Stanley Feld M.D.,FACP,MACE
President Obama’s actions as leader of this country have been either pure genius or purely stupid.
I think it is pure genius. He promised Americans he was going to fundamentally change America. He has!
Americans have been under stress during the last few weeks. First it was the government shutdown. Now it is the nation going into default. It is common knowledge the shutdown and default is political theater.
President Obama has run circles around Republican in the game of political theater.
The traditional media has ignored the underlying causes of America’s problems.
We are increasing debt to the point of unaffordability. The only way out is to increase taxes further or decrease government spending while lowering taxes.
Increased deficits are not good. Deficit increases devalues our currency. America’s currency has already been devalued by the Federal Reserve increase in printing money.
Increasing taxes leads to decreased jobs creation. Decreased employment leads to decreased discretionary spending. The result is decreased economic growth.
Rather than trying to decrease spending rationally by increasing government efficiency, President Obama has closed down silly things to make it most painful and noticeable to the public. These noticeable services have little overhead. These closures are not an example of reducing inefficient spending.
In the meanwhile his administration has spent over $600 million dollars for a health insurance exchange software program. The program is poorly designed and does not have an integrated back end.
Even if the software was great, the cost of healthcare insurance through the exchanges is increased and out of reach of the individual buyers.The cost of insurance is cheap for the poor who qualify for government subsidies. The poor will receive a tax credit which will be credited to the insurance company whose policy the poor person buys.
The math is grotesque. If a healthcare policy costs $10,000 and a patient makes $30,000 dollars a year, he pays only 2% of his net income for the policy or $600 per year. The taxpayer pays $9,400 a year for that policy.
This is an example of hidden “redistribution of wealth” and another entitlement.
The Obama administration has waived the verification requirement for receiving a health insurance exchange subsidy. Verification of need does not have to be fulfilled by the health insurance exchanges. Anyone can lie and receive a subsidy to purchase healthcare insurance threw an exchange.
Another big mistake was the design of the roll out to promote electronic medical records. After 4 years only 11% of these records are functional. Physicians have spent money for EMRs they could not afford. Hospital systems spent money they could not afford. The government wasted $30 -60 million dollars of taxpayers money in the unsuccessful effort to implement EMRs.
America is a long way away from being computerized with a functional EMR.
Accountable care organizations (ACO) are another important cog in Obamacare’s success or failure. The administration brags about the fact that 250 ACOs are in development.
There are over 5,000 ACOs that need to be developed. A premier organization such as the Cleveland Clinic had to drop out of the program because of the cost to the institution. The Mayo Clinic refused to participate.
At the same time ACO’s are turning out not to be cheaper or have better outcomes than traditional medical care.
ACOs were supposed to improve quality. ACOs were supposed to be a free market solution to the dysfunctional healthcare system.
The administration has been bragging about the greatness of the VA system. The bragging stopped when the system’s poor quality of care was exposed. Veterans are receiving poor treatment.
Everyone would certainly have to admit Obamacare has been disruptive to the delivery of healthcare in America.
The months of healthcare insurance open enrollment for people is starting. People are starting to see massive increases in their healthcare premiums. In order to avoid these premium increases and the Obamacare penalties, large organization such as Home Depot are hiring only part time workers.
The Obama administration has developed a low cost insurance plan for the McDonalds of the world. These health insurance policies cost little a cover less.
President Obama has also provided waivers for congress and its employees. He is at present trying to sneak in waivers from Obamacare to unions.
“First, there was the delay of Obamacare’s Medicare cuts until after the election. Then there was the delay of the law’s employer mandate. Then there was the announcement, buried in the Federal Register, that the administration would delay enforcement of a number of key eligibility requirements for the law’s health insurance subsidies, relying on the “honor system” instead. Now comes word that another costly provision of the health law—its caps on out-of-pocket insurance costs—will be delayed for one more year.”The Obama administration has issued a blizzard of mandates and regulations. These regulations have increased the cost of health insurance.
The caps on out-of-pocket insurance costs, such as co-pays and deductibles have not been publicized. On January 1, 2014, deductibles were supposed to be limited to $2,000 per year for individual plans, and $4,000 per year for family plans.
In February 2014, the Department of Labor published a little-noticed rule delaying the cap until 2015. The costs of these deductible limits were already built into the 2014 healthcare insurance premiums and were not removed.
The government did nothing to reduce the increased healthcare premiums after the limits did not apply.
“Federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs. In many cases, the companies have separate computer systems that cannot communicate with one another.”
“We had to balance the interests of consumers with the concerns of health plan sponsors and carriers.”
How is it in the consumers’ interests to pay far more for health insurance than they do already?
I have a theory.
President Obama’s ultimate goal is to have a complete government takeover of the healthcare system. A takeover the government cannot afford.
He figures by creating as much chaos as possible now in the “not so free market healthcare system”, he can declare the free market healthcare system has failed.
There will be a resulting public outcry for the government to help and take over the system.
The takeover will be with a single party payer system.
What are the chances a government takeover will result in an efficient, cost effective system that will provide access to care without rationing of care while being affordable?
With all the delays, exemptions and regulations, it looks as if Obamacare is destined to fail. Obamacare is going to be impossible to execute effectively.
Obamacare’s ultimate failure is playing right into President Obama’s ideological goal of a single party payer system.
President Obama is not stupid. He is a genius.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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