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Bureaucratic Barriers To Medical Care

May 7, 2014

inDefective scientific studies, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The greatness of America lies in the freedoms provided by the constitution and the bill of rights.

These freedoms have stimulated Americans to be innovative, creative and inventive.

The constitution promotes individual freedoms with the federal government being held in check by the states.

Many feel that over the last 50 years as society has become more complex the power of Federal government has increased. The central government has increased its power, limited individual freedoms and increased control over the people.

The usurping of power by the Federal government seems to have accelerated over the last 5 years. President Obama has even usurped power over the congress and might have intimidated the Supreme Court. He has decreased the effectiveness of the checks and balance system.

It could be argued that congress has given President Obama and his administration the power and control in the checks and balances system that congress is supposed to have.

Obamacare is the best example of this. When Sarah Palin screamed about the Independent Physician Advisory Board (IPAB) being a “Death Panel” she was ridiculed as being ignorant.

Sarah Palin’s fear was that government bureaucrats, opposed to individuals making that decision, would usurp the individuals’ right to make their own life-and-death medical decisions.

The argument for the formation of the IPAB is that this board will make rational and cost effective medical treatment decisions that individuals are incapable of making.

The IPAB will take the freedom of treatment choice out of the individual’s hands.

I contend that the ultimate goal of Obamacare is to work toward a single party payer system. The government will be the single party payer.

Since the government is the payer, the government will say it is entitled to make the best and most cost efficient treatment decisions for patients.

I have heard cries from Democrats that this is not President Obama’s intention.

The irony is that it is happening right now. CMS is issuing regulations to restrict care even before the IPAB has been formed.

“The introduction of a powerful and largely unaccountable board into health care merits special scrutiny.”

In the Affordable Care Act unfettered power to make policy decisions has been given to the Secretary of Health and Human Services by a partisan Democratic congressional vote.

Last year (2013) government bureaucrats had already usurped a life-and-death medical decision. Health and Human Services Secretary Kathleen Sebelius refused to waive the bureaucratic rules barring access to the adult lung-transplant list by 10-year old Sarah Murnaghan.

A judge ultimately intervened and Sarah received a lifesaving transplant June 12,2013.

There will not be recourse for patients to any IPAB decision once the IPAB is formed. Obamacare also stipulates that there "shall be no administrative or judicial review" of the board's decisions. Its members will be nearly untouchable, too.

“But the grip of the bureaucracy will clamp much harder once the Independent Payment Advisory Board gets going in the next two years.”

“An Obamacare Board Answerable to No One.”

The IPAB is directed to:

Develop detailed and specific proposals related to the Medicare program.
Include proposals cutting Medicare spending below a statutorily prescribed level.
Encourage to make rules "related to" Medicare.

The IPAB will control more than a half-trillion dollars of federal spending annually. After the health insurance exchanges failure the IPAB will control the 2.7 trillion dollar healthcare industry.

Once the board acts, its decisions can be overruled only by a three-fifths supermajority in Congress. If the IPAB fails to implement cuts in spending, all of its powers are to be exercised by the HHS Secretary.

None of the Republican congressmen have made a stink about this board since Democrats shot down Sarah Palin for being so ignorant as to call the IPAB “Death Panels.”

The Obama administration is feeling its oats even before the IPAB has been formed.

CMS created its own panel to restrict access to care. The panel is called Medicare Evidence Development and Coverage Advisory Committee.

A Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers. The nine-member panel is against Medicare paying for the screening tool.

A December 2013 recommendation by the U.S. Preventive Services Task Force said current or past heavy smokers ages 55 to 80 should get the scans. The two government agencies have contradicted each other.

I wonder if there was a pulmonologist or lung cancer special on either panel. Is this what we are to look forward to with the IPAB?

Under Obamacare, the U.S. Preventative Services Task Force's recommendation means that private insurers are required to cover the screening with no out-of-pocket obligation for their non-Medicare members.

The reason is Obamacare offers better insurance policies through the health insurance exchanges than insurance coverage pre Obamacare. The increased cost is passed on to the consumer in higher premiums.

This is called redistribution of wealth.

The CAT scan should typically cost $300 to $400. If the patients were responsible for the bill under present law, it might cost $1,000- $2,000 dollars.

The Medicare Evidence Development and Coverage Advisory Committee advises CMS on coverage determinations. The committee gave a lame explanation for the reason to discontinue coverage.

The committee members said they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.

The USPSTF made their decision based on the National Lung Screening Trial, which found a 20% reduction in deaths among current and former heavy smokers over age 55 who were screened using CT scans versus those screened using chest X-rays.

The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease.

The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented.”

Which government agency is right?

It is not enough for the Medicare panel to say, “they agreed the study was impressive in its implementation and results, they concluded it was not enough to recommend a new coverage policy to the CMS.”

Is the makeup of the committee qualified to make that judgment that will affect 20,000 patients’ lives? Unknown.

Please note that patients (consumers) had no input on the decision. We are told that President Obama is an advocate of disease prevention.

This recommendation contradicts President Obama’s pledge to prevent the onset of disease or to catch disease early in order to cure the disease.

The two agencies even contradict each other. Which one is right? Where is the scientific discussion?

Should Americans give up their freedom of choice to inconsistent government bureaucrats who might not be qualified to make the personal decisions for them?

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

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Another Trap From Ezekiel Emanuel and President Obama

April 9, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama and Ezekiel Emanuel set a trap in the Affordable Care Act (Obamacare) for all Americans including middle class and upper class wage earners.

The administration has claimed that 7.1 million people have signed up on the exchanges as of March 31, 2014. It is now 10 days after his April 1^st claim.

I doubt that we are going to have a breakdown of the enrollees. I doubt that we are going to hear anything about the Rand Corp survey showing that only 875,000 people actually signed up for insurance that did not have insurance previously.

I have not heard any demands for those numbers from the traditional media or congress. It looks like President Obama got away with another one to the American people.

Ezekiel Emanuel M.D. is one of the main architects of Obamacare.

President Obama’s promised the American people that you can keep your doctor if you like your doctor and if you like your plan you can keep your plan. President Obama knew it was a lie before Obamacare was passed. Dr. Emanuel admitted as much in his multiple television interviews

Americans are starting to see another lie beginning to unfold. President Obama promised that his health insurance exchanges are a free market solution to promote competition. It looks like he knew that this was not true before Obamacare was passed.

If you recall both John Kerry and Barney Frank said the Affordable Care Act would not work unless we have a single party payer system. They said the bill must contain a “Public Option.”

http://youtu.be/-522hcm3woA

President Obama said, “don’t worry. We don’t have the votes. Also, we don’t need a “Public Option.”

He should have added, “We don’t need a “Public Option” the way the bill is written.”

The truth is a “Public Option” and a single party payer will happen by default as implementation of Obamacare proceeds.

In his recently published book, “Reinventing American Health Care” Ezekiel Emanuel predicted; by 2025, “fewer than 20 percent of workers in the private sector will receive traditional employer-sponsored health insurance.”

With all the changes President Obama has made without congressional approval, it is obvious that each change will help Obamacare get to a single party payer system more quickly.

There must be a public outcry by the public to stop its loss of freedoms especially freedom of choice of physicians and choice of care.

All the stakeholders are confused about Obamacare at this point.

Many patients have lost insurance. If President Obama did not waive the corporate mandate and the small business mandate many more would be uninsured right now.

Many who think they are insured are not insured. Many physicians do not know if they are going to get paid. Insurance companies do not know if they are going to make money.

If the mandate were in place for all those that received waivers, there would have been a gigantic public outcry that would have sunk Obamacare immediately.

The mandate’s delay decreases the number of people directly affected all at once.

If a person is not directly affected by Obamacare, the long-term implications of the law are ignored. It is difficult to have a public outcry.

Dr. Emanuel’s book is subtitled; “How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System.”

All of the above are true. The healthcare system has been driven to this level of dysfunction because one action by one stakeholder leads to an unintended consequence which in turn leads to another untended consequence and another stakeholder’s reaction.

It is clear that government must set up concise rules that level the playing field for all the stakeholders.

All President Obama has to do is to discontinue the mandate for large corporations year after year. The large employers will drop its employer sponsored healthcare insurance for its employees. Having no other choice these employees will go to the health insurance exchanges to get the cheapest insurance.

“Dr. Emanuel argues that in the next two or three years, “a few big, blue-chip companies will announce their intention to stop providing health insurance.”

I believe this was the plan before the law was passed. It forces people into the “Public Option” without there being a “Public Option” in the law.

“Dr. Emanuel says that few small businesses will join the SHOP exchanges set up for them and that most of those that offer coverage now are even more likely than big companies to drop the coverage since those who employ fewer than 50 workers face no mandate.”

Enrollment in the health insurance exchanges to non-covered employees will increase if the price is right. The price has been right for the government subsidized people. The premiums are much higher for the employees that do not qualify for government subsidy.

“Dr. Emanuel thinks is fine.”

Many employees previously covered by the employer-sponsored plans will receive government subsidies.

The healthcare insurance furnished by the health insurance industry for both private insurance plans and government plans will still be price at non-subsidy prices for the government.

The government subsidy will result cause greater government deficits and/or an additional tax increase.

Employees who previous received healthcare coverage from employers received those benefits with pre-tax dollars.

Now they are going to pay for healthcare insurance with post tax dollars.

Employers received a tax deduction for the employer sponsored healthcare plan’s insurance payments.

Both employees and employers will be losing In Dr. Emanuel and President Obama’s system.

The winner is the government by collecting more taxes. The biggest loser is the consumer earning over $50,000 a year.

The next step is for government to stop calling the subsidized private insurance healthcare coverage.

“President Obama should call it something like it “Medicare G.” Obamacare will have achieved another entitlement without calling it a “Public Option.”

Why doesn’t the Obama administration concentrate on eliminating fraud, abuse, and waste in the healthcare system?

Why doesn’t it concentrate on making the healthcare system more efficient?

Why doesn’t it promote the patient/physician relationship?

Why doesn’t it concentrate on making the healthcare system more patient friendly?

Why doesn’t it put the patients in control of their healthcare dollars and promote patient responsibility for their health and healthcare?

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

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Why Is Obamacare A Mess?

March 2, 2014

inInformation Technology in Healthcare, Innovations in Healthcare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

Obamacare is a mess because the architects of Obamacare created a system that does not align all the stakeholders’ incentives.

Pre Obamacare we had a dysfunctional healthcare system because no one developed a system to improve the care of patients. When a consumer of medical care got sick he received very good treatment or the illness.

Consumers were not taught how to avoid illness. If consumers of medical care had a chronic disease they were not taught how to self-manage their chronic disease.

Medical care in the healthcare system became too expensive for employers to pay for. Consumers were the recipients of this largess. They had no responsibility or incentive for controlling their healthcare cost.

The healthcare system became more expensive because all the stakeholders except consumers tried to maximize their profit at the expense of each other.

President Obama promised to transform the healthcare system. Initially Tom Daschle was his chief. He wrote a book about healthcare after he was defeated in his bid for the Senate.

Any physician who practiced medicine knew that Tom Daschle’s ideas could not work. He had some good ideas to make healthcare delivery more efficient. The ideas were presented in an impractical way. He did not know who the customer was.

Dr. Donald Berwick was next. He tried to extend and implement some of Tom Daschle’s ideas with his own ideas.

Dr. Berwick was the co-founder the IHI (Institute for Healthcare Improvement).

Dr. Berwick has some excellent ideas. The ideas are an adaptation from the Institute of Medicine's six improvement aims for the health care system: care that is safe, effective, patient-centered, timely, efficient, and equitable.

The Institute of Medicine’s report “ Crossing The Quality Chasm” points out how to develop a new healthcare system for the 21^st Century utilizing 21^st century technology.

The problem is Dr. Berwick’s ideology is defective. His famous quote, “the very definition of a equitable healthcare system is the redistribution of wealth” does not sit well with the American psyche.

There has never been a system of successful redistribution of wealth system.

Most people have experienced the deadening effect of bureaucratic systems on innovation. This is what we are experiencing right now with the Obamacare rollout.

People still cannot sign up. People are still spending hours on the telephone and not getting insurance. These are not glitches. These are system disasters.

I have long thought President Obama wants to destroy the present healthcare system so that the masses will demand a single party payer healthcare system with the government in control. Such a system will not be any different than Obamacare.

The government will still be dependent on consumers of healthcare, physicians, pharmaceutical companies, device companies and most of all insurance companies.

Insurance companies will still do the administrative services for the government at a very high price.

Obamacare has not even gotten to the problems it is going to have with the delivery of care, the access to care and the rationing of care.

Obamacare’s business model is defective. It will be impossible to utilize the advances in technology under a system of increased government bureaucratic control.

I have previously presented a new business model. It’s possible it has not caught on for several reasons.

1. My business model could have been presented too early in the course of Obamacare’s demise.

2. My business model is not politically correct.

3. My business model challenges legacy stakeholders. They do not want to give up any power.

Legacy stakeholders are having a horrible time figuring out how to make a living under the evolving Obamacare system. Maybe by that adopting my new business model, one that aligns everyone’s incentive costs will decrease and profits for everyone will increase.

4. The presentation of my new business model could have been too complicated.

Over the next several months I am going to present my new business model.

This business model aligns all the stakeholders’ incentives except the government takeover of the healthcare system.

The government’s role should be that of a facilitator and not the director of the healthcare system.

I hope it will start making sense to people who can and want to do something to improve the healthcare system.

It will make life better for everyone.

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

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TRANSPARENCY? There Is None

February 12, 2014

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

President Obama promised Americans transparency in government. He has not fulfilled his promise.

Transparency in the Healthcare System must be considered on multiple levels. It consists of transparency as it related to both primary and secondary stakeholders.

The primary stakeholders in the healthcare system are patients (consumers) and physicians.

The secondary stakeholders are the government, insurance industry, hospitals and drug companies.

Each stakeholder has it own issues with transparency. There is a lack of transparency with each other. Most of all there is a total opacity of all the stakeholders toward consumers of healthcare.

A reader sent me these Medicare Part B documents. He asked if I would explain these document to him. He went to the hospital to do a pre-op evaluation for knee surgery. The evaluation included blood testing as well as an EKG and chest x-ray.

This document is an EOB (explanation of benefits) for the outpatient evaluation services at a hospital.

It is now called Outpatient Claims for Medicare Part B. If these procedures were done as an inpatient the fees would be higher.

The hospital outpatient fees are outrageous. A freestanding physician’s lab fees would be much lower.

The EOB has changed a little over the years. At one point a patient could not tell what the payment was for and how much Medicare would allow and pay for each procedure.

This year it is clearer. However, Medicare has done something with allowable fee that is incomprehensible. Medicare has created a conflict within its own form.

A simple example is the service of drawing blood. Code 36415. The facility charged $30.80. The Medicare approved amount was $30.80. However, the amount paid by Medicare was $2.94. The maximum the patient could be billed was $0.00.

Here is the contradiction. In the definition of columns section the Medicare –Approved Amount is defined as follows.

“Medicare-Approved Amount: This is the amount a facility can be paid for a Medicare service. It may be less than the actual amount the facility charged. The facility has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.”

In the case of the needle stick to collect blood note A for above claim says;

A. This service is paid at 100% of Medicare approved amount.

The contradiction is the Medicare approved amount was $30.80.

Why did the government change the approved amount from $30.80 to the $2.94 that it approved? Why did they ignore the $30.80?

Why would the hospital accept $2.94 when they had a Medicare approved amount of $30.80?

Something fishy is going on.

If patients are not covered by healthcare insurance, the patient would be liable for $30.80. The facility can always claim this is a legitimate charge because Medicare approved it.

Who will get stuck paying full price?

People who are poor and cannot afford insurance. Persons who do not qualifying for a government subsidy will get stuck. Young people who refuse to buy insurance from the health insurance exchange.

This could be another one of President Obama’s tricks to drive everyone into the health insurance exchanges. The result could lead to total destruction of the private insurance industry. Then the only option will be a single party payer system.

I have said previously that President Obama’s goal is to destroy Obamacare. It would prove to everyone that a free market system does not work.

What President Obama doesn’t realize is that Americans recognized that Obamacare has not set up a free market system. It has set up a system of regulations that place horrible restraints on a free market system.

The American people do not trust President Obama anymore.

As we look at the other claims in this document there is more that is deceiving. The hospital facility charged $726 for a chemistry profile (code 80053). Medicare approved $726 but paid $14.24 for the chemistry profile.

In 1980 Medicare approve $24.00 and paid 80% of $24. The price Medicare pays for a chemistry profile has dropped since 1980.

The hospital charged $752.50 for a simple blood typing and cross matching (code 86850,86900,86901). Medicare approved the fee but only paid $28.20, which is 80% of what Medicare approved amount is. The patient or his Medicare supplement would be responsible for $7.79

The Medicare approved amount for an automated CBC (Code 85027) was $452.80 but Medicare paid $8.71.

An EKG is an important part of the pre op testing. The facility charged $593.95 and Medicare approved that amount. However Medicare only paid $20.49. The patient or their supplement is responsible for $5.24. Since the beginning of Medicare in 1965 the Medicare approve amount for an EKG has never been greater that $80.00.

There is definitely something fishy with the determination of the Medicare approved amount calculation and Medicare Part B payment.

I hope I have succeeded in explaining how to understand this Outpatient Claims for Medicare Part B.

I also hope I have succeed in explaining the crazy Medicare approved amount pricing.

I believe that the only conclusion to be reached is that there is deception in the document.

There is absolutely no transparency for the patient. The hospital will not give the patient the price before he gets the work done. The consumer cannot make a wise healthcare choice for the use of his healthcare dollars.

The government is not interested in giving patients control of their healthcare dollars. Consumers are the victims.

Neither the government nor the insurance company gives the consumer any help.

Physician owned laboratories charge patients much less than the hospital facilities.

At the same time the government is putting more and more restrictions on physician owned laboratories in order to eliminate physician owned laboratories even though the cost is less.

The government’s excuse for restricting physician laboratories is that physicians will have incentive to do additional testing.

The bottom line is the government does not want to control costs or to put the patient in control of their healthcare and their healthcare dollars.

Remember the statement, “I am the government and I am here to help.”

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

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Obamacare is Right On Schedule

January 26, 2014

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

Is President Obama trying to destroy the healthcare system in America?

Yes he is!

Actually he is right on schedule to have Obamacare implode on itself.

I remember when he told Barney Frank and John Kerry not to worry about not including the Public Option in the Affordable Care Act. We will get to a single party payer system.

http://youtu.be/f3BS4C9el98

http://youtu.be/-522hcm3woA

They did not understand how President Obama could make such a compromise. They thought the Public Option was the only way in the Affordable Care Act Obamacare) to get to their goal.

The goal was a single party payer system.

They did not have the votes then and they do not have the votes now.

President Obama has used a lot of trick plays to get his way in passing and implementing Obamacare. I have pointed out these trick plays along the way. They should be reviewed.

As hard as it is to believe, it seems that President Obama wants his legacy legislation Obamacare to fail.

Otherwise he would not have had Obamacare constructed with so many perverse incentives for stakeholders.

The only route to success is to align both primary and secondary stakeholders incentives. Obamacare is misaligning all of the stakeholders' incentives.

The incentives are more misaligned now than they were in the dysfunctional healthcare systems days before Obamacare.

The stated goal of Obamacare was to provide affordable healthcare insurance to all, with access to quality care to all without rationing of care.

The effect of Obamacare has been just the opposite. The healthcare insurance coverage will not be universal. It is unaffordable to many in the middle class. It is also unaffordable to many of the subsidized poor that do not qualify for Medicaid. There is limited access to care. There is an increase in the rationing of care.

President Obama claimed Obamacare’s health insurance exchanges would create a competitive free market insurance system.

The health insurance exchanges would force the healthcare insurance companies to be competitive. Healthcare insurance competition would lead to a decrease in healthcare costs.

Health insurance exchanges have not worked as advertised. President Obama’s health insurance exchanges have not resulted in a competitive free market system.

Healthcare premiums have skyrocketed.

Healthcare insurance deductibles and copays are higher.

Hospitals and doctor networks are skimping for two reasons. Doctors and hospitals are choosing not to participate in Obamacare. Healthcare insurance companies are not electing to include many well known doctor and hospital networks.

Many excellent drugs are not on the insurers' formularies because of the cost. When newer brand name medications are on the formulary the co-pays are unaffordable to patients who need them. Patients therefore do not fill the prescription.

The healthcare insurance premiums are often higher than what consumers previously paid for their private insurance pre Obamacare even after some consumers receive government subsides.

The Obama administration will conclude soon that the free market healthcare system does not work.

The administration will claim that only healthcare system that will work is a government single party payer system.

However, President Obama has not created a free market healthcare system with his health insurance exchanges. It is a highly regulated market.

In his over regulated marketplace he has created incentives that have further misaligned stakeholders vested interests than they were pre Obamacare.

In the Obamacare system the healthcare insurance companies are led to believe they remain the king of the healthcare industry. They believe they can continue to control healthcare costs.

The government remains totally dependent on the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for government healthcare programs.

In performing these services the government has permitted the healthcare insurance industry to pad direct patient care costs with items that are insurance companies expenses and should not be counted as direct patient care.

The increased distortion is magnified when the government dictates the benefits the insurers must offer patients in the health insurance exchanges and the private insurance markets.

This causes the premium prices to skyrocket .

Consumers might not need these added government benefits. Consumers have no choice. They have to pay for unneeded benefits. These benefits are added to the cost of insurance as well as the net profit of the healthcare insurance companies.

The healthcare insurance industry is also permitted to choose their own networks of physicians and hospitals.

The insurance companies try to maximize their net profit at their lowest cost. Therefore they have kept the best hospital and physicians out of their networks. This affects the quality of care.

It must be realized that quality of care has not been adequately defined or accurately measured.

In some cities and states consumers only have one insurance carrier. Other carriers have opted out. There is not even a pretense of competition. This insurance carrier usually picks the hospitals and physicians that will accept the lowest reimbursement. The healthcare insurance industry is offering low fees to providers. They will take only those providers into their networks that accept those low fees.

An additional incentive distortion is the Obamacare requirement for the healthcare insurance companies to charge the same premium for anyone who signs up for Obamacare. There is no risk weighting permitted.

The hope is all consumers will sign up and enable the industry to keep premiums down.This rule generates two negative incentives. The healthcare insurance industry must overcharge the healthy and undercharge the sick. Therefore the healthcare insurance companies try to attract the healthy and avoid the sick.

This has backfired on Obamacare. The healthy young have realized the trap. They are not signing up in the heath insurance exchanges.

Previously when they were employed the employer didn’t mind covering the young. The young help lowered the overall premium because they were young healthy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           &#
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There are only two options left to the government. Obamacare can bail out the insurance industry and bully the healthy and low risk young into buying healthcare insurance from the government health insurance exchanges.

Many cities, towns and stats have underfunded healthcare coverage commitments. These local commitments include retirees. These cities, towns and states can now dump these consumers into Medicare and the health insurances exchanges.

In addition, there are many people who have chronic illnesses who have been afraid to leave their jobs because they could not get healthcare insurance in the individual market in the past.

These patients can now obtain insurance in the health exchanges at the same cost as everyone else. This will further contaminate the risk pool and increase the health insurance exchange premiums.

The Obama administration figures all taxpayers will cover the added costs. Taxpayers will bail out insurance companies for the poor risk pools that are decreasing their profits.

It looks like the real purpose of Obamacare is to destroy the relationship between the employer and his employee by driving employees into the health insurance exchanges just as it has destroyed the relationship between the consumers and their physicians.

President Obama understood this as the bill was written.

Small employers are dumping employees from their healthcare insurance plans into the individual market and the health insurance exchanges.

In 2015 group employer insurance will affect an estimated 80 million people. They will loss their insurance and be forced into the health insurance exchanges.

The insurance industry will quit providing insurance and President Obama’s plan to have a single party payer will occur by default.

Taxpayer will pay the difference through higher taxes. In the meanwhile nothing has been done in making healthcare premiums more affordable, access to care more available, quality of care better or preventing the rationing of care by a government body.

Consumers will not stand for government control over their healthcare decisions.

There is a better and cheaper way. It is to put the consumer in charge, not the government.

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

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What President Obama Forgot To Tell US

January 15, 2014

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust, War on Obesity

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Stanley Feld M.D.,FACP, MACE

Nancy Pelosi was correct. The only way we are going to know what is in the Affordable Care Act is to pass the bill.

The weeks before January 1^st when the web site was going so poorly we heard a lot about the healthcare insurance companies taking a bath on Obamacare because of the skewed enrollment.

Only the sick and elderly were buying healthcare insurance from the health insurance exchanges. Young people were needed to buy insurance in order to keep Obamacare from the “death spiral.”

The sick and elderly were more likely to be hospitalized and run up a big hospital bill. The high bills would eat into the insurance companies profits. Young people were needed to stabilize the risk pool or insurance premiums would sky rocket because insurance company profits would fall. Insurance companies could go bankrupt.

The government’s expressed fear is the healthcare insurance industry would not participate in the health insurance exchanges.

President Obama offered to bail out the healthcare insurance companies if this was to occur.

This was another of President Obama’s deception.

It is similar to the deception “If you like your insurance you can keep it. If you like you doctor you can keep him/her.”

Last week we learned that the insurance company bailout was built into the original bill passed in 2010. The President knew about this bailout before Obamacare was passed.

Did the congressional members who passed the bill know about the built in bailout?

If they did they should all be voted out of office. If the Democrats needed to pass Obamacare did not know about the bailout they should have and they should all be voted out.

It should be recalled that this was a Democrat controlled House and Senate. There was not a single Republican vote included in the passage of Obamacare.

The American people did not know about the built in bailout at taxpayers’ expense.

Obamacare contains a "Reinsurance Program that caps big claim costs for insurers (individual plans only)." Robert Laszewski, a prominent consultant to health insurance companies, writes that in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government [read: by taxpayers], for example."

Private insurance plans bought through the health insurance exchanges are not private health insurance plans. They are plans that are subsidized by the government if the insurance bill goes over $45,000.

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

Who makes the profit from this subsidy?

The healthcare insurance industry makes the profit because the insurance policies have been priced at high risk (Increased deductibles, and increased premiums for consumers not eligible for government subsidies).

"The reinsurance program has done and will continue to do what it was intended to do; help attract and keep more carriers in Obamacare than might have otherwise come." Thus, Obamacare is being aided by having taxpayers subsidize big insurance companies' business expenses.”

Obamacare also provides the healthcare industry a greater subsidy. It is called the “Risk Corridor Program”. The “Risk Corridor Program” limits the overall losses of the healthcare insurance industry to 2.4%.

This is the way the “Risk Corridor Program” works. The healthcare insurance company submits its expected costs to the government for a particular year.

If the expected costs of the insurance exceed 102%, the government will pay the healthcare insurance company 80% of the difference above 102% at taxpayers’ expense.

“Taxpayers' are unwitting generosity toward these "participating health plans" (plans sold through Obamacare's government-run exchanges):

"[I]f the health plan has costs at 110% of the medical cost target [the costs that the insurer expects to accrue], it will be responsible for only 102.4% of the target (a 2.4% shortfall)-only about a quarter of its losses.”

There is little risk to the healthcare insurance company for being involved in the healthcare insurance exchanges.

The key point is President Obama had this written into Obamacare without telling taxpayers about it. I wonder if the CBO knew about it and calculated it into the original cost estimates of Obamacare.

“In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine ("single payer") that liberals drool about in their sleep.”

The problems with a government controlled single party payer system are multiple. I have enumerated them in the passed.

I will summarize the problems:

1.Consumers are dependent on the government to make their healthcare and medical care decisions.

2. A single party payer system does not encourage consumers to be responsible for their health, healthcare dollars or medical care.

3. The inevitable cost overruns will result from government bureaucracy, regulations and inefficiencies.

4. The occurrence of fraud and abuse is inevitable. We have seen some fraud and abuse already.

Navigators are paid $48 an hour to help the poor enroll in Obamacare. One reader told me about a case were the navigator had to apply four times before the application was accepted without any errors.

This is only the first step in obtaining healthcare eligibility and then healthcare insurance.

4. Government will be forced to limit access to care and ration care in order to keep the direct medical care costs down.

5. All the secondary stakeholder costs are escalating as physician reimbursement is decreasing.

6. Most importantly freedoms to choose your physician, your insurance and your treatment are being compromised at the expense of all taxpayers.

Something is very wrong with this plan.

This is all going to be done slowly so we do not notice.

America has been deceived. We are already feeling the effects of the deceptions.

There is more to come.

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

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We Ain’t Seen Nothing Yet!

January 5, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Have a Happy and Healthy New Year Everyone!

I have received many incredible examples about the effect Obamacare has had on the loss of insurance and the increased cost of insurance through Obamacare’s health insurance exchanges.

President Obama has changed the Obamacare law ad lib for everyone except the 14 million people in the individual healthcare insurance market. He has granted waivers to favorites including the unions and the congress. He has delayed the employer mandate without congressional approval.

This was smart. Maintaining the employer mandate would have affected at least 100,000 families. Everyone would have lost their insurance at once.

The outrage would have been intolerable.

America will wake up one day with a completely unaffordable healthcare system, with rationing of care and long delays in access to care.

This is reality and not naysayer talk. There are so many things wrong with Obamacare that Max Bacchus’s train wreck will be a reality before we know it.

PolitiFact called “If you like your health-care plan, you can keep it.” the lie of the year.

Obamacare was supposed to be a refinement to the current healthcare system minus its waste and inefficiency.

It was going to increase access to healthcare care and make medical care affordable for all. It was going to force the healthcare insurance industry to provide affordable insurance.

It has already made insurance unaffordable to those middle class families who do not qualify for subsidies.

The "sticker shock" that many buyers of new, ACA-compliant health plans have experienced—with premiums 30% higher, or more, than their previous coverage—has only begun.

The costs borne by individuals will be even more obvious next year as more people start having to pay higher deductibles and copays.

President Obama promised that the Affordable Care Act was not going to cost the federal government a dime.

It was going to decrease the federal deficit over ten years by over 1 trillion dollar.

The current CBO estimate is that it will increase the deficit by over 1 trillion dollars. The Affordable Care Act was misnamed. It should be the Unaffordable Care Act.

Obamacare was force down the throat of the American public by the Democratic majorities in both houses of congress. It did not get one Republican vote. Most of the Democrats have admitted they did not read the bill in its entirety.

Nancy Pelosi told America “we have to pass the bill to know what is in it.”

It is now obvious that President Obama was able to pass the bill by feeding everyone a pack of deceptions about the bill and its implications.

It was a magnificent con job.

The deceptions once discovered must not be tolerated by our congressional representatives and senators.

Government is supposed to be by the people, for the people. Consumers did not pay attention to the defects in Obamacare until it started to affect them directly.

The mainstream media has been sympathetic to President Obama’s lies and deceptions. Now the people are discovering the deceptions and the media is starting to report them.

Now that over 6 million people have lost their insurance coverage, and premiums have skyrocketed Obamacare is affecting the consumers who make under $250,000 a year.

Obamacare has affected consumers financially. There have been significant Obamacare hidden taxes for four years. Obamacare officially starts January 1,2014.

President Obama or his administration has lost the public’s trust because of all the lies and deceptions.

My guess is the media does not know of all the lies and deceptions. The media also does not understand all the defects in Obamacare.

The Obama administration launched a $685 million dollar public relations campaign to disguise the impending Obamacare disaster.

The disastrous website (healthcare.gov) is only the tip of the iceberg.

The web site is incomplete and not secure. It was written using obsolete code at a cost of $650 million dollars. The $650 million dollars is $649 million dollars over what it should have cost according to some sources.

There remains much work to be done before it is fully functional.

The healthcare insurance industry is becoming fed up with all the constant changes in the rules the Obama administration is making.

The healthcare insurance premiums on the health insurance exchanges are higher than last year’s commercial insurance. The patient deductibles for these policies put them out of affordable range for the middle class.

It will be a fair deal for consumers with families who earn up to $49,000 per year. This group will qualify for various levels of subsidy. It is a terrible deal for everyone making $50,000 to $250,000 dollars a year.

The 6 million people losing their insurance coverage started American’s wake up call.

President Obama said their healthcare insurance coverage was defective and inadequate.

The subtext is the government will decide what you need.

Those who expect better days ahead for the Affordable Care Act are in for a rude awakening. The shocks—economic and political—will get much worse next year and beyond.

In 2014, millions must choose among unfamiliar physicians and hospitals, or paying more for preferred providers who are not part of their insurance network. Some health outcomes will deteriorate from a less familiar doctor-patient relationship.

Those who expected better and more affordable medical care with the government as single party payer will experience tax increases both obvious and disguised and worse medical care.

The government does not know how to run things efficiently.

The other defects in Obamacare that will shock the nation and hurt all consumers in the near future will be;

The lack of functional electronic medical records and transportability of patient medical information.
Increased paralyzing and incomprehensible regulations for physicians and hospitals leading to patient care delays.
The lack of development of Accountable Care Organizations for integrated care with penalty. ACO’s were suppose to save money but are failing.
The inability of Obamacare to facilitate timely and cost effective medical care.
The decrease in physician practitioners signing up to accept Obamacare leading to an increased physician shortage and decrease in consumers’ access to care.
The lack of tort reform will result in an increase in defensive medicine testing. Physicians and hospitals will refuse to participate in Obamacare. They will demand direct payment from the patients.
The new ICM 10 coding system will drive physicians and hospital out of business and certainly out of participating in Obamacare.
Lack of compelling chronic disease management initiatives will not increase quality of care or decrease the cost of care. The cost of treating chronic disease complications account for 80% of the cost of care.
More Web Site and IT failures are likely. The application process is easier.“The complex back-office side of the website—where the information in their application is checked against government databases to determine the premium subsidies and prices they will be charged, and where the applications are forwarded to insurance companies—is still under construction.
Consumers will experience problems in eligibility, coverage, billing, claims, insurer payment and patient information-protection and security.
Obamacare has taxpayer-funded "risk corridors." The risk corridors will bailout potential insurance company losses without bailing out consumers, physicians and hospitals. The bailout could result in an increase in taxes, collapse of the healthcare system, the medical care system and the economy.

The bailout will certainly result in a level of consumer anger worse that the anger caused by 5 million people losing their healthcare coverage.

One hundred and eighty million people might loss their coverage within a year.

Obamacare misses the entire point about the way to repair the healthcare system.

The point is about giving consumers incentives to be responsible for themself and controlling their own healthcare decisions. Most consumers do not want to be dependent of the government.

Americans will take government handouts but as soon as they realize they are being dictated to and controlled by the government there will be a public outcry.

Consumers are much smarter than President Obama thinks.

Unfortunately there is much more money to be wasted and grief that the public is going to experience in the coming year. At that point America’s view of Obamacare will reach the boiling point.

Only then will we experience real healthcare reform.

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

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Are Medicare Premiums Increasing In 2014

December 11, 2013

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

The other day a reader received the new notification of Social Security benefits for himself and his wife in 2014.

He wrote,

Dr. Feld

I am 72 years old.

I am a person who earns a substantial amount of earned and unearned income.

I am also forced by law to take a portion of money out of my retirement plan. I have been confused by the disinformation, misinformation, false promises we have been given by President Obama and his administration.

In the past I had not been curious about my Social Security benefits. It had no impact on my way of life. I paid into Social Security all my life and figured I should get some benefit.

However, with all the talk about the redistribution of wealth and Dr. Donald Berwick saying the essential fabric of universal healthcare coverage is the redistribution of wealth, I have been paying a little more attention to the Social Security benefit in recent years.

The change in the amount taken out of my benefit next year seemed way out of proportion to the amount taken out this year. I believe I made the same amount of money in earned and unearned in 2012 as I did in 2011.

I tried to figure out why the difference and ran into a lot of disjointed and uninterpretable explanations for these increases. Attached are mycommunications from the Social Security Administration. I have redacted our names from the letters.

Can you please explain these increases?

Thank you in advance.

Dear Sir;

I will give it a try. The Obama administration has not raised the premium rates on Medicare Part B for 2014. I guess the plan is not to agitate seniors as Obamacare has agitated people in the individual market.

Most people do not pay attention to laws and regulations until those laws affect them adversely.

Most of our senators and representatives did not read the Obamacare law before they passed it. On realizing Obamacare’s impact on them Congress lobbied the President for a waiver. Congress received the waiver.

Nancy Pelosi said in all her brilliance,

“We need to pass the law in order to find out what is in it.”

http://youtu.be/R3GwEJrnC08

Snopes.com printed this statement before the November elections in 2012.

"What you permit, you promote."

" The per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to: $104.20 in 2012; $120.20 in 2013; and $247.00 in 2014.

These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to 'confuse' the 2012 re-election campaigns."

The delay of the increase was one of President Obama’s trick plays.

The author asked us;

"Send this to all seniors that you know, so they will know who's throwing them under the bus. Obama knows this will kill his chances for a second term if enacted now, and he thinks that voters are stupid and won't know or care about anything that doesn't affect them now!

REMEMBER THIS IN NOVEMBER 2012 & VOTE ACCORDINGLY”

This is a list of the increases from 2009 through 2012.

2009: $96.40
2010: $110.50
2011: $115.40
2012: $99.90

You will notice the base price went up each year until the election year. In 2012 the prices were published before the presidential election. President Obama used Medicare’s base price reduction as an election asset.

The projected increases published in April 2012 are,

2013: $109.10

2014: $112.10

2015: $117.00

2016: $122.00

2017: $128.20

2018: $135.50

The new projected increase to be published in November 2014 after the election cycle is a jump to a base price of $247 dollars a month per person.

The 2014 increase is from $99.90 to $104.90.

The big increase seniors will experience is in the deductibles, allowed services, and a restricted drug formulary.

The means testing adjusted gross income fees have not changed for 2014 price increases for the means adjusted gross income.

Sir, your means adjusted gross income must have jumped from $214,000 range to over $428,000 on your 2012 tax return.

You might have had a large carried forward tax lose on your 2011 tax return if your income in 2011 and 2012 were the same.

The result was a MAGI adjustment to a $230.80 increase to the base premium from the adjustment of $42.00 for 2013.

The Obama administration did not increase the prices in means testing for 2014.

The total premium for complete Medicare A,B,D,F is not cheap.

The premium is $405 dollars a month for each of you or a total of $810 dollars.

This amount will be deducted from your monthly Social Security check or $9,720 dollars a year.

This amount does not include the $170 per month for each of your Medicare Part F supplemental insurance. Medicare Part F pays all your physician and hospital deductibles. The total premium is $4,080 per year in after tax dollars. Medicare Part D premium cost about $57 dollar per month each or a total of $1368 in after tax dollars.

The total in addition to $9,720 in pre tax dollars is $4,080 in post tax dollars or $13,800.

The $4,080 post tax dollar premium is equal to $6,800 pre-tax dollars. This premium is not deductible.

Therefore the total is $6,800 plus $9,720 or a grand total of $16,520 a year for Medicare Part B, Part D, and Part F premiums for both you and your wife in 2014.

This is excluding deductible cost for brand name drugs and full the cost for drugs not on the formulary. It also does not pay for physicians that do not participate in Medicare.

The Part A deductible has increased in 2014 to $1,216.00 from $1,084.00 in 2013. Medicare also pays 80% of the hospitals allowable fee after the $1,216.00.

The Medicare Part B deductible is unchanged at $147.00. However you will get one free physical examination each year.

These premiums are an example of the redistribution of wealth in our healthcare system.

The means testing formula serves to supplement seniors who live on Social Security.

Many have lost retirement benefits in the last few years. Medicare’s base premium is too expensive for those less fortunate. Many are struggling to survive even if they do not need medical care.

Raising taxes or lowering premiums by the government is not going to solve the problems.

A single party payer system is not going to solve the problems.

Medicare is already single party payer system!! Its structure is wrong and destined to failure.

A consumer driven system for seniors with financial incentives to stay healthy will go a long way to decreasing costs and save consumers money.

It will also save the government a great deal of money.

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

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Obamacare’s Disasters Are Unfolding

November 24, 2013

inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Along with the web site’s disastrous failures, other impending Obamacare disasters are unfolding.

Things look so bad for Obamacare that President Obama sent out a directive to change its name from Obamacare to the Affordable Care Act.

I believe Americans are well aware of the fact that Obamacare is neither affordable nor accountable to consumers. A name change will not help. Obamacare will not bend the cost curve nor save each family $2500 a year for healthcare insurance.

I have pointed out the problems with Obamacare since before its inception.

The list includes;

Loss of your current insurance policy.

Loss of your present doctor.
Loss of participating doctors in your network.
Loss of your present insurance coverage.
Failure of the development of Accountable Care Organizations.
Failure of Pay4Performance measures to reimburse physicians and hospitals.
The lack of incentive for consumers to take care of their health or healthcare dollars.
The lack of dealing with the issue of tort reform. Tort reform would lower the cost of care dramatically.
It does not decrease healthcare insurance industry abuse of the Medical Loss Ratio.
It has not increased the ease of data transfer among providers.
The loss of freedom of choice for consumers and physicians.

Consumers are becoming outraged at the inefficiency of implementation as all these are beginning to affect them personally.

Where is the physicians’ outrage?

Premiums and deductibles are rising. Medical care is starting to be rationed. The intensity of the outrage will rise as access to care decreases.

A physician friend of mind who is over 65 years old on Medicare said Medicare has been good to him and his wife.

Medicare has also been good to his practice of internal medicine. He believes America should have Medicare for all with a single party payer.

I just listened and smiled. The old Medicare system is unsustainable. Wait until he sees the new Medicare premiums for seniors and the reimbursement schedule for physicians in 2014.

Forget the regulations he is going to have to deal with. Forget the restrictions of access to care he will have to deal with. Forget the rationing of care he will have to deal with.

It will not be pleasant.

Consumers are realizing they are the victims of higher prices and lower levels of care. Hospitals, insurance companies and doctors are also going to be the victims of enslavement by regulations.

Government bureaucracy, inefficency and waste will flourish.

I hope everyone realizes that the individual market was the first market to be attacked by Obamacare because it is the smallest market. The individual market only affects 5 million people.

The next market in line to be destroyed is seniors and Medicare. It is starting already with the destruction of Medicare Advantage.

The employer sponsored healthcare insurance market will start being destroyed in 2014.

President Obama just delayed the implementation of the private market mandate from October 15^th until after the November 2014 elections.

The delay will not take the spotlight off the failure of Obamacare and protect Democrats from the outrage of Americans toward Democrats during to 2014 election campaigns.

I believe the American people are on to President Obama’s tactics of attacking his enemies personally.

Consumer outrage about Obamacare will dominate the media despite President Obama’s attempt to manipulate the liberal traditional media.

He seems desperate to create a distraction. His Iranian deal will create a temporary distraction.

President Obama brought several selected progressive “influential commentators” to the White House for a little policy briefing last week.

They all said the meeting was confidential. I say the meeting was an attempt at media manipulation. Hopefully the media is realizing reality.

Obamacare was supposed to be built by the best minds in the healthcare policy business. It appears the problem was these best minds knew little about the healthcare insurance business, the hospital system business or the practice of medicine.

Obamacare has not aligned any of the vested interests of the primary and secondary stakeholders. In fact, misalignment of vested interests has increased since passage of the law.

I cannot figure out what the President Obama was thinking. All signs point to the fact that President Obama wants to destroy the present healthcare system and replace it with a single party payer system.

I have pointed out multiple examples in this thinking including President Obama’s declaration as far back as 2003 and since that he prefers a single party payer system.

He has also emphasized that the universal care system he will put into place (Obamacare) is a transitional system. It is a system that will collapse and be replaced with a single party payer.

http://youtu.be/BKkTRMEyAhs

This You Tube is compelling. It demonstrates President Obama’s ideological goal not practical goals.

President Obama admits that Obamacare is a transition system. He wants to eliminate employer sponsored healthcare coverage and the destruction of the healthcare insurance industry.

President Obama simply ignores the fact that the administrative services are provided by the healthcare insurance industry to administer Medicare and Medicaid.

The government could not do it without the healthcare insurance industry. The cost of the administrative services is a non-transparent 40% of every Medicare and Medicaid dollar.

Medicare and Medicaid are single party payer systems. The healthcare insurance industry presumably bids for each states contract. Indirectly the healthcare insurance company rips off the consumers by ripping off the government for the administrative service for Medicare and Medicaid.

All we have to do is remember the $2,000 toilet seats in a government cargo plane to understand the efficiency of a government run program that outsources the fulfillment of a mission.

It is hard for most people to believe that President Obama’s purpose all along was to destroy Obamacare (his namesake) and replace it with a single party payer system.

Everyone must notice that he is now been calling Obamacare the Affordable Care Act.

I am sure he wanted the hysteria that is going on right now over dropped insurance coverage, dropped physicians and changed insurance plans to subside.

However he did not expect the mistrust the public has for him. The genie is out of the bottle. The country doesn’t trust this nice guy anymore.

He did not expect the outrage to be directed at him. This is the reason he is blaming the failure on the Republican Party one day, the healthcare insurance companies the next and doctors and hospital systems the next.

He has also giving special favors to his political base. These favors has made the middle class public very angry at him.

A more glaring favor is exempting all of congress from participating in Obamacare.

The fast food companies’ exemption has angered small business owners.

Exempting unions from Obamacare has been totally disgraceful.

The destruction of Medicare Advantage for seniors is on the way. Senior outrage will be seen in the next few months.

President Obama is going to try to blame the healthcare insurance industry, hospital systems and physicians for this disaster.

Very few Americans are going to believe him.

Americans understand that he is forcing premium prices and out of pocket expenses up with unnecessary bureaucracy and regulations.

He is restricting care to the elderly and access to care in hospitals and doctors’ offices.

He has created greater dysfunction in the healthcare system.

The dysfunction is going to get worse.

He will achieve his goal to force the healthcare system to collapse.

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

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