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People Are Not Stupid

February 22, 2016

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

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Stanley Feld M.D.,FACP, MACE

The next time I hear that people are stupid I am going to scream.

The next time I hear Bernie Sanders saying college education should be free, and medical care should be free I am going to scream.

The next time I here that the healthcare insurance industry is losing money I am going to scream.

How can the healthcare insurance industry be losing money when insurance executives receive these salaries?

Does the healthcare insurance industry think we are stupid?

The healthcare insurance industry loads premiums with all kinds of expenses.

There are hundreds of insurance executives making a million dollars or more a year reporting to each one of the above chief executives in each company.

There are hundreds of empty office buildings owned by the healthcare insurance industry. These buildings pay rent to the subsidiaries of each insurance company.

Those rents are an expense and are used to justify to state and federal regulators the reason for increasing insurance premiums yearly. Claims adjustors who previously occupied those buildings have been replaced by computer software.

Those buildings are empty but are still considered an expense by state and federal regulators.

The more money the taxpayers are forced to pay for healthcare premiums the more the healthcare system uses in its inefficient bureaucracy.

It is estimated that the healthcare insurance industry takes 40% out of every healthcare premium dollar for expenses. Many expenses are paid to subsidiaries of each company. Each subsidiary generates a profit that helps pay the executives’ inflated salaries.

The insurance company’s actual profit is not the 3% that is claimed.

This behavior by the healthcare insurance industry and state and federal regulators is enough to make a guy like Bernie Sander mad as hell.

In turn he has made all of his Democratic followers mad as hell. Something should to be done about this healthcare insurance industry rip off.

What is Bernie Sanders going to replace the present system with? Bernie Sanders will tell us healthcare coverage is going to be free as he replaces the present healthcare system with a healthcare system that will provide more money to insurance companies in order to provide the administrative services.

He is propagating a lie and he knows it.

Healthcare coverage will never be free.

Nothing is free. Taxes will increase to unbearable levels as beauracratic inefficiencies increase.

The taxpayers get it. All they have to do is look at the VA healthcare System.

The government cannot provide the administrative services in a universal healthcare system. The government will have to outsource the administrative services to the healthcare insurance industry.

The government will provide an increased opportunity for these companies to abuse the taxpayer even further.

I always hear that Medicare for all is the answer. That it is a single party system that works. Yes, it works for the beneficiaries. However, it is unsustainable. Most experts agree that is unsustainable for the government and the taxpayer.

It is an irrational thought that Medicare work for all at an affordable cost for everyone. Bernie Sanders should be smart enough to know it. The taxpayers are smart enough to know it.

Taxpayers are demanding that our politicians stop trying to feed us Kool-Aid.

The only way to fix the system is to replace it with a system that demands that the people are responsible for their health and their healthcare dollars.

On the other side, big governments entitlement programs are out of control. People can play our entitlement system so hard that it does not pay to look for work. The article below is unbelievable.

America has come to an interesting juncture. Both the right and the left take advantage of the systems provided by big government.

There is massive abuse on both the right and the left. The abuse is so great that it has proliferated so that the ethic of everyone working hard at a job is evaporating.

The loser is the middle class hard working taxpayer who is paying for all the abuse in the unsustainable systems that have been created.

The Obama administration either does not know what to do or doesn’t want to do anything. Once we experience economic collapse the government can take over.

I believe it knows exactly what it is doing. The Obama administration is changing America as promised. The administration is pushing us on to the Road to Serfdom.

For this reason alone we have to throw the bums out and elect new people who will help us get back to economic growth and the American hard work ethic.

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

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Thought You Could Win?

February 16, 2016

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

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Stanley Feld M.D.,FACP,MACE

There are lots of healthcare systems that think they can win by supporting Obamacare.

It has always been clear to me that hospital systems cannot win by participating in the present rules of the Affordable Care Act.

Major hospital systems are finding that fact out slowly but surely.

“HealthSpan is the insurance arm of Catholic hospital system (Mercy Health).”

The Catholic Healthcare System is one of the top ten rapidly growing hospital systems with a network of 387 acute care hospitals.

The governance of the Catholic Healthcare System thought it could profit from Obamacare, its federal Health Insurance Exchanges and the formation of an Accountable Care Organization.

Mercy Health believed it could profit by setting up an insurance arm for its network and selling insurance in the Obamacare Health Insurance Exchanges.

In order to form an ACO it bought an existing integrated physicians group.

Mercy Health, a 23-hospital system, formerly known as Catholic Health Partners, bought Kaiser’s Ohio business in 2013.

Mercy Health tried hard to make the strategy work for its financially.

I have stated previously that it is very difficult to set up ACOs. The business model is destined to fail because of faulty premises and inadequate cultural and financial incentives.

Patients should be responsible for their healthcare dollars. Healthcare insurance companies should be responsible for financial risk and financial reward by providing the insurance coverage.

“HealthSpan, the insurance arm of Catholic Healthcare System Mercy Health, is getting rid of its medical group (Kaiser) and halting sales of Affordable Care Act policies just two years after acquiring Kaiser Permanente’s Ohio subsidiary.”

The move represents a failure of one health system trying to replicate the much-heralded Kaiser model of healthcare which integrates the payment and delivery sides.

HealthSpan has been a failure financially. Mercy Health’s managers realized that the two new programs became a financial disaster for the entire healthcare system.

The reality is in contrast to the optimistic statement made by CEO Michael Connelly two years ago. His announcement was not dissimilar for the many other statements by hospital systems that are on the road to failure. It almost sounds like they had the same consultant.

In announcing its agreement with Kaiser Permanente, Catholic Health Partners president and CEO Michael D. Connelly said in the joint release, “This opportunity interests us because it preserves a values-based, patient-centered care model that we can expand throughout the region. Additionally, it enables us to focus on enhancing quality, improving access to health care, and effectively managing costs.”

No one ever asks practicing physicians what system will work to Repairing the Healthcare System.

No one every talks about the patients’ responsibility in preventing chronic diseases or once a chronic disease occurs, what is their responsibility in managing the disease.

Until a healthcare system is built around patients’ responsibility along with ways to prevent insurance company, hospital system and physician abuse, a healthcare system will not be built that is cost efficient with increased quality of care.

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

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Stop Confusing Me With Misleading Facts

February 8, 2016

inPoliticians,Healthcare and Vested Interests

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Stanley Feld M.D. FACP, MACE

The truth is derived from facts. In social sciences such as politics and economics isolated facts can lead to conclusions that are far from the truth. It is also possible to manipulate statistics that lead to false conclusions.

Misleading facts can lead to false conclusions and inaccurate opinions.

The Obama administration has mastered the art of picking isolated facts and manipulating statistics. It has used that skill and the traditional mainstream media to mold public opinion.

Government agencies are supposed to be politically neutral. The Obama administration uses isolated reported facts out of context to mold favorable public opinion using the traditional media.

This methodology has been pervasive in misinforming and transforming America. This phenomenon is especially true as it relates to the healthcare system.

Healthcare.gov’s enrollment supposedly ended for 2016 on January 31, 2016. Enrollment has been abysmal for 2016. It is no higher that the enrollment reported in 2014.

The only real increase has been the increase in Medicaid enrollment.

“As announced yesterday, the official QHP selection number ended up coming in right in the middle of this: 12.7 million nationally (9.6 million via HC.gov).”

Nevertheless, Secretary Burwell announced that enrollment surpassed expectations.

In mid-December President Obama announced as proof of the success of Obamacare;

“Nearly 6 million Americans so far have enrolled in insurance for 2016 through HealthCare.gov, President Obama announced on Friday, touting a big increase over last year that he said shows the Affordable Care Act is succeeding.”

The truth is Obamacare is a failure. State healthcare exchanges are failing. Many states have closed down their state healthcare exchanges. Yet, President Obama’s message is that his signature legislation, the Affordable Care Act, is succeeding.

The administration never addresses the reason Obamacare is failing. However, people who know the facts know it is failing and why it is failing. Obamacare simply does not meet the needs of the middle class consumers.

“It’s time to look at the major reasons for the shortfall.

Some of these are well-documented criticisms: Premiums and/or deductibles are simply too damned high for many policies/regions in general.”

There are many additional reasons for the poor enrollment but that is not the point of this article.

The point of this article is the Obama administration deceiving the public .

There are other areas of consumer (public) deception by the Obama administration.

One outstanding example is the administration’s conclusion that there is no inflation in America, which is hard to believe. Every time we go into a grocery store the price of food seems to increase. Every time we buy clothing, an appliance, a car or a restaurant meal the price seems to increase.

Few people know that food and fuel are not included in the Consumer Price Index (CPI). The CPI is a measure used in determining the inflation rate.

The article that stimulated me to write this blog was last week’s announcement that the unemployment rate has just decreased to below 5%.

President Obama, who expressed frustration that he has not received the credit he feels he deserves for the country’s improving economy, said the jobs numbers were further signs of progress.

“After reaching 10 percent in 2009, the unemployment rate has now fallen to 4.9 percent even as more Americans joined the job market last month,” he told reporters at a White House briefing in Washington. “Americans are working.”

The New York Times reported that the Obama administration has used this figure to brag about how well the economy is doing under his administration.

A non-traditional media publication, PJ media, has reported, in detail, the interpretation of the real numbers using the government’s own statistics. It is worthwhile reading the entire article and forming your own opinion about the unemployment rate.

“Every so often a monthly employment report is full of so many irregularities that it pays to discount the report. This might be one of those times.

We’ve commented several times over the years about the BLS cooking the books on jobs. James Pethokoukis lists some other stats that tell far more of the real story about the employment picture than the bare-bones numbers highlighted by the media:

Not everything was great: job gains far short of 185,000 expectations (though averaging 231,000 the past three months), U-6 unemployment-underemployment rate unchanged at 9.9%, long-term unemployment worsened, labor force participation and employment rate still way below pre-recession levels, wages gains short of what you would expect to see in a full-throttle economy. Particularly vexing for Barclays was job weakness in the service sector.

The unemployment rate figure is a fact used to mold public opinion. The mainstream media is the message. The problem is the Obama administration’s message is an absolute lie.

“In other words, the job situation in America still sucks, and the president is blowing smoke by touting the numbers as good news.”

One commenter wrote, using the government raw data;

“empiresentry 1st Boomer • 15 hours ago

Yeah that 30% was a ‘laugh’ and the Dims fell for it. Cali and some other Dim states mistakenly were unable to submit their numbers (cough cough)
.
For January 2016:
First time INITIAL jobs claims for unemployment insurance
Jan. 9, 2016 284,000
Jan. 16, 2016 294000
Jan. 23, 2016 277000
Jan. 30, 2016 285000
————-
940,000 human being lost their jobs

Jan. 623,000 “stopped looking for work”.
We did not stop looking for work. The government stopped counting us because our unemployment insurance ran out.

151,000 people found new jobs, most were retail and restaurant part time.”

The Obama administration and its agencies have presented distorted facts to us over and over again during the past 7 years. It has distorted the truth and, in turn, public opinion.

If one uses the wrong facts, one will come to the wrong conclusion.

Everyone is entitled to his or her own opinion. They are not entitled to their own facts.

That includes the President of the United States of America and his administration’s agencies.

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

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Here It Comes!

February 3, 2016

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

The mainstream media has been very quiet about Obamacare lately as the defects in its execution keep rolling along.

You may recall President Obama telling Senator John Kerry and Representative Barney Frank not to worry about including a Public Option in the bill. He told them they would not have to include the Public Option in the Affordable Care Act.

Barney Frank said we would never get a single party payer system unless we have a Public Option in the bill.

President Obama was right. He didn’t need a Public Option because the single party payer system was already embedded in the bill without anyone knowing it.

Medi-Cal is California’s name for its Medicaid program. California is one of the states that have expanded the Medicaid program under Obamacare.

Twenty states have not expanded their Medicaid program for fear of the federal government impinging on states rights while sticking their state with the bill.

The states also feared increases in their budget deficit. States are required to balance their budget. The result would be an increase in state taxes.

The increase in state taxes would render the state unattractive to companies and their business. Less company growth would mean an increase in unemployment and a decrease in state tax revenue. A decrease in tax revenue would result in a decrease in state services.

President Obama said, “Don’t worry.” He promised to fund Medicaid expansion fully for the first 3 years. Federal funding would decrease after the first three years to 50%. The funding percent has changed a few times since that promise. One could not know the present decrease unless one read the Federal Register daily.

Expanding Medicaid was a key part of the Affordable Care Act (Obamacare). It was also a hidden trap set by President Obama to slip the healthcare system into a single party payer system by default. That is why President Obama insisted we did not need a Public Option.

Obamacare required nearly all Americans, under penalty of law, to have insurance starting in 2014.

“Though a surprise, the high Medi-Cal enrollment is generally hailed as a success. California’s uninsured population has been cut in half since Obamacare, in large part because so many Californians signed up for Medi-Cal, which is free for beneficiaries.

Medi-Cal was opened to all low-income Californians starting two years ago, with the federal government paying for those new enrollments.”

In 2016 one third (1 in 3) or 12.7 million Californians are covered by Medi-Cal.

The total cost of the Medi-Cal explosion is $91 billion dollars, up from $54 billion dollars in 2012. California is responsible for $12 billion dollars. It will increase California’s budget deficit and may result in another tax increase.

The cost per insured is $7,165.35.

“The Medi-Cal program continues to grow at a very substantial rate, which is great. We are very happy that we’re able to provide healthcare to getting close to 13 million Californians,” said Mari Cantwell, chief deputy director at the state Department of Health Care Services, at a hearing in downtown L.A. this month. But, Cantwell added: “Obviously with that comes cost.”

The Medi-Cal is viewed by many state officials as being underfunded.

Medi-Cal patients are struggling to find doctors.

Many patients are receiving low quality of care by government standards.

A psychiatrist in Los Angeles told me that all the private practice internists in L.A. require an upfront concierge fee of at least $2,000 a year at the beginning of the year to be in their panel. If this is true, Internists in L.A. are insulating themselves against the low reimbursement of Medi-Cal. This concierge fee increases the California physician shortage.

The result has been that groups of activists have filed a federal civil rights complaint alleging that Latinos are being denied access to healthcare because the program does not pay doctors enough.

“The Affordable Care Act allowed states to open up Medicaid to anyone making less than 138% of the federal poverty level.”

Twenty states did not sign up for the expanded Medicaid because of the fear of federal takeover and the further impingement of state rights.

Pre-Obamacare, states were required to pay 43% of Medicaid’s cost and the federal government paid 57% of the costs. States ran the program and determined reimbursement.

As costs increased reimbursement was decreased and physician participation decreased because of the decreased reimbursement.

As a result of the 20 states resisting Medicaid expansion the federal government will pay 100% of the cost of new expansion enrollees and 93 percent off the cost of expanding Medicaid over the next nine (9) years instead of the next two (2) years.

The present rule looks like a great deal for the states. However with the federal government paying most of the Medicaid bill for the next nine (9) years the federal government will want to control Medicare.

Who needs a Public Option to get to a single party payer?

Who is going to stop the federal government from changing the eligibility for Medicaid to 200 or 400% of the poverty level?

Who is going to force doctors to participate in Medicaid if they want to practice medicine with a federal license?

Where is the government going to get the money without having skyrocketing increases in taxes?

Tax laws and lack of pro-growth tax reforms are inhibiting America’s economic growth.

America has been set up to have the future state of healthcare be a single party payer system. President Obama has done it in a clever way. He has had no regard for being fiscally responsible in the face of a 19 trillion dollar, and rising, debt.

Single party payer systems have failed in England and Canada.

Why should America create another failure?

Can Americans have a future state healthcare system that is not destined to fail?

Yes we can!

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

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Premises Must Be Re-examined

January 31, 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

A few weeks ago I had a terrific exchange with Steve Brachet M.D. who forwarded my blog to Steve Gregg.

“Stan,

I forwarded your recent blog featuring the five essential steps for HC reform to Stephen Gregg of Portland Oregon.

Steve Gregg is a former senior hospital executive, turned CEO of a managed care plan (successful in WA and OR), developer of alternative healthcare products, developer of patient care informatics, and thought leader in past 10 years on dimensions and confounding variables of health care in all its complexities.

He asked me to send the attached (very brief) piece recently published in the Oregon main media.

I don’t know if he expects a comment or two – but if you care to comment feel free to respond to Steve Gregg directly.

I take it that you are continuing to do your best to ‘right this HC ship’ that seems unlikely to improve on its own – nor with the help of the current Congress.

Steve Barchet M.D.”

I was fascinated with the article Steve Gregg wrote. I agree with many of the points he makes. I am publishing his article with Steve Gregg’s permission. I wrote back and said;

Dear Steve

I welcome your article.

My blog explains the elements needed to Repair the Healthcare System from a physician’s point of view.

As a result of the Internet and improved software, consumers have become king and are driving the consumer consumption market. Amazon and ebay have led the way. Opaque purchasing models have been replaced by price transparent purchasing.

Wal-Mart has been forced to close stores because of online purchasing to remain competitive.

A consumer driven transparent online purchasing model has replaced airline ticket purchasing through travel agencies.

Online banking is transforming banking services. Hardly anyone goes into banks anymore.

There is no reason that shopping for healthcare services cannot transform the healthcare industry with all its opacity.

Consumers must be put in a position to drive the healthcare system and be responsible for their health and healthcare dollars.

Our 2020 business model can transform the dysfunctional healthcare system that can align all the stakeholders’ vested interests by empowering consumers and letting them drive the system.

The result will be a decrease in cost. It will eliminate the entitlement mentality of healthcare consumers and create a competitive mentality for all stakeholders as it has done in the examples above.

All Obamacare is doing is trying to put a patch on a healthcare system whose demise has been accelerated since passage of the Affordable Care Act.

Your articles describe many essential premises that must be reexamined.

However, consumers must be involved and be the responsible party in the healthcare system. They have to be given financial incentive to be involved and responsible.

Thank you for letting me reprint your article.

Health Reform…What Next?

Steve Gregg

With the expensive collapse of Oregon’s Health Exchange, a New Year, and approaching changes at the Federal level, it is time to reconsider the formative assumptions driving health care reform.

Ten Game Changing Assumptions Shaping Health Reform:

The ideologies of the left and right will not sustain a reform solution grounded in compromise and “deal making”. The endless search for consensus confuses the problem, and is a recipe for failure.

The State’s public bureaucracy is too conflicted with its own self interest to impartially govern health reform.

3.The plethora of proposed actions to reduce demand will not reduce costs. “Supply” being a more important driver of costs than ”Demand”.

Sustainable reform cannot tolerate the variation in provider pricing to patients with differing sources of payment. Perhaps less than 15% of the typical hospital’s patients pay what the hospital bills.

It is wrong headed to view reform as a matter of amending the existing system.

Financial goals stabilizing health care costs cannot be achieved without prospectively stated and independently measured metrics.

Equal access is not a realistic expectation. Universal coverage must be.

Genuine Altruism is a deceptive and widely abused value of our non- profit institutions and trade associations.

The United States spends twice as much per capita on health care because our health care workers of all stripes (including insurance companies,hospital sytems, government and pharmaceutical companies) s(take out twice as much from the system.

The health care structures of other countries, while instructive, are not transferrable to the United States.

Bonus:

The Oregon Healthcare Project rationing experiment was a colossal hoax that channeled billions of new dollars to Oregon’s health care interests. Never measured, never critically evaluated. It was a severe case of the “Emperor Wears No Clothes”.

Conclusion: Think in terms of 2-3 alternative systems reflecting differing ideologies: Liberal / Conservative / Libertarian.

What would this suggest for process?

Form 3 small task forces assembled around three ideologies: Liberal, Conservative, and Libertarian to articulate assumptions, problem definition, and a broad solution compatible with each ideology.
At the end of the process examine what consolidation can occur and if not presume the development of 3 systems available to the free will of people to chose.

Liberal: Socially and fiscally liberal

Conservative: Fiscally and socially conservative

Libertarian: Socially liberal / Fiscally conservative

Note: The prospect of 3 systems capturing U.S. Healthcare, sounds daunting but in reality we have more than that now: Employer, Medicare, Medicaid, TriCare, Municipal, Insured, Self funded etc.

Alternative List of Assumptions:

A sustainable health reform strategy cannot be achieved without the foundation of a well-conceived definition of the problem and formative assumptions.

Subsidized or “free” health care is inflationary and will overwhelm administrative protocols for cost reduction.

Genuine Altruism is rare and a widely abused cover for proprietary agendas. Excessive profit is a measure of good management.

The community’s health care pathology is infinite and those making a living and profits from health care will seek to capitalize on that.

Our health care system in the main is a proprietary endeavor with millions of economic interests seeking to protect or increase revenues. Any initiative that threatens that cash flow will be vigorously resisted.

Does the system tilt toward choice and self – determination or equalness, limited choice, and a central authority?

“Nearly half of all care delivered produces no medical benefit” is in obvious conflict with a prevailing view of vast health manpower shortages. Does increasing supply reduce prices and the costs of health care?

If the national will demands universal coverage, the utility of competing traditional insurance companies should be called into question.

The reformed system must promote individuals seeking care from the “best” provider of care as early as possible in the development of any adverse health care condition. Forcing patients into an inferior food chain of care is unethical and probably more costly in the end.

There is something wrong with a requirement to select a health plan, provider network, and insurance in advance of acquiring a dire condition, and then being locked out of access to the “best” provider.

Steve

I do not see consumers playing an active role in your assumptions to Repair the Healthcare System.

Obamacare is wasting money developing an entitlement system that cannot work. The only stakeholder that can develop a healthcare system that can work is a system driven by consumers.

Consumers can force the secondary stakeholders to be competitive and transparent, as they have done in other industries.

It would be cheaper for the government to invest in empowering all consumers using the revolution in information technology and providing financial incentives to all using My Ideal Medical Saving Accounts.

Everyone could be insured as I have described in my article The Ideal Medical Saving Account Is Democratic.

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

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Obamacare Is Increasing Health Savings Account Participation

January 25, 2016

inHealth Savings Accounts vs Medical Savings Accounts, Medicine: 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

Patients’ responsibility for their health and their healthcare dollars is one of the most important elements in a functioning and cost effective healthcare system.

Despite the fact that my ideal medical savings account (MSAs) would be more effective than health savings accounts (HSAs) in encouraging patient responsibility for their health and healthcare dollars, health savings accounts are flourishing because of Obamacare is costly and has taken freedom of choice away from individuals.

Devenir is a HSA Mutual Fund that accepts and invests HSA trust contributions and invests those contributions. Devenir just published a study that showed that:

“1. As of June 30, 2015, the number of HSAs had climbed 23% from the previous year to 14.5 million.”

“2. Account balances jumped 25% to approximately $28.4 billion over the same time period.”

In 2010 the year Obamacare was passed, there were 5.7 million HSAs with balances totaling $7.7 billion.

The Obamacare bronze plan is the least expensive federal health insurance exchange plan. Its coverage is poor and it has a high deductible that most people cannot afford.

The premium and deductible are only good for patients with pre-existing illnesses that have no other place to purchase insurance. That is the reason the demographic for enrollees from healthcare.gov is so poor.

The government is loosening the noose on HSAs even though it is still restrictive.

“For the 2016 tax year, you can make a deductible HSA contribution of as much as $3,350 if you have qualifying high-deductible self-only coverage or as much as $6,750 if you have qualifying high-deductible family coverage. If you are age 55 or older as of the end of 2016, the maximum deductible contribution goes up by $1,000.

For 2015, the contribution caps are the same, except the maximum deductible contribution for family coverage is $6,650. These amounts are increased by $1,000 if you were 55 or older as of December 31, 2015. You have until April 18, 2016, to make an HSA contribution for the 2015 tax year.”

You must have a qualifying high-deductible health insurance policy — and no other general health coverage — to be eligible for this HSA contribution privilege. For 2015 and 2016, a high-deductible policy is defined as one with a deductible of at least $1,300 for self-only coverage or $2,600 for family coverage.

For 2016, qualifying high-deductible policies can have out-of-pocket maximums of as much as $6,550 for self-only coverage and $13,100 for family coverage. For 2015, these amounts are $6,450 and $12,900, respectively.

If you are eligible to make an HSA contribution for a tax year, the deadline is April 15 of the following year (adjusted for weekends and holidays) to open an account and make a contribution for the earlier year.”

The government has increased the maximum deductible in 2015 and continues to increase in 2016.

For the 2016 tax year, you can make a deductible HSA contribution of as much as $3,350 if you have qualifying high-deductible self-only coverage or as much as $6,750 if you have qualifying high-deductible family coverage.

“ If you are age 55 or older as of the end of 2016, the maximum deductible contribution goes up by $1,000.”

More large companies are Increasingly offering workers high deductible health saving account. However, the employee is responsible for the high deductible and most of the plans are 70/30 coverage after the deductible is reached up to a maximum of $10,000.

Most large and small employers can afford to pay all or some of the high deductible and buy reinsurance for first dollar coverage beyond the deductible.

Both large employers and small employers are offering their employees health savings accounts. The full insurance premiums have become so high that employers are shifting the burden to employees by having the employee pay the deductible and the employer paying the reinsurance.

UnitedHealth has about 40 individual high deductible plans with 70/30 copays over the limit of the deductible. The maximum out of pocket cost is $10,000. The premium for a young married couple without kids is from $125 to $350 per month depending oo the deductible chosen. The premium increases with the number of children.

A great advantage to these plans now is that UnitedHealth has already negotiated the physicians’ and hospitals’ fees for you. The uninsured would pay retail price for the same services.

The cost to small to large companies is relatively difficult to find in an online search.

Most companies are self-insured and would not fall under the rigid coverage rules of Obamacare. The company can decide on the amount of the deductible they would pay for the employee.

The point of all this is health saving accounts are not as good as my ideal medical saving account. HSA’s do not provide enough incentive for employees or individuals to manage their health or healthcare dollars wisely as an MSA would.

A large defect in Obamacare is patients do not have incentive to be wise shoppers of their healthcare. They have restricted choice. They have little incentive to stay healthy because they have an entitlement program available that will take care of their expenses. There is no financial incentive for them to try and reduce the cost of healthcare.

If the consumers managed their health and healthcare dollars well the cost of healthcare would drop because the complications of chronic diseases would decrease to at least 50%.

If Republicans are looking for an alternative plan to the liberals’ and progressives’ inevitable march to a singe party payer system most of the infrastructure is already in place.

Only small modifications to the HSAs have to be made by the congress and the President and America would be on its way to a free market healthcare system.

This alternative healthcare system would align all of the stakeholders incentives including the government’s incentives, if the Obama administration did not want to increase its power by having more control over its people and its people’s freedom of choice.

My ideal Medical Saving Accounts would be democratic and cover everyone.

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

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Accelerating The Destruction Of The Healthcare System

January 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

Most of you are familiar with my slide of the demise of the healthcare system.

Obamacare is accelerating the total collapse of the healthcare system. Once total collapse has occurred Americans might beg for a complete government taken over of the healthcare system with a single party payer system.

I have pointed out most of Obamacare’s new rules causing the unintended consequences and accelerating the healthcare system’s demise.

An unintended consequence in the Accountable Care Organization leads to a new rule to correct the consequence. Unelected officials then create another rule. The new rule results in other unintended consequences. All of these consequences accelerate the healthcare system’s demise.

Obamacare’s first year in operation was 2014. The Obama administration started taxing everyone in 2010 to support the added expenses Obamacare would generate.

Only the individual insurance portion of Obamacare was initiated.

The following are examples of unintended consequences.

Fourteen million people lost their individual healthcare insurance coverage in 2012 because of Obamacare’s new rules. Insurance coverage premiums increased because of the ACA’s required coverage.

Many workers lost their full time jobs. They were put on part-time employment in order for employers to avoid Obamacare penalties.

CMS reported that 13 million signed up for Obamacare in 2014 despite the healthcare.gov website disaster. The number of enrollees was revised a few of times down to 6.6 million because of counting errors.

The direct and indirect costs of Obamacare were never reported to the public.

Obamacare activated a reinsurance program that was built into the Affordable Care Act. The reinsurance program was a bailout to entice the healthcare insurance industry to participate in the Federal Health Insurance Exchanges without experiencing any loses.

The insurance industry has claims the Obama administration owed it 2.5 billion dollars in 2014. The Obama administration was able to pay only 12%. The law restricted the government’s reinsurance payment to a certain percentage of the premiums paid. The amount owed as promised to the healthcare insurance industry for their participation in Obamacare was $2.2 billion short.

I believe the healthcare insurance industry will be loath to participate in the Federal Health Insurance Exchanges in 2017. UnitedHealth has already threatened to quit participating.

This year (2016) during open enrollment only 8.1 million enrolled in the Federal Health Insurance Exchanges.

It has been difficult to trust CMS’s overall claims for the number of enrollees. It has nothing to do with how many people have paid first premium or the anticipated number who will continue to pay premiums throughout the year.

President Obama stated in his state of the union speech that 18 million previously uninsured have received insurance under Obamacare. This is not true.

For argument’s sake let say his number is correct.

More than half the enrollees received Medicaid. President Obama is urging states to expand Medicaid.

What is going to happen when Medicaid is expanded? More people will get free government supplied healthcare insurance but will not be able to find physicians. Medicaid reimbursement is so poor that few physicians participate.

The healthcare system’s demise is rapidly accelerating. Obamacare’s claiming to increase people being covered but these people cannot obtain healthcare services.

Obamacare does not incentivize these people to be responsible consumers. Obesity continues to increase and the dollars spent for healthcare continues to increase.

The truth is enrollment has been terrible for 2016. President Obama is expanding the enrollment period again this year to try to increase enrollment.

“Eager to maximize coverage under the Affordable Care Act, the Obama administration has allowed large numbers of people to sign up for insurance after the deadlines in the last two years, destabilizing insurance markets and driving up premiums, health insurance companies say.”

“The administration has created more than 30 “special enrollment” categories and sent emails to millions of Americans last year urging them to see if they might be able to sign up after the annual open enrollment deadline.

The Obama administration has done nothing to verify whether these late arrivals are eligible for insurance. They just sign up and are insured.

People have figured out they can wait until they become ill or need medical services to sign up. They then sign up and pay their premiums a few months’ premiums. They stop paying their premiums after they have received their medical services. They figure they do not need insurance any more.

“Individuals enrolled through special enrollment periods are utilizing up to 55 percent more services than their open enrollment counterparts” who sign up in the regular period, the Blue Cross and Blue Shield Association, whose local member companies operate in every state, told the administration.

The Obama administration has told the healthcare insurance industry that it has heard their concerns. The problem is that CMS has not done anything about the insurance industry’s concerns.

“Many individuals have no incentive to enroll in coverage during open enrollment, but can wait until they are sick or need services before enrolling and drop coverage immediately after receiving services, making the annual open enrollment period meaningless,” Steven B. Kelmar, an executive vice president of Aetna.”

Twenty five percent of Aetna enrollees have signed up during the special extended enrollment periods. It has been reported that last year 950,000 people enrolled during the special enrollment period between February and July 2015.

“Kevin J. Moynihan, the chief executive of the federal insurance marketplace, said it shows the marketplace is working to meet people’s needs. He said certain life changes like losing your coverage, having a child, turning 26, moving or getting married may qualify you for a special enrollment period.”

People who are qualified for insurance do not get verified for insurance. It is easy to understand that this leads to unstable insurance markets and subsequent increases in premium prices.

It is o.k. for progressives if healthcare insurance is considered a right under a single party payer system with the losses taken by the government even if the deficit increases.

It is not o.k. if the Obamacare healthcare system pretends to be developing an efficient free enterprise system with the healthcare insurance industry experiencing the loss under the weight of unidentified risks created by the federal government.

The number of people not continuing to pay their insurance premiums their entire year is enormous. The healthcare insurance industry had no way of anticipating this occurrence.

“On average,” Aetna said, “special enrollment period enrollees stay with us for less than four months, while enrollees who come to us during the annual open enrollment period maintain their coverage on average for eight to nine months.”

The same turnover rate has happened to UnitedHealth. It is one of the many reasons UnitedHealth has threatened to quit participating in Obamacare in 2017.

The result will be even higher insurance premiums next year. Most of the Obamacare insurance rates are unaffordable this year.

“Enroll America, a nonprofit group with close ties to the Obama administration, said the government “should not tighten eligibility or verification standards in ways that could place an undue burden on consumers.”

There is no verification for late enrollment. The last statement by “Enroll America” reflects President Obama’s progressive and irresponsible attitude toward fiscal responsibility.

It is no wonder the national debt has grown to $19.2 trillion dollars.

It is another way to accelerate the collapse of the healthcare system.

I believe President Obama knows exactly what he is doing. His problem is he does not understand or care about the significance of the effect the deficit increase will have on America’s financial stability.

Middle class Americans are getting slaughtered.

Additionally he does not understand that Americans will not accept a government controlled single party payer system.

The Republican Party must get on the stick right now. They must offer a viable alternative to President Obama’s goal of a single party payer system. They should not wait until after the election.

The alternative should work in an efficient way. It should put consumers in charge of their health and healthcare dollars.

It would be a good idea for Republicans to understand and offer as an alternative My Ideal Medical Saving Accounts.

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

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$3 Trillion And Rising

January 11, 2016

inConsumer Driven Health Care, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

The Obama administration is spending money on Obamacare like a drunken sailor. It has no respite for the budget deficit. Paul Krugman even said deficit spending is not a problem.

The deficit could almost be justified if there was a possibility that Obamacare could work.

If Obamacare could provide universal healthcare at an affordable price, increase the efficiency and quality of care, and align all the stakeholders’ interests the increasing deficit caused could almost be justified.

Obamacare can’t work. Its business model is just accelerating the path to the total collapse of the healthcare system.

The dysfunction and inefficiencies didn’t happen overnight. It started when the government set up its bureaucracy for Medicare in 1965 and has gotten worse as progressives tried to adjust to the unintended consequences and rising costs.

Obamacare has accelerated the path toward total collapse of the healthcare system. It has caused more rules and regulations. The increase in bureaucracy leads to more inefficiency and increasing adjustments by providers to make the defective business model work for their vested interests rather than the patients’ vested interests..

Little tweaks to fix the healthcare system have lead to unintended consequences, greater dysfunction and higher costs.

In 2010 with the passage of Obamacare, bureaucracy increased. Businesses have invested great deals of money to adjust to new regulations imposed by Obamacare.

David Brooks said on the PBS News Hour on January 8, 2016 that Obamacare cannot be repealed because it was embedded in the business model of too many healthcare businesses.

I thought healthcare reform was dedicated to the proposition of providing universal healthcare and improved healthcare at an affordable price to patients.

In the last two years there has not been an increase in the number of new patients insured in the Federal Health Exchanges.

There has been an increase in the number of Medicaid patients insured. However, Medicaid provides such poor insurance reimbursement that few physicians participate.

The few physicians who do participate have to see many patients a day using many physician assistants. “These Medicaid Physicians” are frequently accused of running “Medicaid Mills.”

The physicians are accused of corruption and gaming the system. Then they come under federal investigation. Some of these physicians are corrupt but most aren’t.

David Brooks is drinking the Kool Add of the progressives and President Obama. He stated that Obamacare is now embedded in the fabric of our culture.

None of the stakeholders are having any fun. I believe everyone would jump at being given a viable alternative. The viable alterative is not a single party payer system.

Countries which have a single party payer system are working hard to avoid bankruptcy.

All one has to do is read Canada’s Fraser Institute Report.

Obamacare is an entitlement. It does not promote consumer responsibility for their care or healthcare dollars.

There is a better way. The Republican political establishment just refuses to listen. The Democratic establishment continues to make fun of the Republican establishment for not having an alternative.

Meanwhile all of the stakeholders, including the government, are experiencing increased pain.

Last month government officials announce that healthcare spending in the United States was 3 trillion dollars or an average of $9,500 a person.

A soon as the figure was announced the Obama administration’s spin machine got started with disinformation about the 3 trillion dollars.

The New York Times continues to report that Obamacare is working. The logic used is America has had a lower growth in healthcare spending in the last five years.

The New York Times completely ignores the fact that healthcare taxes have increased yearly over the last five years while Obamacare healthcare coverage has only been in effect for two years since 2014.

The spending curve for every aspect of healthcare experienced a sharp upturn in 2014.

The Obama administration is trying to blame the upturn on drug prices. Drug prices are partly to blame increase in cost. If one digs deeper it will be seen as a small part of the cost increase.

The increase cost is due to the accelerated dysfunction caused by Obamacare.

“Health spending in the United States last year topped $3 trillion — an average of $9,500 a person — as five years of exceptionally slow growth gave way to the Affordable Care Act’s expansion of Medicaid and private insurance coverage, and as prescription drug prices resumed their sharp climbs, the government said Wednesday.”

Only a few of the major provisions in the Affordable Care Act (Obamacare) took effect in 2014.

What is going to happen when all of the major provisions of Obamacare take effect?

“Total spending on health care increased 5.3 percent last year(2014), the biggest jump since 2007, and accounted for 17.5 percent of the nation’s economic output, up from 17.3 percent in 2013, the Department of Health and Human Services said in its annual report on spending trends.”

“By contrast, health spending grew 2.9 percent in 2013, the lowest rate of increase since the federal government began tracking it in 1960.”

2013 was three years into increased Obamacare healthcare taxes that affect all taxpayers including those that make less than $250,000,000 per year.

The people making less than $250,000/year were promised they would not spend one dime more for Obamacare.

I believe many American are aware of the mind games the Obama administration has played on them and are ready for an alternative that is a consumer centered and consumer driven system with them being in control of their health and healthcare dollars.

Republicans should at least offer the public a choice of My Ideal Medical Saving Account.

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

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Destroying The Healthcare System

January 6, 2016

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

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Stanley Feld M.D, FACP,MACE

I believe President Obama’s goal is to destroy the healthcare system. The people will then beg the Obama administration to institute a single party payer system with the government being in full control.

The fact is Obamacare is not working despite the Obama administration’s convincing the mainstream media to advertise that it is very successful.

I was shocked at a December 9^th New York Times article stating:

“ A million new customers have signed up for health insurance during the Affordable Care Act’s third open-enrollment season, Obama administration officials said on Wednesday, and call centers have been deluged.”

This statement is an optimistic statement and a distraction from the true. A readers impression would be Obamacare is doing great.

The Obama administration simply ignored last year’s enrollment numbers. Ten million people were supposed to have signed up for healthcare coverage through the Federal Health Insurance Exchanges. Only seven million of those who signed up paid their premiums for the entire year.

The premiums and deductibles were too high even for the poor who received federal subsidies.

Most of the people remaining in the Obamacare in the federal exchanges were people with a pre-existing illness. One diabetic told me her individual premium for Obamacare was $12,500 dollars with a $6,000 dollar deductible. Her bill for last year, being hospitalized one time, was almost $100,000. She felt Obamacare was a very good deal for her.

The insurance company covering these kinds of patients with a pre-existing illness cannot make money for the insurance coverage they are required to provide.

If all the patients have pre-existing illnesses, the only thing the insurance companies can do is raise the premiums or stop selling insurance in this Federal Health Exchange market.

The Obama administration promised it would limit the insurance industry’s loss with its reinsurance program. The Obama administration reneged on its word and only paid 12% of what was due for 2014. The administration did not have the money to pay for it.

In 2014, the first year of coverage, we were told 13 million signed up, but only 7 million had coverage at the end of the year.

The administration provided data to the CBO to predict the number of enrollees Obamacare will have in 2016. The CBO predicted 21 million would be signed up for 2016. The CBO used data provided by the Obama administration to make this calculation.

What happened to the remaining 7 million enrollees for 2015? We are not told how many enrollees automatically re-enrolled.

We only hear that, ‘ A million new customers have signed up for health insurance.”

We can now understand the concerns expressed by UnitedHealth Group and other insurers that say they are losing money in the Obamacare Federal Health Insurance Exchanges.

Open enrollment is due to end January 1, 2015. In mid December CMS announced,

‘We are now seeing a surge of interest as we get closer to the deadline,” “Each day has been bigger than the day before.”

The last two weeks in December had less that 100,000 people sign up. Yet the government published these numbers. Many wonder how real these numbers are. If they are real there has been no increase in enrollment in the last year.

Confirmed 2016 Exchange QHPs: 9,584,850 as of 12/30/15
Projected Exchange QHPs: 11.32M by 01/02/15 (8.60M via HC.Gov)
In the last week in December only 80,000 people signed up compared to 96,000 the same week last year.

The coverage is poor and too expensive for most people.

Open enrollment has now been extended to January 31 for enrollment March 1^st.

“People who go without insurance next year may be subject to tax penalties of $695 a person or more, although some may be able to qualify for hardship exemptions.”

This is a joke. However, the joke is on the consumers and taxpayers.

So far, Obamacare has created a 10% increase in federal taxes middle-class taxpayers.

It has increased coverage for the Medicaid eligible poor. However, these people cannot find a doctor who will treat them.

The healthcare system is costing over three trillion dollars a year and increasing our deficit more than $1.5 trillion dollar a year. There are still 34 million people uninsured. How many people are under insured because their jobs have been changed to part time jobs? They cannot afford to buy Obamacare’s insurance?

2017 is the year the healthcare insurance markets are supposed to stabilize. These markets have not stabilized. Healthcare insurance companies, and business groups can not understand how the new CMS’ proposals will regulate and expand provider networks and standardize plan options let alone have insurance markets result in lower premiums.
“We remain deeply concerned that this proposed rule will not stabilize the individual market,” Steven Kelmar, Aetna’s executive vice president for corporate affairs, wrote in a letter to the CMS. “Unless some fundamental flaws are corrected, we believe there is a grave risk that the federal exchange will not operate as a viable, competitive market in 2017.”

One of the more significant and controversial provisions in the proposed rules involves the adequacy of provider networks. The CMS proposal demands that ACA-compliant health plans sold on the federal exchanges in 2017 would have to abide by new network standards.

All plan networks would have to include hospitals and doctors within certain travel times or distances from members. There would also be minimum provider-to-member ratios for some medical specialties.

CMS proposed that all health plans in each metal tier on the federal exchange have the same benefits. For example, all 2017 bronze options would have a $6,650 deductible, and all plans would have no more than one provider tier.

This proposal practically guarantees that the healthcare insurance industry selling insurance under Obamacare’s exchanges would lose money. Therefore, the industry would choose not to participate.

The big losers would be patients with preexisting illnesses. They would lose their insurance.

The traditional mainstream media is already cranking up the Obama administration spin machine to promote a single party payer system as the best and simplest option to provide insurance for all Americans.

Nobody is thinking about who will pay for a single party payer system after the administration emotionally conditions the public to beg for a single party payer system.

The hardest by increased costs in the system are consumers at every income level.

As the cost rises to unaffordable levels all consumers are starting to take think about taking responsibility for their health and healthcare dollars.

“The new research also finds that as a result of the increase in health care costs, focus group participants are changing how they operate within the health care system.

They are questioning their doctors recommendations more frequently, comparing cost and quality information for local providers, and even putting off seeking care altogether.”

Despite the low of enrollment in 2016 (that the Obama administration denies), CMS is about to publish new 2017 rules for the insurance industry. These rules are guaranteed to make the healthcare system more dysfunctional.

The fact is the structure of Obamacare is failing and about to collapse.

All of the Obama administration’s tinkering to stop the free fall is creating greater momentum for total collapse of the healthcare system.

The answer to fixing the healthcare system is not a single party payer system.

The answer is a consumer driven healthcare system with the aid of smart phones and the Internet and Medical Savings Accounts.

Progressives have a tendency to forget the math. They have more interest in satisfying an emotional response. The resulting entitlement policies lead to the unintended consequences and only make things worse.

Neil Cavuto demonstrated this logic recently in an interview with a student campaigning for free student loans.

https://youtu.be/Zmji36q8E4o

Progressives’ logic is faulty. It demonstrates a lack of understanding of the affects of entitlements and their unintended consequences.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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