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Keeping Obamacare Out Of The News

May 27, 2014

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

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Stanley Feld M.D.,FACP,MACE

President Obama has tried to keep the bad news about Obamacare from us. The bad news concerning errors in design and execution are being recognized daily. The administration has not published the demographic figures of those who enrolled in Obamacare yet.

It is going to be impossible for the administration to keep Obamacare implementation errors out of the news. Even the traditional media, big Obamacare fans, are starting to realize the huge defects in Obamacare and the hardships it is about to bring.

The defects are becoming obvious because they are affecting the majority of the working middle class signed up through the health insurance exchanges.

Bureaucracy has created evaluation of care panels. While the panel members, most of them clinicians, agreed that a study could be impressive in its implementation and results, they have concluded that some studies were not good enough to recommend a new coverage policy to the CMS.

The members of the committees are usually not the most expert in the field they are evaluating. Thus, access to care through government coverage is denied when it should not be.

I previously gave the example of Medicare’s discussion to not pay for lung cancer screening even though the U.S. Preventive Services Task Force made the following recommendation based on their review.

"Smoking-related lung cancer kills about 130,000 Americans each year. The five-year overall survival rate for lung cancer patients in the U.S. is 16.8%. That low rate has been attributed to the late stage of diagnosis for the disease. The Preventive Services Task Force estimated that as many as 20,000 lives could be saved each year if its recommendation was fully implemented."

The USPSTF is not the ultimate authority in my view, but even using it as the ultimate authority Medicare ignores its recommendation because of the cost burden.

The Affordable Care Act (Obamacare) has touted Preventive Services.

What is the meaning of Preventative Services?

I guess it is to prevent diseases from occurring.

I believe if we could prevent obesity, stop cigarette smoking and alcoholism we could prevent a lot of diseases from occurring.

However, patients are the only ones' who can only prevent these diseases from occurring.

If we could genetically type diseases and alter those genes we could prevent the disease from occurring. This would relieve individuals of their own responsibilities.

The government defines Preventive Services as identifying disease by screening for disease in people who have no signs or symptoms of disease.

The idea of screening patients for diseases is to make the diagnosis early enough in a disease process so that when treated early patients can be cured.

In other words, a 40 year- old woman can have a free screening mammogram.

If the same woman notices a breast lump by self-examination and goes to her doctor to have it evaluated, she’ll pay for a diagnostic mammogram.

The mammogram can be as much as $300. With a high deductible Health Insurance Exchange plan she would pay out of her pocket because of the high deductible.

It means that a woman with no breast lump and at lower risk for cancer has incentive to be tested because it is free while the woman with a lump at higher risk of cancer faces financial disincentive to get a mammogram.

Isn’t that a little crazy? That’s the problem with giving patients things for free under different circumstances.

“Subsequent interventions are an integral part of all screening. Were I a mammographer, I’d happily argue that additional mammographic views, ultrasounds, M.R.I.s and breast biopsies are all part of screening.”

This decision should not be made by the by a committee of non-experts. Individual patients should make these decisions after discussion with their physicians.

This is a defect in the bureaucratic definition of Preventative Services. Should the government provide the entire work up free?

A crazier example is a 50 year old undergoing a screening for colon cancer.

If a patient had a fecal test for occult blood for screening for colon cancer and it was positive, the patient would have to have a colonoscopy. Occult blood screening is inaccurate. It is cheap and free. It has a lot of false positives.

If the patient had an initial colonoscopy for screening it would also be free according to the Obamacare rules.

If during a colonoscopy a polyp were found the screening test would be reclassified as a diagnostic test. If it were a diagnostic test patients would have to pay for it. It would be an out of pocket expense for the patient on Obamacare making over $50,000 a year.

The outcry caused the government to change the rule. The polyp biopsy would be part of the colonoscopy and still be free to the patient. Do not forget someone is paying for it.

Medical decisions should not be made by government rules. Patients should make the medical decisions for themselves with the advice of their physicians.

If patients had control of their health care dollars with the ideal medical savings account they would become true consumers of healthcare.

Patients would become responsible for making the decision on when to screen and what diagnosis to screen for and how often to screen for disease.

Patients would have to have the information to make those decisions. With the state of the information available and their physicians’ help responsible patients can make those judgments.

Patients have to drive the healthcare system. The government should be concentrating on setting up systems to teach patient how to be educated purchasers of healthcare.

The confusion created by confusing and ever-changing rules puts an emotional and a financial burden on all stakeholders.

Some use the argument that patients are not smart enough to be responsible for they health and healthcare dollars. It is their reason for totally free healthcare for all.

I believe this is disrespectful to our intelligence and our ability to learn to survive.

Paul Krugman a devoted liberal/progressive has shown little respect for the average Americans’ intelligence.

In my view Paul Krugman has been wrong about almost everything. He writes articles of opinion for the New York Times that are not based on any facts.

In 2011 he wrote an article “The VA Is A Huge Policy Success Story’

Paul Krugman wrote; “The V.H.A. is a huge policy success story, which offers important lessons for future health reform.”

And yes, this is “socialized medicine”. But it works — and suggests what it will take to solve the troubles of U.S. health care more broadly.

Where is Paul Krugman’s evidence? The VA healthcare system didn’t work in 2011 and it doesn’t work today. The VA produces nice reports that do not have anything to do with reality.

There is much to write about the recent VA problems. I promise to get to these problems shortly.

The lessons to be learned from the VA’s problems are these problems a precursor to the Obamacare problems.

I fear this is what the American public is going to be facing as the Obama administration tries to implement Obamacare.

Obamacare is a terrible business model. America cannot afford this business model that is destined to failure.

A effective business model is needed which will be advantageous for all the stakeholders must replace it.

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

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Another Obamacare Trick Exposed And Backfiring

May 18, 2014

inMedicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

The drug industry has been quiet during the Obamacare debate. However, the industry’s lobbying group worked with the Obama administration to get Obamacare.

Why would PhRMA do that when President Obama encouraged everyone to buy generic drugs in order to get full coverage for their drug costs?

It is because President Obama promised PhRMA huge concessions and windfall profits after the health insurance exchanges were successful.

PhRMA is not going to make those windfall profits. When Americans see that the health insurance exchanges are more expensive than the private plans. Only those who cannot buy private insurance because they have pre-existing illnesses will sign up for Obamacare.

This will drive the health insurance exchange premiums higher,cover less, restrict access to care and drugs and ration care.

President Obama provided waivers from the implementation of Obamacare to many special groups except the individual market. Those waivers delayed implementation of Obamacare for one to two years.

The administration was concerned that implementation of Obamacare to everyone would cause a storm of protest that the administration could not contain.

These special groups will lobby for the continuation of those waivers as they realize that premiums and deductibles will be higher in the health insurance exchange market than the private market.

The profits PhRMA expected will evaporate.

Consumers not subsidized by Obamacare who bought Silver plans in the individual market through the health insurance exchanges are cooked.

They will pay one and one half to two times the price for drugs next year than they are paying this year.

The government will be paying drug companies for the increased price of drugs for people whose Silver plans are subsidized.

The result will be an increased cost of Obamacare to the public as President Obama redistributes wealth on the backs of the middle class making $50,000.01 or more

How did PhRMA help President Obama get Obamacare passed?

PhRMA paid for the multimillion dollar Harry and Louise ad campaign on TV during the debate for passage of Obamacare.

It financed a false message that was in support of Obamacare as opposed to its original Harry and Louise message that sunk the passage of Hillarycare in 1993.

http://youtu.be/fOr17a4ZOIU

“A new report by Milliman, Inc. finds that Silver plans with combined deductibles offered through the Health Insurance Exchanges may require patients to pay more than twice as much out of pocket for prescription medicines overall as they would under a typical employer plan.”

“This is a far larger increase in out-of-pocket costs than was found for other medical care.”

The cost of drugs to consumers buying a Silver plan through the Health Insurance exchange without government subsidy and high deductibles will cost twice as much as employer sponsored plans.

“Americans participating in the Exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” said John Castellani, President and CEO of PhRMA.

Patients’ with high deductible Silver plans will have difficulty affording medicines necessary to manage their illnesses. Paying for medications will be especially difficult for consumers earning more than $50,000.00 who are not subsidized and have chronic diseases. These people need multiple medications to control their chronic disease in order to avoid complications of their disease.

Eighty percent of the healthcare dollars are spent on treating the complications of chronic disease.

The unaffordability of medication to prevent acute and chronic complications of chronic diseases such as Diabetes Mellitus results in an increase in hospitalizations and higher health care costs overall.

Conversely, programs that encourage better adherence have been shown to reduce emergency department visits, hospitalizations, and other preventable, costly care.

The Obamacare rules and regulations are going to encourage an increase, not a decrease, in healthcare costs for non-subsidized Americans.

This contradicts President Obama’s pledge to encourage prevention of illness.

However, it fulfills President Obama’s goal of redistribution of wealth. It could also be interpreted as increasing the tax on the middle class.

If the public realized this would happen with Obamacare it would have protested the passage of Obamacare.

A house panel uncovered the secret deal in an email between PhRMA and the Obama administration in 2012. It was not revealed to the public until recently.

Nancy Pelosi’s statement about not knowing what is in Obamacare until it is passed was an ominous signal that the public would be taken advantage of. No one picked up the signal.

President Obama’s signal legislation is leaving hard working Americans no option but to demand that Obamacare be repealed.

It must be replaced by a healthcare plan that will work.

It must be replaced by a plan that gives consumers the opportunity to be responsible for their health and their healthcare dollars.

It must be replaced by a plan where common sense prevails.

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

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Seniors Should Be Madder Than Hell About Obamacare And Not Take It Anymore

May 14, 2014

inMedicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

President Obama promised seniors on Medicare that Medicare would not be affected by Obamacare. He has also told us Obamacare is a success.

President Obama lied to seniors.

One way to stop the lies is to vote against all the Democrats up for reelection in both houses of congress. The Democrats were the only ones who voted for Obamacare. Both representatives and senators rely on the senior vote to be elected or re-elected. Democrats in congress are terrified by the threat of losing the senior vote.

Many of my friends read the New York Times and listen to network news. These people believe they are well informed. They are constantly arguing with me about what they think President Obama has accomplished with Obamacare.

They believe President Obama’s sound bites about Obamacare.

Many seniors trust President Obama. They believe he would not deceive them about Medicare. Seniors have held on to their beliefs about Obamacare until it affects them personally.

In November 2013 I wrote a blog entitled “Medicare’s Perverse Incentive Against Seniors.”

Many seniors did not believe my post until they or a friend personally experienced the perverse incentive Obamacare had on Medicare.

A senior named Evelyn, who sometimes publishes my blog, received a letter about Medicare from a gentleman and sent it to her contacts.

This letter was about the perverse incentives Obamacare has imposed on hospitals. Seniors are being penalized by not receiving Medicare coverage and having to pay out of pocket expenses.

The new Medicare rules were intended to decrease the number of re-hospitalizations within 30 days of discharge. Many seniors are admitted to the hospital in congestive heart failure. Many of those seniors have difficulty staying out of congestive heart failure. They have to be readmitted in 30 days.

If a senior is readmitted in 30 days after discharge from the hospital, Medicare does not cover the hospital bill. The senior is not responsible for the bill. The hospital system takes the financial hit.

The implication of the readmission is the hospital system did not do a good job in treating the patient.

It could be that the patient did not do a good job taking care of himself and staying out of congestive heart failure. It could also be that the patient is too sick to stay out of congestive heart failure.

Hospitals can avoid being penalized by admitting seniors for outpatient observation.

This is a glaring defect in government rules created by bureaucrats who have little clinic experience.

Hospitals can admit patients to observation and send them home in less than 48 hours. If they are readmitted within 30 days it does not count as a re-hospitalization. Medicare would cover the bill for the seniors’ readmission. The hospital will get paid.

Medicare will not cover the outpatient observation admission bill.

I wrote:

“It is all about money. It is about the government spending less, the hospital collecting more and the patients getting stuck with the bill.

Government officials realize that Medicare costs are unsustainable. CMS creates rules and regulations to expose Medicare to less liability.

Unfortunately the unintended consequence is that CMS exposes Medicare patients to more liability in the process.”

Once more President Obama lied to us.

“People are shocked when they receive the bill. Nobody is required to tell them they’re outpatients.”

Those patients who have been outpatient observation admissions do not qualify for the rehabilitation benefits. Patients can be responsible for many thousands of dollars for the first 20 days of rehab (nursing home) services.

Evelyn’s friend writes about his experience with a recurring urinary tract infection that has been easily treated of the years:

“I just found myself in the middle of a medical situation that made it very clear that "the affordable care act" is neither affordable, nor do they care.”

This is where Evelyn’s friend’s story gets interesting.

He said he was diagnosed as having of prostate cancer diagnosed by needle biopsy in 2007. He had a “radical prostatectomy.” The final pathology report of the tumor turned out to be benign.

Since surgery he has had numerous “urinary tract infections (UTIs).” He assumed the UTIs were a side effect of the surgery since he never had a UTI pre surgery. His Family Physician confirmed his assumption.

In March 2014 he developed a UTI. He went to an Urgent Care Center (Doc In The Box) to get his usual urine culture and an appropriate antibiotic.

After a forty-five minute wait for a physician he had to urinate. He also became nauseous and light headed. The receptionist told him he should not to go to the bathroom until after he saw the doctor and he (the patient) provided a urine specimen.

He then passed out. This can happen with a full, irritated and distended bladder. Hypotension (low blood pressure) can occur and cause a patient to faint.

He woke up with dry heaves and was confused. He tried to stand but was still hypotensive.

He was told by the Urgent Care Center that an ambulance was called to bring him to the nearest hospital emergency room for evaluation.

The cause of the hypotensive episode was clear. However because of malpractice concerns the Urgent Care Center staff was required to send him to the nearest hospital emergency room for complete evaluation.

If an emergency room physician could have used his clinical judgment (not the dictated care rules) the physician would have concluded, after work-up, past history, and clinical evaluation of the work-up, that the patient could get necessary treatment as an outpatient at home.

The patient wrote;

“Now, "the rest of the story", and the reason for sending this to so many of you.”

“I finally got to see a Doctor. I asked "what is going on." I'm just having a UTI, just get me the proper medication and let me go home.”

The Emergency Room Physician told him;

“That his symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.”

The appropriate studies were done over the next three hours. At about 7:30 pm the nurse came back to his room to tell him that one of the tests takes 1- 2 days to complete.

He asked if the hospital could email the (the results) to him. I assume the missing test were a urine culture and a blood culture.

The nurse informed him that he wouldn't need the tests emailed because he wasn't going anywhere.

He told her he had no intention of staying overnight. He wanted to see the doctor. He asked the physician if he was going to be admitted for treatment or admitted for outpatient observation.

“He told me that I would be admitted for observation. I said Doctor, correct me if I'm wrong, but if you admit me for observation Medicare will not pay anything. The non Medicare coverage was due to the affordable care act ( An Obamacare regulation). The doctor said that's right, it won't.”

Another physician came into the room as he was getting dressed to leave the hospital ER against doctor’s orders. The next physician confirmed the patient’s interpretation of Medicare rules.

After the last physician prepared his discharge papers, the discharge nurse came into the room for him to sign the papers in order to relieve the hospital of any liability.

The patient told her; “ I wasn't trying to be obstinate, but I wasn't going to be burdened with the full (financial) responsibility for my hospital stay.”

After making sure the door was closed, she said, "I don't blame you at all, I would do the same thing."

She went on to say, "You wouldn't believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney."

She further said, "The 'Affordable Care Act' is going to be a disaster for seniors.

Yet, if you are in this country illegally, and have no coverage, you will be covered in full."

The patient went for a follow up appointment with to his Family Practitioner since his white blood count was pretty high.

“During the visit I shared the experience at emergency, and that I had refused to be admitted. “

“His response was "I don't blame you at all, I would have done the same thing".

“He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70.”

“I told him that I had heard that the affordable care act (Obamacare) would no longer pay for cancer treatment for those 76 and older, is that true?

“His understanding is that it is true.”

“The more I hear, and experience the Affordable Care Act (Obamacare), the more I'm beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they'll be.”

Evelyn is doing a great service by publishing this man’s letter. I hope it makes seniors aware of what is happening to Medicare coverage.

I am repeating a lot of this letter to re-emphasize, to followers of my blog, much of what I have said in the past. It is important to point out that all of Obamacare’s defects are becoming a reality to patients.

The defects are directly affecting seniors and their access to healthcare coverage.

Seniors must become “professors of their diseases” and control their health and healthcare dollars.

Remember, politicians are supposed to be working for seniors, not controlling them.

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

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Bigger Problems Ahead For Obamacare

March 30, 2014

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

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Stanley Feld M.D.,FACP, MACE

Accountable Care Organization are supposed to be the organizations that reduce Obamacare’s healthcare costs.

Accountable Care Organizations (ACOs) were supposed to be operational in 2012 throughout the United States.

ACOs are supposed to provide financial incentives to health care organizations in order to reduce costs and improve quality of medical care. There are too many defects in the ACOs’ infrastructure to improve the financial and medical outcomes.

At a conceptual level, the incentive for ACOs is to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members (physicians and hospital systems) would share the savings resulting from the coordination and integration of care.

Accountable Care Organizations (ACOs) are not designed to decrease the waste in the healthcare system.

Waste occurs because of:

1. Excessive administrative service expenses by the healthcare insurance industry that provides administrative services for private insurance and Medicare and Medicaid. A committee is writing the final regulations covering Medical Loss ratios for President Obama’s healthcare reform act. The insurance industry regulations are far from curative.

2. The excessive administrative waste in hospitals and hospital systems leading to outrageous nontransparent hospital fees.

3. The lack of patient responsibility in preventing the onset of chronic disease. The obesity epidemic is an example.

4. The lack of patient education to prevent the onset of complications of chronic diseases. Effective systems of chronic disease self- management must be developed.

5.The use of defensive medicine resulting in over testing. Defensive medicine can be reduced by effective malpractice reform.

ACOs are not a market-based system. They do not put patients at the center of their medical care or permit patients to choose their medical care.

The government assigns patients to certain ACOs. The government controls the healthcare dollars and is at the center of patients’ medical care decisions directly and indirectly.

Consumers/patients are the only stakeholders in the healthcare system that can demand that this waste be eliminated. “They with walk will their feet” if given the chance.

Keith Smith M.D. and the Surgery Center of Oklahoma have proven that consumers desire choice and making their own medical care decisions with the Surgery Center’s transparent prices and their light administrative costs.

Patients must control their healthcare dollars and be responsible for their care in order to Repair The Healthcare System. Consumers/patients will make sure prices become competitive. Patients in control of their healthcare dollars will not allow duplication of services.

In order to truly Repair The Healthcare System a system of incentives for patients and physicians must be created.

“In theory, ACOs provide financial incentives to health care organizations to reduce costs and improve quality. In reality, given the complexity of the existing system, ACOs will not only fail; they will most likely exacerbate the very problems they set out to fix.”

ACOs shift the risk of patient care away from the healthcare insurance industry to physicians and hospital systems.

Most physicians are reluctant to assume accountability for patient outcomes. Physicians recognize that much of the outcome is directly under the patients’ behavior and adherence to recommended therapy.

ACOs remove the consumer/ patient from being responsible or accountable for their medical care. ACOs undermine any attempt to create a truly accountable healthcare system that can drive down costs.

There are also grave uncertainties and practical issues in distributing savings between the hospital system and physicians. There is a long history of hospital systems taking advantage of physicians’ skills and intellectual property.

Many physicians and hospital systems are concerned about the shifting of risk and the lack of control over this risk.

“The Mayo Clinic says it will not be part of a critical piece of national health care reform under the government's proposed rules.”

“ The Mayo Clinic announced that the proposed regulations “conflict with the way it runs its Medicare operations.” Mayo treats about 400,000 Medicare patients a year. The bottom line is that Mayo figured out that they would assume too much risk, lose too much money and relinquish too much control over its processes to the federal government.”

ACOs are really HMOs on steroids. There is too much risk that neither physicians nor hospitals can control. Neither consumers or physicians nor hospital system liked HMOs.

This same sentiment is reflected in statistics released the Leavitt Partners Center for Accountable Care Intelligence. Centers for Medicare and Medicaid Services (CMS) and the Obama administration are spinning these numbers the same way they are spinning the figures for Obamacare enrollment.

Chart 4: Accountable Care Organizations by State; Source: Leavitt Partners Center for Accountable Care Intelligence

California leads all states with 58 ACOs followed by Florida with 55 and Texas with 44. ACOs are primarily local organizations, with 538 having facilities in only one state.

Chart 5: Accountable Care Organizations by Hospital Referral Region; Source: Leavitt Partners Center for Accountable Care Intelligence

The number of ACOs, again, is of secondary importance to the number of covered lives. Nationally, approximately 6 percent of the population is estimated to be enrolled in an ACO.

Chart 6: Estimated Accountable Care Organization Covered Lives by State; Source: Leavitt Partners Center for Accountable Care Intelligence

Chart 7: Estimated Accountable Care Organization Covered Lives by Hospital Referral Region; Source: Leavitt Partners Center for Accountable Care Intelligence

President Obama and his administration must be living in some fantasy world. It does not matter what the Obama administration is saying adoption of ACOs by physician groups and hospital systems is poor.

The call for forming ACOs started in 2010. The government tried to stimulate the formation of ACOs with sizable grants. It has not worked very well.

Many of the formed ACOs are not functioning in a cost effective manner. In ACOs that are sharing cost saving with the government the fighting between the hospital systems and physicians is just beginning.

Patients in ACOs are starting to feel the dysfunction.

The delivery of medical care under Obamacare and the ACOs are in big trouble.

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

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The Next Obamacare Tragedy

March 26, 2014

inMedicine: Healthcare System, Physician's Problems, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP, MACE

Late in the afternoon March 25^th the Department of Health and Human Services announced that it is extending the enrollment period for Obamacare to April 15^th from March 31^st.

“The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.”

Those who are going to apply have enough time to apply in seven days if the website and the navigators are working correctly.

It sounds as if enrollment figures are not good.

“Under the new rules, people will be able to qualify for an extension by checking a blue box on HealthCare.gov to indicate that they tried to enroll before the deadline. This method will rely on an honor system.”

“The government will not try to determine whether the person is telling the truth.”

This is not a very good way to run a business.

The next tragedy in the implementation of Obamacare is providers’ participation in the Affordable Care Act. There is so much uncertainty in the Obamacare that many physicians and physician groups have opted out of participation in Obamacare.

In California, independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting Covered California, the state health exchange.

Dr. Richard Thorp, president of the California Medical Association said, “It doesn't surprise me that there's a high rate of nonparticipation,”

The CMA represents 38,000 of the roughly 104,000 doctors or 20% of the physicians in California. Dr. Thorp said nothing about the California Medical Association doing a study to determine the percentage of physicians who are not participating in Obamacare.

However the Daily Kos ranted about the Washington Examiner story not being true.

“The latest right-wing disinformation campaign, all over the far-right media is that 70 percent of California's doctors are boycotting Obamacare. Is it true? Of course not. Is anything the Washington Examiner, WND, or Breitart publishes true?”

However the Daily Kos did not offer any facts about what is true.

It is a typical Alinsky disinformation tactic. You must freeze your enemy and then criticize and discredit him.

The LA Times reported in December that the state exchange Covered California reported,

In fact, according to Covered California, the only source with verifiable numbers, some 58,000 doctors, or more than 80% of the state's practicing physicians, will be available to enrollees in the exchange's health plans.

First of all, 58,000 physicians are not over 80% of California practicing physicians, if the 58,000 number is true. It is 55.77% of practicing physicians.

“Covered California says that the doctors participating in its exchange plans include 100% of Kaiser Permanente's 14,000 California doctors, 43,000 taking HealthNet patients and 35,000 in Blue Shield's network. (There's probably some overlap between the latter two networks.)”

The twisting of the facts is the method of operation.

On February 7, 2014 the LA Times reported Covered California admitted there are many errors in their physician directory.

“Admitting Covered California gave some consumers bad information, California's health insurance exchange pulled its physician directory for having too many errors.”

It appears that Covered California was not a very good source for the LA Times and Daily Kos to quote. Both media outlets called the Washington Examiner story a right wing lie.

“Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.”

California patients are discovering that their physicians are not participating in Covered California. Some have discovered that they are not covered by healthcare insurance coverage at all because of computer glitches.

The exchange previously yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November.

The updated list at that time still had some serious problems. The list misled consumers into signing up on the exchange. Covered California is bragging about the number of people they have signed up.

California is supposed to be the star of the state exchanges. Yet they had to close down the exchange in February for repairs and updates. The federal government gave the state exchange an additional $155,000 million dollars to fix the exchange. This is not a small amount of money for a “superb exchange”.

Here are some facts from practicing physicians.

In September 2013 insurance companies disclosed that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. This is contrary to the Daily Kos claim that the physician fees are negotiated.

Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor is quoted as saying, “In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal's reimbursement is $24,.” “In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160.

It is logical that physicians in California would say no to the state exchange, Covered California. No matter what lies the spin masters use the facts are the facts.

Physicians say, “We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,”

California physicians have protested that the Covered California's website lists many doctors as participants when they aren't. This is false advertising.

“Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy.

Donald Waters, executive director of the Alameda-Contra Costa Medical Association said. “They may be listed as actually participating, but not of their own volition”.

Waters said. He called the exchange's doctors' list a “shell game” because “the vast majority” of his doctors are not participating.

“This is a dirty little secret that is not really talked about as California promotes Covered California”.

Dr. Sherry Franklin, a pediatric endocrinologist at Rady’s Children’s Hospital, San Diego said, last summer she "got a letter in the mail letting me know if I wanted to participate with Blue Cross through the exchange, which is different from my regular Blue Cross practice, because they are paying les.s

They did not tell me how much less. You had to agree or disagree. So, of course, I said no."

Covered California expects 85% of the physicians in California to participate. So far they have made these statements to the press but have not published any proof of participation.

Covered California asks physicians to participate but does not disclose the reimbursement rates they will pay for participation in Obamacare.

Other state exchanges’ are also in trouble. Oregon and Connecticut are the most outstanding.

This is only the beginning of Obamacare’s provider problems. It is too bad that America is afflicted with this albatross at this time. Obamacare is destroying the healthcare system for consumers and physicians.

President Obama will not be able to charm his way out of the failure of Obamacare.

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

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Obamacare’s New Taxes And The Middle Class

March 16, 2014

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

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Stanley Feld M.D.,FACP, MACE

It is important to review all the taxes written into the Affordable Care Act (Obamacare). Americans are recognizing that those tax increases are being passed on to all consumers. The middle class were not supposed to experience tax increases. The middle class is realizing it has less disposable income because of these new taxes.

Since 65% (sixty-five percent) of America’s economy is dependent on consumers discretionary spending, America is destined to further economic difficulty.

These new tax increases are timed in the hope that no one would notice them.

The increased taxes are supposed to fund Obamacare. The taxes continue to be collected even though much of the law’s implementation is delayed.

“The increases in Obamacare taxes arearranged by their respective effective dates. Below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today: 

 Taxes that took effect in 2010:

 1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971. 

 2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

  3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

  4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980. 

 5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

 6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.  

Taxes that took effect in 2011: 

 7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959. 

 8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.  

Taxes that took effect in 2012:

 9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.  

Taxes that took effect in 2013: 

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.

	Capital Gains	Dividends	Other*
2012	15%	15%	35%
2013+	23.8%	43.4%	43.4%

 *Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

	First $200,000 ($250,000 Married) Employer/Employee	All Remaining Wages Employer/Employee
Current Law	1.45%/1.45% 2.9% self-employed	1.45%/1.45% 2.9% self-employed
Obamacare Tax Hike	1.45%/1.45% 2.9% self-employed	1.45%/2.35% 3.8% self-employed

  Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

 12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986 

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994 

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

  Taxes that take effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

	1 Adult	2 Adults	3+ Adults
2014	1% AGI/$95	1% AGI/$190	1% AGI/$285
2015	2% AGI/$325	2% AGI/$650	2% AGI/$975
2016 +	2.5% AGI/$695	2.5% AGI/$1390	2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346   Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993 

Taxes that take effect in 2018: 

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956 

 This “tax” is under everyone’s radar. It has never been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present  Monthly Fee of $96.40, rising to:

  $104.20 in 2012  

$120.20 in 2013  

  $247.00 in 2014."

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.

These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

Please send this blog to everyone you know and their children. It is important for them to know that President Obama is throwing seniors under the bus. Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation and create a diversion to the facts.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare must be repealed.

Everyone interested in America’s economic future must tell a friend to repeal these crippling taxes. President Obama has deceived Americans with Obamacare and its new taxes.

It is time for everyone to get angry and give control of the House and Senate to the Republicans in November.

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

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The Obamacare Alternative That Would Work!

February 9, 2014

inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

Some have complained that "My Ideal Medical Savings Account" cannot work. I have communicated with some of these people who made this and similar comments. I discovered two common themes to their comments.

The first theme was that people are too dumb to take care of themselves and make their own medical decisions.

The government must make the healthcare decisions for them.

The second was people would not handle their healthcare dollars appropriately if they were given the money.

These people might be talking about 5% per of the population who will be a burden to society no matter what healthcare system is put into place.

Why burden the other 95% of the population who want to be responsible for their health and healthcare dollars if they were given the chance?

The chance given has to include complete transparency, equal tax treatment, and adequate education to use their healthcare dollars wisely to made wise medical care decisions.

The week Tammy Bruce wrote an article in the Washington Times entitled, “Obamacare Isn’t A Train Wreck, It’s A Cancer.”

She explains how it is metastasizing throughout our economy and culture. It will destroy our society.

It is clear me that people commenting did not read my blog “My Ideal Medical Savings Account Is Democratic” carefully.

I decided to republish that blog at this time when it appears that Obamacare is failing on every level as I had predicted.

My hope is people will read the blog more carefully this time and understand it as an alternative to the impending disaster of Obamacare.

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

A reader sent this comment; “My Ideal Medical Savings Account (MSA) was not democratic and leads to restriction of medical care for the less fortunate.'

This comment is totally incorrect. I suspect the comment came from a person who has “an entitlements are good mentality.”

I believe that incentives are good. They lead to innovation. Innovation leads to better ideas.

Healthcare entitlement leads to ever increasing costs, stagnation, restrictions on freedom of choice and a decrease in access to care.

I have written extensively about the virtues of My Ideal Medical Savings Accounts (MSAs). They are different than Health Savings Accounts (HSAs).

HSAs put money not spent in a trust for future healthcare expenses. MSAs take the money out of play for healthcare expenses. MSAs provide a trust fund for the consumer’s retirement.

MSAs provide added incentives over HSAs to obtain and maintain good health. Obesity is a major factor in the onset of chronic diseases. Consumers must be motivated to avoid obesity to maintain good health. MSAs can provide that incentive.

The MSA’s can replace every form of health insurance at a reduced cost. It limits the risk to the healthcare insurance industry while providing consumers with choice.

This would result in competition among healthcare providers. Competition would bring down the cost of healthcare.

Some people might not like MSA’s because they are liberating. They provide consumers of healthcare with freedom of choice. They also give consumers the opportunity to be responsible for their healthcare dollars while providing them with incentives to take care of their health.

MSAs could be used for private insurance purchasers, group insurance plans, employer self-insurance plans, State Funded self-insurance plans and Medicare and Medicaid.

In each case the funding source is different. The cost of the high deductible insurance is low because the risk of spending $6,000 for most people is low.

If it were a $6,000 deductible MSA, the first $6,000 would be placed in a trust for the consumer. Whatever they did not spend would go into a retirement trust. If they spent over $6,000 they would have first dollar healthcare insurance coverage. Their trust would obviously receive no money that year.

The incentive would be for consumers to take care of their health so they do not get sick and end up in an expensive emergency room.

If a person had a chronic illness such as asthma, Diabetes, or health disease with a tendency to congestive heart failure and ended up in the emergency room they would use up their $6,000.

If they took care of themselves by spending $3,000 of their $6,000 trust their funding source could afford to give their trust a $1500 reward. The benefit to the funding source is it saved money by the consumer not being admitted to the hospital. The patient stayed healthy and was more productive.

President Obama does not want to try this out. He wants consumers and businesses to be dependent of the central government for everything.

MSAs would lead to consumer independence from central government control of our healthcare. MSAs would put all consumers at whatever socioeconomic level in charge of their own destiny.

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

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I Gave President Obama An Alternative To Obamacare

February 5, 2014

inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Medicine: Healthcare System

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Stanley Feld M.D.,FACP, MACE

I formulated an alternative to Obamacare in 2006, long before Obamacare existed. President Obama has ignored a plan that will work and align every stakeholder’s incentive.

Obamacare is failing because President Obama does not know who the customer is in the healthcare system. He is blinded by ideology and the belief that government knows what consumers need.

The consumer is the customer. Without consumers of medical care and physicians to provide medical care we would not need a healthcare system.

Consumers and physicians are the primary stakeholders. All the others are secondary stakeholders.

However, physicians receive between 15-20% of the healthcare dollars. Hospitals receive 25% of the healthcare dollars.

Where does the remaining 60% of the healthcare dollars go?

The insurance industry takes at least 40% off the top. The pharmaceutical industry receives 10% and the government wastes 10%.

It is a pity that only 40% of our healthcare dollars is spent on direct medical care. There is much waste and inefficiency built into that direct medical care.

There is also much waste included in the 60% the secondary stakeholder take off the top.

How else would UnitedHealth’s CEO get paid $1.8 billion dollars in cash and stock options from 1998 to 2006?

The excessive insurance industry profits are the direct result of ineffective regulatory agencies controlling insurance pricing.

In 2006 consumer power was demonstrated when UnitedHealth tried to decrease reimbursement to Hospital Corporations of America. HCA protested and threated to quit participation in United Health. Consumer protests followed.

UnitedHealth was the main insurance carrier in the Denver Area. Consumers threated to boycott buying insurance from UnitedHealth. UnitedHealth backed off.

The HCA/United pushback is the first big step. It represents how “Patient Power” should work. Patients should be madder than hell and not want to take it any more.”

In 2006, many of the uninsured were self employed consumers who cannot qualify for insurance because they have a preexisting illness or they are at risk for illness.

The insurance companies refused to sell them insurance. The same consumer in a group insurance plan by law would receive insurance from the same insurance company that turned down the individual.

A self-employed individual can only buy insurance with after tax dollars. A corporate employee receives healthcare insurance coverage with pre-tax dollars.

The same applies for the individual insurance market post Obamacare.

The price of insurance is very high for small businesses. The small business owners do not have the negotiating power of the large corporations.

This results in both the individual and small business not being covered by healthcare insurance. All of the above can be easily fixed.

The problem with Obamacare is the insurance premiums are higher than they were pre- Obamacare. The reasons are obvious.

The only winner is the individual who makes a low enough income to receive a federal subsidy. The loser is the taxpayer.

Obamacare also creates a perverse incentive resulting in people not striving to get ahead.

In 2006 I wrote:

 Patients drive the healthcare system. Patients have tremendous power. They must be taught to use that power in order to Repair the Healthcare System.

Patients must use their “Patient Power” to take control of their healthcare dollars and their health. They should be provided with financial incentives to save the money they spend on medical care.

Neither the healthcare insurance industry nor the government should determine the consumers’ access to care. Patients’ freedom of choice and self- responsibility is the key to Repairing the Healthcare System.

If there are financial incentives consumers will learn to become informed consumers of healthcare. Reliable education must be provided to give consumers the opportunity to become informed consumers.

There are preconditions.

Prices must be transparent so consumers know what they are buying. The insurance industry should negotiate the price with the physicians and the hospitals. The industry can remain the surrogate broker for the payment of money belonging to the consumer. Consumers’ who overspend will not receive the financial incentive. They will lose their medical saving account money. Patients who have an expensive illness, like diabetes, can be rewarded for spending money if they keep themselves in good health and prevent complications of disease.

The consumers are then the responsible party purchasing their medical care. It is not the healthcare insurance industry or the government.

The healthcare insurance industry or any financial industry with an adequate computer system can be the administrator and adjudicator of payment.

Medicare director Mark McClellan M.D. said that 90% of the healthcare dollar of a specific disease (Diabetes) is spent on the complications of disease. If we reduce the complications of a disease we could save at least 45% of the current healthcare expenditure for that disease.

Obamacare gives this vital fact lip service. It puts the responsibility of outcomes on physicians’ shoulders. If physicians have poor outcomes they get penalized.

The medical outcome is a dual responsibility of both consumers and physicians. Consumers should be made aware of physicians’ outcomes. Some of the poor outcomes are the result of consumers not taking the responsibility to learn about their disease, prevent the complications of their disease, or comply with the treatment recommended. The result is a poor outcome.

Consumer overspending is another important aspect of increasing healthcare costs. Consumers do not have incentive to be cautious with their healthcare dollars because they have been given first dollar coverage. They do not have financial incentives to save money on medical care.

Consumer overspending was best described by Victor Fuchs an economist from Stanford.

He made the case for a Consumer Driven Health Care System.

The Health Saving Accounts that congress has approved in my opinion is impotent. It does not provide a strong enough financial incentive for consumers to want to save money.

The trust account of $1,000 per year is too low to motivate consumers to become wise shoppers. A Medical Savings Account of $6,000 per year begins to represent financial motivation.

HSA’s represent the same false hope HMO’s and managed care represented in the 1980’s and 1990’s.

Dr. Fuchs calls it “The Restaurant Check Problem.”

“You go out to a restaurant with a bunch of friends and you sort of understand that you will split the check,” he said.

“The waiter comes along and says, ‘the lobster looks very good, and how about a soufflé for dessert?’

The restaurant check balloons, but you are not so careful because you figure everyone is splitting it.

“That’s the way medical care gets paid for,” he said.

Dr. Fuchs added, “We want to spend our money on the things that will bring the most value for the dollar.

When we are spending collective money as we are in health care, then it becomes much more difficult.”

We want Diabetics to spend money for good medical care in order to prevent complications. Prevention of complications will keep Diabetics out of the hospital and out of the emergency room. The result will be a decrease in medical costs.

The consumer driven healthcare plans can be set up to give provide Diabetic consumer the financial motivation to take care of himself. This reward is much cheaper than paying for a hospitalization or emergency room visit.

If an insurance product is overloaded with salaries, waste, overhead and unnecessary benefits patients will not buy the product.

The insurance product would have to be modified. It would become more cost efficient.

Patients have it in their power to remove the waste and inefficiency in the system.

Some very clever entrepreneur will realize the consumer is the customer. He will develop an insurance product that everyone wants. State governments have the power to encourage development of this product.

The examples in industry in America are numerous. Sam Walton revolutionized retailing in America with Wal-Mart and Sam’s. Michael Dell almost brought IBM to its knees and revolutionized the distribution of information technology.

My goal is to describe the necessary components of a healthcare insurance product that does not offer another and false hope.

I hope to show the way to develop an insurance product that can work for patients first and then all the other stakeholders.

There is no reason we cannot provide excellent affordable insurance coverage to all including the corporate employed, the small business employed, the self employed, the unemployed, and the Medicare covered seniors, with all the stakeholders making a reasonable profit in a simplified system.

President Obama, I have provided a viable alternative long before you became President.

I also provided this alternative to you when you became President in the letters I wrote to you.

For you to say no one has come up with a better alternative than Obamacare is disingenuous on your part.

I hope you are listening now.

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

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Obamacare is Right On Schedule

January 26, 2014

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

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Stanley Feld M.D.,FACP, MACE

Is President Obama trying to destroy the healthcare system in America?

Yes he is!

Actually he is right on schedule to have Obamacare implode on itself.

I remember when he told Barney Frank and John Kerry not to worry about not including the Public Option in the Affordable Care Act. We will get to a single party payer system.

http://youtu.be/f3BS4C9el98

http://youtu.be/-522hcm3woA

They did not understand how President Obama could make such a compromise. They thought the Public Option was the only way in the Affordable Care Act Obamacare) to get to their goal.

The goal was a single party payer system.

They did not have the votes then and they do not have the votes now.

President Obama has used a lot of trick plays to get his way in passing and implementing Obamacare. I have pointed out these trick plays along the way. They should be reviewed.

As hard as it is to believe, it seems that President Obama wants his legacy legislation Obamacare to fail.

Otherwise he would not have had Obamacare constructed with so many perverse incentives for stakeholders.

The only route to success is to align both primary and secondary stakeholders incentives. Obamacare is misaligning all of the stakeholders' incentives.

The incentives are more misaligned now than they were in the dysfunctional healthcare systems days before Obamacare.

The stated goal of Obamacare was to provide affordable healthcare insurance to all, with access to quality care to all without rationing of care.

The effect of Obamacare has been just the opposite. The healthcare insurance coverage will not be universal. It is unaffordable to many in the middle class. It is also unaffordable to many of the subsidized poor that do not qualify for Medicaid. There is limited access to care. There is an increase in the rationing of care.

President Obama claimed Obamacare’s health insurance exchanges would create a competitive free market insurance system.

The health insurance exchanges would force the healthcare insurance companies to be competitive. Healthcare insurance competition would lead to a decrease in healthcare costs.

Health insurance exchanges have not worked as advertised. President Obama’s health insurance exchanges have not resulted in a competitive free market system.

Healthcare premiums have skyrocketed.

Healthcare insurance deductibles and copays are higher.

Hospitals and doctor networks are skimping for two reasons. Doctors and hospitals are choosing not to participate in Obamacare. Healthcare insurance companies are not electing to include many well known doctor and hospital networks.

Many excellent drugs are not on the insurers' formularies because of the cost. When newer brand name medications are on the formulary the co-pays are unaffordable to patients who need them. Patients therefore do not fill the prescription.

The healthcare insurance premiums are often higher than what consumers previously paid for their private insurance pre Obamacare even after some consumers receive government subsides.

The Obama administration will conclude soon that the free market healthcare system does not work.

The administration will claim that only healthcare system that will work is a government single party payer system.

However, President Obama has not created a free market healthcare system with his health insurance exchanges. It is a highly regulated market.

In his over regulated marketplace he has created incentives that have further misaligned stakeholders vested interests than they were pre Obamacare.

In the Obamacare system the healthcare insurance companies are led to believe they remain the king of the healthcare industry. They believe they can continue to control healthcare costs.

The government remains totally dependent on the healthcare insurance industry. The healthcare insurance industry performs all the administrative services for government healthcare programs.

In performing these services the government has permitted the healthcare insurance industry to pad direct patient care costs with items that are insurance companies expenses and should not be counted as direct patient care.

The increased distortion is magnified when the government dictates the benefits the insurers must offer patients in the health insurance exchanges and the private insurance markets.

This causes the premium prices to skyrocket .

Consumers might not need these added government benefits. Consumers have no choice. They have to pay for unneeded benefits. These benefits are added to the cost of insurance as well as the net profit of the healthcare insurance companies.

The healthcare insurance industry is also permitted to choose their own networks of physicians and hospitals.

The insurance companies try to maximize their net profit at their lowest cost. Therefore they have kept the best hospital and physicians out of their networks. This affects the quality of care.

It must be realized that quality of care has not been adequately defined or accurately measured.

In some cities and states consumers only have one insurance carrier. Other carriers have opted out. There is not even a pretense of competition. This insurance carrier usually picks the hospitals and physicians that will accept the lowest reimbursement. The healthcare insurance industry is offering low fees to providers. They will take only those providers into their networks that accept those low fees.

An additional incentive distortion is the Obamacare requirement for the healthcare insurance companies to charge the same premium for anyone who signs up for Obamacare. There is no risk weighting permitted.

The hope is all consumers will sign up and enable the industry to keep premiums down.This rule generates two negative incentives. The healthcare insurance industry must overcharge the healthy and undercharge the sick. Therefore the healthcare insurance companies try to attract the healthy and avoid the sick.

This has backfired on Obamacare. The healthy young have realized the trap. They are not signing up in the heath insurance exchanges.

Previously when they were employed the employer didn’t mind covering the young. The young help lowered the overall premium because they were young healthy.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           &#
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There are only two options left to the government. Obamacare can bail out the insurance industry and bully the healthy and low risk young into buying healthcare insurance from the government health insurance exchanges.

Many cities, towns and stats have underfunded healthcare coverage commitments. These local commitments include retirees. These cities, towns and states can now dump these consumers into Medicare and the health insurances exchanges.

In addition, there are many people who have chronic illnesses who have been afraid to leave their jobs because they could not get healthcare insurance in the individual market in the past.

These patients can now obtain insurance in the health exchanges at the same cost as everyone else. This will further contaminate the risk pool and increase the health insurance exchange premiums.

The Obama administration figures all taxpayers will cover the added costs. Taxpayers will bail out insurance companies for the poor risk pools that are decreasing their profits.

It looks like the real purpose of Obamacare is to destroy the relationship between the employer and his employee by driving employees into the health insurance exchanges just as it has destroyed the relationship between the consumers and their physicians.

President Obama understood this as the bill was written.

Small employers are dumping employees from their healthcare insurance plans into the individual market and the health insurance exchanges.

In 2015 group employer insurance will affect an estimated 80 million people. They will loss their insurance and be forced into the health insurance exchanges.

The insurance industry will quit providing insurance and President Obama’s plan to have a single party payer will occur by default.

Taxpayer will pay the difference through higher taxes. In the meanwhile nothing has been done in making healthcare premiums more affordable, access to care more available, quality of care better or preventing the rationing of care by a government body.

Consumers will not stand for government control over their healthcare decisions.

There is a better and cheaper way. It is to put the consumer in charge, not the government.

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

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