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Where Is The Missing Money?

November 30, 2015

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Stanley Feld M.D.,FACP,MACE

Does anyone know how much Obamacare cost each year? Does anyone know if Obamacare is the cause of America’s more than one trillion-dollar deficit each year despite the Obamacare tax increases that are supposed to pay for it ?

If someone knows they sure are not telling taxpayers. A good friend who is a liberal and a big fan of President Obama said to me he is not worried about the federal deficit. Neither is President Obama. President Obama has convinced his base that the budget deficit and America’s escalating debt is an insignificant problem.

It follows that he can spend money as he wishes and waste money with impunity. I was taught that is not the way to run a business. Especially when the waste fullness gets negative results that leads to more deficit spending.

The problem is the waste of money is reported in dribs and drabs and usually on a Friday afternoon.

We have seen that happen in the VA system. After one year and billions of dollars spent the waiting times have decreased slightly. The medical service to veterans has not improved. No one in the bureaucracy has been held responsible. Veterans have been complaining more loudly since nothing has improved.

Missing Money

“The federal government awarded over $5 billion to help states set up Obamacare exchanges, with the vast majority – $4.6 billion – going to 16 states and Washington, D.C.”

The Government Accountability Office (GAO) recently reported that most of the money has not been accounted for. Several of those State Health Insurance exchanges have gone out of business this year.

$1.4 billion of that has been spent on IT projects. This sounds very high for 16 different web sites. Why couldn’t everyone use the same website?

Three ($3 billion) has been “spent or drawn down.” Only some of the drawn down spending has been detailed.

At least $1.6 billion is unaccounted for. Only three states returned any portion of the money. The federal government has only received back $1 million.

It sounds like government bureaucracy inefficiency at best and fraud and abuse at worst with no one being held accountable.

Can Americans trust the government to run our healthcare system?

Where did those taxpayer dollars go?

More Missing Money

Obamacare created the co-ops to encourage State Health Insurance Exchanges to increase competition in state insurance markets.

The intent was to offer consumers choices with the hope of holding down premiums.

Co-ops were snuck into Obamacare to replace the public option. No one has spoken about this being a substitute for the “public option.” The public option is an obvious ploy to convert the healthcare system quickly to a single party payer system.

The public option was designed to compete with private insurers on the state level by offering lower premiums in order to force the insurance industry to lower its premiums. The co-ops were designed to do the same thing.

President Obama offered state co-ops $6 billion dollars for start-up costs. Since there were only 23 states co-op formed instead of 50 Congress decreased the total payment to $2.4 billion to the 23 start-up co-ops.

All 23 co-ops received their proportional federal loans to meet solvency requirements as well as start-up costs.

President Obama now claims the Republican house denied Obamacare enough money for the co-op to be successful.

Twelve (12) of the 23 nonprofit insurance co-ops announced they will not offer coverage to consumers who bought healthcare coverage in 2015 in 2016. They are bankrupt. Where did the money go?

Somewhere between 300,000 and 600,000 people will be shopping for more expensive healthcare coverage for 2016.

The remaining 11 standing co-ops are $500 million dollar in the hole.

There is no accounting available to explain why these co-ops have failed

Does anyone think these $2.4 billion dollar loans will be paid back to the federal government? I do not. It will simply be added to the federal deficit.

“CMS said the government would “use every tool available to recover taxpayer dollars” from the co-ops going out of business, but it declined to say how much she expected to recoup.”

There are many reasons these co-ops have failed. Republicans not giving the co-ops more money, as progressives and Democrats have claimed, is not one of the reasons.

Another area of missing taxpayers’ dollars.

The Senate Finance Committee is looking into the millions of taxpayer dollars being spent on ads to promote Obamacare enrollment.

The total federal government budget for ads and PR was nearly $1 billion in fiscal 2013. How much was spent on Obamacare?

The Health and Human Services budget for “paid media” is about $35 million for the current enrollment period. The $35 million dollars will be spent in the 38 states using HealthCare.gov in the 2016 enrollment period.

Chairman Orrin Hatch, R-Utah, raised concerns about agency ad spending and sent a letter to the acting head of the Centers for Medicare and Medicaid Services (CMS) asking for a full accounting of agency ad spending.

“Increased transparency on government spending on advertising will improve accountability and help ensure that the taxes from hardworking Americans are not squandered and wasted on ineffective or misguided government programs,” he wrote to Acting Administrator Andrew M. Slavitt.

Senator Hatch demanded the accounting by November 25^th. Does anyone think he received it?

In 2010, the nonpartisan Government Accountability Office (GAO) reported the Obama administration spent nearly $20 million on a Medicare brochure that contained “instances in which HHS presented abbreviated information and a positive view of Patient Protection and Affordable Care Act (PPACA) that is not universally shared.”

The GAO papered over the ridiculous expenditure.

GAO concluded that “nothing in the brochure constitutes communications that are purely partisan, self-aggrandizing, or covert.”

CRS reported HHS was second only to the Department of Defense, spending $197.4 million on advertising in fiscal 2013.

“The total federal government budget for ads and PR was nearly $1 billion in fiscal 2013.”

Would healthcare be so expensive if the government was transparent and congress was really on top of everything?

Physicians only receive 20% of the healthcare dollars spent.

President Obama and his administration spend taxpayer’s money at will.

Americans have to demand “more efficiency and much more transparency.”

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

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Wanting Something To Fail?

October 13, 2015

inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

If someone wants something to fail, make it complicated enough so no one understands what is going on.

I am convinced that President Obama wants Obamacare, Medicaid and Medicare to fail.

President Obama wants a single payer health care system. He said it as far back as 2003. This You Tube was uploaded on Aug 12, 2009.

https://youtu.be/LhEX3rHssJI

President Obama won’t tell the American people the truth about his plans for health care. Watch President Obama declaring his intention in his own words.

The result is everyone will receive the same healthcare under the government direction and control.

The ultimate goal is to make people dependent on the government.

The people will have no power to choose their physician or their treatment. It is true that every country in the western world has this system.

No country has proven that a single party payer system works for countries with the single party payer systems economy or their citizens. Surveys have shown that their citizens are satisfied.

The main reason people like it is because it relieves anxiety of being able to receive medical care even though they have relinquished their freedom to choose their physician or insurance company.

The biggest loss is independence from the government bureaucracy. People will be dependent on the decisions of unelected government bureaucrats.

The big questions that are never answered about medical costs are; who is spending most of the healthcare dollars and what are the healthcare dollars being spent on?

Do you want the government to decide if you are young enough to get an artificial hip or knee when you need it?

Do you want the government to decide about your treatment or do you want your doctor to help you decide on what your best treatment is?

President Obama is changing medical care in a methodical way. He is utilizing executive orders and rules and regulations written by non-elected bureaucrats, who are forced to follow his orders. Our elected officials should be in charge of government spending.

Many in congress know better and would not let President Obama do what he is doing. Most in congress are happy that he has exempted congress from Obamacare.

President Obama and his administration have been trying to do bad things very quietly to avoid political uproar. The mainstream media has been a great Obamacare ally.

The mainstream media has helped Obamacare keep these destructive regulations and their subsequent failures out of public view.

The media has also publicized President Obama’s lies about the success of Obamacare.

President Obama is adept at diverting blame for errors and failures in pursuit of his single party agenda.

At the same time he is trying to take power away from the states he is trying to persuade states to not permit big insurance premium rate increases requested by many health insurance companies for 2016.

President Obama’s Obamacare is the cause of the increases. He is positioned to blame the state regulators for the insurance companies not showing up to sell insurance for 2016.

If the states act to cut back rate increases the insurance companies will not participate in the federal and state exchanges for the 2016 enrollment period. The result will be the erosion of the possibility of competitive pricing.

The Obama spin machine started working at the beginning of the summer to shift the blame and/or force insurance companies out of the market.

Kevin J. Counihan, the chief executive of the federal insurance marketplace said in letter to state insurance commissioners, “Recent claims data show healthier consumers.”

He also said, “The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

This claim of costs data by Obamacare does not square with the healthcare insurance companies’ costs data. They are finding that new customers were sicker than expected. The insurance industry is also losing money because the Obama administration has paid them $2.5 billion dollars less than they were promised.

Health insurance plans sold through Obamacare’s Federal and State Health Insurance Exchanges are seeking 10 to 40 percent increases in premiums.

They are also seeking the same increase in the private sector as well as in Medicare and Medicaid.

The Obama administration is making up its own story to force state regulators to not allow the increased premiums.

The Obama agenda is choreographed to prove that insurance choices do not work. He is hoping that the public will conclude the only solution is a single party payer system.

The problem is the government cannot afford a single party payer system and the people will not tolerate it.

What is more bizarre is the Obama administration made loans to help start up state co-ops. These state co-ops were supposed to compete with the big insurance companies. They were supposed to sell insurance on the health insurance exchanges. The Obama administration invested $38 billion in startup costs and solvency loans to these co-ops.

Nevada Health Co-op received $66 million in federal loans. It is closing down on January 1,2016 because it ran out of money.

Louisiana Health Cooperative announced in July that it was voluntarily shutting down operations.

CoOportunity Health, which sold policies in Iowa and Nebraska, was liquidated and forced to close earlier this year.

Many state Co-op’s are on the way to bankruptcy. In Nevada alone one third of the health insurance exchange population will lose insurance coverage.

Nevada Health CO-OP’s departure will leave a big hole in Nevada’s exchange market. Open enrollment begins Nov. 1, and consumers will have to shop for plans with other carriers. The co-op had 21,300 members as of the first quarter this year. Nevada’s exchange population was about 63,000 at that time.

A.M. Best’s report shows a majority of the nation’s 22 co-ops have combined medical and administrative expense ratios above 100%.

All these failures and impending failures mean that either the Obama administration is stupid or things are going precisely as President Obama had planned.

The healthcare system is on its way to destruction. The federal government as the payer of last resort will replace it.

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

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What Are The 3R’s?

July 22, 2015

inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.FACP,MACE

The 3R’s are the Risk Adjustment, Reinsurance, and Risk Corridors program built into The Accountable Care Act (Obamacare). The 3R’s were meant to encourage the healthcare insurance industry to participate in providing insurance to participants in the State Health Insurance Exchanges. President Obama has extended the 3R’s to included Federal Health Insurance Exchanges.

The 3R’s were activated because of the poor enrollment in the State and Federal Healthcare Exchanges. It was billed to offer protection to the healthcare insurance industry against any losses incurred by participation in Health Insurance Exchanges.

The healthcare insurance industry’s participation in Obamacare’s Health Insurance Exchanges was negative at first.

The Health Insurance Exchanges were viewed as a trap set by the Obama administration to control the healthcare insurance industry. In the process the healthcare insurance industry would ultimately lose money.

The healthcare insurance industry did not participate widely in the health insurance exchanges at first.

“These risk-sharing programs are often called the “3 Rs” because they are Risk Adjustment, Reinsurance, and Risk Corridor.” The three risk-sharing provisions were intended to protect insurers financially, especially in the first few years the Exchanges are in effect if activated.”

The ACA includes various mechanisms to accomplish this goal including requiring insurers to cover everyone who applies, prohibiting insurers from imposing preexisting conditions limitations, and severely limiting the factors insurers can consider in setting premiums. Obviously, these mechanisms put insurers at financial risk, since their underwriters won’t have sufficient data to predict claims costs, such as the number of people likely to enroll, their health status or claims history, or other demographic information on enrollees.

The Obama administration included this safety net for healthcare insurers. It also set the traps for the healthcare insurance industry.

Purpose of Permanent Risk Adjustment

To combat overall adverse selection since health insurance is now guaranteed to anyone who applies. Healthcare insurance carriers cannot impose pre-existing conditions limitations. They cannot vary premiums based on individual’s health status.

The trap is that the government will redistribute money between insurance carriers. The Permanent Risk Adjustment scheme is supposed to redistribute profit from insurers with lower claims enrollees to those with higher claims enrollees and losses.

All non-grandfathered insured plans in the individual and small group market, in or out of the health insurance exchanges, are supposed to pay for this redistribution of money. This redistribution is to be monitored by the federal government. (Another bureaucracy)

Does anyone think this can work? I don’t.The second R is the Transitional Reinsurance Program. It is to run from 2014-2016 and then stop running.

The Transitional Reinsurance Program’s purpose is to stabilize premiums in the individual market during the first 3 years the exchanges operate, because higher-cost (sicker) individuals are more likely to enroll early.

This program’s purpose is to redistribute money from group health plans that make a profit to certain insurers with Qualified Health Plans on the individual State and Federal Exchanges that have high cost (claims) enrollees to prevent loses for those insurance companies. This is supposed to encourage insurance companies to join the exchanges.

All group health plans are required to pay for losses in 2014. There has been no reporting as yet to let anyone know how this has worked out in 2014. This provision further exposes President Obama’s lie that “if you like your plan you can keep your plan.” He knew no one could keep their healthcare plan as the bill was written.

A specific waiver was provided for 2015 & 2016. There are a few self-insured plans that self-administer their claims. Most corporations use healthcare insurance companies as third party payers. Therefore, the wavier is essentially eliminated.

The traditional reinsurance program is going to be very difficult to administer.

The Temporary Risk Corridor for 2014-2016 makes the 3R program even more complicated and more difficult to administer.

The goal of the temporary risk corridor is to limit insurer gains and losses in first 3 years of Obamacare and place all healthcare insurance company risks on a level playing field. The healthcare insurers have a limited amount of data on the risk of claims for Health Exchange enrollees. The healthcare companies have histories of claims for Qualified Health Insurance Plans and the expected enrollment. The health Insurance companies have to guess at their actuarial risk if they participate in Obamacare in order to set premiums.

Limiting the healthcare insurance industry’s risk will be complicated for the government.

Insurers who have actual claims more than expected claims will be paid the excess if funds from these insurers are not sufficient. HHS is directed to pay the excess.

The problem is Obamacare (ACA) did not provide for creation of a specified source of funds or a revolving fund for HHS to pay this excess.

In 2014, the first year of the exchanges insurers received $450 million dollars. The source of the government funds is unclear.

An important concept about insurance reimbursement is always ignored. Insurance claims have nothing to do with the actual insurance reimbursement. Reimbursement is usually 50% less than the claims.

Therefore, the amount of supposed payment is doubled using claims to calculate payment and probably future premiums.

The government is hoping that the entire scheme is budget neutral. It will collect and redistribute the profit made by one insurance company to the insurance company that loses money from the high-risk patients.

The government thinks it will have no out of pocket reimbursement obligation.

The government plans to compare insurers within a state based on the average financial risk of their enrolled population.

“ To more evenly spread the financial risk among insurers, government payments are made to insurers who cover a higher-risk population (e.g., people who are older, sicker or have more chronic conditions) from the profit of lower risk insurers. “

Theoretically, the insurers who make a profit from the lower risk population pay the insurers who make less from their older, sicker population with many chronic diseases.

This is called redistribution of profit and wealth. I have a tough time believing that profit making companies will sign up for that.

Below are the formulas that will be used in 2014 and 2015 for the redistribution of profit of healthcare insurance companies.

“2014: Once an insurer has paid $45k in claims for an individual (the attachment point), the insurer is reimbursed for 80% of costs between $45k & $250k per person. (Originally $45k was $60k)”

“2015: $70k attachment point per insured, then insurer will be reimbursed for 50% of costs between $70k & $250k per person. HHS publishes a Notice of Benefit & Payment Parameters each March, with the numbers for following year.”

“If actual claims are within 3% of expected claims, insurers in Exchanges keep the profits or bear the risks. If claims are 3-8% more (or less) than expected, insurer pays the gov’t (or is reimbursed by the gov’t) 50% of the gains (losses) and keeps (or bears the loss of) the other 50%.”

“If claims are at least or > 8% more (or less) than expected, insurer pays the gov’t (or is reimbursed by the gov’t) 80% of the gains (losses) and keeps (or bears the risk of) the other 20%.”

It is all very complicated. It will be impossible to enforce. This is another Obamacare trick to fake out the very profitable healthcare insurance industry.

I think the healthcare insurance industry knows all this. They are taking steps at this very moment to dodge the Obama administrations trap.

The losers will be the American people who will experience an increase in healthcare insurance premiums and higher taxes.

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Republican Leadership Is Chickening Out!

January 7, 2015

inConsumer Driven Health Care, Medicine: Healthcare System

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Stanley Feld M.D.FACP, MACE

Since the Republican’s massive victory in November President Obama has been setting up strategy to blame Republicans for all that will go wrong as that majority pledged they would repeal Obamacare.

It was strange that President Obama was not contrite or acted defeated by the election. He said 66% of the people did not vote. He said that those 66% did agreed with his policies and therefore it was a mandate for him to carry on.

President Obama knows he has the RINO’s on their heels

The traditional mainstream media did not question President Obama’s premise that 66% liked his policies.

Another explanation could be that those 66% disagree with President Obama’s policies. They believe in President Obama but believe his policies are wrong and did not vote for them.

After all, President Obama said the election was about his policies.

He has not paid attention to needs or will of the Americans people.

President Obama has used the traditional mainstream media (TMM) to promote his agenda. After the TMM publishes the Obama administration’s lies over and over again it becomes the truth even though it remains a lie.

A perfect current example is the administration’s lie that open enrollment for Obamacare is going great.

‘The Republican moves come, ironically, as the Affordable Care Act is working fairly well. The three-month enrollment season for 2015 is going smoothly and will likely surpass the administration’s modest second year goals of having 9 million covered in exchange plans.’

After two years of open enrollment if Obamacare signs up the original estimate of 13 million, it still has 320 million people short. However, President Obama will tout the amazing success ever though Obamacare is unsuccessful and harmful to Americans who were satisfied with their insurance and their doctor before Obamacare.

President Obama has been collecting increased taxes for Obamacare for 4 years.

“Republicans have been vowing to repeal Obamacare for nearly five years. But 2015 could be the year that Republicans finally define how they would replace it.”

Now Republicans are chickening out. Some Republicans want to delay their repeal strategy until after the Supreme Court rules on the King v. Burwell case in June. Some want to delay it until the presidential campaign in 2016.

I believe Republicans should be aggressive. They should lay out a business model that will work immediately. Then repeal Obamacare . Let the President veto the bill as Republican actively work to replace Obamacare with a carefully explained alternative that makes sense to the public. Republicans can then try to overturn the Presidents veto.

President Obama has asked Republicans over and over again to give him some ideas to fix Obamacare. Obamacare cannot be fixed because of President Obama’s ideology. It must be repealed.

Republicans have many ideas to replace Obamacare with. For years they’ve discussed tax credits to buy insurance, high-risk insurance pools that work and allowing insurance to be sold across state lines. They need to put these ideas together with a compelling and viable business plan such as my ideal medical savings account.

Republicans must create a consumer driven healthcare system.

President Obama and the media have mocked Republicans for not having a plan or offering a fix for Obamacare. I said previous there is not fix for Obamacare. The American public does not want their freedoms restricted. In addition a single party payer system have failed economically in all of the developed countries except Switzerland.

“Various Republican proposals have been put forth over the years, but forging agreement requires bridging deep ideological differences among Republicans about the scope of a plan, the role and responsibility of the federal government in health care, and how much to money to spend.”

A plan must include an entirely new system that includes a business plan. The plan must include the freedom for consumers of healthcare to choose and provide access to care without rationing of care.

The plan must also include systems of care for the most expensive chronic diseases such as Diabetes, Asthma, Cancer and Chronic Infectious Diseases.

The plan must not exclude access of care for the elderly that need hip replacements, knee replacements, cancer treatment or heart disease.

The plan must develop a system for decreasing the cost of the treatment of chronic diseases. It must have within the treatment system a plan to make the consumers more responsible for the health and healthcare dollars.

It should shift the responsibility of care from the government and insurance companies to consumers. Consumers should decide what they need not the government.

Republicans have had six years to decide on what they should be promoting.

President Obama is in a perfect position to mock and veto any Republican piecemeal suggestion.

President Obama has already smiled regarding the new Republican majorities when he said he has to sharpen his veto pencil implying all they will do is present bills that are stupid.

However, the Republican leadership, rather than passing bills in the senate and house of representative to repeal Obamacare, have chosen to work with the Democrats and President Obama.

The Republican leadership is too afraid to do anything scary. They are afraid to lose votes to the Saul Alinsky tactic of ridicule. It might cause them to lose the 2016 Presidential election.

So what does the Republican leadership do the first day they are in power? They take away key healthcare committee chairmanships of leaders who have voted for the removal of Speaker Boehner.

Next they propose a lame reform to change the definition of part-time employment from 29 hour a week to 40 hours per week.

“President Obama would veto Republican legislation that would alter the definition of full-time work under Obamacare from 30 to 40 hours, the White House said Tuesday.”

It is a stupid proposal on many levels.

The Harvard faculty uproar of the last few days is very important. Almost all the faulty were big supporters of Obamacare until it affected them. I hope the rest of the country reacts the same way and demands their local newspapers publish multiple stories about their citizens pain.

Now that the Republicans are in power in both houses they should be educating the public about the irreparable issues in Obamacare and define its business model for 2020.

The Republicans should let everyone know they are feeling the public’s pain. Republicans should define a business plan that will provide healthcare for everyone at an affordable cost.

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

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What Republicans Must Do Now

December 2, 2014

inMedicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

The following is a weekly tracking of 2015 enrollees for Obamacare. I will try to report it weekly. Open enrollment ends February 28, 2015.

The only information the Obama administration has provided to the traditional mainstream media is the statement that open enrollment is going well.

ACASignup.net is providing weekly tracking against the estimates CMS has provided on the government’s web site. The data is there but the traditional mainstream media does not look at it or report it.

ACASigup.net

Tracking Enrollments for the Affordable Care Act (aka Obamacare)

Confirmed 2015 QHPs: 534,000 as of 11/27/14

 Estimated 2015 QHPs (

Cumulative): 1st Week: 610K (462K HC.gov) • 2ndweek: 1.04M (780K HC.gov) 1,160,000 as of 11/30/14

The actual enrollment versus estimate enrollment is minus 626,000 for the first 2 weeks of open enrollment. To look at state by state enrollment go to http://acasignups.net/projection

What must Republicans do about Obamacare now that they have control of the Senate and the House of Representatives?

The Republican majorities in the House of Representatives and the Senate must develop positive alternatives to Obamacare that all the stakeholders can accept.

Republicans must address the concerns that led to Obamacare’s enactment in the first place. The dysfunctional parts of the healthcare system pre-Obamacare were unsustainable healthcare costs, too many uninsured and a lack of protection for patients with pre-existing conditions.

The healthcare system’s business model was dysfunctional before President Obama forced Obamacare through congress. All Obamacare has done is add more rules, regulations and bureaucracy to the healthcare system while imposing increasing government control.

The result has been greater impingement on Americans’ freedoms as well as increased costs to taxpayers. Taxpayers are experiencing less personal care, less choice of care, less access to care, higher taxes and higher out of pocket expenses.

The healthcare costs to society are becoming more, rather than less, unsustainable as a result of Obamacare. These increased costs have had a negative impact on the entire economy.

“We need to get rid of Obamacare instead of attempting to fix it because it is fundamentally flawed, cleverly designed to lead us over time to a single-payer system.”

This notion is widely accepted. Is a single party payer system a dirty phrase? No.

The problem is that a single party payer system has not worked efficiently anywhere in the developed world except Switzerland despite progressives’ spin to the contrary.

Obamacare’s road to a single party payer will become clearer when the employer mandate provisions kick in. The employer mandate was to begin in January 2015. It has already been delayed to 2016 or 2017. The Obama administration changed the law in order to make the ultimate goal of a single party payer system less obvious to consumers.

Meanwhile, new taxes to pay for Obamacare have been in effect since 2010.

Companies have already dumped workers from their employer plans into government-run exchanges by decreasing full time jobs to part time jobs.

The exchanges should have theoretically swelled. They haven’t because the premiums and deductibles are too high. If the exchanges swell they will become more costly to taxpayers. Americans will be told we must switch to a single payer system because a government monopoly will be more cost-efficient.

At that point it will be Medicare for all. Medicare is a single party payer system that has become unsustainable. Where is the logic?

Republican majorities must articulate Obamacare’s destructive mayhem to the American public. The public is experiencing this mayhem right now. Republican must describe it and its cause.

President Obama is going to come back and blame Republicans for being obstructionist. Republicans must be right there and explain that President Obama and his administration owns the mayhem.

The public is not stupid.

Republicans should start proposing constructive alternatives. I have outlined these constructive alternatives in the past.

Republicans must present a plan which addresses the unsustainable healthcare costs, the uninsured and the lack of protection for patients with pre-existing conditions.

These alternatives should be developed through congressional committee debate, media debate and a public relations campaign.

Stakeholders other than consumers have invested lots of money in adjusting and profiting from Obamacare’s new rules and regulations. They think they have a competitive advantage. They are wrong.

Medical care must between patients and physicians. Patients have tremendous power in the healthcare system. They just do not realize it yet.

Large financial companies with their lobbying power are investing in healthcare in order to profit from the Obamacare chaos. They view consumers and physicians as commodities.

Soon their companies will be too big to fail. However, the government is the only entity that can bail them out. The problem is the government will have failed too. These companies will have no one to bail them out.

Republicans must be responsible and responsive right now.

Republicans must promote and harness Patient Power so that consumers, not government, are in control of their health, healthcare dollars and their medical care.

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

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Another Day, Another Unconstitutional Change

March 5, 2014

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

The Obamacare’s new mandate delays are a bid to save Senate Democrats from losing their election in 2014.The mandate delays are also a bid to save Obamacare’s health insurance exchange.

It is strange that no one has noticed that the taxes resulting from Obamacare have not been waived.

An additional insider leaked delay in the law is coming up in the next few days. The hope of this next delay is to keep Obamacare off the minds of the voters in November 2014.

The Russian invasion of Ukraine has steered the subject away from Obamacare in the news.

President Obama has continued to spin Obamacare positively.

“President Obama predicted at the House Democratic retreat on Friday that "10 years from now, five years from now" people will look back on the Affordable Care Act as "a monumental achievement."

Unfortunately Obamacare has so many defects that it continually reminds the American people it is a disaster.

The laws mandate requires businesses with the equivalent of 50 full-time employees based on a 30-hour work week to cover 100% of their workers or else pay a fine, starting Jan. 1, 2014.

The unconstitutional change is to push the deadline to 2016. President Obama also changed the definition of the category. The new category is a business with 100 or less people rather than 50 people working in the business.

Businesses with more than 100 people employed full time will have to cover only 70% of their workers as opposed to 100% of their workers.

I think this will continue to prevent businesses from expanding and dampen the creation of jobs. Business does not trust President Obama anymore.

The only way for President Obama to alleviate labor market uncertainty would be to ask Congress to repeal the mandate permanently.

I am waiting for someone to challenge these ad hoc changes to Obamacare on constitutional grounds. No one has the guts in this election year.

I think healthcare insurance cancellations will still occur before the November 2014 elections.

Insurance companies are permitted to charge for Obamacare’s costly gold-plated "essential benefits" that all plans will have to cover. Insurance premiums will be unaffordable. The elimination of these essential benefits would reduce the cost for small business coverage.

We get it. President Obama does everything for his political benefit. He has created a political alibi of claiming to exempt some businesses so he can shift the blame to the insurers when the cancellations begin.

The public will remember that he created the insurance burden and had also permitted the healthcare insurance industry to raise the price of premiums.

The mandate delays can also serve as another President Obama trick play. As small business employers drop coverage of their employees more employees will sign up for Obamacare health insurance exchange coverage.

He might be surprised as more and more healthy people opt out of the insurance market to be self-insured.

The Obama administration is doing its best to eliminate high deductible insurance plans. However hospital systems are exempt from the Obama administration restrictions on high deductible plans. They are adopting these plans in order to gain advantage over their local competitors.

Obamacare enrollment has been abysmal through February. The administration has been very quite about the actual numbers as both Dick Durbin and President Obama are announcing that10 million have signed up.

My guest is they will be lucky if 3 million have signed up and gotten insurance coverage. All of these probably have preexisting conditions and are at high risk for high cost.

This number is far below the 6.6 million people who have lost insurance in the individual market so far because of Obamacare.

The more lies we are told the more credibility and trust is lost and the less cooperation will be forthcoming.

America is waking up.

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

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Great Questions!

April 1, 2012

inMedicine: Healthcare System, Summary Blogs

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Stanley Feld M.D.,FACP,MACE

A reader wrote,

“Stan

If the Supreme Court watchers are correct, it appears the court will strike down parts or possibly all of Obamacare later this spring.

If that happens, it is a good thing?

And if so, where do we go from here?”

The court should overturn Obamacare. In my view Obamacare is unconstitutional. President Obama deceived the congress, the public and the Congressional Budget Office about the true costs and intent of the law.

I hope the Supreme Court overturns Obamacare. Obamacare will be a disaster. Obamacare will destroy healthcare in this country. The public, media, and congress cannot yet understand it.

Many congressmen said they did not read the entire bill. Nancy Pelosi said “Don’t worry, we will understand what is in the bill once it has passed.”

Democratic spin-doctors and the traditional media accused the Internet page-by-page summaries of the bill as being anti-Obama propaganda.

President Obama disguised the costs and intent of Obamacare in a deceptive and clever way. It is a bill that puts America on Hayek’s Road to Serfdom.

Obamacare promotes dependence on the central government as it expands a failed entitlement.

It eliminates initiatives and incentives.

It decreases freedom of choice.

It expands an entitlement that America cannot afford.

America cannot afford to keep paying for the entitlement (Medicare) at the present enrollment. The states cannot afford the Medicaid entitlement much less its expansion.

President Obama ignores this enormous cost burden whose real cost estimates increase monthly by the CBO as the impact of Obamacare’s rules and regulations increase. Non-elected officials without a congressional oversight mechanism make rules and regulations.

How would you like to be told which doctor or which hospital you can go?

How would you like your physician to treat you in a certain way dictated by the federal government?

Medical science is changing rapidly. Best practices change quickly. The bureaucratic machinery implements change very slowly. Decisions for best practices and payment will be made by committee and not individualized by your physician using his best clinical judgment.

How would you like to put your health and healthcare needs and decisions in the arbitrary hands of some government institution that is being forced to save money?

How would you like to be forced to purchase a government insurance policy that has the right to restrict access to care and ration care?

How would you like the government to make all your healthcare decisions for you?

How would you like to not have freedom of choice and the right to participate in decisions about your health and healthcare decisions?

How would you like to be paying taxes for a very inefficient bureaucracy that does all these things to you?

Obamacare has already demonstrated that it is inefficient, wasteful, plays favoritism at the government's whim with no recourse by the individual.

An overriding goal of President Obama is central control of one sixth of the economy. He is pasting his healthcare reform act on top of a doomed 2011 business model.

Obamacare is accelerating the collapse of this doomed business model. Obamacare must be repealed or eliminated.

This has been healthcare journey so far.

Figure 1 shows the path of the healthcare business models since 1945

Figure 2 describes the hairball of interference by the government and the healthcare insurance industry in the physician patient relationship. It also describes the fragment view of the patient as a result of this hairball.

If the reader is interested in the reasons this all came about click on the underlined heading to read the source material in figure 3.

Figure 3: This is an easier figure to click on the source material and reference. The chasm between the patients and physicians must be eliminated in order to have an effective healthcare system.

Figure 4: America is at the critical turn now. All of the mistakes President Obama is making to Repair the Healthcare System are listed. He is going to accelerate the collapse of the healthcare system. The mistakes are referenced in the underlined headings. The references can be read by double clicking on the underlined headings.

Figure 5: My proposed future direction can be seen in this figure. The detail below these headings can be read by double clicking on each heading. Some of the headings are included in Obamacare. President Obama’s problem is he is going about implementing them in the wrong way.

Figure 6: The spokes of the business model that must be implemented in the correct way are outlined in this figure. Details of the future state business model have been described in previous blogs.

I hope I have answered the reader's questions

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