Repairing the Healthcare System

One Picture Is Worth 1,000 Words

Stanley Feld M.D.,FACP, MACE

One picture is worth 1,000 words. The second picture says it all.

The list of one humdred and fifty nine new bureaucratic new agencies can be found at https://libertylegalfoundation.org/obamacare-class-action/quagmire-of-new-obamacare-agencies/#.UkNfRmRgZlQ

The one hundred and fifty–nine new agencies generated by the Accountable Care Act (Obamacare) increases the complexity of an already uncontrollable bureaucracy. Americans have seen many examples of the inefficiency and waste because of the growth of bureaucracy in everyday life.

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2013/09/employer-mandate-confusion.html

 

 To date, before Obamacare has been in full swing, these agencies have created the pile of regulations demonstrated by Mitch McConnell.

 What are the chances the recipients of these regulations will understand and obey all these regulations?

 What are the chances the government bureaucrats can enforce these regulations?

What are the chances favored, privileged parties will be exempt from these regulations?

What is the value added cost these agencies and regulations provide for the direct treatment of patients with disease?

These are all good questions. The answers are not readily available. The administration, our congressmen or the traditional media do not discuss these questions.

The American public has already felt the consequences of the growth of bureaucracy and regulations.

Seventy seven percent of new jobs have been part-time jobs. A person working less than 30 hours a week is not required to receive healthcare insurance from his employer. Employers have done this to avoid an Obamacare penalty.

Healthcare insurance premiums for next year are skyrocketing. The Obama administration continually tells the traditional media that insurance premiums will be affordable and decrease in 2014.

True unemployment rises to over double digits while government statistics claim it is falling. It is a statistical trick.

Americans are noticing the sting of the 20 hidden taxes Obamacare has put in place. Despite these taxes, the deficit for this year remains one trillion dollars. It means the administration is spending more despite the tax increases.

The Democrats keep saying we must raise the debt limit. The Federal Reserve keeps saying we need to print more money. President Obama keeps saying you must pay the bills Americans and congress voted to incur. America cannot default on its debt.

Few are saying we must decrease the debt by decreasing bureaucracy, regulations and inefficiency.

Fewer are saying we must stop this overspending.

President Obama has given countless waivers to countless companies. The first waver was MacDonalds which provides Mini-Med insurance to their low wage employees. Mini-Med insurance is worthless. It provides practically no healthcare insurance coverage.

President Obama figures that all these people would sign up for the Health Insurance Exchange rates. These exchanges would provide tax credits for the low wage income earner by law. The law seemed to change in the last few months from tax credits to subsidies without congressional approval. Law wage earners do not pay taxes and cannot benefit from tax credits.

After October 1 we will see if young healthy persons without pre-existing condition sign up for healthcare insurance through these health insurance exchanges.  

 The only insurance rates seen through these exchanges so far are the California health Insurance exchange rates. The rates are too high to buy adequate healthcare coverage for someone making $40,000 per year. The affordable rates do not provide adequate healthcare insurance coverage.

 The Obama administration claim’s that the New York State rates are lower than the private insurance rates. It might be true for certain levels of coverage. The reality is the private insurance rates in New York are too high. The New York State Board of Insurance permits healthcare insurance companies to receive an unconscionable return on investment.

A one year delay of Obamacare for corporations will get President Obama past the mid term elections. It will permit public awareness of the harm Obamacare is doing to the economy which the administration is striving to keep hidden.

After the election cycle it will dawn on the majority of the public that Obamacare is a destructive train-wreck to the economy and economic growth.

The delay will also have a lesser effect on the tremendous increase in deficit spending that would diminish the debate on the administration’s overspending.

President Obama doesn’t seem to think deficit spending is an important issue.  He is also not bothered by the Federal Reserve’s quantitative easing.

The most offensive action by President Obama is exempting congress and the congressional staff from Obamacare.  

Why should the individual hard working person suffer the effects of Obamacare when government officials do not? 

Can Obamacare work when we have so many agencies generating so many regulations? Can it work when so many people have waivers and exemptions?

I doubt it!

No only is it not fair to hard working people. It is probably unconstitutional.

It doesn’t look like the American individual taxpayers that are not exempt from Obamacare are going to get much help from the Supreme Court.

Maybe President Obama’s goal is to destroy the healthcare system’s infrastructure. He is setting up the failure of Obamacare.

Obamacare seems to be designed to destroy our healthcare system. Maybe Obamacare is not supposed to work. Maybe it is designed to cost so much that the entire economy will fail.

This can be the only reason Obamacare has been permitted to continue to exist by both Democrats and Republicans.

Obamacare is neither affordable nor executable.

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

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What Are Private Insurance Exchanges?

Stanley Feld M.D.,FACP,MACE

Corporations have been providing healthcare insurance since after WWII. The cost of healthcare insurance has been rising since.

The increase in premiums became intolerable in the 1980’s when cost shifting occurred. Medicare decreased reimbursement and the fees were shifted to private insurance.  Several experiments in healthcare coverage were tried to reduce the cost to employers. All the schemes failed to control costs.

The schemes include managed care and HMO’s. All the insurance schemes were defined benefit plans. Employees were immune from responsibility for themselves or their healthcare dollars.

As the costs have risen to unsustainable levels corporations have been trying to figure out how to get out of providing healthcare coverage for their employees as a benefit.

Most employers, large and small, want to limit their exposure to healthcare premiums and Obamacare penalties.

A movement to limit employment to less than 30 hours a week to avoid providing healthcare insurance to employees and avoid Obamacare penalties has become viral.

No one has tackled the real reasons for the rising healthcare costs. No one has tackled the perverse incentives and advantages given to the healthcare insurance industry all these years.

I have argued that this perverse incentive can lead to all the other perverse incentives initiated by the rest of the stakeholders in the healthcare system in order to survive.

Once more the healthcare insurance industry figured out how to increase their profits while making it appear they are helping both employers and employees.

It must be remembered that the healthcare insurance industry profits through both private insurance and government provided healthcare coverage.

The industry makes its profits by providing administrative services. The government outsources the administrative services to the healthcare insurance industry.

The profit generated in both the private sector and the government sector is far from transparent.

The healthcare industry’s new scheme converts defined benefit coverage to defined contribution coverage for healthcare benefits.

In recent months we have seen large corporations switch their employee healthcare benefits to defined contribution programs.

A partial list of companies includes Walgreens, Home Depot, Sears, Trader Joes, Xerox and IBM retirees.

Rather than provide a healthcare insurance coverage benefit through the corporation, the corporation is providing employees with a defined contribution each year. The employees can then buy their insurance through their employer’s contracted Private Health Insurance Exchange.

The Private Health Insurance Exchanges are provided to the corporations by the healthcare insurance industry. There will be a menu of insurance plans and premium levels employees eligible for coverage can choose from.

The principals of healthcare coverage include all of the basic requirements of Obamacare’s Health Insurance Exchanges. Employees having a preexisting illness must be accepted. However, premiums might be higher for patients with pre-existing conditions.

The defined contribution amount has not been defined. It could be a couple of hundred dollars a year to a couple of thousand dollars a year. In any event it does not sound as if it will be enough to cover the cost of the healthcare insurance premium.

There will be high deductible plans with patients not covered for the deductibles and co-pays.

If an employee doesn’t like what he buy in the companies Private Insurance Exchange, he can always sign up for Obamacare’s Health Insurance Exchange.

It sounds great for the employer because the employer can predict costs. It is wonderful for the healthcare insurance industry.

It sounds terrible for the consumer.

It sounds both good and bad for the government. It depends on how one looks at it.

The Obama administration will have more people sign up for Obamacare’s Health Insurance Exchanges. The result will be greater control over the healthcare system. I believe this is the reason the Obama administration has not opposed the Private Health Insurance Exchanges.

However, the consumers signing up for Obamacare Health Insurance Exchanges will be the sickest consumers. These consumers will use the system more than average.

This will result in an increase in the deficit and unsustainability of Obamacare. The only way out is to increase premiums and taxes.

This is called a “redistribution of wealth” because people making up to $40,000 per year do not pay taxes. If the tax increases are means tested it will increase the amount of wealth that is redistributed will increase.

The increase in taxes will decrease economic growth.

At the present time Obamacare’s Healthcare insurance Exchanges do not have verification software. The system is vulnerable to fraud and abuse even if it could work.

America is just becoming aware of the fraud and abuse in the food stamp entitlement program. The food stamp entitlement has double. The government has not fixed the food stamp program.

It is likely the same thing will happen with the government run Health Insurance Exchanges. It will drive the federal deficit even higher.

Even though the Private Health Exchanges shift financial responsibility to the consumer to pay for their own insurance it does not provide financial incentive for patients to become responsible for their health.

It does not contain educational programs to help patients deal with their chronic diseases. It does not teach consumers to be responsible for their health and healthcare dollars.

Obamacare does not provide these incentives either.

The only plan that does is my Ideal Medical Saving Accounts with employers providing support while shifting responsibility to consumers by providing incentives for patients to lower the cost of their care.

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

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Significance Of IBM Retiree Decision

Stanley Feld M.D.,FACP,MACE

 IBM’s dropping of retirees’ healthcare plans will be the cause of a continuing avalanche of companies dropping healthcare insurance for its non-retired employees.  These companies are doing it in two ways. They are decreasing work hours from 40 to 30 hours per week. They are hiring part time employees. The are also outsourcing work to avoid paying an “Obamacare penalty.”

Companies are contracting with “Private Health Exchanges” to service the rest of their employees. The companies provide a stipend for healthcare coverage and send employees to the “Private Health Exchange” to buy coverage. If employees cannot afford the coverage, employees would be able to buy insurance from the government health insurance exchange.

 

In February 2011 I wrote about the McKinsey study that estimated the percent of employers that would stop providing healthcare insurance for their employees in 2014.

None of the Obamacare fans wanted to believe this study.

Senator John Kerry and Representative Barney Frank said a public option was essential in order for Obamacare to work.

President Obama told them not to worry. Obamacare will work without a public option.

I called Obamacare’s health insurance exchanges essentially Obamacare’s Public Option. Consumers will be forced into the health insurance exchanges in 2014.

The Congressional Budget Office provides congress estimates of the effects of legislation. The CBO is not required to think.

 The CBO crunches numbers provided to it by the administration. The administration has been less than candid with everyone including the American public

“The Congressional Budget Office estimated that only 7 percent of employees currently covered by employer-sponsored insurance (ESI) will have to switch to government subsidized-exchange policies (Public Option) in 2014.”

The McKinsey study concluded; Feb 2011

 

• Overall, 30 percent of employers will definitely or probably stop offering ESI in the years after 2014.
• Many Human Resources officers and CFOs do not know the implications of Obama care.
• Among employers having a high understanding of President Obama’s Healthcare Reform Act more than 50% will stop offering employee healthcare benefit and more than 60% will make some kind of change.
• At least 30 percent of employers feel they would gain economically from dropping coverage and paying the penalty. They would even gain if they increase their employees’ salary or other benefits.
•  The insurance coverage is in excess of $15,000 per year per employee. The government penalty is $2,000 per employee.
• The difference in cost will force employers to drop ESI and force employees into the Public Option.  This was President Obama’s plan all along.
• The survey also showed that more than 85 percent of employees would remain at their jobs even if their employer stopped offering ESI.
• Sixty (60) percent of employees would expect an increase in compensation from their employers. 
• Who are these rules in favor of? They are not in favor of the employee.”

 

“Health care reform fundamentally alters the social contract inherent in employer-sponsored medical benefits and how employees value health insurance as a form of compensation.”

 “Obamacare” guarantees the right to health insurance regardless of an individual’s medical status or ability to pay. In doing so, it minimizes the moral obligation employers may feel to cover the sickest employees, who would otherwise be denied coverage in today’s individual health insurance market.

The logical result is healthcare insurance premiums would increase for the individual and benefits would decrease to keep the premium cost down.

In 2014, people who are not offered affordable health insurance coverage by their employers will receive income-indexed premium and out-of-pocket cost-sharing subsidies from the government through public health insurance exchanges.

The highest subsidies will be offered to the lowest-income workers. It enables these low paid workers to obtain coverage they could not afford in today’s individual healthcare insurance market.

It will force people into the dysfunctional individual insurance market under public supervision of public health insurance exchange.

The government will pay the subsidies for the resulting increased premiums that will result from expanded coverage in this “Public Option.” The government would then pass the increased premium cost on to the taxpayer on a means tested basis and with higher taxes.

This is what Don Berwick and President Obama meant by redistributing wealth. 

The next step is government’s complete control of a single party healthcare system. 

Employers will no longer be able to offer better healthcare insurance benefits to their highly compensated executives either. Companies will be forced to discontinue employee healthcare coverage. We see that happening in the Fall of 2013.

The penalty is set low to further encourage companies to discontinue coverage. President Obama’s goal is to have most people in the “Public Option.”

This will lead to government control of the healthcare system and all the inefficiencies that will result. These inefficiencies will increase the cost of care and result in a decrease in access to care as well as rationing of care.

 State insurance exchanges will be paid for by the states with a federal subsidy. These exchanges will offer individual and family policies of set benefit levels (bronze, silver, gold, and platinum) from a variety of insurance companies.

The effect on the federal deficit will be much greater than the original CBO’s estimated. The number of people who will loss their company insurance was estimated by the CBO at 10 million, or about 7 percent of employees, currently covered by ESI.

Seventy (70) million people was McKinsey’s estimate in 2011.

“ A July study by Craig Garthwaite of Northwestern University’s Kellogg School of Management predicts as many as 940,000. That number is an estimate of how many adults without children are working because of what the researchers call “employment lock.”

This increased number of participants will add to the federal deficit. The increased federal deficit will result in higher taxes for everyone, including the middle class.

“The taxpayers are going to get hammered,” says Douglas Holtz-Eakin, a former Congressional Budget Office director who is now president of American Action Forum, a Washington-based advocacy group that opposes the health law. “It’s going to be extraordinarily expensive.”

President Obama wins his ideological goal. Consumers will have less control over their own healthcare decisions and choices. 

The healthcare insurance industry will gain more control over pricing. This will increase profits because they will administer government health insurance exchange services. President Obama will continue to outsource the administrative services to the healthcare insurance industry.

 The losers will be consumers and physicians.

The impending results are all totally predictable. Obamacare fans refuse to listen.

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

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Who Losses? Who Wins?

Stanley Feld M.D.,FACP,MACE

IBM wins because it wants out of providing healthcare insurance for retirees.

The government wins because it gains more control over the healthcare system.

It is as if big business is playing right into the Obama administration’s hands.

 The healthcare insurance industry wins because it gets more administrative services fees from the government without risk.

The brokers for the healthcare insurance industry win because they will take more commissions from individual consumers than they would from an institutional company.

IBM retirees lose.

 Most retirees will go on Medicare Part B or Medicare Advantage. President Obama is planning to eliminate Medicare Advantage.

Medicare Part B is means tested so the more income that is generated from any source by a retiree the higher the premium paid to the government for Medicare Part B.

The Medicare premiums are paid with pre tax dollars from retirees Social Security payment. The supplemental insurance (Medicare Part F) covering deductibles and co-pays are not tax deductible.

Medicare is increasing the deductible and co-pay requirement in 2014. Therefore the non tax-deductible supplemental premiums will increase in price.

The premiums of both Medicare and Medicare supplements for services and drugs can amount to more that $16,000 a year for a husband and wife calculated in terms of after tax dollars..

Large companies provided the healthcare coverage as a benefit to retirees tax-free.

IBM has been trying to get out of providing healthcare coverage for employees since 1999. Obamacare has provided an excuse for IBM to discontinue its coverage for retirees.

General Electric (GE) made the same announcement a while ago. Time Warner made its announcement right after IBM.

Companies who have changed their healthcare coverage for retirees include DuPont, Caterpillar, Sears and Darden Restaurants.

Many more companies are about to joint in.

It is obvious this was coming as a result of Obamacare.

The move disregards the social contract made with employees when employees were first hired.

International Business Machines Corp. (IBM) is going to discontinue its company-sponsored health plan for about 110,000 retired employees.

 IBM plans to provide retirees a fixed payment. The payment will be used for retirees to buy their own health care coverage through a “private” health insurance exchange.

 Once retirees are eligible for Medicare at age 65, IBM would not be responsible for managing these retirees’ healthcare benefits.

IBM said, “the growing cost of care makes its current plan unsustainable without big premium increases.”

IBM told retirees, “that its current retiree coverage will end for Medicare-eligible retirees after Dec. 31, 2013.”

IBM is shifting the responsibility to the retirees for buying their own coverage through “Private Health insurance Exchanges.”

It sounds like a costly rip off to the retiree. IBM is providing a subsidy for now. Then IBM will discontinue the subsidy.

One Private Health Insurance Exchange executive said.

"Companies were turning off plans," he said. "We've given them a proven way to subsidize. At some point every single retiree will join a Medicare exchange."

Some union-affiliated groups and retirees weren't convinced. Lee Conrad, national coordinator for the IBM Global Union Alliance, said

The worker group sees this as just another take-away of retiree and employee benefits."

Donald Parry, an engineer who retired in 1992 after nearly 32 years at IBM, said he is concerned he may have to pay more. "The worst thing right now is not knowing what's going on,"

At the moment the cost of the government providing Medicare coverage is unsustainable according to the CBO. This is despite Medicare premiums being means tested and the escalation of Medicare premiums.

Despite the increase in premiums Medicare will run out of funds by 2024.

The choices are higher means tested Medicare premiums (redistribution of wealth), decreased access to care or rationing of care. I believe it will be all of the above. The burden of this change will fall on the taxpaying consumers’ shoulders.

As big businesses drop coverage for retirees, the Medicare roles will increase and the government will run out of fund prior to 2024.

Excessive costs, commissions, and bureaucratic inefficiencies part of any government program.

The Obamacare bureaucracies seem to have no concern for the inefficiencies and increase in deficit spending.

It is as if they are saying, “Bring it on.” All the government wants is control of the healthcare system.

The result will not be affordable care. It will be unaffordable care that is rationed with limited access to care.

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

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You Cannot See the Pattern Unless You Look

 Stanley Feld M.D.,FACP,MACE

Let us assume President Obama wants to destroy the healthcare system. I have presented steps taken by the Obama administration to accomplish that goal.

It is possible that this assumption is correct.

It looks as if President Obama uses the same patterns in the actions he takes to govern.

He promises a group something that group wants to hear. Then he disregards the promise. He acts to further his political agenda.

This methodology is not the methodology of leadership, nor does it promote trust.

However, he has used the same methodology in finance, in the environment, in immigration, in defense, in energy, in racial relations, and most of all in Medicine.

He first captures his base with ideas that promote their vested interest. He then undermines his base’s vested interests replacing these vested interests with his own political agenda.

The next step is to shift the blame to someone else. His best victim has been the Republican Party. It is incomprehensible to me that the Republican Party sits back and takes it. I guess it is politically correct to do so. However, it does not win elections.

If an element of his base makes a big enough stink, he provides an executive waiver for the issue.

Some of the patterns are hard to see. The traditional media under reports them.

Other actions using the same pattern are not seen because they are not examined carefully. They are only seen after they have a direct affect on an individual’s or group’s vested interest where they have been betrayed. This leads to mistrust.

President Obama then proceeds to become the judge. As judge he plays one group against the other.

He now has angered adjunct university and colleges teachers. This group has been a steady ally.

“Adjunct faculty at a local college were asked to sign a petition to the White House to "explore options to prevent colleges/universities from cutting adjunct and contingent faculty hours to circumvent [the] PPACA," better known as ObamaCare”

This is in response to the massive assault on the livelihood of adjunct faculty who now face devastating salary cuts as a direct result of Obamacare.

University and college professors have universally been President Obama fans. The tide is shifting for President Obama.

He has blamed the shifting tide on the Republicans.

In medicine President Obama’s budget cuts have already resulted in rationing of care and a decrease in access to care. Cancer Clinics across the United States are turning away thousands of Medicare cancer patients.

The cost of the medication to the cancer clinics is higher than   government reimbursement for the medication.  

"Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them."    

The reduced Medicare funding already has taken place April 1,2013.

Cancer treatment in hospitals, in many cases, are 2 to 4 times higher than treatment in outpatient cancer clinics just as surgery done in an outpatient surgery clinic is one half to one fifth the cost of surgery in a hospital.

Yet the hospital systems continue to receive adequate fees.

 The Community Oncology Alliance, which advocates for hundreds of outpatient cancer clinics nationwide has sent letters to legislators urging them to exempt cancer drugs from the sequester for outpatient cancer treatment to make less expensive outpatient cancer treatment available to patients.

 The hypocrisy of President Obama, who early on claimed that the passage of the American Recovery and Reinvestment Act (ARRA) would "launch a new effort to conquer a disease that has touched the life of nearly every American.

 Thus, it is perplexing that the cuts outlined by CMS will negatively impact cancer patients, making advances in cancer care more difficult to deliver."

Seniors could not know about this until they develop cancer and experience the cost. It too has been under reported.

President Obama who introduced the idea of sequestration, in his negotiations for a continuing resolution last year, has refused to take responsibility for it.

Republicans attempted to make the sequester cuts "less reckless,” such as severe military cuts, closing the White House to visitors and all the other restrictions President Obama introduced for this two per cent cut in the budget.

Harry Reid said the Republican’s proposed cuts were dead on arrival in the Senate.

 “Thus, Obama's duplicity emerged, as he sought to blame the Republicans for sequestration even though he originated it.”

There have been many instances where the Obama administration has divided Americans into class warfare. The class warfare has occurred in immigration reform, cancer victims vs. non cancer victims, union workers vs. non union workers, right to work states, college teachers and the administrators, black vs. whites and rich vs. poor for example.

The traditional media fill the airwaves with these distractions. The real issues are diverted by the distractions. President Obama plays “Wag the Dog” constantly.

Some examples of real issues would be how to solve the problem of government inefficiency, waste, fraud and abuse. It is not to create more agencies, rules and regulations and impediments on business development to destroy job growth?

Why beat up on doctors and patients when the real problems are insurance companies, hospitals and tort reform despite the administration and its advisors’ denials.

Why is he giving out preferential waivers? America should be outraged to have Obamacare passed into law by a Democratic Party, which then in turn receives a waiver from President Obama by executive order to be exempt from Obamacare.

The media should be outraged. Instead the media has given congress and the President a pass.   

“Though I value my First Amendment right to petition the government for change, we need far more puissant action.”  

We need to demand a total eradication of Obamacare.  And it needs to be done as a united front.  Otherwise, we actually play right into President Obama's overarching aims of divide and conquer by duplicity and coercion.” 

President Obama wants to avoid personal blame for the expensive, unwieldy health care law. He will probably figure out a way to blame Republicans for its failure.

The majority of the people are against the healthcare law. Physicians know it will make the healthcare systems problems worse and more expensive.  Yet the President ignores all of these voices while he is spending massive amounts of money on marginally added value medical projects.

Some believe the tactics used by the used by the President to pass the healthcare law started all the problems. In reality Obamacare is a bad law that will be impossible to implement.

President Obama always uses the same pattern to avoid personal blame. (“I did not draw a Red Line, the international community did”). He always diverts our attention from the real problems. He tells lies or half-truths about issues, and divides and conquers to create class warfare.

He uses the same moves over and over again. If America doesn’t start looking, Americans will not see the destruction to most of our institutions.

The so-called unintended consequences in every area might not be so unintended.

President Obama is accomplishing exactly what he wants to accomplish. It looks to me as if he wants total government control over our society. Many institutions have begun to crumble before he reaches his goal.

The disregard for our constitution is one vivid example. 

What massive government intervention means to me is that it is creating more misery, resentment and anger among all the diverse groups in American society. 

Most Americans believed President Obama when he said it is time for a change. It was time for a change.

 Since he did not define the change he was seeking, we all assumed it would be for the better.

Our assumption was wrong. 

It is time we start looking and seeing.

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

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Employer Mandate Confusion

Stanley Feld M.D.,FACP,MACE

Confusion about any rules or regulations is not good for business, bad for job growth and bad for the economy.  Large and small enterprises become cautious and are afraid to spend money on expansion. Expansion might increase a tax liability without increasing production.

A few months ago there was a dispute about how many new rules and regulations have been released by the Obama administration to implement Obamacare.

“Implementation has also become a bureaucratic nightmare, with some 159 new government agencies, boards and programs busily enforcing the roughly 20,000 pages of rules and regulations already associated with this law.”

— Sen. Mitch McConnell (R-Ky.), on the third anniversary of the law’s passage, March 22, 2013

The process the McConnell folks used is fairly simple. They went to the Web site for the Federal Register and searched for “Affordable Care Act,” the official name for the health-care law. That turned up 897 documents.

On the Web site, there’s a button that will download the documents to an Excel spreadsheet (CVS/excel). Then you use the sum feature on Excel to add up the pages and presto, you end with 20,202 pages. These were then printed out and duly stacked in a pile.

Mitch McConnell might be way off in his calculation. The rules and regulations are reported in the small print Federal Register. It is possible as many as 40,000 rules and regulations have been published. All of the rules and regulations for Obamacare will not have been written by January 1, 2014. 

The cost of the writing of the rules and regulations, the cost of the formation of new agencies formation, and the cost of implementation have not been discussed.

Rules and regulations tend to be open to misinterpretation, conflict, lawsuits and lack of enforcement.

An increase in rules and regulations leads to more confusion and conflict. Some rules contradict other rules. This results in greater inefficiency and more not less costs.

Our healthcare system can ill afford more non added value expenses.

The IRS is going to be in control of enforcing the “Employer Manadate.” Many of the rules and regulations have been written. However, many of the IRS’s rules and regulations are not clear.

I have written about employers decreasing the number of hours employees are permitted to work in order to avoid the penalty “tax” of not providing healthcare insurance for full time workers.

Seventy seven percent of the “job growth” in the past few months has been part time employment growth. The Obama administration has consistently denied this is true despite the Bureau of Labor statistic reports.

What is part time employment? It has been defined in Obamacare as an employee working less than 30 hours a week.

“Just to understand how the penalty applies practically requires a flow chart. But as the Internal Revenue Service has tried to interpret the mandate, the agency and the businesses and employees affected by the mandate are discovering that it is even more challenging than it reads.”

Answers to questions by the I.R.S. have generated even more questions. Confusion mounts as more rules and regulations are generated.

A big question has surfaced. How does an employer determine whether employees whose hours fluctuate should be offered insurance or pay a penalty “tax”?

Obamacare sets that threshold at 30 hours per week. Many companies schedule some of their work force on variable hours. An employee might work 25 hours one week and 33 hours another week. 

In its preliminary rules, released late last year, the I.R.S. devised an approach to the problem of the variable-hour employee that it calls the “look-back measurement method.”

The I.R.S regulations would allow an employer to choose a measurement period of three months to a year in which to average the employee’s weekly hours.

The measurement period would then be followed by a stability period of a year for a total of two years.

Is anyone following this?

If an employee’s schedule averaged out to full time (over 30 hours a week) during the measurement period, then the company would be obliged to offer health insurance in the stability period or pay a penalty.

The new measurement period would begin immediately after the old one ended. The process of measurement and stability periods would begin again.

 If the company anticipates that a new hire will work full-time (over 30 hours a week), it must offer insurance by the start of the fourth month on the job.

 Why not offer insurance immediately on hiring the person? Is this not confusing?

 To make things more confusing, what happens if an employee goes from full time to part-time? The rules were unclear. “Do you get to keep your coverage?”

The I.R.S. took the position that the employee would keep the coverage through the end of the stability period.

If it turned out that the worker still managed to average a full-time schedule, which would be possible, if he or she made the switch late in the period. The company would have to offer insurance in the next stability period as well or face the penalty.

A full-time employee who was switched to part-time in August, before open enrollment in October, would be entitled to an additional 16 months of insurance coverage.

Employers have figured out they should fire the employee and avoid the penalty or the insurance coverage. This is not good for job creation or the economy.

The law and its rules are encouraging these actions.

The rule also penalizes an employee who is switched from part time to full time employment. The employee has to wait at least a year before the employer must offer that employee insurance coverage rather than by the fourth month.

“Measurement and stability periods should be used to infer a status of variable-hour employees only,” 

“Once an employee is no longer a variable-hour employee and is in a full-time position, he or she should be offered coverage within, at most, four calendar months.”

Is all this confusing? You bet. Just visualize the cost of the mountain of paper work and reports.

Is all of this cost effective? No!

This represents a tiny fraction of the rules and regulations by the Affordable Care Act (Obamacare) that are causing confusion.

The more confused one gets the less one wants to participation.

The only option left is a government take over of the healthcare system. It wouldn’t be bad except for the fact that America cannot afford it, and the government could not implement it without a terrible cost to society.

It would result in rationing of care and a decrease in access to care. The only solution is for consumers to be responsible for their own care and control their own healthcare dollars.

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

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A Weekend With Brad

  Stanley Feld M.D.,FACP, MACE

 Every year Brad and I spend a weekend in some city just walking around bonding with each other. We try to solve the world’s problems. We talk about everything from life in the present to life in the future.

 It is truly a great experience for me. I learn more from him than he learns from me. Our roles are reversed at this stage of life. He is now my mentor.

 Last week he expressed interest in going to visit his place of birth, Blytheville Arkansas, for our 2014 weekend.

 I have many wonderful stories about Blytheville Air Force Base and its 851^st Medical Division. My first is:

  Drafted Into The Air Force 1965

 On February 13, 1965, President Lyndon Baines Johnson authorized Rolling Thunder, the sustained bombing of North Vietnam. With Rolling Thunder, the Vietnam War officially escalated.

Even though I received a Berry Plan exemption to complete my Internal Medicine training, I was drafted to active duty when the war escalated.

My orders said to report to Blytheville Air Force Base Hospital, 851^st Medical Group on July 1,1965.

I found out who to protest to. The Major General I spoke to in Washington said, “Sorry son, America is at war.”

Cecelia was pregnant with our first son, Brad. He kicked for the first time in Smokey Mountain National Park. Cecelia screamed and I almost went off the road.

Physicians practicing at the hospital found out through the grapevine that I was going to be stationed in Blytheville, Arkansas. Many just looked as if they pitied me for my bad luck.

Stanley Gittleson M.D. a practicing pediatrician at the hospital, came up to me in the hall one day and said he heard I was going to be stationed at Blytheville Air Force Base in Arkansas. I said, “Yes.”

He said,

My roommate at Cornell University came from Blytheville, Arkansas. His parents lived there because his father was a civil engineer who had a government contract to build the Bayous along the Mississippi River from St Louis to 200 miles south of Memphis.

 Jerry Cohen was brought up in Blytheville. His father sent him east to his alma mata, Cornell for college and graduate school. Jerry wanted to become a civil engineer and join his father’s construction company.

At Cornell Jerry met a girl from New London Connecticut. After graduate school Jerry and Huddy married.  Jerry convinced Huddy to move to Blytheville, Arkansas.”

Stanley Gittleson said “They are two great people. They will welcome you and Cecelia to Blytheville.

Just call him up and say, “ Gittleson sent you.”

 
Cecelia and I were nervous about going to Blytheville, Arkansas. We were two kids who grew up on the streets of New York. We had never traveled anywhere except to the Catskill Mountains in New York State during our familys’ summer vacations.

We were immediately relieved to know all we had to do was call and say “Gittleson sent us.”

It was exactly what I did the first afternoon we got there. Jerry said in his charming southern accent, “Why don’t you guys come over to the house tonight for dinner.”

Jerry, Huddy and their two girls took us in as family immediately. They were at our side during Cecelia’s pregnancy. Huddy was right there at the Air Force Base Hospital as we waited for Brad’s birth on December 1, 1965.

As it turned out, Blytheville Arkansas was a great experience  that neither of us will forget.

I look forward to visiting Blytheville with Brad in 2014. We will stay in Memphis for the weekend.

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



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