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The House And Senate Bills Are Terrible Bills For Medical Care And The Economy. Budget Tricks Part 7


Stanley Feld M.D.,FACP,MACE

President Obama said he will not sign a healthcare reform bill that was not budget neutral. You can view this statement at 3.50 minutes into this video clip.

The only way that can happen is if the healthcare expenses in both bills are hidden, unrealistic expense estimates are or expenses deflected to other areas in the budget. The Senate and House bill do both.

“ As history has proven, government health care programs end up costing much more than first promised.”

The most obvious gimmick is to delay healthcare benefits while collecting increased taxes. The Senate bill is designed to collect revenue from increased taxes and fees over 10 years but it delays paying any benefits and subsidies until year 5.

“So, the 2010-2019 estimate is not a full cost estimate of all provisions fully implemented and will certainly add significantly to the true cost of the bill.”

President Obama made a deal with the AMA to get its support for his healthcare reform bill. The deal was to eliminate the Medicare reductions for physician reimbursement that were due and deferred each year during the past 5 years. These deferred reimbursements reductions amounted to $200 billion dollars. The $200 billion in deferred fee Medicare reimbursement reductions was going to take place January 1, 2010

Harry Reid claims the elimination of reimbursement reductions to physicians would reduce the deficit. His claim makes no sense to me or the CBO.

However, in a letter released today, CBO estimates that combining the House bill (H.R. 3961) with the “Dr. Fix” bill (H.R. 3962) would actually “add $89 billion to budget deficits over the 2010–2019 period.”

Mr. Reid thinks he can get away with this claim. The claim of a deficit reduction reveals a profound disrespect for the electorate’s intelligence. It will backfire on the Democratic Party.

The deal with the AMA does not eliminate deep cuts in Medicare that have been proposed for next year. Each year congress has backed off and deferred the cuts to physicians. There is little reason to believe that Congress will not defer reductions next year or in the future.

Reasons for deferring the Medicare cuts in the past were sound. It is unwise to pay your primary vendors (physicians) less than the vendors’ expenses. They might be unwilling to provide services.

The healthcare reform bill should be attacking the abuses of all stakeholders. It should not focus on punishing the most vulnerable stakeholder (physicians).

The House and Senate bill’s budget includes a Medicare inflation rate of 2% per year for 20 years. This is unrealistic.

The calculations include a reduction in Medicare payment of 21%.

“The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time. It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010.”

Historically these estimates have not been valid. It is especially invalid now when the economy is being primed by monetary infusions. America seems to be heading for a strong inflationary period. The CBO stated that the estimates are not meaningful


“However, a detailed year-by-year projection, like those that CBO prepares for the 10-year budget window, would not be meaningful because the uncertainties involved are simply too great. Among other factors, a wide range of changes could occur—in people’s health, in the sources and extent of their insurance coverage, and in the delivery of medical care (such as advances in medical research, technological developments, and changes in physicians’ practice patterns)—that are likely to be significant but are very difficult to predict, both under current law and under any proposal.”

In fact, the CBO’s estimates includes the additional taxes and fees proposed to make up a projected 900 billion dollar deficit. The deficit prediction appears to be a gross underestimation. The estimates of spending reductions are projected at $426 billion dollars. Receipts would be increased by the tax surcharge on high-income individuals plus other provisions by $572 billion dollars making the bill budget neutral. The other provisions are the rub. These other provisions are fees and hidden tax increases on the middle class.

“Over the 2010–2019 period, the net cost of the coverage expansions would be more than offset by the combination of other spending changes, which CBO estimates would save $426 billion, and receipts resulting from the income tax surcharge on high-income individuals and other provisions, which Joint Tax Committee (JCT) and CBO estimate would increase federal revenues by $572 billion over that period.”

The real cost of the House and Senate bills are likely to be more than the estimated $900 billion dollars. Both the CBO and JCT have admitted it is a low estimate. Some have guessed the real costs will be in the $3 trillion dollars range. The purpose of the healthcare reform bill was to provide universal coverage, provide affordable insurance and increase the quality of care. There are serious doubts that it will accomplish any of these goals.

Americans must demand the true facts.

Enough is Enough!!

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

  • dprosenthal

    If Obama really, honestly means he will not sign any bill that is not ‘budget neutral’, we have nothing to worry about!! Of course, my interpretation of budget neutral and his may not be exactly the same, so I still intend to let Congress know that this bill is a disaster waiting to happen. It will cost billions and do very little to actually improve basic health care in this country, while adding more to the deficit and further ruining the economy’

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The House And Senate Bills Are Terrible Bills For Medical Care And The Economy. Part 6


Stanley Feld M.D.,FACP,MACE

President Obama’s administration has been disingenuous. During the Presidential campaign he promised to reach across the aisle. He also promised a totally transparent administration. All we have had is non transparency, partisanship and disinformation.

A reader wrote “the only reason healthcare reform has been partisan is because one of the parties did not show up to negotiate.” I asked which party he is talking about.

Tom Daschle withdrew from the administration because of a brewing lobbying scandal.

On November 19, 2009 the Senate was presented with a 2074 page healthcare reform bill that was crafted behind closed doors to merge the finance and health committee’s healthcare bills.

Senate Majority Leader Harry Reid scheduled the vote to allow debate of the bill 72 hours after it was published. Tom Daschle has been a frequent advisor to the secret Senate Democratic Party committee meetings.

Mr. Reid declared the Senate will pass the bill without any Republican support if necessary. Somehow he intimidated the entire Democratic caucus to vote for debate despite strong objections by some Democratic Senators to the bill. The Republicans and the majority of the public are against the bill. Public support for President Obama’s bill is well below 50%. The latest Rassmussen Poll has approval of the bill at under 40% with 56% disapproving.

The Senate bill is similar to Nancy Pelosi’s House bill with a few additional trick plays and much creative accounting. .

Americans should be furious because they are being ignored. I hope they are not being worn down by repeated promises of transparency and false hope. Carl Sandberg said, “if you tell a lie enough times it becomes the truth.”

President Obama’s Healthcare Reform Plan is unchanged from the plan Tom Daschle outlined in his book published two years ago. The healthcare plan was destined to fail then and it is destined to fail now.


There are many flaws in the Senate healthcare bill. These are just a few.

1. The Public Option remains in the Senate healthcare bill. It would create a new government-run healthcare plan intended to “compete” with private healthcare insurance in a new healthcare insurance plan. We were told by Harry Reid that the Public Option would not be in the Senate bill. The problem is the rule maker cannot be a fair competitor. Since President Obama’s ultimate goal is a single party payer system for healthcare the Public Option is another trick play.


Peter Pitts, President, Center for Medicine in the Public Interest and former associate commissioner, FDA sent me this YouTube production. It is a cynical explanation of the Public Option.


Barney Frank and others have stated “the Public Option is a must” . It is a first step toward a government run single party payer system. The House does not have the votes for going directly to a single party payer system. The Public Option is another entitlement program. The costs of entitlement programs have historically been underestimated.

The Center for Medicare and Medicaid Services has concluded that millions of Americans will lose their existing employer-based private healthcare coverage to a government subsidized plan. Over time private employer based coverage will vanish.

2. Federal Regulation of Health Insurance would result in sweeping and complex federal regulation of health insurance. The healthcare insurance industry needs regulation. The government plan with the administration and enforcement of the regulations will increase not decrease cost of care because of the increased bureaucracy and the system of pricing premiums. Massachusetts’ health plan is the prime example of a poor design failure.

3. Employer Mandates would be imposed on those who do not offer healthcare coverage. If coverage did not meet the government standard the government would impose a penalty on the company.

The employer mandate would inhibit small companies from hiring low income workers. This is the worst thing to do when the country desperately needs incentives for job creation. It also imposes more government rules on small business decision making.

4. Individual Mandates will require people of all ages to buy healthcare insurance. If the
y did not buy health insurance they would be penalized with a tax. In some extreme cases they could be jailed. This is another example of government controlling our lives.

5. Massive Expansion of Medicaid and New Taxpayer-Funded Subsidies are included in the bill. It is the administration’s way of covering more people earning less than $60,000 per year. At least three things are wrong with expanding Medicaid in its present form. The burden of administration and cost will be shifted to the States. Most States except Texas are in straits financial condition or at the brink of bankruptcy.

Medicaid is underfunded by the States and the Federal government. The underfunding will lead to rationing. Medicaid does not provide adequate services or vendor reimbursement.

There is nothing in the bill that has incentives to encourage patients to be responsible for their health and healthcare decisions. One fifth of the economy will be on welfare and subject to the government’s regulations.

President Obama and the Congressional Democrats have not listened to the people. President Obama has not changed anything in the bill since it was first proposed.

President Obama and Congress should remember that the independent voters and thinkers are the people who elected them. He is rapidly losing their support.

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

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The House And Senate Bills Are Terrible Bills For Medical Care And The Economy. Part 5


Stanley Feld M.D.,FACP,MACE

I have asked readers to write to the President and their representatives. I have had several requests asking for an outline of the note. Below is a letter outlining the points to make if you oppose the bills in congress. The note should be sent to the President and your Senators and Representatives. The political party they belong too does not matter. If Congress receives 100,000 letters it might understand the sentiment of the people it is suppose to represent.

All you have to do is copy the text and paste it into an email to the President and your representatives. The email address can be found at;

Dear Representative, Senator, or President Obama

I am asking Congress and the administration to use common sense to repair the healthcare system. Enough is enough. The Democratic dominated Senate and House have constructed bills that will increase spending, increase the deficit, increase bureaucracy, increase government power over our lives and decrease our freedom of choice.

The Democratic controlled Congress continues to use creative bookkeeping to present bills it claims are budget neutral. The claim is fooling no one. Despite all the protests, Congress is ignoring the will of the people.

The universal healthcare strategy in Massachusetts has failed. President Obama’s healthcare strategy (with similar defects as the Massachusetts plan) with fail and cost the nation dearly.

The healthcare policies in both bills will not achieve the goals of universal care, affordable care and increasing the quality of care. It will commoditized medical care and destroyed the patient physician relationship. I am afraid the President and congress are about to compound past errors in healthcare policy at a very high cost to taxpayers and our economy.

Our present problems in the healthcare system are the result faulty regulations piled upon faulty regulations in an attempt to correct the previous defects. Stakeholders have been driven to adjust to these faulty regulations to protect their vested interests. These actions have lead to ever increasing costs and more defects in healthcare policy.

Willie Sutton (bank robber) told us to go where the money is. In healthcare the biggest waste of money is in:

  1. Healthcare insurance industry administrative services waste and healthcare insurance industry abuse; The wastes amounts to $200 billion dollars per year. Appropriate rules and regulations could eliminate the problem of administrative services waste. The public option will not eliminate the administrative services waste. It will add to it.
  1. Ineffective chronic disease management: 80% of the healthcare dollars spent ($1.6 trillion dollars per year) is spent on treating the complications of chronic disease. These diseases include hypertension, diabetes mellitus, asthma, osteoporosis, and obesity. CMS estimated that the cost is even higher at 90% of the healthcare dollar spent for chronic disease complications. The obesity epidemic across all age groups. It is going to bankrupt us all. There is in the bills to combat the obesity epidemic.
  2. Defensive medicine: As a result of the malpractice systems in many states the cost of defensive medicine is somewhere between $460 billion and $750 billion dollars a year. Putting a cap on malpractice awards and appropriate education of physicians and consumers could eliminate the $750 billion dollars of unnecessary expense. The is nothing in the bills that addresses the malpractice reform issue.
  1. A universal electronic medical record is essential to reducing healthcare costs. Lack of a universal EMR costs the healthcare system at least 100 billion dollars a year in medical errors and duplication of testing.

The $30 billion dollar subsidy in the economic subsidy package will not solve the problem. The average physician’s cost for a universal record is $60,000 dollars. A $20,000 dollar subsidy does not help many primary care physicians afford an EMR.

A universal electronic medical record could be distributed by the government free of charge. Physicians would be charged by the click for its use. EMR software and maintenance service fees would be included. Presently less than 10% of physicians and hospital systems have fully functional EMR’s.

The administration should be going to where the money is rather than developing a more complex bureaucracy with increased potential for waste and abuse. Repair of the healthcare system should be consumer directed with the help of the government and not government directed.

Instead the President and Democrats controlled congress will increase taxes and out of pocket expenses for everyone. The taxes will be imposed four years before the benefits are instituted in order to decrease the real deficit spending. During a recession penalties imposed on employers will decrease employment. The only job growth in this recession so far has been government related or government created jobs. The tax increases will lengthen the recession and inhibit job creation and innovation.

The bill will decrease freedom of choice, result in an increase in rationing of care and intensify the doctor shortage.

Please listen to the people who elected you.

Please do everything in your power to fix what is broken and not destroy our innovative spirit and inhibit our freedoms.


Please write to the President, your Representatives, and Senators before it is too late. The Democratic controlled government has decided to ram this bill through without bipartisan participation. You can stop them one vote at a time.

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


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The House Bill Is A Terrible Bill For Medical Care And The Economy. Part 4

Stanley Feld M.D.,FACP,MACE

Rationing of healthcare services exists already. Medicare, Medicaid and private healthcare insurance companies ration medical care in many ways. Rationing is done to decrease the economic burden of healthcare.

Some physicians and most patients are not aware that rationing exists. President Obama’s healthcare reform plan will make rationing very obvious especially to the elderly. Americans will not tolerate rationing. Physicians will not tolerate rationing especially when it interferes with their concept of ethical medical care.

Yet 220 representatives voted to impose rationed medical care on the American public.

H.R. 3962 puts this power in the hands of one unelected official, the Secretary of Health and Human Welfare. The Secretary will determine if a treatment can be performed and how much physicians will be reimbursed.

The medical social contract should be between patients and physicians. Patient should have the freedom to choose. The choice of treatment should not be left up to an unelected official.

Should the government, healthcare insurance company or hospital make our medical choices for us? My answer is no. H.R. 3962 says yes.

“Title 1, Section 101, subsection (h)(2), found on pages 25-26 of the bill. The provision applies in a situation of insufficient funds for high risk individuals and reads:

“If the Secretary estimates for any fiscal year that the aggregate amounts available for payment of expenses of the high-risk pool will be less than the amount of the expenses, the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.”

Note “the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists.”

This is rationing, restricting access to care and not adhering to the principle of affordable premiums.

Hospital systems are now rationing care to maximize profits. Many are providing generic drugs rather than brand drugs. Many are substituting different medical devices for the device physicians have prescribed for their patients.

The only way a hospital can be profitable since the government has instituted price controls is to provide a less expensive product.

This is the complaint in the second part of the note I received from the practicing obstetrician. It is only one hospital and one experience. However, the experience and frustration is universal among physicians.

Part 2 of the letter I received:

A very expensive cost to the hospital is buying a joint, for a joint replacement surgery. Let’s say a knee joint for argument’s sake. It’s true…it is expensive. The problem? Medicare won’t even pay enough to cover the actual cost of the joint. Hospitals lose money every time a joint is done.

So, our hospital went to the 6 joint companies and said " We will pay you $100.00
per joint" (not a true  number…this is argument’s sake). Only 2 of the
companies accepted the  offer…Stryker and Smith-Nephew. 
So guess what? If you come to our hospital, that is the only joint you will get. Period. End of story.

But what if a different joint is truly better for you?? The  hospital told the Orthopedic doctors, "We would rather lose you, the doctor, to a different hospital than provide the joint you feel is best". " We’ll  just get doctors who will do that joint and not  complain"…….
WOW….Did you catch that?? They would rather lose 
the doctor, than give the better joint……And we all
know, most joint  replacements are for the elderly….hmmm the elderly…..WHO CARES …they  cost us money…Medicare doesn’t even cover costs and is getting cut another 10% this year… go somewhere else……but where?

ALL HOSPITALS are doing this…………Rationed care…….Are you scared yet?? This is the
tip of the iceberg……
So are AMERICAN doctors who can speak  English tired…..very.

I am tired of doing the right thing and being threatened for it. I’m tired of taking pay-cuts
while seeing more patients  every year. I’m tired of malpractice premiums of
$58,000 dollars a year. I’m tired of the threat of always being sued, especially since Leapfrog and the  hospital are telling me how to practice medicine.
Be forewarned that 40% of AMERICAN doctors state they will get out of medicine if the 
Healthcare billed is passed…..including this doctor.
I can not and  WILL NOT practice unethical medicine…..and that is
what being asked of  us…….

If you are scared……..write your  congressmen…….vote….  ..if you aren’t scared, God help  you.

What are consumers’ responsibilities in healthcare reform? Consumers elect their representatives. The representatives are not listening to the people. The solution is to elect new officials.

First write to your elected officials and tell them what you object too.

President Obama’s healthcare reform plan is not about improving care, reducing the cost of medical care, and increasing accessibility to care.

It is about increasing central government power over our lives, increasing taxes and will result in decreasing access to care. It will not accomplish universal coverage.

Write to your congressperson and the President NOW!

Enough is enough.

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

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The House Bill Is A Terrible Bill For Medical Care And The Economy. Part 3

Stanley Feld M.D.,FACP,MACE

The problem with the economic recovery is increasing unemployment and the increasing deficit spending. A new healthcare entitlement will increase the deficit leading to increased taxes. Increased taxes on large and small business will lead to fewer jobs and less tax revenue. We are experiencing this in our jobless economic recovery. All the new jobs are going to third world countries. Government jobs is the only sector growing.

The House’s 1900 page bill that was passed in less than 72 hours after publication. This was after the Democratic Party controlled congress pledged to be totally transparent.

Americans have a Democratic controlled congress that ignores the will of the people. Americans had no idea of what President Obama meant by change. The Democratic Party leaders do not realize they were elected by independent voters and women. Both groups now seem to have become disillusioned with President Obama and the Democratic majorities.

Last week we heard former President Clinton. He told the Senate to past any healthcare bill even if it is not perfect. You can fix it later.

This week I received the following note. It is a heartfelt note from a practicing obstetrician. She expresses the anger and frustration of many physicians. The note shows the impact the bill will have on the practice of medicine.

My generation of physicians has been told that the new younger physicians will accept change in the future because they do not know any better. We lived in the golden years of medical practice. .

My answer is you are wrong. The satisfaction of being a physician is to have the privilege of relating to patients and treating patients the best you can. The special quality of the patient physician relationship will not be lost on the new breed of physicians.

President Obama’s control and ineffective quantification of healthcare will destroy the patient physician relationship and medical care in America.

President Obama’s task forces will outsource the quantification of healthcare to groups like Leapfrog. Leapfrog knows much about the economics of healthcare but little about the practice of medicine.

Dear Family and Friends,

Where to start……how about from the  beginning……
I’ve been in private practice for 15+ years now.
I’m  44yo. That means I started when I was 29yo….that is YOUNG for a physician.

Consider you are 18yo when you get out of high school (17 yo in my 
case). Add 4 years of college, 4 years of medical school and 4 more years of  residency.
So 12 years of graduate/postgraduate work. Consider being 
200K in debt after those 12 years.
Want to know who is running your  healthcare? It’s not doctors………It’s not people who have one minute of  training in medicine.

Let me share what has happened at MY hospital  in the last 2 weeks. Two examples will follow;
There is an  "organization" called Leapfrog. Here is their link . Hospitals are buying into their "program" for rewards and incentives.

Go to the link…..look at their board members. What do you see?? BIG EXECUTIVES…….not a single doctor….not one. Study their website…..It is driving YOUR
healthcare… where does  it mention how they get their medical "quality" other than saying our  "experts"……..oh, and yes they have a disclaimer stating they aren’t responsible for anything (in tiny print at the bottom of their website  page).
Now, you can search for hospitals to see Leapfrog’s "Quality" 
of care….. Money driven quality…..
Lets take my department for example… OBSTETRICS: Leapfrog has ONE (ONLY ONE) criteria for quality… have to deliver after 39 weeks. Doesn’t matter your fears, 
discomforts, family, prenatal care, baby’s outcome….NOTHING besides you are 39 weeks or greater.
My hospital has now MANDATED that I deliver you  at 39 weeks or greater…..because they want Leapfrog to give them 4 bars  (i.e. highest quality) Now this has NOTHING to do with
true medicine. By text book definition, a full term pregnancy is 37 weeks or  greater.

If you look at my hospital on Leapfrog….we have 1 bar, implying poor quality. Leapfrog even goes so far as to say we have a 31.7% PRETERM delivery rate. This is a LIE! Remember full-term to Leapfrog is 39 weeks……which has NO medical basis.

Consider the patient who previously had a 39 week stillborn…….the patient who is losing her insurance…..the patient whose husband is a pilot and is leaving town…the  patient whose husband is in the military….the patient whose family is  flying in from overseas. The physician hears the patient over and over  again, every office visit….it’s called a relationship.
Do you think  Leapfrog, who is simply bargaining with big executives for better prices, 
cares about the patient’s individual situation……NOT AT ALL….but hospitals want Leapfrog’s 4 bars (better quality) rating, so they get  "rewarded" better. 
So as it stands now, if I deliver a patient before 39 weeks, the hospital will place that in my permanent file. Then they can  choose to "deselect" me and not allow me to deliver at their  hospital.
Physicians are now faced with making ethical  decisions… I do what is truly right and best for this patient and get  "deselected"? Or do I do what the hospital tells me to do……..

The unintended consequences will destroy medical care in this country.

This physician is thinking of quitting the practice of obstetrics and gynecology at a time we have a shortage of physicians doing obstetrics. President Obama refuses to deal with the structural problems in the healthcare system such as the need for malpractice reform.

The President must think that when his healthcare plan evolves to complete socialized medicine all physicians will work for the government. Physicians will then be immune to malpractice suits.

Wake up America!! Write the President, Congress, and your local newspaper. Tell your congressional representatives who vote for this bill that you will not vote for them.

Enough is enough.


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

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The House Bill Is A Terrible Bill For Medical Care And The Economy. Part 2

Stanley Feld M.D.,FACP,MACE

Let us assume it is important to have universal care, affordable healthcare insurance and increase an in quality of care. The House of Representative’s (Pelosi’s) bill will not accomplish these goals. It will provide increased government control over our lives, a loss of freedom of choice, a large increase in our national deficit and increased taxes for all.

The economic impact to the government and the public as well as the implications to our freedom of choice must be understood by everyone. The implications regarding the delivery of medical care must also be understood.

1. The initial defect in the bill is in estimating the cost of the new entitlement. Nancy Pelosi estimates a cost of $829 billion over 10 years.

Initial Congressional Budget Office (CBO) figures suggested $1.055 trillion. However, the CBO estimates assume that:

    • Doctors will accept more than 20% cuts in Medicare payments for their services. President Obama supposedly waived this portion of the bill to obtain the AMA support. It looks like the AMA made a deal with the devil.
    • Middle-class Americans will accept an arbitrary distribution of benefits. The distribution of benefits has not been defined. President Obama panel of experts will dictate best practices. The panel has already been funded by the economic stimulus bill. The $30 billion dollars will not be charged to the healthcare reform bill.
    • Congress ‘finds’ additional funding in 2017, 2018, 2019 and 2020.”

Entitlement programs are notorious for exceeding budgetary estimates. My guess is the cost will be close to $3 trillion dollars over 10 years if all the bureaucratic costs are included. This cost will force taxes to be increased for all Americans. Additionally, there will be an absolute need for rationing care.

2. The Obama/Pelosi plan is a government takeover of the U.S. Healthcare system. Some Americans want a government takeover because the healthcare insurance industry has been irresponsible in the past during the quest for increased profit. The healthcare insurance industry’s irresponsibility has led to the hospital systems and physicians becoming almost as irresponsible. All of these actions have been to the disadvantage of patients, patient care and affordability of care.

3. The Pelosi bill passed by a very slim partisan majority. The bill dictates that the federal government will tell you what insurance you have to buy, where you have to buy it and what you will pay.

If you refuse to purchase government-approved insurance, the government will assess a penalty tax on 2.5% of your income. Your tax return will be attached to the government mandated insurance just as seniors’ tax returns are attached to Medicare to determine seniors’ yearly means tested insurance premium for Medicare coverage.

The house bill will raise $572 billion in new taxes to be deficit neutral. The majority of the new tax will be charged to small businesses.

“All businesses will have to pay at least 72.5% of their workers’ insurance. If a business does not pay 72.5% of the healthcare insurance premium, it will be charged an additional 8% payroll tax.”

The negative effect of this tax increase will be to decrease job creation by businesses of all sizes and increase the unemployment burden in our jobless recovery.

Americans will be forced out of their current insurance plans into government qualified healthcare plans despite President Obama’s frequent promise that "you can keep your current plan, if you like it.”

By creating yet another massive entitlement program, President Obama will dramatically expand the federal deficit. The plan will significantly increase the size of the burden of the federal government’s unfunded liabilities.

The burden to consumers will be just as massive. In addition to increases in taxes to small businesses, there will be increases in taxes to all consumers, even those making under $250,000 a year. Consumer healthcare insurance premiums will be means tested as Medicare premiums are.

“ The Congressional Budget Office estimated what the government qualified healthcare plans will likely cost. An individual earning $44,000 before taxes who purchases his own insurance will have to pay a $5,300 premium and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year, which is 17% of his pre-tax income.”

If consumers have to pay for their healthcare insurance premiums with after tax dollars the real price will be at least 30% higher.

“ A family earning $102,100 a year before taxes will have to pay a $15,000 premium plus an estimated $5,300 out-of-pocket, for a $20,300 total, or 20% of its pre-tax income.”

“ Individuals and families earning less than these amounts will be eligible for subsidies paid directly to their insurer.”

A reader sent me this note expressing his frustration.

The House bill passed last Saturday is so remarkably bad. Hopefully it will wake up the entire citizenry to realize what is about to happen to all of us.  Certainly very few will have the time or stamina to read the entire bill but there have already been enough headlines and short summaries to inform anyone who cares about the consequences to see the bill for what it is and reject it.

In all of this I am aghast about the willingness of the members of congress to allow President Obama to lead them by their noses.  Why is Congress willing to give up its prerogative to be the legislative branch and subjugating itself to the executive branch?

The members of congress need to reread the Constitution and also remember they are to be representatives of their constituents, not lapdogs for this or any other president.

Furthermore, it is very cheeky for Obama especially to goad Congress to vote on a short timetable on a matter so important since he seldom voted on any bill when he was a member of the Senate.

The house consensus bill is hardly an affordable healthcare bill. Premiums will not be affordable. The tax increases necessary will decrease job creation at a time our country needs to stimulate job creation. I encourage everyone to say enough is enough. Please write or call your representatives and express your displeasure.



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

  • shadowfax

    “The Obama/Pelosi plan is a government takeover of the U.S. Healthcare system.”
    Seems to me that you’re writing for an audience that already has the same opinions you do. So if you’re just trying to preach to the choir, never mind.
    Statements like the above pretty much cause you to lose any credibility in the eyes of serious correspondents interested in policy. I’d ordinarily ask you to explain or substantiate such a claim, but it’s right up there with: “You know who else liked government run health care? Hitler.” It’s such a vapid and disingenuous claim that it’s not worthy of argument.
    “By creating yet another massive entitlement program, President Obama will dramatically expand the federal deficit.”
    Here’s another example of sloppy thinking (charitably assuming it’s not deliberate dishonesty). Both the House and the Senate bill are deficit-reducing, and not by small amounts. I suppose you can argue that the CBO is biased or the asssumptions are wrong or that Congress will spend more money than is budgeted or something — but you don’t make that argument, do you? You just make a simple decarative statement which is directly counter-factual with no explanation or qualification. Furthermore, you seem confused as to what an “entitlement” is. There is no new entitlement created in the HCR bills. There are subsidies and tax credits, and I suppose if you redefine “entitlement” as “anytime the government pays for something” then that could be correct. That definition, however, is inconsistent with the common policy usage of that term.
    “Consumer healthcare insurance premiums will be means tested”
    Actually the premiums are not means tested; they are actuarially set and community rated. The subsidies are means tested, which is a good thing. I hope that even you would admit that if you are going to subsidize, that less needy families should recieve lower levels of support.
    “If consumers have to pay for their healthcare insurance premiums with after tax dollars the real price will be at least 30% higher.”
    Are you unaware that in the current system that consumers buying individual policies already are doing so with after-tax dollars?
    I’d go on with the other bits of inaccuracy and demagoguery in this piece and the others on this blog, but I’m not sure that there’s any point.

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The House Bill Is A Terrible Bill For Medical Care And The Economy. Part 1

Stanley Feld M.D.,FACP,MACE


President Obama was elected on the themes of change and hope. He captured the imagination of all generations. Americans were starved for innovative change. He inspired many with hope for the future.

Voters did not dream that the change Democrats had in mind was making health care even more expensive and rigid than the broken existing healthcare system most Americans were dissatisfied with.

The combined 1900 page House of Representatives bill released last week is more ominous than the 1100 page HR 3200.Few have had the energy to read and comprehend the full implications and unintended consequences of Nancy Pelosi’s bill President Obama has raved about.

President Obama said Nancy Pelosi is not only the first woman speaker of the house but the greatest speaker in the history of the United States.

“Speaker Nancy Pelosi has reportedly told fellow Democrats that she’s prepared to lose seats in 2010 if that’s what it takes to pass ObamaCare, and little wonder. The health bill she unwrapped last Thursday, which President Obama hailed as a "critical milestone.”

The bill contains increased new spending, higher taxes, higher insurance premiums, rationed care, plus a lot of dishonest accounting.

The bill ignored the citizen protests of last summer.

It is not paying attention to the American public’s needs at the time of the worse economic recession since the depression. America’s economic growth depends on consumers spending. The economy cannot grow in a time of increased taxes on the middle class and a jobless recovery.

It is not paying attention to the historically underestimation of costs of a new entitlement program.

“With spending and debt already at record peacetime levels, the bill creates a new and probably unrepealable middle-class entitlement that is designed to expand over time.”

“ Taxes will need to rise precipitously, even as ObamaCare so dramatically expands government control of health care that eventually all medicine will be rationed via politics.”

The middle class independent voters have caught on. They have forcefully expressed themselves in the November 2 elections even though the administration denies it.

“Democrats have dumped any pretense of genuine bipartisan "reform" and moved into the realm of pure power politics as they race against the unpopularity of their own agenda. The goal is to ram through whatever income-redistribution scheme they can claim to be "universal coverage." The result will be destructive on every level—for the health-care system, for the country’s fiscal condition, and ultimately for American freedom and prosperity.”

President Obama and the congress either do not understand medicine and basic economics or they are sinister. I choose to believe they do not understand medicine or basic economics. In either case the President and congress are doing a tremendous disservice to this country and its citizens.

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

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President Obama’s Healthcare Reform Plan Is Failing

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.

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