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We Never Learn: Watch Out Colorado

August 10, 2016

inDisinformation and the healthcare system, 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

“You can always count on Americans to do the right thing – after they’ve tried everything else.”

Winston Churchill

There are many smart people in America.

Americans form opinions from the information presented to them. When the information presented in incorrect or incomplete it is easy to form the wrong opinion.

The art of presenting misinformation and disinformation has been perfected.

The people of Colorado are now being bombarded with the need to pass Amendment 69 or ColoradoCare.

Most Coloradans have not paid sufficient attention to the amendment. Their opinions are being influenced by misinformation or inadequate information concerning the unintended consequence that are inevitable.

Many might look at ColoradoCare’s official website. http://www.coloradocare.org/know-the-facts/increases-savings/ and read the following.

“With Amendment 69, ColoradoCare, every Colorado resident can contribute their best, knowing ColoradoCare has everyone covered with universal health care.” Sounds wonderful.
“ Imagine life with ColoradoCare. If you’re a resident and you need any kind of health care (including mental health), you just go to see your provider, and ColoradoCare pays the bill.”Free is great.
“Without the layers of hassles, businesses, providers, and everyone in the state can go about their important work of contributing to their families and communities knowing ColoradoCare has everyone covered.” The problem is nothing is free.
In a statement to the Colorado Independent October 2016, Bernie Sanders lent his support to the single-payer measure.
“Colorado could lead the nation in moving toward a system to ensure better healthcare for more people at less cost. In the richest nation on earth, we should make healthcare a right for all citizens.”

Hillary Clinton has not yet supported ColoradoCare. I believe she is afraid it will steal her thunder by having large increases in government healthcare expenditures she has planned. She plans to increase taxes and get healthcare governance firmly in the hands of the federal government.

The ColoradoCare website goes an to say,

“An economic analysis of health care spending in Colorado has calculated that comprehensive health coverage for every resident could be paid for with pre-tax payroll premiums of 3.33% for employees and 6.67% for employers.”

There has been no effort to prove these numbers are correct.

In fact, all of the Republican establishment politicians in Colorado are against ColoradoCare as well as many high ranking members of the Democratic establishment.

The Democratic establishment includes Governor John Hickenlooper and former governor Bill Ritter. They are opposed to Amendment 69’s passage because they understand the financial burden ColoradoCare would put on the state’s budget and growth.

The size of the current state budget is $25 billion dollars. The tax increase for ColoradoCare would be an additional $25 billion dollars. Everyone can assume the state would need more to implement the program.

“ColoradoCare would be far and away the largest tax increase in state history, and would give Colorado the highest tax rate in the nation.”

“ This would be implemented as a payroll tax that would be split into 3.33% for employees, and 6.67% by employers.

An additional $18billion dollars would be asked of the federal government, as well as a waiver to let the state opt out of the Affordable Care Act in order to fund Colorado care.

If voters approve ColoradoCare, it would be written into the state constitution, making it very difficult to dismantle and impossible to amend.

The president of the Denver chamber of commerce is opposed to ColoradoCare because the chamber knows this will drive businesses out of the state and inhibit businesses from coming into the state. The Denver chamber of commerce has worked very hard and very successfully to bring business into the state.

Most of all these politicians know that Obamacare has failed. Oregon’s attempt at the state being the single party payer has failed.

Most recently, Vermont’s attempt at a single party payer system has failed.

Both Oregon’s and Vermont’s governance realized the great fiscal burden to the state budget as well as its businesses and residents.

These states quit before the taxpayers realized the extraordinary tax burden the single party payer system would have on their state.

However, most progressive thinking people cling to the ideology that a single party payer system is the way to universal coverage.

Why did Vermont fail to institute a single party payer system after the state legislature passed the bill?

I will describe the reasons for failure in my next blog.

Walker Stapleton, the Colorado state treasurer said, “a major part of his responsibilities is attention to the fiscal and economic condition of the state.”

He goes on to say,

“If passed by the voters, the provisions of Amendment 69 will have a great negative impact on the state’s fiscal and economic health, as well as impacting individual residents fiscally.”

“If passed, Amendment 69 — creating a governmental entity called ColoradoCare to administer the health care payment system — would amend the Colorado Constitution. It would not be a legislative issue to which the Colorado Legislature could make amendments as needed.”

Walker Stapleton said the state health exchange was supposed be self-sustaining. However, the state health exchange has blown through federal dollars provided.

The State has no way to fix the state exchange or has a way to pay back the federal loan. Walker Stapleton acknowledged the problems with Colorado Health Benefit Exchange, saying, “The exchange was intended to be self-sustaining, and it is anything but, and we have blown through federal dollars.”

United Health and others are leaving the exchange. The exchange has one-fifth of the enrollment anticipated because of cost, network size and service.

“The exchange is in a hole and we have not yet come up with a way to fix it,” he said.

He added that Amendment 69 would assume the state health exchange burden in addition to its debt.

This burden is not good for the single party payer financial burden.

ColoradoCare (Amendment 69) was proposed by a Boulder State Senator, a progressive M.D., with support of the other progressive M.D.s in the Boulder, Colorado community.

Most of the M.D. practices in the Boulder community are owned by Boulder Community Hospital.

I wonder if the M.Ds understand the unintended consequences to the state’s fiscal health, the unintended consequence to the business environment as a result of the increase in tax rate and the unintended consequence to residents experiencing increases in taxes.

I wonder if these physicians are aware of the unintended consequences to their ability to practice medicine.

I suspect the author of the amendment and her followers have not thought about the unintended consequences.

Consequences.

1. Amendment 69 authorizes state taxes be increased $25 billion annually in the first full fiscal year and by such amounts that are raised thereafter.

2. ColoradoCare would be exempt from Taxpayer’s Bill of Rights (TABOR).

3. “A 10 percent payroll tax for every employer in Colorado,” Stapleton said.

The employer would pay 6.7 percent and the employee 3.3 percent. If a taxpayer were self-employed, he/she would pay both, for a total 10 percent.

4. Investment income is subject to this tax. 5. If the employer is outside the state, the tax does not apply for the employer’s 6.7 percent so the employee pays the full 10 percent. Walker Stapelton said, “It is possible retirement income would be taxed,”

Also of great concern to Stapleton are these additional provisions in Amendment 69:

• Transferring administration of the Medicaid and children’s basic health programs and all other state and federal health care funds for Colorado to ColaradoCare;

• Transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers’ compensation insurance;

• Requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado health care system;

• And suspending the operation of the Colorado health benefit exchange and transferring its resources to Colorado Care.

I hope the people of Colorado understand what this dangerous amendment represents to the fiscal health of the state.

The population will only understand its negative connotations if it starts paying attention to the consequences.

If it only believes that free medical care is good they do not understand that nothing is free.

A system in which the state offers free medical care will fail at the expense of all the taxpayers.

It has already been proven in Oregon and Vermont.

There is a more effective and less expensive way!

If you are interested please read the following links.

My ideal medical savings account is democratic and provides universal coverage with the consumers being responsible for their choice of medical care while being in control of their healthcare dollars.

Consumers’ responsibility for their health is always left out of models of healthcare reform.

If the federal government or a state government wants a business model to be successful, it should adapt my future state business model.

It is a consumer driven model with consumer responsibility built in so that consumers control their healthcare dollars.

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

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More On The Public Option

August 4, 2016

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

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Stanley Feld M.D.,FACP,MACE

Hillary Clinton is a tax and spend Democrat. She will be an extension of the Obama administration.

Her list of promises and expenditures will continue in healthcare without success in providing better cost effective care to Americans.

Her plans for healthcare will result in increased government control of Americans’ lives and freedoms while escalating the federal deficit.

The expansion of President Obama’s failed programs will simply accelerate the path toward total collapse of our healthcare system.

Dr. Robert Kocher was special assistant to President Obama for health care and economic policy from 2009 to 2010. He was instrumental in promoting the consolidation of healthcare systems. He also encourage these healthcare systems to buy physicians practices in order to consolidate networks.

The rational was the government would then deal with one provider (the hospital system). The communications within the network would improve the quality of care and decrease the cost of care.

Theoretically, this should be true. However, the differences between the culture of hospital administrator and physicians made Dr. Kocher’s goals impossible to achieve.

“I believed then that the consolidation of doctors into larger physician groups was inevitable and desirable under the ACA.”

This last week he admitted that he was wrong and individual practicing physician groups are more efficient and less expensive than “hospital controlled networks of physicians.”

“I, along with Ezekiel Emanuel and Nancy-Ann DeParle, argued that “these reforms will unleash forces that favor integration across the continuum of care.”

“We thought only hospitals or health plans can afford to make the necessary investments” needed to provide the care we will need in a post-ACA world.”

“Now I think we were wrong to favor it.”

“What I know now, though, is that having every provider in health care “owned” by a single organization is more likely to be a barrier to better care.”

In 2010, I predicted hospital systems owning physicians would not work. Anyone with an understanding of hospital politics and hospital administrators thinking knew it could not work.

The only reason physicians let hospital systems buy their practices was because the physicians were disgusted with the intrusive government rules and regulations and they were afraid they would be left out of the growing future trend.

It was clear to me the trend was misguided political manipulation.

The best of the clinicians tried to make it work but failed. ACO’s controlled by hospital systems were destined to fail and not save money.

ACO’s that are owned by private group practices are barely saving money and profiting by that savings.

President Obama and his administration fell for the concept because they visualized it as a path to control physicians and the healthcare system.

The Obama administration and its experts never considered what the consumers might want or need.

The healthcare insurance industry is now suing the government because the government is reneging on its reinsurance commitment totaling billions of dollars.

President Obama and Hillary Clinton are calling for a public option. This is a diversionary tactic The public option is certain to fail.

The government will continue to remain totally dependent on the healthcare insurance companies for administrative services.

The reintroduction of the public option will accelerate the collapse of the healthcare system. It appears that Ms. Clinton has no idea of the unintended consequences.

The unspoken reality of the “public option” is to destroy private healthcare insurance. It is not a good idea. It will accelerate the collapse of the healthcare system.

I have written extensively about the consequences of the public option.

The government would squeeze private insurance out of the marketplace through regulatory control over access to care, premium control over consumers, and financial control over providers. The government would undercut the marketplace.

The government will remain dependent on the healthcare insurance industry to administer the services provided for all of the existing government healthcare services including Medicare, Medicaid and Obamacare.

The healthcare insurance industry would be in better shape because all the insurance risk would be transferred to the government.

The government programs are unsustainable at the moment. This unsustainability will escalate.

“While private plans must negotiate market rates with doctors and hospitals, a Medicare-like “public option” would fix payment rates by fiat, well below the rates that would otherwise prevail in a real market.”

President Obama said just the opposite in his Journal of the American Medical Association article.

“Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.”

President Obama’s statement is a total lie. However, the mainstream media is repeating the lie as a fact.

I hope President Obama and Hillary Clinton’s public option is no more convincing today to the public than it was in 2009.

It should be less convincing in the face of all the Obamacare failures to date.

Taxpayers are realizing that the public option will put them at more real financial risk. Taxpayer financial risk was clearly stated in the first version of the public option with no congressional questions asked.

The public option does not create a competitive marketplace and level the playing field. The competition will disappear at the taxpayers’ expense.

“Using a market mechanism, like a “health insurance exchange,” then adding a “public option” to undercut private plans and destroy a competitive private market was a political strategy.”

“All the public relations rhetoric about expanded “consumer choice,” promoting “market competition,” and keeping private plans “honest” was, of course, classic boob bait.”

It is clear that both Barack Obama and Hillary Clinton think the American public is stupid.

President Obama has been playing the American public for 71/2 years. He was correct when he told Senator Kerry and Representative Barney Frank that we don’t need a public opinion.

Obamacare was enough to get central government control of the healthcare system.

Let us think about it a little.

The federal government mandated coverage. The problem is the mandates didn’t work.

Then, Obamacare defined what healthcare plans are permissible.

These Obamacare regulations escalated the premiums and the deductibles to unaffordable heights.

The federal government determined what health benefits consumers could receive.

It didn’t work. If a benefit was not included, consumers bought that benefit outside the system or did not buy healthcare insurance if the benefits where too many.

Physicians started to not participate in the Obamacare system. This non-participation has caused a shortage of providers.

Some medical procedures or treatments were not covered. The government decided what should be covered, what level of coverage should exist and what copayments and deductibles were to be allowed.

Consumers have been protesting. The government has not been listening.

Obamacare has all the tools and power of the law to control the healthcare system without a public option.

However, the Obama administration and another future Clinton administration feel they must destroy the healthcare insurance industry in order to give the public no choice and compel them to comply.

The public option will also fail. It will lead to restrictions on freedoms and liberty. When this is clear the public will get very angry.

The cost of healthcare will rise, not fall, because of greater inefficiency and bureaucratic control.

There will be reams of red tape and unenforceable provisions as a result of government control.

There will be special deals to certain providers in order to avoid uncontrollable protest.

Who will lose? The poor and the middle class!

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

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Deals With The Devil, How To Destroy The Healthcare System

July 1, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D., FACP, MACE

President Obama’s goal is to destroy the healthcare system. His deals and regulations lead the healthcare system on the path of destruction.

The strategy is creating so much pain to all the stakeholders that the healthcare system will implode.

At that time public opinion will demand the government take over the healthcare system.

What makes the government a better manager than the free market? The key is to have a system that aligns all the stakeholders’ incentives.

The government is not doing a good job keeping Medicare and Medicaid solvent and providing access to care. It is providing horrible healthcare services to our veterans in the VA system.

The government has conditioned progressive Democrats to continuously declare; “ I don’t mind paying a little more to make the system better.”

The destruction of the healthcare system is a slow process. The Obama administration is proceeding step by step in a very organized fashion.

When it is replaced by a single party payer system controlled by non-elected bureaucrats, consumers will have no control over their free choices.

Hopefully, the U.S. and its citizens are too diverse and too accustomed to freedom of choice and freedom of expression to let this happen.

Hopefully, consumers realize that central government control and socialized medicine doesn’t work. The concept of central control and socialism has failed too many times to count.

Our founding fathers certainly understood this concept.

Hopefully, consumer will realize that Adam Smith was right. The free market is self-correcting. It is only self-correcting with everyone plays by the rules and the government enforces the rules.

A government run by the political establishment that is controlled by vested interests does not work. It will eventually generate mistrust among all parties.

The mistrust of government is building to a tipping point.

Two recent examples of approaching the tipping point are the new ACO rules and the deception involved in the Obamacare reinsurance scandal.

Most of the 242 ACOs out of 3000 potential ACOs have three-year contracts. Many ACOs are not about to reach their Shared Savings goals for the reason I have mentioned.

I don’t know if these ACOs realized in their quest to become more efficient they would eventually lose money. Next year’s sharing goal will be this year’s modified to be the new profit sharing benchmark.

It might be impossible to deliver care more efficiently by the new benchmark.

When the ACO automatically progress to track 2 and fall short of the most recent efficient cost sharing savings benchmark these ACOs will have to repay the government for the losses.

The second important point that is propelling the healthcare system to the tipping point is that the new ACO rules do not take into consideration the healthcare systems that signed up to become ACOs initially.

Any savings the new rules offer in order to attract more healthcare systems to sign up for the ACO program have not been offered to the original signees until 2019. The original 242 have to wait until 2019 to be eligible for the extra bonuses given to new signees.

This might get the original hospital systems to quit their ACO participation completely. If the old ACOs quit the program, it would create more dysfunction in the healthcare system.

It would be just the thing the Obama administration wants to happen. The more dysfunction, the closer America is to a single party payer system.

An equally frustrating example was the money promised to the healthcare insurance industry to guarantee it a profit if it participates in the federal and state health insurance exchange program.

I have described President Obama’s reinsurance program in detail previously.

I was opposed to the reinsurance program. The Obama administration is totally dependent on the healthcare insurance industry to perform healthcare administrative services.

I am not sure either house of congress was aware of or appreciated the implications of the reinsurance program until it because obvious three years after Obamacare was passed.

“The healthcare insurance industry knowing full well that they couldn’t make legitimate profits selling coverage through Obamacare’s exchanges, relied on Democrat guarantees that their losses would be covered by the taxpayers.

But a funny thing happened on the way to easy profits. Congress refused to appropriate the funds.”

When congress realized what was going on it capped the funds appropriated to the reinsurance program. President Obama is still trying to find the fund to pay the healthcare insurance industry.

President Obama paid only 12.6% of the 2.87 billion dollars the industry claimed the government owed it.

Now the healthcare insurance companies that have not been paid are starting to sue the Obama administration.

The companies included are Health Republic Insurance Company. It has filed a class action lawsuit against the government for $5 billion, Highmark Health has sued for $223 million, Moda Healthfiled filed a $180 million suit. Blue Cross & Blue Shield of North Carolina has sued for $129 million. Land of Lincoln Health has filed a $70 million suit.

“It isn’t clear that these lawsuits aren’t going anywhere. “

“The defendant in the class action suit, for example, is “The United States of America” and the plaintiffs ask the court to strike down provisions of two congressional budget resolutions that require the risk corridor program to be budget neutral.”

Congress is the only branch of government that has the power of the purse. It is not the administration or the court.

“As U.S. District Judge Rosemary Collyer put it in a ruling against the Obama administration in a similar case involving unauthorized HHS spending, “Congress is the only source for such an appropriation … See U.S. Constitution, Art. I, § 9, cl. 7”

“(‘No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.…’).” And a budget resolution becomes law once it has been signed by the President. That’s why the 2015 spending bill is titled, “Public Law 113–235.” Yet the Health Republic class action suit holds that losses somehow render the law invalid:”

Qualified Health Plans have incurred even greater compensable losses in 2015 that CMS and HHS cannot pay as a result of the 2016 Spending Bill.

“Neither the Obama administration nor the congressional Democrats with whom they made their cynical deal can save them. In the end, the Devil will have his due.”

Another way to look at the entire debacle of Obamacare is this is exactly the way President Obama and his administration wanted it to turn out. It will lead the way to a single party payer system. The single party payer system will be another disaster.

Was Obamacare designed and implemented with such incredible ineptitude that Co-Ops like Health Republic and Lincoln Health were doomed from the onset?

Were Texas and the thirty other states that did not join smart enough to know the Co-Ops and state exchanges were destined to fail and go bankrupt?

Was it done purposefully by the Obama administration in order to create chaos in the healthcare system?

Why would anyone believe that a central government that runs and controls the healthcare system be any different than the VA system and the insolvent Medicare and Medicaid System?

Who is responsible for the debacle? The traditional mainstream media such as the New York Times and the Washington Post will blame it on a Republican congress that is refusing to change the law to pay President Obama’s illegal debts.

Who do you think will pay for the upcoming debacle?

You guessed it.

The taxpayers will pay for President Obama and his administration’s obvious fiscal irresponsibility.

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

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Thought You Could Win?

February 16, 2016

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

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Stanley Feld M.D.,FACP,MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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President Obama Tries To Bully The Supreme Court

June 10, 2015

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

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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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Where Are Your Actionable Points To Replace Obamacare?

March 8, 2015

inUncategorized

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Stanley Feld M.D.,FACP,MACE

Some have criticized me for always criticizing Obamacare. There is plenty to criticize. President Obama has asked if anyone has a better idea than Obamacare please let him know.

The question asked by some readers is where are your actionable points to repair the healthcare system.

My answer is, “you have not been reading my blog.”

Democrats and President Obama have not read my blog.

The Republicans have been searching for an alternative plan. President Obama has mocked them for not having an alternative than Obamacare.

Republican leaders have not read my blog either. If they had and really thought about my plan they would conclude it could work.

My plan aligns all the stakeholders’ incentives while reducing the cost of healthcare coverage to consumers. It also decreases secondary stakeholders’ costs and increases their profits. It is very democratic. It would provide universal care without government interference.

These actionable points have been clearly described in many of my blog posts. It is a “consumer driven healthcare plan.” The real customers in the healthcare system are consumers, not physicians, insurance companies, hospitals or the government.

Below are some of the links that provide actionable points to Repair The Healthcare System.

The first link is an overview using a slide presentation. It outlines the business model for 2020. The details of each specific point can be found in the links in the slide presentation or in the websites search engine.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2012/10/business-model-for-medical-care-2020-the-ideal-future-state.html

Obamacare ignores many of the key points. Obamacare will fail because of the absence of these key points. Simple things must be done for an alternative to Obamacare to succeed.

The second link is My Ideal Medical Savings Account is Democratic. My ideal Medical Savings Account can cover and motivate every socioeconomic group. It provides incentives for all consumers to remain healthy and take care of their chronic disease. It promotes consumer responsibility.

Consumer self-responsibility is an essential element in the Repair of the Healthcare System.

My Medical Savings Account is different that a Health Savings Account.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2012/05/my-ideal-medical-savings-account-is-democratic.html

Self-management of chronic diseases is a vital element necessary in a law that attempts to Repair the Healthcare System. It requires education and incorporation of all the spokes of the wheel in the link above to the slide presentation.

President Obama has done some pilot studies using the wrong groups (political groups) to study the self-management hypothesis.

They have all failed because the administration picked the wrong groups to do the pilots.

Systems of care must be developed to teach patients to self-manage their chronic disease to decrease the complication rate of those diseases.

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=systems+of+care+for+the+management+of+chronic+disease&x=24&y=9

Eighty percent of the healthcare dollars are spent on treating the complications of chronic diseases. Twenty percent of patients have a chronic disease that is not well controlled and will lead to complications eventually. This can be solved with a properly executed Systems of Care by physicians using information technology as an extension of their care patient.

Obamacare does not seriously consider any of these vital corrections necessary to create an affordable healthcare system. The hospitals and/or physicians cannot be responsible for consumers’ behavior to avoid the complications of chronic diseases. Accountable Care Organizations are based on the fact that the hospitals and physicians are responsible for better outcomes.

Hospitals and physicians have to have the infrastructure to teach patients to become “professors of their diseases.”

Another simple action point is to provide equal tax deductibility for the individual insurance market and group insurance market.

At the moment employers providing insurance to employees can deduct premiums from revenue. An individual buying insurance for himself and his family does not get the same tax deduction. This discrepancy can easily be cured by providing the individual market with the same tax deduction as the group market.

The above links to blogs I have written are just some of the important actionable points necessary to Repair the Healthcare System.

Please study these action points in the links and try to understand how vital they are to maintaining a viable healthcare system.

Obamacare’s complicated rules and regulations have only driven the healthcare system to further dysfunction and increased costs while only having less than 10 million people really signed up after 2 years of enrollment and 6 years of increased taxes.

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

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Simple Fixes

March 1, 2015

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

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Stanley Feld M.D.,FACP,MACE

Republicans are trying to figure out what to change in Obamacare to make it work. I believe Republicans should change all the perverse biases built into Obamacare. The result would be a small but important dent in Repairing the Healthcare System.

It is best to start all over again with a bill that puts consumers in charge of their healthcare dollars. Consumers must be responsible and own their healthcare decisions and healthcare dollars. Consumers must drive the healthcare system in order to have reduced costs, increased efficiency of care and competition among stakeholders.

Obamacare is a political strategy by progressives to get more power. It is not about improving delivery of healthcare.

“It is about "redistribution of wealth"… or, by its more common name, "SOCIALISM.”

Republicans do not understand this. They don’t have the courage to call out President Obama or the Democrats.

Democrats cannot or do not want to understand the power of market based consumer driven healthcare because their ideology of central government control of healthcare does not allow it.

Consumers, taxpayer and voters must drive the change to a better, more cost efficient and less dysfunctional healthcare system.

Obamacare’s basic theme is built on hospital ownership of physicians’ practices. If hospitals or hospital systems own all the physicians’ practices in a community, the government has to only negotiate prices with the hospital system. The central government can then control a community and decide on access to care and the rationing of care of the community’s citizens.

The hospital receives a bundled reimbursement for a disease encounter. The hospital divides the reimbursement between the doctor and the hospital.

Once physicians are in the employ of hospitals, the government and hospital systems think that the non-compete clause will hold up in court and physicians will be afraid to leave the hospital systems.

Hospitals think they can lower the salary of physicians during negotiations for renewal of physician employment contracts since physicians will be afraid to leave the hospitals’ employ.

I’ll bet if a group of physicians decided to leave at the same time, the hospitals would be in the trap hospitals set to apply to physicians. Physicians should wake up. Some physicians have.

These are some of the perverse biases Obamacare has created against physician practices and patients.

The biases created against groups of private practitioners and to the advantage of hospital systems costs government and healthcare insurers more than it would if there was a level playing field for practicing physicians. It would create market place competition. Consumers and taxpayers absorb these government overpayments.

A common belief is that the payment system must be changed from a fee for service system to a bundled payment system.

HMOs failed in the 1980’s and early 1990’s because of the pressure of patient and physician dissatisfaction with the quality of care that was provided with a bundled payment system.

Accountable Care Organizations (ACOs) run by hospital systems are the organizations that will take risk and accept a bundled fee. It is similar to the HMO’s that failed previously.

ACOs will fail because it is difficult to predict medical risk. The increases in premiums are the result of the insurance industry’s miscalculation of risk.

Physicians are not willing to take on the risk of patients’ compliance and adherence. Physicians are not mechanics that put a new part in patients and then patients are fixed.

The popular notion is payment reform requires coordinated delivery of medical care in an Accountable Care Organization in which a single institution owns the physicians.

Everyone knows the physicians are at risk. Much of that risk depends on the patients’ responsibility to understand their illness and their behavior toward caring for that illness.

Obamacare is biased against less centralized engagements where independent doctors enter into contractual relationships with their patients. The government has imposed less reimbursement and more paperwork for these independent practices to discourage them from remaining in private practice.

Private practitioners cannot afford to participate in reformed payment plans. Private physicians need complex IT infrastructure in order to comply with the rules and regulations needed to participate in the complex payment reform structure that shifts risk to physicians.

“It makes participation absurdly expensive for anyone but a hospital that already has its own server hub.”

The problem is hospital systems cannot control physician’s medical judgments. Medical judgments are complex and cannot be boiled down to cookbook decision solutions.

Obamacare also provides favorable anti-kickback provisions to hospital systems only when hospital and physicians qualify as Accountable Care Organization. ACO qualification is dependent on requirements that create the same need for physical infrastructure and bureaucratic overhead that is hard to replicate outside the hospital setting.

In the end physicians shouldn’t care to be in an ACO because their freedom to practice medicine according to their medical judgment could be impaired.

However, many physicians still feel compelled to join hospital systems so they are not left out of the “new age.”

Those physicians who do not participate are joining the surge of interest in the fast growing concierge medicine phenomenon. Consumers want someone to relate to them and not to be a commodity in a failing healthcare system.

I know of only one group of physicians in a small city in Texas who have supposedly taken control of the hospital and enjoy government provided benefits for developing an ACO.

The hospital is dependent on the organized physician group rather than the hospital taking over the physician’s group and dictating how these physicians should practice medicine.

In order for real reform to occur Congress must level the playing field between hospitals and independent private practice physicians. Only then will there be a competitive system where both hospitals and physicians will compete for patient pools.

Congress has to put consumers in the drivers seat, not hospital systems.

The government could set up a new class of “independent risk managers” to help groups and individual physicians analyze and manage risk.

Managing risk depends on patients assuming responsibility in the participation in managing their diseases.

Hospital systems do not evaluate risk very well. Neither does the healthcare insurance industry or the government.

Government should be the facilitator of improving care, not the manager of the healthcare system.

“Obamacare deliberately crowds out this sort of market innovation in favor of hospitals and their existing networks.”

Another simple solution to increasing costs would be to provide physician owned private groups and individual physicians with the same reimbursement provided to hospitals and hospital owned physicians.

“ Medicare is paying much more for many procedures when performed in a hospital outpatient clinic rather than an independently owned medical office.

Things as common as heart scans ($749 versus $503), colonoscopies ($876 versus $402) and even a 15-minute doctor visit ($124 versus $70) all pay more when done by a hospital-based doctor than a privately owned medical office.”

This is true in all coding categories. The difference produces a sizable profit incentive to the hospital at a great cost to government.

Hospital systems are driven to buy physicians’ practices to take advantage of the difference since money-making long inpatients hospital stays are becoming a thing of the past with new advances in medical and surgical care.

The profit margin from owning brick and mortar is shrinking and the profit from owning intellectual property and surgical skills is increasing. Hospitals want to take advantage of this phenomenon.

Why is the Obama administration doing this?

Once the hospital own the physicians in the community the government can then squeeze the reimbursement to the hospital system. Hospital systems will have no option but to accept the reduced reimbursement.

It is called “got you in checkmate.”

It has happened before. This strategy has never worked.

When will the government ever learn?

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

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Another Great Father and Son Weekend

February 10, 2015

inUncategorized

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Stanley Feld M.D.,FACP,MACE

Every year Brad and I go on a father and son weekend from a Friday afternoon to Sunday afternoon. The place does matter. We just hang out and shoot the breeze.

I absolutely love the weekends we spend together. Brad teaches me a ton. I teach him a little.

A few years ago we spent our weekends at the Consumer Electronic Show in Las Vegas. I loved the weekends. I got to hang out with his Foundry Group partners , Seth Levine,Ryan McIntyre, and Jason Mendelson.

These four guys are really smart. They grasp concepts, trends, patterns and bullshit as fast as Purple Martins catch insects.

I always came back from these weekend invigorated. I love to learn new things. I always feel I understand the technology world a little better.

Last year we both got sick just before we were scheduled to go to Memphis Tennessee.

Why Memphis?

Memphis is a very underrated city with lots to do and see.

However, the most important reason for going to Memphis was that Brad was born on Blytheville Air Force Base in Blytheville, Arkansas during the Vietnam War. He expressed a desire to see the place of his birth. Blytheville is 70 miles northwest of Memphis on Highway 55.

We will get to Memphis one day. However, this year when he asked me where I wanted to go I said Las Vegas just because the weather would be perfect, the food would be good, the walking would be great and experiencing the energy of the crowds would be fun.

Brad pays for everything. It is his treat to his Dad. Mom is not here. He tries to get me to overeat. He always succeeds.

We had ice cream twice on Friday, once before dinner at Café Gelato in the Bellagio and once after dinner at Ghirardelli Ice Cream & Chocolate Shop.

The Ghiardelli’s chocolate hot fudge sundae is overpriced but memorable. I remember a weekend with Brad at South Beach Miami where we were at the Ghiardelli's on Lincoln Road four times in one weekend.

In 1985, when Brad was at MIT he started Feld Technologies, a software and hardware company that installed office software, hardware and networks.

I hired Feld Technologies to build a network and install all the software and hardware for my large Clinical Endocrinology practice Endocrine Associates of Dallas P.A.. The installation lasted 15 years and put the practice 10 years ahead of other free-standing medical practices.

When he finished dealing with four doctors, a diabetes education center, a nuclear medicine center, an osteoporosis center and an obesity center he said, “Dad, I will not deal with medicine or doctors ever again.”

Unfortunately, our healthcare system desperately needs Brad Feld to grasp the problems and teach the government, healthcare insurance industry, hospital systems, physicians and patients how to fix it.

He refuses to pay attention to the problem.

There are no big thinkers out there.

Nothing was planned for this weekend. Brad sent out a Twitter telling his 197,000 followers that he was taking his dad to Las Vegas and does anyone have any suggestions for us.

Within three minutes we had a few dozen suggestions. That’s the power of social networking.

A fellow named Ryan Negri reached out and suggested Mon Ami Gabi for dinner. It is across the street from the Bellagio. He said he could get us a table on the patio over looking Las Vegas Blvd. I had not heard of the place but it sounded cool.

We were running late for our reservation so we took a cab. The restaurant was just across the street from the Bellagio. The taxi porter that put us in a cab asked us why don’t we walk because it is just across the street? We didn’t know it was across the street.

The cab driver took off without saying a word. We asked him how long he was waiting in the holding area for the fare. He told us three quarters of an hour. He did not say a thing in protest.

Brad blew me away taking out a $20 bill and giving it to the cabbie. It made the cabbie’s night.

It also made me aware of the many acts of kindness my son does for so many people.

It is consistent with his philosophy of giving without expecting to receive. The magnificent power of that philosophy is that you receive much more in the end than you give.

This is a part of his business philosophy and will be the main theme of an upcoming book he is writing in his series of books on the Startup Revolution.

Cecelia and I are very lucky to have such a wonderful son. I hope all you readers can tell I am a big Brad Feld fan.

On Saturday, after exercise, we tried to get tickets for the Rod Stewart Show at Caesar’s Palace and Absinthe. Both were sold out. We are both pretty resilient. We decided to opt for dinner at Nobu, plus after dinner ice cream.

After failing to get tickets for a show we headed downtown to see Tony Hsieh’s Downtown Project. Anyone going to Las Vegas and staying on The Strip should take a cab to The Downtown Project. Tony Hsieh started www.Zappos.com on a shoe string and sold it to Amazon in 2009 for $1.2 billion dollars.

The philosophy of Tony Hsieh project has been misinterpreted or misrepresented by most media outlets. He has also made some mistakes while developing the Downtown Projects.

He bought 60 acres of dilapidated Downtown Las Vegas after he moved Zappos.com to Las Vegas’ old downtown city hall. The plan was to transform the acres into a new kind of urban renewal project. It is very cool to people with an open mind.

“Tony Hsieh promised to spend $350 million to create his own utopian community, a place of inspiration and serendipity where everyone could become smarter and, of course, happier. He wasn’t leading people into the desert, exactly.”

He hoped to turn the Downtown Project into a thriving hub of high-tech creativity. When he started in 2012, his pitch was, “What if you could play SimCity for real?”

The media confusion started with the use of the word utopian community.

“Hsieh often said he wanted his $350 million to generate a “return on community,” not just a return on investment.”

“Though Hsieh’s camp used the word often at the Downtown Project’s inception, officials later removed all mentions about “return on community” from the Downtown Project website, adding the word “connectedness” to cut down on confusion.

“Tony Hsieh said he views the Downtown Project as a startup — an endeavor that often comes with mistakes waiting to happen.

“Every startup makes a ton of mistakes,” Hsieh said. “There have been investments that we’ve made and they’ve gone out of business.”

Hsieh’s key to moving forward?

“Learn and adapt quickly,” he said.

Our first stop was Container City. It is a section of the property made up of restaurant and shops. The business spaces are made up of newly constructed shipping container piled on each other. There are multilevel spaces with playgrounds for kids, dinning area tables and open areas.

Container Park Entrance

I had a great hamburger. Brad had fried tacos. We had a long conversation at lunch.

Brad and Tony are friends. Tony invited us to hang out with him at his Trailer Village down the street from Container Village.

This Airstream Trailer Village is more novel than the Container Village. It is in a large parking lot. It has security at the entrance. Once you get approval to enter you enter a walkway lined with artificial turf and covered with an archway made of wooden slatted park fencing and artificial ivy. Tony and Jennifer greeted us halfway down the makeshift hallway as we entered the village.

This space is something special in this day and age. It is kind of like a hippie, flower child experience of the 1960 in a much more cultivated and sophisticated way.

He has the periphery lined with Airstream Trailers and Wooden House Trailers. There is a large center common space for entertainment and hanging around.

Tony told us they show movies and have entertainment on most nights.

Goldspike is a Downtown Project redone casino/hotel with no gambling or booze.

On Sunday morning, we had brunch with a fellow who reached out to Brad in a classy way. Ryan Negri is a 33-year-old entrepreneur who sold a company he started at age 24. He and his wife moved from Newport Beach California to Las Vegas 14 month ago after he sold his company.

He is working on getting involved in the start up community is Las Vegas. Brunch was delightful. Ryan impressed me a very bright a fast thinking entrepreneur. I predict he will go places.

After brunch headed to the airport, concluding another fabulous father,son weekend.

My number one priority is to schedule my weekend with Daniel Feld.

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

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If You Like You Doctor

December 7, 2014

inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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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.

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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