Stanley Feld M.D., FACP, MACE Menu

All items for December, 2009


Government By The People For The People vs. Government For The People In Our Opinion


Stanley Feld M.D.,FACP,MACE

It is easy to introduce bias into poll results and surveys. Most people are cynical about polling results

However, when every one of the major polling services’ come up with the same answer, one must believe the results represent unified public opinion. The Democrats in the House of Representative, the Democrats in the Senate and President Obama are ignoring the fact that the American public is against President Obama’s healthcare reform plan.

There is no question that America needs healthcare reform. It does not need President Obama’s version of healthcare reform as I have discussed in the past. Most importantly President Obama’s healthcare reform system will not work. It ignores the basic problems and defects in the present healthcare system.

President Obama continues to say his healthcare reform bill will provide universal coverage, affordable coverage and increasing quality of care. None of those results will be achieved with his healthcare reform plan. The American people know this and are afraid of the increased taxes and the restrictions on our freedom.


The composite polling data express the sentiment of the American public. The progression of these polling data can be seen by clicking See All Obama and Democrats’ Health Care Plan Polling Data

Polling Data






RCP Average

12/8 – 12/20




Against/Oppose +12.6


12/15 – 12/20




Against/Oppose +17

CNN/Opinion Research

12/16 – 12/20




Against/Oppose +14

Rasmussen Reports

12/18 – 12/19




Against/Oppose +14

NBC News/Wall St. Jrnl

12/11 – 12/14




Against/Oppose +15

Associated Press/GfK

12/10 – 12/14




Against/Oppose +8


12/11 – 12/13




Against/Oppose +2

ABC News/Wash Post

12/10 – 12/13




Against/Oppose +7

Pew Research

12/9 – 12/13




Against/Oppose +13

FOX News

12/8 – 12/9




Against/Oppose +23

The Democratic controlled Senate version of the bill also contains some sinister amendments. Many organizations are lining up to challenge the constitutionality of the bill.

Buried in Harry Reid’s massive amendment to the Senate version of Obamacare is Reid’s is Section 3403 designed to prevent any future Congress from repealing a central feature of this monstrous legislation.

Section 3403 reads in part: "… it shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment or conference report that would repeal or otherwise change this subsection."

Do you think all the Democratic Senators understand the implications of this maneuver? If section 3403 remains in the bill and President Obama signs this measure into law, Harry Reid intends that no future Senate or House will be able to change a single word of Section 3403, regardless whether future Americans or their representatives in Congress want to change it.

The subsection at issue is the regulatory power of the non elected Medicare Advisory Board to "reduce the per capita rate of growth in Medicare spending." It is an open ended grant to a regulatory agency granting power to control costs, quality and quantity of healthcare coverage.

And Reid wants the decisions of this group of unelected federal bureaucrats to be untouchable for all time”.

Harry Reid makes compounds the problems of Section 3403 by ignoring two centuries of Senate rules. He passed the measure in the dead of night in less than 48 hours. I suspect few Democratic Senators who voted for this bill have read and understood the implication of Section 3403.

“The final Orwellian touch in this subversion of democratic procedure is found in the ruling of the Reid-controlled Senate parliamentarian that the anti-repeal provision is not a change in Senate rules, but rather of Senate "procedures." Why is that significant?

se for 200 years, changes in the Senate’s standing rules have required approval by two-thirds of those voting, or 67 votes rather than the 60 Reid’s amendment received.”

Few Democratic Senators have listened to the wishes of the American people. President Obama refuses to listen to the wishes of the American people.


How many points made about the healthcare reform bill by President Obama correct?

Should Americans be angry? Yes. What can we do? Throw the bums out when you go to the polls next November.



After the New Year I will resume twice a week entries. I wish all a happy and healthy New Year.

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

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Aim Carefully Then Fire: Don’t Fire, Then Aim

Stanley Feld M.D.,FACP,MACE

Dr. Val Jones publishes Get Better Health a smart health an excellent healthcare website.

It is composed of a selection of many of her chosen healthcare bloggers. Val publishes blog entries of many contributors in her network daily. Val published my December 19th entry. It generated the following comment.

I am surprised that a diabetes doctor let his politics permeate his opinion of the AHRQ? We know that over 50% of the time patients don’t receive the standard of care and I would be interested to know what the numbers are like in his practice?
If he had given any research or documentation to his claims (the CBO for example predicts 130 billion dollar drop in the deficit) so he lost all credibility in his first few sentences. Does his practice have better outcomes than the standard of care? Is he worried that he will lose income for practicing medicine that makes huge profits but doesn’t increase lifespan or other measurable outcomes?
This blog seems to be a little bit behind the times. Quality matters and is here to stay. Guys you not only lost the election but large employers and other purchasers know that what we have been paying for doesn’t work.”

The commenter would do well to follow my blog at He might learn something about what is necessary and effective to repair a broken healthcare system.

 President Obama’s healthcare reform plan will not achieve his goals.  “The legislation has no master plan for dealing with the problem of soaring medical costs. And this is a source of deep unease.” It also does not have a master plan to deal with the dysfunction in the healthcare system

It is unnecessary for the commenter to take pot shots with sound bites on issues whose details are ignored.

I refer the commenter to my summary blog category section

My guess is the commenter is a salaried surgeon in a comfortable subspecialty that fixes things that are broken and does not practice preventive medicine.

It is not necessary, in a surgeon’s world, to understand that medicine needs to develop systems of care that put patients in charge of the care of their disease in order to prevent disease complications. Doing that will generate great savings because 90% of the healthcare dollars are spend on the complications of chronic diseases.

Patients need to be taught how to be responsible for their own care.

I am an Independent voter. I am apolitical and have never been affiliated with either Party. I voted for President Obama. I thought it was going to be a good thing when he promised to fundamentally reform America’s way of doing things following the wishes of powerful vested interest as opposed to the vested interests of the people. He has been a catastrophe.

I am a retired Clinical Endocrinologist. I have no economic vested interest in the financial aspects of the practice of medicine. I do have a vested interest in keeping medical practice a highly regarded profession and maintaining the patient physician relationship.

I oppose medical care becoming a commodity.

The secondary stakeholders (the healthcare insurance industry, big pharma, and the hospital systems and big government) have taken over healthcare. They have made medical care a commodity.

President Obama has played right into the hands of these vested interests in order to increase the scope of government. The devil is always in the details.

The details of his healthcare reform bill will tax all income groups, increase the budget deficit, decrease access to care and increase out of pocket expenses. It has been done in a non transparent way ignoring the wishes of the majority of Americans.

The healthcare reform bill does not consider to malpractice reform. Defensive medicine and unjustified law suits are wasteful and costly.

I suggest the commenter read critically some of the guidelines the USPHTF has written with an emphasis on Breast Cancer, Coronary Artery Disease and Osteoporosis.

He should study some of the defects in the clinical research studies the Task Force has chosen.

Our medical care system needs flexible standards of care that are disseminated to the medical community in an educational fashion and not in a punitive and disruptive way. Evidence medicine is ever changing and these changes need to be integrated in a physicians work flow in an education way. The Breast Cancer guidelines have been implemented already by California

No one has defined quality care effectively to this point or developed systems to measure the financial impact of care. In diabetes for example, the definition of quality medical care should not be defined as the measuring HbA1c’s four times a year. It is measuring clinical outcomes against financial outcomes and comparing its value. It should be defined by patient compliance with treatment. Claims data analysis is meaningless.

President Obama’s healthcare plan makes medical care worse for patients and physicians, not better. His plan is going to produce unintended medical and financial consequences that will render effective care more difficult for physicians to give and patients to get. There is plenty of evidence that it will make care more expensive, raise taxes, and increase the deficit.

None of the secondary stakeholders will be hurt as badly as patients and physicians. Reading my blog and following the links will give the commenter an in depth understanding of my reasoning.

I had hoped President Obama would provide a transparent administration as promised and not an administration for vested interests and lobbying groups. Unfortunately, this has not happened. This point is demonstrated by many examples including Tom Daschle’s access to the White House and private Democratic congressional meetings.

President Obama’s healthcare reform is about increasing government control over the healthcare system and commoditizing medical care. It will fail. The government has been unsuccessful at this as demonstrated by Medicare’s mounting deficits.

Secret Democratic caucus sessions and 2000 page bills that have to be evaluated in less than 72 hours are not my idea of transparency. My vote for President Obama was a big mistake.

If the commenter studied the various scorings by the CBO, I am sure he would not use the invective against me and challenge my credibility.

The CBO changed its scoring from a one trillion dollar deficit increase in ten years to a 130 billion dollar reduction in deficit overnight. These estimated are based on the changing assumptions provided by either Harry Reed or Nancy Pelosi. The last estimate was based on increasing taxes from 2010-2014 and not providing benefits until 2014. Ninety eight percent of the benefits will kick in after 2014. The CBO states its scoring can be in error because the assumptions provided could be wrong.

The $130 billion dollar decrease in the deficit is another trick play. It seems everyone within the Beltway understands this trick play.

Entitlement programs always cost more than estimated.

Primary care physicians’ and all cognitive subspecialists’ intellectual property is undervalued and underpaid. Cognitive intellectual property provides the most valuable element of medical care. It is embedded in the patient physician relationship.

The details in President Obama’s healthcare reform plan will undervalue cognitive services even further through punitive mechanisms. It could increase its value through educational mechanisms.

The healthcare insurance industry will not take a big hit because antitrust exemption and Medical Loss Ratio are not dealt with effectively.

I believe it is much wiser to aim and carefully learn the real details before firing.

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

  • Lisa

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Don’t Listen To What They Say. Watch What They Do.

Stanley Feld M.D., FACP,MACE

If President Obama’s healthcare bill is passed there is certain to be an increase in taxes, an increase in the budget deficit and a rationing of healthcare.

The President promised an increase in funding for preventative medicine. The term preventative medicine should mean discovering a disease process before it manifests itself through its complications. After discovering the disease it should be treated in the best possible way available.

The federal government is going to spent billions of dollars expanding a bureaucracy to further evaluate best practices.. The Agency for Healthcare Research and Quality was created to standardize the practice of medicine. The organization encouraged medical specialty organizations to write guidelines for the care of diseases in their specialty. A National Clearing House was created that published these guidelines. These guidelines are to be updated every five years.

I was suspicious of the intent of the AHRQ. Medical knowledge changes at about 10% per year. I believe that physicians in a specialty area have an obligation to physicians in all specialties to help them keep current. Guidelines are usually devoid of clinical judgment.

I was afraid the AHRQ would use guidelines as a weapon to punish physicians who were not current.

I was chair of the AACE guidelines for the treatment of Type 2 Diabetes Mellitus. I was also the co chair for AACE’s guidelines for hyper and hypothyroidism, thyroid nodules and thyroid cancer.

My goal was to help primary care physicians understand the Clinical Endocrinologists’ interpretation of the state of the art diagnosis and treatment of endocrine diseases. AACE had no ulterior motive. I hoped the AHRQ had no ulterior motives.

The U.S. Preventive Services Task Force is a branch of the Agency for Healthcare Research and Quality. USPTF started writing its own guidelines for diagnosis and treatment of many diseases. The USPTF does not seek input from subspecialty groups. The panel selects major articles on diseases from the literature and grades these articles. From the grading of the selected articles it develops guidelines on the use of procedures and treatments.

There are several problems with this method of developing guidelines. There is a danger that the best articles are not selected by non experts in that disease. There is also a danger that the natural history of the disease is overlooked. The natural history of many diseases is not considered in many “major” articles.

A vivid example of this is in the Women’s Health Initiative.

The most important defect in the USHPTF guidelines is it disregards the most important element of medical care, namely physicians’ clinical judgment.

The USPFS guidelines disregard clinical judgment and the patient physician relationship. In fact they destroy these critical elements in the therapeutic relationship between physician and patient.

USPHTF guidelines have rationed access to care for several years. President Obama is extending the USPHTF’s scope in rationing healthcare.

“Think Congress is regretting having allocated over a billion dollars to let the government generate studies to tell us what medical tests and procedures should be covered under Obamacare?”

I am most familiar with the US Preventive Services Task Force’s guidelines for the diagnosis and treatment of osteoporosis. I did not recognize one expert in the task force’s panel to evaluate the evidence for the diagnosis and treatment of osteoporosis.

The panel might be experts in evaluating the statistical power of the clinical studies chosen. However if clinical studies were not done to evaluate diagnosis and treatment of males with osteoporosis the USPHF conclusion would be there is no evidence for this diagnosis and treatment. The government would not approve bone density studies for elderly men even though there is an abundance of clinical evidence that hip fractures are as common in men as they are in women.

Most large clinical studies are funded by the pharmaceutical industry. Most of the osteoporosis studies have been done on women. Therefore there are no large studies in males. There it is easy to arrive at the conclusion that there is no evidence for diagnosing and treating males. The government will not pay for the evaluation and treatment of males for osteoporosis.

Experts in osteoporosis who understand the natural history of osteoporosis would disagree. The panel of U.S. Preventative Task Force did not ask osteoporosis experts for an opinion about the guidelines and disregarded the guidelines written by experts in the area.

Similar defects occurred with the USPTF’s recommendations for breast cancer. The breast cancer recommendations reviewed only 10 studies. The reviewers admit their conclusions cannot be generalized to individual forms of breast cancer and different groups of patients.

No sooner had the Health and Human Services Department’s U.S. Preventative Services Task Force recommended against mammography for women under 50 than Secretary Kathleen Sebelius rushed to say don’t worry. The decision had "caused a great deal of confusion and worry among women," she said, promising that no policies would change.”

Secretary Kathleen Sebelius said no policy would change today. It will change in the near future. The bankrupt State of California already has changed its policy.

“Although women ages 50 and older will still be eligible, women ages 40-49 will no longer be screened.”

I will have more to say about the USPHTF and its Breast Screening Guidelines in the future.

In the meantime watch what they do. Don’t listen to what they say.

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

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Healthcare Reform Has Become A Moral Imperative

Stanley Feld M.D.,FACP,MACE

The Obama Administration’s call for healthcare reform has changed from providing universal care, affordable healthcare insurance and increasing the quality of care to healthcare reform is a moral imperative.

President Obama has called it a “core ethical and moral obligation.’’ House Speaker Nancy Pelosi introduced her bill by saying, “We also have a moral responsibility to pass health insurance reform and we will do so this year.’’ And Senate majority leader Harry Reid has opined that “health care is a moral issue.’’

I believe America has a moral obligation to provide affordable healthcare insurance with a guarantee of universal coverage to every American. President Obama has chosen the wrong strategy. His plan will not achieve universal coverage or be affordable to many individuals or to the nation. It does not solve any of the important structural problems in the healthcare system.

The Democrats, by their own admission, are focused on getting a bill, any bill, passed by Christmas that will put the country on a path to a single party payer.

Extending this successful program to those between 55 and 64 would be the largest expansion of Medicare in 44 years and would perhaps get us on the path to a single-payer model,” said Representative Anthony Weiner, Democrat of New York.

The proposed healthcare insurance exchange creates 20,000 new government jobs that will create a bloated bureaucracy. It will not lower premiums. It will increase government spending on healthcare.

The Congressional Budget Office stated that the cost of healthcare premiums through Health Insurance Exchange would be 10 to 13% higher than the cost of healthcare insurance under the present government rules and regulations.

A family’s annual health premiums will increase by $3,100 over status quo (CBO & JCT). The average American family would pay more than $20,000 per year for healthcare premiums (CBO & JCT).


People buying health insurance under the "exchange" in Senate Democrats’ health care bill would pay higher premiums than they would under current law for their plans.”

One of President Obama’s goals was to provide affordable healthcare coverage. The CBO and CFO estimate dismiss this goal. President Obama’s Healthcare Reform will provide new subsides paying almost 60% of the premiums for over 50% of the population. He will mandate insurance for people who might not want it at a higher price than they are currently paying. The mandates are going to force Americans to purchase insurance they might want to buy.

The winner is the healthcare insurance industry. It will be the administrative service provider for the healthcare reform bill.

“According to CBO, however, "the majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies . . . would cover nearly two-thirds of the total premium." That means that while premiums cost more, most people required to buy them under the legislation’s mandate to have insurance would actually pay far less than they would otherwise.”

This is another Robin Hood example of the Obama administration’s political philosophy. It will bankrupt the country. Senator Max Baucus turned implications of the CBO report on its head and called it good news.

"The vast majority of Americans will see lower premiums than they would if we don’t pass health reform," Baucus said, citing the estimate. "We also learned that the millions of Americans who are underinsured—who don’t have enough coverage to prevent them from financial ruin—would be able to purchase significantly more coverage for an affordable price."

Who will be paying the subsidies? I assume it will be the government. It will borrow the money, print the money or increase taxes. The question is maybe the people who cannot afford the subsidized premium can afford the subsidized premiums?

"The Democrat bill will actually increase premiums for American families," Senate GOP Leader Mitch McConnell of Kentucky said in a statement Monday. "A bill that’s being sold as a way to reduce costs actually drives them up."

Senate Democrats have provided few details about their latest health care proposal. This much seems clear. Anyone who wants to buy the same health benefits as members of Congress, or to buy coverage through Medicare, should be prepared for premium increases. Medicare premiums are not cheap.

The cost to a family earning $54,000, slightly more than the current median household income, will have a monthly premium costs of more than $825 in post tax dollars.

The Democrats’ proposal would also allow some people ages 55 to 64 to “buy in” to Medicare, starting in 2011. That could cost about $7,600 a year per person or $15,200 in 2011 for a couple with post tax dollars, according to a budget office analysis of an earlier version of the concept. No subsidies would be available until 2014.

It is true that people 55 to 65 years old, with a pre existing illness like hypertension, or high cholesterol levels, cannot buy healthcare insurance as an individual.

The Medicare buy-in proposal is intended to fill a gap in the social safety net for millions of people nearing retirement who are unable to obtain or afford insurance. In general, the new Medicare option would be available only to people who are uninsured. People 55 to 64 who have employer-sponsored insurance would be expected to keep it.”

Overlooked is the fact that employers are going to opt out buy employee insurance because it is cheaper to pay the penalty than the premium for its workers. Therefore everyone will be forced to buy an individual policy through the health exchange.

The healthcare reform bill does not offer the same benefits or subsidies that members of congress or other federal employee receive.

In order to get 60 votes in the Senate, Harry Reid had to add Medicare for 55 to 65 year olds. Medicare is a terrific but unaffordable program. It is putting the federal government on an insolvency trajectory. The Senate should be focused on fixing Medicare not adding more people to it rolls.

“Republicans denounced the proposal, saying it would add new financial obligations to a program that could not afford its existing commitments.”

Democrats have declared that it is essential to pass a bill before Christmas. After the bill is passed they will fix it later. Nothing ever gets fixed later unless there is a scandal. The only chance to fix it is now.

America needs healthcare reform. The momentum of debate should be used to pass a logical bill that will provide universal and affordable coverage without accounting and taxation tricks that will be regretted later .

Write to the President and congress.

The email address can be found at;

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


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Are Mandates Unconstitutional?

Stanley Feld M.D.,FACP,MACE

There are a growing number of congressmen and constitutional lawyer that are challenging the constitutionality of President Obama’s healthcare bill.

The American Center for Law and Justice, is prepared to take the case to the Supreme Court and challenge its constitutionality if the bill is passed by Congress.

Senator Orin Hatch, a longtime member of the Judiciary Committee, said recently
“I think there’s a real constitutional issue there,”

“You know, the illustration they give all the time is: Well, states require people to buy auto insurance. Yeah, they do, if they want to drive,” said Hatch. “But here would be the first time where our [federal] government would demand that people buy something that they may or may not want.”

President Obama taught constitutional law in Chicago. He should understand the Bill of Rights. The justification for President Obama’s view is discussed beautifully in a Washington Post article by Ruth Marcus. The issue is between a strict interpretation of constitutional rights and a broad interpretation of interstate commerce.

President Obama’s bill being debated in Congress requires Americans to either secure or purchase health insurance with a particular threshold of coverage, estimated to cost up to $15,000/year for a typical family or pay a tax penalty. Such a purchase mandate has never been attempted.

The underlying purpose of this forced healthcare insurance purchase, coupled with the arbitrary price ratios and controls, is to require all citizens who do not qualify for government subsidy to buy artificially high-priced policies to subsidize the coverage for others. Its stated purpose is to increase the insurance pool. Increasing the insurance pool and increasing the deductible will presumably keep insurance premiums down.

I believe this will not solve the healthcare insurance problem.

A reader sent me letter that critiques President Obama’s healthcare bill. It is written by Michael Connelly a constitutional lawyer. I called Mr.Connelly and received verbal permission to publish his critique.

Michael Connelly’s critique also appears on his excellent and insightful blog site


I have done it! I have read the entire text of proposed House Bill 3200
The Affordable Health Care Choices Act of 2009. I studied it with
particular emphasis from my area of expertise, constitutional law.

I was frankly concerned that parts of the proposed law that were
being discussed might be unconstitutional. What I found was far worse than what I had heard or expected.

To begin with, much of what has been said about the law and its
implications is in fact true, despite what the Democrats and the media are

  • The law does provide for rationing of health care, particularly
    where senior citizens and other classes of citizens are involved,
  • Free health care for illegal immigrants,
  • Free abortion services, and probably forced participation in abortions by members of the medical profession.
  • The Bill will also eventually force private insurance companies out
    of business and put everyone into a government run system.

  • All decisions about personal health care will ultimately be made by federal bureaucrats and most of them will not be health care professionals.

  • Hospital admissions, payments to physicians, and allocations of necessary medical devices will be strictly controlled.
    However, as scary as all of that is, it just scratches the surface.

In fact, I have concluded that this legislation really has no intention of
providing affordable health care choices.

Instead it is a convenient cover for the most massive transfer of power to the Executive Branch of government that has ever occurred, or even been contemplated.

If this law or a similar one is adopted, major portions of the Constitution of the United States will effectively have been destroyed.

The first thing to go will be the masterfully crafted balance of power between the Executive, Legislative, and Judicial branches of the U.S. Government.

The Congress will be transferring to the Obama Administration authority in a number of different areas over the lives of the American people and the businesses they own.

  • The irony is that the Congress doesn’t have any authority to legislate in most of those areas to begin with. I defy anyone to read the text of the U.S. Constitution and find any authority granted to the members of Congress to regulate health care.
    This legislation also provides for access by the appointees of the Obama administration of all of your personal healthcare information,
  • Your personal financial information, and the information of your employer,
    physician, and hospital.
  • All of this is a direct violation of the specific provisions of the 4th Amendment to the Constitution protecting against unreasonable searches and seizures.
  • You can also forget about the right to privacy. That will have been legislated into oblivion regardless of what the 3rd and 4th Amendments may provide.
  • If you decide not to have healthcare insurance or if you have private insurance that is not deemed "acceptable" to the "Health ChoicesAdministrator" appointed by Obama there will be a tax imposed on you.
  • It is called a "tax" instead of a fine because of the intent to avoid application
    of the due process clause of the 5th Amendment.
  • However, that doesn’t work because since there is nothing in the law
    that allows you to contest or appeal the imposition of the tax,

  • It indefinitely deprives someone of property without the "due process of law.

So, there are three of those pesky amendments that the far left hate so much out the original ten in the Bill of Rights that are effectively nullified by this law. It doesn’t stop there though.

  • The 9th Amendment that provides: "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people;"

  • The 10th Amendment states: "The powers not delegated to the United States by the
    Constitution, nor prohibited by it to the States, are preserved to the States respectively, or to the people." Under the provisions of this piece of Congressional handiwork neither the people nor the states are going to have any rights or powers at all in many areas that once were theirs to

I could write many more pages about this legislation, but I think you get the idea. This is not about health care; it is about seizing power and limiting rights.

Article 6 of the Constitution requires the members of both houses of Congress to "be bound by oath or affirmation" to support the Constitution.
If I was a member of Congress I would not be able to vote for this legislation or anything like it without feeling I was violating that sacred oath or affirmation. If I voted for it anyway I would hope the American people would hold me accountable.

For those who might doubt the nature of this threat I suggest they consult the source.

Here is a link to the Constitution:

And another to the Bill of Rights

There you can see exactly what we are about to have taken from us.

Michael Connelly
Retired attorney,
Constitutional Law Instructor
Carrollton, Texas

None of these provisions will guarantee universal coverage, affordable healthcare insurance or improve the quality of medical care. President Obama has a chance to pass a historic healthcare bill that would Repair the Healthcare System. If this present bill passes it will not achieve his goal while increasing taxes, increase federal government power over our freedoms to choose, and increase out of pocket expenses.

Write to the President and congress.

The email address can be found at;

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

  • red bottom heel

    let’s join our hands together to stop this kind of wrong doings. It may risk lives in the future if we just let them continue.

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The Horror Of Mandates

Stanley Feld M.D.,FACP,MACE

A reader wrote;” I am getting tired of you telling me how bad the healthcare reform bill is.”

I am tired of writing about the bill. I feel compelled to try to clearly explain the harmful potential of the bill to an unsuspecting public.

Most Americans agree the country needs healthcare reform.

Many intelligent people believe President Obama is on the right track. They believe he is going to provide universal healthcare coverage, affordable healthcare cost, and improve the quality of medical care.

Few in the mainstream media are discussing the real impact of President Obama’s Healthcare Reform Plan.

President Obama cannot accomplish his goals with this bill. He is going to increase federal spending and taxes for every American’s not just the wealthy.

His healthcare plan is going to increase the power of the federal government at the expense of States’ rights. He is going to control American freedom of choice.

“In short, while the House bill doesn’t impose a single-payer, It does give federal bureaucrats – in this administration or any future administration – the power to impose precisely such a system without any further congressional action”.

“To add insult to injury, we would pay vastly more for this new system – a system even less responsive to patient preferences and choices than our current system. We would face higher taxes and, according to the Congressional Budget Office, higher premiums. Both the House and Senate bills penalize employers for hiring workers, especially workers from low-income families – the people who need help the most.”

How would the mandates in the bill harm all taxpayers?

The individual and employer mandates use taxes and penalties to punish uninsured Americans not help them. It also punishes small businesses who hire workers from low income families. It is most harsh on single parents whom it is suppose to help.

“If you wanted to punish the poor and kill the job prospects of people who need jobs the most, this bill would be an effective way to do it.”

President Obama opposed healthcare insurance mandates during his presidential campaign. His healthcare reform bill has two critical mandates. There are individual mandates and employer mandates. Both are very explicit and detailed.

The individual mandate has a euphemism called the “individual responsibility provision.”

“First, there is the “individual responsibility” provision in Section 1501 (pages 320-340). This would require anyone who fails to obtain a qualifying health plan – with a benefit package to be defined later by bureaucrats – to pay an annual tax penalty”

The Senate bill requires everyone to have qualified healthcare coverage between 2014 and 2016 as defined by the government. If they do not have a qualified healthcare plan the annual tax penalty will be $750 per adult family member and $375 per child, with a maximum penalty of $2,250 per family. The tax penalty will be indexed to inflation and will be based on family size, not income. The poor might qualify for an exemption.

The individual mandate in the House bill is worse than the Senate bill. The tax is 2.5% of the modified adjusted income. In either case it is a tax on the middle class. Government is mandating people to buy healthcare insurance against their will.

There is a hardship exemption if the bare bones healthcare insurance is greater than 8% of adjusted gross income. The trick play is you have to make less than $28,000 a year to qualify for the exemption.

The employer mandate also has a pleasant sounding name.

“There is the “employer responsibility” provision (Section 1511-1513, pages 346-357). Companies with more than 50 employees are required to offer qualified health plans – with a benefit package to be defined later by bureaucrats – to their full-time employees.”

Notice the tricks:

a. More than 50 full time employees.

b. Benefits defined later by non elected bureaucrats

The effect will be that small businesses will hire only part time employees. The employees will be mandated to buy their own insurance with after tax dollars.

The penalty for the employer will be $750 per full time employee. $750 dollars per employer is a lot cheaper than the $12,000 to $14,000 for healthcare insurance premiums for the employee’s family paid with after tax dollars.

If a full time employee qualifies for a premium subsidy in the “health insurance exchange” the employer will have to pay a tax penalty of $3000 for that employee. It is still cheaper than a full insurance premium. It will discourage employers from hiring full time employees. There are lots of ways this will hurt the poor. It will shift the burden to the employee.

Companies will be motivated to drop their health plans entirely, dumping all employees into the federal exchange at their own expense.

“In other words, employers will have a strong tax incentive to lay off the workers who need the jobs most – people without other sources of income.”

This is not a healthcare reform bill for the people. It is not robbing from the rich to give to the poor. It will make the poor even poorer.

Meanwhile, congress is not debating the essential elements needed to effectively decrease the cost of healthcare. The bill will not decrease the complications of chronic disease, promote early detection of disease or prevent its complications. The bill will increase taxes, decrease job creation, cause consumers to have less discretionary income and decrease American’s standard of living.

Write to the President and congress.

The email address can be found at;

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


  • Steve Keller

    Dr. Feld,
    Thank you for these postings. I agree with much of this article, and would like to suggest another cost savings not included in the bill: Malpractice limits. This would save tremendous amounts of money.
    Steve Keller

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The House And Senate Bills Are Terrible Bills For Medical Care And The Economy. Part 8 : The Bill’s New Taxes

Stanley Feld M.D.,FACP,MACE


The Senate healthcare reform bill contains a host of new taxes for both the wealthy and the middle class. The tax increases are designed to raise $370 billion dollars. Another $202 billion dollars will be raised from other provisions such as fees and penalties.

The fees and penalties are really tax increases. Many of these tax increases will start in 2010 before benefits begin.

The most shocking tax increase is a payroll tax increase that will permanently sever the link between the Medicare Payroll tax and its contributions to Medicare.

An additional Medicare payroll tax will go into the general revenue fund rather than the Medicare Trust Fund. The funds collected can be used for other programs.

“The shift emerges from the liberals. They have long been tried to turn social insurance programs into welfare programs that redistribute wealth. The Reid payroll tax is a huge step down the road of using social insurance payroll taxes as regular taxes to transfer income.”

This payroll tax increase will be 5% on earnings above $200,000 for singles and $250,000 for couples.

President Obama promised anyone earning less than $ 200,000 will not experience a tax increase. He failed to mention the other taxes and fees that will be imposed on the middle class.

There will be an excise tax on healthcare insurance companies. This excise tax is projected to raise $150 billion dollars. Everyone knows this tax will be passed on to all consumers in the form of higher premiums either for private insurance or government insurance.

There will be taxes imposed on drug companies and medical device companies which in turn will pass on these added costs to consumers. The increase in the costs of drug and medical devices will result in increased healthcare insurance premiums. Consumers will pay these extra costs with post tax dollars. Isn’t this a hidden tax for all consumers?

Consumers will have less discretionary income to support America’s economy which depends on consumer spending.

The Joint Tax Committee published an complete list of the new taxes and its projected revenue generation for the federal government.

A 40% Excise tax on High Value healthcare insurance plans such as $8,500 for Individual and $23,000 for a couple. This tax is projected to generate $149.1 billion in new revenue over the next ten years. The government will not collect this excise tax because companies will not buy these healthcare plans.

The 5% increase in the Medicare Payroll Tax for single earners over $200,000 and joint earners over $250,000 will generate $53.8 billion in new taxes over the next ten years.

President Obama’s unintended consequences will eliminate innovative healthcare insurance products that would make real gains toward repairing the healthcare system.

A proposed change would tax and restrict Health Savings Accounts, Archer Medical Spending Accounts and Health Flexible Spending Accounts and Health Reimbursement Arrangements in order to generate $5 billion in new federal revenues. This is another mistake. These innovative healthcare plan products are a step in the right direction. They make consumers more responsible for their healthcare. Their elimination makes consumers be more dependent on the government.

A tax on branded drugs will cost the pharmaceutical industry $22.2 billion over ten years. This tax will be passed on to all consumers as another hidden tax increase.

The annual tax on the health insurance companies is projected to generate $60.4 billion over ten years resulting in an increase of $60.4 dollars in premium increases plus a handling fee.

Medical device companies will experience a $19.3 billion dollar increase in taxes over ten years. Again, this increase will be passed on to consumers. It will also stifle medical device innovation.

The federal government is going to impose a 5% federal sales tax on cosmetic surgery and procedures over ten years. I am not a big fan of cosmetic surgery but this move is a tax on consumers’ freedom of choice

A more complicated and less transparent tax increase is the change of the Medical Expenses Deduction from 7.5% of Adjusted Gross Income to 10%. The floor for seniors will be maintained at 7.5%. It is a tax on having an expensive illness. Consumers will not be able to deduct medical expenses to the degree they could in the past.

The federal revenue projection is it will generate an additional $15.2 billion dollars. President Obama is penalizing someone who becomes sick. The tax increase consumer out of pocket expenses. It is also decreasing discretionary income for consumer spending.

Harry Reid’s bill will eliminate the income tax deduction of Medicare Part D (prescription drug plan) and generates $5.4 billion dollars in new taxes over the next ten years.

The federal government plans to cap salaries for all employees of health insurance companies at $500,000. Any salary above $500,000 will not be a deductible expense to the company. The government claims making salaries of over $500,000 a year a non deductible expense will save over $6 billion over ten years.

All these taxes, fees and penalties will be taxes not only on the wealthy but on the middle class as well. They will have a negative effect on innovation. They will eliminate incentives.

President Obama’s healthcare reform bill is not really about healthcare reform. It transfers the power of healthcare regulations from the states to the federal government and is a tax increase to all consumers.

Healthcare insurance mandates for employers and employees are going to increase taxes to consumers even further. There has been much confusion about these mandates. I will cover the specifics of this draconian provision in detail in my next blog.

President Obama’s bill is not about improving healthcare. It is about concentrating the power of the Federal government and increasing its control over American citizens. It is about reducing their freedom to choose and making their own decisions.

The Democrats have tried in the past to accomplish this. It failed.

If Americans wake up the Democrats will fail again.

Write to the President and congress.

The email address can be found at;


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


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