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A Bogus Attack For A Political End

September 24, 2014

inChronic Disese Management, Disinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

The New York Times continues to be a mouthpiece for the Obama administration. I suspect the editorial board thinks the only thing that will save the healthcare system in America is a government controlled single payer system.

This is President Obama’s goal even if he has to destroy the medical care system.

On September 20^th, 2014 the front page top right hand column article in the Sunday New York Times was After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know appeared.

In the past the New York Times reserved this spot for the most important story of the day.

This story was the most important news story on Sunday September 20^0h 2014. The Times thought it was more important than a story about the economy, ISIS, the mid-term elections, Israel, Hamas or Iran’s nuclear ambitions.

The story intended to inflame the New York Times’ readers so they would be angry at the medical profession.

The problem is that the story is peppered with misinformation and disinformation.

The New York Times writer used a typical Saul Alinsky tactic. Her goal was to prevent the opponents of the story from responding intelligently.

Public opinion will be on her side because the New York Times is supposed to be a credible source.

Saul Alinsky’s rules instruct one to lie if necessary. The next step is to frighten consumers into thinking the system under attack cannot work.

“Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms.”

Peter Drier did not read or modify the consent forms. He should have made the hospital and his doctor liable for any unauthorized expenses, providers, or events.

Peter Drier is a bank technology manager. Banks have their own small fine print intended to keep consumers liable and uniformed.

Peter Drier should have modified the consent forms before he signed them. He can refuse to authorize treatment or payment to any provider or procedure performed in the hospital that was outside of his insurance network.

In Network providers have to agree to accept the negotiated fee. If they need an additional provider it must be a provider that will accept the negotiated fee of his insurance company.

A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee.

Every consumer should find out if their providers are in their insurance network .

All of those prices are ridiculous retail prices. The real question is how much did his insurance company pay and how much is he liable for.

Peter Drier did not do a very good job in researching his insurance company’s coverage. A third party payer would never approve a $56,000 payment to the hospital for the proposed procedure.

Hospitals bill very high retail prices. They will negotiate a price that is 50-90

5 lower than the retail fee.

The author, ELISABETH ROSENTHAL, has a list of recent articles criticizing the healthcare system about exorbitant retail pricing.

COLONOSCOPY: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures
PREGNANCY: American Way Of Birth, Costliest In The World
JOINT REPLACEMENT: In Need Of A New Hip, But Priced Out of the US Market
HOSPITAL PRICES SOAR: A Stitch Tops $5000

All of these articles criticize the retail price providers charge. They do not tell the reader what the providers receive as reimbursement by the government or the healthcare insurance company.

Consumers are the victims of the constant effort to try to reduce healthcare costs and stick consumers with the bill.

Obamacare has driven the healthcare insurance industry to raise premiums and decrease coverage in order to cover their supposed actuarial risk.

The decreased reimbursement by the healthcare insurance industry has driven providers to increase their fees for service. The hope is to occasionally catch a consumer who is uninsured and liable for the fee.

The uninsured consumer cannot afford the fee and therefore will not pay the fee. The provider then has to sue the consumer to collect whatever they can. The cost of the suit is not profitable for the provider. He usually writes off a loss.

President Obama and the government control advocates will use the resulting chaos in the marketplace to prove that a free market for healthcare system does not work. Therefore the country needs a government controlled single party payer system.

The problem with these horror articles is they frighten consumers. They do not address the reason that the healthcare industry costs $2.7 trillion dollars a year.

The chaos in the marketplace is the result of the government (Obamacare) involvement into the free market system.

I am also not sure if the $2.7 trillion dollars is from retail charges or negotiated payments. The answer to the question is totally opaque.

The reasons for the increasing costs are many.

Americans are becoming less healthy because they are not being responsible for their health. It is hard to maintain weight when almost every restaurants main dish is higher than their daily caloric allotment.

The result is an obesity epidemic. Over 50% of Americans are Obese.

Obese individuals have a 40% increased incidence of chronic disease.

Eighty percent of the healthcare dollars spent are spent on treating chronic diseases and the complications of those chronic diseases.

Controlling a chronic diseases can decrease the complication rate of those diseases by at least 50%.

If we ran the numbers we could reduce the healthcare costs below one trillion dollars a year.

Everyone complains about the grotesque profits the healthcare insurance companies make. Everyone understands the profits result from the inflated bureaucracies and double payments made to segments of the bureaucracy.

If one insurance company wanted to be competitive it would lower its premiums and overhead. All the other insurance companies would do the same to stay competitive.

One has only to look at the cell phone industry. Not only has the cost of the cell phones been lowered but monthly charges are continually decreasing.

One should also look at what ITunes did to the music industry.

Look at what Dr. Keith Smith’s surgical center model is doing to the local hospitals’ costs for surgery in Oklahoma City. They are falling precipitously.

The government should stop feeding the public disinformation leading to confusion of the facts..

President Obama's goal is to destroy the medical system so that consumers will believe the only thing that will work is a government controlled single party system.

Single payer systems throughout the world have proven to be unsustainable.

The healthcare system is dysfunctional. Medical care has been distorted at the consumers’ expense and for the profit of the profit of the healthcare industry.

America has to become innovative and build a healthcare system to the advantage of the consumer.

The solution

Is about consumers becoming aware.

Is about leadership.

Is about innovation.

Is about consumers being responsible for their health and their healthcare dollars.

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

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When Will We Ever Learn

September 10, 2014

inDefective scientific studies, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

When will President Obama ever learn?

His ideology blinds him to the facts. I vividly remember him telling John Kerry and Barney Frank not to worry about not having a Public Option.

Barney Frank said we need a Public Option for the Affordable Care Act to work. The only way Obamacare could work is by ending up with a single-payer system.

President Obama had a clandestine “Public Option” built into Obamacare.

Progressives believe deeply in their ideology. They do not consider past history, present reality or facts.

All progressives have to do is look at what is happening to socialized medicine all over the developed western world.

It is failing even as some people believe it is succeeding.

The Commonwealth Fund (a private progressive foundation) with a focus on healthcare is certain that a single party payer system is the only viable healthcare system.

The report ranked healthcare systems throughout the developed western world. In its published ranking the National Health Service of Great Britain was considered the best medical system among the 11 of the world's mostadvanced nations, including Canada, France, Germany, Switzerland and Sweden.

The United States came in last.

Few have the time or patience to read the complete report or pick out the defects in the study.

Most people reads the summary. The summary in this study is not close to the evidence presented.

The Commonwealth Fund’s rankings of countries are contradicted by objective data about access and medical-care quality in these countries in peer-reviewed academic journals.

The Commonwealth Fund’s methodology is defective. Its conclusions relied heavily on subjective surveys about "perceptions and experiences of patients and physicians."

Kenneth Thorpe made an important point by examining differences in disease prevalence and treatment rates for ten of the most costly diseases between the United States and the ten European countries with a single payer system.

He used surveys of the non-institutionalized population age fifty and older. Disease prevalence and rates of medication and treatment are much higher in the United States than in these European countries.

Why would that be?

There are many reasons for this finding. The main one is the availability of care in the United States compared to the ten socialized western countries.

Another is lifestyle and incidence of obesity in the United States. Both lead to the onset of chronic disease and increased treatment.

“Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.”

“Americans are diagnosed with and treated for several chronic illnesses more often than their European counterparts are.”

Americans diagnosed with heart disease receive treatment with medications and procedures more frequently than patients in Western Europe.

In the past local peer review was all that was needed along with confidence in the treating physician’s judgment. This confidence in physicians’ judgment has been destroyed by excessive media sensationalism. The real percentage of abuse is small and easily discoverable by peers and the use of the new social media.

Cancer treatment survival rates in America are far greater than the survival rates in Britain, and countries in western Europe.

The reasons for the higher cure rates are the availability of early detection and treatment.

Cancer treatment costs are high. The government should look into the reasons for this high cost and try to lower the cost.

The Commonwealth Fund’s report does not consider any of these factors.

The NHS has a waiting list of 3.2 million people for admission to the hospital. In London alone over 500,000 patients are on a waiting list for diagnosis and treatment.

A large percentage of patients triaged as urgent after being diagnosed with suspected cancer have a 62-day wait time to receive therapy.

The British Health and Social Care Act 2012 authorized the use of the small private sector of healthcare to help the NHS with its problems.

The share of NHS-funded hip and knee replacementsby private doctors increased to 19% in 2011-12, from a negligible amount in 2003-04. Each year there is an increase in NHS funded care by the private sector.

It sounds like the VA Healthcare System’s solution to its problems.

Englishmen who can afford private care and private healthcare insurance to avoid the NHS are switching to private insurance even though they have to pay $3,500 for each man, woman and child in a family into the NHS.

The single party payer system (NHS) is struggling with unsustainable costs even though we hear from progressives how great socialized medicine is in England.

The key ingredient missing in all these systems is patient responsibility for their health and their healthcare dollars. Both are powerful motivators to healthy living and detecting disease early.

There are big problems in Canada that have been undisclosed in the United States.

There were two articles in American newspapers in 2011 that applaud the Canadian system.

Article 1. Debunking Canadian health care myths – The Denver Post

Article 2. Everything you ever wanted to know about Canadian health care in one post. Washington Post

Both articles are opinion articles and lack concrete evidence. The articles contain both misinformation and disinformation.

The Fraser Institute is a well-respected Canadian think tank. Its research is considered accurate with a libertarian slant.

Its 2011 report contradicts the statistics in these articles on the Canadian government healthcare costs.

Article 1. “Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's.”

Article 2. “In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries.”

This is not true according to the Fraser report. Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the Frazer Institute. To be specific, in 2011, health care spending consumed 50% GDP in Canada’s two largest provinces, Ontario and Quebec.

“Total federal, provincial and territorial government health spending has grown by 8.1 percent annually, while the national GDP in Canada rose by only 6.7 percent during the same period.”

The provincial governments have raised taxes and rationed care, while increasing patient wait times.

“Provincial drug plans have also more often refused to pay for most of the drugs that are certified as “safe and effective” by Health Canada.”

“Unsustainable rates of growth in health care spending crowd out the resources available for other purposes including education, public safety, and economic growth-enhancing tax relief,”

One has only to think about the Obama administration’s initial propaganda and the stunning reality we are facing presently.

The VA is now asking for additional funding to clear up the disaster.

The problem is entitlements are too expensive for a government. Entitlements do not work because governments cannot legislate behavior by directives. Individuals must be responsible for their health and healthcare dollars.

The other problem is government entitlement programs generate a large bureaucracy. The bureaucracy stimulates the development of inefficiencies and corruption. The new bureaucracy practically guarantees failure of the entitlement.

The Government can help people be responsible for their health with incentive programs.

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

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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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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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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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