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All items for October, 2015


I Told You What To Do 8 Years Ago

Stanley Feld M.D.,FACP,MACE

I started my blog Repairing The Healthcare System in 2006. I methodically described the defects in the Healthcare System.

I provided healthcare alternatives in policy and regulations to both Democrats and Republicans to Repair the Healthcare System.

No one listened to me.

In 2007 the healthcare system was unaffordable and unmanageable.

Republicans had some weak ideas and no inclusive business model for the future.

The election of President Obama and the partisan passage of Obamacare have accelerated our healthcare system’s demise.

I believe President Obama’s goal is to destroy the healthcare system. He wants it replaced with a single party payer system (2003). Consumers of healthcare know the government cannot manage healthcare.

American cannot sustain Obamacare financially. Consumers cannot be sustained medically with Obamacare or after the collapse of Obamacare with a government run single party payer system.

The obvious proof is the dysfunction and failure of the VA Healthcare System, Medicaid and Medicare.

All these healthcare systems are government run single party payer systems. All are unsustainable.

As I was archiving my blogs I ran across four blogs I wrote in 2007 outlining the problems and what should be done about them.

The government has made none of the repairs I have suggested. Obamacare has made the situation worse. I will present all four parts of “What Have I Said So Far? Spring 2007” consecutively as written.

What Have I Said So Far? Spring 2007 Part 1

Stanley Feld M.D.,FACP,MACE

April 01, 2007 in Medicine: Healthcare System

 In August 2006 I summarized my blog to that point. I outlined some important solutions necessary to Repair the Healthcare System.

Since then I have covered many of the solutions to the key questions I raised. Not one of these questions has been addressed effectively by our leadership or people in control of making policy.

One must ask: Do they really want to solve the problems in healthcare delivery in this country or are they focused on preserving their own vested interest to the exclusion of a breakthrough that might benefit not only their vested interests but the vested interest of all the stakeholders.

The questions were:

  • How do we reduce the cost of medical care? • How do we provide affordable insurance for the 45 million people uninsured?
    • How to we provide affordable medical care coverage so that all the patients can have access to medical care?
    • How do we align all stakeholder incentives?
    • How do we construct a system so that all the stakeholders make a reasonable return on investment?
    • How do we close the holes in the system to eliminate abuse by stakeholders?
    • How do we restore trust between stakeholders?
    • How do we restore trust between the patient and physician?
    • How do we stop secondary facilitator stakeholders from continuously destroying the patient physician relationship?

In reality, developing solutions to these questions are in themselves business opportunities for facilitator stakeholders that can help Repair the Healthcare System.

However, neither the insurance industry, hospital systems, nor the government see the long term advantage and economic opportunity.

In a comment to my blog Shel Isreal said “

98% of the people think it is broken and the other 2% work for the insurance industry.

The insurance industry has the money and the power.”

However, we have demonstrated the abuse and misuse of the power of information technology by the insurance industry. The misuse and abuse has lead to further dysfunction in the healthcare system and mistrust by the hospitals and physicians.

The insurance industry and the government have used information technology to penalize both physicians and patients using the wrong data to draw their conclusions.

Insurance companies do not have the information technology resources to measure the correct parameters to measure quality care.

I do not see an attempt on their part to correct this deficiency. I only see a movement to make the healthcare system worse with a Pay for Performance (P4P) reimbursement system that is not well thought out. .

It is essential that the solutions I have proposed be coordinated and introduced simultaneously as a single plan rather than introducing elements of the solution separately.

Unfortunately, the government with the pressures of its present political vested interest influences finds it difficult to present the components of repair as a single plan.

The solutions will have to be driven by the consumer (the patient) and not the government. The patients have the power to drive the solutions because they are the users of the healthcare system. If they were the purchases of healthcare, some clever entrepreneur could provide the option for a compelling insurance product that could reward the patient for being responsible for their own care and well being.

The insurance produce could be built to fix the healthcare system.

All that is needed is for the government to write sensible regulations, enforce them and get out of the way.”

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

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Healthcare Spending Increases To 18.2% of GDP


Stanley Feld M.D.,FACP, MACE


Healthcare spending has increased each year. Healthcare spending is now 18.2% of the GDP up from 17.7% in 2014.

In 2000 it was 14% of the GDP.

Healthcare GDP

National spend pic1

The data presented in the following charts are partially correct. They are derived from clams data which are also partially correct. The charts can give an idea on how the healthcare money is

spent. and wasted. Fuel medical costs 2

Wasted Money

Wasted money 3

Drivers of increased Healthcare Spending

Drivers 4

Distribution of Healthcare Spending


There are many reasons for this increase. The Obama administration prefers to blame the increasing spending on his most popular reasons.

His reasons might not be completely true.

The traditional media then publicizes the President Obama’s popular reasons. The reasons get translated into public understanding and public opinion.

President Obama’s reasons for the increased healthcare spending are hospitals’ and physicians’ prices are increasing. Hospital and physician retail prices are increases. However, their insurance reimbursement has decreased. Public opinion then demands that physicians decrease their prices.

The reality is physician reimbursement has been steadily declining in recent years as spending has been increasing.

I have continually pointed this out.

Medicare, Medicaid and private insurance have forced physicians to accept lower reimbursement. Patients are increasingly discovering that “my doctor doesn’t take my insurance or my Medicare or my Medicaid.”

Consumers without insurance coverage are charged retail price by hospitals and physicians rather than the discounted prices hospitals and physicians accept.

These consumers can try to negotiate the prices. They are usually more successful with physicians than hospitals.

Decreasing reimbursement is one of the main reasons physicians are driven to see more and more patients in less and less time.

Physicians must continue to pay overhead and salaries.

This phenomenon of increased patient volume disrupts the magic of the physician/patient relationship. It is also the driving force behind the massive increase in concierge medicine.

If it is not the rise in physician reimbursement, what is the reason for the increase in healthcare spending?

There are several possibilities.

  1. GDP is increasing at a lower rate than healthcare spending.
  2. Consumers are sicker. They need more medical and surgical care than previously.
  3. Healthcare insurance premiums are increasing at a greater rate than the GDP.
  4. Bureaucratic support of the healthcare system is growing at a greater rate than the GDP.
  5. Pharmaceutical use is increasing because a sicker population needs more drugs.
  6. RNA Technology has lead to the discovery of more potent therapies that are costly to the healthcare system.

Statistics published by the Altarum Institute in July suggest that President Obama and his fans in the traditional media reevaluate their premises about the rising healthcare spending.

Out-of-control spending on prescriptions drugs and the soaring cost of health insurance administration continue to be the two major drivers behind rising healthcare costs.”

Healthcare spending grew to $3.3 trillion in this year.


  1. Prescription drug spending increased by 9.2% from the previous year. Part of that increase was the introduction of new drugs.


The Obama administration ignores the fact that more people are becoming sick because of an increase in obesity, diabetes and hypertension. These people now have to take medicine, see doctors, and buy medical devices.

  1. Administration services costs and net costs of health insurance (after paying medical bills) have increased 9.4% from a year ago.

These costs included government bureaucratic costs, insurance bureaucratic costs, out of pocket expenses and insurance premium costs.

How much waste is in all these administrative services costs.

3. Hospital spending rose 6.1% from a year ago. Hospital bureaucracy has been try how to decrease spending by decreasing waste and personal. However, bureaucracy and unnecessary administrators and outrageous hospital executive salaries continue to increase.

  1. Physician and outpatient clinical expenditures rose 5.0%.

Physician investment in medical structures and equipment rose only 1.7%. Physicians are reluctant to make investments in a failing healthcare system.

Each category in the various graphs above reveals opportunities to decrease the cost of medical care.

It cannot be done by the government’s complete take over of healthcare.

The government is the problem as we have seen and still are seeing with the VA Healthcare system.

Socialism does not work. In leads to unintended consequences as consumers adjust to the rules and regulations of an attempt to manage society.

Consumers must demand rule changes and permit the market place to sort things out.

Repair of the healthcare system can only occur in a consumer driven healthcare system with consumers in control of their healthcare and their healthcare dollars.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Obamacare Is Unaffordable For All

Stanley Feld M.D.,FACP,MACE

The 2016 Obamacare enrollment period through is going to have lots of problems. The Obama administration knows it.

The enrollment projection by the Obama administration is far below the nonpartisan Congressional Budget Office’s projection of about 21 million people.

The CBO gets the numbers to calculate its projections from the Obama administration.

“ The administration has set the goal of 10 million to have coverage. That is about the same amount of enrollees who have paid for Obamacare now.”

“We believe 10 million is a strong and realistic goal,” said Health and Human Services Secretary Sylvia Burwell. “

The next sentence is the Obama administration’s spin to confuse the public about the truth.

“We’ve seen high levels of satisfaction with the marketplace and expect the vast majority of our current customers will re-enroll. And our target assumes that more than one out of every four of the eligible uninsured will select plans.”

The original Obama administration enrollment prediction for 2015 was 17 million.

The Obama administration claimed Obamacare was a success in 2014. Eleven million people enrolled despite the problems.    Enrollment in 2014 was extended for most of the year.

The final enrollment number was reduced to 6.6 million after not payment of premiums, false applications, miscounting and dropouts.

Enrollment numbers for 2015 were published as more than 13 million. It was again revised to 11 million and finally 9 million. Enrollment again was extended in 2015.

Two weeks ago it was announced that 330,000 enrollees did not make their second month’s premium payment. Enrollees have a 90 grace period in which they can use their insurance to pay for medical care.

The result is enrollees can have four months of healthcare insurance for the price of one.

People stopped paying the premium because they realized they could not afford the 2015 premium cost. This year the cost will be between 10-40 percent higher than 2015.

In 2012 fifteen (15) million people lost their individual healthcare insurance because of Obamacare’s changes in insurance policy requirements.

The CBO predicts there will be 21million enrollees in 2016.

The Obama administration, using taxpayers’ money, has loaned health insurance co-ops more than $2.4 billion spread over just 23 states.

Most of the Co-Ops are hemorrhaging cash. Four have gone bankrupt and Colorado and Oregon are on the way. Consumers who bought healthcare insurance from these “Co-Op’s” are going to have to find another insurance company through the health insurance exchange.

People are not going to be able to find an affordable insurer. Premiums and deductibles are going to be out of reach to everyone including people on subsidies.

In 2015 the 300,000 that did not pay after the first premium payment has proved this already.

Obamacare has other huge problems. Medicare is one of them

Medicare will expose millions of senior americans to a staggering 50 percent increase in their premiums for Medicare Part B.

It is a result of provisions in the laws governing Medicare and Social Security.

Here is the impending disaster.

The Part Medicare B premiums have been rising each year. The premiums are deducted from Social Security payments made to beneficiaries’ each month.

There is a “hold harmless” provision in the Medicare rules that guarantees that a dollar amount increase in Medicare’s premium one year cannot be so big that the senior is left with a Social Security check payment that is less than the year before.

The goal of the provision is to ensure that senior beneficiaries don’t have less money to live on the next year than the year before.

Inflation is not calculated into the equation.

Watch this.

Seventy percent of the Medicare beneficiaries are held harmless and do not have to pay the increased premium because of the rising premiums. These seniors will pay the same premium they paid the previous year.

The increased costs to the government will have to be paid by higher Medicare premiums and deductibles by the remaining 30 percent of beneficiaries not held harmless.

The Medicare rule is that beneficiaries have to cover at least 25% of the government’s Medicare Part B costs.

As premiums to the government are increased 10-40% by the healthcare insurance companies that do the administrative services for the government, the premium costs to the 30% who are not held harmless are going up over 50% of the previous year’s premiums.

“Medicare Part B deductible, which must be paid by everyone on Medicare (no one is “held harmless”). Medicare Part B premiums will rise from $147 in 2015 to $223 in 2016.”

“This will pose a particular burden to beneficiaries just above the poverty line who aren’t eligible for assistance from Medicaid in paying deductibles.”

The Medicare deductible of $1300 for each hospital admission is a tremendous burden on a senior.

President Obama and the Democrats are frantically seeking ways to avoid a senior uproar as seniors discover yet another hidden Obamacare tax increase.

The Democratic leadership is trying to figure out how to blame Republicans for this mess.

The leadership of both parties is quietly trying to figure out a way around the increase to the affected seniors.

“Premium increases could affect about 30 percent of the 51 million people enrolled in Part B of Medicare, which covers doctors’ services, outpatient hospital services, some home health care and other items.”

Nancy Pelosi has started grandstanding to blame the Republicans for the increase in premiums.

She said, “Congress has a responsibility to act,”

“If we do nothing, millions of American seniors will suffer. Democrats continue to press the Republican leadership to bring a fix to the floor so we can prevent the serious harm this increase will have.”

To avoid a big uproar from seniors Democrats want the federal government to absorb the estimated $7.5 billion dollar premium increases in 2016.

The blame game starts. John Boehner’s aids told Mrs. Pelosi’s staff that the cost would have to be offset by savings elsewhere in the federal budget.

“ President Obama’s staff is considering administrative action to moderate the increase in premiums, perhaps by using a Medicare contingency fund.”

The White House is grandstanding without regard for the law or fiscal responsibility.

“We share the goal of keeping Medicare’s premiums affordable, are exploring all options, and appreciate the interest and ideas of members of Congress,” said Katie Hill, a White House spokeswoman.

Republicans are worried that Democrats will depict them as waging a “War on Seniors” if they do not go along to soften the affect of any premium increase on some irresponsible funding solution.

Isn’t this terrible? Congress and the President refuse to look at and solve the real cause of these problems. They are the unintended consequences of Obamacare that got us into this situation.

The Democrats are using the banal excuse is that the country is to far down the road with Obamacare to abandon it.


Maybe this is exactly what President Obama intended?

Obamacare has only enrolled 9 million people and yet.

  1. It is destroying employer insurance.
  2. The cost of adjusting to Obamacare’s rules is too high.
  3. It has left more uninsured than insured.
  4. It has caused insured persons healthcare insurance to be unsustainable.
  5. It has added millions to the Medicaid roles.
  6. Medicaid reimbursement is very low.
  7. People on Medicaid cannot find a physician because of low reimbursement.
  8. It has pushed up premiums and deductible for seniors who can barely afford the costs.
  9. Seniors on Medicare cannot find a physician.
  10. Obamacare has made the cost of our healthcare system more unsustainable that previously.

Why don’t Republicans teach the people to understand why Obamacare is such a terrible law?

Why can’t they stand up for what they believe?

Why can’t they use my ideal medical saving account to simplify and solve the complications of Obamacare?

The answer always is 50% of people are getting entitlements and they do not want to give them up.

Entitlements can be formatted so that they are earned and responsible entitlements that will not bankrupt the country.

Entitlements can be formatted to help people become independent and prosperous as opposed to more dependent on government and poorer.

Socialism has not worked well anywhere not even in Sweden.

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

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Wanting Something To Fail?

Stanley Feld M.D.,FACP,MACE

If someone wants something to fail, make it complicated enough so no one understands what is going on.

I am convinced that President Obama wants Obamacare, Medicaid and Medicare to fail.

President Obama wants a single payer health care system. He said it as far back as 2003. This You Tube was uploaded on Aug 12, 2009.

President Obama won’t tell the American people the truth about his plans for health care. Watch President Obama declaring his intention in his own words.

The result is everyone will receive the same healthcare under the government direction and control.

The ultimate goal is to make people dependent on the government.

The people will have no power to choose their physician or their treatment. It is true that every country in the western world has this system.

No country has proven that a single party payer system works for countries with the single party payer systems economy or their citizens. Surveys have shown that their citizens are satisfied.

The main reason people like it is because it relieves anxiety of being able to receive medical care even though they have relinquished their freedom to choose their physician or insurance company.

The biggest loss is independence from the government bureaucracy. People will be dependent on the decisions of unelected government bureaucrats.

The big questions that are never answered about medical costs are; who is spending most of the healthcare dollars and what are the healthcare dollars being spent on?

Do you want the government to decide if you are young enough to get an artificial hip or knee when you need it?

Do you want the government to decide about your treatment or do you want your doctor to help you decide on what your best treatment is?

President Obama is changing medical care in a methodical way. He is utilizing executive orders and rules and regulations written by non-elected bureaucrats, who are forced to follow his orders. Our elected officials should be in charge of government spending.

Many in congress know better and would not let President Obama do what he is doing. Most in congress are happy that he has exempted congress from Obamacare.

President Obama and his administration have been trying to do bad things very quietly to avoid political uproar. The mainstream media has been a great Obamacare ally.

The mainstream media has helped Obamacare keep these destructive regulations and their subsequent failures out of public view.

The media has also publicized President Obama’s lies about the success of Obamacare.

President Obama is adept at diverting blame for errors and failures in pursuit of his single party agenda.

At the same time he is trying to take power away from the states he is trying to persuade states to not permit big insurance premium rate increases requested by many health insurance companies for 2016.

President Obama’s Obamacare is the cause of the increases. He is positioned to blame the state regulators for the insurance companies not showing up to sell insurance for 2016.

If the states act to cut back rate increases the insurance companies will not participate in the federal and state exchanges for the 2016 enrollment period. The result will be the erosion of the possibility of competitive pricing.

The Obama spin machine started working at the beginning of the summer to shift the blame and/or force insurance companies out of the market.

Kevin J. Counihan, the chief executive of the federal insurance marketplace said in letter to state insurance commissioners, “Recent claims data show healthier consumers.

He also said, “The federal tax penalty for going without insurance will increase in 2016, he said, and this “should motivate a new segment of uninsured who may not have a high need for health care to enroll for coverage.”

This claim of costs data by Obamacare does not square with the healthcare insurance companies’ costs data. They are finding that new customers were sicker than expected. The insurance industry is also losing money because the Obama administration has paid them $2.5 billion dollars less than they were promised.

Health insurance plans sold through Obamacare’s Federal and State Health Insurance Exchanges are seeking 10 to 40 percent increases in premiums.

They are also seeking the same increase in the private sector as well as in Medicare and Medicaid.

The Obama administration is making up its own story to force state regulators to not allow the increased premiums.

The Obama agenda is choreographed to prove that insurance choices do not work. He is hoping that the public will conclude the only solution is a single party payer system.

The problem is the government cannot afford a single party payer system and the people will not tolerate it.

What is more bizarre is the Obama administration made loans to help start up state co-ops. These state co-ops were supposed to compete with the big insurance companies. They were supposed to sell insurance on the health insurance exchanges. The Obama administration invested $38 billion in startup costs and solvency loans to these co-ops.

Nevada Health Co-op received $66 million in federal loans. It is closing down on January 1,2016 because it ran out of money.

Louisiana Health Cooperative announced in July that it was voluntarily shutting down operations.

CoOportunity Health, which sold policies in Iowa and Nebraska, was liquidated and forced to close earlier this year.

Many state Co-op’s are on the way to bankruptcy. In Nevada alone one third of the health insurance exchange population will lose insurance coverage.

Nevada Health CO-OP’s departure will leave a big hole in Nevada’s exchange market. Open enrollment begins Nov. 1, and consumers will have to shop for plans with other carriers. The co-op had 21,300 members as of the first quarter this year. Nevada’s exchange population was about 63,000 at that time.

A.M. Best’s report shows a majority of the nation’s 22 co-ops have combined medical and administrative expense ratios above 100%.

All these failures and impending failures mean that either the Obama administration is stupid or things are going precisely as  President Obama had planned.

The healthcare system is on its way to destruction. The federal government as the payer of last resort will replace it.

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

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Obamacare Owes Insurance Companies $2.5 Billion Dollars For 2014 Health Exchange Losses

Stanley Feld M.D.,FACP,MACE

These days there is very little news in the traditional mainstream media about Obamacare.

The average person thinks everything is fine. President Obama has told us over and over again that Obamacare is a great success.

Unfortunately, this is far from the truth as the Obama administration prepares for the 2016 enrollment period.

Open enrollment is supposed to start November I, 2015 and end January 15, 2016 for 2016.

In 2013 and 2014 open enrollment was extended many months because of poor enrollment. I suspect the same will happen during the 2016 enrollment period.

The disastrous web site is still not fixed.

The healthcare insurance industry has increased Obamacare insurance premiums by double digits. The Obamacare deductibles remain in the thousands.

Even with large Obamacare subsidies people making under $50,000 cannot afford the subsidized premiums or deductibles.

Some people are registered through both the health insurance exchanges and Medicaid. This has been recently discovered by the Obama administration.

These people have received the Obamacare cash subsidy and Medicaid coverage. Now the Obama administration expects to be paid by these recipients for the government’s overpayment.

The Obama administration has refused to publish the number of people affected.

None of these issues have appeared in the traditional mainstream media.

The Obama administration continues to publish conflicting figures about how many people are actually enrolled through its federal health insurance exchanges.

The administration needs the healthcare insurance industry to do the administrative services for the health insurance exchanges.

At the onset of enrollment in 2013 healthcare insurance companies did not want sign up to do the administrative services. The companies figured that high-risk people without insurance would sign up for insurance and they would lose money. Obamacare required that the premium would be equal for everyone regardless of the health risk.

Obamacare originally wrote into the law three risk corridor programs that would be activated if necessary to subsidize the healthcare insurance industry against undo risk.

As a result of the healthcare industry’s lack of participation in the federal and state insurance exchanges, the risk corridors were activated.

“The healthcare reform law established three “market stabilization” programs to help insurers weather the first few years of covering a new population with unpredictable healthcare needs. At issue is the risk corridors program.”

I was astonished when I learned of these risk corridors. The corridors encouraged the healthcare insurance industry to participate in providing administrative services for each state and federal exchange at no risk of loss.

It was amazing that the leading Republicans for repeal of Obamacare did not make this clear to the public.

The insurance industry was actually guaranteed a profit because they provided its own profit and lost data. The Obama administration simply accepted its data. The healthcare insurance industry was supposed to receive the subsidy for its loss.

The government’s hope was to provide enough insurance choices to enrollees in the health insurance exchanges so there would be competitive pricing.

Unfortunately for Obamacare it did not work out as planned.

The government had planned on releasing risk corridors data in August but waited until October 1, 2015 due to discrepancies in the data.”

I suspect the delay was for political reasons and to provide enough time for the government to present the data in a less negative fashion.

The data provided by the Health insurers that sold health insurance plans showed that those insurers lost a great deal of money on the Affordable Care Act‘s exchanges in 2014.

The data shows the Obama administration has short changed the healthcare insurers that participated in Obamacare $2.5 billion dollars promised to them in the safety value risk corridor subsidies.

The Obama administration now is promising those insurance companies that the $2.5 billion dollars to cover the deficiency will be covered with budgeted monies from 2015 and 2016 if possible.

President Obama is now sowing the seeds to blame the nonpayment on Republicans since Republicans control congress.

Republicans thought the health insurance risk corridors were a stupid idea to begin with and predicted failure. Now the Obama administration is trapping the Republicans for not wanting to pay bills that are owed.

Some smaller insurance companies who were seduced into participating in this no risk insurance policy folly are now worried about experiencing “solvency and liquidity problems”.

CMS would not give the number of companies affected. It said the cases are isolated.

The insurers requested $2.87 billion in payments to cover their losses. The CMS will only reimburse 12.6% of the payment requests, meaning insurers will still be owed more than $2.5 billion.”

“ Names of companies that are owed money were not released.”

Does anyone think the insurance companies are going to sign up for the 2016 enrollment cycle?

Insurance companies do not know how much Obamacare will short- change them for the 2015 subsidies yet.

One can also begin to understand why insurance rates for both government and private insurance are increasing when physician and hospital reimbursement are falling.

The insurance industry feels it has to make up its loss.

Why are the Republicans not saying anything about this to the public?

Why aren’t Republican candidates for President not pointing out this folly?

Why are they letting themselves be set up to be blamed for not wanting to pay the government’s bill?

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

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