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Describing Fake News

Stanley Feld M.D.,FACP,MACE

The front-page headline in the Sunday New York Times on August 26 read;

“Health Insurers Start To Prosper.

The subtitle was; Trump’s Warnings on Affordable Care Act Masks Upside.”

 “Supporters of the Affordable Care Act achieved a major victory this past week when, thanks to cajoling and arm-twisting by state regulators, the last “bare” county in America — in rural Ohio — found an insurer willing to sell health coverage through the law’s marketplace there.”

“So despite earlier indications that insurance companies would stop offering coverage under the law in large parts of the country, insurers have now agreed to sell policies everywhere.”

 A casual Sunday Times reader would respond to this headline and initial paragraph by thinking that President Trump is frightening the public about Obamacare’s failures.

The casual reader would conclude this is just another one of President Trump lies. Obamacare is not failing. He is just trying to scare the public.

The New York Times is telling the public that the insurance industry is going to offer insurance through Obamacare in every county in the country.

The American people cannot trust President Donald Trump.

The causal reader got the message. Obamacare is doing fine. It is not necessary to continue reading the article.

The online Sunday NY Times headline of the dame article was different than the headline that appeared in print.

Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers”

This headline is also misleading. One insurer in a bare county signed up. This does not represent a upside gain or create a competitive market place.

“The Centers for Medicare and Medicaid Services (CMS) reported that 1,476 counties, over 45 percent of counties nationwide, will only have one health insurer on the Obamacare exchanges next year.”

This article is an example of “fake news.” It is totally misleading to the casual reader

Why a single insurance company will sell insurance in that bare county in Ohio is not explained. All the other insurance companies have pulled out of that county.

If the reader got this far into the story he could still be satisfied that Obamacare was not imploding.

However, the article goes on to explain the potential failure of Obamacare.

“But a moment of truth still looms for the industry in the coming weeks under the law known as Obamacare.”

“Companies must set their final plans and premiums by late September, even as the Trump administration continues to threaten to cut off billions of dollars in government subsidies promised by the legislation.”

This is more fake news aimed at blaming Donald Trump for Obamacare’s failure.

The NYT ignores the fact that President Obama promised the healthcare insurance industry the reinsurance subsidy in order to get them to participate in Obamacare in the first place.

President Obama paid the healthcare insurance industry only 12% of what the insurance companies claimed President Obama promised them in their reinsurance package.

President Obama promised the healthcare insurance industry a subsidy through the government backed reinsurance package, if there were cost overruns in Obamacare.

The costs overruns were massive according to the healthcare insurance industry. The legislator only budgeted 12% of that claimed by the healthcare insurance industry.

President Obama could not find the money to pay the remaining 88%.

The industry continues to demand the remaining 88% promised in order to participate in this year’s (2018) Obamacare health insurance exchanges.

All twenty-two of the state run insurance administrative companies that received loans from the federal government have gone bankrupt and have not paid the insurance industry.

Those federal loans will never be paid back to taxpayers.

The Democrats and the mainstream media are trying to blame President Trump for this deficiency in payment and the lack of insurance company participation.

The shortfalls resulted in healthcare insurance premium raises for both the Obamacare health insurance exchanges and the premiums for private group insurance.

Subsequently, most of the healthcare insurance companies have dropped out of providing the insurance through the Obamacare health insurance exchanges.

A third piece of fake news is the success of providing insurance for twenty million enrollees.

The NYT article ignores the fact that Obamacare through the health insurance exchanges only enrollee nine million people in the individual market. Fourteen million lost individual coverage lost their insurance at the onset of Obamacare.

The 22 million additionally insured includes the additional thirteen million were added to the Medicaid roles. Some of those thirteen million are illegal immigrants.

Soon a portion of the financial burden of the Medicaid increase will be dumped on the states.

The Obamacare law requires comprehensive insurance coverage packages for both the individual market and the group markets driving the price of coverage up.

These increases make Obamacare unaffordable. Obamacare is not successful as implied in the New York Times article.

President Trump did not do anything to distort the Obamacare coverage. President Obama did it with his tremendous cost overruns.

It is possible President Obama wanted to prove that an insurance-based healthcare system couldn’t work. It would have to be replaced with a government controlled single payer system.

It is the reason he wanted to include the “Public Option.”

However he placed so many regulations in the way of any possible success.

President Obama believes that the only system that would work is a single party payer system with the government being in control of the money, the coverage and the freedom to choose by the public.

President Obama had no concern for the government inefficiency or cost to the government.

There was no consideration for a more cost efficient and affordable healthcare system.

“The fate of the landmark law, Obamacare, depends in large part on the health of the insurance marketplaces and the ability of insurers to make a viable business out of selling coverage to individuals.”

Healthcare insurers have tried to make a viable business plan out of Obamacare. When the law passed seven years ago, insurers saw a potential bonanza: tens of millions of brand-new paying customers, many backed by generous government subsidies and required by the new law to have health coverage.

The burdensome regulations, lack of coverage flexibility and one size fits all coverage all have cause people not to sign up for Obamacare. They would rather pay the penalty even though they can ill afford it.

On Thursday, Northwell Health, the largest hospital system in New York State, announced that it would shut down its insurance unit, CareConnect, which had been selling coverage in the state marketplace. The move forces tens of thousands of its customers to find another plan for 2018. Northwell’s chief executive put much of the blame on Washington.

As we get closer to enrolling participants in Obamacare for 2018 and the insurance industry’s publishing their premiums more insurance companies are dropping out of participating in the health insurance exchanges.

Most of the startup insurance companies and state sponsored have closed down their business.

The article quoted is fake news.

The article starts off giving the casual reader the impression that Obamacare’s insurance coverage is doing fine.

The reality is It is not fine. Americans have to worry about it. Affordable healthcare insurance will not be available at an affordable price.

The Democrats are happy because then the country will be offered a single party payer system.

The problem is that the federal government cannot afford a single party payer system. At this moment Medicare and Medicaid are not sustainable. A single party payer system will be inefficient and unsustainable.

I don’t know how Mitch McConnell can to say most of the news is not fake news.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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They Are Getting There

Stanley Feld M.D.,FACP, MACE

As Obamacare implodes, President Trump is trying to get a Republican congress to repeal and replace Obamacare in an orderly fashion with a minimum of disruption to the present healthcare system.

The Republican establishment in congress is trying to disrupt his goal. All the Democrats are going to stonewall him.

Republicans won both houses of congress because they promised to repeal and replace Obamacare. They had seven years to create a plan. They have failed to achieve a consensus in the Republican caucus.

Democrats are starting to talk about making it easy. They are suggesting congress replacing Obamacare with a government run single party payer healthcare system.

You may recall President Obama told John Kerry and Barney Frank that America would get to a single party healthcare system via Obamacare. He told them not to worry.

The reality of the situation is America is inching its way to a universal single party payer healthcare system.

Medicaid, Medicare and the VA system are already single party payer systems. Each one of these programs has been declared unsustainable.

It is incomprehensible to me that the Republican politicians who the American people elected in good faith are not hearing their complaints

Presently 41.5% of the population is in one of these single party payer healthcare plans. 49% of Americans pay no taxes. This means that 51% of Americans are paying the healthcare bill for 49% who do not pay taxes.

This is the redistribution of wealth that Dr. Donald Berwick said was essential in America.

If fact many of the 49% receive additional monies from the government such as food stamps, free mobile telephone service and free housing.

America is on its way to European socialism, This ideological system has failed in Europe.

The following calculation is how I came up with the percentage of Americans that are in an entitlement healthcare system. I use U.S. agency census data.

The current population of the United States of America is 326,613,397 as of Monday, July 24, 2017, based on the latest United Nations estimates.”

hfo/world-population/us-population/ 

The chart below displays the total number of individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in the current month (April 2017) and the period prior to the start of first Marketplace open enrollment period or “baseline” period (July – Sept. 2013).

The current enrollment is obviously post Obamacare.

Month Expansion States Non-Expansion States Total
Baseline July-Sept 2013 (Monthly Average) (49 states) 37,069,415 19,733,676 56,803,091
Apr 2017 (preliminary) (51 states) 52,058,495 22,472,507 74,531,002

Medicaid and Chip increased by 22,472,507 since the onset September 2013.

74,531,002/326,613,397 equals 22.81% of the population is on Medicaid so far.

Medicare enrollment is lower than present Medicaid enrollment. As of May 2017, 37,976,052 are on original Medicare and 20,089,220 are on Medicare Advantage or others Medicare plans for a total of 58,065,272 on this single party payer entitlement.

Medicare is an entitlement program with high premiums. The premiums are means tested. People in the upper tax brackets pay over $18,000 a year in after tax dollars premiums for Part B, Part D and Part F.

The people in lower tax brackets pay less. The premium deduction for Part B is taken out of their monthly Social Security check. This creates a burden on their standard of living.

The additional 58,065,272 to the 74,531,002 bring the total percentage of the population on a single payer healthcare system to 40.6%.

(132,596,274/326,613,397= 40.6%)

If the VA healthcare system enrollees are added to the analysis of the number enrollees to a government run single party payer healthcare system the percentages increase.

In Fiscal Year 2014 the total veteran population was 21,619,731. 9,111,955 veterans were enrolled. 6,616,963 veterans used the VA Hospital System. The VA System brings the total number enrollees in a single party payer system to 133,508,229 or 40.9%

9,111,955 + 132,596,274= 133,508,229

133,508,229/326,613,397= 40.87%

https://fas.org/sgp/crs/misc/R43579.pdf

The IHS provides a comprehensive health service delivery system for approximately 2.2 million American Indians and Alaska Natives who belong to 567 federally recognized tribes in 36 states.

https://www.ihs.gov/aboutihs/

133,508,229+2,200,000= 135,708,229

135,708,229/326,613,397= 41.5%

41.5% of the American population is already in a government controlled single party payer healthcare system. President Obama was right. He promised he would get there

Barney Frank and John Kerry did not have to worry. The only problem is that Obamacare is collapsing because it is unsustainable.

It is a pity is Republicans cannot agree to an innovative plan to repeal and replace Obamacare. Maybe the Republican want to have control over the healthcare system and deny Americans their freedoms.

The Democrats don’t care about the welfare and freedoms of Americans or the fiscal health of the nation.

Something needs to be done about this madness now.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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The Republican Establishment’s Failure

Stanley Feld M.D.,FACP, MACE

I am coming to the conclusion that the Republican establishment does not want to Repair the Healthcare System.

The Republican establishment has the same goal as the Democratic establishment.

Recently the mainstream media is saying that a single party payer system is looking good.

Neither party has any interest is having consumers control their healthcare dollars. It looks as if both parties want the government to control the consumer’s healthcare dollars.

All the politicians ignore the fact that government control is unaffordable. It also ends up not working.

The best example is the bureaucratic VA Hospital System and its system wide corruption.

A reader wrote:

I have read your last blog post carefully and agree with many of the points put forward but there is a glaring omission.” 

 “How are patients supposed to be responsible for their healthcare dollars when there is absolutely no transparency and no consistency in pricing.”

The lack of transparency is a major defect in our present healthcare system.

Only 20% of consumers use the healthcare system at any one time. Eighty percent of the consumers have not run into the lack of transparency problem in the healthcare system.

Most consumers do not care about transparency because they have first dollar coverage provided by their employer. They think their medical care is free. They believe they have excellent healthcare insurance.

President Obama took care of that notion with Obamacare. The defective structure of Obamacare caused healthcare insurance premiums and deductibles to skyrocket. First dollar healthcare insurance became too expensive for most employers.

Employers stopped providing first dollar coverage. Middle class employees are now noticing that out of pocket expenses have made their healthcare insurance unaffordable. Consumers have tried to compare prices of competitive providers. They have discovered that it is impossible!

Consumers are becoming aware of the lack of transparency. They have been astonished by this lack of transparency.

There is nothing in the new Republican bill that addresses Republican politicians’ awareness that the lack of transparency is a major defect in the healthcare system.

The lack of transparency is only one of the major defects in our healthcare system.

There is nothing in the Republican bill that speaks to the consumers’ responsibility for their health and healthcare dollars. Consumer driven healthcare is completely ignored.

There is nothing in the bill that addresses effective tort reform. The Massachusetts Medical Society survey showed that defensive testing to avoid lawsuits costs the healthcare system between $250 billion to $700 billion dollars a year.

The lack of the development of systems of care for chronic diseases cost another $700 billion dollars a year that our healthcare system does not address. There is nothing in the bill that emphasizes this very important defect in the healthcare system.

The Republican establishment thinks consumers are too stupid to take care of themselves.

The mainstream media likes to tell us that people love entitlements. The public does not want to give up these entitlements.

My question is how come less than 9 million people signed up for Obamacare’s individual healthcare plans last year if they love entitlements?

It is because they cannot afford to buy the health exchange insurance even though 85% of the premiums of those 9 million consumers are subsided by the government. Their high deductibles are not subsidized.

The Republicans are going claim they are promoting health savings accounts. The public is not told the amount of money they can put into a health savings account or whether it will provide first dollar coverage over that amount if they get sick.

There is no financial incentive for consumers to be responsible for their healthcare or their healthcare dollars.

My Ideal Medical Saving Account is a much better idea.

These are only a few of the major defects in the Republican establishment’s concept to fix the healthcare system.

President Obama did some of the awful things to Obamacare through rules and regulations after certain vested interests complained about the law. Obamacare’s rules and regulations have to be eliminated

There were crony waivers that would make one’s blood boil. In fact, elected congressional members got the best exemptions.

It is becoming apparent that congress doesn’t want to fix the healthcare system for the majority of Americans. The congressional establishment wants to control consumers.

Socialism does not work!

Socialsim for blog

Our political establishment does not tell us about the economic result in other countrys’ single party payer universal healthcare systems.

We don’t have to go to other countries. We only have to go to the indigent areas in California were everyone is covered by Medicaid.

The Republican establishment needs to get off the stick before all of them are kicked out of congress.

Just imagine the healthcare systems savings if every consumer were empowered to shop for the best healthcare at the best price.

The result would be a free market healthcare system in which competition would cleanse the system and make it affordable to everyone.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Better Care Reconciliation Act (BCRA)

Stanley Feld M.D.,FACP,MACE

It looks like the Senate is making a mess out of its version (BCRA) of repeal and replace Obamacare.

My first reaction was that Better Care Reconciliation Act is a stupid name for a bill to repeal and replace Obamacare.

I have not heard a single specific criticism of BCRA by the Democratic leadership.

Nancy Pelosi said the bill will kill hundred of thousands of people. Hillary Clinton said it was a death bill. Chuck Schumer told the American people it is a terrible bill and leave millions uninsured. They all said it is going to make the rich richer and the poor poorer.

The evidence for these statements has not been presented.

Democrats have used these scare tactics so often that no one believes them anymore.

Americans are smarter than that.

Republicans have not explained the strategy behind BCRA in making the healthcare system better than Obamacare either.

All I have heard from President Trump is that it is a beautiful bill. It will make our healthcare system great.

If no one understands BCRA how can a media driven public poll with a 17% approval rate have any meaning?

The survey of public opinion is meaningless.

At present Obamacare has left 26 million uninsured and rising. It has only insured less than ten million people in the individual market.

Obamacare is also unaffordable. The deductibles are as high as $6500 before any insurance kicks in. People who buy the insurance have no insurance until they spend more than $6500.

I don’t understand the Senate Republicans who want a perfect conservative bill. They are not going to get it. They will yield the floor to the minority Democrats.

The turkey buzzards are circling the corpse already. The corpse being Obamacare and the Republican replacement

Elizabeth Warren said we must go to the next steps which is a single party payer system now.

I believe Obamacare is going to self-destruct in 2018 if nothing is passed immediately.

The choice for the Republicans who are oppose compromise and the passing of BCRA is clear to me.

Either the Republicans pass this bill and have a chance for a free market healthcare system or reject it and end up with a failed Obamacare healthcare system.

Everyone knows the replacement for a failed Obamacare system is a single party payer system just like the VA Healthcare System.

A single party payer system will be an unaffordable disaster.

I will not comment on the specifics of the Better Care Reconciliation Act (BCRA) except to say it is not perfect.

Let us see if it passes and what form takes. I will make some comments at that time.

President Trump needs BCRA to pass in order to make significant inroads in reforming the tax code.

I would be a pity if his fellow Republicans tied his hand on significant tax reform to simplify the tax code.

My hope is that Tom Price knows how to fix the healthcare system once the house and senate agree on specifics of the bill in conference.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Senate Republicans Are Making Repeal and Replace Harder Than It Should Be

 Stanley Feld M.D.,FACP,MACE

I think the Republican establishment in the senate is trying to undermine President Trump’s agenda.

It would be easy to repeal and replace Obamacare if the reasons for its failure where publicized. The main reason is that it does not align the initiatives of most of the stakeholders. The cost of administration is a close second.

Obamacare is about redistribution of wealth and control over the healthcare system. It ends up penalizing the middle class the most because of premium increases.

People like entitlements because they are free. Someone else is paying for them.

Politicians want to keep their jobs. They do not want to upset people who receive these entitlements.

“But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law.

Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.”

The healthcare insurance companies do not want to lose money selling healthcare insurance. They are getting out of the healthcare market because, by their calculations, they are losing money.

The Republicans establishment in the Senate want to continue to provide subsidies to the healthcare insurance industry.

Congress needs the healthcare insurance industry’s ability to provide administrative services whether it is for Medicare, Medicaid, health insurance exchange coverage (Obamacare) or private insurance.

The government’s goal is to provide enough financial incentives for the healthcare insurance industry to provide affordable healthcare insurance coverage while saving money.

President Obama subsidized the healthcare insurance industry for any perceived losses through the Obamacare reinsurance program. Then President Obama reneged on the agreement. He only paid 12% of what was owed according to the insurance industry’s calculations..

Democrats want a single party payer system. They want everyone on Medicare or Medicaid. It is simple. The result is the government provides healthcare insurance for everyone. Everyone receives first dollar coverage. This would be the mother of all entitlements.

The single party payer system would also provide the government with tremendous power over the people. It would control consumers’ freedom of choice.

Along with this simple single party system comes a complex bureaucracy with all the inefficiencies that I have described previously.

Consumers would be chained to the inefficient healthcare system. The inefficiencies in the system have been graphically demonstrated by the VA Healthcare System and its ever increasing costs.

It would be nice if a single party payer system were efficient and affordable. Canada has a universal healthcare system. Canadians who are not sick and do not need their healthcare system believe the Canadian system is great.

They ignore the fact that the Canadian provinces are paying 50% of their GNP to provide free healthcare to all Canadians.

Canada’s health-care wait times costing patients many millions in lost time, wages”

Ontarians wait longer for health care than citizens of other universal health-care countries”

The fact is single party payer systems do not work for all the stakeholders.Both Democrats and Republicans are missing the essential point about what would work to provide an affordable healthcare system that aligns the incentives of all stakeholders.An essential element is to develop a system that encourages consumers of healthcare to be responsible for their health and have control over their healthcare dollars.

The Senate’s present revision does not consider this. The Senate is considering the needs of the healthcare insurance industry and not the needs of consumers.

The Senate should be considering the following in order to repeal and replace Obamacare.

  1. My Ideal Medical Savings Account should be instituted immediately. It will provide financial incentives for consumers as well and incentives to maintain health.

Self-management of chronic disease is essential for a healthcare system to become affordable. My Ideal Medical Saving Account provides that financial incentive.

1. The Ideal Medical Saving Account will provide instant adjudication of medical care claims.

  1. The ideal Medical Savings Accounts will encourage patient responsibility for their health, the care of their disease and their healthcare dollars.
  2. The Republican Party should establish an organized system of disease management education for persons with chronic disease. The education system should be designed to be an extension of physicians’ care. It should not be a free-standing education system. Physicians should be provided with incentives to set up these educational systems.

http://stanfeld.com/chronic-disease-management-and-education-as-an-extension-of-physicians-care/

  1. A system of social networking with physicians and their patients should be developed. The government could provide the template for physicians and their team.

http://stanfeld.com/social-networks-patient-education-and-the-healthcare-system/

The networks could be physicians to patients networks, patients to patients networks, patients to their physicians’ healthcare team networks. These networks need to be an extension of the physician’s care. All encounters should be imported to the patient’s chart with certain restrictions.

  1. Social networking between physicians should also be developed.
  2. Integrated care systems with generalists to specialists must be developed for both treatment and cost transparency for the physicians and patients.
  1. There must be instant communication between physicians and patient via an effective electronic medical record. The EMR must be a teaching tool for physicians. It must not be a tool to judge physicians’ care and penalize them. The EMR should be cloud based. Maintenance and upgrades should be free and seamless. Physicians should be charged by the click.

http://stanfeld.com/?s=EMRs

  1. Tort Reform is an essential element in a healthcare system that would work and be affordable. It would decrease the cost of over testing. It would also decrease the cost of malpractice insurance and legal fees. These cost are built into the cost of care. The cost of care would be reduced significantly. http://stanfeld.com/?s=tort+reform

The goal of effective healthcare reform should be to align all the stakeholders’ incentives. Patient incentives should be at the center of this alignment.

Align patient 1

Align government

Obamacare did not bother to try to align any of the primary stakeholders’ (patients and physicians) incentives. In fact Obamacare destroyed the patient/physician relationship.

The house bill to repeal and replace Obamacare touches on some alignment.

The senate is fighting about issues that are not significant in aligning all stakeholders’ incentives.

The healthcare system will not be repaired until all the stakeholders’ incentives are aligned. Healthcare policies must be put in place to align those incentives.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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It Looks Like The Dice Are Loaded

Stanley Feld M.D., FACP, MACE

Everyone is probably familiar with Leonard Cohen’s song “Everybody Knows.” If you are not you should read the words and /or listen to it.

https://www.google.com/#q=leonard+cohen+song+everybody+knows

The first paragraph says it all.

“Everybody knows that the dice are loaded
Everybody rolls with their fingers crossed
Everybody knows the war is over
Everybody knows the good guys lost
Everybody knows the fight was fixed
The poor stay poor, the rich get rich
That’s how it goes
Everybody knows”

Leonard Cohen nailed it.

That is what is going on with the repeal and replacement of Obamacare in the congress.

“Everybody knows” the Republicans have shown little enthusiasm in repealing and replacing Obamacare. House Republicans barely got it passed. They had seven years to develop a replacement plan.

I think Republicans do not want replace Obamacare. They have used repeal and replace as a calling card to get a majority in both the house and the senate.

It looks like the American public has been used as a pawn for Republican to gain control of congress.

The Republicans talked a good game for the seven years that Obamacare has been the law of the land.

Obamacare has been a disaster. The majority of people have seen large increases in their healthcare insurance premiums and deductibles along with poor access to care.

Obamacare has cost our treasury trillions of dollars because of it poor business model design and mismanagement.

Obamacare claims it has provided healthcare coverage for twenty million Americans. It is not true. Thirteen million of those twenty million have been added to the enrollees in Medicaid.

Medicaid is a single party payer system that does not provide effective insurance coverage. It does not provide easy access to care in most parts of the country. There is also built in rationing of care.

“Everybody knows”

The healthcare insurance industry insurers are dropping out of Obamacare’s health insurance exchanges. Almost all the state insurance exchanges have gone bankrupt and are out of business.

Americans heard over and over again from Republicans that Obamacare is going to die from it own weight. It is true.

There will continue to be insurance to coverage for the nine million insured with preexisting illness. The government mostly subsidizes these nine million patients. However they have unaffordable deductibles.

“Everybody knows that the dice are loaded.”

This week both Mitch McConnell and other Republican senators were publicly pessimistic about their prospects of repealing and replacing Obamacare this year.

Senate Republicans remain publicly pessimistic about their prospects of repealing and replacing Obamacare this year with several raising concerns this week about the party’s central campaign promise even as one of their leaders vowed to pass such a bill this summer.”  

The fix is in. The dice are loaded! Everybody knows.

Russ Limbaugh blew his top when he heard this.

“Rush Limbaugh said during his show that Republicans are road blocking the President’s agenda to a greater extent than Democrats are.

Limbaugh specifically pointed to remarks by Senate Majority Leader Mitch McConnell (R-KY), specifically about the Obamacare repeal bill.

Check it out:”

“I don’t understand how people don’t get that it’s not just the Democrats in Washington that are road blocking Trump. I mentioned it earlier.

 “Mitch McConnell says he can’t see a way to getting 50 votes for the House Obamacare repeal bill?

Now, stop and think here, folks. Back when the only element that we had was the House of Representatives and Republican voters were constantly saying, “Why aren’t you doing more to stop Obama? Why aren’t you trying to do something to stop Obamacare?”

The answer was always, “Well, all we’ve got is the House. W-w-we can’t get anything through the Senate because the Democrats own the Senate. Obama’s in the White House! He’ll veto anything if it did make it there.”

Limbaugh continued that prior to this year, Republicans always blamed failed policy attempts on a lack of majority in the Senate.

“Then, when we won the Senate, they blamed failed agendas on President Obama.”

So we’ve given Washington a Republican House, Republican Senate, and a Republican president in the White House, and it still feels as though nothing is getting done.”

How come?

“It’s the Republicans standing up and saying, “I just don’t see how we’re — there’s no room here.

“ I don’t know how we’re goanna lower rates when you have this exemption over here and you have this exemption there.”

 Mitch McConnell is giving hollow excuses. The Republican establishment’s motives and method are becoming very transparent.

Everybody knows the dice are loaded.

Rush Limbaugh continues,

“ And I just read this stuff and I shake my head. They don’t want to cut taxes.

  Either they don’t want to cut taxes institutionally, they don’t want to cut taxes economically, or they just don’t want to do the heavy lifting.”

The Republican and Democratic establishment has built a very successful swamp for themselves. It is both socially and economically rewarding. It is a strong powerbase that neither is willing to relinquish.

 “ I don’t know what it is. My guess is they don’t want to help Trump.”

President Trump has pledged to drain the swamp. He has pledged to put power back into the hands of the people. He represents a real threat to the power the establishment in both parties has over the people and their freedoms.

Neither party anticipated his victory and neither party understands his popularity. The Democrats are trying to hobble him directly with fake scandals. The mainstream media are trying to hobble him with fake news.

“They just don’t see how they can do it,” Limbaugh said, remarking how especially incredible it is:”

Because, of course, there’s a way.

 They just don’t want to do it.

I think it’s all establishment, all the time anti-Trump, throw the media in there as well.

 But even in the middle of this I can tell you almost assuredly that Trump is not off his game. He’s not despondent. He’s not sitting there worried about why all these people hate him.

 He’s not worried about all that. He’s just head down and moving ahead full speed as he can…

Rush Limbaugh should not be confused. Republicans are defending the swamp they built. These guys are not going to let President Trump disrupt the powerbase that is in the swamp.

While the Republican establishment is stonewalling President Trump, the Democratic establishment is rolling out a single party payer option again. The Democratic establishment is going to try to sneak it in.

The Democrats argue that it is obvious the Republican establishment does not have a plan. The Democrats proclaim they have a replacement for Obamacare. They claim that a single party payer is easy to understand. Their proclamation is, “Doesn’t Medicare work for seniors?”

“At rallies and in town hall meetings, and in a collection of blue-state legislatures, liberal Democrats have pressed lawmakers, with growing impatience, to support the creation of a single-payer system, in which the state or federal government would supplant private health insurance with a program of public coverage

Medicare does work for seniors. The problem is the premiums and co-payment is becoming higher each year. Supplemental insurance increases each year. Healthcare insurance coverage for seniors is unaffordable to many.

Medicare is also unsustainable for the federal government. The premiums do not cover the costs of coverage.

The Democrat-controlled California State Senate approved a preliminary plan for enacting single-payer system. 

This is a joke. California has a huge budget deficit presently. Where are they going to pay for its proposal?

When are Democrats going to realize the importance of fiscal responsibility?

They don’t now. The expansion of Obamacare to a Medicare model is unsustainable and will bankrupt the state.

This kind of thinking by liberals and Democrats is not going to repair the healthcare system. It will result in collapse of the healthcare system as politicians try to increase their power over the people.

 

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Democrats Still Think Americans Are Stupid

Stanley Feld M.D.,FACP, MACE

The House Republicans finally got their act together and passed their version of the Obamacare repeal and replace act. It seems that many representatives do not trust Paul Ryan, Tom Price and President Donald Trump.

The Republican house version of the bill does not repeal and replace Obamacare completely.

The Affordable Care Act (Obamacare) permitted Kathleen Sibelius, the Secretary of HHS, to issue regulations to administer the act at her discretion. Many of her regulations were destructive to the healthcare system.

Tom Price, the new Secretary of HSS can eliminate many of these destructive regulations. The goal of the Obama administration’s regulations was to cause the healthcare system to fail and be replaced not by free market principals but by a single party payer system.

Her regulations were designed to eliminate any modicum of free choice for patients and physicians.

Tom Price’s actions and regulation eliminations should complete the repeal and replacement of Obamacare.

President Obama ignored the fact that a single party payer system would be destined to bankrupt the country. His plan was to get the health care insurance industry out of the healthcare picture.

The defect in his logic was that the government would have to continue to outsource the administrative services to the healthcare insurance industry. The government now outsources the administrative services for Medicare and Medicaid.

The government then lies to the public declaring that its overhead is only 2.5% while the healthcare insurance industry takes 30% for services that are charged as direct patient care.

The healthcare insurance industry would continue to rip off the healthcare system in a single party payer system for all.

The completion of the repeal and replace act will be done as promised by Ryan, Price and Trump in three stages.

As soon as the house bill is passed the House Democrats came out with their talking points criticizing the act. These talking points had little substance and no compelling evidence. They only declared that the legislation was terrible without any explanation of why it was terrible.

They just said 20 million people are going to lose their insurance coverage. The Republican health care act is going to kill people.

The talking points are mostly lies.

A recent study had reported that Obamacare has cost 80,000 people to die.

“Democrat’s immediately made the accusation that the GOP “repeal and replace” bill will kill Americans.  It seems that Obamacare has already done that.” 

In a previous blog I pointed out that more people have lost insurance in the individual market that have gained insurance from Obamacare’s health insurance exchanges.

Fourteen million lost insurance in the individual market in 2009 and at most 8 million gained insurance through Obamacare’s health insurance exchanges.

The 20 million new insured comes from the 12 million new people receiving healthcare insurance through Medicaid.

“Quoting Oren Cass over at National Review, it turns out that fewer people – not more people – had health insurance after Obamacare.  The only increase in “coverage” was Medicaid, but, sadly, it turns out that Medicaid kills people.  It’s better to have no medical insurance at all.” 

 Researchers have found that in 2015 Medicaid patients experienced worse outcomes than similar uninsured Medicaid eligible patients.

Public-health data from the Centers for Disease Control confirm… [that had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000-13 period, 80,000 fewer Americans would have died in 2015 alone.”

The Democrats are using the typical progressive tactic of creating a lie. Many people died because of Obamacare but the Democrats threaten that the Republican bill will cost many lives. It diverts attention from the Democrats’ failure with Obamacare.

This is fear mongering for the progressives’ political gain.

This is one of Sol Alinsky’s favorite tactics. One should do everything to marginalize opponents even if it needs to be done by lying.

“Democrats are hurting real people with their scary shrieking about death by Republican.”

The Democrats criticize without facts. The Democrats will lie about the effects of the bill without evidence. I would guess that many have not even read it.

One should expect nothing less from Nancy Pelosi and Chuck Schumer.

The Democrats have even rolled out Jonathan Gruber, the MIT professor of economics and co-author of Obamacare, who infamously said, “the stupidity of the American voter” helped get the measure to become law.

This week Gruber blamed President Trump for Obamacare’s failure on one of the Sunday news programs.

“Whose fault is this (rising premium costs)?” Gruber asked on “Fox News Sunday.” “Since President Trump has been elected … premiums are going up and insurers are exiting.”

This is total nonsense.

Jonathan Gruber still thinks Americans are stupid. However he has no credibility with the American public. Therefore his opinion has no impact on the discussion about the new bill.

Nancy Pelosi and Chuck Schumer’s lack of credibility with the American public does not seem to bother them.

Every lie they tell decreases their credibility even further.

Nancy Pelosi said, “the new Obamacare repeal bill is a ‘a very sad, deadly joke’

This is the same woman who said we will not know what is in the Affordable Care Act (Obamacare) until it is passed.

What is so deadly about it? She does not explain her statement. She figures the media is the message. The media will carry the message for her.

Chuck Schumer’s quote was even worse. He said, “Senate GOP should toss House healthcare bill ‘out the window’”

He called on Senate Republicans,

“To avoid following the lead of their colleagues in the House and to work on a bipartisan basis on healthcare reform rather than pushing for repeal of the Affordable Care Act.”

He is trying to save President Obama’s legacy Obamacare. Obamacare is an unmitigated disaster. It is beyond saving.

It was a poorly constructed healthcare bill aimed at giving big government total control of the healthcare system. President Obama totally ignores the fact that Americans did not want it, have not joined it. He felt he clearly know what is best for America.

He goal was to get it passed by the partisan vote. President Obama lied to Americans and lied to his party members.

Obamacare is unsustainable economically to America and is in the process of destroying the economy.

Chuck Schumer said, “Trumpcare is a giant, broken promise to working people, the hard-working people of this great country of ours.

It would be valid if Chuck Schumer could prove his statement.

President Obama broke his promise to the working people, the hard working people of this great country of ours, when he said, “ If you like your doctor you can keep your doctor and if you like your insurance you can keep your insurance.”

Chuck Schumer did not see it then and he does not see Obamacare’s failure now.

I suggest that Chuck Schumer read the Republican bill carefully before he makes his false statements.

Clearly, he was dead wrong in his judgment about Obamacare

If he read the Obamacare law carefully and voted for doing the right thing, America’s healthcare system might not be in the mess it is in.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Obamacare Coverage: The Big Lie

Stanley Feld M.D., FACP, MACE

President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success.

The Obama administration told us that 20 million new people have obtained healthcare insurance because of Obamacare.

We know 14.5 million people lost their healthcare insurance in the individual market the year after Obamacare was passed.

Many assumed they got their insurance back through Obamacare. There is no evidence for that assumption.

I followed Obamacare enrollment carefully on acasignup.net.

This site was supposed to be publishing the exact numbers published by the government weekly. www.acasignups.net

It turns out that the numbers published were inaccurate. They were too high.

“Since the release of the HHS study, the government has published two additional surveys of health-insurance coverage – the Current Population Survey (CPS) and the American Community Survey (ACS). Both offer data through the end of 2015, allowing for comparison with the NHIS estimate.”

The government now claims these studies are only estimates of nonelderly adults, under the age of 65, who gained insurance coverage.

The estimate in increased adult coverage ranges from 13.5 million in the CPS study to 16.5 million in the NHIS study.

Where did the number 20 million new lives covered come from? Bill Clinton boosted the number to 25 million when campaigning for Hilary Clinton.

Edmund F. Haislmaier and Drew Gonshorowski of the Heritage foundation examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.

“Their study found that 14 million people (including children) gained public or private coverage in 2014 and 2015.”

This total is even lower because it includes S-Chip coverage for children.

Compounding the government lies of estimated enrollees was that 84% of the new enrollees was either Medicaid or S-Chip children.

This means only 2,240,000 people signed up in President Obama’s Health Insurance Exchanges.

It also means that there were 11,760,000 new Medicaid or S-Chip patients.

Edmund F. Haislmaier concluded in testimony to congress;

“While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that

for the three year period 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private sector coverage enrollment.”

http://budget.house.gov/uploadedfiles/house_budget_testimony-haislmaier.pdf

Eighty-five percent of the 2.7 million have pre-existing conditions. Most are receiving government subsidies.

The 2.7 million covered under Obamacare have destabilized the healthcare insurance market so that healthcare costs for businesses have become unaffordable.

No one has even mentioned the cost of this Obamacare folly to the average hard working taxpayers with healthcare coverage from their employers.

Obamacare’s failure to has been devastating.

The authors also found that nearly half the new Medicaid enrollees met eligibility standards that were in place before the ACA.”

Maybe Jonathan Gruber is right when he said we, the public, are too stupid to know the wool is being pulled over their eyes.

 

“For all the hoopla about the ACA exchanges, it appears that Medicaid accounts for the lion’s share of coverage gains and that many new Medicaid enrollees would have been eligible for that program even if the ACA had never passed.”

Medicaid is a single party payer system (socialized medicine) that works very poorly. It is almost as bad as the VA Healthcare System.

Is this what the public wants? No

America needs a better healthcare system. Hopefully Dr. Tom Price knows what to do replace Obamacare with once he dismantles all of the Obama administrations regulation.

Maybe Jonathan Gruber is wrong.

The general taxpayer may be smarter than Dr. Gruber thinks. Maybe it is the reason the public elected Donald Trump.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Stop The Noise: Start Working

Stanley Feld M.D.,FACP, MACE

The New York Times is filled with case reports of people helped by Obamacare.

The implication is Obamacare is successful and the Republicans do not have a better plan.

Articles appear daily defending Obamacare despite the fact that premiums and deductibles are up, access to care and coverage is down and the medical profession and consumers are despondent.

Obama Says Healthcare Law is Working Fine

https://www.nytimes.com/2013/05/01/health/obama-says-health-care-law-is-working-fine.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obama Says Healthcare Law is Helping White Americans Despite Perceptions

http://www.nytimes.com/politics/first-draft/2014/12/29/obama-says-health-law-is-helping-white-americans-despite-perceptions/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Is The Healthcare Law Creating More Part Time Work?

http://takingnote.blogs.nytimes.com/2013/09/27/is-health-care-reform-creating-more-part-time-work/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Why Even Some Republicans Are Rejecting The Replacement Bill

https://www.nytimes.com/2017/03/07/upshot/why-even-some-republicans-are-rejecting-the-replacement-bill.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obamacare Users Await Repeal and Replacement With Dread Anticipation

http://www.cbsnews.com/news/obamacare-users-await-repeal-and-replacement-with-dread-anticipation/

All of this is “Fake News.”

I cannot understand how Dr. Ezekiel Emanuel, with a straight face on national television, can say Obamacare is not failing.

Dr. Emanuel thinks Obamacare is a great deal. He is one of its authors.

His problem is he cannot prove it is great in reality.

 

 https://youtu.be/1-PRvZ_R0-0

I guess the Democrats hope is if you tell a lie enough times it becomes the truth.

The conservative media is starting to figure out how to neutralized this tactic that engenders sympathy for Obamacare. The Wall Street Journal published an article “How Obamacare Punishes the Sick.”

This article stimulates feeling against President Obama’s lies.

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions.”

 If one can disregard the fact that one case does not win a medical argument, one can start talking about what might work to create a cost effective quality healthcare system.

Obamacare and its bureaucracies have set up perverse incentives for stakeholders and against consumers.

A recently reported study by Harvard and the University of Texas in Austin demonstrated these perverse incentives.

Obamacare is supposed to help the sick. It turns out Obamacare punishes the sick with certain illness.

“But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.”

Diseases such as multiple sclerosis, rheumatoid arthritis, infertility and others high cost conditions are being charged higher deductibles, experiencing more prior-authorization for drugs, an increase in lesser quality substitution drugs, and often no coverage for the drugs they need.

Most of these conditions require long- term expensive medications.

Therefore consumers with these diseases cannot get treated adequately.

For example, a patient with multiple sclerosis might file a $61,000 claim.

Insurers lose money on every MS patient. An incentive is created for insurers to avoid enrolling patients with MS. The insurers then make its healthcare policy unattractive to people with multiple sclerosis.

Obamacare’s subsidy for patients with multiple sclerosis is inadequate for the cost of the disease’s care.

To mitigate that perverse incentive, ObamaCare lobs all manner of taxpayer subsidies at insurers. Yet the researchers find insurers still receive just $47,000 in revenue per MS patient—a $14,000 loss per patient.”

 

The insurer doesn’t want to loss $14,000 per patient. Patients are not stupid. They find the best coverage at the lowest price,

This insurer suffers high losses. He either leaves the market or decreases coverage. The perverse incentive leads to low quality care.

Patient with multiple sclerosis on Obamacare are not getting high quality healthcare.

Everyone losses. The government loses, the insurer loses but most of all the patient loses.

There is a better way to insure these people. In a free market system driven by my ideal medical saving accounts the creation of a high risk pool funded by all participating insurance companies in the lucrative private market spreads the risk to insurance companies and government while providing high quality care to qualified patients.

Politicians must start thinking smart.

The format of previous high-risk healthcare insurance pools was a disaster for all the stakeholders. High-risk pools can be formatted in a way that works for patients and does not contaminate the private market with spiraling insurance prices.

The Democrats ought to give up Obamacare. It is a dead horse.

Obamacare has failed for the many reasons I have pointed out in my blog over the past 7 years.

The Democrats’ knee jerk reaction would be why not just adopt a single party payer system.

The answer is look at the mess the VA system is in with it bureaucracy and apathy.

Republicans ought to stop trying to prove Obamacare is a failure.

The politicians ought to try to do something right for the people who put them in power.

They ought to get rid of Obamacare in the least disruptive way possible as quickly as possible.

I believe President Trump, Tom Price M.D., and Paul Ryan are trying to do just that with the American Healthcare Act that is being voted on the house tomorrow.

The conservative coalition in the house should get off its high horse and not shoot itself in the foot.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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