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All items for August, 2013


President Obama Should Listen To Physicians

Stanley Feld M.D.,FACP,MACE

Obama keeps saying over and over that Republicans do
not have any good health care reform solutions.

don’t have an agenda to provide health insurance to people at affordable

It all depends
on the definition of a good idea. Is it one that will work or one that will
fail? A good idea is it one that agrees with President Obama’s agenda. If it
doesn’t agree with his agenda it is a bad idea.

By President
Obama and Harry Reid own admission they believe Obamacare is a good step toward
a single party payer. They believe Obamacare will fail.

Any idea that
interferes with President Obama’s is defined as a bad idea.

The Republicans
and thoughtful people with actual healthcare experience have plenty of good
ideas. They do not agree with President Obama’s agenda.

This program containing Republican ideas three years ago had only 807 views on You Tube.

Congress voted for the
law (only Democrats voted for the law). They have now exempted themselves from
the law because they realize it is a bad law. It looks as if Obamacare will be
a train wreck.


Perhaps that is where
President Obama wants it to end.


 As each day
passes Obamacare looks like it will be a very expensive train wreck.

 Physicians are tired of being blamed for the rising
healthcare costs. They are starting to realize that they have to take action to
preserve their professional integrity.

In fact, in a recent study by the Physicians Foundation, six
out of ten physicians said they would quit medicine.

Most physicians love practicing medicine but cannot
understand the unbelievably wrong direction President Obama is taking to reform
the healthcare system.

 Many physicians
are looking for viable exit strategies to avoid quitting.

Physicians Foundation commissioned an extensive survey of
nearly 13,575 physicians. Meritt Hawkins, the physician search and consulting
firm, conducted the survey.

“The survey found
60% of physicians would
retire today
, if given the
opportunity—an increase from 45% in 2008. And it's not just disgruntled and
tired Baby Boomers who want to abandon their healing work. At least 47% of
physicians under 40 also said they would retire today, if given the

survey pointed out many major problem areas.

Two specific issues consistently agreed on by physicians
were malpractice concerns and the need for tort reform as well as the lack of
cohesive leadership among all physician groups to represent the vested
interests of physicians and their patients.

This survey is an excellent and detailed survey that has
heightened the awareness of physicians’ practice problems.

The Massachusetts Medical Society survey pointed out the
scope of defensive medicine. I extrapolated findings of the society’s survey to
the nation.

My conclusion was that $500 billion to $700 billion
dollars a year is spent on defensive medicine testing. Tort reform would
decrease the cost incurred by defensive medicine over testing.

The Mass Medical Society survey demonstrated that
physicians are frightened by the multidimensional stress of malpractice suits.
Physicians will do as much testing as necessary to avoid a malpractice suit for
missing a diagnosis. Most physicians do not experience financial gain in over
testing. The hospital system does.

President Obama and his advisors have ignored tort reform
and defensive medicine as an insignificant cost. Ezekiel Emanuel M.D. one of
President Obama’s advisors thinks defensive medicine only raises the cost of
the healthcare system between $2 to $3 billion dollars a year. This is a
misguided bias.

The Physician Foundation survey notes that many policy
makers, academics, and others identify fee-for-service reimbursement as a key
driver of health care costs. Physicians believe that "defensive
medicine is a far more important cost driver."

percent (40%) of the physicians surveyed said "liability/defensive
medicine pressures" was the least satisfying aspect of medical practice.

 Sixty nine percent
(69%) of physicians said defensive medicine is the "number one ranked
factor" driving up healthcare costs. The survey described the ordering of
tests, prescribing of drugs, and conducting of procedures done "partly or
solely to drive a wedge against potential malpractice lawsuits."  

malpractice lawsuits are common, adding an additional layer of paperwork,
expense, and stress in virtually every physician's work day," the report

The government ought to be listening to physicians practicing medicine every
day rather than ivory tower professors who have never practiced medicine a day
in their lives.

understand to some degree that's the cost of doing business, but the defensive
medicine goes deeper than that, in the ordering of extra tests, doing the extra
procedures, and extra scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of overspending in
American healthcare. President Obama and Obamacare have ignored it. Some states
have addressed it and the cost of care has been decreasing slowly. I believe it
will take time in those states.  If
anyone is sincere about bending the healthcare cost curve they have to take
defensive medicine seriously. 

According to the survey physicians
felt that there is a lack of a forceful cohesive voice representing them.

is a systematic, endemic series of problems," Ray says. "Everywhere there
is defensive medicine, regulation issues, reimbursement issues. We are all in
the same boat. But physician representation is balkanized. There is not a
national organization that represents a majority of physicians."

When the survey asked which best describes
their feelings about the current state of the medical profession, only 3.9
percent of physicians used the words “very positive,” while 23.4 percent of
physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent —
described their feelings as either somewhat negative” or “very negative,” while
only 31.8 percent of physicians’, described their feelings as “somewhat positive”
or “very positive”.

A "least satisfying" aspect of
practicing medicine included dealing with Medicare/Medicaid/government
regulations (27.4%) and reimbursement issues (27.3%).

The American Medical Association (AMA)
represents only 15% of physicians, according to the Physician Foundation report. One of the reasons for the low enrollment is that physicians feel the
AMA does not represent their vested interests.

 Sermo is another physician organization. It is an Internet social
network. In less than 2 years Sermo had as many members as the AMA.

Sermo originally concentrated on
socioeconomic issues. It also discussed difficult clinical cases. 

The socioeconomic activity has recently
faded. Sermo’s power was using the social network to do instant surveys of physicians’
opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to
the public as media stories of physicians’ opinions. It was done through public
service announcements and daily press releases.

Physicians were able to let the public know
how they felt about an issue instantly. It was very attractive. Somehow the
initial vigor stalled. Physicians are now left without a vehicle or organization
to express their feelings.

Government, the healthcare insurance industry
and the hospital systems have little desire to listen to the concerns of
practicing physicians. It is more important for these stakeholders to control
physicians. It will not work long term.

The Physicians Foundation Biennial Survey is
valid and accurate. However it is not dynamic or evolving. Neither the PFB
survey of the Sermo survey have gotten the attention they deserve.

Both are must reads along with the
Massachusetts Medical Society survey for those interested in physician concerns
and behavior.

Patients’ problems with the healthcare system
get less attention. The government and insurance companies tell patients what
they can and cannot do.

Repair of the healthcare system will only
happen when the American healthcare system evolves to a consumer driven
healthcare system with individual responsibility and patient control of their
healthcare dollars.

The reality is that health care should be as decentralized and regulated as close
to the people as possible, not run by Washington mandates.

This concept
opposes President Obama’s agenda.  

Obama has the power of the pulpit and has the gift of misdirection.

healthcare system is going to fail unless the public wakes up to the facts.

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

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Are The Unintended Consequence’s Of Obamacare Unintended?

Stanley Feld M.D.,FACP,MACE

It is hard to tell whether the unintended
consequences were really intended consequences on the way to destroying the
healthcare system.

Harry Reid and the President have already
admitted that Obamacare is a good first step on the way to a government
controlled single party payer system.

There are several problems with a single
party payer system,

  1. The
    government cannot afford it.
  2. The
    government cannot run it. It will have to hire the healthcare insurance
    industry to administer it. It costs the government 40% of the healthcare
    dollars to have the healthcare insurance industry provide administrative
    services for Medicare and Medicaid presently.
  3. Providers
    will not have incentive to produce. Reimbursement will be low and salaries will
    be low.

Normally if one works for a company, the
company provides healthcare insurance to the family. When Obamacare raised the
mandate limit forcing employers to provide healthcare insurance for employees’
children living at home to 26 years old, companies have been trying to figure
out how to avoid paying the increased premium cost of healthcare insurance.

Most companies have reduced or are reducing
employment to less than 30 hours to avoid the penalty for not providing
healthcare insurance.

Many companies have applied for wavers.
These companies will get waivers if they are the Obama administration’s
friends. Congress got a waiver.

U.P.S. announced it would discontinue
Health Benefits
for spouses of some workers. U.P.S. joins the list of other
companies doing the same thing. These include large employers like Xerox and Teva Pharmaceuticals. They
have chosen to impose surcharges on employees for spousal coverage.

Cities like Terre Haute,
Ind., are adopting a spousal carve-out so that working spouses would not be
covered under its health plans even if the healthcare insurance plan of the
spouse’s company is worse than Terra Haute’s healthcare insurance plan.

The University of Virginia
has just announced a similar spousal carve out. It is rumored that the state of
Virginia is next.

“UVA said
this is only one of many “major changes” coming to their health plans a
s a
result of ObamaCare. The university says the changes are necessary because the
law is projected to add $7.3 million to the cost of the university’s health
plan in 2014 alone.”

Isn’t Obamacare called the
Affordable Care Act?
In truth it is not. It will drive these spouses into a
health insurance exchange.

 “U.P.S. said, “Limiting plan eligibility is
one way to manage ongoing health care costs, now and into the future, so that
we can continue to provide affordable coverage for our employees.”

 — U.P.S. told employees, “Since the Affordable
Care Act requires employers to provide affordable coverage, we believe your
spouse should be covered by their own employer — just as U.P.S. has a
responsibility to offer coverage to you, our employee.”

Delta Airlines announced
that someone
leaked a letter from Delta Air Lines to the Obama administration.

letter stated that the “cost of providing health care to our employees will
increase by nearly $100,000,000 next year.” The letter also states that much of
the increase is due to Obamacare.

It means the airline tickets are going to increase in
price. This will become a burden on businesses who depend on flying to do
business. In turn, products these companies produce will increase in price.  

The ordinary consumer will also be affected by rising
airline ticket prices.

U.P.S. said, “Limiting plan
eligibility is one way to manage ongoing health care costs
, now and into the
future, so that we can continue to provide affordable coverage for our

U.P.S. estimates they cover
33,000 spouses. Fifteen thousand (15,000) spouses can get coverage through
their own employers. It should be added that they can get insurance until the companies
of these15,000 spouses drop their own healthcare coverage.

 If U.P.S
cannot lower insurance costs, they will raise shipping prices. Once again the middle
class is the victim. Another option is to drop healthcare insurance for all
employees and let them participate in the health insurance exchanges.

 Companies providing executive insurance
of $27,500 or more for employee family coverage or $10,200 for individual
coverage (Cadillac plans) will have to pay an additional 40% Obamacare tax in

This Cadillac plan tax is
something many companies are thinking about and making plans to discontinue in
the future.

The whole thing stinks.

It might not be an
unintended consequence. It might be an intended consequence.

 It might be exactly what President Obama wants
to drive as many people as possible into his health insurance exchanges.

His excuse for the increased
costs is that the American people cannot refuse to pay for something they have
obligated themselves to pay. In reality they have been deceived. They have been
tricked, forced and deceived into this obligation.

The Obama
administration is building a detective squad to target and penalize consumers and
companies that don't follow Obamacare's rules.

Department of Health and Human Services has hired 1,814 criminal investigators.
On the day President Obama signed the Affordable Care Act into law in 2010, HHS received authority
to hire 1,814 investigators to
sleuth out violations of the law.

Congressmen who supported Obamacare find this new police force

“HHS received authority from the Office of Personnel Management
(OPM) to make as many as 1,814 new hires under an emergency 'Direct Hiring
Authority' order.”

 The Obama administration ordered that employment expansion despite
a government-wide hiring freeze that is in place.

Why doesn’t President Obama
listen to the will of the people?

Everyone is against it. Everyone
has to be more vocal. Everyone has to vote these people out of power.

Otherwise we are on the Road
to Serfdom.

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

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America’s Rural Hospitals Are Being Destroyed

Stanley Feld M.D.,FACP,MACE

There is no question the federal government must decrease the amount of
money it is spending on healthcare. It simply cannot sustain the increasing
cost of health care.

Instead of figuring out how to make the system more efficient and cost
effective, the Obama administration is slowly destroying assets that have been
built at great costs to society in the past.

One example is the community hospital systems in large cities and the
voluntary hospital in smaller cities.
The government has subsidized their
development with tax incentives and reconciliation paybacks.

In recent years rural hospitals have been failing because of decreasing
government reimbursement. Many service the poor and elderly with emergency care
and outpatient clinics.

  • The role and structure of rural
    hospitals is changing,
    but they continue to be important local and
    regional centers of health care activity.
  • Rural hospitals tend to depend
    more on Medicare and Medicaid patients.
  • Most rural hospitals are organized
    on a not-for-profit basis
  • Rural hospitals make an important
    contribution to rural economies; expansion and diversification of the
    services that they offer will be important in their survival.
  • The quality of care provided in
    rural hospitals is generally equal to that provided by urban institutions,
    with some exceptions.

The Department of Health and Human Services' Office of the
Inspector General has recommended that Congress allow the Centers for Medicare
& Medicaid Services to strip critical access designation from any hospital
that was brought into the program under a state "necessary provider"

Brian Jordan, a program analyst for OIG's Office of
Evaluation and Inspections in Chicago, said that nearly 1,000 of the
approximately 1,300 critical-access hospitals
in 45 states gained the "permanent exemption"
under the necessary provider designation. Congress closed the loophole in 2006,
but grandfathered in the hospitals.

that designation, Jordan said about 800 hospitals would not have met location
requirements in 2011 because they were too close to another hospital.”

The "necessary provider"
designation is withdrawn if two hospitals are within 15 miles of one another.
It is estimated that Medicare could save 1.3 million per year for every
hospital eliminated from the necessary provider program.  

The total cost savings from eliminating
these rural hospitals would be less
than the
amount of money all salaries of the CEOs and other healthcare executives of healthcare
insurance companies take from Medicare a year.

If there is a problem with rural
hospitals it is their inefficiency and waste. The inefficiency should be fixed.
If the government wanted to do something constructive it should help rural
hospitals fix the inefficiencies.

“necessary provider hospitals “never had to meet the distance requirements."

 Necessary provider hospitals get paid more
from Medicare than non- designated hospitals. As towns expand new hospitals are
build close to the older standing hospitals. 

Maybe having a rural hospital in a
small city will increase economic growth of the area? It attracts industry and
more jobs. Many communities need two rural hospitals.

Both hospitals receive necessary
provider status and increased payment.

 Alan Morgan, CEO of the National Rural Health
Association, blasted the report. He said the OIG report would kill rural health
and access to healthcare. The closing of 800 rural hospitals would also close
emergency services in local communities, eliminate rural health clinics, access
to mental healthcare and nursing home support.

Morgan said, OIG
viewed this with blinders on
, not looking at how healthcare is delivered in
rural America.

about access and this report is only about finances and not access. It is a spending and finance issue and we seem to
have forgotten the rationale for the creation of this program, which was an
access issue."

If the Obama administration is trying to help
seniors and the underprivileged it should study this decision more carefully. I
can only imagine the cost of the unintended consequences to all taxpayers.

I believe the Obama administration wants to
destroy the entire healthcare system and replace it with a single party payer

It is time to go after the real excess cost
drivers in the healthcare system. It is a mistake to destroy the infrastructure.

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

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Some More Obamacare Deceptions

Stanley Feld M.D.,FACP, MACE

 Does anyone remember the CLASS Act as part of
the Obamacare promise for affordable healthcare coverage? I do. It sounded
great but I knew it couldn’t be done without tremendous cost to the federal

It would drive deficit spending through
the roof.

The CLASS Act (Community Living
Assistance Services and Support) was shut down 19 months after passage of

 There was little discussion
of the CLASS Act until Kathleen Sibelius’ announcement to discontinue

 She said,

 The administration was shutting down CLASS. After 19 months of research and consultation, “we have not
identified a way to make Class work at this time.

The thing that bothers
me the most about Obamacare is the sneaky machinations the Obama administration
uses to hide the bad news about Obamacare from the American public. When the American
public finds out they are disappointed and feel deceived.

However, it also feels
so complicated that they tend to ignore it.

 When the Obama administrated delayed the
employer mandate for a year employers were relieved. None of the traditional
media made a big deal about delaying the employer mandate which meant that Obamacare was
in trouble.

 Some conservatives and conservative outlets
cried, “Why not delay the individual
mandate as well?”

The reason is obvious.
The Obama administration wants the entitlement to start whether it is ready or
not so it cannot be repealed or discontinued. People do not like to relinquish
a freebie.

As soon as that
discussion was over the government announced that the verification process for
subsidies might not be ready until October 1, 2013.

If the tests find security
problems in the verification systems, the information officer could delay the
marketplace opening or decide to open the insurance exchanges with
less-than-optimal assurances that users’ personal information is adequately

The Obama administration
then announced it would provide premium subsidies on an “honor system” so as
not to delay the onset of the individual mandate.

“The administration promises no one will lie
because once they get the verification process started they will be able to
find out who lied about the subsidies

The Obama administration’s
navigators program is a program to train and pay people to go into the
community and sign up people to enroll in the Obamacare health insurance

“More than 100 groups
will split $67 million to help people “navigate”
the new Obamacare health insurance

These “navigators” will have to undergo mandatory federal
training and become certified.

The 67 million dollars is more money than the
administration initially
said would be available but short of what advocates
say will be needed to help people sign up”.

It sounds like another cash for clunkers program.

When are Republicans or
Conservatives going to say something to make the public aware of what is going on?

To add insult to injury
congress exempted itself from Obamacare because of economic hardships leaving
ordinary people to be subject to penalties if they do not join the health
insurance exchanges.

 The Obama administration has given over 2,000 group

The Obama administration
and Harry Reid and Nancy Pelosi are working on the Unions’ problems with
Obamacare. One could bet that it will be fair to the Unions as the rest of us
are ignored.

 With all of the IRS’s problems of late it is
frightening to think of the IRS monitoring abuses of Obamacare.

The IRS employees union
is presently seeking a way to get a waiver from Obamacare.

And speaking of haunting, does anyone in this
country look forward to being scrutinized by the IRS on every aspect of his or
her personal health care decisions, especially after we learn of the
politicizing and privacy abuses by that agency?”

 Does anyone remember the 60 lawsuits the
Catholic Church initiated challenging President Obama’s contraception mandates?

The church claims the mandate to provide contraceptives represents an attack on
religious freedom and the first amendment.

Despite all this the
traditional media and President Obama keep saying Obamacare is right on

We have heard nothing
about the extra costs Obamacare is generating for start-up and implementation. 

Last weekend Harry Reid let the cat out of the bag. President Obama real goal is to have Obamacare fail and replace it with a single party payer system.


Harry Ried and a single party payer

The biggest political maneuver by President
Obama of all is the maneuver to delay the law’s caps on out of pocket expenses for consumers
such as for deductibles and co-pays.

This is perhaps the most
attractive benefit of Obamacare after guaranteed insurability.  

"Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group
health plan and a health insurance issuer offering group or individual health
insurance coverage may not establish lifetime limits on the dollar value of
benefits for the any participant or beneficiary.”

Annual limits on cost-sharing are
specified by Section 1302(c) of the Affordable Care Act; in addition, starting
in 2014, deductibles are limited to $2,000 per year for individual plans, and
$4,000 per year for family plans.

This is a wonderful
benefit. If someone gets sick he is only liable for $2,000 if single and $4,000
if he has a family.

The problem arises when the
healthcare insurance industry calculates the premium with this benefit included.
The insurance premiums skyrocket. Premiums are scheduled to dramatically
increase in 2014.

President Obama’s
problem is that 2014 is a congressional election year. Skyrocketing premiums in
2014 may make Obama fans and the Democratic base angry with President Obama and
the Democrats running for congress.  

President Obama having
gotten away with all his other delays in implementation simply delayed this
part of the law until after the election.

The American public
doesn’t realize that he has delayed perhaps the best benefit in the law from
the public’s viewpoint. His hope is the public will not notice the delay with
the help of the traditional media’s lack of coverage.

In 2015 he will sock the
increased premiums to the public. He will then blame it on the

There are two basic
issues. The first is the need for the public to realize all these deceptions in

The second one is the
public is beginning to realize that it cannot trust President Obama or congress
to represent its welfare.

It is time for
Republicans to stand up and put an end to this charade. I hope someone has the guts
to do it.

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

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A Review Of The Deception In Obamacare


The goal to provide
affordable healthcare and access to care for all Americans is an admirable

Obamacare is making
Americans dependent on the government for their healthcare access and health
decisions. This is bad.  

President Obama is doing
this slowly but surely. The goal is to first destroy the present healthcare
system. The more he destroys, the more the stakeholders, healthcare insurance
industry, hospital systems, physicians, drug companies and patients game the

Americans are known to
be individualists. They cherish their freedoms. However, over the last 50 years
many entitlements have been introduced at the price of forfeiting many

Some entitlements have
been for consumer protection. Others have not.

Obamacare is about
government control and takeover of the healthcare system. President Obama
understands that he cannot force people to do what they do not want to do.

However they will do
anything when they have no choice. He is creating a no choice environment
slowly but surely. He is doing it with a bad law, lots of lies and
disinformation, and a golden tongue,

He changes and ignores
parts of the law he wrote to fit he needs by executive order, disrespects the
will of the people and congress and folds to pressures of lobbying from his
base. He marginalizes his enemies.

His changing the law
without the consent of congress is probably unconstitutional. However no
Republican has questioned his tactics.

He stays on the
offensive and keeps Republicans on the defensive. Republicans must have someone
who could parry his offenses and put him on the defense even though he has the
unequivocal support of the traditional media.

On Friday August 9th
was a perfect example of this offensive.

 The idea that you
would shut down the government unless you prevent 30 million people from
getting healthcare is a bad idea.

I'm assuming they will not take that path…I have
confidence that common sense, in the end, will prevail.

He explained his delay
of the employer mandate by saying going through congress would be the
"normal thing" to do "but
we're not in a normal atmosphere around here when it comes to

The president called efforts to defund and repeal Obamacare the
Republicans' "holy grail" and an "ideological fixation."

You have got to give it
to him. No one would ever think Obamacare is having so much trouble because it
is a lousy law, that is impossible to build out its structure, Impossible to
implement, impossible to execute and impossible to enforce.

The majority of the
country and majority of the stakeholders are against the bill. President Obama
just goes right ahead despite the will of the people.

Obamacare did not get
one single Republican vote. President Obama’s twist and turns have kept
Republicans in a reactive and defensive mode.

Every time Republicans
go on the offense they are blamed for the bad law’s (Obamacare’s) failure. They
do not answer back.

I believe the majority
of the people know what President Obama is about. They do not trust him. The
lack of trust renders him ineffective.

Someone needs to turn
the tables on him.

I also believe President
Obama is about to turn the tables on himself. His says he is all ears for a
good idea but Republicans have not presented him with one.

This is not true. The
problem is President Obama doesn’t listen.

The list of lies and
misrepresentations are enormous. These lies and misrepresentations have
resulted in the lack of trust.

 Below are some of the things promised that so
we should not forget.

 1. Imposing President Obama’s idea of
transformation by social engineering in which the majority of the population
does not agree with.   

 2. Imposing 21 hidden taxes that few knew
about before the bills passage. Few knew the effect of these taxes on small
business until after passage of Obamacare. These tax increases amount to
the biggest tax increase in our history.

This occurred after
President Obama pledged no new taxes for anyone making less than $250,000
dollars. All of these taxes are passed on to consumers.

3. The medical device
tax alone is a job-killing and innovation-stifling medical device tax.  33 Democrat senators are now opposed to this tax. He does not have the support of his
party on this tax.

4. Independent Payment
Advisory Board (the IPAB) is going to ration healthcare. Sarah Palin called it aka death
panels. Howard Dean, recently termed it a "health care rationing body" that
Congress should be "getting rid of." The Obama administration insists
there is not going to be rationing of care.

5. The original CBO
cost estimate was a reduction in healthcare costs in 10 years. The
CBO used six years of costs and ten years of taxes. The next estimate using
rigged numbers given to the CBO by the Obama administration was less than $1

The ten-year CBO cost
estimate has now reached $2.6 trillion. We have not heard from the Obama
administration about this new estimate.

6. Health
insurance premiums are soaring despite President Obama’s recent statements that
healthcare premiums are falling. All employer and employees will say President
Obama is wrong.

Four years ago President
Obama promised the public that, “Obamacare
reduce a "typical family's premium by up
to $2,500 a year."

 7. We will all recall these famous lines, “If you like your doctor, you
will be able to keep your doctor. Period.”

  If you like your healthcares plan, you will be able to
keep your health care plan. Period.

  “No one will take it
away. No matter what.”

No statement is more
dramatic but false.

8. Obamacare is making an already serious shortage of doctors worse. Many physicians are opting out of Obamacare, Medicare and Medicaid.

To make thing worse
patients will have to pay physicians directly. The Obama administration
published a new rule for seniors. CMS will not reimburse patients the 70% of
their out of pocket expenses for physicians that do not accept Medicare or

The result will be an
increased out of pocket burden for all patients, rich and poor.

9. Many employers
are likely to drop health coverage. There has been widespread reduction of work hours to avoid paying an Obamacare
mandated penalty to provide employee health insurance.

 Obamacare has created a burden on economic
growth. It has resulted in the creation of "seven times more part-time jobs"
than full-time jobs. It has decreased the living wage for millions of Americans
and created millions more uninsured patients.

These part time workers
will be forced to buy insurance through the health insurance exchanges. This
will balloon the federal deficit even further.

10. The states have been
given the option to participate in health insurance exchanges and expanding
Medicare and Medicaid. Thirty three states have refused to participate. They
know they cannot afford to increase their states’ budget deficit.

11. The healthcare
insurance industry thought it would make a killing by insuring people through
the health insurance exchanges. In Medicare and Medicaid they bill the
government for doing the administrative services. President Obama has changed
the promised health insurance rules. Several insurers are leaving all of the states. More are to follow.

12. Recent surveys show that 63 percent of voters think the law
needs to be changed, and a 57-percent majority feeling that implementation is
"a joke."

This is happening despite
the traditional media helping President Obama’s political campaign to promote

These are just a few of
the reasons for the mistrust of the administration.

Next will be a summary
of President Obama’s probable unconstitutional delays in the law without
congressional permission.

Max Baucus was
corrected. Obamacare is an expensive train wreck.

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

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Another Friday Afternoon 3 P.M. Press Release

Stanley Feld M.D.,FACP, MACE

It seems
that all official Obama administration reports that portend bad news for the
administration’s policy are released late Friday afternoon when everyone is
heading home for the weekend.

It is a
time when the news of the reports and press releases are least noticed.

The late
Friday afternoon report on August 2, 2013 was released the afternoon congress
was going on summer recess for the month of August.

The HHS Inspector General announced that Obamacare’s privacy protections program
is way behind schedule. It will not be ready by October 1st when
policies will be available to the public. It opens the door for rampant
violations of the law.  

'Based on OIG’s analysis, Obamacare’s exchanges
may end up illegally exposing Americans’ private records to hackers and

The Privacy Act of 1974
mandates that each agency of the federal government utilize administrative and
physical security systems to prevent the unauthorized release of personal

The Federal Information
Security Management Act of 2002 requires the executive branch to ensure that
Americans’ private records are protected from misuse and security breaches.

The Obama administration is
ignoring these laws. On his road show this week he said the health insurance
exchanges will start selling insurance on October 1,2013 to go into effect
January 1, 2014.

“In the
case of the Obamacare hub, any serious security breach could result in
identity theft.”

The Obamacare “Hub”
computer system cost the government $267 million so far.
  It is
supposed to provide the government with the means to see which applicants
qualify for what programs.

On another Friday afternoon during the July 4th weekend,” Sarah Kliff and Sandhya Somashekhar of
the Washington Post discovered that the Obama administration had
buried in the Federal Register the
announcement that the government won’t be able to verify whether or not
applicants for Obamacare’s insurance exchange subsidies are actually qualified
for the aid
, in the 16 states that are setting up their own exchanges."

until at least 2015, these states will be able to “accept the applicant’s
attestation [regarding eligibility] without further verification.”

This appeared in the Federal
Register two days after the July 3rd announcement that the federal
government would postpone for one year a requirement that employers with 50 or
more full-time workers provide health coverage.

I think these announcements
warrant the term ”Weekend Surprises
or DBA “I hope no one notices.”

“The Obamacare health insurance exchanges
mandate the creation of a “data hub” through which exchanges can access
personal records from seven different agencies—the Internal Revenue Service,
the Social Security Administration, the Department of Homeland Security, the
Veterans Health Administration, the Department of Defense, the Office of
Personnel Management, and the Peace Corps—in order to determine eligibility for
exchange subsidies and mandate penalties.”

Under FISMA, the Obama administration must
adhere to the guidelines of the National Institute of Standards and Technology
in achieving these safeguards, before the Obamacare exchanges can legally

 It seems it is much more convenient to ignore the law
written by the Obama administration and Democrats. Unfortunately, Republicans
have not pointed this out to the people.

It gets worse. This policy
not only ignores the law of the land it encourages fraud and abuse.

 According to the law, a person or family is
not eligible for Obamacare’s subsidies if your employer has offered you what
the government considers “affordable” coverage.

Employers are not going
to have to report whether or not they’ve offered “affordable” coverage. How can
the government verify whether or not workers are eligible for subsidies? 

 The Centers for Medicare
and Medicaid Services said. “The exchange may accept the applicant’s
attestation regarding enrollment in an eligible employer-sponsored plan…without
further verification, instead of following the procedure in

The Obama administration
will also allow people to gain means-tested subsidized coverage on the
exchanges without having to have the IRS do means testing on their income.

According to CMS,

 “For income verification, for the first year of operations, we are
providing Exchanges with temporarily expanded discretion to accept an
attestation of projected annual household income without further verification.”

 Another President Obama
If enough people enroll in the new entitlement it will be politically
impossible for Republicans to repeal Obamacare in the future.

These ad-lib rules
deliberately encourage tens of billions of dollars of waste, fraud, and abuse.  

Who is going to suffer
in the long run? Hard-working taxpayers. These taxpayers will not receive
subsidies. Many of them do not support Obamacare.

Where is the Republican

President Obama
anticipated the Republican outrage this week on his political road show.

President Obama blamed Republicans for doing
everything in their power to torpedo Obamacare implementation
during a Friday afternoon “press conference” before going on his $7.6 million
dollar a week vacation on Martha’s Vineyard.

 “The “one unifying principle” for Republicans
was keeping 30 million people from getting healthcare, hurting the elderly,
removing care for the ill.

“There’s not a
pretense how they’re going to replace it with something better,” Obama said. He
accused Republicans of an “ideological fixation.” He then compared the
Obamacare rollout glitches to glitches in Apple rolling out a new iPad. “I make
no apologies” for such glitches, he state

Then he said it
would be foolish for Republicans to “shut down the government to prevent 30
million people from getting healthcare.”

Notice President Obama's use of words.

Pure unadulterated well crafted demagoguery.

When are the Republicans’ going to respond? When are the
people going to recognize President Obama’s game.

Hopefully not before it is too late.

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

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Maybe Obamacare Is Not Such A Good Idea


President Obama;

Maybe Obamacare
is not such a good idea.

I suspect
you will not read this nor have you read my letters to you when you were first

The letters
were about how our healthcare system became so dysfunctional and what solutions, that will work,
are needed to repair the healthcare system.

Dear President Obama Part 1

Dear President Obama Part 2

Dear President Obama Part 3

Dear President Obama Part 4

Dear President Obama Part 5–elect-barack-obama-part-5.html

Dear President Obama Part 6


Stanley Feld M.D., FACP, MACE

President Obama did not listen to me at all. It looks like his
agenda was not to "Repair the Healthcare System." It was to destroy it and
replace it with a government control single party payer system.

I continually think about the statement President Obama made to
Barney Frank and John Kerry when passing the law. They said the law must have a
public option and a single party payer to work.

President Obama told them not to worry about the public option.

Now Obamacare is experiencing objections from the interest
groups whose support is needed.

The unions, government workers in congress, the IRS, the healthcare
insurance industry, small businesses, large corporations, large fast food
businesses, privately insured Americans, Medicare insured seniors, physicians, hospital
systems all have objections to the law now.

Many states realized they would get stuck with the bill for the
health insurance exchange. Thirty-three states did not want to participate.
Many did not want to increase their budget deficits.   

All these stakeholders are realizing that President Obama has thrown
them under the bus despite his initial promises.

Obamacare does not serve the vested interests of any of these

Some of the stakeholders are going to get special treatment with

For Obamacare to work, everyone must participate. The mandate was
included in the law to force everyone to participate.

The Supreme Court called it a tax to allow the Obamacare law to be

A basic insurance principle is that everyone must participate to spread
the risk for the insurance industry.

The present system and Obamacare exempts the insurance companies from incurring risk.
It also exempts patients from being responsible for their own health and
healthcare dollars. When Americans spend their own money the free market works as
we have seen in many industries. They support the best product within their

The government could support the underprivileged by providing them with
their healthcare dollars and teaching them how to use them.

The biggest villains in the healthcare system are the healthcare
insurance companies. They take 40% of every healthcare dollar spent by private
and public insurers off the top.

The healthcare insurance industry is the administrative service
provider for all public employees, public healthcare entitilments and private health insurance plans. The 40% overhead is charged
to all. The charge is not transparent.

Obamacare sets the conditions for continued abuse by the healthcare
insurance industry.

The Obama Administration estimates that
of the projected 7 million exchange enrollees next year, 2.7 million need to be young adults (with a low
risk of being sick) to make the premiums work.

 If young people don’t show up for Obamacare,
premiums for everyone else in the exchanges will skyrocket—which, of course,
dramatically increases the cost for taxpayers.

and congressional government workers wanted to be exempt from Obamacare because

 “The 2010 law
generally requires lawmakers and aides who work in their personal offices to
get coverage through the exchanges.”

That implies that they would no longer receive
coverage through the Federal Employees Health Benefits Program…

It does not clearly
authorize the government to pay premiums for federal employees who obtain
insurance through the exchanges.

Nor does it
authorize the government to reimburse federal employees who buy health
insurance on their own.”

Congress and their aides have
the best insurance coverage in the nation. Taxpayers subsidize their healthcare

Through the years this
subsidy has been discussed.  Many have objected
to the cost of this Congressional benefit.

Congress has
objected to Obamacare changing the healthcare insurance they have enjoyed. Congress wants to be exempt from Obamacare.

Barack Obama privately told Democratic senators he is now personally involved
in resolving
a heated dispute over how Obamacare treats Capitol Hill aides and
lawmakers, according to senators in the meeting.”

Few on Capital Hill objected to President Obama changing the
rules of the law himself to protect their benefit.

A question should be asked, “Why should Congress and
congressional aides be treated differently than the general population?”

“At issue is whether
Obama’s health care law allows the federal government to continue to pay part
of the health insurance premiums for members of Congress and thousands of Hill
aides when they are nudged onto health exchanges.”

Currently, the government
pays nearly 75 percent of these premiums.

 The government’s contributions are in jeopardy
due to a controversial Republican amendment to Obamacare, which
says that by 2014, lawmakers and their staff must be covered by plans “created”
by the law or “offered through an exchange.”

President Obama declared,
“I'm on it”
to clear up Capital Hill’s objections to Obamacare’s effect on
Capital Hill’s healthcare insurance.

The IRS employees also want to be exempt from Obamacare.

chief Danny Werfel, the head of the agency charged with administering Obamacare
said that he would rather keep his own insurance than get coverage under the
system created by President Barack Obama's single domestic policy

Danny Werfel made this statement before the
House Ways and Means Committee,

"I would prefer to stay with the current policy that I'm
pleased with rather than go through a change if I don't need to go through that

other federal workers, IRS employees currently get their health insurance
through the Federal Employees Health Benefits Program, which also covers
members of Congress.

House Ways and Means Committee Chairman Dave Camp said he has long
believed, every American ought to be exempt from
the law, which is why he supports full repeal,”

IRS employees have the
responsibility to enforce much of the health insurance law
especially in terms of collecting the taxes and distributing subsidies that finance
the whole system.

IRS agents, in addition to
collecting taxes will also collect data and apply penalties for those who fail
to comply with many of Obamacare’s requirements.

The special favors are coming
next. The Obama administration will only create more dysfunction in the
healthcare system. President Obama’s published goals are good. However, the law
is bad and its execution is worse.

Maybe he ought to consider
my Ideal Medical Savings Accounts as a free market solution to our healthcare
system’s problems.

If you do
not like what is going on, please write your senator, congressman and the
President and tell them that,

“Maybe Obamacare Is Not Such A Good

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

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Physicians Opting Out Of Medicare And Obamacare

Stanley Feld M.D.,FACP,MACE

I have discussed the disillusionment of Obamacare by several
major stakeholders, hospital systems, insurance companies, union leaders and
large corporations in my last three blog posts.

As Obamacare gets more complicated physicians are opting out of Medicare and will
not participate in Obamacare.

All most physicians want is to practice the best medicine they can
using their intellectual property or surgical skills.

Physicians are people who want to help people. They are not street

Obamacare is trying to commoditize medical care, decrease physician
value and reimbursement.

Commoditization of medical care will decrease physicians’ freedom to
exercise their medical judgment. Medical decision-making will be in the hands
of distant involved bureaucrats. Access to care will be determined by
bureaucratic rules and not the patients and their physicians.

 Physicians are opting out of Medicare, Medicaid and
Obamacare.  They have become totally frustrated
with Medicare and Medicaid reimbursement rates and the mounting rules and

Marilyn B. Tavenner R.N., the
administrator of the Centers for Medicare and Medicaid Services told congress
that an insignificant number of physicians have dropped out of Medicare and
This is clearly not true.

CMS report said 9,539 physicians who had accepted Medicare in the past opted
out of the program in 2012, up from 3,700 in 2009. That compares with 685,000
doctors who were enrolled as participating physicians in Medicare last year,
according to CMS, which has never released annual opt-out figures before.

The number of physicians opting out of Medicare last year
nearly tripled from three years earlier, according to the Centers for Medicare
and Medicaid Services.

This is not an insignificant number of physicians when
America is experiencing a shortage of primary care physicians.

A study in the
journal Health Affairs this month found that 33% of primary-care physicians
didn't accept new Medicaid patients in 2010-2011,”
even though they continue to participate
in Medicare.

Some physicians are limiting the number of Medicare patients
they treat even if they don't formally opt out of the system.

The reason is Medicare reimbursement is so low and getting
lower. It some cases reimbursement is lower that the cost to deliver the care.

 A study found that 4%
of family physicians are now in cash-only or concierge practices.

 The Obama administration issued an
executive order this year where Medicare would not reimburse anything to
patients paying cash to non-participating physicians.

This is putting an increased burden on Medicare patients.

All told, health experts say the number of doctors going
"off-grid" isn't enough to undermine the Affordable Care Act.”

The Obama administration’s bureaucrats are not facing
reality. Today, before the expansion of Medicaid it is difficult for Medicare
and Medicaid patients to find a physician.

Joe Baker,
president of the Medicare Rights Center, said his patient-advocacy group has
had an increase in calls from seniors who can't find doctors willing to treat

Many physicians will not accept Medicaid patients. CMS
administrators want the public to believe this is not true. They say the number
of physicians not taking Medicaid is insignificant.

Medicaid physicians have to see as many as 200 patients or
more a day to make a living.  There are
not enough minutes in a day to see that many patients and have a quality care visit.
These physicians have employees who are seeing patients for them. These
physicians then sign off as seeing the patient.

This volume then triggers a probe on their practices and
accusations of fraud. As Medicaid gets expanded through Obamacare to cover the
uninsured, there will be even fewer and fewer Medicaid physicians and a greater
physician shortage.

Medicaid physicians are not interested nor can they take the
government abuse.

Employers are cutting back on hiring full time employees and
hiring part time employees to avoid the rising insurance costs.

Marilyn B. Tavenner, the administrator of the
Centers for Medicare and Medicaid Services,
told Congress that she
had heard of only “isolated incidents” in which employers tried to cut back
hours. Representative Steve Scalise, Republican of Louisiana, told her that she
must be “living in some cocoon” because he heard of such actions almost every

Every large corporation is converting as many
full time workers to part-time workers as possible because of Obamacare in
order to avoid the Obamacare mandate. Part-time workers have felt the
disastrous impact on wealth production and economic activity.

These are the revised statistics from the Bureau
of Labor Statistics for May and June.

The establishment
survey showed a gain of 162,000 jobs.

The previous two months were revised
lower. The employment change for May revised down by 19,000 (from +195,000 to
+176,000), and the employment change for June revised down by 7,000 (from
+195,000 to +188,000).

The unemployment rate dropped 0.2 to 7.4%. 

the Unemployment Rate Drop

  • Employment
    rose by 227,000 of which 103,000 were part-time jobs. 
  • The Civilian Labor
    Force Declined by 37,000 even though population rose by 204,000.
  • Those "Not in
    Labor Force" rose by 240,000.
  • Participation Rate
    fell 0.1 to 63.4%, a mere 0.1 higher than the low of 63.3% dating back to 1979.

July BLS Jobs
Statistics at a Glance


  • Payrolls
    +162,000 – Establishment Survey
  • US Employment +227,000
    – Household Survey
  • US Unemployment
    -263,000 – Household Survey
  • Involuntary Part-Time Work +19,000 –
    Household Survey
  • Voluntary Part-Time Work +84,000 –
    Household Survey
  • Baseline Unemployment
    Rate -0.2 – Household Survey
  • U-6 unemployment -0.3
    to 14.0% – Household Survey
  • Civilian Labor Force
    -37,000 – Household Survey
  • Not in Labor Force
    -240,000 – Household Survey
  • Participation Rate
    -0.1 at 63.4 – Household Survey


 Marilyn B. Tavenner making the above statement to congress
makes her a liar or a person not in touch with reality. Have can the American
people entrust our healthcare decisions to these bureaucrats?

The Obama administration needs both the primary and
secondary stakeholders’ cooperation if Obamacare has the slightest chance of

I do not think Obamacare can survive. It will sink under its
own weight as it tries to control all of the stakeholders through oppressive
regulations without regard for their vested interests.

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

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More Government Control

Stanley Feld M.D., FACP, MACE

I have covered the discovery of the
tricks Obamacare has played on hospital systems, insurance companies, union
leaders and large corporations in the last three blogs.

The Obama administration needs all three
groups to cooperate if Obamacare has the slightest chance of success.

Physicians are now starting to react to
Obamacare and its restrictive regulations.

It is clear to me that the Obama
administration has no respect for physicians, their intellectual property,
their surgical skills, their honesty or their character. 

The Obama administration has labeled
physicians as commodities and thieves. Obamacare devalues physicians and figures
whatever reimbursement it offers physicians will accept.

Ezekiel Emanuel M.D., Obamacare policy advisor, expresses a vivid example of this disrespect in
his recent article in the New York Times entitled “Don’t Give Up On Healthcare

Dr. Emanuel discusses S.G.R., or the Sustainable Growth Rate

The formula is seriously flawed in its attempt to contain rising
healthcare costs. 

The formula is rigged to penalize physicians
yearly for their reimbursement for treating Medicare patients. Every year
Congress waives the penalty for that year. This waiver is commonly known as the
“doc fix.”

The yearly penalty has been accumulating since 2002
so this next year it is scheduled to reduce physician payment by 24.5%.

Neither the AMA nor the traditional media
has articulated the meaning of the S.G.R to the public in a comprehensible way.

The S.G.R provides no incentive for individual
doctors to be more efficient since the target level applies to total nationwide
physician costs.

The cuts from the formula are indiscriminate. The
cuts would affect high quality, cost-effective doctors the same as it would
inefficient free spending physicians. It would also affect underpaid primary
care physicians.

The goal should be to incentivize all physicians to
be efficient and cost effective providers in their treatment and patient recommendations.

Ezekiel Emanual’s disrespect shines through when he

desperately want the S.G.R. repealed and replaced
so they can charge what they
want without the potential of massive cuts hanging over them each year.”

Congress agrees with physicians that S.G.R. is seriously flawed. The House Energy and
Commerce Committee is starting to mark up the repeal of the S.R.G formula. It
is going to replace it with a 0.5% yearly increase in physician reimbursement
until 2018. In 2019 the government will link Medicare payment to the quality of
care each physician provides.

The measurement of physician performance will be
measured, by big data provided by the Enhanced Quality Reporting System. The
EHQRS is being developed using the ICM-10 coding system. ICM-10 uses 68,000 codes
vs. 18,000 codes in ICM-9.

Ezekiel Emanual M.D. doesn’t like this
formula. It does not provide incentives for physicians to accept bundle reimbursement
for the treatment of their patients.

Dr. Emanual believes  

payment incentivizes quantity over quality. Physicians make more money by
ordering more tests, seeing patients more frequently in follow-ups and
providing more treatments. The payment system is a key accelerator driving up
Medicare costs — and therefore the federal government’s deficit”.

Dr. Emanual does not trust physicians to
do the best job possible. He also ignores the defensive medicine issue. He

“In 2009, the
Congressional Budget Office did a comprehensive assessment of the potential
cost savings from medical malpractice reforms

Its conclusions: A
package that included a $250,000 cap on noneconomic damages, a $500,000 cap on
punitive damages and a one-year statute of limitations for claims by adults
would save about $11 billion a year
percent from reduced malpractice premiums and the rest in the form of fewer
defensive procedures like M.R.I.’s.

Emanuel concluded that $11 billion
dollars a year savings is insignificant because it is a cost saving below $26
billion dollars a year
He contends tort reform is a distraction from real
efforts to control healthcare costs and should be ignored. The CBO
scoring information has lead Dr. Emanuel to an inaccurate opinion.

Douglas W. Elmendorf’s,
head of CBO
at the time, conclusion was not nearly as definitive as Dr. Emanuel’s

The malpractice issue of defensive
medicine and over testing is real. The Massachusetts Medical Society survey of
defensive medicine is real. Most physicians in Massachusetts are
liberal/progressive and so the sample is not biased toward conservatives.

truth is a full accounting reveals that more than 10 percent of America's
health expenditures per year are spend on tort liability and defensive

percentage of healthcare costs is even greater when the Massachusetts
Medical Society survey
is taken into account. The amount spent for
defensive medicine can be extrapolated to actual costs from this survey.  

I have
written a series of blogs analyzing the impact Massachusetts Medical Society’s
survey. The extrapolated costs turn out to be about $700 billion dollars a
year. The real cost of defensive medicine is somewhere between $242 and $700
billion dollars a year.

2008 damage awards alone for medical malpractice claims reached $5.9 billion
  The total of medical tort costs was $16 billion for legal
costs, underwriting costs and administrative expenses. From 1986 the average
jury award was $100,000. In 2006 the average award increased to $637,000. No
one knows what the award value is for cases settled out of court.

year, 25% of practicing physicians are sued. 90% of physician sued are found
innocent. The average defense cost is $100,000. This cost is not included in
the CBO scoring

fear of lawsuits causes most doctors to practice "defensive medicine"
as the interviews of Massachusetts physicians points out.  The result is
unnecessary testing, referrals, and procedures to protect themselves from
allegations of medical negligence.  

recent survey of doctors published in the Journal of the American Medical
Association found that 93% of physicians admit to practicing defensive
medicine. A 2008 survey by the Massachusetts Medical Society found that about
25 % of medical procedures are defensive in nature.

waste results in increased healthcare insurance premiums. The premium increases
result in an increase of at least 3 million uninsured people per year. When
these uninsured people get sick they avoid going to a physician. This results
in a decrease in work productivity. It is estimated that the annual decrease in
productivity is more than $40 billion dollars a year.

states where tort reform has been instituted by placing caps on so-called
non-economic damages, the malpractice costs have decreased 39%. This drop in
costs is a result of decreased malpractice suits. The decrease is economically
bad for the plaintiff attorneys. Annual malpractice premiums have gone down at
least 13%. In fact, the medical malpractice business for plaintiff attorneys
has about dried up in Texas.

Dr. Emanuel and the
administration want to connect the leverage they have with the SGR formula to
getting physicians to accept a bundled rate for treating a patient.

Dr. Emanuel “would tie an
S.G.R. repeal to a slow reduction in fee-for-service payments to those
physicians who do not switch to bundled payments and other payment models.”

In other words, accept risk
for treatment that an insurance company would normally accept risk for while
ignoring the malpractice implications of missing a diagnosis or not seeing a
patient at appropriate intervals.

Isn’t the government going
to test physician’s treatment with 88,000 codes in ICM -10 and the Enhanced
Quality Reporting System?

Isn’t the government going
to force the decisions of the Independent Physician Advisory Board on

Now the government wants to
force physicians to accept the potential liability for not using their medical

This is not aligning physician
incentives with efficient treatment cost. It is dictating medical treatment to

This is putting physicians
well on the Road to Serfdom.

Physicians are getting
tired of all of this. They are about to quit treating Medicare patients.

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

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