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President Obama: Please Stop Deceiving Us!

February 16, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama, please stop deceiving Americans. Please tell us the truth. Please be transparent as you promised us you would be.

President Obama promised to transform America. Americans did not know what that meant. They thought is was for the good. 

The healthcare system was dysfunctional before President Obama became president. In order to fix a dysfunctional system, one must try to get to the root of the problem.

President Obama has not done that. He has pasted another layer of bureaucracy on top of an already dysfunctional system. This has created further dysfunction.

He has further compounded the dysfunction in the healthcare system by changing the law unilaterally by executive order without the consent of congress.

There is question on whether his actions are unconstitutional. If they are unconstitutional it is grounds for impeachment.

At best these unilateral changes have destabilized the healthcare system further. The changes have also increase uncertainty in the investment community. The result of the uncertainty is to slow the jobs market and the economy.

President Obama is a charming fellow. The problem is the veneer has rubbed off. At the beginning he pandered to all the stakeholders vested interests.

He told them glorious things about what they could expect. People have recently found out that they have been deceived.

President Obama is not about innovation and opportunity as many hoped for in 2008.

President Obama is about increased central government control over our freedoms and our choices.

All of his actions and deceptions are starting to backfire on him. The majority of the American public is becoming aware of his tricks and abuse of power.

The tricks, deceptions, abuse of power and outright lies are starting to directly affect the majority of Americans in a negative way.

In healthcare we have been deceived by many actions. At present it is the reporting the enrollment figures in the health insurance exchanges.

President Obama, his administration, and even Dick Durbin have inflated the numbers without giving Americans the facts.

Last week even the Washington Post could not take it anymore. 

“The Washington Post, has given "three Pinocchios" to the White House for its claim that 6 million people have enrolled in Obamacare, and warned the media to ignore the distorted government figures.”

After President Obama announced these figures during his Super Bowl interview, he tweeted them on his official Twitter account.

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https://twitter.com/BarackObama/status/421668496120897536/photo/1

The figure comes from a combination of 2.1 million people who have enrolled under federal and state healthcare insurance exchanges, plus 3.9 million who have qualified for coverage on Medicaid through November.

The key words in President Obama’s statement are qualified for coverage on Medicaid through November. These words tells you almost nothing about how the Affordable Care Act is affecting Medicaid enrollment."  

The mainstream media keeps on using the same incorrect numbers over and over again thinking they are fooling the American people.

"No one really knows, though some have tried to tease out figures from the data that has been presented."



 

California was supposed to have the strongest state insurance exchange.  Covered California signed up the most people for Obamacare since October 1,2013. It was the model exchange. After January 1st, 2014 the problems became apparent.

As of Dec. 31, 2013, nearly 500,000 California residents had enrolled in health coverage through Covered California, the state's health insurance exchange created under the Affordable Care Act, according to data released Monday by HHS, KQED's "The California Report" reports.

Overall, California residents accounted for 22% of the total 2.2 million exchange enrollees nationwide (Aliferis, "The California Report," KQED, 1/13).

I would call this bragging without presenting the facts or the potential problems.

These are the potential problems.

According to the data, 85% of the 498,794 Californians who have enrolled in coverage through Covered California received a federal subsidy, compared with 79% nationally (Seipel, Contra Costa Times, 1/14).

The state and the federal government will have to come up with the subsidies. The result will be higher premiums for those that pay full premium price and increased taxes for those who pay taxes.

The data also show that:

  • 61% of enrollees chose a silver-level plan; and
  • 23% chose a bronze-level plan ("The California Report," KQED, 1/13).

          52% of enrollees were between ages 45 and 64 ("The California Report," KQED, 1/13); and

  • 25% were between ages 18 and 34 (Contra Costa Times, 1/14).

 The number of enrollees is different than the number of people who definitely are insured. Enrollees are not insured until they paid their premiums.

Even so, the enrollee mix, if it stays the same will necessitate an increase in insurance premiums and a bailout of the insurance companies. The insurance company bailout was built into Obamacare upon passage of the act.

The public did not know about insurance company bailouts until recently. 

In California consumers have not receive the coverage they thought they bought. Consumers are not able to see physicians who were caring for them before the new year. Many cancer patients who require continuing care have not seen been able to see their physicians.

Seventy percent of the physicians in California have not signed up to accept Covered California because reimbursement is too low.  

 The White House was dealt a stunning new blow on Obamacare sign-up numbers:

“Reports have leaked showing that only about half of the people "enrolled" at healthcare exchanges in various states have actually paid their premiums.”

“Minnesota's exchange enrollment goal of 67,000 seemed within reach on Jan. 4, when signups stood at 25,860.”

 “But after surging by more than 4,000 per week in the prior five weeks, signups collapsed back to November's pace of less than 700 per week.”

  “As of Feb. 1, Nevada had just 14,999 paid enrollees — vs. the state's March 31 goal of 115,000.”

 “Washington state, meanwhile, was slightly more than halfway to its goal of 340,000 signups — but only 88,071 had paid as of Feb. 1.”

 “The January data available from a handful of states raise new doubts about whether ObamaCare's downgraded first-year prospects are still too optimistic.”

These numbers have been kept out of the mainstream media.

 The poor premium payments by enrollees of 50% in Washington and 66% in Nevada creates a risk that the demographics of the paid exchange population may be older and possibly sicker than the information the Obama administration has publicized to get more people to enroll.

This is only a partial list of President Obama’s present deceptions.

 A complete list of the 35 changes made to the law by executive order without consent of congress is in order about now.

Why are so few in Congress speaking out?

When are the people going to speak out?

Congresspeople who do not speak up should not be reelected!

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

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TRANSPARENCY? There Is None

February 12, 2014
inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D., FACP, MACE

President Obama promised Americans transparency in government. He has not fulfilled his promise.

Transparency in the Healthcare System must be considered on multiple levels. It consists of transparency as it related to both primary and secondary stakeholders.

The primary stakeholders in the healthcare system are patients (consumers) and physicians.

The secondary stakeholders are the government, insurance industry, hospitals and drug companies.

Each stakeholder has it own issues with transparency. There is a lack of transparency with each other. Most of all there is a total opacity of all the stakeholders toward consumers of healthcare.

A reader sent me these Medicare Part B documents. He asked if I would explain these document to him. He went to the hospital to do a pre-op evaluation for knee surgery. The evaluation included blood testing as well as an EKG and chest x-ray.

 This document is an EOB (explanation of benefits) for the outpatient evaluation services at a hospital.

It is now called Outpatient Claims for Medicare Part B.  If these procedures were done as an inpatient the fees would be higher.

The hospital outpatient fees are outrageous. A freestanding physician’s lab fees would be much lower.

The EOB has changed a little over the years. At one point a patient could not tell what the payment was for and how much Medicare would allow and pay for each procedure.

This year it is clearer. However, Medicare has done something with allowable fee that is incomprehensible. Medicare has created a conflict within its own form.

Lyle page 1 copy
 

Lyle 2Claim example 1b (1) copy 3

 

 

A simple example is the service of drawing blood.  Code 36415. The facility charged $30.80. The Medicare approved amount was $30.80. However, the amount paid by Medicare was $2.94. The maximum the patient could be billed was $0.00.  

Here is the contradiction. In the definition of columns section the Medicare –Approved Amount is defined as follows.

“Medicare-Approved Amount: This is the amount a facility can be paid for a Medicare service. It may be less than the actual amount the facility charged. The facility has agreed to accept this amount as full payment for covered services. Medicare usually pays 80% of the Medicare-approved amount.”

In the case of the needle stick to collect blood note A for above claim says;

A. This service is paid at 100% of Medicare approved amount. 

The contradiction is the Medicare approved amount was $30.80.

Why did the government change the approved amount from $30.80 to the $2.94 that it approved? Why did they ignore the $30.80?

Why would the hospital accept $2.94 when they had a Medicare approved amount of $30.80?

Something fishy is going on.

If patients are not covered by healthcare insurance, the patient would be liable for $30.80. The facility can always claim this is a legitimate charge because Medicare approved it.

Who will get stuck paying full price?

People who are poor and cannot afford insurance. Persons who do not qualifying for a government subsidy will get stuck.  Young people who refuse to buy insurance from the health insurance exchange.

This could be another one of President Obama’s tricks to drive everyone into the health insurance exchanges. The result could lead to total destruction of the private insurance industry. Then the only option will be  a single party payer system.

I have said previously that President Obama’s goal is to destroy Obamacare. It would prove to everyone that a free market system does not work.

What President Obama doesn’t realize is that Americans recognized that Obamacare has not set up a free market system. It has set up a system of regulations that place horrible restraints on a free market system.

 The American people do not trust President Obama anymore.

As we look at the other claims in this document there is more that is deceiving. The hospital facility charged $726 for a chemistry profile (code 80053). Medicare approved $726 but paid $14.24 for the chemistry profile.

 In 1980 Medicare approve $24.00 and paid 80% of $24. The price Medicare pays for a chemistry profile has dropped since 1980.

The hospital charged $752.50 for a simple blood typing and cross matching (code 86850,86900,86901). Medicare approved the fee but only paid $28.20, which is 80% of what Medicare approved amount is. The patient or his Medicare supplement would be responsible for $7.79

The Medicare approved amount for an automated CBC (Code 85027) was $452.80 but Medicare paid $8.71.

An EKG is an important part of the pre op testing. The facility charged $593.95 and Medicare approved that amount. However Medicare only paid $20.49. The patient or their supplement is responsible for $5.24. Since the beginning of Medicare in 1965 the Medicare approve amount for an EKG has never been greater that $80.00.

There is definitely something fishy with the determination of the Medicare approved amount calculation and Medicare Part B payment.

I hope I have succeeded in explaining how to understand this Outpatient Claims for Medicare Part B.

I also hope I have succeed in explaining the crazy Medicare approved amount pricing.

I believe that the only conclusion to be reached is that there is deception in the document.

There is absolutely no transparency for the patient. The hospital will not give the patient the price before he gets the work done.  The consumer cannot make a wise healthcare choice for the use of his healthcare dollars.

The government is not interested in giving patients control of their healthcare dollars.  Consumers are the victims.

Neither the government nor the insurance company gives the consumer any help.

Physician owned laboratories charge patients much less than the hospital facilities.

At the same time the government is putting more and more restrictions on physician owned laboratories in order to eliminate physician owned laboratories even though the cost is less.

 The government’s excuse for restricting physician laboratories is that physicians will have incentive to do additional testing.  

The bottom line is the government does not want to control costs or to put the patient in control of their healthcare and their healthcare dollars.

 Remember the statement, “I am the government and I am here to help.”

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

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The Obamacare Alternative That Would Work!

February 9, 2014
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

Some have complained that "My Ideal Medical Savings Account" cannot work. I have communicated with some of these people who made this and similar comments. I discovered two common themes to their comments.

The first theme was that people are too dumb to take care of themselves and make their own medical decisions.

The government must make the healthcare decisions for them.

The second was people would not handle their healthcare dollars appropriately if they were given the money.

These people might be talking about 5% per of the population who will be a burden to society no matter what healthcare system is put into place.

Why burden the other 95% of the population who want to be responsible for their health and healthcare dollars if they were given the chance?

The chance given has to include complete transparency, equal tax treatment, and adequate education to use their healthcare dollars wisely to made wise medical care decisions.

The week Tammy Bruce wrote an article in the Washington Times entitled, “Obamacare Isn’t A Train Wreck, It’s A Cancer.”

She explains how it is metastasizing throughout our economy and culture. It will destroy our society.

It is clear me that people commenting did not read my blog “My Ideal Medical Savings Account Is Democratic” carefully.

I decided to republish that blog at this time when it appears that Obamacare is failing on every level as I had predicted.

My hope is people will read the blog more carefully this time and understand it as an alternative to the impending disaster of Obamacare. 

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrictions on freedom of choice and a decrease in access to care.

I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health.  Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self-insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk of spending $6,000 for most people is low. 

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust.  If they spent over $6,000 they would have first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes, or health disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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I Gave President Obama An Alternative To Obamacare

February 5, 2014
inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System
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Stanley Feld M.D.,FACP, MACE

I formulated an alternative to Obamacare in 2006, long before Obamacare existed.  President Obama has ignored a plan that will work and align every stakeholder’s incentive.

Obamacare is failing because President Obama does not know who the customer is in the healthcare system. He is blinded by ideology and the belief that government knows what consumers need.

The consumer is the customer. Without consumers of medical care and physicians to provide medical care we would not need a healthcare system.

Consumers and physicians are the primary stakeholders. All the others are secondary stakeholders.

However, physicians receive between 15-20% of the healthcare dollars. Hospitals receive 25% of the healthcare dollars.

Where does the remaining 60% of the healthcare dollars go?

The insurance industry takes at least 40% off the top. The pharmaceutical industry receives 10% and the government wastes 10%.

It is a pity that only 40% of our healthcare dollars is spent on direct medical care. There is much waste and inefficiency built into that direct medical care.

 There is also much waste included in the 60% the secondary stakeholder take off the top.

How else would UnitedHealth’s CEO get paid $1.8 billion dollars in cash and stock options from 1998 to 2006? 

 The excessive insurance industry profits are the direct result of ineffective regulatory agencies controlling insurance pricing.

In 2006 consumer power was demonstrated when UnitedHealth tried to decrease reimbursement to Hospital Corporations of America. HCA protested and threated to quit participation in United Health. Consumer protests followed.

UnitedHealth was the main insurance carrier in the Denver Area. Consumers threated to boycott buying insurance from UnitedHealth. UnitedHealth backed off.

The HCA/United pushback is the first big step. It represents how “Patient Power” should work. Patients should be madder than hell and not want to take it any more.”

In 2006, many of the uninsured were self employed consumers who cannot qualify for insurance because they have a preexisting illness or they are at risk for illness.

The insurance companies refused to sell them insurance. The same consumer in a group insurance plan by law would receive insurance from the same insurance company that turned down the individual.

A self-employed individual can only buy insurance with after tax dollars. A corporate employee receives healthcare insurance coverage with pre-tax dollars.

The same applies for the individual insurance market post Obamacare.

The price of insurance is very high for small businesses. The small business owners do not have the negotiating power of the large corporations.

This results in both the individual and small business not being covered by healthcare insurance. All of the above can be easily fixed.

The problem with Obamacare is the insurance premiums are higher than they were pre- Obamacare. The reasons are obvious.

The only winner is the individual who makes a low enough income to receive a federal subsidy. The loser is the taxpayer.

Obamacare also creates a perverse incentive resulting in people not striving to get ahead.  

In 2006 I wrote:

  
Patients drive the healthcare system. Patients have tremendous power. They must be taught to use that power in order to Repair the Healthcare System.

Patients must use their  “Patient Power” to take control of their healthcare dollars and their health. They should be provided with financial incentives to save the money they spend on medical care.

Neither the healthcare insurance industry nor the government should determine the consumers’ access to care. Patients’ freedom of choice and self- responsibility is the key to Repairing the Healthcare System.

If there are financial incentives consumers will learn to become informed consumers of healthcare. Reliable education must be provided to give consumers the opportunity to become informed consumers.

There are preconditions.

 Prices must be transparent so consumers know what they are buying. The insurance industry should negotiate the price with the physicians and the hospitals. The industry can remain the surrogate broker for the payment of money belonging to the consumer. Consumers’ who overspend will not receive the financial incentive. They will lose their medical saving account money. Patients who have an expensive illness, like diabetes, can be rewarded for spending money if they keep themselves in good health and prevent complications of disease.

The consumers are then the responsible party purchasing their medical care. It is not the healthcare insurance industry or the government.

The healthcare insurance industry or any financial industry with an adequate computer system can be the administrator and adjudicator of payment.

Medicare director Mark McClellan M.D. said that 90% of the healthcare dollar of a specific disease (Diabetes) is spent on the complications of disease. If we reduce the complications of a disease we could save at least 45% of the current healthcare expenditure for that disease.

Obamacare gives this vital fact lip service. It puts the responsibility of outcomes on physicians’ shoulders. If physicians have poor outcomes they get penalized.

The medical outcome is a dual responsibility of both consumers and physicians. Consumers should be made aware of physicians’ outcomes. Some of the poor outcomes are the result of consumers not taking the responsibility to learn about their disease, prevent the complications of their disease, or comply with the treatment recommended. The result is a poor outcome.

Consumer overspending is another important aspect of increasing healthcare costs. Consumers do not have incentive to be cautious with their healthcare dollars because they have been given first dollar coverage. They do not have financial incentives to save money on medical care.

Consumer overspending was best described by Victor Fuchs an economist from Stanford.

He made the case for a Consumer Driven Health Care System.

The Health Saving Accounts that congress has approved in my opinion is impotent. It does not provide a strong enough financial incentive for consumers to want to save money.

The trust account of $1,000 per year is too low to motivate consumers to become wise shoppers. A Medical Savings Account of $6,000 per year begins to represent financial motivation.

 HSA’s represent the same false hope HMO’s and managed care represented in the 1980’s and 1990’s.

 Dr. Fuchs calls it “The Restaurant Check Problem.”

“You go out to a restaurant with a bunch of friends and you sort of understand that you will split the check,” he said.

 “The waiter comes along and says, ‘the lobster looks very good, and how about a soufflé for dessert?’

The restaurant check balloons, but you are not so careful because you figure everyone is splitting it.

“That’s the way medical care gets paid for,” he said.

 Dr. Fuchs added, “We want to spend our money on the things that will bring the most value for the dollar.

When we are spending collective money as we are in health care, then it becomes much more difficult.”

We want Diabetics to spend money for good medical care in order to prevent complications. Prevention of complications will keep Diabetics out of the hospital and out of the emergency room. The result will be a decrease in medical costs.

The consumer driven healthcare plans can be set up to give provide Diabetic consumer the financial motivation to take care of himself. This reward is much cheaper than paying for a hospitalization or emergency room visit.

 If an insurance product is overloaded with salaries, waste, overhead and unnecessary benefits patients will not buy the product.

The insurance product would have to be modified. It would become more cost efficient.

Patients have it in their power to remove the waste and inefficiency in the system.

Some very clever entrepreneur will realize the consumer is the customer. He will develop an insurance product that everyone wants. State governments have the power to encourage development of this product.

The examples in industry in America are numerous. Sam Walton revolutionized retailing in America with Wal-Mart and Sam’s. Michael Dell almost brought IBM to its knees and revolutionized the distribution of information technology.

 My goal is to describe the necessary components of a healthcare insurance product that does not offer another and false hope.

I hope to show the way to develop an insurance product that can work for patients first and then all the other stakeholders.

There is no reason we cannot provide excellent affordable insurance coverage to all including the corporate employed, the small business employed, the self employed, the unemployed, and the Medicare covered seniors, with all the stakeholders making a reasonable profit in a simplified system.

President Obama, I have provided a viable alternative long before you became President.

I also provided this alternative to you when you became President in the letters I wrote to you.

For you to say no one has come up with a better alternative than Obamacare is disingenuous on your part.

I hope you are listening now.

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

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What An Experience!

February 2, 2014
inMedicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Every congressman should try registering a poor (below poverty level) constituent for Obamacare aid.

If you have not, you do not deserve to be in office or have a vote.

Most of you know my story of Moses and his healthcare insurance. I have tried to obtain Medicaid healthcare coverage for both Moses and his wife in the past in Texas. I failed after trying hard.

I had been successful in registering his kids for SCHIP.

Moses annual income qualifies him and his family for Medicaid in Texas. Texas is a state that isn’t expanding Medicaid.

You might recall that Medicaid is not great insurance. The reimbursement is extremely low and there are few physicians who participate.

If Moses lived in a state that is expanding Medicaid, he could earn up to $32,500 dollars per year and still qualify.

"If your state is expanding Medicaid, you’ll probably qualify if you make up to about $15,800 a year for 1 person ($32,500 for a family of 4). (These are 2013 numbers, and likely to be slightly higher in 2014.)"

 "If your state isn’t expanding Medicaid in 2014

Some states aren’t expanding their Medicaid programs in 2014. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls.

Moses earns less than $23,500 a year. He should qualify for Medicaid in Texas.

I have encouraged him to apply for Medicaid using the Obama Health Insurance Exchange in Texas. Texas has a federal Health Insurance Exchange.

I offered to help him fill out the application online at the beginning of December. He did not want to bother me.

He said he had a friend in North Texas who works for one of the Texas insurance  companies. He said his company has people who help people like Moses fill out the healthcare insurance application. He said they are called Navigators. 

I told him the Navigator should be able to help him complete the application. The insurance company assigned him a Navigator in Las Vegas, Nevada.

Moses said she was very nice. She asked Moses all of the questions over the telephone.

I called him on December 12th and asked him if he had insurance yet. If you recall President Obama extended the deadline for applying until December 23th and then December 31th in order to have coverage for January 1st, 2014.

Moses said she told him she did not understand why his application was not accepted.  I told him to call her every day and find out what is going on.

She was going to try again the next day. It sounded like she tried at least every other day through December 31st and failed to get any information or his application accepted.

I told him to keep having her try. This went on through the next extended deadline of January 15th. She said could not understand it. I couldn’t understand it either.

Everything I read said the web site healthcare.gov was working smoothly. However, the back end was not connected to the application process.

 She was unsuccessful through January 30th. On January 30th I told him to come over. I would try and I would fill out an application online for him.

Again he did not want to bother me. I insisted. In the meantime another friend in North Texas connected him with a Spanish speaking Navigator in North Texas.

The Navigator called him when we were about to start filling out the application. After speaking with Moses in Spanish, he asked to speak to me. He practically begged me to let him complete the application for Moses and get him healthcare insurance.

I said O.K.

He asked Moses to come over to him that afternoon. Moses went to him. They spoke for an hour. He then gave Moses a list of questions and a telephone number to call.

Moses told me the questions were complicated. He was afraid he would make a mistake in answering them. The Navigator told him he would not get Medicaid but he could buy a number of insurance policies.

I told him to let me try to register him online.

Last Thursday Moses came over to the house with his citizenship papers and social security numbers of his wife and two kids.

I started to complete the form at 9 am. I completed the form for him at 11.30 am. The form was long and tedious.

Ten seconds after the application was completed the health insurance exchange acknowledged the submission of application. It then accepted the application.

The next screen asked if I wanted to see coverage the applicant was qualified to receive. Within four minutes of accepting the application the message was sent that the application does not qualify for Medicaid. 

This decision seems impossible. Healthcare.gov is not connected to insurance carriers or government databases. The decision was too fast. It would have had to be done by hand.

In any event I clicked on the coverage the application was qualified for. As I clicked on that I noticed there was an appeals button on the previous screen. I figured I could get back to the appeals button shortly.

He was given a choice of healthcare policies. There was no discussion of the possibility of government subsidies.

See below.

  Scan

 The deductibles offered for his income level were outrageous. The lowest deductible was $1500 which he couldn't afford it.  

It was painful to see the dejection on his face.

I tried to re-log into his application.  Healthcare.gov would not recognize the registration number they had given him fifteen minutes earlier.

Where is his application?

When will he receive notification of his eligibility for subsidy?

How much subsidy will he receive?

How does he appeal the Medicaid decision?

Is there anyone out there that can help?

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

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Not One Dime In New Taxes

January 29, 2014
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

I received a note from a reader last week. I debated with myself whether or not to publish it. Americans have discovered, and are continuing to discover, President Obama’s many lies/deceptions about Obamacare.

He kept telling us that the law would only tax families earning over $250,000 a year. People earning less than $200,000 per individual and $250,000 per family will not pay a dime more in taxes.

“No family making less than $250,000 will see "any form of tax increase."

"I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes."

Sources:  President Obama

Subjects: Taxes”

 

It has become apparent that President Obama and his administration have told the American people many lies during his administration. The lies are at best half-truths. President Obama promised us an administration that would be totally transparent and truthful.

Americans trusted him to live up to his promise.

Many believed him only to find out he was not telling the truth.

The traditional media has supported many of President Obama’s lies. This same media had zero tolerance for George H Bush’s (41) lie.

 “Read my lips’. No new taxes.”

 There are at least ten hidden taxes imbedded in Obamacare.

In the last few weeks we learned that an insurance industry bailout was imbedded in Obamacare. President Obama knew about the bailout at the time Obamacare was passed.

Nancy Pelosi was correct. “We won’t know what is in the bill until we passed it.”

Americans used to trust their leaders. This administration has made us very cynical.

There is something called a “Medical Device Excise Tax.”  This medical device excise tax is in the original Obamacare legislation. The 2.3% tax is imposed on the manufacturers of the medical device.

The 2.3% is ultimately passed on to all, both the rich and the poor.

The reader sent me the following:

 "The 2.3% Medical Excise Tax that began on January 1st, 2013 as part of Obamacare’s tax structure is supposed to be "hidden" from the consumer, but it's been brought to the public's attention by hunting and fishing store Cabela's who have refused to hide it and are showing it as a separate line item tax on their receipts, the email states.

Cabella 2

I did some research and found directly from the IRS 's website information that PROVES this to be true and an accurate portrayal of something hidden in Obamacare that I was not aware of! Now being skeptical of this I went to the IRS website and found this!"

"Q1. What is the medical device excise tax? A1. Section 4191 of the Internal Revenue Code imposes an excise tax on the sale of certain medical devices by the manufacturer or importer of the device sales of taxable medical devices after Dec. 31, 2012.

Q3. How much is the tax? A3. The tax is 2.3 percent of the sale price of the taxable medical device.

See Chapter 5 of IRS Publication 510, Excise Taxes, and Notice 2012-77 for additional information on the determination of sale price.

 Chapter Five

So being more curious I clicked on "Chapter 5

of IRS Publication 510."

And what do I find under "MEDICAL DEVICES" under

"MANUFACTURERS TAXES"?

The following discussion of manufacturers taxes

applies to the tax on:

Sport fishing equipment;

Fishing rods and fishing poles;

Electric outboard motors;

Fishing tackle boxes;

Bows, quivers, broadheads, and points;

Arrow shafts;

Coal;

Taxable tires;

Gas guzzler automobiles; and

Vaccines."

"I think we have definitely been fooled, if we believe that the Affordable Care Act is all about health care. It truly does appear to be nothing more than a bill laden with a whole lot of taxes that we the people have yet to be aware of."

"Please pass this on. I am still incredulous that this can go on.

Where is our press ?  


What is next? What else is there we do not know about? God help us ."

 This is not the first time we have not been told the truth by this administration.

  

http://youtu.be/VQb8MFUn3QQ

However I did my own fact checking and discovered that the author misread Chapter 5 of IRS Publication 510 Excise Taxes, and Notice IRS Publication 510.

The publication deals with all things subject to excise taxes. Chapter 5 covers “manufacturers taxes” of which the medical devices excise price 2.3% is a part of.

The anonymous author found the list of items including fishing equipment, bows and cars. Some of these excise taxes existed pre Obamacare.  Some of the manufacturers excise taxes are a result of Obamacare. They are all separate from the medical device excise tax.

The publication says the tax on fishing rods and fishing poles is a 10% excise tax not to exceed $10 per article.” The tax on fishing tackle boxes and electric outboard boat motors is 3 percent of the sales price. The tax on bows is even higher, at 11 percent.

Cabela’s sales reflect the manufacturer excise tax because the increase in cost of manufacture of the item is passed on to the consumer.

Cabela was wrong in adding 2.3% to the final bill. It misread the law. The sporting goods store realized its error the first week adding stopped adding the excise tax. Cabela repaid customers who were charged the excise tax.

One must think of the increase in price of an item to all consumers for the manufacturers’ tax is in reality a hidden tax to the middle class. It reduces the consumers’ purchasing power.

This is true for the tax on tanning bed salons also.

What additional Obamacare taxes are affecting the under $200k/$250k earners?

1. Obamacare Home Sales Tax increases taxes on unearned income by 3.8%. 

2. Obamacare increases the medical expense deduction threshold. Unreimbursed medical expense deductions will now be available only for those medical expenses in excess of 10% of AGI, which has been raised from 7.5%.  

3. Starting in 2018, the new health care law imposes a 40% excise tax on the portion of most employer-sponsored health coverage that exceed $10,200 a year and $27,500 for families.

Unions who have negotiated these healthcare plans for its members are upset because the tax will severely affect its membership. Members might elect to quit the union.

There are many more hidden taxes I have not discussed in this discussion.

Democrats now admit after going through the new Obamacare taxes line by line that those taxes will increase the tax burden and decrease the purchasing power of the middle class.   

President Obama has promised that Obamacare will help all Americans get access to quality affordable healthcare and new benefits, rights and protections.

So far Americans have seen the opposite occur.

The reaction to the Cabela incident is simply an indication of the middle class’ cynicism. President Obama promised people making less than $250,000 a year will not pay one dime more in taxes.

It is clear he knew that was a false promise at the time.

Americans do not trust President Obama anymore.

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

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Obamacare is Right On Schedule

January 26, 2014
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

Is President Obama trying to destroy the healthcare system in America?

Yes he is!

 Actually he is right on schedule to have Obamacare implode on itself.

 I remember when he told Barney Frank and John Kerry not to worry about not including the Public Option in the Affordable Care Act.  We will get to a single party payer system.

  

http://youtu.be/f3BS4C9el98

  

http://youtu.be/-522hcm3woA

They did not understand how President Obama could make such a compromise. They thought the Public Option was the only way in the Affordable Care Act Obamacare) to get to their goal.

The goal was a single party payer system.

They did not have the votes then and they do not have the votes now.

President Obama has used a lot of trick plays to get his way in passing and implementing Obamacare. I have pointed out these trick plays along the way. They should be reviewed.

As hard as it is to believe, it seems that President Obama wants his legacy legislation Obamacare to fail.

Otherwise he would not have had Obamacare constructed with so many perverse incentives for stakeholders.

The only route to success is to align both primary and secondary stakeholders incentives. Obamacare is misaligning all of the stakeholders' incentives.

The incentives are more misaligned now than they were in the dysfunctional healthcare systems days before Obamacare.

The stated goal of Obamacare was to provide affordable healthcare insurance to all, with access to quality care to all without rationing of care.

The effect of Obamacare has been just the opposite. The healthcare insurance coverage will not be universal. It is unaffordable to many in the middle class. It is also unaffordable to many of the subsidized poor that do not qualify for Medicaid. There is limited access to care. There is an increase in the rationing of care.

President Obama claimed Obamacare’s health insurance exchanges would create a competitive free market insurance system.

The health insurance exchanges would force the healthcare insurance companies to be competitive. Healthcare insurance competition would lead to a decrease in healthcare costs.

Health insurance exchanges have not worked as advertised. President Obama’s health insurance exchanges have not resulted in a competitive free market system.

Healthcare premiums have skyrocketed.

Healthcare insurance deductibles and copays are higher.

Hospitals and doctor networks are skimping for two reasons. Doctors and hospitals are choosing not to participate in Obamacare. Healthcare insurance companies are not electing to include many well known  doctor and hospital networks.

Many excellent drugs are not on the insurers' formularies because of the cost. When newer brand name medications are on the formulary the co-pays are unaffordable to patients who need them. Patients therefore do not fill the prescription.

The healthcare insurance premiums are often higher than what consumers previously paid for their private insurance pre Obamacare even after some consumers receive government subsides.

The Obama administration will conclude soon that the free market healthcare system does not work. 

The administration will claim that only healthcare system that will work is a government single party payer system.

However, President Obama has not created a free market healthcare system with his health insurance exchanges. It is a highly regulated market.

In his over regulated marketplace he has created incentives that have further misaligned stakeholders vested interests than they were pre Obamacare.

In the Obamacare system the healthcare insurance companies are led to believe they remain the king of the healthcare industry. They believe they can continue to control healthcare costs.

The government remains totally dependent on the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for government healthcare programs.

In performing these services the government has permitted the healthcare insurance industry to pad direct patient care costs with items that are insurance companies expenses and should not be counted as direct patient care.

The increased distortion is magnified when the government dictates the benefits the insurers must offer patients in the health insurance exchanges and the private insurance markets.

This causes the premium prices to skyrocket .

Consumers might not need these added government benefits. Consumers have no choice. They have to pay for unneeded benefits. These benefits are added to the cost of insurance as well as the net profit of the healthcare insurance companies.

The healthcare insurance industry is also permitted to choose their own networks of physicians and hospitals.

The insurance companies try to maximize their net profit at their lowest cost. Therefore they have kept the best hospital and physicians out of their networks. This affects the quality of care.

It must be realized that quality of care has not been adequately defined or accurately measured.

 In some cities and states consumers only have one insurance carrier. Other carriers have opted out. There is not even a pretense of competition.  This insurance carrier usually picks the hospitals and physicians that will accept the lowest reimbursement. The healthcare insurance industry is offering low fees to providers. They will take only those providers into their networks that accept those low fees.

An additional incentive distortion is the Obamacare requirement for the healthcare insurance companies to charge the same premium for anyone who signs up for Obamacare.  There is no risk weighting permitted.

The hope is all consumers will sign up and enable the industry to keep premiums down.This rule generates two negative incentives. The healthcare insurance industry must overcharge the healthy and undercharge the sick. Therefore the healthcare insurance companies try to attract the healthy and avoid the sick.

This has backfired on Obamacare. The healthy young have realized the trap. They are not signing up in the heath insurance exchanges.

Previously when they were employed the employer didn’t mind covering the young. The young help lowered the overall premium because they were young healthy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           &#
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There are only two options left to the government. Obamacare can bail out the insurance industry and bully the healthy and low risk young into buying healthcare insurance from the government health insurance exchanges.

Many cities, towns and stats have underfunded healthcare coverage commitments. These local commitments include retirees. These cities, towns and states can now dump these consumers into Medicare and the health insurances exchanges.

In addition, there are many people who have chronic illnesses who have been afraid to leave their jobs because they could not get healthcare insurance in the individual market in the past.

These patients can now obtain insurance in the health exchanges at the same cost as everyone else. This will further contaminate the risk pool and increase the health insurance exchange premiums.

The Obama administration figures all taxpayers will cover the added costs. Taxpayers will bail out insurance companies for the poor risk pools that are decreasing their profits.

It looks like the real purpose of Obamacare is to destroy the relationship between the employer and his employee by driving employees into the health insurance exchanges just as it has destroyed the relationship between the consumers and their physicians.

President Obama understood this as the bill was written.  

Small employers are dumping employees from their healthcare insurance plans into the individual market and the health insurance exchanges.

In 2015 group employer insurance will affect an estimated 80 million people. They will loss their insurance and be forced into the health insurance exchanges.

The insurance industry will quit providing insurance and President Obama’s plan  to have a single party payer will occur by default. 

Taxpayer will pay the difference through higher taxes. In the meanwhile nothing has been done in making healthcare premiums more affordable, access to care more available, quality of care better or preventing the rationing of care by a government body.

Consumers will not stand for government control over their healthcare decisions.

There is a better and cheaper way. It is to put the consumer in charge, not the government.

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

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Where’s The Money Going To Come From?

January 22, 2014
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

Where is the money coming from to pay for Obamacare? Enrollment has been terrible from October 1st 2013 to December 31st 2013. 

The Obama administration has been bragging that 2.1 million consumers who have signed up for Obamacare.

The Obama administration originally estimated Obamacare needed 7.2 million consumers to sign up on the health insurance exchanges to make Obamacare viable. Of the 7.2 million people, the administration needs at least 2.7 million people to be young and healthy 18-34 year olds. These young, healthy people are needed to pay for the sicker, older people who are likely to use the healthcare dollars.

I believe 7.2 million is a low estimate of the necessary participants to make Obamacare viable. 

As a result of Obamacare, employers have been converting many employees to part time workers. The employers’ goal is to avoid paying for healthcare insurance while avoiding Obamacare penalties. This has resulted in an undisclosed number of uninsured people.

The cancelation of 6.5 million healthcare policies in the individual marketplace due to non-compliant Obamacare mandated coverage will further increase the number of uninsured.

The Obama administration has spun the numbers to look favorable even though they are terrible.

Kathleen Sebelius released the Obamacare participation numbers for the first two month last week.

 “Key findings from today’s report include:

  • Nearly 2.2 million (2,153,421) people selected Marketplace plans from Oct. 1 through Dec. 28, 2013
  • These signups in the state and federal marketplaces represent a nearly five-fold increase from October-November, including nearly 1.8 million (1,788,739) people who selected a plan in December (compared with the previous two-month cumulative total of 364,682 through Nov. 30, 2013).
  • Of the almost 2.2. million:
    • 54 percent are female and 46 percent are male;
    • 30 percent are age 34 and under;
    • 24 percent are between the ages of 18 and 34, and;
    • 60 percent selected a Silver plan, while 20 percent selected a Bronze plan; and
    • 79 percent selected a plan with Financial Assistance.”
  • Today’s report also details state-by-state information where available.  In some cases, only partial datasets were available for state marketplaces. 
  • The report features cumulative data for the three-month period because some people apply, shop, and select a plan across monthly reporting periods.  Enrollment is measured as those who selected a plan.

To read the complete report visit: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf

There are several problems not emphasized by the report.

How many of the 2.1 million applied and were approved and receive insurance?

How many actually received an insurance card?

How many paid the first month’s premium?

How many applying for insurance lost their insurance as a result of the Obamacare change in insurance requirements?

How many of these people have a pre-existing illness and are an expensive health risk?

What is the average amount of financial assistance the 79% will receive?

The young healthy people have not applied because most are facing at least a 50% increase in the cost of insurance premiums along with higher deductibles.

They feel they are being ripped off by Obamacare and refuse to join. Many simply cannot afford it.

“No group has been hit as hard by the Obama economy and Obamacare as America’s young people. After seeing massive premium increases and failed bureaucracy in the Obama administration, it’s no wonder they are staying away,” said Don Stewart, a spokesman for Senate Minority Leader Mitch McConnell.

House Speaker John Boehner’s office said the figures prove the health law has been “a bust so far.” “When they see that Obamacare offers high costs for limited access to doctors — if the enrollment goes through at all — it’s no surprise that young people aren’t rushing to sign up,” said Boehner spokesman Brendan Buck.

 How many have tried to apply for healthcare insurance only to have their application kicked back without explanation?

Moises is a case in point. He is a U.S. citizen with a wife and two kids. His kids have SCHIP. He and his wife do not have Medicaid or other insurance.

I volunteered to fill out his application for him. He said he did not want to bother me. He has a friend who knows someone who will complete the application for free.

He friend works for an insurance company. The company has navigators that will complete the application for free for him.

It took 3 weeks to complete the application. How many hours was the government billed to complete his application at $48 an hour?

The October 31st deadline passed for Moises and his wife to have insurance November 1St.

He and his wife contracted what sounded like a viral illness on October 30th. They went to the doctor on November 2nd. They had some lab tests done and were given a “real expensive antibiotic.”

The encounter cost him $200 that he could not afford. I would guess the same transaction would have cost the insurance company $50.

The navigator promised him she would have the application in by November 15th so that he would have insurance on December 1st. On November 21st the application has yet to be accepted by healthcare.gov.

There has been no explanation by the navigator as to why his application did not go through. He has called the navigator at least 15 times. She says she will keep trying.How many more people has this happened to as they have tried to apply for Obamacare? 

Last week the Washington Examiner said that the IRS has started bullying young people to sign up.

President Obama is in the midst of multimillion dollar spending public relations campaign to convince young people to sign up for Obamacare.

This bizarre commercial to "Get Covered" by Obamacare received 72,000 hits on You Tube. How many of those 72,000 applied for Obamacare? We will never know.

 

 http://www.youtube.com/watch?v=ZJQXkIEqMMA

 Other “Get Covered” bizarre commercials can be seen at the completion of the above video.

 Is this a good use of taxpayers’ dollars?

 President Obama is spending money like a “drunken sailor.”

 After receiving the Obama administration’s original numbers, the CBO’s estimate predicted Obamacare would save $114 billion dollars over the next 10 years.

In May 2013 the CBO revised its estimate of the Obamacare costs. The graph below shows that Obamacare will cost over $140 billion dollars per year over the next 10 years. The net budgetary impact will be $1.4 trillion dollars. The deficit represents an increase more than $1.54 trillion dollars over the cost savings of  $114 billion dollars in the original estimate.

  Cbo budget projections

This estimate is not even close to what the eventual net budgetary impact will be.

The real cost will skyrocket because of all the defects in the law, terrible implementation of the law, the fraud and abuse that will occur because of implementation of the law and the entire skewed enrollment that is going to take place.

America ought to face reality and ignore President Obama’s rhetoric now before disaster occurs and America is bankrupt.

Americans should insist that Obamacare be repealed now before it is too late!

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

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Beware Of Disinformation and Punishment

January 19, 2014
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D., FACP, MACE

The gigantic error President Obama is making is trying to force Americans to do something they do not want to do.

It took a little while for Americans to realize the trap they were getting themselves into by supporting Obamacare.

Now that 2014 has arrived Americans are feeling the punitive effects of Obamacare. The consumer outrage is beginning.

We must realize that the healthcare system was unsustainable before Obamacare was passed. Having Obamacare passed by a totally partisan vote by a left leaning Democrats and left leaning President was another mistake.

Obamacare has accelerated the unsustainability of the current healthcare system.

Group and individual insurance policies have skyrocketed in price. Healthcare insurance deductibles have also increased.

Consumers of medical care previously covered by their company’s healthcare plan have had their work hours reduced to less than 30 hours so their company can discontinue their healthcare insurance coverage and avoid government penalty.

The majority of people were not aware of the 10 hidden taxes collected since 2009 for Obamacare.

Since the disaster of the website rollout more people are becoming aware of the potential impending disaster of Obamacare.

In addition to the 48 million people who were uninsured pre Obamacare at least 6.5 million have lost their insurance in the individual insurance market.

President Obama has provided waivers for the group healthcare insurance market for a year. This was done to avoid a much bigger public outcry for the lose of healthcare insurance they liked than what has resulted from the 6.5 million people that lost their healthcare insurance in the individual market.

The Obama administration is spending $600 million dollars to try to convince millions of uninterested and reluctant 18 to 35 year olds to buy healthcare insurance from the Obamacare health insurance exchanges.

So far less the government reports that only 24% of the risk pool population are healthy young people. This is well below the 40% that are needed to pay for the sick and elderly that have already applied. The young are suppose to pay for the older sick patients.

“The heart of Obamacare is coercion. If Americans fail do what the law's Democratic authors believe is best, the federal government will punish them, through the progressively higher penalties of the individual mandate, until it hurts more not to buy coverage than it does to give up and purchase it.”

Incentives work! Punishment does not!

It looks as if these young Americans are rebelling. They mistrust the government and feel they are being used. They feel they are being misled into buying healthcare insurance that might not meet their needs even if the government is telling them it does meet their needs.

What if they continue to refuse to buy the insurance the government is trying to force them to buy at prices they do not want or cannot afford to pay?

Obamacare has a mandate provision. The Obama administration still calls it a mandate even though the Supreme Court called it a penalty tax.

The Obama administration also calls it by a nicer name. It is called “The Shared Responsibility Provision.”

Everyone believes a mandate is a mandate.

 Bob Laszewski, a respected health care analyst said it.

 "How the hell are you going to enforce a mandate to buy something that people don't think is valuable enough to buy? If the uninsured don't start to see value in Obamacare and buy it, is the Democratic solution to fine the heck out of them until it hurts so much they have to buy it? That is great political strategy!"

The mandate, penalty, tax in the first year is meaningless. It is $95. Neither President Obama nor the traditional media have emphasized the more significant part of the penalty. The actual penalty is $95 dollars or 1% of the mean adjusted income whichever is greater.

The mean adjusted income includes capital gains, dividends, interest and royalties. A young healthy person making $50,000 would be penalized $500 dollars the first year, $1,000 the second year and $1,250 the third year. If they had income from inheritance or other sources the penalty would be higher.

“Your tax penalty (shared responsibility fee) for not having insurance is paid on your taxes at the end of the year. If your taxable income is below 133% of the FPL you are exempt from this tax.”

2014 = $95 per person per year or 1% of your Income
2015 = $325 per person per year or 2% of your Income
2016 = $695 per person per year or 2.5% of your Income
2017 = Tax Penalty will increase by the rate of inflation going forward, or 2.5% of your Income

• The penalty is based on modified adjusted gross income.

• The total penalty for the taxable year cannot exceed the national average of the annual premiums of a bronze-level health insurance plan offered through the health insurance marketplaces.

How is the government going to collect the penalty? The present plan is for the IRS to deduct the money from a tax refund. 

Democrats in Congress who passed the bill feared public reaction and political fallout to forcing Americans to write a check to the government to cover the penalty. Therefore this method of collection by the IRS is barred.

If the penalized person is not due a refund the IRS has no legal way of collecting the money.

 Obamacare has some good ideas that need to be incorporated into the healthcare system. However their format and implementation are horrible.

The goal of Obamacare is central government control and implementation of the healthcare system.

Community organizers, lawmakers, and bureaucrats designed the bill. The ideology was socialistic. The designers do not believe in the free market. They were influenced and manipulation of lobbyists.

Obamacare is not consumer driven healthcare system law.

If Obamacare had been designed by businesspeople, it might have had many more features that appeal to customers.

Bon Laszewski said "The problem with Obamacare is it’s product driven and not market driven,".

 "They didn’t ask the customer what they wanted. And I think that’s the fundamental problem with Obamacare.

It meets the needs of very poor people because you’re giving them health insurance for free. But it doesn’t really meet the needs of healthy people and middle-class people."

I believe it could have been designed to be cheaper and more effective to meet the needs of the poor people without destroying the ability to meet the needs of the middle class.

A government can try to force people to do buy something they do not want. However, throughout history this method has not worked.

Should Americans continue to travel down the proven path of failure at great financial, economic and political cost?

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

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