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Obamacare Owes Insurance Companies $2.5 Billion Dollars For 2014 Health Exchange Losses

October 7, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

These days there is very little news in the traditional mainstream media about Obamacare.

The average person thinks everything is fine. President Obama has told us over and over again that Obamacare is a great success.

Unfortunately, this is far from the truth as the Obama administration prepares for the 2016 enrollment period.

Open enrollment is supposed to start November I, 2015 and end January 15, 2016 for 2016.

In 2013 and 2014 open enrollment was extended many months because of poor enrollment. I suspect the same will happen during the 2016 enrollment period.

The disastrous web site is still not fixed.

The healthcare insurance industry has increased Obamacare insurance premiums by double digits. The Obamacare deductibles remain in the thousands.

Even with large Obamacare subsidies people making under $50,000 cannot afford the subsidized premiums or deductibles.

Some people are registered through both the health insurance exchanges and Medicaid. This has been recently discovered by the Obama administration.

These people have received the Obamacare cash subsidy and Medicaid coverage. Now the Obama administration expects to be paid by these recipients for the government’s overpayment.

The Obama administration has refused to publish the number of people affected.

None of these issues have appeared in the traditional mainstream media.

The Obama administration continues to publish conflicting figures about how many people are actually enrolled through its federal health insurance exchanges.

The administration needs the healthcare insurance industry to do the administrative services for the health insurance exchanges.

At the onset of enrollment in 2013 healthcare insurance companies did not want sign up to do the administrative services. The companies figured that high-risk people without insurance would sign up for insurance and they would lose money. Obamacare required that the premium would be equal for everyone regardless of the health risk.

Obamacare originally wrote into the law three risk corridor programs that would be activated if necessary to subsidize the healthcare insurance industry against undo risk.

As a result of the healthcare industry’s lack of participation in the federal and state insurance exchanges, the risk corridors were activated.

“The healthcare reform law established three “market stabilization” programs to help insurers weather the first few years of covering a new population with unpredictable healthcare needs. At issue is the risk corridors program.”

I was astonished when I learned of these risk corridors. The corridors encouraged the healthcare insurance industry to participate in providing administrative services for each state and federal exchange at no risk of loss.

It was amazing that the leading Republicans for repeal of Obamacare did not make this clear to the public.

The insurance industry was actually guaranteed a profit because they provided its own profit and lost data. The Obama administration simply accepted its data. The healthcare insurance industry was supposed to receive the subsidy for its loss.

The government’s hope was to provide enough insurance choices to enrollees in the health insurance exchanges so there would be competitive pricing.

Unfortunately for Obamacare it did not work out as planned.

“ The government had planned on releasing risk corridors data in August but waited until October 1, 2015 due to discrepancies in the data.”

I suspect the delay was for political reasons and to provide enough time for the government to present the data in a less negative fashion.

The data provided by the Health insurers that sold health insurance plans showed that those insurers lost a great deal of money on the Affordable Care Act‘s exchanges in 2014.

The data shows the Obama administration has short changed the healthcare insurers that participated in Obamacare $2.5 billion dollars promised to them in the safety value risk corridor subsidies.

The Obama administration now is promising those insurance companies that the $2.5 billion dollars to cover the deficiency will be covered with budgeted monies from 2015 and 2016 if possible.

President Obama is now sowing the seeds to blame the nonpayment on Republicans since Republicans control congress.

Republicans thought the health insurance risk corridors were a stupid idea to begin with and predicted failure. Now the Obama administration is trapping the Republicans for not wanting to pay bills that are owed.

Some smaller insurance companies who were seduced into participating in this no risk insurance policy folly are now worried about experiencing “solvency and liquidity problems”.

CMS would not give the number of companies affected. It said the cases are isolated.

“The insurers requested $2.87 billion in payments to cover their losses. The CMS will only reimburse 12.6% of the payment requests, meaning insurers will still be owed more than $2.5 billion.”

“ Names of companies that are owed money were not released.”

Does anyone think the insurance companies are going to sign up for the 2016 enrollment cycle?

Insurance companies do not know how much Obamacare will short- change them for the 2015 subsidies yet.

One can also begin to understand why insurance rates for both government and private insurance are increasing when physician and hospital reimbursement are falling.

The insurance industry feels it has to make up its loss.

Why are the Republicans not saying anything about this to the public?

Why aren’t Republican candidates for President not pointing out this folly?

Why are they letting themselves be set up to be blamed for not wanting to pay the government’s bill?

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

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President Obama Tries To Bully The Supreme Court

June 10, 2015
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

President Obama attacks his opponents, marginalizes them, throws them under a bus, lies, ignores reality, or bullies them.

The reality about Obamacare is that none of the stakeholders like it.

It is causing states with State Health Insurance Exchanges to go deeper in debt.

The government has been forced to create 37 Federal Health Insurance Exchanges. Premiums are skyrocketing because of poor enrollment and demographic distribution. Only people with pre-existing illnesses or those receiving subsidies are joining.

Premiums are now unaffordable even applicants receiving subsidies.

Obamacare is driving corporations providing healthcare insurance for their employees to figure out how to avoid providing healthcare insurance and penalties.

The government has provided waivers for companies such as McDonalds, Burger King and 1300 other companies to not participate in Obamacare.

 Obamacare has tried to take away Medicaid subsidies from states that did not start a State Health Insurance Exchange and would not expand Medicaid. The Supreme Court stopped that two years ago.

Obamacare has driven physicians into hospital employment. Many physicians are unhappy and less productive working for hospitals themselves.

Many physicians have retired early because of Obamacare. This is a bad sign in light of our present physician shortage.

Obamacare has created incentives for hospitals to create Accountable Care Organizations (ACOs).

Logically ACOs cannot work because they shift financial risk for patients on to physicians and hospitals and away rom the healthcare insurance industry.

Hospitals and physicians are finally starting to realize the risk and are dropping out of the ACO programs.

Obamacare has spent over one billion dollars for a web site that is still not fully functional.

The promise of universal healthcare coverage has resulted in more people being uninsured than before Obamacare was passed. Only 9 million people are signed up and 6.4 million receive subsidies.

The original prediction in 2009 for 2015 was 17 million participants.

The expanded Medicaid program in 14 states is  experiencing severe physician shortages and financial problems.

Obamacare patients and Medicaid and Medicare patients are starting to experience limitations on access to care and rationing of care.

I am only naming a few of the many problems Obamacare has created.

Yet with all these defects and failures President Obama has the gall to say,

 “There's something deeply cynical about the ceaseless partisan attempts to roll back progress.”  

"I understand people being skeptical or worried before the law was passed and there was no reality to examine. But now that we can see millions of people having health care—and all the bad things that were predicted didn't happen—you'd think it was time to move on."

Obamacare is not working despite President Obama’s claims.

I think it is time to move away from Obamacare and in another direction.

This week President Obama did another astonishing thing. It reveals   his consistent disrespect for the constitution and the separation of powers.

He has tried to intimidate the Supreme Court to rule in favor of Obamacare with his personal attack on the court and its upcoming decision in King vs. Burwell.

 “The law provides for subsidies only for policies purchased on exchanges "established by the state", inserted in the law as an inducement to states to set up exchanges.”

Congress limited the subsidies to State Health Insurance Exchanges to encourage the states to set up their own exchanges. Thirty-seven states saw the trap that President Obama was setting for them and refused to cooperate.  

The IRS, operating under the direction of President Obama, tried to “fix” the law by permitting federal exchange to provide subsidies.

The infamous Dr. Jonathan Gruber, a principle framer of Obamacare, who was paid by the Obama administration $375,000 for his consultations with the White House staff, said the exclusivity of state exchanges rewarding subsidies was put into the law to induce states to set up exchanges.

Dr. Gruber, a healthcare economist, also said the law would have not passed if the public was not so stupid and could recognize the lack of transparency of the law.

President Obama said at the time of the scandal that he did not know Dr. Gruber. President Obama said Jonathan Gruber played a minor role in the construction of Obamacare.

During the last month President Obama has used the traditional media to try to convince the Supreme Court and the American people that congress really meant to give the State Exchanges and the Federal Exchanges to ability to provide insurance subsidies.

Article after article was published confirming that what the law meant to say was both State and Federal Exchanges had the ability to provide subsidies. This was morally the right thing to do.

President Obama said this week. “That we have an obligation to put ourselves in our neighbor’s shoes, and to see the common humanity in each other.”

First of all congress didn’t write the law. It should have and it should have been bipartisan. Most Democratic congressmen who voted for Obamacare didn’t even read the law.

The IRS has no authority to change the letter of the law with a regulation.

The law as written should be the law. The Obama administration overstepped its constitutional limits. If the law is wrong, congress should amend the words to include subsidies for federal exchanges also.

Obamacare is a terrible law. It is distorting and destroying our already dysfunctional healthcare system. The Republican dominated House and Senate are not going to change a law that is self destructing, if the Supreme Court favors King and the letter of the law.

Since President Obama’s traditional media campaign has been a flop, he has personally gone after the Supreme Court. He tried to intimate it by challenging its integrity.

President Obama said, “Frankly, the Supreme Court should not have taken up the lawsuit challenging Obamacare subsidies.” 

Who is he to decide which cases the Supreme Court should take up?

 President Obama continued,“There is no reason why the existing Federal Health Insurance Exchanges should be overturned through a Supreme Court case,”

 President Obama is preparing the country to be angry at the Supreme Court if the Supreme Court rules in favor of King.

President Obama is disregarding the notion that the Supreme Court is interpreting and upholding the constitution, a concept he frequently ignores.

“I think it’s important for us to go ahead and assume that the Supreme Court is going to do what most legal scholars who've looked at this would expect them to do.”

 This statement is both a lie and a veiled threat to the court.

“Elena Kagan  recently wrote in another case that, "This Court has no roving license, in even ordinary cases of statutory interpretation, to disregard clear language simply on the view that (in [the IRS’s] words) Congress 'must have intended' something broader."

During oral arguments in March, Justice Antonin Scalia suggested Congress could step in and fix the problem.

“Congress just adjusts, enacts a statute. It would take care of the problem. It happens all the time,” he said. “Why is that not going to happen here?”

President Obama did say there was one way to resolve the dispute over the law: “Congress could fix this whole thing with a one-sentence provision.”

President Obama said, “He is puzzled by the legal challenges against his signature healthcare law, arguing there is ample evidence that the system is working.

“Fortunately, there's no reason to have to do it. It doesn't need fixing,”

President Obama keeps harping on the same lies. He believes if you tell a lie enough times it becomes the truth.

President Obama said, “Part of what's bizarre about this whole thing is, we haven't had a lot of conversation about the horrors of ObamaCare because none of them have come to pass.”

There has been limited conversation about the horrors of Obamacare in the media because President Obama and the traditional media have limited the conversation

President Obama cannot bully the Supreme Court into not of upholding the constitution and it obligation to interpret the constitution accurately.

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

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Simple, Viable Republican Alternatives To Obamacare

April 12, 2015
inChronic Disese Management, Consumer Driven Health Care, Disinformation and the healthcare system, Health Savings Accounts vs Medical Savings Accounts, Healthcare Insurance Industry, Medicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust, Universal Healthcare
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Stanley Feld M.D., FACP, MACE

There are many simple and viable alternatives to Obamacare which Republicans should start considering.

Republicans should seriously consider My Ideal Medical Savings Account as an alterative to Obamacare. It is logical, simple, does not require a large complicated infrastructure and aligns all the stakeholders’ incentives.

It is easy for consumers to understand.

Consumers want to have choices. The dysfunction of our healthcare system has gotten to the point where most consumers don’t have a choice. Consumers simply do not know they lost their freedom of choice and access to care until they get sick.

Consumers think they have adequate healthcare coverage until they get sick. Only 20% of the population gets sick.

The other 80% of the population refuses to think about the problem.

When they do experience illness, the dysfunction in the healthcare system makes them furious. They want to blame someone. Physicians are usually the targets of their frustration.  

Most physicians are trapped in a situation that causes them to fight for their own survival for all the reasons I have previously enumerated. This creates a more dysfunctional healthcare system.

All the stakeholders fight for their own vested interests. These vested interests have become misaligned. The vested interest of the government is to control of the system and decrease its costs.  

Costs cannot be controlled by regulations without consumer involvement.   Consumers of healthcare must understand the effectiveness of their care is dependent on their involvement in their own medical care.

Consumers’ adherence to treatment is a key component in the effectiveness of medical care.

Medical costs cannot be controlled by government price fixing.

Medical costs cannot be controlled by government restrictions to access of care. Consumers will become sicker resulting in a higher cost illness.

Consumers must be empowered to be intelligent, motivated and responsible consumers of medical care. Only then can healthcare costs be controlled.

A functional healthcare system must provide financial incentives to consumers in order for them to want to be empowered to control costs. Consumers should not be dependent on the government to control costs.

The government must repair the actuary and accounting rules of the healthcare insurance industry. Insurance reserves should not be scored as a loss to justify premium increases.

The healthcare insurance industry takes 40 cents off the top of every insurance dollar that is spent. Consumers with both private insurance and government insurance are only getting 60 cents value for every healthcare dollar spent. The healthcare industry is allowed to do some strange accounting with their required reserves.

If this accounting method were repaired, premium costs would decrease.

Effective malpractice reform would result in a significant decrease in healthcare costs. The Obama administration refuses to believe tort reform is needed.  

Many of the rules written into Obamacare, Medicare, and Medicaid are so screwy they defy common sense and penalize consumers. One glaring rule is Medicare permitting hospitals to admit Medicare patients to the hospital for observation for 48 hours.

Medicare does not pay for Observation admissions. Patients have to pay out of pocket for these admissions.

Consumers must become aware of these screwy rules and protest them. These rules have been written by the Obama administration to save the government money. These rules penalize patients the government professes to help.

Consumers are the only stakeholders that can motivate President Obama and congress to fix the significant points of waste in the healthcare system. Consumers have the power to vote.

I do not believe that President Obama has an interest in repairing the healthcare system. All of his actions signify that he wants the healthcare system to fail. After it fails people will beg the government to completely take over and have a single party payer.

Does anyone trust the government to take over our most valuable asset, our healthcare?

The government take over will also fail because dependent consumers will figure out how to game the system just as food stamp recipient have figured out how to game that inefficient system.

The goal of a sincere administration and congress is to figure out how to motivate consumers to be “PROSUMERS” (productive consumer) with an economic interest in the healthcare system.

Airlines, banks, bookstores, entertainment venues have all figured it out. Why can’t the government help consumers figure it out?

My blog entitled “My Ideal Medical Saving Account Is Democratic” presents a consumer driven healthcare formula. It gives every socioeconomic group the opportunity to be an effective “Prosumer”.

It gives all Prosumers the incentive to be responsible for their health and healthcare dollars.

Below is the blog My Ideal Medical Savings Account Is Democratic!

My Ideal Medical Savings Account Is Democratic!

Stanley Feld M.D.,FACP,MACE

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

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

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

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

The excellent example of increasing costs, decreasing choice, and decreasing access to care is Medicaid.

The fact that someone is covered by healthcare coverage does not mean they have access to medical care.

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

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

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

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

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

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

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

In each case the funding source is different. The cost of the high deductible insurance is low because the risk is low. 

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

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

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

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

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

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

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

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Republicans who really want to repair the healthcare system should take notice of these suggestions. They should stop proposing complicated alternatives to Obamacare that will not work.

Republicans should start trying to understand the real problems in the healthcare system.

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

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The Republican Alternative to Obamacare

April 7, 2015
inHealthcare Insurance Industry, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests
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Stanley Feld M.D. FACP MACE

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

The Obama administration insists that the Republicans do not have a viable alternative. I doubt that anyone in the administration has read the alternatives.

President Obama’s tactic is to marginalize any opposition even if he has not reviewed it.  

The Republicans have some good ideas. However, they do not address the basic problems in our healthcare system.

The implementation of their ideas will not repair our healthcare system.

 “Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.”

Obamacare has so many parts. Most of Obamacare’s parts could have been predicted to fail. It is clear that congress did not understand this destiny before passage.

Obamacare was destined to fail from the start. It is on the way toward failure today. It will also destroy the entire healthcare system.

The Republican alternative is called, "The Patient Choice, Affordability, Responsibility, and Empowerment Act." 

It's key provisions include:

A Full Repeal and Replacement of Obamacare

Eliminate Individual Mandate to Buy Health Insurance or an Employer Mandate to Offer Coverage

Consumer Protections – Republicans want to retain the popular consumer protections in Obamacare including no lifetime limits, coverage for children to age 26 on their parent's plan, and guaranteed renewability of coverage.

However, they propose to decrease the costs of healthcare insurance for younger consumers but want to increase the cost of healthcare insurance for older buyers.

The Republicans would create a new set of losers (older buyers) while increasing the incentive for younger people to buy insurance.

Republicans should be providing financial incentives for consumers to be responsible for their health and their own healthcare dollars. Consumers with chronic diseases should also be responsible for the control of their chronic disease.

 A Return to Pre-Existing Condition Limits.  This is a ridiculous provision. It guarantees the biggest villain in the healthcare system (the healthcare insurance industry) its control of premiums and profitability.

Default Enrollments – Republicans would allow states to create a default enrollment system for those eligible for tax credits as a means to reduce the number who would otherwise remain uninsured.

A complex agency would be needed to administer a complicated process.

  
High Risk Pools for the Uninsured – High-risk insurance pools did not work previously because of healthcare insurance companys’ control of the premiums for the sickest people and their high risk of disease.

 Affordable Insurance Policies – This is also a pipe dream. America’s population is becoming more obese. Obesity generates more illness and higher risk. As long as the healthcare insurance industry is calculating and is in control of the actuary risk, healthcare insurance will not be affordable. The problem is how the insurance industry is allowed to do its accounting.  

The Republicans are proposing the elimination of benefit mandates and downsizing guaranteed insurability with their "continuous coverage" provision.  

This proposal is ridiculous. As long as consumers are not responsible for their health and their healthcare dollars and the healthcare insurance industry controls  price,  the healthcare system will be increasingly more expensive and dysfunctional.

Tax Credits to Buy Coverage – Tax credits are an unearned entitlement. Unearned entitlements do not work. Tax credits would be available for those in the individual health insurance market, those working for businesses with fewer than 100 employees, and those working for larger employers that do not offer coverage.

Tax Credits Only Up to 300% of Poverty – A system of tax credits leads to an agency that must be connected to another government agency, which leads to a larger government bureaucracy. In turn the bureaucracy leads to fraud and abuse

Flat Amount Tax Credits By Age – The goal of this proposal is to eliminate federal and state exchanges. Obamacare’s state and federal exchanges have not worked no matter how the administration spins the truth.

It would be easy to just give everyone a tax credit by age. A new bureaucracy would not be needed.

However, control of price and actuarial risk is still determined by the healthcare insurance industry. Consumers are not empowered. The healthcare insurance industry is empowered. Only at the time consumers are stimulated to control their health and healthcare dollars will the system work. Tax credits and price controls do not work.
 
 No Limits on the Kind of Insurance Policies That Could Be Offered – This is not a bad idea.

Capping the Tax Exclusion on Employer-Provided Health Insurance – The entire tax benefit for the employer and the individual should be equalized. Benefits should not be exclusive. Healthcare insurance premiums should be paid for with pre-tax dollars by all. The individual market should not pay for premiums with after tax dollars and the group market pay for premiums with pre-tax dollars. The present system is a hidden tax on consumers buying insurance in the individual market.
 
 
Moving Toward Defined Contribution Health Insurance – This is a stab in the dark by Republicans. It would penalize consumers and it would benefit employers. Employer want to avoid providing the same level of healthcare coverage for all their employees
 
Medical Malpractice Reform – This is a sensible reform. It is estimated that is would lower healthcare cost between $300 and $750 billion dollars a year if all costs were included.

If malpractice reform took the right form to protect consumers and physicians, the abuse in the malpractice system by lawyers and the insurance industry would be eliminated.

Both the Democrats and the Republican have protected the lawyers and the insurance industry in the past. Past behavior is a predictor of future behavior.    

Repealing the Medicaid Expansion – Medicaid should be eliminated and replaced by an all-inclusive healthcare system.

The poor should have the same insurance coverage as the rest of society. The immediate response is the nation couldn’t afford it. Yet President Obama is expanding Medicaid as access to care is being restricted. Therefore formulas that try to control costs fail because the development of severe illness is more expensive than consumers of healthcare learning how to control their disease. A consumer having healthcare insurance coverage does not make those consumers well.  

 Empower Poorer Consumers by Giving Them Mainstream Health Plans –

Republicans do not offer a plan of action within this category. It sounds good but feels as if it is an empty promise. Actually it is an important factor in repairing the healthcare system. I will explain in the next blog.

The solution to the healthcare system’s dysfunction must be a simple solution.

The Republican solutions are almost as complex as Obamacare. It does not decrease governmental bureaucracy nor does it avoid the potential for fraud and abuse.

The Republican solutions promote continued control over consumers and their freedoms.

The Republican solutions do not get to the main problem in the healthcare system.

The healthcare system must be set up so consumers are motivated to have incentive to be responsible for their own health and healthcare dollars.

The alternative to Obamacare should exclude the government from making consumers dependent on the government. 

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

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View Of A Young Doctor: Dr. Starner Jones

January 21, 2015
inMedicaid, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System
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Stanley Feld M.D.,FACP,MACE

 A reader sent this note to me with a request to pass it on. The note hits the nail on the head.

 Dr. Starner Jones is an intern in a large community hospital.

 As a young physician he understands the folly of America’s entitlement society.

His short two-paragraph letter to President Obama accurately puts the blame for America’s dysfunctional healthcare system and its accelerated unsustainability on our  "Culture Crisis." Our country has a "Health Care Crisis" as a result of its "Cultural Crisis".

He presents the crisis, its diagnosis, prognosis and cure in just three (3) short paragraphs.

If you doubt any part of what Dr. Jones says, go visit your local hospital emergency room as an observer for an hour or so some Friday or Saturday night. Then see how many responsible people you can send his solution to for them to send it on. 

 “Dear Mr. President:

During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ring tone.

While glancing over her patient chart, I happened to notice that her payer status was listed as "Medicaid"! (A Completely Free Healthcare Program provided by our Government) During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.

And you and our Congress expect me to pay for this woman's health care?

 I contend that our nation's "health care crisis" is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a "crisis of culture", a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one's self or, heaven forbid, purchase health insurance. It is a culture based on the irresponsible credo that "I can do whatever I want to because someone else will always take care of me."

Once you fix this "culture crisis" that rewards irresponsibility and dependency, you'll be amazed at how quickly our nation's health care difficulties will disappear.

Respectfully, 
STARNER JONES, MD"

 If you agree…pass it on to responsible friends. 

There are additional reasons for America’s “healthcare crisis.” However, as long as we elect local, state and federal politicians who believe that all of society must be responsible for the welfare of the irresponsible members of society, America’s unsustainable economic situation will become worse.

Someone told me America is the greatest economic machine in the world “only because we print more money and suck less.”

 The more people receiving the benefits of the inefficient redistribution of wealth through entitlement programs the harder it will become to reinvigorate the American dream.

America is working its way toward a totally socialist society where the government supports us and tells us what to do and where and when to do it.

We will wake up one day and ask what happened to the freedoms guaranteed by the Constitution and Bill of Rights.

The answer is we gave them away to power hungry politicians who want to control us.

France just dropped its 75% tax rate because its society was economically unsustainable no matter how high its tax rate and the economy is collapsing.

France has had a "Culture Crisis "that is causing its social and economic collapse. The country finally realizes the people must have incentives to be creative. Progress does not happen as a result of entitlement and the redistribution of wealth.

The British National Health Service is in grave financial difficulty. 

 The NHS is in danger of being shut down.

"It’s a period of unprecedented pressure, of undue pressure. the NHS is facing very difficult times, yes. The word "crisis" implies that you can’t deal with it."

"A Department of Health spokesman said: "In common with healthcare systems around the world, the NHS is facing unprecedented demand, but undermining the principle of services being free at the point of use is not the answer."

I think rather than repeating the same mistakes over and over again, someone would learn something about fixing the “Culture Crisis”.

 As other countries are trying to fix their “Culture Crisis”, President Obama is going in the other direction and accelerating the road to economic failure.

Jack P, Athens wrote the following comment in MailOnline.com,  

“Socialism always brings a good laugh when it collapses as the politicians raise taxes to cover their mistakes.”

President Obama is destroying the healthcare system with Obamacare.

I would try to fix America’s “Culture (entitlement) Crisis” by helping people become responsible and act independently. I would not increase policies that promote individual dependency on the government.

Somehow Americans have to wake up as a people and try to stop the government from following this path.

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

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Things Happen When No One is Looking

January 4, 2015
inMedicaid, Medicare, Medicine: Healthcare System, Patients Problems, Physician's Problems, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

I wish you all a Happy and Healthy New Yew Year.

I have not written blogs during the holiday season because I figured no one would pay attention to what is happing in healthcare.

President Obama figured the same and snuck in a few things to continue to destroy the healthcare system.

Obamacare “innovative programs” seem to be going nowhere. The Obama administration continues to insist that all is going well.

The money spent is being wasted. The taxes for the funding of Obamacare’s 6.7 million enrollees is increasing as it attempts to increase enrollment to 9 million down from the original enrollment goal of 12 million.

I received a note from a reader who said Obamacare is here to stay. It is what it is. We should try to repair Obamacare rather than repeal it and replace it.

In my view Obamacare cannot be repaired. It was created to destroy the healthcare system. President Obama’s goal is to replace Obamacare with a government controlled single party payer system.

 The result will be to control and restrict access to care and ration care. It is a step on the way to restrict citizens’ freedoms.

Every week indications of Obamacare’s failures appear but are kept under the public’s radar.  The Obama administration spins the facts and the mainstream media’s regurgitates that spin.

 The Obamacare signup figures as complied by http://acasignups.net as of 12/30 2014 are very different that the administration’s spin to the media that the open enrollment period is going great.

Obamacare’s enrollment is still 1 million below estimate at this point

Confirmed 2015 QHPs: 7,403,558 as of 12/29/14
Estimated 2015 QHPs (Cumulative):
11/21: 610K (462K HCgov) • 11/28: 1.02M (765K HCgov) • 12/05: 1.80M (1.35M HCgov)
12/12: 3.26M (2.46M HCgov) • 12/15: 4.70M (3.52M HCgov) • 12/19: 8.52M (6.40M HCgov)
12/23: 8.65M (6.50M HCgov) • 12/30: 8.84M (6.54M HCgov)
state-level projections

 HHS finally announced that approximately 87% of Americans who selected 2015 health insurance plans through HealthCare.gov in the first month of open enrollment are receiving financial assistance to lower their monthly premiums. This percentage of subsidy awards is higher than in the same period last year.

The number is significant because, should the U.S. Supreme Court decide against the Obama administration in the King v. Burwell case it is scheduled to hear in March, consumers living in the 37 states relying on the subsidies from HealthCare.gov could lose their premium subsidies.

Another problem is even with the subsidy the people who received them cannot afford the insurance deductible. They do not seek medical care.

HHS has yet to disclose if it has a contingency plan should a ruling come down that only those who buy Obamacare insurance through state exchanges are eligible for coverage subsidies.

The CMS Innovation Center was established by section 3021 of the Affordable Care Act (Obamacare) for the purpose of testing “innovative payment” and service delivery models to reduce healthcare expenditures while preserving or enhancing the quality of care” for those individuals who receive Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) benefits.

To date the CMS Innovation Center has awarded $2.6 billion through September 2014 to hospitals, doctors and others through nearly two dozen programs that tested new ways to deliver healthcare and pay for it.

“Results of those programs some underway since 2011including more than 60,000 providers and 2.5 million patients in Medicare, Medicaid and the Children's Health Insurance Program, are largely not yet available, the Innovation Center said in its second report to Congress.”

The ICD-10 diagnostic and procedure codes were to be implemented two years ago. It appears to be going nowhere because it is too complicated. President Obama will probably delay it again.

The change toICD-10 from ICD-9 has been pushed forward at least three times. It is too complicated. It is designed to commoditized medical treatment and eliminate physician judgment. Codes have been increase from 18,000 (complicated enough) to 68,000. Neither physicians nor their unsophisticated computer systems can comply correctly.

The Obama administration is still pushing for its execution and wasting money yearly. Physicians cannot and will not comply with this government regulation.

 It is destined to fail at a tremendous waste of taxpayers’ dollars.

“President Obama promised the AMA he would fix the defective Medicare Sustainable Growth Rate formula( GRF) for calculating Medicare reimbursement to physicians. As a result of that promise the AMA supported President Obama’s healthcare reform bill.” 

The GRF is not fixed yet. Congress delays the reductions in reimbursement due to this defective bureaucratic formula  each year and adds the percentage reduction in physician reimbursement to next year’s reimbursement reduction.

This year physicians can expect another 4% reduction for a total of 32% since 2002.  We will see if congress fixes this defective formula this year.  

On January 1, 2015 physicians are going to experience a series of pay cuts from CMS.  If functional electronic medical records are not implemented physicians will experience additional reimbursement reductions from Medicare and Medicaid.

http://www.forbes.com/sites/brucejapsen/2015/01/01/multiple-pay-cuts-hit-doctors-in-2015/#comment_reply

Physicians are struggling to deal with new measurements to improve quality and deal with a myriad of new changes in Medicare and Medicaid rules and regulations.

Two years ago in order to attract more physicians to accept Medicaid to care for the growing number of enrollees in Medicaid, Obamacare increased Medicaid reimbursement by 40%. The increase in reimbursement was to last only until January1, 2015 and then revert to the 2012 reimbursement schedule.

Those pediatricians, family practitioners and internists were faked out once more by Obamacare and President Obama’s promises.

The biggest pay surprise to physicians will come when the old reimbursement returns. Poor Americans on Medicaid will suffer when they cannot find a physician.  

“No other segment of the health care industry faces penalties as steep as these and no other segment faces such challenging implementation logistics,” Dr. James Madara, the AMA’s CEO wrote to the Obama administration.  “The tsunami of rules and policies surrounding the penalties are in a constant state of flux due to scheduled phase-ins and annual changes in regulatory requirements.”

 The cascade of rules and regulations will affect every specialty of medicine. The only thing left is for physicians to quit participating in government programs.

Then government can force medical license renewal to be tied to participation in government healthcare programs.

Where is physicians’ choice and freedom? There is currently a physician shortage. If physicians quit medicine and surgery what will happen to patient care?

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

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If You Like You Doctor

December 7, 2014
inConsumer Driven Health Care, Disinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 This is a message for the Republican majorities in the House and Senate. Obamacare is a disaster built on a failed ideology, deceptions and lies.

Obamacare started off with lies and continues to deceive the American public.  

Its emotional seductions have also deceived many physicians.

All one has to remember is Jonathan Gruber’s statement about the lack of transparency being a powerful political tool. Gruber said given the lack of transparency, the public is too stupid to figure out the truth.

http://www.lijit.com/search?uri=http%3A%2F%2Fwww.lijit.com%2Fusers%2Fstanleyfeld&start_time=&p=g&blog_uri=http%3A%2F%2Fstanleyfeldmdmace.typepad.com%2F&blog_platform=&view_id=&link_id=7386&flavor=&q=Jonathn+Gruber&x=28&y=9

President Obama told us; ”If you like your doctor you can keep you doctor, period.”

This statement was not true for an instant. President Obama knew it but ideology trumps reality. Many have blamed Obamacare’s failure on President Obama’s inexperience as a manager. This is not the reason.

The failed progressive ideology of big government controlling choices and freedoms of the American people is the reason for Obamacare’s failure.

Last week, Senator Charles Schumer (D-N.Y.) admitted the passage of Obamacare was a mistake. Not surprisingly, the mainstream traditional media has not mentioned Schumer’s admission.

The mainstream media has been a shill for Democrats and President Obama. It has helped the Obama administration keep the truth from the American public.  

 

 

 

http://youtu.be/O9m7fsSUUKQ

 

  

http://youtu.be/kOJfyT8juhA

President Obama keeps the American public uninformed with the help from the traditional mainstream media. His goal is central government control of Americans’ choices and freedoms. President Obama’s support is derived from his appeal to Americans’ emotions and not from the facts.

His problem is Americans are not stupid. They can separate reality from appearance when they pay attention. Obamacare is now affecting them directly and they are paying attention.

President Obama is waking up the sleeping tiger of Patient Power.

Obamacare is failing, but Obama’s lies keep coming. One recent lie is Obamacare’s open enrollment period is going well. I have shown evidence to the contrary in my last blog. So far the administration is 50% behind their estimated sign ups.

As of 12/05/2014 open enrollment is still (884,354/1,050,000) behind with 59% of estimates to sign up.

 

Confirmed 2015 QHPs: 884,354 as of 12/04/14


 

Estimated 2015 QHPs (Cumulative):11/21: 610K (462K HC.gov) • 11/28: 1.02M (765K HC.gov)
12/05: 1.50M (1.12M HC.gov) (special: 1.64M / 1.23M HCgov)

Thru 12/06: 1.57M (1.18M HC.gov)

 The biggest lie, since “you can keep your doctor, period” is that healthcare spending is decreasing because of Obamacare. This lie is a complicated lie. It is important to understand this lie.

 Obamacare is not lowering healthcare spending. It is increasing healthcare spending. Premiums and out of pocket costs are increasing for consumers.

 As a result of Obamacare deductibles have increased beyond affordability. Consumers cannot afford to utilize their “healthcare insurance” until absolutely necessary. The result will be higher costs when patients are forced to use the insurance because of the development of complications from a chronic disease.

 “The Bureau of Economic Analysis issued its advance estimate of first-quarter growth in 2014, which barely made it into the black with an annualized GDP growth rate of 0.1 percent.

Healthcare spending rose at an annualized rate of 9.9 percent, far outstripping inflation and standing in stark contrast to other components of the BEA report.

 Exports fell 7.6 percent, and demand for imports declined by 1.4 percent. Consumer consumption rose 3.0 percent, but that came in part from the high rate of health-care spending.

Without the spending on health care in 2014 Q1, annualized GDP would have dropped to a recessionary -1.0 percent, according to economist Ian Shepherdson.”

 In 2008, pre Obamacare, the US had seen a drift downward in health-care spending.

 The downward trend began to reverse as Obamacare first officially launched in October 2013. In the fourth quarter of 2013, health-care spending rose 5.6 percent, far above the 2.6 percent growth rate of the economy, to which it significantly contributed.

 The New York Times writes article after article claiming that the cost of healthcare is decreasing. The implication is that Obamacare is working.

 Nothing could be further from the truth.

“The rapid increase in spending does not indicate that the system is working to lower costs, an absurd if not Orwellian construct by President Obama.

“Nor is the debate “over,” no matter how many times Obama claims otherwise. Too bad the White House chose not to take advice from National Journal’s Ron Fournier. 

“The president risks insulting a vast majority of Americans by dismissing their concerns with a consultant's talking point,” Fournier wrote before the economic figures were released, “and Obama can't afford any more blows to his credibility.”

Consumers are tired of President Obama’s lies. He has lost all credibility with the American public.

The Obama administration keeps telling us how well Obamacare’s Accountable Care Organizations are doing. The Obama administration keeps saying hospital systems must set up integrated healthcare systems (ACOs) to increase the quality of care.  

 Hospital systems have been promised increased revenue incentives by setting up ACOs. Most hospital systems are losing money with their ACO’s.

As a result of losing money hospital systems are dropping out of the federal ACO program.

 This week, the Obama administration published regulations to decrease the hospital systems’ risk and increase its financial incentives, in order to decrease the ACO dropout rate.

President Obama refuses to believe that even though the ACO model sounds great its successful execution is difficult to impossible. 

The chances for ACOs to succeed is not only dependent on the hospital system’s ability to decrease utilization, it is heavily dependent on patients taking responsibility for their own care. Patients must follow instructions.

President Obama believes he can lie his way out of reality. The American public is not buying these lies any more.

Republicans must focus on the reasons for the obvious failures of Obamacare.

Consumers want to have freedom of choice. They do not want the government to control them.

Republican must focus on creating programs to provide incentives for consumers to be in control and responsible for their health and healthcare dollars. 

Republican must focus on ways to permit consumers “to keep their doctors if they like their doctors period.”

My ideal medical saving account will do all of the above.

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

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Incentives and Mechanism Design

October 22, 2014
inMedicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley Feld M.D.,FACP,MACE

Why are Obamacare’s initiatives failing? There are several reasons.

1. Government is inefficient. It outsources all of its administrative services.  

The contractors, in turn, subcontract out most of the work. The overhead for each function increases non-transparent costs. The execution of tasks decreases.

2. President Obama’s healthcare policy advisors are academics. They have little clinical experience. It is clear they have little experience in the trenches.

The healthcare policy advisors have no idea how to create incentives for physicians and hospitals.

They have no idea how destructive to clinical practice the lack of tort reform is.

3. Without clinical experience the policy advisors do not know how to create effective incentives for patients.

I have emphasized that patients must be responsible for themselves and their diseases. They must become professors of their diseases. They have to be provided with adequate incentives to become professors of their diseases.

Physicians must be provided with incentives to teach patients to be professors of their diseases.

4. The government outsources the administrative services to adjudicated Medicare and Obamacare billings. The government has little idea of the actual profits built into the fees the insurance companies charge the government. At intervals insurance companies are required to enter another bidding process. The government probably picks the lowest bidder.

It is not an efficient way to pick an insurance company. This is especially true when the government guarantees the insurance company‘s profit. The government does not know what the insurance company’s profit actually is. The profit is about 40% of the healthcare dollars.

President Obama’s ideological goal leads to these errors. His only concern is for the government to control the healthcare system.

Government control of a healthcare system has not been successful. The V.A. healthcare system is on example. Medicaid and Medicare’s increasing deficits has been another example.

None of the countries in the developed world have a financially viable universal healthcare system except Switzerland.

A few years ago I learned about “Mechanism Design.”  My first reaction was “what is that?”

Leoid Hurwicz, Roger Meyerson and Eric Maskin received a Nobel Prize was  for this economic theory in 2007.

Mechanism Design is a brilliant economic theory. If the theory was applied to the healthcare system it could solve much the system’s dysfunction.

When I wrote about Mechanism Design I felt that few people understood it.  

What is it?  Mechanism Design is the art and science of designing rules of a game to achieve a specific outcome, even though each participant may have a separate vested self-interest.

The design of the game is to align all the stakeholders’ vested self-interests.  

 Each stakeholder has an incentive to behave as the game designer intends. The game can then implement the desired outcome.

 The strength of such a result depends on the solution concept used in the game.  

None of the stakeholders’ vested interests are aligned in Obamacare except the vested self-interest of President Obama and his ideology.

The healthcare insurance industry thinks it has President Obama over a barrel.

Some of the hospital systems have figured out that they will be at the mercy of Obamacare.

 Physicians already feel they are at the mercy of President Obama’s ideology.

Medical device companies and pharmaceutical companies have figured out they are dead already. It is only a matter of time until they cannot move. They are working around the system to come back from the dead.  

None of the stakeholder’s vested interests are are aligned. This non-alignment will lead to destruction of the healthcare system.

Mechanism designers commonly try to achieve the following basic outcomes for stakeholders: truthfulness, individual rationality, budget balance, and social welfare.

 With those four outcomes for stakeholders in the healthcare system one could get close to aligning stakeholders incentives.

Lodi Hurwicz’ point is the way to get as close to the most efficient economic outcomes is to design mechanisms in which everyone does best for themselves.

He says this can be achieved by sharing information truthfully (Price Transparency). It is easy to understand that some people can do better than others by not sharing information or lying in the short term. It will not serve all the stakeholders’ vested self-interest in the long term.

If everyone’s incentives are aligned you have a much more efficient economic system.

The example given in the military is defense contracting. If you agree to pay on a cost plus basis you have created incentives for the contractor to be inefficient.  

If you do not you have incentives aligned and truthful information you create the incentive to be overcharged. Most people can do better by not sharing truthful information.

Many have observed that Obamacare has not been transparent or truthful.

If the rules of the game require truthful information you can get close to an efficient market driven solution.

The concept of Pareto efficiency means no one can be made better off without someone becoming worse off.  

Hurwicz observed, as had others, that the dispersion of information was at the heart of the failure of a planned economy.

He observed that the free market economy can get us closer than central planning to incentive compatibility because in the end the consumer can drive the discovery of truthful information

A free market economy is by no means immune to the Pareto efficiency concept.

However, the free market mechanism was far less afflicted than central planning bureaucracy. A consumer driven system serves to force truthfulness.

Empowering consumers is the key to an efficient system. Customers determine success of an enterprise by creating demand. In a transparent environment they can get closer to incentive efficiency. They create the rules of the game for compatible incentive.

How does Mechanism Design relate to the Repairing The Healthcare System?

The rules of the games can align all the stakeholders’ incentives without one stakeholder taking advantage of another.

In our healthcare system everyone is pursuing his vested interest in a game that has rules that do not lead to “incentive compatibility.”

Some politicians think central planning will straighten out the rules. Historically, central planning has not worked. These Nobel Prize winners in economics have proven this fact.

A  consumer driven healthcare system using the ideal medical saving account. Will be a good start in achieving alignment of all the stakeholders.

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

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Government Is The Problem Not The Solution

October 1, 2014
inDisinformation and the healthcare system, Healthcare Insurance Industry, Medicare, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP,MACE

 

The government has been attempting to take over the healthcare system since 1935 at the time of the Roosevelt administration.

The government took over the healthcare system 30 years later during the Lyndon Johnson administration. LBJ passed Medicare and Medicaid. It turned out that financial projections were faulty and the business model was defective.

Medicare and Medicaid provided medical care for the elderly and the poor at an affordable price at that time. Everyone loved it. At the time it was also affordable for the government.

I do not think anyone contemplated the healthcare inflation that occurred as a result of the government’s business model.

Inflationary pressure increased rapidly.

Finally, President Reagan said the government could not afford the increasing prices any more. He said enough is enough. He decreased provider (hospital, doctors, pharmaceutical company, and insurance company) reimbursement for Medicare and Medicaid services.

The reduction in reimbursement for services resulted in price shifting increases in reimbursement in the private sector.

Both the private sector and the public sector experienced increased inflationary pressure as a result of this maneuver.

It was clear by 1984 that Medicare and Medicaid were unsustainable long term.  

America did not have a free market healthcare system before Obamacare. It was a hybrid system.

The country already had 90 million Americans in a single-payer system. Ninety million Americans get coverage from Medicare, Medicaid, and the Veterans Health Administration systems.

The problem is these government controlled single-payer systems did not work efficiently. They were financially unsustainable.

Obamacare expands the single party payer system to eventually cover all Americans. Obamacare simply adds on to an existing unsustainable healthcare.   Raising taxes is not going to make it more sustainable.

The expanded bureaucracy will only make the system more inefficient and more prone to fraud and abuse.

President Obama is already modifying the law without congressional approval. He is trying to hide elements of this unsustainability from the American public.

The federal government’s Obamacare enrollment system www.Healthcare.gov alone has already cost taxpayers about $2.1 billion dollars according to a Bloomberg government analysis of contracts related to the project.”

The website is still not working perfectly at the backend after spending $2.1 billion dollars.

Americans will experience more of the www.healthcare.gov dysfunction after the mid term elections.  

Navigator companies hired to help people enroll cost $48 a session. These companies are increasing their prices for the 2015 enrollees.

 

These same companies have had their fraud and abuse exposed. Nevertheless they have been rehired at the increased price by the Obama administration.

President Obama announced to Democrats last spring that Obamacare would not be an issue at the time of the midterms.

This week the administration also announced that the cost of healthcare insurance through the health insurance exchanges is decreasing next year.

It was also announced that there is an increase in the choice of insurance carriers in most states resulting in competitive premium pricing and lower premiums.

President Obama announced that Obamacare is working. He said Obamacare is a non issue in the 2014 mid term elections.

Nothing could be further from the truth.

If our elected officials cannot see President Obama’s trick play how can the public expect to understand the deception?

This is another of the manipulations of Obamacare designed to hide its impending failure from the public.  

The Obama administration set up a reinsurance company funded by taxpayers that eliminates any insurance risk the healthcare insurance companies might incur in insuring enrollees.

Healthcare insurance companies are signing up and competing for market share to gain profit from this no risk insurance. They can easily afford to lower the premiums because the government will cover their supposed loses.

None of this has anything to do with patient care or the quality of patient care.

It has little to do with providing low cost insurance. The cost of insurance keeps increasing. The government pays the difference between the cost of insurance and what patients who receive subsidies pay for their premiums.

Obamacare misses the main problems in the healthcare system. Obamacare creates more dysfunction in the healthcare system.

 Obamacare will result in greater unfunded future liabilities.

“White House spin pretends otherwise, but the unfunded liabilities may exceed $100 trillion.”

 The Congressional Budget Office said,

 “Looking indefinitely into the future, the unfunded liability, with optimistic assumptions, is $43 trillion—almost three times the size of today's economy.”

Based on more plausible assumptions, such as those reflected in the "alternative" scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.

It is the responsibility of our elected officials control America’s expenditures.

Unfortunately, for American’s, this is not how a government controlled system works.

Voters must decide how long they are going to tolerate this abuse of power.

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



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