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Where Is The Missing Money?

Stanley Feld M.D.,FACP,MACE

Does anyone know how much Obamacare cost each year? Does anyone know if Obamacare is the cause of America’s more than one trillion-dollar deficit each year despite the Obamacare tax increases that are supposed to pay for it ?

If someone knows they sure are not telling taxpayers. A good friend who is a liberal and a big fan of President Obama said to me he is not worried about the federal deficit. Neither is President Obama. President Obama has convinced his base that the budget deficit and America’s escalating debt is an insignificant problem.

It follows that he can spend money as he wishes and waste money with impunity. I was taught that is not the way to run a business. Especially when the waste fullness gets negative results that leads to more deficit spending.

The problem is the waste of money is reported in dribs and drabs and usually on a Friday afternoon.

We have seen that happen in the VA system. After one year and billions of dollars spent the waiting times have decreased slightly. The medical service to veterans has not improved. No one in the bureaucracy has been held responsible. Veterans have been complaining more loudly since nothing has improved.

Missing Money

The federal government awarded over $5 billion to help states set up Obamacare exchanges, with the vast majority – $4.6 billion – going to 16 states and Washington, D.C.” 

The Government Accountability Office (GAO) recently reported that most of the money has not been accounted for. Several of those State Health Insurance exchanges have gone out of business this year.

$1.4 billion of that has been spent on IT projects. This sounds very high for 16 different web sites. Why couldn’t everyone use the same website?

Three ($3 billion) has been “spent or drawn down.” Only some of the drawn down spending has been detailed.

At least $1.6 billion is unaccounted for. Only three states returned any portion of the money. The federal government has only received back $1 million.

It sounds like government bureaucracy inefficiency at best and fraud and abuse at worst with no one being held accountable.

Can Americans trust the government to run our healthcare system?

Where did those taxpayer dollars go?

More Missing Money

Obamacare created the co-ops to encourage State Health Insurance Exchanges to increase competition in state insurance markets.

The intent was to offer consumers choices with the hope of holding down premiums.

Co-ops were snuck into Obamacare to replace the public option. No one has spoken about this being a substitute for the “public option.” The public option is an obvious ploy to convert the healthcare system quickly to a single party payer system.

The public option was designed to compete with private insurers on the state level by offering lower premiums in order to force the insurance industry to lower its premiums. The co-ops were designed to do the same thing.

President Obama offered state co-ops $6 billion dollars for start-up costs. Since there were only 23 states co-op formed instead of 50 Congress decreased the total payment to $2.4 billion to the 23 start-up co-ops.

All 23 co-ops received their proportional federal loans to meet solvency requirements as well as start-up costs.

President Obama now claims the Republican house denied Obamacare enough money for the co-op to be successful.

Twelve (12) of the 23 nonprofit insurance co-ops announced they will not offer coverage to consumers who bought healthcare coverage in 2015 in 2016. They are bankrupt. Where did the money go?

Somewhere between 300,000 and 600,000 people will be shopping for more expensive healthcare coverage for 2016.

The remaining 11 standing co-ops are $500 million dollar in the hole.

There is no accounting available to explain why these co-ops have failed

Does anyone think these $2.4 billion dollar loans will be paid back to the federal government? I do not. It will simply be added to the federal deficit.

  • “CMS said the government would “use every tool available to recover taxpayer dollars” from the co-ops going out of business, but it declined to say how much she expected to recoup.”

There are many reasons these co-ops have failed. Republicans not giving the co-ops more money, as progressives and Democrats have claimed, is not one of the reasons.

Another area of missing taxpayers’ dollars.

The Senate Finance Committee is looking into the millions of taxpayer dollars being spent on ads to promote Obamacare enrollment.

The total federal government budget for ads and PR was nearly $1 billion in fiscal 2013. How much was spent on Obamacare?

The Health and Human Services budget for “paid media” is about $35 million for the current enrollment period. The $35 million dollars will be spent in the 38 states using HealthCare.gov in the 2016 enrollment period.

Chairman Orrin Hatch, R-Utah, raised concerns about agency ad spending and sent a letter to the acting head of the Centers for Medicare and Medicaid Services (CMS) asking for a full accounting of agency ad spending.

“Increased transparency on government spending on advertising will improve accountability and help ensure that the taxes from hardworking Americans are not squandered and wasted on ineffective or misguided government programs,” he wrote to Acting Administrator Andrew M. Slavitt.

Senator Hatch demanded the accounting by November 25th. Does anyone think he received it?

In 2010, the nonpartisan Government Accountability Office (GAO) reported the Obama administration spent nearly $20 million on a Medicare brochure that contained “instances in which HHS presented abbreviated information and a positive view of Patient Protection and Affordable Care Act (PPACA) that is not universally shared.”

The GAO papered over the ridiculous expenditure.

GAO concluded that “nothing in the brochure constitutes communications that are purely partisan, self-aggrandizing, or covert.” 

CRS reported HHS was second only to the Department of Defense, spending $197.4 million on advertising in fiscal 2013.

“The total federal government budget for ads and PR was nearly $1 billion in fiscal 2013.”

Would healthcare be so expensive if the government was transparent and congress was really on top of everything?

Physicians only receive 20% of the healthcare dollars spent.

President Obama and his administration spend taxpayer’s money at will.

Americans have to demand “more efficiency and much more transparency.”

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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Lie. Why Not?

Stanley Feld M.D.,FACP,MACE

President Obama and his administration continue to lie to the American people. One of the major criticisms of letting Syrian refugees into this country is that our vetting process is not robust enough to determine if some of the young strong men might be ISIS operatives.

Ben Rhodes, Deputy National Security Adviser, repeated President Obama’s lie about the U.S. intelligence agencies having a robust vetting procedure. The agencies contradicted President Obama.

How can President Obama have the nerve to tell the American people that Obamacare is working when few enrollees are signing up on www.healthcare.gov so far during this open enrollment period.

On Thursday UnitedHealthcare said it is losing too much money on servicing www.healthcare.gov enrollees to continue. It is threatening drop out of servicing the Health Insurance Exchanges.

The traditional mainstream media did not cover this important news release on its important evening cycle.

In the latest piece of ObamaCare news (Failure) that the liberal media has chosen to ignore, ABC, NBC, and Spanish networks Telemundo and Univision skipped on Thursday night and Friday morning word from United HealthCare from Thursday that it may withdraw from ObamaCare exchanges in the future after reporting losses of around $700 million for the year.”

While ABC and NBC were joined by CBS in censoring this story from their Thursday evening newscasts, Friday’s CBS This Morning stepped forward with a measly 18-second, 46-word brief from co-host Charlie Rose that alluded to a Wall Street Journal piece on United HealthCare.

Charlie Rose said with little emotion, editorial comment or explanation of its meaning, “The Wall Street Journal reports on one of the nation’s biggest health insurance company considering pulling out of ObamaCare. United Health Group said it suffered major losses on the policies sold on the Affordable Care Act exchanges. Operating losses this year will total about $700 million.

The CEO of UnitedHelath’s actual statement was, “in recent weeks growth expectations for individual exchange participation have tempered industrywide, Obama”s co-operatives have failed and market data has signaled higher risks and more difficulties while our own claims experience has deteriorated, so we are taking this proactive step.” 

These are the reasons for the UnitedHealthcare pull out. Fox News covered the story in full on Thursday evening in primetime and Friday morning.

Special Report to devote a full story to the matter from correspondent Rich Edson.” 

“Host Bret Baier declared in a short lead-in that “a major setback” is possibly “in the works tonight for ObamaCare” as “[t]he President’s health care law could be losing a huge source of the coverage provided.”

“Edson also made sure to mention that such a story has given “ObamaCare critics” additional reasons to argue that “with rising premiums, fewer health provider choices, is another sign of the unsustainability of the health care law.”

How can anyone expect the public to be informed about Obamacare’s failures when the major networks who these important stories?

But the public is catching on. The major networks are acting as a shill for the Obama administration. The major networks should not be surprised that their viewership is declining.

 As opposed to covering the major healthcare story Thursday’s CBS Evening News and NBC Nightly News each found time to tout the Food and Drug Administration’s approval of a genetically-modified salmon for human consumption that won’t actually become widely available for at least a few years.

How can President Obama think the American people have confidence in him?

The lies continue daily. The majority of the information sources have become a super pac for President Obama. What is the public recourse to stop this madness?

Most of the people in the country have never heard of Saul Alinsky or his book “Rules for Radicals.”

Saul Alinsky’s recommendations are exactly what President Obama is using.

You lie to the people and restrict information so that the critics of your policies seem unreasonable. Opponents cannot mount an effective offensive and therefore get enough public support to demand change.

I suggest Republicans hire an effective and innovative public relations firm to counteract President Obama’s attacks on the freedoms of the American people.

President Obama’s response to his critics has been that Republicans are fear mongers and should be ignored. He presents no evidence just accusations.

I am republishing the following 2014 blog’s You Tubes because viewing these amazing You Tube compilations of President Obama’s lies are essential to understanding President Obama’s method of operation.

http://youtu.be/4puS-yjwsiE

This You Tube is worse than the Words Matter You Tube

 

http://youtu.be/1YqXCFCXXL8

The American people must do their own research, get involved and not let President Obama manipulate us into a socialist state.

Socialism does work as we are seeing in Europe. France cannot afford to fight ISIS because entitlements consume 54% of the GDP and taxes are close to 70% of personal income.

The wealthy people with large incomes who paid high taxes in the past are fleeing the France.

As corporate taxes and individual taxes have gone up in the United States on President Obama’s watch we have not only had a tax inversion occur with corporations moving over 3 trillion dollars overseas, we are now seeing a tax inversion movement by rich individuals.

President Obama’s lies and manipulations cannot be ignored anymore. These lies are a clear and present danger to America’s economy and way of life.

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



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My Two TechStars Sons

Stanley Feld M.D., FACP,MACE

A few Mondays ago I flew to Boulder on the first American Airlines flight from Dallas to Denver get to TechStars FounderCon before 9.30 a.m. and the first morning session.

I wanted to see what FounderCon was all about and how my son, Daniel Feld, put it together.

Daniel and his staff put on FounderCon in Boulder. It attracted over 800 TechStars founders. I wanted to be there to celebrate Daniel’s success.

Also I wanted to spend time with all these young people observing how their powerful social network works.

I love spending time hanging out and learning from my sons. I try to take every opportunity I can to learn from them

Daniel Feld is Vice President of Operations for Techstars. He leads its powered by TechStars expansion efforts with corporate partners including Nike, Kaplan, R/GA, Sprint, Disney, Barclays, Ford, MetroAG and others.

FounderCon is a TechStars annual event for all Techstars graduate founders. The conference is two full days of keynote speakers and breakout sessions in addition to social and business opportunity networking.

The primary purpose is to learn and network with almost 800 Techstars founders across the 36 TechStars programs in the U.S. and around the world.

My conclusion at the end of the conference was that Daniel is an excellent organizer and administrator. His staff is dedicated to his leadership.

His father (me) is very proud of him. I also learned a ton from all these young entrepreneurs about their corner of the world.

What is TechStars?

TechStars is a startup accelerator founded by David Cohen, David Brown, Brad Feld and Jared Polis in 2006.

In Las Vegas in 2006 on one of our father-son weekends Brad told me the two David’s idea to see how I would react. I knew he had already made up his mind that he was going to go for it.

I thought it was great. There is nothing like a young startup entrepreneur learning how to start and run a business from mentors who have already started up a business. It is much better and more efficient than learning from scratch.

TechStars has grown into a fabulous franchise in the last nine years. There are founders who have learned how to startup a company from all over the world. It is growing rapidly.

FounderCon provides an opportunity for graduates of TechStars to grow and help each other.

The TechStars mantra is give first. Do not worry about the return. The concept is expressed eloquently in Brad seminal book for start ups Startup Communities Building An Entrepreneurial Ecosystem In Your City. “ The book has been published in many languages.

The book is the foundation of his Startup Revolution.

The startup energy results from his Boulder Hypothesis. This hypothesis has led to the formation of many very successful startup companies.

TechStars has expanded geometrically in the pursuit of developing Startup communities.

The magic of TechStars and the development of a successful Startup Community are expressed in the following You Tube.

 

My sons Daniel and Brad teach me more that I teach them these days.

I am all ears and try to learn all I can.

We also have a great time hanging out and enjoying chocolate ice cream.

 

Daniel and I at foundercon

Daniel and Stan. Which One is Stan?

Brad and I Boulder founderCon

Brad and Stan at our tradition.

Thanks guys. I love you both very much.

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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President Obama Says Medicare, Medicaid ‘Not In Crisis’

Stanley Feld M.D.,FACP,MACE

The media is the message. President Obama controls the media and his messages come out loud and clear even if they are lies.

On the 50th anniversary of Medicare and Medicaid President Obama said,Obamacare is “finishing the job” begun by Presidents Kennedy and Johnson”.

President Obama also claims that, the two federal health care programs are not in crisis, and those who say they’re in trouble are playing politic.”

This is the Saul Alinsky attack method to marginalize your enemies whether they are right or not.

According to Obama, those who say “Medicare and Medicaid are in crisis” are doing so as “a political excuse to cut their funding, privatize them, or phase them out entirely.”

President Obama was the one that cut Medicare funding not his political enemies.

 No one wants to phase out Medicare or Medicaid entirely.

Sensible critics know both programs are not economically sustainable in their present form.

They are suggesting making the recipients of Medicaid and Medicare more responsible for themselves and their care in order to convert each program to an economically sustainable one.

President Obama is the one playing politics. He is using the media via his bully pulpit to proclaim his indefensible message.

Even Medicare actuaries and the Centers for Medicare and Medicaid Services – say both programs are “unsustainable.”

Anyone on Medicaid would be surprised to learn they are receiving “efficient, high quality care” with their difficulties in seeing a doctor and their rapid non-communicative visits.

It is not “efficient high quality care.” Price constraints do not permit efficient high quality care.

President Obama prefers to live in his own fantasy world about this issue as he does with most issues including the Iran nuclear bomb deal.

The current supposed percentage decrease in spending is fiction as I explained in my last post. The decrease in the percentage of the budget deficit is the result of an increase in taxes.

The advantage of tax increases without service increases is about to disappear. Then the budget deficit resulting from Obamacare will skyrocket.

Additionally there will be a doubling of the Medicare population as a result of the aging baby boomers. This increase will require combinations of benefit cuts, eligibility changes and cost-share increases.

All of these changes are occurring right now. Seniors who are aware of the changes only because they are presently receiving care are feeling it and are complaining. Soon a great percentage of seniors will begin complaining.

President Obama will have no hesitation to increase taxes and decrease payment to providers even further.

As baby boomers age into Medicare eligibility, a significant and growing proportion of doctors don’t accept Medicare patients. Many primary care physicians are becoming concierge doctors. They will only accept Medicare patients if the patients pays $2,000 to $30,000 per year to be a member of his panel. Medicare and Medicaid reimbursement is too low. Physicians have to see many patients to make ends meet.

 According to the nonpartisan Medicare Payment Advisory Commission, 29% of Medicare beneficiaries who were looking for a primary-care doctor in 2008 already had a problem finding one.

All of this is beyond President Obama’s vision even though it is happening right now.

Obamacare is causing private insurance to become unaffordable for the middle class.

Obamacare’s regulations on pricing and coverage have already forced termination of private health insurance for more than at least five million Americans in the individual insurance market.

The Congressional Budget Office is now projecting that as many as 10 million people will be forced off their chosen employer-based health insurance by 2021.

This increase represents at least a tenfold increase in the 2011 projections at the onset of the law.

“Numerous reports in the top medical journals like CancerAmerican Journal of Cardiology, Journal of Heart and Lung Transplantation, and Annals of Surgery clearly show that patients with private insurance have better outcomes than similar patients on government insurance. It is highly likely that restrictions in access to important drugs, specialists and technology account for these differences.”

All one has to think of is the VA hospital system and its scandals to visualize the effect of government bureaucracy and its bureaucrats on a healthcare system.

Another example is the government bureaucracy’s inefficiency in building the web site for the federal health insurance exchanges.

Why are Americans not protesting? Why are Americans letting President Obama get away with destroying the healthcare system?

Medicaid’s problems are more complicated than Medicare’s problems as a result of Obamacare. I have a feeling the Democratic congress that voted for Obamacare is realizing they should have read the law and understood the law before they passed it.

Originally Medicaid was healthcare insurance for people receiving welfare. Obamacare expanded coverage to all people below 138% of the definition of poverty. In most states the yearly salary is below $38,000 per year.

The federal government originally subsidized the states at the 50% level for Medicaid costs. For the next year the subsidy is 100%. Then the federal government will decrease the matching rate to 90% and subsequently to 80%.

States cannot print money to cover their obligations. States must balance their budgets. One of the reasons thirty-seven (37) states opted out of the program is because they would have to increase state taxes even further. Somewhere along the way Medicaid coverage for the poor has to be revised. Medical care is poor and reimbursement is terrible. The poor cannot find doctors. It is unsustainable and medical care needs to be improved.

President Obama keeps on lying to the American public as he tries to protect his “legacy” legislation Obamacare. It has become a legacy history will prove he should not be proud of.

To declare on Medicare’s and Medicaid’s 50th anniversary that both of these programs are not in crisis is a bold faced lie.

Medicare and Medicaid will decimate the federal budget unless something positive is done about these two programs.

Medicare and Medicaid in their present form will crowd out funding for vital priorities like national defense, infrastructure security and homeland safety while failing to deliver on their promises of quality health care at an affordable price for seniors and the poor.

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

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President Obama: “Obamacare is driving Down the Federal Budget Deficit”

Stanley Feld M.D.,FACP,MACE

In July 2015 in a speech on the economy at American University, Barack Obama  made the following statements.

The cost of “health care is now the single-biggest factor driving down” the federal budget deficit.”

The American public is tired of listening to President Obama’s lies, mostly lies and half truths.

Politifact analyzes many of President Obama’s statements of fact and grades them with Pinocchio’s and scores these statements.

 

President Obama’s statements by ruling

  • True               119         (21%)   (119)
  • Mostly True   149          (26%)  (149)
  • Half True       151          (27%)  (151)
  • Mostly False    67         (12%)    (67)
  • False                70          (12%)   (70)
  • Pants on Fire     9             (2%)   (9)

 

Total                                    100%          565

Politifact determined that President Obama was telling the whole truth only 21% of the time.

He was mostly truthful 26% of the time. We have seen these mostly true statements over and over again.

A recent example is that he has not seen the private agreements in the Iran Nuclear Deal. He has not seen the agreement in writing but he has heard about it as John Kerry heard about it.

I consider this an act of deceiving the American public.

Half true, Mostly false, False and Pants on fire classifications add up to 53% of the time President Obama has used the bully pulpit of the President Of the United States to deceive the American people.

If you add the 26% of the mostly true statements to the rest of the deceptions you get an astonishing 79% of the time an attempt has been made to deceive the American public.

This brings me to President Obama’s statement at American University. “Obamacare is driving Down the Federal Budget Deficit”

Politifact gave this statement a mostly true.

The statement is mostly false in my opinion. The devil is always in the details. President Obama has mastered the details of deceptions.

“Partly because health care prices have been growing at the slowest rate in nearly 50 years, the growth in what health care costs the government is down,” Obama said in a speech about the economy last week at the American University.

The budget deficit is a result of revenue generated as compared to expenses. If a government spends more money than it takes in it has a deficit. The size of the deficit is a function of the deficit over the revenue. A deficit reduction from one year to another is that percentage difference one year to another. It is a percent and not a real amount.

A deficit reduction can result from many factors. One very important influence on the deficit is an increase in revenue resulting from an increase in Obamacare taxes. There has been a tremendous increase in taxes resulting from Obamacare. The effective tax rate as I have shown previously as a result of Obamacare is up to 50%.

Another influence on the deficit is a decrease in spending.

Medicare spending has decreased as a result of a very clever maneuver by the Obama administration. It claims it has increased reimbursement by around 2%.

Originally Medicare would pay 80% of the allowed reimbursement and the patients would be responsible for 20% of the fee allowed. The allowed fees have decreased. Fees previously allowed have been changed to non allowed fees.

Physicians’ claims for services might be for $200. Medicare might allow $80. Medicare would pay $64 and the patient or his Medigap coverage would be responsible for $16.

This has not changed. However the percentage of the claim allowed has been reduced and patients without Medigap insurance are responsible for the difference.

This is in addition to Medicare premiums and deductibles increasing yearly. Medigap premiums have also increased yearly.

Medicare recipients are experiencing greater out of pocket costs. Many cannot afford the cost and are not going to get medical care.

This has two potential effects. Office visit claims are reduced and Medicare payments are reduced. It decreases the deficit but could result in a sicker patient. Patient cannot afford the out of pocket expenses.

The result is Medicare experiences a decrease in the percentage it affects the federal deficit.

It could result in a valid decrease in office visits or an increase in sicker patients and higher Medicare expenses.

Obamacare might have helped decrease the resulting government deficit but it could result in increased spending in the future.

It did not result in better quality care.

All of this is very difficult for a casual observer to follow. Meanwhile, President Obama has established the media message that Obamacare is working to decrease the budget deficit.

Then pundits like Paul Krugman, can ridicule opponents of Obamacare for saying Obamacare will fail.

President Obama uses an argument that is a half-truth. However, it does not represent real numbers. He uses percentages.

In addition, many of the costs of Obamacare such as the web site and the website navigators are left out of the real costs of healthcare.

Other costs are left out of deficit reduction analysis such as the direct cost to the consumers and the direct loss of revenue to providers.

“Since the Affordable Care Act was first proposed, policymakers have been debating its potential effect not just on health care but on the economy as a whole. The bill effectively increases some types of spending, reduces other types and increases some taxes.”

 

Growth in national health spending, which had dropped to historic lows in recent years (deficit reduction), has snapped back and is set to continue at a faster pace over the next decade, federal actuaries said last week.

Senator Ron Johnson, member of the budget committee, discusses the real present and future costs of Obamacare. He also discusses President Obama’s misleading promises about Obamacare. Senator Johnson gives us a real understanding of the Obama administration’s manipulation of the facts.

https://youtu.be/gIN50dswlL0

Obamacare is a bad deal. It is destroying the medical profession. It is destroying the economy and America’s chances for economic growth.

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

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Where Are Your Actionable Points To Replace Obamacare?

Stanley Feld M.D.,FACP,MACE

 Some have criticized me for always criticizing Obamacare. There is plenty to criticize. President Obama has asked if anyone has a better idea than Obamacare please let him know.

The question asked by some readers is where are your actionable points to repair the healthcare system.

My answer is, “you have not been reading my blog.”

Democrats and President Obama have not read my blog.

The Republicans have been searching for an alternative plan. President Obama has mocked them for not having an alternative than Obamacare.

Republican leaders have not read my blog either. If they had and really thought about my plan they would conclude it could work.

 My plan aligns all the stakeholders’ incentives while reducing the cost of healthcare coverage to consumers. It also decreases secondary stakeholders’ costs and increases their profits. It is very democratic. It would provide universal care without government interference.

These actionable points have been clearly described in many of my blog posts. It is a “consumer driven healthcare plan.” The real customers in the healthcare system are consumers, not physicians, insurance companies, hospitals or the government.

Below are some of the links that provide actionable points to Repair The Healthcare System.

The first link is an overview using a slide presentation. It outlines the business model for 2020.  The details of each specific point can be found in the links in the slide presentation or in the websites search engine.   

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

Obamacare ignores many of the key points. Obamacare will fail because of the absence of these key points. Simple things must be done for an alternative to Obamacare to succeed.

The second link is My Ideal Medical Savings Account is Democratic. My ideal Medical Savings Account can cover and motivate every socioeconomic group. It provides incentives for all consumers to remain healthy and take care of their chronic disease. It promotes consumer responsibility.

Consumer self-responsibility is an essential element in the Repair of the Healthcare System.

My Medical Savings Account is different that a Health Savings Account.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2012/05/my-ideal-medical-savings-account-is-democratic.html

Self-management of chronic diseases is a vital element necessary in a law that attempts to Repair the Healthcare System. It requires education and incorporation of all the spokes of the wheel in the link above to the slide presentation.

President Obama has done some pilot studies using the wrong groups (political groups) to study the self-management hypothesis.

They have all failed because the administration picked the wrong groups to do the pilots.

Systems of care must be developed to teach patients to self-manage their chronic disease to decrease the complication rate of those diseases.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=systems+of+care+for+the+management+of+chronic+disease&x=24&y=9

Eighty percent of the healthcare dollars are spent on treating the complications of chronic diseases. Twenty percent of patients have a chronic disease that is not well controlled and will lead to complications eventually. This can be solved with a properly executed Systems of Care by physicians using information technology as an extension of their care patient. 

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=Chronic+disease+management&x=0&y=0

Obamacare does not seriously consider any of these vital corrections necessary to create an affordable healthcare system. The hospitals and/or physicians cannot be responsible for consumers’ behavior to avoid the complications of chronic diseases. Accountable Care Organizations are based on the fact that the hospitals and physicians are responsible for better outcomes.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=ACOs&x=22&y=7

 Hospitals and physicians have to have the infrastructure to teach patients to become “professors of their diseases.”

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=Professor+of+their+disease&x=17&y=9

Another simple action point is to provide equal tax deductibility for the individual insurance market and group insurance market.

At the moment employers providing insurance to employees can deduct premiums from revenue. An individual buying insurance for himself and his family does not get the same tax deduction. This discrepancy can easily be cured by providing the individual market with the same tax deduction as the group market.

The above links to blogs I have written are just some of the important actionable points necessary to Repair the Healthcare System.

Please study these action points in the links and try to understand how vital they are to maintaining a viable healthcare system.

Obamacare’s complicated rules and regulations have only driven the healthcare system to further dysfunction and increased costs while only having less than 10 million people really signed up after 2 years of enrollment and 6 years of increased taxes.

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

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Another Great Father and Son Weekend

Stanley Feld M.D.,FACP,MACE

Every year Brad and I go on a father and son weekend from a Friday afternoon to Sunday afternoon. The place does matter. We just hang out and shoot the breeze.

I absolutely love the weekends we spend together. Brad teaches me a ton. I teach him a little.

Brad

A few years ago we spent our weekends at the Consumer Electronic Show in Las Vegas. I loved the weekends.  I got to hang out with his Foundry Group partners , Seth Levine,Ryan McIntyre, and Jason Mendelson.

These four guys are really smart. They grasp concepts, trends, patterns and bullshit as fast as Purple Martins catch insects.

I always came back from these weekend invigorated. I love to learn new things. I always feel I understand the technology world a little better.

Last year we both got sick just before we were scheduled to go to Memphis Tennessee.

Why Memphis?

Memphis is a very underrated city with lots to do and see.

However, the most important reason for going to Memphis was that Brad was born on Blytheville Air Force Base in Blytheville, Arkansas during the Vietnam War. He expressed a desire to see the place of his birth. Blytheville is 70 miles northwest of Memphis on Highway 55.

We will get to Memphis one day. However, this year when he asked me where I wanted to go I said Las Vegas just because the weather would be perfect, the food would be good, the walking would be great and experiencing the energy of the crowds would be fun.

Brad pays for everything. It is his treat to his Dad. Mom is not here. He tries to get me to overeat. He always succeeds.

 We had ice cream twice on Friday, once before dinner at Café Gelato in the Bellagio and once after dinner at Ghirardelli Ice Cream & Chocolate Shop.

 The Ghiardelli’s chocolate hot fudge sundae is overpriced but memorable. I remember a weekend with Brad at South Beach Miami where we were at the Ghiardelli's on Lincoln Road four times in one weekend.  

 In 1985, when Brad was at MIT he started Feld Technologies, a software and hardware company that installed office software, hardware and networks.

I hired Feld Technologies to build a network and install all the software and hardware for my large Clinical Endocrinology practice Endocrine Associates of Dallas P.A.. The installation lasted 15 years and put the practice 10 years ahead of other free-standing medical practices.

When he finished dealing with four doctors, a diabetes education center, a nuclear medicine center, an osteoporosis center and an obesity center he said, “Dad, I will not deal with medicine or doctors ever again.”

Unfortunately, our healthcare system desperately needs Brad Feld to grasp the problems and teach the government, healthcare insurance industry, hospital systems, physicians and patients how to fix it.

He refuses to pay attention to the problem.

There are no big thinkers out there.

Nothing was planned for this weekend. Brad sent out a Twitter telling his 197,000 followers that he was taking his dad to Las Vegas and does anyone have any suggestions for us.

 Within three minutes we had a few dozen suggestions. That’s the power of social networking.    

 A fellow named Ryan Negri reached out and suggested Mon Ami Gabi for dinner. It is across the street from the Bellagio. He said he could get us a table on the patio over looking Las Vegas Blvd. I had not heard of the place but it sounded cool.

We were running late for our reservation so we took a cab. The restaurant was just across the street from the Bellagio. The taxi porter that put us in a cab asked us why don’t we walk because it is just across the street? We didn’t know it was across the street.

The cab driver took off without saying a word. We asked him how long he was waiting in the holding area for the fare. He told us three quarters of an hour. He did not say a thing in protest.  

 Brad blew me away taking out a $20 bill and giving it to the cabbie. It made the cabbie’s night.

 It also made me aware of the many acts of kindness my son does for so many people.

It is consistent with his philosophy of giving without expecting to receive. The magnificent power of that philosophy is that you receive much more in the end than you give.

This is a part of his business philosophy and will be the main theme of an upcoming book he is writing in his series of books on  the Startup Revolution.

Cecelia and I are very lucky to have such a wonderful son. I hope all you readers can tell I am a big Brad Feld fan.

On Saturday, after exercise, we tried to get tickets for the Rod Stewart Show at Caesar’s Palace and Absinthe.  Both were sold out. We are both pretty resilient. We decided to opt for dinner at Nobu, plus after dinner ice cream.

After failing to get tickets for a show we headed downtown to see Tony Hsieh’s  Downtown Project. Anyone going to Las Vegas and staying on The Strip should take a cab to The Downtown Project. Tony Hsieh started www.Zappos.com on a shoe string and sold it to Amazon in 2009 for $1.2 billion dollars.

Good Hsieh_t653
The philosophy of Tony Hsieh project has been misinterpreted or misrepresented by most media outlets. He has also made some mistakes while developing the Downtown Projects.

He bought 60 acres of dilapidated Downtown Las Vegas after he moved Zappos.com to Las Vegas’ old downtown city hall. The plan was to transform the acres into a new kind of urban renewal project. It is very cool to people with an open mind.

 “Tony Hsieh promised to spend $350 million to create his own utopian community, a place of inspiration and serendipity where everyone could become smarter and, of course, happier. He wasn’t leading people into the desert, exactly.”

 He hoped to turn the Downtown Project into a thriving hub of high-tech creativity. When he started in 2012, his pitch was, “What if you could play SimCity for real?”

The media confusion started with the use of the word utopian community.

 “Hsieh often said he wanted his $350 million to generate a “return on community,” not just a return on investment.”

“Though Hsieh’s camp used the word often at the Downtown Project’s inception, officials later removed all mentions about “return on community” from the Downtown Project website, adding the word “connectedness” to cut down on confusion.

 “Tony Hsieh said he views the Downtown Project as a startup — an endeavor that often comes with mistakes waiting to happen.

“Every startup makes a ton of mistakes,” Hsieh said. “There have been investments that we’ve made and they’ve gone out of business.”

Hsieh’s key to moving forward?

“Learn and adapt quickly,” he said.

Our first stop was Container City. It is a section of the property made up of restaurant and shops. The business spaces are made up of newly constructed shipping container piled on each other. There are multilevel spaces with playgrounds for kids, dinning area tables and open areas.

Container park
 Container Park Entrance

Container park 2

Container park 3

Container park 4

 

I had a great hamburger. Brad had fried tacos. We had a long conversation at lunch.

Brad and Tony are friends. Tony invited us to hang out with him at his Trailer Village down the street from Container Village.

This Airstream Trailer Village is more novel than the Container Village. It is in a large parking lot. It has security at the entrance. Once you get approval to enter you enter a walkway lined with artificial turf and covered with an archway made of wooden slatted park fencing and artificial ivy. Tony and Jennifer greeted us halfway down the makeshift hallway as we entered the village.

 This space is something special in this day and age. It is kind of like a hippie, flower child experience of the 1960 in a much more cultivated and sophisticated way.

  _Airstream_Village_1 LE14_t300

He has the periphery lined with Airstream Trailers and Wooden House Trailers. There is a large center common space for entertainment and hanging around.

  Airstream_Village_LE16_t1000

Tony told us they show movies and have entertainment on most nights.

_Airstream_Village_3 LE4_t300

Goldspike is a Downtown Project redone casino/hotel with no gambling or booze. 

On Sunday morning, we had brunch with a fellow who reached out to Brad in a classy way. Ryan Negri is a 33-year-old entrepreneur who sold a company he started at age 24. He and his wife moved from Newport Beach California to Las Vegas 14 month ago after he sold his company.

  Ryan and Brad

He is working on getting involved in the start up community is Las Vegas. Brunch was delightful. Ryan impressed me a very bright a fast thinking entrepreneur. I predict he will go places.

 After brunch headed to the airport, concluding another fabulous father,son weekend.

 My number one priority is to schedule my weekend with Daniel Feld.

 

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

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The Reality Of Price Transparency. It Is Non-Existent

Stanley Feld M.D., FACP,MACE

The price transparency of healthcare costs is non-existent unless a consumer works very hard to determine the costs.

I am sure many interested consumers have experienced the price disparity of what hospitals, physicians and “other providers” charge and what Medicare and healthcare insurance companies allow. The allowed charges are the contracted and negotiated prices.

The retail charges have been the subject of many published studies. These charges have nothing to do with the reimbursed charges. Consumers without healthcare insurance are liable for the retail charges.

Consumers with healthcare insurance are liable for the negotiated and contracted charges only.

Those contracted and negotiated prices are the prices that are opaque to the public.

In response to my last post “The Charade Of Price Transparency” a reader sent me a description of his experience dealing with price transparency. I have reconstructed the essential points in his note to me in order to make it easy for readers to understand the problem.

This reader’s healthcare insurance policy is a high deductible ($6,000) healthcare insurance policy with a health saving account (HSA) feature attached to it. He is responsible for the first $6,000 of his medical bills.

The healthcare insurance industry has been creating many inventive healthcare insurance policies that give the illusion of saving consumers money.

The government, through its health insurance exchanges, is creating the same illusion of inexpensive insurance.

This reader’s healthcare insurance policy pays 90% of all negotiated fees from $6,000 to $10,000.  The total out of pocket expense is up to $10,000 a year plus the cost of the insurance policy premium’s cost. After the patient has spent $10,000 he gets first dollar medical cost coverage.

The reader said, “The good news is,since I was on an insurance plan, my total charges for this procedure and hospital stay should be closer to $4-5k vs without insurance (and their negotiated rates) it would be closer to $20-25k.

Plus by using my HSA account to pay with pre-tax dollars, I effectively save myself about 30% or $1200.”

The health insurance premium is not inexpensive but is less than having a traditional healthcare policy with first dollar coverage.

 This healthcare insurance is best if you do not get sick and do not have to pay the initial $6,000.

The reader has a partial urinary obstruction. A transurethral resection prostatectomy was recommended.

He was given a choice. He could either have green laser TURP surgery or traditional TURP. He was told he would be in the hospital overnight.

He knew about the difference between the billed prices and the contracted prices. He also knew he would be liable for his insurance company’s contracted negotiated price and not the providers billed price.

His goal was to figure out what his liability would be for the procedure. 

His overall impression was,

 “What a horrible nightmare it was trying to find out the negotiated prices. Who is the main person responsible for this as a whole?! Why do I have to guess at what pieces might be involved in this, and then go track down from different places?”  

These were the steps he had to go through to figure out his liability for his upcoming surgical procedure.

 

        1. He called the insurance company and asked what the reimbursed fee would be for a TURP to his         physicians and the hospital. His insurance company told him that he needed to tell them the         hospital and physician’s billing codes in addition to the hospital and physician’s identification         number.

  1. He could never get the information needed to figure out the negotiated price for the surgeon.
  2.  “The surgeon’s fee is $1500. I don't know negotiated contracted fee. I was told by the healthcare insurance company that most fees are reimbursed at 50% of the submitted fee.”
  3. He next called the hospital’s billing department and was told to call “same day surgery department.”
  4. The same day surgery department could not give him a price until after the procedure.   However they could give him an estimated price if everything went well. The price includes pre-surgery testing, surgery, drugs, operating room fees, recovery room fees and pharmacy fees.
  5. The price did not include the anesthesiologist’s fee or the pathologist’s fee. 
  6. The price would be $18,485. He was also given the billing code and facility id number.

        7.He then called the healthcare insurance company. After three calls to different departments he             finally got to a person that would give him the average contracted reimbursement for a day             surgery TURP.

        8. Thirteen hundred and eighty-two dollars ($1,382) was the average negotiated price for the             TURP. It was less than 10% of the billed price. I am sure the hospital has figured out the way to             add onto the final reimbursement.

            9. He next called the anesthesiologist group. The billing department told him many of the                 anesthesiologists bill different prices. She could not give him a price. The anesthesiologists                 bill in15 minute intervals. She could not assign him to a particular anesthesiologist because                 they go in rotation.

 

The following are quotes from the reader’s note to me.

 

  • “I placed at least 8 calls to doctors, hospital, insurance and estimators to try to figure this out. I think I made it halfway through before I gave up.”

 

  • I gave up trying to figure out all the charges.”

 

  • “What you should understand is I decided to prioritize where I
    put my energy. Given the stress of the upcoming surgery and the stress of my ongoing discomfort, I decided it wasn't worth trying to figure
    out what the 15 min incremental charge would be for an

            anesthesiologist.

 

  •  I just think the system is flawed. Like I said I don't think they were malicious or purposefully confusing. They don't know what the doctor or hospital will put through as charges until they are put through.”

 

  • “If this were just an academic exercise perhaps I would have gone
    further. But when I understood the charges well enough to know the
    range of my liability, I was done researching.”

This is the reality of price transparency, as it exists today. It is non-existent! Most consumers do not care about price transparency because it does not affect their pocketbook.

Most consumers believe they can go to the doctor or hospital and their healthcare insurance policy we pay the bill. Their personal cost will be small.

Obamacare’s influence on the cost of healthcare insurance is causing employers to provide insurance with higher deductibles and co-pays. They are receiving less insurance coverage resulting in higher out pocket expense.

Consumers are realizing that they are being forced to be responsible for their healthcare costs.

It is these changes that will heighten the awareness and demand for real price transparency and price competition among insurers, hospitals and physicians.

If consumers are to become educated consumers, the charade of price transparency must cease to exist.

 The real prices for healthcare must be made easily available.

 It will only occur by consumer action.

Consumers must remember they are the customers.

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



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Combining My “Ideal Medical Savings Accounts” And “Reference Pricing”

Stanley Feld M.D.,FACP,MACE

President Obama has declared over
and over again that no one has presented ideas better than Obamacare. 

I believe he has no interest in
listening to anyone.

I sent him 6 letters between 2008-2009
presenting my solution to repairing the health care system. These ideas were
from a practicing physician’s perspective. President Obama paid no attention.


President Obama fooled many people
with his intentions, including me. The traditional media is finally catching on
to him. 

All of the stakeholders are at fault
in causing the dysfunctional healthcare system. The dysfunction is the result
of all the stakeholders trying to adjust to ever changing government regulations
during the last 48 years

Obamacare is making that dysfunction
worse.

A consumer driven healthcare system
is the only way to Repair the Healthcare System.

I think President Obama wants the
healthcare system to fail. He wants to prove that the free market cannot
succeed.

He is deaf to the fact that the
healthcare system is not a very free market system.  Government regulations, tax favors, and tax
barriers over the years have interfered with the free market in healthcare.

The Affordable Care Act (Obamacare) intends to transform the
health-care system, extend coverage,
reduce costs and increase quality—all
without asking anything of the patients.

 Consumers will pay
with higher taxes, of course, but otherwise will face no incentives to make
wise choices, compare price with performance or shop for value.

 Doctors, hospitals,
insurers and, most of all, the government will do that for them, which is
hardly reassuring.

 This reflects what I
call the "impossibility theorem" in health care. The impossibility theorem maintains that patients cannot
make good choices, but, rather, must be dependent on the well-intentioned
decisions of others.

Policy makers believe this theorem by
definition. But, just to make sure, they have structured the health-insurance
system to ensure that patients are never asked or allowed to make
price-conscious choices.

The arrangement underlies the innumerable
rules, subsidies, entitlements, mandates and prohibitions that collectively
make health care the least efficient part of the economy.

 ObamaCare makes it worse.

I do not think consumers believe or trust President
Obama. Consumers certainly do not believe “the impossibility theorem.”

Consumers are ready for some common sense healthcare
policy. They just do not know what to do.

Consumers must be given incentives to control
healthcare costs. This can be done in several ways.

Consumers must be put in charge of their health and
healthcare dollars.

The
central pillar of effective healthcare reform is the creation of a system that
forces the healthcare insurance industry to be competitive and answerable to
consumers.

Consumers
must have incentives to control costs. This, in turn, would force hospital
systems and physicians to be competitive and reduce costs.

The government’s
role should be to empower consumers to have greater control over their
healthcare decisions, their health, their healthcare dollars and their
healthcare coverage.

The
government should teach consumers to make educated choices in their healthcare
decision-making.

Price
transparency of healthcare fees and parity of tax deductions between the individual
insurance market and the group healthcare insurance market is essential.

It is fool
hearty to assume that the redistribution of wealth, raising taxes by means
testing and price fixing will solve the problems in the healthcare system.

  “Why on earth would we want a system,
especially with something as personal as health care, where all of these free market
signals are lost, and insurers responding to regulators, not to us?”

Entitlement programs have never produced free market
efficiencies
. Entitlements have created unsustainable, unfunded liabilities.

Leadership must face this problem not add to the
problem.     

In the past seventy years medical advances through
research and technology have improved medical care and medical outcomes. Medical
advance has focused on fixing diseases after they have occurred.   

Consumers are the only ones that can prevent most
medical and surgical problems.

They can prevent most chronic diseases such as Type 2
Diabetes, heart disease, lung disease and others. 

Consumers are also the only ones that can prevent the
costly complications of a chronic disease.

A healthcare system must be constructed to incentivize
consumers to be responsible for their health and healthcare dollars.

Eighty percent of the healthcare dollars spend on
diabetes care is spent treating the complications of diabetes.

A healthcare system must be developed to align all of
the primary and secondary stakeholders’ incentives.

Only consumers can align all the stakeholders’
incentives.

Government control of the healthcare system cannot and
has not aligned those incentives.

Right now we are seeing bureaucracies making a $634
million dollar error with healthcare.gov. This is only the tip of the iceberg
for the problems in store for Obamacare.

The solution is not a single party payer. We will have
the same problems or worse because of the expansion of Medicaid. President
Obama’s hope was the cost of increasing Medicaid would be shifted to the
states.

The increase in cost will increase the federal deficit
and unfunded liabilities.

A healthcare system must be constructed to empower
consumers. I have written in detail about my ideal medical savings accounts.

I have pointed out that it can be very democratic.
Everyone can be insured while decreasing the costs.    

The ideal medical
saving accounts will motivate and empower consumers to save money by staying
healthy, staying out of the emergency rooms, and decrease over testing and over
treatment.

Consumers would be
motivated to shop for the top value and quality care.  

The government would
require providers to publish the discounted prices paid by the government and
the healthcare insurance companies to all consumers.

My ideal medical
saving account would incentivize consumers to save money. It would be the
responsibility of consumers to shop for the best price at the best quality.

Consumers would
carry their medical records digitally on a flash drive or on their smart phone
to avoid over testing. They would reap the financial benefits of these cost savings.

Consumers, after
the initial $6,000 dollars was spent, would receive first dollar healthcare coverage.
 

I have always been
satisfied with the front-end incentives. I have never been satisfied with the
catastrophic coverage. It does not provide financial incentive for consumers to
save.

I finally figured
it out. Consumers would continue to receive first dollar coverage if they spent
over the initial $6,000 after the initial stakeholders.

The discounted
hospital, surgical and medical device costs would be published along with
outcomes.

Discounted prices
for services could also vary for the same services. The outcomes could be the
same.

A hospital system
with better outcomes should receive more. If the hospital system negotiates a
higher fee than another hospital system but has the same outcome the consumer
should be liable for the difference.

 In this way the decision for choosing the
provider is in the hands of the consumer.

Combining my ideal medical saving account and “reference
pricing” will incentivize consumers to be in control of their healthcare costs
and their health and healthcare dollars.

Consumers should receive pretax dollar treatment for
all expenditures.

Consumers will then shop for price and quality to
their financial advantage.  This will
incentivize providers to compete on both price and quality.

The Oklahoma Surgical Center has forced local
hospitals to do just that
. The Surgical Centers’ online prices were one half to one
fifth the prices of the local hospital.  The hospital centers are now starting to
compete on price and quality.

 The combination
of the ideal medical saving accounts and reference pricing will incentivize
providers to be aligned with consumers’ goals.  

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

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