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The Destruction of Private Healthcare Insurance

January 9, 2013

inHealthcare Insurance Industry, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

One of these days Americans
are going to pay attention to how President Obama is destroying private
healthcare in America.

Many people will fine this
hard to believe because he is such a nice guy and many people like him.

He is making the healthcare
insurance industry destroy itself by forcing them to increase healthcare
insurance rates.

The destruction is so well
designed that the public cannot take notice. The healthcare system will not be
more affordable or accessible to anyone in the nation.

The changes will provide
President Obama with another tool to redistribute wealth and increase the individual’s
dependence on the federal government. This defines President Obama’s goal in affecting
all areas of our life.

Americans are on the Road To
Serfdom.

I remember Barney Frank and
John Kerry saying that healthcare reform would not work without a “Public Option.”
I also remember President Obama saying we can make it work without a “Public Option.”

President
Obama’s original plan was to eliminate private insurance. Americans would have
no choice but a “Public Option.” (National Health Plan)

Kathleen
Sebelius, the secretary of health and human services
said, she “retains authority to make the
final decision” on insurance rates if she finds that a state acted in an
arbitrary or capricious way in denying a rate increase sought by a nationwide
health plan.

This is the first time I
have seen President Obama’s administration use the words “National Health
Plan.”

It was obvious President
Obama was not truthful when he said “if
you like your physician you can keep him” and “if you like your healthcare insurance you can keep it.”

Congress made a gigantic while
passing Obamacare and transferring all healthcare policy decision making power
to the executive branch of government.

President Obama’s goal is to
have complete control over the healthcare system. He wants to force the private
healthcare insurance industry out of business. He wants to socialize the entire
medical care industry into a single party payer system. The government will be the single party payer.

Healthcare will then be a
ubiquitous entitlement program that the government cannot afford unless it increases
taxes entire population according to the taxpayers means.

This is the pattern behind many
of the articles written in isolation by the traditional media.

The unintended consequences
resulting from each policy change will be overwhelming.

I have been fascinated by President
Obama’s negotiating strategy.

Americans are going to wake
up to the fact that President Obama has increased taxes for the funding of
Obamacare by $1 trillion dollars over the next ten years aside from the tax
hikes effective January 1^st.

Americans are going to wake
up and feel deceived by President Obama when they realize they are getting
little for their increased taxes except government control over their freedoms.

I predict President Obama’s
plans will blow up in his face.

Consumers will protest when
they recognize the impact these multiple new taxes will have on their
discretionary income. President Obama will not get the funding he needs from
congress.

His physician workforce will
not cooperate. Hospitals are starting to wake up and are seeing they were
deceived. They thought they would do better because they have bought physician
practices.

Recently they automatically
received cuts in reimbursement while the doctor fix was extended for another
year. Physician reimbursement will be cut and the physician workforce will
dwindle.

On Friday afternoon November
30^th 2012 the Obama administration pulled a stunt on the healthcare
insurance industry.

“The Obama administration
said Friday that it would charge insurance companies for the privilege of
selling health insurance to millions of Americans in new online
markets run by the federal government.”

The cost of these “user
fees” can be passed on to consumers. The proposed fees could add 3.5 percent to
premiums for private health plans sold in insurance exchanges operated by the
federal government.

The "user fees" are another tax to consumers.

The government is
disregarding the fact that healthcare insurance premiums are too high for
employers to provide healthcare insurance for employees now.

Employers are opting to drop
healthcare insurance coverage and pay the government penalty. Some are dropping
healthcare insurance and avoiding the penalty by decreasing the number of
employees to under 50 employees or decreasing employees work hours to under 30
hours per week.

This will increase, not
decrease the tax burden on the consumer.

The exact effect of the
health insurance exchange on the healthcare industry is muddled.

It looks as if President
Obama is rapidly moving toward a “Public Option.”

Consumer advocates, insurers,
and some state officials had expressed concern about delays in publication of
the rules for this new proposal.

President Obama has used
this is the same tactic before. Consumers and agencies must accept the changes
before the rules are published.

Consumers and state
governments do not trust President Obama. They are afraid to say yes when they
do not know what they are saying yes to. In the end it looks like the state governments and the
consumers will get stuck with the bill and the federal government will have
complete control over the healthcare system.

CMS said. “These plans will
be offered by private insurance companies under contract with the United States Office of Personnel Management. The agency already provides insurance to eight
million federal employees, retirees and dependents.”

The scary part is the administration said,
“It (the government) retains
authority to make the final decision” on rates if it finds that a state acted
in an arbitrary or capricious way in denying a rate increase sought by a
nationwide health plan.”

The term “Nationwide Health Plan” and “final authority” sounds as if the
government is taking over.

The federal government will
also have control over physicians and hospital fees. It will also control access to care and the
rationing of care.

It is almost too late for
consumers to wake up.

No one can say President
Obama didn’t tell us.

It can only be said the plan
was so obfuscated, final rules so delayed and unsubstantiated promises made and
not publicized on a Friday afternoon the week after Thanksgiving that the
public did not understand what was going on and could not express an opinion.

The games President Obama
and his administration play are dizzying. The irresponsibility of our elected
congressional officials who are supposed to be our surrogates is
unconscionable.

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

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Problems With State Health Insurance Exchanges

December 17, 2012

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

December 15^th was the deadline
for states to sign up to implement state health insurance exchanges.

President
Obama was hoping all 50 states would agree to set up and implement health
insurance exchanges.

Health
insurance exchanges might be able to dis-intermediate the healthcare insurance
industry. They might also cause the insurance industry to leave the healthcare
business.

If that happens President
Obama would not have anyone to provide administrative services for Medicare and
Medicaid.

Why
would President Obama be interested in expanding a failed entitlement program
such as Medicaid? Medicaid is bankrupting the healthcare system. States would
go deeper in debt if they try to implement health insurance exchanges.
In order to survive states would have to increase state taxes.

Businesses
and people are leaving California in droves because of the real effective tax
rate will be over 60% of gross income on January 1, 2013.

Governors
realize their state can have a competitive advantage over others in attracting corporations to move to their state
if they balance their budget. They are trying to avoid this federal government
disaster.

Over
60% of the population is opposed to Obamacare.

States
refusing to set up state health insurance exchanges are reflecting public
opinion.

President
Obama’s goal should be to improve entitlement programs such as Medicare and
Medicaid so that the programs would save money and improve the healthcare
system.

“Even
President Obama has recognized Medicaid is broken," says Mike Schrimpf,
spokesman for the Republican Governors Association. "For many states,
placing more individuals into a broken system would be like adding more
passengers to the Titanic. And regardless of whether it's federal dollars or
state dollars, taxpayers are still on the hook."

A total of 30 states are leaning toward rejection
of the health insurance exchange concept. Only 17 states plus DC have agreed to
run a health insurance exchange.

The federal government will have to set up 30
health insurance exchanges. The latest reports are the administration is not
prepared to set up run the exchanges.

“As
of November 19, 2012, seventeen states, NY, MA, RI, NH, DC, KY, DE, W VA, MS.
NM, CO, CA. OR, NV, MN, WA, and HI have declared their intention to establish a
State-based Exchange (SBE).”

After my recent articles about health insurance
exchanges several readers asked why the health insurance exchanges were a bad
idea from a state’s point of view.

There are many reasons:

1. States are under
no obligation to create a health insurance exchange that could create a large
financial burden to the state and its citizens. A Supreme Court ruling has given
states that option.

2. 14 states have
enacted either statutes or constitutional amendments (or both) forbidding state
employees to participate in an essential exchange function. It made operating
Obamacare illegal in the following states; Alabama, Arizona, Georgia, Idaho,
Indiana, Kansas, Louisiana, Missouri, Montana, Ohio, Oklahoma, Tennessee, Utah,
and Virginia

States passing these amendments was by a state was part of
the strategy to reject Obamacare.

3. State governors
estimated that health insurance exchanges would cost the state $10 to $100
million dollars a year. State constitutions prohibit budget deficits. Health insurance exchanges would
necessitate increased taxes.

Increasing taxes has a negative effect when states are trying
to lure businesses. i

4. Deadlines have continually been delayed. Concrete rules
and regulations have not been published. Uncertainty prevails as if a trap is
going to be sprung on the states.

President Obama has
not yet provided the crucial information for
states to make an intelligent decision about setting up a health insurance
exchange. President Obama wants the states to trust him, sign up, and then
accept federal regulations.

5. States have been given the option to create health
insurance exchanges at a later date. Some state politicians fear the loss of
federal funds. Others see the federal funds as a carrot that will cost their
state more in the long run.

6. In the preliminary rules the “state-created exchanges”
are not controlled by a state-controlled exchange.
The exchanges are to be controlled by rules created by the Obama
administration.

7. President Obama has authorized payment to the states
for start up costs and expenses for Medicaid Expansion until 2017.

Congress has not authorized these
funds. President Obama might not be able to get the funds from congress to fund
the states’ health insurance exchanges.

The states’ would be stuck with
the bill.

8. State officials responsible for setting up the exchanges
believe Obamacare will fail. Many feel it will increase private insurance
premiums and deny assess to care.

These state officials do not want to take the blame for this
disastrous mess that they have no control over.

9. President Obama’s ultimate goal is to create a “Public Option”
and then have the federal government control all the stakeholders in the
healthcare system. His ultimate goal is
to have a single party payer system.

State governors understand that public outcry will stop it.
States want to control their own destiny.

10. If the federal government must set up health insurance
exchanges because the state refuses, the Obamacare law as written exempts a
state’s employers from the employer mandate of $2,000 per employee per year.

The Supreme Court called the mandate a tax but everyone
knows it’s a mandate.

11. If the states
avoided the mandate and save $2,000 per state employee it would put the state
at a competitive advantage to improve the prospect for job creation. It would
protect individual and states rights. It would protect some tenants of
religious freedom that Obamacare ignores.

There is no evidence that Medicaid is
cost effective, that medical outcomes are improved or that access to medical care
for the poor would improve.

“There is scant reliable evidence that Medicaid improves health
outcomes, and no evidence that it is a
cost-effective way of doing so.”

In the short term it has been predicted that healthcare insurance premiums for the
middle class will increase by 50% and access to medical care will decline.

State health insurance exchanges
will result in higher state taxes, fewer jobs, and less protection of religious
freedom. States are better off defaulting to a federal exchange.

Neither the states nor the federal government has the money
to expand Medicaid.

Theoretically,
health insurance exchanges are a good idea. Practically, they are not.

If all states refuse to set up health insurance exchanges
and avoid falling into President Obama’s trap Obamacare will be doomed.

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

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Big Data Is A Major Problem For The Healthcare System.

October 31, 2012

inChronic Disese Management, Consumer Driven Health Care, Information Technology in Healthcare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

President
Obama is blinded by his ideology. His healthcare policy goal is to eventually
have a single party payer system. Medical care will be commoditized with
treatment decisions made by the central government.

It
is a charade that his health insurance exchanges will lead to affordable
private insurance. It is misguided to believe that a non-elected central
committee (IPAB) will be tolerated to make treatment decisions for the
population.

The
larger pretense is that President Obama is building an inexpensive bureaucracy.
Last week he again stated that government overhead for Medicare and Medicaid is
very low. He again declared that the overhead expense is only 2½ percent.

It
cost two and one half percent for the central government to outsource administrative
services to the healthcare insurance industry. The healthcare insurance
industry, in turn, charges the government 18-40% to administer the programs.

Everyone
knows most everything government run is inefficient. President Obama is
enlarging the scope of government in all areas at a time when government is too
large and inefficient. The government’s income is $1 trillion dollars less than
its expenses per year since he has been President.

President
Obama thinks if he spends enough money he will spend his way out off the jam.

President
Obama believes one way to become more efficient is to gather more data. He can
then figure out which hospital systems and physicians are inefficient and
penalize them.

This
philosophy has two potential pitfalls. If the data is faulty the conclusions
are wrong. The second pitfall is that penalties do not encourage cooperation
and meaningful improvements.

“Decision-making in
healthcare can be painfully slow, as any physician will tell you. Hospital systems and
physicians are being spurred on in part because healthcare is beginning to deal
with a shift in reimbursement toward one that rewards quality and disincentives
inefficiency and waste.

One problem is that quality is not clearly
defined and is sometime false. The government must reexamine its premises.

Most hospitals and health systems have lots of
data that might improve outcomes and cut waste.

The
problem is getting that data, which is often unstructured, into a format that
allows clinicians to make decisions faster and in a more coordinated fashion.

All
of the innovation is happening without input from physicians. It is being done
to decrease the cost of the hospitals. One thought would be to get rid of a few
excess salaried, $750,000 a year hospital administrators and $2,000,0000 plus
healthcare insurance company administrators which would go a long way to reduce
the cost of healthcare coverage.

Instead
the government is looking to penalize physicians. Physicians are the providers
that deliver medical care.

There
is software being developed that deals with real time processing of clinical
data. The software can communicate those data to networked physicians instantly
and help physicians deliver more timely care.

Many
hospital systems are trying to install these real time systems. Unfortunately,
many hospital administrators do not understand its power as a teaching tool to
increase the efficiency and effectiveness of medical care.

The hospital systems’ only interest is in the
financial result and the question of whether the huge investment is worth the
capital expenditure.

Some
physician group practices, independent of hospital systems, are incorporating
these software systems into their electronic medical records. These groups recognize the potential
importance of having instantaneous predictive data.

Most
physicians do not have an EMR and only 7% of physicians have a fully
functioning EMR.

In
the monograph from “Pathways to Data Analytics” two things were very apparent. It
looks like the healthcare insurance industry controls the committee and its
plans is to continue to control the healthcare dollars and hope to control the
healthcare data.

Increasingly, a
data-driven approach to healthcare is necessary.

The complexity of clinical care requires it, says Glenn Crotty
Jr., MD, FACP, executive vice president and chief operating officer at CaMC.

“We’re moving from an
individual practitioner cottage industry to a team-based process now . . .. [Medical
care] is beyond the capacity of any one individual to be expert enough to do
that. So we have to do it in a team.”

A team requires information. The changing dynamics of healthcare
spending and reimbursements also require data to navigate.

“Our analytics are not just for finance, which traditionally is
what hospitals invested in,” says St. Luke’s Chief Quality Officer Donna Sabol
, MSN, RN. “When you look at how [hospital] payment is changing [to] a value-based
equation, you have to have good analytics for finance and for quality.”

Absent from the report is the patient and his/her responsibility
to the therapeutic unit. Until some policy maker understands the role of
patients to the therapeutic unit they will get nowhere in improving the
healthcare system.

A glaring example is the money spent by hospital systems to
improve the discharge process to avoid re-hospitalization within the 30 days
post discharge.

Obamacare has instituted the rule November1,2012 that if a
patient is re-hospitalized within 30 days of the initial hospitalization the
hospital system will not get paid.

I can think of 5 ways hospital systems can get around this rule
without suffering the penalty.

None-the-less the hospital systems are buying software to study
and automate the process to avoid re-hospitalization using its clinical data in
real time.

The Seton Hospital System in Austin Texas
might have figured it partially out.

It started what it calls an extensivist
program. It is acting as an extension of its physicians care to help avoid re-hospitalization
and use the best data it can collect.

Its is helping clinicians identify patients who
would benefit most from extra attention following discharge. The program
started with congestive heart failure patient

"A
lot of it is about enabling decision-making," Ryan Leslie says

"It's taking the whole universe of
information we have and cutting out what's extraneous and giving clinicians the
information they need to make decisions."

Ryan Leslie is vice
president of analytics and health economics at Seton Healthcare system. He is taking
unstructured clinical information and connecting that with billing or
administrative information and social demographic information.

He says, "you start connecting all those things
together and you get a more complete picture of the patient as a person, rather
than as a recipient of a bill," he says. "That's been the exciting
thing recently. You realize that a patients' success or failure may not have to
do with the care plan details or the clinical attributes of the patient as much
as the social attributes."

Physicians
outside the hospital work with a team of social workers, nurses, and others to
visit patient homes and figure out what's keeping a patient from effectively
following treatment protocols that will likely keep them out of the hospital.

The software
helps determine, based on a host of combined data, which patients are most
likely to be re-hospitalized within 30 days. Targeting the patients is like
looking into a crystal ball. The hospital system cannot afford to service all
the patients with congestive heart failure. The program is in its early stages.
If successful the plan is to expand it to diabetes and other chronic diseases.

This will
happen well beyond November 2012 and January 1,2014. This hospital system
finally realized that it can and must be an extension of its physicians’ care
and not a competitor for patient care.

Missing is the
patients responsibility and incentive in not being readmitted to the hospital.
This can only be accomplished when consumers not only have a desire to be
healthy they have a financial interest to stay healthy.

This can be
accomplished in a consumer driven healthcare system where the patients are responsible
for their health and own their healthcare dollars. The easiest way to get there
is using my ideal medical savings accounts.

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

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There Is A Way To Fix The Healthcare System!!

October 14, 2012

inUncategorized

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Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

This is the way the healthcare system looks
today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Health Insurance Exchanges And The Federal Government

September 16, 2012

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

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Stanley Feld M.D., FACP,
MACE

Health
Insurance Exchanges are supposed to be state-regulated
and standardized health care plans in the United
States, from which individuals may purchase health insurance
coverage eligible for federal subsidies.

All exchanges must be fully certified and
operational by January 1, 2014 under federal law.^[1]

The health insurance
exchanges in all states are not going to be operational on time.

However, Americans of
all income brackets are experiencing the increases in 20 hidden taxes in
Obamacare right now. The increase in taxes is supposed to amount to $1.2
trillion dollars.

The health insurance
exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing
despite President Obama’s publicity.

If they are created President
Obama will have a clear path to the Democratic Party’s cherished Public Option.

This will be a giant
step to achieving a single party payer healthcare system.

Unfortunately, the
single party payer system will in turn fail because it will be unaffordable for
America.

Individual states and
the healthcare insurance industry will do everything they can to undermine the
success of health insurance exchanges.

Federal officials never
thought they would end up running the Health Insurance Exchanges. President
Obama’s plan was to dump this formidable and complex task on the states. Half
the states have refused to participate.

“Obama
administration officials are getting ready to set up and operate new health insurance markets
in about half the states, where local officials appear unwilling or unable to
do so.”

“So far, Governors of 13 states with nearly
one-third of the United States population have sent letters to the Obama administration
saying they intend to set up exchanges. Complete applications are due on Nov.
16, 2013.”

In other words, 37 states have not signed up
yet. Once those 13 states that have signed up and start calculating their costs
for setting up and running the health insurance exchanges I suspect they will
also withdraw.

The Secretary of Health and
Human Services, Kathleen Sibelius’ plan was to complete the regulations for the
states to start the health insurance exchanges by January 1,2014.

The Secretary of Health and
Human Service has emphasized that states must meet her standards of transparency
and accountability.

The federal government requires
state exchanges to develop budgets and project operating costs, revenues and
expenditures to the central government’s satisfaction.

States must explain how the
revenue will be generated and how the exchange will address any financial
deficits.

The federal government wants to
set up the rules and require the states to execute these rules at the states
expense. President Obama promised to “fund” the exchanges for the states for
two years. After that they are on their own.

The health exchange programs
will be delayed because the government pledged to set up the health exchanges
in the states that opted out of the program. It has not started to set up these
exchanges.

Creation
of Health Insurance Exchanges is a complex and expensive task. States are
required to operate under a balanced budget. States cannot balance their
budgets with health insurance exchanges unless they further increase taxes.

“Federal and state officials and health policy experts expect that
the federal government will run the exchanges in about half of the 50 states.”

My
guess is it will be closer to 35 states. Federal officials are preparing to do
the job. It will be poorly executed and difficult politically.

President Obama knows the
public fears a federal takeover of the healthcare system. He realizes the
public understands the health Insurance exchanges are one more step toward a
federal takeover of the healthcare system.

The Obama administration
does not want to encourage that fear by taking over the Health Insurance
Exchanges.

Neither does the Obama
administration want to alienate state officials whose help they need to execute
the federally run healthcare exchanges.

The federal government
does not have the manpower to run all these exchanges. It is outsourcing the
work to private contractors.

We have seen the
disastrous abuse to physicians by outsourcing fraud and abuse investigations to
private contractors.

“The Obama
administration has invited advertising agencies to devise an elaborate
“outreach and education campaign” to publicize the federal exchanges and their
potential benefits for consumers.”

The Federal officials
are hiring private contractors to provide “in-person assistance” to consumers
and to operate call centers.

President Obama’s
administration has attacked Mitt Romney and Bain Capital for outsourcing of
jobs.

President Obama is now outsourcing
these jobs to a foreign company, while America desperately needs jobs here.
This is duplicity to its highest degree.

He better keep it out of
the mainstream media or Mitt Romney out to get it in the mainstream media
somehow.

Federal officials
have turned to the American subsidiary of a Canadian company, the CGI Group, to
provide information technology services to the federal exchanges under a
contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency
of state health insurance exchanges yet planning for the federal exchanges has been done
almost entirely behind closed doors.

“We have gotten
little bits of information here and there about how the federal exchange might
operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance
Department.

“I was on a panel at
Rockhurst University here, and I was asked, ‘Where is the Web site for the
federal exchange?’ I chuckled. There really isn’t any federal exchange Web
site.”

In New Hampshire, Thomas
M. Harte, the president of Landmark Benefits, which arranges health insurance
for 300 employers of all sizes, said:

“Nobody has any idea
what the federal exchange will look like. There has not been much communication
between officials drafting plans for the federal exchange and the people who
will use it: consumers, employers, brokers and insurers.”

Administration officials
have not set forth a budget for the federal exchanges.

“They said they
intended to charge “user fees” to the participating health insurance plans.

It is unclear whether
the fees are subject to approval by Congress or whether insurers could pass the
costs on to consumers.”

The Federal Government
is not telling us what they are going to do. It is not following its call for transparent
regulations.

It is pretty clear to me
this will be one of many steps toward the destruction of the healthcare system.
The healthcare system will self implode. At that point everyone will be begging
the government to take over.

It will be impossible
for President Obama to take over a business the government cannot afford.

A key to Repairing the
Healthcare System is to decrease the outsourcing and bureaucratic complexity.

It is to let Americans
be independent, own their healthcare dollars and their health and not be
dependent on government complexity, inefficiency and rationing of care.

Entitlements do not save
money!

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

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Health Insurance Exchanges And The Federal Government

August 8, 2012

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

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Stanley Feld M.D., FACP,MACE

Health Insurance Exchanges are supposed to be state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies.

All exchanges must be fully certified and operational by January 1, 2014 under federal law.^[1]

It is not going to happen on time. However the 20 hidden taxes in Obamacare are happening right now.

The health insurance exchanges, are supposedly one of the centerpieces of President Obama’s health care law,

Their formation is failing.

President Obama will then have a clear path to a Public Option and a single party payer healthcare system.

Unfortunately, the single party payer system will fail because it will be unaffordable for Americans and the federal government.

The states and the healthcare insurance industry will do everything they can to undermine its success.

Federal officials never thought they would end up running the Health Insurance Exchanges. Their plan was to dump this formidable and complex task on the states. Half the states refused to participate.

“Obama administration officials are getting ready to set up and operate new health insurance markets in about half the states, where local officials appear unwilling or unable to do so.”

“So far, Governors of 13 states with nearly one-third of the United States population have sent letters to the Obama administration saying they intend to set up exchanges. Complete applications are due on Nov. 16, 2013.”

Stated another way, 37 states have not signed up yet. Once those 13 states that have signed up calculate the cost to setting up and running the health insurance exchanges I suspect they will withdraw.

The Secretary of Health and Human Services, Kathleen Sibelius’,plan was to create regulations for the states to develop the health insurance exchanges by January 1,2014. She has emphasized that states must meet her standards of transparency and accountability.

The federal government requires state exchanges to develop budgets and project operating costs, revenues and expenditures.

There are a great many regulations attached to qualify as a state exchange.

States must explain how the revenue will be generated and how the exchange will address any financial deficits.

The federal government wants to set up the rules that require the states to execute these rules at the states expense after the federal government funds the exchange for two years.

The health exchange program will be delayed because the government pledged to set up the health exchanges in the states that opted out of the program.

Creation of Health Insurance Exchanges is a complex and expensive task. States have to operate under a balanced budget. States cannot afford this undertaking.

“Federal and state officials and health policy experts expect that the federal government will run the exchanges in about half of the 50 states.”

My guess is it will be closer to 35 states. Federal officials are preparing to do the job but it will be a difficult political task.

The public fears a federal takeover of the healthcare system. This takeover is one more step by the government to increase its control over the healthcare system.

The Obama administration does not want to encourge that fear with its takeover of Health Insurance Exchanges.

The Obama administration does not want to alienate state officials whose help they need in the execution of the federally run healthcare exchanges.

The federal government does not have the manpower to run all these exchanges. It is outsourcing the work to private contractors.

We have seen the disastrous abuse to physicians by outsourcing fraud and abuse investigations to private contractors.

“The Obama administration has invited advertising agencies to devise an elaborate “outreach and education campaign” to publicize the federal exchanges and their potential benefits for consumers.”

The Federal officials are hiring private contractors to provide “in-person assistance” to consumers and to operate call centers.

President Obama’s administration has attacked Mitt Romney and Bain Capital for outsourcing of jobs.

President Obama is now outsourcing these jobs to a foreign company, while America desperately needs jobs here.

Federal officials have turned to the American subsidiary of a Canadian company, the CGI Group, to provide information technology services to the federal exchanges under a contract that could be worth $93.7 million over five years.

Kathleen Sibelius has demanded total transparency of state health insurance exchanges yet planning for the federal exchanges has been done almost entirely behind closed doors.

“We have gotten little bits of information here and there about how the federal exchange might operate,” said Linda J. Sheppard, a senior official at the Kansas Insurance Department.

“I was on a panel at Rockhurst University here, and I was asked, ‘Where is the Web site for the federal exchange?’ I chuckled. There really isn’t any federal exchange Web site.”

In New Hampshire, Thomas M. Harte, the president of Landmark Benefits, which arranges health insurance for 300 employers of all sizes, said:

“Nobody has any idea what the federal exchange will look like. There has not been much communication between officials drafting plans for the federal exchange and the people who will use it: consumers, employers, brokers and insurers.”

Administration officials have not set forth a budget for the federal exchanges.

“They said they intended to charge “user fees” to the participating health insurance plans.

It is unclear whether the fees are subject to approval by Congress or whether insurers could pass the costs on to consumers.”

I get it.

The Federal Government is not telling us what they are going to do because they probably want to follow its non-transparent regulations.

It is pretty clear this will be one of many steps toward the destruction of the healthcare system. The healthcare system will self implode. At that point everyone will be begging the government to take over.

It will be impossible for President Obama to take over a business system it cannot afford.

A key to Repairing the Healthcare System is to decrease the outsourcing and bureaucratic complexity.

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

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Here Comes The Defective Judge (CMS)!

July 29, 2012

inDefective scientific studies, Medicine: Healthcare System

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Stanley Feld M.D., FACP, MACE

President Obama’s goal is to have the government be the single party payer for the entire healthcare system.

There is no doubt in my mind that the government as the single party payer will not work for patients or physicians.

President Obama cannot control CMS’s misuse of it assignments because bureaucratic complexity. One area of abuse and misuse of the department’s power is its attempt to eliminate fraud and abuse in Medicare and Medicaid.

There is no question that some healthcare providers abuse the Medicare and Medicaid payment system.

No one ever asks the critical question. Should the payment system used in Medicare and Medicaid be changed to prevent fraud and abuse?

Never the less President Obama is expanding the old punitive system. He thinks he is going to stop abuse with his expansion.

“ Stepping up their game against health care fraud, the Obama administration and major insurers announced Thursday they will share raw data to try to shut off billions of dollars in questionable payments.”

I don’t know how many times I have shown that claims data to determine quality of care or fraud and abuse is defective.

"Fraud is estimated by the administration to cost Medicare about $60 billion a year, and the Obama administration has beefed up the government's efforts to stop it, bringing in record settlements with drug companies for marketing violations as well as using new powers in the health care law to pursue low-level fraudsters with greater zeal."

This is a small amount compared to the $2.5 trillion dollar healthcare system cost when one considers the government’s investigative costs and the hardship these errors impose on many innocent physicians and patients investigated.

The hardships are enough to destroy physicians’ trust in the government and their desire to deal with the government.

It also serves to destroy the physician patient relationship.

Physician patient relationships are essential to the therapeutic success of a treatment regime.

Physicians have complained about this bureaucratic abuse to their congressmen. Congress has looked into this abuse. CMS’s approach has been to criminalize physicians using questionable data and decisions by unqualified judges.

Chairman Charlie Gonzalez of the House Small Business Committee outlines the problems brought to his attention several years ago. His hearings did not receive much attention.

Opening statement by Chairman Charlie Gonzalez

http://www.youtube.com/watch?v=0SmKmLMPu-s&feature=relmfu

Dr. Karen Smith a former President of the North Carolina chapter the American Association of Family Practitioners describes her encounter with CMS’s subcontractor for investigating fraud and abuse. CMS’s assignment is to discover Medicare and Medicaid underpayment or overpayment as well as fraud and abuse.

http://www.youtube.com/watch?v=3v4Sq7oDCgo&feature=player_embedded

I believe it is important for anyone who is interested in what is happening to the healthcare system to view the several You Tubes I am including in this blog.

Dr. Michael Schweitz, Vice President of The Coalition of State Rheumatology Organizations in West Palm Beach, FL discusses the defects in the RAC system and the need to change.

http://www.youtube.com/watch?v=E5K8iPqsmjY&feature=relmfu

Dr. Schweitz states that administrative costs in dealing with the government is overwhelming to physician practices. The stress imposed on physicians detracts from their ability to deliver quality medical care to their patients.

Most important is the government’s attitude toward the physicians and their practices. The physicians are guilty until they prove themselves innocent. Government’s subcontractors use claims data to prove the physicians guilt

Another problem is the more the outsourced company collects from physicians, the larger the commission it collects from CMS.

Mr. Timothy B. Hill is Chief Financial Officer, Director of the Office of Financial Management, Centers for Medicare & Medicaid Services. He answers questions from Chairman Charlie Gonzalez

http://www.youtube.com/watch?v=FBpXubSY8O8&feature=relmfu

The questions continue to Mr. Hill. He says CMS recognizes its abuse of physicians. He hopes to improve.

Since Obamacare has expanded physicians’ complaints have increased.

http://www.youtube.com/watch?NR=1&feature=endscreen&v=uRX1M31T8LA

Can anyone believe this testimony given by Mr. Hill? I hope his message is not believed by congress. Mr. Hill does not document his department policy changes

“ This week White House officials said a "trusted third party" would comb through data from Medicare, Medicaid and private health plans and turn questionable billing over to insurers or government investigators. That third party organization has yet to be selected.”

With the impending a thirty percent reduction in Medicare payments on January 1, 2013 physicians will not be able to afford care for Medicare and Medicaid patients.

Mr. Joseph A. Schraad, MHA Chief Executive Officer Oklahoma Allergy and Asthma Clinic, in Oklahoma City, describes the challenges that the practice he manages face. Less and less providers are going to accept Medicare.

http://www.youtube.com/watch?v=cINHOZmo_wA&feature=relmfu

Dr. Forrest in his direct care payment model for patients describes the formula he uses to avoid the government’s interference with his practice of medicine. He talk is riveting.

http://www.youtube.com/watch?v=dUX4P7XfY8o

Other formulas can be used. The You Tubes presented here demonstrate that the Judge (CMS) is using the wrong formula. The CMS cannot control their outsourced venders who have inappropriate incentives.

The are driving physician away from accepting Medicare and Medicaid payments. In the process patients lose

The way to solve fraud and abuse is to have patients police the healthcare system. Patients can uncover fraud and abuse if they own their healthcare dollar and have financial incentives to save unspent money in a retirement fund.

Education and financial incentives will make consumers productive consumers.

The way to approach physicians is not to assume they are criminals and subject them to the stress and expense to defend them in a defective evaluation system.

Physicians must be educated on how to improve coding efficiency and the government’s system of measurement must be made more accurate and less complex. ICD 10 is a big mistake. It makes coding complicated.

The best formula, in my opinion, is to empower and educate patients.

Government and employers must provide patients with financial incentives to become educated buyers of medical care services. Patients must be given the opportunity to own their healthcare dollars and be responsible for their own health and healthcare.

My ideal medical savings account provides patients with that opportunity.

Physicians collect only 10% of the healthcare dollars spent.

The real question is who collects the remainder of the 2.5 trillion dollars spent?

America should not depend on increased bureaucracy and bureaucratic staff to administer medical care with increased and confusing rules.

Everyone knows this will only result in increased inefficiency and higher costs.

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

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An Excellent Reader Comment On P4P (Pay for Performance)

April 14, 2012

inConsumer Driven Health Care, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System, Pay for Performance (P4P)

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Stanley Feld M.D., FACP, MACE

The costs of healthcare system have become unsustainable. There are many ways to reduce the costs in a sensible way. Pay for performance is not one of them.

President Obama and others have concluded that the way to reduce the costs is to change the way physicians are reimbursed.

President Obama is ignoring the fact that physicians receive only 10 to 15% of the healthcare dollars spent.

Who is the rest of the money going to?

Pay for Performance (P4P) is stupid idea to me. It sounds good to some.

P4P failed to produce cost savings during the major pilot program by undefined criteria. President Obama is rolling out the program to the rest of the country because he and his healthcare staff believe in it.

In my opinion P4P will only increase the cost of healthcare.

I offer President Obama a piece of advice. He should listen to retired physicians who practiced medicine for many years and understands patients’ wants and needs.

It is entirely possible that President Obama wants to collapse the healthcare system and have the government become the payer of last resort. Then he can create his beloved “single party payer” healthcare system.

Medicare is a “single party payer” in its present form is unsustainable and will disappear in 2016 or 2021. The addition of another 30 million people to its roles will make it less sustainable.

The problem with a single party payer system is that it will not work in America. It is turning out that it does not work in England and many other countries.

A retired radiation oncologist sent me this comment about the Pay For Performance (P4P) concept.

P4P?

Now there's an excellent example of a term that sounds good but, absent a definition of the second "P", has no meaning at all.

I haven't heard anybody address that issue in a way that could be understood and accepted by all of the parties at interest. Patients, physicians, hospitals, and insurance companies might be considered in the same light as the proverbial blind men describing the elephant of performance.

Perhaps, instead of "evidence-based medicine" we could look at developing the concept of "goals based medicine".

Yogi Berra is credited with the thought, "If you don't know where you're going, any road will get you there".

If the second "P" stands for performance, the question is begged, "Whose performance?" The assumption is made that the party doing the performing is the physician, I suppose.

If that is the case, how is performance to be measured?

Patient satisfaction? (pretty subjective).

Compliance with some set of guidelines? (If so, whose guidelines?)

Restoration of health of the patient? (Now there's an interesting idea, that sounds pretty good, but must take into account the state of health being experienced by the patient before the current illness began.)

Quality of life? (Who defines that?)

Relief of symptoms? (Pretty easy to assess, but different patients will define the severity of symptoms differently, and nobody else's definition really matters to each one of them. People "suffer" differently, and some of their suffering is culturally derived.)

Extension of some number of life-years? (Quality adjusted, or just more years? Who can tell?)

Almost never, in the initial transaction between a physician and a patient and family is there any conversation about the goals or expectations to be accomplished in the experience the "system participants" are entering into and sharing.

I would suggest that such an interaction might be the place to begin to define "performance". Were the expectations met? If they were, we have done our job. If they were not met, there is either more work to be done in the current relationship between physician and patient, or there is a need for the formation of a new relationship between the patient and a new physician.

Left unsaid is that such a discussion of goals and expectations, if held as early as possible in the relationship, may be the time for the physician to share with the patient what is capable of being accomplished, in contrast to what is expected to be accomplished.

Only when these terms are understood by all of the parties, can "performance" be adequately measured,

If "P4P" becomes the way services are valued, it is the only rational process through which the transaction can result in fair compensation.

Bureaucrats sitting in offices far away cannot do this, only those directly involved in any clinical situation can.

And, to makes matters more difficult, every clinical situation will differ from every other clinical situation in one way or another.

This physicians comment is an excellent argument for a Consumer Driven Healthcare System. Consumers must have the right to pursue their own destiny and be responsible for their own choices.

Consumers must own their healthcare dollars even it those dollars are given to them by the government. Consumers must have a financial incentive to be responsible for their own health and healthcare needs.

My Ideal Medical Savings Account accomplishes this. It can provide first dollar coverage to all at a lower cost to the healthcare system presently and motivate Americans to have a healthier life style further reducing the cost.

Mandates do not work!

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

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President Obama Tries To Intimidate Critics

June 26, 2011

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

Last week McKinsey published an in-house survey that showed that at least 30% of corporations would drop employee sponsored healthcare insurance (ESI) and let employees buy their own “affordable” “government subsidized” healthcare insurance (Public Option”) through the Government’s Healthcare Insurance Exchanges in each state. Adding thirty percent of the corporate work force to Healthcare Insurance Exchanges would place states and the federal government in deeper debt.

The McKinsey survey echoes what Doug Holz-Eakin (economist and former head of the CBO) and John Goodman (a healthcare economist and CEO of NCPA) have said about the impact of President Obama’s Healthcare Reform Act.

“If Mr. Holtz-Eakin is correct that there will be 11 million more people in the exchange, then costs could be nearly 40% higher than the $511 billion price tag. If between 78 million and 117 million people are moved into the exchanges the NCPA predicts the costs could more than triple to $2 trillion dollars more than expected over the first decade.”

“Most of this extra expense would come from workers losing their employer-sponsored insurance.”

Immediately, President Obama’s administration attacked McKinsey’s honesty. The Obama administration accused McKinsey of patronizing their clients and working for the sponsors of the survey.

The administration had no proof to support any of its accusations against McKinsey. Its aim was to tarnish McKinsey’s reputation as well as intimidate McKinsey and other organizations that might draw negative conclusions about his healthcare law.

Nancy Parmalee, the deputy chief of staff who is running “ObamaCare” from the White House in her Whitehouse blog, launched a ferocious attack on McKinsey.

“Unfortunately, the study misses some key points and doesn’t provide the complete picture about how the Affordable Care Act will strengthen the health care system and make it easier for employers to offer high quality coverage to their employees. Here are the facts:

She said the McKinsey survey is an outlier. She also accused the survey of being fixed. The results of the McKinsey survey were the opposite of the results of respected independent organizations and the CBO.

She said “McKinsey says they obtained their data after they “educated respondents” about reform and that their survey used proprietary research. We don’t know what respondents were told or whether they had the chance to check with their colleagues or crunch the numbers for their business before responding.”

In Ms. Paralee’s mind McKinsey cooked the survey in favor of a negative result about Obamacare. She then quotes the findings of three independent surveys.

Respected independent organizations have examined whether employers will continue to offer coverage. Here’s what they found:

The Rand Corporation: "The percentage of employees offered insurance will not change substantially, but a small number of employees in small firms (defined as those with under 100 employees in 2016) will obtain employer-sponsored insurance through the state insurance exchanges."

The Urban Institute: "Some have argued that the Patient Protection and Affordable Care Act would erode employer-sponsored insurance (ESI) by providing incentives for employers to stop offering coverage. Others have claimed that most businesses would face increased costs as a result of reform. A new study finds that overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform."

Mercer: "In a survey released today by consulting firm Mercer, employers were asked how likely they are to get out of the business of providing health care once state-run insurance exchanges become operational in 2014 and make it easier for individuals to buy coverage. For the great majority, the answer was 'not likely.'"

The White House has routinely tried to intimidate its health-care critics. Nancy Parmalee’s facts in the administration’s campaign against McKinsey are wrong. She misread the studies she quoted.

The White House sponsored the Urban Institute study cited by Nancy Parmelee. Bowen Garrett who now works for McKinsey wrote it.
Some of the notable work on employers discontinuing to sponsor healthcare insurance and pay the penalty comes from Eugene Steuerle of the Urban Institute. His paper predicts a mass discontinuation of ESI by corporation of all sizes.

“Even so, droves of employees—potentially tens of millions—are likely to shift out of employer-provided insurance over the next decade or two, especially as newer firms and their employees find it more profitable to get the exchange subsidies than the subsidies for health insurance provided by the employer.”

Eugene Steuerle of the Urban Institute wants universal coverage run by the government as the single party payer. I could just see President Obama saying, “Don’t worry Gene we will get there.”

Nancy Parmalee also misstated the Mercer findings. The graphs show exactly what Mercer reported. It is not dissimilar to McKinsey’s survey.

David Brooks expressed common sense in a recent New York Times article.

He said,

"Obamacare incentivizes companies to drop health coverage for their employees. Employers who drop coverage have to pay a fine, but the fine is cheaper than offering health insurance. Employees will be able to buy their insurance on state-based “exchanges,” where they can take advantage of the law’s new subsidies.

(Americans making less than 400 percent of the federal poverty level are eligible for subsidized coverage on the exchanges.) AT&T has calculated that it would save $1.8 billion a year by dumping its workers into the government’s lap.

Other companies are keeping quiet about their plans for now, but make no mistake: If Obamacare remains the law of the land, nearly every corporation in America will do what AT&T has contemplated. So will cash-strapped state governments."

McKinsey released the entire methods, detail and results of its survey. The survey was non biased, well designed and answered each of President Obama’s administration’s criticism.

1.McKinsey and not clients funded the survey.

2.Ipsos, a well-established neutral opinion research firm, conducted the survey.

3.The companies surveyed were representative of corporations and businesses from the broader economy.

4.Respondents were required to be either the “primary decision maker” or “have some influence in the decision-making process” for employee health benefits.

5.Respondents were informed of Obamacare’s exchange subsidies in a neutral, factual manner.

6.Employer surveys (McKinsey survey) and economic simulations (CBO’s analysis) are different. CBO analysis has underestimated the result by a factor of five.

The attack on McKinsey was unfounded. Hopefully, McKinsey’s reply will not inhibit others from revealing the truth about President Obama’s policies not only in healthcare but in other areas.

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

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