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Obamacare Post Mid-Term Elections

November 9, 2014
inConsumer Driven Health Care, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The mid-term elections are over. The Republicans captured majorities in the House and Senate. The election was a clear repudiation by the people of President Obama’s policies.

President Obama has denied this reality. He has pledged to pursue his ideological goals that have hobbled the people and the country so badly.

 The polls have indicated that the public is opposed to Obamacare and all of its unintended consequences.

We ain’t seen nothin yet. The unintended consequences are going to escalate starting with the delayed open enrollment season on November 15 2014. This opened enrollment was unnoticed, so Democrats did not suffer any blowback from Obamacare during the mid-term elections.  

Larger categories of people and businesses will be affected by Obamacare’s rules and regulations on January 1,2015. Last year only people in the individual healthcare insurance market were affected.

President Obama continues to mock Republicans by telling them he will be happy to listen to them to see if they have a better idea than Obamacare.

Everyone knows he has no interest in changing or repealing his legacy healthcare law.

The majority of people are dissatisfied with Obamacare. All the Republicans have to do is come up with an idea that is compelling to all of the public. The power of public opinion can demand that Obamacare must change.

 It has to be a simple idea. It has to teach consumers how to be responsible for their health and their own healthcare dollars. It has to educate consumers on how to drive the healthcare system and remove government from controlling their healthcare choices.

The basic problem with our present healthcare system is medical care is fragmented. In addition, all the stakeholders’ vested interests are misaligned. 

President Obama, with his forced passage of Obamacare, has added to the dysfunction of the healthcare system.  .

 Obamacare is meant to be a step toward a single party system. 

 The government cannot afford, and the nation will not accept, a government controlled single party payer system. 

Obamacare does not do anything to repair the distortions of to the system that have led to the dysfunction of the healthcare system pre Obamacare.

The most important stakeholder in the healthcare system is the consumer. Obamacare has marginalized consumers/patients even further.

It was hard for consumers to have notice the dysfunction in the healthcare system because only 20% of consumers use the healthcare system at one time. The remaining 80% thought their healthcare insurance was fine.

Since Obamacare was passed into law it is affecting everyone directly and they are starting to complain.

The current state problem are shown in the figure below.

Barriers

 A dizzying array of stakeholders is all fighting for a competitive advantage, or at the very least survival, in the dysfunctional current state.

Obamacare’s rules and regulations have made the current state more difficult for everyone.  This is leading to the impending collapse of the healthcare system.

Republican Party should not tinker with legislation to try to fix Obamacare.

It should step in right now and educate the consumers about their consumer power. Republicans need to present a market driven solution that is easy to understand.

 My ideal medical saving account can provide the financial incentives for consumers to act and drive the new healthcare systems.

Once the public understands what they can do, it will change its attitude from the helplessness and hopelessness to an empowered reaction to do something to change the system.  

There are many other things that need to be demanded by the public. I believe empowering the public to demand a market driven system is crucial to a viable and affordable healthcare system.

Almost all the stakeholders believe something must change. The centrally controlled healthcare system’s business model will not work or be sustainable. All one has to do it look at the VA Health System.

Consumers and businesses are becoming frightened and beg the government for help.  The government will institute a single party payer system.

 The result is that consumers will not be able or willing to tolerate a centrally controlled healthcare system.

 As I see it, the nation has two choices: Alternative 1 and Alternative 2.

Alternative 1:

  Alternative 1 future state

 If we extend the course of our present healthcare system to a single party payer system (Alternative 1) the costs will escalate, and access to care will decrease. It is inevitable the rationing of care will occur.

 Alternative 2

Alternative 2 Future state
 Alternative 2 would be a market-based system that would put the consumer in the center of the healthcare system.

Provider systems and administrative systems would have incentive to make its products attractive to consumers at the lowest price possible with the highest quality of care.

Consumers, by owning their healthcare dollars, would have the freedom and resources to choose. Government and its bloated and inefficient bureaucracies should not be making medical care choices for consumers. 

Two things must happen. Republicans must teach consumers the advantages of a market based business model.

 The Republican congressional majority must start teaching all the other stakeholders (physicians, hospital systems, the government, the healthcare insurance industry and Big Pharma) the advantages of this market-based system to their vested interest.

 The alignment of vested interests must start right now and not down the line.

 The Obama administration will dismiss the possibility of a successful market based system. Republicans must not be intimidated. Didn’t they win the election this time?

The Obama administration’s conclusions are based on ideology not past history, logic, fact or evidence.

 The Obama administration and its followers will reject the possibility of success for an incentive driven system instead of a government controlled system.

 A market-based system can be presented in a way where all the stakeholders can buy into a successful consumer driven future state.

 

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 31st, "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 15th 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 15th to November 15th for 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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Obamacare Application Data Is Wrong For 2 Million Applicants Receiving Subsidies

August 20, 2014
inDisinformation and the healthcare system, Information Technology in Healthcare, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The second really big deal is the fact that over two million people lied on their application for Obamacare through the federal health insurance web site www.healthcare.gov.

We do not know how many of the 1.2 million who received insurance through state exchanges lied. 

Unfortunately, the Obama administration throws so many numbers out of context at the American public that it is impossible to follow the true facts and subsequent disastrous consequences.

Let us look at the numbers slowly. President Obama was claimed that 8 million people signed up for Obamacare by March 31,2014.

President Obama and the healthcare insurance industry were terrified about adverse selection by the people signing up. Both worked hard to get young people with no preexisting illnesses to sign up so the insurance premiums would not increase next year.

Basketball, baseball and football stars were recruited to advertise Obamacare’s benefits on TV and encourage enrollment.

The population, in the uninsured individual insurance market, was only 14 million out of a population of 350 million people. Three hundred and thirty six million received waivers from Obamacare for one reason or another.

What will happen when 336 million must participate in Obamacare? The percentage of participants in the population will be tiny if the individual market is a guide.

Seven million of the fourteen million lost their healthcare insurance because of Obamacare’s requirements. Eight million signed up for healthcare insurance under Obamacare. This represents an increase of only one million and not and increase of eight million.

Of the 8 million, 85% or 6.8 million people applied and received government subsides. These subsidies were supposed to be tax credits.

The www.healthcare.gov did not have a functional back end to the website to check if these people were lying about their income, job status, and even citizenship.

 If people intentionally misstated information, they were warned they could be charged with perjury. I assume President Obama will waive that charge.

Only citizens and legal immigrants are eligible under the law for subsidized coverage.

 The government signed up about 5.4 million people, while state-run websites signed up another 2.6 million.

Only 1.2 million of those were not eligible for subsidies.

Are these 1.2 million the part of the 7 million who lost their insurance because of Obamacare? Are the 8 million the people who did not have insurance before Obamacare?

Both are important questions that we have not gotten answers to.

My guess is the people who signed up were people who could not get insurance because of preexisting conditions or people who could not afford insurance in the individual market.

In either case the will be adverse selection and increased healthcare utilization. Insurance premiums will increase for everyone in the health insurance exchanges. 

 “Some 80% of all those who have enrolled in plans nationwide, according to federal statistics released today, have chosen a silver plan, meaning deductibles of $2,000 for singles and $4,000 for families, or gold or platinum plans, which have no deductibles. “

“Only 18% have opted for bronze plans, which offer lower premiums, balanced by deductibles of $4,500 for singles/$9,000 for families.”

Many consumers can hardly afford the bronze plans with subsidies much less the high deductibles. Those consumers will be forced drop out of Obamacare.

“The Associated Press reports that of the 5.4 million people who signed up for health insurance through the federal marketplace 2 million submitted information that does not match up with federal data.”

The discrepancies could affect their subsidy adversely. Applications were accepted on boy scouts’ honor. The subsidies were determined on the basis of the information on the application. These people will owe the government the difference plus a penalty. They are also liable for perjury.

The back end of www.Healthcare.gov is still incomplete.

“Serco, a foreign contractor already under investigation, was awarded a $1.2 billion contract to process Obamacare’s paper applications, and the AP reports they will be tasked with resolving these application issues. “

Despite having had three years and more than $600 million to work with the federal governmentand its chosen contractor could not build a functional website. It cost an additional $200 million dollars and four months to get the front end to work.

The $600 million to build www.healthcare.gov was more than it cost Apple to develop the iPhone. Apple is an American company with American jobs. 

It should be recalled that another foreign contractor (CGI of Canada) got the first contract. Michelle Obama’s Princeton classmate happened to be an executive,

 

“Serco is a foreign company riddled with a history of transgressions. The most recent transgression was that Obamacare contractors were literally being paid to do nothing.”

The White House has attempted to dispel concern about the website being dysfunctional.

However, the report of over 2 million falsified applications has reignited the questions of government incompetence and misleading information about the dysfunctional website as the enrollment period approached.

“As Americans for Prosperity reported in the Washington Times early last month, “the website was originally intended to function automatically, calculating premium subsidies, making government payments, and tracking enrollment information that would affect future costs.”

“ But the interim system currently in place (that resulted in the newly revealed data discrepancies) is “pretty much a spreadsheet and some informed estimates,” according to Politico.

Compounding www.healthcare.gov  problems are a Roll Call report that almost 3 million Medicaid enrollees have not yet had their applications processed.

These issues are all separate issues from Obamacare’s cancelled healthcare plans, physicians opting out or retiring, and the scandal with the Veterans’ Affairs health care system.

In reality all the issues are one with the Obama administration making it clear that a government run bureaucratic healthcare system is a nightmare that will destroy the healthcare system in America.

8 20 2014 Obamacare-Delays

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

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More Bad News For Obamacare And Taxpayers

July 13, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

The Obama administration and the traditional mainstream media are working very hard to keep the bad news about Obamacare away from the general public.

The Colorado exchange (Connect for Health Colorado) expects nearly 24% of the enrollees to drop health exchange coverage in fiscal 2015.

This is a direct contradiction to the Obama administration’s projection of the growth of health insurance exchanges.

“In April 2014 after open enrollement closed, the staff of Connect for Colorado projected 13 percent of people enrolled will drop or not pay for policies in fiscal 2015, but now they are expecting about 24 percent to drop their policies, according to the latest model.”

“And in fiscal 2016, the revised figures show dropped policies going from the 16 percent projected in April to nearly 22 percent.”

The Colorado Health Insurance Exchange’s chief financial officer Cammie Blais said the staff is using the higher drop rate in more recent models because that is how national figures are tracking.

President Obama and the Obama administration are aware of these figures. As usual they are keeping it from the public.

Why is happening nationally? There are multiple reasons.

Eighty five percent of the people who have enrolled have qualified for subsidies on the basis of the information they gave on the enrollment form.

The federal government was not set up to verify the information given on the enrollment form at the time of enrollment.

President Obama told everyone he would take his or her word for the information’s accuracy. This was a tremendous defect in the Obamacare system.

Many enrollees are going to lose part or the total subsidy provided by Obamacare. For some, the original subsidy was not enough to reduce the burden of insurance. In many cases the burden included high deductibles and copays that were unaffordable.

Many of the remaining fifteen percent of the enrollees had preexisting illnesses and could not buy insurance on the open market and/or were making over $50,000 a year.

Their premiums plus deductibles and copays are so high that enrollees making over $50,000 a year realize they cannot afford the insurance and have to drop out of next year’s exchange.

As a result of this adverse selection healthcare insurance industry’s premiums are going to skyrocket in 2015 as they have skyrocketed in 2014.

If the government starts convincing the majority of the public that the free market solution of the health insurance exchanges doesn’t work, the only choice will be a single party payer system for the entire population.

The VA system is an example of a single party payer system run by the government. It is a bureaucratic mess that is inevitable with a government run single party payer system.

A large bureaucratic single party payer systems relying on rules and regulations will end up with as non-transparent bureaucracy built for the benefit of the bureaucrats and not the people.

I think the public understands this. I think the Obama government is out of touch with the people.

President Obama ought to reexamine his premises.

The Obamacare system being built is destined to fail. It is not a consumer driven free market system. It does not follow that a single party payer system will work.

In reality none of the government controlled single party payer systems throughout the world work. They are just free. However, these systems are unsustainable.

The 8 million enrollees that President Obama ran his Obamacare victory lap on continues to dwindle at an accelerated rate.

If the DC appeals court rules against the federal government ability to provide subsidies, the number of enrollees will decrease even further.

The law states that only State health insurance exchanges can provide subsidies.

Obamacare is getting further and further away from being functional.

The Obama administration and the traditional media are working very hard to keep this information from the general public.

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

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Bigger Problems Ahead For Obamacare

March 30, 2014
inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

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

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

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

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

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

Waste occurs because of:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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The Next Obamacare Tragedy

March 26, 2014
inMedicine: Healthcare System, Physician's Problems, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP, MACE

Late in the afternoon March 25th  the Department of Health and Human Services announced that it is extending the enrollment period for Obamacare to April 15th from March 31st.

“The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.”

Those who are going to apply have enough time to apply in seven days if the website and the navigators are working correctly.

It sounds as if enrollment figures are not good.

“Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system.”

“The government will not try to determine whether the person is telling the truth.”

This is not a very good way to run a business.

The next tragedy in the implementation of Obamacare is providers’ participation in the Affordable Care Act. There is so much uncertainty in the Obamacare that many physicians and physician groups have opted out of participation in Obamacare.

In California, independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting Covered California, the state health exchange.

Dr. Richard Thorp, president of the California Medical Association said,  “It doesn't surprise me that there's a high rate of nonparticipation,” 

The CMA represents 38,000 of the roughly 104,000 doctors or 20% of the physicians in California. Dr. Thorp said nothing about the California Medical Association doing a study to determine the percentage of physicians who are not participating in Obamacare.

However the Daily Kos ranted about the Washington Examiner story not being true.

“The latest right-wing disinformation campaign, all over the far-right media is that 70 percent of California's doctors are boycotting Obamacare. Is it true? Of course not. Is anything the Washington Examiner, WND, or Breitart publishes true?”

However the Daily Kos did not offer any facts about what is true.

It is a typical Alinsky disinformation tactic. You must freeze your enemy and then criticize and discredit him.

The LA Times reported in December that the state exchange Covered California reported,

In fact, according to Covered California, the only source with verifiable numbers, some 58,000 doctors, or more than 80% of the state's practicing physicians, will be available to enrollees in the exchange's health plans.

First of all, 58,000 physicians are not over 80% of California practicing physicians, if the 58,000 number is true. It is 55.77% of practicing physicians.

“Covered California says that the doctors participating in its exchange plans include 100% of Kaiser Permanente's 14,000 California doctors, 43,000 taking HealthNet patients and 35,000 in Blue Shield's network. (There's probably some overlap between the latter two networks.)”

The twisting of the facts is the method of operation.

On February 7, 2014 the LA Times reported Covered California admitted there are many errors in their physician directory.

“Admitting Covered California gave some consumers bad information, California's health insurance exchange pulled its physician directory for having too many errors.”

It appears that Covered California was not a very good source for the LA Times and Daily Kos to quote. Both media outlets called the Washington Examiner story a right wing lie.

“Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.”

California patients are discovering that their physicians are not participating in Covered California. Some have discovered that they are not covered by healthcare insurance coverage at all because of computer glitches.

The exchange previously yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November.

The updated list at that time still had some serious problems. The list misled consumers into signing up on the exchange. Covered California is bragging about the number of people they have signed up.

California is supposed to be the star of the state exchanges. Yet they had to close down the exchange in February for repairs and updates. The federal government gave the state exchange an additional $155,000 million dollars to fix the exchange. This is not a small amount of money for a “superb exchange”.

Here are some facts from practicing physicians.

In September 2013 insurance companies disclosed that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. This is contrary to the Daily Kos claim that the physician fees are negotiated.

Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor is quoted as saying, “In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal's reimbursement is $24,.” “In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160.

It is logical that physicians in California would say no to the state exchange, Covered California. No matter what lies the spin masters use the facts are the facts.

Physicians say, “We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,”

 

California physicians have protested that the Covered California's website lists many doctors as participants when they aren't. This is false advertising.

“Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy.

Donald Waters, executive director of the Alameda-Contra Costa Medical Association said. “They may be listed as actually participating, but not of their own volition”.  

Waters said. He called the exchange's doctors' list a “shell game” because “the vast majority” of his doctors are not participating.

 “This is a dirty little secret that is not really talked about as California promotes Covered California”.

Dr. Sherry Franklin, a pediatric endocrinologist at Rady’s Children’s Hospital, San Diego said, last summer she "got a letter in the mail letting me know if I wanted to participate with Blue Cross through the exchange, which is different from my regular Blue Cross practice, because they are paying les.s

 They did not tell me how much less. You had to agree or disagree. So, of course, I said no."

Covered California expects 85% of the physicians in California to participate. So far they have made these statements to the press but have not published any proof of participation.

 Covered California asks physicians to participate but does not disclose the reimbursement rates they will pay for participation in Obamacare.

Other state exchanges’ are also in trouble. Oregon and Connecticut are the most outstanding.

This is only the beginning of Obamacare’s provider problems. It is too bad that America is afflicted with this albatross at this time. Obamacare is destroying the healthcare system for consumers and physicians.

President Obama will not be able to charm his way out of the failure of Obamacare.

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

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Insurers Wary of Obamacare Administration

December 15, 2013
inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

The government is dependent on the healthcare insurance industry for administrative services.

Obamacare’s success is dependent on the healthcare insurance industry selling insurance to consumers who buy insurance from the healthcare exchanges.

Several insurance companies have opted not to participate in the health insurance exchanges.

The companies that are participating are the companies that have figured they will make a killing. The killing will come if there is a minimum of administrative services and a maximum of consumers who present little risk.

The government has  a commitment to the insurance industry to pay the total cost of healthcare insurance to the healthcare insurance companies for all subsidized consumers.

If partially subsidized consumers do not pay the insurance company their premiums the lag time before the insurance company can drop that consumer can be up to a year.  The consumer can enjoy the coverage benefits of the policy at a loss to the healthcare insurance company.

It is almost impossible to know whom to believe or trust.

Is the Obama administration lying or is it the insurance companies?

What are the real numbers?

Who is insured?

 How many people have applied through the health insurance exchanges?

 How many people have been approved for coverage by the Obama administration?

 How many are approved for Medicaid?

How many people of the 5.5 million who lost coverage are now covered under Obamacare?

What percentage of Obamacare covered consumers will have a preexisting illness?

 How many people have paid their premium and will have insurance January 1, 2014?

How many people who have lost their insurance have signed up and paid their premium?

 How many people are getting subsidies?

 How much is the subsidy?

 How many people have bought non-subsidized private insurance from the health insurance exchanges?

None of the answers are easily available. 

If President Obama didn’t exempt group insurance policy holders’ from Obamacare for one year, the nation would be experiencing a greater disaster.  

The public is becoming wary of the misinformation. President Obama has lost the public trust.

The news of increasing problems with implementation of Obamacare is becoming boring. People are becoming more frightened. 

This is just where President Obama wants us. He wants us to give it over to the government.

Can we trust government to run the healthcare system? The answer is no!

America cannot afford this incompetence medically or financially.

The attitude of Obamacare fans is that it happened, the President is trying to fix it. Let’s live with it. It is the law of the land?

President Obama has even blamed the structure of government agencies for the screw up. It is not his fault.

This should be the precise argument for why the government should not run the healthcare system. 

He might have found a way to shift the blame.  A New York Times/CBS poll said President Obama's approval rating is improving at the same time all the other polls said it has fallen below 39%.

Both the NYT and CBS are big Obama fans. Again, what is the truth?

The healthcare insurance industry is screaming bloody murder. There is no back end to the web site. There are errors in applications. One error begets another error. The insurance companies, rather that make a killing, will lose their shirt.

President Obama promised to make them whole without the companies providing evidence of loss.

Insurers say they don't know the full extent of back-end problems with healthcare.gov and are wary of the Obama administration’s claims they are fixing the issues quickly.

President Obama and White House officials are trumpeting new fixes to the Obamacare website, saying they met a self-imposed Nov. 30 deadline to deliver a smooth user experience to the vast majority of Americans trying to enroll in the online insurance exchanges.

As of December 13,2013 at least 20% of the applications have been plagued with problems.

“Insurers and federal officials sifting through insurance applications under the health-care law have identified a raft of errors, including missing customers and inaccurate eligibility determinations that mean people may be enrolled in the wrong coverage.”

 “In some cases described by a state official with knowledge of the matter, legal immigrants who aren't yet eligible for Medicaid in were nevertheless told they would be enrolled.”

The Obama administration has provided few details on the remaining back end technical bugs. These bugs are preventing insurance brokers from enrolling people in coverage. There is a great difference between applying for coverage, enrolling in coverage and finally obtaining coverage.

www.Healthcare.gov is supposed to transmit 834 forms to the insurer of the consumer’s choice by computer.

Insurers have either received these forms riddled with errors or not at all. They cannot possibly issue insurance to people who have applied and have sent incomplete or inaccurate information to the insurer.

The Department of Health and Human Services urged insurers to help avoid Jan. 1 mix-ups. The Obama administration modified coverage rules. Officials asked the healthcare insurance industry to cover people retroactively who missed paying for the premiums by January 1 because of defective applications. The Obama administration has asked the insurance industry to pay for drugs next month, even for customers who haven't yet fully enrolled.

This is not a good way to run a business. The Obama administration seems to be playing it by ear. They are changing the requirements of the law daily. Obama fans say it is a pragmatic adjustment. Others say it is unconstitutional. President Obama, you cannot play both sides of It’s “the law game.”

“Insurance-industry executives warn, that some of these data problems will only emerge once customers begin seeking care in January at physicians' offices, pharmacies and hospitals.

 The result could be bureaucratic chaos as doctors and patients storm insurers' phone banks and federal officials work to clean up the inaccuracies.

 The National Association of Health Underwriters sent a letter to President Obama on Tuesday asking him to fix a bunch of back-end obstacles.

 “We want to make it clear that a number of back-end technical obstacles still exist for health insurance agents and brokers trying to actively support the federal marketplace,” she wrote.

“Agents and brokers would like to help increase marketplace enrollment as much as possible over the next few months, but technical barriers prevent them from doing so.”

I think everyone gets this point.

However, a more important point is that if this has happened with the web site can we trust the government to have control over the large slice of our economy that healthcare represents?

More importantly, can we trust the government to make our medical care decisions for us?

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

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Permalink:

What Is Going On With Obamacare?

November 17, 2013
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama’s implementation of Obamacare is right on course to destroy the healthcare system and replace it with the federal government being the single party payer.

He is out to prove that the free market system does not work.

President Obama uses the strategies of Cloward and Pivan as well as Saul Alinsky to overwhelm the healthcare system. The goal is to create chaos in the system.

At the same time he attacks his enemies personally.

Cloward and Pivan said full enrollment of those eligible for welfare (entitlement/Obamacare) “would produce bureaucratic disruption in welfare agencies and fiscal disruption in local and state governments” that would “deepen existing divisions among elements in the big-city political parties and party coalitions.

The remaining white middle class, the working-class ethnic groups and the growing minority poor would be polarized. This would further weaken democratic institutions and existing political parties.

"In order to avoid the continuation of the chaos the federal government would step in and be obligated to advance a federal solution to poverty that would override local welfare failures, local class and racial conflicts and local revenue dilemmas.”[3]

Doesn’t this sound familiar? This week President Obama presented a non-fix to fix the problem of over five million people losing their insurance coverage. His move will only accelerate the chaos in the healthcare system he has already created.

Saul Alinsky said “do not let the enemy attack with a constructive solution. The enemy must be neutralized before its solution takes hold.”

The way to neutralize the enemy is by focusing on an individual you are going to attack. “Do not attack the constructive solution or the institution.”

Freeze the criticism on the individual; personalize the individual criticism and then polarize the populous against the individual and the constructive solution that individual represents. 

This is exactly what President Obama and the Democrats did to Mitt Romney and Paul Ryan. President Obama ignores the opposition’s constructive solutions.

An unidentified source sent me this comment. I am in total agreement

“Obamacare was designed to fail so that the unwashed masses, at the mercy of a cumbersome and unworkable system would look to Obama and the Feds for salvation in the form of single-payer medical care”. 

The only "incompetent and unknowledgeable" aspect of the situation is that Obama never, ever considered that the sycophantic Mainstream Media would ever call him out on this.

President Obama has never considered the wisdom of the American people.

In reality, government interference with the free market and its bureaucratic structure, inefficiencies and ill informed advisors have been the major cause of all the chaos.

Ben Carson quote

Barney Frank and John Kerry told President Obama that the only way Obamacare would work is with a strong public option and a single party payer system. President Obama’s response was don’t worry just pass the Affordable Care Act.

The creation of chaos in the healthcare system is the first step. Obamacare has succeed is creating chaos for people having their healthcare insurance coverage cancelled.

President Obama promised them that they could keep their insurance if they like their insurance. They could also keep their doctor if they liked their doctor.

He knew that this was not true in 2010. Nevertheless he promised it 23 more times since.

The New York Times reported,” A Contrite Obama Unveils a Health Fix

President Obama announced a fix to his signature health care law that will allow existing customers to keep their insurance plans.”

President Obama was far from contrite in my view. His non-fix fix will serve to accelerate the chaos in the marketplace.

His pronouncement is unconstitutional.

The insurance industry is not inclined to do things obviously against the “law of the land”. The main reason is the insurance industry has already purged the old insurance policies from their systems.

It will be impossible to reactivate them again in four weeks.

Increasing chaos is an important step in accelerating President Obama’s endgame to collapse the entire healthcare system.

Let us look at what he said during his “contrite” press conference.

"His announced fix is aimed at remedying the mass cancellation of individually purchased insurance plans by letting insurance companies re-offer non-compliant policies."

President Obama let slip that this is one big blame-shifting exercise. He announced that no one would be able to say Obamacare caused him or her to lose insurance.  

This is a Saul Alinsky tactic. The insurance industry has no inclination or ability to change its policies this late in the game. The industry can only lose money doing this.

President Obama has thus set up the healthcare insurance industry to take the blame for the before and after crisis in the healthcare system.

The fix undermines the essential premise of Obamacare. The young healthy people need to be forced into buying insurance through the health insurance exchanges. Insurance they do not want or need.

The President’s new fix will explicitly encourage many people to stay out of the exchange. The signal is clear that no one should sign up now because the entire program is in flux.  Young people do not trust President Obama anymore.

There were a series of incredible statements and lies made at the fix press conference.  Those paying close attention could hear them.

“We fumbled the rollout on this health-care law.”

No kidding. Where is the lie about the promise you made after you knew this would happen with both the web site and the ability to keep your insurance.

“I completely get how upsetting this can be for a lot of Americans.”

Thank you Mr. President.

“It is a complex process.”

Therefore, no one in the administration is to be blamed for anything that went wrong because it is a complex process.

“I was not informed directly [How about indirectly?], that the Web site would not be working. . . .

I don’t think I’m stupid enough to go around saying this is going to be like shopping on Amazon or Travelocity, a week before the Web site opens, if I thought that it wasn’t going to work.”

This is either an intentional lie or he did not listen to people who were telling him the web site was not ready.

People were telling him for months that the web site was not ready, not secure and not tested.

It is time for President Obama take some personal responsibility.

“With respect to the pledge I made that if you like your plan you can keep it. . . that there is no doubt that the way I put that forward unequivocally ended up not being accurate.”

President Obama didn’t lie. He was just inaccurate. Hah!

“The Affordable Care Act is not going to be the reason why insurers have to cancel your plans.”

President Obama must be kidding. His administration’s regulations made the old insurance policies against the law of the land.

“The federal government does a lot of things really well. One of those things it does not do well is information technology procurement.”

Is it the federal government’s fault when President Obama awarded the non-bid contract to build the web site to Michelle Obama’s girlfriend?

“In terms of what happens on Nov. 30th or Dec. 1st, I think it’s fair to say that the improvement will be marked and noticeable.”

I thought we were promised that the web site would be fixed by November 30.

“What we are also discovering is insurance is complicated to buy.”

 Why make it more complicated with Obamacare? The process could and should be simplified.

“There is no doubt that our failure to roll out the ACA smoothly has put a burden on Democrats, whether they’re running or not.”

The burden is on the Democrats. They were fools to pass this un-executable law without reading it or understanding it.

Didn’t Nancy Pelosi tell fellow Democrats that they have to pass the bill in order to see what is in it?

Democrats were the only ones that voted yes for the bill. They are responsible for what is in it.

They all deserve to be kicked out of office in 2014.

“There have been times where I thought we were … slapped around a little bit unjustly. This one’s deserved, all right?”

Again Saul Alinsky comes up. In the last few days I have once again seen the race card come up in the traditional media and among celebrities. Alinsky said attack your enemy personally.

There is beginning to be outrage and fear among the people of all socioeconomic groups. Everyone is now getting President Obama number. No one trusts him anymore.

 Obamacare must be repealed. America must start all over again to reform the healthcare system.

A good place to start is with My Ideal Medical Savings Accounts and Tort Reform.

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

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 .[3]

Permalink:

Obamacare Drives Premiums Up In 45 Of 50 States

October 20, 2013
inConsumer Driven Health Care, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP, MACE

President Obama promised
during his campaign for passage of the Affordable Care Act that the Act would
cause premiums "for the typical family" to fall by $2500.

He also said it would bend
the healthcare cost curve and if you like your doctor you can keep him or her.
We all remember these sound bites. The sound bites are all turning out to be
false.

Many intelligent people who
believe in Obamacare refuse to consider these facts. I can understand the
denial.

They will pay attention as
soon as it effects them.   

The added required benefits mandated
in insurance coverage in the law and the way the healthcare insurance industry
is permitted to calculate its Medical Loss Ratio makes President Obama’s
calculation impossible.

President Obama has been telling
the American public a lie all the while. People are starting to understand.  

The average one month premium
change from buying insurance in the non-group market in 2013 versus the
Obamacare exchanges in 2014 is not revealed in any government statistics. Two
studies were completed by private sources.

 Premium comparisons between
2013 and 2014 are not available from Health and Human Services (HHS).

The 2013 premiums increased
by double digits from the 2012 premiums because of Obamacare. The traditional
media has not pressed the government to provide these comparisons.

The media continues to quote
the administration press releases of lower premium prices.  The Obama administration uses CBO estimates
of premium prices calculated in 2010 for 2016 by data provided by the Obama
administration. The tradition media refuses to report reality.

A 50-state study has found
that insurance premiums will increase the first year of Obamacare in 45 of 50
states.

Insurance cost under obamacare

Premiums paid outside the
health insurance exchange will increase the same percentage or more.

No one can
say the American public has not been warned.  

There is
going to be tremendous public outcry in the individual market for insurance
when the cost to individuals and the American taxpayers is realized.

October
1,2013 is open enrollment season for the individual and group insurance market.

President
Obama has exempted the group market from Obamacare until 2015.

One of the
reasons for the exemption for the group market is to try to mute the outcry by
splitting the non group insurance from the group insurance holders.

Some of the
premium increases have already been report in the traditional media.

 "Individuals in most states will end up
spending more on the exchanges," policy analyst Drew Gonshorowski writes”

The Department of Health and Human Services published a similar
report. The government’s report is incomprehensible to me.

It does not compare pre Obamacare premiums of 2013 to
Obamacare Health Insurance Exchange premiums of 2014.

There
are literally no comparisons to current rates. That is, [the Department of Health
and Human Services] has chosen to dodge the question of whose rates are going
up, and how much. Instead they try to distract with a comparison to a
hypothetical number that has nothing to do with the actual experience of real
people.

—Douglas
Holtz-Eakin
President, American Action Forum[1]

 

The Department of Health and Human Services has
declared a 16% decrease in premium costs compared to the CBO’s 2010 estimate of
premiums for 2016.

It is important to remember the CBO’s
calculation was with faulty data provided by the administration.

“Based on a Manhattan Institute analysis of the HHS numbers,
Obamacare will increase underlying insurance rates for younger men by an
average of 97 to 99 percent, and for younger women by an average of 55 to 62
percent. Worst off is North Carolina, which will see individual-market rates
triple for women, and quadruple for
men.”

  

http://youtu.be/JwPr59nA1fM

The Obama
administration’s methods of deception are cunning, powerful and effective.

He always blames others and hides his ideology.

President
Obama continues to try to fool a majority of the people most of the time.

Americans will
get the point where the rubber meets the road. The public is going to
have to reach into their pockets and pay these enormous increases in premiums
or not buy healthcare insurance coverage.

Taxpaying
Americans are also going to experience massive increases in taxes above and beyond those already experienced.

I predict the
public outcry will drown out the spin of the Obama administration. The
traditional media will not be able to ignore this public outcry.

People will
finally realize the enormous government grab of power and control of Obamacare at
taxpayers’ expense.

People
can’t complete applications or secure premium prices on the health insurance
exchanges because of technical problems resulting from ancient information technology
used by the government to construct the exchanges.

All of the
consumers’ demographics must be filled out before the government provides a
premium price. There is at tricky reason for this.

This
computer “glitch” solidifies my view that President Obama wants Obamacare to
fail in order to replace it with a single party payer system that America
cannot afford.

This last
statement is counterintuitive but I believe true.

Is it wise
for consumers to hand over all their medical decision making to a government
that has this much difficulty with executing a computer program and providing
healthcare insurance premiums?

Americans
must wake up soon. They have to insist on a consumer driven healthcare system
in which they have control over their healthcare and their healthcare dollars.

Americans have
to insist on having an Ideal Medical Saving Account healthcare system. 

I have described the Ideal Medical Saving Account System in great detail.

 

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

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