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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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Doctors’ Salaries; The Media Is The Message

June 1, 2014

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Physicians’ salaries are not the cause of the escalating healthcare costs.

The economic factors involved are complex. The escalating costs result from cost shifting, government regulations and the lack of tort reform. The result is each stakeholder tries to optimize his stake in the dysfunctional healthcare system.

Further dysfunction occurs in reaction to the individual stakeholder’s attempts at optimization. The costs escalate.

The government permits insurance companies and hospital systems to calculate expenses and profits in strange ways.

Physicians’ socio-economic interests have the weakest representation in the healthcare ecosystem. The lack of representation allows physicians to be the easiest stakeholders to blame for healthcare’s rising costs.

As always the media is the message. The traditional print media are desperate to print anything that will capture the attention of the public and sell newspapers.

The Dallas newspaper published a story a few weeks ago titled “North Texas Medicare Millionaire Doctors.” and asks the public,

“Is your doctor one of the 340 in Texas to make more than $1 million from Medicare?”

"More than 340 doctors and other care providers in Texas received over $1 million each in 2012 under the government’s Medicare health insurance program, according to data released Wednesday that provides the public its first inside look at physician billing practices."

CMS released the Medicare database to inform the public what physicians and physician groups are charging Medicare.

The data reflects payments made by Medicare.

The data does not

reflect whether one physician identifier number is included in the billing for multiple providers.

reflect the charges and payment for a service.
reflect if it was physically possible for the individual named to perform all the services implied.

It lets the reader imagine that the providers “physicians” are crooks as well as a millionaires.

It then follows that most physicians must be crooks.

There is nothing to be learned from the data as presented. This data must go through many layers of dissection in order to mean anything.

However, “the media is the message” and the point was made.

The bad thing is many of these articles with their imbedded implied conclusions are written from press release information provided by the government. This is called "government induced disinformation."

Reality is much different. Physicians are the most highly trained workers in the healthcare system. Without patients and physicians a healthcare system would not exist. What is the individual physician’s salary? What is he/she worth? These questions are the real questions.

Physicians have seen their incomes fall, their clout with insurers shrink, and their practices weighed down by a plethora of new requirements.

Physicians are starting to wake up and realize that all this is the direct result of them being exploited by payers, hospitals, policymakers, government and other groups that have become more powerful than the medical profession.

The example of the disinformation generated by the implications of the millionaire physicians ripping off the public is just one example of this exploitation of the medical profession.

The other stakeholders are doing this to deflect attention from how they are ripping off the healthcare system.

‘That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.”

“The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys.”

The survey shows that the average salary for

An insurance chief executive officer is $584,000
A hospital C.E.O. $386,000
A hospital administrator $237,000,
Compared to an surgeon $306,000
And an average general doctor $185,000 .

This is an interesting payment gap. These secondary stakeholders do not add value to direct patient care.

The salary gaps between secondary stakeholders get worse because these numbers represent only the average base salaries.

The basic question is what are these executives worth?

What encourages a board of directors of their organizations to award these high salaries?

What in the government tax structure and regulations encourage these high salaries?

“And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in non-salary compensation.”

Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised.

Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012 the year he retired, but total compensation of $21.7 million.

These two minor examples are appropriate. These are also low-end examples. There are many more.

The Wellpoint and United examples are more stunning.

Sources: Compdata Surveys (salaries); the Commonwealth Fund and the Organization for Economic Cooperation and Development (administrative costs)

Physicians are waking up. They are starting to step forward and are pointing out the real abuses in the healthcare system.

“Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin took out an advertisement in The Wisconsin State Journal demanding widespread health reforms to lower prices, including penalizing hospitals for overbuilding and requiring that 95 percent of insurance premiums be used on medical care.

The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

Keith Smith M.D. in Oklahoma City has done it. His surgical center is doing surgery for 25-40% less than the typical hospital whose costs are bloated by administrator salaries and bureaucracy that add no value to direct patient care.

Somewhere there is a corporation that is self –insured and will set up an Ideal Medical Savings Account for its employees that will by-pass all the bloated bureaucracy and large salaries of the healthcare insurance industry.
It will result in a decrease in cost and a user-friendly healthcare system.

The generation of a consumer driven healthcare system will begin. All President Obama has to do is get out of the way.

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

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What Is Net Neutrality?

May 21, 2014

inDisinformation and the healthcare system, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Net neutrality is the idea that broadband operators shouldn't be allowed to block or degrade Internet content and services–or charge content providers an extra fee for speedier delivery or more favorable placement.

In November 2011 I wrote about the government attempt to control the Internet Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261).

The title of the article was “The Government and American Censorship: 1984 in 2011.”

I searched the New York Times to see what the newspaper that (“Prints all the news fit to Print”) had to say about the bills. My search produced this reply.

Your search – Protect IP Act (PIPA – S.968) and Stop Online Privacy Act (SOPA – H.R.3261). – did not match any documents under All Results Since 1851.

The most vital part of our economy and job growth at the moment is the Internet. These two bills will destroy this monumental jobs creating machine.

It is another piece of lunacy brought to you by our federal government. I wonder how many Representatives and Senators have read the bills.

“There are two very disturbing bills making their way through Congress: These bills are coated in rhetoric that I find disgusting since at their core they are online censorship bills. It’s incredible to me that Congress would take seriously anything that censors the Internet and the American public but in the last few weeks PIPA and SOPA have burst forth with incredibly momentum, largely being underwritten by large media companies and their lobbyists.”

Let me remind everyone that large media companies offered huge support to President Obama and the Democrats in congress. These bills are congruent with the large antiquated media”s vested interest and President Obama’s goal of central control over our lives.

EFF, Free Software Foundation, Public Knowledge, Progress, Fight, Participatory Politics Foundation, and Creative Commons in support of free speech and a free and open Internet are opposing the bills and have organized American Censorship Day for tomorrow (11/16/11). The goal is to make every American aware of this new trick play and stop this lunacy.

This video does a great job of explaining the two bills’ potential primary and secondary impact. I do not believe our congressional representatives understand the impact of the bills.

Someone is trying to railroad passage through congress.

PROTECT IP Act Breaks The Internet from Fight for the Future on Vimeo.

Both failed to pass in congress because of the overwhelming outcry by the technology community.

President Obama promised the American public he would issue regulations through executive orders and agency powers to enact laws that congress failed to enact.

When President Obama was running for president in 2007 and 2008 he was a strong proponent of Net Neutrality.

At that time President Obama was asked: "Would you make it a priority in your first year of office to reinstate Net neutrality as the law of the land? And would you pledge to only appoint FCC commissioners that support open Internet principles like Net neutrality?"

"The answer is yes," Obama replied. "I am a strong supporter of Net neutrality."

The White House announced: President Obama is strongly committed to Net Neutrality in order to keep an open Internet that fosters investment, innovation, consumer choice, and free speech. The announced action by FCC Chairman Genachowski, building on the work of Chairman Waxman's collaborative effort to craft legislation in this area, advances this important policy priority.

http://youtu.be/-Lz-bPHojVE

http://youtu.be/mP01t0Z4Hr8

In 2014 President Obama hires a lobbyist Tom Wheeler who is a former telecommunication lobbyist. Mr. Wheeler is opposed to Net Neutrality. The president has the FCC issuing regulations that oppose Net Neutrality and transfer great power and a complex bureaucracy to the federal government.

It represents another broken promise by President Obama.

“Federal Communications Commission Chairman Tom Wheeler went ahead with his proposal on Thursday to give his agency the power to decide whether the terms and prices of broadband Internet services are "reasonable."

http://youtu.be/km1AhFkt4Dk

This is another power grab by the central government to have control of the Internet. The concept is once again not covered by the traditional media in an understandable way.

As a reaction to satisfy the “Net Neutral” community Mr. Wheeler said the goal is not to have a fast and slow speed Internet no matter how much broadband they consume.

Mr. Wheeler said he prefers the "reasonable" pricing standard. But he also suggested another, even worse option to regulate broadband prices: reclassifying Internet connections as "telecommunications services."

A reader of my blog wrote, "Can you think of anything that the U.S. government does really, really well?"

“For two decades Congress has wisely refused to give the FCC the same power over the Internet that it holds over the telephone system. And for two decades the Internet has enabled a gusher of creativity that was unimaginable over a century of regulated telephony. “

Regulators from every state will also be able to get into the act. I cannot imagine it will be regulated for the benefit of consumers. There is something strange about all the telecoms companies merging with each other in the past few months.

“Mr. Wheeler's brainstorm to change all this is simply to pretend the Internet is a phone network.”

Since this designation would automatically impose myriad obligations that have nothing to do with current customer needs—and that many modern firms could not possibly fulfill—the commission would then have to issue a flurry of exemptions ("forbearance" in FCC parlance) to prevent chaos in the market for Internet connections.

The FCC is inventing an Obamacare for the Internet. It is enacting an unworkable system upon a system (the Internet). Then the FCC will have to get busy issuing waivers which will prevent the new system from operating as it was theoretically designed to operate.

The telecommunication industry will have a field day at the expense of the public.

“GOP Commissioner Michael O'Rielly, who also dissented, notes that the FCC's net-neutrality campaign "rests on a faulty foundation of make-believe statutory authority."

Imagine all the costs, confusion, lawsuits, legal fees, and regulations that will occur to restrict the freedom of the internet and all the innovations in commerce the Internet has created.

The elimination of Net Neutrality is all about increasing government power, restricting individual freedoms and shifting the costs of government’s inefficient control on to consumers.

Anna Eshoe is the ranking Democrat on the Communications and Technology Subcommittee. She has pointed out that the new FCC wording has not fooled Silicon Valley entrepreneurs.

“Like many Internet users, I fear that the latest round of proposed Net Neutrality rules from the FCC will not do enough to curtail discrimination of Internet traffic, but rather leave the door open to discrimination under more ambiguous terms.”

The new regulations diminish Net Neutrality while empowering government bureaucracy. The online gatekeepers threaten free speech, harm competition and diminish the continued openness of the Internet. The proposed regulations do not protect the freedoms and available to consumers and businesses in a Net Neutral environment.

Barack Obama promised in the 2008 and 2012 campaigns that he would enforce Net Neutrality. He has not kept that promise.

The affect on Americans’ freedoms will be as bad or worse than Obamacare.

Please write to your congressmen and President Obama and ask them to preserve Net Neutrality.

Thank you

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

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Risk

April 2, 2014

inConsumer Driven Health Care, Disinformation 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

The purpose of insurance is to cover risk. For many years the government has protected the healthcare insurance industry’s profit through laws and administrative regulations.

The state insurance regulators are supposed to protect consumers again abuses by the healthcare insurance companies. Many State Boards of Insurance have not administered their responsibility effectively.

The federal government put out for bid the administration of the federal programs such as Medicare, Medicaid and the VA systems. It has not done this job very effectively. There has been much fraud and abuse in this system.

Somehow the healthcare insurance industry has talked these regulators into permitting the insurance industry to take 40% of the healthcare premiums off the top.

Obamacare mandated a Medical Loss ratio of 80/20. Eighty percent of the premium dollars are to be spent on direct patient care and 20% can be held back for expenses and profit.

However, the regulatory agencies have permitted an additional 20% of expenses to be written off as direct patient care.

The details of these expenses are so complex that few can understand the direct patient care expenses.

Recently, we have heard that if the insurance demographic mix is inappropriate, provisions are written into Obamacare that permit the healthcare insurance industry to achieve a profit.

If it does not reach its profit goal, Obamacare will bail out the healthcare industry. The traditional media has not paid much attention to this provision.

High deductible healthcare plans are very attractive to people who are at low risk for disease. If an unforeseen illness occurs they could buy an inexpensive first dollar coverage plan.

Obamacare is slowly eliminating those plans.

President Obama is trying to drive everyone into a health insurance exchange plan in the name of creating competition among insurance companies. His administration is also picking preferred insurance companies to sell these plans state by state.

President Obama is also choosing hospitals to participate in the state insurance plans’ networks. In some states the insurance company choices are thin to nonexistent. An example is New Hampshire with one healthcare insurance vendor. The same state has eliminated two thirds of hospitals and physicians eligible to participate in the health insurance exchanges.

Some of the best hospitals and clinics are not participating in the exchanges. In some cases reimbursement is too low.

Obamacare’s excuse is this will eliminate the facilities that overcharge and eliminate the risk of cost overruns.

All this keeps the healthcare insurance industry in charge of the risk. In order to reduce costs patients have to be motivated to avoid illness and be responsible for their own health and healthcare dollars.

This concept is not embodied in Obamacare. The government and the healthcare insurance industry will make the healthcare decisions for consumers.

Another big idea included in Obamacare is the concept of shifting risk from the government and the healthcare insurance industry to physicians and consumers.

Accountable Care Organizations (ACOs) are supposed to be set up to integrate care. If an organization does better than average or better than the year before it gets to share the cost savings with the government. If it does worse it receives less money.

If it improves one year there is little room for improvement the next year. Its share will be less. It is self-defeating motivation.

A major problem is physicians can only control certain risks. Many risks depend on patients’ ability or willingness to adhere to the care recommended. Eighty percent of the healthcare dollars for any chronic disease is spent on treating the complications of the chronic diseases.

There are no provisions for risk weighting payments to physicians for disease complications resulting from patients’ lack of adherence to treatment. The more complications of a chronic disease patients have the greater the risk of higher costs that cannot be controlled.

Severe complications and decreased adherence increases the risk of higher medical costs.

ACO’s bundle payments for disease entities. One size does not fix all.

ICM-10 increases the number of diagnostic and treatment codes from 18,00 to 68,000 codes. This increases the complexity of coding. It is an opening for fraudulent coding. It also can result in the possibility of over or under coding as well as miscoding. It will take years to learn and years to get right.

If physicians miscode those physicians will not get paid by the government or the insurance industry.

This brings us to the next barrier to the success of Obamacare. There is a constant threat of penalty to consumers and physicians. There should be a constant incentive to receive a monetary reward.

Consumers have higher deductible and higher premiums with Obamacare. Many middle class people cannot afford the higher premiums and higher deductibles. The government subsidizes the healthcare insurance for the poor.

The funding for these subsidies is unclear. It will probably result in yet another tax increase for the middle class. The poor are exempt from income tax payments.

Is this redistribution of wealth?

There are no incentives for anyone to stay healthy and avoid unnecessary and expensive physician visits and diagnostic testing.

There is no tort reform in Obamacare. The lack of tort reform increases the need for excess testing in order to avoid lawsuits for physicians not doing a complete workup.

Physicians and hospital systems have never figured out how to calculate Health Maintenance Organizations’ reimbursement. Physicians and hospitals lost a great deal of money trying to price HMOs bundled payments.

Physicians and hospital systems know less about pricing bundled payments for ACOs. They have no control over consumer usage even though they are being asked to cover the risk. They are hesitant to assume risk.

This is part of the reason ACO participation has been so poor as I pointed out in my last blog.

It is Insurance coverage (public or private) that should cover and assume the risk. This is the definition of insurance. It is not in the physicians power to control risk nor should it be his responsibility.

It is the responsibility of the State Insurance Boards to price that risk for the healthcare insurance industry wisely. These boards should provide a wide range of products to fit consumers needs. The consumer should have the freedom to choose.

Federal and State officials should not accept the insurance industry’s word.

It is unacceptable.

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

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Bigger Problems Ahead For Obamacare

March 30, 2014

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP, MACE

Accountable Care Organization are supposed to be the organizations that reduce Obamacare’s healthcare costs.

Accountable Care Organizations (ACOs) were supposed to be operational in 2012 throughout the United States.

ACOs are supposed to provide financial incentives to health care organizations in order to reduce costs and improve quality of medical care. There are too many defects in the ACOs’ infrastructure to improve the financial and medical outcomes.

At a conceptual level, the incentive for ACOs is to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members (physicians and hospital systems) would share the savings resulting from the coordination and integration of care.

Accountable Care Organizations (ACOs) are not designed to decrease the waste in the healthcare system.

Waste occurs because of:

1. Excessive administrative service expenses by the healthcare insurance industry that provides administrative services for private insurance and Medicare and Medicaid. A committee is writing the final regulations covering Medical Loss ratios for President Obama’s healthcare reform act. The insurance industry regulations are far from curative.

2. The excessive administrative waste in hospitals and hospital systems leading to outrageous nontransparent hospital fees.

3. The lack of patient responsibility in preventing the onset of chronic disease. The obesity epidemic is an example.

4. The lack of patient education to prevent the onset of complications of chronic diseases. Effective systems of chronic disease self- management must be developed.

5.The use of defensive medicine resulting in over testing. Defensive medicine can be reduced by effective malpractice reform.

ACOs are not a market-based system. They do not put patients at the center of their medical care or permit patients to choose their medical care.

The government assigns patients to certain ACOs. The government controls the healthcare dollars and is at the center of patients’ medical care decisions directly and indirectly.

Consumers/patients are the only stakeholders in the healthcare system that can demand that this waste be eliminated. “They with walk will their feet” if given the chance.

Keith Smith M.D. and the Surgery Center of Oklahoma have proven that consumers desire choice and making their own medical care decisions with the Surgery Center’s transparent prices and their light administrative costs.

Patients must control their healthcare dollars and be responsible for their care in order to Repair The Healthcare System. Consumers/patients will make sure prices become competitive. Patients in control of their healthcare dollars will not allow duplication of services.

In order to truly Repair The Healthcare System a system of incentives for patients and physicians must be created.

“In theory, ACOs provide financial incentives to health care organizations to reduce costs and improve quality. In reality, given the complexity of the existing system, ACOs will not only fail; they will most likely exacerbate the very problems they set out to fix.”

ACOs shift the risk of patient care away from the healthcare insurance industry to physicians and hospital systems.

Most physicians are reluctant to assume accountability for patient outcomes. Physicians recognize that much of the outcome is directly under the patients’ behavior and adherence to recommended therapy.

ACOs remove the consumer/ patient from being responsible or accountable for their medical care. ACOs undermine any attempt to create a truly accountable healthcare system that can drive down costs.

There are also grave uncertainties and practical issues in distributing savings between the hospital system and physicians. There is a long history of hospital systems taking advantage of physicians’ skills and intellectual property.

Many physicians and hospital systems are concerned about the shifting of risk and the lack of control over this risk.

“The Mayo Clinic says it will not be part of a critical piece of national health care reform under the government's proposed rules.”

“ The Mayo Clinic announced that the proposed regulations “conflict with the way it runs its Medicare operations.” Mayo treats about 400,000 Medicare patients a year. The bottom line is that Mayo figured out that they would assume too much risk, lose too much money and relinquish too much control over its processes to the federal government.”

ACOs are really HMOs on steroids. There is too much risk that neither physicians nor hospitals can control. Neither consumers or physicians nor hospital system liked HMOs.

This same sentiment is reflected in statistics released the Leavitt Partners Center for Accountable Care Intelligence. Centers for Medicare and Medicaid Services (CMS) and the Obama administration are spinning these numbers the same way they are spinning the figures for Obamacare enrollment.

Chart 4: Accountable Care Organizations by State; Source: Leavitt Partners Center for Accountable Care Intelligence

California leads all states with 58 ACOs followed by Florida with 55 and Texas with 44. ACOs are primarily local organizations, with 538 having facilities in only one state.

Chart 5: Accountable Care Organizations by Hospital Referral Region; Source: Leavitt Partners Center for Accountable Care Intelligence

The number of ACOs, again, is of secondary importance to the number of covered lives. Nationally, approximately 6 percent of the population is estimated to be enrolled in an ACO.

Chart 6: Estimated Accountable Care Organization Covered Lives by State; Source: Leavitt Partners Center for Accountable Care Intelligence

Chart 7: Estimated Accountable Care Organization Covered Lives by Hospital Referral Region; Source: Leavitt Partners Center for Accountable Care Intelligence

President Obama and his administration must be living in some fantasy world. It does not matter what the Obama administration is saying adoption of ACOs by physician groups and hospital systems is poor.

The call for forming ACOs started in 2010. The government tried to stimulate the formation of ACOs with sizable grants. It has not worked very well.

Many of the formed ACOs are not functioning in a cost effective manner. In ACOs that are sharing cost saving with the government the fighting between the hospital systems and physicians is just beginning.

Patients in ACOs are starting to feel the dysfunction.

The delivery of medical care under Obamacare and the ACOs are in big trouble.

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

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Healthcare Needs Some Big Time Disintermediation

March 9, 2014

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

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Stanley Feld M.D., FACP, MACE

What is disintermediation?

Disintermediation is a process that provides a user or end consumer with direct access to a product, service or information that would otherwise require a mediator (middleman) such as a wholesaler, lawyer or salesperson.

In many cases the information available on the Internet has often eliminated the need for a middleman.

As commerce grew in the United States after WWII, there was a need for multiple middlemen to fulfill each commercial endeavor.

One of the strongest examples of early Internet disintermediation was Dell Computers. Consumers were able built custom computers by picking the components. They bought exactly what they wanted at a lower price. Michal Dell sold directly to the consumer and bypassed all the middlemen channels and normal retail outlets.

Amazon is another compelling example. It started with books and now includes almost everything. Amazon bypasses most of the channels and all of the expense of brick and mortar structures to lower the cost to the consumer.

Steve Jobs did it best with ITunes. Most people did not want the16 tunes on a CD. They might want one or two. Music publishers and all the middlemen in that industry fought him tooth and nail.

Steve Jobs won because he provided the consumer with what they wanted, the one song at 99 cents as opposed to 16 songs at $16 dollars.

The music publishing companies have now realized that they are doing better since ITunes with less middlemen and more product sales.

My son, Brad Feld, is going to disintermediate the book publishers. Brad authored 5 books for Wiley Press as part of the Start Up Revolution. Wiley Press and its bureaucracy treat him and other authors unfairly.

He and his partners at Foundry Group Venture Capital started FG Press.

“We treat authors like partners, not service providers. Instead of flat fees and unequal royalty assignments, we abandoned the old model and rebuilt it with the author as our top priority.”

I believe the FG Press results will be to disintermediate the entire book publishing industry.

Disintermediation though the Internet also happened in the travel industry, the airline industry, the stock broker industry and the banking industry.

Disintermediation cuts out the middleman.

“By using the Internet, companies and even manufacturers can deal directly with users or end consumers, which is a significant factor in decreasing the cost of servicing customers. The high market transparency often enables the buyers to pay less as they deal directly with the manufacturer, bypassing the wholesaler and the retailer. As another alternative, buyers can also buy directly from wholesalers.”

There is no reason disintermediation cannot be applied to healthcare. The goal in healthcare is to lower the cost, increase quality of care and increase access to care.

The way to do it is by making consumers the most important stakeholder. Consumers must drive the healthcare system just as consumers are put at the head of the line in other disintermediated systems that work.

I have described the evolution of the healthcare business model of 1946 to the business model of 2014 and beyond.

In 1946 the healthcare business model was simple. The healthcare contract was between consumers/patients and physicians.

Consumers were responsible for their medical care. The only technology was physicians’ car his stethoscope and his doctors bag. Consumers were also cautious in their utilization of healthcare services. They did not want to waste their money. They were responsible for their health and their healthcare dollars.

Healthcare insurance destroyed this relationship. Healthcare insurance was attractive to sick people. It was attractive to employers to help their employees stay well. It also helped employer keep their valuable labor force.

Consumers became less cautious about spending their healthcare dollars as third parties were paying for healthcare costs.

The use of technology boomed in medicine. The cost of healthcare escalated as more and more technology was used.

In 1965 the government created Medicare. Medicare regulations distorted the free market healthcare system. The distortion increased further in the early 1980s.

All of a sudden there were more and more middlemen. The middlemen added little value to the medical care of consumers/patients. However they did add increased costs to the healthcare system.

In 2008 the healthcare system became so complex and riddled with rules and regulations that enormous barriers existed between the consumers/patients and their physicians.

It looks like a giant hairball that cannot be digested.

Obamacare was invented to use technology and ideology to straighten this all out. It has made and is making healthcare more unsustainable.

Obamacare cannot work. It is government control. The majority of consumers and physicians are against it.

Obamacare destroys the patient physician relationship. Obamacare has resulted in more bureaucracy, large overhead, more middlemen and an increase in costs to the consumers in terms of higher taxes and higher healthcare insurance premiums.

The major problems are there are too many middlemen and the bureaucracy is superimposed on a failed legacy healthcare system.

The healthcare insurance industry takes 40% off the top leaving 60% of the premium dollars working for the delivery of medical care.

Hospitals charges are outrageous. Hospital expenses are inflated.

The need for cost shifting puts a large burden on hospital systems.

Government interference simply escalates costs.

An example is the cost of chemotherapy. In hospital chemotherapy cost is 2 to 3 time the cost of the chemotherapy done by the same doctor in that doctor’s office. The government does not pay for chemotherapy in the doctor’s office.

An example of disintermediation in the healthcare system is the Oklahoma Surgery Center.

“The Oklahoma Surgery Center demonstrates that it’s possible to offer high quality care at low prices. Surgeons can do twice as many surgeries in an outpatient surgery center than they can in a traditional hospital surgical suite.

Most industries try to improve efficiency. However, simple efficiencies have not occurred in most traditional hospitals. Surgeons spend half their time waiting for the patients to come to the operating room or for the availability of operating rooms and equipment.

The Surgery centers have solved these efficiency problems. They can service surgeons’ needs at less than half the cost without the wasted time.”

A key reason is there are not multiple administrators creating multiple regulations and collecting multiple $500,000 to $3 million dollar a year salaries. Surgical centers have one head nurse responsible for everything and zero administrators.

The cost of a “complex bilateral sinus procedure” at the Surgery Center was an all-inclusive $5,885. The traditional hospital bill totaled $33,505 without the surgeon’s and anesthesiologist’s bill included.”

Hospital systems in the area are lowering their prices and becoming more transparent.

Obamacare has made the healthcare insurance costs worse for the middle class. The middle class healthcare insurance premiums are not subsidized by the government.

Obamacare has made the premium cost better for the poor and sick. It has not necessarily lowered the deductible. It has not made access to care better for the poor.

Obamacare may make quality of care worse. It will restrict access to care. It will ration care. Obamacare will make medical care decisions for consumers.

The only way to repair the healthcare system is to make it a consumer driven healthcare system using my ideal medical saving accounts.

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

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Don’t Confuse Me With Facts

October 9, 2013

inDisinformation and the healthcare system, Healthcare Insurance Industry, 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

Sometimes,
in order to believe a certain ideology, some smart people take the position of
not wanting to be to be confused by facts.

Countries
with socialized medicine have said their citizens are happy with their care.
Therefore, this is the evidence that the U.S. should have a socialized medicine
system.

Less
than 20% of a nation’s population experiences the healthcare system at a moment
in time. The 80% who are not sick are happy because they feel secure. If they
got sick they believe they would receive free medical care. The result is the
majority of the population under a socialized medical system likes the system.

This
Is A FACT (TIAF)

Dr.
Donald Berwick former acting head of CMS and author of Obamacare wrote, in a
personal letter to “Senior Government Officials and Senior Executives of the National
Health Service in England after doing a review of the NHS.”

“You are stewards of a
globally important treasure: the NHS. In its form and mission, guided by the
unwavering charter of universal care, accessible to all, and free at the point
of service, the NHS is a unique example for all to learn from and emulate.”

Dr.
Donald Berwick added, “redistribution of
wealth is the very essence of a compassionate healthcare system for all.”

I
disagreed with Dr. Berwick in an earlier blog. I said citizens responsible for
their own health, healthcare and healthcare dollars are essential ingredients
for a cost efficient healthcare system.

Patients
are the primary stakeholders. Patients must be actively responsible for their
health. They must have a moral and intellectual responsibility for their own
health as well as a financial incentive to be responsible for themselves.

They
must have own their healthcare dollars, have the freedom to make their own
healthcare choices and have access to care.

The
government must create educational vehicles to help patients make the correct
choices.

The government must provide financial
incentives for people to make those choices.

Medical
care and medical decisions made for patients by a bureaucracy has historically
failed to control costs or provide efficient and compassionate medical care.

Socialized
medicine run by bureaucrats has failed in England. Medical care consumes more
than 50% of England’s GDP.

This
Is A Fact (TIAF)

Medicare
is wonderful for people over 65 years old. Seniors could not buy healthcare
insurance from a healthcare insurance company. The healthcare industry had not
figured out how to make money from these people so they disqualified them.

If
the government got rid of the $250 billion dollars in administrative waste and
inefficiencies each year, Medicare and Medicaid would become sustainable.

This
Is A Fact (TIAF)

Medicare
and Medicaid provide no incentives for patients to take care of their health.

Chronic
diseases are ineffectively managed. The complications of chronic diseases
consume 80% of Medicare’s healthcare dollars. If chronic diseases were managed
properly the complication rate from chronic diseases could be decreased by at
least 50%.

This
Is A Fact (TIAF)

Many
patients do not have the incentive to take care of themselves. They leave it up
to the system to take care of them.

Unfortunately,
it has be demonstrated that a government controlled system creates ever
increasing bureaucracies and cost inflation.

This
Is Fact. (TIAF)

Most
all of the nation’s attempts to control healthcare costs in the past 50 years
have failed. (Price control of the 70’s, HMO’s, Managed Care, PPOs.)

These
systems had to be abandoned. Nevertheless, healthcare policy wonks continue to
give the same advice and make the same mistakes. The policy wonks’ advice is to
institute greater government controls over medical care.

This
Is A Fact (TIAF)

A recent report about England’s hospital
conditions in Mid Staffordshire has emphasized the defects in England’s 60 year
socialized medicine experiment.

The
report only covers hospital inpatient defects. It does not cover the many
defects in outpatient services.

The report is “Report of the Mid Staffordshire NHS Foundation Trust
Public Inquiry

5
February 2013 to the Secretary of State.”

The
report stated that;

1. For
many patients the most basic elements of care were neglected.

2. Calls
for help to use the bathroom were ignored and patients were left lying in
soiled sheeting and sitting on commodes for hours.

3.
Patients felt afraid and disenfranchised.

4. Patients
were left unwashed, at times for up to a month.

5.
Food and drinks were left out of the reach of patients and many were forced to
rely on family members for help with feeding.

6. Staff
failed to make basic observations and pain relief was provided late or in some
cases not at all.

7. Patients
were too often discharged before it was appropriate, only to have to be
re-admitted shortly afterwards.

8.
The standards of hygiene were at times awful, with families forced to remove
used bandages and dressings from public areas and clean toilets themselves for
fear of spreading infections.

9. These
healthcare conditions caused the deaths of an unknown number of patients.

Robert Francis QC Inquiry Chairman who wrote
the report covered a wide range of system failures. I will only highlight the
key failures contained in the 500-page report. This report was mandated by the House of Commons.

These defect are occurring throughout the
entire NHS system. The NHS is not as glorious as the Obama administration or
Dr. Berwick’s has idealization the NHS to be.

"The
story the report tells is first and foremost of appalling suffering of many
patients. This was primarily caused by a serious failure on the part of a
provider Trust Board. (Bureaucracy)"

"The trust board did not listen
sufficiently to its patients and staff or ensure the correction of deficiencies
brought to the Trust’s attention."

The NHS bureaucracy did not put patients
first. It put the various levels of bureaucracy in charge. Bureaucracies deaden
incentives and lose focus on who is the main stakeholder in the healthcare system.

"The
trust failed to tackle an insidious negative culture involving a tolerance of
poor standards and a disengagement from managerial and leadership
responsibilities".

"This
failure was in part the consequence of
allowing a focus on reaching national access targets; achieving financial
balance and seeking foundation trust status to be at the cost of delivering
acceptable standards of care."

Appropriate
statistical reports and collection of reports are more important that
appropriate patient care.

Robert
Francis goes on to outline how the bureaucracy puts measurements first, not
patients.

None
of the bureaucrats want to take responsibility for what is going wrong. Finger
pointing and blame shifting is an occupation in the British healthcare system.

"The
NHS system includes many checks and balances. These checks and balances should
have prevented serious systemic failure of this sort."

"There
were and are a plethora of agencies, scrutiny groups, commissioners, regulators
and professional bodies, all of whom might have been expected by patients and
the public to detect and do something effective to remedy non-compliance with
acceptable standards of care.

For
years that did not occur."

Watch out America!

We are falling into the same trap with Obamacare.
It might sound good to some. It will not work judging by the experience of
others.

Unfortunately,
the Obamacare’s model is the British healthcare system. I do not think the
traditional media should praise it. The traditional media should publish the
facts of history.

The
traditional media should call for the repeal of Obamacare.

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

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Who Losses? Who Wins?

September 11, 2013

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

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Stanley Feld M.D.,FACP,MACE

IBM wins because it wants out of
providing healthcare insurance for retirees.

The government wins because it gains more
control over the healthcare system.

It is as if big business is playing right
into the Obama administration’s hands.

The healthcare insurance industry wins because
it gets more administrative services fees from the government without risk.

The brokers for the healthcare insurance
industry win because they will take more commissions from individual consumers than
they would from an institutional company.

IBM retirees
lose.

Most retirees will go on Medicare Part B or
Medicare Advantage. President Obama is planning to eliminate Medicare
Advantage.

Medicare Part B is means tested so the
more income that is generated from any source by a retiree the higher the premium
paid to the government for Medicare Part B.

The Medicare premiums are paid with pre
tax dollars from retirees Social Security payment. The supplemental insurance
(Medicare Part F) covering deductibles and co-pays are not tax deductible.

Medicare is increasing the deductible and
co-pay requirement in 2014. Therefore the non tax-deductible supplemental
premiums will increase in price.

The premiums of both Medicare and
Medicare supplements for services and drugs can amount to more that $16,000 a
year for a husband and wife calculated in terms of after tax dollars..

Large companies provided the healthcare
coverage as a benefit to retirees tax-free.

IBM has been trying to get out of
providing healthcare coverage for employees since 1999. Obamacare has provided
an excuse for IBM to discontinue its coverage for retirees.

General Electric (GE) made the same
announcement a while ago. Time Warner made its announcement right after IBM.

Companies who have changed their
healthcare coverage for retirees include DuPont, Caterpillar, Sears and Darden
Restaurants.

Many more companies are about to joint in.

It is obvious this was coming as a result
of Obamacare.

The move
disregards the social contract made with employees when employees were first
hired.

International Business
Machines Corp.
(IBM) is going to discontinue its company-sponsored health plan for about
110,000 retired employees.

IBM plans to provide retirees a fixed payment.
The payment will be used for retirees to buy their own health care coverage
through a “private” health insurance exchange.

Once retirees are eligible for Medicare at age
65, IBM would not be responsible for managing these retirees’ healthcare
benefits.

IBM said,
“the growing cost of care makes its current plan unsustainable without big
premium increases.”

IBM told retirees, “that its current retiree coverage will end
for Medicare-eligible retirees after Dec. 31, 2013.”

IBM is shifting the responsibility to the
retirees for buying their own coverage through “Private Health insurance
Exchanges.”

It sounds like a costly rip off to the retiree.
IBM is providing a subsidy for now. Then IBM will discontinue the subsidy.

One Private Health Insurance Exchange
executive said.

"Companies
were turning off plans," he said. "We've given them a proven way to
subsidize. At some point every single retiree will join a Medicare
exchange."

Some union-affiliated groups and retirees
weren't convinced. Lee Conrad, national coordinator for the IBM Global Union
Alliance, said

The
worker group sees this as
just another take-away of retiree and employee benefits."

Donald
Parry, an engineer who retired in 1992 after nearly 32 years at IBM, said he is
concerned he may have to pay more. "The worst thing right now is not
knowing what's going on,"

At the moment the cost of the government
providing Medicare coverage is unsustainable according to the CBO. This is
despite Medicare premiums being means tested and the escalation of Medicare
premiums.

Despite the increase in premiums Medicare
will run out of funds by 2024.

The choices are higher means tested
Medicare premiums (redistribution of wealth), decreased access to care or
rationing of care. I believe it will be all of the above. The burden of this
change will fall on the taxpaying consumers’ shoulders.

As big businesses drop coverage for
retirees, the Medicare roles will increase and the government will run out of
fund prior to 2024.

Excessive costs, commissions, and bureaucratic
inefficiencies part of any government program.

The Obamacare bureaucracies seem to have
no concern for the inefficiencies and increase in deficit spending.

It is as if they are saying, “Bring it on.”
All the government wants is control of the healthcare system.

The result will not be affordable care.
It will be unaffordable care that is rationed with limited access to care.

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

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You Cannot See the Pattern Unless You Look

September 8, 2013

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

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Stanley Feld M.D.,FACP,MACE

Let us assume President Obama wants to destroy the
healthcare system. I have presented steps taken by the Obama administration to
accomplish that goal.

It is possible that this assumption is correct.

It looks as if President Obama uses the same patterns
in the actions he takes to govern.

He promises a group something that group wants to
hear. Then he disregards the promise. He acts to further his political agenda.

This methodology is not the methodology of
leadership, nor does it promote trust.

However, he
has used the same methodology in finance, in the environment, in immigration,
in defense, in energy, in racial relations, and most of all in Medicine.

He first captures his base with ideas that promote
their vested interest. He then undermines his base’s vested interests replacing
these vested interests with his own political agenda.

The
next step is to shift the blame to someone else. His best victim has been the Republican Party. It
is incomprehensible to me that the Republican Party sits back and takes it. I
guess it is politically correct to do so. However, it does not win elections.

If an element of his base makes a big enough stink,
he provides an executive waiver for the issue.

Some of the patterns are hard to see. The
traditional media under reports them.

Other actions using the same pattern are not seen
because they are not examined carefully. They are only seen after they have a
direct affect on an individual’s or group’s vested interest where they have
been betrayed. This leads to mistrust.

President Obama then proceeds to become the judge.
As judge he plays one group against the other.

He now has angered adjunct university and colleges
teachers. This group has been a steady ally.

“Adjunct faculty at a local college
were asked to sign a petition to the White House to "explore
options to prevent colleges/universities from cutting adjunct and contingent
faculty hours to circumvent [the] PPACA," better known as ObamaCare”

This is in
response to the massive assault on the livelihood of adjunct faculty who
now face devastating salary cuts as a direct result of Obamacare.

University and college
professors have universally been President Obama fans. The tide is shifting for
President Obama.

He has blamed the
shifting tide on the Republicans.

In medicine President
Obama’s budget cuts have already resulted in rationing of care and a decrease
in access to care. Cancer Clinics across the
United States are turning away thousands of Medicare cancer patients.

The cost of the
medication to the cancer clinics is higher than government reimbursement for the medication.

"Patients at these clinics would need to
seek treatment elsewhere, such as at hospitals that might not have the capacity
to accommodate them."

The reduced Medicare
funding already has taken place April 1,2013.

Cancer treatment in
hospitals, in many cases, are 2 to 4 times higher than treatment in outpatient
cancer clinics just as surgery done in an outpatient surgery clinic is one half
to one fifth the cost of surgery in a hospital.

Yet the hospital systems
continue to receive adequate fees.

The Community Oncology Alliance, which
advocates for hundreds of outpatient cancer clinics nationwide has sent letters
to legislators urging them to exempt cancer drugs from the sequester for outpatient cancer
treatment to make less expensive outpatient cancer treatment available to
patients.

The hypocrisy of President Obama, who early on
claimed that the passage of the American Recovery and Reinvestment Act (ARRA)
would "launch a new effort to conquer a disease that has touched the life
of nearly every American.

Thus, it
is perplexing that the cuts outlined by CMS will negatively impact cancer
patients, making advances in cancer care more difficult to deliver."

Seniors could not know
about this until they develop cancer and experience the cost. It too has been
under reported.

President Obama who introduced the idea of sequestration, in his
negotiations for a continuing resolution last year, has refused to take
responsibility for it.

Republicans attempted to
make the sequester cuts "less reckless,” such as severe military cuts,
closing the White House to visitors and all the other restrictions President
Obama introduced for this two per cent cut in the budget.

Harry Reid said the
Republican’s proposed cuts were dead on arrival in the Senate.

“Thus,
Obama's duplicity emerged, as he sought to blame the Republicans for
sequestration even though he originated it.”

There have been many instances where the
Obama administration has divided Americans into class warfare. The class
warfare has occurred in immigration reform, cancer victims vs. non cancer victims,
union workers vs. non union workers, right to work states, college teachers and
the administrators, black vs. whites and rich vs. poor for example.

The traditional media
fill the airwaves with these distractions. The real issues are diverted by the
distractions. President Obama plays “Wag the Dog” constantly.

Some examples of real
issues would be how to solve the problem of government inefficiency, waste,
fraud and abuse. It is not to create more agencies, rules and regulations and
impediments on business development to destroy job growth?

Why beat up on doctors
and patients when the real problems are insurance companies, hospitals and tort
reform despite the administration and its advisors’ denials.

Why is he giving out preferential
waivers? America should be outraged to have Obamacare passed into law by a
Democratic Party, which then in turn receives a waiver from President Obama by
executive order to be exempt from Obamacare.

The media should be
outraged. Instead the media has given congress and the President a pass.

“Though I value my First Amendment right to
petition the government for change, we need far more puissant action.”

We need to demand a total eradication of Obamacare.
And it needs to be done as a united front. Otherwise, we actually
play right into President Obama's overarching aims of divide
and conquer by
duplicity and coercion.”

President Obama wants to
avoid personal blame for the expensive, unwieldy health care law. He will
probably figure out a way to blame Republicans for its failure.

The majority of the
people are against the healthcare law. Physicians know it will make the
healthcare systems problems worse and more expensive. Yet the President ignores all of these voices
while he is spending massive amounts of money on marginally added value medical
projects.

Some believe the tactics
used by the used by the President to pass the healthcare law started all the
problems. In reality Obamacare is a bad law that will be impossible to
implement.

President Obama always uses
the same pattern to avoid personal blame. (“I
did not draw a Red Line, the international community did”). He always
diverts our attention from the real problems. He tells lies or half-truths
about issues, and divides and conquers to create class warfare.

He uses the same moves
over and over again. If America doesn’t start looking, Americans will not see
the destruction to most of our institutions.

The so-called unintended
consequences in every area might not be so unintended.

President Obama is
accomplishing exactly what he wants to accomplish. It looks to me as if he
wants total government control over our society. Many institutions have begun to
crumble before he reaches his goal.

The disregard for our
constitution is one vivid example.

What massive government
intervention means to me is that it is creating more misery, resentment and
anger among all the diverse groups in American society.

Most Americans believed
President Obama when he said it is time for a change. It was time for a change.

Since he did not define the change he was seeking,
we all assumed it would be for the better.

Our assumption was
wrong.

It is time we start
looking and seeing.

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

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