Repairing the Healthcare System

President Obama Should Listen To Physicians

Stanley Feld M.D.,FACP,MACE

President Obama keeps saying over and over that Republicans do not have any good health care reform solutions.

“Republican don’t have an agenda to provide health insurance to people at affordable rates.”

It all depends on the definition of a good idea. Is it one that will work or one that will fail? A good idea is it one that agrees with President Obama’s agenda. If it doesn’t agree with his agenda it is a bad idea.

By President Obama and Harry Reid own admission they believe Obamacare is a good step toward a single party payer. They believe Obamacare will fail.

Any idea that interferes with President Obama’s is defined as a bad idea.

The Republicans and thoughtful people with actual healthcare experience have plenty of good ideas. They do not agree with President Obama’s agenda.

 

http://youtu.be/4-lnzEwt3HM

This program containing Republican ideas three years ago had only 807 views on You Tube.

Congress voted for the law (only Democrats voted for the law). They have now exempted themselves from the law because they realize it is a bad law. It looks as if Obamacare will be a train wreck.

Perhaps that is where President Obama wants it to end.

 

 As each day passes Obamacare looks like it will be a very expensive train wreck.

 Physicians are tired of being blamed for the rising healthcare costs. They are starting to realize that they have to take action to preserve their professional integrity.

In fact, in a recent study by the Physicians Foundation, six out of ten physicians said they would quit medicine.

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

 Many physicians are looking for viable exit strategies to avoid quitting.

The Physicians Foundation commissioned an extensive survey of nearly 13,575 physicians. Meritt Hawkins, the physician search and consulting firm, conducted the survey.

  “The survey found that 60% of physicians would retire today, if given the opportunity—an increase from 45% in 2008. And it's not just disgruntled and tired Baby Boomers who want to abandon their healing work. At least 47% of physicians under 40 also said they would retire today, if given the opportunity.”

The survey pointed out many major problem areas.

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

This survey is an excellent and detailed survey that has heightened the awareness of physicians’ practice problems.

The Massachusetts Medical Society survey pointed out the scope of defensive medicine. I extrapolated findings of the society’s survey to the nation.

My conclusion was that $500 billion to $700 billion dollars a year is spent on defensive medicine testing. Tort reform would decrease the cost incurred by defensive medicine over testing.

The Mass Medical Society survey demonstrated that physicians are frightened by the multidimensional stress of malpractice suits. Physicians will do as much testing as necessary to avoid a malpractice suit for missing a diagnosis. Most physicians do not experience financial gain in over testing. The hospital system does.

President Obama and his advisors have ignored tort reform and defensive medicine as an insignificant cost. Ezekiel Emanuel M.D. one of President Obama’s advisors thinks defensive medicine only raises the cost of the healthcare system between $2 to $3 billion dollars a year. This is a misguided bias.

The Physician Foundation survey notes that many policy makers, academics, and others identify fee-for-service reimbursement as a key driver of health care costs. Physicians believe that "defensive medicine is a far more important cost driver."
 
Forty percent (40%) of the physicians surveyed said "liability/defensive medicine pressures" was the least satisfying aspect of medical practice.

 Sixty nine percent (69%) of physicians said defensive medicine is the "number one ranked factor" driving up healthcare costs. The survey described the ordering of tests, prescribing of drugs, and conducting of procedures done "partly or solely to drive a wedge against potential malpractice lawsuits."  

"Medical malpractice lawsuits are common, adding an additional layer of paperwork, expense, and stress in virtually every physician's work day," the report adds.

The government ought to be listening to physicians practicing medicine every day rather than ivory tower professors who have never practiced medicine a day in their lives.

"Physicians understand to some degree that's the cost of doing business, but the defensive medicine goes deeper than that, in the ordering of extra tests, doing the extra procedures, and extra scans to protect [oneself] against a malpractice suit.”

Medical malpractice is at the heart of overspending in American healthcare. President Obama and Obamacare have ignored it. Some states have addressed it and the cost of care has been decreasing slowly. I believe it will take time in those states.  If anyone is sincere about bending the healthcare cost curve they have to take defensive medicine seriously. 

According to the survey physicians felt that there is a lack of a forceful cohesive voice representing them.

"There is a systematic, endemic series of problems," Ray says. "Everywhere there is defensive medicine, regulation issues, reimbursement issues. We are all in the same boat. But physician representation is balkanized. There is not a national organization that represents a majority of physicians."

When the survey asked which best describes their feelings about the current state of the medical profession, only 3.9 percent of physicians used the words “very positive,” while 23.4 percent of physicians indicated their feelings are “very negative.”

The majority of physicians – 68.2 percent -- described their feelings as either somewhat negative” or “very negative,” while only 31.8 percent of physicians’, described their feelings as “somewhat positive” or “very positive”.

A "least satisfying" aspect of practicing medicine included dealing with Medicare/Medicaid/government regulations (27.4%) and reimbursement issues (27.3%).

The American Medical Association (AMA) represents only 15% of physicians, according to the Physician Foundation report. One of the reasons for the low enrollment is that physicians feel the AMA does not represent their vested interests.

 Sermo is another physician organization. It is an Internet social network. In less than 2 years Sermo had as many members as the AMA.

Sermo originally concentrated on socioeconomic issues. It also discussed difficult clinical cases. 

The socioeconomic activity has recently faded. Sermo’s power was using the social network to do instant surveys of physicians’ opinions on healthcare policy and patient care hassles.

These surveys were quickly disseminated to the public as media stories of physicians’ opinions. It was done through public service announcements and daily press releases.

Physicians were able to let the public know how they felt about an issue instantly. It was very attractive. Somehow the initial vigor stalled. Physicians are now left without a vehicle or organization to express their feelings.

Government, the healthcare insurance industry and the hospital systems have little desire to listen to the concerns of practicing physicians. It is more important for these stakeholders to control physicians. It will not work long term.

The Physicians Foundation Biennial Survey is valid and accurate. However it is not dynamic or evolving. Neither the PFB survey of the Sermo survey have gotten the attention they deserve.

Both are must reads along with the Massachusetts Medical Society survey for those interested in physician concerns and behavior.

Patients’ problems with the healthcare system get less attention. The government and insurance companies tell patients what they can and cannot do.

Repair of the healthcare system will only happen when the American healthcare system evolves to a consumer driven healthcare system with individual responsibility and patient control of their healthcare dollars.

The reality is that health care should be as decentralized and regulated as close to the people as possible, not run by Washington mandates.

This concept opposes President Obama’s agenda.  

President Obama has the power of the pulpit and has the gift of misdirection.

The healthcare system is going to fail unless the public wakes up to the facts.

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

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Are The Unintended Consequence’s Of Obamacare Unintended?

Stanley Feld M.D.,FACP,MACE
 

It is hard to tell whether the unintended consequences were really intended consequences on the way to destroying the healthcare system.

Harry Reid and the President have already admitted that Obamacare is a good first step on the way to a government controlled single party payer system.

There are several problems with a single party payer system,

1. The government cannot afford it.
2. The government cannot run it. It will have to hire the healthcare insurance industry to administer it. It costs the government 40% of the healthcare dollars to have the healthcare insurance industry provide administrative services for Medicare and Medicaid presently.
3. Providers will not have incentive to produce. Reimbursement will be low and salaries will be low.

Normally if one works for a company, the company provides healthcare insurance to the family. When Obamacare raised the mandate limit forcing employers to provide healthcare insurance for employees’ children living at home to 26 years old, companies have been trying to figure out how to avoid paying the increased premium cost of healthcare insurance.

Most companies have reduced or are reducing employment to less than 30 hours to avoid the penalty for not providing healthcare insurance.

Many companies have applied for wavers. These companies will get waivers if they are the Obama administration’s friends. Congress got a waiver.

U.P.S. announced it would discontinue Health Benefits for spouses of some workers. U.P.S. joins the list of other companies doing the same thing. These include large employers like Xerox and Teva Pharmaceuticals. They have chosen to impose surcharges on employees for spousal coverage.

Cities like Terre Haute, Ind., are adopting a spousal carve-out so that working spouses would not be covered under its health plans even if the healthcare insurance plan of the spouse’s company is worse than Terra Haute’s healthcare insurance plan.

The University of Virginia has just announced a similar spousal carve out. It is rumored that the state of Virginia is next.

“UVA said this is only one of many “major changes” coming to their health plans as a result of ObamaCare. The university says the changes are necessary because the law is projected to add $7.3 million to the cost of the university’s health plan in 2014 alone.”

Isn’t Obamacare called the Affordable Care Act? In truth it is not. It will drive these spouses into a health insurance exchange.

 “U.P.S. said, “Limiting plan eligibility is one way to manage ongoing health care costs, now and into the future, so that we can continue to provide affordable coverage for our employees.”

 — U.P.S. told employees, “Since the Affordable Care Act requires employers to provide affordable coverage, we believe your spouse should be covered by their own employer — just as U.P.S. has a responsibility to offer coverage to you, our employee.”

Delta Airlines announced that someone leaked a letter from Delta Air Lines to the Obama administration.

The letter stated that the “cost of providing health care to our employees will increase by nearly $100,000,000 next year.” The letter also states that much of the increase is due to Obamacare.

It means the airline tickets are going to increase in price. This will become a burden on businesses who depend on flying to do business. In turn, products these companies produce will increase in price.  

The ordinary consumer will also be affected by rising airline ticket prices.

U.P.S. said, “Limiting plan eligibility is one way to manage ongoing health care costs, now and into the future, so that we can continue to provide affordable coverage for our employees.”

U.P.S. estimates they cover 33,000 spouses. Fifteen thousand (15,000) spouses can get coverage through their own employers. It should be added that they can get insurance until the companies of these15,000 spouses drop their own healthcare coverage.

 If U.P.S cannot lower insurance costs, they will raise shipping prices. Once again the middle class is the victim. Another option is to drop healthcare insurance for all employees and let them participate in the health insurance exchanges.

 Companies providing executive insurance of $27,500 or more for employee family coverage or $10,200 for individual coverage (Cadillac plans) will have to pay an additional 40% Obamacare tax in 2018.

This Cadillac plan tax is something many companies are thinking about and making plans to discontinue in the future.

The whole thing stinks.

It might not be an unintended consequence. It might be an intended consequence.

 It might be exactly what President Obama wants to drive as many people as possible into his health insurance exchanges.

His excuse for the increased costs is that the American people cannot refuse to pay for something they have obligated themselves to pay. In reality they have been deceived. They have been tricked, forced and deceived into this obligation.

The Obama administration is building a detective squad to target and penalize consumers and companies that don't follow Obamacare's rules.

 The Department of Health and Human Services has hired 1,814 criminal investigators. On the day President Obama signed the Affordable Care Act into law in 2010, HHS received authority to hire 1,814 investigators to sleuth out violations of the law.

Congressmen who supported Obamacare find this new police force confusing.

“HHS received authority from the Office of Personnel Management (OPM) to make as many as 1,814 new hires under an emergency 'Direct Hiring Authority' order.”

 The Obama administration ordered that employment expansion despite a government-wide hiring freeze that is in place.

Why doesn’t President Obama listen to the will of the people?

Everyone is against it. Everyone has to be more vocal. Everyone has to vote these people out of power.

Otherwise we are on the Road to Serfdom.

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

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America’s Rural Hospitals Are Being Destroyed

Stanley Feld M.D.,FACP,MACE

There is no question the federal government must decrease the amount of money it is spending on healthcare. It simply cannot sustain the increasing cost of health care.

Instead of figuring out how to make the system more efficient and cost effective, the Obama administration is slowly destroying assets that have been built at great costs to society in the past.

One example is the community hospital systems in large cities and the voluntary hospital in smaller cities. The government has subsidized their development with tax incentives and reconciliation paybacks.

In recent years rural hospitals have been failing because of decreasing government reimbursement. Many service the poor and elderly with emergency care and outpatient clinics.

• “The role and structure of rural hospitals is changing, but they continue to be important local and regional centers of health care activity.
• Rural hospitals tend to depend more on Medicare and Medicaid patients.
• Most rural hospitals are organized on a not-for-profit basis
• Rural hospitals make an important contribution to rural economies; expansion and diversification of the services that they offer will be important in their survival.
• The quality of care provided in rural hospitals is generally equal to that provided by urban institutions, with some exceptions.

The Department of Health and Human Services' Office of the Inspector General has recommended that Congress allow the Centers for Medicare & Medicaid Services to strip critical access designation from any hospital that was brought into the program under a state "necessary provider" designation.

Brian Jordan, a program analyst for OIG's Office of Evaluation and Inspections in Chicago, said that nearly 1,000 of the approximately 1,300 critical-access hospitals in 45 states gained the "permanent exemption" under the necessary provider designation. Congress closed the loophole in 2006, but grandfathered in the hospitals.

“Without that designation, Jordan said about 800 hospitals would not have met location requirements in 2011 because they were too close to another hospital.”

The "necessary provider" designation is withdrawn if two hospitals are within 15 miles of one another. It is estimated that Medicare could save 1.3 million per year for every hospital eliminated from the necessary provider program.  

The total cost savings from eliminating these rural hospitals would be less than the amount of money all salaries of the CEOs and other healthcare executives of healthcare insurance companies take from Medicare a year.

If there is a problem with rural hospitals it is their inefficiency and waste. The inefficiency should be fixed. If the government wanted to do something constructive it should help rural hospitals fix the inefficiencies.

The “necessary provider hospitals “never had to meet the distance requirements."

 Necessary provider hospitals get paid more from Medicare than non- designated hospitals. As towns expand new hospitals are build close to the older standing hospitals. 

Maybe having a rural hospital in a small city will increase economic growth of the area? It attracts industry and more jobs. Many communities need two rural hospitals.

Both hospitals receive necessary provider status and increased payment.

 Alan Morgan, CEO of the National Rural Health Association, blasted the report. He said the OIG report would kill rural health and access to healthcare. The closing of 800 rural hospitals would also close emergency services in local communities, eliminate rural health clinics, access to mental healthcare and nursing home support.

Morgan said, “OIG viewed this with blinders on, not looking at how healthcare is delivered in rural America.

"It's about access and this report is only about finances and not access. It is a spending and finance issue and we seem to have forgotten the rationale for the creation of this program, which was an access issue."

If the Obama administration is trying to help seniors and the underprivileged it should study this decision more carefully. I can only imagine the cost of the unintended consequences to all taxpayers.

I believe the Obama administration wants to destroy the entire healthcare system and replace it with a single party payer system.

It is time to go after the real excess cost drivers in the healthcare system. It is a mistake to destroy the infrastructure.

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

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Some More Obamacare Deceptions

Stanley Feld M.D.,FACP, MACE

 Does anyone remember the CLASS Act as part of the Obamacare promise for affordable healthcare coverage? I do. It sounded great but I knew it couldn’t be done without tremendous cost to the federal government.

It would drive deficit spending through the roof.

The CLASS Act (Community Living Assistance Services and Support) was shut down 19 months after passage of Obamacare.

 There was little discussion of the CLASS Act until Kathleen Sibelius’ announcement to discontinue CLASS.  

 She said,

 “The administration was shutting down CLASS. After 19 months of research and consultation, “we have not identified a way to make Class work at this time.

The thing that bothers me the most about Obamacare is the sneaky machinations the Obama administration uses to hide the bad news about Obamacare from the American public. When the American public finds out they are disappointed and feel deceived.

However, it also feels so complicated that they tend to ignore it.

 When the Obama administrated delayed the employer mandate for a year employers were relieved. None of the traditional media made a big deal about delaying the employer mandate which meant that Obamacare was in trouble.

 Some conservatives and conservative outlets cried, “Why not delay the individual mandate as well?”

The reason is obvious. The Obama administration wants the entitlement to start whether it is ready or not so it cannot be repealed or discontinued. People do not like to relinquish a freebie.

As soon as that discussion was over the government announced that the verification process for subsidies might not be ready until October 1, 2013.

If the tests find security problems in the verification systems, the information officer could delay the marketplace opening or decide to open the insurance exchanges with less-than-optimal assurances that users’ personal information is adequately protected.

The Obama administration then announced it would provide premium subsidies on an “honor system” so as not to delay the onset of the individual mandate.

“The administration promises no one will lie because once they get the verification process started they will be able to find out who lied about the subsidies.”

The Obama administration’s navigators program is a program to train and pay people to go into the community and sign up people to enroll in the Obamacare health insurance exchange.  

“More than 100 groups will split $67 million to help people “navigate” the new Obamacare health insurance exchanges.”

These “navigators” will have to undergo mandatory federal training and become certified.

“The 67 million dollars is more money than the administration initially said would be available but short of what advocates say will be needed to help people sign up”.

It sounds like another cash for clunkers program.

When are Republicans or Conservatives going to say something to make the public aware of what is going on?

To add insult to injury congress exempted itself from Obamacare because of economic hardships leaving ordinary people to be subject to penalties if they do not join the health insurance exchanges.

 The Obama administration has given over 2,000 group waivers.

The Obama administration and Harry Reid and Nancy Pelosi are working on the Unions’ problems with Obamacare. One could bet that it will be fair to the Unions as the rest of us are ignored.

 With all of the IRS’s problems of late it is frightening to think of the IRS monitoring abuses of Obamacare.

The IRS employees union is presently seeking a way to get a waiver from Obamacare.

“And speaking of haunting, does anyone in this country look forward to being scrutinized by the IRS on every aspect of his or her personal health care decisions, especially after we learn of the politicizing and privacy abuses by that agency?”

 Does anyone remember the 60 lawsuits the Catholic Church initiated challenging President Obama’s contraception mandates? The church claims the mandate to provide contraceptives represents an attack on religious freedom and the first amendment.

Despite all this the traditional media and President Obama keep saying Obamacare is right on schedule.

We have heard nothing about the extra costs Obamacare is generating for start-up and implementation. 

Last weekend Harry Reid let the cat out of the bag. President Obama real goal is to have Obamacare fail and replace it with a single party payer system.

  

Harry Ried and a single party payer

 http://youtu.be/SXgSKwYMnWo

The biggest political maneuver by President Obama of all is the maneuver to delay the law’s caps on out of pocket expenses for consumers such as for deductibles and co-pays.

This is perhaps the most attractive benefit of Obamacare after guaranteed insurability.  

"Section 2707(b) of the Public Health Service Act, as added by Obamacare, requires that “a group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime limits on the dollar value of benefits for the any participant or beneficiary.”

Annual limits on cost-sharing are specified by Section 1302(c) of the Affordable Care Act; in addition, starting in 2014, deductibles are limited to $2,000 per year for individual plans, and $4,000 per year for family plans.

This is a wonderful benefit. If someone gets sick he is only liable for $2,000 if single and $4,000 if he has a family.

The problem arises when the healthcare insurance industry calculates the premium with this benefit included. The insurance premiums skyrocket. Premiums are scheduled to dramatically increase in 2014.

President Obama’s problem is that 2014 is a congressional election year. Skyrocketing premiums in 2014 may make Obama fans and the Democratic base angry with President Obama and the Democrats running for congress.  

President Obama having gotten away with all his other delays in implementation simply delayed this part of the law until after the election.

The American public doesn’t realize that he has delayed perhaps the best benefit in the law from the public’s viewpoint. His hope is the public will not notice the delay with the help of the traditional media’s lack of coverage.

In 2015 he will sock the increased premiums to the public. He will then blame it on the Republicans. 

There are two basic issues. The first is the need for the public to realize all these deceptions in Obamacare.

The second one is the public is beginning to realize that it cannot trust President Obama or congress to represent its welfare.

It is time for Republicans to stand up and put an end to this charade. I hope someone has the guts to do it.

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

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A Review Of The Deception In Obamacare

Stanley Feld M.D.,FACP, MACE

The goal to provide affordable healthcare and access to care for all Americans is an admirable goal.

Obamacare is making Americans dependent on the government for their healthcare access and health decisions. This is bad.  

President Obama is doing this slowly but surely. The goal is to first destroy the present healthcare system. The more he destroys, the more the stakeholders, healthcare insurance industry, hospital systems, physicians, drug companies and patients game the system

Americans are known to be individualists. They cherish their freedoms. However, over the last 50 years many entitlements have been introduced at the price of forfeiting many freedoms.

Some entitlements have been for consumer protection. Others have not.

Obamacare is about government control and takeover of the healthcare system. President Obama understands that he cannot force people to do what they do not want to do.

However they will do anything when they have no choice. He is creating a no choice environment slowly but surely. He is doing it with a bad law, lots of lies and disinformation, and a golden tongue,

He changes and ignores parts of the law he wrote to fit he needs by executive order, disrespects the will of the people and congress and folds to pressures of lobbying from his base. He marginalizes his enemies.

His changing the law without the consent of congress is probably unconstitutional. However no Republican has questioned his tactics.

He stays on the offensive and keeps Republicans on the defensive. Republicans must have someone who could parry his offenses and put him on the defense even though he has the unequivocal support of the traditional media.

On Friday August 9^th was a perfect example of this offensive.

 The idea that you would shut down the government unless you prevent 30 million people from getting healthcare is a bad idea...

I'm assuming they will not take that path...I have confidence that common sense, in the end, will prevail.

He explained his delay of the employer mandate by saying going through congress would be the "normal thing" to do "but we're not in a normal atmosphere around here when it comes to 'Obamacare.'"

The president called efforts to defund and repeal Obamacare the Republicans' "holy grail" and an "ideological fixation."

You have got to give it to him. No one would ever think Obamacare is having so much trouble because it is a lousy law, that is impossible to build out its structure, Impossible to implement, impossible to execute and impossible to enforce.

The majority of the country and majority of the stakeholders are against the bill. President Obama just goes right ahead despite the will of the people.

Obamacare did not get one single Republican vote. President Obama’s twist and turns have kept Republicans in a reactive and defensive mode.

Every time Republicans go on the offense they are blamed for the bad law’s (Obamacare’s) failure. They do not answer back.

I believe the majority of the people know what President Obama is about. They do not trust him. The lack of trust renders him ineffective.

Someone needs to turn the tables on him.

I also believe President Obama is about to turn the tables on himself. His says he is all ears for a good idea but Republicans have not presented him with one.

This is not true. The problem is President Obama doesn’t listen.

The list of lies and misrepresentations are enormous. These lies and misrepresentations have resulted in the lack of trust.

 Below are some of the things promised that so we should not forget.

 1. Imposing President Obama’s idea of transformation by social engineering in which the majority of the population does not agree with.   

 2. Imposing 21 hidden taxes that few knew about before the bills passage. Few knew the effect of these taxes on small business until after passage of Obamacare. These tax increases amount to the biggest tax increase in our history.

This occurred after President Obama pledged no new taxes for anyone making less than $250,000 dollars. All of these taxes are passed on to consumers.

3. The medical device tax alone is a job-killing and innovation-stifling medical device tax.  33 Democrat senators are now opposed to this tax. He does not have the support of his party on this tax.

4. Independent Payment Advisory Board (the IPAB) is going to ration healthcare. Sarah Palin called it aka death panels. Howard Dean, recently termed it a "health care rationing body" that Congress should be "getting rid of." The Obama administration insists there is not going to be rationing of care.

5. The original CBO cost estimate was a reduction in healthcare costs in 10 years. The CBO used six years of costs and ten years of taxes. The next estimate using rigged numbers given to the CBO by the Obama administration was less than $1 trillion.

The ten-year CBO cost estimate has now reached $2.6 trillion. We have not heard from the Obama administration about this new estimate.

6. Health insurance premiums are soaring despite President Obama’s recent statements that healthcare premiums are falling. All employer and employees will say President Obama is wrong.

Four years ago President Obama promised the public that, “Obamacare would reduce a "typical family's premium by up to $2,500 a year."

 7. We will all recall these famous lines, “If you like your doctor, you will be able to keep your doctor. Period.”

  If you like your healthcares plan, you will be able to keep your health care plan. Period.

  “No one will take it away. No matter what.”

No statement is more dramatic but false.

8. Obamacare is making an already serious shortage of doctors worse. Many physicians are opting out of Obamacare, Medicare and Medicaid.

To make thing worse patients will have to pay physicians directly. The Obama administration published a new rule for seniors. CMS will not reimburse patients the 70% of their out of pocket expenses for physicians that do not accept Medicare or Medicaid.

The result will be an increased out of pocket burden for all patients, rich and poor.

9. Many employers are likely to drop health coverage. There has been widespread reduction of work hours to avoid paying an Obamacare mandated penalty to provide employee health insurance.

 Obamacare has created a burden on economic growth. It has resulted in the creation of "seven times more part-time jobs" than full-time jobs. It has decreased the living wage for millions of Americans and created millions more uninsured patients.

These part time workers will be forced to buy insurance through the health insurance exchanges. This will balloon the federal deficit even further.

10. The states have been given the option to participate in health insurance exchanges and expanding Medicare and Medicaid. Thirty three states have refused to participate. They know they cannot afford to increase their states’ budget deficit.

11. The healthcare insurance industry thought it would make a killing by insuring people through the health insurance exchanges. In Medicare and Medicaid they bill the government for doing the administrative services. President Obama has changed the promised health insurance rules. Several insurers are leaving all of the states. More are to follow.

12. Recent surveys show that 63 percent of voters think the law needs to be changed, and a 57-percent majority feeling that implementation is "a joke."

This is happening despite the traditional media helping President Obama’s political campaign to promote Obamacare.

These are just a few of the reasons for the mistrust of the administration.

Next will be a summary of President Obama’s probable unconstitutional delays in the law without congressional permission.

Max Baucus was corrected. Obamacare is an expensive train wreck.

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

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Another Friday Afternoon 3 P.M. Press Release

Stanley Feld M.D.,FACP, MACE

It seems that all official Obama administration reports that portend bad news for the administration’s policy are released late Friday afternoon when everyone is heading home for the weekend.

It is a time when the news of the reports and press releases are least noticed.

The late Friday afternoon report on August 2, 2013 was released the afternoon congress was going on summer recess for the month of August.

The HHS Inspector General announced that Obamacare’s privacy protections program is way behind schedule. It will not be ready by October 1^st when policies will be available to the public. It opens the door for rampant violations of the law.  

'Based on OIG’s analysis, Obamacare’s exchanges may end up illegally exposing Americans’ private records to hackers and criminals."

The Privacy Act of 1974 mandates that each agency of the federal government utilize administrative and physical security systems to prevent the unauthorized release of personal records.

The Federal Information Security Management Act of 2002 requires the executive branch to ensure that Americans’ private records are protected from misuse and security breaches.

The Obama administration is ignoring these laws. On his road show this week he said the health insurance exchanges will start selling insurance on October 1,2013 to go into effect January 1, 2014.

“In the case of the Obamacare hub, any serious security breach could result in identity theft.”

The Obamacare “Hub” computer system cost the government $267 million so far.  It is supposed to provide the government with the means to see which applicants qualify for what programs.

On another Friday afternoon during the July 4^th weekend,” Sarah Kliff and Sandhya Somashekhar of the Washington Post discovered that the Obama administration had buried in the Federal Register the announcement that the government won’t be able to verify whether or not applicants for Obamacare’s insurance exchange subsidies are actually qualified for the aid, in the 16 states that are setting up their own exchanges."

 "Instead, until at least 2015, these states will be able to “accept the applicant’s attestation [regarding eligibility] without further verification.” 

This appeared in the Federal Register two days after the July 3^rd announcement that the federal government would postpone for one year a requirement that employers with 50 or more full-time workers provide health coverage.

I think these announcements warrant the term ”Weekend Surprises” or DBA “I hope no one notices.”

“The Obamacare health insurance exchanges mandate the creation of a “data hub” through which exchanges can access personal records from seven different agencies—the Internal Revenue Service, the Social Security Administration, the Department of Homeland Security, the Veterans Health Administration, the Department of Defense, the Office of Personnel Management, and the Peace Corps—in order to determine eligibility for exchange subsidies and mandate penalties.”

Under FISMA, the Obama administration must adhere to the guidelines of the National Institute of Standards and Technology in achieving these safeguards, before the Obamacare exchanges can legally operate.

 It seems it is much more convenient to ignore the law written by the Obama administration and Democrats. Unfortunately, Republicans have not pointed this out to the people.

It gets worse. This policy not only ignores the law of the land it encourages fraud and abuse.

 According to the law, a person or family is not eligible for Obamacare’s subsidies if your employer has offered you what the government considers “affordable” coverage.

Employers are not going to have to report whether or not they’ve offered “affordable” coverage. How can the government verify whether or not workers are eligible for subsidies? 

 The Centers for Medicare and Medicaid Services said. “The exchange may accept the applicant’s attestation regarding enrollment in an eligible employer-sponsored plan…without further verification, instead of following the procedure in §155.320(d)(3)(iii).”

The Obama administration will also allow people to gain means-tested subsidized coverage on the exchanges without having to have the IRS do means testing on their income.

According to CMS,

 “For income verification, for the first year of operations, we are providing Exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification.”

 Another President Obama trick. If enough people enroll in the new entitlement it will be politically impossible for Republicans to repeal Obamacare in the future.

These ad-lib rules deliberately encourage tens of billions of dollars of waste, fraud, and abuse.  

Who is going to suffer in the long run? Hard-working taxpayers. These taxpayers will not receive subsidies. Many of them do not support Obamacare.

Where is the Republican outrage?

President Obama anticipated the Republican outrage this week on his political road show.

President Obama blamed Republicans for doing everything in their power to torpedo Obamacare implementation during a Friday afternoon “press conference” before going on his $7.6 million dollar a week vacation on Martha’s Vineyard.

 “The “one unifying principle” for Republicans was keeping 30 million people from getting healthcare, hurting the elderly, removing care for the ill.

“There’s not a pretense how they’re going to replace it with something better,” Obama said. He accused Republicans of an “ideological fixation.” He then compared the Obamacare rollout glitches to glitches in Apple rolling out a new iPad. “I make no apologies” for such glitches, he stated.

Then he said it would be foolish for Republicans to “shut down the government to prevent 30 million people from getting healthcare.”

Notice President Obama's use of words.

Pure unadulterated well crafted demagoguery.

When are the Republicans’ going to respond? When are the people going to recognize President Obama’s game.

Hopefully not before it is too late.

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

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Maybe Obamacare Is Not Such A Good Idea

Stanley Feld M.D.,FACP ,MACE

Dear President Obama;

Maybe Obamacare is not such a good idea.

I suspect you will not read this nor have you read my letters to you when you were first elected.

The letters were about how our healthcare system became so dysfunctional and what solutions, that will work, are needed to repair the healthcare system.

Dear President Obama Part 1

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama.html

Dear President Obama Part 2

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-2.html

Dear President Obama Part 3

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/11/dear-president-elect-obama-part-3.html

Dear President Obama Part 4

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-4.html

Dear President Obama Part 5

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president--elect-barack-obama-part-5.html

Dear President Obama Part 6

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2008/12/dear-president-elect-obama-part-6-why-dont-you-listen-to-practicing-physicians.html

Respectfully,

Stanley Feld M.D., FACP, MACE

President Obama did not listen to me at all. It looks like his agenda was not to "Repair the Healthcare System." It was to destroy it and replace it with a government control single party payer system.

I continually think about the statement President Obama made to Barney Frank and John Kerry when passing the law. They said the law must have a public option and a single party payer to work.

President Obama told them not to worry about the public option.

Now Obamacare is experiencing objections from the interest groups whose support is needed.

The unions, government workers in congress, the IRS, the healthcare insurance industry, small businesses, large corporations, large fast food businesses, privately insured Americans, Medicare insured seniors, physicians, hospital systems all have objections to the law now.

Many states realized they would get stuck with the bill for the health insurance exchange. Thirty-three states did not want to participate. Many did not want to increase their budget deficits.   

All these stakeholders are realizing that President Obama has thrown them under the bus despite his initial promises.

Obamacare does not serve the vested interests of any of these stakeholders. 

Some of the stakeholders are going to get special treatment with waivers.

For Obamacare to work, everyone must participate. The mandate was included in the law to force everyone to participate.

The Supreme Court called it a tax to allow the Obamacare law to be constitutional.

A basic insurance principle is that everyone must participate to spread the risk for the insurance industry.

The present system and Obamacare exempts the insurance companies from incurring risk. It also exempts patients from being responsible for their own health and healthcare dollars. When Americans spend their own money the free market works as we have seen in many industries. They support the best product within their means.

The government could support the underprivileged by providing them with their healthcare dollars and teaching them how to use them.

The biggest villains in the healthcare system are the healthcare insurance companies. They take 40% of every healthcare dollar spent by private and public insurers off the top.

The healthcare insurance industry is the administrative service provider for all public employees, public healthcare entitilments and private health insurance plans. The 40% overhead is charged to all. The charge is not transparent.

Obamacare sets the conditions for continued abuse by the healthcare insurance industry.

The Obama Administration estimates that of the projected 7 million exchange enrollees next year, 2.7 million need to be young adults (with a low risk of being sick) to make the premiums work.

 If young people don’t show up for Obamacare, premiums for everyone else in the exchanges will skyrocket—which, of course, dramatically increases the cost for taxpayers.

Congress and congressional government workers wanted to be exempt from Obamacare because

 “The 2010 law generally requires lawmakers and aides who work in their personal offices to get coverage through the exchanges.”

That implies that they would no longer receive coverage through the Federal Employees Health Benefits Program…

It does not clearly authorize the government to pay premiums for federal employees who obtain insurance through the exchanges.

Nor does it authorize the government to reimburse federal employees who buy health insurance on their own.”

Congress and their aides have the best insurance coverage in the nation. Taxpayers subsidize their healthcare insurance.

Through the years this subsidy has been discussed.  Many have objected to the cost of this Congressional benefit.

Congress has objected to Obamacare changing the healthcare insurance they have enjoyed. Congress wants to be exempt from Obamacare.

“President Barack Obama privately told Democratic senators he is now personally involved in resolving a heated dispute over how Obamacare treats Capitol Hill aides and lawmakers, according to senators in the meeting.”

Few on Capital Hill objected to President Obama changing the rules of the law himself to protect their benefit.

A question should be asked, “Why should Congress and congressional aides be treated differently than the general population?”

“At issue is whether Obama’s health care law allows the federal government to continue to pay part of the health insurance premiums for members of Congress and thousands of Hill aides when they are nudged onto health exchanges.”

Currently, the government pays nearly 75 percent of these premiums.

 The government’s contributions are in jeopardy due to a controversial Republican amendment to Obamacare, which says that by 2014, lawmakers and their staff must be covered by plans “created” by the law or “offered through an exchange.”

President Obama declared, “I'm on it” to clear up Capital Hill’s objections to Obamacare’s effect on Capital Hill’s healthcare insurance.

The IRS employees also want to be exempt from Obamacare.

IRS chief Danny Werfel, the head of the agency charged with administering Obamacare said that he would rather keep his own insurance than get coverage under the system created by President Barack Obama's single domestic policy achievement. 

Danny Werfel made this statement before the House Ways and Means Committee,

"I would prefer to stay with the current policy that I'm pleased with rather than go through a change if I don't need to go through that change."

Like most other federal workers, IRS employees currently get their health insurance through the Federal Employees Health Benefits Program, which also covers members of Congress.

House Ways and Means Committee Chairman Dave Camp said he has long believed, “every American ought to be exempt from the law, which is why he supports full repeal,”

IRS employees have the responsibility to enforce much of the health insurance law, especially in terms of collecting the taxes and distributing subsidies that finance the whole system.

IRS agents, in addition to collecting taxes will also collect data and apply penalties for those who fail to comply with many of Obamacare’s requirements.

The special favors are coming next. The Obama administration will only create more dysfunction in the healthcare system. President Obama’s published goals are good. However, the law is bad and its execution is worse.

Maybe he ought to consider my Ideal Medical Savings Accounts as a free market solution to our healthcare system’s problems.

If you do not like what is going on, please write your senator, congressman and the President and tell them that,

“Maybe Obamacare Is Not Such A Good Idea.”

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

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Physicians Opting Out Of Medicare And Obamacare

Stanley Feld M.D.,FACP,MACE

I have discussed the disillusionment of Obamacare by several major stakeholders, hospital systems, insurance companies, union leaders and large corporations in my last three blog posts.

As Obamacare gets more complicated physicians are opting out of Medicare and will not participate in Obamacare.

All most physicians want is to practice the best medicine they can using their intellectual property or surgical skills.

Physicians are people who want to help people. They are not street crooks.

Obamacare is trying to commoditize medical care, decrease physician value and reimbursement.

Commoditization of medical care will decrease physicians’ freedom to exercise their medical judgment. Medical decision-making will be in the hands of distant involved bureaucrats. Access to care will be determined by bureaucratic rules and not the patients and their physicians.

 Physicians are opting out of Medicare, Medicaid and Obamacare.  They have become totally frustrated with Medicare and Medicaid reimbursement rates and the mounting rules and regulations.

Marilyn B. Tavenner R.N., the administrator of the Centers for Medicare and Medicaid Services told congress that an insignificant number of physicians have dropped out of Medicare and Medicaid. This is clearly not true.

A CMS report said 9,539 physicians who had accepted Medicare in the past opted out of the program in 2012, up from 3,700 in 2009. That compares with 685,000 doctors who were enrolled as participating physicians in Medicare last year, according to CMS, which has never released annual opt-out figures before.

The number of physicians opting out of Medicare last year nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services.

This is not an insignificant number of physicians when America is experiencing a shortage of primary care physicians.

“A study in the journal Health Affairs this month found that 33% of primary-care physicians didn't accept new Medicaid patients in 2010-2011,” even though they continue to participate in Medicare.

Some physicians are limiting the number of Medicare patients they treat even if they don't formally opt out of the system.

The reason is Medicare reimbursement is so low and getting lower. It some cases reimbursement is lower that the cost to deliver the care.

 A study found that 4% of family physicians are now in cash-only or concierge practices.

 The Obama administration issued an executive order this year where Medicare would not reimburse anything to patients paying cash to non-participating physicians.

This is putting an increased burden on Medicare patients.

“All told, health experts say the number of doctors going "off-grid" isn't enough to undermine the Affordable Care Act.”

The Obama administration’s bureaucrats are not facing reality. Today, before the expansion of Medicaid it is difficult for Medicare and Medicaid patients to find a physician.

Joe Baker, president of the Medicare Rights Center, said his patient-advocacy group has had an increase in calls from seniors who can't find doctors willing to treat them.

Many physicians will not accept Medicaid patients. CMS administrators want the public to believe this is not true. They say the number of physicians not taking Medicaid is insignificant.

Medicaid physicians have to see as many as 200 patients or more a day to make a living.  There are not enough minutes in a day to see that many patients and have a quality care visit. These physicians have employees who are seeing patients for them. These physicians then sign off as seeing the patient.

This volume then triggers a probe on their practices and accusations of fraud. As Medicaid gets expanded through Obamacare to cover the uninsured, there will be even fewer and fewer Medicaid physicians and a greater physician shortage.

Medicaid physicians are not interested nor can they take the government abuse.

Employers are cutting back on hiring full time employees and hiring part time employees to avoid the rising insurance costs.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, told Congress that she had heard of only “isolated incidents” in which employers tried to cut back hours. Representative Steve Scalise, Republican of Louisiana, told her that she must be “living in some cocoon” because he heard of such actions almost every day.

Every large corporation is converting as many full time workers to part-time workers as possible because of Obamacare in order to avoid the Obamacare mandate. Part-time workers have felt the disastrous impact on wealth production and economic activity.

These are the revised statistics from the Bureau of Labor Statistics for May and June.

The establishment survey showed a gain of 162,000 jobs.

The previous two months were revised lower. The employment change for May revised down by 19,000 (from +195,000 to +176,000), and the employment change for June revised down by 7,000 (from +195,000 to +188,000).

The unemployment rate dropped 0.2 to 7.4%. 

Explaining the Unemployment Rate Drop


• Employment rose by 227,000 of which 103,000 were part-time jobs. 
• The Civilian Labor Force Declined by 37,000 even though population rose by 204,000.
• Those "Not in Labor Force" rose by 240,000.
• Participation Rate fell 0.1 to 63.4%, a mere 0.1 higher than the low of 63.3% dating back to 1979.

July BLS Jobs Statistics at a Glance

 

• Payrolls +162,000 - Establishment Survey
• US Employment +227,000 - Household Survey
• US Unemployment -263,000 - Household Survey
• Involuntary Part-Time Work +19,000 - Household Survey
• Voluntary Part-Time Work +84,000 - Household Survey
• Baseline Unemployment Rate -0.2 - Household Survey
• U-6 unemployment -0.3 to 14.0% - Household Survey
• Civilian Labor Force -37,000 - Household Survey
• Not in Labor Force -240,000 - Household Survey
• Participation Rate -0.1 at 63.4 - Household Survey

Read more at http://globaleconomicanalysis.blogspot.com/2013/08/establishment-survey-162k-jobs-may-and.html#llfksKs7fC6lhCcU.99

 Marilyn B. Tavenner making the above statement to congress makes her a liar or a person not in touch with reality. Have can the American people entrust our healthcare decisions to these bureaucrats?

The Obama administration needs both the primary and secondary stakeholders’ cooperation if Obamacare has the slightest chance of succeeding.

I do not think Obamacare can survive. It will sink under its own weight as it tries to control all of the stakeholders through oppressive regulations without regard for their vested interests.

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

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More Government Control

Stanley Feld M.D., FACP, MACE

I have covered the discovery of the tricks Obamacare has played on hospital systems, insurance companies, union leaders and large corporations in the last three blogs.

The Obama administration needs all three groups to cooperate if Obamacare has the slightest chance of success.

Physicians are now starting to react to Obamacare and its restrictive regulations.

It is clear to me that the Obama administration has no respect for physicians, their intellectual property, their surgical skills, their honesty or their character. 

The Obama administration has labeled physicians as commodities and thieves. Obamacare devalues physicians and figures whatever reimbursement it offers physicians will accept.

Ezekiel Emanuel M.D., Obamacare policy advisor, expresses a vivid example of this disrespect in his recent article in the New York Times entitled “Don’t Give Up On Healthcare Costs.” 

Dr. Emanuel discusses S.G.R., or the Sustainable Growth Rate formula. 

The formula is seriously flawed in its attempt to contain rising healthcare costs. 

The formula is rigged to penalize physicians yearly for their reimbursement for treating Medicare patients. Every year Congress waives the penalty for that year. This waiver is commonly known as the “doc fix.”

The yearly penalty has been accumulating since 2002 so this next year it is scheduled to reduce physician payment by 24.5%.

Neither the AMA nor the traditional media has articulated the meaning of the S.G.R to the public in a comprehensible way.

The S.G.R provides no incentive for individual doctors to be more efficient since the target level applies to total nationwide physician costs.

The cuts from the formula are indiscriminate. The cuts would affect high quality, cost-effective doctors the same as it would inefficient free spending physicians. It would also affect underpaid primary care physicians.

The goal should be to incentivize all physicians to be efficient and cost effective providers in their treatment and patient recommendations.

Ezekiel Emanual’s disrespect shines through when he says,

“Physicians desperately want the S.G.R. repealed and replaced so they can charge what they want without the potential of massive cuts hanging over them each year.”

Congress agrees with physicians that S.G.R. is seriously flawed. The House Energy and Commerce Committee is starting to mark up the repeal of the S.R.G formula. It is going to replace it with a 0.5% yearly increase in physician reimbursement until 2018. In 2019 the government will link Medicare payment to the quality of care each physician provides.

The measurement of physician performance will be measured, by big data provided by the Enhanced Quality Reporting System. The EHQRS is being developed using the ICM-10 coding system. ICM-10 uses 68,000 codes vs. 18,000 codes in ICM-9.

Ezekiel Emanual M.D. doesn’t like this formula. It does not provide incentives for physicians to accept bundle reimbursement for the treatment of their patients.

Dr. Emanual believes  

“fee-for-service payment incentivizes quantity over quality. Physicians make more money by ordering more tests, seeing patients more frequently in follow-ups and providing more treatments. The payment system is a key accelerator driving up Medicare costs — and therefore the federal government’s deficit”.

Dr. Emanual does not trust physicians to do the best job possible. He also ignores the defensive medicine issue. He believes,

“In 2009, the Congressional Budget Office did a comprehensive assessment of the potential cost savings from medical malpractice reforms.

Its conclusions: A package that included a $250,000 cap on noneconomic damages, a $500,000 cap on punitive damages and a one-year statute of limitations for claims by adults would save about $11 billion a year — 40 percent from reduced malpractice premiums and the rest in the form of fewer defensive procedures like M.R.I.’s.

 Dr. Emanuel concluded that $11 billion dollars a year savings is insignificant because it is a cost saving below $26 billion dollars a year. He contends tort reform is a distraction from real efforts to control healthcare costs and should be ignored. The CBO scoring information has lead Dr. Emanuel to an inaccurate opinion.”

Douglas W. Elmendorf’s, head of CBO at the time, conclusion was not nearly as definitive as Dr. Emanuel’s conclusion.

The malpractice issue of defensive medicine and over testing is real. The Massachusetts Medical Society survey of defensive medicine is real. Most physicians in Massachusetts are liberal/progressive and so the sample is not biased toward conservatives.

The truth is a full accounting reveals that more than 10 percent of America's health expenditures per year are spend on tort liability and defensive medicine.

The percentage of healthcare costs is even greater when the Massachusetts Medical Society survey is taken into account. The amount spent for defensive medicine can be extrapolated to actual costs from this survey.  

I have written a series of blogs analyzing the impact Massachusetts Medical Society’s survey. The extrapolated costs turn out to be about $700 billion dollars a year. The real cost of defensive medicine is somewhere between $242 and $700 billion dollars a year.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-par.html

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2009/04/president-obama-if-you-really-want-to-reduce-healthcare-costs-effectively-reform-the-medical-malpractice-tort-system-part-2.html

 In 2008 damage awards alone for medical malpractice claims reached $5.9 billion dollars.  The total of medical tort costs was $16 billion for legal costs, underwriting costs and administrative expenses. From 1986 the average jury award was $100,000. In 2006 the average award increased to $637,000. No one knows what the award value is for cases settled out of court.

Each year, 25% of practicing physicians are sued. 90% of physician sued are found innocent. The average defense cost is $100,000. This cost is not included in the CBO scoring

The fear of lawsuits causes most doctors to practice "defensive medicine" as the interviews of Massachusetts physicians points out.  The result is unnecessary testing, referrals, and procedures to protect themselves from allegations of medical negligence.  

A recent survey of doctors published in the Journal of the American Medical Association found that 93% of physicians admit to practicing defensive medicine. A 2008 survey by the Massachusetts Medical Society found that about 25 % of medical procedures are defensive in nature.

This waste results in increased healthcare insurance premiums. The premium increases result in an increase of at least 3 million uninsured people per year. When these uninsured people get sick they avoid going to a physician. This results in a decrease in work productivity. It is estimated that the annual decrease in productivity is more than $40 billion dollars a year.

In states where tort reform has been instituted by placing caps on so-called non-economic damages, the malpractice costs have decreased 39%. This drop in costs is a result of decreased malpractice suits. The decrease is economically bad for the plaintiff attorneys. Annual malpractice premiums have gone down at least 13%. In fact, the medical malpractice business for plaintiff attorneys has about dried up in Texas.

Dr. Emanuel and the administration want to connect the leverage they have with the SGR formula to getting physicians to accept a bundled rate for treating a patient.

Dr. Emanuel “would tie an S.G.R. repeal to a slow reduction in fee-for-service payments to those physicians who do not switch to bundled payments and other payment models.”

In other words, accept risk for treatment that an insurance company would normally accept risk for while ignoring the malpractice implications of missing a diagnosis or not seeing a patient at appropriate intervals.

Isn’t the government going to test physician’s treatment with 88,000 codes in ICM -10 and the Enhanced Quality Reporting System?

Isn’t the government going to force the decisions of the Independent Physician Advisory Board on physicians?

Now the government wants to force physicians to accept the potential liability for not using their medical judgment.

This is not aligning physician incentives with efficient treatment cost. It is dictating medical treatment to physicians.

This is putting physicians well on the Road to Serfdom.

Physicians are getting tired of all of this. They are about to quit treating Medicare patients.

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

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