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Democrats Still Think Americans Are Stupid

May 11, 2017
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D.,FACP, MACE

The House Republicans finally got their act together and passed their version of the Obamacare repeal and replace act. It seems that many representatives do not trust Paul Ryan, Tom Price and President Donald Trump.

The Republican house version of the bill does not repeal and replace Obamacare completely.

The Affordable Care Act (Obamacare) permitted Kathleen Sibelius, the Secretary of HHS, to issue regulations to administer the act at her discretion. Many of her regulations were destructive to the healthcare system.

Tom Price, the new Secretary of HSS can eliminate many of these destructive regulations. The goal of the Obama administration’s regulations was to cause the healthcare system to fail and be replaced not by free market principals but by a single party payer system.

Her regulations were designed to eliminate any modicum of free choice for patients and physicians.

Tom Price’s actions and regulation eliminations should complete the repeal and replacement of Obamacare.

President Obama ignored the fact that a single party payer system would be destined to bankrupt the country. His plan was to get the health care insurance industry out of the healthcare picture.

The defect in his logic was that the government would have to continue to outsource the administrative services to the healthcare insurance industry. The government now outsources the administrative services for Medicare and Medicaid.

The government then lies to the public declaring that its overhead is only 2.5% while the healthcare insurance industry takes 30% for services that are charged as direct patient care.

The healthcare insurance industry would continue to rip off the healthcare system in a single party payer system for all.

The completion of the repeal and replace act will be done as promised by Ryan, Price and Trump in three stages.

As soon as the house bill is passed the House Democrats came out with their talking points criticizing the act. These talking points had little substance and no compelling evidence. They only declared that the legislation was terrible without any explanation of why it was terrible.

They just said 20 million people are going to lose their insurance coverage. The Republican health care act is going to kill people.

The talking points are mostly lies.

A recent study had reported that Obamacare has cost 80,000 people to die.

“Democrat’s immediately made the accusation that the GOP “repeal and replace” bill will kill Americans.  It seems that Obamacare has already done that.” 

In a previous blog I pointed out that more people have lost insurance in the individual market that have gained insurance from Obamacare’s health insurance exchanges.

Fourteen million lost insurance in the individual market in 2009 and at most 8 million gained insurance through Obamacare’s health insurance exchanges.

The 20 million new insured comes from the 12 million new people receiving healthcare insurance through Medicaid.

“Quoting Oren Cass over at National Review, it turns out that fewer people – not more people – had health insurance after Obamacare.  The only increase in “coverage” was Medicaid, but, sadly, it turns out that Medicaid kills people.  It’s better to have no medical insurance at all.” 

 Researchers have found that in 2015 Medicaid patients experienced worse outcomes than similar uninsured Medicaid eligible patients.

“Public-health data from the Centers for Disease Control confirm… [that had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000-13 period, 80,000 fewer Americans would have died in 2015 alone.”

The Democrats are using the typical progressive tactic of creating a lie. Many people died because of Obamacare but the Democrats threaten that the Republican bill will cost many lives. It diverts attention from the Democrats’ failure with Obamacare.

This is fear mongering for the progressives’ political gain.

This is one of Sol Alinsky’s favorite tactics. One should do everything to marginalize opponents even if it needs to be done by lying.

“Democrats are hurting real people with their scary shrieking about death by Republican.”

The Democrats criticize without facts. The Democrats will lie about the effects of the bill without evidence. I would guess that many have not even read it.

One should expect nothing less from Nancy Pelosi and Chuck Schumer.

The Democrats have even rolled out Jonathan Gruber, the MIT professor of economics and co-author of Obamacare, who infamously said, “the stupidity of the American voter” helped get the measure to become law.

This week Gruber blamed President Trump for Obamacare’s failure on one of the Sunday news programs.

“Whose fault is this (rising premium costs)?” Gruber asked on “Fox News Sunday.” “Since President Trump has been elected … premiums are going up and insurers are exiting.”

This is total nonsense.

Jonathan Gruber still thinks Americans are stupid. However he has no credibility with the American public. Therefore his opinion has no impact on the discussion about the new bill.

Nancy Pelosi and Chuck Schumer’s lack of credibility with the American public does not seem to bother them.

Every lie they tell decreases their credibility even further.

Nancy Pelosi said, “the new Obamacare repeal bill is a ‘a very sad, deadly joke’

This is the same woman who said we will not know what is in the Affordable Care Act (Obamacare) until it is passed.

What is so deadly about it? She does not explain her statement. She figures the media is the message. The media will carry the message for her.

Chuck Schumer’s quote was even worse. He said, “Senate GOP should toss House healthcare bill ‘out the window’”

He called on Senate Republicans,

“To avoid following the lead of their colleagues in the House and to work on a bipartisan basis on healthcare reform rather than pushing for repeal of the Affordable Care Act.”

He is trying to save President Obama’s legacy Obamacare. Obamacare is an unmitigated disaster. It is beyond saving.

It was a poorly constructed healthcare bill aimed at giving big government total control of the healthcare system. President Obama totally ignores the fact that Americans did not want it, have not joined it. He felt he clearly know what is best for America.

He goal was to get it passed by the partisan vote. President Obama lied to Americans and lied to his party members.

Obamacare is unsustainable economically to America and is in the process of destroying the economy.

Chuck Schumer said, “Trumpcare is a giant, broken promise to working people, the hard-working people of this great country of ours.“

It would be valid if Chuck Schumer could prove his statement.

President Obama broke his promise to the working people, the hard working people of this great country of ours, when he said, “ If you like your doctor you can keep your doctor and if you like your insurance you can keep your insurance.”

Chuck Schumer did not see it then and he does not see Obamacare’s failure now.

I suggest that Chuck Schumer read the Republican bill carefully before he makes his false statements.

Clearly, he was dead wrong in his judgment about Obamacare

If he read the Obamacare law carefully and voted for doing the right thing, America’s healthcare system might not be in the mess it is in.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Obamacare Coverage: The Big Lie

March 25, 2017
inDisinformation and the healthcare system, Medicine: Healthcare System
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Stanley Feld M.D., FACP, MACE

President Trump keeps telling us Obamacare is a disaster. Paul Krugman and Ezekiel Emanuel keep telling us it is a success.

The Obama administration told us that 20 million new people have obtained healthcare insurance because of Obamacare.

We know 14.5 million people lost their healthcare insurance in the individual market the year after Obamacare was passed.

Many assumed they got their insurance back through Obamacare. There is no evidence for that assumption.

I followed Obamacare enrollment carefully on acasignup.net.

This site was supposed to be publishing the exact numbers published by the government weekly. www.acasignups.net

It turns out that the numbers published were inaccurate. They were too high.

“Since the release of the HHS study, the government has published two additional surveys of health-insurance coverage – the Current Population Survey (CPS) and the American Community Survey (ACS). Both offer data through the end of 2015, allowing for comparison with the NHIS estimate.”

The government now claims these studies are only estimates of nonelderly adults, under the age of 65, who gained insurance coverage.

The estimate in increased adult coverage ranges from 13.5 million in the CPS study to 16.5 million in the NHIS study.

Where did the number 20 million new lives covered come from? Bill Clinton boosted the number to 25 million when campaigning for Hilary Clinton.

Edmund F. Haislmaier and Drew Gonshorowski of the Heritage foundation examined data from insurance company regulatory filings and from the government’s own headcount of Medicaid enrollment.

“Their study found that 14 million people (including children) gained public or private coverage in 2014 and 2015.”

This total is even lower because it includes S-Chip coverage for children.

Compounding the government lies of estimated enrollees was that 84% of the new enrollees was either Medicaid or S-Chip children.

This means only 2,240,000 people signed up in President Obama’s Health Insurance Exchanges.

It also means that there were 11,760,000 new Medicaid or S-Chip patients.

Edmund F. Haislmaier concluded in testimony to congress;

“While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that

for the three year period 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private sector coverage enrollment.”

http://budget.house.gov/uploadedfiles/house_budget_testimony-haislmaier.pdf

Eighty-five percent of the 2.7 million have pre-existing conditions. Most are receiving government subsidies.

The 2.7 million covered under Obamacare have destabilized the healthcare insurance market so that healthcare costs for businesses have become unaffordable.

No one has even mentioned the cost of this Obamacare folly to the average hard working taxpayers with healthcare coverage from their employers.

Obamacare’s failure to has been devastating.

“The authors also found that nearly half the new Medicaid enrollees met eligibility standards that were in place before the ACA.”

Maybe Jonathan Gruber is right when he said we, the public, are too stupid to know the wool is being pulled over their eyes.

 

“For all the hoopla about the ACA exchanges, it appears that Medicaid accounts for the lion’s share of coverage gains and that many new Medicaid enrollees would have been eligible for that program even if the ACA had never passed.”

Medicaid is a single party payer system (socialized medicine) that works very poorly. It is almost as bad as the VA Healthcare System.

Is this what the public wants? No

America needs a better healthcare system. Hopefully Dr. Tom Price knows what to do replace Obamacare with once he dismantles all of the Obama administrations regulation.

Maybe Jonathan Gruber is wrong.

The general taxpayer may be smarter than Dr. Gruber thinks. Maybe it is the reason the public elected Donald Trump.

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

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Stop The Noise: Start Working

March 22, 2017
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP, MACE

The New York Times is filled with case reports of people helped by Obamacare.

The implication is Obamacare is successful and the Republicans do not have a better plan.

Articles appear daily defending Obamacare despite the fact that premiums and deductibles are up, access to care and coverage is down and the medical profession and consumers are despondent.

Obama Says Healthcare Law is Working Fine

https://www.nytimes.com/2013/05/01/health/obama-says-health-care-law-is-working-fine.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obama Says Healthcare Law is Helping White Americans Despite Perceptions

http://www.nytimes.com/politics/first-draft/2014/12/29/obama-says-health-law-is-helping-white-americans-despite-perceptions/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Is The Healthcare Law Creating More Part Time Work?

http://takingnote.blogs.nytimes.com/2013/09/27/is-health-care-reform-creating-more-part-time-work/?smprod=nytcore-ipad&smid=nytcore-ipad-share

Why Even Some Republicans Are Rejecting The Replacement Bill

https://www.nytimes.com/2017/03/07/upshot/why-even-some-republicans-are-rejecting-the-replacement-bill.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

Obamacare Users Await Repeal and Replacement With Dread Anticipation

http://www.cbsnews.com/news/obamacare-users-await-repeal-and-replacement-with-dread-anticipation/

All of this is “Fake News.”

I cannot understand how Dr. Ezekiel Emanuel, with a straight face on national television, can say Obamacare is not failing.

Dr. Emanuel thinks Obamacare is a great deal. He is one of its authors.

His problem is he cannot prove it is great in reality.

 

 https://youtu.be/1-PRvZ_R0-0

I guess the Democrats hope is if you tell a lie enough times it becomes the truth.

The conservative media is starting to figure out how to neutralized this tactic that engenders sympathy for Obamacare. The Wall Street Journal published an article “How Obamacare Punishes the Sick.”

This article stimulates feeling against President Obama’s lies.

“Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions.”

 If one can disregard the fact that one case does not win a medical argument, one can start talking about what might work to create a cost effective quality healthcare system.

Obamacare and its bureaucracies have set up perverse incentives for stakeholders and against consumers.

A recently reported study by Harvard and the University of Texas in Austin demonstrated these perverse incentives.

Obamacare is supposed to help the sick. It turns out Obamacare punishes the sick with certain illness.

“But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance.”

Diseases such as multiple sclerosis, rheumatoid arthritis, infertility and others high cost conditions are being charged higher deductibles, experiencing more prior-authorization for drugs, an increase in lesser quality substitution drugs, and often no coverage for the drugs they need.

Most of these conditions require long- term expensive medications.

Therefore consumers with these diseases cannot get treated adequately.

For example, a patient with multiple sclerosis might file a $61,000 claim.

Insurers lose money on every MS patient. An incentive is created for insurers to avoid enrolling patients with MS. The insurers then make its healthcare policy unattractive to people with multiple sclerosis.

Obamacare’s subsidy for patients with multiple sclerosis is inadequate for the cost of the disease’s care.

“To mitigate that perverse incentive, ObamaCare lobs all manner of taxpayer subsidies at insurers. Yet the researchers find insurers still receive just $47,000 in revenue per MS patient—a $14,000 loss per patient.”

 

The insurer doesn’t want to loss $14,000 per patient. Patients are not stupid. They find the best coverage at the lowest price,

This insurer suffers high losses. He either leaves the market or decreases coverage. The perverse incentive leads to low quality care.

Patient with multiple sclerosis on Obamacare are not getting high quality healthcare.

Everyone losses. The government loses, the insurer loses but most of all the patient loses.

There is a better way to insure these people. In a free market system driven by my ideal medical saving accounts the creation of a high risk pool funded by all participating insurance companies in the lucrative private market spreads the risk to insurance companies and government while providing high quality care to qualified patients.

Politicians must start thinking smart.

The format of previous high-risk healthcare insurance pools was a disaster for all the stakeholders. High-risk pools can be formatted in a way that works for patients and does not contaminate the private market with spiraling insurance prices.

The Democrats ought to give up Obamacare. It is a dead horse.

Obamacare has failed for the many reasons I have pointed out in my blog over the past 7 years.

The Democrats’ knee jerk reaction would be why not just adopt a single party payer system.

The answer is look at the mess the VA system is in with it bureaucracy and apathy.

Republicans ought to stop trying to prove Obamacare is a failure.

The politicians ought to try to do something right for the people who put them in power.

They ought to get rid of Obamacare in the least disruptive way possible as quickly as possible.

I believe President Trump, Tom Price M.D., and Paul Ryan are trying to do just that with the American Healthcare Act that is being voted on the house tomorrow.

The conservative coalition in the house should get off its high horse and not shoot itself in the foot.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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I Was Wrong

March 14, 2017
inMedicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

I was profoundly disappointed when The American Healthcare Act was introduced last week. There was immediate rejection by Republicans and Democrats in both the House and Senate.

The mainstream media commentators emphasized the Republicans’ rejections and added their own scornful objections. The mainstream media painted the Republican Party as a party is disarray.

The media was presumably giving a boost to the Democratic Party and Obamacare’s failure.

Both Paul Ryan and Dr. Tom Price gave complete explanations of their strategies on how this bill, along with its two other components, will repeal and replace Obamacare.

I was profoundly disappointed in the bill until I was able to hear Dr. Tom Price and Paul Ryan’s explanation of their reasons for the initial reconciliation bill and the plan of the other two components necessary for replacement.

Vice President Pence and President Donald Trump then repeated Ryan ad Price’s strategy in less detail.

I reacted immediately to the bill being a sell-out to the healthcare insurance industry and central government control of healthcare. It looked like Obamacare Lite or Obamacare 2.0. There was no other explanation presented.

It took them 24 to 36 hours to explain the logic of the strategy.

By that time there was so much mainstream media noise and politician noise that It was impossible to hear what Tom Price and Paul Ryan were trying to say.

No one listened to what President Trump was trying to say. They were only listening to the media describing Republican caucus’ members outburst against the bill.

President Trump tweeted “it is a beautiful healthcare bill. Everyone will be happy with the result.”

No one listened. No one heard.

The mistake Ryan and Price made was that in the initial introduction of the bill they were being too cute, cunning and clandestine. In reality they were very prepared. They have been working of this repeal and replacement since 2010.

The plan to repeal and replace Obamacare has three parts.

  1. Reconciliation
  2. Administrative Action
  3. Additional Action

It would be very helpful to understand their positions if you watch them explain their positions in their entirety.

 

This lecture by Paul Ryan is an excellent review of the metodology necessary to Repeal and Replace Obamacare

 

Both videos are a must see in order to understand the Trump administration and congressional leadership strategy.

Obamacare was supposed to provide an opportunity for people in the individual insurance market to buy healthcare insurance at an affordable price. It was not meant to affect the employer provided healthcare insurance market.

This was supposed to be done by State Health Insurance Exchanges that would supply this insurance. Much of the individual market would be subsided by the federal government..

Only 22 states signed up and most have failed after receiving over $200 billion dollar loans to cover startup cost. These state health insurance exchanges are never going to pay back the federal loans.

Additionally, Obamacare extended Medicaid coverage by increasing the poverty levels in states. This increased the eligibility for patients to participate in Medicaid.

President Obama completely ignored the fact that Medicaid was a financially unsustainable subsidy that was failing rapidly.

Thirty-three States signed up for this expanded Medicaid coverage because they were afraid to get stuck with the bill.

All states are supposed to have balanced budgets. Most states have budget deficits.

They share the costs of Medicaid with the federal government to provide free healthcare coverage to the poor.

President Obama said he would pay 90% of the Medicaid bill. He then increased it to 95% and then 100% in the first few years in order to induce states to join.

Remember, President Obama’s ultimate goal was to have the federal government be in total control of healthcare with a single party payer system.

Twelve million new people have signed up for Medicaid under Obamacare. Additionally new immigrants have been added to the Medicaid roles.

Only nine million have signed up for Obamacare through the health insurance exchanges. Most of the enrollees have preexisting illness.

Most of the enrollees cannot afford the premiums even though President Obama provides subsides to 85% of these people.

Additionally, these enrollees cannot afford the deductibles that are up to $6,000 in some states.

Obamacare has affected the employer market. Obamacare does not pay the insurers enough or have a high enough enrollment distribution to give the insurance industry a high enough return on investment.

Insurers compensate by increasing insurance rates in the employer sponsored private market in almost all of the states. The industry increased rates in both individual and employer sponsored private market by as much as 116% in Arizona.

This forces small and large employers to decrease insurance coverage for employees.

If they did not provide healthcare insurance many small businesses had to pay Obamacare’s mandated penalty.

A mandated penalty was avoided if people worked less than 29 hours a week. Therefore, large employers reduced full time jobs to part time.

There are many other reasons that Obamacare has failed. It has inhibited economic growth.

Obamacare must be completely repealed.

The Ryan plan’s process is repealing as much of Obamacare as it can through the reconciliation process. This is only the first stage. does.

Congressional reconciliation only needs 50 votes in the reconciliation process thanks to Harry Reed.

“Congress and the Trump Administration must completely repeal the law, beginning by seizing the opportunity to accomplish as much of repeal as possible through the reconciliation process.”

After passage of the American Healthcare Act, Dr. Tom Price will then move on to part two.

He will repeal all the administrative rules and regulations that President Obama and Donald Berwick put in place that hurt Americans and the economy.

He will replace them (one regulation for two eliminated) that will help people obtain affordable healthcare insurance and help our economy grow.

Republicans opposed to the Ryan plan do not seem to get this point.

If Republicans could get total repeal through the House of Representatives with they would not get the 60 votes necessary to get Senate approval.

In stage three Republicans will be able to get the 60 votes necessary for Senate approval.

There are 18 vulnerable Democratic senators up for reelection in 2018.

With Obamacare’s rules and regulations repealed at that time, Democrats’ opposition to things like expanded Health Savings Accounts, malpractice Reform, insurance Reform and insurance across state lines will melt. It will be important for these vulnerable Democrats to vote for these reforms in order to get reelected..

The Ryan plan now looks like an excellent strategy to me. I do not see why the opposition Republicans cannot see it.

Doing it their way with complete repeal a stage one might not work. Then will be stuck with Obamacare and the loss of both Republican controlled of the house and senate in 2018.

There are still refinements necessary to be a consumer driven healthcare plan that is patient-centered.

I hope the Ryan/Price plan is passed by congress.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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Profoundly Disappointed

March 9, 2017
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP, MACE

I am profoundly disappointed in Paul Ryan, the Republican caucus and the RINO establishment for introducing the Paul Ryan bill to repeal and replace Obamacare.

It doesn’t completely repeal Obamacare or completely replace it.

In fact the supposed anti- entitlement party (Republicans) are adding another entitlement.

They are even leaving the healthcare insurance industry in charge of the money and the access to care.

It doesn’t even fulfill the five principles President Trump listed in his address to congress.

Those five principles alone would not Repair the Healthcare System.

The bill does nothing to encourage consumers to be responsible for their health and their healthcare dollars.

Consumers must be involved in driving the healthcare system in order for the healthcare system to be viable.

The bill continues to allow the government and the healthcare insurance companies to drive the cost and the healthcare system.

The Republican bill does not provide incentives for consumers to use their healthcare dollars wisely.

It does not include malpractice reform.

If President Trump buys the nonsense Republicans are calling a repeal and replacement for Obamacare, then the RINO’s have pulled the wool over his eyes.

It would be a gigantic mistake to push this bill in its present form. You would be producing political capital for the politically bankrupt Democrats.

This bill is a typical bait and switch. Rand Paul is correct. It is Obamacare lite.

It does not put consumers in charge. It keeps the healthcare insurance industry in full control of medicine, healthcare and the government.

Rather than discontinuing an entitlement it creates another one.

Refundable tax credit is another term for redistribution of wealth. You give money to everyone. You then take it back from some and let the others have it.

It does not repeal most of the Obamacare regulations.

It extends many of the programs past 2019.

President Trump, it does not help drain the swamp as you promised. It makes the swamp worse.

The insurance companies are not returned to a free market. It is a clever way to support the insurance companies by switching from a mandate and penalty to a tax credit (giving the money away to everyone).

This is another entitlement to further enrich the healthcare insurance industry.

Americans elected these Republican politicians to drain the swamp. This bill is no different than Obamacare.

Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons said:

“Refundable” tax credits – for those who don’t owe taxes – are still a subsidy. It is still redistribution of wealth, with winners (those who get the subsidy) and losers (those who pay for it). And the chief winner is the “health plan.” It gets money; the supposed beneficiary may get nothing, or only rationed care from a narrow network.

“The problem is comprehensive third-party payment,” Orient adds. “The bill perpetuates this disastrous concept. A true free-market bill – “there shall be a free market in health insurance” – would remove all federal mandates, subsidies, barriers to competition, or protections or advantages for cartels.”

“Instead of returning the insurance market to the vigor of a free market, the government will be supporting it with tax credits – the flip side of the ACA insurance penalty.”

Americans are not stupid. The Republican bill will expose all the Republicans who are for the bill. They are not working for the good of the people

Democrats have already demonstrated they do not work for the people.

An group like the tea party can put up candidates against these guys and elect people who are for the people.

Where are the plans for consumer driven healthcare, patient centered healthcare, malpractice reform and the physician patient relationship?

Where are incentives for consumers to focus on their health, to help cure the obesity problem in order to decrease the incidence of diabetes and other chronic diseases?

Where is a free insurance market?

Paul Ryan’s plan is the road to failure.

The next step would be replacement of the Republican’s failure with a government controlled single party payer system.

It will fail as it is in so many countries.

President Trump. Wake up!!! Keep your promise to the American people.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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When Its Not Your Money

October 25, 2016
inMedicaid, Medicine: Healthcare System
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Stanley Feld M.D.,FACP,MACE

No one should be surprised at the money wasted by federal government programs. President Obama has been the biggest offender of wasting taxpayers’ money in my lifetime.

He increased the national debt from 10 trillion to 20 trillion dollars.

The volume of regulations, the creation of bureaucratic agencies, bureaucratic czars and the lack of enforcement of existing laws have served to create much of this waste.

However the public is unaware of the amount of taxpayers’ dollars spent because of the lack of government transparency. Congress ought to be standing on every mountain screaming about the waste.

I have observed the opposite. All we have to do is remember how congress marginalized Tom Coburn’s efforts to eliminate waste by eliminating duplication.

Obamacare is no exception to immeasurable waste while it destroys the healthcare system.

Improper payments for Obamacare are soaring because of a defective law and government inefficiency and incompetence.

A study by HHS shows that the improper payment rate for Medicaid will be 11.5% for 2016. It means that more than one out of every 10 dollars spent is wasted on either fraud, errors in payment or accounting inaccuracy.

The pre-Obamacare improper payment rate was 5.8% or one in 20 dollars spent. In 2015 it was reported that the improper payment rate was 9.7%.

This is the waste rate for only 10 million people added to the Medicaid roles.

I would suspect all three reports are an underestimate of the real improper payment rates.

The actual dollar amounts of improper payment rates are increasing because Obamacare has expanded Medicaid enrollment.

As the number of Medicaid recipients increase the wasted dollars will increase.

With President Obama’s new executive order to expand the eligibility of illegal immigrants for Medicaid coverage, the rate and amount of dollars improperly deployed will skyrocket.

To my amazement a lot of intelligent people are ignoring this simple arithmetic.

Medicaid eligibility is increasing rapidly. In 2015 Medicaid enrollment increased by 13.8%. One in five Americans as well as all illegal immigrants are entitled to Medicaid coverage.

I guessed that HHS would blame physicians for the waste. I was correct.

Medicaid reimbursement is so low that physicians have figured out ways to see more patients per day. They are using physician extenders extensively.

These physicians are accused of running Medicaid mills. They are accused of Medicaid fraud.

Then these physicians are put through a costly audit and are penalized. Many get fined for fraud and abuse due to overbilling.

There are many other reasons for this waste. Most important is HHS’ lack of proper diligence in administering the program. It smacks of reasons similar to the VA Healthcare System scandals.

“There’s no particular reason the error rate should be spiraling upward other than overwhelming incompetence.”

On closer look, home health agencies are probably the biggest abuser along with an ineffective bureaucracy that becomes more ineffective as the program grows.

“In recent audits of Medicaid in Arizona, Florida, Michigan and New Jersey, the GAO uncovered 50 dead people who recouped at least $9.6 million in benefits after they died; 47 providers who registered foreign addresses as their location of service in places such as Saudi Arabia; and $448 million bestowed on 199,000 beneficiaries with fake Social Security numbers—12,500 of which had never been issued by the Social Security Administration.”

The problem is not discussed by the traditional mass media. The public has no idea this is occurring.

Medicaid is a single party payer system completely controlled by the government. Patients have no control over which doctors they will see for an illness.

Medicaid is another clear example of the lack of concern or incompetence by government agencies for spending other peoples’ money.

Even worse, the system does not work for patients or physicians. Patients are the most important stakeholders in the healthcare system. They are treated like a commodity.

Medicaid is inefficient and costly.

Twenty percent of our population is now in this system. There is limited access to care and rationing of care.

There is a better way. It is a consumer driven healthcare system using my ideal medical saving account.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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If You Tell A Lie

October 20, 2016
inMedicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D., FACP, MACE

If you tell a lie enough times it becomes the truth. President Obama and Hillary and Bill Clinton keep telling the American public that there are 20 million new Obamacare enrollees.

Obamacare advocates believe that Obamacare provided healthcare insurance for 20 million people who did not have healthcare insurance before Obamacare.

These Obamacare advocates have little understanding of the details of this lie. They usually react negatively when I tell them the 20 million new enrollee figure is a lie.

Republicans do not pick this up and call Democrats out about this lie. Perhaps they have no understanding of what is going on.

The lie then becomes the truth.

I follow Charles Gabbe at http://acasignups.net. Charles Gabbe is pro Obamacare. He publishes daily and weekly statistics as well as news in general about Obamacare’s progress and enrollment.

His numbers come from government sources. His numbers are very different than the numbers President Obama, Hillary and Bill Clinton are announcing.

The Obama administration continually manipulates the enrollment figures in order to give the impression that Obamacare has been successful.

President Obama continuously lies about the enrollment figures.

Obamacare has been a total failure because of its structure.

On December 9, 2015 ACAsignups.net published these enrollment numbers for 2016.

“ACAsignups.net publishes government release enrollment numbers weekly. These are the December 9th numbers.

Confirmed 2016 Exchange QHPs: 3,260,356 as of 12/09/15


Estimated 2016 Exchange QHPs: 4.73M as of 12/09/15 (3.60M via HCgov)

Projected Exchange QHPs: 5.76M by 12/12/15 (4.34M via HC.Gov)

Projected #OE3 QHP Selections: 14.70M nationally (11.23M via HC.gov)

Projected #OE3 QHP Selections by State

http://acasignups.net

Maybe 9 million signed up for Obamacare last year. (2015)

What were the 12/09/14 enrollee numbers with 3 weeks to go until January 1, 2015?

Christmas to New Years consumes one week of enrollment. Holiday shopping will consume the other two weeks.

Why did the government reduce the expected enrollment to 5 million when enrollment was 9 million last year (2016)?

Does the Obama administration expect 4 million people to drop out of Obamacare because it is too expensive?

How did the Obama administration’s data given to the CBO cause the CBO to predict an enrollment of 21 million enrollees for 2016?

The 2016 Obamacare enrollment figures barely touch 10 million, not 20 million.

What is enrollment going to be when most of the major insurance companies have dropped out of the health insurance exchanges?

What is enrollment going to be when 18 of the 22 Obama administration created State Co-Ops have gone bankrupt?

President Obama and his administration have mislead Americans about the exact number of enrollees since the very beginning of the first enrollment period starting October 1, 2013. The first enrollment was delayed until November 1, 2013 and extended 6 months.

The American public has been mislead about:

  • The disastrous website development, reason for website crashes and cost of website development.
  • The exact number of enrollees the first year. (9.5 million corrected to 8 million and then re-corrected to 6.8 million)
  • An additional correction that resulted in another decrease of an additional 800,000 enrollees losing Obamacare insurance. The government belatedly discovered these 800,000 were ineligible for subsidies.
  • Decreasing the original predicted enrollees for 2015 from 13.5 million to 9.5 million.
  • The change in the start of enrollment from October 1, 2014 to November 15th to avoid discussion of enrollment around the time of the November 2014 elections.
  • Extending the 2014 enrollment 6 months.
  • Extending enrollment for 2015 for one to three months.
  • Finally, in 2015 announcing the back end of the website’s ability to send information to the IRS was still not complete.
  • Rehiring CGI, the same Canadian company that built the disastrous healthcare.gov, to fix the back end of the website. A company’s employee is a friend of Michelle Obama.
  • Discovering that 1.2 million enrollees were counted that should not have been because they got dental insurance instead of healthcare insurance bringing the number of enrollees down from a recalculated 8 million to 6.8 million enrollees for 2014.
  • Announcing that 11.5 million people have enrolled for 2015 (these numbers seemed shaking at the time of enrollment. It seemed to be closer to 9.5 million or less.)
  • Announcing that the group market Obamacare insurance enrollment is being delayed a year or two while the mandate penalty for employers was to start January 1,2015.

Along the way I got the feeling that none of the enrollment numbers could be trusted. HHS and CMS kept modifying and lowering them.

The Obama administration keeps telling American how great the enrollment is and that Obamacare is a success.

However, we are told only ten million enrollees had Obamacare insurance in 2016.

Eighty five percent of those on Obamacare are receiving subsidies so the premiums are affordable. These subsidized recipients still cannot afford the deductibles.

The remaining 15% enrollees have a pre-existing illness. They cannot find private insurance to buy.

What about the 330 million people who might have subpar healthcare insurance? How many employers might discontinue employee insurance?

After five years with all the new Obamacare taxes, I would not call Obamacare a successful healthcare reform program.

All of these enrollees are in the individual insurance market. These numbers do not include the group insurance market.

14 million people in the individual market lost their healthcare insurance pre Obamacare.

10 million gained insurance on the healthcare insurance exchanges in 2016. There is a net decrease of 4 million individuals that is not discussed by the Obama administration or the traditional mass media.

Many of the state healthcare insurance exchanges have failed.

Eighteen of the 22 state insurance co-ops have failed so far.

An unknown number of enrollees in 2014 did not re-enroll in 2015 because of the loss of the subsidy.

Other enrollees did not sign up again because they could not afford the high deductible.

At the end of 2015 enrollment the Obama administration announced that 11.5 million people were enrolled.

On March 16, 2015 the administration said about 16.4 million people have gained health insurance coverage since the Affordable Care Act became law nearly five years ago.

Please notice the tricky wording. The Obama administration is counting children under 26 that now can be included in their parents’ group insurance plans and the additional Medicaid recipients added by some states.

The count is not only the people who enrolled in Obamacare through the healthcare insurance exchanges.

The discussion should be about the success of the healthcare insurance exchanges not the increase in Medicaid coverage.

The 2014 enrollment figures as of March 18, 2015 were also inflated. It is noteworthy than the Medicaid/CHIP estimate was 14.1 M. It is down to 10 million in 2016.

Confirmed Exchange QHPs: 11,699,473 as of 3/18/15

Estimated: 11.95M (9.06M via HCgov) as of 3/18/15

Estimated ACA Policy Enrollment: 33.1M
(10.46M Exchange QHPs, 8.20M OFF-Exchange QHPs, 330K SHOP, 14.1M Medicaid/CHIP)

 http://acasignups.net

Written into the law is that only state healthcare exchanges can provide subsidies not the federal health exchanges.

President Obama has not asked congress to rewrite the law’s provision.

This was another example of executive overreach of power by President Obama.

It looks as if President Obama cannot help himself from trying to manipulate the American public.

Republicans have not pointed out all this manipulation to the voting public.

I believe the public has figured out the manipulation.

Hillary Clinton has promised she will expand Obamacare. Why expand a failed program?

Her unspoken goal is to institute a single party payer system. A single party payer system will also be unsustainable.

There is a better way!

It is a consumer driven healthcare system with my ideal medical saving account.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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Bill Clinton Is Crazy As A Fox

October 9, 2016
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP, MACE

 Many Republicans and Democrats thought Bill Clinton had lost his mind when he made his Obamacare statement earlier this week.

Most of the conservative traditional and alternative media also thought he lost his mind. They repeated Bill Clinton’s statement over and over again. The media’s goal on both sides of the aisle simply wanted to make sure it sunk into the head of the American people.

Notable & Quotable: Bill Clinton on ObamaCare

“Former President Bill Clinton speaking about ObamaCare at a rally Monday in Flint, Mich.:”

 “The people that are getting killed in this deal (Obamacare) are small business people and individuals who make just a little too much to get any of these (Obamacare’s) subsidies.”

 “ Why? Because they’re not organized.”

 “ They don’t have any bargaining power with insurance companies. And they’re getting whacked.”

 “ So you’ve got this crazy (healthcare) system where all of a sudden 25 million more people have health care, and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half.

 It’s the craziest thing in the world.”

Clinton

 


https://youtu.be/ETVcsPRTSHM

 

Trump

https://youtu.be/jziTLD0Gc7Y

Bill Clinton knew exactly what he was doing. Hillary Clinton’s position on Obamacare has been clearly stated. She is for Obamacare and for the public option. She has stated that she is going to expand Obamacare.

Bill Clinton’s position sounds totally opposite his wife’s position.

Hillary Clinton’s website explains her position on healthcare clearly.

She wants to : “Defend and expand the Affordable Care Act, which covers 20 million people.”

Hillary Clinton stating that 20 million people were covered by Obamacare is untrue. In 2016 the health insurance exchanges only cover 10 million people. Obamacare has expanded Medicaid coverage by 10 million people. Medicaid coverage is less than ideal.

The comments in the WSJ about Bill Clinton’s comments are more entertaining than Bill’s comments about Obamacare.

One comment suggested that Bill Clinton is jealous of his wife.

“This is called a “Bill bomb”, designed to passive aggressively tank Hillary’s campaign so he doesn’t have to go back on the leash.”

“She was lagging in the polls, Bill had nothing, but she is surging again and Bill can’t have that.”

Some of the comments applaud Bill Clinton for finally speaking the truth.

       1.” You gotta love it when Bill sounds like a Republican.”

  1. “It is so refreshing to hear a Democrat politician speak the truth. And oh, so rare. Perhaps Bill forgot to take his medication.”
  1. “Give the Democrats credit whenever they do something intelligent, and non-ideological, even if they do it for a confounding reason.”

      4. “Leave it to Bill to hit the nail on the head.  Pure genius.”

      5.”Perhaps there is one Clinton who tells the truth.”

This commentator forgot all of the lies Bill Clinton’s told us (the public) when he was president such as his most famous lie, “I did not have sex with that woman.”

      6.” I don’t know what’s more shocking: Bill slamming Obama’s signature law or a Clinton telling the truth.”

      7.” He must have been off his meds at the time he made the comment, the next day he was back on track. I guess Hillary had to break another lamp over his head.”

I believe Bill Clinton did a brilliant thing for his wife. Obamacare is going to fail. He and Hillary do not want to have anything to do with Obamacare’s failure.

Consumers have discovered that their premiums and deductibles for 2017 are rising to unaffordable level. These increases are because of Obamacare. The private sector has also experienced tremendous increases in premiums and deductible because of Obamacare.

Open enrollment for the health insurance exchanges are supposed to start November 1, 2016, seven days before the Presidential election. If Hillary Clinton does not separate herself from Obamacare it will sink her chances to be elected.

I think the Obama administration will delay open enrollment until after the Presidential election.

President Obama might be able to pull Obamacare’s failure out of the dirt if he is able to illegally obtain the “Judgement Fund” money to pay the healthcare insurance industry the money he owes them.

The Republican establishment in congress should make a stink about the release of this money. The Republican establishment should not sell out to President Obama.

President Obama is pulling another illegal fast play on congress and the American taxpayer by getting this money.

President Clinton’s statement is his effort to distance his wife from the Obamacare impending failure.

His statement demonstrates the Clintons’ character. After President Obama and Michelle Obama went all out to endorse Hillary Clinton for President, Bill Clinton stabs President Obama’s legacy legislation in the back.

“Now that the Obamas have given Hillary their full-throated endorsement, Bill can take policy positions more in line with suffering middle class voters. In Clintonworld expedience supersedes truth.” 

Hillary Clinton’s goal is to usurp credit for healthcare reform from President Obama.

She wants to be able to say that healthcare insurance plans do not work.

America needs a single party payer system and it needs it now.

Bill Clinton’s assessment is correct on the issue of Obamacare. All Obamacare is doing is merely shifting costs from those who cannot pay to those who can pay.

It is truly a healthcare system that redistributes wealth as Dr. Don Berwick said a long time ago.

The Clintons want a single party payer system real fast so that they look like they are coming to the rescue of the American people.

Democrats running for congress have rapidly gotten on the Clinton bandwagon.

Clinton’s proposal is simply bait and switch.

The problem is a single party payer system detrimentally affects the middle class taxpayer the most as I have explained.

They are trying to make Obamacare’s failure into an election issue asset for Hillary Clinton who will come to the rescue with her single party payer system.

A single party payer system is unsustainable and has huge defects.

I also know the majority of the middle class does not trust Hillary or Bill Clinton.

The Clintons will not fooled the majority of the middle class again.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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What Exactly Is A Public Option?

September 28, 2016
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

Obamacare is failing. The impending disaster is coming November 1st when the insurance vendors publish their premium prices for Obamacare’s Health Insurance Plans.

Consumers will be shocked by the 20% increase in premiums, the sparse selection of insurance vendors and the higher deductible.

As a distraction from the failure of Obamacare, the progressive Democrats are now trying to sell the “Public Option” as the savior of Obamacare.

I have received several questions asking what exactly is the “Public Option.” The “Public Option” was turned down in 2009 when Democrats were in control of both houses of congress.

How could a “Public Option” be passed in a Republican controlled congress? It can’t be passed.

The Democratic push to sell the “Public Option” is political theater. It is meant to provide hope for President Obama’s progressive base and blame Obamacare’s failure on the Republicans.

It is also meant to distract the traditional mainstream media from the impending Obamacare failure and upcoming disasterous enrollment before the Presidential election.

Here is the answer to the question “What exactly is the Public Option ? ”

It is another defective program that will fail. If passed by congress it will result in the deepening distruction of the healthcare system.

The “Public Option” was first introduced into Obamacare at the onset of the passage of the act. It was eliminated from the bill in a Democratic dominated congress because as Barney Frank said, “We don’t have the votes”.

Barney Frank and John Kerry were convinenced that the only way to get to a single party payer system in the United States was though a “Public Option.”

The “Public Option” is the creation of a federal government-run health insurance agency. The goal of this new insurance company would be to compete with private health insurance companies on price within the United States.

The original published purpose of the “Public Option” was to provide more affordable health insurance rates to uninsured citizens who are either unable to afford the rates of or are rejected by private health insurers.

Now it will be providing cheaper insurance than the private insurance companies are offering to force the private insurance companies to reduce their premiums.

The private insurance companies will not show up to compete.

Obamacare was supposed to be doing creating competition through its Health Insurance Exchanges and State Co-Ops for the people with pre-existing illness and the poor.

The result was premiums went through the roof for both the Health Insurance Exchange policies and private insurance policies.

The government is ended up providing subsidies for 85% of only 10 million people who have bought insurance through the Health Insurance Exchange. It is economically unsustainable for the government and tax payers if the entire population would buy insurance through the Public Option.

It is obvious that the government would try to undercut the private insurance companies and force the private insurance compaies to lower their prices. The result would be bankruptcy as the State Co-Ops experienced.

“Supporters argued that a government insurance company could successfully lower its rates by using greater leverage than private industry when negotiating with hospitals and doctors,[18] as well as paying the employees of the public option insurance company salaries as opposed to paying based on individual medical procedures.[19]”

However, the federal government is dependent of the healthcare insurance industry for the administrative services necessary in adjudicating healthcare insurance claims.

Federal government dependence is true of all government healthcare programs except the VA Healthcare System.

Does anyone think the federal government bureacracy can run a healthcare system effectively and efficiently?

The healthcare insurance industry builds profit into its administrative services contracts. The federal government’s bureacracy cannot control those prices.

The reduced premium pricing would result in government subsidizing the “Public Option” further resulting in an increase in the federal deficit. This has happened in Medicare. Premiums have gone up, covered care has gone down. Medicare is unsustainable.

The recipients of Medicare think it is a wonderful program. The trustees of Medicare feel it is unsustainable simply because of the massive hidden subsidies and cost overruns.

There is no question that premiums are increased, reimbursement to providers has decreased, care is rationed and access to care has decreased.

No one in government is thinking of a more efficient way to format Medicare.

Neither Barak Obama, Hillary Clinton, or Bernie Sanders are thinking about the consumer and the consumers’ needs at this point.

Neither are they thinking about a healthcare system that is affordable to the federal government or the consumers of healthcare.

No one is thinking about consumers driving the healthcare system and being responsible for their health and healthcare dollars.

These politicians are only thinking about power and central control by the federal government over the healthcare system no matter the cost to the federal government, the tax payer, the quality of care delivered to consumers, or the system’s effect on economic growth.

“The real sign of how Bernie Sanders changed the Democratic Party can be seen not just in shifts in the Democratic Party platform, but in how the party’s current leader, Barack Obama, has altered his own posture. “

“And this week, in a special communication to the Journal of the American Medical Association, Obama endorsed a public health insurance option to enhance the Affordable Care Act, his signature legislative achievement.”

“This puts Obama in line with his preferred successor, Hillary Clinton, who recently reiterated her support for a public option and for allowing Americans between 55-65 to buy into Medicare. Both policies tilt toward Sanders’s vision of universal coverage.”

Philosophically it is called Socialism.

Big government controlling society does not work. There are countless examples of socialism’s failures in Europe, bankruptcies, unemployment and stagnation, both economically. and politically.

America must learn now. We ought to adopt a healthcare system that is consumer driven.

Big government and its bureaucracies cannot do it for us. It has led from one disaster to the next. It will destroy our healthcare sytem.

America should try a system that provides financial incentive to the public so people are responsible for their health and healthcare dollars.

The government should adopt a healthcare system that I have outlined.

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

 All Rights Reserved © 2006 – 2016 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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