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All items for December, 2013


Medicaid’s Problems And Obamacare

Stanley Feld M.D.,FACP. MACE

Some of my reader’s read my article about Moises and Medicaid on December 30, 2007. This was before President Obama was elected President.

At that time I was unsuccessful in my attempt to help Moises receive Medicaid healthcare coverage for his family of 4 in the state of Texas. I was successful in getting his kids covered in SCHIP.

We have all experienced the frustrations of government bureaucracy. The actual government policy might be praiseworthy. The execution of the policy hardly ever reflects the purpose of the policy.

Moises and Medicaid is an example of a failure to implement a policy designed to help the poor circa 2007. The consequences of not getting Medicaid coverage were potentially grave to Moises and his family. It is no different in 2013.

Moises is a hard working law abiding American citizen born in El Salvador. He is presently going through a government certified navigator to optain Medicaid coverage or Obamacare coverage..

He application is stuck. He does not know what his final income will be in 2013. I told him I thought they meant his income on his April 2013 tax return.

He started this application two weeks ago. It will not be completed by the December 23th deadline for January 1 coverage.

The Obama administration’s policy is to provide healthcare coverage for all.  

The poverty level income number is outdated. It was written in 1955. The income levels are supposed to be defined by the states. There have been slight increases in income levels to qualify for assistance each year. Medicaid eligibility is based on the poverty level in each state.

The federal government defines Medicaid eligibility in 2013 as earning an income of 133% above the poverty level. The poverty level is $23,550 for a family of four. One hundred and thirty three percent of that is $31,321.50 per year or approximately $15 per hour in a forty-hour work week.

"For many eligibility groups, income is calculated in relation to a percentage of the Federal Poverty Level (FPL). For example, 100% of the FPL for a family of four is $23,550 in 2013. The Federal Poverty Level is updated annually."

In 2007 President Bush did not permit a realistic change in the definition of poverty. The title of the New York Times article was “U.S. Curtailing Bids to Expand Medicaid Rolls.”

An hourly rate of $8.75 equates to a weekly pay of $350, monthly pay of $1,517, and an annual salary of $18,200. An hourly rate of $15.00 equates to a weekly pay of $600, monthly pay of $2,600, and an annual salary of $31,200.

 On Dec. 20,2007 the Bush administration rejected a proposal by Ohio to expand its Medicaid program to cover 35,000 more children. Ohio now offers Medicaid to children with family incomes up to twice the poverty level, or about $41,000 a year for a family of four. The state had proposed increasing the limit to three times the poverty level, to about $62,000.”

Is it better not to work?  

The average national unemployment insurance benefit was about $300 per week in 2010, 2011, and 2012.  However, individual benefit levels vary greatly depending on the state and the worker’s previous earnings.  In addition, in several states, workers receive higher benefits if they have dependents. 

 The maximum state-provided benefit in 2012 ranged from $133 in Puerto Rico and $235 in Mississippi (the lowest for a state) to $653 ($979 with dependents) in Massachusetts.[11]  

A hard working laborer is probably better off on unemployment insurance than working especially if unemployment insurance is extended to 99 weeks.

The average national unemployment insurance benefit is equal to a little under $15 an hour.

Unemployment coverage is 99 weeks. These people are also eligible for Medicaid. If you earn one dollar over $15 an hour you are not eligible for Medicaid.

Do these numbers encourage people to work and be independent or dependent on government largess?

This is a disincentive for someone to be a productive worker and advance in an earning position.

Obamacare creates a disincentive to be independent and make more than $31,321.50 annually.

 The healthcare insurance subsidy is not readily available.  

Obamacare subsidies might be a good deal for the poor who work hard to increase their income. So far it looks like the premiums and the $5,000 dollar deductibles are unaffordable for working families.

The key to successful healthcare reform is to encourage consumers to take responsibility for their care through incentives. Healthcare reform must encourage independence, self-responsibility and not to be dependent on the government.

Medicaid has big problems.

Medicaid does not insure all eligible consumers.

Physician reimbursement is horrible.

Most physicians do not participate in Medicaid.

Why don’t eligible patients participate?

The Medicaid application is too complicated.

Many of these citizens are laborers with meager education and cannot understand the application.

Many come from countries where medical care is free. They feel intimidated by the lengthy application.

They are afraid of government questions because they have experienced government oppression in the past. They want to be independent of government.

They believe it is too difficult to see a doctor. They only go to doctors when they absolutely need to go to the doctor.

Obamacare does not deal with any of these issues.

 I became aware of another horrible truth about Medicaid this week.

 "MEDICAID COMMUNICATION NO. 10-08", PDF  on November 24, 2010 from the state of New Jersey updated guidelines that were issued in Medicaid Communication No. 00-16, dated August 10, 2000, governing the recovery of correctly paid Medicaid benefits from the estates of deceased Medicaid clients or former Medicaid clients.

 “Medicaid benefits received on or after age 55 are subject to estate recovery.

This is specifically stated and acknowledged on the authorization page of the

PA-1G Medicaid Application Form.”

“Estate recovery in New Jersey includes payments for ALL services, not merely

services for institutionalized clients. There is no limitation on the type of

service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees.”

Many other states are looking into enforcing the Medicaid mandate now that many sick older (greater than 55 years old) consumers are applying for Medicaid.

I believe in helping the less fortunate. I am not for increasing government waste and bureaucracy. I am not for the state taking away assets of the unfortunate family just because these consumers used Medicaid.

Who should you trust? Is it the government or yourself? The government’s job should be to level playing field for all the stakeholders. It is not to control the consumers and make them dependent on the government.

There are many things wrong with the Medicaid system. Rather than adding on to the complexity of the system and making it more inefficient, the Medicaid system must be revamped to encourage freedoms, independence, self responsibility, and incentives so that consumers can learn to become healthy, maintain their health and ultimately decrease the cost of healthcare.

A healthcare system that drives consumers into dependence on the state will diminish freedom, self-responsibility and incentives to stay healthy and diminish healthcare costs.  

It will ultimately fail.

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

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Insurers Wary of Obamacare Administration

Stanley Feld M.D.,FACP,MACE

The government is dependent on the healthcare insurance industry for administrative services.

Obamacare’s success is dependent on the healthcare insurance industry selling insurance to consumers who buy insurance from the healthcare exchanges.

Several insurance companies have opted not to participate in the health insurance exchanges.

The companies that are participating are the companies that have figured they will make a killing. The killing will come if there is a minimum of administrative services and a maximum of consumers who present little risk.

The government has  a commitment to the insurance industry to pay the total cost of healthcare insurance to the healthcare insurance companies for all subsidized consumers.

If partially subsidized consumers do not pay the insurance company their premiums the lag time before the insurance company can drop that consumer can be up to a year.  The consumer can enjoy the coverage benefits of the policy at a loss to the healthcare insurance company.

It is almost impossible to know whom to believe or trust.

Is the Obama administration lying or is it the insurance companies?

What are the real numbers?

Who is insured?

 How many people have applied through the health insurance exchanges?

 How many people have been approved for coverage by the Obama administration?

 How many are approved for Medicaid?

How many people of the 5.5 million who lost coverage are now covered under Obamacare?

What percentage of Obamacare covered consumers will have a preexisting illness?

 How many people have paid their premium and will have insurance January 1, 2014?

How many people who have lost their insurance have signed up and paid their premium?

 How many people are getting subsidies?

 How much is the subsidy?

 How many people have bought non-subsidized private insurance from the health insurance exchanges?

None of the answers are easily available. 

If President Obama didn’t exempt group insurance policy holders’ from Obamacare for one year, the nation would be experiencing a greater disaster.  

The public is becoming wary of the misinformation. President Obama has lost the public trust.

The news of increasing problems with implementation of Obamacare is becoming boring. People are becoming more frightened. 

This is just where President Obama wants us. He wants us to give it over to the government.

Can we trust government to run the healthcare system? The answer is no!

America cannot afford this incompetence medically or financially.

The attitude of Obamacare fans is that it happened, the President is trying to fix it. Let’s live with it. It is the law of the land?

President Obama has even blamed the structure of government agencies for the screw up. It is not his fault.

This should be the precise argument for why the government should not run the healthcare system. 

He might have found a way to shift the blame.  A New York Times/CBS poll said President Obama's approval rating is improving at the same time all the other polls said it has fallen below 39%.

Both the NYT and CBS are big Obama fans. Again, what is the truth?

The healthcare insurance industry is screaming bloody murder. There is no back end to the web site. There are errors in applications. One error begets another error. The insurance companies, rather that make a killing, will lose their shirt.

President Obama promised to make them whole without the companies providing evidence of loss.

Insurers say they don't know the full extent of back-end problems with and are wary of the Obama administration’s claims they are fixing the issues quickly.

President Obama and White House officials are trumpeting new fixes to the Obamacare website, saying they met a self-imposed Nov. 30 deadline to deliver a smooth user experience to the vast majority of Americans trying to enroll in the online insurance exchanges.

As of December 13,2013 at least 20% of the applications have been plagued with problems.

“Insurers and federal officials sifting through insurance applications under the health-care law have identified a raft of errors, including missing customers and inaccurate eligibility determinations that mean people may be enrolled in the wrong coverage.”

 “In some cases described by a state official with knowledge of the matter, legal immigrants who aren't yet eligible for Medicaid in were nevertheless told they would be enrolled.”

The Obama administration has provided few details on the remaining back end technical bugs. These bugs are preventing insurance brokers from enrolling people in coverage. There is a great difference between applying for coverage, enrolling in coverage and finally obtaining coverage. is supposed to transmit 834 forms to the insurer of the consumer’s choice by computer.

Insurers have either received these forms riddled with errors or not at all. They cannot possibly issue insurance to people who have applied and have sent incomplete or inaccurate information to the insurer.

The Department of Health and Human Services urged insurers to help avoid Jan. 1 mix-ups. The Obama administration modified coverage rules. Officials asked the healthcare insurance industry to cover people retroactively who missed paying for the premiums by January 1 because of defective applications. The Obama administration has asked the insurance industry to pay for drugs next month, even for customers who haven't yet fully enrolled.

This is not a good way to run a business. The Obama administration seems to be playing it by ear. They are changing the requirements of the law daily. Obama fans say it is a pragmatic adjustment. Others say it is unconstitutional. President Obama, you cannot play both sides of It’s “the law game.”

Insurance-industry executives warn, that some of these data problems will only emerge once customers begin seeking care in January at physicians' offices, pharmacies and hospitals.

 The result could be bureaucratic chaos as doctors and patients storm insurers' phone banks and federal officials work to clean up the inaccuracies.

 The National Association of Health Underwriters sent a letter to President Obama on Tuesday asking him to fix a bunch of back-end obstacles.

 “We want to make it clear that a number of back-end technical obstacles still exist for health insurance agents and brokers trying to actively support the federal marketplace,” she wrote.

“Agents and brokers would like to help increase marketplace enrollment as much as possible over the next few months, but technical barriers prevent them from doing so.”

I think everyone gets this point.

However, a more important point is that if this has happened with the web site can we trust the government to have control over the large slice of our economy that healthcare represents?

More importantly, can we trust the government to make our medical care decisions for us?

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

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Are Medicare Premiums Increasing In 2014

Stanley Feld M.D., FACP, MACE

The other day a reader received the new notification of Social Security benefits for himself and his wife in 2014.

He wrote,

 Dr. Feld

I am 72 years old.

I am a person who earns a substantial amount of earned and unearned income.

I am also forced by law to take a portion of money out of my retirement plan. I have been confused by the disinformation, misinformation, false promises we have been given by President Obama and his administration.

In the past I had not been curious about my Social Security benefits. It had no impact on my way of life. I paid into Social Security all my life and figured I should get some benefit.

However, with all the talk about the redistribution of wealth and Dr. Donald Berwick saying the essential fabric of universal healthcare coverage is the redistribution of wealth, I have been paying a little more attention to the Social Security benefit in recent years.

The change in the amount taken out of my benefit next year seemed way out of proportion to the amount taken out this year. I believe I made the same amount of money in earned and unearned in 2012 as I did in 2011.

I tried to figure out why the difference and ran into a lot of disjointed and uninterpretable explanations for these increases. Attached are mycommunications from the Social Security Administration. I have redacted our names from the letters.

Can you please explain these increases?

 Thank you in advance. 


Dear Sir;

I will give it a try.  The Obama administration has not raised the premium rates on Medicare Part B for 2014. I guess the plan is not to agitate seniors as Obamacare has agitated people in the individual market.

Most people do not pay attention to laws and regulations until those laws affect them adversely.

 Most of our senators and representatives did not read the Obamacare law before they passed it. On realizing Obamacare’s impact on them Congress lobbied the President for a waiver. Congress received the waiver.

Nancy Pelosi said in all her brilliance,

 “We need to pass the law in order to find out what is in it.” printed this statement before the November elections in 2012.

"What you permit, you promote."

" The per person Medicare insurance premium will increase from the present monthly fee of $96.40, rising to: $104.20 in 2012; $120.20 in 2013; and $247.00 in 2014.

These are provisions incorporated in the Obamacare legislation, purposely delayed so as not to 'confuse' the 2012 re-election campaigns."

 The delay of the increase was one of President Obama’s trick plays.

 The author asked us;

"Send this to all seniors that you know, so they will know who's throwing them under the bus. Obama knows this will kill his chances for a second term if enacted now, and he thinks that voters are stupid and won't know or care about anything that doesn't affect them now!


This is a list of the increases from 2009 through 2012.

You will notice the base price went up each year until the election year. In 2012 the prices were published before the presidential election. President Obama used Medicare’s base price reduction as an election asset.

The projected increases published in April 2012 are,

2013:   $109.10

2014:   $112.10

2015:   $117.00

2016:   $122.00

2017:   $128.20

2018:   $135.50

The new projected increase to be published in November 2014 after the election cycle is a jump to a base price of $247 dollars a month per person.

 The 2014 increase is from $99.90 to $104.90.

 The big increase seniors will experience is in the deductibles, allowed services, and a restricted drug formulary.

The means testing adjusted gross income fees have not changed for 2014 price increases for the means adjusted gross income.

Sir, your means adjusted gross income must have jumped from $214,000 range to over $428,000 on your 2012 tax return.

You might have had a large carried forward tax lose on your 2011 tax return if your income in 2011 and 2012 were the same.

The result was a MAGI adjustment to a $230.80 increase to the base premium from the adjustment of $42.00 for 2013.

The Obama administration did not increase the prices in means testing for 2014.

The total premium for complete Medicare A,B,D,F is not cheap.

The premium is $405 dollars a month for each of you or a total of $810 dollars.

This amount will be deducted from your monthly Social Security check or $9,720 dollars a year.

 This amount does not include the $170 per month for each of your Medicare Part F supplemental insurance. Medicare Part F pays all your physician and hospital deductibles. The total premium is $4,080 per year in after tax dollars. Medicare Part D premium cost about $57 dollar per month each or a total of $1368 in after tax dollars. 

 The total in addition to $9,720 in pre tax dollars is $4,080 in post tax dollars or $13,800.

 The $4,080 post tax dollar premium is equal to $6,800 pre-tax dollars. This premium is not deductible.

Therefore the total is $6,800 plus $9,720 or a grand total of $16,520 a year for Medicare Part B, Part D, and Part F premiums for both you and your wife in 2014.

This is excluding deductible cost for brand name drugs and full the cost for drugs not on the formulary. It also does not pay for physicians that do not participate in Medicare.

 The Part A deductible has increased in 2014 to $1,216.00 from $1,084.00 in 2013. Medicare also pays 80% of the hospitals allowable fee after the $1,216.00.

 The Medicare Part B deductible is unchanged at $147.00. However you will get one free physical examination each year.

 These premiums are an example of the redistribution of wealth in our healthcare system.

 The means testing formula serves to supplement seniors who live on Social Security.

 Many have lost retirement benefits in the last few years.  Medicare’s base premium is too expensive for those less fortunate. Many are struggling to survive even if they do not need medical care.

Raising taxes or lowering premiums by the government is not going to solve the problems.

A single party payer system is not going to solve the problems.

Medicare is already single party payer system!! Its structure is wrong and destined to failure.

A consumer driven system for seniors with financial incentives to stay healthy will go a long way to decreasing costs and save consumers money.  

It will also save the government a great deal of money.

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

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I Gave You A Better Plan In 2008

Stanley Feld M.D., FACP, MACE

“The hardest thing to explain is the glaringly evident, which everybody has decided not to see.”

Any Rand, The Fountainhead


                                                                        December 7,2013

Dear President Obama;

Last week you said no one has showed you a better plan for healthcare than Obamacare.

You were the dysfunctional healthcare system’s great hope in 2008. Your problem is you listened to the wrong people when you wanted to repair the healthcare system.

 Unfortunately, these people believe as you believe. Their ideology believes in central government control and the redistribution of wealth. This ideology has only led to the failure of national economies in the past.

There are better plans than Obamacare.

In fact, I sent you six letters right after you were elected President explaining how the healthcare system had gotten into the mess it was in and what must be done to repair the mess.

You ignored me completely. I understand why. Your ideology is to increase central government control and redistribute wealth.

I believe in giving individuals the ability to control their own destiny, make free choices, and have incentives to improve and become innovative.

Increasing incentives promotes innovation. You believe in decisions by committee. I have never seen that work in business.

There are several key elements needed to Repair the Healthcare System.

The first is consumers must be responsible for their own healthcare dollars and their own health. Government should not be responsible for consumers’ healthcare dollars.

Consumers must be given positive financial incentives and education to use their healthcare dollars wisely and take care of their health.

A system of financial incentives can be set up so that people who are sick with a chronic disease such as diabetes, heart disease or lung disease can be rewarded if they keep themselves from getting a complication of their chronic disease.

Eighty percent of the healthcare dollars are spent on the complications of chronic diseases. Clinical research studies have shown that appropriate medical care and appropriate self-management can decrease the complications of chronic disease by at least 50%.

People are not dumb. If they had control of their money and freedom to choose they would choose to keep themselves healthy.

Past government attempts at redistributing wealth have never worked. Redistribution of wealth by increasing taxes on “the wealthy” has never historically increased efficiency or productivity.

What makes you think total government control and the redistribution of wealth will work now?

I appreciate your desire to have all Americans covered with healthcare insurance.

What makes you think healthcare coverage will make Americans healthy?

If you would provide incentives to American consumers to practice healthy habits and save money you would better serve us.

The healthcare insurance industry takes at least 40% of the healthcare dollars off the top of both private and public insurance.

You have done nothing with Obamacare to decrease the insurance industry’s incentives except try to penalize them. Obamacare has been unsuccessful.

The reason is clear. Obamacare is totally dependent on the administrative services of the insurance industry.

If fact, because of your disastrous web site you have asked the insurance industry to tell you how much the government owes them. This is the fox in the hen house.

What have you done about Tort Reform?

You have done nothing. Why?

Your healthcare policy advisors know little about medical care and the problems in the practice of medicine.  They believe that the practice of defensive medicine has a minor effect on the cost of medical care.

An estimate is that defensive medicine costs the medical care system $300 billion to $750 billion dollars a year in unnecessary testing.

Obamacare’s solution is to pay less money for those tests, not to eliminate the need to do those tests.

At the same time Obamacare lets secondary stakeholders take advantage of the system. It costs the government $1700 dollars for a fifteen minute ambulance drive to a hospital. Why? What are the basic costs and a reasonable profit to the ambulance company?

Physicians who treat those Medicaid patients brought in by the ambulance receive $24 dollars in reimbursement for his care. Does that make any sense to you?

Your government bureaucrats say we need to save money somewhere.

Hospital systems also receive special deals from the government.

Every hospital has a least two sets of books. One set for the government to see how much the hospital system is losing and the other set to show the hospital administration and board of trustees how much they are making.

Why are hospital administrator salaries increasing as physician salaries are decreasing?

Physicians are smart people. They will figure out how to get around the distortions being created by Obamacare. The result will be a more costly healthcare system and a further increase in the redistribution of wealth.

Who approved of the $640 million dollars contract to CGI for  only to receive a system that doesn’t function and is probably about half built using an antiquated software program that should not be used?

Is it cronyism or stupidity? I know you are not stupid.

We have seen many examples of cronyism. In healthcare the multiple waivers from Obamacare are egregious. Two of the most agregious waivers were the waivers to congress and the unions.

What should the role of government be in healthcare?  Government should work to align everyone’s vested interests. It should set conditions to give all stakeholders real incentives to improve the healthcare system efficiently.

Consumers should be given the most incentive. Consumers are the only one that will be able to lower the costs. Consumers and physicians generate those costs. You do not impose restrictions by penalty. You increase incentives to get consumers to save money.

Try my ideal medical savings accounts.

Below are the links to the letters I had written to you when you were President-elect in case someone in your administration misplaced them.

In those letters is the course you should have followed to have a legacy to be proud of.

I have also provided a host of summary blogs that have explained repairs in detail.

Dear President-elect Obama Part 1

Dear President Obama-elect Part 2

Dear President Obama-elect Part 3

Dear President Obama-elect Part 4

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

Dear President Obama-elect Part 6

Summary Blogs

You are the one who asked to “show me a better plan.”

I hope you pay attention to my letters this time.

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

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Is This A Lie?

Stanley Feld M.D., FACP,MACE

In the last ten days before the November 30 deadline to fix President Obama dialed down his definition of fixing

President Obama knew at that time that the back end of  was not completed. He knew a security was not built into the system. Yet he is telling the people it would not work perfectly.

At the same time he made this promise he was fighting the reality. It looked like the traditional media was finally presenting reality and not President Obama campaign hype.

Obamacare is directly affecting them. Over 5 million people, in the individual market have lost a healthcare insurance policy.  They could not get on to buy insurance from the health insurance exchange.

I would expect at least 5 million more to lose their individual insurance. It is predicted that at least 80 million more will lose their group policy under Obamacare.

The premiums for new policies are skyrocketing because of the required Obamacare coverage mandate.

On Sunday, as a Nov. 30 deadline set by the administration for improvements to the web site had passed.

CMS issued a report concluding: "We believe we have met the goal of having a system that will work smoothly for the vast majority of users."

On October 5, we were told that would be completely operational by November 30th. Would that statement be considered a lie given the result?

Federal officials have acknowledged they had only begun to make headway on the biggest underlying problems: the system's ability to verify users' identities and accurately transmit enrollment data to insurers.

Insurers have complained they have not gotten accurate data to do their due diligence. There is no mechanism for payment of premiums or subsidies. The insurance companies have not issued insurance policies.

Many people think they have signed up for insurance. They do not have an insurance policy that covers their healthcare.

 They have not been issued insurance policies because of the lack of  the health insurance exchange transfer of accurate verified data nor have they paid the premium.

Once a person applies for insurance, income must be verified, subsidy calculated and a premium must be paid before insurance is in effect.

Much of this data collection and transfer has not been built into the system.

Many software programmers claim the software used by CGI makes the integration impossible to do effectively.

Insurers do not want to take the risk without verification of the criteria for qualifications or premium collection.

 Insurers and some states are continuing to look for ways to bypass the balky technology underpinning the health-care law despite the Obama administration's claim Sunday that it had made "dramatic progress" in fixing the federal insurance website.

The Obama administration has not released the number of people who have applied, been approved and have paid their premiums.

Only 26,000 people signed up and think they “got” insurance coverage by November 2 according to data released November 15th.

The November 30th numbers have not been officially released.

I do not blame the healthcare insurance industry for doing business in a business like way.

Obamacare is facing these and other giant issues.

Another big issue is the security of personal information issue an applicant enters on the web site. The security of information has not been addressed. In fact, hidden code in the web sites code releases from responsibility for maintaining privacy.

 The application process is still complex. This is a glimpse of the steps necessary to complete the application. Double click on the image to enlarge the image.

  Flow sheet Obamacare Nov 2

As far as President Obama is concerned he has delivered on his promise to make  functional by November 30 even if he modified his promise along the way.

The traditional media is cheering for him on his delivery of his promise.

Can anyone believe this?

After spending two months of defending and his ill advised promises about “keeping your healthcare insurance and doctor period”, President Obama figured it is time to change the subject and go on the offensive since he has delivered as promised on the web site.

President Obama, starting Tuesday, will hold an event a day that will emphasize a different benefit of the law and try to remind Americans why Democrats pushed the law through Congress in the first place, according a White House official.

The plan is to have an event-a-day push to extoll the virtues of Obamacare. It will continue through much of the holiday season until the Dec. 23 enrollment deadline for January coverage.

The Obama administration coordinated the promotional blitz with Democratic allies on Capitol Hill and the party's campaign committees, all of which will be involved in pitching the daily message through press events and social media.

The idea of this campaign is to refocus the media and citizens away from the upcoming problems with and emphasize the core principles of Obamacare.

President Obama has used the same strategy many times with healthcare, and his other scandals as he pursues his transformational agenda. It is called a diversion.

He plans to make clear the direct benefits Obamacare has provided to millions of Americans already.

Americans are starting realize Obamacare has meant more taxes,( to everyone including the poor, middleclass and wealthy), tremendous increases in healthcare insurance premiums, less full time jobs, less access to care and glimpses of the upcoming torrent of rationing of medical care.

 Democrats and consumers are realizing the sham of this promotional campaign.

 Many congressmen are running for the exits because they are up for reelection in 2014. They are trying to avoid the folly of President Obama’s promotional blitz.

The public relations ploy will further decrease President Obama’s credibility.

How can we trust the government with our healthcare decisions when it is having so much difficulty constructing a web site?

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

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It Is Just The Beginning Of The Problems

Stanley Feld M.D.,FACP,MACE

The recent problems with are just the beginning of President Obama’s problems with Obamacare.

CMS has tried every public relations trick in the book to restore public confidence in Obamacare. The web site is failing. The cost of healthcare insurance is rising above affordability for everyone except people who qualify for government subsidies.

The deficit is going to skyrocket because the young healthy people are not going to sign up unless they receive a subsidy. Even with a subsidy, the price of insurance through the health insurance exchanges is too high to afford.

President Obama has even tried to rebrand Obamacare. The new name is the Affordable Care Act. The ACA is the wrong name. Maybe it should be called the Unaffordable Care Act (UCA)? 

The health insurance exchange policies are unaffordable because of government mandates for required care. This unaffordability will result in an increase in uninsured.

At the beginning of October, President Obama placed a November 30,2013 date for the web site being fully operational after the glitches were fixed.

It turns out that the problems are much worse than a few glitches.

“Despite recent progress at, a raft of problems will remain beyond the Obama administration's Saturday deadline to make the troubled federal insurance website work.”

The November 30th deadline will be missed. President Obama has revised his declaration. Now the web site will be partially operational.

Once again President Obama’s original promise does not ring true. President Obama announced web site would be 80% operational. What does that mean?

Americans were warned by Henry Chao, the top IT official at the Centers for Medicare and Medicaid Services, who testified on Capitol Hill Tuesday on November 19th   2013 that more than 30% of the "back end" infrastructure still remains to be built in the federally-run marketplace.

The front end looks better according to recent users. The pages load faster. More people are getting through to sign up for health plans.

However the devil is in the details of the “back end.”

As of December 1,2013 is missing the following,

  1. The ability to verify users’ identities.
  2. The ability to verify income for the purpose of subsidies.
  3. The ability to transmit accurate enrollment data to insurers.
  4. The tools for processing payments by insurers haven't been built.
  5. The data centers ability to support the various site functions has been inconsistent causing the site to crash often.
  6. The ability to supply adequate security for personal information.
  7. Total disregard for HIPPA privacy.
  8. Adequate security on every level.


Problems with the performance of the site's databases, storage and servers and their interaction with each other continue to slow the site or make it unavailable for short periods, as of December 1,2013, according to government officials and contractors working on the project.

There are many problems. Forty-eight dollar an hour navigators, CMS spokespersons, and other government official are all rationalizing about the problems.

No one in the Obama administration comes out and tells the public the real problems. They just say it will be fixed.

The comment sections of online articles are many times more truthful than the media fed “facts” by the Obama administration.

One comment appearing in the article, “Health Site Is Improving But Likely to Miss Saturday Deadline.” Said the headline should have been written as  “Health Site Is Improving But CERTAINLY to Miss Saturday Deadline.” 

Richard Sullivan wrote,

“Our father, whose art be in heaven, Hollywood be thy name…………”

  John Rogitz wrote;“The web site will be fixed. Eventually. What won't be so easily fixed is a culture that has relinquished its medical care to government overseers.”

Teresa Rich replied; We haven't relinquished our "care," Mr. Rogitz. We have relinquished our "freedom" — all for the promise of "free" health insurance for "the COLLECTIVE." 

 Charles Whitlach wrote the most educational comment of all.

"We programmers are laughing at the incompetence of this administration. I write in the very same server code as this website developer.”

 “I am a Microsoft Certified Solutions Developer [MCSD]. I have been certified by Microsoft as an expert in this language.

Although I haven't written in 2.0 since 2005. We use 5.0 now.”

The primitive program is a result of giving a non-bid contract to Michelle Obama’s friend rather than going through a competitive bidding process. 

“The Javascript & CSS files are uncompressed. Programming 101 says compress them before release. Why are there so many JavaScript files? I have never seen so many JavaScript files on a page, even with sites like Google.” 

“What happened to Unit Testing Mr. President? 

Didn't anyone test this web site for load capacity? That is why people can never get to the "Select State Page". No one tested for load capacity.

 Didn't anyone put in redundancy and fall back servers? These are the basic questions/steps every good IT person checks off before release.” 

“Every good programmer knows that 2.0 is "Leak-o-Matic". Who uses 2.0 anymore? This goes beyond legacy issues. What possible justification could anyone have in creating a website today in 2.0? There are none. 

Obama calling in the best and brightest to fix the problem? Why didn't he call us in, in the first place?” 


The website written in 10 yr old code cannot be tweaked. There have been too many API changes since 2005. The code must be rewritten.

 The client-side and server side code of this website must be redone. 5 million lines of code need to be rewritten? In my field that is an epic failure.”

“Who ever created this website should return the money. This was utter incompetence. 

The $684 million was wasted."

President Obama has been modifying his statements about the web site being completely fixed by November 30th for the last two weeks.

“It will work for 80% of the people who try to enroll.“

 Officials mixed optimism with caution. "November 30th does not represent a relaunch of," said Julie Bataille, a spokeswoman for the government's Centers for Medicare and Medicaid Services, which operates the site.

 "It (November 30,2013) is not a magical date. There will be times after November 30th when the site, like any website, does not perform optimally."

The administration said plans are in place to replace the Verizon unit with H-P this spring.

Someone should tell the administration they need to rewrite the program. Switching database vendors is not going to fix the program.

HHS also didn't initially contract for a backup website or monitoring tools like those used by sophisticated consumer sites, according to people familiar with the matter.”

 Patrick Reikofski might be right when he said.  “Ladies and gentlemen, your Federal Government in action…”

I have not covered the problems Obamacare will have with physicians, insurance companies or hospitals. Obamacare’s implementation will be a nightmare.

If we wasted $684 billion dollars so far on broken web site, how much more will we waste until Obamacare fails completely?

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

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