Stanley Feld M.D.,FACP,MACE

Joe
Klein is TIME's political columnist and author of six books, most recently “Politics
Lost.” His weekly TIME column, "In the Arena," covers national
and international affairs. In 2004 he won the National Headliner Award for best
magazine column.

He
is a Democrat and a big supporter of President Obama.

Joe
Klein is a major liberal leaning reporter within the traditional mainstream media.
His last two articles in TIME magazine are finally starting to show
understanding of the problem with Obamacare. Here are some of these articles
more important statements.

He
starts one article with,

 “Let
me try to understand this: the key incentive for small businesses to support
Obamacare was that they would be able to shop for the best deals in health care
superstores — called exchanges.

 "The Administration has had three years to set
up these exchanges. It has failed to do so."

 "This is a really bad sign.”

The
administration continuously claims it is not its fault programs are failing. It
is always the other guy’s fault.

The
other “guys fault” was the main
strategy of President Obama’s reelection campaign. He needs more time to make
things work.

“There will be those who argue that
it’s not the Administration’s fault. It’s the fault of the 33 states that have
refused to set up their own exchanges. Nonsense. Where was the contingency
planning?” 

The
Obama administration just announced it couldn’t have the health insurance
exchanges program ready by January 2014.

It
is refreshing to read a liberal mainstream media writer saying what I have said
all along.

The
Obama administration’s trick here was to stick the states with the costs of the
exchanges.

The
states that have thought out the consequences have refused to accept
responsibility for the health insurance exchange.

The
Obama administration has also demanded that states follow the administration’s
conditions and rules. The states have viewed this as a threat to states rights.

The
Supreme Court sided with the states’ rights argument.

"The Obama Administration has announced
that it won’t have the exchanges ready in time, that small businesses will be
offered one choice for the
time being — for a year, at least."

A hidden story is the administration does not have the funding
to pay the states for the health insurance exchanges for three years.

This is one of the reasons President Obama is again demanding
the ability to raise taxes in a budget agreement. Republicans are saying he has
received his tax increases January 1, 2013.

“No doubt, small-business owners will be skeptical of the Obama
Administration’s belief in the efficacy of the market system to produce lower
prices through competition. That was supposed to be the point of this plan.”

Joe Klein goes on to say,

“We are now seeing weekly examples of this Administration’s
inability to govern. Just a few weeks ago, I reported on the failure of the Department of Defense and Veterans
Affairs to come up with a unified electronic health care records system.”

We have been told that the VA had an excellent electronic health
record. The VA advertises that every physician can download it and use it free.
I downloaded it.

The VA EHR is very difficult to use.

 Joe Klein had sharp
criticism for the “Head Start Program”,

 "There have been the
oblique and belated efforts to reform Head Start, a $7 billion program that a
study conducted by its own bureaucracy — the Department of Health and Human
Services — has found nearly worthless." 

 The
list of Obama administration failures is indeed endless. It is the work of a
community organizer trying to run a big business.

 “Barack
Obama is not a “how” President. Oh, he pays lip service to government reform.
His people can tell you the number of unnecessary regulations they’ve
eliminated.”

 “
It barely scratches the surface of what needs to be done—there is no creative
destruction in government, regulations pile up on top of each other like silt,
generation after generation.”

 The
next statements confirm Joe Klein’s liberal leanings.

 “One thing is clear:
Obamacare will fail if he doesn’t start paying more attention to the details of
implementation.”

 “But, as a Democrat — as
someone who believes in activist government — he has a vested interest in
seeing that federal programs actually work efficiently. I don’t see much
evidence that this is anywhere near the top of his priorities.”

 “And, in a larger sense,
the notion of activist government will be in peril — “  

“The problem is not, as the Republicans
claim, big government. It’s bad government.”

At
last the traditional mainstream media is starting to get it. There is starting
to be recognition of the problem with government controlled and operated
systems.

I
have explained many times that the mess in the healthcare system is not a
liberal or conservative problem.

It
is a problem in creating a healthcare system that aligns all the stakeholder
incentives and works for every consumer of healthcare.

A
consumer driven healthcare system with appropriate tort reform will have to be developed
by the government.

A
healthcare system must be constructed that allows consumers to own their
healthcare dollars and be responsible for their health and healthcare.

The
government could provide the subsidy to the needy. The result would be a
healthcare system that would be more efficient and less costly.

Individual
responsibility and freedom to choose is essential for a successful healthcare
system.

 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

Obamacare will fail because none of the stakeholders’ vested
interest are aligned.

The storm is brewing in the healthcare system.

Even Democrats are concerned.

Recently, I have been criticized for blaming the impending failure
on President Obama. President Obama would rather blame the impending failure on
congress.

 A reader wrote;

“President Obama is a nice
guy. He is trying very hard. Give him a chance.”

It is true. He seems like a nice guy. My criticism is not personal.
The fact is his philosophy and tactics are responsible for the mess. As time
goes on it seems more likely that Obamacare will not work out.

There are multiple reasons for the impending failure. A major
reason is Obamacare is developing new perverse incentives for stakeholders
rather than aligning all the stakeholders’ vested interests.

Obamacare is extraordinarily complex. It is confusing to all the stakeholders,
 especially as new rules and regulations
are being written.

By forcing the development of programs such as health insurance
exchanges, accountable care organizations, pay for performance plans,
functional electronic medical records, and the consolidation of healthcare
hospital systems and physicians against their will, Obamacare is creating
tensions and uncertainties that will be difficult to overcome.

Patients’ medical care and their relationships with their
physicians are personal issues. Obamacare is commoditizing medical care. It is
destroying the patient physician relationships. These relationships account for
at least one half of the therapeutic effect of medical treatment.

The 2300 page law usurps the power of the legislative branch of
government and shifts it to the executive branch. This is dangerous. It has
created additional tension and uncertainty for the nation.

Many congressmen who voted for the law did not read the law’s 2300
pages. The implications of much of the law were not understood. It did not have
bipartisan support.

In 2012, the executive branch of the federal government issued another
70,000 pages of guidance for participants in Obamacare. The executive branch
has created at least 22,000 new regulations and 68,000 new ICM codes.

The more complex a law becomes the more likely it is to be unsuccessful.

There is no question the healthcare system nears repairing. Healthcare
costs are exploding. Waste and bureaucracy are expanding.  Dysfunctional interactions between
stakeholders are mounting.

All of this results in an inability to deliver effective medical
care.

At present 55% of Americans of all ages receive healthcare
insurance through an employer sponsored healthcare plan. An additional 32% receive
healthcare insurance through government programs.

Thirteen percent (13%) of the population are uninsured or under
insured. Obamacare’s goal is supposed to provide healthcare insurance for that
13%.

Present predictions are that Obamacare will not provide universal
care. It is predicted that it will not save $850 billion dollars. The CBO, on
the basis of numbers provided by the administration, predicted the law would
save $850 prior to the passage of the law.  The CBO’s current prediction is Obamacare will
cost the nation an additional  $1.2
trillion dollars over 10 years.

Healthcare insurance rates are rising by double digits each year.
Employers are passing the costs of the increasing insurance rates to their
employees through higher deductibles and copays along with lower healthcare
coverage plans.

 Obamacare will require
employers, who offer skimpy healthcare benefits such as Mini-med insurance, to
provide more robust ones.

To date the Obama administration has waived more than 2000
employers from providing more robust healthcare insurance coverage. At the time
these waivers expire companies with waivers, such as McDonald’s, will scream
bloody murder.

They will opt out of providing any healthcare insurance at all and
avoid government penalties. They will accomplish this by decreasing the number
of hours an employee will work to less than 30 hours a week. This is not good
for minimum wage workers. The uninsured rolls will increase.

The penalty of $3,000 per employee is less than the $15,000 healthcare
insurance cost per employee for employees working more than 30 hours a week.

Surveys have been published concluding that more than 50% of
employers are planning to drop healthcare insurance coverage.

The federal government is trying to discourage this by invoking
the IRS anti-abuse rules;

“The IRS has indicated that anti-abuse rules
will be implemented to curtail the use of Obamacare loopholes to
dodge the play or pay requirement.

  Yet as
some have already questioned, can the IRS legitimately utilize rule-making to modify
core components of a federal act? Or will this rule-based clean-up effort
simply spawn more lengthy litigation?” 

Obamacare’s health insurance exchange program is in big trouble.
Less than half the states have signed up to participate.

 States have opted out
because of the potential cost overruns. States are struggling to balance their
budgets. The federal government is only going to pay for health insurance
exchanges’ development and execution for the first two years.  The cost burden will then fall on the states.

The federal government keeps extending the deadline for states to
sign up. The federal government does not have infrastructure or manpower to set
them up.

The health insurance exchanges are supposed to be up and ready to sign
up consumer up in October 2013 and operating in January 2014.

Physicians do not know what to do about Obamacare. Physicians feel
helpless. They know Obamacare cannot work. Physicians do not have a leadership
organization that can direct physicians to have an effective voice.

Accountable Care Organizations (ACO’s) will fail because physicians
are trained to use medical judgment. They have not been trained to obey the
rules of hospital administrators.

They bristle when their value is determined by hospital systems or
federal agencies such as IPAB. They prefer to have their value determined by
their patients.

Physician leadership needs a new mentality to enable physicians to
act and articulate  the steps needed to
be taken to repair the healthcare system.

Physicians want the healthcare system to function equitably for
all the stakeholders and effectively for their patients.

Medical organizations have been consistently losing membership
because it has not represented or articulated the needs of practicing
physicians.

If Obamacare works as President Obama hopes, he will have secured
his legacy and solved the long-festering problem of the uninsured.

Obamacare will not solve the problems of increasing healthcare
costs nor provide universal care in its present form. This has been a pipe
dream all along.

Another reason Obamacare will fail is because it does not consider
the cost of defensive medicine significant. President Obama is not interested
in tort reform.

Obamacare doesn’t align any of the stakeholders’ vested interests.

When Obamacare fails it will provoke a citizen backlash that will
be very difficult to overcome.

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

I have been a New York Times reader since 7th grade. At
that time I delivered the New York Times to all the classrooms in my Junior
High School.

The New York Times has become pretty shabby in recent
years. It has stopped printing unbiased news. It does not print,  “All
The News Fit To Print.”

It has been publishing biased news, news leaks as well as
opinions that have contained innuendo and not based on facts.

A glaring example is the healthcare editorial on Sunday October
21,2012.

The New York Times is trying very hard to help defeat
Mitt Romney and push President Obama over the finish line.

I hope intelligent readers can see through the Times’
smokescreen of no facts and evaluate the candidates objectively.

The editorial’s first sentence is absolutely correct.

“The outcome of the presidential election will determine which of
two opposing paths the nation will follow on health care for all Americans.”

One
path represented by Obamacare is a path of government takeover of healthcare.
It will convert the healthcare system totally to an entitlement system.  The government will make the rules and create regulations.
Many will be difficult to follow and impossible to enforce.

This
path leads to restriction of freedom of choice, rationing and a decrease in
access to healthcare.

Americans
did not expect this option when they elected President Obama.

It
is easy to remember the sound-bite, “ If you like your present
insurance you can keep it. If you like your physicians you can keep them.”

His
campaign principles were vague. His promises were broad brushstrokes of
policies and not a specific outline of policies. At the end of these vague
promises was the appealing promise of affordable healthcare insurance coverage
for all.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/09/is-medicare-an-effective-bureaucracy-part-1.html

It
turns out that after four years healthcare insurance coverage has become more
expensive. There is no relief in sight. All Americans are subjected to 10
hidden taxes that in effect increases the cost of healthcare insurance
coverage.

America
has passed a 2400 page bill that few read and fewer understand. The bill has
generated over 44,000 new regulations so far and massive new government
bureaucracies.

The
bill was supposed to decrease the cost of healthcare by over $125 billion
dollars during the next ten years.

It
is now estimated to cost taxpayers an additional $1 trillion dollars over ten
years.

The
New York Times editorial goes on to say:

“If voters re-elect President Obama, he will
protect the health care reforms that are his signature domestic achievement.”

It
sounds like the New York Times believes this is a good thing. My guess is the
Times is not a very good judge of sound business practices because it is itself
on the verge of bankruptcy.  Obamacare is
unsustainable and destined to drive America into bankruptcy.

So
far President Obama has done nothing to decrease the number of uninsured and
nothing to decrease the cost of care. In fact the cost of care has escalated as
patient deductibles have increased, premiums have increased and the quality of
employer coverage has decreased. Employer sponsored healthcare insurance
coverage is expected to decrease further in the next two years.

The
New York Times editorial goes on to state:

“If they elect Mitt
Romney, they will be choosing a man who has pledged to repeal the reform law
and replace it with — who knows what?”

The biggest defects in today’s healthcare system are ;

1. It does not encourage individuals to be responsible for the
maintenance for their own health

2, it does not give consumers control of their healthcare dollars
or incentives to preserve those dollars.

3. It does not discourage the practice of defensive medicine with
effective tort reform.

4. It does not create a competitive healthcare market that must
become consumer driven in order to control costs.

The New York Times invites us to visit Mitt Romney’s web site
after this biased preamble:

“The competing visions are often difficult to evaluate because the
Republican candidates — Mr. Romney and his running mate, Paul Ryan — have
become so artful about obfuscating their plans for Medicare, Medicaid and what
they will do to reform the whole system.”

I went to the web site to see what Mitt Romney’s plan is. He has
very specific proposals in his healthcare plan. The proposals could Repair the
Healthcare System if implemented correctly.

I imagine the New York Times did not pay attention to any of the
words in the plan because they are drinking President Obama/Mr. David Axelrod’s
"Kool Aid."

The Times tells us in the very next sentence;

“Almost nothing the Republican candidates say on these or other
health care issues can be taken at face value.”

I would say this is not objective reporting.

What is Mitt Romney’s healthcare plan? I would like readers to
read it carefully and judge for themselves.

He first explains the Obamacare failures. The failures are
important to keep in mind because Obamacare has been shoved down the mouth of
Americans.

OBAMA'S FAILURE

Unfortunately,
the transformation in American health care set in motion by Obamacare will take
us in precisely the wrong direction. The bill, itself more than 2,400 pages
long, relies on a dense web of regulations, fees, subsidies, excise taxes,
exchanges, and rule-setting boards to give the federal government extraordinary
control over every corner of the health care system. The costs are
commensurate: Obamacare added a trillion dollars in new health care spending.
To pay for it, the law raised taxes by $500 billion on everyone from
middle-class families to innovative medical device makers, and then slashed
$500 billion from Medicare.

Obamacare
was unpopular when passed, and remains unpopular today, because the American
people recognize that a government takeover is the wrong approach. While
Obamacare may create a new health insurance entitlement, it will only worsen
the system’s existing problems. When was the last time a massive government
program lowered cost, improved efficiency, or raised the consistency of
service? Obamacare will violate that crucial first principle of medicine: “do
no harm.” It will make America a less attractive place to practice medicine,
discourage innovators from investing in life-saving technology, and restrict
consumer choice.

In short,
President Obama’s trillion dollar federal takeover of the U.S. health care
system is a disaster for the federal budget, a disaster for the constitutional
principles of federalism, and a disaster for the American people.

MITT'S PLAN

On his
first day in office, Mitt Romney will issue an executive order that paves the
way for the federal government to issue Obamacare waivers to all fifty states.
He will then work with Congress to repeal the full legislation as quickly as
possible.

In place
of Obamacare, Mitt will pursue policies that give each state the power to craft
a health care reform plan that is best for its own citizens. The federal
government’s role will be to help markets work by creating a level playing
field for competition. 

Restore
State Leadership and Flexibility

Mitt will
begin by returning states to their proper place in charge of regulating local
insurance markets and caring for the poor, uninsured, and chronically ill.
States will have both the incentive and the flexibility to experiment, learn
from one another, and craft the approaches best suited to their own citizens.

• Block grant Medicaid and other payments to
  states
• Limit federal standards and requirements on
  both private insurance and Medicaid coverage
• Ensure flexibility to help the uninsured,
  including public-private partnerships, exchanges, and subsidies
• Ensure flexibility to help the chronically
  ill, including high-risk pools, reinsurance, and risk adjustment
• Offer innovation grants to explore
  non-litigation alternatives to dispute resolution

Promote
Free Markets and Fair Competition

Competition
drives improvements in efficiency and effectiveness, offering consumers’ higher
quality goods and services at lower cost.  It can have the same effect in
the health care system, if given the chance to work.

• Cap non-economic damages in medical
  malpractice lawsuits
• Empower individuals and small businesses to
  form purchasing pools
• Prevent discrimination against individuals
  with pre-existing conditions who maintain continuous coverage
• Facilitate IT interoperability

Empower
Consumer Choice

For
markets to work, consumers must have the information and the power to make
decisions about their own care.  Placing the patient at the center of the
process will drive quality up and cost down while ensuring that services are
designed to provide what Americans actually want.

• End tax discrimination against the individual
  purchase of insurance
• Allow consumers to purchase insurance across
  state lines
• Unshackle HSAs by allowing funds to be used
  for insurance premiums
• Promote "co-insurance" products
• Promote alternatives to "fee for
  service"
• Encourage "Consumer Reports"-type
  ratings of alternative insurance plans

Mitt Romney’s plan is an outline of his healthcare plan that
corrects all of the defects in our healthcare system. Obamacare has amplified
the healthcare system’s defects.

By giving states the opportunity to select a waiver from Obamacare,
Governor Romney is eradicating all the new taxes, regulations, bureaucracy, and
impingement on individual choice, individual freedoms and access to care
issues. He is also opening the door for subsidized healthcare coverage for
those in need.

It is much more specific than the plan President Obama presented before
his election in 2008. I have reviewed my articles on his proposals. President
Obama disguised his real intentions. He made it sound much better than he
intended. If one reads between the lines it is clear President Obama wanted the
federal government to control the healthcare system.

The blog post from 2008 make interest reading. Please click on
them.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-1.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-3.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-4.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/08/is-barack-obama-any-different-than-other-politicians-part-5.html

President Obama is the pot calling the kettle black.

Government Romney puts the consumer first, not the government. His
plan also strengthens states rights which have been severely discounted during
his term in office. The states can be a little more efficient that the central
government.

President Obama has presented nothing about his healthcare plan
during his reelection cycle,

Many of the regulations have not been written yet. President Obama
is waiting until after the election when “he
will have more flexibility. ”

Please remember I voted for him in 2008. President Obama has been a
tremendous disappointment to me. He does not understand the American psyche and
is ignoring Americans’ wishes.

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

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