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The Growth Of Concierge Medicine

June 25, 2014

inMedicine: Healthcare System, Patients Problems, Physician's Problems, Quality medical care measures

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Stanley Feld M.D.,FACP,MACE

In the accelerated chaos Obamacare has created for both patients and physicians an increasing number are trying to find ways to maintain their freedom of choice. Patients are recognizing that Obamacare is causing a commoditizing of healthcare and the destruction of the Patient/Physician relationship.

Patients and physicians yearn to have a good Patient/Physician relationship.

Physicians love the practice of medicine but they hate the burden being imposed on them.,

Increased government regulations and requirements,
Increased paper work to prove every clinical decision they make on the patient’s behalf.
The restrictions on their use of clinical judgment.
The increased overhead to comply with regulations of both the government and the private insurance plans.
The decreasing reimbursement.
The lack of malpractice reform.
The pressure on primary care physicians to see 30-50 patients a day to cover overhead resulting from decreased reimbursement.
The inability to spend more time with patients because of this patient volume pressure.
The inability to get to know their patient better because of time constraints.

10. Their inability for physicians to have empathy for patients after they see the tenth patient because of burnout.

11. Their inability to develop a viable patient/physician relationship.

12. Spending at least three hours weekly dealing with insurance plans preauthorization.

13. Their clerical staff and nursing staff spending at least fifteen hours weekly obtaining preauthorization from the insurance company or government before providing patient care.

14.Their ability to keep up and comply with all the bureaucratic requlations and requirements.

An AMA survey of 2,400 primary care physicians believe private insurers and government insurers have excessive requirements for preauthorization for tests, procedures, and medications.

More than one out of three have a rejection rate of 20 percent for first-time preauthorization on tests and procedures,
More than half of physicians have a 20 percent rejection rate on prescriptions.
About one half of physicians have difficulty obtaining preauthorization from insurance plans.
About two out of three wait several days for permission.
About the same proportion report difficulty in determining which tests, procedures and medications require preauthorization.

These are just a few of the reasons the enjoyment has been taken of the practice of medicine. Many physicians have said I am finished dealing with all these rules and regulations, the government and the private insurance industry.

Many Primary Care Physicians are converting their medical practices to Concierge Medical Practices.

“Proponents say concierge care is a revolt against the modern health care system where diminishing Medicare and insurance payments have forced doctors to herd dozens of sick patients through their offices in five-minute increments every day.”

What is concierge medicine?

Concierge medicine is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges depending on the business model being used and the retainer charged.

The up front retainer allows physicians to decrease full time staff to a minimum. It decreases the complexity of practicing medicine. Physicians do not deal with insurance companies or the government. They only deal with their patients. This permits physicians to decrease the number of patients they see a day and increase time spent with and relating to patients.

“Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies.”

Concierge medicine is a way of taking first dollar coverage away from the healthcare insurance industry and putting control of care in patients’ hands. It prevents the insurance companies from feeling they own physicians and patients.

If the Patient/Physician relationship is not important too many large healthcare companies. Physician are simply one provider among many such as nurse practitioners, physicians assistants, social workers and pharmacists.

All these healthcare companies are interested in is maximizing their profits from this 2.7 trillion dollar business.

Concierge medicine would not be growing by leaps and bonds if this companies concentrated on the welfare of consumers.

Both physicians and patients are feed up with the development of central control of the healthcare system.

All of us remember President Obama’s lie, “If you like your doctor you can keep your doctor with Obamacare.”

Obamacare was passed because of this lie.

The concierge retainer fees can vary from $500 to $38,000 dollars per year. Concierge medicine will create a two tier Healthcare System. I disagree with a two tier system!

It is occurring because we have a dysfunctional healthcare system. Obamacare is making the healthcare system more dysfunctional.

The healthcare system is not servicing either patients or physicians well. Each is searching for an alternative before Obamacare and the entire healthcare system collapses under it own weight.

Patients yearn for a positive Patient/Physician relationship. As more physicians are adopting the concierge business model patients are signing up to the surprise of the government and the healthcare insurance industry.

These stakeholders have underestimated the value of the Patient/Physician relationship.

Maybe the trend will wake up the government and the healthcare insurance industry and fix the things that are broken.

Obamacare is not doing it! It is making things worse.

Maybe these two stakeholders will realize that they do not own the physicians or patients. Any attempt to own them is futile. It is not in the American culture being to be enslaved.

The answer is not fancy information systems that do not work perfectly. It is not by creating expert panels to tell physicians what they can do. It is not these panels telling patients the care they can have. Our healthcare system is dysfunctional. The system does not evaluate the quality of care effectively.

All one has to do is look at the VA system’s problems. The VA system’s problems are a disgrace. It should also be a warning about the future of Obamacare.

Obamacare and its bureaucracies are going to create another VA system for all Americans.

The answer is to teach consumers what is good treatment and what is not good treatment. It is to help consumers evaluate their physicians. Price transparency is a good beginning in order to get the stakeholders to start competing.

Tort reform is another good start.

Government could help by teaching consumers to ask the right questions.

It should start realizing that we have to have a consumer driven patient centric system where patients are responsible for their health and healthcare dollars.

The problems in the healthcare system can be solved with a consumer driven healthcare system using my ideal medical saving account.

The public health problems are a different issue. There are three diseases we can prevent. They are obesity, alcoholism and drug addiction. The government must deal with these diseases on an educational and social level.

The government has not done a very good job with any of these three diseases. The prevention of these diseases is a public health problem.

It should not be mixed up with individual medical care. Obamacare does with the causes of these diseases or the environmental cures.

Obamacare is another unsustainable entitlement program. The government should not be creating another unsustainable entitlement program.

It should be creating a program that promotes individual responsibility for health, healthcare, and healthcare dollars.

Hopefully the growth of concierge medicine will be a wake up call to a misguided Obama administration wanting top down control of the healthcare system.

They must realize that the Patient/Physician relationship is sacred to cost effective medical care.

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

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Doctors’ Salaries; The Media Is The Message

June 1, 2014

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

Physicians’ salaries are not the cause of the escalating healthcare costs.

The economic factors involved are complex. The escalating costs result from cost shifting, government regulations and the lack of tort reform. The result is each stakeholder tries to optimize his stake in the dysfunctional healthcare system.

Further dysfunction occurs in reaction to the individual stakeholder’s attempts at optimization. The costs escalate.

The government permits insurance companies and hospital systems to calculate expenses and profits in strange ways.

Physicians’ socio-economic interests have the weakest representation in the healthcare ecosystem. The lack of representation allows physicians to be the easiest stakeholders to blame for healthcare’s rising costs.

As always the media is the message. The traditional print media are desperate to print anything that will capture the attention of the public and sell newspapers.

The Dallas newspaper published a story a few weeks ago titled “North Texas Medicare Millionaire Doctors.” and asks the public,

“Is your doctor one of the 340 in Texas to make more than $1 million from Medicare?”

"More than 340 doctors and other care providers in Texas received over $1 million each in 2012 under the government’s Medicare health insurance program, according to data released Wednesday that provides the public its first inside look at physician billing practices."

CMS released the Medicare database to inform the public what physicians and physician groups are charging Medicare.

The data reflects payments made by Medicare.

The data does not

reflect whether one physician identifier number is included in the billing for multiple providers.

reflect the charges and payment for a service.
reflect if it was physically possible for the individual named to perform all the services implied.

It lets the reader imagine that the providers “physicians” are crooks as well as a millionaires.

It then follows that most physicians must be crooks.

There is nothing to be learned from the data as presented. This data must go through many layers of dissection in order to mean anything.

However, “the media is the message” and the point was made.

The bad thing is many of these articles with their imbedded implied conclusions are written from press release information provided by the government. This is called "government induced disinformation."

Reality is much different. Physicians are the most highly trained workers in the healthcare system. Without patients and physicians a healthcare system would not exist. What is the individual physician’s salary? What is he/she worth? These questions are the real questions.

Physicians have seen their incomes fall, their clout with insurers shrink, and their practices weighed down by a plethora of new requirements.

Physicians are starting to wake up and realize that all this is the direct result of them being exploited by payers, hospitals, policymakers, government and other groups that have become more powerful than the medical profession.

The example of the disinformation generated by the implications of the millionaire physicians ripping off the public is just one example of this exploitation of the medical profession.

The other stakeholders are doing this to deflect attention from how they are ripping off the healthcare system.

‘That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.”

“The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys.”

The survey shows that the average salary for

An insurance chief executive officer is $584,000
A hospital C.E.O. $386,000
A hospital administrator $237,000,
Compared to an surgeon $306,000
And an average general doctor $185,000 .

This is an interesting payment gap. These secondary stakeholders do not add value to direct patient care.

The salary gaps between secondary stakeholders get worse because these numbers represent only the average base salaries.

The basic question is what are these executives worth?

What encourages a board of directors of their organizations to award these high salaries?

What in the government tax structure and regulations encourage these high salaries?

“And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in non-salary compensation.”

Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised.

Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012 the year he retired, but total compensation of $21.7 million.

These two minor examples are appropriate. These are also low-end examples. There are many more.

The Wellpoint and United examples are more stunning.

Sources: Compdata Surveys (salaries); the Commonwealth Fund and the Organization for Economic Cooperation and Development (administrative costs)

Physicians are waking up. They are starting to step forward and are pointing out the real abuses in the healthcare system.

“Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin took out an advertisement in The Wisconsin State Journal demanding widespread health reforms to lower prices, including penalizing hospitals for overbuilding and requiring that 95 percent of insurance premiums be used on medical care.

The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

Keith Smith M.D. in Oklahoma City has done it. His surgical center is doing surgery for 25-40% less than the typical hospital whose costs are bloated by administrator salaries and bureaucracy that add no value to direct patient care.

Somewhere there is a corporation that is self –insured and will set up an Ideal Medical Savings Account for its employees that will by-pass all the bloated bureaucracy and large salaries of the healthcare insurance industry.
It will result in a decrease in cost and a user-friendly healthcare system.

The generation of a consumer driven healthcare system will begin. All President Obama has to do is get out of the way.

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

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President Obama Tries To Shut Up Media

April 30, 2014

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

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Stanley Feld M.D.,FACP,MACE

On April 16^th President Obama tried to shut up the media’s criticism of Obamacare with his announcement that 8 million people have enrolled in Obamacare. The administrations had reached its goal. Obamacare is a success

Mr. Obama pointed to the number to declare the law a success and that Republicans should stop trying to overturn it.

"The point is, the repeal debate is and should be over," the president said. "The Affordable Care Act is working and I know the American people don't want us spending the next 2½ years refighting the settled political battles of the last five years."

One month earlier we heard from the same administration that the 6.6 million people who had lost their healthcare insurance because of Obamacare was an insignificant sliver of the population.

President Obama’s announcement contained few new details about enrollment.

The entire point of Obamacare was supposed to be to insure people who were uninsured previously.

It turns out (from insurance company data) that as many as 80% of the 8 million enrollees were replacing extremely expensive healthcare insurance policies with Obamacare healthcare policies.

Individual healthcare insurance for older people with a pre-existing disease is unobtainable or extremely expensive.

These people were in the individual healthcare market only. Many had pre-existing diseases and chronic diseases.

Their risk is much higher than low risk patients. Many of these people received government subsidies because they made less than $50,000 dollars a year.

The administration has still not published the number of people who did not have insurance before Obamacare went into effect and have signed up and paid their premium.

President Obama claims he does not know that number. If the healthcare insurance companies know the exact number the Obama administration has to know that number.

President Obama’s declaration of success is ludicrous.

Patients who enrolled and paid their premium are going to realize the negative impact it will have on their medical care shortly.

There is no class of American professionals who will be more negatively impacted by Obamacare than physicians.

Obamacare reinforces the worst features of third-party payment arrangements for payment of medical care. The third party payment system of healthcare insurance has already compromised the independence and integrity of the medical profession.

“With Obamacare physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. “

These are some of the difficulties physicians will face with Obamacare.

The Medicare Payment Formula is flawed. Physicians continue to face the threat of deep payment cuts under Medicare’s sustainable growth rate (SGR) formula.

The SGR governs the annual growth of Medicare physician payments. Congress has kicked the can down the road since 2003. Physicians have incurred a potential reduction of 30% from the present payments if congress does not provide a permanent fix.

Medicaid will be expanded in states that agree to do so to cover any individual earning up to 138 percent of the federal poverty level—$15,856 for an individual in 2013. Many states have refused to expand Medicaid.

The Congressional Budget Office (CBO) projects that this expansion will add 12 million individuals to Medicaid by 2015.

The physician reimbursement rates for Medicaid patients is 58% lower than the reimbursement physicians receive in the private sector.

Thirty three percent of physicians do not participate in Medicaid. Patients’ access to physicians is decreased. The result is Emergency room overcrowding. ER overcrowding was the very thing the President Obama’s healthcare policy wizards wanted to decrease.

Obamacare is imposing more bureaucracy, rules, regulations, and restrictions on physicians.

Since 2010, with few exceptions, the law prohibited physicians from referring Medicare patients to hospitals in which they have ownership.

Thus, a whole class of physician-owned, specialty hospitals has been removed from competition, even though they enjoyed an undisputed record of providing high-quality patient care.
This regulation has driven a large number of physicians to stop accepting Medicare even thought their service is of high quality and less expensive than hospital systems.
There have been mountains of new regulations that are impossible to keep up with. These regulations have driven physicians away from accepting Medicare reimbursement.
Obamacare has created multiple federal agencies, boards and commissions to regulate the practice of medicine.
These creations are partly the fault of physician groups not effectively regulating their peers.

a. Obamacare created a “nonprofit” Patient-Centered Outcomes Research Institute. The institute will determine clinical effectiveness of medical treatments, procedures, drugs, and medical devices.

The result will be an administrative implementation nightmare. All medicine is local. Only financial incentive can work. Penalties and regulatory requirements will not work. It will simply generate an atmosphere of mistrust and non-cooperation.

The Patient-Centered Outcomes Research Institute could be a teaching tool for physicians and patients.

However, the likelihood of the government dictating cookbook care guidelines and regulations, and interfering with physicians’ clinical judgment and the further destruction of the patient-physician relationship is high. The Institute will also retard clinical innovation in the delivery of care.

b. President Obama’s Independent Payment Advisory Board (IPAB) is comprised of 15 unelected bureaucrats. It will be composed of non-practicing physicians, lawyer, laypersons and government bureaucrat.

The goal is to reduce the growth rate of Medicare spending and non-federal spending through health insurance exchanges.

“IPAB’s recommendations would go into effect unless Congress enacts an alternative proposal of equivalent savings.”

The chance of congress presenting an alternative equivalent saving is small. President Obama has stated in the past that the IPAB has little power except to make recommendations. This is not true!

Former Vermont Democratic Governor Howard Dean (D) has said,

"IPABs are essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."

This is the only thing that Dr. Dean has ever said that I have ever been able to agree with.

The IPAB will control spending through reimbursement cuts. It can enable limited or no payment for selected services and medical procedures or for Medicare physician payment.

It looks as if it could drive physicians out of practice and hospital out of business. This is especially true in the absence of tort reform.

c. Pay-for-performance programs are another terrible idea. Physicians can only control some of the outcomes. Patients’ compliance/adherence is the key to most outcomes.

Payment will be adjusted to reflect performance. The measurement will be based on data from the Physician Quality Reporting System and cost data from Medicare fee-for-service claims.

I have previously demonstrated the ineffectiveness of using claims data to make outcomes decisions.

These programs can be used to create powerful economic incentive by complying with standardized guidelines at the expense of individual patient care.

All you have to do is “check the box” to achieve a high and financially beneficial score as a condition of participating in the government’s health programs.

It is aa attempt created by bureaucrats that will not work in the real world.

Most physicians hate Obamacare. Forty-three percent of physicians are considering retiring in the face of the need for an additional 91,500 physicians by 2020.

“Obamacare neglects physicians’ most pressing concerns, such as tort reform, and significantly worsens the already painful problems that come with third-party payment and government red tape.”

Obamacare misses all the keys necessary for Repairing the Healthcare System. Obamacare steers out of the skid (wrong direction). It makes things worse.

Consumers must drive the healthcare system. The physician/patient relationship must be restored. Physicians must help patients make treatment decisions not government, insurance executives and other bureaucrats.

Repairing the Healthcare System will not be achieved until patients, not the government, control their health care dollars and decisions at the advice of their physicians in a viable physician patient relationship.

My Ideal Medial Savings accounts steer into the skid and repairs the healthcare system.

The Obamacare debate is hardly over as President Obama has declared.

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

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The Wrong View Of The Right Problem

April 23, 2014

inChronic Disese Management, Consumer Driven Health Care, Medicine: Healthcare System

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Stanley Feld M.D.,FACP, MACE

Most of the stakeholders in the healthcare industry are not stupid. Most understand the issues very well.

The problem is they all look at the same problem from the prism of their own vested interest. Each government action causes these stakeholders to react in their vested interest.

Each reaction causes a compensatory reaction from the other stakeholders, which in turn causes another chain of reactions.

The healthcare system becomes further twisted into a tighter non-functioning hairball that is more expensive than previously.

Aetna CEO Mark Bertolini was the keynote speaker at HIMSS14. His analysis was correct He said,

“Antiquated systems and out-of-control healthcare costs in the United States are not sustainable.”

He went on to say the healthcare system is plagued by inefficiency and waste.

“ We can’t afford it. It’s unsustainable.”

Employees are now paying 41 percent of their healthcare dollars to the healthcare insurance industry. It includes premium costs, deductibles, and copays.

These costs consume much of employees’ disposable income. Mark Bertolini predicts that employees will be paying 50% in 5 years as insurance premiums increase.

Mark Bertolini is really saying consumers will stop buying insurance soon. The result will be a decrease in Aetna’s profit.

Who is at fault?

All the stakeholders are at fault. Consumers are at fault for not taking care of themselves. The incidence of the onset of all chronic diseases increases with the incidence of obesity.

When there is an increase in chronic disease there is an increase in the complications of chronic diseases.

Eighty percent of the money spent on treating that chronic disease is spent on treating the complications of that chronic disease.

Patients must manage their chronic diseases under their physicians’ direction. The patient lives with that disease 24/7.

Patients must be taught to be the “Professor of Their Disease” so that they do not get a complication of that disease.

Patients must also be given financial incentives to become the manager of their disease. This incentive can be developed in many ways.

Reimbursement for education is not routine. There is little financial incentive for physicians to set up educational systems.

Hospitals at one time set up educational systems for chronic disease. They found them a financial burden and discontinued them. The educational systems did not distinguish one hospital from another.

The educational systems were not set up correctly. They should have been set up as an extension of the patient’s physician’s care.

I believe the healthcare insurance industry really wants to lower costs while retaining the profit margins enjoyed in the pre and post Obamacare era.

Aetna’s Bertolini got it right. “We can’t afford it.”

“If we really want to take care of people, we should align incentives around keeping them healthy.”

He is right. His problem is he thinks he controls patients and patient care.

The government thinks it controls patients.

Physicians know they do not control their patients’ behavior.

Neither the healthcare industry and government nor physicians controls patients.

Patients control themselves.

Bertolini said. "Recent data compiled by Aetna found that the top 5 percent of Medicare patients consumed 43 percent of Medicare dollars. They spent on average $108,000 a year per person."

The demographics of these patients disease including past and present lifestyle are not discussed in the data mining survey. This information would be helpful to know the true meaning of this data.

He then concludes, “Let’s not keep sending these people around with 25 different prescription and all these different doctors and hospitals.”

Who is the stakeholder sending patients to all the different hospitals and giving all the different prescriptions.

Physicians, of course!

Therefore, let us penalize physicians for spending all this money on our patients.

This is the wrong way to look at the problem.

If there was meaningful Tort Reform, physicians wouldn’t be doing so much unnecessary testing and treating to avoid missing something that could result in a malpractice suit.

If there were meaningful incentives for patients to be responsible for themselves people would stay healthy.

Patients should be responsible for their healthcare dollars not the government or the insurance industry.

People should also be rewarded if they stay healthy just as the auto insurance industry rewards drivers who do not have an accident.

If the government made a meaningful effort to change our eating habits through meaningful education much illness and medical costs would be reduced.

The center of the new healthcare system should be the patients. It should be a consumer driven system.

As soon as all the secondary stakeholders focus on that fact and start helping instead of penalizing patients and their physicians, the cost of the healthcare system will come down.

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

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Risk

April 2, 2014

inConsumer Driven Health Care, Disinformation 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

The purpose of insurance is to cover risk. For many years the government has protected the healthcare insurance industry’s profit through laws and administrative regulations.

The state insurance regulators are supposed to protect consumers again abuses by the healthcare insurance companies. Many State Boards of Insurance have not administered their responsibility effectively.

The federal government put out for bid the administration of the federal programs such as Medicare, Medicaid and the VA systems. It has not done this job very effectively. There has been much fraud and abuse in this system.

Somehow the healthcare insurance industry has talked these regulators into permitting the insurance industry to take 40% of the healthcare premiums off the top.

Obamacare mandated a Medical Loss ratio of 80/20. Eighty percent of the premium dollars are to be spent on direct patient care and 20% can be held back for expenses and profit.

However, the regulatory agencies have permitted an additional 20% of expenses to be written off as direct patient care.

The details of these expenses are so complex that few can understand the direct patient care expenses.

Recently, we have heard that if the insurance demographic mix is inappropriate, provisions are written into Obamacare that permit the healthcare insurance industry to achieve a profit.

If it does not reach its profit goal, Obamacare will bail out the healthcare industry. The traditional media has not paid much attention to this provision.

High deductible healthcare plans are very attractive to people who are at low risk for disease. If an unforeseen illness occurs they could buy an inexpensive first dollar coverage plan.

Obamacare is slowly eliminating those plans.

President Obama is trying to drive everyone into a health insurance exchange plan in the name of creating competition among insurance companies. His administration is also picking preferred insurance companies to sell these plans state by state.

President Obama is also choosing hospitals to participate in the state insurance plans’ networks. In some states the insurance company choices are thin to nonexistent. An example is New Hampshire with one healthcare insurance vendor. The same state has eliminated two thirds of hospitals and physicians eligible to participate in the health insurance exchanges.

Some of the best hospitals and clinics are not participating in the exchanges. In some cases reimbursement is too low.

Obamacare’s excuse is this will eliminate the facilities that overcharge and eliminate the risk of cost overruns.

All this keeps the healthcare insurance industry in charge of the risk. In order to reduce costs patients have to be motivated to avoid illness and be responsible for their own health and healthcare dollars.

This concept is not embodied in Obamacare. The government and the healthcare insurance industry will make the healthcare decisions for consumers.

Another big idea included in Obamacare is the concept of shifting risk from the government and the healthcare insurance industry to physicians and consumers.

Accountable Care Organizations (ACOs) are supposed to be set up to integrate care. If an organization does better than average or better than the year before it gets to share the cost savings with the government. If it does worse it receives less money.

If it improves one year there is little room for improvement the next year. Its share will be less. It is self-defeating motivation.

A major problem is physicians can only control certain risks. Many risks depend on patients’ ability or willingness to adhere to the care recommended. Eighty percent of the healthcare dollars for any chronic disease is spent on treating the complications of the chronic diseases.

There are no provisions for risk weighting payments to physicians for disease complications resulting from patients’ lack of adherence to treatment. The more complications of a chronic disease patients have the greater the risk of higher costs that cannot be controlled.

Severe complications and decreased adherence increases the risk of higher medical costs.

ACO’s bundle payments for disease entities. One size does not fix all.

ICM-10 increases the number of diagnostic and treatment codes from 18,00 to 68,000 codes. This increases the complexity of coding. It is an opening for fraudulent coding. It also can result in the possibility of over or under coding as well as miscoding. It will take years to learn and years to get right.

If physicians miscode those physicians will not get paid by the government or the insurance industry.

This brings us to the next barrier to the success of Obamacare. There is a constant threat of penalty to consumers and physicians. There should be a constant incentive to receive a monetary reward.

Consumers have higher deductible and higher premiums with Obamacare. Many middle class people cannot afford the higher premiums and higher deductibles. The government subsidizes the healthcare insurance for the poor.

The funding for these subsidies is unclear. It will probably result in yet another tax increase for the middle class. The poor are exempt from income tax payments.

Is this redistribution of wealth?

There are no incentives for anyone to stay healthy and avoid unnecessary and expensive physician visits and diagnostic testing.

There is no tort reform in Obamacare. The lack of tort reform increases the need for excess testing in order to avoid lawsuits for physicians not doing a complete workup.

Physicians and hospital systems have never figured out how to calculate Health Maintenance Organizations’ reimbursement. Physicians and hospitals lost a great deal of money trying to price HMOs bundled payments.

Physicians and hospital systems know less about pricing bundled payments for ACOs. They have no control over consumer usage even though they are being asked to cover the risk. They are hesitant to assume risk.

This is part of the reason ACO participation has been so poor as I pointed out in my last blog.

It is Insurance coverage (public or private) that should cover and assume the risk. This is the definition of insurance. It is not in the physicians power to control risk nor should it be his responsibility.

It is the responsibility of the State Insurance Boards to price that risk for the healthcare insurance industry wisely. These boards should provide a wide range of products to fit consumers needs. The consumer should have the freedom to choose.

Federal and State officials should not accept the insurance industry’s word.

It is unacceptable.

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

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We Ain’t Seen Nothing Yet!

January 5, 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

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;

The lack of functional electronic medical records and transportability of patient medical information.
Increased paralyzing and incomprehensible regulations for physicians and hospitals leading to patient care delays.
The lack of development of Accountable Care Organizations for integrated care with penalty. ACO’s were suppose to save money but are failing.
The inability of Obamacare to facilitate timely and cost effective medical care.
The decrease in physician practitioners signing up to accept Obamacare leading to an increased physician shortage and decrease in consumers’ access to care.
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.
The new ICM 10 coding system will drive physicians and hospital out of business and certainly out of participating in Obamacare.
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.
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.
Consumers will experience problems in eligibility, coverage, billing, claims, insurer payment and patient information-protection and security.
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.

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I Gave You A Better Plan In 2008

December 8, 2013

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

“The hardest thing to explain is the glaringly evident, which everybody has decided not to see.”

Any Rand, The Fountainhead

December 7,2013

Dear President Obama;

Last week you said no one has showed you a better plan for healthcare than Obamacare.

You were the dysfunctional healthcare system’s great hope in 2008. Your problem is you listened to the wrong people when you wanted to repair the healthcare system.

Unfortunately, these people believe as you believe. Their ideology believes in central government control and the redistribution of wealth. This ideology has only led to the failure of national economies in the past.

There are better plans than Obamacare.

In fact, I sent you six letters right after you were elected President explaining how the healthcare system had gotten into the mess it was in and what must be done to repair the mess.

You ignored me completely. I understand why. Your ideology is to increase central government control and redistribute wealth.

I believe in giving individuals the ability to control their own destiny, make free choices, and have incentives to improve and become innovative.

Increasing incentives promotes innovation. You believe in decisions by committee. I have never seen that work in business.

There are several key elements needed to Repair the Healthcare System.

The first is consumers must be responsible for their own healthcare dollars and their own health. Government should not be responsible for consumers’ healthcare dollars.

Consumers must be given positive financial incentives and education to use their healthcare dollars wisely and take care of their health.

A system of financial incentives can be set up so that people who are sick with a chronic disease such as diabetes, heart disease or lung disease can be rewarded if they keep themselves from getting a complication of their chronic disease.

Eighty percent of the healthcare dollars are spent on the complications of chronic diseases. Clinical research studies have shown that appropriate medical care and appropriate self-management can decrease the complications of chronic disease by at least 50%.

People are not dumb. If they had control of their money and freedom to choose they would choose to keep themselves healthy.

Past government attempts at redistributing wealth have never worked. Redistribution of wealth by increasing taxes on “the wealthy” has never historically increased efficiency or productivity.

What makes you think total government control and the redistribution of wealth will work now?

I appreciate your desire to have all Americans covered with healthcare insurance.

What makes you think healthcare coverage will make Americans healthy?

If you would provide incentives to American consumers to practice healthy habits and save money you would better serve us.

The healthcare insurance industry takes at least 40% of the healthcare dollars off the top of both private and public insurance.

You have done nothing with Obamacare to decrease the insurance industry’s incentives except try to penalize them. Obamacare has been unsuccessful.

The reason is clear. Obamacare is totally dependent on the administrative services of the insurance industry.

If fact, because of your disastrous web site you have asked the insurance industry to tell you how much the government owes them. This is the fox in the hen house.

What have you done about Tort Reform?

You have done nothing. Why?

Your healthcare policy advisors know little about medical care and the problems in the practice of medicine. They believe that the practice of defensive medicine has a minor effect on the cost of medical care.

An estimate is that defensive medicine costs the medical care system $300 billion to $750 billion dollars a year in unnecessary testing.

Obamacare’s solution is to pay less money for those tests, not to eliminate the need to do those tests.

At the same time Obamacare lets secondary stakeholders take advantage of the system. It costs the government $1700 dollars for a fifteen minute ambulance drive to a hospital. Why? What are the basic costs and a reasonable profit to the ambulance company?

Physicians who treat those Medicaid patients brought in by the ambulance receive $24 dollars in reimbursement for his care. Does that make any sense to you?

Your government bureaucrats say we need to save money somewhere.

Hospital systems also receive special deals from the government.

Every hospital has a least two sets of books. One set for the government to see how much the hospital system is losing and the other set to show the hospital administration and board of trustees how much they are making.

Why are hospital administrator salaries increasing as physician salaries are decreasing?

Physicians are smart people. They will figure out how to get around the distortions being created by Obamacare. The result will be a more costly healthcare system and a further increase in the redistribution of wealth.

Who approved of the $640 million dollars contract to CGI for www.healthcare.gov only to receive a system that doesn’t function and is probably about half built using an antiquated software program that should not be used?

Is it cronyism or stupidity? I know you are not stupid.

We have seen many examples of cronyism. In healthcare the multiple waivers from Obamacare are egregious. Two of the most agregious waivers were the waivers to congress and the unions.

What should the role of government be in healthcare? Government should work to align everyone’s vested interests. It should set conditions to give all stakeholders real incentives to improve the healthcare system efficiently.

Consumers should be given the most incentive. Consumers are the only one that will be able to lower the costs. Consumers and physicians generate those costs. You do not impose restrictions by penalty. You increase incentives to get consumers to save money.

Try my ideal medical savings accounts.

Below are the links to the letters I had written to you when you were President-elect in case someone in your administration misplaced them.

In those letters is the course you should have followed to have a legacy to be proud of.

I have also provided a host of summary blogs that have explained repairs in detail.

Dear President-elect Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama-elect Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama-elect Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama-elect Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama-elect Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president–elect-barack-obama-part-5.html

Dear President Obama-elect Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Summary Blogs

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/summary-blogs/

You are the one who asked to “show me a better plan.”

I hope you pay attention to my letters this time.

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

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Obamacare’s Disasters Are Unfolding

November 24, 2013

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

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Stanley Feld M.D.,FACP,MACE

Along with the web site’s disastrous failures, other impending Obamacare disasters are unfolding.

Things look so bad for Obamacare that President Obama sent out a directive to change its name from Obamacare to the Affordable Care Act.

I believe Americans are well aware of the fact that Obamacare is neither affordable nor accountable to consumers. A name change will not help. Obamacare will not bend the cost curve nor save each family $2500 a year for healthcare insurance.

I have pointed out the problems with Obamacare since before its inception.

The list includes;

Loss of your current insurance policy.

Loss of your present doctor.
Loss of participating doctors in your network.
Loss of your present insurance coverage.
Failure of the development of Accountable Care Organizations.
Failure of Pay4Performance measures to reimburse physicians and hospitals.
The lack of incentive for consumers to take care of their health or healthcare dollars.
The lack of dealing with the issue of tort reform. Tort reform would lower the cost of care dramatically.
It does not decrease healthcare insurance industry abuse of the Medical Loss Ratio.
It has not increased the ease of data transfer among providers.
The loss of freedom of choice for consumers and physicians.

Consumers are becoming outraged at the inefficiency of implementation as all these are beginning to affect them personally.

Where is the physicians’ outrage?

Premiums and deductibles are rising. Medical care is starting to be rationed. The intensity of the outrage will rise as access to care decreases.

A physician friend of mind who is over 65 years old on Medicare said Medicare has been good to him and his wife.

Medicare has also been good to his practice of internal medicine. He believes America should have Medicare for all with a single party payer.

I just listened and smiled. The old Medicare system is unsustainable. Wait until he sees the new Medicare premiums for seniors and the reimbursement schedule for physicians in 2014.

Forget the regulations he is going to have to deal with. Forget the restrictions of access to care he will have to deal with. Forget the rationing of care he will have to deal with.

It will not be pleasant.

Consumers are realizing they are the victims of higher prices and lower levels of care. Hospitals, insurance companies and doctors are also going to be the victims of enslavement by regulations.

Government bureaucracy, inefficency and waste will flourish.

I hope everyone realizes that the individual market was the first market to be attacked by Obamacare because it is the smallest market. The individual market only affects 5 million people.

The next market in line to be destroyed is seniors and Medicare. It is starting already with the destruction of Medicare Advantage.

The employer sponsored healthcare insurance market will start being destroyed in 2014.

President Obama just delayed the implementation of the private market mandate from October 15^th until after the November 2014 elections.

The delay will not take the spotlight off the failure of Obamacare and protect Democrats from the outrage of Americans toward Democrats during to 2014 election campaigns.

I believe the American people are on to President Obama’s tactics of attacking his enemies personally.

Consumer outrage about Obamacare will dominate the media despite President Obama’s attempt to manipulate the liberal traditional media.

He seems desperate to create a distraction. His Iranian deal will create a temporary distraction.

President Obama brought several selected progressive “influential commentators” to the White House for a little policy briefing last week.

They all said the meeting was confidential. I say the meeting was an attempt at media manipulation. Hopefully the media is realizing reality.

Obamacare was supposed to be built by the best minds in the healthcare policy business. It appears the problem was these best minds knew little about the healthcare insurance business, the hospital system business or the practice of medicine.

Obamacare has not aligned any of the vested interests of the primary and secondary stakeholders. In fact, misalignment of vested interests has increased since passage of the law.

I cannot figure out what the President Obama was thinking. All signs point to the fact that President Obama wants to destroy the present healthcare system and replace it with a single party payer system.

I have pointed out multiple examples in this thinking including President Obama’s declaration as far back as 2003 and since that he prefers a single party payer system.

He has also emphasized that the universal care system he will put into place (Obamacare) is a transitional system. It is a system that will collapse and be replaced with a single party payer.

http://youtu.be/BKkTRMEyAhs

This You Tube is compelling. It demonstrates President Obama’s ideological goal not practical goals.

President Obama admits that Obamacare is a transition system. He wants to eliminate employer sponsored healthcare coverage and the destruction of the healthcare insurance industry.

President Obama simply ignores the fact that the administrative services are provided by the healthcare insurance industry to administer Medicare and Medicaid.

The government could not do it without the healthcare insurance industry. The cost of the administrative services is a non-transparent 40% of every Medicare and Medicaid dollar.

Medicare and Medicaid are single party payer systems. The healthcare insurance industry presumably bids for each states contract. Indirectly the healthcare insurance company rips off the consumers by ripping off the government for the administrative service for Medicare and Medicaid.

All we have to do is remember the $2,000 toilet seats in a government cargo plane to understand the efficiency of a government run program that outsources the fulfillment of a mission.

It is hard for most people to believe that President Obama’s purpose all along was to destroy Obamacare (his namesake) and replace it with a single party payer system.

Everyone must notice that he is now been calling Obamacare the Affordable Care Act.

I am sure he wanted the hysteria that is going on right now over dropped insurance coverage, dropped physicians and changed insurance plans to subside.

However he did not expect the mistrust the public has for him. The genie is out of the bottle. The country doesn’t trust this nice guy anymore.

He did not expect the outrage to be directed at him. This is the reason he is blaming the failure on the Republican Party one day, the healthcare insurance companies the next and doctors and hospital systems the next.

He has also giving special favors to his political base. These favors has made the middle class public very angry at him.

A more glaring favor is exempting all of congress from participating in Obamacare.

The fast food companies’ exemption has angered small business owners.

Exempting unions from Obamacare has been totally disgraceful.

The destruction of Medicare Advantage for seniors is on the way. Senior outrage will be seen in the next few months.

President Obama is going to try to blame the healthcare insurance industry, hospital systems and physicians for this disaster.

Very few Americans are going to believe him.

Americans understand that he is forcing premium prices and out of pocket expenses up with unnecessary bureaucracy and regulations.

He is restricting care to the elderly and access to care in hospitals and doctors’ offices.

He has created greater dysfunction in the healthcare system.

The dysfunction is going to get worse.

He will achieve his goal to force the healthcare system to collapse.

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

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What Is Going On With Obamacare?

November 17, 2013

inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

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

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

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

At the same time he attacks his enemies personally.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

His pronouncement is unconstitutional.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you Mr. President.

“It is a complex process.”

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

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

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

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

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

It is time for President Obama take some personal responsibility.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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