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We Never Learn: Watch Out Colorado

August 10, 2016

inDisinformation and the healthcare system, Medicine: 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

“You can always count on Americans to do the right thing – after they’ve tried everything else.”

Winston Churchill

There are many smart people in America.

Americans form opinions from the information presented to them. When the information presented in incorrect or incomplete it is easy to form the wrong opinion.

The art of presenting misinformation and disinformation has been perfected.

The people of Colorado are now being bombarded with the need to pass Amendment 69 or ColoradoCare.

Most Coloradans have not paid sufficient attention to the amendment. Their opinions are being influenced by misinformation or inadequate information concerning the unintended consequence that are inevitable.

Many might look at ColoradoCare’s official website. http://www.coloradocare.org/know-the-facts/increases-savings/ and read the following.

“With Amendment 69, ColoradoCare, every Colorado resident can contribute their best, knowing ColoradoCare has everyone covered with universal health care.” Sounds wonderful.
“ Imagine life with ColoradoCare. If you’re a resident and you need any kind of health care (including mental health), you just go to see your provider, and ColoradoCare pays the bill.”Free is great.
“Without the layers of hassles, businesses, providers, and everyone in the state can go about their important work of contributing to their families and communities knowing ColoradoCare has everyone covered.” The problem is nothing is free.
In a statement to the Colorado Independent October 2016, Bernie Sanders lent his support to the single-payer measure.
“Colorado could lead the nation in moving toward a system to ensure better healthcare for more people at less cost. In the richest nation on earth, we should make healthcare a right for all citizens.”

Hillary Clinton has not yet supported ColoradoCare. I believe she is afraid it will steal her thunder by having large increases in government healthcare expenditures she has planned. She plans to increase taxes and get healthcare governance firmly in the hands of the federal government.

The ColoradoCare website goes an to say,

“An economic analysis of health care spending in Colorado has calculated that comprehensive health coverage for every resident could be paid for with pre-tax payroll premiums of 3.33% for employees and 6.67% for employers.”

There has been no effort to prove these numbers are correct.

In fact, all of the Republican establishment politicians in Colorado are against ColoradoCare as well as many high ranking members of the Democratic establishment.

The Democratic establishment includes Governor John Hickenlooper and former governor Bill Ritter. They are opposed to Amendment 69’s passage because they understand the financial burden ColoradoCare would put on the state’s budget and growth.

The size of the current state budget is $25 billion dollars. The tax increase for ColoradoCare would be an additional $25 billion dollars. Everyone can assume the state would need more to implement the program.

“ColoradoCare would be far and away the largest tax increase in state history, and would give Colorado the highest tax rate in the nation.”

“ This would be implemented as a payroll tax that would be split into 3.33% for employees, and 6.67% by employers.

An additional $18billion dollars would be asked of the federal government, as well as a waiver to let the state opt out of the Affordable Care Act in order to fund Colorado care.

If voters approve ColoradoCare, it would be written into the state constitution, making it very difficult to dismantle and impossible to amend.

The president of the Denver chamber of commerce is opposed to ColoradoCare because the chamber knows this will drive businesses out of the state and inhibit businesses from coming into the state. The Denver chamber of commerce has worked very hard and very successfully to bring business into the state.

Most of all these politicians know that Obamacare has failed. Oregon’s attempt at the state being the single party payer has failed.

Most recently, Vermont’s attempt at a single party payer system has failed.

Both Oregon’s and Vermont’s governance realized the great fiscal burden to the state budget as well as its businesses and residents.

These states quit before the taxpayers realized the extraordinary tax burden the single party payer system would have on their state.

However, most progressive thinking people cling to the ideology that a single party payer system is the way to universal coverage.

Why did Vermont fail to institute a single party payer system after the state legislature passed the bill?

I will describe the reasons for failure in my next blog.

Walker Stapleton, the Colorado state treasurer said, “a major part of his responsibilities is attention to the fiscal and economic condition of the state.”

He goes on to say,

“If passed by the voters, the provisions of Amendment 69 will have a great negative impact on the state’s fiscal and economic health, as well as impacting individual residents fiscally.”

“If passed, Amendment 69 — creating a governmental entity called ColoradoCare to administer the health care payment system — would amend the Colorado Constitution. It would not be a legislative issue to which the Colorado Legislature could make amendments as needed.”

Walker Stapleton said the state health exchange was supposed be self-sustaining. However, the state health exchange has blown through federal dollars provided.

The State has no way to fix the state exchange or has a way to pay back the federal loan. Walker Stapleton acknowledged the problems with Colorado Health Benefit Exchange, saying, “The exchange was intended to be self-sustaining, and it is anything but, and we have blown through federal dollars.”

United Health and others are leaving the exchange. The exchange has one-fifth of the enrollment anticipated because of cost, network size and service.

“The exchange is in a hole and we have not yet come up with a way to fix it,” he said.

He added that Amendment 69 would assume the state health exchange burden in addition to its debt.

This burden is not good for the single party payer financial burden.

ColoradoCare (Amendment 69) was proposed by a Boulder State Senator, a progressive M.D., with support of the other progressive M.D.s in the Boulder, Colorado community.

Most of the M.D. practices in the Boulder community are owned by Boulder Community Hospital.

I wonder if the M.Ds understand the unintended consequences to the state’s fiscal health, the unintended consequence to the business environment as a result of the increase in tax rate and the unintended consequence to residents experiencing increases in taxes.

I wonder if these physicians are aware of the unintended consequences to their ability to practice medicine.

I suspect the author of the amendment and her followers have not thought about the unintended consequences.

Consequences.

1. Amendment 69 authorizes state taxes be increased $25 billion annually in the first full fiscal year and by such amounts that are raised thereafter.

2. ColoradoCare would be exempt from Taxpayer’s Bill of Rights (TABOR).

3. “A 10 percent payroll tax for every employer in Colorado,” Stapleton said.

The employer would pay 6.7 percent and the employee 3.3 percent. If a taxpayer were self-employed, he/she would pay both, for a total 10 percent.

4. Investment income is subject to this tax. 5. If the employer is outside the state, the tax does not apply for the employer’s 6.7 percent so the employee pays the full 10 percent. Walker Stapelton said, “It is possible retirement income would be taxed,”

Also of great concern to Stapleton are these additional provisions in Amendment 69:

• Transferring administration of the Medicaid and children’s basic health programs and all other state and federal health care funds for Colorado to ColaradoCare;

• Transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers’ compensation insurance;

• Requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado health care system;

• And suspending the operation of the Colorado health benefit exchange and transferring its resources to Colorado Care.

I hope the people of Colorado understand what this dangerous amendment represents to the fiscal health of the state.

The population will only understand its negative connotations if it starts paying attention to the consequences.

If it only believes that free medical care is good they do not understand that nothing is free.

A system in which the state offers free medical care will fail at the expense of all the taxpayers.

It has already been proven in Oregon and Vermont.

There is a more effective and less expensive way!

If you are interested please read the following links.

My ideal medical savings account is democratic and provides universal coverage with the consumers being responsible for their choice of medical care while being in control of their healthcare dollars.

Consumers’ responsibility for their health is always left out of models of healthcare reform.

If the federal government or a state government wants a business model to be successful, it should adapt my future state business model.

It is a consumer driven model with consumer responsibility built in so that consumers control their healthcare dollars.

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

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President Obama Continues to Deceive i.e. The Public Option

July 27, 2016

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

President Obama continues to deceive the American people about Obamacare’s success as his term in office is winding down.

He is trying to use his charming personality to erase the fact tat Obamacare is failing.

The public must keep their eyes and ears open.

Obamacare is falling apart as the months continue. President Obama and the liberals are queuing up to pour more money into a failing healthcare reform model by reintroducing the need for a public option.

On June 30, 2016“CMS division of the HHS Dept. released the HHS Dept. released the actual Q1 effectuation report,

Each year the Obama administration has lied to Americans about enrollment in the health insurance exchange program.

As of June 30,2016, only 11.1 million people have signed up and continued to pay their premiums for Obamacare coverage in the 38 federal health exchanges as opposed to over 13 million that were published. State exchanges are closing monthly.

The latest prediction is that only 10.2 million will have insurance through Obamacare for the entire year. Eighty-seven percent of those insured through the federal health insurance exchanges have government subsidies in the government’s attempt to make health insurance purchased through the exchanges affordable.

If President Obama is correct about Obamacare providing insurance for 20 million people who did not have healthcare insurance previously then 9 million new people have signed up for Medicaid coverage.

Medicaid coverage is completely free to the recipients and is a single party payer system. The federal government presently pays for Medicaid coverage. The increased enrollment is also increasing the federal deficit.

Soon the federal government is going to dump some of the financial responsibility on participating states that are already running budget deficits.

It is only a matter of time before all the 23 state Co-Ops will go out of business and the federal health insurance exchange will take over.

Illinois is the 16^th state to close its Co-Op doors. It followed one week after Oregon Health Co-Op closed its doors.

Land of Lincoln Health received $160.1 million in loans from the Centers for Medicare and Medicaid Services. More than 54,000 enrolled in coverage from the co-op through March 31.

Where are these 54,000 people going to go for healthcare insurance?

“It’s a bad day for the marketplace in Illinois and our consumers,” Jason Montrie, Land of Lincoln Health’s CEO said. “This is the end.”

Who is going to pay CMS back for these federal loans? The state of Illinois cannot afford to pay CMS back. The American taxpayers will re-pay the loan.

So far the total number of federal loans given to the failed nonprofit insurers is more that $1.5 billion for an experiment that was destined to fail from the start.

When are the liberals and progressives going to learn? You cannot keep spending other peoples’ money. You will eventually run out.

These last two weeks have been a big distraction because of party conventions.

Hillary Clinton announced her healthcare proposals. She has proposed an increase of $40 billion dollars in mandatory federal spending insulated from annual budget fights over the next 10 years to develop community health centers.

Hillary Clinton also wants to expand Medicare by letting people age 55 years old or older to opt into Medicare.

In addition she wants a public option.

“Bernie Sanders tweeted. “Together these steps will get us closer to the day when everyone in America has access to quality, affordable health care.”

Who is paying? The middle class taxpayer will pay the burden of the increase in taxes. It will not be paid by the 50% of the entitled citizens who do not pay taxes.

This is an attempt by Hillary Clinton to expand coverage for middle-aged adults. It also gives us a glimpse at how she wants to make Obamacare her own.

President Obama was not taking this lying down. He published an article in the Journal Of the American Medical Association, a “scientific journal.” This article is complete progressive propaganda. Why the AMA permitted this publication is beyond my understanding?

In his “special communication” President Obama once more presents another Trojan Horse (A destructive program that masquerades as a benign application.) to the physicians of America and the consumers of healthcare.

“Some parts of the country have struggled with limited insurance market competition for many years, which is one reason that, in the original debate over health reform, Congress considered and I supported including a Medicare-like public plan.

Public programs like Medicare often deliver care more cost-effectively by curtailing administrative overhead and securing better prices from providers.⁵⁹^,⁶⁰

The public plan did not make it into the final legislation. Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited.

Adding a public plan in such areas would strengthen the Marketplace approach, giving consumers more affordable options while also creating savings for the federal government.⁶¹^”

In 2009 Barney Frank and John Kerry insisted that a public option was essential for Obamacare to evolve into a single party payer system.

President Obama told them they would get to a single party payer system without a public option.

He has now changed his mind.

https://youtu.be/f3BS4C9el98

I have written extensively about the defects in a public option. http://stanfeld.com/?s=public+option

The New York Times writers did not describe the meaning or consequences of the public option in articles about both Hillary Clinton’s and President Obama’s call for a public option.

The American people should be told the real reason for the public option.

The combination of a “public option” within a health insurance exchange system was originally developed by liberal health policy analysts as a dual action mechanism to secure a “single payer” system. It presents the facade of a free market system but the end game is a full-scale government monopoly.

“If a public option became part of government-run health, the Health and Human Services secretary would establish such a plan, set its benefits, and fix its payment rates.

While private plans must negotiate market rates with doctors and hospitals, a Medicare-like “public option” would fix payment rates by fiat, well below the rates that would otherwise prevail in a real market.”

The “public option” would be a better deal for consumers rather than private healthcare coverage. The government would artificially force premiums down with subsidies. It could indiscriminately lower non-negotiated reimbursement to physicians and hospitals and force insurance companies out of the healthcare market.

It would result in an increase in federal taxes.

Additionally, the result will be a defacto single party payer system with less choice and access to care.

President Obama continues to ignore the fact that the government is dependent on the healthcare insurance industry to perform the administrative services for this government program. He ignores the fact that he needs doctors and hospitals to treat and care for sick patients.

He is only interested in financing the healthcare system and controlling the consumer’s ability to choose.

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

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America Is Being Set Up By Progressives

July 12, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D.,FACP, MACE

During the past six months the Obama administration and its surrogates have being setting up Americans to believe that Obamacare is increasing in popularity in America. The surrogates being used are the New York Times, the Washington Post and progressive organizations such as the Kaiser Foundation and various think tanks that issue surveys geared to make that point.

Donald Trump is correct. The system is rigged.

The widely quoted Kaiser Health Tracking Poll published monthly spins its information in the direction the administration wants it to be. The conclusions of the February 2016 survey were;

Americans (36 percent) say policymakers should build on the existing law to improve affordability and access to care than any other option presented.
Sixteen percent say they would like to see the health care law repealed and not replaced.
13 percent say it should be repealed and replaced with a Republican-sponsored alternative.
24 percent say the U.S. should establish guaranteed universal coverage through a single government plan.

There are several things wrong with these findings.

The Republicans did not have an understandable alternative at the time of the survey and they still do not have an understandable alternative.
In February 2016 the Real Clear Poll survey of all state polls resulted in 51.9 % opposing Obamacare while 43% of all those surveyed approved of Obamacare.

Here is the rub in the February 2016 Kaiser Health Tracking Poll. Opinions of those surveyed were swayed after hearing counterarguments about Obamacare.

Before those surveyed heard the counterarguments the survey found that 50% were in favor of a single party payer system with the government running the system. 43 percent were opposed.

After the counterarguments were explained, the survey results were completely different. When it was understood that taxes would go up many changed their vote. Now, 43% of those surveyed plus an additional 20% opposed a single party payer system. Only 30% of those surveyed were in favor of a single party payer.

When the question was asked after the counterarguments were understood about how many would want the current healthcare law (Obamacare) eliminated or replaced, 14% switched their vote to favor eliminating Obamacare for a total vote of 14% plus 43% (57% total).

This is a very different view of the popularity of Obamacare.

These numbers appear in the weeds of the survey and were never advertised. One has to look carefully but they are there. The percentages opposed in these survey numbers are higher than the percentages in the Real Politics Poll.

Since the media is the message the conclusion of a casual reading would be that more than 50% want a single party payer system.

The disinformation creates a false impression of Obamacare’s popularity for the public. The hope is that the public would believe that more people like Obamacare and the prospect of a government controlled single party payer system.

In June 2016 the Kaiser Tracking Poll followed up with another survey that contained more disinformation.

The conclusions were:

Current attitudes about the ACA are divided, with 44 percent expressing an unfavorable opinion and 42 percent reporting a favorable opinion; 16 percent of Democrats report an unfavorable opinion, down from 25 percent in April.

It is not at all divided as reported by the Real Politics Polls or Kaiser’s previous corrected survey.

In May 2016 a Real Clear Politics survey of all state polls showed that 48.8% percent of all polled opposed Obamacare and wanted it repealed. Only 39.2% were in favor of Obamacare. The media had set the administration’s false message.

Increases in the amount people pay for their health insurance premiums tops health care costs concerns; premiums and deductibles are the biggest financial burdens.

This is true but the increases noticed it is because of the 10 hidden taxes for Obamacare and the healthcare insurance companies projected premium increases as of result of Obamacare.

A majority of Americans are following the news about rising health insurance premiums, but the public doesn’t differentiate reports about ACA marketplace premiums from private insurance premiums overall.

In the individual private insurance market premiums were always high and not tax deductible to the individual. Now that everyone is guaranteed healthcare insurance coverage in the individual private market the projected premiums have increased. This is the result of Obamacare regulations. I have described the exact details previously.

However, it is convincing enough to say Obamacare is falling short of providing universal care. The administration’s conclusion is that Obamacare must be expanded to a single party payer system with the government in control to achieve universal care at an affordable cost.

All I can say is everyone should remember the cost of VA Healthcare System is astronomical as well as universal. In this government controlled single party payer system our veterans are treated very poorly despite several scandals and the infusion of more government money.

Three weeks later, on July 10, along comes Hillary Clinton declaring that Obamacare must be expanded and more money must be spent. What will follow is higher taxes and more government bureaucracy.

Can anyone deny that something fishy is going on?

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

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Deals With The Devil, How To Destroy The Healthcare System

July 1, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D., FACP, MACE

President Obama’s goal is to destroy the healthcare system. His deals and regulations lead the healthcare system on the path of destruction.

The strategy is creating so much pain to all the stakeholders that the healthcare system will implode.

At that time public opinion will demand the government take over the healthcare system.

What makes the government a better manager than the free market? The key is to have a system that aligns all the stakeholders’ incentives.

The government is not doing a good job keeping Medicare and Medicaid solvent and providing access to care. It is providing horrible healthcare services to our veterans in the VA system.

The government has conditioned progressive Democrats to continuously declare; “ I don’t mind paying a little more to make the system better.”

The destruction of the healthcare system is a slow process. The Obama administration is proceeding step by step in a very organized fashion.

When it is replaced by a single party payer system controlled by non-elected bureaucrats, consumers will have no control over their free choices.

Hopefully, the U.S. and its citizens are too diverse and too accustomed to freedom of choice and freedom of expression to let this happen.

Hopefully, consumers realize that central government control and socialized medicine doesn’t work. The concept of central control and socialism has failed too many times to count.

Our founding fathers certainly understood this concept.

Hopefully, consumer will realize that Adam Smith was right. The free market is self-correcting. It is only self-correcting with everyone plays by the rules and the government enforces the rules.

A government run by the political establishment that is controlled by vested interests does not work. It will eventually generate mistrust among all parties.

The mistrust of government is building to a tipping point.

Two recent examples of approaching the tipping point are the new ACO rules and the deception involved in the Obamacare reinsurance scandal.

Most of the 242 ACOs out of 3000 potential ACOs have three-year contracts. Many ACOs are not about to reach their Shared Savings goals for the reason I have mentioned.

I don’t know if these ACOs realized in their quest to become more efficient they would eventually lose money. Next year’s sharing goal will be this year’s modified to be the new profit sharing benchmark.

It might be impossible to deliver care more efficiently by the new benchmark.

When the ACO automatically progress to track 2 and fall short of the most recent efficient cost sharing savings benchmark these ACOs will have to repay the government for the losses.

The second important point that is propelling the healthcare system to the tipping point is that the new ACO rules do not take into consideration the healthcare systems that signed up to become ACOs initially.

Any savings the new rules offer in order to attract more healthcare systems to sign up for the ACO program have not been offered to the original signees until 2019. The original 242 have to wait until 2019 to be eligible for the extra bonuses given to new signees.

This might get the original hospital systems to quit their ACO participation completely. If the old ACOs quit the program, it would create more dysfunction in the healthcare system.

It would be just the thing the Obama administration wants to happen. The more dysfunction, the closer America is to a single party payer system.

An equally frustrating example was the money promised to the healthcare insurance industry to guarantee it a profit if it participates in the federal and state health insurance exchange program.

I have described President Obama’s reinsurance program in detail previously.

I was opposed to the reinsurance program. The Obama administration is totally dependent on the healthcare insurance industry to perform healthcare administrative services.

I am not sure either house of congress was aware of or appreciated the implications of the reinsurance program until it because obvious three years after Obamacare was passed.

“The healthcare insurance industry knowing full well that they couldn’t make legitimate profits selling coverage through Obamacare’s exchanges, relied on Democrat guarantees that their losses would be covered by the taxpayers.

But a funny thing happened on the way to easy profits. Congress refused to appropriate the funds.”

When congress realized what was going on it capped the funds appropriated to the reinsurance program. President Obama is still trying to find the fund to pay the healthcare insurance industry.

President Obama paid only 12.6% of the 2.87 billion dollars the industry claimed the government owed it.

Now the healthcare insurance companies that have not been paid are starting to sue the Obama administration.

The companies included are Health Republic Insurance Company. It has filed a class action lawsuit against the government for $5 billion, Highmark Health has sued for $223 million, Moda Healthfiled filed a $180 million suit. Blue Cross & Blue Shield of North Carolina has sued for $129 million. Land of Lincoln Health has filed a $70 million suit.

“It isn’t clear that these lawsuits aren’t going anywhere. “

“The defendant in the class action suit, for example, is “The United States of America” and the plaintiffs ask the court to strike down provisions of two congressional budget resolutions that require the risk corridor program to be budget neutral.”

Congress is the only branch of government that has the power of the purse. It is not the administration or the court.

“As U.S. District Judge Rosemary Collyer put it in a ruling against the Obama administration in a similar case involving unauthorized HHS spending, “Congress is the only source for such an appropriation … See U.S. Constitution, Art. I, § 9, cl. 7”

“(‘No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law.…’).” And a budget resolution becomes law once it has been signed by the President. That’s why the 2015 spending bill is titled, “Public Law 113–235.” Yet the Health Republic class action suit holds that losses somehow render the law invalid:”

Qualified Health Plans have incurred even greater compensable losses in 2015 that CMS and HHS cannot pay as a result of the 2016 Spending Bill.

“Neither the Obama administration nor the congressional Democrats with whom they made their cynical deal can save them. In the end, the Devil will have his due.”

Another way to look at the entire debacle of Obamacare is this is exactly the way President Obama and his administration wanted it to turn out. It will lead the way to a single party payer system. The single party payer system will be another disaster.

Was Obamacare designed and implemented with such incredible ineptitude that Co-Ops like Health Republic and Lincoln Health were doomed from the onset?

Were Texas and the thirty other states that did not join smart enough to know the Co-Ops and state exchanges were destined to fail and go bankrupt?

Was it done purposefully by the Obama administration in order to create chaos in the healthcare system?

Why would anyone believe that a central government that runs and controls the healthcare system be any different than the VA system and the insolvent Medicare and Medicaid System?

Who is responsible for the debacle? The traditional mainstream media such as the New York Times and the Washington Post will blame it on a Republican congress that is refusing to change the law to pay President Obama’s illegal debts.

Who do you think will pay for the upcoming debacle?

You guessed it.

The taxpayers will pay for President Obama and his administration’s obvious fiscal irresponsibility.

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

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All Medical And Healthcare is Local

May 7, 2016

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D., FACP, MACE

It is apparent that Obamacare is failing. Obamacare was built on a defective business plan designed with the goal to have all medical care controlled by the federal government.

If a stakeholder could potentially develop a plan that would threaten the central government’s takeover of the healthcare system, President Obama and his administration would simply rewrite the rules to destroy the initiative.

A clear example is the new rules to destroy health savings accounts. Medical savings accounts are similar to health savings account. The difference is Medical saving accounts put the money in the consumers’ hands initially. If there is any money left of the deductible it goes into a retirement account that is not directed to healthcare. Health saving account direct the unspent money to healthcare costs in the future.

The states are responsible for Medicaid. States claim that the central government is impinging on states’ rights by directing states to do what the federal government tells them to do with respect to Medicaid.

States have fought and won their argument in the Supreme Court when the federal government was paying 100% of the bill for Medicaid if states extended Medicaid. The Federal government will pay 100% until 2017. Then payment will decrease to 95% until 2020. At that time it will decrease to 90%.

Twenty-two states are not participating. The issue is a states’ rights issue rather that a healthcare issue even though the states need the federal help.

Even with this help many people on Medicaid cannot find a physician or can afford the medical care.

“Many plans are being canceled, and many doctors and hospitals are no longer being covered by the new plans on the health insurance exchanges.”

A Medicaid patient said, “Even though I am now on Medicaid, I cannot use it because I cannot find a doctor. “

Another recently discovered stifling of states innovative ability has come to light.

After much bickering after the Affordable Care Act was written state innovation waivers, also called 1332 waivers, which are to begin in 2017, were written into the law.

The state innovation waivers or 1332 waivers are like a golden parachute to states both participating and not participating in the Medicaid expansion program. They are allowed to dictate the conditions and receive federal money.

The 1332 waiver solves the states’ rights problem.

The 1332 waiver would provide states with block grant funding to provide healthcare insurance to state citizens. It also waives nearly every major component of the Affordable Care Act (Obamacare).

A major provision of the 1332 waiver is that it is deficit neutral.

Two things could happen.

States wanting to experiment with a single party payer system could pursue it.

States that want to experiment with a free market healthcare system could pursue it.

Two prominent examples of innovative experimentation have been proposed.

In Arkansas, “Governor Asa Hutchinson has signaled that the state’s “private option” Medicaid expansion. Medicaid beneficiaries would receive private insurance plans.”

These private insurance plans would require higher spending for Medicaid. Theoretically the decreased spending in the Obamacare Exchange would offset the increased spending and better service for Medicaid patients. It would remain deficit neutral.

Rhode Island and Hawaii want to pursuit innovative entitlement programs that would cost less than the inefficient bureaucratic central cost.

The Obama administration could not tolerate the thought of the states being independent of federal control. A recent Friday afternoon, at 3 pm, the Department of Health and Human Services announced a rule change.

“These 1332 innovation waivers must still be deficit-neutral. However,

Savings from Obamacare may not be used to offset increased costs in other parts of a state’s health-care budget.”

The ruling by non-elected officials now makes these state controlled innovative experiments mostly impossible because the states cannot offset the savings.

Since all medicine is local, common sense dictates that states should be able to do a better job than a bloated federal bureaucracy in serving its local citizens’ healthcare needs.

The present system is a multi-trillion dollar failure. The states are correct in wanting to try something new.

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

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More Double Digit Obamacare Price Increases

May 2, 2016

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

Its getting boring to hear about Obamacare’s double-digit health insurance premium increases each year. The healthcare insurance industry is now preparing the public for another round of double-digit premium increases in 2017.

It is important to remember the public experienced double-digit health insurance premium every year since 2014.

The cost of buying insurance has skyrocketed since Obamacare was enacted. The public is not forgetting this.

The table below compares health insurance premiums before and after Obamacare.

This table includes both the numbers in the federal and state exchanges and the private healthcare insurance markets.

President Obama and his administration are bragging that the healthcare insurance markets are stabilizing.

All the federal funded state health Co-ops will be bankrupt before the 2017 enrollment period.

Updated state reports on enrollment since the close of 2016 extended enrollment period indicates that more than 1 million of the 12.7 million who were reported to enroll for 2016 have dropped their Obamacare healthcare insurance policies.

In 2015 only 1.5 million consumers out of 11.7 million enrollees dropped out the entire year.

Arielle Levin Becker of the Connecticut Mirror reported, “In Connecticut of the 18,800 customers who dropped out (16%), 20% failed to provide required information; 53% didn’t pay; 10% asked to have their plans canceled; and 12% shifted to Medicaid.

Those exiting customers were partly offset by nearly 8,000 latecomers, more than one-third of whom lost Medicaid.”

The truth is the Obamacare health exchanges are not stabilizing the healthcare insurance markets. Obamacare is destabilizing the healthcare markets.

It is becoming more and more difficult to believe anything President Obama says or his administration reports.

United Healthcare declared they are dropping out of most of the exchanges they are participating in because of the toll the health exchanges have taken on their bottom line.

Aetna just announced it lost more than $100 million on its healthcare exchange business last year (2015) but hopes to break even this year (2016).

This is a pipe dream on Aetna’s part. Less people have signed up for Obamacare and the people who signed up have been sicker people with pre-existing illnesses.

Aetna chairman and CEO Mark Bertolini said Thursday, “ the nation’s third-largest health insurer still sees a good business opportunity, but Congress needs to provide leeway for companies to design lower-cost plans tailored to young, healthy people.”

President Obama is not going to let insurers design lower cost policies tailored for young, healthy people. His legacy legislation is built on equal premiums for all.

These announcements can put the healthcare debate back in the headlines for the general election. It can re-ignite consumer and voter backlash once again.

President Obama ignored the backlash before. Can Hillary Clinton ignore the upcoming price increase backlash?

“Hillary Clinton is the only one promising to build on the Affordable Care Act. She’s proposed an aggressive effort to increase enrollment along with measures to reduce consumer costs.”

Hillary Clinton is mouthing words that sound good but are impossible to fulfill. People understand these empty promises now.

“ The Republican candidates all want to repeal “Obamacare.”

No one has come up with a solid proposal. Not even Donald Trump.

“Vermont Sen. Bernie Sanders would incorporate it into a bigger government-run system covering everyone.”

Bernie Sanders is dead wrong. America cannot afford the cost and it has been proven not to work in the healthcare systems in the rest of the world.

The health law has many problems. The problems are too numerous to list here. The biggest problem in terms of costs for next years premiums (2017) are the lower-than-hoped-for enrollment, sicker-than-expected customers, and a bloated bureaucracy that is not an efficient business model.

Obamacare has created a financial drain for many healthcare insurance companies. The increase in premiums and the government pressure to keep prices low have in turn created pressure on insurance companies to lower reimbursement to physicians and hospitals.

Hospitals have to participate in the health exchanges, Medicare and Medicaid for survival. Physicians do not. Obamacare has created a more severe physician shortage.

The healthcare insurance companies would never consider becoming more efficient and lowering their cost. Some top executives are making more than 100 million dollars a year.

The healthcare insurance industry is setting the stage for 2017 premium hikes that could reach well into the double digits.

Virginia has nine returning insurance companies participating in Obamacare in 2017. These companies have submitted premium price increases ranging from 9.4 percent to 37 percent to the state board of insurance.

I am sure the Virginia state board of insurance will start negotiating with the participating insurance companies.

Obamacare will only cover 11 million enrollees in 2016. As more enrollees drop out of Obamacare because they cannot afford the premiums the total might be closer to 8 million. Many of the enrollees are subsidized. These subsidized enrollees have dropped out because they cannot afford the remaining premiums and deductibles.

The healthcare insurance industry increases premiums in the individual and group private markets to protect its profit margin.

This is occurring on top of the destruction of Health Saving Accounts and does not speak well for a stable healthcare insurance market.

President Obama’s goal is to destroy the healthcare system and replace it with a single party payer system.

Does anyone think a government run single party payer system will be more efficient or deliver cost effective care?

If you do, please think of the efficiency and effectiveness of the VA healthcare system?

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

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One Could Go Nuts

April 26, 2016

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Quality medical care measures

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Stanley Feld M.D.,FACP,MACE

Measuring quality care in the healthcare system is out of control. My conclusion is that these measurements of hospitals and providers by Obamacare to determine medical care quality is distraction to quality medical care.

The method used is so complex that its measurements are inaccurate and the system is destined to fail.

The measurements are a distraction and costly. They end up diverting resources away from the hospitals’ and providers’ primary mission to provide quality healthcare at an affordable price.

In March 2016, the Healthcare Association of New York State (HANYS) published a report called Measure Madness. The report identified 2,100 required measurements of “quality care” imposed by the federal government and in turn the healthcare insurance industry on hospitals and physicians. The goal is to rate the quality of care given by hospitals and physicians.

The measurement agency claims that the rating system is set up to help consumers make better healthcare choices.

Below is a graph of the various measurements:

Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on time spent per physician to enter the data into the electronic health record to keep track of newly introduced measures and create protocols to track and report them.

“Each year US physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion dealing with the reporting of quality measures.”

This report only covers 4 common specialties,and not all specialties and all hospital costs. There is no telling what it costs other hospitals and providers
HANYS report stated “

The volume of measures that exist, promulgated by lack of alignment and poor coordination, has created an environment of measure madness, “Consuming precious resources that could be directed toward meaningful efforts to continuously enhance quality and patient safety.”

The “measurement madness” may be doing more harm than good, according to the report. It’s the latest in a growing number of reports urging consolidation and standardization among the various groups that require reporting of healthcare quality and safety data.

The Electronic Medical Record is a great idea in theory. I have discussed functional Electronic Medical Records in detail previously. A reader can go to the search engine on this blog to review my criticism of the defects in the Electronic Medical Records sold to hospitals and doctors.

A major defect in EMR is hardly ever discussed. There is a massive amount of copy and pasting to complete the “documentation. The record does reflect anything about the patient’s illness or real progress. It does not provide a true reflection of the patient’s quality of care, natural history of his disease or disease improvement. It does not compare efficiency of medical care outcomes with the financial results of care.
The HANYS report listed the number of reports required for a computer program to evaluate the quality of medical care delivered. It is reflected in the crazy cartoon at the top of this blog.

Number of Reports Per Measurement

Accountable care organizations: 33

The Delivery-System Reform Incentive Payment (or DSRIP) : more than 100

Private Health Plans: 546

National Quality Forum: 635

CMS: 850

Each report has at least one sub report. One has only to recall all the agencies Obamacare has set up.

ObamaCare-Chart.jpeg

This bureaucratic scheme can never work efficiently.

HANYS urges stakeholders to do the work to fix the system.

The call for action was for providers of healthcare to jointly commit to the minimum number of measures needed to evaluate healthcare quality, align them with national, standardized, evidence-based data, and focus on efforts that target the most vital aspects of care.

Last week CMS was forced to delay publishing its hospital quality ratings until July 2016 because of the perceived defects in the Obamacare’s measurements.

Congress received tremendous pressure from hospitals because of the confusion the measurements have created.

“CMS also plans to host calls with providers to clear up questions about current methodology and get feedback on refining the program”.

Obamacare has been promoting the ratings for hospitals, nursing homes, dialysis facilities and other providers as a way for consumers to compare and select providers.

If one measures the wrong things one will get the wrong answer.

Only 87 hospital of more than 3,600 U.S. hospitals got the highest five-star rating, according to the American Hospital Association.

Just over half of the hospitals fell within the three-star range.

A total of 142 got one star. In January, the AHA challenged the CMS, stating that the program “oversimplifies the complexity of delivering high-quality care.”

Hospitals reviewed the ratings earlier this year.
Sixty U.S. senators heard the hospitals’ message. They sent a letter to CMS earlier this month urging the delay of the program. The senators warned of confusing methods, compromised outcomes for hospitals in disadvantaged communities and the potential to mislead consumers.

The American Hospital Association (AHA) has not been able to come up with the same conclusions as CMS, using the same data sets and methods.

“The delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients,” the AHA said in a statement.

On May 12 a conference call is scheduled to educate hospitals on how to analyze and interpret the data. In general, even the government has been confused about how best to interpret the data.

Ben Harder and Avery Comarow of U.S. News & World Report said in a recent article, “Different methodologies can produce different results even when the same raw data sets are used, said cent article.

“No approach to identifying outstanding medical centers is ideal—not ours or the government’s or anyone else’s,” the column stated.”

A case in point: none of CMS’ five-star facilities made it onto U.S. News’ annual Honor Roll. Ben Harder said, It is likely because the CMS does not yet adjust for socio-economic factors.

Again the Obama administration is making another costly complicated mistake that is making hospitals and providers go nuts and distract from their main mission of providing quality care at an affordable price.

If anyone thinks complete control of the healthcare system by the federal government via a single party payer system can do better than this government mishmash they should think again.

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

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April 20, 2016

inDisinformation and the healthcare system, Medicare, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System

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We Don’t Need A Public Option

Stanley Feld M.D.,FACP.MACE

When President Obama told Barry Frank and John Kerry “We don’t need a Public Option in the Affordable Care Act legislation” he was right.

https://youtu.be/SHPsEVQ9dGQ

https://youtu.be/4iR_iKRKewQhttps://youtu.be/4iR_iKRKewQ

Senator Chuck Grassley know all along what President Obama’s scheme was. His problem was none of his Republican friend would listen to him or do anything about it.

https://youtu.be/-522hcm3woA

President Obama’s goal all along was to sneak in a Public Option in through the expansion of Medicaid. He wanted the local states to be administratively and financially responsible for Medicaid while the Federal government controlled the system through regulations.

President Obama had figured out the way to get to a single party payer without a Public Option. However, he and his advisors misjudged the defects in Medicaid.

Republicans have been opposed to a single party payer system and government control of the healthcare system. Republicans felt government control would increase the cost of healthcare, increase inefficiency in the administration of healthcare care, ration healthcare and decrease access to healthcare.

President Obama thought he could use a myriad of regulations to help Obamacare back into a single party payer system. The State and Federal Health Exchanges (“so called Obamacare competitive model”) has resulted in both the health exchange and the private insurance industry increasing the cost of healthcare to unaffordable levels, decreasing access to care, rationing of care and destroying the healthcare system.

The politicians, in a state like California, by following the federal money, ignored the will of the people. The people hate Obamacare because it is restrictive. They are angry about the lie President Obama told them to get their support. “If you like your doctor you can keep your doctor. If you like your insurance you can keep your insurance.”

President Obama has created a healthcare system infrastructure that played on states’ greed. Many states have tremendously high budget deficits. They have over taxed state residents.

State citizens and businesses are leaving for more tax friendly states. The migration has created larger state budget deficits. State politicians say a way of getting more federal money into the states and perhaps attracting people back to the state will be by expanding Medicaid. The federal government promised to pay 100% for the first three years of the Medicaid expansion program

Twenty-two states fell into President Obama’s trap. These states are on their way to a single party payer system without even knowing it.

I predict his scheme will fail.

California was the first state to jump into this pot of boiling water.

The federal government is going to pay 100% of newly qualified enrollees to Medicaid until 2017. Medicaid is under state control.

A record number of people have signed up for Medi-Cal in California. This has led to huge cost increases in Medi-Cal. Its price tag has jumped from $59 billion to $91 billion.

Where does President Obama get the money to pay for it? He increased the federal deficit. I guess $32 billion dollars would be considered a rounding error to most Democrats in congress.

States will have to start paying 5% of the bill for the newly eligible and enrolled enrollees in 2017. In 2020 the states will start paying 10% of the bill.

Medi-Cal is the state’s Medicaid plan for low-income Californians. Nearly one in three Californians now receive coverage in Medi-Cal. With its continued Medi-Cal expansion it is predicted to expand to 20 million by 2020.

The people of California are going to be the first victims of the increased costs and decreased services.

Every government program creates a complex bureaucracy along with money wasting inefficiencies and abuses.

California politicians were bragging about the great deal the government had given them.

“That’s a really great deal for California,” said Scott Graves, research director at the California Budget & Policy Center. “You don’t find that anywhere else.”

“Advocates say the expansion, with the huge infusion of federal money, should in fact eventually yield savings for states, possibly enough to make up for the costs.”

“UC researchers calculated that each new federal dollar brought to California by Medi-Cal will generate 5.4 cents in tax revenue for the state, which would mean several billion dollars. That’s because the money creates jobs in healthcare, which creates income and sales tax.”

Over the years because of the cost overages, Medi-Cal has been forced to decrease reimbursement to physicians and ration both care and access to care. Physicians have opted out of Medi-Cal participation. As Medicaid has grown as a result of Obamacare, Medi-Cal patients cannot find a physician to care for them.

I suppose President Obama could force physicians to accept Medicaid payment in order to retain their license to practice medicine. This executive action would attack freedom of choice and propelling the United States further down the road to serfdom.

As predicted, a group of Californians filed a civil rights complaint against Medi-Cal, alleging that failures in the program have prevented Latinos from accessing their healthcare they needs.

“But the complaint filed with the U.S. Department of Health and Human Services claims that because Medi-Cal administrators don’t pay doctors enough to see patients, they “effectively deny the full benefits of the Medi-Cal program to more than seven million Latino enrollees.”

Many complain that Medi-Cal’s reimbursement rates, among the lowest in the nation, create a shortage of doctors willing to see Medi-Cal patients.

“The audit confirmed our long-standing concerns about access for Medi-Cal patients,” said Anthony Wright, executive director of the advocacy group Health Access California. “The findings of the audit cry out for more oversight.”

Gov. Jerry Brown’s budget for the 2014-15 fiscal year accommodates an influx of uninsured residents into Medi-Cal.

“However, at Governor Brown’s request, the Legislature left in place a 10 percent recession-era cut in reimbursement to most doctors, dentists and other health care providers who treat Medi-Cal patients.”

Health providers predicted this harmful contradiction. The contradiction is that Medi-Cal expansion will provide more of the poor with adequate healthcare coverage. It is, in fact, reducing poor persons ability to get into clinics, practices and even hospitals.

The California HealthCare Foundation reported that 76 percent of primary physicians accept new patients through private insurance. Only 57 percent accept new Medi-Cal patients.

The optimism of politicians for the expansion of Medi-Cal improve state revenue has vanished. California’s deficit is increasing rapidly as a result of Obamacare’s largess.

In California, state officials are discussing how they’ll afford the program next year (2017). Gov. Jerry Brown called a special legislative session this year to address funding for Medi-Cal.

“It’s a strained system,” said Hernandez, “and I really believe we need to figure out how to resolve. ”

The 20 states that have not accepted President Obama’s offer to expand Medicaid were correct. These states wanted to make their own decision in the name of states’ rights. Many of the states could not afford expansion in the way President Obama was dictating it. Their budget deficits and taxes would have to increase.

California has just proven these states fears. In 2017 California will start paying 5% into the Medi-Cal expansion. It will make the budget deficit worse.

California will, once again, start begging the federal government to bale it out.

President Obama’s plan was to dump the financial burden on the states while controlling the system and creating a single party payer by default.

There is a much better way to provide healthcare to all people at an affordable cost.

The better way is to put consumers in control of their healthcare dollars.

They will control their health to avoid costly complications of chronic diseases. The people will be given financial incentive to be responsible for their health to try to avoid the onset of chronic disease.

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

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Obamacare Co-Op Folly

March 21, 2016

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

I apologize for spending so much time on the failure of the Obamacare Co-Ops. It is worth emphasizing because this is an example the common denominator of the many other Obamacare failures.

A reader asked me to list the 12 states that closed down and declared bankruptcy before 2016 enrollment leaving 700,000 consumers without insurance coverage.

In my last blog on Co-Ops I did not mentioned the name of the 12 states Co-Ops that went bankrupt. These state Co-Ops defaulted on their federal loans. The federal taxpayers loss was $1.2 billion dollars.

I did not list them because I predicted that all 22 state Co-Ops would go bankrupt by the end of 2016. Taxpayer’s will lose at least $2.5 billion dollars in loans for a program destined to fail from the start.

CMS has said it will regain most of the money and but has not explained how it will recover the loan losses. There were multiple reasons for the Co-Op failures.

An important reason is the disastrous business plans. The Obama administration hired Deloitte to evaluate each state’s loan application. Deloitte’s advice concerning the applications deficiencies was ignored by CMS and the HHS.

The point is the Co-Ops are ill conceived, as many of the Obamacare “innovations” are ill conceived. Once the ideology is approved the Obama administration ignores the advice from expensive hired consultants.

Deloitte Consulting evaluated the viability of the state Co-Ops by evaluating their loan applications and business plans. Deloitte expressed concerns about the now defunct 13 Co-Ops. According to the study from Republicans on the Senate Permanent Subcommittee on Investigations, the Department of Health and Human Service and CMS ignored Deloitte’s warnings.

“HHS instructed Deloitte to evaluate the proposed budgets for completeness as well as “reasonableness and cost effectiveness.” The Department told Deloitte to review the pro forma financial statements for completeness, clarity of assumptions, and consistency with each Co-OP’s business plan.

In its review, Deloitte identified numerous problems ranging from comparatively minor issues, such as omitting needed expenses, to more significant concerns, like presenting an unreasonable budget.”

2. In addition to inconsistencies, Deloitte noted that many of the Co-Ops’ budgets appeared to be unreasonable or did not align with the states own financial projections.”

This is typical of many bureaucracies in government agencies.

3. Deloitte also expressed skepticism about the risk-taking and unreasonable assumptions reflected in some of the Co-Ops’ financial projections.

4. “Each CO-OP loan applicant was required to “identify its management team, explain their qualifications and experience, and submit an organizational chart and detailed position descriptions, including the qualifications required for each position.

5.Based on its review of this portion of the CO-OP’s business plans, Deloitte consultants expressed concern over key leadership position gaps or thin industry expertise for all of the 12 failed Co-Ops.”

This observation, by Deloitte alone, should have disqualified the state Co-op from obtaining a federal loan.

The devil is always in the details. The details are so voluminous than few dig in to find the defects. The goal is only to have the paperwork done.

Deloitte had many negative comments. The loans were made despite the negative comments by the Obama administration.

Some state CO-Ops did not even list the senior management team.

6.“These failed co-ops were a costly experiment gone wrong, and real people got hurt, including the more than 700,000 Americans who lost their health plans,” Sen. Rob Portman, chairman of the subcommittee, said today at a hearing on the co-ops.”

How many more Obamacare programs are constructed to fail?

Can taxpayers trust the government to control its medical care with a single party payer system when a single portion of Obamacare is so poorly constructed and consultants ignored?

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

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