Stanley Feld M.D.,FACP,MACE

Let us assume President Obama wants to destroy the
healthcare system. I have presented steps taken by the Obama administration to
accomplish that goal.

It is possible that this assumption is correct.

It looks as if President Obama uses the same patterns
in the actions he takes to govern.

He promises a group something that group wants to
hear. Then he disregards the promise. He acts to further his political agenda.

This methodology is not the methodology of
leadership, nor does it promote trust.

However, he
has used the same methodology in finance, in the environment, in immigration,
in defense, in energy, in racial relations, and most of all in Medicine.

He first captures his base with ideas that promote
their vested interest. He then undermines his base’s vested interests replacing
these vested interests with his own political agenda.

The
next step is to shift the blame to someone else. His best victim has been the Republican Party. It
is incomprehensible to me that the Republican Party sits back and takes it. I
guess it is politically correct to do so. However, it does not win elections.

If an element of his base makes a big enough stink,
he provides an executive waiver for the issue.

Some of the patterns are hard to see. The
traditional media under reports them.

Other actions using the same pattern are not seen
because they are not examined carefully. They are only seen after they have a
direct affect on an individual’s or group’s vested interest where they have
been betrayed. This leads to mistrust.

President Obama then proceeds to become the judge.
As judge he plays one group against the other.

He now has angered adjunct university and colleges
teachers. This group has been a steady ally.

“Adjunct faculty at a local college
were asked to sign a petition to the White House to "explore
options to prevent colleges/universities from cutting adjunct and contingent
faculty hours to circumvent [the] PPACA," better known as ObamaCare”

This is in
response to the massive assault on the livelihood of adjunct faculty who
now face devastating salary cuts as a direct result of Obamacare.

University and college
professors have universally been President Obama fans. The tide is shifting for
President Obama.

He has blamed the
shifting tide on the Republicans.

In medicine President
Obama’s budget cuts have already resulted in rationing of care and a decrease
in access to care. Cancer Clinics across the
United States are turning away thousands of Medicare cancer patients.

The cost of the
medication to the cancer clinics is higher than   government reimbursement for the medication.
 

"Patients at these clinics would need to
seek treatment elsewhere, such as at hospitals that might not have the capacity
to accommodate them."    

The reduced Medicare
funding already has taken place April 1,2013.

Cancer treatment in
hospitals, in many cases, are 2 to 4 times higher than treatment in outpatient
cancer clinics just as surgery done in an outpatient surgery clinic is one half
to one fifth the cost of surgery in a hospital.

Yet the hospital systems
continue to receive adequate fees.

 The Community Oncology Alliance, which
advocates for hundreds of outpatient cancer clinics nationwide has sent letters
to legislators urging them to exempt cancer drugs from the sequester for outpatient cancer
treatment to make less expensive outpatient cancer treatment available to
patients.

 The hypocrisy of President Obama, who early on
claimed that the passage of the American Recovery and Reinvestment Act (ARRA)
would "launch a new effort to conquer a disease that has touched the life
of nearly every American.

 Thus, it
is perplexing that the cuts outlined by CMS will negatively impact cancer
patients, making advances in cancer care more difficult to deliver."

Seniors could not know
about this until they develop cancer and experience the cost. It too has been
under reported.

President Obama who introduced the idea of sequestration, in his
negotiations for a continuing resolution last year, has refused to take
responsibility for it.

Republicans attempted to
make the sequester cuts "less reckless,” such as severe military cuts,
closing the White House to visitors and all the other restrictions President
Obama introduced for this two per cent cut in the budget.

Harry Reid said the
Republican’s proposed cuts were dead on arrival in the Senate.

 “Thus,
Obama's duplicity emerged, as he sought to blame the Republicans for
sequestration even though he originated it.”

There have been many instances where the
Obama administration has divided Americans into class warfare. The class
warfare has occurred in immigration reform, cancer victims vs. non cancer victims,
union workers vs. non union workers, right to work states, college teachers and
the administrators, black vs. whites and rich vs. poor for example.

The traditional media
fill the airwaves with these distractions. The real issues are diverted by the
distractions. President Obama plays “Wag the Dog” constantly.

Some examples of real
issues would be how to solve the problem of government inefficiency, waste,
fraud and abuse. It is not to create more agencies, rules and regulations and
impediments on business development to destroy job growth?

Why beat up on doctors
and patients when the real problems are insurance companies, hospitals and tort
reform despite the administration and its advisors’ denials.

Why is he giving out preferential
waivers? America should be outraged to have Obamacare passed into law by a
Democratic Party, which then in turn receives a waiver from President Obama by
executive order to be exempt from Obamacare.

The media should be
outraged. Instead the media has given congress and the President a pass.   

“Though I value my First Amendment right to
petition the government for change, we need far more puissant action.”  

We need to demand a total eradication of Obamacare.
 And it needs to be done as a united front.  Otherwise, we actually
play right into President Obama's overarching aims of divide
and conquer by
duplicity and coercion.” 

President Obama wants to
avoid personal blame for the expensive, unwieldy health care law. He will
probably figure out a way to blame Republicans for its failure.

The majority of the
people are against the healthcare law. Physicians know it will make the
healthcare systems problems worse and more expensive.  Yet the President ignores all of these voices
while he is spending massive amounts of money on marginally added value medical
projects.

Some believe the tactics
used by the used by the President to pass the healthcare law started all the
problems. In reality Obamacare is a bad law that will be impossible to
implement.

President Obama always uses
the same pattern to avoid personal blame. (“I
did not draw a Red Line, the international community did”). He always
diverts our attention from the real problems. He tells lies or half-truths
about issues, and divides and conquers to create class warfare.

He uses the same moves
over and over again. If America doesn’t start looking, Americans will not see
the destruction to most of our institutions.

The so-called unintended
consequences in every area might not be so unintended.

President Obama is
accomplishing exactly what he wants to accomplish. It looks to me as if he
wants total government control over our society. Many institutions have begun to
crumble before he reaches his goal.

The disregard for our
constitution is one vivid example. 

What massive government
intervention means to me is that it is creating more misery, resentment and
anger among all the diverse groups in American society. 

Most Americans believed
President Obama when he said it is time for a change. It was time for a change.

 Since he did not define the change he was seeking,
we all assumed it would be for the better.

Our assumption was
wrong. 

It is time we start
looking and seeing.

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

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Stanley Feld M.D.,FACP,MACE

Confusion
about any rules or regulations is not good for business, bad for job growth and
bad for the economy.  Large and small
enterprises become cautious and are afraid to spend money on expansion.
Expansion might increase a tax liability without increasing production.

A
few months ago there was a dispute about how many new rules and regulations
have been released by the Obama administration to implement Obamacare.

“Implementation has
also become a bureaucratic nightmare, with some 159 new government agencies,
boards and programs busily enforcing the roughly 20,000 pages of rules and
regulations already associated with this law.”

— Sen.
Mitch McConnell (R-Ky.), on the third anniversary of the law’s passage,
March 22, 2013

The process the McConnell folks used is fairly
simple. They went to the Web site for the Federal Register and
searched for “Affordable Care Act,” the official name for the health-care law.
That turned up 897 documents.

On the Web site, there’s a button that will download
the documents to an Excel spreadsheet (CVS/excel). Then you use the sum feature
on Excel to add up the pages and presto, you end with 20,202 pages. These were
then printed out and duly stacked in a pile.

Mitch
McConnell might be way off in his calculation. The rules and regulations are
reported in the small print Federal Register. It is possible as many as 40,000
rules and regulations have been published. All of the rules and regulations for
Obamacare will not have been written by January 1, 2014. 

The
cost of the writing of the rules and regulations, the cost of the formation of
new agencies formation, and the cost of implementation have not been discussed.

Rules
and regulations tend to be open to misinterpretation, conflict, lawsuits and
lack of enforcement.

An
increase in rules and regulations leads to more confusion and conflict. Some
rules contradict other rules. This results in greater inefficiency and more not
less costs.

Our
healthcare system can ill afford more non added value expenses.

The
IRS is going to be in control of enforcing the “Employer Manadate.” Many of the
rules and regulations have been written. However, many of the IRS’s rules and
regulations are not clear.

I
have written about employers decreasing the number of hours employees are
permitted to work in order to avoid the penalty “tax”
of not providing healthcare insurance for full time workers.

Seventy
seven percent of the “job growth” in the past few months has been part time
employment growth. The Obama administration has consistently denied this is
true despite the Bureau of Labor statistic reports.

What
is part time employment? It has been defined in Obamacare as an employee
working less than 30 hours a week.

“Just to understand how the penalty applies practically requires
a flow chart. But as the Internal
Revenue Service has tried to interpret the mandate, the
agency and the businesses and employees affected by the mandate are discovering
that it is even more challenging than it reads.”

Answers to questions by
the I.R.S. have generated even more questions. Confusion mounts as more rules
and regulations are generated.

A big question has
surfaced. How does an employer determine whether employees whose hours fluctuate
should be offered insurance or pay a penalty “tax”?

Obamacare sets that
threshold at 30 hours per week. Many companies schedule some of their work
force on variable hours. An employee might work 25 hours one week and 33 hours
another week. 

In its preliminary
rules, released late last year,
the I.R.S. devised an approach to the problem of the variable-hour employee
that it calls the “look-back measurement method.”

The I.R.S regulations
would allow an employer to choose a measurement period of three months to a
year in which to average the employee’s weekly hours.

The measurement period
would then be followed by a stability period of a year for a total of two
years.

Is anyone following this?

If an employee’s schedule
averaged out to full time (over 30 hours a week) during the measurement period,
then the company would be obliged to offer health insurance in the stability
period or pay a penalty.

The new measurement period
would begin immediately after the old one ended. The process of measurement and
stability periods would begin again.

 If the company anticipates that a new hire
will work full-time (over 30 hours a week), it must offer insurance by the
start of the fourth month on the job.

 Why not offer insurance immediately on hiring
the person? Is this not confusing?

 To make things more confusing, what happens if
an employee goes from full time to part-time?
The rules were unclear. “Do you get to keep your coverage?”

The I.R.S. took the
position that the employee would keep the coverage through the end of the
stability period.

If it turned out that the
worker still managed to average a full-time schedule, which would be possible,
if he or she made the switch late in the period. The company would have to
offer insurance in the next stability period as well or face the penalty.

A full-time employee who was
switched to part-time in August, before open enrollment in October, would be
entitled to an additional 16 months of insurance coverage.

Employers have figured out
they should fire the employee and avoid the penalty or the insurance coverage.
This is not good for job creation or the economy.

The law and its rules are
encouraging these actions.

The rule also penalizes an
employee who is switched from part time to full time employment. The employee
has to wait at least a year before the employer must offer that employee
insurance coverage rather than by the fourth month.

“Measurement and stability
periods should be used to infer a status of variable-hour employees only,” 

“Once an employee is no longer a variable-hour employee and is
in a full-time position, he or she should be offered coverage within, at most,
four calendar months.”

Is all this confusing? You
bet. Just visualize the cost of the mountain of paper work and reports.

Is all of this cost
effective? No!

This represents a tiny
fraction of the rules and regulations by the Affordable Care Act (Obamacare) that
are causing confusion.

The more confused one gets
the less one wants to participation.

The only option left is a government
take over of the healthcare system. It wouldn’t be bad except for the fact that
America cannot afford it, and the government could not implement it without a
terrible cost to society.

It would result in
rationing of care and a decrease in access to care. The only solution is for
consumers to be responsible for their own care and control their own healthcare
dollars.

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

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