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Single Party Payer Will Fail

December 21, 2015

inDisinformation and the healthcare system, Repairing the Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld MD, FACP, MACE

Socialism does not work!

Intellectually, socialism is attractive and easy to understand.

Simple Definition of Socialism

“: a way of organizing a society in which major industries are owned and controlled by the government rather than by individual people and companies.”

Full Definition of socialism

“1 : any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods 
2 a : a system of society or group living in which there is no private property b : a system or condition of society in which the means of production are owned and controlled by the state 
3 : a stage of society in Marxist theory transitional between capitalism and communism and distinguished by unequal distribution of goods and pay according to work done.”

It would be nice to have the government tend to all our needs equally.

Everything would be free to the public.

Not one would need to “get ahead.”
No one would have special privilege.
Everyone would live the same housing.
No one would have to have responsibility for anything.
No one would have incentive to be creative or inventive.
No one would need to take the initiative to be innovative and create new good and services.

The government would then run out of money because people would have little to be innovative about or have any incentive to work hard to provide for their family.

People would have little incentive to produce income that would generate taxes for government to spend on goods and services to support the benefits offered the people in a socialistic system.

The government would have to borrow more money from others because the people would not produce enough income to tax.

What lender would be inclined to lend money to a country that could not pay it back?

The socialistic system would then become unsustainable and collapse.

This explanation might be considered by some to be a fifth grade explanation of socialism. It is simple to understand but direct and to the point.

America is headed in that direction. The present healthcare system as is unsustainable.

Government cannot spend other peoples’ money when the money is not there.

In America the federal government and state governments keep making the same mistakes over and over again.

Obamacare’s regulations caused 335,000 healthcare insurance policies to be cancelled in Colorado. In 2010 Obamacare made these Coloradan healthcare insurance policies illegal.

Obamacare has failed for the citizens of Colorado.

The state’s politicians tried to fix Obamacare by borrowing hundreds of millions of dollars from the federal government to set up Colorado HealthOP the state’s co-op health insurance plan.

The goal was to stimulate competition among insurance companies by providing lower priced insurance. The co-op is in debt to the federal government for hundreds of millions of dollars.

Colorado HealthOP became the largest insurer on a state health insurance exchange in Colorado.

Colorado HealthOp lost so much money that it could not borrow any more. The Colorado HealthOp had to shut down in October 2015 leaving the federal government to absorb its loan to the state of Colorado.

The closure of Colorado HealthOP left 80,000 Coloradans without health insurance coverage for 2016.

The other state insurance plans are increasing premiums an average of 11.7% to stay above water according to state calculations.

It has made premiums and deductibles too expensive for many of these uninsured 80,000 people.

Coloradans are tired of all the insurance changes, increasing prices and uncertainty. They want something new.

The knee jerk reaction is to change to something easy to understand. A socialistic single party payer system (SPPS) is the easiest to understand. Let the state provide healthcare insurance to everyone. Healthcare would be universal and free to the public.

The problem is nothing is free. The advocates in Colorado (progressives and liberals) are mobilizing to replace Obamacare with either the Canadian or United Kingdom healthcare system.

However, both of these nations healthcare systems are unsustainable. They are failing because of the cost, inefficiency, long wait times for diagnosis and treatment and lack of services despite the governments claims and some of the consumers’ perceptions.

The progressive advocates accumulated 100,000 Coloradans’ signatures. These progressive democrats have gotten a single party payer (SPPS) proposal on the 2016 ballot.

“ColoradoCare,” as it is being called, would replace private insurance with health care funded completely by the government, substituting higher taxes for premiums.

The conservatives in Colorado do not have a proposal to replace Obamacare to put on the ballot in 2016. They have been asleep at the switch.

Conservatives and libertarians have been sleeping at the switch in every state except Vermont.

Conservatives and libertarians did nothing in Vermont. Peter Shumlin was elected governor to institute a SPPS.

The Vermont experiment with a single party payer system has been a disaster already.

“In 2010 Vermont voters elected Democratic Gov. Peter Shumlin, who promised to institute single payer in lieu of ObamaCare.”

Jonathan Gruber, who designed Obamacare, and thinks Americans are stupid, along with William Hsiao, who thinks price controls work designed the system for Vermont.

“Helping design the system was advisers such as Jonathan Gruber, the MIT economist often described as the architect of Obamacare, and William Hsiao, the Harvard economist who developed the Medicare price controls that are driving up prices around the country.”

Vermont played right into President Obama’s goal of creating a single party payer system (SPPS). Colorado is trying to follow the same path to disaster.

The Obama administration provided Vermont with many millions of dollars in federal grants in order to accomplish President Obama’s dream of a single party payer healthcare system.

In order to pay for Vermont’s SPPS the state proposed an 11.5% payroll tax on businesses, which would have taken the total payroll-tax burden to nearly 20%.

Vermont contemplated a new state income tax of 9.5% to pay for the SPPS on top of the existing 3.55-8.95% individual state tax.

The state budget would need to be doubled with the SPPS, therefore taxes would need to be doubled.

Even with these increases in taxes the plan would be deep in the red in three to five years.

Gov. Shumlin (Vermont) was elected to create a SPPS. In 2014 he abandoned single payer system he was about to create because of its effect on the state economy.

Gov. Peter Shumlin woke up to the impending disaster, “The potential economic disruption and risks,” he remarked, “would be too great to small businesses, working families and the state’s economy.”

Ben and Jerry might even flee the state and move to Texas because of the high taxes and economic disruption.

The people of Colorado should look carefully at Vermont’s mistake. The Denver Post has already predicted tax increases that would drive business and job growth out of the state.

Colorado also has a large VA Hospital System. In April 2015 the Colorado Springs Gazette reported that four of Colorado’s VA facilities were among the 10-worst in terms of wait times of all VA hospitals.

The Veterans Affairs hospital system is a pure a single-payer system.

“ A September report by the agency’s inspector general supports the conclusion that thousands of veterans may have died while waiting for the care they needed, although shoddy record-keeping made it impossible to know for sure.”

All Coloradans have to look at is their state’s VA SPPS that cannot take care of the 400,000 veterans in the state. Why should Coloradans expect a SPPS would work for five (5) million residents it their state?

What have conservatives and liberations offered as a substitute for the failed Obamacare experiment?

Nothing!

Leaders should start looking at My Ideal Medical Savings Account system that would put consumers in charge of their health and healthcare dollars.

Please send my summary blogs about an alternative to Obamacare and my Ideal Medical savings accounts to your elected representatives.

Spread the word about My Ideal Medical Savings Account as an alternative to Obamacare.

I wish everyone a HAPPY AND HEALTHY HOLIDAY SEASON

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

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Restricting Access To Care

April 15, 2015

inDisinformation and the healthcare system, Medicine: Healthcare System, Patients Problems, Physician's Problems, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP, MACE

As a retired Clinical Endocrinologist I don’t have a vested interest in generating income for myself from the healthcare system.

What I am trying to do is help consumers and healthcare policy makers understand the present healthcare system. I fear they have no interest in understanding what would work to repair the healthcare system.

I am also trying to explain to consumers that few politicians are interested in helping them. Politicians are interested in power. They are interested in making the people dependent on them.

Politicians and the central government are interested in controlling the healthcare system, the financial system, the Internet and the environment. Once politicians control these systems the people have lost their independence and freedom. Politicians will have the power they seek.

Many of our constitutional freedoms have been disappearing. American have been on the Road To Serfdom for many years.

President Obama has hastened the journey on the road to serfdom with his blatant disregard for the constitution and the bill of rights. To my chagrin he is succeeding.

President Obama is pretending to want to provide universal care. His goal is to destroy the healthcare system so that the people will beg for the central government to control the healthcare system. There are more uninsured people now than when he became President.

Paul Krugman is one of President Obama’s henchmen. He stated in a recent article that Obamacare is costing the government less money than the administration thought it would. He therefore calls Obamacare a success.

This administration and its henchmen in the traditional media flood us with half-truths.

Obamacare might be costing the government less than they expected. The Obama administration never told Americans what they expected to spend.

The Obama administration is the most non-transparent administration in my lifetime. Meanwhile, the Obama administration tells Americans it is the most transparent administration in history.

CGI is a Canadian company with offices in the U.S. It had the contract to develop the Obamacare website healthcare.gov. The website was a disaster. The development cost overruns were unbelievable.

CGI received the contract through an Obama crony capital award and a non-competitive bid.

CGI receive another contract to complete the backend of healthcare.gov.

The Affordable Care Act (Obamacare) is supposed to be affordable for consumers. Consumers are experiencing higher premiums and out of pocket expenses for medical services.

1. Obamacare has been under subscribed. Only 10 million people are verified premium paying subscribers. The Obama administration projected 30 million subscribers by 2015 when Obamacare was passed in 2010.

2. The deductibles are unaffordable. Obamacare is even unaffordable to those people who receive subsidies.

The subsidized people have avoided seeing physicians in a timely manner. The result is government costs are less in the short run but will be more in the long run as people get very ill.

3. The Obama administration is keeping the expenses for infrastructure and bureaucratic structure non transparent.

4. Obamacare’s rules and regulations are resulting in restricting access to care.

5. Paul Krugman and the Obama administration spin the truth by ignoring consumer out of pocket expenses.

There has been an explosive increase in premiums and higher deductibles though the health insurance exchanges as well as private insurance.

The Obama administration has been silent about this reality.

The Affordable Care Act is not affordable. It has not increased the “quality of care.”

Paul Krugman does not publish the real truth in his New York Times articles. Those who still read the New York Times take his words literally. They are deceiving themselves.

One of the ways the Obama administration is restricting access to care to lower its costs is through the U.S. Preventive Services Task Force’s (USPSTF) recommendations.

I have criticized the USPSTF methodology in the past for its conclusions about many clinical practices.

The task force is composed of a group of physicians that do not have clinical expertise in the medical or surgical topic they are evaluating.

The group simply reads the medical papers assigned to them to evaluate. The committee decides the efficacy of treatment on the quality of the literature they are given to evaluate. Clinical judgment is not included in their evaluation.

A positive decision is made if the literature contains a double blind controlled study yielding positive results.

Last month the U.S. Preventive Services Task Force (USPSTF) issued its final recommendation statement on Screening for Thyroid Dysfunction. The USPSTF studied this topic in 2004 with the same final opinion.

This time Obamacare will probably take action and restrict the evaluation on the basis of this recommendation

“ In its statement, the task force said that without more data from randomized clinical trials it could not assess the balance of benefits and harms from pre-clinical thyroid disease treatment and, thus, could not recommend that asymptomatic, non-pregnant adults be screened for thyroid dysfunction.”

The Annals of Internal Medicine (AIM), a journal of the American Medical Association published the USPSTF recommendation without expert clinical endocrinology comment or critique.

R. Mack Harrell, MD, FACP, FACE, ECNU current President of the American Association of Clinical Endocrinologists (AACE) is having the AACE Thyroid Scientific Committee submit a note to the Annals of Internal Medical addressing AACE’s concerns with the USPSTF’s paper.

AACE has studied and written many guidelines on the evaluation and treatment of thyroid disease. Its members have vast experience as practicing clinicians in the treatment of thyroid disease. Its input should be sought by the Obama administration not ignored in favor of a default decision that saves Obamacare money and puts the financial burden of care on consumers.

The following is Dr. Mack Harrell’s comment to AACE’s membership.

In my opinion Dr. Harrell’s’ comments are totally correct and should be heeded by the Obama administration.

“While agreeing with the USPSTF’s call for new, controlled thyroid screening studies, AACE issued a press release outlining its position on aggressive case finding suggesting: that this approach is an appropriate alternative to screening in patient groups where thyroid risk factors are present.

More specifically, AACE stressed that testing and treatment are indicated in those patients who are at highest risk for developing life-altering, overt thyroid disease, including:

Patients over 60, in whom symptoms of hypothyroidism are often minimal, absent or atypical

Newborns (continued mandatory screening for congenital hypothyroidism recommended)
Those with autoimmune diseases often associated with thyroid disease, such as type 1 diabetes and pernicious anemia
Patients with a prior history of thyroid disease or thyroid surgery, an abnormal thyroid exam, or taking drugs known to affect the thyroid
Patients with a family history of thyroid illness

AACE further emphasized that careful consideration should be given to thyroid testing in women who are planning pregnancy or are already pregnant given the clear-cut detrimental effects of thyroid hormone lack on fetal development in the early phases of pregnancy.

We also intend to submit to AIM a formal statement from the AACE Thyroid Scientific Committee to address concerns that the task force’s “lack of data” argument could be incorrectly interpreted as a “lack of clinical need” to find and treat thyroid disease.

For years, members of AACE and the American College of Endocrinology have worked diligently to provide up-to-date, useful clinical guidelines and recommendations regarding decision-making about thyroid function testing for physicians. We will continue to keep our members and the medical community apprised as we communicate our position regarding thyroid disease testing.

Best regards,

R. Mack Harrell, MD, FACP, FACE, ECNU

The Obama administration has made many mistakes in writing Obamacare. Most of them have not been in favor of the consumers it professed to help.

About 50% of women over the age of 60% might have subclinical hypothyroidism. Overt clinical hypothyroidism can take several years to declare itself. During the time of subclinical hypothyroidism evolves to overt hypothyroidism patients can suffer mild to moderate symptoms that would decrease their quality of life on many levels.

I believe President Obama should show compassion and responsibility toward the millions of who people would suffer from subclinical hypothyroidism. President Obama is setting up the healthcare system to restrict access to care for these people.

I do not think he should rely on a committee that does not have the expertise in the field of clinical thyroidology.

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

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Let’s Do The Numbers : Another Obama Trick

March 19, 2015

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

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Stanley Feld M.D.,FACP,MACE

Have the increased Obamacare taxes added enough value to the healthcare system to be worth the costs?

The answer is no.

Are the increased taxes becoming painful yet?

The answer is yes.

The yearly cost of Obamacare has not been transparent. There have been multiple delays in the implementation of Obamacare.

Favored businesses and unions have received waivers and exemptions from the laws required coverage. All the while taxes have increased and less than 10 million people have received healthcare coverage from the healthcare insurance exchanges. Eighty-five percent of those people enrolled are receiving federal subsidies.

No one has explained how a tax credit becomes a federal subsidy.

The public has no idea what the costs of Obamacare are or will be in the future. The CBO has revised its estimates several times.

Are all the Obamacare pronouncements confusing?

Yes. I believe they are intentionally confusing.

All the stakeholders are dissatisfied. Neither President Obama nor his administration is listening to the primary stakeholder (patients).

Why are there so many waivers and exemptions being handed out by the Obama administration? I believe it is because President Obama is listening to his political base.

He is delaying the implementation of his agenda so his goal of socialized medicine is not obvious to all Americans.

President Obama and his administration have mislead us about the exact number of enrollees since the very beginning of the first enrollment period, October 1,2013.

The American public was mislead about ,

The disastrous website development, reason for website crashes and cost of website development.
The exact number of enrollees the first year. (9.5 million correct to 8 million and then down to 6.8 million)
The resulting further correction by a decrease in 800,000 more people losing insurance because of discovered ineligibility for subsidies.
Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
The change in the start of enrollment from October 1,2014 to November 15^th to avoid discussion of enrollment around the time of the November 2014 elections.
Extending the 2014 enrollment three months.
Extending enrollment for 2015 for one to three months.
Finally in 2015 announcing the back end of the website sending information to the IRS was still not complete.
Rehiring CGI the same Canadian company that built the disastrous healthcare.gov to fix the back end of the website.
Discovering that 1.2 million were counted that should not have been because they got dental insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
Eight hundred thousand (800,000) enrollees lost their subsidy because they lied on their application
Announcing that the group market Obamacare enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

Along the way I got the feeling that none of the enrollment numbers could be trusted. HHS and CMS keeps on modifying and lowering them.

The Obama administration keeps telling us how great the enrollment is and that Obamacare is a success.

However, only ten million people have Obamacare insurance. Eighty five percent of those on Obamacare are receiving subsidies and still cannot afford the deductibles.

The rest of the enrollees have a pre-existing illness. They cannot find private insurance to buy. What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?

After five years with all these new Obamacare taxes, I would not call this a successful healthcare reform program.

All of these enrollees were in the individual market. These numbers do not include the group insurance market.

14 million lost their healthcare insurance on the individual market. 10 million gained insurance on the healthcare insurance exchanges.

Several states healthcare insurance exchanges have failed.

An unknown number of enrollees in 2014 did not re-enroll in 2015 because of the loss of the subsidy and the high deductibles.

Other enrollees did not sign up again because they could not afford the high deductible.

The following is President Obama’s next trick play.

At the end of 2015 enrollment the Obama administration declared that 11.5 million people were enrolled.

On March 16,2015 the administration said about 16.4 million people have gained health insurance coverage since the Affordable Care Act became law nearly five years ago.

Please notice the tricky wording. The Obama administration is counting children under 26 that now can be included in their parents’ group insurance plans and the additional Medicaid recipients added by some states.

The count is not only the people who enrolled in Obamacare through the healthcare insurance exchanges.

The present discussion is about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

Confirmed Exchange QHPs: 11,699,473 as of 3/18/15

 Estimated: 11.95M (9.06M via HCgov) as of 3/18/15

Estimated ACA Policy Enrollment: 33.1M (10.46M Exchange QHPs, 8.20M OFF-Exchange QHPs, 330K SHOP, 14.1M Medicaid/CHIP)

http://acasignups.net

There are two possible reasons for the Obama administration’s pronouncement at this time.

The first is the Republicans are about to announce its alternative plan to Obamacare. The administration’s goal would be to blunt the impact of the alternative plan by announcing the false success of Obamacare.

The second reason is to play mind games with the Supreme Court.

Justice Kennedy’s questioning at the hearing of King vs. Burwell expressed his concern for 85% of 10 million people who would loss their federal subsidy. Justice Kennedy did not address the letter of the law in his questioning.

Only the state healthcare exchanges can provide subsidies not the federal exchanges according to the written law. This is executive overreach of power granted by the constitution. President Obama should have asked congress to rewrite the law’s provision.

In an attempt to pressure the Supreme Court to vote in President Obama’s favor the administration has given the impression of confidence the Supreme Court will act in its favor.

The Obama administration has announced, a few times, that it does not have an alternative plan if the Supreme Court rules against it.

This is not true. The Obama administration has at least three alternative plans in the works.

It looks as if President Obama cannot help himself from trying to manipulate the American public and now the Supreme Court.

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

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Keeping Obamacare’s Failures Out Of The News

September 21, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP, MACE

The Obama administration has tried its best to keep Obamacare’s failures away from the people. However, it has been almost as difficult as putting toothpaste back in the tube. The reasons are clear to me.

People are paying attention now because most are personally affected by the failures of Obamacare.

These failures along with President Obama’s other policy failures such as the IRS scandal, Benghazi scandal, Fast and Furious, border control failures, immigration failures, foreign policy failures, NSA privacy intrusions and his lying about those intrusions, attempts at Internet takeover, and unconstitutional unilateral changing of laws through executive orders have lead the American people to lose confidence and trust in whatever President Obama and the Obama administration say.

The traditional mass media has tried mightily to protect President Obama. They have tried to help him keep Obamacare’s failures out of the news.

They have been unsuccessful. If our only source for news was the traditional news media we could be fooled.

Americans must work to stay informed in order to maintain our freedoms.

I will list some of Obamacare’s failures of the last few months.

These failures have had little coverage in the traditional media. Obamacare has continued to move forward to hobble and then destroy the medical care system in America.

President Obama’s goal is to prove that a free market healthcare system does not work. He has disregarded the fact that the healthcare system is not a free market system.

In a recent blog I presented the reasons for physicians’ discontent with Obamacare.

Survey of Physicians And Their Discontent

In July 2014 the “Physicians Foundation” published a survey sent to 660,000 physicians. Twenty thousand physicians completed the survey.

“Forty-six percent of doctors give President Obama's healthcare law a "D" or an "F," according to a new survey from the Physicians Foundation. In contrast, just 25 percent of those surveyed gave the law an "A" or a "B."

A large number of physicians complained about the vast new bureaucracy that has been added to the medical profession.

A physician comment read, "I'm a Canadian physician practicing in the United States. The politicians and policy makers need to understand that government involvement in healthcare never works."

The only newspaper that reported the survey to my knowledge was the Washington Examiner.

Enrollment Failures

President Obama and his administration are playing a numbers game with the enrollment figures. His March 31,2014 figures were inaccurate. The figures were grossly inflated.

President Obama said on March 31^st, "this thing is working” successfully. President Obama claimed that 8 million enrolled in Obamacare.

“At a hearing Thursday September 18, 2014 at House Oversight and Government Reform Committee, Marilyn Tavenner, head of the Centers for Medicare and Medicaid Services, finally confessed that 7.3 million were enrolled in ObamaCare plans as of mid-August.”

The 7.3 million figure is also fiction. At least 115,000 additional enrollees have not validated their citizenship or legal status. The validation must be completed by September 30,2014.

An additional 360,000 could lose their Obamacare subsidies because of discrepancies over their income. Eighty-five percent of the enrollees are receiving government subsides for healthcare coverage.

Most do not pay taxes because they make less than forty thousand dollars a year. They will not be able to afford the overpriced premiums.

How many of the 8 million have not continued to pay the premiums? No one knows or is telling. Enrollees have a three-month grace period.

California reported in late August that an additional 100,000 of those who enrolled through its state-run exchange were at risk of losing their coverage over citizenship issues.

By my calculations less than three million of the forty-eight (48) million people who were uninsured pre Obamacare became insured. An additional 7 million people lost their healthcare insurance in the individual market.

President Obama provided the American public with a grossly overestimated enrollment figure.

Ms. Tavenner had to put a positive spin on this latest revelation of the fictional enrollment numbers by saying,

"We are encouraged by the number of consumers who paid their premiums."

No one is buying this explanation.

She didn't provide answers to important details for these latest enrollment figures.

How many who dropped out were young and healthy?
How many have signed up through the so-called special enrollment process?
How many are keeping up with premiums?
How sturdy are the back-office computer programs in order to detect enrollment misinformation?
How will the government collect the money due to it from these non-paying enrollees?
Is the November 15^th open enrollment period going to go smoothly?

Next Open Enrollment Disaster

It is easy to see that President Obama has delayed the open enrollment time from October 15^th to November 15^thfor political reasons. He wants the potential disaster to occur after the mid-term elections.

Kevin Counihan, the former chief executive of Access Health CT, Connecticut’s online marketplace, was just named head of the insurance marketplaces for the federal government.

He said, “Part of me thinks that this year is going to make last year look like the good old days.”

The front end of the web site looks like it will run smoothly. The back end of the web site still needs work. The government is still trying to see if the links to the IRS, the healthcare insurance industry and social security are functioning properly.

There were not enough healthy young subscribers to keep the insurance rates low. The premiums were too high for many young and healthy uninsured people.

This year the healthcare insurance premiums will be up at least 20%. Healthcare insurers fear it could be even more difficult to sign up young healthy people than it was last year.

Adding to the problem is that the sign up period for choosing a new policy this year will be shorter than last. It will be 3 months instead of six months.

President Obama will probably break the law again and extend the signup period an additional 3 months.

This year it should be more difficult to receive subsidies than last year.

People will drop out of the pool because of the increase in insurance rates. The renewal procedure has not been worked out yet.

Andrew Slavitt, principal deputy administrator for Medicare said they are working hard to make the process as easy as possible.

“We’re putting in place the simplest path for consumers this year to renew their coverage.”

This is another Obamacare smokescreen.

I predict it will be a price disaster.

Obamacare And Zeke Emanuel Setting Us Up For Rationing

One of the most bizarre articles imaginable was Zeke Emanuel’s article in the Atlantic Monthly “Why I Hope to Die at 75”

Dr. Emanuel, one of Obamacare’s authors, gives all the reasons why he doesn’t want to live past 75 years old.

His argument is why should you live longer since you probably are not useful to society.

You have contributed all you are going to contribute. After 75 years old affliction will accumulate and disabilities will make life less pleasant.

It is apparent to me that he is setting us up for government rationing of healthcare for seniors.

The government controls Medicare. It is cheaper for the government not to pay for procedures such as hip replacements, knee replacements, for coronary artery surgery or cardiac pacemakers. All these procedures will extend the life of seniors over 75 years old who need them.

We have also heard rumors that this bureaucratic thinking is already in progress.

Don’t we live in a free country?

Isn’t it up to individuals to make their own life decisions?

Should we leave these decisions up to the government and bureaucrats?

Should they decide our choose of treatment for us?

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

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When Will We Ever Learn

September 10, 2014

inDefective scientific studies, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

When will President Obama ever learn?

His ideology blinds him to the facts. I vividly remember him telling John Kerry and Barney Frank not to worry about not having a Public Option.

Barney Frank said we need a Public Option for the Affordable Care Act to work. The only way Obamacare could work is by ending up with a single-payer system.

President Obama had a clandestine “Public Option” built into Obamacare.

Progressives believe deeply in their ideology. They do not consider past history, present reality or facts.

All progressives have to do is look at what is happening to socialized medicine all over the developed western world.

It is failing even as some people believe it is succeeding.

The Commonwealth Fund (a private progressive foundation) with a focus on healthcare is certain that a single party payer system is the only viable healthcare system.

The report ranked healthcare systems throughout the developed western world. In its published ranking the National Health Service of Great Britain was considered the best medical system among the 11 of the world's mostadvanced nations, including Canada, France, Germany, Switzerland and Sweden.

The United States came in last.

Few have the time or patience to read the complete report or pick out the defects in the study.

Most people reads the summary. The summary in this study is not close to the evidence presented.

The Commonwealth Fund’s rankings of countries are contradicted by objective data about access and medical-care quality in these countries in peer-reviewed academic journals.

The Commonwealth Fund’s methodology is defective. Its conclusions relied heavily on subjective surveys about "perceptions and experiences of patients and physicians."

Kenneth Thorpe made an important point by examining differences in disease prevalence and treatment rates for ten of the most costly diseases between the United States and the ten European countries with a single payer system.

He used surveys of the non-institutionalized population age fifty and older. Disease prevalence and rates of medication and treatment are much higher in the United States than in these European countries.

Why would that be?

There are many reasons for this finding. The main one is the availability of care in the United States compared to the ten socialized western countries.

Another is lifestyle and incidence of obesity in the United States. Both lead to the onset of chronic disease and increased treatment.

“Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.”

“Americans are diagnosed with and treated for several chronic illnesses more often than their European counterparts are.”

Americans diagnosed with heart disease receive treatment with medications and procedures more frequently than patients in Western Europe.

In the past local peer review was all that was needed along with confidence in the treating physician’s judgment. This confidence in physicians’ judgment has been destroyed by excessive media sensationalism. The real percentage of abuse is small and easily discoverable by peers and the use of the new social media.

Cancer treatment survival rates in America are far greater than the survival rates in Britain, and countries in western Europe.

The reasons for the higher cure rates are the availability of early detection and treatment.

Cancer treatment costs are high. The government should look into the reasons for this high cost and try to lower the cost.

The Commonwealth Fund’s report does not consider any of these factors.

The NHS has a waiting list of 3.2 million people for admission to the hospital. In London alone over 500,000 patients are on a waiting list for diagnosis and treatment.

A large percentage of patients triaged as urgent after being diagnosed with suspected cancer have a 62-day wait time to receive therapy.

The British Health and Social Care Act 2012 authorized the use of the small private sector of healthcare to help the NHS with its problems.

The share of NHS-funded hip and knee replacementsby private doctors increased to 19% in 2011-12, from a negligible amount in 2003-04. Each year there is an increase in NHS funded care by the private sector.

It sounds like the VA Healthcare System’s solution to its problems.

Englishmen who can afford private care and private healthcare insurance to avoid the NHS are switching to private insurance even though they have to pay $3,500 for each man, woman and child in a family into the NHS.

The single party payer system (NHS) is struggling with unsustainable costs even though we hear from progressives how great socialized medicine is in England.

The key ingredient missing in all these systems is patient responsibility for their health and their healthcare dollars. Both are powerful motivators to healthy living and detecting disease early.

There are big problems in Canada that have been undisclosed in the United States.

There were two articles in American newspapers in 2011 that applaud the Canadian system.

Article 1. Debunking Canadian health care myths – The Denver Post

Article 2. Everything you ever wanted to know about Canadian health care in one post. Washington Post

Both articles are opinion articles and lack concrete evidence. The articles contain both misinformation and disinformation.

The Fraser Institute is a well-respected Canadian think tank. Its research is considered accurate with a libertarian slant.

Its 2011 report contradicts the statistics in these articles on the Canadian government healthcare costs.

Article 1. “Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's.”

Article 2. “In 2009, Canada spent 11.4 percent of its Gross Domestic Product on health care, which puts it on the slightly higher end of OECD countries.”

This is not true according to the Fraser report. Six of ten Canadian provinces are on track to spend half of their revenues on health care, according to the Frazer Institute. To be specific, in 2011, health care spending consumed 50% GDP in Canada’s two largest provinces, Ontario and Quebec.

“Total federal, provincial and territorial government health spending has grown by 8.1 percent annually, while the national GDP in Canada rose by only 6.7 percent during the same period.”

The provincial governments have raised taxes and rationed care, while increasing patient wait times.

“Provincial drug plans have also more often refused to pay for most of the drugs that are certified as “safe and effective” by Health Canada.”

“Unsustainable rates of growth in health care spending crowd out the resources available for other purposes including education, public safety, and economic growth-enhancing tax relief,”

One has only to think about the Obama administration’s initial propaganda and the stunning reality we are facing presently.

The VA is now asking for additional funding to clear up the disaster.

The problem is entitlements are too expensive for a government. Entitlements do not work because governments cannot legislate behavior by directives. Individuals must be responsible for their health and healthcare dollars.

The other problem is government entitlement programs generate a large bureaucracy. The bureaucracy stimulates the development of inefficiencies and corruption. The new bureaucracy practically guarantees failure of the entitlement.

The Government can help people be responsible for their health with incentive programs.

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

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Drug Pricing Is Weird

July 9, 2014

inConsumer Driven Health Care, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld MD, FACP,MACE

Many of my readers have asked me to explain drug pricing. I have not covered the pharmaceutical industry’s pricing in this blog because I have not been able to figure out drug pricing.

I do know there is a lot profit in both the retail and wholesale drug business. I know government pricing is different that benefit management pricing. I know there has been a growth in drug benefit management companies.

My sense is neither the pricing for Medicare Part D or private insurance drug benefits are for the patients’ advantage.

I recently asked a good friend Dr. Dale Fuller, a retired radiation oncologist, to explain the outrageous cost of oncology drugs (Drugs used to treat patients with cancer).

I wanted to know the reason the government pays almost twice as much to hospitals for the same treatment patients get in the oncologist’s office even though the treatment is given by the same oncologist.

I have added a couple of comments to Dr. Fuller’s note into the body of his reply.

Dr. Fuller writes,

"Is pharmaceutical pricing weird, or what?"

Dale Fuller M.D.

"Lately I have been thinking about pharmaceutical pricing, and as an old pharmacist turned radiation oncologist, it was the pricing of cancer drugs that caught my interest.

Then, my wife showed me some information about a product called “Symbicort” that she uses on a regular basis.

Introduced into the US in March of 2009, it goes off patent in 2014. The other day she brought home a 90 day supply for which she had paid $120.00, and Medicare part D allegedly paid $839.89. At least, the package from Walgreen’s informed her that her “insurance had saved her that $839.89”.

The $839.89 plus the $120 or $959.89 is going to be charged against her Medicare Part D donut.

During the initial coverage phase, you pay a copayment or coinsurance, and your Part D drug plan pays its share for each covered drug until your combined amount (including your deductible) reaches $2840.

Once the patient and the patient's Part D drug plan has spent $2,840 for covered drugs, the patient will be in the donut hole.

Previously, the patient had to pay the full cost of your prescription drugs while in the donut hole.

Starting 2011, the patient gets a 50% discount on covered brand-name prescription medications. The donut hole continues until your total out-of-pocket cost reaches $4,550.

This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.

When you spend more than $4,550 out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year.

The patient will then be responsible for a small copayment. This is known as catastrophic coverage.

In 2014, Medicare will pay 28% of the price for generic drugs during the coverage gap. You'll pay the remaining 72% of the price.

What you pay for generic drugs during the coverage gap will decrease each year until it reaches 25% in 2020—in 2015, you'll pay 65% of the price for generic drugs during the coverage gap.

Confusing isn’t it.

That would be a total of $959.89 for her 3 months’ supply of medication, or $319.96 a month, or $2.67 a squirt, of which there are four a day. Who knows how much Uncle Sam actually paid Walgreen’s for his share of the bill.

How to save 85% on Symbicort.

However a senior cannot buy this inexpensive brand named Symbicort using his Medicare Part D drug plan because he would be buying it from a Canadian Pharmacy.

So much for competitive innovation in a global economy. Government control trumps innovation.

Similar abstruse drug pricing strategies exist in abundance in the field of medical oncology.

Consider first the situation in the office of the medical oncologist. The physician purchases pharmaceuticals from a supplier. He must retain at least a basic inventory of frequently used products, some of which are very expensive.

The “acquisition cost” becomes the basis for the reimbursement the doctor receives from Medicare for the drug. To the acquisition cost the doctor was allowed to add 6%, which was intended to cover the preparation for administration.

The actual infusion of the medication in the doctor’s infusion room, including the cost of the nurses working there, was reimbursed at a rate of $133 per hour (“chair time”). Keep that figure in mind.

The US budget debacle in which Uncle Sam cut everything he paid for by 2%, actually amounted to a 33% reduction in the 6% the doctor was allowed, leaving ~4% to underwite the preparation for administration of the drug required for the care of a Medicare patient.

There are other patients who come to the infusion room, as well. Some have private insurance, and some have no insurance at all.

The private insurance may carry a different level of reimbursement for pharmaceuticals from that paid by Medicare, or it may not.

Very few uninsured patients have the wherewithal to pay out of pocket for the cost of their care. The doctor has two choices in handling their situations: charity or referral to a hospital where the cost of chemotherapy agents and their administration is handled in a different way.

The absence of any significant profitability for many medical oncologists has resulted in the closure of at least 400 practices between 2007 and 2012, and closures continue to this day. Patients in these situations have been forced to seek outpatient infusion services in local hospitals, where administration reimbursement to the hospital is an average of $299 per hour in comparison to $133 in the doctors’ offices.

It is said that hospital outpatient infusion services use more drugs (see below for how they are acquired), charge higher prices, and require higher co-pays from patients. Go figure.

And, don’t forget the drugs! Doctors are now reimbursed by Medicare at acquisition plus 4%, while hospitals, under “340B” programs enjoy a margin of about 30% versus the doctors’ 0-2%.

Remember the Symbicort example I started with? The 304B acquisition price for Symbicort is listed at $88! Even with a 50% markup for a patient, a month’s supply would come to $132. Go figure.

The evolution of this mess has prompted a congressional advisory organization called MedPac http://www.medpac.gov/ to call for changes to equalize payments for oncologists’ care in their offices as compared to payments for services provided in hospital outpatient departments. And, who can argue against the creation of a level playing field?

Symbicort is now generic. I tried to find the price of the generic drug. I could not without providing a prescription. Go Figure. Is this transparency?

Patients and physicians are being taken advantage of here. They are the pawns that drive the profits in the healthcare system.

Someone has to stop it for the sake of good medical care delivery.

I wish to thank Dr. Dale Fuller for this submission.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.  Please have a friend subscribe

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Another President Obama Lie

June 11, 2014

inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

At the moment, ideology and political philosophy stands in the way of Repairing the Healthcare System.

President Obama believes in central control of the healthcare system. Central control of other healthcare systems has not worked to control healthcare costs while maintaining quality of care. The only possible exception is Switzerland’s healthcare system.

Each province in Canada spends at least 50% of its GDP on healthcare according to the Frazier Report. The access to care is less than ideal. Healthcare spending is unsustainable in Canada

England is slowly switching to a private healthcare system.

Obamacare has already demonstrated its inefficiencies and lack of cost control even though most of the population has received waivers from Obamacare for at least one year.

The trajectory of failure is not going to change until President Obama is out of office and the system changes to put the consumers in control of their health and healthcare dollars rather than having the government in control.

President Obama declared in 2010;

“Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the regulations, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.”

Unfortunately, for Americans, President Obama tells us what we want to hear in a very seductive way and then does the opposite.

President Obama is always calling for someone to provide a new idea in order to fix Obamacare. His promise to the public is a good idea. However it is not reflected in the Obamacare regulations.

What is the meaning of Medical Loss Ratio?

The definition of medical loss ratio is the incurred claims received divided by premiums collected.

The healthcare insurance industry negotiated all the rules it wanted from President Obama and Kathleen Sebelius in defining incurred claims in the new Obamacare regulations. The rules contradict Mr. Obama’s promise to the American public.

The healthcare insurance industry is supposed to spend 85% of the premiums collected on direct medical care costs.

The remaining 15% of the premiums is for the insurance industry’s expenses and profit.

The healthcare insurance industry claims it is lucky if it clears 3% profit under the Obamacare rules.

In order to encourage the healthcare industry to participate in Obamacare, President Obama pledged that the government would subsidize the healthcare insurance industry for any shortfall in profit.

A self-insured employer sponsored healthcare plan outsources the administrative services to the lowest bidding healthcare insurance company. The government outsources Medicare, Medicaid and Tricare (VA insurance) to the lowest bidding healthcare insurance company.

The Obama administration has included most of the healthcare insurance industry’s requests in the incurred claims (direct patient care) formula that is used to calculate the medical loss ratio.

Inflating the incurred claims decreases the amount of money spent on direct patient care in order to maintain an eighty-five percent (85%) medical loss ratio.

If the incurred claims costs go up the medical loss ratio goes down. The potential increase in the medical loss ratio is the justification used by the insurance industries to increase premiums.

Obamacare requires insuring with a pre-existing condition. Insuring everyone with a pre-existing condition increases the insurance risk. Hence Americans experience double-digit increases in healthcare of insurance premiums.

The expenses the industry wanted included:

1. The cost of verifying the credentials of doctors in its networks.

2. The cost of ferreting out fraud such as catching physicians over testing patients or doing unnecessary operations.

3. The cost of programs that keep people who have diabetes out of emergency rooms.

4. The sales commissions paid to insurance agents.

5. Taxes paid on investments.

6. Taxes paid on premium income.

7. Unpaid claim reserves associated with claims incurred.

8. Change in contract reserves.

9. Claims-related portion of reserves for contingent benefit.

10. Lawsuits experience-rated refunds (exclude rebates based on issuers MLR.

All these expenses are administrative expenses in my view. It is questionable that these should be included in direct patient care (incurred claims).

These expenses also increase a healthcare insurance company’s profit. Each incurred cost has a built in 15-20% profit.

As these expenses continue to be are permitted as incurred claims (direct medical care expenses), the resources available for direct medical care decrease from eighty-five cents to sixty cents on every premium-collected dollar.

At the same time people complain about the grotesque profits and salaries of those in the healthcare insurance industry.

Obamacare, contrary to President Obama’s promise, did nothing to solve this abuse.

It is almost as bad as the promise," If you like your doctor you can keep your doctor. If you like your insurance plan you can keep your insurance plan.

The closest I could get to transparency and the distribution of one healthcare dollar to direct medical care is the following.

Fifteen cents goes to the doctor and twenty-five cents to the hospital. The remaining sixty cents goes to the healthcare insurance companies.

The definition of direct medical care according to Obamacare is:

Definition of Medical Claims By Obamacare

Incurred claims = direct claims incurred in MLR reporting year + unpaid claim reserves associated with claims incurred + change in contract reserves + claims-related portion of reserves for contingent benefits and lawsuits +

experience-rated refunds (exclude rebates based on issuers MLR

Medical Claims and Quality Improvement Expenditures

As illustrated in Figure 1, increases in either medical claims or quality improvement expenditures (holding other factors constant) will increase

the MLR and reduce the likelihood of premium rebates to policyholders. Conversely, reductions in medical claims and/or quality improvement

expenditures (holding other factors constant) will decrease the MLR and increase the likelihood that insurers will have to provide rebates to policyholders.

Medigap plans (Medicare Part F) have separate medical loss ratio requirements. The healthcare insurance industry has to meet a 65% level for individuals and a 75% level for groups. It means that for every dollar in premium the individual has 65 cents minus incurred expenses coverage for direct medical care and for groups 75 cents minus incurred expenses.

Medigap plans, which are supplemental policies that Medicare beneficiaries can purchase to fill gaps in Medicare coverage, are not covered by the ACA MLR provisions.

Medigap plans are subject to their own separate MLR requirements, found in Title 18 of the Social Security Act; the MLR requirements are 65% in the individual marketplace and 75% in the group market.

Finally, the ACA’s MLR requirements do not apply to long-term care, dental, vision or retiree healthcare plans.

President Obama promised to fix these problems. He said,

He didn’t. He won’t.

He knows the problem. Fix it.

If he did he would save Obamacare and tax payers a great deal of money.

I am confident this suggestion will be ignored and at election time more false promises will be made.

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

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Father Son Weekend With Daniel

November 10, 2013

inLife's Experiences

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Stanley Feld M.D., FACP,MACE

On Halloween Cecelia and I
flew to Denver. We wanted to share Halloween with our granddaughter.

They do trick or treat up big
in Boulder. Everyone was in costume. We wanted to share her thrill of trick or
treating. It was so cold and windy that Cecelia and I lasted less than an hour.

Sabrina lasted two and a half
hours. She was dressed as a ninja. I was dressed as a Boston Red Sox player.
Cecelia wore a fancy mask.

Friday night Cecelia had an
exhibit opening with reception at Artwork Network Gallery in Denver. Brad, Amy,
Dan Laura and Sabrina came to the show. Cecelia and her art were eloquent.

Friday night was a beautiful
fall night in Denver. It was Gallery Walk Night in the Denver Arts District.
Hundreds of people turned out for Cecelia’s show.

Cecelia was there from 5-9pm.
The rest of us went to the Smokehouse at 8pm. When they dropped me off at 9pm
the gallery was still packed.

We were in the car and back
to Boulder at about 9:45 pm. The gallery was still going strong.

Daniel and I were out of his
house at 7:30 am for our annual Father/Son weekend.

Daniel and I and Brad and I
usually go on one weekend a year. We usually fly to some city and bond with
each other. We do more talking and eating than anything else.

One activity is required. We
must work out each morning first thing.

This year Brad and I are
going to Blytheville,Arkansas, the town of his
birth, when Cecelia and I were in the

Air Force. I must say we have
been warned by people that Blytheville is not much these
days. We are ignoring everyone.

This year because of Dan’s
schedule, we went to Denver. It was Cecelia’s idea.

Our first stop was Zaidy’s in
the Cherry Creek shopping area. The parking lot was packed at 8:3am.

Zaidy’s was a pretty good
deli. We shared a pastrami and egg white omelet with an order of potato latkes.
My mother and Cecelia make better potato latkes. The sour pickles were very
good.

We talked and talked for over
an hour at the table. It was then warm enough to go outside. As a Dallasite, I
am not used to being 35 degrees on November 2.

After breakfast we then walked
the shopping area all the while talking about the meaning of life.

It was about noon and time to
check into the Hyatt at the convention center.

We got our room early. Our
goal was to walk and continue our conversation. We were off to Larimer Square. At about one o’clock neither of us felt hungry after the Zaidy's
breakfast so we did not go for a big lunch.

I wanted to take Dan to the
Clyfford Still museum. He had not been there yet. Cecelia and I went to the
Clyfford Still museum with Todd Siler when it just opened. It is a gem. It my
book it is one of the best museums in the country.

The museum sits in the shadow
of the Denver Art Museum. The DAM is about 10 times larger than the Clyfford
Still Museum. Everyone knows size does not matter. Clyfford Still was a genius.
It is hard to understand his genius when most museums have only one Still. The
piece is usually out of context. This exhibition is still a blockbuster even
though many of the paintings were different the second time around.

Daniel and I walked back to
the hotel after the museum. We had an early dinner at John Elway’s. We walked
another mile and a half to the restaurant. We split the steak at Elway’s and
then walked and talked to the Pepsi Center where the Denver Avalanche was playing
the Montreal Canadians. We had great seats.

I am not a big hockey fan but
I had a great time for 2 of the 3 periods.

I was 10 pm and we had to
leave before all the ice cream parlors closed. We walked back toward the hotel
looking for ice cream. We finally found a café, diner, and coffee shop about
two blocks from the Hyatt. We did not know what we were getting our selves
into. However the place made a great hot fudge sundae.

It was so good we decided to
have breakfast there on Sunday. FAT chance. We got there at 8:30am. There was a
one and one half hour wait for breakfast in a downtown café, diner, and coffee
shop on a Sunday morning. Where did all the people come from?

We went back to the Hyatt and
had breakfast in the three quarters empty hotel dinning room.

Daniel and I checked out of
the hotel and drove to the Denver Museum of Art to meet the girls for the exhibit
Court
to Café: Three Centuries of French Masterworks from the Wadsworth Atheneum and Passport to
Paris .

Passport to Paris was much better than Court to Café but all
five of us had a good time.

No one was hungry at 1pm. We drove back to Boulder and had a
small bite at Chili’s.

The weekend with Daniel was a roaring success.

Sunday night we met Brad and Amy for dinner at Mateo’s in
Boulder.

Cecelia and I love being with our kids.

I cannot tell you how lucky we feel.

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

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The Method Of Operation

October 27, 2013

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

It’s clear. President Obama
has used the same techniques to neutralize the scandals and mishaps during his
administration.

In has been the same for Benghazi,
NSA, IRS, and Fast and Furious scandals.

President Obama makes his
characteristic statement, “This is unacceptable
and we will get to the bottom of this.”

After this statement there is
never any follow-up. What has been done? Has President Obama gotten to the
bottom of it?

The public never learns who
was responsible for the debacle. No one ever gets fired and the traditional
media carries on. The public soon forgets about a non-resolved scandal.

President Obama always leads the
public to believe he had nothing to do with the scandals or the decision-making
leading to the scandals.

He is the President. He should
know. If congress investigates the scandal it gets stonewalled by the administration. The investigationg committee then is accused
of muckraking.

Somehow the traditional media
buys this story and sells it to the public. It is the journalist’s obligation to
dig into a scandal and find out the real story. It is not done.

Nothing this administration
does has been transparent. The traditional media ignores the scandals and so
does the public.

The devil is always in the
details.

The real story is the attack on individual
freedoms and choices. They are being impinged upon by the bureaucratic regulations of
big government. The traditional media should make this clear.

America does have a freedom
of information act and constitutional rights that have to be protected and not
ignored.

All the participants in the
various scandals finger point to others being responsible for the actions that
would not be approved by the people.

No one ever questions whether President Obama is
responsible for the scandals.

The same method of operation
is being put in place to explain the colossal disaster of www.healthcare.gov’s rollout.

The Obamacare web site has
many problems. It is not a simple fix as the President and his administration
has declared it to be.

President Obama claims he did
not know anything about the problems before the launch. He has promised to get
to the bottom of this.

He is finger pointing to
everyone except himself and his administration.

If the Obama administration
did not know about the impending failure it is either stupid, or irresponsible
or both.

President Obama is not stupid. He is cunning.

These are President Obama’s remarks in the
Rose Garden of the White House last week.

“Shortly
before the president’s appearance, White House officials let it be known that the “president will directly address the technical
problems with HealthCare.gov – troubles he and his team find unacceptable.” But
in that Rose Garden appearance, the president did not explain what the
technical problems with HealthCare.gov were, though he did acknowledge their existence and stated “there is no excuse” for them.

He then promised he would recruit the best
information technology talent in the country to come to the rescue and fix the
problems.

President Obama happened to hire one of Michelle
Obama classmates at Princeton in a no-bid contract to build the web site. The
administration paid $634 million taxpayer dollars to Michelle Obama’s friend’s
company and got a disaster.

"Toni
Townes-Whitley, Princeton class of ’85, is senior vice president
at CGI Federal, which earned the no-bid contract to
build the $678 million Obamacare enrollment website at Healthcare.gov. CGI
Federal is the U.S. arm of a Canadian company.

"Townes-Whitley
and her Princeton classmate Michelle Obama are both members of the Association of Black Princeton Alumni."

The Obama administration also awarded CGI
another no-bid contract for 2 billion dollars to clean up from the Sandy
Hurricane.

Mr.
Nelson chair
of Housing Trust Fund Corporation presented that the State
received a $1.7 billion allocation in CDBG Disaster Recovery aid from HUD to
aid impacted businesses and residences.

The
corporation requires immediate access to consultant services to assist in policy and
procedure development, training, surge capacity, and call center assistance,
and stated that CGI Federal Inc. could provide such services.

The
resolution was passed and scheduled to “take effect immediately.”

Nearly a
year after the devastating storm, a majority of the 24,000 families that have
requested monetary assistance have yet to receive a penny from the federal aid
package.”

Does anyone think something funny going on at
taxpayers’ expense?

Shouldn’t President Obama have hired the best
minds in the country to build the web site to begin with?

Do you
remember this famous statement?

http://nyti.ms/18ThbbJ

Ezra Pound
is a big fan of President Obama and Obamacare. What happened? Did he change his
mind?

http://www.youtube.com/watch?v=AQxYY2dyChY&feature=player_detailpage

Uwe Reinhardt is an economics professor
Princeton. He gave
President Obama an F on his mid-term grade on Obamacare.

“With proper management and more energetic work earlier
on, and untainted by the political desiderata reported to have affected the architecture of
HealthCare.gov, that Web site’s management team should have been able to
achieve the same success. It did not, hence the midterm grade F.”

A key discussion being avoided in the
mainstream media is whether President knew about the impending disaster. I suspect
he did.

It was one of the reasons he gave the group
healthcare insurance holders a one-year waiver. Parenthetically, he is not
seeking the advice or consent of the congress. This is probably
unconstitutional.

The group healthcare insurance market represents
the largest percentage of people insured. The individual insurance market represents
a relatively small percentage of the total insured population. The number of
people affected cannot make a big enough stink to be noticed by the traditional
media.

If the group insurance market were included in
the rollout, the community uproar would be too great for the Obama administration
to ignore or pivot from.

The public is already hearing the pivot from
President Obama and Kathleen Sibelius. They claim the past is the past. We must
ignore the past and go forward to fix the problem.

It sounds like the same story Hillary Clinton
told congress about Benghazi when she scolded a congressman during her Benghazi
testimony about Ambassador Stevens death. “He
is dead. Let us go on and deal with the problem.”

This method of operation is going to back fire
on President Obama for two reasons.

1. Americans are finally recognizing the Obama
administration’s methods of operation. It is to deflect with half-truths,
deceive and pivot. The public is getting angry.

2. There are an increasing number of people
who have lost their job, their healthcare insurance and the doctors. In the last
week 650,000 people lost healthcare insurance coverage they liked.

This is because of the exclusive regulatory
control the Democrats gave Kathleen Sibelius in passing Obamacare.

Not one single Republican voted for the
Affordable Care Act (Obamacare).

The preparations for the implementation of
Obamacare for the group healthcare insurance market through health insurance
exchanges and www.healthcare.gov have unleashed gigantic outcries from both the
young and the middle-aged middle class.

The outrage is not over yet.

President Obama said he did not anticipate
that so many corporations would reduce insuring so many of their workers.

President Obama has discovered an obviously
scapegoat.

The “glitch” is not
Obamacare fault. It is the big bad corporations that are trying to make a
profit.

Wait a minute! Isn’t that the American way?
You build a business to try to make a profit within the rules.

The 40,000 new Kathleen Sibelius healthcare
regulations are preventing them from making a profit while providing healthcare
insurance. They want to provide affordable healthcare coverage.

The only way corporations can make a profit is
by dropping healthcare insurance of their employees.

Maybe driving people into the health insurance
exchange was President Obama’s goal in the first place. Remember Barney Frank
and John Kerry’s dismay about passing a bill without a public option. President
Obama response was don’t worry.

Well, we have an expensive public option that
doesn’t work. Who is going to pay for it?

The
middle class is going to pay for it with increased healthcare insurance
payments and increased taxes.

The
cost of insurance on the health insurance exchange is high unless one qualifies
for a government subsidy. I have previously explained the dynamics involved in the
cost of healthcare insurance when a person receives a government subsidy.

Young healthy people will not buy insurance.
With the present computer programs the government will not know who qualifies
for a subsidy or be able to identify people will should be penalized.

A key to a business’ survival is to adjust to
adverse circumstance as long as the business has the freedom to adjust.

Watch out for the freedom to adjust to
anything.

Watch out seniors. Medicare is next.

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

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