Stanley Feld M.D.,FACP,MACE

President Obama’s goal might be for his healthcare reform plan to fail. Once it fails the default plan will be a public option with a single party payer system.

Everyone will be forced to opt into the public option. There will not be a private option.

The cost of healthcare will not decrease. The government will be paying the private healthcare insurance industry to administer the public option. Hospitals and physicians will figure out how to game the new system. The increasing costs will force a restriction to access to care.

President Obama must re-examine his premises. The medical care crisis is neither a Democratic nor Republican problem. It is an American problem. Americans need to be motivated to live a healthier existence. Only then will the cost of care diminish.

Consumers must be provided with education to live a healthier existence. The culture must be changed to emphasize better nuitrition and exercise.

Brad Feld pointed me to a fascinating paper by Carliss Y. Baldwin (Harvard) and (Brad’s mentor) Eric von Hippel (MIT). The paper suggests that some of the most basic theories on which the patent system is based are wrong. The thesis is our present patent system might hinder innovation.

The same logic can apply to the premises President Obama and his healthcare policy wonks apply to medical care. President Obama’s healthcare reform plan is punitive to both patients and physicians. It does not promote patient responsibility. It penalizes physicians for poor patient care outcomes.

Effective healthcare reform should promote patient responsibility and physician innovation. Inappropriate patient incentives and punitive regulations for physicians encourage patients and physicians to get around the healthcare reform system. President Obama’s healthcare reform plan does not achieve its goal of saving money and building efficient medical care systems.

A way to develop efficient medical care systems is through a consumer driven healthcare system with patients being in control of their healthcare dollars.

Nevertheless, President Obama’s healthcare plan is law. He won the election and forced through a partisan vote for a healthcare reform plan the overwhelming majority of the public and the physician community oppose. Only time will demonstrate the impending disaster in the healthcare system.

“Mindful that the new health care law’s ability to slow rising medical costs will depend to a great extent on how it is put in effect, President Obama is assembling a high-level team to carry out key elements of the overhaul and is considering moving faster than the law requires to put them into action. “

Kathleen Sebelius, the secretary of health and human services is reorganizing the Centers for Medicare and Medicaid Services. She is developing an innovation center whose goal is to test ways to reduce reimbursing providers.

She can enforce ideas she deems important nationwide without Congressional approval. The power of the secretary of health and human services has been expanded greatly without checks and balances.

She has started working on new regulations in an attempt control Medicare, Medicaid costs. She is also working on regulations to control independent private health care providers. President Obama wants an Independent Payment Advisory Board for controlling Medicare spending before 2014.

The problem with the Independent Payment Advisory Board is its total independence of congressional oversight. In the past Congress has ignored the Medicare Trustees’ recommendations to reduce costs. President Obama’s healthcare reform bill eliminates congressional oversight. Congress has not exercised its responsibility. However congress is accountable to the public and the Independent Payment Advisory Board is not.

The new board’s responsibilities will be in the hands of a 15 member board nominated by President Obama and confirmed by the Senate for the six-year term. The memberships will be full-time positions.

“Each year that Medicare spending exceeds annual targets, as most analysts expect it will, the board must propose ways to reduce payments to care providers.”

The Independent Payment Advisory Board provides Congress with an excellent opportunity to shirk its responsibility. The executive branch will have a firm grasp on control of the healthcare system.

“With the federal debt projected to rise to levels that many economists consider unsustainable, mainly due to growing health costs and an aging population, Congress might have little choice in coming years but to accede to unpopular limits on payments for doctors, hospitals and other health care providers of the kind that lawmakers have ignored in the past. The board would give them political cover to do so. “

“It’s a very promising structure,” said Peter R. Orszag, Mr. Obama’s budget director. “But like anything else in life, it’s what you make of it. So whether it realizes its potential depends on how it’s implemented.”

Tom Daschle, wants the board to be expanded to deal with not only Medicare but also all healthcare insurance.

“ Otherwise, he said, doctors will shift their costs that Medicare does not fully reimburse to patients with private insurance, “which really exacerbates the problem.”

Tom Daschle said it. It is all about the government takeover of the healthcare system. It is about government regulating the healthcare system at the expense of all the stakeholders including patients. It is not about healthcare reform to produce efficient and safe systems of care through patients influencing physicians to develop innovative systems of medical care.

When was the last time a government controlled system was efficient and cost effective? Government should make the rules and then get out of the way.

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

Stanley Feld M.D.,FACP,MACE

Unfortunately, the answer is yes.

President Obama’s healthcare reform plan will fail because of its poor construction.

The majority of Americans agree with President Obama’s goals. Americans want affordable universal high quality healthcare. President Obama’s healthcare reform bill will not accomplish these goals.

President Obama’s healthcare reform bill will waste 2 trillion dollars, restrict access to care, raise taxes, ration care and destroy infrastructure of a healthcare system that provides excellent medical care to the sick.

Our healthcare system is broken because prices are out of control. President Obama’s healthcare reform bill with a mushrooming government bureaucracy will not control prices by competition. It will try to control prices by regulations and force. Price controls never work.

Previous behavior is a predictor of future behavior. It follows that previous healthcare system reform failures are a predictor of future healthcare reform failure.

President Obama’s healthcare reform plan is similar to the failed Massachusetts healthcare reform plan (Romneycare). Romneycare was destined to fail from the onset.

The similarities between Obamacare and Romneycare are glaring;

1. Both the Massachusetts healthcare reform plan and Obamacare mandate individual healthcare insurance.
2. If individuals do not have insurance they must pay a penalty.
3. Most businesses are required to participate or pay a fine.
4. Both healthcare reform plans rely on government-designed purchasing exchanges (healthcare insurance exchanges)
5. The healthcare insurance exchanges are supposed to provide a vehicle to control private health insurance.
6. The uninsured are covered by the expansion of Medicaid and with Obamacare the expansion of Medicare.
7. Qualified citizens receive healthcare insurance subsidies to help pay for their mandated healthcare insurance policies.
8. The state of Massachusetts has set up many new boards and committees to oversee and administer the healthcare reform plan. The added bureaucracy has failed to control costs.

I predicted the Massachusetts plan would fail at its onset. It has been plagued with cost overruns from the start. I cannot image President Obama’s plan can be budget neutral after ten years. I suspect many Americans can’t image it either. I think the Scott Brown election has given America the notion that the citizens of Massachusetts don’t think Obamacare can be successful.

Why did the Massachusetts Healthcare Reform Plan fail?

1. The healthcare reform plan is administered by the healthcare insurance industry. It controls the healthcare dollar and determines the premiums based on defective accounting rules. These rules permit the healthcare insurance industry to overestimate expenses and underestimate reserves. The result is increased premiums.
2. No one has the political will to challenge or change these rules. The rules permit the healthcare insurance industry to declare a loss while it is removing sixty five cents out of every healthcare dollar from the healthcare dollar pool.
3. There are 410,000 people who are newly insured in Massachusetts. Of those 200,000 are fully subsidized by Massachusetts state insurance exchange.

Policy makers underestimated the number of people that would qualify for subsidy.

1. 3% of the population remains uninsured. The total 140,000 uninsured are required to pay a penalty. Half (70,000) uninsured cannot afford the premiums or penalty and receive a waiver.
2. The state’s premiums have increased every year since the onset of healthcare reform. A typical family of four’s annual premium costs almost $13,788, the highest in the country. This is twice the cost of premiums in Texas. The premiums are 27% higher than the national average.
3. This cost does not include out of pocket expenses.
4. Massachusetts regulations serve to eliminate competition in the healthcare insurance market.
5. Mandates dictate the services needed to be covered.
6. Healthcare insurance vendors are required to sell "just-in-time" policies even if people wait until they are sick to buy coverage.
7. Patients game the system by purchasing health insurance when they need it. Patients then drop insurance a few months later and pay the less expensive penalty. The same will apply to President Obama’s plan.
8. Massachusetts’ safety-net hospitals are treating a disproportionate number of lower-income and uninsured patients. State compensation of these safety-net hospitals has been reduced under the new healthcare plan. It is only a matter of time before the safety net hospitals will declare bankruptcy. The alternative is to increase state taxes further. The result is people will move out of Massachusetts lowering the tax base
9. There is a "critical shortage" of primary-care physicians as a result of increasing the number of people covered and an increase in demand for medical services.
10. Physician compensation is decreasing. Physicians are fleeing the state. Patients cannot get doctor appointments.
11. New patients wait 44 days to get an appointment with a primary-care doctor. A secondary market for primary-care doctor appointments is developing. People are selling their appointment times to patients.
12. Appointment time shortages have led to an increasingly expensive emergency room visit for basic medical services. Emergency room visits increased 7%. More than half need emergency room attention. ER visits are very costly.
13. President Obama gave the state of Massachusetts an 8 billion dollar bailout to help cover healthcare reform expenses. The healthcare insurance industry benefited by the stimulus bailout.

The state has refused to permit the insurance industry to raise rates. The insurance industry will leave the state or decrease reimbursement for services. The results are obvious.

If you do not fix the defects in the healthcare system you will not fix the financial difficulties. People must own their healthcare dollar, be responsible for their own care and have the freedom to choose. All this adds up to consumer driven healthcare using the ideal medical saving accounts.

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

Sixty three percent of physicians are unhappy with the implications of President Obama’s healthcare reform plan. The government has reduced reimbursements arbitrarily over the last decade.

Physicians have had an underlying mistrust of government healthcare policy. Congress and especially Pete Stark mistrust physicians. Pete Stark feels all physicians game the healthcare system.

I believe there is some abuse of the healthcare system by a small percentage of physicians. I also believe congress has a lack of understanding of medical practice expenses, the value of physicians’ intellectual property and skill sets.

In September 2009 an Investor Business Daily Survey was criticized for its findings in a physician opinion survey.

“We were harshly criticized last September for an IBD/TIPP Poll that showed 45% of doctors would consider leaving medicine if a health care takeover passed.”

The liberal media refused to believe the survey. It is a pity the media is so polarized. The liberal media is blind to information that could affect liberal healthcare policy adversely.

"IBD/TIPP Doctors Poll Is Not Trustworthy," ran the headline of one much-read piece on the FiveThirtyEight: Politics Done Right blog.

The Huffington Post attacked the very integrity of our poll: "Investor’s Business Daily Publishes Ludicrous Poll Claiming 45% Of Doctors Would Quit Over Reform."

While the Democratic caucus in the Senate and the House were crafting the healthcare reform bill, no one asked practicing physicians how they felt about a government takeover of the healthcare system. The implementation of healthcare reform is dependent on physician support.

The government villainized the healthcare insurance industry. It is hard to tell who is the bigger villain the healthcare insurance industry or the government.

The government will hire the healthcare insurance industry to provide administrative services for the healthcare reform bill.

The healthcare insurance industry will continue to receive 65 cents of every healthcare dollar.

The Medicus Firm, a physician search firm, conducted a survey published in the Investor’s Business Journal, March 18, 2010. 

For text:

http://www.themedicusfirm.com/pages/medicus-media-survey-reveals-impact-health-reform

The Medicus Firm survey was emailed to a random sample of 2,250 physicians from their physician database. Of the 2,250 emailed, 1,195 responded. Of the 1,195 responses, 36.4% were primary care physicians (family practice, internal medicine, or pediatrics), and 63.6% were specialists.

This survey response was impressive.

• 45% said they’d consider closing their practice or retiring early if the healthcare reform bill being considered was enacted.
• 65% said they opposed the government’s attempts at taking over the health care system.
• 33% supported President Obama’s healthcare reform bill.

“Given that the White House and Congress both promised then — as they do now — to provide health care coverage for 31 million new patients while at the same time cutting costs from the $2.4 trillion a year we spend on medical care.”

“The poll reveals that doctors won’t go along with it, says IBD:”

• If the sampling is valid of the 800,000 physicians practicing in the United States in 2006, as many as 360,000 might leave the profession.
• President Obama will be trying to cover 31 million more patients with up to 45 percent fewer doctors. 

“Impossible.  It can’t be done, says Investor Business Digest.”

· 29.2 percent of the 1,200 doctors said they would quit or retire early if a health reform bill was passed.

• That number jumped to 45.7 percent — the same Investor Business Digest‘s original survey — if a public option were included. 

"Many physicians feel that they cannot continue to practice if patient loads increase while pay decreases," wrote Kevin Perpetua, managing partner of the Medicus Firm, summing up his findings.

“So for the record, we still stand by our findings said IBD. Our poll wasn’t "ludicrous" or "untrustworthy." It was dead-on. And it’s still relevant.”

It is interesting to look at some of the survey questions and answers. The questions were asked without or with a public option.

Only 24% of the physicians were in practice for more than 20 years.

Without a Public Option

Your Career Satisfaction:

• 1.2%= improve Dramatically
• 13% = Improve Somewhat
• 40% = No Impact / Remain Same
• 33% = Decline/Worsen Somewhat
• 13.2% = Decline/Worsen Dramatically

With a Public Option

Your Career Satisfaction:

• 5.5% = Improve Dramatically
• 16.5% = Improve Somewhat
• 14% = No Impact / Remain Same
• 25% = Decline/Worsen Somewhat
• 39% = Decline/Worsen Dramatically

Without a Public Option

Physician Supply in General:

• 2% = Improve Dramatically
• 9% = Improve Somewhat
• 33% = No Impact/Remain the Same
• 42% = Decline/Worsen Somewhat
• 14% = Decline / Worsen Dramatically

With a Public Option

Physician Supply in General:

• 3% = Improve Dramatically
• 11% = Improve Somewhat
• 14% = No Impact/Remain the Same
• 27% = Decline/Worsen Somewhat
• 45% = Decline / Worsen Dramatically

Without a Public Option

Quality of Medical Care in General:

• 1% – Improve Dramatically
• 11% = Improve Somewhat
• 34% = No Impact/Remain Same
• 40% = Decline/Worsen Somewhat
• 14% = Decline/Worsen Dramatically

With a Public Option

Quality of Medical Care in General:

• 9% – Improve Dramatically
• 17% = Improve Somewhat
• 6% = No Impact/Remain Same
• 30% = Decline/Worsen Somewhat
• 40% = Decline/Worsen Dramatically

Which of the following best describes your overall opinion / support for health reform?

• I support the current proposed legislation – 28.5%
• I support the current proposed legislation minus the public option* – 5.0%
• I support reform but would prefer a different, more incremental approach – 63.0%
• I prefer the status quo – the healthcare system is fine the way it is – 3.6%

*at the time of th
e survey, public option was still a possibility. It still is by default.

President Obama ought to pay attention to physician opinion. If he doesn’t there are going to be severe shortages in physician manpower.

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

Stanley Feld M.D.,FACP,MACE

President Obama and the Democratic Party controlled congress have used multiple procedural tricks to pass a terrible healthcare reform bill. In the opinion of many constitutional lawyers they have passed legislations that are unconstitutional.

The majority of the public has felt President Obama and the Democrats have ignored the will of the people. President Obama does not think so. He has stated Americans will decide in his favor in the November midterm elections.

President Obama has been disingenuous and arrogant in his selling his healthcare reform bill. His attitude was made clear during his speech in Maine on April 1^st. (Go to you tube below and start at 7.47 minutes).

President Obama’s goal is default to the public option. The public will have no other choice.

The public option will socialize medicine, increase taxes, increase healthcare insurance premiums (subsidized by the government, ration care, decrease access to care, eliminate freedom of choice, decrease the quality of care and bankrupt the nation.

Federal deficit spending has increased to over 2 trillion dollars this past year. The federal deficit ceiling has been increased from $11 trillion to almost $14 trillion dollars. Despite all the deficit spending unemployment is almost 10% and not falling. The only new jobs are government jobs or government related jobs.

The legislative and executive branches of government have totally disregarded the will of the American people. The only option left for the public is to appeal to the judicial branch of government.

Legal action does not add value to the healthcare system. However, when people feel abused they take legal action. The winners are always the lawyers.

The losers will be the taxpayers. Taxpayers will be paying both the plaintiff and defendant fees to lawyers.

There is no question the healthcare system is dysfunctional. President Obama’s healthcare reform bill will make the healthcare system worse.

I have demonstrated that the healthcare reform bill can only increase the deficit. The bill might appear to have the potential to reduce the deficit because of the disinformation the administration feeds to the traditional media.

There has been much criticism of the AMA and its President because of the position they have taken to support the healthcare reform bill. The AMA is losing membership. Other physician organizations such as Sermo and the Association of American Physicians and Surgeons have an equal number of members

The Association of American Physicians and Surgeons (AAPS) became the first medical organization to sue the government to overturn the newly enacted health care bill, the Patient Protection and Affordable Care Act (PPACA). AAPS v. Sebelius et al.).

“If the PPACA goes unchallenged, then it spells the end of freedom in medicine as we know it,” observed Jane Orient, M.D., the Executive Director of AAPS. “Courts should not allow this massive intrusion into the practice of medicine and the rights of patients.”

The law suit makes many compelling arguments. These arguments represent the vested interest of patients first. Physician leadership and input is required to educate the public and the courts.

1. “There will be a dire shortage of physicians if the PPACA becomes effective and is not overturned by the courts.
2. The PPACA requires most Americans to buy government-approved insurance starting in 2014, or face stiff penalties.
3. This violates the Fifth Amendment protection against the government forcing one person to pay cash to another. AAPS is the first to assert this important constitutional claim.

Insurance company executives will be enriched by this requirement. Federal and State government will be forced to subsidize the unaffordable healthcare insurance premiums. Ultimately taxes will be increased. The result will be a slowing of the economic recovery.

1. The PPACA also violates the Tenth Amendment, the Commerce Clause, and the provisions authorizing taxation.

Taxing and spending power are unconstitutional when payments go to private healthcare insurance companies. President Obama and Congress recognized that PPACA cannot be funded without the insurance mandates.

5. The traditional sovereignty of the States over the practice of medicine is destroyed by the PPACA.

6. AAPS asks the Court to enjoin the government from promulgating or enforcing insurance mandates.

7. AAPS asks HHS Secretary Kathleen Sebelius and Social Security Commissioner Michael Astrue to provide the Court with an accounting of Medicare and Social Security solvency.

8. Court action is necessary “to preserve individual liberty” and “to prevent PPACA from bankrupting the United States generally and Medicare and Social Security specifically,”

AAPS contends Congress imposed assumptions on the Congressional Budget Office resulting in the PPACA reducing the budget deficit. These include assumptions leading to a $500 billion savings in Medicare. The savings was accomplished by moving the Doctor Fix out of the Healthcare Reform Bill budget. Moving the Doctor Fix out of the healthcare budget still increases the federal deficit.

AAPS contends that Congress and President Obama know the opposite to be true. They know the CBO’s assumptions are unrealistic.

This law suit is the first of a long list of law suits to come. The states are lining up to defend their state sovereignty and protect their state budgets.

President Obama’s view is that everyone is playing into his hands. He has many legal tricks up his sleeves. The public is sick of his trick plays.

A fear is the American public will get tired of the healthcare debate before it is too late to repeal.

The education of the public must continue.

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

Stanley Feld M.D.,FACP,MACE

Over the years congress has made many deals with the secondary stakeholders. The new rules were made to correct previous rules. They did not work and made the healthcare system worse.

Americans are information junkies. Information is important to decision making. The wrong information leads to making wrong decisions

The traditional media is usually fed the wrong information by vested interests. It, in turn, feeds the public a short version of the wrong information. The result is faulty decisions.

President Obama’s healthcare bill was finalized last Thursday. On Friday AT&T and several other corporations took required tax write downs as a result of the bill’s passage

“The returns for the healthcare reform bill are already rolling in. AT&T announced that it will be forced to make a $1 billion tax write down due solely to the health bill, in what has become a wave of such corporate losses.”

The tax write downs have been announced by Deere & Co., $150 million; Caterpillar, $100 million; AK Steel, $31 million; 3M, $90 million; and Valero Energy, $20 million.

Other write downs have not been announced in the media. Corporations must declare the increase in healthcare related tax liabilities to the SEC immediately.

President Obama has used every tax trick in the book to make the new healthcare entitlement look affordable and deficit neutral.

An Increased tax liability to these corporations occurred when congress placed the new rule on top of the rule providing a tax subsidy.

The government provides a 28% subsidy to corporate America for continuing the drug benefit for their retirees as incentive to continue retirees’ drug coverage plans.

The twist of the tax law permitted these companies to deduct 100% of its drug benefit expense. In effect corporations were getting 28% free money while retaining the ability to deduct the 28% as an expense.

This is called double counting. It is difficult to follow the tax accounting. It represents a large tax benefit. The tax rule saved AT&T $100 billion dollars a year. It also saved most corporations large amounts of money. The savings went directly to its bottom line.

With the passage of the healthcare reform bill, corporations will not be allowed to deduct the subsidy.

“Black-letter financial accounting rules require that corporations immediately restate their earnings to reflect the present value of their long-term health liabilities, including a higher tax burden. Should these companies have played chicken with the Securities and Exchange Commission to avoid this politically inconvenient reality?”

It appears Henry Waxman and other House Democrats were unaware of this unintended consequence. If they were, the healthcare reform bill is more sinister than it looks.

“ Mr .Waxman announced his committee will call for a hearing demanding these companies explain their action because their judgment "appears to conflict with independent analyses, which show that the new law will expand coverage and bring down costs."

Media coverage and analysis of these write downs have been minimal. Why?

I do not think the media understands the consequences.

President Obama has said repeatedly, “if you like your insurance you can keep it. If you like your doctor you can stay with him.”

Nancy Pelosi said; “After the bill is passed we will understand it.”

You bet we will.

This rule will precipitate several consequences. Corporations have been trying to eliminate healthcare benefits for employees and retirees for years.

The new rule provides an excuse to drop the healthcare insurance benefits. The government will also eliminate the pretax benefit of private healthcare insurance.

If corporations eliminate the healthcare insurance benefit for employees, employees will be forced to buy individual insurance policies. The individual healthcare insurance plans will be unaffordable.

The government public option will be affordable because the government will subsidize the premiums. The healthcare insurance mandate will increase an entitlement burden to the states who presently have deficits. It means increased state taxes.

Corporations will be happy to pay the penalty for not insuring employees. The penalty is less than the insurance premium.

If a corporation chooses not to eliminate the healthcare benefit it will increase prices. The result is inflation. Corporations will also decrease its work force resulting in increased unemployment.

The public option as a sole source of healthcare insurance is only a matter of time. Then the government will fully control the healthcare system.

Regulations such as these will be President Obama’s back door approach to government control of the healthcare system.

However, President Obama overlooked the increase in unemployment and a decrease in people insured. Few people would be able to keep their own doctor, individual insurance premiums will be unaffordable and the deficit will escalate.

A prominent physician, who understands all this, sent me a copy of a letter he wrote to the President of the AMA opposing the AMA’s position on President Obama’s healthcare reform bill. He said;

“Surely, you didn’t arrive on a load of turnips yesterday.

Doc, the congress is the same wonderful group that gave us Medicare and Medicaid in the first place and then endlessly tinkered with it for nearly 50 years, and also gave us the SGF, and a host of other ill-considered acronyms that did our patients and the physicians (not the providers) of our country no good at all.”

He then wrote;

“It is a sad situation, not just for the docs but for their patients.

So, now what?  Until cast of characters in the congress, assorted criminals, tax dodgers, and others of ill repute, is changed, I am afraid we are all screwed.  That includes the patients, more is the pity.

My own suggestion is that the AMA seize the moral high ground and take on the role of being the advocate for the patient (not the consumer) and view any effort to reform the reform  through the lens of what is best for all of our patients.

If the AMA were to do that, physicians would find that they will come out well, I am certain. While we are it, it would be a good thing to advocate for a reasonable and sane system of pricing so that what is done for people is simply costed at acquisition plus a reasonable margin of profit and the retail price is then the same for all patients.” 

This physician has said it all. Consumers owning their healthcare dollar and driving the healthcare system is the only way to accomplish affordable universal care with the government subsidizing or paying for the uninsured with the ideal medical savings account.  It will be less costly and give consumer incentive to be responsible for their health and healthcare dollars.

Both physicians and patients must wake up
and protest this folly at the polls and to their congresspersons immediately during the Easter recess.

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

Stanley Feld M.D.,FACP,MACE

Physicians in practice work hard and have little time for political and legal trickery. They assume their leadership will look out for their interests while they take care of patients.

The problem is physicians do not have effective leadership explaining the difficulties practicing physicians have every day with the healthcare insurance industry, hospital administrators, the government and the threat of liability. Most physicians are caring professionals who are not looking to rip off anyone.

Physicians do expect reasonable compensation commensurate with their training, level of expertise and level of responsibility.

I recently presented a physician income survey to a group of corporate executives. The executives were astonished by the level of physician income relative to their level of responsibility.

The unanimous reaction of these corporate executives was the average physician’s income was that of a low mid level manager. It is true some practice specialties earn more but the average income of practicing physicians is not commensurate with their knowledge and responsibility.

At the time President Obama’s healthcare reform bill was in trouble, the President courted physician leadership (AMA). Medicare reimbursement is sometimes below the cost of service. Physicians do not realize it because most are poor business people. Most physicians accept the low reimbursement because they view it as their duty to take care of these patients.

A noted physician executive wrote to me and stated that physicians are being treated like indentured servants by the government and the healthcare insurance industry. I had the same perception.

I told a CEO of a large healthcare insurance consolidator that physician apathy to their treatment is a sleeping tiger. The tiger is going to awaken if the healthcare insurance industry, the government and the plaintiff attorneys keep kicking them.

His reply was they are betting physicians will not react and remain passive. Physicians keep accepting price cuts because they love taking care of patients. I believe physicians will wake up and realize who is ripping off the healthcare system. They will react soon. I believe patients will side with physicians and aid in the physician protest. The time is getting close.

The President of the AMA and the AMA ‘s board of trustees have supported President Obama’s healthcare reform bill all along. I was shocked because it is a terrible bill for the improvement of the healthcare system.

President Obama promised the AMA he would repair the defective Growth Rate formula (SGR aka as the Doctor Fix). Physicians knew as soon as Congress created the Sustainable Growth rate (SGR) formula that it would not work. The physician belief has been proven every year for nearly a decade.

The AMA’s support of President Obama’s healthcare reform bill has infuriated many practicing physicians. They have quit the AMA.

H.R. 3962 is not the perfect bill, and we will continue to advocate for changes," AMA President J. James Rohack, MD, said, "but it goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians.

I could not believe the AMA would trust congress or President Obama’s promise to postpone the 21.3% reimbursement cut.

President Obama has stated that the cuts will not go into effect and there will be a fix for physician reimbursement. The government needs to decrease its entitlement exposure.

The U.S. House of Representatives passed a separate bill H.R. 4851 and delayed the cut until October 1^st. This was before President Obama’s healthcare reform bill was passed by both houses of Congress.

The suspension of the doctor fix had been removed from the healthcare reform bill so as not to be included in the CBO evaluation of the healthcare reform bill’s impact on the budget deficit. This represents another of President Obama’s tricks. What is going to happen to entitlement costs or physician reimbursement when Medicare and Medicaid expand?

Dr. Rohack (AMA President) again applauded President Obama for his great leadership when the bill passed. Three days later the Senate rejected the House of Representative’s “Doctor Fix.” The cut are now scheduled to go into effect on April 1.

“Congress failed to act yet again, and as a result, the 21.3 percent Medicare physician payment cut will take effect on April 1. Congress will adjourn for its two-week spring recess without taking action to stop these programs from expiring.”

Now that the bill has passed the games start all over again. Sen. Tom Coburn, R-Okla., said the “Doctor Fix” should not be considered emergency spending. Emergency spending would exempt the Doctor Fix from budgetary offsets. The “Doctor Fix” should not be a budgetary offset. It must be included in the cost of President Obama’s healthcare reform bill because it will increase the budget deficit.

This repeated game of brinksmanship is wreaking havoc with physician practices and is causing both physicians and patients to lose confidence in the Medicare program. It illustrates in stark terms why medicine can no longer support short-term “fixes” to a formula that we knew would not work at the time Congress created it.

If congress keeps kicking those tigers they are going to wake up. The government and the healthcare insurance industry will lose its work force. Patients will be forced to carry the burden of the cost of care. President Obama’s healthcare reform bill will not have provided affordable healthcare. It will get the government off the hook.

Congress must stop playing games with physicians and patients and do what they know must be done: Repeal the SGR formula once and for all.

President Obama is not stupid. He must decrease the increasing cost of government entitlements. He must do it while looking good and being the defender of the people.

His problem is as soon as everyone (consumers, employers, physicians and patients) wake up and become aware of what he is doing his game will be over.

Organized medicine, consumer groups, or employer groups are not defending their constituents.

The primary stakeholders in the healthcare system (consumers and physicians) will wake up to the unintended consequences. Only then will we see a dramatic fall in President Obama’s approval rating and repeal of this terrible bill.

It is a terrible because it does not attack the systemic problems in the healthcare system. The bill increases the systemic problems.

The primary stakeholders (physicians and consumers) must demand sensible effective change.

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