. .

Republicans cannot understand that consumers are smart. Most know how to spend their money wisely. Consumers can solve problems if they are given the right tools and incentives.

In last week’s Republican debate Mike Huckabee got close when he said we have to solve four chronic diseases and the costs to the healthcare system would plummet. He mentioned diabetes, heart disease, cancer and lung disease. He was almost correct.

The care of chronic diseases that are manageable consume 80% our healthcare dollars. Most of the 80% is spent on the complications of these chronic diseases.

Motivating patients to become the “Professor of Their Disease” can prevent at least 50% of the complications of these diseases.

Mike Huckabee missed that part. Patients must be provided with financial incentives to prevent a chronic disease from occurring in the first place and then learn how to prevent complications from occurring.

I am publishing the spring of 2007 blog summaries to demonstrate that none of the obvious fixes have been executed to put consumers in a position to make wise choices and be responsible for them.

What Have I Said So Far? Part 2 Spring 2007

April 3,2007

Stanley Feld M.D.,FACP,MACE

 

The solutions I have proposed are all directed to a patient centered, patient driven, and patient advantaged system. I will review the proposed solutions in the next two blogs.

 Price transparency is an essential beginningNot only must the retail price be published but all of the discounted prices must be transparent as well.

The government must enact legislation so that the providers and the insurance companies post their range of prices. The government has to empower the patient with negotiating power to get the best price.

There are many different prices paid for a service depending on the negotiating power of the purchaser. The net effect of this total price transparency will be lower the prices and decrease cost of health insurance.

Consumer must demand real price transparency. Aetna’s declaration of price transparency last year was a rouse. The hospital associations of Wisconsin and now Texas have developed web sites to provide hospital retail prices.

We have little idea how much the government or insurance companies pay for these services. I assure you the discount is very deep and the hospitals are satisfied with the payments. 

The automobile industry has figured out how to deal with total price transparency and the Internet publication of the MSRP, the invoice prices and the average prices paid for an individual automobile. 

We should demand that the healthcare system does the same. The system should be set up where patients can negotiate price pre or post treatment. Sometimes the patients need a care emergently and are not in a position to negotiate in an emergency room.

Yet an oncologist is not permitted to administer the drug in his office for one and one half times the cost of the drug. It is estimated that $150 billion dollars are wasted on administrative costs in the hospital and in the insurance industry. These costs add not value to the treatment of patients. Increased executive salaries and increasing construction of enlarging hospital facilities absorb the administrative waste. The brick and motor expansion of hospitals should be over since much can be done on an outpatient basis.

 These are some of the solutions necessary to repair the healthcare system. The solutions have to be instituted as a total plan and not introduced piecemeal. Each of the pieces of the solution is dependent on each other in order to have a positive effect on repairing the healthcare system. Next time I will review the other elements of my plan needed to Repair the Healthcare System.

April 03, 2007  

There are two more parts to go. If only our elected officials would listen. The only way that will occur is if consumers start making demands. If the politicians do not listen them kick them out of office.

The most profound thing said at the Republican debate last week was by Marco Rubio. He said the traditional media is the Democrats largest and most powerful special interest group.

I suggest people start reading between the lines of the New York Times articles for a start.

Wake up, America.

 

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

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I Told You What To Do 8 Years Ago

Stanley Feld M.D.,FACP,MACE

I started my blog Repairing The Healthcare System in 2006. I methodically described the defects in the Healthcare System.

I provided healthcare alternatives in policy and regulations to both Democrats and Republicans to Repair the Healthcare System.

No one listened to me.

In 2007 the healthcare system was unaffordable and unmanageable.

Republicans had some weak ideas and no inclusive business model for the future.

The election of President Obama and the partisan passage of Obamacare have accelerated our healthcare system’s demise.

I believe President Obama’s goal is to destroy the healthcare system. He wants it replaced with a single party payer system (2003). Consumers of healthcare know the government cannot manage healthcare.

American cannot sustain Obamacare financially. Consumers cannot be sustained medically with Obamacare or after the collapse of Obamacare with a government run single party payer system.

The obvious proof is the dysfunction and failure of the VA Healthcare System, Medicaid and Medicare.

All these healthcare systems are government run single party payer systems. All are unsustainable.

As I was archiving my blogs I ran across four blogs I wrote in 2007 outlining the problems and what should be done about them.

The government has made none of the repairs I have suggested. Obamacare has made the situation worse. I will present all four parts of “What Have I Said So Far? Spring 2007” consecutively as written.

What Have I Said So Far? Spring 2007 Part 1

Stanley Feld M.D.,FACP,MACE

April 01, 2007 in Medicine: Healthcare System

 In August 2006 I summarized my blog to that point. I outlined some important solutions necessary to Repair the Healthcare System.

Since then I have covered many of the solutions to the key questions I raised. Not one of these questions has been addressed effectively by our leadership or people in control of making policy.

One must ask: Do they really want to solve the problems in healthcare delivery in this country or are they focused on preserving their own vested interest to the exclusion of a breakthrough that might benefit not only their vested interests but the vested interest of all the stakeholders.

The questions were:

  • How do we reduce the cost of medical care? • How do we provide affordable insurance for the 45 million people uninsured?
    • How to we provide affordable medical care coverage so that all the patients can have access to medical care?
    • How do we align all stakeholder incentives?
    • How do we construct a system so that all the stakeholders make a reasonable return on investment?
    • How do we close the holes in the system to eliminate abuse by stakeholders?
    • How do we restore trust between stakeholders?
    • How do we restore trust between the patient and physician?
    • How do we stop secondary facilitator stakeholders from continuously destroying the patient physician relationship?

In reality, developing solutions to these questions are in themselves business opportunities for facilitator stakeholders that can help Repair the Healthcare System.

However, neither the insurance industry, hospital systems, nor the government see the long term advantage and economic opportunity.

In a comment to my blog Shel Isreal said “

98% of the people think it is broken and the other 2% work for the insurance industry.

The insurance industry has the money and the power.”

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/01/the_ideal_elect.html.

However, we have demonstrated the abuse and misuse of the power of information technology by the insurance industry. The misuse and abuse has lead to further dysfunction in the healthcare system and mistrust by the hospitals and physicians.

The insurance industry and the government have used information technology to penalize both physicians and patients using the wrong data to draw their conclusions.

Insurance companies do not have the information technology resources to measure the correct parameters to measure quality care.

I do not see an attempt on their part to correct this deficiency. I only see a movement to make the healthcare system worse with a Pay for Performance (P4P) reimbursement system that is not well thought out. .

It is essential that the solutions I have proposed be coordinated and introduced simultaneously as a single plan rather than introducing elements of the solution separately.

Unfortunately, the government with the pressures of its present political vested interest influences finds it difficult to present the components of repair as a single plan.

The solutions will have to be driven by the consumer (the patient) and not the government. The patients have the power to drive the solutions because they are the users of the healthcare system. If they were the purchases of healthcare, some clever entrepreneur could provide the option for a compelling insurance product that could reward the patient for being responsible for their own care and well being.

The insurance produce could be built to fix the healthcare system.

All that is needed is for the government to write sensible regulations, enforce them and get out of the way.”

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

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Wanting Something To Fail?

Stanley Feld M.D.,FACP,MACE

If someone wants something to fail, make it complicated enough so no one understands what is going on.

I am convinced that President Obama wants Obamacare, Medicaid and Medicare to fail.

President Obama wants a single payer health care system. He said it as far back as 2003. This You Tube was uploaded on Aug 12, 2009.

 

https://youtu.be/LhEX3rHssJI

President Obama won’t tell the American people the truth about his plans for health care. Watch President Obama declaring his intention in his own words.

The result is everyone will receive the same healthcare under the government direction and control.

The ultimate goal is to make people dependent on the government.

The people will have no power to choose their physician or their treatment. It is true that every country in the western world has this system.

No country has proven that a single party payer system works for countries with the single party payer systems economy or their citizens. Surveys have shown that their citizens are satisfied.

The main reason people like it is because it relieves anxiety of being able to receive medical care even though they have relinquished their freedom to choose their physician or insurance company.

The biggest loss is independence from the government bureaucracy. People will be dependent on the decisions of unelected government bureaucrats.

The big questions that are never answered about medical costs are; who is spending most of the healthcare dollars and what are the healthcare dollars being spent on?

Do you want the government to decide if you are young enough to get an artificial hip or knee when you need it?

Do you want the government to decide about your treatment or do you want your doctor to help you decide on what your best treatment is?

President Obama is changing medical care in a methodical way. He is utilizing executive orders and rules and regulations written by non-elected bureaucrats, who are forced to follow his orders. Our elected officials should be in charge of government spending.

Many in congress know better and would not let President Obama do what he is doing. Most in congress are happy that he has exempted congress from Obamacare.

President Obama and his administration have been trying to do bad things very quietly to avoid political uproar. The mainstream media has been a great Obamacare ally.

The mainstream media has helped Obamacare keep these destructive regulations and their subsequent failures out of public view.

The media has also publicized President Obama’s lies about the success of Obamacare.

President Obama is adept at diverting blame for errors and failures in pursuit of his single party agenda.

At the same time he is trying to take power away from the states he is trying to persuade states to not permit big insurance premium rate increases requested by many health insurance companies for 2016.

President Obama’s Obamacare is the cause of the increases. He is positioned to blame the state regulators for the insurance companies not showing up to sell insurance for 2016.

If the states act to cut back rate increases the insurance companies will not participate in the federal and state exchanges for the 2016 enrollment period. The result will be the erosion of the possibility of competitive pricing.

The Obama spin machine started working at the beginning of the summer to shift the blame and/or force insurance companies out of the market.

Kevin J. Counihan, the chief executive of the federal insurance marketplace said in letter to state insurance commissioners, “Recent claims data show healthier consumers.

He also said, “The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

This claim of costs data by Obamacare does not square with the healthcare insurance companies’ costs data. They are finding that new customers were sicker than expected. The insurance industry is also losing money because the Obama administration has paid them $2.5 billion dollars less than they were promised.

Health insurance plans sold through Obamacare’s Federal and State Health Insurance Exchanges are seeking 10 to 40 percent increases in premiums.

They are also seeking the same increase in the private sector as well as in Medicare and Medicaid.

The Obama administration is making up its own story to force state regulators to not allow the increased premiums.

The Obama agenda is choreographed to prove that insurance choices do not work. He is hoping that the public will conclude the only solution is a single party payer system.

The problem is the government cannot afford a single party payer system and the people will not tolerate it.

What is more bizarre is the Obama administration made loans to help start up state co-ops. These state co-ops were supposed to compete with the big insurance companies. They were supposed to sell insurance on the health insurance exchanges. The Obama administration invested $38 billion in startup costs and solvency loans to these co-ops.

Nevada Health Co-op received $66 million in federal loans. It is closing down on January 1,2016 because it ran out of money.

Louisiana Health Cooperative announced in July that it was voluntarily shutting down operations.

CoOportunity Health, which sold policies in Iowa and Nebraska, was liquidated and forced to close earlier this year.

Many state Co-op’s are on the way to bankruptcy. In Nevada alone one third of the health insurance exchange population will lose insurance coverage.

Nevada Health CO-OP’s departure will leave a big hole in Nevada’s exchange market. Open enrollment begins Nov. 1, and consumers will have to shop for plans with other carriers. The co-op had 21,300 members as of the first quarter this year. Nevada’s exchange population was about 63,000 at that time.

A.M. Best’s report shows a majority of the nation’s 22 co-ops have combined medical and administrative expense ratios above 100%.

All these failures and impending failures mean that either the Obama administration is stupid or things are going precisely as  President Obama had planned.

The healthcare system is on its way to destruction. The federal government as the payer of last resort will replace it.

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

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Obamacare Owes Insurance Companies $2.5 Billion Dollars For 2014 Health Exchange Losses

Stanley Feld M.D.,FACP,MACE

These days there is very little news in the traditional mainstream media about Obamacare.

The average person thinks everything is fine. President Obama has told us over and over again that Obamacare is a great success.

Unfortunately, this is far from the truth as the Obama administration prepares for the 2016 enrollment period.

Open enrollment is supposed to start November I, 2015 and end January 15, 2016 for 2016.

In 2013 and 2014 open enrollment was extended many months because of poor enrollment. I suspect the same will happen during the 2016 enrollment period.

The disastrous web site is still not fixed.

The healthcare insurance industry has increased Obamacare insurance premiums by double digits. The Obamacare deductibles remain in the thousands.

Even with large Obamacare subsidies people making under $50,000 cannot afford the subsidized premiums or deductibles.

Some people are registered through both the health insurance exchanges and Medicaid. This has been recently discovered by the Obama administration.

These people have received the Obamacare cash subsidy and Medicaid coverage. Now the Obama administration expects to be paid by these recipients for the government’s overpayment.

The Obama administration has refused to publish the number of people affected.

None of these issues have appeared in the traditional mainstream media.

The Obama administration continues to publish conflicting figures about how many people are actually enrolled through its federal health insurance exchanges.

The administration needs the healthcare insurance industry to do the administrative services for the health insurance exchanges.

At the onset of enrollment in 2013 healthcare insurance companies did not want sign up to do the administrative services. The companies figured that high-risk people without insurance would sign up for insurance and they would lose money. Obamacare required that the premium would be equal for everyone regardless of the health risk.

Obamacare originally wrote into the law three risk corridor programs that would be activated if necessary to subsidize the healthcare insurance industry against undo risk.

As a result of the healthcare industry’s lack of participation in the federal and state insurance exchanges, the risk corridors were activated.

“The healthcare reform law established three “market stabilization” programs to help insurers weather the first few years of covering a new population with unpredictable healthcare needs. At issue is the risk corridors program.”

I was astonished when I learned of these risk corridors. The corridors encouraged the healthcare insurance industry to participate in providing administrative services for each state and federal exchange at no risk of loss.

It was amazing that the leading Republicans for repeal of Obamacare did not make this clear to the public.

The insurance industry was actually guaranteed a profit because they provided its own profit and lost data. The Obama administration simply accepted its data. The healthcare insurance industry was supposed to receive the subsidy for its loss.

The government’s hope was to provide enough insurance choices to enrollees in the health insurance exchanges so there would be competitive pricing.

Unfortunately for Obamacare it did not work out as planned.

The government had planned on releasing risk corridors data in August but waited until October 1, 2015 due to discrepancies in the data.”

I suspect the delay was for political reasons and to provide enough time for the government to present the data in a less negative fashion.

The data provided by the Health insurers that sold health insurance plans showed that those insurers lost a great deal of money on the Affordable Care Act‘s exchanges in 2014.

The data shows the Obama administration has short changed the healthcare insurers that participated in Obamacare $2.5 billion dollars promised to them in the safety value risk corridor subsidies.

The Obama administration now is promising those insurance companies that the $2.5 billion dollars to cover the deficiency will be covered with budgeted monies from 2015 and 2016 if possible.

President Obama is now sowing the seeds to blame the nonpayment on Republicans since Republicans control congress.

Republicans thought the health insurance risk corridors were a stupid idea to begin with and predicted failure. Now the Obama administration is trapping the Republicans for not wanting to pay bills that are owed.

Some smaller insurance companies who were seduced into participating in this no risk insurance policy folly are now worried about experiencing “solvency and liquidity problems”.

CMS would not give the number of companies affected. It said the cases are isolated.

The insurers requested $2.87 billion in payments to cover their losses. The CMS will only reimburse 12.6% of the payment requests, meaning insurers will still be owed more than $2.5 billion.”

“ Names of companies that are owed money were not released.”

Does anyone think the insurance companies are going to sign up for the 2016 enrollment cycle?

Insurance companies do not know how much Obamacare will short- change them for the 2015 subsidies yet.

One can also begin to understand why insurance rates for both government and private insurance are increasing when physician and hospital reimbursement are falling.

The insurance industry feels it has to make up its loss.

Why are the Republicans not saying anything about this to the public?

Why aren’t Republican candidates for President not pointing out this folly?

Why are they letting themselves be set up to be blamed for not wanting to pay the government’s bill?

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

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Hospital Readmission Penalties

Stanley Feld M.D.,FACP,MACE

 Obamacare has set up a system whereby if a patient is readmitted to a hospital 30 days after discharge the hospital will not be paid for the readmission and will incur a fine.

Hospitals are paid for admissions by diagnoses. The more diagnoses the more they get paid. The length of stay the government will pay for is also determined by the diagnosis.

The number of games played with the diagnosis of a patient is legendary. Hospitals are in the business of making money. The more money hospitals make the higher the administrator’s salary.

If patients have to be readmitted to the hospital within 30 days the patients are told to get readmitted to a different hospital to avoid government non-payment.

Bureaucrats who know nothing about patient care and the natural history of disease created this dumb readmission criteria.

The bureaucrats’ goal was to provide incentives by the threat of penalty for hospitals to improve quality of patient care.

I told my readers that the incentives were wrong. It would be to the disadvantage of patients. Hospitals would figure out how to get around the penalties.

Medicare does not pay for outpatient (observation) admissions. Hospitals can admit patients on observation (outpatients) for 48 hours.

I explained how hospitals could extend outpatient admissions (observations) 72 hours. Patients are responsible out of pocket for the admission bill.

Many of the readmissions are recurrent congestive heart failure. These patients can be treated and released from the hospital in less than 24 hours and at most 48 hours. Patients with congestive heart failure must become “Professors of the Treatment of Congestive Heart Failure.” Patients must be responsible for their care. They must be provided with financial incentives to become “Professors” of their disease.

Most of the time readmission is not the result of poor quality hospital care. It is the result of patients not understanding the cause of the recurrence of their congestive heart failure.

Most of the time patients do not pay attention to what they are taught to abort an episode of congestive heart failure and subsequent readmission to the hospital.

Most of the time hospital call in help desks does not improve patient compliance with treatment.

Hospital readmissions that Medicare penalizes under the Affordable Care Act are largely driven by patient characteristics such as income and education rather than the quality of care they receive, according to a new study.”

“This finding suggests that Medicare is penalizing hospitals to a large extent based on the patients they serve,” the authors conclude.

Hospitals in poor areas and urban hospitals have been disproportionately penalized under the readmission program.

In fiscal 2016, about 1,600 hospitals will see their base operating DRG payments knocked down as much as 3%.

Medicare payments were decreased 1% in fiscal 2013 for readmission before 30 days. That number increased to 2% in fiscal 2014 and 3% in 2015.

Penalties and fines applied only for heart attack, heart failure or pneumonia until 2015. In 2015 readmission rates for chronic obstructive pulmonary disease and total hip and total knee replacements have been added to the penalty list.

The addition of these diagnoses will result in additional fines to hospitals. Additional penalties will affect hospitals’ bottom line severely and not lead to increased quality care.

Only 769 of more than 3,370 hospitals have avoided fines. Some hospital might have to close because of the penalities.

I have said many times that policy wonks do not know how to measure quality.

Hospitals that are flourishing are paying the CEO and other administrators millions of dollars a year in salaries.

Hospitals avoiding penalties and fines are not necessarily providing better quality care. These hospitals might treat less sick patients or more intelligent patients,

The Obamacare incentives are upside down. Punishment hardly ever works to improve quality healthcare.

Has anyone ever thought about providing incentives to patients to learn how to improve their own compliance to medical care?

In an entitlement society patients are taught to expect (entitled) to be cured without applying much effort on their own.

They are taught to be dependent on physicians and hospitals to cure them of their chronic disease.

Physicians should be the coaches. Patients are the players in the treatment of their diseases.

Obamacare’s readmission policy is all wrong. Its goal is to keep patients in a passive dependent role.

Only when government healthcare policy wonks understand that consumers of healthcare must be provided with incentives to be responsible for their healthcare and medical care decisions will America be on the way to Repairing the Healthcare System.

No one in Washington is thinking this way.

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

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President Obama Keeps Doing It

Stanley Feld M.D., FACP,MACE

President Obama is trying to avoid the press attention about  Obamacare’s continuing mess.

The insurance industry announced that insurance premiums in both the federal and state health insurance exchanges are going up to 50% in 2016. The group private markets will increase by the same percentages.

Insurance rates for 2015 were unaffordable for small businesses, and large corporations.

One church that buys insurance in the private healthcare insurance market had its rates increased 37%.

Instead of dropping insurance for their employees and paying the penalty, the church agreed to the pay the increased premiums. The church compensated for this increase in expenses by increasing church membership dues. Some members had to quit the church.

Eighty-five percent of members in Obamacare are receiving a government subsidy. A high percentage of that 85% are receiving higher subsidies than they are entitled to receive because of government lack of verification.

Eventually, when healthcare.gov website connects with the IRS, the government will find out that people received higher subsidies than they are entitled to. The recipients will get a bill they cannot afford.

Obamacare’s reinsurance subsidies for the health insurance industries are expiring in 2016.

The insurance industry is raising insurance premiums to cover the revenue lost by not receiving the Obamacare insurance company subsidies in 2016.

President Obama opened the Obamacare reinsurance program when too few insurance companies signed up to sell insurance through the health insurance exchanges.

The reinsurance program was a subsidy to cover the healthcare insurance industry’s supposed loses.

Obamacare hoped that multiple insurance companies would sign up in order create price competition among the companies and result in lower consumer premiums.

The healthcare insurance industry did not want to sign up. The insurance companies knew there would be adverse selection for insurance consumers.

Sicker people would enroll in the federal or state Health Insurance Exchanges. These sicker people could not afford or were not eligible to buy private healthcare insurance. The participating insurance companies would be at risk to pick up these sicker and more expensive patients.

“After finding that new customers were sicker than expected, some health plans have sought increases of 10 percent to 40 percent or more.”

Obamacare healthcare insurance coverage requirements would also cause them to seek an increase in premiums.

None of these issues appear in news stories that are covering this aspect of the story.

The political spin by the Obama administration is that the Obama administration is trying to persuade states to cut back big rate increases requested by many health insurance companies for 2016.”

I predict if the insurance companies do not get their rate increases they will drop out of the healthcare insurance market.

This is exactly what the Obama administration wants. It is a de-facto victory for a single party payout system and all of its ramifications.

It will not work because the Obama administration still needs the healthcare insurance industry to process and pay the claim. The result will be a higher premium for the consumer and an increased payout to the healthcare insurance industry by the government.

The government will be required to raise taxes or increase the deficit.

Kevin J. Counihan, the chief executive of the federal insurance marketplace is trying to convenience the healthcare insurance industry to reconsider its decision.

The facts spin war is starting. Mr. Counihan said in a letter to state insurance commissioners “Recent claims data show healthier consumers.”

This is apparently not true.

Scott Keefer, a vice president of Blue Cross and Blue Shield of Minnesota, which requested rate increases averaging about 50 percent for 2016, said his company had not seen an improvement in the health status of new customers.

“Our claims experience has not slowed at all,” Mr. Keefer said. “The trend has gotten a little worse than we expected.”

I have recently shown that the Obama administration’s claim that it is bending the cost curve is fiction. The cost to the government and the direct out of pocket cost to the consumers has increased.

The government costs have not risen as quickly as predicted by some but they are rising even more now.

Another weak argument the Obama administration is using is the federal tax penalty is increasing in 2016.

The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

Why should these people buy insurance when they cannot afford the premiums or the deductibles?

Two additional weak arguments are being used.

“Federal officials said, much of the pent-up demand for health care has been met because consumers who enrolled last year have received treatments they could not obtain when they were uninsured.”

There has not been a very large increase in those insured by the state and federal exchanges between 2013 and 2014 to eliminate the “pent up” demand.

“Federal officials have also told state regulators that medical inflation will be less than what many insurers assumed in calculating their rates for 2016.”

The Obama administration has told these lies over and over again.

Does the president really believe if you tell a lie over and over again it becomes the truth?

There is a much better way to deliver universal health care and spend less money.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2012/10/business-model-for-medical-care-2020-the-ideal-future-state.html

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‘Chutzpah’- America Last Chance

Stanley Feld M.D.,FACP,MACE

Chutzpah’s definition :shameless audacity; impudence.

synonyms: audacity, cheek, guts, nerve,boldness,temerity

President Obama has Chutzpah. Why don’t the American people have CHUTZPAH?

We have many smart people in the United States. Most are busy with their daily life at work and raising a family.

They do not have the time or bandwidth to focus on the problems in our country. People do not have the time to ask the important questions.

Why doesn’t the political establishment on both sides of the aisle represent us properly?

We continue to elect politicians that do not represent the will of the people and their welfare.

Healthcare is a big problem. Its costs are unsustainable. The bureaucratic inefficiencies result in a huge waste of resources.

President Obama is methodically transforming Healthcare by destroying it. He is destroying all the independence and innovation that has been in the hallmark of the healthcare system.

He is forcing it into a government controlled healthcare system. The result will eventually be a commoditized third world healthcare system.

President Obama knows exactly what he is doing. He is doing it well.

However, healthcare is not our country’s only problem.

We can easily open our eyes and scream, “What’s It All About Alfie?”

A reader wrote and said this is our last chance to elect people who represent America’s safety, economic growth, racial harmony and prosperity for all. We must elect people who replace lawlessness with sanity.

If our government officials do not act responsibly, how can we expect our citizens to act responsibly?

A reader sent this note to me. I think it is worth passing on.

The note starts connecting the dots of all the misuse of power.

It puts the past 6 years of President Obama’s administration in perspective.

“To : DEMOCRATS & Republicans & INDEPENDENTS

Someone please tell me, what’s wrong with
all the people that run this country.!!!! 

Both Democrats and Republicans
They Say,”We’re broke”
And can’t help our own
Veterans, Seniors,
Orphans, Etc.,?????

But, over the last several years, THEY
have provided direct cash aid to…..

Hamas – $351 M,
Libya $1.45 Billion ,
Egypt – $397 M,
Mexico – $622 M,
Russia – $380 M,
Haiti – $1.4 Billion,
Jordan – $463 M,
Kenya – $816 M,
Sudan – $870 M,
Nigeria – $456 M,
Uganda – $451 M,
Congo – $359 M,
Ethiopia – $981 M,
Pakistan – $2 Billion ,
South Africa – $566 M,
Senegal – $698 M,
Mozambique – $404 M,
Zambia – $331 M,
Kazakhstan – $304 M,
Iraq – $1.08 Billion ,
Tanzania – $554 M,

A total of $14,933,000,000
that’s 14.933 BILLIONS, of Dollars
& they all still hate us.!!! 

(NOTE HOW MANY AFRICAN NATIONS!) 

But, on the other hand,

OUR MILITARY IS BEING CUT,
OUR SOLDIERS ARE HAVING THEIR BENEFITs
CUT & THE GOVERNMENT’S GONE BACK ON ITS
PROMISE OF FREE MEDICAL CARE & DENYING DISABLITY TO THOSE PHYSICALLY & MENTALLY TORN APART, FOR NO GOOD REASON,
IN POLITICAL WARS! 

Our retired seniors,
living on ‘fixed incomes’, have their
taxes raised, to send to these countries,
& also, are having medical benefits cut. 

Our own citizens receive NO aid, unless they’re the ones who
refuse to work, & have babies
for welfare payments! 

Nor do the seniors & working public
get any breaks, 

while our government
& religious organizations will pour
Hundreds of Billions Of dollar’s,
& Tons of Food,
to Foreign Countries & the illegals,
& the leeches within our borders!
AMERICA: 

A country where we have
Our brave warriors, damaged for life,
waiting in year long lines for their due,( VA Hospital System)

the elderly going without needed medication,
& the mentally ill without treatment,
& for all of us, our safety is at risk,

& YET …….
They’ll have a “Benefit Show”
For the people of Haiti, on 12 TV Stations ;
with ships & planes lining up with food,
water, tents, clothes, bedding, doctors
& medical supplies. 

Now Just Imagine, if
Our own * GOVERNMENT * gave ‘US’
the same support they give foreign countries.
________________________________________
Sad, isn’t it? 
Logic is dead.
Excellence is punished.
Mediocrity is rewarded.
And dependency is encouraged. 

99% of people won’t have the
‘chutzpah’ to forward this. 

WELL, I’m one of the 1% who just did .!!”

Americans are beginning to see how ineffective and screwed up our government and its bureaucracies are. We must elect a government that puts America’s priorities first.

A majority of the population is starting to see how wrong President Obama is. He has forced us to accept Obamacare. The majority of Americans neither want nor like Obamacare. The majority of Americans neither want  nor like central government control over healthcare.

President Obama is forcing us to accept a nuclear deal with Iran that is obviously not going to be honored by Iran yet they will receive billions of dollars to further their terrorist activities.

Past behavior is a predictor of future behavior if there are no deterrents

Our representatives in congress are not doing a thing about healthcare or the nuclear deal despite their promises to us at election time.

Iran has essentially told us they will not change. They have continued their military and ICBM buildup as the Obama administration dismantles America’s military.

When are Americans going to become angry enough to kick the bums out of office?

How can we force congress and the administration to express the will of the people?

President Obama knows exactly what he is doing it and how fast it should be done.

President Obama knows how to marginalize his critics with his Saul Alinsky tactics. He always comes out on top in battles that he should lose? He should lose these battles because they do not benefit the American people.

James Greene’s latest Jim’s Daily Rant is partially reproduced below with his permission.

The Rant offers a less vitriolic summary of our politicians’ (specifically President Obama) abuse of the American people and their freedoms.

The article defines TOTALITARIANISM.

 

WHAT IS TOTALITARIANISM?

 

Greene starts off with

American critic Irving Howe, in his essay on George Orwell’s 1984, “Orwell’s profoundest insight is that in a totalitarian world man’s life is shorn of dynamic possibilities. 

The end of life is completely predictable in its beginning, the beginning merely a manipulated preparation for the end.”

“Howe points out: “The totalitarian state assumes that—given modern technology, complete political control, the means of terror and rationalized contempt for moral tradition—anything is possible. 

Anything can be done with men, anything with their minds, with history and with words. 

Reality is no longer something to be acknowledged or experienced or even transformed; it is fabricated according to the need and will of the state…”

“Obama’s Insane Worldview”

“This is a perfect example of what Howe characterizes as totalitarianism’s “rationalized contempt for moral tradition.”

“Obama’s Black vs. White Divisiveness”

“When you ask why Obama is lashing out against U.S. police forces, you come up with the same answer as to why Obama is weakening U.S. defenses around the world: That’s his strategy.”

Where is President Obama’s instant outrage against police murders all over the country? He has been silent.  “It is because this does not fit into his strategy.”

“Obama: The Anti-Reagan”

“What President Obama wants is to impose his meaning of reality, which amounts to a reign of terror on America, resulting in worldwide and domestic chaos.”

Domestic and worldwide chaos is occurring. Terrorism is practiced on our street corners without consequences.

Americans are starting to notices despite the lack of this news in the traditional media.

It doesn’t matter whether you are a Republican, Democrat, Independent, conservative or libertarian America is slowly becoming a TOTALITARIAN state with complete central government control.

President Obama promised transformation. He has kept his word. Unfortunately americans did not understand his meaning.

He is transforming America from a constitutional Republic that provides many freedoms. Americans should be independent, responsible and undivided despite, color or creed to a people dependent completely dependent on government.

All people should realize that our government is not working well and our freedoms are disappearing. The people are becoming enslaved by central government control.

“Has the American Voter Surrendered?”

“The Obama long-range strategy is that those that come after him can preside over a docile American population that will be glad to give up its individualism and Constitutional freedoms for obedience to government in exchange for government largesse.”

In short, it’s about power over people–instituting the reign of totalitarianism Orwell and many others predicted as a possibility.”

 “Therefore, the next presidential election will not be a contest between Democrats and Republicans; it will be a contest between increased individual freedom and increased government control.”

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Lies About Government Spending

Stanley Feld M.D.,FACP,MACE

President Obama and the mainstream media have been bragging about how well Obamacare is working. They cite that Obamacare is bringing down government health-spending growth.

However they have not been telling the truth. They have taken numbers out of context and have spun a lie.

The evidence presented by federal actuaries is that health growth has been under 4% in the five years prior to 2014.

The Obama administration has made a big deal out of this finding. President Obama has bragged that he is bending the cost curve with Obamacare.

His statements are deceptive. It means government health spending growth has been just under 4%. It is still increasing by 4% year to year and not the usual 6%-10% increase.  

Obamacare spending for direct medical care did not go into effect until 2014. All that went into effect was increases in taxes from 2010 until 2014 and spending on the growth of the bureaucracy resulting in a 4% growth. The math had nothing to do with increased direct medical care.

According to federal actuaries, spending on all health care grew 5.5% in 2014. Actual enrollment was lower than expected enrollment in 2014.

2014 was the first year of spending on direct medical care. Healthcare spending will continue to increase in 2015 to 5.3%. The reason is spending for Obamacare took affect in 2014 and continued in 2015. The reason for the slight predicted percentage decrease for 2015 is at least two fold. Less people signed up for Obamacare in 2015 than predicted and reimbursement for physicians and hospitals decreased.

Other reasons for a government decrease in spending are consumers are paying a greater share of their medical bills and reining in their use of medical care services.

One in three Americans said they or a family member delayed medical care because of costs in 2014, according to a report late last year by survey company Gallup.”

President Obama and his administration are deceiving the American public about the success of Obamacare.

The cost to taxpayers and people who are insured has actually increased. President Obama continually tells us costs are decreasing.

The mainstream media, especially The New York Times and Paul Krugman, continually repeat the lie. If you repeat a lie enough times people begin to believe it is the truth.

A reader asked me where did the New York Times readers leave their thinking apparatus. Someone else pointed out that the New York Times readership is decreasing because the newspaper has lost its credibility.

The New York Times opinions seem to be presented without supporting evidence.

The truth is premiums are increasing, coverage is decreasing and insurance deductibles are increasing for everyone including the middle class. Access to medical treatment is decreasing. Out of pocket expenses are skyrocketing.

The deception continues unchallenged by Republicans. No one is talking about the fact that the Obama administration is lying about what is happening on the ground.

“According to a report from actuaries at the Centers for Medicare and Medicaid Services published in the journal Health Affairs. In the years through 2024, spending growth is expected to average 5.8%, peaking at 6.3% in 2020.”

The cost of healthcare to the government is going to increase further and faster than predicted by federal actuaries as a result of expanded government insurance coverage under the 2010 health law, and the ever expanding Medicare’s baby-boom beneficiaries entering Medicare age.

As technology increases and as the baby boomers enter Medicare and more expensive life-saving drugs are developed costs to the government are going to increase.

The cost of pharmaceuticals is reported to have increased by 12% last year. The deals the government makes with the pharmaceutical companies are pathetic. The prices continue to mount for the government as consumer out of pocket costs for drugs increase.

By 2024 healthcare costs to the government and consumers are projected to be over 20% of our GDP and rising at the present Obamacare rate.

Americans will be older and sicker.

There is little government focus on helping our population become motivated to become  healthier and more responsible for their health and their own healthcare as they age.

Obamacare is forcing Americans to become more dependent on the government for their healthcare needs.

Hopefully, people are noticing that government does not work and more government will be a disaster to our medical and financial health.

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King vs. Burwell and The Supreme Court

Stanley Feld M.D.,FACP,MACE

I have received a couple of emails asking me why I have not responded to the Supreme Court’s ruling in King vs. Burwell.

A ruling in King’s favor seemed so clear to me. I thought the case would be decided in favor of the letter of the law. This seemed obvious since Jonathan Gruber, the author of Obamacare, admitted the words “state health exchanges are the only exchanges that could provide subsidies” were intentional.

It was clear that the author of the law (Jonathan Gruber) and President Obama wanted to encourage states to create State Health Insurance Exchanges.

The carrot was money. If the states did not create State Health Insurance Exchanges they would lose their government grants.

The legislators of the states that refused the Obamacare trap would experience angry voters and get kicked out of office.

Dr. Gruber also admitted that if there was transparency during the law’s creation it would never have been passed. Jon Gruber called Americans stupid.

This comment motivated President Obama to distance himself from Jonathan Gruber. He said Dr. Gruber was not a major player in the creation of Obamacare. President Obama claimed that he barely knew him.  He claim Jonathan Gruber had only been to the White House a couple of times.

President Obama’s statement has been proven to be a lie.

 http://www.foxnews.com/politics/2015/06/24/editor-says-owes-gop-sources-apology-after-new-gruber-emails/?intcmp=ob_article_sidebar_video&intcmp=obinsite

 The Supreme Court’s decision has been a mind blower to me. I still have not figured out how to respond.

I thought the Supreme Court Justices’ job was to interpret laws within the context of the constitution. They should not create new laws or create new meanings for laws.

They also should not allow themselves to be bullied by the executive or legislative branch of government.

President Obama has been doing heavy duty bullying of the Supreme Court to rule in his favor in the last four months. President Obama’s goal is to not let anyone stand in his way on the road to control the entire healthcare system.

The justices live in our society. They are aware of the media and have access to the same information as everyone else.

It should be obvious to them that all the stakeholders dislike Obamacare now that they “know what is in it.”

Obamacare is a terrible law. President Obama told many lies and has taken many unlawful steps to hide the law’s failures.

The justices should have recognized that Obamacare is not a bipartisan law. Only Democrats voted for the bill even though many have admitted they did not read it.

It hardly represents the will of the people as they are now recognizing all its faults and deficiencies.

The Supreme Court’s codifying the law seems bizarre to me.

I also thought that the Supreme Court’s decisions had to be made in the context and spirit of the law and the meaning of the constitution. 

I am especially disappointed in Chief Justice John Roberts. His reasoning for ruling on King vs. Burwell was just the opposite of his reasoning for his ruling on gay marriage.

It is as if he has been influenced by outside sources in each ruling. 

I know the ruling has stunned many people. Congress made the law. Congress should change the law to mean what the Supreme Court said it meant.

I have not figured out what an appropriately reasoned response should be.

I believe the will of the people will prevail once people understand the harmful effects of this law. Its affect on the economy is becoming obvious. Its affect on Americans individually is also becoming obvious.

Obamacare will eventually die under its own weight. The Democratic Party will never be able to get rid of the label “tax and spend party.”

The Democratic Party and President Obama are putting America into greater debt.

I believe the lower socioeconomic groups, who President Obama claims to help, are realizing President Obama is doing them more harm than good.

His goal is to make Americans more dependent on the central government.

I do not think President Obama or the Democrats are going to be able to survive the coming tsunami of a plebiscite against Obamacare.  

In the end Americans are not fans of socialism. They know it doesn’t work.

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

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