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President Obama Tries To Bully The Supreme Court

Stanley Feld M.D.,FACP,MACE

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

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

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

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

Premiums are now unaffordable even applicants receiving subsidies.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Obamacare is not working despite President Obama’s claims.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Where Are Your Actionable Points To Replace Obamacare?

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. 

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=Chronic+disease+management&x=0&y=0

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.

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=ACOs&x=22&y=7

 Hospitals and physicians have to have the infrastructure to teach patients to become “professors of their 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=Professor+of+their+disease&x=17&y=9

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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Another Great Father and Son Weekend

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.

Brad

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.

Good Hsieh_t653
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
 Container Park Entrance

Container park 2

Container park 3

Container park 4

 

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.

  _Airstream_Village_1 LE14_t300

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

  Airstream_Village_LE16_t1000

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

_Airstream_Village_3 LE4_t300

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.

  Ryan and Brad

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

Stanley Feld M.D.,FACP,MACE

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

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

Its emotional seductions have also deceived many physicians.

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

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

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

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

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

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

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

 

 

 

http://youtu.be/O9m7fsSUUKQ

 

  

http://youtu.be/kOJfyT8juhA

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

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

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

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

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

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

 Nothing could be further from the truth.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Fantasy vs. Facts

Stanley Feld M.D.,FACP,MACE

President Obama is continues to mock the critics of Obamacare who predict failure even as Obamacare is obviously failing.

He knows the media is the message even if his message has nothing to do with the facts.

 

President Obam's first victory lap.

 There had been three failures at the time he declared Obamacare a success this month.

1. The Obama administration announced that accountable care organizations (ACOs) in the Pioneer ACO model and Medicare Shared Savings Program (MSSP) have generated more than $372 million in total program savings for Medicare ACOs over the program’s two-year span.

The details of the Pioneer ACO models’ savings are difficult to follow.

  • An estimated total model savings of over $96 million and at the same time qualified for shared savings payments of $68 million
  • Eleven Pioneer ACOs earned shared savings, 3 generated shared losses, and 3 elected to defer reconciliation until after the completion of performance year three.
  • The organizations showed improvements in 28 of the 33 quality measures and experienced average improvements of 14.8 percent across all quality measures.
  • The mean quality score among Pioneer ACOs increased by 19 percent, from 71.8 percent in 2012 to 85.2 percent in 2013.

 

Can anyone make any sense out of this word salad?

One week later three of the 22 remaining Pioneer ACOs dropped out of the program. The program originally had 32 members. 

The Franciscan Alliance, Genesys PHO and Renaissance Health Network have exited the Pioneer ACO program, which is now in its third year.

Only 19 of the original 32 ACOs remain.

Sharp Healthcare, a San Diego-based health system, dropped out August 2014, saying that the ACO model was “financially detrimental.”

The Mayo Clinic and Cleveland Clinic were invited to be in the Pioneer ACO program but rejected the offer. It was clear to them that ACO’s meant taking on too much uncontrollable financial risk.

The ACOs were supposed to deliver a higher quality of care through their integrated hospital systems. The hospital system would also experience greater profits.

At the onset of the program some hospital systems and integrated medical practices recognized they would lose money and possibly be penalized.

The thirteen integrated systems that quit the Pioneer ACO model recognized their losses after they started the program.

I predicted ACOs would fail and provided detailed reasons. I predicted that ACOs would fail because of the financial risks to the ACO. The job of risk is an insurance issue. A healthcare provider cannot control the confounding variables influencing risk.

“Genesys PHO received a $2.5 million penalty in the program's first year and a $1.9 million penalty in the program's second year (Evans, Modern Healthcare, 9/25; Leventhal/Hagland, Healthcare Informatics, 9/25; Beck, Wall Street Journal, 9/25).”

One could conclude that Genesys’ ACO was becoming an improved integrated better because it experienced a smaller loss the second year. It was not Genesys’ conclusion. It withdrew from the program.

2. Last week President Obama predicted that enrollment in Obamacare increase this year. The web site is fixed and enrollment will be easier.

At the same time at least 300,000 people in last years group of enrollees lost their subsidies or coverage because they did not offer proof of their eligibility by September 30th.

There has been little media coverage of this event. This is not the definition of success.

3. In addition, the insurance industry announced that thousands will lose health insurance their current insurance policy with their employer by the end of 2014.

They will have to apply for which will probably be more expensive through the health insurance exchanges. Insurers are cancelling the private healthcare insurance policies because they no longer make business sense.

Of course, it makes no business sense when the insurance company can make more money from the federal health insurance exchange plans. The Obama administration is guaranteeing the healthcare insurance company’s profit and eliminating its risks.

All this appeared at the time President Obama called Obamacare a success and mocked his critics who predicted failure.

The media is the message. If President Obama can manipulate the media enough he can help the Democrats maintain a majority in the Senate with two more years of Harry Reid control.

I do not think the American public is going to fall for President Obama’s disinformation campaign once again.

I hope not.

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



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Bigger Problems Ahead For Obamacare

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

Aco by state-Chart-4

 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

Aco by region-Chart-5

 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

Aco covered lives-Chart-6

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

Aco covered lives by region-Chart-7

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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Pure Genius Or Pure Stupidity?

Stanley Feld M.D.,FACP,MACE

President
Obama’s actions as leader of this country have been either pure genius or purely
stupid.

I think it
is pure genius. He promised Americans he was going to fundamentally change
America. He has!

Americans
have been under stress during the last few weeks. First it was the government
shutdown. Now it is the nation going into default. It is common knowledge the
shutdown and default is political theater.

President
Obama has run circles around Republican in the game of political theater.

The
traditional media has ignored the underlying causes of America’s problems.

We are increasing
debt to the point of unaffordability. The only way out is to increase taxes
further or decrease government spending while lowering taxes.

Increased
deficits are not good. Deficit increases devalues our currency. America’s currency
has already been devalued by the Federal Reserve increase in printing money.

Increasing
taxes leads to decreased jobs creation. Decreased employment leads to decreased
discretionary spending. The result is decreased economic growth.

Rather
than trying to decrease spending rationally by increasing government
efficiency, President Obama has closed down silly things to make it most painful
and noticeable to the public. These noticeable services have little overhead.
These closures are not an example of reducing inefficient spending.

In the
meanwhile his administration has spent over $600 million dollars for a health
insurance exchange software program. The program is poorly designed and does
not have an integrated back end.

Even if
the software was great, the cost of healthcare insurance through the exchanges
is increased and out of reach of the individual buyers.

 The cost of insurance is cheap for the poor who
qualify for government subsidies. The poor will receive a tax credit which will
be credited to the insurance company whose policy the poor person buys.

The math
is grotesque. If a healthcare policy costs $10,000 and a patient makes $30,000
dollars a year, he pays only 2% of his net income for the policy or $600 per
year. The taxpayer pays $9,400 a year for that policy.

This is
an example of hidden “redistribution of
wealth
” and another entitlement.

The
Obama administration has waived the verification requirement for receiving a health
insurance exchange subsidy. Verification of need does not have to be fulfilled
by the health insurance exchanges. Anyone can lie and receive a subsidy to
purchase healthcare insurance threw an exchange.

Another
big mistake was the design of the roll out to promote electronic medical
records. After 4 years only 11% of these records are functional. Physicians have
spent money for EMRs they could not afford. Hospital systems spent money they
could not afford. The government wasted $30 -60 million dollars of taxpayers
money in the unsuccessful effort to implement EMRs.

America
is a long way away from being computerized with a functional EMR.

Accountable
care organizations (ACO) are another important cog in Obamacare’s success or
failure. The administration brags about the fact that 250 ACOs are in
development.

There
are over 5,000 ACOs that need to be developed. A premier organization such as
the Cleveland Clinic had to drop out of the program because of the cost to the
institution. The Mayo Clinic refused to participate.

At the
same time ACO’s are turning out not to be cheaper or have better outcomes than
traditional medical care.

ACOs
were supposed to improve quality. ACOs were supposed to be a free market
solution to the dysfunctional healthcare system.

The
administration has been bragging about the greatness of the VA system. The
bragging stopped when the system’s poor quality of care was exposed. Veterans
are receiving poor treatment.

Everyone
would certainly have to admit Obamacare has been disruptive to the delivery of healthcare
in America.

The
months of healthcare insurance open enrollment for people is starting. People
are starting to see massive increases in their healthcare premiums. In order to
avoid these premium increases and the Obamacare penalties, large organization
such as Home Depot are hiring only part time workers.

The
Obama administration has developed a low cost insurance plan for the McDonalds
of the world. These health insurance policies cost little a cover less.

President
Obama has also provided waivers for congress and its employees. He is at
present trying to sneak in waivers from Obamacare to unions.

First, there was the delay of
Obamacare’s
 Medicare cuts until
after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement,
buried in the
Federal Register, that the administration would delay
enforcement of a number of key eligibility requirements for the law’s health
insurance subsidies, relying on the “honor system” instead. Now comes word that another
costly provision of the health law—its caps on out-of-pocket insurance
costs—will be delayed for one more year.”

 The
Obama administration has issued a blizzard of mandates and regulations. These
regulations have increased the cost of health insurance.

The caps
on out-of-pocket insurance costs, such as co-pays and deductibles have not been
publicized. On January 1, 2014, deductibles were supposed to be limited to $2,000 per year for
individual plans, and $4,000 per year for family plans.

In
February 2014, the Department of Labor published a little-noticed rule delaying
the cap until 2015. The costs of these deductible limits were already built into
the 2014 healthcare insurance premiums and were not removed.

The
government did nothing to reduce the increased healthcare premiums after the
limits did not apply.

 “Federal officials said that many insurers and
employers needed more time to comply because they used separate companies
to
help administer major medical coverage and drug benefits, with separate limits
on out-of-pocket costs. In many cases, the companies have separate computer
systems that cannot communicate with one another.”

“We
had to balance the interests of consumers with the concerns of health plan
sponsors and carriers.”

How is it in the consumers’ interests to pay far
more for health insurance than they do already?

I have a theory.

President Obama’s ultimate goal is to have a complete
government takeover of the healthcare system. A takeover the government cannot
afford.

He figures by creating as much chaos as possible
now in the “not so free market healthcare system”, he can declare the free
market healthcare system has failed.   

There will be a resulting public outcry for the
government to help and take over the system.

The takeover will be with a single party payer
system.

What are the chances a government takeover will
result in an efficient, cost effective system that will provide access to care
without rationing of care while being affordable?

With all the delays, exemptions and regulations,
it looks as if Obamacare is destined to fail. Obamacare is going to be
impossible to execute effectively.

Obamacare’s ultimate failure is playing right
into President Obama’s     ideological goal
of a single party payer system.

President Obama is not stupid. He is a genius.

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

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Hospital Systems Are Finally Realizing There Are Problems With Obamacare

Stanley Feld M.D.,FACP, MACE

Hospital systems loved the prospect
of Obamacare. Physicians would be forced into full time salaried hospital
system positions. Hospital systems would own physicians’ intellectual property
and surgical skills.

Physicians would be the hospital
systems’ cash cow. Its brick and mortar model was failing. Surgery and recovery
from surgery was improving. Length of hospital stays was decreasing.

The problem hospital systems were
discovering was that physicians were not as productive when salaried as they
were when they owned their own practices.

Surgery was being performed as
outpatient surgery in freestanding surgery centers. Physicians own most of
these surgery centers independent of hospital systems.

The advantage of these outpatient
surgery centers to patients is they are cheaper, price transparent and have
comparable outcomes.


The healthcare insurance industry has
even encouraged their use. The Obama administration doesn’t like them because they
encourage patient choice and independence.
This is the opposite of Obamacare's goal of government dependence and control of patient choice.

Hospital systems thought Obamacare
would provide millions of newly insured patients. This would translate to
higher profits for the hospital systems.

Obamacare’s supposed
goal was
improving access to care for low-income families and individuals. Hospital systems were led to believe that they would treat more
patients with health insurance through expanded Medicaid eligibility.

With the
introduction of health insurance exchanges, low-income individuals would be
able to purchase healthcare insurance coverage at a subsidized rate.

The subsidy would
come in the form of a tax credit. Hospital systems did not realize that low-income
families do not pay taxes so they would not pay any tax to apply a tax credit.
These families making up to $38,000 dollars a year could not afford the lowest
insurance of $12,000 dollars a year. They would opt to not buy the health
insurance exchange offerings.

The health
insurance exchanges would not reduce the amount of uncompensated care provided
by the nation's hospitals.

Suddenly hospital
systems realized that their hospital consultants were wrong.  While it sounded good on paper, many hospital
finance administrators are terrified that Obamacare will result in a hospital
system taking great losses as a result of decreased reimbursement and a
decrease in the promised insured population.

Tim
Nguyen, corporate controller at Palomar Health, a San Diego–based system with
690 licensed acute care hospital beds and $2.5 billion in gross annual revenue
,
says there is a catch-22 built into the healthcare legislation that will
ultimately hurt hospital systems.”

 There is another catch to Obamacare. I cannot
tell if this was an unintended consequence or purposeful deception by the Obama
administration.  The exchanges will have
different tiers with different deductibles and copays.

California's
health exchanges will have four tiers when the program goes live in January
2014, Nguyen explains: platinum (where the patient pays 10% of total healthcare
expenses); gold (20%); silver (30%); and bronze (40%).”

"These
patients will still be responsible to pay
, and they probably don't make that
much money and are likely to choose the silver or bronze tier to keep the
premiums low. … That will increase our bad debt even though they have
insurance."

The low- income
families will believe they have good insurance coverage. If they get sick they
will be responsible for the high deductibles and co-pays.

If they choose to buy
the insurance they will use the hospital facilities without realizing that the
insurance does not cover everything.

 After hospitalization
they will be hit with a bill they cannot afford. The hospital system will
pursue payment but will not be able to collect. The hospital will have to write
it off.

 There is total
uncertainty about the rules. However, before a hospital system should accept
the program they should know the rules. Their participation can ruin them financially.

Marlene Zurack is senior vice president of
finance and chief financial officer for New York City Health and Hospitals
Corporation (HCC). HCC is a municipal integrated healthcare delivery system
with $7.1 billion in total operating revenue when combined with HHC's MetroPlus
health plan.

HCC cares for indigent and low-income
patients. It is subsidized by the Medicaid's Disproportionate Share Hospital
program.


She is doubtful that the insurance exchanges
will result in a net benefit to her organization. She insures 1.4 million
people. The systems treat 475,000 uninsured patients. She has two problems with
the health insurance exchanges.

She does not know how many of the uninsured
will get insurance, what level of insurance will they buy and how much of a
difference the insurance payment is from the Medicaid's Disproportionate Share
Hospital program.

“HHC
is likely to lose revenue in the end
, Zurack says, due to cuts being made to
Medicaid's Disproportionate Share Hospital program, which distributes payments
to qualifying hospitals that serve a large number of uninsured individuals.”

In
reality, Zurack says, the cuts will be extremely damaging to hospitals that
serve this population.

New York City Health and Hospital Corporation
is scheduled to lose $17.1 billion dollars between 2014 and 2020 due to federal
cuts In the Medicaid Disproportionate Share Hospital program.

Obamacare is becoming a reality. Hospital
systems such as HCC are realizing the financial impact of Obamacare.

Accountable
Care Organizations are Obamacare’s signature tool to improve access to care and
decrease the cost of care.

The promise to hospital
systems’ is that by increasing efficiency ACOs could increase hospital systems’ profit.

Incorporated into the ACO scheme
is profit sharing with the government if there are reduced costs. Included is
reduction in payment if costs exceed benchmark costs.

Only 10% of hospital systems
have signed up in the last two years. The Obama administration has done a lot
of bragging about enrollment
.

Originally there were thirty-two “Pioneer”
hospital systems. The Mayo Clinic and the Cleveland Clinic rejected being
Pioneer participants. The goal of ACOs is to develop integrated care delivery
systems.

Last week 9 of the original 32
Pioneer ACOs withdrew from the original program.
CMS gave no explanation for
them leaving.

I believe they realized they
couldn’t integrate their delivery system the way the government wants.

They cannot make any money
participating in the Medicare Shared Savings Program.

Seven of the nine are applying to transition
to the Medicare Shared Savings Program, while two are abandoning the program
completely. CMS declined to identify which ACOs are leaving the Pioneer program
and which are simply shifting to the MSSP.

 The nine departing
ACOs are
:

  • Prime Care Medical Network Inc., an IPA-based ACO serving San
    Bernadino and Riverside counties in California.
  • University of Michigan Health System in Ann Arbor.
  • Physician Health Partners LLC, a medical management company in
    Denver.
  • Seton Health Alliance, a network of providers comprised in the
    11-county Austin area.
  • "Plus ACO," a partership between North Texas Specialty
    Physicians and Texas Health Resources
  • Healthcare Partners Nevada ACO LLC, a multispecialty medical
    group and IPA serving Clark and Nye counties in Nevada
  • Healthcare Partners California ACO LLC, a multispecialty medical
    group and IPA serving Los Angeles and Orange counties in California.
  • JSA Care Partners LLC, a primary medical group and IPA serving
    the Orlando, Tampa and South Florida area.
  • Presbyterian Healthcare Services, an integrated delivery system
    serving the Albuquerque area.

 “Plus
ACO”, a partnership between Texas Health Resources and North Texas Specialty
Physicians
, has plans to leave the Pioneer ACO program by mid-August, but the
two organizations say they are open to "remaining in the Pioneer ACO
program if we can find an economically viable way to do so."

 ACO’s are doomed. Obamacare is falling apart.

President Obama immediately went on the campaign
trail telling the country how great Obamacare is already.  

 
 

http://youtu.be/Kyv8ZRkXnfU?t=58s

He continues to ignore problems with Obamacare’s implementation
and costs. He has no regard for America’s financial stability.

Americans’ are starting to understand his attitude.

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

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An Interesting Unintended Consequence of Obamacare

Stanley
Feld M.D.,FACP , MACE

 The Obama administration has encouraged local hospital systems
throughout the United States to consolidate physicians practicing in their
hospitals.

Hospital systems have found this attractive. There has been a
movement to buy physicians’ practices and then pay physicians a salary.
This
has been encouraged by the Obama administration because someone in the
administration believes this will encourage physicians to stop over testing.

Hospital systems love it because they understand that brick and
mortar facilities are not worth as much as they use to be. If they own
physicians’ intellectual property in the form of primary care physicians and
skills in the form of surgeons, the value of the hospital system increases. 

It has not worked out as well as many hospital systems would
like
because when physicians worked for themselves they were more productive
than when they worked for the hospital system.

The Obama administration also believes that it can bundle the
payment of a treatment and share the savings with the hospital system if the
treatment costs less. If the treatment uses more assets and costs more the
hospital system will not be paid.

In other words, the government and the healthcare insurance
industry want to offload the risk of treatment to the hospital system. They
administration thinks this will force hospital systems to deliver a better
quality of care. You may recall quality of care has not been defined
adequately.

The example often used is the non-payment for hospital
readmissions within thirty days.

This policy doesn’t work because reasons for hospital
readmissions are multifactorial. Many of those factors are uncontrollable. One
hospital system can also divert the patient to another hospital system or treat
the readmitted patient in the emergency room.

The Obama administration is encouraging Accountable Care
Organizations
. There are so many problems in forming, administrating and
managing ACOs that they are destined to fail.

Anyone reading the administration’s propaganda would not think
so, but it is true, and as time goes on it will become apparent.

Finally, hospital systems and physician groups are realizing the
negotiating power they are accumulating by consolidating and integrating
physicians’ practices.

Consolidation is not good
for the patients. It is great for the hospital system and the large independent
physician specialty groups. Physicians who have sold their practices to
hospital systems will not do so well because the hospital systems are in
control of the collections and salaries.

Large medical specialty groups are negotiating with Obamacare’s
new healthcare plans. These providers are demanding, and in some cases
securing, pretty rich reimbursement rates from the new Obamacare health plans.

It is the same thing that happened in the 1980’s when HMOs
negotiated high reimbursement deals with medical and surgical specialists the
HMO wanted in the group.
The HMO’s reasons were to promote the HMO’s brand and
to get better medical results for the patients they had enrolled.

“To take care
of patients that will be covered by the new insurance scheme
, these providers
are requesting payment rates that are higher than what they're being offered by
Medicare. Some providers are even insisting on premiums over what they're paid
by the existing private, employer-based health plans.”

Hospital systems in a town they dominate are doing the same
thing. The result will be an increase in the costs to the government and the
healthcare insurance companies. They will pass the increased costs on to the
consumers.

“Some of the
Obamacare plans, stuck in markets where there are few competing groups of
providers to choose among, are being forced to accept these high prices.”

The Obama administration told us, at the passage of Obamacare,
that providers would be discounting to get the volume of business that
Obamacare offered as the new legislation banded large groups of patients into
statewide insurance pools.

The defective central premise was that Obamacare would entice
providers to take lower reimbursement because of increased volume.  

“The people
that now seem most likely to enter these state-based insurance pools, and buy
the new coverage, represent a costly mix of patients with a lot of pre-existing
medical conditions. The volume is also unlikely to materialize.”

Obamacare has tripped over its central premise. It is not going
to lower costs. It is going to raise costs.

Obamacare has stimulated the consolidation of hospitals and
physician groups that's now rampant in healthcare. This consolidation is
starting to give providers leverage over Obamacare’s health plans.

This unintended consequence of Obamacare was obvious to most
healthcare policy thinkers who believe that control and planning do not work.
Unfortunately, President Obama did not listen to them.

The other thing President Obama did not listen to is that Health
Maintenance Organizations (HMO’s) of the 1980 and 1990s did not work. Obamacare
is a HMO on steroids
.  

 “Under the scheme, doctors are paid lump sums of money to care
for large groups of patients.

The idea is to put the financial risk on the doctor for the
cost of the medical care that they deliver
. This was a central premise for how
Obamacare would put financial pressure on providers as a way to help to lower
healthcare costs.”

Physicians and Hospital Systems have been to this movie before. 

Hospital Systems are making believe they are taking Obamacare’s
financial bait. They are using the concept to frighten physicians and buying
local medical practices.

Hospital systems’ goal is to get a geographic monopoly then take
advantage of the negotiating monopoly. Physician groups especially specialty
groups will stay independent of hospital systems, integrate practices and get
in a negotiating reimbursement.

This will increase the cost of medical care. Everyone knows all
healthcare is local. Central control of healthcare is innately flawed. 

This is one of the many defects in Obamacare’s structure.

Obamacare has dismantled the last vestiges of local competition
among physicians for patients.

Now Obamacare will have to deal with the physician and hospital
system cartels it has created.

 The victims in all of this are patients
and the cost of patient care.

The Obama administration’s public service campaign is starting
to sell Obamacare’s virtues to young people through the NFL, NBA and major
league baseball. It is also signing up non suspecting consumers at supermarkets and churches.

Good luck. I think everyone is starting to catch on.

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

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