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Obamacare Tax Hikes That Are Forgotten

Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens earning less than $250,000 dollars a year.

According to Grover Norquist there will be ½ trillion dollars ($500 billion) in new taxes collected from the group of people making less than $250,000 a year.

These new taxes contradict President Obama’s promise that “anyone making under $250,000 a year will not pay a dime in new taxes.” Many of these taxes on businesses have been passed on to consumers in the form of higher prices.




I am not talking about the increase in taxes on capital gains and dividends that seniors rely on to survive. I am talking about all the other taxes that affect purchasing power.

In 2012, Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

The traditional media have ignored these new taxes and Mr. Norquist’s summary.   No one is talking about how these taxes are hurting seniors and the middle class economically.  

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said people earning under $250,000 would not pay one single dime more in taxes.

I suggest everyone watch President Obama’s lying and defending of his lies. After the first You Tube let it keep playing to hear subsequent You Tubes.

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organized the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in their taxes.

Mr. Norquist’s article appeared in 2012.

“Obamacare contains 20 new or higher taxes on American families and small businesses. 

Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.


Capital Gains











*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:


First $200,000
($250,000 Married)

All Remaining Wages

Current Law

2.9% self-employed

2.9% self-employed

Obamacare Tax Hike

2.9% self-employed

3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that took effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following


1 Adult

2 Adults

3+ Adults


1% AGI/$95

1% AGI/$190

1% AGI/$285


2% AGI/$325

2% AGI/$650

2% AGI/$975

2016 +

2.5% AGI/$695

2.5% AGI/$1390

2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

© 2012 Newsmax. All rights reserved.

Mr. Norquist left out the worst tax of all. The “tax” is under everyone’s radar. It has not been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"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


$247.00 in 2014."


All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.


This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.  

These are provisions incorporated in the Obamacare legislation, purposely
delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.


Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus.  Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare could be repealed.   

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.  

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

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Nobody Seems To Care About The Increases In Obamacare Taxes

Stanley Feld M.D.,FACP,MACE

There are at least two ways to balance the budget. Increase taxes or decrease spending.

If you increase spending without increasing taxes, you increase the budget deficit. If taxes are increased enough the budget deficit might be reduced.  

It was the Obama administration’s hope that if taxes were raised slowly, Americans would not notice the increases.

This is exactly what President Obama and the tax and spend Democrats are doing.

A frustrated reader writes about the slow rise but unrelenting rise in taxes.

“Here is a message from my buddy Brad.

As Jim Naybors/Gomer Pyle used to say – "surprise surprise."

Here is what happened on January 1, 2015:

Top Medicare tax went from 1.45% to 2.35%

Top Income tax bracket went from 35% to 39.6%

Top Income payroll tax went from 37.4% to 52.2%

Capital Gains tax went from 15% to 28%

Dividends tax went from15% to 39.6%

Estate tax went from 0%to 55%

Remember this fact:

These taxes were all passed only with Democrat votes, no Republicans 
voted for these taxes.

These taxes were all passed under the Affordable Care Act, aka 

The problem is taxes are at the tipping point. The rich and the middle class are now noticing the yearly tax increases. They are starting to shout, “no new taxes. Where is the value of these new taxes?”

A problem in America is an increasingly large  group of people who pay no taxes. These people have no choice but to accept government handouts to survive.

It has been reported that government handouts are equivalent to about a $50,000 a year post tax income. The entitlements blunt incentives to take the initiative and find work in order to be productive citizens.

Working people are experiencing the increased tax burden and are unhappy.

I have written a few articles listing Obamacare increases in taxes. President Obama has steadily increased taxes each year for the last six years.

The most irritating thing about the increased taxes is Americans are not getting value for their money.  All they are getting is lies and failed programs.

Administrator Marilyn Tavenner is resigning her post overseeing Obamacare just months after she admitted that the Obama White House’s highly publicized 8 million Obamacare enrollment figure was inflated by at least 1.3 million.

There is always a fall guy. It is never President Obama or his policies that are at fault. There is never full disclosure or transparency about these failed programs.

A vivid example of the lack of transparency is a recent disclosure by the budget committee about the Obama administration’s using unauthorized funds to pay for Obamacare cost overruns. Congress is supposed to authorize the use of funds according to the constitution.

Obamacare was having trouble getting insurance companies to participate in Obamacare’s health insurance exchanges. President Obama activated the government guarantee reinsurance program to subsidize the insurance industry. The goal was to induce the healthcare insurance industry to participate in the health insurance exchanges. The Obamacare reinsurance program guarantees the insurance industry that it cannot loss money in providing insurance through the health insurance exchanges.

 The Treasury Department has rebuffed a request by House Ways and Means Chairman Rep. Paul Ryan to explain $3 billion in payments that were made to health insurers even though Congress never authorized the spending through annual appropriations.

At issue are payments to insurers known as cost-sharing subsidies. These payments come about because President Obama’s healthcare law forces insurers to limit out-of-pocket costs for certain low income individuals by capping consumer expenses, such as deductibles and co-payments, in insurance policies. In exchange for capping these charges, insurers are supposed to receive compensation.

What’s tricky is that Congress never authorized any money to make such payments to insurers in its annual appropriations, but the Department of Health and Human Services, with the cooperation of the U.S. Treasury, made them anyway.

There are several other incidences of money shifting without congressional appropriation.

President Obama continually forgets that the constitution provides for three independent branches of government. They were formed in order to maintain checks and balance so one branch does not become all powerful.

The apparent disregard for the constitution is ubiquitous in the Obama administration.

If anyone is bothered by these actions by the Obama administration, please write to your representatives in congress.

If you think it is important that everyone in the U.S. should 
know these things, feel free to pass this on.

If there is value to the healthcare system with Obamacare, a debate about the need for increased funds is appropriate.

Most Americans do not like Obamacare. Most physicians do not like Obamacare. America’s budget cannot stand Obamacare.

President Obama loves Obamacare. Isn’t President Obama supposed to represent the will of the people?

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

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Where Are Your Actionable Points To Replace Obamacare?

Stanley Feld M.D.,FACP,MACE

 Some have criticized me for always criticizing Obamacare. There is plenty to criticize. President Obama has asked if anyone has a better idea than Obamacare please let him know.

The question asked by some readers is where are your actionable points to repair the healthcare system.

My answer is, “you have not been reading my blog.”

Democrats and President Obama have not read my blog.

The Republicans have been searching for an alternative plan. President Obama has mocked them for not having an alternative than Obamacare.

Republican leaders have not read my blog either. If they had and really thought about my plan they would conclude it could work.

 My plan aligns all the stakeholders’ incentives while reducing the cost of healthcare coverage to consumers. It also decreases secondary stakeholders’ costs and increases their profits. It is very democratic. It would provide universal care without government interference.

These actionable points have been clearly described in many of my blog posts. It is a “consumer driven healthcare plan.” The real customers in the healthcare system are consumers, not physicians, insurance companies, hospitals or the government.

Below are some of the links that provide actionable points to Repair The Healthcare System.

The first link is an overview using a slide presentation. It outlines the business model for 2020.  The details of each specific point can be found in the links in the slide presentation or in the websites search engine.

Obamacare ignores many of the key points. Obamacare will fail because of the absence of these key points. Simple things must be done for an alternative to Obamacare to succeed.

The second link is My Ideal Medical Savings Account is Democratic. My ideal Medical Savings Account can cover and motivate every socioeconomic group. It provides incentives for all consumers to remain healthy and take care of their chronic disease. It promotes consumer responsibility.

Consumer self-responsibility is an essential element in the Repair of the Healthcare System.

My Medical Savings Account is different that a Health Savings Account.

Self-management of chronic diseases is a vital element necessary in a law that attempts to Repair the Healthcare System. It requires education and incorporation of all the spokes of the wheel in the link above to the slide presentation.

President Obama has done some pilot studies using the wrong groups (political groups) to study the self-management hypothesis.

They have all failed because the administration picked the wrong groups to do the pilots.

Systems of care must be developed to teach patients to self-manage their chronic disease to decrease the complication rate of those diseases.

Eighty percent of the healthcare dollars are spent on treating the complications of chronic diseases. Twenty percent of patients have a chronic disease that is not well controlled and will lead to complications eventually. This can be solved with a properly executed Systems of Care by physicians using information technology as an extension of their care patient.

Obamacare does not seriously consider any of these vital corrections necessary to create an affordable healthcare system. The hospitals and/or physicians cannot be responsible for consumers’ behavior to avoid the complications of chronic diseases. Accountable Care Organizations are based on the fact that the hospitals and physicians are responsible for better outcomes.

 Hospitals and physicians have to have the infrastructure to teach patients to become “professors of their diseases.”

Another simple action point is to provide equal tax deductibility for the individual insurance market and group insurance market.

At the moment employers providing insurance to employees can deduct premiums from revenue. An individual buying insurance for himself and his family does not get the same tax deduction. This discrepancy can easily be cured by providing the individual market with the same tax deduction as the group market.

The above links to blogs I have written are just some of the important actionable points necessary to Repair the Healthcare System.

Please study these action points in the links and try to understand how vital they are to maintaining a viable healthcare system.

Obamacare’s complicated rules and regulations have only driven the healthcare system to further dysfunction and increased costs while only having less than 10 million people really signed up after 2 years of enrollment and 6 years of increased taxes.

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

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Obamacare’s Solyndras

Stanley Feld M.D.,FACP, MACE

Peter Orszag was previously President Obama’s director of Office of Management and Budget. He was wrong about Obamacare’s economic impact, improvements in the healthcare system and efficiency in 2009.  He is wrong about it in 2015 in his critique of Steven Brill’s book “A Bitter Pill”.

The problem is Peter Orzag still believes in the Obama administration’s fiction. He quotes the Obama administration’s spin of the results as proof of Obamacare’s success. There is little valid data to back up the spin.

Obamacare has had its share of Solyndras. Solyndra was destined to fail. It had a lot of built in organizational waste.

I fear the few Obamacare experiments that we are aware of that have failed are only the tip of the Obamacare failure iceberg. There will be many more debacles that the Obama administration is probably hiding. 


Community Living Assistance Services and Supports, or CLASS, was designed to provide cash benefits for those patients needing long-term services and support. CLASS was a part of Obamacare (Affordable Care Act). Many Republican and moderate Democrats objected to CLASS and considered it fiscally unsustainable. It would only waste money.

Senate Budget Committee Chairman at the time Kent Conrad D-N.D. called CLASS “a Ponzi scheme of the first order”. In any event the $68 billion dollar program was rammed through as part of Obamacare.  

Two years later the Department of Health and Human Services determined CLASS could not be implemented in a fiscally solvent manner, and in January 2013 Congress repealed CLASS.

In 2015 the American public still does not know how much of the $68 million dollars was wasted.

Just how much did cost?

 The American public will never know. We will never know what we should have paid for the website or what we finally paid.

In October 2013 as soon as it was apparent that was a train wreck the Obama administration denied all the published prices contracted for building the website.

Prices to build the website varied from $91 million dollars to $634 million dollars to over 1 trillion dollars ($1,000,000,000.00).

Americans did not know what the website should have cost. They never found out what the cost was to rebuild the website after the initial disaster.

It was never clear whether the contract to CGI was won by competitive bid. The Obama administration never answered the question of Michelle Obama’s influence in choosing CGI.

The history is clear. CGI has failed to deliver for other projects they have done in other parts of the world.

What is the truth? Why would the Obama administration pick this company? What can we do about this waste of taxpayers’ money?

I guess Americans can remain passive and pay more taxes.

Americans have given up on the truth about the

 debacle. The attitude of many is that it is what it is. We must go on.

All Americans are hearing or want to hear is the current website is easy to use and is working well.The important question is, Is it?

It is easy to understand why Jonathan Gruber would say Americans are stupid and the lack of transparency is a powerful tool. The implication of that statement indicates an Obama administration attitude. It is the reason the administration says they hardly knew the guy.

CoOportunity Health falters, taken over by state

This Obamacare debacle almost got away from recognition by the American public.

 CoOportunity Health is a fledgling Iowa health insurance cooperative set up under  Obamacare with Obamacare money.  It is going bankrupt.

CoOportunity Health was set up by the Obama administration. The Obama administration granted the company $146 million dollars in funding from Obamacare funds. The idea was to provide consumers and small businesses alternative insurance in healthcare markets with limited insurance choices. It could also be thought of as a disguised “Public Option”.

The healthcare insurance industry had refused to participate in the federal and state insurance exchanges in many states. The healthcare insurance companies thought the risk was too great. They would lose money.

Just before this year’s open enrollment period President Obama activated the reinsurance provisions in Obamacare guaranteeing insurance companies that they can only make money and not lose money on providing insurance through the government health insurance exchanges.

The Healthcare insurance companies are falling all over themselves to provide healthcare insurance in high risk states now.

 Where else can you sell insurance to more people at no risk?

“As of December 12,2013 Cooportunity has only $17 million of the $146 million dollars left.  CoOportunity has been taken over by state regulators and could soon go under, officials said Wednesday.

The Obama administration knows they can now throw government funded insurance companies like CoOportunity under the bus because they have guaranteed backup companies from the healthcare industry that want to sell no risk insurance.

 The CoOportunity hasn't reached insolvency yet but it doesn’t have  enough money on hand to continue to run the company.  It will leave 96,350 consumers uninsured with unresolved claims healthcare insurance claims. These consumers will also lose their un-used premiums.

The 96,350 should be able to get insurance through the federal health insurance exchange in their state.

The federal government as banker has simply cut CoOportunity’s credit and took a $146 million dollar loss.

I wonder how many other Obamacare funded insurance companies are out there?

I wonder how many other Solyndra like experiments Obamacare has. I can think of at least 4 or 5.

I wonder how much money Obamacare is losing on experiments and bureaucratic waste?

It is making medical care more expensive for taxpayers and for patients with increased out of pocket expenses.

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

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Looking For Alternatives To Obamacare

Stanley Feld M.D.,FACP,MACE

The dice have been loaded against the American people by the rules and regulations in Medicare and Obamacare.

Patients liked their doctors. Once they discovered that they could not keep their doctors under Obamacare they became angry at President Obama for lying to them. The soon to be released new payment rules will increase the anger.

Physicians have found it more difficult to run small private practices.  The complexities of compliance with the rules, regulations and the payment systems for both Medicare and Obamacare are forcing physicians to sell out to hospital systems.

These complexities are in effect ending independent medical practices. This has been intentional. The Obama administration doesn’t want to control 600,000 independent physicians. It wants to deal with the hospital systems the are involved with. The hospital systems can then deal with the doctors.

Republicans are looking for a compelling alternative to Obamacare.

Just as Obamacare was forced through congress, President Obama is trying to force how medicine is practiced in America down the throats of Americans.

It is consistent with Jonathan Gruber’s view that Americans are to stupid to understand what is going on. It follows that Americans are too stupid to be responsible for their own care.

Americans want freedom of choice. They do not want the government to tell them what to do.

Republicans are looking for an alternative to Obamacare. A viable alternative could be to save the private practice of medicine and not subject Americans to the inefficiencies of a government controlled bureaucracy.

 Physicians by nature and education are competitive. Competition leads to improvement of the delivery of medical care.

All medicine is local. The alternative to Obamacare is to have local completion among physicians and permit patients to choose their doctors.

The answer to the Republican’s dilemma is right in front of their eyes.

A real Republican alternative to Obamacare would support physician ownership of independent medical practices and preserve local competition between doctors and maintain choice for patients.

Obamacare’s promotion of large hospital systems with salaried physicians eliminates physicians competing for patients. The lack of physicians competing for patients destroys the physician/patient relationship.

Physicians listen to patients if patients have a choice. The interaction is a partnership called the patient /physician relationship.

This solves the problem of President Obama’s lie. “If you like your doctor you can keep your doctor period.” Patients choose their doctors.

Dr. Donald Berwick and Jonathan Gruber’s view the consolidation of physicians and hospital systems as a necessary step to enable payment liability onto providers through hospital systems and away from government programs such as Medicare and Obamacare.

President Obama does not understand that doctors are not stupid either. At the moment physicians feel financially cornered by the government and the hospital systems and are joining hospital systems as a temporary means of surviving.

President Obama also does not realize that over the last 50 years there has been a build up of physician distrust for most hospital administrations.

Most administrators have tried to repair that mistrust but it has not been very successful. Hospital systems have been trying for years to own their physicians’ intellectual property and surgical skills for their hospital system’s profit. It is all about economics. Patient care is secondary.

As hospital systems consolidate competition will be eliminated.  Then hospital systems will realize they are losing money because of the risk they agreed to accept from the government. Hospital systems will demand more money from the government or consumers or go out of business.

Who loses? 

Patients lose, taxpayers lose, and the American healthcare system loses.

The abuses of the healthcare system by all the stakeholders must be fixed. It will never be fixed by forcing stakeholders to fix it. It will only be fixed by aligning incentives of all the stakeholders. Consumers must lead the way.

A recent Physicians Foundation survey of 20,000 U.S. doctors found that 35% described themselves as independent, down from 49% in 2012 and 62% in 2008.

It has also been reported that hospital systems are complaining that they are losing money on their physicians in these integrated systems.

Hospital systems are dropping out of the Obamacare Accountable Care Organization programs. There have been reports that salaried physicians are less productive that independent practicing physicians.

I believe in the team approach to the management of chronic disease. The patient must be at the center of the team with the physician being the head coach or manager and his team being an extension of the physician’s care.

Medical decision making entities must not be the insurance company or the government.

The idea that integrated systems with salaried physicians leads to increased economic efficiency, better quality of care and clinical outcomes than small independent private practices never made syllogistic sense to me.

Patient care becomes depersonalized in large hospital systems. Both patients and physicians become commodities in systems focused on the bottom line.

Small practices have the advantage of providing a personal style of care. Consumers want that comfort when they are sick. They want someone they know who is going to listen to them and talk to them.

In a private setting physicians can practice the way they want, without interference by a large, impersonal organization driving efficiency.

If a physician in private practice does not satisfy the consumer’s need the consumer can leave the practice and go somewhere else.

  "When you work closely with patients and empower them, they are going to make better choices," said Craig C. Koniver, MD, a solo family physician in North Charleston, South Carolina. He said a team of caregivers at a large practice will not have the same impact, because none of them are as close to the patient as he is.”

Health Affairs published a study in August 2014 looking at primary care physicians in small practices and “ambulatory care sensitive” admission rates. The study included such conditions as congestive heart failure in which admission to the hospital can be preventive by high quality primary care. The patient relates positively to the physician and the physician relates positively to the patient (positive patient/physician relationship).

“The study found that practices with 1 to 2 physicians had ambulatory care-sensitive admission rates fully 33% lower than practices with 10 to 19 physicians.”

This is not the only study that shows that small independent private practices can deliver just as high or higher quality of care than large integrated hospital systems with salaried physicans.

“ A 2013 study[2] showed that small practices in general had slightly lower hospital readmission rates than large practices.”

Additionally, “a 2012 study[3] looking at practices ranging from 5 to 750 physicians found that the smaller ones had fewer ambulatory care-sensitive admissions and lower overall costs of care for diabetes.”

 All three studies turned a piece of conventional wisdom on its head; that large practices, with their care management teams and sophisticated clinical information systems, produce better clinical outcomes.

Republicans should start presenting alternatives to Obamacare. The alternative must provide consumers with what they want rather than systems that let the government to tell consumers what they are going to get.

The ideal medical savings account will let consumers choose and keep their doctor if they like their doctor.

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

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Obamacare Application Data Is Wrong For 2 Million Applicants Receiving Subsidies

Stanley Feld M.D.,FACP,MACE

The second really big deal is the fact that over two million people lied on their application for Obamacare through the federal health insurance web site

We do not know how many of the 1.2 million who received insurance through state exchanges lied. 

Unfortunately, the Obama administration throws so many numbers out of context at the American public that it is impossible to follow the true facts and subsequent disastrous consequences.

Let us look at the numbers slowly. President Obama was claimed that 8 million people signed up for Obamacare by March 31,2014.

President Obama and the healthcare insurance industry were terrified about adverse selection by the people signing up. Both worked hard to get young people with no preexisting illnesses to sign up so the insurance premiums would not increase next year.

Basketball, baseball and football stars were recruited to advertise Obamacare’s benefits on TV and encourage enrollment.

The population, in the uninsured individual insurance market, was only 14 million out of a population of 350 million people. Three hundred and thirty six million received waivers from Obamacare for one reason or another.

What will happen when 336 million must participate in Obamacare? The percentage of participants in the population will be tiny if the individual market is a guide.

Seven million of the fourteen million lost their healthcare insurance because of Obamacare’s requirements. Eight million signed up for healthcare insurance under Obamacare. This represents an increase of only one million and not and increase of eight million.

Of the 8 million, 85% or 6.8 million people applied and received government subsides. These subsidies were supposed to be tax credits.

The did not have a functional back end to the website to check if these people were lying about their income, job status, and even citizenship.

 If people intentionally misstated information, they were warned they could be charged with perjury. I assume President Obama will waive that charge.

Only citizens and legal immigrants are eligible under the law for subsidized coverage.

 The government signed up about 5.4 million people, while state-run websites signed up another 2.6 million.

Only 1.2 million of those were not eligible for subsidies.

Are these 1.2 million the part of the 7 million who lost their insurance because of Obamacare? Are the 8 million the people who did not have insurance before Obamacare?

Both are important questions that we have not gotten answers to.

My guess is the people who signed up were people who could not get insurance because of preexisting conditions or people who could not afford insurance in the individual market.

In either case the will be adverse selection and increased healthcare utilization. Insurance premiums will increase for everyone in the health insurance exchanges. 

 Some 80% of all those who have enrolled in plans nationwide, according to federal statistics released today, have chosen a silver plan, meaning deductibles of $2,000 for singles and $4,000 for families, or gold or platinum plans, which have no deductibles. “

“Only 18% have opted for bronze plans, which offer lower premiums, balanced by deductibles of $4,500 for singles/$9,000 for families.”

Many consumers can hardly afford the bronze plans with subsidies much less the high deductibles. Those consumers will be forced drop out of Obamacare.

“The Associated Press reports that of the 5.4 million people who signed up for health insurance through the federal marketplace 2 million submitted information that does not match up with federal data.”

The discrepancies could affect their subsidy adversely. Applications were accepted on boy scouts’ honor. The subsidies were determined on the basis of the information on the application. These people will owe the government the difference plus a penalty. They are also liable for perjury.

The back end of is still incomplete.

“Serco, a foreign contractor already under investigation, was awarded a $1.2 billion contract to process Obamacare’s paper applications, and the AP reports they will be tasked with resolving these application issues. “

Despite having had three years and more than $600 million to work with the federal governmentand its chosen contractor could not build a functional website. It cost an additional $200 million dollars and four months to get the front end to work.

The $600 million to build was more than it cost Apple to develop the iPhone. Apple is an American company with American jobs. 

It should be recalled that another foreign contractor (CGI of Canada) got the first contract. Michelle Obama’s Princeton classmate happened to be an executive,


Serco is a foreign company riddled with a history of transgressions. The most recent transgression was that Obamacare contractors were literally being paid to do nothing.”

The White House has attempted to dispel concern about the website being dysfunctional.

However, the report of over 2 million falsified applications has reignited the questions of government incompetence and misleading information about the dysfunctional website as the enrollment period approached.

As Americans for Prosperity reported in the Washington Times early last month, “the website was originally intended to function automatically, calculating premium subsidies, making government payments, and tracking enrollment information that would affect future costs.”

“ But the interim system currently in place (that resulted in the newly revealed data discrepancies) is “pretty much a spreadsheet and some informed estimates,” according to Politico.

Compounding  problems are a Roll Call report that almost 3 million Medicaid enrollees have not yet had their applications processed.

These issues are all separate issues from Obamacare’s cancelled healthcare plans, physicians opting out or retiring, and the scandal with the Veterans’ Affairs health care system.

In reality all the issues are one with the Obama administration making it clear that a government run bureaucratic healthcare system is a nightmare that will destroy the healthcare system in America.

8 20 2014 Obamacare-Delays

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

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More Bad News For Obamacare And Taxpayers

Stanley Feld M.D.,FACP,MACE

The Obama administration and the traditional mainstream media are working very hard to keep the bad news about Obamacare away from the general public.

The Colorado exchange (Connect for Health Colorado) expects nearly 24% of the enrollees to drop health exchange coverage in fiscal 2015.

This is a direct contradiction to the Obama administration’s projection of the growth of health insurance exchanges.

“In April 2014 after open enrollement closed, the staff of Connect for Colorado projected 13 percent of people enrolled will drop or not pay for policies in fiscal 2015, but now they are expecting about 24 percent to drop their policies, according to the latest model.”

“And in fiscal 2016, the revised figures show dropped policies going from the 16 percent projected in April to nearly 22 percent.”

The Colorado Health Insurance Exchange’s chief financial officer Cammie Blais said the staff is using the higher drop rate in more recent models because that is how national figures are tracking.

President Obama and the Obama administration are aware of these figures. As usual they are keeping it from the public.

Why is happening nationally? There are multiple reasons.

Eighty five percent of the people who have enrolled have qualified for subsidies on the basis of the information they gave on the enrollment form.

The federal government was not set up to verify the information given on the enrollment form at the time of enrollment.

President Obama told everyone he would take his or her word for the information’s accuracy. This was a tremendous defect in the Obamacare system.

Many enrollees are going to lose part or the total subsidy provided by Obamacare. For some, the original subsidy was not enough to reduce the burden of insurance. In many cases the burden included high deductibles and copays that were unaffordable.

Many of the remaining fifteen percent of the enrollees had preexisting illnesses and could not buy insurance on the open market and/or were making over $50,000 a year.

Their premiums plus deductibles and copays are so high that enrollees making over $50,000 a year realize they cannot afford the insurance and have to drop out of next year’s exchange.

As a result of this adverse selection healthcare insurance industry’s premiums are going to skyrocket in 2015 as they have skyrocketed in 2014.

If the government starts convincing the majority of the public that the free market solution of the health insurance exchanges doesn’t work, the only choice will be a single party payer system for the entire population.

The VA system is an example of a single party payer system run by the government. It is a bureaucratic mess that is inevitable with a government run single party payer system.

A large bureaucratic single party payer systems relying on rules and regulations will end up with as non-transparent bureaucracy built for the benefit of the bureaucrats and not the people.

I think the public understands this. I think the Obama government is out of touch with the people.

President Obama ought to reexamine his premises.

The Obamacare system being built is destined to fail. It is not a consumer driven free market system. It does not follow that a single party payer system will work.

In reality none of the government controlled single party payer systems throughout the world work. They are just free. However, these systems are unsustainable.

The 8 million enrollees that President Obama ran his Obamacare victory lap on continues to dwindle at an accelerated rate.

If the DC appeals court rules against the federal government ability to provide subsidies, the number of enrollees will decrease even further.

The law states that only State health insurance exchanges can provide subsidies.

Obamacare is getting further and further away from being functional.

The Obama administration and the traditional media are working very hard to keep this information from the general public.

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

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Lies and Concealed Failures

Stanley Feld M.D.,FACP,MACE

Americans are now certain that President Obama lies indiscriminately to them. He tells us what we want to hear. At the beginning of his quest for the presidency all Americans wanted to believe him.

Unfortunately he has been lying to us all along.

YouTube has given Americans the ability to easily review statements President Obama has made to see if he was deceiving us.  

His lies about Obamacare are now legend. What follows is a compilation of these lies.

There are compilations of all the lies for each of the scandals including Fast and Furious, Bengashi, the IRS, and the VA among others on YouTube.

President Obama continues to call them all these scandals “phony scandals”.

To paraphrase Carl Sandberg, in his book Prairie Years, “if you tell a lie you better have a good memory.” I do not think President Obama feels he is obligated to have a good memory.  YouTube has made this point clear.

Since March 31, 2014 President Obama and his administration have tried to keep Obamacare out of the news. On March 31,2014 President Obama had declared Obamacare an overwhelming success. He declared there is no further need for the press to generate untrue controversy about Obamacare.

The mainstream media has complied with his request. It has been been silent about Obamacare’s ongoing failures.

In the last three months several reports have been published but never have reached the public through the mainstream media.

Americans may never get an accurate projection of Obamacare's impact on the deficit because the administration has not been transparent and or truthful about its impact.

Before Obamacare became law, the Congressional Budget Office (CBO) projected, using figures given to it by the Obama administration, that Obamacare would cost $938 billion over ten years. The CBO also projected Obamacare would reduce the budget deficit by $143 billion over the first decade.

President Obama collected increased hidden taxes for the four years before Obamacare was supposed to be implemented.

Full implementation has now been delayed by five to six years while the increased taxes continued to be collected.

The delay in full implementation is the result of the unconstitutional waivers President Obama gave to some groups.

The original CBO estimate included a $780 billion reduction in Medicare spending cuts along with a double counting scandal.

In April 2014, the CBO said that the cost of the ACA from 2015 to 2024 would be more than $1.8 trillion — twice as much as its first ten-year projection.”

The addition of $1.8 trillion to the budget deficit as opposed to a $143 billion reduction is a very big difference.

In that same April report, the CBO include a significant footnote:

"CBO and (the Joint Committee on Taxation) can no longer determine exactly how the provisions of the (Affordable Care Act) that are not related to the expansion of health insurance coverage have affected their projections of direct spending and revenues. Isolating the incremental effects of those provisions on previously existing programs and revenues four years after enactment of the ACA is not possible."

“Also it is not clear that the law's proposed Medicare cuts will remain in place. Additionally, unions, insurers, drug makers and medical device companies each would like relief from the law's new tax provisions.” 

It was obvious to everyone that Obamacare would not reduce the deficit or decrease healthcare costs.

The bigger issue is none of this was reported in the traditional media. This represents one failure concealed from the American public.

Nonetheless President Obama is still telling Americans Obamacare will save money and reduce the deficit.

In President Obama’s victory lap on YouTube he states over and over again that Obamacare is a tremendous success.  It is almost as if he is pleading with the American public to believe him. 

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

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The VA Healthcare System-The Precursor Of Obamacare

Stanley Feld M.D.,FACP,MACE

The VA Healthcare System scandal has been in the headlines for a few weeks. The scandal has brought out the fact, once more, that President Obama lied to the American people.

His excuses are very thin. He knew about the VA problems in 2005. He pledged to fix the problems before he was elected President in 2008. In 2011 he repeated his pledge.

Now he has the gall to tell the American public in 2014 that he didn’t know anything about the problems until he read about them in the press.

President Obama addressed the Veterans Affairs scandal on Wednesday, saying he's waiting for an Inspector General "audit" of what went wrong.

How stupid does he think we are?

President Obama probably wishes he had control over You-Tube and the Internet. He could then eliminate his past statements and promises.

It looks like he is trying his best by attempting to defeat Net Neutrality.

Liberals have long hailed the VA Healthcare System as the model of government health care.  Liberals believe everything the government runs is the best thing for America.

Can you think of anything that the US government runs works really, really well? 

If so, please share that information with the rest of us. 

How can it run a healthcare system?

The government has systems problems in everything it tries to run. It can publish mountains of regulations. It cannot execute much because of the way the systems have been set up or not changed over time. There are multiple examples of such failures of execution.

None of these agencies seem to work including the Post Office, Amtrak, FEMA (Katrina rescue), Obamacare (website or the health insurance exchanges), and even the government itself.

 I believe it is because government has imbedded in it a deadening bureaucracy.

The bureaucracy suppresses innovation and the ability to repair defects quickly as they occur. This leads to cover ups that are eventually leaked.

The fact that no one is ever held responsible for errors of execution just adds to the awkwardness of the cover up.

The recent scandals, Benghazi, the IRS, Fast and Furious and the reporting on Obamacare, are a few examples of this.

The press never shows us facts about the supposed “investigations” and who was responsible for the missteps. It only leads to more mistrust and suspicion.

The forced resignation of VA Secretary Eric Shinseki will not serve as a distraction from the real problems in the VA.  Eric Shinseki’s firing is not going to fix the VA’s Healthcare System’s problems.

Liberals are blinded by their ideology. They have long hailed the VA as the model of government health care. They ignore the facts. The VA Healthcare System’s problems have been around for a long time.  

There is little evidence that President Obama has tried to do anything about the VA Healthcare System since he became President.

 All the public heard is how great the VA system of healthcare delivery is and how his administration is going to make it better.

Paul Krugman is the chief purveyor of the Obama administration’s progressive ideology. Mr. Krugman’s problem is he ignores facts as he formulates his “socialistic” beliefs.

It is almost as if he is saying, “don’t confuse me with facts.” Just believe that I know what I am talking about because I am a Nobel Prize winner.

The crazy thing is many very smart people believe him, just as they believe President Obama.

Paul Krugman praised the VA as a triumph of "socialized medicine."  He even listed what's behind this success.

“Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it.”

“So it's free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense."

The progressives ignore the government system’s own “perverse incentives.” The most important is as VA bureaucrats they must cover their own backside for non- performance.

It leads to long treatment delays and deaths that are preventable. This is only the tip of the iceberg. The rationing of care has been devastating for those veterans awaiting appointments.

 The bureaucracy is forced to cover up the errors. The problem the bureaucrats have is free speech in America. The morality of some is drives them to tell the rest of us about the problems.

“VA centers fudge their data.” The VA has consistently boasted in its performance reviews that more than 90% of patients receive appointments within 14 days of their "desired date."

The hidden waiting lines and treatment delays are not the only problems.

Infection rates and poor treatment outcomes have also been hidden from other bureaucrats in the system as well as the public. These problems are as important or more important than hiding appointment lists.

"The rate of potentially lethal bloodstream infections from central-intravenous lines was more than 11 times as high among patients at the Phoenix facility than it was at top VA hospitals, data from the year ended March 31, 2014, show," notes the Journal.

"Those infections, called sepsis, can quickly cause multiple organ failure and kill an otherwise relatively healthy patient within days or even hours. The data don't show what percentage of patients died as a result."

 The Journal also reports, "Among patients admitted to the hospital for acute care, the Phoenix VA Health Care System had a 32% higher 30-day death rate than did the top-performing VA hospitals, a finding flagged as statistically significant by the agency's medical analysts."

William E. Duncan, supervised publication of VA Healthcare Systems medical outcomes until his 2012 departure.

He said in an interview that he urged that more data be posted regardless of the impact," adds the Journal. But he tells the paper that he was forced out of the VA amid a dispute over the issue.”

President Obama has said all we need to do is throw more money at the problem.


President Obama needs to fix the defects in the VA Healthcare System’s business model.

Inherent in the present VA Healthcare System business model is a system of misallocation of resources and inefficiency. Resources are allocated by political force rather than individual consumer choices.

This is true in most socialistic systems.

It is all about who you know. It is not about who are the most innovative, creative or truthful people trying to execute a system for the consumers’ benefit.

Obamacare's ultimate destination is the same as the VA Healthcare System.

It is going to happen by President Obama’s design. The government will completely control America’s healthcare system. The transformation is happening slowing by design to avoid protest. President Obama doesn’t care about the cost or creating a more efficient system.

He is doing it the same way you cook a live frog. He is raising the temperature one degree at a time. The frog will never notice the heat until he is cooked.

It is time for America to wake up!

We cannot take it any more.

America must demand that we change the business model NOW!

Repeal Obamacare now. 

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

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