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All items for November, 2014


Obamacare Deceptions Keep Coming

Stanley Feld M.D.,FACP,MACE

President Obama and CMS have been extremely quiet about Health Insurance Exchange enrollment since enrollment opened November 15,2014

President Obama reported that on  opening day the health insurance marketplace performed much better than last year. However, some consumers reported long, frustrating delays trying to buy insurance and gain access to their own accounts at

Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which also vexed many people last fall.

Some people did complete their applications, but it often took them 90 minutes. Some people were unable to finish what they started, so they left the clinic with plans to return at another time.

The insurance exchanges are supposed to be the centerpiece of Obamacare.

 Ms.Sylvia Burwell, the Secretary of the Department of Health and Human Services said, “23,000 people had completed online applications in the first eight hours after, the federal website, opened on Saturday morning.”

Twenty three thousand is a low number for a 45-day enrollment period with four days each at Thanksgiving and Christmas.  It is only 1,035,000 enrollees (45 x 23,000). We do not know if they are new or old enrollees. 

Ms. Sylvia Burwell has given us signals previously that all is not well with Obamacare.

The estimate of total enrollees (old and new) for the end of the 2015 enrollment period was lowered from 13 million to 9 million. If 8 million were enrolled in 2014 this is only an increase of 1 million new enrollees.

There were clearly not 8 million valid enrollees when President Obama did his victory lap at the end of the extended enrollment period on March 31,2014.


It was later announced that 85% of enrollees were to receive subsidies (tax credit). The tax credits were to make the insurance premiums affordable to enrollees earning less than $50,000 a year.

It turned out that 65% of those approved for subsidies originally had the subsidy reduced when they could not verify their claimed income.

The American taxpayers, who are responsible for the subsidy (tax credit), were never told how the government was going to collect the government over payment. Taxpayers were never told the amount of  payment due from people who received the invalid subsidies.

 How many of those over subsidized people dropped out of Obamacare because they could not afford the premium or the deductible.

How many enrollees remained from the 8 million claimed to have enrolled?

 Somehow the published number of enrollees dropped to 7.3 million. Did the decrease from 8 million to 7.3 million include the over subsidized dropouts?  

I should think an inspector general or someone in congress would start connecting the dots.

I would think the CBO would recalculate their estimates.

I should think someone in the press would sense there was something fishy and start investigating.


Last week it was discovered that 400,000 people were counted in the total enrollment number that did not buy healthcare insurance. The 400,000 enrolled for low cost dental insurance.

 This new revelation lowered the total number of claimed enrollees to 6.9 million from the 7.3 million claimed enrollees.

Kathleen Sibelius declared over a year ago that Obamacare would have to have over seven million enrollees to be viable and declared successful.

In a previous blog my estimate of valid enrollees for 2014 was 3 million. I have also pointed out that the healthcare insurance industry is not worried about the number of enrollees because if they lose money the government would bale them out and subsidized the difference.

The loser is the taxpayer. We have been paying a tax increase of more than 10% for Obamacare since 2010.

The public has not yet seen any numbers proving Obamacare’ s viability or it’s bending of the cost curve.

 We have seen patients complaining that they cannot afford the 6-10 thousand dollar deductibles of the health insurance policies. People have realized that they are not covered by insurance until they reach their deductibles. People have been hesitant to get necessary medical care in order to avoid paying the deductibles.

The Obama administration claims to have reduced healthcare costs. The administration does not count the patient’s deductible costs (out of pocket costs) in their bogus calculation of costs to the healthcare system.

The avoidance of follow-up care by patients with pre-existing illnesses (chronic diseases) is only going to lead to complications of those chronic disease and higher societal healthcare costs.

Lowering the goal for the number of enrollees to 9 million if only there are only 3 million valid enrollees that stayed in the system is going to be a very difficult task.

The changing of the date to begin open enrollment from October 1 to November 15 for political reasons is not going to help achieve the goal.

President Obama will probably extend the enrollment period from December 15,2014.

The Obama administration already announced the 2016 open enrollment period. It starts October 1 2015 and ends December 15, 2015.

There is a great website that calculates the estimated weekly enrollment and actual enrollment. Enrollment is not going very well. President Obama and his administration are very quiet about the enrollment. The mainstream traditional media is also ignoring enrollment.    


The website is,

As of 11/21/2014 the website reports confirmed enrollees for 2015 QHPs: at least 39,215 have enrolled as of 11/21/14 as opposed to the government estimated enrollees for 2015 QHPs of at least 410,000 as of 11/21/14.

No one is paying attention to the website. The Obama administration is not providing the information necessary for consumers to judge how well Obamacare enrollment is doing.

Ms. Burwell said,

Ms. Burwell said that attention should be on all of the people who now have health insurance, rather than the miscalculation.

While we understand some will be skeptical, our clarity that this is mistake and the fact that we have quickly corrected the numbers should give people confidence,” she said. “It is important to continue to focus on the fact that millions of Americans are getting affordable health care.”

The Obama administration persists in trying to distract the American public.

I think the Obama administration continues to believe, as Jonathan Gruber believes, that Americans are too stupid to understand what the administration is doing.

The administration wants to prove that the free market and private insurance cannot provide healthcare coverage for all that only total government control of the healthcare system can work.

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

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Obamacare Deception Continues

 Stanley Feld M.D.,FACP,MACE

Open Enrollment for Obamacare started November 15th rather than October 1st. Open Enrollment for Health Insurance Exchanges was originally going start October 1,2014 to run until December 15,2014 for enrollees to have insurance on January 1,2015.

It think the open enrollment dates were delayed to prevent negative publicity for Democrats in the midterm elections. The date to close open enrollment has been moved to March 15th or March 31st2015 instead of December 31,2014.

President Obama is changing dates at will without congressional approval. It is creating confusion. Americans are giving up on following changes in the law.

President Obama probably believes, as Jonathon Gruber, that the American public is too stupid to follow all of his maneuvers.

It is impossible to know when open enrollment ends by following the mainstream media. I think it will end when the Obama administration has something to brag about despite what the law demands.

Early in 2014 it became clear to health insurance consultants that the healthcare insurance industry would raise Obamacare 2015 premiums by double digits (15-30%). The demographic of 2014 enrollees was actuarially unsound according to the healthcare insurance industry.

The Obama administration expressed fear that the healthcare insurance industry would not participate in the health insurance exchanges because they were destined to loss money.

The Obama administration is presently boasting that the average premiums are going to rise only slightly in 2015.  

Healthcare insurance companies are flocking to sell insurance in more markets rather than quitting the health insurance exchanges.

The Obama administration claims that Obamacare has created a competitive atmosphere for the healthcare insurance industry.

You bet it has. It has done the by creating subsidies for the healthcare insurance industry so it takes on no risk along with increased profit. This is the reason all the companies are fighting to get into the health insurance exchange market.

President Obama has offered to bail out the healthcare insurance companies if they do not make an adequate profit in the health insurance exchange.

The mainstream traditional media has not reported that Obamacare provided insurance company subsidies, nor have the subsidies been connected to the dampening of extreme increases predicted for premiums in 2015.

However, the decreases that are being reported by the Obama administration are deceptive.

Below is a CMS provided map of states and counties with either increases or decreases in premiums.


Prices as a jpeg 1

In about a fifth of the counties in states using the federal insurance exchange, premiums for the lowest-priced silver plans will increase by 10 percent or more. But rates for the same plans will decrease in all of Maine, Montana and New Hampshire, and most parts of Mississippi and South Dakota. NOV. 14, 2014

Largest decrease: -28.0%

Greatest increase: +29.5%

Minneapolis, Honolulu, Seattle, Phoenix, San Diego, St. Louis,  New Orleans , Dallas, Boston, Tampa, Philadelphia Detroit, Anchorage, San Francisco, Denver, Houston, Miami, Atlanta, Chicago, Los Angeles, Washington, D.C. New York all are experiencing increases in premiums.

 Source: Centers for Medicare and Medicaid Services

A PricewaterhouseCoopers report on all individual market premiums — on and off Obamacare exchanges — found a large range of rate changes, from a drastic 35 percent hike in Colorado to a 22 percent cut, also in Colorado (the state’s Obamacare exchange changed the geographic rating areas this year to cut costs for ski resort towns). Overall, the average rate hike nationwide is 5.6 percent, according to PWC.

The published map belies the Obama administration’s claim that premiums have been, on the average, lowered. It does not take into account population density in counties where premiums are lowered or raised.

Eight states are facing double-digit premium hikes in 2015 while just four states have reported decreases according to the Daily Caller.

 The premiums in some states could be lowered. However, the high deductibles included in these health insurance plans have not been lowered. The high deductibles are out of pocket expenses. The high deductibles continue to be unaffordable to many even thought these enrollees might receive sizable “tax credits? subsidies?” to help them pay for the premiums.

In January 2014, I described the subsidies provided by the Obama administration to the healthcare insurance industry. The Obama administration guaranteed a profit for participating in the health insurance exchange at no risk through the Reinsurance program and the Risk Corridor program that is buried in Obamacare.

(Nancy Pelosi: “We will not know what is in the bill until we pass the bill.”)

 “This was one of President Obama’s deceptions.

It is similar to the deception “If you like your insurance you can keep it. If you like you doctor you can keep him/her.”

Last week we learned that the insurance company bailout was built into the original bill passed in 2010. The President knew about this bailout before Obamacare was passed.

Did the congressional members who passed the bill know about the built in bailout?

If they did they should all be voted out of office. If the Democrats needed to pass Obamacare did not know about the bailout they should have and they should all be voted out.

It should be recalled that this was a Democrat controlled House and Senate. There was not a single Republican vote included in the passage of Obamacare.

The American people did not know about the built in bailout at taxpayers’ expense.

Obamacare contains a "Reinsurance Program that caps big claim costs for insurers (individual plans only)." Robert Laszewski, a prominent consultant to health insurance companies, writes that in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government [read: by taxpayers], for example." 

Private insurance plans bought through the health insurance exchanges are not private health insurance plans. They are plans that are subsidized by the government if the insurance bill goes over $45,000.

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

 Who makes the profit from this subsidy?

 The healthcare insurance industry makes the profit because the insurance policies have been priced at high risk (Increased deductibles, and increased premiums for consumers not eligible for government subsidies).

 "The reinsurance program has done and will continue to do what it was intended to do; help attract and keep more carriers in Obamacare than might have otherwise come."  Thus, Obamacare is being aided by having taxpayers subsidize big insurance companies' business expenses.”

Obamacare also provides the healthcare industry a greater subsidy. It is called the “Risk Corridor Program”. The “Risk Corridor Program” limits the overall losses of the healthcare insurance industry to 2.4%.

This is the way the “Risk Corridor Program” works. The healthcare insurance company submits its expected costs to the government for a particular year.

If the expected costs of the insurance exceed 102%, the government will pay the healthcare insurance company 80% of the difference above 102% at taxpayers’ expense.

 “Taxpayers' are unwitting generosity toward these "participating health plans" (plans sold through Obamacare's government-run exchanges):

 "If the health plan has costs at 110% of the medical cost target [the costs that the insurer expects to accrue], it will be responsible for only 102.4% of the target (a 2.4% shortfall)-only about a quarter of its losses.”

There is little risk to the healthcare insurance company for being involved in the healthcare insurance exchanges.

The key point is President Obama had this written into Obamacare without telling taxpayers about it. I wonder if the CBO knew about it and calculated it into the original cost estimates of Obamacare.

“In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine ("single payer") that liberals drool about in their sleep.”

 There are many other deceptions that lie ahead. Now that the Jonathan Gruber controversy has increased the American public’s awareness of Obamacare deceptions Americans will begin to shout about the costs and rationing of care.

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

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The Significance Of The Jonathan Gruber Controversy

Stanley Feld M.D.,FACP,MACE

Jonathan Gruber, a professor of Economics at MIT and one of the authors of Obamacare, made comments in 2013 about the trick plays the Obama administration used to pass the Affordable Care Act.

Jonathan Gruber’s comments serve to help Americans understand the mechanics of the passage of Obamacare. Hopefully it will serve as a wakeup call for the entire electorate.

Jonathon Gruber’s comments reflect the attitude of President Obama and his entire administration toward the electorate.

The cover-up always makes it worse.

Mr. Gruber admits what many of us have understood throughout President Obama’s years in office. President Obama’s attitude is reflected in all the trick plays he has pulled on congress and the American people during the passage and implementation of Obamacare.

Please look at all the articles covering President Obama’s trick plays since 2008 by clicking here.

The mainstream media has done President Obama’s bidding. It has not covered the meaning of Jonathan Gruber’s comments and the disrespect he and others have for the intelligence of the American public.

A reader sent me this comment before Jonathan Gruber’s comments were discovered.

“Dr. Feld,

There is some science behind the Progressive methodology that non-progressives need to learn.  The Progressive movement talks directly to the limbic portion of the brain while non-progressives tend to sort through facts in the neocortex.

Decisions are made in the emotional limbic portion of the brain, hence the reason and way marketers appeal to emotions versus your facts. 

The bottom line is this, non-progressives need to turn their facts into stories that are emotional or conservatives will always be out sold by those who’s arguments are devoid of facts (or outright lies) but full of emotion.

Have an awesome day.”

The Gruber controversy has given Americans a story that stimulates an emotional response. Americans are offended by being called stupid.

Jonathan Gruber did not make these statements in a void. It had to reflect the thinking of Obama administration. Even John Kerry gave him some help.



Published on Nov 12, 2014

Gruber explains how Senator John Kerry helped him fool stupid voters into accepting a tax hike.

 Mr. Gruber could not have made the decisions on his own to take the policy actions he described.

He never should have described the actions of those involved in public.

 The Obama administration also provided the Congressional Budget Office (CBO) with wrong information. The information led to wrong CBO’s conclusions regarding Obamacare’s real costs. The CBO crunches numbers fed to it by the Obama administration.

 The Obama administration used CBO’s false scoring to sell the CBO’s economic conclusions to the public through the mainstream media.  

It is clear that President Obama and his administration believe they are smarter than the American people. President Obama believes that his administration knows what is best for Americans.

The only reason the American people have not connected the dots is because they believe the president is an honorable man. The president is not expected to lie to the public.  

The progressive press is trying to divert attention from Jonathan Gruber’s comments. It is trying to get the public to ignore Mr. Gruber.

An initial diversion came from Paul Krugman in his Victory Lap article about Obamacare.

Paul Krugman said the health economist Jonathan Gruber, one of the principal architects of health reform  recently summed it up:

The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.”

Paul Krugman did not provide any facts just an appeal to emotion.

 MSNBC used this emotional stimulation to get its followers to ignore Jonathan Gruber’s comments.

“Part of the problem with the Jonathan Gruber “stupid” story is that it’s a shiny object for the political world to stare at for a while. It offers more heat than light. It’s a bouncing ball for political insiders to chase after, despite its relative insignificance.”

“But since it’s likely to soon be the subject of congressional hearings, and since your crazy uncle who watches Fox News all day will be talking about nothing else at Thanksgiving, let’s grudgingly tackle this week’s Most Important Story Of All Time As Agreed Upon By Republicans And The Beltway Media.”

Please note the inference that Republicans and Fox News are stupid for making an issue out of Jon Gruber’s statements. The implication is MSNBC is smart.

Progressives need public support in order to maintain power.

The problem is the public is tired of progressives’ emotional appeals devoid of facts.

The progressive press including MSNBC and The New York Times need examine their premises. They are daily losing listeners and readers .

Nancy Pelosi is incredible.

She said,

“Let’s put Jonathan Gruber aside.”

 “House Minority Leader Nancy Pelosi responds to Jonathan Gruber’s comments on the Affordable Care Act, saying, “I don’t know who he is. He didn’t help write our bill. So with all due respect to your question, you had a person who wasn’t writing our bill commenting on what was going on when we were writing the bill who has withdrew some of the statements that he made. So let’s put him aside.”

It is almost as bad as "we will not know what is in the bill until we pass it."

President Obama and his administration are trying to prevent public understanding of his current tricks plays. He continues to try to divert American from the truth about Obamacare.

President Obama needs to explain the truth to regain his credibility with the American people.

He must address these unanswered issues if he wants to maintain his promise of transparency.

  1. Why the open enrollment period was delayed until November 15th.
  2. What is the actual number of valid enrollees in Obamacare in 2014? Is it 8 million, 7 million, 5.6 million or 3 million? I thought Obamacare and its mandate would be in effect for small businesses and corporations in 2015.
  3. Why has the estimate of total enrollment for 2015 been reduced from 13 million to 9 million? I thought 2015 Obamacare would be fully implemented and many more people would sign up as they lost employer sponsored insurance.
  4. How many people who received government subsidies last year lied on their application?
  5. Why weren’t the rules for subsidies enforce?
  6. How many people lost their subsidy?
  7. How are you going to collect the subsidy from people that lied?
  8. How many people have claimed they are not going to re-enroll in Obamacare this year and why are they not going to enroll?
  9. How does a person receive a tax credit when he has no taxable income to apply that tax credit to?  

     10. Explain the status of the open enrollment and the mandate for small businesses and large corporations.

      11. What is the status of waivers that companies and unions received from Obamacare for 2015?

      12. Why does the state of Massachusetts have a failed State Health Insurance Exchange that     required  $400 million dollars in federal  supplements each year if Romneycare is so successful?

      13. Why would the government subsidize healthcare insurance companies to participate in Obamacare?

     14. Why is the public being told that healthcare exchanges premiums are going down when in reality they are going up?

     15. What is happening with the Minimed Insurance policies that were supposed to expire in 2015?

     16. What does Obamacare cost the federal government? Is it budget neutral?

     17. What is the exact amount of increased taxes used to fund Obamacare?

     18. What percentage of the increased taxes are collected from each income group?

These are just a few of the questions President Obama and his administration have not provided the answer to.

 The answers to these questions would permit the public to understand Obamacare’s sustainability.

 The Jonathan Gruber incident has made it clear how President Obama and his administration operates as well as its lack of respect for the intelligence of the American public.

 Americans are not dumb. They want to believe their leaders. Their leaders have lied to them. Americans recognize that. President Obama and his administration have little credibility with the American public. President Obama promised a transparent government. There is not any transparency.

The midterm elections proved Americans are aware. It is a good first step.  Now we have to see what the Republicans will do with this leadership opportunity. 



An explanation of Obamacare.

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

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Why Republicans Need A Viable Healthcare Plan NOW

Stanley Feld M.D.,FACP,MACE

I have been asked by many of my conservative friends why so many of my liberal friends believe Obamacare is great.

My liberal friends think conservatives are are illogical, callous, spiteful, partisan and soulless. Some even believe conservatives are ignorant.

 Obamacare provides coverage for people who cannot get coverage or afford healthcare coverage in the pre Obamacare era. Insurance options and county healthcare system were inadequate for servicing these people.

It turns out that people who need to buy healthcare insurance coverage through Obamacare cannot afford the coverage either.

Even with the illegal subsidies they cannot afford the deductibles.

Obamacare is not the solution to our healthcare system problems. Obamacare is an inefficient bureaucracy that was pasted onto a pre-existing dysfunction and unsustainable healthcare system.

The costs overall are increasing despite the Obama administration and progressives telling us the costs are decreasing. Healthcare taxes have increased the overall federal tax rate to 50%.

Americans have not been provided with the real tax rate increases or unemployed or partially employed statistics since 2009. Yet progressive quote the figures the administration provides as absolute facts.

Americans know something funny is going on because they have less money to spend.

Progressives do not want to understand these consequences. The acceleration of unintended consequences of Obamacare will lead to the economic collapse of the healthcare system as well as the economic collapse of the country.

Progressives want to ignore the effects Obamacare is having on the economy even though only 15 of the 350 million of us are in the individual market and less that 7 million are insured under Obamacare.

Progressives ignore the facts and revert to name calling aimed at conservatives.

Conservatives do not know how to respond. Progressives continue to call conservatives tax adverse, callus, ignorant and for the vested interest of big business.

I try reading and listening both the progressive and conservative media. Progressives play the same theme continuously.

Progressives continuously use emotionally charged examples that anyone would be sympathetic to. At the same time they belittle their “conservative opponents.”

A New York Magazine article by Jonathan Chait entitled, “Yes, the Republican Obamacare Strategy Will Kill People”  illustrates my point.

“There is a famous thought experiment called the trolley problem, and it goes like this: A runaway trolley is headed toward five people bound on the tracks. You are standing before the switch that could divert it onto another track, where it would kill only one person. Do you pull the switch?

The problem is a way of grappling with the moral responsibility of actively killing a person for some larger end, a problem that lurks behind much of the role of the state, from policing to Harry Truman dropping the atomic bomb on Japan.”

The reader should not be confused by where this story is going. It is a distraction from the real problems of Obamacare’s healthcare policy and implementation.

“The trolley problem is the most flattering possible way to think about the conservative movement’s fanatical commitment to repealing Obamacare.”

“ That is, if you ignore the obvious elements of partisan spite, callousness, and self-deception, one can posit a commitment to abstract moral principles about the role of the state.”

This sentence serves as an invective against the conservative enemy.

Conservatives’ abstract principles, like most people, can come attached to specific costs. If they pull the switch and repeal Obamacare, or if they persuade five Republican Supreme Court justices to cripple it, they will spare America from the evils of mandates, taxes, regulation, and what they imagine being European socialist horrors. They will also kill what are now identifiable human beings”.

This sums up progressives’ attack against conservatives. The reader will be convinced that the conservatives are evil, use corrupt tactics and act immorally.

Mr. Chiat ignores the unworkable healthcare policy and economically unsustainable facts.

It is all about character assassination of an opponent. It is a typical Saul Alinsky tactic.

Mr. Chiat then goes on to describe a Washington Post report of a patient (Mr. Tedrow) who without the benefit of Obamacare’s health insurance exchange coverage plus subsidy could not have had a liver transplant. Obamacare saved the patient’s life.

There have been many stories like this published in the traditional progressive media in defense of Obamacare.

The article states that all the Republican Party wants to do is repeal Obamacare and go back the pre-Obamacare dysfunctional healthcare system.

Republican health-care plan is no better than the pre-reform status quo. Conservatives are within their rights to prefer freedom from taxes and regulation even at the cost of David Tedrow’s well being.”

The New York Magazine article presupposes that a Republican Healthcare Plan will ignore patients like David Tedrow.

But any morally serious position has to account for the brutal realities embedded in this trade-off. Truman’s war strategy involved killing a lot of Japanese civilians.”

The Republican health-care strategy is to flip a switch whose immediate effect will be to impoverish and kill a lot of people. Is there a single conservative who will admit this?”

The article also presupposes that Republicans will just flip the switch on the people that need help and kill them.

Republicans must immediately present an understandable healthcare plan to the public that is sustainable and will preserve our freedoms to make our own our healthcare decisions rather than the government choosing for us.

Republican cannot propose tweaks around the edges of Obamacare such as repealing the medical device tax. This proposal will have little effect on repairing the healthcare system.

 A reader responding to by last post wrote that describe the writing of a sustainable plan,

 “I think you could more simply say this to rally America:

 “We must change our healthcare system because its current costs are unsustainable.  The only two choices we have is to freely change it by taking more responsibility for ourselves (The American Way) or be forced to do what the Government tells us to do (The Obamacare way).” 

“After that, everything else is tactics.  Obamacare must be seen for what is it, Government force.  It is not healthcare.”

I think the majority of voting Americans, who take the time to think about these things, are aware of the limitations on our freedom to choose and the financial unsustainability of Obamacare.

Americans are aware of the fact that they have been lied to by the Obama administration over and over again. Americans do not trust the Obama administration to make serious healthcare decisions for them.

They do not understand what they can do about it. The President and the congress are supposed to work for us. It is imperative to express your opinion to them.

They understand the progressive spin masters whose only tool is to discredit conservative integrity, thought and intentions.

 Republicans must immediately develop and publicize a logical plan will provide  universal healthcare for all Americans while maintaining their freedoms.

Americans must be in control of their health and their healthcare dollars even if the government has to supply the needy with healthcare dollars.

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

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Obamacare Post Mid-Term Elections

Stanley Feld M.D.,FACP,MACE

The mid-term elections are over. The Republicans captured majorities in the House and Senate. The election was a clear repudiation by the people of President Obama’s policies.

President Obama has denied this reality. He has pledged to pursue his ideological goals that have hobbled the people and the country so badly.

 The polls have indicated that the public is opposed to Obamacare and all of its unintended consequences.

We ain’t seen nothin yet. The unintended consequences are going to escalate starting with the delayed open enrollment season on November 15 2014. This opened enrollment was unnoticed, so Democrats did not suffer any blowback from Obamacare during the mid-term elections.  

Larger categories of people and businesses will be affected by Obamacare’s rules and regulations on January 1,2015. Last year only people in the individual healthcare insurance market were affected.

President Obama continues to mock Republicans by telling them he will be happy to listen to them to see if they have a better idea than Obamacare.

Everyone knows he has no interest in changing or repealing his legacy healthcare law.

The majority of people are dissatisfied with Obamacare. All the Republicans have to do is come up with an idea that is compelling to all of the public. The power of public opinion can demand that Obamacare must change.

 It has to be a simple idea. It has to teach consumers how to be responsible for their health and their own healthcare dollars. It has to educate consumers on how to drive the healthcare system and remove government from controlling their healthcare choices.

The basic problem with our present healthcare system is medical care is fragmented. In addition, all the stakeholders’ vested interests are misaligned. 

President Obama, with his forced passage of Obamacare, has added to the dysfunction of the healthcare system.  .

 Obamacare is meant to be a step toward a single party system. 

 The government cannot afford, and the nation will not accept, a government controlled single party payer system. 

Obamacare does not do anything to repair the distortions of to the system that have led to the dysfunction of the healthcare system pre Obamacare.

The most important stakeholder in the healthcare system is the consumer. Obamacare has marginalized consumers/patients even further.

It was hard for consumers to have notice the dysfunction in the healthcare system because only 20% of consumers use the healthcare system at one time. The remaining 80% thought their healthcare insurance was fine.

Since Obamacare was passed into law it is affecting everyone directly and they are starting to complain.

The current state problem are shown in the figure below.


 A dizzying array of stakeholders is all fighting for a competitive advantage, or at the very least survival, in the dysfunctional current state.

Obamacare’s rules and regulations have made the current state more difficult for everyone.  This is leading to the impending collapse of the healthcare system.

Republican Party should not tinker with legislation to try to fix Obamacare.

It should step in right now and educate the consumers about their consumer power. Republicans need to present a market driven solution that is easy to understand.

 My ideal medical saving account can provide the financial incentives for consumers to act and drive the new healthcare systems.

Once the public understands what they can do, it will change its attitude from the helplessness and hopelessness to an empowered reaction to do something to change the system.  

There are many other things that need to be demanded by the public. I believe empowering the public to demand a market driven system is crucial to a viable and affordable healthcare system.

Almost all the stakeholders believe something must change. The centrally controlled healthcare system’s business model will not work or be sustainable. All one has to do it look at the VA Health System.

Consumers and businesses are becoming frightened and beg the government for help.  The government will institute a single party payer system.

 The result is that consumers will not be able or willing to tolerate a centrally controlled healthcare system.

 As I see it, the nation has two choices: Alternative 1 and Alternative 2.

Alternative 1:

  Alternative 1 future state

 If we extend the course of our present healthcare system to a single party payer system (Alternative 1) the costs will escalate, and access to care will decrease. It is inevitable the rationing of care will occur.

 Alternative 2

Alternative 2 Future state
 Alternative 2 would be a market-based system that would put the consumer in the center of the healthcare system.

Provider systems and administrative systems would have incentive to make its products attractive to consumers at the lowest price possible with the highest quality of care.

Consumers, by owning their healthcare dollars, would have the freedom and resources to choose. Government and its bloated and inefficient bureaucracies should not be making medical care choices for consumers. 

Two things must happen. Republicans must teach consumers the advantages of a market based business model.

 The Republican congressional majority must start teaching all the other stakeholders (physicians, hospital systems, the government, the healthcare insurance industry and Big Pharma) the advantages of this market-based system to their vested interest.

 The alignment of vested interests must start right now and not down the line.

 The Obama administration will dismiss the possibility of a successful market based system. Republicans must not be intimidated. Didn’t they win the election this time?

The Obama administration’s conclusions are based on ideology not past history, logic, fact or evidence.

 The Obama administration and its followers will reject the possibility of success for an incentive driven system instead of a government controlled system.

 A market-based system can be presented in a way where all the stakeholders can buy into a successful consumer driven future state.


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

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Going In The Wrong Direction

Stanley Feld M.D.,FACP,MACE

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Strange things happen in California.  

In 1975,California Governor Jerry Brown signed into law the Medical Injury Compensation Reform Act (MICRA). It converted California from the worst state in the union to practice medicine into the best state to practice medicine by changing the limit on economic and non-economic damages to $250,000.

Malpractice insurance rates dropped, as did malpractice lawsuits. MICRA ruined the litigation business for California’s plaintiffs’ attorneys.

 Many malpractice attorneys and a number of researchers say that of the various med-mal tort reforms, the caps on noneconomic damages have had the greatest impact. (Anderson says that to be successful, a cap must be around $250,000.)”

In 2003 Texas followed, lowering economic and non-economic damages to $250,000. It decreased the malpractice business for defense attorneys in Texas.

Twenty-six states have now followed California’s lead. 

In 1975 physicians and consumers applauded Jerry Brown as a hero for this minimal reform.

Physicians stopped leaving California after the cap was placed on economic and noneconomic damages. The cost of medical care declined in 1975.

This year Jerry Brown is governor of governor of California and running for an unprecedented fourth term.

The California’s plaintiff attorneys are pushing for the cap on damages to be lifted to $1.1 million, from $250,000. Its provisions are embedded in Proposition 46. Proposition 46 also includes physician drug testing.

The malpractice insurance companies, hospitals and physician groups are warning that consumer healthcare costs will soar and doctors will flee to other states.

 Paul Phinney, a pediatrician and former president of the California Medical Association, said drug testing is a legitimate issue, but the proposal before voters is not the answer.

Phinney and other opponents have pointed to the disclosure that the testing provision was included as a political sweetener, with the intent of making Proposition 46 more appealing.

He said the initiative was designed to trick voters into supporting “something the consumer attorney lobby has wanted to do for a long time,” lifting a ceiling on damages for clients that has been in place since the 1970s. The lawyers “stand to benefit, personally and financially,” he added.

Dr. Ezekiel Emanuel, an author of Obamacare, believes tort reform is not necessary because it has little impact on healthcare costs. Dr. Emanuel ignores the facts just as Paul Krugman and many Obamacare advocates do. Dr. Emanuel has never been in private practice.

He says,

“ A useful threshold for savings is 1 percent of costs of healthcare, which comes to $26 billion a year. Anything less is simply not meaningful.”

One percent is arbitrary. It permits Dr. Emanuel to dismiss tort reform as a significant issue.

 Dr. Emanuel says only $1.3 billion results from the lack of tort reform. His source is not given. He also ignores physician over-testing, actual cost of malpractice insurance, the cost of lawsuits and the emotional impact on practices physicians and their practices.

He says,

“Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable and meaningless. In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

A study, closer to truth than just an opinion, disclosed:

The 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 medicine.

This study concludes that $242 billion a year extra spent because of the lack of tort reform.

The $242 billion is well above Dr. Emanuel’s fictitious threshold.

Physicians have admitted to over testing in the Massachusetts Medical Society survey . Physicians fear having to defend themselves against frivolous malpractice suits for potentially missing a diagnosis. The result is expensive over testing.

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

Physicians are becoming disillusioned by politicians’ stated intentions to create a better healthcare system.

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

The lack of tort reform is reflected in the percentage of healthcare costs by the Massachusetts Medical Society survey.

The amount of money wasted on defensive medicine can be extrapolated from this survey.

 I have written a series of blogs analyzing the impact of the Massachusetts Medical Society’s survey.

The extrapolated costs turn out to be about $700 billion a year. The real cost of defensive medicine is somewhere between $242 and $700 billion dollars a year.

 In 2003, Texas Governor Rick Perry and the Texas legislature unenthusiastically changed tort reform laws in Texas.

Rick Perry and the Texas legislature rewrote the medical malpractice laws, ending plaintiff attorneys’ practice of venue shopping for friendly judges. They also put a cap of $250,000 on noneconomic damages.

These reforms have changed the malpractice legal climate in Texas. The reforms limited plaintiff’s attorneys profitability on frivolous liability claims.

Texans believe that because of these reforms and the lack of a state income tax, Texas is the country's best state for economic growth and job creation.

A Perryman group report concluded,

“Perhaps the most visible economic impact of lawsuit reforms is the benefits experienced by Texans who have better access to high-quality healthcare.

Doctors and hospitals are using their liability insurance savings to expand services and initiate innovative programs; those savings have allowed Texas hospitals to expand charity care by 24%.”

The medical malpractice business for plaintiff’s attorneys has dried up in Texas. They are moving to other states. Physicians are applying for licenses to move to Texas away from high medical malpractice states. 

 “In 2001, according to the American Medical Association, Texas’ ranking in physicians per capita was a dismal 48th out of 50.”

“Beginning in 2003, physicians started returning to Texas. The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years.”

 “Dr. Perryman, subsequent to the issuance of his Report, informed TLR Foundation that at least 1,887 of those physicians are specifically the result of lawsuit reform.”

 The Texas Hospital Association reported a 70% reduction in the number of lawsuits filed against the state’s hospitals.

Medical liability insurance rates declined. Many doctors saw average rates drop between 20% to 50%.

The Perryman Group during the course of this study suggests that premiums are declining even further in 2008.”

The American Medical Association removed Texas from its list of states experiencing a liability crisis; marking the first time it has removed any state from the list.

 A survey by the Texas Medical Association also found a dramatic increase in physicians’ willingness to resume certain procedures they had stopped performing, including obstetrics, neurosurgical, radiation and oncological procedures during the Texas malpractice crisis.

Two simple changes in the tort laws made malpractice suits unprofitable for plaintiff’s attorneys.

Rick Perry has been so impressed with the results of his tort reforms that he now wants to extend his state's impressive tort reform record.

Mr. Perry is proposing a British-style "loser pays" rule, which would require plaintiffs to pick up the legal costs of their targets if they lose their suits.

 Almost all of America's economic competitors in the world follow this standard. “Loser Pays” as a deterrent to law suits decreases the cost of doing business resulting in lower prices and a competitive advantage for business. “Loser Pays” would deter frivolous lawsuits.

If President Obama really wanted to do something sensible about lowering the cost of healthcare, Texas style tort reform should become the law of the land, including loser pays all.

I hope California votes down Proposition 46. It is going in the wrong direction. It will not Repair the Healthcare System for California.

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

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Election Time! Obamacare Is Not Working

Stanley Feld M.D.,FACP,MACE

Despite the proclamations of President Obama and Paul Krugman Obamacare is not working.

However, if you tell a lie enough times it becomes the truth. This is especially true if you have enough traditional media coverage of the lie.

The reality is consumers cannot keep their own doctor, access to care is decreasing, and you cannot keep your healthcare insurance plan if you liked your  plan because of Obamacare’s imposed rules and regulations.

Healthcare insurance premiums are increasing despite President Obama’s proclamation that healthcare insurance premiums are affordable. Consumers’ out of pocket costs are increasing despite President Obama’s claims.

The narrow and ultra-narrow new networks on the federal health insurance exchanges are decreasing consumer choice of physicians. The access to quality healthcare at a reasonable price is vanishing.

Consumers are feeling these negative affects on their quality of life already. They will not forget it at the polls on Tuesday despite the efforts of the Democrats to keep Obamacare a non-issue.

President Obama wishing that Obamacare is working does not make it so. He cannot simply decree lower prices. He cannot simply say I want better quality. Neither happens out of thin air. Obamacare’s rules and regulations are disastrous.

The reality is government cannot do a thing about the negative affects Obamacare is having on consumers except repeal it.

Neither federal nor state government can tweak Obamacare and fix the negative affects. These affects are here already. Federal and state government cannot hide the avalanche of negative affects that are coming.

Consumers don’t believe President Obama or the government’s spin anymore.   

The mid-term elections are two days away and the progressives Democrats are trying to make Obamacare better with propositions on the mid-term ballot.

They are trying to improve Obamacare in their states and disguise its goal of increasing government control of healthcare. Increasing the rules and regulations in order to control the healthcare system does not work.  

In the process, progressive in various states are contradicting each other. The bottom line is none of the propositions will work.

Progressives have become prisoners of Obamacare as well as prisoners of their own thinking.

California liberals (progressives) are always the leaders in progressive propositions that make no sense. On Tuesday November 4th California’s propositions 45 and 46 stand out.

Prop. 45 would give the healthcare insurance commissioner the power to reject rates he deems “unreasonable,” with no reference to actuarial or solvency standards.

Anthem Blue Cross is raising small healthcare insurance group premiums 9.8% in 2015.  This is happening even though Obamacare guarantees the healthcare insurance industry an adequate profit through the federal government’s reinsurance plan for healthcare insurance carriers.

 Who is paying for this guarantee and this rate increase? Consumers are through higher taxes. The California commissioner is going to try to reduce the increase to 2.1% through added power given to him by Prop. 45. 

What is the commissioner going to do about it?  Nothing! If he does not permit the raise the exchange will not have healthcare insurance companies providing administrative services for its healthcare coverage. The government cannot provide administrative services.  Any attempt at price control has not worked in the past and will not work in the future.

The healthcare insurance industry’s alternative is to have narrower networks and less coverage. The consumer will have to cover the cost of better coverage.

Proposition 45 also gives trial lawyers the right to challenge rates in court. It is a good deal for trial lawyers on both sides of the price control issue. It is a terrible   deal for taxpayers on both sides of the issue. It will increase the cost of healthcare resulting in higher taxes.

A logical proposition would be to develop a competitive system for consumers and insurance companies so that insurance companies fight for consumers’ business rather than impose the bureaucratic practice of selective contracting. The bureaucracy provides a list of demands and then picks a few compliant winners. The losers are excluded from the federally subsidized exchange.

Government would dictate what products consumers are allowed to buy and use its clairvoyance to decide what businesses can charge.”

Why wouldn’t you let consumers decide what they want rather than bureaucrats telling consumers what healthcare policy they can have?

Proposition 46 is another disastrous proposition.

In 1975 the then Governor Jerry Brown limited medical malpractice awards to $250,000 for non-economic injury. It decreased the medical malpractice business for lawyers in California.  Lawyers would not take cases that did not make them enough money.

Proposition 46 is proposing to lift the $250,000 restrictions for non-economic damages on medical malpractice awards to $1.1 million dollars. The affect will be more medical malpractice lawsuits because lawyers once again can make some serious money from frivolous malpractice suits with minimal effort.

Physicians’ malpractice premiums will rise once again, and once again doctors will be forced to raise their fees or leave the state. The availability of physicians will decrease. Consumers will suffer again suffer from a proposition that was not thought out.

It does not make sense. I hope the citizens of California are paying attention to the implications of these two propositions.

The common denominator is the propositions are great for trial lawyers and terrible for consumers. The propositions will not be effective in making Obamacare better for consumers.

The goal should be to lower the cost of healthcare for consumers not increase it.  

South Dakota has a proposition (Prop IM-17) which, rather than limiting networks expands networks.

Prop IM-17 is trying to regulate back into existence the access to medical providers that ObamaCare destroyed.

Patients expecting to keep the doctor they liked continue to discover that the narrow networks offered on the exchanges resemble the standard of care in Medicaid.

“Measure-17 would force insurers to accept “any willing provider.” All doctors and hospitals licensed by the state that met certain de minimis conditions must be covered by all plans, regardless of cost or quality.

“IM-17’s cure is worse than the Obamacare disease.”

Healthcare prices will increase. Healthcare insurance premiums will increase. The conflicts among providers will intensify. Consumers’ access to care will be diminished.

The California and South Dakota referenda reflect liberal health-care confusion.”

America is supposed to be a government by the people for the people. The government should not be a government dictating what can have.

Progressives are prisoners of their ideology.

I hope the American people understand this on November 4,2014 and vote to stop progressives“stinkin thinkin.”  

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

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