Stanley Feld M.D.,FACP,MACE

Last week a reader sent me the link for the full debate between Dinesh D’Souza and Bill Ayers at Dartmouth College on January 30 2014.

Dinesh D’Souza wrote, directed and produced 2016:Obama’s America in 2012’

 It is based on D'Souza's book The Roots of Obama's Rage (2010). Through interviews and reenactments, the film compares the similarities of the lives of D'Souza and President Barack Obama as D'Souza presents his theory of how early influences on Obama are affecting the decisions he makes as president. http://en.wikipedia.org/wiki/Dinesh_D%27Souza

The film has grossed over $33.45 million in the United States, making it the fourth highest-grossing documentary (domestically) since 1982.

Those who didn’t see documentary can see it here for free.

https://archive.org/details/ObamaBiography

Recently Dinesh D’Souza has been the subject of a recent IRS probe.

I had read about the debate but never had the time to listen to Bill Ayers.   Bill Ayers is an American elementary education theorist and a former leader in the counterculture movement that opposed U.S. involvement in the Vietnam War.

He is known for his 1960s radical activism as well as his current work in education reform, curriculum, and instruction. In 1969 he co-founded the Weather Underground, a self-described communist revolutionary group that conducted a campaign of bombing public buildings (including police stations, the U.S. Capitol Building, and the Pentagon) during the 1960s and 1970s in response to U.S. involvement in the Vietnam War.

He is a retired professor in the College of Education at the University of Illinois at Chicago. President Obama worked with and for in the 1980s and 1990s as a community organizer. 

 A reader sent me a link to the debate last week and I watched it. It is a worthwhile use of your time.

http://www.realclearpolitics.com/video/2014/01/30/full_debate_dinesh_dsouza_vs_bill_ayers_at_dartmouth_college.html

Obamacare cannot work improve the healthcare system. After listening to Bill Ayers and rereading Saul Alinsky’s thoughts on how to create a socialist state President Obama’s only goal is to control healthcare. If you control healthcare you control the people.   

 According to Saul Alinsky there are 8 levels of control that must be obtained before you are able to create a socialist state.

"The first is the most important.

8) Class Warfare — Divide the people into the wealthy and the poor. This will cause more discontent and it will be easier to take (Tax) the wealthy with the support of the poor.'

Read more at http://www.snopes.com/politics/quotes/alinsky.asp#RGukF0aROOEmmdSO.99

 President Obama is using these tactics to control our country and drive it into being a socialist state.

President Obama combines these tactics with Alinsky’s rules for radicals.

Alinsky’s third rule is: “Wherever possible go outside the experience of the enemy.” Here you want to cause confusion, fear, and retreat. He did this to Mitt Romney during his re-elections. Mitt Romney’s people did not know how to handle it. 

The fourth rule is: “Make the enemy live up to their own book of rules. “ You are free to act as you wish.

You can kill your opponent with this, for they can no more obey their own rules than the Christian church can live up to Christianity.

The fifth rule: “Ridicule is man's most potent weapon.” It is almost impossible to counterattack ridicule. Also it infuriates the opposition, who then react to your advantage.

How many times have we seen the President and Vice-President try to ridicule their opponents? They use this rule often in domestic policy but are afraid to use it in foreign policy.

The eighth rule: “Keep the pressure on, “with different tactics and actions, and utilize all events of the period for your purpose.

“Pick the target, freeze it, personalize it, and polarize it.”  Doesn’t this sound familiar?

The ninth rule: The threat is usually more terrifying than the thing itself.

 The eleventh rule : If you push a negative hard and deep enough it will break through into its counterside; this is based on the principle that every positive has its negative.

The twelfth rule: The price of a successful attack is a constructive alternative. You cannot risk being trapped by the enemy in his sudden agreement with your demand and saying "You're right — we don't know what to do about this issue. Now you tell us."

 If one studies the lies President Obama has told the public he has gotten trapped by his own pressure on his opponents and could not escape or change the subject.

I will have the most transparent administration in history.  It is not transparent at all.

TARP is to fund shovel-ready jobs. He finally had to admit the jobs were not shovel ready.

I am focused like a laser on creating jobs. Each month job growth was less which is the goal of a socialist society.

The IRS is not targeting anyone. Each cover up statement makes the lie worse.

If you like your healthcare plan, you can keep your healthcare plan, period. This was never the intent.

Benghazi was a spontaneous riot about a movie. Something very bad went wrong here.

If I had a son… T Martin. Stirring racism. It was a mistake.

I will put an end to the type of politics that "breeds division, conflict and cynicism". This was never the intention.

You didn't build that! This was an attempt to make Americans uncertain about their achievement and way of life. It failed and President Obama’s credibility shrank even further.

I will restore trust in Government. All the obvious deception during President Obama’s times President Obama contradicts this statement.

However a good offense is many times the best defense. He tried but failed. Attacking FOX News is was not a good strategy as his credibility waned.

The public will have 5 days to look at every bill that lands on my desk. He never kept his word.

It's not my red line — it is the world's red line. You cannot step away from your commitments when people are depending on you.

Whistle blowers will be protected in my administration. This is another lie and empty promise.

We got back every dime we used to rescue the banks and auto companies, with interest. This is an outright lie. He could not control the auditors. 

I am not spying on American citizens. This is a beauty!

ObamaCare will be good for America. It has been very bad for America. It is going to get worse because Americans do not trust President Obama anymore.

Premiums will be lowered by $2500. Premiums have increased and taxes have been increasing. It has cost Americans much more that the $2,500 they were suppose to save.

People making less than $250,000 a year will not pay one dime more in taxes. This is totally untrue as the middle class is learning..

If you like it, you can keep your current healthcare plan Lie of the year.

It's just like shopping at Amazon. President Obama should have tried himself. I did it and it was tedious. If Amazon was like it I would never use it.

I knew nothing about "Fast and Furious" gunrunning to Mexican drug cartels. You should have known everything. You are President. If you didn’t know about Fast and Furious you were not doing your job.

I knew nothing about IRS targeting conservative groups. You should know everything about IRS targeting. Who would make that decision.

I knew nothing about what happened in Benghazi. You should know everything about Benghazi. It was reported to you instantaneously acoording to you own defense department. None of this is very transparent.

 "I, Barrack Hussein Obama, pledge to preserve, protect and defend the Constitution of the United States of America."

In the light of Bill Ayers philosophy and in light of President Obama’s attacks on the constitution and the Bill of Rights, one could question if President Obama meant his pledge to preserve, protect and defend the Constitution of the United States of America.

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

Have a Happy and Healthy New Year Everyone!

I have received many incredible examples about the effect Obamacare has had on the loss of insurance and the increased cost of insurance through Obamacare’s health insurance exchanges.

President Obama has changed the Obamacare law ad lib for everyone except the 14 million people in the individual healthcare insurance market. He has granted waivers to favorites including the unions and the congress. He has delayed the employer mandate without congressional approval.

This was smart. Maintaining the employer mandate would have affected at least 100,000 families. Everyone would have lost their insurance at once.  

The outrage would have been intolerable.

America will wake up one day with a completely unaffordable healthcare system, with rationing of care and long delays in access to care.

This is reality and not naysayer talk. There are so many things wrong with Obamacare that Max Bacchus’s train wreck will be a reality before we know it.

PolitiFact called “If you like your health-care plan, you can keep it.” the lie of the year.

Obamacare was supposed to be a refinement to the current healthcare system minus its waste and inefficiency.

It was going to increase access to healthcare care and make medical care affordable for all. It was going to force the healthcare insurance industry to provide affordable insurance.

It has already made insurance unaffordable to those middle class families who do not qualify for subsidies.

The "sticker shock" that many buyers of new, ACA-compliant health plans have experienced—with premiums 30% higher, or more, than their previous coverage—has only begun.

The costs borne by individuals will be even more obvious next year as more people start having to pay higher deductibles and copays.

President Obama promised that the Affordable Care Act was not going to cost the federal government a dime.

It was going to decrease the federal deficit over ten years by over 1 trillion dollar.

The current CBO estimate is that it will increase the deficit by over 1 trillion dollars. The Affordable Care Act was misnamed. It should be the Unaffordable Care Act.

Obamacare was force down the throat of the American public by the Democratic majorities in both houses of congress. It did not get one Republican vote. Most of the Democrats have admitted they did not read the bill in its entirety.

Nancy Pelosi told America “we have to pass the bill to know what is in it.”

It is now obvious that President Obama was able to pass the bill by feeding everyone a pack of deceptions about the bill and its implications.

It was a magnificent con job.

The deceptions once discovered must not be tolerated by our congressional representatives and senators.

Government is supposed to be by the people, for the people. Consumers did not pay attention to the defects in Obamacare until it started to affect them directly.  

The mainstream media has been sympathetic to President Obama’s lies and deceptions. Now the people are discovering the deceptions and the media is starting to report them.

Now that over 6 million people have lost their insurance coverage, and premiums have skyrocketed Obamacare is affecting the consumers who make under $250,000 a year.

Obamacare has affected consumers financially. There have been significant Obamacare hidden taxes for four years. Obamacare officially starts January 1,2014.

President Obama or his administration has lost the public’s trust because of all the lies and deceptions.

My guess is the media does not know of all the lies and deceptions. The media also does not understand all the defects in Obamacare.

The Obama administration launched a $685 million dollar public relations campaign to disguise the impending Obamacare disaster.

The disastrous website (healthcare.gov) is only the tip of the iceberg.

The web site is incomplete and not secure. It was written using obsolete code at a cost of $650 million dollars. The $650 million dollars is $649 million dollars over what it should have cost according to some sources.

 There remains much work to be done before it is fully functional.

The healthcare insurance industry is becoming fed up with all the constant changes in the rules the Obama administration is making.

 The healthcare insurance premiums on the health insurance exchanges are higher than last year’s commercial insurance. The patient deductibles for these policies put them out of affordable range for the middle class.

It will be a fair deal for consumers with families who earn up to $49,000 per year. This group will qualify for various levels of subsidy. It is a terrible deal for everyone making $50,000 to $250,000 dollars a year.

The 6 million people losing their insurance coverage started American’s wake up call. 

President Obama said their healthcare insurance coverage was defective and inadequate.

 The subtext is the government will decide what you need.

Those who expect better days ahead for the Affordable Care Act are in for a rude awakening. The shocks—economic and political—will get much worse next year and beyond.

In 2014, millions must choose among unfamiliar physicians and hospitals, or paying more for preferred providers who are not part of their insurance network. Some health outcomes will deteriorate from a less familiar doctor-patient relationship.

Those who expected better and more affordable medical care with the government as single party payer will experience tax increases both obvious and disguised and worse medical care.

 The government does not know how to run things efficiently.

The other defects in Obamacare that will shock the nation and hurt all consumers in the near future will be;

1. The lack of functional electronic medical records and transportability of patient medical information.
2. Increased paralyzing and incomprehensible regulations for physicians and hospitals leading to patient care delays.
3. The lack of development of Accountable Care Organizations for integrated care with penalty. ACO’s were suppose to save money but are failing.
4. The inability of Obamacare to facilitate timely and cost effective medical care.
5. The decrease in physician practitioners signing up to accept Obamacare leading to an increased physician shortage and decrease in consumers’ access to care.
6. The lack of tort reform will result in an increase in defensive medicine testing. Physicians and hospitals will refuse to participate in Obamacare. They will demand direct payment from the patients.
7. The new ICM 10 coding system will drive physicians and hospital out of business and certainly out of participating in Obamacare.
8. Lack of compelling chronic disease management initiatives will not increase quality of care or decrease the cost of care. The cost of treating chronic disease complications account for 80% of the cost of care.
9. More Web Site and IT failures are likely. The application process is easier.“The complex back-office side of the website—where the information in their application is checked against government databases to determine the premium subsidies and prices they will be charged, and where the applications are forwarded to insurance companies—is still under construction.
10. Consumers will experience problems in eligibility, coverage, billing, claims, insurer payment and patient information-protection and security.
11. Obamacare has taxpayer-funded "risk corridors." The risk corridors will bailout potential insurance company losses without bailing out consumers, physicians and hospitals. The bailout could result in an increase in taxes, collapse of the healthcare system, the medical care system and the economy.

The bailout will certainly result in a level of consumer anger worse that the anger caused by 5 million people losing their healthcare coverage.

 One hundred and eighty million people might loss their coverage within a year.

 Obamacare misses the entire point about the way to repair the healthcare system.

 The point is about giving consumers incentives to be responsible for themself and controlling their own healthcare decisions. Most consumers do not want to be dependent of the government.

Americans will take government handouts but as soon as they realize they are being dictated to and controlled by the government there will be a public outcry.

Consumers are much smarter than President Obama thinks.

Unfortunately there is much more money to be wasted and grief that the public is going to experience in the coming year. At that point America’s view of Obamacare will reach the boiling point.

Only then will we experience real healthcare reform.

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

Please have a friend subscribe.

Stanley
Feld M.D.,FACP , MACE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Physicians and Hospital Systems have been to this movie before. 

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

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

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

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

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

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

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

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

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

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