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Obamacare’s Games For Stakeholders And The Unintended Consequences

July 21, 2013
inConsumer Driven Health Care, Medicine: Healthcare System, Patients Problems, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP,MACP

I can’t help remembering
Nancy Pelosi’s famous statement, “We have to pass the bill to find out what is
in it.”


  

http://youtu.be/lAt54NKsRRk

The public didn’t like
Obamacare to begin with.

Each day “we are finding out what is in it.”

Each day it gets worse
despite the fact the President Obama keeps saying Obamacare is great and will save us
money. Americans do not believe him.

If you are a big
government control advocate, the ideology of Obamacare could be applauded.

Practically, Obamacare is
naïve and an impending “train wreck.”
Unintended consequences keep appearing because of defects in the theory and poor
design.

Patients, the healthcare
care insurance industry, physicians, hospital systems, and drug companies could
have predicated these unintended consequence if they knew what was it the bill
at its passage. Those who did understand the Accountable Care Act (Obamacare)
hated the act at its passage.

Many of my progressive
friends blame the problems Obamacare is having on Republicans.

I think they are getting
that idea because the New York Times and its editorial op-ed writers that are making
that claim. However, the New York Times offers no concrete proof.

Obamacare is failing on it
own. Its implementation gets harder and more expensive each day.

The unions were President
Obama biggest ally. All of a sudden Obamacare’s unintended consequences has
angered the unions. The unions realize what Obamacare is doing to them.


On July 12, James Hoffa of the Teamsters (1.4
million members), Joseph Hansen of the Food and Commercial Workers (1.3 million
members) and D. Taylor of UNITE-HERE (200,000 members, mostly culinary and
hotel workers) wrote to complain about the president's Affordable Care Act.

Obamacare is destroying
the 40-hour workweek unions worked many years to achieve.  Employers are hiring part time employees to replace full
time employees that had been laid off because of the recession.

Employers are doing this
to avoid a $2,000 penalty for not providing healthcare insurance for each employee.
 

The majority of the job
growth figure of 195,000 for June consisted of part time job growth.

Union
leaders are correct. Obamacare "creates
an incentive to keep employees’ work hours below 30
hours a week."

After
all, employers can avoid a $2,000-per-worker penalty if they don't provide mandated insurance as long as employees
work fewer than 30 hours a week.

" Union leaders have realized—too late—that
ObamaCare will affect the livelihood of millions of workers who wait tables,
wash dishes, clean hotels, man registers, stock shelves and perform other tasks
that can be limited to shifts of less than 30 hours a week."

White
house Press Secretary Jay Carney said it "is
belied by the facts."

Once
again he was lying. He used 2010 Bureau of Labor Statistics numbers to answer
the complaint.

“So far
this year, as ObamaCare is being implemented, full-time employment has grown at
an average monthly rate of 21,700 while part-time employment has increased an average
of 93,000 a month.”


These
are terrible numbers that belie Jay Carney’s “facts.”

 Three big unions
worry that the health law will hurt their members' benefits and paychecks.

The letter to Nancy
Pelosi and Harry Reid was unusually harsh.

The letter was not from
Mr. Obama's GOP adversaries but from the president’s allies, the big three most
powerful unions. A fourth union joined the group a few days later.

The unions finally
realized that Obamacare was going to cut unions out of some government
subsidies. Obamacare makes a unionized workforce more expensive for employers.  It makes it less attractive for workers to
join unions.

"Millions of union workers, the
letter notes, are covered by nonprofit health plans jointly administered by
employers and unions, and won't qualify for ObamaCare's generous taxpayer
subsidies."

This will drive union
members out of their unions.

Further, the unions
nonprofit insurance plans are subject to "Obamacare’s new 2-3% tax on each
insurance policy they place."

The union wants their members
exempt from this tax because the union will be forced to pass it on to their
members. Members will be forced to use the health insurance exchanges to buy
their healthcare insurance.

Unions are starting to
realize the goal of Obamacare is to force everyone into his “Public Option”
that will default to a single party payer. The result will be complete
government control of the healthcare system.

There are three insurance
options in the health insurance exchanges. Citizens will buy the cheapest
“affordable option.”  The deductibles
will be high. Citizens will have to pay deductibles out of pocket decreasing
their purchasing power.

Republicans are enjoying
this meltdown. They want Obamacare
repealed.

“House Republicans say their goal is to repeal President Obama's
health care law, not to present an alternative plan.”


This is a big mistake on
the part of the Republicans. Republicans do not have a viable substitute to
repair the dysfunctional healthcare system.

"Every voter knows what Republicans are against. They don't
know what they're for" on health care, said Rep. Steve Israel of New York,
who heads House Democrats' campaign committee.”


 “He said the strategy would haunt Republicans next year among
moderate and independent voters who want changes, not outright repeal.”

Republicans need an
innovative alternative to Obamacare that will work and excite the public.  They need a plan that will put consumers in
charge of their health and healthcare dollar. Consumers do not want a healthcare
system that puts the government in charge of their health.

Consumer driven
healthcare with my democratic ideal medical savings account should be adopted
by the Republican Party to replace Obamacare.

Republicans must take a
stand and help Americans avoid Obamacare’s impending disaster to our economy,
job growth and financial viability. 

Republicans must show Americans
that they care about them and have a viable solution to our healthcare systems problems.

Otherwise as President
Obama said this week, “he will blow right
through it” as he
has done in the past.

 Now that Americans are waking up it is time
for the Republican leadership to start waking up and fight back effectively.

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

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Permalink:

An Interesting Unintended Consequence of Obamacare

June 30, 2013
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

 The Obama administration has encouraged local hospital systems
throughout the United States to consolidate physicians practicing in their
hospitals.

Hospital systems have found this attractive. There has been a
movement to buy physicians’ practices and then pay physicians a salary. This
has been encouraged by the Obama administration because someone in the
administration believes this will encourage physicians to stop over testing.

Hospital systems love it because they understand that brick and
mortar facilities are not worth as much as they use to be. If they own
physicians’ intellectual property in the form of primary care physicians and
skills in the form of surgeons, the value of the hospital system increases. 

It has not worked out as well as many hospital systems would
like because when physicians worked for themselves they were more productive
than when they worked for the hospital system.

The Obama administration also believes that it can bundle the
payment of a treatment and share the savings with the hospital system if the
treatment costs less. If the treatment uses more assets and costs more the
hospital system will not be paid.

In other words, the government and the healthcare insurance
industry want to offload the risk of treatment to the hospital system. They
administration thinks this will force hospital systems to deliver a better
quality of care. You may recall quality of care has not been defined
adequately.

The example often used is the non-payment for hospital
readmissions within thirty days.

This policy doesn’t work because reasons for hospital
readmissions are multifactorial. Many of those factors are uncontrollable. One
hospital system can also divert the patient to another hospital system or treat
the readmitted patient in the emergency room.

The Obama administration is encouraging Accountable Care
Organizations. There are so many problems in forming, administrating and
managing ACOs that they are destined to fail.

Anyone reading the administration’s propaganda would not think
so, but it is true, and as time goes on it will become apparent.

Finally, hospital systems and physician groups are realizing the
negotiating power they are accumulating by consolidating and integrating
physicians’ practices.

Consolidation is not good
for the patients. It is great for the hospital system and the large independent
physician specialty groups. Physicians who have sold their practices to
hospital systems will not do so well because the hospital systems are in
control of the collections and salaries.

Large medical specialty groups are negotiating with Obamacare’s
new healthcare plans. These providers are demanding, and in some cases
securing, pretty rich reimbursement rates from the new Obamacare health plans.

It is the same thing that happened in the 1980’s when HMOs
negotiated high reimbursement deals with medical and surgical specialists the
HMO wanted in the group. The HMO’s reasons were to promote the HMO’s brand and
to get better medical results for the patients they had enrolled.

“To take care
of patients that will be covered by the new insurance scheme, these providers
are requesting payment rates that are higher than what they're being offered by
Medicare. Some providers are even insisting on premiums over what they're paid
by the existing private, employer-based health plans.”

Hospital systems in a town they dominate are doing the same
thing. The result will be an increase in the costs to the government and the
healthcare insurance companies. They will pass the increased costs on to the
consumers.

“Some of the
Obamacare plans, stuck in markets where there are few competing groups of
providers to choose among, are being forced to accept these high prices.”

The Obama administration told us, at the passage of Obamacare,
that providers would be discounting to get the volume of business that
Obamacare offered as the new legislation banded large groups of patients into
statewide insurance pools.

The defective central premise was that Obamacare would entice
providers to take lower reimbursement because of increased volume.  

“The people
that now seem most likely to enter these state-based insurance pools, and buy
the new coverage, represent a costly mix of patients with a lot of pre-existing
medical conditions. The volume is also unlikely to materialize.”

Obamacare has tripped over its central premise. It is not going
to lower costs. It is going to raise costs.

Obamacare has stimulated the consolidation of hospitals and
physician groups that's now rampant in healthcare. This consolidation is
starting to give providers leverage over Obamacare’s health plans.

This unintended consequence of Obamacare was obvious to most
healthcare policy thinkers who believe that control and planning do not work.
Unfortunately, President Obama did not listen to them.

The other thing President Obama did not listen to is that Health
Maintenance Organizations (HMO’s) of the 1980 and 1990s did not work. Obamacare
is a HMO on steroids.  

 “Under the scheme, doctors are paid lump sums of money to care
for large groups of patients.

“The idea is to put the financial risk on the doctor for the
cost of the medical care that they deliver. This was a central premise for how
Obamacare would put financial pressure on providers as a way to help to lower
healthcare costs.”

Physicians and Hospital Systems have been to this movie before. 

Hospital Systems are making believe they are taking Obamacare’s
financial bait. They are using the concept to frighten physicians and buying
local medical practices.

Hospital systems’ goal is to get a geographic monopoly then take
advantage of the negotiating monopoly. Physician groups especially specialty
groups will stay independent of hospital systems, integrate practices and get
in a negotiating reimbursement.

This will increase the cost of medical care. Everyone knows all
healthcare is local. Central control of healthcare is innately flawed. 

This is one of the many defects in Obamacare’s structure.

Obamacare has dismantled the last vestiges of local competition
among physicians for patients.

Now Obamacare will have to deal with the physician and hospital
system cartels it has created.

 The victims in all of this are patients
and the cost of patient care.

The Obama administration’s public service campaign is starting
to sell Obamacare’s virtues to young people through the NFL, NBA and major
league baseball. It is also signing up non suspecting consumers at supermarkets and churches.

Good luck. I think everyone is starting to catch on.

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

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Permalink:

Obamacare’s Medicaid Deals With States Are Deceptive

June 2, 2013
inDisinformation and the healthcare system, Medicaid, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Mistrust
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Stanley
Feld M.D.,FACP, MACE.

Tennessee Gov. Bill Haslam (R.) has asked the
Obama administration for flexibility in implementing Obamacare's Medicaid
expansion; he has been rebuffed.

It is becoming clear to me that the Obama
administration is heavy on the posturing and light on the reform. The goal
seems to be to have the healthcare system fail completely in order to create a
public panic.

The panic will result in the federal
government taking over the healthcare system completely and instituting a
healthcare system that controls patients, physicians and hospitals.

Some might call it socialized medicine. I
call it total impingement on incentive, initiative and innovation which will decrease
productivity and economic growth.

This is all being done by the Obama
administration with a total disregard for cost. President Obama’s assumption is
cost overruns can be covered by increased taxes. However, he is not considering
the effect of increased taxes on economic growth. He is also not considering
the effect of increasing taxes and increasing the money supply on purchasing
power. An increase in economic growth usually translates to an increase in GNP
and increased federal revenue.

Several examples come to mind
immediately.

  1. States
    who have thought out the Obamacare expansion of Medicaid through health
    insurance exchanges have discovered that they are going to have tremendous cost
    overruns when the federal government stops paying the total costs. Originally the
    federal government was going to share the costs with the states.
  2. The
    100% federal funding will be in effect only from 2014 to 2016. Then the states
    pick up their share of the burden. The problem is the federal government will continue
    to control all the rules. This leaves no room for states to be innovative.
  3. We
    have seen HHS refuse to give Indiana’s Medicaid improvement plan a waiver even
    though it is wildly successful. Its success can be attributed to several
    factors.
  4.  It
    provides incentives for patients not to overuse the system.
  5.  It
    expands the income requirements for eligibility into the system.
  6. The
    definition of poverty is an obsolete 1955 definition. Obamacare eligibility
    requirement is 133% of the poverty level or $14,400 per year.
  7.  Indiana requires eligible consumers to put up a
    small percentage of their income (2-5%)     to enter into its Medicaid system. It
    also permits recipients to put money not spent into a health saving account for
    future use.
  8. The
    effect of this is to encourage patients not to overuse the healthcare system
    and not to show up in emergency rooms for care that can easily be performed in
    less complex facilities.
  9. Simple observations have led to intensive
    studying of the population that costs the most money to treat. 

 It turns out that, “According to a report released earlier this year by the Agency for Healthcare Research and Quality,
1 percent of patients accounted for roughly a fifth of all health care spending
in 2009, or more than $90,000 per person. Five percent of patients accounted
for half of overall health care costs. By contrast, 50 percent of patients
accounted for only 3 percent of health care spending, the AHRQ report found.”

The high spending by this small
percentage of high utilizers is not linked to a patient simply being uninsured
without access to a primary care physician.

According to a recent report from
the IMS Institute for Healthcare Informatics,
1 percent of patients in a survey of 10.6 million health plan members accounted
for 25 percent of their plan's total costs, and 5 percent accounted for
slightly more than half, mirroring the AHRQ survey.

Most ER physicians and social workers
know who shows up in emergency rooms over and over again and which patients are
readmitted to the hospital over and over again. These physicians also know the
reason for this. However, no one ever asks these physicians the reasons.

Isa Gorman analyzed the data
of the value of insurance for the indigent in saving lives.” Does Lack of Health Insurance
Kill?” She demonstrates that all the studies that support
the notion of a lack of insurance are in error.

The Richard Kronick study proves they are wrong.

Kronick found that “adjusted for demographic, health status, and
health behavior characteristics, the risk of subsequent mortality is no
different for uninsured respondents than for those covered by
employer-sponsored group insurance at base line.”


 He concluded that “the
Institute of Medicine’s estimate was that lack of insurance leads to 18,000
excess deaths each year is almost certainly incorrect.”

Arkansas Gov. Mike Beebe (D.) first announced that he had reached
a deal with the Obama administration to use the Affordable Care Act’s private
insurance exchanges to expand coverage to poor Arkansans.

His Democratic base for the deal congratulated Governor Bebee.
Arkansas was able to accept health insurance exchanges. The Republican majority
in the state’s congress was skeptical. 

Governor Beebe reached a deal with
Kathleen Sibelius to provide the poor in Arkansas with higher quality private
insurance through the health insurance exchanges.

“Then the Good Friday memo came from HHS stating that its deal
with Arkansas is not that different from its traditional endorsement of the use
of private managed-care plans to administer the Medicaid benefit.”

“The memo makes clear that it will only permit state variations on
the coverage expansion that are “comparable” to what HHS would have spent
otherwise.”

“The HHS memo explicitly
states that these private plans cannot modernize the design of Medicaid
insurance to make it more cost-effective.”

 Governor Beebe was surprised and deceived.

“A Good Friday memo from the U.S.
Department of Health and Human Services, however, splashes cold water on that
aspiration. It’s now clear that the Beebe-HHS deal applies a kind of
private-sector window dressing on the dysfunctional Medicaid program, and it’s
not obvious that the Arkansas legislature should go along.”

According to the
law these low income individuals will be automatically enrolled in Medicaid with
significantly expanded insurance coverage. Medicaid
has been plagued by concerns about its quality, access, and financing virtually
since its inception.

Obamacare is
supposed to add 17 million new patients to the rolls of Medicaid.

Medicaid had posed a severe fiscal threat to many
state budgets. The federal restrictions on the states Medicaid program’s
management has limited the state’s ability to manage states budgets and adjust
payment of the severe low reimbursement to Medicaid providers.

The result has been severe underpayment of
physicians. The underpayment resulted in a lack of physicians’ participation in
the Medicaid program and limited access to care. In turn this has led to
significantly worse outcomes and higher mortality rates for Medicaid recipients
vs. private insured and Medicare.

“Under
the Obamacare, individuals and families with incomes between 138 percent and
400 percent of the Federal Poverty Level (FPL) will be eligible for generous
premium subsidies and cost-sharing credits, which they can use to offset the
cost of purchasing private insurance on state or federal insurance exchanges
created under the law.”

I have a feeling Governor John Kasich (R)
of Ohio fell for the same bogus deal as he agreed to sign up for the health
insurance exchanges. His Republican base is screaming their lungs out.

He will get his rude awaking soon as HHS
changes the deal he thought he got.

Medicaid is a failed program medically
and fiscally. Adding more recipients is not going to solve Medicaid problems.
Accepting the health insurance exchanges is going to make the states’ budget
problems worse.

An innovative program such as Indiana’s
Health Plan can do much more toward making Medicaid viable. The Obama
administration has objected to this plan.

Why? I can think of several possible reasons
including the desire to have the healthcare system result in total collapse.

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

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Why Does Congress Want to Exempt Itself from Obamacare?

April 30, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust
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 Stanley Feld
M.D.,FACP.MACE

In mid-April
Max Baucus one of the authors of Obamacare and a major proponent of the law
made the following statement to Health and Human Services Secretary Kathleen
Sibelius at a Senate hearing.

 

 
.
 
 

 

http://youtu.be/Y9airckwqA8

Unfortunately only 11,723 people watched this 29 second You Tube.  The traditional media gave his statement
sound bite coverage without explaining the reasons for him saying Obamacare is
going to be a "train wreck."

West Virginia Senator Jay Rockerfeller said Obamacare is beyond
comprehension.

  

Only 157 people looked at this You Tube whick has been up for 3 weeks.

It would have
been a good idea for congress to have read and understood the bill.

Meanwhile, congressional leaders in both
parties have been engaged for months  now in high-level, secretive confidential
talks about exempting lawmakers and Capitol Hill aides from Obamacare’s  health insurance exchanges that they are
mandated to join as part of President Barack Obama’s health care overhaul,
sources in both parties said.

These talks involve the Obama administration,
Senate Majority Leader Harry Reid (D-Nev.), House Speaker John Boehner
(R-Ohio), along with other top lawmakers.

“These talks are extraordinarily sensitive,
with both sides acutely aware of the potential for political fallout in the
2014 mid term elections from giving carve-outs from the hugely controversial
law to 535 lawmakers and thousands of their aides. “

Politico
along with other Internet news agencies has been the only news agency to have
in depth coverage of this attempt to exempt congress and its aids from
Obamacare and its health insurance exchanges.

Henry Chao, the Administration’s chief
technical official in charge of  the
implementation of the Obamacare’s health insurance exchanges, “just hopes that Americans can avoid a “third-world experience.”

Why would both
Democrats in congress want to avoid participating in Obamacare and its health
insurance exchanges?

We need to
be reminded that the Democrats had overwhelming majorities in both houses of
congress at the time of passage of the law in 2009 without a single Republican
vote.

I am
reminded of Nancy Pelosi’s argument for Obamacare's passage.


  

http://youtu.be/KoE1R-xH5To

 Now that
congress knows what is in Obamacare they want to be exempt.

Congress is content to let the rest
of us suffer.

What is
congress afraid of?

 

  1. Higher
    healthcare costs for themselves, their families and their aides.
  2. Being
    mandated into Obamacare’s health insurance exchanges will result in  them not qualifying for government subsidy.
  3. Congresspersons and their aids could
    also lose their employer-based coverage.
  4. This is also true for millions of
    ordinary Americans.
  5. They would also face higher costs of
    insurance through health insurance exchange.
  6. Every policy the healthcare insurance
    industry sells will be taxed. It will result in passing the tax on to the
    policy holders.
  7. Contrary to the President’s promises, independent analysts expect health insurance premiums to
    rise sharply, particularly for younger workers and their families.       

Congressional
members have other fears if they fail to create an exemption for themselves and
their aides. These fears are:

1. They fear the
impact on Capitol Hill employment.

2. The increase in healthcare insurance
costs “could lead to a ‘brain drain’ on
Capitol Hill, as several sources close to the talks put it.”  

3. Ordinary Americans who run businesses
are also faced with the same problem. President Obama and Democratic
congressmen have refused to be responsive to the dilemma faced by ordinary
businessmen.

4. American business owner fear they will not
be able to hire or retain valued employees.

5. These businessmen are presently
reducing full-time workers to part-time employees in order to avoid Obamacare’s
mandatory insurance coverage or penalty.

6. This will have the consequence of
increasing the unemployment rate and decreasing consumer spending.

7. In turn it will create an unending
spiral which will seriously impact economic growth.

8. The question Americans must ask is “what about me.”

 

The Obama
administration and congress have done similar things before in their effort to
passing Obamacare.

Obamacare
was passed using backroom dealings such as the “Cornhusker Kickback,” the
“Louisiana Purchase,” and the threats to political careers.

This congressional
exemption also brings back memories of (more than
1,200 waivers) to favored
businesses and unions who received special exemptions from Obamacare’s
insurance rules.

“If Congress quietly wants
to exempt itself from Obamacare, that’s great—so long as it includes the rest
of us in that midnight amendment.”

If you are "mad as hell and do not want to take this anymore" 
sign this petition.

  

 

 

Please
click on this link to sign up and send the link on to your friends.

https://www.change.org/petitions/force-congress-to-obey-obamacare

This is the petition

To: 

Senator Harry Reid, Senate Majority Leader 

Rep. Nancy Pelosi, House Minority Leader 

You told me we had to pass
Obamacare to find out what was in it. Now your gold-standard health insurance
is on the chopping block as Obamacare is implemented. 


If the tin-plated plan is good enough for me, my family, and my friends, it is
good enough for you and your staff. 


You passed the law — now live with it like the rest of us. Or overturn the whole
rotten thing!


Stop the effort by liberal Democrats to seek an exemption from Obamacare for
Members of Congress and their staff.

Sincerely, 

[Your name]

Some of us will remember
Walter Cronkite’s signature was ending
each newscast with the phrase, "And that's the way it is".

 I am adding this “it is now up to you ladies and gentlemen.”

 

Please sign
the petition. Thank you.

 

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

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Permalink:

The Traditional Mainstream Media Is Waking Up To Obamacare’s Defects

April 11, 2013
inDisinformation and the healthcare system, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

 Stanley Feld M.D.,FACP,MACE

 

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

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

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

He
starts one article with,

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

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

 "This is a really bad sign.”

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

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

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

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

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

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

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

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

The
Supreme Court sided with the states’ rights argument.

 

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

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

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

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

Joe Klein goes on to say,

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

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

The VA EHR is very difficult to use.

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

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

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

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

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

 The
next statements confirm Joe Klein’s liberal leanings.

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

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

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

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


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

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

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

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

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

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

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

 

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

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Permalink:

Obamacare’s Deception

March 27, 2013
inDisinformation and the healthcare system, Medicaid, Medicare, Medicine: Healthcare System
• Leave a comment

 Stanley Feld M.D.,FACP,MACE

We
all remember Nancy Pelosi’s famous declaration when she said “we will not know
what is in the bill until we pass it.”

I
could remember asking to myself how stupid can Americans be to listen to this
lady?”

Americans
are going to be shocked to learn the extent to which they have been deceived by
Obamacare. The legislation neither protects patients nor makes  the Health Insurance Exchange plans affordable.

The
details of Obamacare have been anything but transparent. New details are
appearing every day in the form of new regulations by new agencies.

I
believe it would be impossible for someone without an intense interest in
Obamacare to understand it.

There
have been over 20,000 new regulations from 300 new agencies so far. Mass
confusion has been generated as regulations from one agency contradict  regulations from other agencies.

The
Obama administrated has said recently that the public should not expect cost
saving from Obamacare.

 The Obama administration has also asked for an
additional $1 trillion dollars over the next ten years in order to fulfill
Obamacare’s promise to the American people.

It
looks as if none of the administration’s advisors or the administration had
considered the unintended consequences.

“Obamacare
works for the insurance companies but not for Americans.”

The
slogans such as “shared responsibility,” “no free riders” and “ownership
society.” dress the insurance industry’s raid on public resources in the cloak
of a “free market” health care system.

Obamacare neither protects patients nor are the healthcare
insurance plans to be offered by the health insurance exchanges affordable.

Americans with incomes between 133% and 400% of the Federal
Poverty Level (Income above 133% of the federal poverty level = $31,322/yr. or $2,610/mo.
Income above 400% of the federal poverty level= $94,200/yr. or $7850/mo.) will
pay for the least expensive   subsidized policies from 2% to 9.5% of Modified
Adjusted Gross Income (MAGI) from their IRS reported income.

Americans with the least income are faced with a substantial yearly
and monthly after tax salary reductions even though their healthcare insurance
policy is subsidized by the government.

On January 1,2014 they are mandated to have healthcare coverage.

A person with a Modified Adjusted Gross Income receiving $27,925
from all sources of revenue will pay $187.33 per family member per month.

The total price for a family of four is ($2,247.96 per year times
4)  $8991.84 in after tax dollars. This
pays for a Silver level plan that is next to the least expensive plan to be
offered by the health insurance exchanges.

If a person who has this plan goes to a physician or a hospital  the patient’s deductible will be sizable
despite the government subsidy.

Even if the family has subsidized healthcare insurance these
families might not be able to afford to use the insurance.

The quality of life of a low earner will be compromised. He must
buy the subsided healthcare insurance. The result will be he will have to make
cuts in buying food and adequate housing in order to pay for the healthcare
coverage.

We have not heard much about this problem from the Obama
administration.

As the insurance industry raises premiums on private insurance
they are also going to raise the prices in the Health Insurance Exchanges.

If the family opts out of buying the insurance they will have to
pay a penalty.

It is actually better to pay the penalty and then sign up for
insurance if you or a member of your family gets sick.

 The fee paid for
insurance in 2014 will varying according to 2012 income. If a family income
rose in 2012 and the breadwinners lost their jobs in 2013 and 2014 the family
could not afford the MAGI healthcare insurance premium they would be required
to pay.

If income increased in 2013 they would be liable for the
increase the next year.

“The
stress alone from such a regressive scheme is, without a doubt, not conducive
to good health and well-being.”

On January 1, 2014 everyone is required to buy healthcare
insurance or else pay a penalty. Even with the government’s subsidy a low income
earner could be forced out of the market.

In the meantime, states such as California are decreasing
reimbursement for physicians. Physicians are choosing not to participate in
both Medicare and Medicaid. This will increase the physician shortage.

The only choice states have left is to tie medical license
renewal to physicians accepting Medicare and Medicaid.

At the same time states and the federal government are
decreasing funding to already financially stressed charity safety net hospital
systems. Many of these institutions have closed. Most of them are failing.

The decrease in safety net hospital systems will further
decrease the options for low-income earners to receive medical care.

Obamacare is turning out to be a not well thought out plan. It
is a series of Catch 22s.

The only winner is the healthcare insurance industry which will
provide the administrative services to the government to adjudicate claims. It
will receive both the government subsidy and the payment made by the low-income
earner. 

Obamacare has deceived the public.  As I have stated in the past Obamacare has
some good ideas but the structure, regulations and execution are terrible.

Obamacare sounds good when President Obama talks about it but it
is an impending disaster medically and financially for Americans.

Only a consumer driven healthcare system with the bullet-proof
ideal medical savings account will align all the stakeholders’ incentives.

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



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Permalink:

Evidence For Impending Healthcare System Failure

October 17, 2012
inMedicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

The following are the links that is the evidence for the impending failure of the healthcare system in its present form and in the form that Obamacare is adopting.

Obamacare is piling on more regulations and restrictions to the present healthcare system. The present system is a failed system.The regulation will be impossible to comply with and impossible to enforce. They will create more opportunity for secondary stakeholder to extract more funds from monies needed for direct patient care creating a greater decrease in access to care for all .

The links follow the slides I presented in my last blog. Those links could not be opened because they were jpegs.

My hope is the links serve as an excellent reference to Repair The Healthcare System presently or when it collapses under it unsubstainable costs and the present system's inability to be executed.

The Etiology of Accelerated
Collapse

Slide03

Medicare 1965-1980 Fee for
service

Nixon
authorized HMO’s

Medicare Price Fixing Begins In 1980

Cost shifting Penalizes Private
insurance

HMO Fail Because Of Faulty Assumptions In 1990.

 Reasons for Hillarycare’s
Failure To Pass.

Distrust of Government
Increases.

Healthcare Insurance Companies
Raise Premiums.

Birth of Managed  Care: Another Compicated Mistake  

Managed Cares Fails. 

Managed Care Pricing And
Premiums Remain  High

2009 Obamacare And The Threat
Of Government Takeover To Freedom, Liberty and Choice.

Rationing Of Healthcare

ACOs Are HMO's On Steroids Combined With Managed Care Is Obamacare's Complicated Mistake. 

ACOs Will Fail At Great Costs To Everyone.

 Tort Reform And Defensive Medicine Are Ignored By Obamacare.

Medical Cost Escalate Out Of
Control And Then The Healthcare System Will Collapse.

The other major slide in the last blog was the barriers to the
Physician/Patient Relationship. This relationship is critical to the
theraputic index. It is almost destroyed and will be totally dstroyed in
Obamacare. Both physicians and patients will become commodities in a
bureaucratic healthcare system. Patients will not win.

 

Physician/ Patient Barriers to the Physicians/Patient Relationship

Slide08

 

The Physician/Patient
Relationship.

 The
physician/patient relationship.

 The Magic  of the Patient Physician Relationship  

 Patient and
Physician responsibility contract

 Patient should be the leader of the team

 Barriers for physicians in the Physician/Patient
Relationship

 

1. Tort
Reform/Defensive Medicine.

2. Restriction
of Physicians Clinical Judgment.

3. Medicine
is a calling not a business 

  4.  Constant
lowering physicians’ reimbursement.

 5. Physicians
are driven to decrease time spent with patients.

6. Government
rations care through panel of experts

7. Physician’s
treatments are driven by government regulations.

8. The
traditional media undermining physician credibility

9. Government
is attempting to commoditize medical treatment.

 

Patient Barriers To the Patient/Physicians Relationship

1. Patients are not in control of their own medical decisions.

2. Patients are not in control of their own healthcare
dollars.

3. Patients
do not have to be responsible for their treatment because they

receive
first dollar coverage.

4.  Education about chronic disease must be extension of
physician’s care  

5.  Internet can undermine the Physician/Patient
relationship..

6. Method of choosing a physician is random and must be
made clearer.

7. Portability of information about previous treatment
is difficult.

8. Patient must be responsible and in control of their
medical record.

9. Patient must endure poor communication by their
physician.

10.
Government and the healthcare insurance industry limit choice with

network
restrictions.

11. Patients should be responsible for their treatment
Management

America's healthcare system is at a critical turn in 2012.

Obamacare must be repeal.

Effective healthcare reform is essential. Both the primary and secondary stakeholders have abused a system. A system that is punitive.

Consumers must drive the system by being responsible to themselve and their healthcare dollars.

Obamacare is building a system of government dependency by all stakeholders (patients,physicians,hospital and healthcare insurance companies).

The healthcare system should be developed to create innovation and competions among stakeholders for the benefit of consumers and their indepent choice.

The government's inefficiency will create a healthcare system destined to doom at the expense of all of us taxpayers.

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

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Permalink:

Romneycare 2012 vs. Obamacare

August 12, 2012
inConsumer Driven Health Care, Medicine: Healthcare System, Stakeholder Mistrust
• Leave a comment

Stanley Feld M.D.,FACP, MACE

Recently President Obama said his Healthcare Reform Act at its core is the same as Romneycare.

Romneycare is different. Romneycare gives a tax credit to people who purchase insurance. Obamacare penalizes those who do not purchase insurance.

Governor Romney wanted to incentivize people to be responsible and buy insurance while President Obama wants to expand an entitlement and increase public dependency on government.

When Romneycare (Massachusetts) was passed I predicted it would result in cost overruns, restrictions of access to care and rationing of care.

Mitt Romney admits the bill was not ideal. There were things he wanted in the bill but the Democrat controlled Massachusetts legislature refused to let him put them in.

This You Tube represents a recent defense of his bill. He has pledged to repeal Obamacare if elected President.

  

http://youtu.be/6d4raK3QJmQ

I predicted that cost overruns would get to a point where the state of Massachusetts would have to force physicians to participate in Romneycare as a condition for state licensure.

“The New Romneycare” is going to penalize the good hospitals that keep people alive and reward hospitals where those people would die. The good hospitals’ readmission rates would be higher than the hospitals where patients died. If a patient died in the hospital the overall readmission rate would fall.

This example illustrates one problem with the interpretation of remote claims data.

President Obama’s Healthcare Reform Act (Obamacare) will end in failure just as Romneycare has only on a grander scale with greater deficits and less access to medical care.

 Both Romneycare and Obamacare have the same defects. Neither gets to the core of the problems in the healthcare system.

A core problem is the unnecessary testing resulting from defensive medicine and the need for effective tort reform.

Another core problem with the healthcare system is the financial abuse of healthcare insurance. Both the state of Massachusetts and Obamacare are dependent on the healthcare industry to provide administrative services for government run plans.

The insurance companies take 40% of the healthcare dollar and blame physicians and hospitals for the rising costs. The 40% is disguised under direct patient care in its financial statements.

An important factor in rising costs is the increasing administrative paperwork for hospitals and physicians for government information gathering. It leaves less time for patient care.

Policy wonks make up rules resulting in the increased documentation in the name of increased quality care. No one has defined quality care precisely.

In 2009 President Obama bailed out Romneycare to the tune of 8 billion dollars.

The mainstream media constantly reports that over ninety plus percent of the population is insured. Reportedly the patients are happy.

No one reports the appointment and emergency waiting times.

There is very little negativity in our press about the Canadian healthcare system. This You Tube presents a former Canadian physician’s experience.

 

http://youtu.be/At9q6uFR3gU

Governor Romney must stop defending RomneyCare. It is a hollow defense.

  

http://youtu.be/4DW6IKG9d_8

 I could not find any negative press in the Boston Globe about the Massachusetts plan in a long while.  The August 3, 2012 Wall Street Journal has a devastating article about the Massachusetts Plan.

The headline was, “With costs rising fast, Massachusetts moves to dictate medical care.” 

My inevitable postscript for Romneycare is cost containment with price controls and the increased bureaucratic dictating how medicine should be practiced.

Rather than Democratic Governor Deval Patrick trying to patch the law and make things worse he should repeal the law and deal with the underlying problems.  

 “The claim then, as with the Affordable Care Act, was that health care would be less expensive if everyone had insurance.”

The claim seems naïve to me if there is no cure for the healthcare insurance industry taking 40-60% off the top and defensive medicine is not reduced through tort reform.

Unless the healthcare industry is consumer driven “bending the cost curve” will not happen.

So what in happening in Massachusetts?                                          

    1. 79% of the newly insured are on public programs.

   2. Health costs—Medicaid, Romneycare's subsidies, public-employee compensation—will consume some       54% of the state budget in 2012 up from about 24% in 2001.

  3. Health spending in real terms has jumped by 59%.

  4. Spending for education has fallen 15%, police and firemen by 11% and roads and bridges by 23%.

  5. Massachusetts spends more per capita on health care than any other state.

   6. Costs are 27% higher than the U.S. average.

Healthcare premiums and taxes are rising and the physicians are the target instead of the health-care insurance industry.

    1. Under the plan, all Massachusetts doctors, hospitals and other providers must register with a new state bureaucracy as a condition of licensure—that is, permission to practice.

    2. They'll be required to track and report their financial performance, price and cost trends, state-sanctioned quality measures, market share and other metrics.

    3. An 11-member board known as the Health Policy Commission will use the data to set and enforce rules to ensure that total Massachusetts health spending, public and private, grows no more than projected gross state product through 2017, and 0.5 percentage points lower thereafter.

    4. The data collected will be claims data and it will stink. If past results are a predictor of future results price control do not work.

    5. No registered provider is allowed to make "any material change to its operations or governance structure," the bill says, without the commission's approval.

    6. The commission can also rewrite the terms of provider contracts with insurers and payment levels and methods if they are "deemed to be excessive."

    7. The commission can decide to supervise the behavior of any provider that exceeds some to-be-specified individual benchmark.

    8. These delinquents must submit a "performance improvement plan" that the commission must endorse.

    9.The commission is empowered to control the practice and organization of medicine.

   10. Some complain this government control is too weak because the delinquents can only be fined $500,000 for disobeying the commission's dictates.

What ever happened to individual freedom of choice and other freedoms?

It is obvious that Romneycare is a bust and getting worse.

However in my view Romneycare is a pretty tame failure compared to what is going to happen down the road with Obamacare. 

Everyone agrees that the healthcare system needs to deliver medicine more efficiently and be more accountable.

But.

Accountable to whom?  

The healthcare system must become more accountable to consumers. The only system that will work is a consumer driven healthcare system with the consumers responsible for their healthcare dollars.

I believe is important for our elected officials to do well.

However it is more important to do well doing the right things.

Our government is not doing the right thing for the people with Obamacare.

It is only going to make things worse as government tries to exercise more control.

 

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

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Permalink:

With Obamacare Patients Lose

July 15, 2012
inMedicine: Healthcare System
• Leave a comment

Stanley Feld M.D.,FACP,MACE

President Obama, in his attempt to create a healthcare system that is more efficient, affordable and democratic does not attack the basic dysfunctions in the healthcare system.

Obamacare does nothing to disintermediate the healthcare insurance industry.

It does not provide incentives for consumers to be responsible for their health or their healthcare dollar.

 It creates another entitlement and increased consumer dependency on government rather than consumer independence.

 It does nothing to alleviate the practice of defensive medicine and the waste of $750 billion dollars for unnecessary tests that would be eliminated if effective Tort Reform were enacted.

President Obama and his advisors believe that defensive medicine accounts for only 2-3 billion dollars a year.

They conclude the cost is insignificant. They are ignoring reality proven by well-done studies. Their premise is incorrect. Ignoring the facts will continue the dysfunction in the healthcare system.

 I have stated repeatedly that I believe President Obama’s goal is complete government control of the healthcare system.

The rules in Obamacare will destroy the patient physician relationship and private healthcare.

The only system left will be the government’s Public Option through Health Insurance Exchanges. Everyone will be on Medicare or Medicaid.

Both Medicare and Medicaid are presently unsustainable. Expanding both will accelerate the demise of both Medicare and Medicaid. 

The resulting socialized Medicine will be an unsustainable disaster as it has become in England and Canada.

The public knows Obamacare will fail. They also know we need to do something. The public needs to hear about a viable alternative.

With Obamacare premiums will increase along with taxes. Access to care and rationing of treatment will occur.   

The path America is on is  “The Road To Serfdom” as described by Fredrick Hayak. Serfdom is occurring slowly but steadily. President Obama has told us in his own words how we will get there.

He sounds great because he is charming and seductive. His only problem is he is not truthful about his goal and its cost to society.

 

http://youtu.be/i2e-86eOIT0

Consumers will be the biggest losers.

The more than 250 million consumers who already have health insurance will see their healthcare insurance change, the cost increase, and the quality of care diminish.

 How will Americans feel when they hear about a brand new cure only to find out that their government’s controlled insurance won’t cover it? The decisions to cover care will be made by a non-elected committee that sends its recommendation to another not elected committee who then sends it to a third committee to decide on whether the treatment is affordable or valid for the age of the patient.

“Patients will have to get used to less access to real health care solutions, fewer approvals for the very latest, personalized, genetic-based cancer treatment or surgical technology that could save your life.”

Who loses? The consumer.

The Doctor Patient Medical Association released survey of doctors showing that 90% believe that Obamacare is on the wrong track.

The same survey revealed that 83% of practicing physicians are contemplating quitting the practice of medicine.  

The physicians remaining in practice will see more patients per hour and have care of their patients dictated to them by the government bureaucrats. Obamacare will turn personalized patient care into commodity care.

There will be no patient physician relationship. There will be rationing of care and decreased access to care. Patient’s will not have freedom of choice for care or treatment.

 A recent article in Britain’s Daily Mail described the use of the “Liverpool Pathway.  A British Professor claims the NHS kills off 130,000 elderly patients every year using the Liverpool Pathway.

The Liverpool Pathway is a set of rules that decide who should receive treatment and who should not receive treatment.

“Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway.”

 Under Obamacare physicians will bear the brunt of explaining how come ever rising premiums are buying you fewer and fewer benefits.

 Consumers who can afford to pay physicians directly will not receive a tax break unless their medical care expenses are more than 10% of their gross income.

 The popular Health Savings Accounts will perish because of the barriers against them as written into the healthcare law.

 The Healthcare System’s savior “My Ideal Medical Savings Accounts” will vanish from consideration.

Obamacare also restricts physicians’ clinical judgment.  Sometimes physicians will sense a patient is really sick with a serious disease. An example is a disease called a fever of unknown origin. Many tests would have to be performed to make the diagnosis. The sooner the diagnosis is made the better the chance for patients to survive.

Physicians might fear the Independent Medicare Advisory Board would deny the workup and penalize the physician. It could be that the Independent Medicare Advisory Board members and the other committees did not factor in the difficulties in the diagnosis.

In time the diagnosis would become obvious but it might be too late to save the patients life.

We have already seen healthcare premiums soar under Obamacare. I have shown that Medicare premiums are schedule to escalate in 2014. Medicare and Medicaid is healthcare insurance.

Healthcare insurance will be less affordable not more affordable even though government subsides will be greater.  The budget deficit will grow increase.     

Access to care will decrease because of the increased number of patients. Physicians will have less time to spend with patients. A growing number of patients will have increased difficulty finding a physician.

There is a current physician shortage. The physician shortage will become compounded when some physicians stop practicing medicine. Other physicians will either restrict the healthcare insurance plans they accept or stop accepting healthcare insurance completely.

The delivery of healthcare is getting worse and more expensive not better and less expensive.

Obamacare is creating an escalating mess.

Patients are going to be the biggest losers on every level of interaction with the President Obama’s Healthcare Reform Act.

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

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