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More On Women’s Health, HRT And WHI

June 13, 2016

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

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Stanley Feld M.D.,FACP,MACE

The Women’s Health Initiative (WHI) was published in 2002. I presented a critique of the study in 2003. I gave a lecture in different parts of the country at that time debunking its statistical significance.

No one paid attention to the statistical results. The media was the message and the message has lasted despite good data refuting the message.

My last blog reviewed the lack of statistical significance of all the conclusions of the WHI study.

I published these thoughts once before in a 2007 blog post. I was stimulated to republish my comments last week because of two excellent lectures I heard at a recent American Association of Clinical Endocrinologists (AACE) meeting reviewing the recent literature as to the value of estrogen replacement therapy in post-menopausal women.

Holly L Thacker M.D. presented “Women Getting Older-and Even Better”.

Dr. Thacker is the Director of the Center for Specialized Women’s Health at Cleveland Clinic.

Mitchell Harman, M.D. presented “Hormonal Treatment of Menopausal Women: What Are The Data Telling Us (and Not Telling Us)?”

Hopefully these two presentations will help us move forward in getting to the truth about hormone replacement therapy in the post menopausal woman.

Neither presentation stated outright that the Women’s Health Initiative conclusions were invalid because of the fact that none of WHI conclusions were statistically significant.

However, several important new points were added to the discussion using the WHI’s own data. I will present the discussion.

First, I want to present an email exchange a reader had with a retired statistician about my last blog.

Mon, Jun 6, 2016,

S wrote:

The blogger writing below is a now retired endocrinologist, academician and oft critic of ObamaCare.

In his post below he takes on many of the reports that were published based upon the WHI and related.

Passing it along to you FYI owing to his assertions as presented below.

Perhaps instructive after all.
S

June 6.

Stan,

I sent your post on the flaws of WHI data and interpretation to a retired statistician for comments.

He applauds your evaluation and comments. As do I.

FYI.
S

From: R
Sent: Monday, June 06, 2016
To: S
Subject: Re: FW: Repairing the Healthcare System

The points made are good ones. The major point missed is that the study was done with horse piss estrogen, not human biologically identical estrogen which have been shown to produce none of the negative effects of horse derived estrogen.

None the less, the scientific criticism of the reported study are very accurate and very good.

In 2011 AZ LaCroix using the WHI’s own data analyzed the myocardial event risk. Women talking estrogen between ages 50-59 had less risk of having a myocardial infarction than women starting to take estrogen replacement therapy from age 60-69 and from age 70-79.

The WHI lumped conclusions lumps all three groups together in its analysis.

It is well known and accepted that the incidence of myocardial disease increases in women as they age and increases in post menopause to the same incidence as males.

The timing hypothesis for starting estrogen therapy was proposed as a result of this new interpretation of WHI data.

The effects of HRT on CVD are dependent upon time HRT is initiated relative to menopause and/or age (the “timing hypothesis”).

The upper two curves reflect the thickness in the carotid artery tested with ultrasound in women starting to take estradiol ten years after menopause. There is not a significant difference in the increase in intimal thickness between the placebo group and the treatment group (p==.029). Significant p values are 0.05 or less (i.e. 0.001).

Whereas the lower curves where estrogen started in less than 6 years post menopause the placebo thickness increased greater than the estradiol thickness for a very significant p value of 0.007.

This data reflect the influence of estrogen on vessels when taken shortly after the onset of menopause. The result presumes the protective effect of estrogen in post-menopausal women as opposed to the conclusions of the WHI.

I believe that WHI stimulated fright that estrogen causes breast cancer has been exaggerated. Only 4% of the causes of death in women are the result of breast cancer.

It is true the WHI was published in 2002. Prior to 2002 early detection of breast cancer with mammogram and treatment with surgery and chemotherapy was prevalent. It certainly resulted in a decrease in the incidence of death from breast cancer. Today the incidence of death from breast cancer might even be lower.

There is a sense that the breast cancer death rate might be even lower if estrogen is used immediately in postmenopausal women. There has been an 80% decrease in women being treated with hormone replacement immediately post menopause.

The goal should be to lower the death rate from breast cancer to zero.

The huge death rate from cardiac disease in women easily surpasses the death rate from breast cancer.

There is evidence that estrogen replacement might serve to lower the 4% death rate from breast cancer if given appropriately as opposed to the message that estrogen raises the breast cancer death rate as the WHI concluded.

Eliminating patients with Breast Cancer genetic makers from receiving estrogen replacement would lower the death rate even further.

The subgroups in the WHI Estrogen only arm were analysized in 2004. Please note that all subgroups at all the diseases catagories crossed 1 and is not statistically significant. Only the incidence of stroke in the 60 – 69 group did not cross 1.

Therefore none of the subgroups except the 60-69 stroke subgroup was statistically significant. However that group did not attain a hazards ratio above 2 required for it to be statistically significant.

Importantly, the Breast Cancers subgroups all crossed 1 indicating there was no difference statistically significant between estrogen treated age groups and placebo age groups. It cannot be concluded from the WHI study that estrogen causes breast cancer.

Colditz,in the Nurses Health study did not use nominal confidence limits as did the WHI in its conclusions. Colditz considered all of the confounding variables such as age, age of menopause, BMI, hysterectomy or normal onset of menopause, BMI, blood pressure, cholesterol level, smoking, oral contraceptive use, and family history of cardiac disease, or breast cancer.

He used adjusted confidence limits required to be used with confounding variables.

The confidence interval for the occurrence of breast cancer in nurses currently using estrogen was 0.59- 1.00 and using estrogen in the past was 0.63-1.09 both touching or crossing 1. Therefore the results were not statistically significant.

The game changer after all the evidence that the WHI data was misinterpreted was the Danish study DOPS published in the British Medical Journal in 2012.

I have presented this data to my readers to ponder after I heard these two excellent reviews at the American Association of Clinical Endocrinologists (AACE) meeting.

I wanted to point out once again that the media is the message. The media without proper peer review of data has changed the way women are treated post-menopausal forever.

Hopefully disseminating this data will help remove some of the emotional stigma that has influence the thinking and use of estrogen replacement therapy since 2002.

It might stimulate the medical profession, the government, the malpractice legal system and women to start re-thinking their recommendations and conclusions.

This is especially true when women are living longer and estrogen therapy can alleviate some of the emotional, and physical effects women suffer in menopause when estrogen is prescribed appropriately.

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

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Women’s Health Initiative (WHI): The Medical Community Is Waking Up

June 5, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems, Physician's Problems

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Stanley Feld M.D. FACP, MACE

The Women’s Health Initiative’s conclusions changed how peri-menopausal and post-menopausal women are treated in the U.S.

The conclusions of the study were released to the media before the medical community had a chance to study or debate the findings.

Since the media is the message and damn the facts, it was clear that estrogen caused heart disease, breast cancer, stroke and pulmonary embolism when used in peri-menopausal and post-menopausal women.

The conclusions frightened every peri-menopausal and post menopausal woman in this country. Hormone Replacement Therapy (HRT) usage has decreased by eighty percent since the WHI was published in 2002.

Women were afraid to take HRT because they were afraid to contract these deadly diseases.

Physicians were afraid to prescribe HRT because of the fear of being sued in our litigious society if their patient contracted one of these diseases.

In the years before the WHI, observational data supported the conclusion that estrogen was of great value in treating symptoms associated with the acute menopausal syndrome, namely hot flashes, vaginal dryness, urinary tract irritation, skin changes and emotional instability.

Estrogen also seemed to protect against heart disease, osteoporosis and weight gain and promote a general sense of well being in peri-menopausal and post-menopausal women. There was no good evidence for or against breast cancer.

One common complaint about observational studies is they are not double blind studies. One observes the outcome against a control group that does not have the same outcome.

“One common observational study is about the possible effect of a treatment on subjects, where the assignment of subjects into a treated group versus a control group is outside the control of the investigator.^[1]^[2] This is in contrast with experiments, such as randomized controlled trials, where each subject is randomly assigned to a treated group or a control group.”

This NIH sponsored double blind placebo controlled study (WHI) was performed to prove with a level A (double blind placebo controlled) study to test the validity of observational data reports of the positive effects of estrogen.

The WHI reported results that concluded that estrogen had the opposite effects of previous observational studies.

The WHI conclusions were that conjugated estrogen caused breast cancer, heart disease, stroke, and pulmonary embolism. The WHI claimed that conjugated estrogen did protect against osteoporosis.

The media is the message and the conclusion resulted in the media frenzy. The implication was the medical profession was killing women by prescribing estrogen.

Prior to the release of the study’s conclusions many women were afraid to take estrogen on general principles alone. Many felt that estrogen deficiency was part of the aging process.

However, women had a life expectancy of 50 years in the early part of the 20th century. Women today live much longer and observational data suggests estrogen therapy (HRT) results in a healthier life.

There are many statistical problems with the WHI study. These problems have not been discussed in the media.

Practicing physicians were confused by the WHI study’s conclusions. They were also enraged because the results were released to the public before there was peer reviewed by the entire medical community.

Patients taking estrogen were upset at their physicians for giving them estrogen.

There are many defects in the WHI study from a statistical viewpoint.

Age Distribution: 66.6% of the patients were between 60 and 70 years old. 87% of the patients were 60 to 80 years old. The majority of the patients in the study receiving Hormone Replacement Therapy (HRT) for the first time were at least 10 years post-menopausal. This age distribution does not represent the usual population starting HRT.

HRT is usually started just prior to the onset of menopause or at menopause (48 years old).

The drop out rate in the placebo and HRT group was 40%. The significance of the dropout rate was not addressed. This dropout rate nullifies the validity of statistical significance of all the conclusions in the study.

Maximal tolerable dropout rate for statistically significance of data in a study should not be greater than 20%.

Everyone had ignored this important statistical fact.

The unblinding of 3000 women in the study represents a departure from the protocol. It biased the findings of treatment difference.

A hazards ratio (HR) in a statistically significant conclusion should be greater than 2.0 in order for a conclusion to be valid. The Hazard Ration should not be expressed to two decimal places.

A Hazards Ratio of less than two does not discriminate causality from bias and confounding of variables.

A 40% drop out rate nullified the power of the study. The study was not sufficiently powered to yield statistically significant results.

Presenting data as a nominal confidence interval is valid only when one outcome is being studied against one placebo.

Adjusted confidence intervals must be used when multiple outcomes are involved that represent multiple confounding variables.

Confidence interval must not cross 1 to be statistically significant.

The WHI’s statistical conclusions of the WHI study were based on using nominal confidence intervals. The nominal confidence intervals were barely significant.

The WHI nominal confidence intervals came close to touching number one (1).

All of the WHI’s published adjusted confidence intervals were non significant because they all crossed 1.

These are the defects in the WHI study’s statistical analysis that invalidates its statistical significance.

The estimated Hazard Ratios (HRs), (Nominal 95% Confidence Intervals [Nom CIs] and Adjusted 95% Confidence Intervals [Adj CIs ) in the WHI study were as follows:

Cardiac Heart Disease: HR 1.29, Nom CI (1.02-1.63) Adj CI 0.85-1.97.

Conclusion should have been the WHI was statistically insignificant for causing Cardiac Disease.

Breast cancer: HR 1.26, Nom CI(1.00-1.59),

Adj CI 0.83-1.92.

Conclusion should have been the WHI was statistically insignificant for causing Breast Cancer.

Stroke: HR 1.41, Nom CI (1.07-1.85)

Adj CI 0.86-2.31.

Conclusion should have been the WHI was statistically insignificant for causing Stroke.

Pulmonary Embolism: HR 2.13, Nom CI(1.39-3.25),

Adj CI 0.99-4.56.

The WHI conclusion for estrogen causing Pulmonary Embolism might be statistically significant if statistical analysis rules were not disregarded.

The Hazard Ratio (HR) was above 2. The Nominal Confidence limit (Nom Cl) did not go below 1. However it cannot be used for this study.

The Adjusted Confidence limit which must be used for this study crossed 1 making the WHI conclusion not statistically significant.

The adjusted confidence intervals were published in the original paper.

Media blitz publicity of the WHI’s invalid conclusions created a high level of public certainty about the results of the study.

Few physicians were in a position to dispute the statistical weakness of the data. Those who were in a position to dispute the statistical significance either remained silent or were marginalized.

The media blitz’ results changed the approach to women’s health in the U.S. in 2002. Eighty percent of women taking HRT discontinued estrogen replacement therapy.

In my opinion, the results have been a great disservice to women’s health. The media publicity also has had a devastating impact on the physician patient relationship and patients’ confidence in clinical research.

Even though estrogen might cause heart disease, pulmonary embolism, stroke, and breast cancer, the Women’s Health Initiative did not prove it in a statistically significant way.

Once again the media is the message.

Freedom of the press is vital to our freedom of speech, but the media’s tendency to sensationalize issues prior to proper judgment is disruptive to seeking the truth.

The medical community is starting to pick apart the conclusions of the WHI study.

I will describe some of the new and contradicting findings next time.

Dr. Joe Goldzieher, Reproductive Endocrinologist, helped me critique the statistics in 2002.

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

More On Women’s Health, HRT And WHI | Stanley Feld M.D., FACP, MACE
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Managing Points Of View and Healthcare

May 27, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems

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Stanley Feld M.D.,FACE, MACE

Finally, it is official. Ben Rhodes, the deputy national security adviser for strategic communications, admitted that the Obama administration lied about the Iranian Nuclear deal to the press, public and congress.

His interview with David Samuels in a New York Times Magazine typified the approach to manipulating the truth by the Obama administration in all areas of the administration’s activities.

The administration has been trying to walk back Ben Rhodes’ statements for a week. The traditional media is trying to bury his statements even though the king of the mainstream media (the New York Times) published the interview.

The justification for this behavior is that it has been used by all-previous administrations including that of George Bush. It is therefore an insignificant objection.

Ben Rhodes explained to David Samuels, in the New York Times profile that, “it was first necessary to lie to a corrupted and inexperienced American media about all sorts of things, beginning with the nature and intentions of the enemy in this case the Iranian regime.”

Subsequent lies were added, as the White House took advantage of a dangerous mix of journalists’ ignorance, their ideological and partisan commitment to the administration, and finally, their career aspirations.

It reminds me of Jonathan Gruber’s attitude toward the press and President Obama’s pretense that he hardly knew Jonathan Gruber.

http://stanfeld.com/?s=Jonathan+Gruber

https://www.google.com/search?q=Ben+Rhodes+Iran+nuclar+deal&ie=utf-8&oe=utf-8

Rhodes went on to say, “The average reporter we talk to is 27 years old, and their only reporting experience consists of being around political campaigns… They literally know nothing.”

This implies the lack of respect the Obama administration has for the press, Americans and for the virtue of honesty. It is not a good example for our youth’s future behavior and the way to mange a Point of View.

Thus they (the press) will believe what he tells them. He also tells friendly non-governmental organizations and think tanks what he is telling the journalists. Those outlets produce “experts” whose expert opinion is just what Rhodes wants it to be. These ignorant young journalists thus have quotes that look like independent confirmation of the White House’s lies. :

Ben Rhodes admitted, when David Samuels asked, “We created an echo chamber of freshly minted experts cheerleading for the deal. ‘They were saying things that validated what we had given them to say.’

This is the apparent attitude of President Obama and his administration. It is applied to every lie they have told to the American people.

Ben Rhodes described a tactic that is an extension of Sol Alinsky’s playbook. I believe the American people are catching on.

The defendants of the Obama administration marginalize the people who expose the lies with additional lies.

The Obama administration and its defendants are usually effective in marginalizing their opponents.

The defendants of the lie have the power of the pulpit and a friendly mainstream media.

The same tactics are used in defending Obamacare as I have described many times in my blog.

I find it difficult to believe that so many smart people believe these lies.

Carl Sandberg said “if you tell I lie enough times its eventually becomes the truth.” This is especially true when people start adjusting and investing in the lie.

Marilyn Travenner, now that she is CEO of the healthcare insurance industry lobbying group, has a different point of view than when she was the head of CMS. Someone else other than government is paying her.

I have said that the dysfunction in the healthcare system is the fault of all the stakeholders, namely the government, the healthcare insurance companies, the drug companies, the physicians and the patients.

Each group adjusts to a dysfunctional element making the healthcare system more dysfunctional. The growing dysfunction is driven by the multiple points of view.

President Obama’s ideology has accelerated the dysfunction.

Marilyn Travenner is now diverting blame for the dysfunction away from the healthcare insurance industry. Many do not realize that the government run healthcare system is totally dependent on the healthcare insurance industry. The healthcare insurance industry does the administrative services for the government.

The administration brags that CMS’ overhead is only 2.5-5% of Medicare’s cost. This is an illusion; It is false.

The percentage of overhead published does not include the cost paid by the government to outsource the administrative services to the healthcare insurance industry.

The administrative services overhead is added into the cost of healthcare. Insurance premiums are calculated using the Medical Loss Ratio calculation. Many insurance company expenses are considered direct medical care expenses. Direct medical care expenses should only be for direct medical care.

The government programs set payments to the healthcare insurance industry for administrative service according to the Medical Loss Ratio.

Insurance administrative expenses, like a help desk or network selection expenses, should not be included in direct medical cost. Presently, it is the method used by the healthcare insurance industry to ultimately take 30-40% of the healthcare dollars off the top.

President Obama and his administration brag that Obamacare is bending the healthcare cost curve for Medicare and Medicaid. The only reason this was true in 2012 and 2013 was because Obamacare’s hidden taxes from citizens at every income level were being collected while there were no Obamacare medical care expenditures until 2014. The 2014 and 2015 cost curve was bent upward contributing to the 19 trillion dollar deficit.

In my last blog I mistakenly left out the word contributing to the 19 trillion dollar deficit. Obamacare is not budget neutral. It is not presently bending the healthcare cost curve.

Some smart people believe Obamacare is bending the healthcare curve because they uncritically believe all the administration’s press releases.

In the last few weeks we have been warned not to believe everything President Obama and his administration tell us.

I am sure the judge in Texas who was lied to by the Department of Justice about immigration reform is not very happy.

The cost of physician services might be increasing on a retail level. However, government and insurance reimbursement to physicians is decreasing.

Travenner, in her previous life blamed the rising cost of medical care on physicians. In order to divert attention from the healthcare insurance industry she continues to blame physicians.

“The cost for everything from office visits to complex surgeries is on the rise, so there’s not much that can be done here to ebb this common cause of premium inflation.”

This is an incorrect premise. It is true that hospital costs are rising. If the premise is incorrect the solution is usually incorrect.

Next, Ms. Travenner explains additional reasons for increasing premiums.

“Prescription drug price inflation is a far bigger problem. A lack of a universal health plan, long periods of patent exclusivity, high demand for pharmaceutical products in the U.S., and the speed with which approved drugs can be brought to pharmacy shelves are all reasons why prescription drug costs could continue soaring in 2017 and future years.”

She omits the most important reasons for the increase in drug prices to the public.

President Bush’s deal with congress to pass Medicare Part D was to eliminate government’s ability to negotiate drug prices with the drug companies. The government negotiates drug prices for the military and VA. It gets negotiated prices that are comparable to all other countries on the globe.

At the same time the government restricts consumers from buying prescription drugs in Canada, suppressing competition.

The Obama administration keeps blaming the drug rules on President Bush’s administration. Why hasn’t President Obama renegotiated a better deal in the last seven years, or just change the rules by executive order as he usually does?

Tavenner also hit on “the point that restructuring the insurance market hasn’t paid benefits as expected.”

New regulations requiring Obamacare insurers to provide plans with a host of minimum benefits, as well as being unable to deny benefits to people with pre-existing conditions, has left insurers exposed to adverse selection.

In plainer terms, it means sicker people who’d been shut out of the insurance system previously have flooded in, and not enough healthier individuals have enrolled.

This last point is valid. The claim that the insurance industry is losing money is not true. It is losing money on adverse selection but they are making up that loss by increasing premium prices to the government and the corporate market.

If they did not make money how could they pay CEOs of some healthcare insurance industry companies 100 million dollars a year?

Finally, Tavenner cautioned that the turbulence can be expected because insurers “sit in the three-R world.”

What Tavenner is alluding to are two programs that are set to end in 2017: the reinsurance program that provided payments to plans that enroll higher-cost members, and the risk corridor, which acted like a modern day Robin Hood by taking excessive profits from top-performing insurers and giving them to Obamacare insurers losing excessive amounts of money.

Without the risk corridor, new insurance entrants could be discouraged, since they’d be responsible for covering the entirety of their losses. The third “r,” risk adjustment, will remain in place to distribute capital from plans with low-risk enrollees to those with high-risk.

The reinsurance aspect of Obamacare was probably illegal. The government guaranteed the insurance companies that it would make up whatever loss they claimed. The Obama administration paid the healthcare insurance industry only 12% of the promised amount. This deception by the government has led to some of the reasons UnitedHealthcare and now Aetna are pulling out of Obamacare’s health exchanges.

However, the government is totally dependent on the healthcare industry for it administrative services.

The devil is always in the details.

There is an ever-growing need to lie to manage the public’s point of view in favor of Obamacare.

The public is becoming aware of the Obama administration’s attempt to mange the public’s point of view. Ordinary citizens are madder than hell at the Obama administration and the establishment in both the Democratic and Republican parties.

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

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A Point Of View Is Not Reality

May 18, 2016

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

I find it harder and harder to believe the administration’s press releases. Every press release and press conference seem to be a lie.

How can President Obama’s press secretary live with himself?

America’s government is supposed to be a government by the people, for the people. The three branches of government are supposed to balance each other’s power.

The executive branch under the Obama administration has usurped much of the power of the legislative and judicial branches of government.

I have pointed out that things are not going well for Obamacare.

Consumers cannot keep their doctors.

Consumer cannot keep their insurance.

Obamacare’s hidden taxes have raise taxes at least 10%. Many increases are passed on to all consumers in every tax bracket.

Healthcare premiums have increased for everyone.

The only real increase in Obamacare enrollment has been in Medicaid enrollment. The central government currently pays for 100% of the insurance cost for Medicaid patients.

The Obama administration pays for the yearly increases for Medicaid premiums billed to it by the healthcare insurance industry.

Eighty-five percent (85%) of Obamacare enrollees receive subsidies. The average taxpayer does not know these facts. I suspect most congressmen do not know these facts.

Meanwhile, during President Obama’s term in office, the budget deficit has increased from 12 trillion dollars to 19 trillion dollars.

Marilyn Tavenner was the former head of the Centers for Medicare and Medicaid Services. She helped construct policy, publicize, sell, and administer Obamacare and its expansion of Medicaid.

Ms. Taverner had one point of view as head of CMS. She helped create greater dysfunction in the healthcare system.

Now, she has a completely opposite point of view. She is presently president and CEO of America’s Health Insurance Plans, the healthcare insurance industry’s premier lobbying group.

She continuously defended Obamacare after each mishap such as the enrollment web site, the enrollment errors in counting enrollees, the insurance premium increases, the poor enrollment and the decrease in service. Each disaster increased the dysfunction of the healthcare system.

Now that her point of view has changed she has become extremely critical of Obamacare.

Her criticisms of Obamacare have gotten her closer to reality. Now, her point of view is that of the healthcare insurance industry.

However, it is not a point of view that supports the needs of consumers.

Someone ought to look at the consumers’ and physicians’ point of view.

Marilyn Tavenner has harsh criticism of the program she once helped get off the ground.

The Obama administration’s continuous praise of Obamacare’s success has marginalized Ms. Taverner’s recent criticism of Obamacare.

Unfortunately, the Obama administration’s praise of Obamacare’s success is a lie.

The news that UnitedHealth Group, the country’s largest health insurer, announced last month that it would pull out of many ACA markets next year is a very big deal.

UnitedHealth, which actually operates in nearly two-thirds of all U.S. markets, has predicted it could lose $500 million on its individual Obamacare plans in 2016.

The Obama administration’s response was a classic misdirection response.

“The news is not all that shocking, and it is not a sign that the law is failing.”

United is not a dominant player in the marketplaces that the ACA “Obamacare” set up for individual insurance buyers. It covers only about 6 percent of 12.7 million marketplace participants. United does not appear to have been very effective at competing to attract customers.

UnitedHealth CEO Stephen Hemsley has blamed higher medical utilization rates for Obamacare members, as well as the ease of switching plans, for his company’s Obamacare woes.

The higher utilization rates are because the government subsidizes 85% of the people in Obamacare. Medical care is essentially free. People do not join Obamacare or pay premiums unless they are sick.

“A huge study released by the Blue Cross Blue Shield Association recently analyzed the medical claims of millions of Obamacare and employer-based members and found that Obamacare members are 22% costlier than employer-based members. Obamacare enrollees also tend to be sicker, coming with a host of chronic or expensive-to-treat conditions.”

United plans offer the largest network of doctors, hospitals and other providers to choose from.

All this is expensive. Unsurprisingly, marketplace insurance buyers tend to pick lower-cost options. All this causes their premiums to be higher.

Most people believe free is best. Many are being conditioned by the administration to love free healthcare insurance.

The quality and availability of care is ignored in the administration’s boasting of Obamacare’s success.

The Obama administration wanted insurance companies with large networks to join. Only companies with restricted networks are joining. These companies are not providing the infrastructure for the access to quality care.

Obamacare ignores individual responsibility for healthcare and emphasizes individual dependence on the federal government.

The Obama administration’s misdirection continues;

“United’s selective exit from ACA marketplaces appears to reflect two positive features of the law. “

“First, Obamacare was meant to spur competition among insurance companies, thus constraining premiums; in many markets, this dynamic appears to be at work, to the detriment of United.”

How is Obamacare promoting competition when UnitedHealth Group is leaving and Aetna is threatening to leave?

“Second, the law has curtailed many of the ways that insurers used to contain their costs, such as refusing to cover certain people or certain treatments, or jacking up premiums for older customers.”

This “positive feature” has caused premium prices and deductibles to increase and the affordable care act (ACA) to become the unaffordable care act (UAC).

“Many insurers on the ACA marketplaces have responded by offering plans that keep costs down by narrowing their networks of providers. This is a better way to contain costs than those the law forbids”.

Does anyone think this will make access to quality care more available?

Marilyn Tavenner is now implying the worst is yet to come. She made this prediction when she rolled out Obamacare and is declaring the same now as she runs the healthcare insurance lobbying group.

“I’ve been asked, what are the premiums going to look like [in 2017]? I think the overall trend is going to be higher than we saw in previous years. That’s my big prediction.”

Marilyn Tavenner was formally a big fan of Obamacare. Her point of view has now changed.

She doesn’t see just one problem pushing premium prices substantially higher next year. She sees a confluence of many factors. This would suggest that overcoming these obstacles isn’t going to be easy.

I will discuss the factors Ms.Taverner is referring to my next blog.

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

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Another Father Son Weekend

May 13, 2016

inLife's Experiences

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Stanley Feld M.D., FACP, MACE

Every year Brad and I go away somewhere to just hang out, eat a lot of ice cream and a couple of fancy meals. Daniel and I do the same drill on a separate weekend.

Both boys and I feel it is very good for our health and spirit. When they were teenagers and young men I felt good because I had the opportunity to teach them something when we were alone.

Those days are long past. I am the one that learns from them and their view of life. I relish the opportunity to just to be with them alone and talk about their life and their worldviews.

Brad and I can walk for hours just talking.

Brad always has me pick the city. This year I picked Chicago. I know Brad’s been to Chicago 100 times. He was the lead investor in Chicago based Feedburner and was on the board of directors.

I guessed Brad had never been on the Chicago Architecture Foundation River Cruise. I have done that tour three (3). It is a very educational experience. Brad knows a good deal about architecture but had never been on the Chicago River Cruise.

The cruise and the Chicago Cubs is the reason I picked a trip to Chicago.

We both got into Chicago about ten a.m. on Friday May 6^th. I had a terrible time getting through security at DFW airport even with TSA Pre. I have had TSA Pre early on and never had a two block line at DFW airport. Something funny is going on with TSA.

The ride from O’hare was not bad because the driver took the side streets.

Brad booked two rooms at the Peninsula Hotel.

It was getting late after checking in, talking and playing with all the electronic toys in the room. We had tickets for a 1.00 p.m. River Cruise.

We had a quick lunch at Rosebud on Rush. I had eaten there before. The pasta was excellent.

We then walked the mile to the River Cruise port just below the Michgan Avenue bridge.

As we walked over the bridge guess what we saw?

Donald Trump is ubiquitous even in Chicago. Actually, this is the first building the tour guide told us about.

The Wrigley building is a wonderful building. It was the first building we went into after the boat tour because it has a Ghiradeli ice cream store.

Brad and I usually have chocolate ice cream twice a day during our weekends together.

Let us get back to the River cruise. The cruise gives one the opportunity to see Chicago and the tremendous architecture along the riverfront from a viewpoint one never sees on the city streets. Chicago has done a wonderful job it showing what can be accomplished using the riverfront as an asset for revitalizing g a city.

I think I have made my point. This is a tour that should not be missed.

After our ice cream we walked the mile back to the hotel. Along the way we stopped in a few stores. We stopped in Disney’s store to see the BB-8 display, the Garmin store, the Nike store, and the Under Armour store.

Along the way we talked politics, philosophy, economics and life in general.

It was time for a half hour nap. Brad and I are both experts on napping. He claims I taught him how to nap.

Next we were off to Swift and Sons for dinner. We met Brad’s friend Jeff Hyman for a drink at Swift and Sons before dinner. I love meeting Brad’s friends. I always learn a lot from them. Brad had invested in one of Jeff’s companies a while ago.

After drinks Brad and I had dinner and talked more. After dinner we were trying to figure out where to have chocolate ice cream. A chocolate ice cream sundae just showed up for both of us with the following note from Phil Nadel of Florida.

Our Chocolate Ice Cream

The note was in response to Brad’s blog post pre our Chicago trip in which he said,

“My only regret about my father son trip with my dad is that we’ve only been doing it for a decade. I wish we had started 40 years ago. If you are a father and your son is at least ten years old, I strongly encourage you to consider this tradition. If you are a son and you are at least 20 years old, I encourage you to take the initiative and just start doing this with your dad.”

I second this comment. I also suggest you open Brad’s link and read the comment section.

On Saturday morning Brad went for a long run along Lake Michigan. I intended to go for a short run (3 miles). I went outside. It was 48 degrees with a strong wind coming from the north. I went back into the Peninsula Hotel and up to its exercise room. It was good enough for me.

Next was the Chicago Cubs game. The game started at 3 p.m. Brad’s partner Jason Mendelson arranged a 12.30 pm tour of Wrigley Field for us.

We had to go to Giardino Pizza which was right across the street on Rush. I had forgot it takes forever to cook a Giardino’s Pizza. We had to down the pizza, then get an Uber to get us to Wrigley Field in time for the tour.

The pizza was great but the eating experience was lousy.

We met our tour guide in front of the Ernie Banks statue.

I look a little stuffed because I had all the clothes I brought in my suitcase on for the game. I wore three undershirts, two button down shirts, one cashmere sweater and a Cubs T shirt.

Brad was still shivering from his run on the lake. He went to the Cubs store and bought a sweatshirt hoody and hat.

The guide took us all around the ballpark showing us the renovations historical elements and collected mementoes.

The Cubs have been a perennial losing team. In the last few years, under Manager Joe Madden, the Cubs become a pennant contender. On May 7^th they had the best record in their division and in all National League divisions.

Thanks to Jason Mendelson and his friendship with the Cubs present owner Brad and I had the best seats in the house. We had a chance to see how Joe Madden manages the team.

It was a fabulous game. The National were first in the eastern division. The lead changed hands 3 times during the game. The Cubs beat the Washington Nationals 8 to 5 in a superbly managed baseball game by both Joe Madden and the Nationals Dusty Baker.

Both managers used almost their bench.

After the game we had dinner at Coco Pazzo with Troy Henikoff (who runs Techstars Chicago) and his wife Kristin (a Columbia College graduate and lawyer). They are two lovely people. The conversation was stimulating. I always learn a lot from Brad’s friends. Thank you Brad.

We walked a mile and a half from Coco Pazzo to the Peninsula at 11 pm. It was warmer than the game time temperature.

We were tired but we are heading home in the morning.

This last picture is at the airport after another unforgettable weekend with Brad.

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

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All Medical And Healthcare is Local

May 7, 2016

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

It is apparent that Obamacare is failing. Obamacare was built on a defective business plan designed with the goal to have all medical care controlled by the federal government.

If a stakeholder could potentially develop a plan that would threaten the central government’s takeover of the healthcare system, President Obama and his administration would simply rewrite the rules to destroy the initiative.

A clear example is the new rules to destroy health savings accounts. Medical savings accounts are similar to health savings account. The difference is Medical saving accounts put the money in the consumers’ hands initially. If there is any money left of the deductible it goes into a retirement account that is not directed to healthcare. Health saving account direct the unspent money to healthcare costs in the future.

The states are responsible for Medicaid. States claim that the central government is impinging on states’ rights by directing states to do what the federal government tells them to do with respect to Medicaid.

States have fought and won their argument in the Supreme Court when the federal government was paying 100% of the bill for Medicaid if states extended Medicaid. The Federal government will pay 100% until 2017. Then payment will decrease to 95% until 2020. At that time it will decrease to 90%.

Twenty-two states are not participating. The issue is a states’ rights issue rather that a healthcare issue even though the states need the federal help.

Even with this help many people on Medicaid cannot find a physician or can afford the medical care.

“Many plans are being canceled, and many doctors and hospitals are no longer being covered by the new plans on the health insurance exchanges.”

A Medicaid patient said, “Even though I am now on Medicaid, I cannot use it because I cannot find a doctor. “

Another recently discovered stifling of states innovative ability has come to light.

After much bickering after the Affordable Care Act was written state innovation waivers, also called 1332 waivers, which are to begin in 2017, were written into the law.

The state innovation waivers or 1332 waivers are like a golden parachute to states both participating and not participating in the Medicaid expansion program. They are allowed to dictate the conditions and receive federal money.

The 1332 waiver solves the states’ rights problem.

The 1332 waiver would provide states with block grant funding to provide healthcare insurance to state citizens. It also waives nearly every major component of the Affordable Care Act (Obamacare).

A major provision of the 1332 waiver is that it is deficit neutral.

Two things could happen.

States wanting to experiment with a single party payer system could pursue it.

States that want to experiment with a free market healthcare system could pursue it.

Two prominent examples of innovative experimentation have been proposed.

In Arkansas, “Governor Asa Hutchinson has signaled that the state’s “private option” Medicaid expansion. Medicaid beneficiaries would receive private insurance plans.”

These private insurance plans would require higher spending for Medicaid. Theoretically the decreased spending in the Obamacare Exchange would offset the increased spending and better service for Medicaid patients. It would remain deficit neutral.

Rhode Island and Hawaii want to pursuit innovative entitlement programs that would cost less than the inefficient bureaucratic central cost.

The Obama administration could not tolerate the thought of the states being independent of federal control. A recent Friday afternoon, at 3 pm, the Department of Health and Human Services announced a rule change.

“These 1332 innovation waivers must still be deficit-neutral. However,

Savings from Obamacare may not be used to offset increased costs in other parts of a state’s health-care budget.”

The ruling by non-elected officials now makes these state controlled innovative experiments mostly impossible because the states cannot offset the savings.

Since all medicine is local, common sense dictates that states should be able to do a better job than a bloated federal bureaucracy in serving its local citizens’ healthcare needs.

The present system is a multi-trillion dollar failure. The states are correct in wanting to try something new.

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

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More Double Digit Obamacare Price Increases

May 2, 2016

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

Its getting boring to hear about Obamacare’s double-digit health insurance premium increases each year. The healthcare insurance industry is now preparing the public for another round of double-digit premium increases in 2017.

It is important to remember the public experienced double-digit health insurance premium every year since 2014.

The cost of buying insurance has skyrocketed since Obamacare was enacted. The public is not forgetting this.

The table below compares health insurance premiums before and after Obamacare.

This table includes both the numbers in the federal and state exchanges and the private healthcare insurance markets.

President Obama and his administration are bragging that the healthcare insurance markets are stabilizing.

All the federal funded state health Co-ops will be bankrupt before the 2017 enrollment period.

Updated state reports on enrollment since the close of 2016 extended enrollment period indicates that more than 1 million of the 12.7 million who were reported to enroll for 2016 have dropped their Obamacare healthcare insurance policies.

In 2015 only 1.5 million consumers out of 11.7 million enrollees dropped out the entire year.

Arielle Levin Becker of the Connecticut Mirror reported, “In Connecticut of the 18,800 customers who dropped out (16%), 20% failed to provide required information; 53% didn’t pay; 10% asked to have their plans canceled; and 12% shifted to Medicaid.

Those exiting customers were partly offset by nearly 8,000 latecomers, more than one-third of whom lost Medicaid.”

The truth is the Obamacare health exchanges are not stabilizing the healthcare insurance markets. Obamacare is destabilizing the healthcare markets.

It is becoming more and more difficult to believe anything President Obama says or his administration reports.

United Healthcare declared they are dropping out of most of the exchanges they are participating in because of the toll the health exchanges have taken on their bottom line.

Aetna just announced it lost more than $100 million on its healthcare exchange business last year (2015) but hopes to break even this year (2016).

This is a pipe dream on Aetna’s part. Less people have signed up for Obamacare and the people who signed up have been sicker people with pre-existing illnesses.

Aetna chairman and CEO Mark Bertolini said Thursday, “ the nation’s third-largest health insurer still sees a good business opportunity, but Congress needs to provide leeway for companies to design lower-cost plans tailored to young, healthy people.”

President Obama is not going to let insurers design lower cost policies tailored for young, healthy people. His legacy legislation is built on equal premiums for all.

These announcements can put the healthcare debate back in the headlines for the general election. It can re-ignite consumer and voter backlash once again.

President Obama ignored the backlash before. Can Hillary Clinton ignore the upcoming price increase backlash?

“Hillary Clinton is the only one promising to build on the Affordable Care Act. She’s proposed an aggressive effort to increase enrollment along with measures to reduce consumer costs.”

Hillary Clinton is mouthing words that sound good but are impossible to fulfill. People understand these empty promises now.

“ The Republican candidates all want to repeal “Obamacare.”

No one has come up with a solid proposal. Not even Donald Trump.

“Vermont Sen. Bernie Sanders would incorporate it into a bigger government-run system covering everyone.”

Bernie Sanders is dead wrong. America cannot afford the cost and it has been proven not to work in the healthcare systems in the rest of the world.

The health law has many problems. The problems are too numerous to list here. The biggest problem in terms of costs for next years premiums (2017) are the lower-than-hoped-for enrollment, sicker-than-expected customers, and a bloated bureaucracy that is not an efficient business model.

Obamacare has created a financial drain for many healthcare insurance companies. The increase in premiums and the government pressure to keep prices low have in turn created pressure on insurance companies to lower reimbursement to physicians and hospitals.

Hospitals have to participate in the health exchanges, Medicare and Medicaid for survival. Physicians do not. Obamacare has created a more severe physician shortage.

The healthcare insurance companies would never consider becoming more efficient and lowering their cost. Some top executives are making more than 100 million dollars a year.

The healthcare insurance industry is setting the stage for 2017 premium hikes that could reach well into the double digits.

Virginia has nine returning insurance companies participating in Obamacare in 2017. These companies have submitted premium price increases ranging from 9.4 percent to 37 percent to the state board of insurance.

I am sure the Virginia state board of insurance will start negotiating with the participating insurance companies.

Obamacare will only cover 11 million enrollees in 2016. As more enrollees drop out of Obamacare because they cannot afford the premiums the total might be closer to 8 million. Many of the enrollees are subsidized. These subsidized enrollees have dropped out because they cannot afford the remaining premiums and deductibles.

The healthcare insurance industry increases premiums in the individual and group private markets to protect its profit margin.

This is occurring on top of the destruction of Health Saving Accounts and does not speak well for a stable healthcare insurance market.

President Obama’s goal is to destroy the healthcare system and replace it with a single party payer system.

Does anyone think a government run single party payer system will be more efficient or deliver cost effective care?

If you do, please think of the efficiency and effectiveness of the VA healthcare system?

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

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One Could Go Nuts

April 26, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Quality medical care measures

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Stanley Feld M.D.,FACP,MACE

Measuring quality care in the healthcare system is out of control. My conclusion is that these measurements of hospitals and providers by Obamacare to determine medical care quality is distraction to quality medical care.

The method used is so complex that its measurements are inaccurate and the system is destined to fail.

The measurements are a distraction and costly. They end up diverting resources away from the hospitals’ and providers’ primary mission to provide quality healthcare at an affordable price.

In March 2016, the Healthcare Association of New York State (HANYS) published a report called Measure Madness. The report identified 2,100 required measurements of “quality care” imposed by the federal government and in turn the healthcare insurance industry on hospitals and physicians. The goal is to rate the quality of care given by hospitals and physicians.

The measurement agency claims that the rating system is set up to help consumers make better healthcare choices.

Below is a graph of the various measurements:

Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on time spent per physician to enter the data into the electronic health record to keep track of newly introduced measures and create protocols to track and report them.

“Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures.”

This report only covers 4 common specialties,and not all specialties and all hospital costs. There is no telling what it costs other hospitals and providers
HANYS report stated “

The volume of measures that exist, promulgated by lack of alignment and poor coordination, has created an environment of measure madness, “Consuming precious resources that could be directed toward meaningful efforts to continuously enhance quality and patient safety.”

The “measurement madness” may be doing more harm than good, according to the report. It’s the latest in a growing number of reports urging consolidation and standardization among the various groups that require reporting of healthcare quality and safety data.

The Electronic Medical Record is a great idea in theory. I have discussed functional Electronic Medical Records in detail previously. A reader can go to the search engine on this blog to review my criticism of the defects in the Electronic Medical Records sold to hospitals and doctors.

A major defect in EMR is hardly ever discussed. There is a massive amount of copy and pasting to complete the “documentation. The record does reflect anything about the patient’s illness or real progress. It does not provide a true reflection of the patient’s quality of care, natural history of his disease or disease improvement. It does not compare efficiency of medical care outcomes with the financial results of care.
The HANYS report listed the number of reports required for a computer program to evaluate the quality of medical care delivered. It is reflected in the crazy cartoon at the top of this blog.

Number of Reports Per Measurement

Accountable care organizations: 33

The Delivery-System Reform Incentive Payment (or DSRIP) : more than 100

Private Health Plans: 546

National Quality Forum: 635

CMS: 850

Each report has at least one sub report. One has only to recall all the agencies Obamacare has set up.

ObamaCare-Chart.jpeg

This bureaucratic scheme can never work efficiently.

HANYS urges stakeholders to do the work to fix the system.

The call for action was for providers of healthcare to jointly commit to the minimum number of measures needed to evaluate healthcare quality, align them with national, standardized, evidence-based data, and focus on efforts that target the most vital aspects of care.

Last week CMS was forced to delay publishing its hospital quality ratings until July 2016 because of the perceived defects in the Obamacare’s measurements.

Congress received tremendous pressure from hospitals because of the confusion the measurements have created.

“CMS also plans to host calls with providers to clear up questions about current methodology and get feedback on refining the program”.

Obamacare has been promoting the ratings for hospitals, nursing homes, dialysis facilities and other providers as a way for consumers to compare and select providers.

If one measures the wrong things one will get the wrong answer.

Only 87 hospital of more than 3,600 U.S. hospitals got the highest five-star rating, according to the American Hospital Association.

Just over half of the hospitals fell within the three-star range.

A total of 142 got one star. In January, the AHA challenged the CMS, stating that the program “oversimplifies the complexity of delivering high-quality care.”

Hospitals reviewed the ratings earlier this year.
Sixty U.S. senators heard the hospitals’ message. They sent a letter to CMS earlier this month urging the delay of the program. The senators warned of confusing methods, compromised outcomes for hospitals in disadvantaged communities and the potential to mislead consumers.

The American Hospital Association (AHA) has not been able to come up with the same conclusions as CMS, using the same data sets and methods.

“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients,” the AHA said in a statement.

On May 12 a conference call is scheduled to educate hospitals on how to analyze and interpret the data. In general, even the government has been confused about how best to interpret the data.

Ben Harder and Avery Comarow of U.S. News & World Report said in a recent article, “Different methodologies can produce different results even when the same raw data sets are used, said cent article.

“No approach to identifying outstanding medical centers is ideal—not ours or the government’s or anyone else’s,” the column stated.”

A case in point: none of CMS’ five-star facilities made it onto U.S. News’ annual Honor Roll. Ben Harder said, It is likely because the CMS does not yet adjust for socio-economic factors.

Again the Obama administration is making another costly complicated mistake that is making hospitals and providers go nuts and distract from their main mission of providing quality care at an affordable price.

If anyone thinks complete control of the healthcare system by the federal government via a single party payer system can do better than this government mishmash they should think again.

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

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April 20, 2016

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

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We Don’t Need A Public Option

Stanley Feld M.D.,FACP.MACE

When President Obama told Barry Frank and John Kerry “We don’t need a Public Option in the Affordable Care Act legislation” he was right.

https://youtu.be/SHPsEVQ9dGQ

https://youtu.be/4iR_iKRKewQhttps://youtu.be/4iR_iKRKewQ

Senator Chuck Grassley know all along what President Obama’s scheme was. His problem was none of his Republican friend would listen to him or do anything about it.

https://youtu.be/-522hcm3woA

President Obama’s goal all along was to sneak in a Public Option in through the expansion of Medicaid. He wanted the local states to be administratively and financially responsible for Medicaid while the Federal government controlled the system through regulations.

President Obama had figured out the way to get to a single party payer without a Public Option. However, he and his advisors misjudged the defects in Medicaid.

Republicans have been opposed to a single party payer system and government control of the healthcare system. Republicans felt government control would increase the cost of healthcare, increase inefficiency in the administration of healthcare care, ration healthcare and decrease access to healthcare.

President Obama thought he could use a myriad of regulations to help Obamacare back into a single party payer system. The State and Federal Health Exchanges (“so called Obamacare competitive model”) has resulted in both the health exchange and the private insurance industry increasing the cost of healthcare to unaffordable levels, decreasing access to care, rationing of care and destroying the healthcare system.

The politicians, in a state like California, by following the federal money, ignored the will of the people. The people hate Obamacare because it is restrictive. They are angry about the lie President Obama told them to get their support. “If you like your doctor you can keep your doctor. If you like your insurance you can keep your insurance.”

President Obama has created a healthcare system infrastructure that played on states’ greed. Many states have tremendously high budget deficits. They have over taxed state residents.

State citizens and businesses are leaving for more tax friendly states. The migration has created larger state budget deficits. State politicians say a way of getting more federal money into the states and perhaps attracting people back to the state will be by expanding Medicaid. The federal government promised to pay 100% for the first three years of the Medicaid expansion program

Twenty-two states fell into President Obama’s trap. These states are on their way to a single party payer system without even knowing it.

I predict his scheme will fail.

California was the first state to jump into this pot of boiling water.

The federal government is going to pay 100% of newly qualified enrollees to Medicaid until 2017. Medicaid is under state control.

A record number of people have signed up for Medi-Cal in California. This has led to huge cost increases in Medi-Cal. Its price tag has jumped from $59 billion to $91 billion.

Where does President Obama get the money to pay for it? He increased the federal deficit. I guess $32 billion dollars would be considered a rounding error to most Democrats in congress.

States will have to start paying 5% of the bill for the newly eligible and enrolled enrollees in 2017. In 2020 the states will start paying 10% of the bill.

Medi-Cal is the state’s Medicaid plan for low-income Californians. Nearly one in three Californians now receive coverage in Medi-Cal. With its continued Medi-Cal expansion it is predicted to expand to 20 million by 2020.

The people of California are going to be the first victims of the increased costs and decreased services.

Every government program creates a complex bureaucracy along with money wasting inefficiencies and abuses.

California politicians were bragging about the great deal the government had given them.

“That’s a really great deal for California,” said Scott Graves, research director at the California Budget & Policy Center. “You don’t find that anywhere else.”

“Advocates say the expansion, with the huge infusion of federal money, should in fact eventually yield savings for states, possibly enough to make up for the costs.”

“UC researchers calculated that each new federal dollar brought to California by Medi-Cal will generate 5.4 cents in tax revenue for the state, which would mean several billion dollars. That’s because the money creates jobs in healthcare, which creates income and sales tax.”

Over the years because of the cost overages, Medi-Cal has been forced to decrease reimbursement to physicians and ration both care and access to care. Physicians have opted out of Medi-Cal participation. As Medicaid has grown as a result of Obamacare, Medi-Cal patients cannot find a physician to care for them.

I suppose President Obama could force physicians to accept Medicaid payment in order to retain their license to practice medicine. This executive action would attack freedom of choice and propelling the United States further down the road to serfdom.

As predicted, a group of Californians filed a civil rights complaint against Medi-Cal, alleging that failures in the program have prevented Latinos from accessing their healthcare they needs.

“But the complaint filed with the U.S. Department of Health and Human Services claims that because Medi-Cal administrators don’t pay doctors enough to see patients, they “effectively deny the full benefits of the Medi-Cal program to more than seven million Latino enrollees.”

Many complain that Medi-Cal’s reimbursement rates, among the lowest in the nation, create a shortage of doctors willing to see Medi-Cal patients.

“The audit confirmed our long-standing concerns about access for Medi-Cal patients,” said Anthony Wright, executive director of the advocacy group Health Access California. “The findings of the audit cry out for more oversight.”

Gov. Jerry Brown’s budget for the 2014-15 fiscal year accommodates an influx of uninsured residents into Medi-Cal.

“However, at Governor Brown’s request, the Legislature left in place a 10 percent recession-era cut in reimbursement to most doctors, dentists and other health care providers who treat Medi-Cal patients.”

Health providers predicted this harmful contradiction. The contradiction is that Medi-Cal expansion will provide more of the poor with adequate healthcare coverage. It is, in fact, reducing poor persons ability to get into clinics, practices and even hospitals.

The California HealthCare Foundation reported that 76 percent of primary physicians accept new patients through private insurance. Only 57 percent accept new Medi-Cal patients.

The optimism of politicians for the expansion of Medi-Cal improve state revenue has vanished. California’s deficit is increasing rapidly as a result of Obamacare’s largess.

In California, state officials are discussing how they’ll afford the program next year (2017). Gov. Jerry Brown called a special legislative session this year to address funding for Medi-Cal.

“It’s a strained system,” said Hernandez, “and I really believe we need to figure out how to resolve. ”

The 20 states that have not accepted President Obama’s offer to expand Medicaid were correct. These states wanted to make their own decision in the name of states’ rights. Many of the states could not afford expansion in the way President Obama was dictating it. Their budget deficits and taxes would have to increase.

California has just proven these states fears. In 2017 California will start paying 5% into the Medi-Cal expansion. It will make the budget deficit worse.

California will, once again, start begging the federal government to bale it out.

President Obama’s plan was to dump the financial burden on the states while controlling the system and creating a single party payer by default.

There is a much better way to provide healthcare to all people at an affordable cost.

The better way is to put consumers in control of their healthcare dollars.

They will control their health to avoid costly complications of chronic diseases. The people will be given financial incentive to be responsible for their health to try to avoid the onset of chronic disease.

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

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