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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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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 Stanley Feld M.D.,FACP,MACE

In my last two blogs I
covered several points. I also asked readers to consider  the unanswered questions.

"Why would a business (the healthcare insurance industry) facing loss of
its customers because of high premiums increase premiums even further?"

"Why, if the traditional media has published articles stating that the
cost of healthcare has been decreasing would a premium increase be justified?"

"Why do consumers’ deductibles continue to increase
each year?"

"How can Medicare be losing money?"

"Where is the extra money going?"

It seems obvious to me that
the Obama administration wants to put healthcare insurance companies out of the
business of selling private insurance.

An Obama administration
regulation created a “user fee” on every healthcare insurance policy sold
through the Health Insurance Exchanges.

In January 2014 Health
Insurance Exchanges will be the only vehicle through which healthcare insurance
can be sold.

At present less than half
the states have signed up to develop State Health Insurance Exchanges.

States are not signing up
because the exchanges will put a tremendous financial burden on individual
states after the second year.  In the end
states will have little say in developing operating rules for the exchanges.

States will also be losing
their independence and freedom.

President Obama’s
administration has said the federal government will run the Health Insurance
Exchanges if states refuse for form their own exchanges.

It looks as if the
healthcare insurance industry is in check-mate. The industry’s response was to
not only pass the 3.5% tax “user fee” for every policy sold but to raise
premiums by double digits.

"My question is why would an
industry having problems holding on to its customers because present premiums
are unaffordable raise premiums?"

I believe the healthcare
industry has lost interest is selling private healthcare insurance.

At present the healthcare
insurance industry sell its administrative services to the government to run
Medicare, Medicaid, Tricare and Government workers Medicare.

The healthcare insurance
industry will continue selling its administrative service to the government for
the new government run Health Insurance Exchanges. Ultimately these exchanges
will be selling National Healthcare Insurance 
(“The Public Option”).

The healthcare insurance
industry is raising premiums now to set a new standard for the fees it will
charge the federal government in the future.

These fees are not
transparent.

President Obama’s
administration claims the government’s overhead for  Medicare is 2.5%. That statement is true. It
will go up to 5% with all the new Obamacare bureaucracies.

However, the 2.5% only
covers the cost for the bureaucrats that out source administrative service to
the healthcare insurance industry. The processing and    adjudication of claims are the administrative
services done by the healthcare insurance industry.

The fees for those services
are anywhere between 30 and 50% of every healthcare dollar spent.

Some of the healthcare
insurance industry’s true “overhead” and expenses are  counted as a direct medical care expense.

The law mandates that 80% of
healthcare dollars are spent on direct patient care and 20% can be for
healthcare insurance expenses.

The problem is direct
medical care expenses include creating provider networks, administering those
networks, negotiating a very complex web of allowable fees and reserving unpaid
claims.

The healthcare industry’s
recent response to the new “user fee” has been,

“Health plans share the
goal of affordable health care coverage for all Americans. Arbitrarily capping
premiums without addressing underlying cost drivers will not move the country
closer to that goal.”

The healthcare insurance industry
claims they are for affordable care for all Americans.

Data show that premiums are increasing
because of the unsustainable rise in medical costs, new benefit mandates that
make coverage more expensive, and the effect of younger and healthier people
forgoing insurance because of a slow economy.

My question is where is the
data? The administration has told us that the costs of medical care is .4% as
opposed to a 2.7% rise in the GNP. The implied claim is Obamacare is bending
the cost curve

“Moreover, the health care
reform law imposed new rate review requirements and a federal cap on health
plan administrative costs and profits, further suggesting that rising premiums
are being driven by increased spending on medical care”.

America’s Health Insurance
Plans association response is lame and unbelievable. The traditional media has
taken the response at face value.

“Focusing on affordability
is critical as the reform law is fully carried out in 2014. That is why policy
makers should address provisions that will further increase premiums, like the
health insurance tax, and take steps to ensure broad participation in the
system.

KAREN IGNAGNI
President and Chief Executive
America’s Health Insurance Plans
Washington, Jan. 7, 2013”

Karen Ignagni has a very difficult job.
She is at times effective. Her current response is a nice gentle way of saying
the government is to blame for the rising premiums.

As I see it both the government and the
healthcare insurance industry are not telling the exact truth. The hope is to
let the rise in premiums slip by the public notice.  

All President Obama has to
do is raise taxes once more to cover the increases he did not anticipate in his
takeover of the healthcare system.

The healthcare insurance industry
will continue to walk away with unconscionable profits.

The victims will be
consumers who feel powerless already.

The dirty little secret is
consumers are not powerless. Consumers simply have to wake up.

Then loud and effective consumer
protests must be organized. These organize orderly protests will get the President's and the congresses' attention.

If nothing is said the
President and the Democratic congress believe consumers are happy with all the tax
increases, premium increases, the deterioration in health care coverage and failures to form new bureaucracies.

It will only get worse for everyone as consumers remain silent.

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



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Stanley Feld M.D.,FACP,MACE

I love Todd Siler’s Truisms.
They are now available at your friendly app store for 99 cents.



  I have told my story about how to “Repair The
Healthcare System.” I have also pointed out the gigantic mistakes President Obama is
making trying to repair the dysfunctional healthcare system.

Let us assume President Obama’s goal is to make
healthcare more affordable and accessible to all.

My plan has the same goal.

President Obama’s approach is to make all the
stakeholders dependent on government largess.

My approach is to have the government create
rules and regulations that does not let one stakeholder take advantage of
another stakeholder.

The most important stakeholder is the consumer
(patient). Rules must be created in favor of the consumer. Consumers must be
empowered to drive the healthcare system.

Consumers must be encouraged to be responsible
for their own care, be educated to make decisions about their care and be
responsible for their own healthcare dollars.

Since government started controlling the
healthcare system in 1965 the healthcare system has become more and more
distorted and expensive.

Many secondary stakeholders have been created.
Each secondary stakeholder has figured out how to take advantage of the
healthcare system and get around the regulations.  

The government has devised, with good
intentions, new regulations to counter adjustments made by all secondary
stakeholders in order to decrease the escalating cost of care.

The result has been a further increase in the
cost of care with further adjustments by secondary stakeholders.

Patients have not been the beneficiaries of these
escalating costs. The healthcare insurance industry and its administrators have
been the primary beneficiaries of these adjustments.

Hospital systems and hospital administrators
have been close a close second.

The pharmaceutical industry has been close
behind.

Physician reimbursement has decreased per unit
of care.

The primary stakeholders, consumers (patients),
have benefited the least.  

Both physicians and consumers feel powerless. The
government has consistently written regulations that make both of those primary
stakeholders powerless.

Physicians are trying to adjust.

Consumers don’t have a clue about how to
adjust.

Hospital systems seem pretty smug to me. They
think they have figured out how to adjust and take advantage of Obamacare.

The healthcare insurance industry figures they “gotcha”
because of the government’s dependence on the healthcare industry for
administrative services.

President Obama figures that by the government
controlling the entire healthcare system he can make it better and affordable.

As far as I can tell the government has not
proven it can achieve these goals in any area of our economy.

To me it is obvious that the cost of healthcare
will not be reduced, medical care will not be available to all, and access to
care will have to be restricted.

No matter how much money the government prints
it will not cover the escalating costs.

A reader wrote: 

“Stan,

As you know I consider you a
friend and love you and your energy and spirit.

Although I have always
enjoyed reading your blog, I wonder what your ultimate goal is at this time.

I imagine it's to educate and
hopefully influence others.

Unfortunately I feel the
message has become repetitive and might, at this time be falling on death ears.

I'm not sure what to advise to
give you.

I merely suggest you consider
this.

I suggest perhaps you try a
different approach.

Perhaps cartoons or interviews, etc.. 

S. M.D..”

I replied:

“I am sure my explanations of
causes and my solutions for the dysfunctional healthcare system are falling on
deaf ears.

Most consumers have given up
trying to understand the solutions. However the solutions are dependent on consumers’
understanding and demands.

President Obama wants
consumers to give up and depend on him. 

Most consumers like you, a physician, are
trying to figure out how to adjust to the dysfunctional system. Your goal is to
learn to take advantage of the coming draconian changes in the healthcare
system.

These adjustments will simply create greater
dysfunction in the healthcare system. The dysfunction will lead to greater pain
for all.

If all the stakeholders think they have
figured out how to take advantage of the coming changes in the healthcare
system they will not pay attention to what I am saying.   

The biggest losers are consumers. All the
other stakeholders will ultimately lose.  

The healthcare system is going to get so bad
and so expensive that something positive will have to be done.

Someone has to be available with a solution.
The solution is common sense.

Hang in there with me. I have been here before.
The critical turn is going to be swift after a lot of bad things happen.

I have no interest in giving
up.

Stan

P.S. You can never make the obvious, obvious
enough but you should never keep trying.  

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



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Stanley Feld M.D.,FACP,MACE

The healthcare system cannot be fixed using a
broken business model.

It can only be fixed by changing the business
model to a consumer driven business model that would include personal
responsibility and individual freedom of choice.

President Obama believes the healthcare system
can be fixed by a single party payer system run by the government.

I do not believe the government has run things
very well. Many examples come to mind in many areas. Two recent examples are
the Fast and Furious scandal and the lack of security for the murdered ambassador
in Benghsi Lybia.

When things go bad with government policy it is
difficult to discover the reasons. I believe consumers are very hesitant to
trust the government to make their healthcare decisions for them. On the other
hand consumers would be happy to allow the government and taxpayers to pay for
their medical costs.

A cultural shift in the healthcare system must
occur.  The shift must be toward
individual responsibility. Consumers must be responsible for their health and
their healthcare dollars if Americans are to be healthier and the cost of
healthcare decreased. The government must allow and encourage the introduction
of innovative forms of healthcare insurance.

The role of government must be to educate
consumers maintain health and to be smart purchasers of healthcare insurance.
Government should make the rules so secondary stakeholder cannot take advantage
of the primary stakeholders  (consumers)
and then get out of the way.

Government should help those who are less well
off with subsidies and equal access to medical care. Consumers must be
financially incentivized to take responsibility for their health or healthcare
dollars. They must not be penalized if they do not take responsibility for
their health and healthcare dollars.

I presented a new healthcare business model a
few months ago. It deserves to be restated.

This is the way the healthcare system looks
today.

Since 1965, as a result of government intervention,
healthcare costs have escalated. This escalation has been the resulted of
increasing government intervention over the years. The path to accelerated
collapse of the healthcare system has started.

The result has been destruction of the patient-physicians
relationship. Effective medical care has been disrupted along with the
impersonal fragmentation of care.

 

All of the underlined headings represent links
to articles that explain these problems. I will publish functional links in the
next blog.

President Obama’s goal is to have a single
party payer healthcare system. He believes this is the only way to an efficient
system.

He realizes he cannot achieve this goal immediately.
He must do it one step at a time.

The methodology he is using will not work.  He is imposing an accountable care
organizations model onto hospital systems and large physician practices. He
plans to pay one fee for certain diseases based on financial outcomes.

The fee is to be divided between the
stakeholders. President Obama wants to collect data to evaluate and direct
physicians and hospital systems care.

It sounds good but it will not work because he
will encounter physician resistance.

He wants to make cost effective judgments about
patients care without giving patients the right to make their own decisions.

It is going to very difficult to divide the
shrinking pot of money between physicians and hospital systems.

President Obama refuses to admit that the
government outsources the administrative services to the healthcare insurance
industry. The healthcare insurance industry’s fee for this service is about 40%
of the healthcare dollar.

In a recent debate he again stated that CMS’s
overhead is very low at 2.5%

President Obama’s ACA (Obamacare) is proceeding
with the same business model that has failed except he wants complete control
and no competition. If the U.S. continues with the same business model the total
collapse of the healthcare system will accelerate.

The healthcare system is at a critical turn.
The disadvantages of President Obama’s healthcare reform act are obvious. The present
healthcare systems model has lead to all of the disadvantages on the above list.

It is going to take many years to get an
accountable care organization to effectively function if at all. It will take
many years to have a fully functional EMR installed in every hospital system
and physician’s office. If something is not done to correct the business model
we will experience total collapse of the healthcare system.

Two things have to happen to change course. The
business model has to change to transfer power from the government to the
consumer.

The healthcare system is good at curing
infectious disease and replacing kidneys, lungs, livers or hearts.

The big question is, “how does the healthcare
system prevent disease from occurring?”

The greatest expense is diseases that can be
prevented such as diabetes mellitus and heart disease. The root causes are not
preventable yet because they are genetic. The expression of the diseases and
its resultant and costly complications can be prevented.

Obesity causes the expression of these diseases.
The avoidance of obesity requires a drastic change in society’s food industry
and culture.

Americans have been programed over time to eat
more calories and do less activity. There is no quick fix for obesity. People
must eat less and be more active in order to lose weight.

The government has not devoted adequate
resources for education and innovation to change this culture.

Mayor Bloomberg had the right idea by
decreasing the size of the soda pop being sold in N.Y.C. but his approach is
wrong.

He must use education and provide real incentives.
He is trying to legislate behavior. It has never worked in the past.

Americans’ attitude toward food must change by creating
hype for decreasing intake and increasing exercise tied to financial
incentives. Penalties do not work. Incentives and freedom to choose does work.

This is the main problem with President Obama’s
business plan for the healthcare system. He is imposing his will on the
consumers, hospital systems and physicians.

It will not work. It must stop now because it
is unsustainable for taxpayers.

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

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Stanley Feld M.D.,FACP,MACE

Ever
since 1965, the Democrats have been able to use the Medicare hammer to bash
Republicans.

Mitt
Romney and Paul Ryan have co-opted the Medicare issue from the Democrats in
this election cycle.  Medicare has been a
popular entitlement program with seniors that has always been unsustainable.

Now
that a huge number of baby boomers are becoming eligible for Medicare coverage is has become more
unsustainable.

Democrats
realize that Obamacare is unpopular. Over 60% of Americans disapprove of the
program.

Democrats
even realize that the passage of Obamacare had cost them the 2010 midterm
elections.

The
Republicans are using Obamacare as a rallying call to defeat President Obama in
his re-election effort.

Everyone
knows that Medicare is almost bankrupt because the government has depleted its
Trust Fund.

They
also know that President Obama has lied, dissembled the truth or has ranted
about the Republicans on the issue of Medicare during his re-election campaign.

President
Obama cannot change a basic truth. Obamacare was designed to destroy Medicare.

Romney
and Ryan are trying to save Medicare without withdrawing the promise of
Medicare coverage for seniors over 55 years old.

President
Obama can try to defend Obamacare, a new entitlement, which will bankrupt the
nation and destroy Medicare.

He
can disavow Obamacare but he cannot do both.

His
plan is to try to confuse everyone into thinking that he can have it both ways.

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

Last
year the nation’s healthcare cost was $2.5 trillion dollars. This year the
quoted healthcare system costs are $2.8 trillion dollars. An increase in $300
billion dollars a year for ten years is $3 trillion dollars.

Physicians
have been blamed for the increase in costs. However, each year physicians have
received reimbursement cuts not increases. President Obama is ignoring the real
causes of the increases in cost.

An
article in the New England Journal of Medicine stated that the Romney Ryan Plan
could work. Paul Ryan (R) and Ron Wyden (D) stimulated this article submitted
to the NEJM. The NEJM seems a most unlikely place to have this article
published.

I
assume the NEJM is feed up with President Obama’s rhetoric. The Wyden-Ryan is
an alternative to traditional Medicare.

It
is a premium support plan. It could shift Americans, under 55 years old, from
traditional Medicare coverage with the total government totally controlling their
healthcare choices by the Independent Physician Advisory Board (IPAB) to a
system of choice by individual seniors controlling their own healthcare decisions.

 “Will this premium-support proposal based on
full competition among private plans and traditional Medicare work?”

President Obama is
afraid the government will lose control over the healthcare system and seniors.
He is arguing that the premium support system is a voucher system. It simply shifts the
cost of care to seniors without improving the efficiency of care.

He makes vouchers sound
like a dirty word.

Traditional Medicare has been shifting the cost of care over to
seniors in the last 4 years by increasing the deductible seniors have to pay
annually. The basic deductible for any hospitalization is now $1300.00 up from
$500.00 in 2007.

The basic premiums are now $109.00 a month up from $96.00 in
2008. The premium is scheduled to increase to $239.00 a month per senior in
2013.

Medicare premiums are means tested so the premiums for seniors
earning more than $110,000.00 per year by any means including dividends,
capital gains, sale of a home, retirement fund payments or any source of income
will increase the premiums markedly.

The means testing is done by CMS having a direct connection to the
IRS and seniors’ tax return each year.

Medicare premium payments for seniors are significant especially when less
than 50 cents of every dollar is going to direct medical care.

 “President Obama’s argument would be true only if there were no
room to improve health care efficiency or if private plans ignored
opportunities to cut costs, increase market share, and improve their bottom
lines.”

 Ryan and Romney believe
government has no business telling private individuals and employers how much
they can budget for healthcare.

A consumer driven plan can force
the market to improve efficiency and quality.

“Under a premium-support system, each additional test or
procedure would not generate additional reimbursement from the government. Most
Medicare beneficiaries live on fixed incomes and are not in a position to pay
more in deductibles or premiums.

That reality can force
health plans and providers to coordinate patient care and find other
efficiencies rather than perpetuating the current fragmented system.

The Wyden–Ryan proposal for people 55 and younger offers this safety
valve.  It converts Medicare to a defined contribution plan from a defined benefit plan. It gets the government out of
the insurance business puts consumers in charge. It saves Medicare.

If President Obama is correct, traditional Medicare with its
price controls and government regulations, will be the low-cost plan in every
market and seniors will shift back to traditional Medicare when the cost
differences become apparent.  The
competitive market place consumer driven healthcare experiment will be declared
a failure.

“One should not be fooled. If the alternative to market
incentives is price controls wielded by the IPAB, access to necessary services
will inevitably be limited, as providers (physicians, hospital and insurance
companies) seek more lucrative business.”

Price controls have never worked.

President Obama is also ignoring the serious fiscal problems
facing this country. The real threat is that America’s creditors will refuse to
lend us more money.

America must slow the growth of Medicare.  Increasing entitlement spending of any kind is
no longer an option.

The only question is how to do it.

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

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

President Obama is starting to realize Obamacare’s problems.  

Seniors are realizing that President Obama is doing more harm to
Medicare with premium increases and rationing care than Paul Ryan.

President Obama is the one throwing grandma off the cliff not
Paul Ryan.

http://youtu.be/bW_H1oCyyCU

President
Obama has also been successful at faking out Americans with his trick plays.  

His
next trick play is to look like he is rebooting Obamacare to eliminate the
objections. 

He has put together a group led by Neera Tanden, who was a senior member of the White House team that
helped pass the health law.

The group includes Peter Orszag (former budget
director), John Podesta (transition director), Donald Berwick (first Medicare
chief), Ezekiel Emanuel (Orszag's health policy guru), Joshua Sharfstein
(former No. 2 at the Food and Drug Administration) and Tom Daschle, D-S.D. (former
Senate Majority Leader and Healthcare advisor).

“Call it Healthcare Overhaul, Version 2.0. Their
biggest idea is a first-ever budget for the nation's $2.8-trillion healthcare
system, through negotiated limits on public and private spending in each state.”

Another diversionary sham.

So far the group’s proposals include additional
ideas, such as a malpractice liability shield for doctors who follow best
clinical practices and competitive bidding for all Medicare supplies and lab
tests, not just home health equipment.

This group wrote the Obamacare law. It views cost
controls as unfinished business.

Government
imposed control over individual freedoms does not work!

Don’t
let him fake us out again! I won’t.

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

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Stanley Feld M.D. FACP, MACE

I am proud to be an American. Today we celebrate Independence Day and what it means to be free. It is worthwhile to review the meaning of the constitution.

An American celebrating July 4th in Santa Fe New Mexico in 2006

I am Including a link to an audio version of the constitution

 http://www.law.uchicago.edu/files/audio/constitution.mp3

a link to an unabridged version of the constitution

http://www.archives.gov/exhibits/charters/constitution.html/

a link to a partially abridged version of the constitutiona

http://en.wikipedia.org/wiki/United_States_Constitution 

and a link to an abridged version that can be read below

http://simple.wikipedia.org/wiki/United_States_Constitution

United States Constitution
Page one of the original copy of the Constitution
Created	September 17, 1787
Ratified	June 21, 1788
Location	National Archives, Washington, D.C.
Author(s)	Philadelphia Convention
Signatories	39 of the 55 delegates
Purpose	To replace the Articles of Confederation (1777)

United States of America
This article is part of the series: United States Constitution
Original text of the Constitution
Preamble Articles of the Constitution I II III IV V VI VII
Amendments to the Constitution
Bill of Rights I II III IV V VI VII VIII IX X Subsequent Amendments XI XII XIII XIV XV XVI XVII XVIII XIX XX XXI XXII XXIII XXIV XXV XXVI XXVII Unratified Amendments I(1) XIII(1) XIII(2) XX(1) XXVII(1) XXVII(2)
The Constitution of the United States is the supreme law of the United States of America. The first three Articles of the Constitution establish the rules and separate powers of the three branches of the federal government: a legislature, the bicameral Congress; an executive branch led by the President; and a federal judiciary headed by the Supreme Court. The last four Articles frame the principle of federalism. The Tenth Amendment confirms its federal characteristics.

The Constitution was adopted on September 17, 1787, by the Constitutional Convention in Philadelphia, Pennsylvania, and ratified by conventions in eleven states. It went into effect on March 4, 1789.^[1] The first ten constitutional amendments ratified by three-fourths of the states in 1791 are known as the Bill of Rights. The Constitution has been amended seventeen times (for a total of 27 amendments) and its principles are applied in courts of law by judicial review.

The Constitution guides American society in law and political culture. It is the oldest charter of supreme law in continuous use, and it influenced later international figures establishing national constitutions. Recent impulses for reform center on concerns for extending democracy and balancing the federal budget.

Articles of the Constitution When it was written in 1787, the Constitution had a preamble and seven main parts, called articles. Preamble The Preamble says: We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America. The Preamble is not a law. It gives the reasons for writing the Constitution. The Preamble is one of the best known parts of the Constitution. The first three words, "We the people," are used very often. The six intentions that are listed are the goals of the constitution. Legislative power Article One: says that the U.S. Congress (the legislative branch) will make the laws for the United States. Congress has two parts, called "Houses," the House of Representatives and the Senate. The Article says who can be elected to each part of Congress, and how they are elected. The House of Representatives has members elected by the people in each state. The number of members from each state depends on how many people live there. Each member of the House of Representatives is elected for two years. The Senate has two members, called Senators, for each state, no matter how many people live there. Each Senator is elected for six years. The original Constitution says that Senators should be elected by the state legislatures, but this was changed later by the seventeenth amendment. Article One also says how the Congress will do its business and what kinds of laws it can make. It lists some kinds of laws the Congress and the states cannot make. Article One also makes rules for Congress to impeach and remove from office the President, Vice President, judges, and other government officers. Executive power Article Two says that the President (the executive branch) will carry out the laws made by Congress. This article says how the President and Vice President are elected, and who can be elected to these offices. The President and Vice President are elected by a special Electoral College chosen by the states, for four years. The Vice President takes over as President if the President dies, or resigns, or is unable to serve. Article Two also says that the President is in charge of the army and navy. He can make treaties with other countries, but these must be approved by two-thirds of the Senate. He appoints judges, ambassadors, and other officers, but the Senate also must approve these appointments. The President can also veto bills. However, Congress can override the veto. Judicial power Article Three says there will be a court system (the judicial branch), including the Supreme Court. The article says that Congress can decide which courts, besides the Supreme Court, are needed. It says what kinds of "cases and controversies" these courts can decide. Article Three also requires trial by jury in all criminal cases, and defines the crime of treason. States' powers and limits Article Four is about the states. It says that all states must give "full faith and credit" to the laws of the other states. It also says that state governments must treat citizens of other states as fairly as they treat their own citizens, and must send arrested people back to another state if they have been charged with a crime. Article Four also says that Congress can make new states. There were only 13 states in 1787. Now there are 50 United States. It says Congress can make rules for Federal property and can govern territories that have not yet been made into states. Article Four says the United States must make sure that each state has a republican form of government, and protect the states from invasion and violence. Process of amendment Article Five says how to amend, or change, the Constitution. Congress can write a change, if two-thirds of the members in each House agree. The state governments can call a convention to write changes, although this has not happened since 1787. Any change that is written by Congress or by a convention must be sent to the state legislatures or to state conventions for their approval. Congress decides whether to send a change to the legislatures or to conventions. Three-fourths of the states must approve a change for it to become part of the Constitution. An amendment can change any part of the Constitution, except one — no amendment can change the rule that each state has equal suffrage (right to vote) in the Senate. Federal power Article Six says that the Constitution, and the laws and treaties of the United States, are higher than any other laws. It also says that all federal and state officers must swear to "support" the Constitution. Ratification Article Seven says that the new government under the Constitution would not start until conventions in at least nine states approved the Constitution. Amendments Since 1787, Congress has written 33 amendments to change the Constitution, but the states have ratified only 27 of them. The first ten amendments are called the Bill of Rights. They were made in 1791. All of these changes limited the power of the federal government. They were: Number Year Description 1st 1791 Congress must protect the rights of freedom of speech, freedom of the press, freedom of assembly, freedom of petition, and freedom of religion. Congress cannot promote any one religion more than others. 2nd 1791 "A well regulated Militia being necessary to the security of a free State, the right of the people to keep and bear arms, shall not be infringed." – People have the right to have weapons, for example guns. 3rd 1791 The government cannot send soldiers to live in private homes without the permission of the owners. 4th 1791 The government cannot get a warrant to arrest a person or search their property unless there is "probable cause" to believe a crime has been committed. 5th 1791 The government cannot put a person on trial for a serious crime until a grand jury has written an indictment. That a person cannot be put on trial twice for the same crime. The government must follow due process of law before punishing a person or taking their property. A person on trial for a crime does not have to testify against himself in court. 6th 1791 Any person who is accused of a crime should get a speedy trial by a jury. That person can have a lawyer during the trial. They must be told what they are charged with. The person can question the witnesses against them, and can get their own witnesses to testify. 7th 1791 A jury trial is needed for civil cases. 8th 1791 The government cannot require excessive bail or fines, or any cruel and unusual punishment. 9th 1791 The listing of individual rights in the Constitution and Bill of Rights does not include all of the rights of the people and the states. 10th 1791 Anything that the Constitution does not say that Congress can do should be left up to the states, or to the people. After the Bill of Rights, there are 17 more changes to the Constitution that were made at different times. Number Year Description 11th 1795 Citizens cannot sue states in federal courts. There are some exceptions. 12th 1804 Changed the way the President and Vice President are elected. 13th 1865 Ended slavery in the United States. 14th 1868 Every person born in the United States is a citizen. States must follow due process of law before taking away any citizen's rights or property. 15th 1870 A citizen's right to vote cannot be taken away because of race, the color of their skin, or because they were previously slaves. 16th 1913 Congress can put a tax on income. 17th 1913 The people will elect Senators. Before this, Senators were elected by state legislatures. 18th 1919 Made a law against drinking alcohol, called Prohibition. 19th 1920 Gave women the right to vote. 20th 1933 Changed the days for meetings of Congress and for the start of the President's term of office. 21st 1933 Ended the Prohibition law of the Eighteenth Amendment. States can make laws about how alcohol is used in each state. 22nd 1951 A person may not be elected President more than two times. 23rd 1961 Gave the people in the District of Columbia the right to vote for President. 24th 1964 Made it illegal to make anyone pay a tax to have the right to vote. 25th 1967 Changes what happens if a President dies, resigns, or is not able to do the job. Says what happens if a Vice President dies or resigns. 26th 1971 Makes 18 years old the minimum age for people to be allowed to vote 27th 1992 Limits how Congress can increase how much its members are paid.

It is important to re-read this document written by our founding fathers. The U.S. Constitution is meant to protect Americans freedoms on this symbolic day of freedom.

 Americans call this day Independence Day.

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

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Stanley Feld M.D.,FACP,MACE

Physicians are upset. They have been marginalized during the entire healthcare reform debate.

Patients are upset about Obamacare. Many states are upset about Obamacare. These states are suing President Obama and his administration for impinging on states rights.

Recent approval /disapproval polls on average showed that patients disapprove of Obamacare by a 43.1%/52.2% average..

“Do you approve/disapprove of Obama's handling of health care?

Some of the polls included in the average may be outdated since the latest poll for each of the pollsters are averaged in. “

A critical question in all of this is, “ Why are we not hearing from physicians?”

There are several reasons for the public not hearing from physicians.

First, the is practicing physicians’ input has been muted or ignored by President Obama, his administration and the traditional media.

The members of the Association of American Physicians and Surgeons are on the front lines of caring for patients and would like to discuss the bill's effect on the patient-doctor relationship. Media coverage has been poor or non existant.

This You Tube expresses the AAPS view of Obamacare’s effect on the patient-physician relationship. It features Congressman Michael C Burgess, MD, Jane Orient, MD, & Richard Amerling, MD.. This briefing was held in the Canon House office Building in Washington DC on May 26, 2011. 

http://youtu.be/5R5f5JhgfcM

http://youtu.be/5R5f5JhgfcM

For many years physicians relied on the AMA for leadership. There is no leadership from the AMA at this time.

Second, the majority of physicians don’t see eye to eye with the AMA on Obamacare. There have been many reports of physicians fleeing the AMA because of a lack of leadership and advocacy for practicing physicians’ views. The AMA has not represent physicians and their patients’ interests.

“Obamacare changes the health care system in several ways that harm physicians. It also fails to address the pivotal issues facing physicians today—for example, low government reimbursement rates that fail to cover the cost of care, or the need for state-by-state medical malpractice reform.”

The AMA is out of touch with practicing physicians’ views.  

During the health care reform debate, the American Medical Association (AMA) emerged as one of the new law’s supporters. But rather than symbolizing physicians’ support for the left’s health care overhaul, the AMA’s stance on Obamacare just proves how detached the organization has become from physicians’ best interests. 

A physician survey by Jackson and Coker affirms this growing gap between the AMA and physicians the AMA should represent. The survey showed:

1. Only 11 percent of the physicians surveyed agreed that “the AMA’s stance and actions represent my views.” Of those who are members of the AMA, only 40 percent agreed.
2. 13 percent of all physicians, and just 35 percent of AMA members, agreed with the AMA’s position on health reform; 70 percent disagreed.
3. Of those who had dropped their AMA membership, 47 percent said it was because of the AMA’s support for Obamacare, and 43 percent who said AMA’s ideology was too far to the left.
4. Only 15 percent of physicians considered the AMA a successful advocate of physicians’ issues. 75 percent of physicians surveyed said that “the AMA no long represents physicians.

Physicians need a more representative voice. Sermo has been moderately successful but has not been permitted to have an appropriate hearing in the traditional media.

 A recent polling underscores deep physicians' discontent.

Athena Health and Sermo did a recent survey of physicians

    1.     79 percent of physicians are less optimistic about the future of medicine.

    2.      66 percent indicated that they would consider dropping out of government health programs.

    3.      53 percent would consider opting out of insurance altogether.

Third-party payment arrangements have compromised the independence and integrity of the medical profession.

Obamacare will reinforce the worst of these features in the present healthcare system. Physicians will be subject to more government regulation and oversight and more bureaucratic direction.

At the same time, Obamacare is ignoring the most important issues facing physicians such as Tort Reform, third party payment reform and increasing government red tape.

Physicians will be more dependent on unreliable government reimbursement for medical services. Physicians are presently under tremendous pressure. It will only become worse under Obamacare.

Dr. Martha Boone is an Atlanta urologist. She explains the consequences of the Obamacare. She explains her fears about Obamacare.

Dr. Boone has moved to a less-expensive office to avoid dropping Medicare patients or laying off an employee.

The is a wonderful You Tube.

http://youtu.be/jwae822Sw-4

Medicare and Medicaid reimbursement, are already well below the prevailing rates in the private sector.

Medicare pays physicians 50-80 percent of the negotiated private sector fee.

The negotiated private fees are at least 50% less than the customary fees.

Medicaid pays 15-30% of the already reduced private sector fees. Medicare payment has resulted in sporadic access problems for Medicare patients,

Obamacare is going to lower these fees. We are already seeing serious problems with access to care for Medicaid patients. The result is an increase in  hospital emergency room use. This increases the emergency room prices for the private sector as it decreases private sector ER capacity. It also increase healthcare insurance premiums.

Sixty seven (67) percent of primary care physicians said that under current conditions new Medicaid enrollees would not be able to find a “suitable primary care physician” in their area.

“Like most seniors, Ann Lorenz relies on Medicare as she copes with serious health care challenges, including Parkinson's Disease. Ann sees a number of doctors and depends on a variety of prescription drugs and therapies to stay independent.

She worries that Obamacare threatens her access to doctors, treatment options and insurance plans and her neurologist shares her concerns."

http://youtu.be/B7MSRtsafG0

“Obamacare does not address physicians’ most pressing concerns, such as tort reform, and it worsens the already painful problems with third-party payment and government red tape.”

President Obama has also ignored the states’ pleas.

Governor Mitch Daniels of Indiana has been a leader in health care reform. He has made a lot of progress in reforming healthcare in Indiana. Obamacare is going to destroy his progress in healthcare reform.

Governor Daniels is speaking out and urging his fellow governors to take a serious look at the threat posed by Obamacare. 

http://youtu.be/oRwgzDnMGlw

Individual practicing physicians are trying to stimulate public uprising through the media with minimal success.

Dr. Marc Seigel reported that 74% of doctors will retire, work part-time or quit if Obamacare takes effect.

This is not what Pelosi and Obama promised.

http://youtu.be/tsQJcK6QpGk

Politicians do not ask physicians and physicians do not have a powerful representative. Physicians are never included in the healthcare policy discussions.

Physicians are going to have to figure out a way to get their patients to get President Obama’s attention.

Here is one idea: Physicians could give their patients a list of talking points that patients could broadcast to their email and Facebook friends.

All of these patients and their friends could be instructed to send these talking points to their local newspapers, their congressmen and President Obama.It would make everyone aware of how physicians feel about Obamacare.

You can help your physician be heard!

Heightening public awareness usually gets politicians to rethink their destructive policies. Obamacare is one such a destructive policy.

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

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Stanley Feld M.D., FACP,MACE

President Obama has continually tricked the Congressional Budget Office with erroneous assumptions about the projected costs of Obamacare. 

On March 20,2010, Douglas Holtz-Eakin former chief of the CBO wrote that “the Congressional Budget Office reported that, if enacted, the latest health care reform legislation would, over the next 10 years, cost about $950 billion, but because it would raise some revenues and lower some costs, it would also lower federal deficits by $138 billion.”

This statement was written shortly before passage of President Obama’s healthcare reform act.

The accounting for the CLASS Act (Community Living Assistance Services and Supports) was one of President Obama’s tricks to the CBO’s scoring. It was an additional entitlement. Premiums from the CLASS act were supposed to decrease the deficit by $123 billion over a decade.

Realistically, the CLASS Act costs should have been estimated to be of an additional $70 billion per year and not a profit of $70 billion a year. 

The CBO was given an estimate of cost and revenue that indicated that the CLASS act would offset a substantial amount of the deficit created by Obamacare. 

In November 2011 the CLASS act was shut down by the government.

“CLASS quietly became an amendment to President Obama’s healthcare reform act at passage. There was little discussion about CLASS when the Democrats in congress passed President Obama’s healthcare reform act. There was little discussion until Kathleen Sibelius’ announcement to discontinue CLASS. “ 

 She said,

 “ the administration was shutting down Class. After 19 months of research and consultation, “we have not identified a way to make Class work at this time.”

Douglas Holtz-Eakin predicted in March 2010,

"In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion." 

Gimmick 1.  The bill front-loads revenues and backloads spending. Taxes and fees for the bill would begin immediately. The new subsidies would be deferred so that the first 10 years of revenue would be used to pay for only 6 years of spending.

Gimmick 2.  Operating costs for Obamacare were estimated to be $114 billion annually for the decade.  These costs were designated as discretionary spending and were excluded from the Congressional Budget Office’s scoring.

Gimmick 3. The CLASS act was expected to generate $70 billion annually totaling $700 billion in premiums over the first 10 years.  The $700 billion was counted as reduction in the healthcare budget deficit. Benefits the premiums were supposed to finance were assumed to be zero over the first 10 years. An estimate of the cost of the benefits does not appear in the CBO scoring creating the $700 billion of healthcare reform budget deficit reduction.

This was a nice trick.

Gimmick 4.  The administration and legislation anticipated higher Social Security tax revenue of $53 billion to offset Obamacare spending.

Social Security revenues were expected to rise as employers shifted from paying for health insurance to paying employees higher wages plus the penalty.

How this supposed increase in Social Security payments could be use to lower the deficit created by healthcare reform is beyond me.

 Gimmick 5.  The legislators put a provision in the bill to have corporations’ deposit $8 billion in higher estimated tax payments in 2014. The goal was to meet the budget targets of the President Obama’s healthcare reform bill for it first five years.

The corporations’ actual taxes would be unchanged in 2014 and 2015. The extra estimated taxes would need to be refunded to the corporations in 2015. The net effect is simply to shift dollars from 2015 to 2014 to lower the deficit created by Obamacare in 2014. The 2015 deficit would simply be increased.

Gimmick 5. The government proposed takeover of all federally financed student loans is rolled into the healthcare bill. The government expected to generate $19 billion in deficit reduction. The student loans have nothing to do with healthcare or deficit reduction that would be attributable to Obamacare.

Gimmick 6. The last bite of unrealistic accounting is the proposed trimming of $463 billion in Medicare spending. The $463 billion in “savings” was to be used to finance new healthcare insurance subsidies granted in the healthcare insurance exchanges.

This notion is where the double counting comes in.

The government cannot afford to cut payments for physicians’ services to Medicare patients. Medicare would lose its physician work force. Seniors would be burdened with much higher healthcare bills if physicians dropped out of Medicare. This increase in expense would be in addition to the ever-increasing Medicare premiums.

There are no convincing innovations in Obamacare that would decrease Medicare’s operating expenses.

All of the pilots studies for innovations have failed to be executed or save money. 

The CBO’s scoring of Obamacare in March 2012 is closer to the truth. It is still a long way from reality.

Obamacare deficit is estimated to be $1.762 trillion dollars. Included expenses reduce the deficit 1.253 trillion dollars. Figure 1

The problems with the CBO estimates are that costs will rise for three reasons.

First is the increase in baby boomers becoming Medicare age will increase Medicare spending.

Second is the expansion of Medicare, Medicaid and the SCHIP programs to 32 million uninsured people.

Third is the increase in enrollees in the subsidized healthcare insurance programs through healthcare insurance exchanges.

Surveys have shown that as many as 60% of employers a going to or thinking about dropping healthcare insurance and paying the penalty. Sixty percent is much higher than the estimates included in this CBO scoring.

 America is developing a gigantic budgetary mess as a result of President Obama’s Healthcare Reform Act.

Innovative thinking with an entirely new strategy is necessary to avoid an impending catastrophe and dissolution of Medicare.

All of President Obama’s “innovative programs” are failing at a huge cost to taxpayers.

Wake up America.

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

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