Stanley Feld M.D.,FACP,MACE

President Obama has tried to marginalize the law suits filed by 20 states concerning the constitutionality of his healthcare reform bill. President Obama has the power of the pulpit. He also has the traditional media helping him.

There are two main issues with these legal challenges:

1. Is the mandate to force citizens to buy healthcare insurance constitutional?
2. Is the nationalization of healthcare a constitutional infringement on States rights?

The lawsuits against the Obama administration have come from 20 State Attorney Generals, plus physicians’ groups and constitutional legal centers. An attempt has been made by the administration marginalize each lawsuit without much explanation.

It is difficult for the average citizens to understand the merits of the challenge. President Obama and his staff keep telling us the bill will reduce the cost of healthcare. It will be good for everyone. President Obama says he has been assured by legal counsel that the bill is constitutional.

Two weeks ago the National Federation of Independent Businesses filed an amended complaint to the lawsuit originally filed by 13 states.

“In addition two individuals also joined the litigation. One is the uninsured owner of an automobile repair shop in Panama City, Fla. The other is a man from Washington State who prefers to pay his medical bills out of pocket rather than being compelled to obtain insurance, as will be the case starting in 2014.”

President Obama’s administration claims the lawsuits are a political ploy by Republicans. The administration has stated it will challenge the law suits on their legal standings and authority.

Dan Danner, president and CEO of the National Federation of Independent Business (NFIB), a nonprofit, nonpartisan organization that works to promote and protect the rights of small businesses to own, operate and grow their businesses wrote;

“We also believe the health-care law is unconstitutional.

The centerpiece of this law is an individual mandate requiring virtually all Americans to purchase health insurance or pay a fine.

We strongly believe that the Commerce Clause of the Constitution does not give Congress the power to force individuals to purchase a private product or face a fine.

Requiring individuals to purchase something simply because they are alive is unprecedented.”

President Obama’s lawyers’ response to the constitutional challenge is it is a political ploy to tarnish the healthcare reform bill.

In court filings the administration has claimed that an individual decision to not purchase insurance is, in effect, a decision about how to pay for future medical care. Taken in the aggregate, those decisions substantially affect interstate commerce by shifting the cost of covering the uninsured to policy-holders, health care providers and taxpayers.

This is a lame argument.

Individual businesses have realized that President Obama’s healthcare bill will dramatically raise health-care costs rather than lower costs. This will increase the overall cost of doing business. There is a built in bias against small businesses.

What’s more, the federal mandate requiring that nearly all U.S. residents carry health insurance by 2014 seriously threatens our basic constitutional rights and individual freedoms.

The government cost estimates are already rising.

“According to the Congressional Budget Office (CBO), the overhaul will cost about $115 billion more than first projected, bringing the total to more than $1 trillion.”

One trillion dollars does not even come close to the real and hidden costs of President Obama’s healthcare reform bill. The bill is not a healthcare reform bill. It is a way of centralizing federal power over individual rights.

President Obama has said the law will significantly help small businesses. He continually focuses on the small business tax credit. In reality the tax credit is not real.

“The reality is that the tax credit is complex and very limited because firms qualify based on number of employees and average wages.

The credit, which is only available for a maximum of six years, puts small business owners through a series of complicated "tests" to determine if they qualify and how much they will receive.

Fewer than one-third of small businesses even pass the first three (of four) tests to qualify: have 25 employees or less, provide health insurance, and pay 50% of the cost of that insurance.”

“More importantly, the credit is temporary, but health-care cost increases are permanent. When the credit ends, small businesses will be left paying full price. They’ll also be forced to deal with all sorts of new taxes, fees and mandates buried in this 2,000-page law.”

One hidden tax is the healthcare insurance industry fee of $8 billion (that escalates to $14.3 billion by 2018) on insurance companies based on its market share. The fee will be passed on to employers in high premiums.

This tax will be paid almost exclusively by small businesses and individuals. The law specifically excludes self-insured plans. Most large corporations and labor union are self insured and will avoid this tax.

President Obama said his healthcare reform bill is going to “go after” the healthcare insurance industry’s grotesque profits.

The healthcare insurance industry is lining up to help the government write the new rules and regulations.

The rules they are helping write will permit the healthcare insurance industry to load its expenses as it has done previously.

With the business association and individual plaintiffs joining the lawsuit public perception might shift from the lawsuit being primarily a political device as President Obama has tried to emphasize to this lawsuit being a serious constitutional and states’ rights issue.

America wake up!

President Obama’s healthcare reform bill is a very expensive law. It will not decrease the cost of healthcare or increase the quality of healthcare.

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

Stanley Feld M.D.,FACP,MACP

Fourteen states are suing the U.S. Government in order to block the healthcare reform bill. The participating plaintiff states are Florida, South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington State, Idaho, and South Dakota.

Virginia has filed a separate lawsuit. It is anticipated that other states will join the lawsuit.

“State attorneys general wasted no time filing legal challenges to President Obama’s healthcare reform law, swinging into action with legal filings in Florida and Virginia within minutes of the White House signing ceremony on Tuesday.”

The state attorneys general charged that the new healthcare reform package exceeds Congress’ power to regulate commerce, violates 10th Amendment protection of state sovereignty and imposes an unconstitutional direct tax.

“This lawsuit should put the federal government on notice that Florida will not permit the constitutional rights of our citizens and the sovereignty of our state to be ignored or disregarded,”

President Obama’s administration has dismissed the lawsuits. Robert Gibbs said White House lawyers have advised them that the administration would win the lawsuits. Mr. Gibbs’ contention received more traditional media coverage than the reasons for the lawsuits.

A Democratic Party spokesman has turned the table on reality and said the lawsuits are a waste of state funds that will create large state deficits.

Who is paying for the federal government’s defense expenses?

Virginia filed a separate law suit in federal court in Richmond. The suit focuses on the mandate issue. A state law protects Virginia residents freedom to refuse unwanted health insurance. President Obama’s healthcare reform bill imposes penalties on anyone who avoids buying healthcare insurance.

“It has never been held that the Commerce Clause [of the Constitution] … can be used to require citizens to buy goods and services,” the suit says. “To depart from that history to permit the national government to require the purchase of goods and services would deprive the Commerce Clause of any effective limits.”

The goal of the multi-state lawsuit is to move through the court system to the U.S. Supreme Court. The states are confident the U.S. Supreme court will declare the new healthcare law unconstitutional.

“The multi-state lawsuit maintains that new law infringes the liberty of individual state residents to choose for them whether to have health insurance. It also says the states themselves are victims of a federal power grab by leaders in Washington.”

During the writing of the U.S. Constitution, our founding fathers worked hard to preserve individual freedoms and states’ rights. The fear was that a federal system of government would attempt to control those rights and freedoms. These debates are beautifully outlined in Richard Deeman’s book”Plain Honest Men”

Michael Connelly is a constitutional lawyer who explains the constitutional issues in President Obama’s healthcare reform bill. His explanation of the issues are clearly stated on his blog.

“The entire bill is a blatant attempt to hide what is really going on when it comes to the Constitutional implications for individual Americans and the states that we live in.”

“Instead, this is a summary of the most important parts of the bill that will deal a severe and possibly fatal blow to the Constitution of the United States of America.”

Michael Connelly permitted me to print his first analysis of the unconstitutionality of the HR 3200. President Obama, Harry Reid, and Nancy Pelosi used a number of tricks to get the bill passed by a partisan congress.

Many of the tricks are unconstitutional. The methodology and results were not the intention of the founding fathers’.

It is essential that the American people understand the specifics of the constitutional issues. The Public should not accept the administrations sleight of hand comments about the lawsuits.

I salute the state governments who are taking a stand. I hope many other states will join the lawsuits.

It is important to present Michael Connelly’s comments as a source reference to the constitutional issues of President Obama’s healthcare reform law.

“ I won’t even attempt to deal with all of the items covered in the bill because that would probably require a book.        

1. the passage of this bill far exceeds the powers granted to Congress under the provisions of Article 1, Section 8 of the Constitution which specifically states what Congress can do.

2. The bill grants powers to President Obama and the Executive Branch of government that are not authorized under the Constitution.

3. The new law requires every American, simply by virtue of the fact that they are alive, to purchase health insurance from private companies that will be heavily regulated by the Federal government. This is not authorized under the commerce clause of the Constitution and the Supreme Court has never rendered a decision saying that such power exists.

4. The legislation not only requires people to purchase health insurance, but establishes the terms and conditions that such insurance plans will have. In other words, Americans will be forced to enter into contracts for coverage that they may not want or need.

5. Failure to comply with the requirements to buy health insurance or even health insurance approved by the Federal Government will result in punitive action against American citizens. People will be fined for this failure although the bill calls it a tax. This is an effort to bypass the provisions of the 5^th Amendment to the Constitution which provides protection against the taking of our property without “due process”.

6. This tax will be collected by the Internal Revenue Service that will have an additional 16,500 agents and auditors hired to enforce it. This opens the door for people who fail to pay the “tax” being subjected to criminal penalties.

7. In order to facilitate the actions by the IRS the Federal government will have real time access to the formerly private information of Americans including medical records and financial information. This is a violation of our right to privacy and the 4^th Amendment protection against illegal searches and seizures.

8. The imposition of this so called “tax” also violates Article 1, Section 9 of the Constitution that limits the type of taxes that Congress can levy.

9. The bill also takes away from the states their historic right to regulate the health care industry, including health care insurance, within their own borders. Everything will now be regulated by the Federal government. This is a clear violation of the 10^th Amendment to the Constitution.

10. In addition, the legislation will force State Governments to add millions of people to Medicaid, yet the Federal government will not be funding most of this. In other words, the bill will force the states to impose massive tax increases on their citizens in order to pay for this coverage. Congress has no authority to do this and it is
another clear violation of the 10^th Amendment.

11. The impact on senior citizens in the United States will be immediate and devastating and will entail a breach of contract between Americans and their own government. We are required to pay taxes for Medicare coverage and have a right to expect that they will have adequate health care coverage when we reach age 65. However, enormous cuts in the funding of Medicare under the provisions of the new law will deny us the coverage we have paid for and inevitably lead to the rationing of health care for senior citizens.

12. There are also numerous new taxes imposed under this law ranging from taxes on so called “Cadillac” policies that provide a high level of coverage, to taxes on medical devices, and even taxes on tanning booths. I consider all of these to be questionable under the powers granted to Congress in the Constitution.

            These are just some of the important Constitutional issues about this bill, yet there are other disturbing aspects that Americans need to consider.

For example, the bill does not prohibit Federal Funding of abortions and that is something many Americans want. Yet, the votes of some members of Congress who opposed this provision were purchased by the President’s promise to sign an Executive Order prohibiting such Federal funding.

In fact, he did sign such an order shortly after he signed the health care bill. This was a ruse. The President has no authority under the Constitution to issue an Executive order changing the provisions of a law passed by Congress that he has just signed. The Executive Order is meaningless.

            Finally, there is another section of the legislation that has nothing to do with health care. It is an authorization for the Federal Government to take complete control of the granting of student loans for our children to further their education.

If you are preparing to send your son or daughter to college you will no longer be able to go to your local bank to take out a student loan. Instead, federal bureaucrats will decide who gets student loans and under what terms and conditions. What will be owed to the Federal government besides the repayment of loans? Will some type of Federal service will be required and will your child have to attend a university approved by the Government. The potential implications are staggering.”

As the bill was unfolding the trick plays and unconstitutional aspects of the healthcare reform bill were obvious. Besides ignoring the constitution President Obama’s healthcare reform bill ignores the will of the people.

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

Stanley Feld M.D.,FACP,MACE

Ann Braly’s ( CEO of WellPoint), article in the Wall Street Journal on February 7,2007 signaled an aggressive campaign by the healthcare insurance industry to force the federal government to subsidize healthcare insurance even more than it is presently.

The healthcare insurance industry wants the passage of Obamacare with the deal President Obama made with them. Part of the deal was to mandate insurance and increase deductibles from 20% to 30%.

“This scheme presented by Obamacare would have been, and might still be, imposed on the rest of the country.”

The original scheme (Obamacare1) was forced to be modified because mandating healthcare insurance was challenged as being unconstitutional.

Thirty two states have passed laws prohibiting healthcare insurance mandates. Mandates would be great for the healthcare insurance industry. They would increase the number of customers insured.

The more insured the lower the actuarial risk. The healthcare industry claims it could lower the cost of healthcare insurance. Obamacare 1 would also increase consumers’ deductibles saving more money for the healthcare insurance industry and increasing the burden to consumers.

At the request of several congressmen last year, including some Democrats, WellPoint mined its own actuarial data to model ObamaCare and found that it would as much as triple premiums for the small businesses and individuals who are most of the company’s customers.

WellPoint is declaring that Obamacare 2 will triple premiums. It is important to note that WellPoint did the math using accounting practices permitted by the government. The result is loading the overhead.

There is no evidence that any congressmen or the President has challenged WellPoint’s estimates until Mrs. Braly’s WSJ interview. No one has challenged the accounting methodology. The government is assuming the healthcare insurance industry numbers are correct. It would also be important to understand the math in the actuarial estimates.

The government should be looking at the defects in accounting methods. It should also look at the accuracy of the actuarial calculation.

“The White House political shop promptly compared WellPoint to a tobacco company.

President Obama uses political sound bytes all the time. His sound bytes have little substance. He should become aware of the fact that the average citizen is tired of his nice sounding rhetoric.

The healthcare insurance industry is ripping off the consumer and the government. The government should make the right accounting rules, incentivize the consumer and physicians to decrease the cost of healthcare and get out of the way.

Four days after Mrs. Braly’s statements about premium increases, Anthem, a California subsidiary of WellPoint, announced it was increasing its insurance premium by 39% for individuals insured.

I knew it would not stop at Anthem in California. The healthcare insurance industry is exempt from antitrust laws. I predicted that WellPoint’s argument is paving the way for other healthcare insurance companies to increase its rates.

“For example, Anthem in Maine was denied an 18.5 percent increase last year and is now requesting that state regulators approve a 23 percent rise.

Michigan’s Blue Cross Blue Shield plan requested approval for premium increases of 56 percent in 2009. And in the state of Washington, rates for some individual health plans increased by up to 40 percent until regulators cracked down.

Other states cited in the report were Connecticut, Oregon and Rhode Island.

The premium increases affect the most vulnerable part of the health insurance market, policies marketed individually to customers buying their own plans.”

The goal of WellPoint is to raise the rates on individual plans which have patients at risk for using healthcare insurance. Its position is the government should pay for the risk and that is the deal they made with President Obama before he changed the deal.

“According to the Census Bureau, only about 9 percent of Americans purchase coverage directly, while nearly 60 percent are covered under employer plans. Family premiums for those with workplace coverage rose 5 percent last year, even as inflation fell 1 percent, but nowhere near the rates seen in the individual market.”

The mandate to the healthcare insurance industry is they must accept all employees regardless of pre existing illness in group plans. They can raise the rates of group plans depending on the demographics of the group rather than community rate the group. Community rating should add a community pressure point to individuals that do not take care of their health.

Older self employed individuals cannot qualify for healthcare insurance under present healthcare insurance company rules. Even if they qualify for insurance these consumers have to pay for insurance with after tax dollars. The existing rules decrease individuals’ ability to afford healthcare insurance.

On top of that the insurance industry demands unconscionable premium increases. The solution is for State Insurance Boards to refuse to grant these companies a license to sell insurance in their state.

Another solution should be making healthcare insurance tax exempt just as employer insurance is tax exempt. Obamacare wants to make all insurance payments non tax exempt to increase government revenue while placing a bigger burden on individuals and groups.

The healthcare reform bill should change the rules so that all insurance is community rated and everyone is qualified to buy insurance regardless of preexisting illness. The bill should create ideal medical savings accounts for everyone so they become responsible for their own health and healthcare dollars.

“Insurers say the push for higher premiums reflects supply and demand. Medical costs keep going up, even in a weak economy. Many healthy people are dropping coverage or switching to bare-bones policies to keep their bills down. That leaves a higher proportion of people with health problems in the risk pool, forcing the steep rate increases.”

This is the reason to start from scratch with the Ideal Medical Savings Account. Medical Savings Accounts are an insurance product Democrats refuse to consider. It will decrease the power of the federal government’s ability to keep the citizens in a state of fear and them in power. (Shock Doctrine).

It is time for us to say we are not going to take this anymore.

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

Stanley Feld M.D.,FACP,MACE

Ann Braly, WellPoint’s CEO, launched a new offensive to protect the vested interests of the healthcare insurance industry now that Obamacare seems to be dead.

The healthcare insurance offensive began with her op- ed article in the Wall Street journal on February 7,2010. Readers will have a deeper understanding of the offensive if they follow the underlined historical links in this article.

It will destroy President Obama’s credibility, the practice of medicine, patient access to care and increase the number of uninsured. It will bankrupt the country if her offensive is successful.

The healthcare insurance industry is killing the goose that laid its golden egg.

WellPoint is the largest U.S. commercial health insurer by membership. Wellpoint’s affiliated health plans are in 14 states and insure over 34 million people or 11.1% of the population.

Wellpoint also has reimbursement contracts with 82% of the nation’s primary-care physicians, 84% of specialists, and 94% of hospitals.

Anthem Blue Cross is California’s largest for-profit insurer and is an affiliate of Wellpoint. Anthem insures 800,000 people.

Four days after Ms. Braly’s article blamed all the other stakeholders for the rising cost of healthcare insurance, Antham announced it will raise member premiums by as much as 39% on March 1.

The parent company, Wellpoint had a net profit of $2.7 billion in the last quarter of 2009 alone.

Since the healthcare insurance industry has an antitrust exemption I expect every other healthcare insurance company will raise its premiums. Extrapolating the profit to the entire population insured, the total net profit in the healthcare insurance industry would be 144 billion dollars. This does not include the inflated and wasted administrative expenses.

Somewhere between 35-65 cents of every healthcare dollar goes to administrative expenses. Assume that 50 cents of every healthcare dollar is expenses plus net profit to the healthcare insurance industry. The healthcare system consumes $2.5 trillion dollars. That means $1.25 trillion dollars goes toward expenses and profit. The profit is distributed to employees and stock holders.

President Obama says;

"I mean, to be fair, the status quo is working for the insurance industry, but it’s not working for the American people," Mr. Obama said recently.”

Ann Braly CEO of Wellpoint says;

“It’s hard to see how WellPoint could be to blame for surging health spending, Mrs. Braly says, when 85 cents out of every premium dollar or more "is paid out in the actual cost of care, doctors, hospitals, suppliers, drugs, devices." Confiscating the 2009 profits of the entire insurance industry would pay for two days of U.S. health care.”

The question is who is incorrect? Are Wellpoint’s financial statements incorrect or is Ann Braly’s sound byte incorrect? I think everyone would agree that $2.7 billion dollars net profit in the last quarter of 2009 is not shabby.

Wellpoint is using a well worn public relations technique by pointing a finger at the other stakeholders. All its administrative costs, additional reserves, and investment costs are included in the “85 cents out of every premium dollar figure.”

Wellpoint makes money on the money withheld from physicians for reimbursement. Wellpoint has held back reimbursement to physicians often. When it was sued in California (at an extra cost to the healthcare system) the settlement was for a fraction of the reimbursement owed. The settlement was a pretty good way of making money.

“You don’t need to be an economist to understand that any middleman interposed between seller and buyer raises the price of a given service or product. Some intermediaries justify this by providing benefits, such as salesmanship, advertising or transport. Others offer physical facilities, such as warehouses. A third group, organized crime, utilizes fear and intimidation to muscle its way into the provider-consumer chain, raking in hefty profits and bloating cost, without providing any benefit at all.”

The healthcare insurance industry is the middleman that controls the healthcare system. The government through Medicare depends on the healthcare insurance industry to be the third party administrator for Medicare. The healthcare insurance industry sets the prices and the benefits using an unscientific social science called actuarial science.

“The health insurance model is closest to the parasitic relationship imposed by the Mafia. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection."

In order to control the healthcare system the healthcare insurance industry has managed to control the process of authorized treatment and reimbursement for the government and private insurance.

Mrs. Braly says;

“To actually be fair, the insurance industry was a cheerleader for the plan, at least until the policy substance congealed sometime in September.”

"Obviously, we’ve been involved in this discussion for a while—more than a year—and if you think about it we came to the table early, early on and said we’re going to be advocates for responsible, sustainable health-care reform done right. We really do have to get at the underlying question of health-care costs."

It is certainly to Wellpoint’s and Mrs. Braly’s advantage to have universal healthcare that is mandated and subsided by the government. Prior to September the healthcare insurance industry had it all set up with President Obama.

Universal healthcare would provide more customers and more premiums. The healthcare insurance industry also worked out a deal with the government to increase the deductibles from 20% to 30% so they could provide affordable healthcare insurance at a lower price.

The $2.7 billion dollars in profit for the last quarter drove me to look at the salaries and stock options posted on the web for officers of Wellpoint. Mrs. Braly’s salary was not available.

CEO, Divisional/Presidents’ salary was 1.18 million and 8.4 million dollars a year.

The CEO and Chairman of the Board made 23.9 milliona year .

Executive VP/CFOs’ made 8.42 million dollars a year.

Geographical CEO/Geographical President/Executive VPs’ made between 15.56- 6.39 per year

The stock options awarded are even higher.

In a March 2007 post I stated that “ UnitedHealthcare claims that costs are out of control. Why? Who paid their CEO $1.8 billion dollars over 8 years? The amount equals $300 million dollars a year or $821,917 a day in salary and benefits to one person. < a href="http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2006/11/administrative_.html">What are the other top executives at UnitedHealthcare receiving in salary and benefits? Do you think these salaries affect the cost of insurance?”

Consumers only realize that health insurance increases yearly. In November 2006 I wrote;

“No leader has the courage to step forward and do something about it. I have emphasized much of the leadership can be exerted at the state level by state boards that license the insurance industry, hospitals and physicians. No one has organized the people to protest. The excuse is that the healthcare system cannot be fixed. It is impossible to control physicians. I believe all these excuses are smoke to cloud the solution. The facilitator stakeholders are simply holding on to what they falsely perceive is their vested interest.
“A theory of limits applies here. In a voluntary market, healthcare purchasers–employers or taxpayers–will tolerate only so much cost growth. Then they’ll recede. It is preposterous to believe the well won’t run dry.”

All of these pricing mismatches and excess non medical value added costs can be eliminated by permitting patients to be in control of their healthcare dollar and selling pure insurance that is fairly priced. The Ideal Medical Savings Account system represents pure insurance in the form of high deductible health insurance and motivation for the patient to become an informed consumer.

The cost of processing claims could be eliminated completely. The service claims could be adjudicated instantly with a credit card. Thousands of diverse businesses adjudicate claims on purchases instantly daily at a low cost. The use of credit cards to pay for Medical Savings Accounts could provide an instant savings of $150 billion dollars in costs in the healthcare system. The losers will be the non competitive insurance companies. The winner will be the bright flexible company that puts the correct 21st century system in place.

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

Stanley Feld M.D.,FACP,MACE

There are many reasons President Obama’s plan for healthcare reform is failing. The public is not dumb enough to believe the public option will work and save money at the same time.

The public does not believe that the creation of a new entitlement program with a massive bureaucracy can save money without rationing care. President Obama has not directly denied there will not be rationing of care.

The public does not believe President Obama’s promises anymore. He has been responsible for the mess created by the economic stimulus package, the bank bailouts, and the automobile bailout while increasing the deficit and devaluing the dollar. When is he going to bailout the people? He is increasing government control over our freedoms and limiting corporate ability to compete for consumer business.

The American public does not believe President Obama when he says he has saved a million jobs. Each month the unemployment rate increases as companies lay off workers. He said unemployment would not surpass 8.5% with his economic stimulus package. Unemployment is greater than 10% as Fed chairman Ben Bernanke declares the recession is over. President Obama said the bailouts would increase lending and yet small businesses cannot obtain loans.

President Obama also promised that people making under $250,000 dollars a year would not be taxed yet it is obvious that taxes are going to increase for everyone if the healthcare bill is passed.

President Obama has made many false promises and created much false hope. I believe President Obama does not understand the core problems with his healthcare plan. He wants to change the healthcare system but not eliminate its major defects. He is trying to impose a government takeover of the healthcare system. The winners will be special interests with increased government power over our lives. Patients will not be the winners.

There are no incentives for patients or physicians in his healthcare plan. There is only punishment and restrictions on access to care.

Americans deserve more credit than President Obama is giving them. America’s opinion is showing up in the polls. The problem is neither the President nor the Democratic congress is listening. The net result is going to be an increase in public anger.

“According to the Gallup polling organization, the percentage of Americans who believe the cost of health care for their families will "get worse" under the proposed reforms rose to 49% from 42% in just the past month. The percentage saying it would "get better" stayed at 22%.”

The public has no great love for the healthcare insurance industry either. The healthcare industry has abused its responsibility to consumers for the sake of profit. Consumers want a free market system in which the government makes rules to level the playing field for them. The public option will not do that because the healthcare insurance industry remains the administrative service provider.

President Obama is ignoring what Americans’ core beliefs in a free enterprise culture, namely the importance of individual choice, personal accountability, and rewards for ambition.

He cannot say “trust me” to take care of America. There are too many contradictions. Harry Reid says there is not going to be a public option one week and the next week he says there is going to be a public option. The public is weary of this double talk

“First, Americans recoil at policies that strip choices from citizens and pass them to bureaucrats. ObamaCare systematically does so. The current proposals in Congress would effectively limit choice across the entire spectrum of health care: “

“ The government will determine what kind of health insurance citizens can buy, what kind of doctors they can see, what kind of procedures their doctors will perform, what kind of drugs they can take, and what treatment options they may have.”

These limitations on choice are directly opposed to main stream America’s beliefs. Most Americans’ believe they should be responsible for the consequences of their actions.

President Obama’s healthcare plan removes individual responsibility. The government will take care of all of us at great cost to the taxpayers. The $1.5 trillion dollar cost estimate has historically been incorrect for other entitlement programs

“ ObamaCare discourages personal ambition. The proposed reforms will institute a set of government mandates, price controls and other strictures that will make highly trained specialists, drug researchers and medical device makers less valued now and in the future.”

Americans understand that when you take away the economic incentives new therapies and medical innovations of tomorrow may never be discovered.

A survey of the follow propositions were tested for public sentiment.

" (a)Government policies should promote fairness by narrowing the gap between rich and poor, spreading the wealth, and making sure that economic outcomes are more equal";

“or (b) Government policies should promote opportunity by fostering job growth, encouraging entrepreneurs, and allowing people to keep more of what they earn."

“Sixty-three percent chose the second option; just 31% chose the first.”

I have no doubt that President Obama wants to help people in need. However, he is proposing government control over a population that is extremely uncomfortable with increasing government control of institutions and businesses. The public is suspicious of government restrictions and proven inefficiency. They do not want to put their healthcare needs in the hand of the government.

I believe he missed his opportunity for effective Repair of the Healthcare system by not leveraging that repair congruent with America’s culture.

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

Stanley Feld M.D.,FACP,MACE

There is good reason for the negative approval rating polls of the congress and the President. They have proven over and over again what they tell us is not what they mean. The public does not trust the Congress or Senate. The public is starting to mistrust President Obama. I suggest he not say trust me anymore. He needs to give the public reason to trust him.

The healthcare insurance industry has little desire to repair the healthcare system. It wants want the healthcare system to generate increased revenue and profits.

“In the first half of 2009, the health service and HMO sector spent nearly $35 million lobbying Congress, the White House and federal healthcare offices, according to data from the Center for Responsive Politics.”

The healthcare lobbying effort has been extremely profitable for healthcare lobbyists. President Obama had promised to decrease the influence of lobbyists.

 
“With more than 900 lobbyists, that sector — whose top spenders are insurance giants UnitedHealth, Blue Cross Blue Shield and Aetna — was poised to spend more than in 2008, a record lobbying year.”

President Obama promised America a change. The president’s directives against lobbyists were among his first official acts. His stated goal was to make government more open and accountable to the public.

“We are here as public servants, and public service is a privilege,” Obama said, addressing his White House staff and Cabinet on his first full day in office. “It’s not about advancing yourself or your corporate clients.”

Tom Daschle is an unregistered and highly paid lobbyist. He is President Obama’s go to man for healthcare reform. Yet he is a consultant for a lobbying firm Alston & Bird whose clients are the healthcare insurance giants like UnitedHealth and hospital associations.

President Obama said; “We need to close the revolving door that lets lobbyists come into government freely and lets them use their time in public service” to promote their own interests when they leave.”

The public does not forget Presidential candidate’s promises. They have recognized the contradictions in President Obama’s actions. His actions only lead to the public’s increasing cynicism and mistrust in him and his administration. There is great public hesitation to trust the government to take care of their healthcare needs.

“The LA Times article that the "change" being supported by the White House is going to make the for-profit companies fatter and wealthier at the expense of a healthcare system bloated by the excessive administrative, profits, and grossly high salaries of the health insurance and drug companies.”

The public protests are not only about the public option. They are about the government offering “affordable” public insurance to all. An entitlement the government cannot afford. The protests are about the control over our freedom of choice.

The healthcare insurance industry will make more money when the insurance pool is increased. The government will subsidize all policies to keep the price “affordable”. The healthcare insurance industry’s profit will increase. President Obama will raise taxes and inflate the economy.

“Undermining support for the public option wasn’t the only gain scored by insurance lobbyists.

Public option was a diversion by the healthcare insurance industry. Its purpose was to frighten and distract the public from the healthcare industry’s other goals. The healthcare lobbyists have made deals with congress and the President. The deals are not transparent.

“In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders’ medical costs under their most affordable plans. Now the committee is considering setting that rate as low as 65%, meaning insurers would be required to cover just about two-thirds of patients’ healthcare bills. According to a committee aide, the change was being considered so that companies could hold down premiums for the policies.”

You bet. President Obama promised to provide affordable premiums. He also promised to regulate the healthcare insurance industry. The terms are favorable to the healthcare insurance industry and not favorable to consumers. President Obama has said nothing about the increase in out of pocket expenses.

“Most group health plans cover 80% to 90% or more of a policyholder’s medical bills, according to a report by the Congressional Research Service. Industry officials urged that the government set the floor lower so insurers could provide flexible, more affordable plans.”

The healthcare insurance industry is going to get its wishes. Healthcare insurance premiums might be more affordable but out of pocket expenses will be higher.

 
"It is vital that individuals, families and small-business owners have the flexibility to choose an affordable coverage option that best meets their needs," said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying shop.”

Isn’t that disingenuous? The greater tragedy is our representatives are going to approve the change in the deductibles. President Obama will call it a victory for healthcare reform. The Democratic party’s goal is to ultimately have a single party payer system.

Who is roping which dope? Who is the dope? The government thinks it is manipulating the healthcare insurance industry. The healthcare insurance industry thinks it is manipulating the government.

The net result is they are both manipulating consumers of healthcare. Consumers will get less healthcare coverage at greater out of pocket expense and higher taxes. The American consumer is the dope.

“Consumer advocates argue that a lower government minimum might quickly become the industry standard, placing a greater financial burden on patients and their families.”

"These are a bad deal for consumers," said J. Robert Hunter, a former Texas insurance commissioner who works with the Consumer Federation of America.”

Consumer advocates have seen through the charade. However they do not have enough money and consumer support to make others aware of what is going on behind the scenes. AARP is not providing awareness. Consumers know they have been promised transparency by President Obama but they have seen little transparency.

"They have beaten us six ways to Sunday," said Gerald Shea of the AFL-CIO. "Any time we want to make a small change to provide cost relief, they find a way to make it more profitable."

Meanwhile, companies would probably see a benefit by providing less insurance "per premium dollar," Hunter said.
Taxpayers do not want more government control over their lives and freedoms. They do not trust government to do things efficiently. Recent experience has confirmed consumer distrust. One only has to look at the inefficiencies in the bank bailouts, the economic stimulus package, the two wars, and the mounting deficits. All theses inefficiencies are at the taxpayers’ expense.

It is time for consumers to take over and demand control of their healthca
re dollars and their own healthcare decisions no matter what socioeconomic level they are in.

The government’s role should be to encourage and incentivize consumers to pursue a path toward better health without permitting them to be taken advantage of by the other stakeholders. This will be the only way to control healthcare costs.

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

Stanley Feld M.D.,FACP,MACE

The healthcare debate is becoming more confusing daily. President Obama has promised change. Fifty-three percent of Americans voted for change. We are not going to get change. It turns out President Obama represents status quo except at a greater expense to the taxpayer.

The healthcare insurance industry controls the healthcare dollars across all insurance lines. These insurance lines are private insurance for small companies, corporations that are self insured, Medicare, Medicaid and self insured local and state governments.

This broad control of the health care dollar comes about because all these healthcare insurance providers outsource their administrative services to the healthcare insurance industry. The major healthcare insurance companies disguise this control by creating differently named subsidiaries that “win the administrative services contracts.”

Fifteen to twenty percent (15-20%) of the healthcare dollar goes to administrative services fees. This is a very high fee. Medicare claims it only pays 2.5% for administrative services. This is probably true for its in-house administrative services but not for outsourced administrative services.

The healthcare industry has also had a stranglehold on all providers of healthcare insurance by increasing premiums and decreasing reimbursement to physicians and hospitals while maintaining its outrageous administrative services fees.

All the stakeholders are captives of the healthcare insurance industry. This stranglehold has caused an increase in the uninsured and destroyed the ill conceived Massachusetts universal healthcare plan.

President Obama’s healthcare reform plan is not focused on eliminating this stranglehold. The Obama healthcare reform plan will still outsource the administrative services to the healthcare insurance industry while increasing the government’s bureaucracy to try contain costs.

When are our politicians going to figure out the only way to repair the healthcare system is to eliminate the middlemen and let the transactions be between patients and physicians?

“This year alone, the healthcare industry has spent over $34 million to hire 923 lobbyists to influence Congress, according to the Center for Responsive Politics.”

Why? Because the healthcare insurance industry has positioned itself so it cannot lose no matter which modified healthcare reform plan is adopted.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama’s massive healthcare initiative. I believe this is an act. Do not let it fool you. Patient welfare is not the healthcare insurance industry’s concern.

“The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers — many of whom would get government subsidies to help pay the companies’ premiums.”

"It’s a bonanza," said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc”.

The healthcare insurance industry hired the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group to do a study opposing the “public option”. The healthcare insurance companies contended that a government-run plan would put the healthcare insurance companies out of business.

I believe this is a diversion. The healthcare industry will make out like a bandit either with or without a public option. The consumer will not be so fortunate. .

Laszewski said the industry’s reaction to early negotiations boiled down to a single word: "Hallelujah!"

"The insurers are going to do quite well," said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. "They are going to have this very stable pool, they’re going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide — plus their administrative costs."

Tom Daschle has emerged, according to the mainstream press, as Obama’s key go-to guy. It is as though he never left. He has the ear of the President as well as the healthcare insurance industry and the pharmaceutical.

“He still speaks frequently to the president, who met with him as recently as Friday morning in the Oval Office.”

Tom Daschle declared after meeting with President Obama that the President is becoming impatient with the debate and might force his healthcare reform bill through the Senate with a 51 vote majority.

“He remains a highly paid policy adviser to hospital, drug, pharmaceutical and other health care industry clients of Alston & Bird, the law and lobbying firm.”

It seemed strange that UnitedHealth and other healthcare insurers would hire Alston and Bird to represent them by a “liberal” Democrat (Tom Daschle) until it became clear that with or without a public option the healthcare industry would experience a bonaza.

“UnitedHealth spent the most, $2.5 million in the first half of 2009, and hired some of Washington’s most prominent political players, including Tom Daschle.”

With the public now opposed to a public option the White House and Senate Democratic leaders have introduced the concept of a on nonprofit insurance cooperatives.

“Mr. Daschle began promoting a cooperative two months ago as a politically feasible alternative to a more muscular government-run insurance plan. It is an idea that happens to dovetail with the interests of many Alston & Bird clients, like the insurance giant UnitedHealth and the Tennessee Hospital Association.”

Liberal democrats are opposed to the nonprofit insurance cooperatives. They fear it will take longer to evolve into a single party payer system than the public option would. Liberal Democrats believe the only way to repair the healthcare system is to have total government control over the healthcare system.

They do not realize that as long as the healthcare insurance industry controls the healthcare dollar the healthcare system will not be repaired. As long as consumers do not have financial incentives to control their health and their healthcare dollar the healthcare system will not be repaired

The healthcare insurance industry does not want the healthcare system repaired. They want the healthcare system to generate more income for them rather than better health for consumers.

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