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King vs. Burwell and The Supreme Court

Stanley Feld M.D.,FACP,MACE

I have received a couple of emails asking me why I have not responded to the Supreme Court’s ruling in King vs. Burwell.

A ruling in King’s favor seemed so clear to me. I thought the case would be decided in favor of the letter of the law. This seemed obvious since Jonathan Gruber, the author of Obamacare, admitted the words “state health exchanges are the only exchanges that could provide subsidies” were intentional.

It was clear that the author of the law (Jonathan Gruber) and President Obama wanted to encourage states to create State Health Insurance Exchanges.

The carrot was money. If the states did not create State Health Insurance Exchanges they would lose their government grants.

The legislators of the states that refused the Obamacare trap would experience angry voters and get kicked out of office.

Dr. Gruber also admitted that if there was transparency during the law’s creation it would never have been passed. Jon Gruber called Americans stupid.

This comment motivated President Obama to distance himself from Jonathan Gruber. He said Dr. Gruber was not a major player in the creation of Obamacare. President Obama claimed that he barely knew him.  He claim Jonathan Gruber had only been to the White House a couple of times.

President Obama’s statement has been proven to be a lie.

 http://www.foxnews.com/politics/2015/06/24/editor-says-owes-gop-sources-apology-after-new-gruber-emails/?intcmp=ob_article_sidebar_video&intcmp=obinsite

 The Supreme Court’s decision has been a mind blower to me. I still have not figured out how to respond.

I thought the Supreme Court Justices’ job was to interpret laws within the context of the constitution. They should not create new laws or create new meanings for laws.

They also should not allow themselves to be bullied by the executive or legislative branch of government.

President Obama has been doing heavy duty bullying of the Supreme Court to rule in his favor in the last four months. President Obama’s goal is to not let anyone stand in his way on the road to control the entire healthcare system.

The justices live in our society. They are aware of the media and have access to the same information as everyone else.

It should be obvious to them that all the stakeholders dislike Obamacare now that they “know what is in it.”

Obamacare is a terrible law. President Obama told many lies and has taken many unlawful steps to hide the law’s failures.

The justices should have recognized that Obamacare is not a bipartisan law. Only Democrats voted for the bill even though many have admitted they did not read it.

It hardly represents the will of the people as they are now recognizing all its faults and deficiencies.

The Supreme Court’s codifying the law seems bizarre to me.

I also thought that the Supreme Court’s decisions had to be made in the context and spirit of the law and the meaning of the constitution. 

I am especially disappointed in Chief Justice John Roberts. His reasoning for ruling on King vs. Burwell was just the opposite of his reasoning for his ruling on gay marriage.

It is as if he has been influenced by outside sources in each ruling. 

I know the ruling has stunned many people. Congress made the law. Congress should change the law to mean what the Supreme Court said it meant.

I have not figured out what an appropriately reasoned response should be.

I believe the will of the people will prevail once people understand the harmful effects of this law. Its affect on the economy is becoming obvious. Its affect on Americans individually is also becoming obvious.

Obamacare will eventually die under its own weight. The Democratic Party will never be able to get rid of the label “tax and spend party.”

The Democratic Party and President Obama are putting America into greater debt.

I believe the lower socioeconomic groups, who President Obama claims to help, are realizing President Obama is doing them more harm than good.

His goal is to make Americans more dependent on the central government.

I do not think President Obama or the Democrats are going to be able to survive the coming tsunami of a plebiscite against Obamacare.  

In the end Americans are not fans of socialism. They know it doesn’t work.

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

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President Obama Tries To Bully The Supreme Court

Stanley Feld M.D.,FACP,MACE

President Obama attacks his opponents, marginalizes them, throws them under a bus, lies, ignores reality, or bullies them.

The reality about Obamacare is that none of the stakeholders like it.

It is causing states with State Health Insurance Exchanges to go deeper in debt.

The government has been forced to create 37 Federal Health Insurance Exchanges. Premiums are skyrocketing because of poor enrollment and demographic distribution. Only people with pre-existing illnesses or those receiving subsidies are joining.

Premiums are now unaffordable even applicants receiving subsidies.

Obamacare is driving corporations providing healthcare insurance for their employees to figure out how to avoid providing healthcare insurance and penalties.

The government has provided waivers for companies such as McDonalds, Burger King and 1300 other companies to not participate in Obamacare.

 Obamacare has tried to take away Medicaid subsidies from states that did not start a State Health Insurance Exchange and would not expand Medicaid. The Supreme Court stopped that two years ago.

Obamacare has driven physicians into hospital employment. Many physicians are unhappy and less productive working for hospitals themselves.

Many physicians have retired early because of Obamacare. This is a bad sign in light of our present physician shortage.

Obamacare has created incentives for hospitals to create Accountable Care Organizations (ACOs).

Logically ACOs cannot work because they shift financial risk for patients on to physicians and hospitals and away rom the healthcare insurance industry.

Hospitals and physicians are finally starting to realize the risk and are dropping out of the ACO programs.

Obamacare has spent over one billion dollars for a web site that is still not fully functional.

The promise of universal healthcare coverage has resulted in more people being uninsured than before Obamacare was passed. Only 9 million people are signed up and 6.4 million receive subsidies.

The original prediction in 2009 for 2015 was 17 million participants.

The expanded Medicaid program in 14 states is  experiencing severe physician shortages and financial problems.

Obamacare patients and Medicaid and Medicare patients are starting to experience limitations on access to care and rationing of care.

I am only naming a few of the many problems Obamacare has created.

Yet with all these defects and failures President Obama has the gall to say,

 There's something deeply cynical about the ceaseless partisan attempts to roll back progress.”  

"I understand people being skeptical or worried before the law was passed and there was no reality to examine. But now that we can see millions of people having health care—and all the bad things that were predicted didn't happen—you'd think it was time to move on."

Obamacare is not working despite President Obama’s claims.

I think it is time to move away from Obamacare and in another direction.

This week President Obama did another astonishing thing. It reveals   his consistent disrespect for the constitution and the separation of powers.

He has tried to intimidate the Supreme Court to rule in favor of Obamacare with his personal attack on the court and its upcoming decision in King vs. Burwell.

 “The law provides for subsidies only for policies purchased on exchanges "established by the state", inserted in the law as an inducement to states to set up exchanges.”

Congress limited the subsidies to State Health Insurance Exchanges to encourage the states to set up their own exchanges. Thirty-seven states saw the trap that President Obama was setting for them and refused to cooperate.  

The IRS, operating under the direction of President Obama, tried to “fix” the law by permitting federal exchange to provide subsidies.

The infamous Dr. Jonathan Gruber, a principle framer of Obamacare, who was paid by the Obama administration $375,000 for his consultations with the White House staff, said the exclusivity of state exchanges rewarding subsidies was put into the law to induce states to set up exchanges.

Dr. Gruber, a healthcare economist, also said the law would have not passed if the public was not so stupid and could recognize the lack of transparency of the law.

President Obama said at the time of the scandal that he did not know Dr. Gruber. President Obama said Jonathan Gruber played a minor role in the construction of Obamacare.

During the last month President Obama has used the traditional media to try to convince the Supreme Court and the American people that congress really meant to give the State Exchanges and the Federal Exchanges to ability to provide insurance subsidies.

Article after article was published confirming that what the law meant to say was both State and Federal Exchanges had the ability to provide subsidies. This was morally the right thing to do.

President Obama said this week. “That we have an obligation to put ourselves in our neighbor’s shoes, and to see the common humanity in each other.”

First of all congress didn’t write the law. It should have and it should have been bipartisan. Most Democratic congressmen who voted for Obamacare didn’t even read the law.

The IRS has no authority to change the letter of the law with a regulation.

The law as written should be the law. The Obama administration overstepped its constitutional limits. If the law is wrong, congress should amend the words to include subsidies for federal exchanges also.

Obamacare is a terrible law. It is distorting and destroying our already dysfunctional healthcare system. The Republican dominated House and Senate are not going to change a law that is self destructing, if the Supreme Court favors King and the letter of the law.

Since President Obama’s traditional media campaign has been a flop, he has personally gone after the Supreme Court. He tried to intimate it by challenging its integrity.

President Obama said, Frankly, the Supreme Court should not have taken up the lawsuit challenging Obamacare subsidies.” 

Who is he to decide which cases the Supreme Court should take up?

 President Obama continued,“There is no reason why the existing Federal Health Insurance Exchanges should be overturned through a Supreme Court case,”

 President Obama is preparing the country to be angry at the Supreme Court if the Supreme Court rules in favor of King.

President Obama is disregarding the notion that the Supreme Court is interpreting and upholding the constitution, a concept he frequently ignores.

I think it’s important for us to go ahead and assume that the Supreme Court is going to do what most legal scholars who've looked at this would expect them to do.”

 This statement is both a lie and a veiled threat to the court.

“Elena Kagan  recently wrote in another case that, "This Court has no roving license, in even ordinary cases of statutory interpretation, to disregard clear language simply on the view that (in [the IRS’s] words) Congress 'must have intended' something broader."

During oral arguments in March, Justice Antonin Scalia suggested Congress could step in and fix the problem.

“Congress just adjusts, enacts a statute. It would take care of the problem. It happens all the time,” he said. “Why is that not going to happen here?”

President Obama did say there was one way to resolve the dispute over the law: “Congress could fix this whole thing with a one-sentence provision.”

President Obama said, “He is puzzled by the legal challenges against his signature healthcare law, arguing there is ample evidence that the system is working.

“Fortunately, there's no reason to have to do it. It doesn't need fixing,”

President Obama keeps harping on the same lies. He believes if you tell a lie enough times it becomes the truth.

President Obama said, “Part of what's bizarre about this whole thing is, we haven't had a lot of conversation about the horrors of ObamaCare because none of them have come to pass.”

There has been limited conversation about the horrors of Obamacare in the media because President Obama and the traditional media have limited the conversation

President Obama cannot bully the Supreme Court into not of upholding the constitution and it obligation to interpret the constitution accurately.

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

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The Facts

Stanley Feld M.D.,FACP,MACE

The fact that the Obama administration believes that Americans are stupid as expressed by Jonathan Gruber is an insult on its own. The fact that the Obama administration persists in treating us as if we are stupid simply compounds the insult.

In the run up to the February 15th ending of the 2015 www.healthcare.gov enrollment period and the new Republican congress’ upcoming vote to repeal Obamacare, the Obama administration is trying to convince Americans that Obamacare is working and is good for all Americans.

The public knows better by now. The middle class is feeling the economic pain Obamacare has created. They sense President Obama telling another lie.

 Recent headlines have been

Obamacare Will Cost 20% Less

Affordable Care Act will Cost 20% Less Than Initial Projections, CBO Says

Right-Wing Media Won't Tell You That The CBO's New Obamacare Cost Estimates Are Lower Than Expected

President Obama’s deception implies Obamacare is cost effective. All the CBO is saying is the numbers given to it, this time, by the Obama administration show the cost of Obamacare will be 20% lower than the CBO original estimate in 2011.

The additional new taxes for Obamacare were initiated in 2011 based on those CBO estimates.

One important reason for the 20% decrease in cost from the original estimate in 2010 is that fewer people have chosen to enroll in www.healthcare.gov in 2014.

Since fewer people enrolled there is a $51 billion of savings in federal subsidies for fewer enrollees in health insurance exchanges.

This represents a failure of Obamacare not a success as claimed by the Obama Administration.

The government estimates a total 10.7 million will enroll by February 15,2015. On February 2,2015 there were 7.53 million qualified enrollees. The original estimate in 2010 was 17.5 million. The first 2015 estimate enrollment in 2014 was reduced 3 months ago to 13 million. The enrollment figure was modified.

The taxes the middle class have been forced to pay for Obamacare were not modified.

The real numbers are totally confusing because the government documentation is very difficult to follow. CMS modifies the numbers constantly with corrections. The modifications serve to keep Americans stupid and confused.

The Obama administration is now spinning the significance of the CBO report to its political advantage.

The online Daily Mail of Britain published this online story. The headline does not exactly reflect potential consequences of the Facts.

"Obamacare program costs $50,000 in taxpayer money for every American who gets health insurance, says bombshell budget report."

  • ·       Government will spend $1.993 TRILLION over a decade and take in $643 BILLION in new taxes, penalties and fees related to Obamacare
  • ·       The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best
  • ·       The law will still leave 'between 29 million and 31 million' nonelderly Americans without medical insurance
  • Numbers assume Obamacare insurance exchange enrollment will double between now and 2025 "

  Buried in a 15-page section of the nonpartisan organization's new ten-year budget outlook were numbers to calculate the cost of Obamacare legislation to add patients to the insurance role. “The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best.”

It is impossible to judge whether these estimated figures are correct because estimates are mostly wrong.

What we do know is Obamacare is not doing well from everyone’s except President Obama’s point of view. The spin is keeping all Americans who are seeking the truth confused. Americans want a solution to the deterioration of the healthcare system.

Another reason for the reduction in Obamacare healthcare spending could come from the reduction in reimbursement to physicians.

Insurance companies have not suffered the same reimbursement insult because the government has subsidized the healthcare insurance industry and provides a guaranteed profit that is not included in the CBO estimate.

A third reason for the reduction in spending could be explained in part by the growth of consumer-driven health plans and the Great Recession.

A fourth reason for the 20% reduction could be that the insurance products on the health insurance exchanges have high deductibles. It takes a while before the patients reach their deductibles and the government starts spending money on reimbursement. Patients can also be staying away from receiving appropriate medical care because they cannot afford the deductible.

The CBO report projects that 75 percent of enrollees will receive subsidies in 2015. However, 87 percent received subsidies in 2014. This is wishful thinking on the part of those who provided the data for the CBO to evaluate to believe the subsidy percentage will decrease.  The CBO projected a further decrease in subsidy to 71% in 2025.

The health insurance exchange experience so far suggests there is adverse patient selection. It can be assumed that there will be an increase in healthcare risk and an increase subsidy percentage in the future.

CBO projects the average exchange subsidy per covered enrollee in 2015 will be $4,330 and increase to $7,710 by 2025. These costs represent a 78 percent increase in costs.

However, I do not think anyone can draw any conclusions from the CBO’s report.

I do believe that Obamacare is President Obama's  push to a single party payer healthcare system because of the structure of its market driven elements are destined to fail.

Government will then take over telling us what medical care we can or cannot have.

”We are fast approaching the stage of ultimate inversion: the stage where the government is free to do anything it pleases, while the citizens may act only by permission.” - Ayn Rand

The CBO report of a 20% reduction is spending as a result of Obamacare is meaningless. It is being used by President Obama to confuse the public for political reasons.

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

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Obamacare’s Solyndras

Stanley Feld M.D.,FACP, MACE

Peter Orszag was previously President Obama’s director of Office of Management and Budget. He was wrong about Obamacare’s economic impact, improvements in the healthcare system and efficiency in 2009.  He is wrong about it in 2015 in his critique of Steven Brill’s book “A Bitter Pill”.

http://www.bloombergview.com/articles/2015-01-12/what-brills-bitter-pill-gets-wrong-on-obamacare

The problem is Peter Orzag still believes in the Obama administration’s fiction. He quotes the Obama administration’s spin of the results as proof of Obamacare’s success. There is little valid data to back up the spin.

Obamacare has had its share of Solyndras. Solyndra was destined to fail. It had a lot of built in organizational waste.

I fear the few Obamacare experiments that we are aware of that have failed are only the tip of the Obamacare failure iceberg. There will be many more debacles that the Obama administration is probably hiding. 

CLASS

Community Living Assistance Services and Supports, or CLASS, was designed to provide cash benefits for those patients needing long-term services and support. CLASS was a part of Obamacare (Affordable Care Act). Many Republican and moderate Democrats objected to CLASS and considered it fiscally unsustainable. It would only waste money.

Senate Budget Committee Chairman at the time Kent Conrad D-N.D. called CLASS “a Ponzi scheme of the first order”. In any event the $68 billion dollar program was rammed through as part of Obamacare.  

Two years later the Department of Health and Human Services determined CLASS could not be implemented in a fiscally solvent manner, and in January 2013 Congress repealed CLASS.

In 2015 the American public still does not know how much of the $68 million dollars was wasted.

Just how much did HealthCare.gov cost?

 The American public will never know. We will never know what we should have paid for the website or what we finally paid.

In October 2013 as soon as it was apparent that www.healthcare.gov was a train wreck the Obama administration denied all the published prices contracted for building the website.

Prices to build the website varied from $91 million dollars to $634 million dollars to over 1 trillion dollars ($1,000,000,000.00).

Americans did not know what the website should have cost. They never found out what the cost was to rebuild the website after the initial disaster.

It was never clear whether the contract to CGI was won by competitive bid. The Obama administration never answered the question of Michelle Obama’s influence in choosing CGI.

The history is clear. CGI has failed to deliver for other projects they have done in other parts of the world.

What is the truth? Why would the Obama administration pick this company? What can we do about this waste of taxpayers’ money?

I guess Americans can remain passive and pay more taxes.

Americans have given up on the truth about the www.healthcare.gov

 debacle. The attitude of many is that it is what it is. We must go on.

All Americans are hearing or want to hear is the current website is easy to use and is working well.The important question is, Is it?

It is easy to understand why Jonathan Gruber would say Americans are stupid and the lack of transparency is a powerful tool. The implication of that statement indicates an Obama administration attitude. It is the reason the administration says they hardly knew the guy.

CoOportunity Health falters, taken over by state

This Obamacare debacle almost got away from recognition by the American public.

 CoOportunity Health is a fledgling Iowa health insurance cooperative set up under  Obamacare with Obamacare money.  It is going bankrupt.

CoOportunity Health was set up by the Obama administration. The Obama administration granted the company $146 million dollars in funding from Obamacare funds. The idea was to provide consumers and small businesses alternative insurance in healthcare markets with limited insurance choices. It could also be thought of as a disguised “Public Option”.

The healthcare insurance industry had refused to participate in the federal and state insurance exchanges in many states. The healthcare insurance companies thought the risk was too great. They would lose money.

Just before this year’s open enrollment period President Obama activated the reinsurance provisions in Obamacare guaranteeing insurance companies that they can only make money and not lose money on providing insurance through the government health insurance exchanges.

The Healthcare insurance companies are falling all over themselves to provide healthcare insurance in high risk states now.

 Where else can you sell insurance to more people at no risk?

“As of December 12,2013 Cooportunity has only $17 million of the $146 million dollars left.  CoOportunity has been taken over by state regulators and could soon go under, officials said Wednesday.

The Obama administration knows they can now throw government funded insurance companies like CoOportunity under the bus because they have guaranteed backup companies from the healthcare industry that want to sell no risk insurance.

 The CoOportunity hasn't reached insolvency yet but it doesn’t have  enough money on hand to continue to run the company.  It will leave 96,350 consumers uninsured with unresolved claims healthcare insurance claims. These consumers will also lose their un-used premiums.

The 96,350 should be able to get insurance through the federal health insurance exchange in their state.

The federal government as banker has simply cut CoOportunity’s credit and took a $146 million dollar loss.

I wonder how many other Obamacare funded insurance companies are out there?

I wonder how many other Solyndra like experiments Obamacare has. I can think of at least 4 or 5.

I wonder how much money Obamacare is losing on experiments and bureaucratic waste?

It is making medical care more expensive for taxpayers and for patients with increased out of pocket expenses.

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

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Notice The Enrollment Spin

Stanley Feld M.D.,FACP,MACE

The disinformation coming from the Obama administration is unrelenting.

CMS has released Obamacare’s open enrollment numbers through 12/15/14.

 On December 15,2014 all of last years enrollees who did not change their health plan or did not discontinued their plan were automatically re-enrolled for 2015.

 

Confirmed 2015 QHPs: 3,039,524 as of 12/15/14”

“Estimated 2015 QHPs (Cumulative):


11/21: 610K (462K HCgov) • 11/28: 1.02M (765K HCgov) • 12/05: 1.80M (1.35M HCgov) Thru 12/15: 4.70M (3.52M HCgov

http://acasignups.net

Enrollment by state can be studied in the following link.

The Obama Administration bragged with the following statement.

The number of people enrolling or re-enrolling last week was considerably higher than in previous weeks. Week one saw 500,000 enrollees, week two had 300,000 and week three saw 600,000 sign up through HealthCare.gov.

Week four saw 850,000 people enrolling or re-enrolling.

The cumulative estimate of people needed to sign up was 4.7 million through 12/15/14. The sign up number included people who were automatically re- enrolled with the same insurance policy they bought last year. This year’s premiums and deductibles will be higher that last year’s premiums in most cases.

The Obama administration picked up 1 million enrollees for the week as a result of the automatic re-enrollment. These enrollees have been warned that they will be paying a higher premium than if they searched for a different plan by a different insurance carrier.

Only 3.4 million sign ups were confirmed to receive healthcare coverage by January 1,2015.

This is only seventy percent (70%) of the expected enrollment through 12/15/14. The enrollment had been extended previously to February 15, 2015.

http://acasignups.net/spreadsheet

CMS told us that last year 8 million were enrolled. The number was modified to 7.2 million and then changed to 6.7 million as 400,000 were not enrolled in healthcare but bought dental care insurance.

We were never told that 65% of the enrollees received federal subsidies in the traditional media. How many of those people who received subsidies subsequently lost their subsidy because the IRS could not confirm their reported income?

The next critical question is how many of the people who lost their subsidy dropped their insurance because they could not afford the premiums and deductibles.

How many people that enrolled have preexisting illnesses? How many of the people who enrolled can pay the high deductibles and copays?

How many people in the individual market can afford to pay the insurance premiums with pre-tax dollars?

Whatever the premium is in the individual market the enrollee has to have twice as much disposable income to pay the premium because the premium is not tax deductible.

Healthcare insurance premiums are tax deductible to employers in the employer group markets.

How many taxpayers know that the Obama administration is subsidizing the healthcare insurance industry so the industry cannot loss money if the healthcare insurance is bought through Obamacare?

The original goal for enrollment for 2015 was 13.5 million. It was lowered to 12 million and now 9 million by the time the enrollment started. If 6.7 million were originally enrolled the increase in new enrollment will only be 2.3 million.

What happened to all the millions of people who lost insurance through their employer because they were shifted to part-time work?

It seems that Obamacare is unattractive or unaffordable to those who need it most. If taxpayers knew the waste in Obamacare’s administration and guarantees to the healthcare industry, taxpayers would not be very happy.

It goes back to Jonathan Gruber’s statement that the people are stupid and the lack of transparency is very powerful political tool.

Meanwhile, the enrollment rate is low but the Obama administration is feeding the traditional media the spin that enrollment is surging. This game is not going to promote Obamacare’s credibility.

More than a million people signed up for health insurance plans onHealthCare.gov in the past week, bringing the overall total of signups for the first four weeks of the current open-enrollment period to nearly 2.5 million, the CMS announced Tuesday.

Dec. 15 was the HealthCare.gov deadline to enroll for coverage to go into effect Jan. 1.” 

“More than half of the people who enrolled between Dec. 6-12 were renewing their coverage.

Many of the State Health Exchanges are already extending the deadline for coverage to begin January 1,2015, California, Maryland and Minnesota, Idaho, Massachusetts, New York, Rhode Island and Washington already have extended their deadlines for signing up.

If enrollment was going as well as the Obama administration claims, there would not be so many 2 week extensions.

 “Our community wants to do everything we can to make sure consumers have greater peace of mind about their healthcare coverage and to support them throughout the open-enrollment process,” Karen Ignagni, CEO of America's Health Insurance Plans, said in a statement Monday.ė

Why wouldn’t the healthcare insurance companies want more enrollees? They are selling insurance policies for the Obamacare at no financial risk.
 
Federal plans are underway for a special outreach campaign to the roughly 250,000 individuals whose existing plans are no longer being offered on the federal exchange for 2015. HHS plans to point these people in the direction of a plan that is substantially similar to the ones they've lost but they won't be auto-enrolled.”

The Obamacare’s enrollment period is desperate for more enrollees

HHS is rolling out online partnerships with three online firms to further promote HealthCare.gov during the current open-enrollment period,which ends Feb. 15.
The partnerships are with Monster.com, Peers.org, and Higi, a provider of interactive health stations tracking weight, BMI and other vital signs to supermarkets such as Kroger and Meijer. The company will post messages informing users of the open-enrollment period. 

The partnerships are innovative but have a low probability of success.

President Obama and his administration continue its information  spin. The real truth is the Obama administration is not transparent at all. It takes hard work to figure out what is the truth.

The public is beginning to figure out that they are not getting the truth.  Consumers are directly affected by the manipulation of the truth personally. Consumers are not showing up to participate.

Presently, Obamacare is only covering consumers in the individual marketplace.

Just wait until Obamacare affects the small group and large group employers that are going to have to pay a penalty for providing  unqualified Obamacare healthcare coverage. 

One outstanding example is the worthless Mini-med plans of McDonald and Burger King that President Obama gave a waiver to until 2017.

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

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Looking For Alternatives To Obamacare

Stanley Feld M.D.,FACP,MACE

The dice have been loaded against the American people by the rules and regulations in Medicare and Obamacare.

Patients liked their doctors. Once they discovered that they could not keep their doctors under Obamacare they became angry at President Obama for lying to them. The soon to be released new payment rules will increase the anger.

Physicians have found it more difficult to run small private practices.  The complexities of compliance with the rules, regulations and the payment systems for both Medicare and Obamacare are forcing physicians to sell out to hospital systems.

These complexities are in effect ending independent medical practices. This has been intentional. The Obama administration doesn’t want to control 600,000 independent physicians. It wants to deal with the hospital systems the are involved with. The hospital systems can then deal with the doctors.

Republicans are looking for a compelling alternative to Obamacare.

Just as Obamacare was forced through congress, President Obama is trying to force how medicine is practiced in America down the throats of Americans.

It is consistent with Jonathan Gruber’s view that Americans are to stupid to understand what is going on. It follows that Americans are too stupid to be responsible for their own care.

Americans want freedom of choice. They do not want the government to tell them what to do.

Republicans are looking for an alternative to Obamacare. A viable alternative could be to save the private practice of medicine and not subject Americans to the inefficiencies of a government controlled bureaucracy.

 Physicians by nature and education are competitive. Competition leads to improvement of the delivery of medical care.

All medicine is local. The alternative to Obamacare is to have local completion among physicians and permit patients to choose their doctors.

The answer to the Republican’s dilemma is right in front of their eyes.

A real Republican alternative to Obamacare would support physician ownership of independent medical practices and preserve local competition between doctors and maintain choice for patients.

Obamacare’s promotion of large hospital systems with salaried physicians eliminates physicians competing for patients. The lack of physicians competing for patients destroys the physician/patient relationship.

Physicians listen to patients if patients have a choice. The interaction is a partnership called the patient /physician relationship.

This solves the problem of President Obama’s lie. “If you like your doctor you can keep your doctor period.” Patients choose their doctors.

Dr. Donald Berwick and Jonathan Gruber’s view the consolidation of physicians and hospital systems as a necessary step to enable payment liability onto providers through hospital systems and away from government programs such as Medicare and Obamacare.

President Obama does not understand that doctors are not stupid either. At the moment physicians feel financially cornered by the government and the hospital systems and are joining hospital systems as a temporary means of surviving.

President Obama also does not realize that over the last 50 years there has been a build up of physician distrust for most hospital administrations.

Most administrators have tried to repair that mistrust but it has not been very successful. Hospital systems have been trying for years to own their physicians’ intellectual property and surgical skills for their hospital system’s profit. It is all about economics. Patient care is secondary.

As hospital systems consolidate competition will be eliminated.  Then hospital systems will realize they are losing money because of the risk they agreed to accept from the government. Hospital systems will demand more money from the government or consumers or go out of business.

Who loses? 

Patients lose, taxpayers lose, and the American healthcare system loses.

The abuses of the healthcare system by all the stakeholders must be fixed. It will never be fixed by forcing stakeholders to fix it. It will only be fixed by aligning incentives of all the stakeholders. Consumers must lead the way.

A recent Physicians Foundation survey of 20,000 U.S. doctors found that 35% described themselves as independent, down from 49% in 2012 and 62% in 2008.

It has also been reported that hospital systems are complaining that they are losing money on their physicians in these integrated systems.

Hospital systems are dropping out of the Obamacare Accountable Care Organization programs. There have been reports that salaried physicians are less productive that independent practicing physicians.

I believe in the team approach to the management of chronic disease. The patient must be at the center of the team with the physician being the head coach or manager and his team being an extension of the physician’s care.

Medical decision making entities must not be the insurance company or the government.

The idea that integrated systems with salaried physicians leads to increased economic efficiency, better quality of care and clinical outcomes than small independent private practices never made syllogistic sense to me.

Patient care becomes depersonalized in large hospital systems. Both patients and physicians become commodities in systems focused on the bottom line.

Small practices have the advantage of providing a personal style of care. Consumers want that comfort when they are sick. They want someone they know who is going to listen to them and talk to them.

In a private setting physicians can practice the way they want, without interference by a large, impersonal organization driving efficiency.

If a physician in private practice does not satisfy the consumer’s need the consumer can leave the practice and go somewhere else.

  "When you work closely with patients and empower them, they are going to make better choices," said Craig C. Koniver, MD, a solo family physician in North Charleston, South Carolina. He said a team of caregivers at a large practice will not have the same impact, because none of them are as close to the patient as he is.”

Health Affairs published a study in August 2014 looking at primary care physicians in small practices and “ambulatory care sensitive” admission rates. The study included such conditions as congestive heart failure in which admission to the hospital can be preventive by high quality primary care. The patient relates positively to the physician and the physician relates positively to the patient (positive patient/physician relationship).

“The study found that practices with 1 to 2 physicians had ambulatory care-sensitive admission rates fully 33% lower than practices with 10 to 19 physicians.”

This is not the only study that shows that small independent private practices can deliver just as high or higher quality of care than large integrated hospital systems with salaried physicans.

“ A 2013 study[2] showed that small practices in general had slightly lower hospital readmission rates than large practices.”

Additionally, “a 2012 study[3] looking at practices ranging from 5 to 750 physicians found that the smaller ones had fewer ambulatory care-sensitive admissions and lower overall costs of care for diabetes.”

 All three studies turned a piece of conventional wisdom on its head; that large practices, with their care management teams and sophisticated clinical information systems, produce better clinical outcomes.

Republicans should start presenting alternatives to Obamacare. The alternative must provide consumers with what they want rather than systems that let the government to tell consumers what they are going to get.

The ideal medical savings account will let consumers choose and keep their doctor if they like their doctor.

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

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If You Like You Doctor

Stanley Feld M.D.,FACP,MACE

 This is a message for the Republican majorities in the House and Senate. Obamacare is a disaster built on a failed ideology, deceptions and lies.

Obamacare started off with lies and continues to deceive the American public.  

Its emotional seductions have also deceived many physicians.

All one has to remember is Jonathan Gruber’s statement about the lack of transparency being a powerful political tool. Gruber said given the lack of transparency, the public is too stupid to figure out the truth.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=Jonathn+Gruber&x=28&y=9

President Obama told us; ”If you like your doctor you can keep you doctor, period.”

This statement was not true for an instant. President Obama knew it but ideology trumps reality. Many have blamed Obamacare’s failure on President Obama’s inexperience as a manager. This is not the reason.

The failed progressive ideology of big government controlling choices and freedoms of the American people is the reason for Obamacare’s failure.

Last week, Senator Charles Schumer (D-N.Y.) admitted the passage of Obamacare was a mistake. Not surprisingly, the mainstream traditional media has not mentioned Schumer’s admission.

The mainstream media has been a shill for Democrats and President Obama. It has helped the Obama administration keep the truth from the American public.  

 

 

 

http://youtu.be/O9m7fsSUUKQ

 

  

http://youtu.be/kOJfyT8juhA

President Obama keeps the American public uninformed with the help from the traditional mainstream media. His goal is central government control of Americans’ choices and freedoms. President Obama’s support is derived from his appeal to Americans’ emotions and not from the facts.

His problem is Americans are not stupid. They can separate reality from appearance when they pay attention. Obamacare is now affecting them directly and they are paying attention.

President Obama is waking up the sleeping tiger of Patient Power.

Obamacare is failing, but Obama’s lies keep coming. One recent lie is Obamacare’s open enrollment period is going well. I have shown evidence to the contrary in my last blog. So far the administration is 50% behind their estimated sign ups.

As of 12/05/2014 open enrollment is still (884,354/1,050,000) behind with 59% of estimates to sign up.

 

Confirmed 2015 QHPs: 884,354 as of 12/04/14

 

Estimated 2015 QHPs (Cumulative):11/21: 610K (462K HC.gov) • 11/28: 1.02M (765K HC.gov)
12/05: 1.50M (1.12M HC.gov) (special: 1.64M / 1.23M HCgov)

Thru 12/06: 1.57M (1.18M HC.gov)

 The biggest lie, since “you can keep your doctor, period” is that healthcare spending is decreasing because of Obamacare. This lie is a complicated lie. It is important to understand this lie.

 Obamacare is not lowering healthcare spending. It is increasing healthcare spending. Premiums and out of pocket costs are increasing for consumers.

 As a result of Obamacare deductibles have increased beyond affordability. Consumers cannot afford to utilize their “healthcare insurance” until absolutely necessary. The result will be higher costs when patients are forced to use the insurance because of the development of complications from a chronic disease.

 “The Bureau of Economic Analysis issued its advance estimate of first-quarter growth in 2014, which barely made it into the black with an annualized GDP growth rate of 0.1 percent.

Healthcare spending rose at an annualized rate of 9.9 percent, far outstripping inflation and standing in stark contrast to other components of the BEA report.

 Exports fell 7.6 percent, and demand for imports declined by 1.4 percent. Consumer consumption rose 3.0 percent, but that came in part from the high rate of health-care spending.

Without the spending on health care in 2014 Q1, annualized GDP would have dropped to a recessionary -1.0 percent, according to economist Ian Shepherdson.”

 In 2008, pre Obamacare, the US had seen a drift downward in health-care spending.

 The downward trend began to reverse as Obamacare first officially launched in October 2013. In the fourth quarter of 2013, health-care spending rose 5.6 percent, far above the 2.6 percent growth rate of the economy, to which it significantly contributed.

 The New York Times writes article after article claiming that the cost of healthcare is decreasing. The implication is that Obamacare is working.

 Nothing could be further from the truth.

“The rapid increase in spending does not indicate that the system is working to lower costs, an absurd if not Orwellian construct by President Obama.

“Nor is the debate “over,” no matter how many times Obama claims otherwise. Too bad the White House chose not to take advice from National Journal’s Ron Fournier

“The president risks insulting a vast majority of Americans by dismissing their concerns with a consultant's talking point,” Fournier wrote before the economic figures were released, “and Obama can't afford any more blows to his credibility.”

Consumers are tired of President Obama’s lies. He has lost all credibility with the American public.

The Obama administration keeps telling us how well Obamacare’s Accountable Care Organizations are doing. The Obama administration keeps saying hospital systems must set up integrated healthcare systems (ACOs) to increase the quality of care.  

 Hospital systems have been promised increased revenue incentives by setting up ACOs. Most hospital systems are losing money with their ACO’s.

As a result of losing money hospital systems are dropping out of the federal ACO program.

 This week, the Obama administration published regulations to decrease the hospital systems’ risk and increase its financial incentives, in order to decrease the ACO dropout rate.

President Obama refuses to believe that even though the ACO model sounds great its successful execution is difficult to impossible. 

The chances for ACOs to succeed is not only dependent on the hospital system’s ability to decrease utilization, it is heavily dependent on patients taking responsibility for their own care. Patients must follow instructions.

President Obama believes he can lie his way out of reality. The American public is not buying these lies any more.

Republicans must focus on the reasons for the obvious failures of Obamacare.

Consumers want to have freedom of choice. They do not want the government to control them.

Republican must focus on creating programs to provide incentives for consumers to be in control and responsible for their health and healthcare dollars. 

Republican must focus on ways to permit consumers “to keep their doctors if they like their doctors period.”

My ideal medical saving account will do all of the above.

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

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Obamacare Deceptions Keep Coming

Stanley Feld M.D.,FACP,MACE

President Obama and CMS have been extremely quiet about Health Insurance Exchange enrollment since enrollment opened November 15,2014

President Obama reported that on  opening day the health insurance marketplace performed much better than last year. However, some consumers reported long, frustrating delays trying to buy insurance and gain access to their own accounts at HealthCare.gov.

Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which also vexed many people last fall.

Some people did complete their applications, but it often took them 90 minutes. Some people were unable to finish what they started, so they left the clinic with plans to return at another time.

The insurance exchanges are supposed to be the centerpiece of Obamacare.

 Ms.Sylvia Burwell, the Secretary of the Department of Health and Human Services said, “23,000 people had completed online applications in the first eight hours after HealthCare.gov, the federal website, opened on Saturday morning.”

Twenty three thousand is a low number for a 45-day enrollment period with four days each at Thanksgiving and Christmas.  It is only 1,035,000 enrollees (45 x 23,000). We do not know if they are new or old enrollees. 

Ms. Sylvia Burwell has given us signals previously that all is not well with Obamacare.

The estimate of total enrollees (old and new) for the end of the 2015 enrollment period was lowered from 13 million to 9 million. If 8 million were enrolled in 2014 this is only an increase of 1 million new enrollees.

There were clearly not 8 million valid enrollees when President Obama did his victory lap at the end of the extended enrollment period on March 31,2014.

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It was later announced that 85% of enrollees were to receive subsidies (tax credit). The tax credits were to make the insurance premiums affordable to enrollees earning less than $50,000 a year.

It turned out that 65% of those approved for subsidies originally had the subsidy reduced when they could not verify their claimed income.

The American taxpayers, who are responsible for the subsidy (tax credit), were never told how the government was going to collect the government over payment. Taxpayers were never told the amount of  payment due from people who received the invalid subsidies.

 How many of those over subsidized people dropped out of Obamacare because they could not afford the premium or the deductible.

How many enrollees remained from the 8 million claimed to have enrolled?

 Somehow the published number of enrollees dropped to 7.3 million. Did the decrease from 8 million to 7.3 million include the over subsidized dropouts?  

I should think an inspector general or someone in congress would start connecting the dots.

I would think the CBO would recalculate their estimates.

I should think someone in the press would sense there was something fishy and start investigating.

 

Last week it was discovered that 400,000 people were counted in the total enrollment number that did not buy healthcare insurance. The 400,000 enrolled for low cost dental insurance.

 This new revelation lowered the total number of claimed enrollees to 6.9 million from the 7.3 million claimed enrollees.

Kathleen Sibelius declared over a year ago that Obamacare would have to have over seven million enrollees to be viable and declared successful.

In a previous blog my estimate of valid enrollees for 2014 was 3 million. I have also pointed out that the healthcare insurance industry is not worried about the number of enrollees because if they lose money the government would bale them out and subsidized the difference.

The loser is the taxpayer. We have been paying a tax increase of more than 10% for Obamacare since 2010.

The public has not yet seen any numbers proving Obamacare’ s viability or it’s bending of the cost curve.

 We have seen patients complaining that they cannot afford the 6-10 thousand dollar deductibles of the health insurance policies. People have realized that they are not covered by insurance until they reach their deductibles. People have been hesitant to get necessary medical care in order to avoid paying the deductibles.

The Obama administration claims to have reduced healthcare costs. The administration does not count the patient’s deductible costs (out of pocket costs) in their bogus calculation of costs to the healthcare system.

The avoidance of follow-up care by patients with pre-existing illnesses (chronic diseases) is only going to lead to complications of those chronic disease and higher societal healthcare costs.

Lowering the goal for the number of enrollees to 9 million if only there are only 3 million valid enrollees that stayed in the system is going to be a very difficult task.

The changing of the date to begin open enrollment from October 1 to November 15 for political reasons is not going to help achieve the goal.

President Obama will probably extend the enrollment period from December 15,2014.

The Obama administration already announced the 2016 open enrollment period. It starts October 1 2015 and ends December 15, 2015.

There is a great website that calculates the estimated weekly enrollment and actual enrollment. Enrollment is not going very well. President Obama and his administration are very quiet about the enrollment. The mainstream traditional media is also ignoring enrollment.    

 

The website is, http://acasignups.net

As of 11/21/2014 the website reports confirmed enrollees for 2015 QHPs: at least 39,215 have enrolled as of 11/21/14 as opposed to the government estimated enrollees for 2015 QHPs of at least 410,000 as of 11/21/14.

No one is paying attention to the website. The Obama administration is not providing the information necessary for consumers to judge how well Obamacare enrollment is doing.

Ms. Burwell said,

Ms. Burwell said that attention should be on all of the people who now have health insurance, rather than the miscalculation.

While we understand some will be skeptical, our clarity that this is mistake and the fact that we have quickly corrected the numbers should give people confidence,” she said. “It is important to continue to focus on the fact that millions of Americans are getting affordable health care.”

The Obama administration persists in trying to distract the American public.

I think the Obama administration continues to believe, as Jonathan Gruber believes, that Americans are too stupid to understand what the administration is doing.

The administration wants to prove that the free market and private insurance cannot provide healthcare coverage for all that only total government control of the healthcare system can work.

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

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Obamacare Deception Continues

 Stanley Feld M.D.,FACP,MACE

Open Enrollment for Obamacare started November 15th rather than October 1st. Open Enrollment for Health Insurance Exchanges was originally going start October 1,2014 to run until December 15,2014 for enrollees to have insurance on January 1,2015.

It think the open enrollment dates were delayed to prevent negative publicity for Democrats in the midterm elections. The date to close open enrollment has been moved to March 15th or March 31st2015 instead of December 31,2014.

President Obama is changing dates at will without congressional approval. It is creating confusion. Americans are giving up on following changes in the law.

President Obama probably believes, as Jonathon Gruber, that the American public is too stupid to follow all of his maneuvers.

It is impossible to know when open enrollment ends by following the mainstream media. I think it will end when the Obama administration has something to brag about despite what the law demands.

Early in 2014 it became clear to health insurance consultants that the healthcare insurance industry would raise Obamacare 2015 premiums by double digits (15-30%). The demographic of 2014 enrollees was actuarially unsound according to the healthcare insurance industry.

The Obama administration expressed fear that the healthcare insurance industry would not participate in the health insurance exchanges because they were destined to loss money.

The Obama administration is presently boasting that the average premiums are going to rise only slightly in 2015.  

Healthcare insurance companies are flocking to sell insurance in more markets rather than quitting the health insurance exchanges.

The Obama administration claims that Obamacare has created a competitive atmosphere for the healthcare insurance industry.

You bet it has. It has done the by creating subsidies for the healthcare insurance industry so it takes on no risk along with increased profit. This is the reason all the companies are fighting to get into the health insurance exchange market.

President Obama has offered to bail out the healthcare insurance companies if they do not make an adequate profit in the health insurance exchange.

The mainstream traditional media has not reported that Obamacare provided insurance company subsidies, nor have the subsidies been connected to the dampening of extreme increases predicted for premiums in 2015.

However, the decreases that are being reported by the Obama administration are deceptive.

Below is a CMS provided map of states and counties with either increases or decreases in premiums.

 

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In about a fifth of the counties in states using the federal insurance exchange, premiums for the lowest-priced silver plans will increase by 10 percent or more. But rates for the same plans will decrease in all of Maine, Montana and New Hampshire, and most parts of Mississippi and South Dakota. NOV. 14, 2014

Largest decrease: -28.0%

Greatest increase: +29.5%

Minneapolis, Honolulu, Seattle, Phoenix, San Diego, St. Louis,  New Orleans , Dallas, Boston, Tampa, Philadelphia Detroit, Anchorage, San Francisco, Denver, Houston, Miami, Atlanta, Chicago, Los Angeles, Washington, D.C. New York all are experiencing increases in premiums.

 Source: Centers for Medicare and Medicaid Services

A PricewaterhouseCoopers report on all individual market premiums — on and off Obamacare exchanges — found a large range of rate changes, from a drastic 35 percent hike in Colorado to a 22 percent cut, also in Colorado (the state’s Obamacare exchange changed the geographic rating areas this year to cut costs for ski resort towns). Overall, the average rate hike nationwide is 5.6 percent, according to PWC.

The published map belies the Obama administration’s claim that premiums have been, on the average, lowered. It does not take into account population density in counties where premiums are lowered or raised.

Eight states are facing double-digit premium hikes in 2015 while just four states have reported decreases according to the Daily Caller.

 The premiums in some states could be lowered. However, the high deductibles included in these health insurance plans have not been lowered. The high deductibles are out of pocket expenses. The high deductibles continue to be unaffordable to many even thought these enrollees might receive sizable “tax credits? subsidies?” to help them pay for the premiums.

In January 2014, I described the subsidies provided by the Obama administration to the healthcare insurance industry. The Obama administration guaranteed a profit for participating in the health insurance exchange at no risk through the Reinsurance program and the Risk Corridor program that is buried in Obamacare.

(Nancy Pelosi: “We will not know what is in the bill until we pass the bill.”)

 “This was one of President Obama’s deceptions.

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

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

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

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

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

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

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

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

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

 Who makes the profit from this subsidy?

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

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

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

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

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

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

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

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

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

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

 There are many other deceptions that lie ahead. Now that the Jonathan Gruber controversy has increased the American public’s awareness of Obamacare deceptions Americans will begin to shout about the costs and rationing of care.

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

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