Stanley Feld M.D.,FACP,MACE

The traditional media is not discussing the economic consequences of President Obama’s healthcare reform program.

In these final days the traditional media is describing the horse race to the finish line for a deemed vote (“Slaughter rule”) vs. a partisan up and down vote on the Senate bill. The horse race is a distraction to avoid discussing the unintended consequences of the bill.

Congressman Paul Ryan is the Ranking Member of the House Budget Committee and senior member of the House Ways and Means Committee. His focus has been to bring fiscal discipline to federal spending. The House Ways and Means committee’s jurisdiction is tax policy, Social Security and healthcare. He has been addressing America’s long-term fiscal crisis and the dangers of explosive entitlement spending.

He has accused President Obama of being dishonest to the American public about the costs of his healthcare bill.

I can understand the emotional appeal of President Obama’s healthcare reform plan. His solution will not repair the healthcare system. It will increase the price of care, decrease access to care and decrease many freedoms.

President Obama has said repeatedly, “I will not sign a plan that adds one dime to our deficits either now or in the future.”

If passed by this phony congressional “Slaughter maneuver” it will simply make the healthcare reform bill’s failure to solve our healthcare system’s problems even more grotesque. I predict the bill will cripple Americans’ ability to maintain their present standard of living.

I am sure Paul Ryan is frustrated that his remarks to President Obama at President Obama’s Healthcare Summit would be thought of as disrespectful by Democrats.

No one has refuted Paul Ryan’s accusations.

President Obama continues to recite his unsound sound bites about his healthcare plan. He claims it will save Medicare, provide coverage for 30 million more Americans and reduce the deficit.

I believe that anyone who votes for this terrible bill should not be reelected. They are doing a disservice to Americans.

Congressman Paul Ryan of Wisconsin made the following points before President Obama at the Healthcare Summit.

1. Medicare, right now, has a $38 trillion unfunded liability. That’s $38 trillion in empty promises to my parents’ generation, our generation, our kids’ generation
2. Medicaid’s growing at 21 percent each year. It’s suffocating states’ budgets. It’s adding trillions in obligations that we have no means to pay for . . .

He then went on to say that the Congressional Budget Office scores bills with the premises and assumptions it is given. If the premises and assumptions are incorrect the score will be incorrect.

1. “And what has been placed in front of them is a bill that is full of gimmicks and smoke-and-mirrors.”

He continued by saying;

“And if you take a look at the CBO analysis—analysis from your chief actuary—I think it’s very revealing.”

1. “ This bill does not control costs. This bill does not reduce deficits. Instead, this bill adds a new health-care entitlement at a time when we have no idea how to pay for the entitlements we already have.”

The CBO letter to Harry Reid on March 11, 2010 states the bill will not decrease the deficit as President Obama claims, but it increases the deficit even as it increases costs.

“March 11, 2010

Honorable Harry Reid

Majority Leader

United States Senate

Washington, DC 20510

Dear Mr. Leader:

The Congressional Budget Office (CBO) and the staff of the Joint Committee onTaxation (JCT) have estimated the direct spending and revenue.

“Under the legislation, federal outlays for health care would increase during the

2010–2019 period, as would the federal budgetary commitment to health care.6

CBO now estimates that the federal commitment would increase by about

$210 billion over that period, rather than by $200 billion as previously estimated.”

If anyone is concerned about our budget increased deficit and increasing taxes for a bill that will not repair the healthcare system, understanding the numbers is important.

Paul Ryan dug into the details at the Healthcare Summitt;

1. “The bill has 10 years of tax increases, about half a trillion dollars, with 10 years of Medicare cuts, about half a trillion dollars, to pay for six years of spending.”

“Therefore the true 10-year cost of this bill in 10 years? That’s $2.3 trillion.”

1. “It takes $52 billion in higher Social Security tax revenues and counts them as offsets. But that’s really reserved for Social Security. So either we’re double-counting them or we don’t intend on paying those Social Security benefits.”
2. “It takes $72 billion and claims money from the CLASS Act. That’s the long-term care insurance program. It takes the money from premiums that are designed for that benefit and instead counts them as offsets.”

Kent Conrad (D) Senate Budget Committee chairman said that this is a Ponzi scheme that would make Bernie Madoff proud.

Five hundred million dollars is taken out of Medicare to fund the healthcare reform bill. This is not shoring up Medicare solvency. It is paying to expand the program.

Paul Ryan did not stop there. He kept pounding away at the smoke and mirrors that the traditional media is not even analyzing much less mentioning.

1. “You can’t say that you’re using this money to either extend Medicare solvency and also offset the cost of this new program. That’s double counting.”
2. “According to the chief actuary of Medicare as much as 20 percent of Medicare’s providers will either go out of business or will have to stop seeing Medicare beneficiaries”.
3. “When you strip out the double-counting and what I would call these gimmicks, the full 10-year cost of the bill has a $460 billion deficit. The second 10-year cost of this bill has a $1.4 trillion deficit.”
4. “Probably the most cynical gimmick in this bill is something that we all probably agree on. We don’t think we should cut doctors [annual federal reimbursements] 21 percent this year and next. We’ve stopped those cuts from occurring every year for the last seven years”.

The “doctor fix” was supposed to go into effect January 1^st. It was delayed until March 1^st. Now it is delayed until October 1^st. It was taken out of the Healthcare Reform Bill and
placed in a separate bill because it added $371 billion dollars to the healthcare reform bill’s deficit.

President Obama’s Healthcare Reform Bill ignores and in actually hides these costs. Hiding these costs does not take the costs off the backs of taxpayers, the deficit, or future tax payers.

12.” I’ll finish with the cost curve. Are we bending the cost curve down or are we bending the cost curve up?”

“If you look at your own chief actuary at Medicare, we’re bending it up. He’s claiming that we’re going up $222 billion, adding more to the unsustainable fiscal situation we have. “

13. “We don’t think the government should control our healthcare system. We want people to be in control. And that, at the end of the day, is the big difference.”

14. “ I’ve got to tell you, the American people are engaged. And if you think they want a government takeover of health care, I would respectfully submit you’re not listening to them.”

President Obama ignored Paul Ryan’s comments. He is ignoring the will of Americans. He is ignoring the fiscal consequences of a bill he is ramming through congress at the expense of the American people for something that will not work.

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

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Stanley Feld M.D.,FACP,MACE

Ann Braly’s (CEO of WellPoint), article in the Wall Street Journal on February 7, 2007 and the announcement of a 37% increase in healthcare insurance premiums by California’s Anthem Blue Cross(a WellPoint affiliate) illustrates several points.

1. The healthcare insurance industry wants Obamacare’s mandated insurance so it can service more enrollees.
2. It is easier to hate the healthcare insurance industry more than Obamacare
3. President Obama is able to ride in on his white horse and save Americans from the evil healthcare insurance industry.

Who wins?

1. The healthcare insurance industry.
2. The President and his goal to increase government. control over our lives and freedom.

Who losses? American citizens

1. Increasing government control over one-sixth of our economy

2. Increasing taxes in different ways.

3. Decreasing freedom to choose.

4. Restricting access to care.

5. Rationing medical care.

6. Infringement on our constitutional rights.

The healthcare insurance industry controls the healthcare system. It sets insurance premiums using defective accounting systems to determine an exaggerated overhead.

The States and their State Insurance Board control licenses to sell insurance. State Insurance Boards have not acted in the citizens’ interest in many states.

All the California State Insurance Board has to do is refuse Anthem Blue Cross a license to sell insurance in California. Anthem Blue Cross would lose 800,000 enrollees.

The healthcare insurance industry is the administrative service vendor for Medicare and Medicaid. The fees government pays to the healthcare industry are excessive.

The healthcare industry believes it adds value to medical care of patients.

“The reason costs are rising so fast, Mrs. Braly says, is because the way the health-care market is structured doesn’t give providers reason to control costs. The solution is to "reintroduce the consumer to the health-care equation," and on that front, she believes, insurers "are actually the part of the health-care delivery system that is there to create the value."

This is an important statement. Medical care is the relationship between patients and physicians. All the other stakeholders are secondary stakeholders. In Repairing the Healthcare System the most important issue to be resolved is how do you provide incentives to patients and physicians to control costs?

The solution is that consumers have to drive the healthcare system not healthcare insurance industry.

Government control of the healthcare system will not control costs. Programs that penalize physicians and patients will not control costs.

Patients can control costs and quality with the appropriate educational infrastructure. At present most patients choose their physician by word of mouth.

Healthcare costs can be controlled by consumers controlling their healthcare dollars. .

“Mrs. Braly thinks patients will make more cost-conscious decisions if they have the incentives and the tools—namely, the information about cost and quality that is the basis of any ordinary market. "Data just sitting there is not helpful, and its got to be meaningful, provided to the doctor and the patient in a meaningful way," she says. Far from simply being a bill-paying outfit or a hedge against risk, she sees WellPoint’s fundamental role as making "the health dollar more valuable, less wasteful, more efficient."

Mrs. Braly knows her company owns the healthcare dollar. She wants patients and physicians to be directed by her company to be more efficient. If they are they will be more valuable to her company’s bottom line.

I do not think she will reduce premiums. . I think increased efficiency will result in greater profits for WellPoint. Consumers have to be incentivized to be responsible for their health and healthcare. This is the only way you will reduce costs and decrease premiums. The government trying to force cost reductions will fail.

I do not think President Obama realizes he is being set up by the healthcare insurance industry. He believes he is setting the healthcare insurance industry up.

He has refused the Republican offer for a bipartisan effort at healthcare reform. It is almost as if he and the healthcare insurance industry are playing bad cop, good cop at the expense of the American people.

President Obama published Obamacare 5.0 on Monday four days before his so called bipartisan healthcare summit. His proposal is almost a duplicate of the Senate bill.

Michael Connelly, a retired constitutional lawyer, wrote a dynamite review of President Obama’s proposal which he dubbed Obamacare 5.0.

“After much anticipation, at least by the so-called mainstream media, the White House has released the new and improved version of Obamacare.

Since I have already had to read two previous versions of these monstrosities in the House and two more in the Senate, I call this version Obamacare 5.0 and it is actually an easy read.

It is not hundreds or thousands of pages long and it doesn’t take long for people to realize that it really changes very little.”

The President’s proposal makes the bill more palatable to the American public because he camouflages the implications.

“Some members of Congress have grown increasingly more concerned about the implications that these proposals have for freedom in this country. In that regard the proposal fails miserably.

This is all an attempt to hide the fact that the bill is still blatantly unconstitutional.”

Michael Connelly points out that President Obama’s proposal exceeds the authority granted to Congress in Article 1 Section 8 of the Constitution. It also violates the 9^th and 10^th amendments that protect the rights of people and the states.

His article is clear and precise. The critical details should be a wakeup call to all Americans. It is a must read.

I believe that President Obama’s proposal is in fact a ruse. It is designed to lure us into believing that the health care bill is actually about affordable health care when it is really about taking control of our lives and limiting our freedoms.

It is a cover for the fact that the Senate will try to pass this bill as a “budget reconciliation act” that will only require a simple majority in the Senate instead of the usual 60 votes.

We must act now to let our representatives in the House and Senate know that we are not buying
into these deceptions and that they will pay a price in November at the polls if this is forced on us.

During Nancy Pelosi’s call to action, she said if necessary they would parachute in and pass the bill.

President Obama’s proposal is a way to get a healthcare bill passed. If it passes it will cost Americans dearly. At this point he wants to pass any bill for the sake of saying he passed a healthcare reform bill.

His present proposal is the same as the terrible Senate bill. He will fail because he makes no attempt to be bipartisan.

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

 Stanley Feld M.D.,FACP,MACE

It is
very clear to me that neither the Obama administration nor the senate wants to
solve the root causes of the federal deficit problem.

The
sequestration debates are not getting to the root causes of the deficit. Eighty
five billion dollars will not make a dent in America’s 16 trillion dollar
budget deficit.

President
Obama is running around the country scaring everyone with the notion that vital
services must be cut or else the country will be paralyzed.

Recently
the congress and the President appropriated $60.2 billion dollars for aid to
Sandy victims. This is almost as much as the sequestration is going to
eliminate.

“The Senate voted
Monday to provide $50.5 billion in aid for victims of Superstorm Sandy. The
vote means Congress has approved a total of $60.2 billion in aid for Sandy
victims”.

America’s
big deficit problem is created by out of control entitlement programs. Obamacare
is adding to entitlement spending. It will only increase the deficit.  

Our
politicians’ should be working hard to figure out a solution to increasing entitlement
spending. Yet the Obama administration has refused to consider entitlement
reform.

America’s
two largest entitlements are Medicare and Social Security. Food stamps, and unemployment
insurance, among others has some impact on the deficit.

Simple
reforms and a decrease in waste could solve the problem.

The
following two articles summarize the illusion of the existence of Social
Security and Medicare Trust Funds.

In
reality the money goes into these trust funds from payroll withholdings. The
government then borrows the money to pay general expenses. It provides an IOU
to the trust funds. In essence the trust funds are broke and the IOUs are an
unfunded liability of the federal government..

“And since the
federal government borrows the surplus from both funds (Social Security and
Medicare) to pay other expenses, the only thing in those trust funds own
special, non-negotiable, interest-bearing IOUs.”

 http://articles.washingtonpost.com/2012-10-18/opinions/35502037_1_trust-fund-medicare-trustees-health-care

http://www.forbes.com/sites/merrillmatthews/2012/08/21/think-social-securitys-trust-fund-is-a-scam-medicare-has-one-too/

In order
to pay Social Security and Medicare obligations the government shifts revenue
of current accounts into the trust fund accounts.

Citizens
paying into Social Security and Medicare all those years thought they were
paying for a retirement annuity. The assumption was the money would grow with
wise government investments and those funds would be able to pay their promised
liability to seniors.

Those
payments were really a disguised tax. As baby boomers become eligible for
Medicare and Social Security the obligation is increasing.

America
is reaching the point where more people are receiving these entitlement
benefits than the younger people who are funding them.

The logical result is the premium price for
Medicare coverage is scheduled to double in 2014. The deductibles for services are
scheduled to increase. The age requirement for eligibility is about to rise.  Access to care is decreasing as physicians
refuse to take Medicare. Rationing of care is increasing as hospitals are being
forced to assume risk. No one wants to assume the risk of taking care of sick
people. Especially when they are not very good at evaluating the risk.

Everyone
knows all of this. Nevertheless they turn away as the government either borrows
more or prints more money.

Americans
have been told by multiple administrations that citizens could not handle their
own Social Security or Medicare annuity very well. Therefore the government
must do it for them.

The
government has done an awful job managing our retirement annuities.

Social
Security and Medicare Trust Funds must become real trust funds that grow in
value in the future or the government should hand control over to the people.

The Obama
administration refuses to believe the significance of defensive medicine.
Defensive medicine’s cost to the healthcare system is somewhere between 300 to
700 billion dollars a year.

The Obama
administration’s estimate is it costs 3 billion dollars a year. They are wrong. Ask any physician.

Why
should physicians or hospital systems assume the risk of missing a diagnosis by
not doing a test?

The
emotional and financial consequences of a frivolous lawsuit can be devastating.

Simple
and fair tort reform will save the healthcare system around 500 billion dollars
a year.  The 500 billion dollars is more
than 5 times the cost of the 85 billion dollar sequestration. The administration
is wasting 500 million dollars to protect the business of malpractice trial
lawyers.

The
administration claims its overhead for Medicare is only 2 ½ %. This represents
the cost to pick an insurance company to adjudicate insurance claims. The true
cost is not clear. However, it is somewhere between 40-60% of every Medicare
dollar spent.

The
insurance company is permitted by the government to pack many expenses into the
direct patient care column and avoid going over the 15% medical loss ratio
allowed.

The ten
hidden taxes written into Obamacare are now starting to be felt. The Obamacare taxes
are going to increase the cost of medical care not decrease the cost as the
affordable care act promises. 

Patients
are directly responsible for many of their own medical outcomes.  If patients had skin in the game and
financial incentives they would pay attention to their self -care and their
physicians’ recommendations. 

There are
no incentives in Obamacare for patients to manage their care effectively.
Financial gain would get their attention.

These are
just a few of the solutions to the real problems in healthcare. There is much
more waste in federal spending than $85 billion dollars a year.

All you
have to do is look at the list of extraordinary waste that Senator Tom Coburn
has compiled.

Rand Paul
did a clever thing. He sent $600,000 of his senate office budget back to the
U.S. Treasury after carefully trying to save money. The 49 other senators and
over 400 congressperson ought to do the same. It would set an example for all
of the bureaucracy to do the same. In fact President Obama ought to demand it.

“The
Kentucky Republican returned $600,000 in funds he saved from his Senate office
budget in the last year, the Louisville Courier-Journal reported.

“It’s
the only budget I control,” Paul said at a news conference in Louisville. “It’s
not enough, but it’s a start.”

If every
congressperson saved 600,000 a year as Rand Paul did the deficit would be
reduced by $321 million dollars more a year. If all the cabinet positions and
their agencies tried to save money and were rewarded for saving money we would
start to make some progress in decreasing the deficit.

The Simpson
Bowles Report commissioned by President Obama would be helpful in eliminating
unnecessary agencies and duplication. Their report has been ignored by the
Obama administration.

Why has
President Obama refused to listen to people who have exposed the many areas of
government waste? It is incomprehensible.  

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



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